You Must Be Some Kind of Therapist

Swell AI Transcript: 81. Karen King.mp3
Karen King: all the hallucinogens or psychedelics, it allows the default mode network to go offline, which is that part of our brain is our forebrain or identity. It gets quiet and other things can happen. And those other things are what they're looking at specifically with MDMA and ketamine, that neural pathways get rebuilt. And that's basically the theory is that what happens is your identity consciousness gets quiet. Other pathways are allowed to come in. Your default mode network goes quiet.
Stephanie Winn: You must be some kind of therapist. Today I'm talking with Karen King. She is a licensed mental health counselor in the state of Washington who practices ketamine-assisted psychotherapy as well as training and supervising other therapists to provide ketamine-assisted psychotherapy. She's been trained by MAPS, the Multidisciplinary Association for Psychedelic Studies, Karen is also hoping to provide one of the first clinics in the Pacific Northwest to be approved to offer MDMA-assisted psychotherapy once that treatment is approved by the FDA. Karen has also partnered with an organ therapist, Tonsa Gutierrez, to offer an ideology-free consultation group called Clarify Consultation for therapists who are concerned with how their clients and practices are being impacted by contentious and limiting influences in the field like critical social justice. So today we're going to talk about ketamine-assisted psychotherapy, other psychedelic-assisted psychotherapy, as well as the infiltration of ideology into the field of psychedelic-assisted therapy. Karen, thank you for joining me today.

Karen King: Thank you so much for having me. I'm excited to talk about these things, always.

Stephanie Winn: Me too. I would say that ketamine is probably the psychedelic that I know the least about from the trainings I've done. I haven't done facilitator trainings, just more kind of overviews of their research. And ketamine is the one that always leaves me with the biggest question mark. So I'm glad to have your expertise. Let's maybe kind of start from the beginning for people who have never heard of this practice at all. What is ketamine-assisted psychotherapy?

Karen King: Ah, such a good question. And I need to get better at describing this for the layperson versus the clinician who's interested. So I'm glad you asked this. So ketamine-assisted psychotherapy is a process where a client is under the influence of a very small dose of ketamine that has antidepressant properties and neuroplastic properties, which is what helps it benefit us psychologically. And it's a process where you have the treatment, and it depends on the method of administration. There are a few different types, but it's about a two-hour session that can happen once a week or twice a week, depending on what the prescription is. And the thought and intention of it is that the set and setting are what is important in having a really beneficial response. So the set and setting is the intention, the guidance, the clarification of having a therapist with you who knows you and knows your history and can hold that space for you. And so the research on it is actually really positive, which is what why we started to add it to our clinic in 2020. Because we were reading that the research was so beneficial. And of course, in use with used in conjunction with psychotherapy, the positive clinical outcomes are doubled, so that people can do a series and then potentially go off antidepressants and only need this maybe once a year. So it's a quite a different approach, which is why it's revolutionizing the field of psychotherapy.

Stephanie Winn: When I first heard of ketamine, it was in the context of it being a party drug, a horse tranquilizer, an associative anesthetic. And so ketamine has been one of these drugs that's just a big question mark for me, like what exactly does it do? I've heard of people with a history of trauma turning toward ketamine-assisted therapy or using ketamine at home, which is different, and that's something I want to talk about. But the dissociative piece, help me understand that. What are the dissociative impacts of ketamine and what situations are clinically indicated or clinically contraindicated for people who may have trauma or dissociation to begin with?

Karen King: Sure. Yeah, that's a good conversation to have that people in the ketamine-assisted world are having right now about people who have a dissociative tendency to So it is a horse tranquilizer. It is a dissociative anesthetic. It is used as a party drug. But what is also true is it's been used, it's an anesthetic that's been used, I guess, for the, I think, 50 years now. So it's used in the battlefield. It's used in pediatrics. It's used in the ER. It's extremely safe. And it increases heart rate and blood pressure versus decreasing it, which is what makes it so stable and useful in the battlefield environments or in ER treatments. So the assisted psychotherapy use of it is a minuscule dose compared to the sedative anesthetic dose. And it does produce a dissociative effect. It's lumped in with psychedelics. It's not actually a psychedelic. A classic psychedelic produces hallucinations. This does not. You can dissociate from your body. You are out of your body and having an experience of some sort. And it really differs throughout. It's very individualized, actually, how people respond. But it is the psychedelic that is most classically similar to a near-death experience. And it meets those criteria pretty closely. So that's actually a whole separate field of study I'm really interested in. But ketamine does produce that dissociative effect, which there are conversations around this in the psychotherapeutic world. Is it helpful? Is it contraindicated for people with PTSD and dissociation? Or is it actually useful because of the moment you come back into your body? And so the moment you come back is usually the point of pain for someone who is experiencing dissociation from a traumatic memory or a dissociative response. But that can become a great therapeutic moment where someone can set the intention for that moment, because it will be such a visceral feeling as you come back into your body, that you can set it up therapeutically to be useful and to learn from it and to create structures of safety around it. So there's no Psychological contraindication in general, people tend to say, so it's an off-label use. That's why it's a gray area. It's an off-label use, which means it can be used to treat depression, treatment-resistant depression and anxiety. But we don't have, from the FDA, prescribed uses for it for certain diagnoses. as a field, figuring this out as we go along, which is why being part of these associations are so important, like the American Society of Ketamine Practitioners. We're really creating the standards, ethics, protocols, and procedures as we go. Sorry, that was a long answer. There's so much to cover. No, that was great.

Stephanie Winn: And you actually, you touched on something I was curious about, the coming back into your body or the comedown. And this is on my mind because when I think of dissociative anesthetic, I think about, of course, my most recent experience. I had an oral surgery. And for that oral surgery, it was not a good idea medically for me to be under full general anesthesia. So we went with oral sedation and nitrous. And I was given triazolam, which I'd never had before. It's in the benzodiazepine class. And I was quite heavily drugged. And I remember being in a really weird dreamy state where nothing could have possibly bothered me. I mean, it didn't bother me that they were ripping a tooth out of my face. I was supposed to forget everything, but I actually remembered, funny story, I remembered after the fact. that while the surgeon was removing the tooth from my face, he was talking about Vipassana meditation with his assistant. That's a good thing to be talking about. That's great. I know. What if he was talking about his divorce or sports ball? Into your subconscious. Into my vagus. Yeah. Wow. But my anxiety was so high the next day. I mean, I know benzodiazepines are a very different class of drugs from what ketamine is, but I hate the comedown from benzos. It's one of the reasons they're so destructive, that somebody who, like me, has no addiction to them, who takes them one time for a medical purpose, could end up feeling like you're having a panic attack the next day when your body's rebounding from it. So that's interesting that when you describe the comedown from ketamine, it's actually, it sounds like it's happening in real time during the course of that two-hour window of psychotherapy. So the time that the ketamine is active is actually pretty short. Is that right?

