CIIS Public Programs Podcast

TRANSCRIPT

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This is the CIIS Public Programs Podcast, featuring talks and conversations recorded live by California Institute of Integral Studies, a non-profit university located in San Francisco on unceded Ramaytush Ohlone Land. 

In this episode, CIIS professor and clinical psychologist Jason Butler and clinical psychologist Genesee Herzberg are joined by psychotherapist and mentor in the CIIS Center for Psychedelic Therapies and Research Gisele Fernandes-Osterhold for a conversation exploring how psychedelic medicine can be incorporated into contemporary psychotherapy. Together, Jason, Genesee, and Gisele examine the practice of psychedelic therapy and offer practical guidance for cultivating a highly effective, ethically grounded, and integral approach to psychedelic therapy.

This episode was recorded during an in-person and live streamed event at California Institute of Integral Studies on January 25th, 2024. You can also watch it on the CIIS Public Programs YouTube channel. A transcript is available at ciispod.com. To find out more about CIIS and public programs like this one, visit our website ciis.edu and connect with us on social media @ciispubprograms.

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Gisele Fernandes-Osterhold: Good evening, everybody. Welcome to CIIS. It's a pleasure to be here tonight with all of you, with Jason, with Genesee, and with all of those that are virtually joining us. Let's take a deep breath, everybody together. Let's arrive, find your sit bones, find your connection to your body. You've made it. Probably a lot of different activities and people and places that you've been involved with today, and now you're here. So enjoy this time together. We are here tonight for a treat. We're going to be talking about this book and diving into some of the deeper topics that this book brings about and are so pertinent to this field. I feel a lot of gratitude for being here at CIIS, as this is a home for me. It's a place that I came through grad school and I came from Brazil. I've taught here for 12 years and have been doing mostly online mentoring through the CPTR because I'm working with a group that is from different parts of the United States and the world that are interested in psychedelic assisted therapy. So I haven't been to campus in a long time. So it's wonderful to be here and to be here with you. Welcome. This room has hosted many important people and has a lot of wonderful... We come here today on the heels of those who came in before us. And so it's a good place to be. As we're getting started, I'll start with Jason. Would you want to tell us a little bit about your inspiration for this book? 

Jason Butler: Sure. Thanks, Gisele. Welcome, everybody. So I'll start with the inspiration kind of in an immediate sense. Genesee and I were driving one day listening to Michael Pollan's book and he was doing a pretty good exposition on the history of psychedelic therapy in the West. But what I found was really missing there was a deeper dive into the therapeutic methods that were really supporting psychedelic medicines, as well as the historical context that extends beyond just the kind of Western approach to psychedelic therapy. So we, Genesee and I, in conversation felt the call to really try to access the conversations that were happening amongst our peers, ketamine clinics and in the MDMA for PTSD research, facilitated by the MAPS organization, really trying to ask the question, what therapeutic methods are going to really support the rolling out of psychedelic medicines to not only meet the client in the depth and breadth of experiences that are possible with psychedelics, but to also meet them in a way that accounts for social context and history. So as I come to that, I just want to situate myself as a person who is constructing this book and really recognize the history of white men, particularly taking the field of psychedelic therapy in a particular direction without really acknowledging where it came from, at least not acknowledging it with much depth or sensitivity to the history of colonialism. So Genesee and I tried to really hold sensitivity to historical context throughout the whole construction of the book. And in doing so, my inspiration was to use the privileges afforded to me as a white man to lift up the voices of other people. So it became really important that this is an edited volume to bring in voices that are typically not represented in the field, as well as perspectives and approaches that really haven't been talked about in the research literature so far. 

Gisele Fernandes-Osterhold: Yeah. So Michael Pollan is brilliant, but he's a journalist and this is about the mental health field. And so in this book, there's a great emphasis of a clinical approach, a book written by clinicians for clinicians, right? And you have a lot of people here, Genesee, that are collaborators. Would you want to say something about the process of bringing the people together, organizing the chapters, the topics? How was that? 

Genesee Herzberg: Yeah, yeah, absolutely. Yeah, it's true. This book is very much intended to go deeply into how does the therapy work? And we were finding that there wasn't enough out there up to this point that really deepened into therapeutic method and supported therapists in feeling well equipped to address the real subtleties of psychedelic work. It's a very specific and potentially vulnerable state that people go into and requires a certain set of skills. And so, yeah, we spent some time thinking about what are those skills? What do we feel is essential for a fully educated psychedelic therapist to know going into doing this work? So often people are trained in a pretty brief and superficial way and step in not fully prepared and that's where harm happens. And so we spent a lot of time thinking through all of the various modalities, the history, as Jason mentioned, the origins of psychedelic medicine in Indigenous cultures and then brought together a group of our colleagues who were experts in these various areas. We actually initially envisioned both the book and a conference. We were planning to throw a conference of other psychedelic practitioners at Wilbur Hot Springs, a small group that was intended to be sort of a council or like a study group almost. And we were hoping to come together and really share our knowledge and expertise and learn from each other and develop the method. You know, Western psychedelic therapy is not that old at this point. While it's been practiced for hundreds of years in Indigenous cultures, the way that it's being held in the Western world in the context of psychotherapy is relatively new. It's less than a century old. And so, yeah, it felt important to come together and really think about how can we refine and develop this work. And so, yeah, the conference got canceled because of COVID. So that didn't happen. And instead, we redirected our efforts towards writing the book. Simultaneously, we also—we really value collaboration over competition. And so, we though, you know, I own a ketamine-assisted therapy clinic called SAGE. And I know a number of folks who own and run other ketamine clinics who typically would be seen as competitors. But instead, we all held a very collaborative attitude and came together to practice together and study together and learn together and support each other and develop the method. And it's really that spirit of collaboration over competition that kind of underlies this book that lays as a foundation of the book. 