Karen King: Yeah. So this is different per route of administration. So you can do IV. infusion, so you have a lot of control over it, and that can be an hour-long session. What we did was what was the most clinically researched and showed the most positive benefit, which is IV push bolus method. So the experience itself is only two to three minutes, but then it takes about 30 minutes to come back into your body, and then that second part of the session, so that second hour, is where the therapy happens. So you're lucid, the client's lucid, maybe in sort of a liminal state, but they're able to talk, they can feel their body, we can even get them to stand up and go to the bathroom if they need to and then bring them back safely. So they're very functional. And then there's lozenge, which I also do in my practice, the psychedelic counselor, where it's a three-hour session. And it's a psycholytic dose, so the person is lucid, slightly dissociated. It really depends on how their body processes it. But just to speak to the anxiety or the comedown afterwards is ketamine has a sedating effect afterwards. I haven't had anyone report anxiety physically after that. There might be anxiety that comes up later because of a psychological response to psychologically what happened in the session. So, for instance, someone's anxiety might be aroused because they feel so much better And their family isn't used to being with this person who doesn't have treatment-resistant depression. So everything becomes destabilized. It's like post-traumatic growth, really, is the biggest challenge I've seen when clients do ketamine-assisted therapy.

Stephanie Winn: So the first method you described, it sounds like most of the therapy is taking place after the person has come down off of the effects of the drug.

Karen King: Yes.

Stephanie Winn: So how did this method originate or who discovered, and maybe you don't know the answer to who originally discovered this, but I'm just curious how it became a practice or how it became discovered that this is sort of the best way to use this drug in therapy.

Karen King: That's a great question. I don't fully know the answer to that. I know that Phil Wolfson is a psychiatrist in California who is the quintessential, probably the earliest practitioner and has written a lot on ketamine-assisted therapy. I'm not sure how it was discovered that it had a neuroplastic effect. I don't know, because this was in the 80s, at the same time that MDMA was being used in couples therapy, so I'm wondering if there was some communication between those researchers, because they were all in California, but I don't know the answer to that. But I do know, to go back to what you're saying, sorry to jump in, but you were, I was mentioning Lozenge, and Lozenge is the treatment that this big company that you might have known about, Mindbloom, is using, and they don't use therapists. The person, they send someone a month's supply of ketamine lozenges, and they have trip sitters, not licensed trained therapists, that they can call and talk to. So it's not, doesn't, from my perspective, have the same ethics or rigor that is needed to really have a successful response to ketamine.

Stephanie Winn: OK, let's talk about that for a moment. But first, I have to acknowledge something you said that some listeners may not be aware of. I think MDMA wasn't actually scheduled as an illegal drug until the mid-80s, right? Yeah. And so there is this entire history of therapists, as you said, using MDMA in individual and couples therapy, and a lot that came out of that. And some of that history has been erased, and now I think later in our conversation we'll talk about the current status of MDMA and where that's headed. So you described this companies sending people a month's supply of sort of DIY. Just take ketamine at home, and if you want, call one of these people. I've heard similar stories, and I don't think it's just from that company, of people being prescribed ketamine to use at home without therapy, without necessarily coordination with the therapist they might be seeing. In your opinion, are there ever times that that's appropriate?

Karen King: You know, I, I tend to be a more nuanced human. And it's hard for me to come down on a black and white sort of way. But I would say But it is not, it's not an appropriate use of ketamine if you are going to be using it, which I presume someone is going to be using it clinically and for a clinical purpose of healing some kind of psychological wound. The power of the therapy comes in the container and the container comes through the therapeutic work with the client. I feel pretty strongly that it's never a good idea to send someone a month's supply of ketamine. There are so many things that could go wrong. And not that it's dangerous, but giving anyone a month's supply of a controlled substance, you really need to have a strong relationship with them. You need to have a contract with them for safety. There's so many things that go into that. But even just the work itself is done in such a strong container. And that is where the therapeutic healing is, is within that relationship with the therapist, with the drug also being in the space.

Stephanie Winn: What are some of the ways that you've observed ketamine having maybe a unique ability when combined with psychotherapy to achieve changes that might have been hard to achieve without it?

Karen King: Yeah, that's the million-dollar question, isn't it? It's like, what makes this so successful? Well, first of all, let me say, so the research showed us, when we started looking into this in December 2020, I got trained in ketamine-assisted therapy and I decided we should really add this to our clinic because it looks like it's really going to be a powerful tool. The research is saying 30 to 37% of people will find this effective, this practice effective of twice a week an IV for three weeks. So it's a three-week window where you do it twice a week, and then a month later you do a booster. And so that's the protocol. We call it the full wave. That's what we do. And after the first year, so it's year three, almost, and we've served 250 clients. And I would say anecdotally, 80, 90 percent, and I am not being hyperbolic here, is that many more people than we expected have been positively impacted. And I think it's because we are one of the only clinics in the Pacific Northwest, in Washington that I know of, that are doing the ketamine-assisted therapy with the medicine. There are a couple clinics in Seattle south of us. And I've actually called in to do sessions with my client who lives in Seattle and can only do the treatment there. But they don't have a structure for that. And I think there's one clinic in Seattle that does it and one clinic in Spokane. But we're new in this field. And what we've noticed is that when you do the assisted psychotherapy with it is when it's really successful. And specifically, I have my first client who did ketamine with us. She had been a client of mine for a decade and had experienced complex trauma, a lot of issues in her life. Her son was a heroin addict. She had a really abusive first marriage. She dealt with fibromyalgia. Really resilient, amazing human being with a lot going on. And we had been working together for years before she started ketamine. When she did Ketamine, her entire… therapy focus shifted. And there was something, I was just talking to her about this last week, is she was able to deepen in herself in a way that was beyond words. So having this mystical experience allowed her to feel more at peace in her life. And I would say that is a really big component even though there's a lot of conversation about does the experience need to be mystical or not, it looks like the more mystical the experience, the more positive the clinical outcome. And that has certainly been reflected in our experience with our clients.

Stephanie Winn: How do you differentiate between a mystical experience and a psychedelic one?

Karen King: So a mystical experience has 30, it's a Likert scale, and it's an actual questionnaire. It's been created to really distinguish a psychedelic experience from a mystical one. A psychedelic experience could include a mystical experience. It would have hallucinations, great insights, but there are criteria that have to be classically matched to indicate a mystical experience, and that is sense of oneness with the universe, timelessness, Gosh, so many things, and I'm getting them confused with the near-death experience because they overlap, but mainly a sense of timelessness, a sense of connectedness to everything, a sense of unconditional love even. So these are things that really impact a client's psychology as well as the physiology of the neuroplasticity afterwards. And that's the thing that the field is really trying to distinguish between. What's the psychological healing? What's the physiological healing?

Stephanie Winn: I love sleep. Sound sleep is a crucial foundation of good mental and physical health, from mood and concentration to metabolism and cellular repair. And I sleep very well thanks to my Eight Sleep Pod Pro Cover. My side of the bed is programmed to be warm when I get in and cool down to a neutral temperature in the middle of the night so I don't wake up overheated like I used to. How would you customize your bed temperature? Visit 8sleep.com and use promo code SUMTHERAPIST to take up to $200 off your purchase. Even if they're already running another sale, this code will get you an additional $50 off. 8 Sleep currently ships not only within the USA, but also to Canada, the UK, select countries in the European Union, and Australia. Thanks for considering purchases that support the show. Earlier you said that ketamine most closely mimics the experience of a near-death experience. And I'm surprised to hear that, because it's my understanding that DMT is released in the brain at birth and at death. And so some of the other psychedelics, like ayahuasca, contains DMT, for instance. And some people use DMT extracted from any original source or synthetic DMT. So it's my understanding that there are certain psychedelics that of course, are illegal, but that actually have a barochemical similarity to what happens in the brain during the near-death experience. I haven't heard this about ketamine. Help me understand the difference there.

Karen King: Yeah, so it's interesting. You might be interested to read Evan Alexander's most recent article. He's the neurosurgeon who had a near-death experience in 2008. And I think his book is called Proof of Heaven. So he had this experience and his experiences are really intriguing, I think, to the near-death community because he is a neurosurgeon. So he has this intimate knowledge of brain function and yet still posits that there is life after death. But he recently underwent a study where he was given 5-MeO-DMT in order to compare the experience of a near-death experience, his month-long coma death experience, and DMT. And he came up with some very interesting differences. And I'll have to read the article again to know specifically what they are, but he said, it's similar but different. And then I actually met him at the Near Death Experiencing Conference I just came back from in DC. And he and I were talking about ketamine and how he now wants to compare ketamine and see what that's like. So hopefully I'll get to do that with him. I think that would be a really interesting process. But ketamine actually meets the criteria of the Grayson scale. And the Grayson scale is Bruce Grayson's. He's a near-death researcher at the University of Virginia, perceptual studies. He came up with this scale to define what a near-death experience classically is. And what they found in giving this to people that have done LSD, psilocybin, DMT, ayahuasca, is that ketamine is the one that most closely resembles it. And my theory is that because it's an anesthetic, you are truly separated from your body as much as you can be without dying. And so I'm wondering if maybe aboga might be similar. Aboga is an African root that is also, from what I understand, a dissociative anesthetic. I haven't heard ketamine and aboga being compared this way. But in ketamine, you zoom out of your body. You can see your body too, much like a classic near-death experience. You experience a sense of timelessness, a presence. It can be unconditional love. It can be universe. It can be God. People have a life review. So, ayahuasca has a life review, but apparently not these other conditions. Ketamine can produce a life review. And then there's a sense of being changed when you come back. And clients report, oh, I know what my meaning, I know what my purpose is now in my life. Oh, yeah, it's powerful. Then my first client had her experience and came back and the first thing she said was, we are the universe experiencing itself.

Stephanie Winn: I'm wondering if part of the therapeutic benefit, when you describe it this way, is the ability to get that sort of 40,000 foot view on life. I feel like in therapy, because I do non-psychedelic assisted therapy, I do regular talk therapy, I often have the inclination to look for some kind of way to help my clients zoom out. That's sort of the language I use, right? Because if you're flooded, if you're ruminating, lost in the weeds or the details of your stressors, then it's like very up close and in your face. Sometimes I use somatic interventions. This was easier to do when I was in an office. But for example, for those who are watching on video, you can see me gesturing with my hands. For those who are listening, you'll just have to imagine. But sometimes, let's say someone has recently left a relationship with a very abusive person, and that person, they're like still in their head, and that person still feels like this internal presence looming so large and they're always thinking about what would he say or do about my every move even though she's exited the relationship, right? So sometimes I'll use sort of like I'll ask my client to demonstrate maybe with her hands how close is he to your face, to your head, to your every thought, how much space is he taking up and then kind of working on gradually distancing strategies, right? Strategies for giving yourself more breathing room from this internalized object and maybe kind of shrinking or putting some kind of bubble around that influence so that you can experience yourself as having some distance from it. So that's one way that I've worked in therapy with the experience of feeling completely absorbed and enmeshed in the details of something really stressful. But I think we do this in other ways too, right? When we want to help our clients zoom out and get the bigger perspective connected to, as you said, the purpose, right? Because if you're connected to who you are, you could say that core level or a soul level, then that offers a lot of perspective on how would the being that I am or the purpose that I have move through this situation. So I'm wondering, because I do think about the role of doing that in psychotherapy, if that's part of the benefit of ketamine is that it allows you to zoom out and get that distant perspective on your life that can be so hard when you're lost in the weeds.