Gisele Fernandes-Osterhold: Wonderful. And Richard Miller, who is not here tonight, is also an editor in the book. And so, we were hot springs, that connection, and then the connection of the clinic. I just want to mention for those who don't know, today, you're talking about SAGE Integrative Health, but SAGE Institute also came out as a vision of this collaboration of bringing people together to provide services of psychedelic-assisted therapy using ketamine to low-income community. And that's how we met. That's how we became connected as I was part of that first cohort of supervisors. And it was a lovely project. And I would say a novel project, the first a pioneer clinic with that focus in the Bay Area that is today called Alchemy Institute. 

Genesee Herzberg: Absolutely. Yeah, thanks for naming both of those things. First, I want to honor Richard Miller, who was the owner of Wilbur Hot Springs at the time. And it was really at Wilbur Hot Springs where Jason and I started to envision into the book project, also into SAGE Institute, which is now Alchemy, into the conference that never was to be. It's such an incredible place to support deepening in and visioning out into the better world that we all know is possible. And we met Richard there, and he became a part of that visioning. So yeah, definitely indebted to him. And then, yes, SAGE Institute, now Alchemy, was an incredible grounds for exploration of the very model that we've been working on and articulating in the book. We got to really develop our training program there based on these various ideas and learn with and from the psychotherapy interns that were part of that program. So a huge amount of gratitude to those interns as well. 

Gisele Fernandes-Osterhold: Before we dive in, I want to start a little broader, Jason. When we're thinking about psychedelic assisted therapy and the combination of the psychotherapy aspect of the work, as we hear so much focus on evidence-based, on cognitive approaches, ways in which symptom management has been a focus in the mental health field, and it might be effective for certain disorders and in certain conditions. But I'm wondering, how do you see the methodology and the approach of what this book brings as it compares to, let's say, cognitive-based therapies? 

Jason Butler: Yeah. You also mentioned evidence-based, and I just wanted to offer a little critique of what the field considers evidence. Yet another example of hubris in our field to put such tight confines on what's considered evidence-based when there's been thousands of years of evidence collected by Indigenous and pagan healers working with sacred medicine. So starting there, building off of that, I'll just offer first a little caveat to say not all CBT, but generally speaking, cognitive behavioral and cognitive approaches work from a perspective of materialism, that it's material causes that are going to be the curative factor. So there's the model derived from Western medicine, and it's the job of the therapist to apply an intervention the way a doctor would apply a pill or an injection. And those models are quite amenable to quantitative research methods, which is our favorite method for gathering knowledge. What that misses, though, as you said, it can be effective for treating some disorders. But what that misses by definition is all of the complexities and contextual factors that any particular client is going to bring into any particular treatment. Moreover, it misses the contextual factors that the therapist as a person in a body in this social world with historical conditions standing behind them and infusing the space, what all of those contextual factors do in a psychotherapy treatment. In fact, the research attempts to control for variables, it attempts to eliminate context. So now I'll contrast that with a holistic model. And there are many different versions of holistic models in psychotherapy. But this particular version that we're representing in the book exemplifies the kind of holistic sensibility of dropping really deeply into context, actually looking to context as the difference that makes all the difference that we want to attend to the particularities that are present in the therapeutic relationship, what social identities do, does the client bring into the room, and the history of cultural experience that's just surrounding and infusing the space, as same thing can be said for the therapist. So that's why a liberation approach is important, which I'll speak to later, one that really accounts for historical and social context, and holds a perspective that aims to undo oppressive practices that are going to infuse any method that doesn't critically think about liberation as a value in the psychotherapy. I'll just add from that, that, you know, we want to account for social context, we want to account for the embodied somatic experience of the client, how are their bodies responding in the here and now to the treatment. And we want our therapists, what therapists in general, to be very sensitive to that, to know how to track and respond to the here and now somatic experience that's happening in all the bodies in the room. Last thing I'll say, maybe, is that these psychedelic medicines unleash unprecedented access to transpersonal, numinous spiritual experiences in psychotherapy. Never before really have we had really democratized numinous spiritual transpersonal experience in a psychotherapy setting. So we need models that don't just focus on this kind of narrow band of human experience like cognition, or behavior, and reducing symptoms, but looking at the full phenomenology of the experience that comes through the lived experience of people taking these psychedelic medicines. And what has been demonstrated even through Western empirical research is that a majority of people have what's considered a mystical experience. And those mystical experiences correspond quite significantly with, you know, here it even fits the Western model, with the reduction of symptoms. So it's demonstrating something that I think we all know in our bones, and that Carl Jung wrote about quite eloquently, is that it's the experience of the numinous that is the healing factor here. It's the encounter with something much bigger than the ego. We can think about how that creates a sense of belonging, a sense of meaning and fulfillment in one's life. So we're extending the scope of the treatment far beyond this narrow channel of reducing symptoms, to looking at what makes for a meaningful life. And in doing so, really getting at the root, not just of a psychological symptom, but of a whole cultural symptom, where systems of meaning have really crumbled. And we're all, I think, scrounging to find what is a good life. Maybe that's a good pause moment. 

Gisele Fernandes-Osterhold: Yeah, wonderful. So we're laying a foundation here for the conversation to further go into more depth of an approach that is person-centered, that is rooted in culture, that includes the body, that takes into account the luminous, the mystical, the transpersonal, that is not prescribed and authoritative in symptom management, but rather invites the unfoldment of the human being in a relational frame that brings meaning. And I'm going to add not only to the individual, but to us as a community, as a group of people, because I think we are living times that this is what we're challenged to be doing. It's how do we heal collectively? So we'll unfold this a little more in a minute, but I'm going to turn into Genesee here and still on that same line. So we're talking about an approach to psychedelic assisted therapy, as Jason is highlighting, the mystical, the transpersonal phenomena, that in which is a deeper types of processes that cannot be quantified and managed. How do you see the difference of this kind of approach, this kind of work to, let's say, traditional psychotherapy? We have a clear distinction there where one takes in medicine that alters your consciousness, but is there ways in which you see those parallels and where they meet and what is different? 

Genesee Herzberg: Yeah, absolutely. Good question. So one important factor to take into account is that in a typical psychotherapy, say trauma focused psychotherapy, where we're working with the client's trauma, it can take a very long time, months, even years to start to access, to get the client to a safe enough place in which they can start to access their underlying trauma and process it. Where there are certain psychedelics, MDMA in particular, and we're finding the ketamine is quite effective for this as well, that can bring people quite quickly into their trauma. There are various mechanisms that enhance that effect, including the decreased blood flow to the amygdala, including the inhibition of the fight or flight response. And so suddenly people are connecting to early memories of their trauma, to repressed emotions, to dissociated self states. And that can open up a lot for the work. And it also requires a certain level of skill to be able to hold those things for the client in a safe way. In particular, one of the kind of orientations that's pretty consistently recommended in most psychedelic assisted therapies is a non-directive or what MAPS is calling an inner directed approach. And so through that process, we're trusting that the client has some part of themselves, something inside themselves that has what it needs to heal and that knows what to do when the obstacles to healing are removed. So if we imagine a safe set and setting, carefully curated therapeutic container and the support of a psychedelic medicine might do exactly what's needed to remove those obstacles, soften the defenses, et cetera, the therapist actually doesn't need to do that much, maybe a lot less than in a typical psychotherapy. Yeah, there's plenty of work to do in preparing the client for the session and in developing a safe relationship prior, but in the psychedelic therapy session itself, there's a lot of sitting back, a lot of really trusting that whatever arises for the client in the moment is important and is a good thing to stay close to and follow and listen to. So yeah, one big piece is actually, as Gisele put it in our conversation earlier, doing by doing less. And that can be a really hard thing to unlearn for many therapists. I mean, I think even just in traditional psychotherapy education, it's something that hopefully most therapists are unlearning just to sit with clients in the room. We so quickly want to fix, we feel people's pain and we want to do something about it. And there are certain methods that recommend doing something about it, but there are many others that have, you know, suggest and that I personally have found it's much more effective to actually just meet people in their pain, to be with them in whatever experience they're in and to legitimize their experience. So just in a traditional psychotherapy training, that learning is huge. And if you're there, then you're set up well to then learn about psychedelic therapy. But many stepping into psychedelic therapy training programs don't have that skill. They've done much more kind of, you know, CBT or other type of solution focused treatments. And so they're needing to basically just unlearn and then relearn a new way of being with clients. So that's a big one. Another important piece here that I want to speak to is consent. So informed consent to treatment. It's something that in typical therapy can get just so easily brushed over. Maybe it's in your consent form, the client reads over it. Maybe you say a few things, you know, like talk about confidentiality or something like that, but usually it doesn't take more than five minutes or so. Then you move on. In psychedelic therapy, it's a very different container that people are walking into and a very different experience that people are walking into. The incredible vulnerability that psychedelics can induce creates a whole new level or a whole new level of need for care and for information and for support in terms of the client knowing what to expect and how to navigate those states and, you know, developing a safe enough relationship with the therapist that they feel comfortable going into those vulnerable places. So that's a big piece of it. And then there also is unfortunately the potential for the kind of amplification of the power dynamic that's already there in a regular psychotherapy gets amplified with the psychedelic. The therapist is not only in the role of professional or expert, but they're also the only sober person in the room. And so there's a lot of potential for abuse of power and therefore a lot of need to do what you can to flatten the hierarchy, to speak to these issues so that the client better understands, you know, who the therapist is, you know, what type of power differentials are present in the room and how they can start to feel more safe given the particular constellation of humans in the room. And then we start getting into things like touch, which is not typically a part of a psychotherapy treatment, although there are some methods out there, including Shirley Bardivere and Jackie Hall's relational somatic touch that is showing is demonstrating that touch can be super effective in regular therapy. But it's commonly integrated into psychedelic therapies for good reason, and there's a lot of risk there. And so an elaborate conversation around concept for touch is also an essential part of this work. I guess the last piece that I'll speak to briefly is just relatedly is the extent to which psychedelics have the potential to increase the intimacy in the therapeutic relationship, to activate attachment systems, to basically kind of bring the therapist and client closer. And given that, it's really important that the therapist have a solid understanding of relational therapy. A solid of understanding of how to work with the dynamics between client and therapist, the transference, the counter transference, the subtle dynamics that most of us could just easily miss if we're not paying attention. I'll talk more about this later, but just kind of adding that I feel that that is so core to stepping into doing this work. 

Gisele Fernandes-Osterhold: Okay, so you've named a stance of non-directive stance, one that is valuing the inner healing intelligence of the client. You've named working with touch. You've named working with attachment. You've named transference and counter transference as being highlighted and amplified in psychedelic assisted therapy and bringing in the attention to ethics and training and depth of understanding of the therapist to these phenomenas and depth of training on how to navigate this potentially vulnerable space that people get into. Now, question goes for both of you. How do you see with now, ketamine clinics all over the country, the MDMA in the hills of approval, psilocybin assisted therapy in Oregon, in Washington, and hopefully soon around here too, as psychedelic therapies become more widely available, what are the challenges that you see in a model like this or for this kind of treatment to be available considering all these factors? 