Karen King: Yes. Yeah, I think that's really well articulated. And I think it's so interesting. I was thinking about it this morning. It's like, what is it that happens when we gain what we could call a spiritual perspective? And I'm using sort of spiritual and mystical interchangeably here and for the moment for the conversation. But I know for myself, when I can disentangle from the physical feeling or the ruminative thoughts and feel like there is a purpose to what I'm going through, that what happens is I have a level of acceptance of my experience that then creates a workability. And so ironically, I think that distance that's created through a mystical experience or even a psychedelic experience only, takes us out of our experience enough so that when we come back to it, we can relate to it differently, and maybe even ultimately more intimately. If I am rewriting my story as not someone who has been psychologically traumatized, Let's say which is partially true for a client. Let's say they have gone through a lot of trauma They are psychologically traumatized but someone who has chosen to enter this body at this time in order to learn this lesson I'm not saying this is true. I'm saying this is the experience. I think people can connect with more when they have a mystical experience Then they come back with a sense almost of heroism. I'm the hero of my journey, and I have a purpose for this, and maybe there's something I need to teach others. So it's like a rewriting of it without having to go into the weeds, like you said, of the trauma.

Stephanie Winn: That's beautiful. Let's shift gears and talk about MDMA now. You have, you've trained with MAPS and you're planning to establish an MDMA clinic or bring that into your practice once MDMA has gained FDA approval. as a therapeutic treatment. So first, let's catch listeners up to speed who may not be familiar with MAPS, MDMA, and what's going on with the FDA.

Karen King: Yeah. So MAPS is the Multidisciplinary Association for Psychedelic Studies, and they are an incredible body that have created the clinical trials for the use of MDMA for PTSD. And those have been going for years now. And they are also the body that will be accrediting or acting as a training for accrediting for psychedelic assisted psychotherapists. They sponsor many trials. They're a public benefit corporation. So they work on from funding from the public. And the training that I've done is a year-long psychedelic-assisted training through Naropa, sponsored by MAPS. And there are two or three programs now over the past year, or there have been more that have come up, that are MAPS-sponsored. And the reason for that, that you want to do a MAPS training, is that so when the FDA approves MDMA, you can say, I have the certification from the right body. So that's the pathway. MDMA, as we had said before, alluded to as a medication that was used in couples therapy in the 80s and was researched successfully then and then was shut down with the scheduling of it as a controlled substance. Research didn't start again until recently. because of that. And now MAPS has sponsored these trials that have hit phase three and having incredible results to where I think I just read 30 percent, this might be low, but 30 percent of people that complete the MDMA trials no longer meet the criteria for PTSD. So that's a series of four to six sessions of MDMA. People that have had PTSD for 17 years no longer meet the criteria. So that's pretty stunning. And so we're just waiting, us and the community are waiting for this to be FDA approved. And when I went to the MAPS annual conference in June, we learned that a new CPT code is going to be approved in January for five to six hours of therapy. And so people are really working hard to make sure this is covered by insurance. So that was exciting as far as accessibility goes.

Stephanie Winn: Wait, I have to know about this. Yeah. There's going to be a billable code. That's what a CPT code is, folks. So for example, and in order to bill, just for the lay listener who's not familiar with this stuff, if you've ever seen a therapist and billed your insurance, you have a diagnosis. Sorry to break it to you. Your therapist might not have broken it to you. It could be something mild like adjustment disorder. Could be major depression. Could be something a lot more serious. But your therapist did come up with the diagnosis. Otherwise, why are they billing insurance? And then there's a CPT code. That's the treatment code. So for example, the first session of therapy, usually 90791. That's a diagnostic assessment. The second session of individual therapy might be 90837. That's a code for, let's say, 55 minutes of individual therapy. So there's always a billing code for a service. The longest I've ever been able to bill for, honestly, is an hour. If I go over that, every now and then there's a code that you can add depending on what insurance will pay for. They'll pay you a little extra for crisis work. So that's the context. And by the way, for those who are following along with this discussion and who are familiar with my work, there is no ICD-billable diagnosis code for anything pertaining to detransition. No ICD-billable diagnosis codes for history of cross-sex hormone use, history of these surgeries, and things like this. And that is a major medical ethics issue that we're navigating in the United States today. But anyway, so you said the FDA is going to approve a CPT code, that's the billing part, the service, for five to six hours of therapy. Now, does this have to go along with psychedelics? Or if I thought it was clinically indicated for my client, and I wasn't providing any psychedelics or anything like that, but if I thought it was clinically indicated for us to spend all day in therapy, I mean, well, it's one thing to have the CPT code. I'm just thinking out loud because this is all new to me. It's one thing to have the CPT code. It's another to have laws that mandate that insurance providers have to cover that code? Right.

Karen King: Right. OK. Did I just interpret your question? But at least it exists. And this is the first hopeful piece, is that at least it exists. But I don't have the answer to that yet. I would suspect it probably has to be used in conjunction with a medical prescription. And I bet that's how they'll limit it, knowing insurance. And just incidentally for listeners out there, while your psychiatrist gets paid for case consultation, note review, charts, assessments, and phone calls, therapists do not. So there's still a mental health bias and that we get paid 30% less than comparably trained people and clinicians and we don't get paid for any of that outside work we do. So it's a really good start that there's a five to six hour CPT code. I think it's beginning the process of acknowledging that there is going to be a psychedelic therapy. So I bet they're going to limit it to some medication being prescribed in conjunction with that.

Stephanie Winn: Honestly, when I've thought of how would I like to work if rules and regulations weren't an issue, I thought that there are times that I would like to spend all day with a family, you know, doing like an intensive intervention, let's say a three-hour family therapy session. I mean, beyond a certain point, people are too burned out, especially adolescents or people who are having a lot of contention.