Jason Butler: It's a really big question. Genesee already touched on some, but I'll just elaborate. You can see from what she just named that there is a depth of training that's required. And I think Genesse will speak to this more too. But what we see is there's a continuous tension between the depth of training required for a professional to really hold this work and accessibility. So it's a dialectic that doesn't have a clear black and white answer. I'm all for making these treatments as accessible as possible, but to what degree do we open access and decrease safety? So that's a fundamental challenge and question that I think is a living question for all of us trying to roll these medicines out in a psychotherapy setting. Genesee also touched on the potential for abuses of power. We're already seeing that. The same old human problems are showing up in psychedelic therapy where people abuse people in vulnerable states. And so ethics is a really important challenge. What are the ethics of being with somebody in the sensitive nature of a psychedelic state? Another piece that I'll say anecdotally, and even through Genesse's dissertation research, we've noticed that there's a challenge around the appropriate level of holding from an attachment relational perspective. These medicines, and I'll name MDMA particularly, let's focus on MDMA, flood the body psyche with our attachment system, flood the body with oxytocin and dopamine and serotonin, and more experientially open our hearts and create very deep intimate connections possibly. If that is not held with just exquisite sensitivity for the particular attachment needs of the client, then it's bound to turn from a healing opportunity into an opportunity to injure, to harm the client. And as Genesse's example we'll point to later, I think, we're seeing this both from folks pursuing these treatments in underground contexts as well as the kind of short term models in ketamine clinics that are really looking to reduce cost by having a non-therapist do the setting or no therapist at all. But where's the client left in that? They're opened up in these profoundly significant ways, but then who's there to hold them and who falls through the cracks? 

Gisele Fernandes-Osterhold: Yeah, so you're highlighting some of the challenges on a clinical sense, on a clinical arena, right? The vulnerability of the client, that opportunity to have a reparative experience with that openness and being perhaps left in that open state, in that vulnerable state, not held in a way that would support their psychedelic experience and their healing ultimately. You're talking about abuse of power, you're talking about ethical issues. How about capitalist forces? How about folks who are not into the mental health field as a commitment to healing themselves and others, but are very interested in the field? There is a lot of them. Would you want to say something about that? 

Genesee Herzberg: Yeah, there sure are more and more. It's becoming a huge industry at this point and it's only going to keep growing. Yeah, I have a lot of concern having been in this field for, I don't know, over a decade now and just seen the incredible growth and evolution, which in some ways is exciting and in other ways is really scary. I do wonder what's going to happen next, how this is all going to unfold and evolve. One of the things that concerns me is what I might call the myth of the magic pill. While Michael Pollan's book was great in getting the word out there about psychedelic therapy and really helping it to become mainstream, it also left a number of people believing that they could go find a psychedelic guide, have one psychedelic experience and be cured for life. We got so many calls of years after that at Sage, at our clinic of people looking for that magic cure basically. A lot of our work then consisted of talking people down, psychoeducation, letting them know that yes, these medicines can support you and can have profound effects and can expedite the therapeutic process and deepen the therapeutic process. But it's not very often that one experience is going to completely heal whatever it is that you're coming in with. Very often it involves an ongoing therapeutic relationship to support the psychedelic work that you're doing and very often it requires a number of psychedelic therapy treatments over time. And in my mind, there is no final magically healed place that we arrive. We're all working over the course of our lives to heal and there certainly are incredible leaps and bounds that we can make in terms of our health and well-being and also there's no arrival place. So unfortunately though, with that myth, there are some clinics like us that are talking people down and trying to provide what we see as a realistic picture of what this work would look like. And then there are other companies that are really trying to jump on that and be like, look, come get your one or two sessions and you'll be good to go. Or even—and also some of this is in an effort to bring the costs down, but like Jason was saying, there are other companies that are taking the therapist out of the therapy. So they're sending a lot of ketamine to people's houses and maybe there's a little bit of guidance around how to use that ketamine, but also a lot of space for people to abuse it or have harmful or scary experiences or all kinds of things. So yeah, and I think some of these offerings are helpful for some people. So I'm not against any of the particular organizations or offerings or companies that are out there per se. Some of them rub me more the wrong way than others, particularly those that are trying to patent really basic therapeutic techniques like holding someone's hand or setting up a nice, comfy room. I'm alluding to Compass and there is a whole thing around this in the past for those who may have heard about it. But beyond that, some companies like Mindbloom who are sending ketamine to people's homes, I think that does help some people who are maybe a little bit more kind of functional and able to care for themselves and able to be thoughtful about how much and when and what kind of support they need, et cetera. But I do get concerned about just the kinds of harms that can evolve there when there's not proper therapeutic holding, especially for people who have a lot of trauma. And then the other thing that I'll speak to, I mean, I have plenty of concerns about where the field is going right now, but I'm just going to build on what Jason said about access. As it is now, in order to cover the cost of the medicine and also cover the cost of the therapy, these treatments are not cheap and it's only a very limited number of people that can access them and afford them. And there are a number of different organizations looking at how do we address this, including Alchemy Community Therapy Center that Jason and I co-founded and Gisele supervised at. But there's still no obvious solution. Health insurance coverage would be a huge support in that area. We're not quite there yet. Government grants, that kind of thing. But it's still a problem that needs to be solved. And it's an issue on both a financial level and also on a cultural level. So at least five years ago, if you look around any room of any event on psychedelics, it would probably be about 95% white. That's changed over time. Thank goodness, just even in the past five years, I've seen that shift dramatically as more and more people speak to this issue. But for very good reasons, ranging from wealth privilege to the drug war to the impact of the drug war on communities of color in particular and attitudes that that then created around the understandable fears and hesitations around drug use. In addition to just kind of the communities who traditionally worked with psychedelics, there was a pretty sharp division in terms of who was using psychedelics and who wasn't and who is stepping into the field to talk about psychedelics at conferences and train on psychedelics and become psychedelic therapists and clients. So I'm seeing some really incredible initiatives to change that. And that's exciting. But we also have a long way to go there. 