Karen King: That's super interesting. I'm starting to run ketamine retreats because, again, at this conference I learned about the group modality for ketamine-assisted therapy, and it looks very successful. I was part of an amazing workshop where we watched a documentary of participants. That we're going through this group ketamine experience over a weekend and I thought I want to offer this so I'm working in partnership with an ARNP in Seattle To offer one this fall and we think we're gonna offer it. I don't know to midlife women. I'm not sure yet, but We're looking for the right population Yeah. But yeah, so in May, thinking June 2024, that's when MAPS is telling its people to look out for FDA approval. And at the conference, I also learned there was a spokesperson from the FDA who said they're really going to be looking at integrative clinics that are already REMS approved for Spravato and things like that. And our clinic is REMS approved for Spravato. So that was- Sorry, I don't know what REMS- RIMS is the, and of course I'm totally spacing on the acronym, but basically it's the hoops of safety and training that you have to jump through in order to be approved by a pharmaceutical company and the FDA to provide a medication. So our psychiatric nurse practitioners have gone through trainings from Janssen Pharmaceuticals to make sure that we meet the safety criteria. Our clinic has a crash cart. We have an RN on staff or an ARNP, an MA who dispenses the medication, that kind of thing. So it's just the safety protocols. So those are the clinics that are going to be more likely approved for MDMA.

Stephanie Winn: That makes sense. MDMA is a stimulant. It can affect things like heart rate, blood pressure. I'm sure there are medical contraindications as well as psychiatric contraindications. So it seems like from the current research, there's strong evidence that MDMA is Well, it's actually been given the status. It's been called a breakthrough therapy. That is the status that's been given by the FDA. But strong evidence that MDMA-assisted therapy can be very helpful with post-traumatic stress disorder. Can you explain a little bit about sort of the mechanism of action and why this treatment is so effective?

Karen King: Yeah, and this is where I'm not a neuropsychologist, so I don't have as much verbiage or education around the physiology of it. But I do know that it is the theory, I mean, it's all theory, actually, they don't know exactly how it works. But what the theory is, is that it allows like all the hallucinogens or psychedelics it allows the default mode network to go offline, which is that part of our brain is our forebrain or identity. It gets quiet and other things can happen. And those other things are what they're looking at, like specifically with MDMA and ketamine that neural pathways get rebuilt. And that's basically the theory is that what happens is your identity consciousness gets quiet. Other pathways are allowed to come in, kind of like DBT. You know, that was the theory with DMT is that, DMT, DBT is that you, you let you access your amygdala less and get into your forebrain more. And that is kind of the opposite of what's happening. They're finding out through functional MRI and all these studies is that your default mode network goes quiet.

Stephanie Winn: That was my understanding from the training I've done in the latest research on psychedelics is that MDMA slows down the activities, as you were saying, both of the default mode network and also the amygdala, so the fear and threat response center, which we know in people with PTSD is sort of hyperactive. It's been conditioned through experience to become hyper responsive to threat. So to be able to take a break from that while at the same time actually, as you're saying, speeding up the activity in the prefrontal cortex, increasing processing ability. And I think, well, I know with psilocybin and I think with MDMA too, there's more sort of cross hemispheric activity going on in the brain. So the brain overall is more active, more able to A lot of people report this sort of sense of unconditional love and freedom from fear that allows them to then reprocess their trauma without that element of fear and move all the way through it.

Karen King: Yeah, I'm just thinking about, this is a whole other conversation. I'm very interested in parapsychology, and my interest in near-death experience, I think, has led me there. But there's a researcher, Michael Persinger, who stimulated the brain, this is back in the 80s and 90s, with electromagnetic stimulation, the God Helmet. This is the guy who did the God Helmet. He found when you stimulate one side of the amygdala, people have a sense of angels and God and unconditional love. And when you stimulate the other side, they have demons and fear. And so he even found some distinction in the stimulation of the side of the amygdala. There's a lot happening when psychedelics are at play that is interesting to think about. Is it, quote, real? Is it something that's stimulated by a brain chemistry or physiology? And I'm personally really happy to hang out in the mystery of maybe it's both, either, and.

Stephanie Winn: Well, that brings up for me is the image of the angel on one shoulder and the devil on the other. I know.

Karen King: Isn't that interesting and physiologically represented?

Stephanie Winn: And the experience of people with schizophrenia. I mean, on a more sobering note, right? Because, you know, any therapist who's spent time with people with schizophrenia or schizoaffective disorder, angels and demons often play big roles in their sort of internal world of what they're seeing and hearing, sort of the messengers from both sides.

Karen King: When I, so I have an appropriate diagnosis, and so I was the first one in our clinic to try ketamine. I felt like it was ethical for me to be able to offer it to people in order to have the experience, felt like an ethical stance, and also I meet criteria. So we did it ethically and above the board. But I had what I now know to be a classic near-death experience, which is what interested me in the field. And one of the things that I really felt strongly was a sense of presence, so a consciousness outside of my own. And on one hand, I can think of that as like, okay, maybe I was actually feeling a consciousness outside my own. And the other is I know that that can be stimulated by the God helmet as well. And so who knows what the answer is, but it was such a powerful experience and life changing. It almost doesn't matter.

Stephanie Winn: If you're looking for a simple way to take better care of yourself, check out Organifi. I start every day with a glass of their original green juice powder mixed with water. It contains moringa, ashwagandha, chlorella, spirulina, matcha, wheatgrass, beets, turmeric, mint, lemon, and coconut water. 100% organic with no added sugar. It's the best-tasting superfood supplement I've ever tried. It's super easy to make, and it makes me feel good. Organifi also makes several other delicious and nutritious superfood blends, such as red juice, immune support, protein powders, a golden milk mix, and even superfood hot cocoa. Check out the collection at Organifi.com slash Sumtherapist. That's O-R-G-A-N-I-S-I dot com slash Sumtherapist. And use code Sumtherapist to take 20% off your order. So we have some questions for you from our locals community. So for those listeners who aren't aware, I have sort of an easy point of entry if you're looking for community around the things we talk about on this podcast. You can find that at somekindoftherapist.locals.com. It's just $8 a month. And that gives you access to a private online community where there's no bullies or trolls. It's a pretty small group. I'm waiting for more people to join for us to be able to expand the offerings. But currently, what we have on offer as part of that group is, well, a couple of things. One of those is that you can post your questions for me to answer in my next live stream. The live stream is members only. Only local supporters can access it. So you could ask sort of any question that's smaller than what you would need a private consultation for. Of course, there are limits to what I can give away for free to somebody I'm not having an in-depth conversation with and in this type of forum. But that's one of the things we do in that community. And then another is that I let my Locals community members know who my upcoming guests are going to be and give them the opportunity to pose questions. So I let my Locals community know that I would be interviewing Karen with her particular expertise. And we have a couple of questions for you. And I think these are related. So I'm just going to say them both at the same time. Okay, so Free to Disbelieve says, I wonder what Karen means by the intrusion of woke into the psychedelic community. And then Kai says, Hi, Stephanie. Looking forward to the conversation. I hold both of you in high regard. Here's a question topic for you and Karen. In each of your practices, have you found more CSJ, that's critical social justice, slash woke has come from clients or from professionals, maybe different versions or emphases from the different groups?

Karen King: Yeah. So I can speak to the first question first, which is I did the training at Naropa, and Naropa is a Buddhist college in Colorado. I actually received my undergraduate there in dance and religious studies. So I thought, oh, I'll go back there and get the certification and revisit that contemplative community, because incidentally, the mode of therapy that is shown to be most clinically, well, I can't really claim that, but it's used successfully in the clinical trials, is contemplative psychotherapy. So that is the method that is being used and taught at Naropa, theoretically, through MAPS. My experience was that it was not really taught, unfortunately. So my experience in the Naropa program is that we spent a whole lot of time in a year-long program, maybe three quarters of it was dismantling our white supremacist beliefs, and we did very little clinical exploration. I was very disappointed in that we didn't talk about consciousness. We didn't talk about altered states of consciousness and the history of that. We didn't talk about working clinically in altered states of consciousness. We talked about the vulnerability of the client, which, of course, is something that CSJ and that victim perspective really has down. So, we did talk about that. It was very heavily focused on decolonizing. We had a lot of guest speakers about their oppressed communities. There was conflict that happened within our cohort where there was a underrepresented, marginalized communities, as they called themselves, the BIPOC circle, that felt very oppressed by the other circles. It was just absolutely infused with what I felt was information that was barely relevant to clinical work. So, it was disappointing. And so, from the Naropa maps perspective, I would not recommend the program. I've heard that there are other programs like IPI, Integrative Psychiatric Institute, that are less infused with critical social justice and actually more about clinical skills. I wish I had done that program.

Stephanie Winn: Yeah, it was frustrating. I had some of that back in, I started grad school in 2010 and, you know, I felt Of course, at the time, like it was my fault. But but now looking back, I see that I was in grad school sort of not at the very beginning of all this stuff, creeping into higher education, but still when it wasn't. 100% like it is now, you know, and so those sort of group dynamics, I mean, there was there was a combination of good clinical stuff and the social justice stuff. But let's just take a moment to explain why this is so concerning. For one thing, for example, if you're coming in with the preconceived notion that I can look at you and I can see the color of your skin and I can know how you think, feel, act, what life experiences you've had, then Setting aside the impact of that on the therapist, let's say therapists were to adopt that ideology, hook, line, and thinker, what's the impact on clients? I've had this experience from the client's perspective of, I sought out a consultation once with a therapist to find out if she would either be a good therapist or a good supervisor for me. I thought maybe one of the two. And I think she went into that I was only thinking that I was looking for supervision so she treated me the way she would treat a potential supervisee not a potential client, which was really an oversight on her part because the email exchange made it clear that I was thinking of her as potentially either. But I went in thinking that as a biracial person that she would actually potentially be uniquely qualified to understand some issues I have with my own sort of hidden multiculturalism. That's not evident from looking at the color of my skin, but is evident if you get to know my background. And, you know, so here I had sort of a positive projection of her, of what it meant to be multicultural or biracial, bilingual, whatever she was, you know? And I ended up getting lectured by her because she had a whole set of assumptions of what it meant for me as a white person to be seeking her out as someone to potentially educate me. Right. So it became sort of this like she went into that sadistic mode that I'm sure you've seen where when someone has that power where the narrative is on their side, the narratives about victimhood and oppression and all that kind of stuff where they're like, oh, I have the mic now. Mind you, I went in expecting professional integrity from her. She, I believe, was a licensed clinical psychologist or a PhD level. I don't know. She had a doctorate. She had supervising experience. She was also experienced in the world of psychedelic therapy. So I went in with nothing but positive assumptions. And I ended up getting lectured because she projected onto me her assumptions of what I was looking for. And she was actually quite incorrect. And it took me a while to sort that out. Like, wait a minute. did not even ask me. She assumed that she knew what significance things like skin color would hold for me. But it was abusive, frankly. And of course, I decided not to work with her and she decided not to work with me. I can only assume or hope, honestly, that part of her follow-up email saying that she didn't think we were a good fit, which I agreed with, I can only assume that part of that was maybe that she felt a little remorseful. she should have, that maybe she had overstepped, because I think she did. So I've seen this. I've seen the impact on clients. I've heard some disturbing stories about people who fear discrimination based on skin color or sex or things like that. And it's scary that therapy has gone in this direction. So that was the beginning of your response to Frida Disbelief's question. I'm uniquely qualified in a weird way to comment on pre and post CSJ at Naropa because I was at Naropa in the 90s and then came back in 2022.

Karen King: And I think the thing that I noticed was that in the 90s, there was percolating a sort of the romanticism of indigenous culture and shamanism. And I even went down to Mexico with Jonathan Knott, Ralph Metzner, Terrence McKenna when I was 22, and did a retreat with them to learn about psychedelic medicine. And that was a very wonderful, interesting experience. there was a lot of romanticization and then therefore attack on what is now called white Western medical culture. And that division was very strong in the program, the MAPS program at Naropa. It was that somehow we're within this medical framework, and that is how MDMA and psychedelics are going to come through legally into our systems. And yet they were being very denigrated as being harmful and abusive, and they were overgeneralized. And I feel like the big blind spot for, ah, mainly the CSJ, there are a lot of blind spots I think are in there, but one of the big ones is that I mean, Western medicine came out of a rich psychedelic tradition. The Oracle of Delphi is definitely part of this, and that altered states of consciousness have been with us in our evolution into Western medicine. I'm not saying it's perfect. Clearly, there's a lot that needs to be changed about our systems, insurance being just one of them. that we can't throw away our civilization and our culture and dismantle it from the inside like people are so want to do now, that we have to honor it and also bring in other ideas and honor both. But there is not the honor both in this modality, in this paradigm, I think that is happening with CSJ within the psychedelic community. It's one or the other. And I think that is very short-sighted. And in the conference I went to in June, Rick Perry, the ex-governor of Texas, was on the docket to speak and to do the welcome ceremony. And people actually tried to have him canceled. These are people in the psychedelic community that are supposedly open to ideas and bringing bigger conscious awareness to normal culture. And they walked out, and a lot of people walked out of his talk. And, of course, his talk was hurtful, genuine about his belief in the use of MDMA for vets, which is, of course, how this work is going to reach our culture, is through this work from, quote, I don't know, both sides. I always hate saying sides, but there are clearly sides in this. but we need to work together. So I saw it represented in the training where it was not training based on classic psychoanalytic or psychological principles of helping, but it was based on anti-clinical modes of helping, and we could only center the victim and indigenous science, as it was called. And that frustrates me to no end. This is going to be a very nuanced conversation moving forward because we're talking about mystical states. And within a medical framework, we have to have the language to contain all these things without excluding either side. That's my soapbox.