Gisele Fernandes-Osterhold: Thank you. A little bit more on challenges. 

Jason Butler: Yeah, Sure.

Gisele Fernandes-Osterhold: I have a few to throw in the pot. 

Jason Butler: Please do.

Gisele Fernandes-Osterhold: Well, you know, I can relate, you know, with the with the expectation being in research UCSF and participants watching Netflix documentaries and reading peer review journals or reading books and coming in with an expectation that that is going to deliver what they want. And it's one, two sessions, sometimes three, sometimes four. And some people, yes, they are able to make that deeper connection inside of themselves that something shifts in the quality in the way they relate to themselves, to their narratives, to ways in which they see the world and the world themselves. But not everybody. And then there's also, you know, what do you do with that? So even for those who have a profound experience and have that immediate relief of a new perspective of a new narrative, how to sustain that and to put that into practice in a way that is not going to just go back to psychedelics over and over again, because that would be actually the opposite of what we were trying to, in the first place, do, which is to reconnect with something inside and then live from a different place. And if you're again, placing it outside, you're, you know, defeats the purpose. And so that's one aspect. On training aspect, I feel sometimes also challenged by people who are coming into the field and want to make their cognitive based frames fit with psychedelics when they themselves have not had the opportunity to commune and understand what psychedelics can do to the psyche. And I guess I'm a little biased here, but would love to hear from you in terms of how important is it to understand the phenomena of psychedelics in order to design treatment models, research pilots, clinics, and roll out in a larger scale, ways that are sustainable, that are safe, and that are in alignment with what psychedelic therapies can do. 

Jason Butler: Great question. Well, I'm obviously going to be coming from my particular bias. And this is a controversial question. And I don't think there's a one size fits all answer. But I will say that I think it's tremendously important than anyone offering these medicines have their own direct experience with the medicine that they're serving. The phenomenology, as you said, that the experience of what it's like to take psychedelics is it's a trip. You know, it's non ordinary. So to take a non to take an ordinary methodology and try to apply it to meet the non ordinary states that psychedelics generate is like trying to take a square and fit it in a round hole. It's at best going to miss a tremendous amount of the phenomenon that are at play. And at worse, it's going to harm people. Misattunement hurts. Ignoring certain aspects of that are often the most meaningful parts of the experience hurts people. So that's that's my opinion about that. 

Genesee Herzberg: I'll just add, I'm right there with you, Jason. And I think having spoken from that perspective for a while, I've also heard others speak up in response and say, Well, there are some people with medical issues, for example, who aren't then able to take a psychedelic for one reason or another. And I think in those circumstances, there are there are a variety of ways to access altered states of consciousness, not just through ingesting something. So whether it's holotropic breathwork, I mean, I've had some of my most profound psychedelic experiences just by breathing. So yeah, holotropic breathwork is a big one. You know, shamanic drumming, music, music can help one enter all on its own into a deeply trance state. Erickson Connect writes about that beautifully in our book. So yeah, lots of different ways to get there, but certainly necessary, I think, for people to have some familiarity with those states. Yeah. And then the other thing I'll say is, I do get concerned when people come out of other fields get excited about this field and suddenly want to jump in and create training programs and create businesses, etc. Though we're a small community, there are many, many elders and, you know, people more where we're at and below who've been doing this work for a long time. And I really hope that, you know, those who had their one mushroom trip and got excited and want to start a company and have the resources for it will seek out people who've been deeply immersed in the field and can inform the process from a place of deep knowing and understanding. 

Gisele Fernandes-Osterhold: Yeah, so it's it's not that you have to necessarily have had psychedelic experience, but it's an honoring of a deeper space and of a kind of openness that has to be respected and acknowledged to be worked with. 

Genesee Herzberg: Exactly. 

Jason Butler: I just want to say I fully agree with that. 

Gisele Fernandes-Osterhold: Yes. So and the book is called Integral Psychedelic Therapy. And we are here at California Institute for Integral Studies and CIIS has a lineage that comes from India with Cheryl Robindle. We also know integral from Ken Wilbur. What do you mean by integral in this book? 

Jason Butler: Yeah, not going to wax philosophical about all the history of integral and what it means. It's really quite simple. What we mean by that is an attempt to get at wholeness. It's synonymous with holistic. So we're really just trying to create therapeutic methodology that meets people in their wholeness and helps people reestablish wholeness after finding fragmentation and various ways fragmentation happens largely through cultural, acute and developmental trauma. So our particular version of integral, which I think we'll have a little time to flesh out is just one version of integral. And the way that wedid that was looking at somatic methodologies to really try to meet people in their embodied  experience and the intelligence of the body, the way the body knows how to heal when the conditions are right. We brought in a depth transpersonal perspective to meet people in the very rich, imaginal, symbolic material that these medicines consistently generate and the numinous mystical experiences that I was referencing earlier. We bring in a liberation social justice perspective because we're all situated in history and a social context. And so often the symptoms, the presenting issues that people show up with can be tracked back to cultural oppression and the inequitable systems that really harm people. So we wanted a model that holds that as an integral component. And lastly, as Genesee was mentioning, we bring in a relational perspective because psychedelics amplify the relational field. I'll leave that for Genesee to speak to, but those are the components that we hold as integral to a robust model for psychedelic therapy. 

Gisele Fernandes-Osterhold: Right. So let's shine some light into those aspects and some of the chapters in the book. So let's start with you with the liberation approach and some of the social justice focus that situates the therapist, situates the client, situates the work with the medicine as it has been used for thousands of years before by different people in different parts of the world. What would you like to share about what's in the book on that front? 

Jason Butler: Sure. Yeah. So just want to shout out to Danielle Herrera and Emma Knighton, who really focused their chapters really directly on kind of social justice considerations. Danielle Herrera's chapter is called Decolonizing Psychedelic Therapy. And Emma Knighton is writing about consent and in writing about consent, is writing about power and writing about intersectionality and the way power shows up in these kind of intersectional matrix, the way our intersectional identities interact with the client's intersectional identities and create power dynamics in the room. So a liberation approach, one aspect to this, one facet that Danielle touches on beautifully is to hold a critical analysis of history, to look at, as Genesee mentioned earlier, the history that stands behind and is infusing the field in the therapeutic space. So for example, let's name the history of medical racism, the history of Black and Brown people being experimented on in ways that are entirely unethical and harmful. And so when a person from a marginalized community, oh, one other piece in terms of critical historical analysis, let's look at LGBTQ populations that have not just been harmed by the Western medical world as a whole, but by psychedelic therapy particularly. Check out Queering Psychedelics, the edited volume that was published by Chukruna. There's a beautiful chapter by Alex Belser, who highlights the way conversion therapy was used by prominent psychedelic researchers. Timothy Leary, Ram Dass all have historical records of using psychedelics to try to convert people from their queer sexuality, from being gay, lesbian, bisexual, to being heterosexual. So that's part of the dark history that one needs to know deeply when one's sitting and offering psychedelic therapy, because your clients are impacted by that. So it's that kind of seeing, not just seeing the person in front of you, but seeing the history that stands behind them and that stands behind us, and really being sensitive to that and being able to name when those dynamics might be at play, when the fear of being harmed in similar ways might be at play and impacting the sense of safety in the room. And not just that, but also can we create opportunities to heal those cultural traumas by really listening deeply. So that's one aspect is having that historical critical analysis, and then also just knowing how you may be experienced by the client. You know, me, for example, being a white man, like I really want to be sensitive to how my clients may have been harmed by other white men and how the cultural transference, the way in which my, just how I present is going to impact the way the client feels towards me. So that's a short, short rendition of a kind of liberation social justice approach. 

Gisele Fernandes-Osterhold: Yeah, thank you. Being in the mental health field, standing in that lineage, and at the same time being part of the medical field that carries all this luggage. Right? So it's that paradox there. So the importance of being trained and knowing all of this, and then also undoing and unlearning. It's a very profound process. And Genesee, in regards to some of the chapters of the book, Jason mentioned some of them also diving into a more somatic, body oriented, the use of touch and ethics, which you already mentioned here tonight. Do you want to talk a little bit more about that? And how is that bringing, being highlighted in the book? 

Genesee Herzberg: Sure. Yeah. Yeah. So as I mentioned earlier, psychedelics through a variety of different changes in the body and brain inhibit the fight or flight response, they soften the defenses, they increase connectivity between different parts of the brain. And that allows us to more easily access our trauma, more easily access our emotional experience, often repressed emotions or emotions that are harder to access otherwise, and also to more easily access our bodies and the ways that trauma is held in our bodies. One of the ways that I think about ketamine is that it turns down the volume, at least at lower doses, it turns down the volume on emotional and physical pain, which can allow us to actually feel pain that otherwise has been dissociating. So thanks to all of those effects, it's incredibly important that the therapist have the capacity to attune to the client on a somatic bodily level. And both Veronica Gold and Jackie Hull go into these topics in great depth, talking about how the body responds to and holds trauma, and also how we can start to drop into a subtler mode of sensing, in which we can start to pick up on where the client is holding their trauma in their body, start tracking certain movements or expressions that might be indicating things happening for them that we might not typically notice or pick up on, and also start to bring words to these things as they're showing up, help the client find mindfulness around these ways of being, and then help them to work with them. And that can happen in a variety of different ways. But both of these chapters actually emphasize the ways in which touch can be incredibly supportive for helping people to move with a trauma that gets stuck in the body. And that, of course, needs to happen with a lot of care. As we spoke about before, there's incredible potential for boundary violations if we're not careful, if we don't have very clear conversations about consent early on and ongoingly. But if it's done well, touch and somatic attention to the body can start to unleash these ways that the body holds trauma through a full bodied experiencing of the trauma of the emotions. And then an expression could be through crying or shaking or kicking or just laughing even all kinds of different ways that trauma can move through. And then on a subtler level, there can also be a sort of just gentle softening that comes from the slow opening to the love that's there. This is something that Jackie and Shirley really emphasize in their relational somatic approach, which involves just gently being present with the clients, meeting them in their nourishment barriers, meeting them in the parts, their protectors that aren't willing to let others in because it's too scary. They don't trust. And just staying with that until those parts soften or maybe they don't soften and that's okay too, but just a real patience and love and care and the ways in which that therapeutic relationship and connection and patience and consistency can lead to significant change and the client can really take in those experiences under the influence of a medicine that's opened them up to receive. 

Gisele Fernandes-Osterhold: Yeah, and I would like to add to that the way we practice at UCSF is to practice touch before they take the medicine. And so people in their ordinary consciousness with their protectors in place, and so they can navigate the degree of intimacy and the degree of touch that feels good to them and then have language for it, whether it's verbal or nonverbal of when they do want the touch, when they do want the support, and then when they don't want it anymore. And so we do that. I train my team and we do that in the prep sessions and participants very quickly turn their attention to, oh, I can ask for that. And it's so interesting to see how the protection and the vulnerability is sometimes it's so hard to say, Kate, can you come sit close to me? Can you hold my hand? In ordinary consciousness, a lot of people have, it's a difficult thing to do. So normalizing that, practicing that with mindfulness so that when they are in an altered state, they know what they have agreed to and how they want to be supported and what feels right for them and how they will go about asking for that and how they will go about saying, I don't want it anymore. And it works really well. 