Stephanie Winn: I love it. There's a story that's been coming to mind as you've been speaking that I wish the details were fresher or that I could pull up the link. But one of the most absurd things I've ever seen as evidence of the intrusion of this woke mentality into the psychedelic community came from an article, I think it was a couple years ago that I came across this, that was something like, I kid you not, are machine elves racist? So for context, do you know what I'm talking about?

Karen King: I do know what you're talking about, but I haven't read the story. Yeah.

Stephanie Winn: People are going to be like, what are these kooks talking about? Okay. So hear me out. Okay. I've never done DMT, but I have heard Anyone who's been following what happens on psychedelics has heard about these machine elves. Apparently, a lot of people who take DMT, whether that's in ayahuasca or extracted or lab-created or whatever, have this experience of encountering these otherworldly beings that they refer to as machine elves. I don't know what that means, but that's a common phrase used to describe them. Okay.

Karen King: Self-transforming elf machines is where that comes from. Terrence McKenna saw in their geometric figures and there, you know, there's a lot of contention on are they real? Are they just a shared hallucination? So, yeah.

Stephanie Winn: Okay. Are they real? Okay, so there's an article written by, this person was black and into the psychedelic community. And apparently they'd had a bad experience on DMT where the machine elves were saying racist things to them. So I read this encounter at first and I'm thinking, Surely you recognized that psychedelics are illuminating the contents of your own psyche and that maybe this psychedelic experience you had was showing you that you've been surrounding yourself with messages from the culture that are leaving you feeling paranoid, disenchanted, afraid of your fellow human being. You're projecting the contents of your psyche onto these hallucinated beings who are calling you the N-word or whatever they're doing. Clearly this is a reflection of your mind, right? This is, I'm reading it. But this article like went to some strange places where the conclusion that they came to was basically DMT is racist. Like DMT has a consciousness that is racist, that is therefore unsafe for black people. And like, I don't know, it was, it went to some bizarre places.

Karen King: Are you sure this wasn't a hoax paper?

Stephanie Winn: I mean, I hope it was. I hope it was. But that's an example of the sort of thinking that we have that it frightens me, right, that people would use psychedelics and not have the proper guidance to interpret what the psychedelics are showing them about their own minds. Because, you know, heaven forbid, if I were to have an experience like that, I would, maybe learn from that experience that, wow, I really have been overdoing it with social media and depressing news. I need a brain break.

Karen King: You know what's fascinating? I'm going to be percolating on this for a while, and I'm going to find this article. What's fascinating about it is that it's reflecting exactly what's happening in society, which is that people are believing their projections are real. So, this person was believing that these self-transforming elf machines were actually a separate sentient consciousness. So, how fascinating that that person would rather believe that, that that's easier to believe than that it was a projection. That is fascinating.

Stephanie Winn: Don't you think? Right. They're choosing to reinforce. They're choosing to reinforce their existing beliefs while using mind-altering substances that increase neuroplasticity when the opposite interpretation, you know, that this thought… Because you could look at a situation like that and think, wow, if I am projecting racism into a hallucination that is entirely a creation of my own mind… Right. then maybe I'm projecting racism into other situations. Sure. And maybe the truth is actually better. Maybe I would benefit from not seeing that everywhere. Maybe the truth is kinder than what my mind is projecting. That is an optimistic interpretation.

Karen King: Yes. I think so, but that takes in a self-empowerment to say, oh, maybe I'm wrong, or maybe I can empower myself in my world. And I think that is the really scary element is that the organization, the self-organization is utterly around disempowerment. So much so that when you take a hallucinogen, you believe that you are disempowered. And let's, I really want to take that to the end and we don't have to talk about this much more, but so what's the, what is her, or I can't remember if you said it was male or female, but what is this person's like summary of the world then? If the universe is racist and there are, let's say alien beings that are racist, What are then, how do you go forward? What do they want us to do about it is my question. Do you know what I mean? Like, what is there to do then? It's fascinating.

Stephanie Winn: Well, it, I don't know, but it seems like it sparks, like the, Judging from the behavior that usually results from that sort of interpretation, it would seem like the interpretation is that then you fight it, you try to eradicate it. But also, if it's so baked into the universe at that level that you're talking about, that's how- You could be the ultimate victim forever then, right?

Karen King: If even the aliens are racist.

Stephanie Winn: All right, but let's get back to Kai's question, because we started to answer it. So have you found more CSJ slash woke has come from clients or from professionals? You can now watch No Way Back, the reality of gender affirming care. This medical ethics documentary, formerly known as Affirmation Generation, is the definitive film on detransition. Stream the film now or purchase a DVD. Visit nowaybackfilm.com and use promo code SUMTHERAPIST to take 20% off your order. Follow us on Twitter at 2022affirmation or on Instagram at affirmationgeneration.

Karen King: I'm in a unique position in that I haven't had very many clients because I've been only focusing on ketamine-assisted therapy and then training and supervising other clinicians. So my experience has been hiring a group of clinicians in the pandemic that had only been trained online, done their internship online, and then had their first professional job with us online. And I saw a lot of that philosophy enter their practice in a way that I was concerned about. I have many stories.

Stephanie Winn: Are there any you'd feel comfortable sharing today?