Genesee Herzberg: Beautiful, beautiful. Yeah. Emma Knighton's chapter on consent, she presents a kink informed model for consent for psychedelic therapy, naming the fact that the kink and BDSM communities have had to think about this more than just about any community out there. And they've figured it out in a way that most haven't, including the psychedelic field. And so she's applying what she's learned in those communities to psychedelics and lays out a super helpful and practical guidelines to do exactly what Gisele is describing here. And the one thing I'll add is she emphasizes that through most of our education and growing up, we don't learn how to even identify our yes’s and our no’s, much less say them out loud. So, you know, so often we're taught to bypass the part of us that doesn't want touch, you know, how many people just go up to a baby and kiss them on the cheek? You know, the consent doesn't exist in a way when we're children in this culture. And so it's a steep learning curve for many of us to learn to find our yeses and our nos in our body and then feel confident enough to say them out loud. So yeah, Emma also provides a really helpful exercise around how to help people do that, which she feels you can't even move into a conversation around consent until you see that people can actively say an embodied yes and embodied no. 

Gisele Fernandes-Osterhold: Yes. And sometimes they cannot say that yet because that's part of their process. And then it's up to us as therapists to pay attention into the nonverbal cues that they're giving because they're contracting, they are uncomfortable. And so we make contact with that and help them gain that access to their voices and their abilities to say yes or no. 

Genesee Herzberg: So important to be tracking those things. They're so easy to miss. 

Gisele Fernandes-Osterhold: Yeah. And, you know, the liberation approach, the social justice approach, the somatic approach, how about the transpersonal aspect, Jason? How is that important in this work and how is the book bringing that about? 

Jason Butler: Yeah, you got a good smile from me because this is where a lot of my heart lives. I wanted to actually share the words of a client here. And as I was mentioning earlier, psychedelics really opened up so much access to the deep psyche and it's really a depth transpersonal approach that has been carefully constructed to meet the client in that kind of experience. So this client has given me permission. This was a client that I saw for ketamine assisted therapy and he's given me permission to share his words. He came in as an artist really struggling with creativity to express his creativity freely in the world and struggling with a tremendous amount of blocked grief from seeing a number of his artist friends perish really to die. So he was struggling with pretty significant depression. In our preparation session, I asked him, what's the image of your struggle right now? And he sits back, he slows down and he lets his psyche speak. What his psyche said is the image was a sealed up tree, all the leaves folding inward toward itself, trapping the birds within the tree, muting their song, killing the life inside. What a poignant image of what was happening at a soul level. We get to the ketamine session and his intention was, I don't need to turn away from people. It's time to face the world again. I want to create a life that's more engaged. I want to be part of the world of people, not run away. He goes inward for the ketamine session and has eyeshades on and following the music. When he comes out about two hours later, he says the following. He described an experience of becoming quote, a field of grass in the bright sun blown by the wind, releasing seed into the wind. He added, I feel my ripeness as though I was an egg that cracked. I'm ready to scatter and disseminate, propagate, let things go. I feel like the germ, small and bent, the introverted part of the wheat seed, a coiled potency of structures folded inwards, waiting for a chance to open. He goes like this, the sun's heat makes me open. My palms are golden with sun. It opens me, unfolds me. I just want to pass along something good. He goes like this, like a warm cup of tea to you. That's a seed. You get chills reading that. So what we see here is a movement from this image of constriction, of life dying inside him, his creative spark, like the birds song being trapped by these defensive barriers that he was feeling, unmourned grief and his own persecutory inner voice to an equality of deep expansion. The image says it perfectly. His seed is ready. What kind of perfect image of fertile creativity moving out into the world and seed blowing in the wind. So we have here now a kind of tension between opposites of his symptoms, his constriction and the expansive state bringing a free flowing expansion of his creativity onto the world. So then came the integration process of holding the tension of these two images and letting the medicine of that expansive state really work on his pattern of contraction. 

Gisele Fernandes-Osterhold: Beautiful. So bringing imagery, the symbolic, the archetypes to inform the psyche and inform the process. Anything that you wanted to highlight, Genesee, about the relational frame that the book addresses? 

Genesee Herzberg: This is the case that we describe in the book. It's a woman who I interviewed for my dissertation who gave me permission to talk about her in the book and in my dissertation as well, although her name is anonymized. But basically she was in a psychotherapy with someone for about a year, just regular psychotherapy. And she was running into blocks, just feeling like she couldn't access her underlying trauma. This is someone who had been abandoned by her mother at two years old and lived primarily with her father after that. And about a year into the treatments, maybe a few months short of a year into the treatment, the psychotherapist mentioned that she did MDMA work and did the client want to participate. The client was very excited about this and thought it could help her to open things up and move things along. There was also an interesting contextual factor which was that the therapist was planning to move out of the country within the next, I believe it was four months. And so they would be ending their treatment at that time. So they go ahead and decide to move into the MDMA work. They spend some time preparing and they finally schedule their MDMA session. The MDMA session I believe is maybe a month or so before the therapist's departure date. And in the session, what the client reported is that she found herself just kind of frolicking around the room, throwing scarves, playing. She'd have these moments of suddenly going inward, like pulling the blankets over her and then having memories come up of her mother. And in fact, she had one very profound vision of being in her mother's stomach in utero and her mother saying, I'm not going to stick around for very long. I'm sorry about that. And she cried a little bit and then she came out and she went to tell her therapist, but she felt like her therapist just wasn't very interested. She didn't feel connected to the therapist. So she ended up going off and doing her own thing, dancing to music. And that was kind of the extent of this session, the MDMA session. She reported to me as I interviewed her that she felt profoundly disappointed by the experience and by the therapist. And that she also, they didn't talk about what had happened in the integration sessions. So they kind of just talked about kind of wrapped things up in their work and said goodbye. And that was it. The client went on to be depressed for a full year after the session. Like her, she had been depressed prior, but her depression aggravated quite, it intensified quite a bit. And so she was more depressed than she had been prior that lasted for about a year. And yeah, that was her experience. And so when we think back on that from a relational perspective, we can identify all of these places where the therapist may have missed something. For one, when you're thinking relationally, when you're thinking psychodynamically, you're thinking about what are some of the early patterns that might be replaying themselves here? So like, oh, this woman was abandoned by her mother. And now we have a year long relationship and I'm about to leave her after entering into a deeply vulnerable and potentially deeply vulnerable and connected place. That was never mentioned. And then this, this rupture of, of feeling like the client was, the therapist was bored or disinterested, that the client didn't bring that up. She felt bad. She didn't want to hurt her. And the therapist wasn't tending to the, what we call the relational field. So the subtle energetics between therapist and client, the subtle relational dynamics, the subtle emotions. That's not our term by the way, but we use it in the book. And so had she been tending to the relational field, she would have picked up on like, hmm, there's something happening for this client that she's really keeping her distance, that she's coming up to share about something, but not really going deep. Like what's happening here. And ideally the therapist would have, if not in the MDMA session, in integration session said, like what, you know, I noticed that there, that there was some distance between us or that I didn't feel that connected to you in the session. You know, I wonder what was happening there. And maybe she would have even, you know, made some space to hear from the client. She might've even disclosed something about herself. Like she was feeling tired that day. I'm sorry. And just really opened up a, you know, a real conversation between the two of them, a relational negotiation to help them start to understand what was happening for both of them and find some repair through that rupture. You know, rupture is not an inherent problem in relationships and in the therapy, if it can be repaired. In fact, it can be something that leads to greater intimacy. It can lead to healing and reparative emotional experiences. If the therapist is able to bring it into the conversation and tend to it with compassion and humility and accountability, willingness to be wrong. So yeah, that's a big piece. The relational chapter is the longest chapter in the book. Jason and I just couldn't stop writing and didn't know what to cut out. And so it's got a lot in there. But there's a lot to say on the topic and yeah, that's just a little, a little piece of it for you. 

Gisele Fernandes-Osterhold: It's a wonderful chapter. I hope that folks get the book and get to read it all. We could sit all night under this full moon by the fire and talk about all the things that happened there. But for the sake of time, I want to begin to my last question to both of you. So where are you at today? So there was the clinic, there was the book, and then what's pulling your, what's feeding your fire these days? Want to share a little bit about that? 

Genesee Herzberg: I can start. Yeah. And I also just wanted to acknowledge that we didn't cover maybe half of the chapters in this book. There's so much good stuff in here. All of our authors wrote really brilliant pieces covering essential topics, including internal family systems and music and integration and mystical states. You just, oh, group therapy. So yeah, lots here that we didn't get to touch on. In terms of next projects, well, one of them relatedly is that we're excited to offer a training, a psychedelic therapy training that's really inspired by the book. And so we'll be going through the chapters one by one and digging into each of these topics. And in addition to some others that we feel are essential, and then we'll have a second component that involves kind of a practical application of what we're talking about through ketamine assisted therapy. So you'll learn the kind of theoretical aspects, and then you'll learn how to do ketamine assisted therapy, and then you'll get to practice them. And we'll have lots of role plays and lots of kind of feedback with… Jason and I will both be teaching along with some other really excellent therapists at SAGE. So yeah, we're excited to launch that. The plan is to launch it sometime in the late summer or early fall. So yeah, that's the biggest one. I'm speaking at a couple of conferences coming up. There's a conference at Harvard on psychedelics, contrasting visions, and I'll talking about access there and kind of looking at what I learned from co-founding an accessible psychedelic therapy clinic. And then at Shakuna's Psychedelic Culture Conference, I'll be talking there on ethics and consent and touch. So yeah, both topics that I'm real passionate about. 

Gisele Fernandes-Osterhold: Wonderful. And you? 

Jason Butler: I really like relaxing in hammocks. I'll be participating in that training Genesee was just mentioning. I'm also on the committee here at CIIS looking at how to expand our offerings around psychedelic psychotherapy at the university. And lastly, Genesee mentioned we couldn't stop writing. We actually have about 200 pages of unpublished material that we couldn't fit in this book. So one of these days we'll weave that all together and put out a second book kind of creating foundations for this practice to support the special topics that were represented in the book.

Genesee Herzberg: Kind of like a handbook of psychedelic therapy. 

Gisele Fernandes-Osterhold: Wonderful. I'm so glad to hear about the committee. Remember how much I had to fight. It took about two years to get approval from the department to be able to teach psychedelic psychotherapy in ICP, in Integral Counseling Psychology. 

Jason Butler: Thank you.

Gisele Fernandes-Osterhold: Yeah. So I, yeah, it was 12 of us and I only had two people who were supportive of me doing that. All the others were like, what is that? And no, we shouldn't, the students shouldn't learn about that. And so the field is evolving very quickly. So I'm very pleased to hear that not only you have been taking on this class, but it's also more involved in even expanding that. Wonderful. Thank you so much. It was my pleasure to be here tonight Jason with you, and Genesee. Thank you for all your work for being pioneers in this field for supporting people in this path and training and holding sessions and teaching for all your engagements throughout all these years, may it all pay back. Thank you for being here tonight. Thank you for this beautiful book, that's your first baby. And thank you the audience for your kind attention and participation. May you all get home safely under the light of the full moon. Until we meet again. 

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