Karen King: You know, I'll start with a gentle one. There's some shocking ones, but the one gentle one is I hired a psychiatric nurse practitioner to join us. She was a student with us for a year, might be a little less than a year, but for a while. And so she was familiar with us and wanted to join us as an employee. She did her preceptorship there. And it was right during the George Floyd riots that she happened to be getting on board with us. And I asked her if she would be interested in running a mental health group that was helping people deal with the tensions and the upset and the trauma. And she became very upset with me and accused me of being racist. This person was a different skin color than me and said that I was using my authority and white privilege to force her to run a group that she wasn't comfortable running. And it was pretty shocking. I looked inward and thought, am I being racist by asking her to run this group? I would ask anyone to run this group. I thought it would be a great opportunity for her as a new clinician. If she wasn't comfortable, that's fine. Often I find that new clinicians need a little support with groups and encouragement. And I think she interpreted my encouragement as, coercion. And so I had, it was tense. And I assured her I wasn't feeling racist, but that I would look at myself. And then about a month later, she came and apologized to me and said she was just very heightened and had marched the day before. So I really appreciated that. That kind of has a positive And to it, she ended up leaving our employment early by her own choice. But I don't know if that had something to do with it. But that was really shocking. I have considered myself a liberal human who believes in the rights of everybody. to exist peacefully. And grew up in the South and had a very different experience with my family, having different beliefs, and I was always the one that stood out with the liberal beliefs. So it was really shocking for me to be accused of being racist. That was one. And in general, there's a sense, there's another really good one, actually, it's brief, that I had a therapist very upset with me in a staff meeting tell me that she had to purchase her clients big sunglasses in order to protect them in the waiting room so people wouldn't look at them. And the, I mean, just let that sink in for a minute. Because the implications of that are so many that she was teaching her clients to be disempowered by having feelings and that they couldn't be witnessed and resilient and be vulnerable in the world. And she had actually, I found, had purchased her clients large sunglasses to wear so they wouldn't have to feel vulnerable as they left her therapy office. And to me, that was the epitome of over-victimizing your client. And those poor clients, they were learning that they couldn't trust their feelings or their resilience or that it was safe to be vulnerable. It was such a disservice to them.

Stephanie Winn: And it shows such poor boundaries. Yeah. To I mean this message that she owes this to her clients that she has to do it for them rather than owning that she is having difficulty managing her countertransference which which is what would be more appropriate to bring to a supervisor. Right. So the more mature responses you come to supervisor and you're saying I'm having difficulty managing my countertransference I'm finding myself wanting tempted to make these boundary violations because I'm perceiving my clients as so fragile and so vulnerable and also somehow so poor that if they want to wear sunglasses, they don't have the money. to buy themselves a pair of sunglasses. That's true. I hadn't even thought of that. Really, it's an incompetence and boundary issue on her part, but then to turn around and blame you for it.

Karen King: Well, that was the hallmark of that era, was that somehow it was the organization's fault to not provide what I perceived to be utter coddling of their client. And it was a fascinating and challenging time. It was a whole crop of employees that really believed that we were, they would ally with their client against our organization to make, it's like they were taught to make somebody the bad guy. And somebody in this scenario had to be triangulated against. and it was the employer, which I think happened probably in a lot of different businesses during the pandemic.

Stephanie Winn: It's very convenient to be the employer. You're sort of the authority, the parental figure in a way. And ideology is fundamentally very juvenile.

Karen King: Yes. Yeah. And that somehow it's like the anonymity of being online and all the lockdowns and the lack of human contact allowed for this wild projection machine to just take over for a while. It was like there was no stop. And that culture in our practice really only changed when we came back into person fully, which was just May of this year. So it's it's a new exploration. And all those counselors that we had, some of them were less indoctrinated into that ideology and left naturally because we have two year cycles as we work with associate licensed folks that are getting fully licensed.

Stephanie Winn: There's a whole separate conversation to be had on the impact of the pandemic on people's paranoia. It was right before the pandemic that I started reading The Righteous Mind by Jonathan Haidt. And I learned some really interesting things about moral psychology and that, like, for example, that the slightest visual cues or sensory cues in our environment that remind us of the possibility of disease and contamination, for example, seeing hand sanitizer or being asked to wash your hands impacted the way people responded to surveys to make them more morally rigid. So I remember learning that fact right as we were going into the pandemic, and then noticing this rigidity, inflammation, paranoia in the culture, thinking, what is this fear of contamination on a mass scale doing to our psychology, plus the social isolation? Anyhow, time to wrap up. This has been a great conversation. Is there anything you wanted to follow up on before we talk about where to find you?

Karen King: I think that I've been listening to the witch trials of J.K. Rowling. Megan Phelps Roper interviews her and I keep thinking about the indoctrination from this ideology and what that's going to take, especially for counselors, young counselors that are coming into the field. And she, in her last episode, comes up with a series of questions that she asks herself after being in a cult for 26 years. She learned she couldn't trust her mind. So she had to really relearn how to trust her sense of reality. And I think these questions are something I would love to put out there. If we have time, it's just a few seconds. Sure. And then for people to percolate on this, I'd love to offer this in the future, somehow a conversation around this. So one is, are you capable of entertaining real doubts? Are you operating from certainty? Two, can you articulate the evidence you would need to change your position, or is your perception unfalsifiable? Three, can you articulate your opponent's position in a way they would recognize? Are you attacking the ideas or the people who hold them? Are you willing to cut off relationships due to these differences? And this last one, are you willing to use extraordinary means against those who disagree with you?

Stephanie Winn: Those are good questions to guard against extremism.

Karen King: Yeah. And especially in the counseling field, because something is really going to be lost unless we challenge this.

Stephanie Winn: Well, thank you, Karen. Very well said. So where can people find you?

Karen King: They can find me at my website, karencking.com. And also, I'm running that consultation group with Hansa Gutierrez, and that is Clarify Consultation. And it is a non-ideology, non-canceling consultation group for therapists who really want to talk about these philosophies and ideas and their practices and how they're showing up.

Stephanie Winn: And that ClarifyConsultation.com? Yes. That's excellent. Really glad to hear about these resources. Well, thank you for joining me, Karen. It's been a pleasure. Thank you. It's been really great. Thank you so much. I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit SomeTherapist.com or follow me on Twitter or Instagram at SomeTherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Care, at nowaybackfilm.com. Special thanks to my producers, Eric and Amber Beals at Different Mix, and to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.