CIIS Public Programs Podcast

transcript

[Cheerful theme music begins] 

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

Before we get into today’s episode, we have an update for you regarding our podcast schedule. We are shifting our schedule to release new episodes every other Thursday. If you are a subscriber, the next episode after this one will appear in the feed of your preferred podcast app on June 17th.  

This episode was recorded during a live online event on April 5th, 2021. It features clinician and CIIS professor Gisele Fernandes-Osterhold in conversation with Multidisciplinary Association for Psychedelic Studies, or MAPS, clinician-researcher Keren Tzarfaty on the benefits and therapeutic applications of MDMA assisted psychotherapy.  

A transcript of this episode 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. 

[Theme music concludes] 

Gisele: Good evening, everybody. It's so, so wonderful to be here with you, Keren, this evening in the psychedelic spring series. Welcome back to CIIS.  

Keren: Thank you. And thank you for inviting me. I'm very excited to be here with you and with everybody. 

Gisele: Yes, you are here today as a co-founder of MAPS Israel to talk about the development of the research of, with MDMA-assisted psychotherapy, but before we go into this treatment modality, would you like to tell us a little bit of your story with CIIS, since you started your career here as a student?  

Keren: Yeah. Well, I was a lawyer in Israel, and I was very much into my own process, kind of exploring my own psychology and somatics and transpersonal experiences. And then I heard that there is a place, a magical place in San Francisco, in which I can learn about integrative somatic and spiritual psychotherapy, and I was very, very excited and came and was interviewed by Ian Grand at the time and was accepted with lots of- I can remember the hug he gave me after the interview and was felt very happy and blessed to join the community at CIIS and to learn the mastering somatics. And then I felt that something is missing for me. There was not enough clinical work with the more spiritual or mystical experiences of who we are, so I decided to continue to have my PhD in the East-West, in which I celebrated while they said transpersonal. Yeah. So, I spent seven, six, seven years in CIIS and I loved every moment. I feel very grateful for my time there. Yeah. 

Gisele: It's wonderful. We have that in common. We both graduated from the Somatic Psychology program at CIIS and Ian Grand, bless his soul, was also one of the people who welcomed me in the same way that he did with you, a big heart that he had.  

Keren: Yeah. And had great views at CIIS. Just to say. 

Gisele: Yes, so it's wonderful to be here today talking about this psychedelic renaissance and the decriminalization efforts, the medicalization of psychedelics. And so, how do you see this potential for the therapeutic use of psychedelics at this moment in your career, at this moment in the world? How is that?  

Keren: I think we're in a special time, special time in which we bring the, you know, the wisdom of traditional and more like earth-based cultures into the West through psychedelics and also the wisdom of the underground communities that are kind of carrying this work for many, many years and the wisdom we’re discovering this in the studies and the research. So, I'm very excited about it. I feel, you know, it almost- I can see an impact in two different ways, one is on the care itself of how we can invite people to explore their wounds and their organic parts of who they are in a very integrative way, in experiential way meeting themself in a very direct and deep way, but also other than just working with the cared for people, also working with the caregivers and I think there is something about psychedelic therapy, if we'd be lucky enough and wise enough to operate in an accurate and professional and safe way, also to professionals in the field. I think we can change the way therapy looks like and this is a- this is a piece I'm very passionate about, to invite psychotherapists psychiatrists, social workers, art therapists and, and so on to know this field, to know this kind of work and to know how to offer psychotherapy that is experience based and body-mind-spirit based to other people. I think it's meaningful because we don't, in most cultures in the West, at least in Israel, we say, we want- we don't have the shaman role in the same way we used to have it and I think it was something about psychotherapy that offers a container that invite people to explore what they are in, in the way the shaman offer in the past. So, for me, thinking about psychedelic therapy is a way to change the healthcare system is a meaningful thing.  

Gisele: Yeah, so, so you're bringing up the idea of not only the patient being transformed by the work, but the psychotherapist being transformed by the work and in that, doing the work differently and so it's a possible whole shift in the concept of healing and how clinical work is done. And I would even go a step further to include medicine because if we think about doctors and nurses working hospitals and how much secondary traumatization, how much compassion, fatigue they suffered from, we can- and I know that there are projects already in place, research projects that are looking into care for the caregiver, right, support the front line workers and what would the work in a hospital look like if doctors and nurses and staff would have the support for their own healing in a profound way. So, I think it's a- there's a possibility here for revolutionary movement in the field of psychology and the field of medicine and healing in general.  

Keren: Right, right, because I think as caregiver if we carry the knowing of where we can go in our self and in also in a- in the way we give back, I think that's a place in which transformation can happen and I think maybe one more thing to say about that, you know in the West and I’m making generalization that- forgive me for that, but just saying that the therapy is very much focused on the individual and if we really surrender and get to know deeper psychedelic work, we learn to expand beyond our individuality, beyond our more personal self and there is something about that that is opening us up and from this place we can really I think, offer transformation or processes, processes of healing or growth in a deeper way in a much more useful way. So, I'm hopeful about that.  

Gisele: Wonderful. We'll get, we'll get into that more deeply as we unfold here because the audience is here to listen more information about MDMA-assisted psychotherapy tonight, so we will try to focus on that. It has been a Schedule 1 drug for over 35 years, and it's also known as a party drug as ecstasy or molly, which is not the same as the pharmaceutical MDMA, what's used in the research. So, would you tell us a little bit about the difference between MDMA and the pharmaceutical use of MDMA and the classical psychedelics? [Keren: Yes.] The overall effect that the drug brings about?  

Keren: Right, so when we talk about MDMA, which is, I think is a psychedelic too, but it's not part of the group of the classical LSD, psilocybin, ayahuasca. I think one thing MDMA does really well and of course it's always with the set and setting with intention of going inside and looking at different wounds and different resources and healthy parts. So, I just will say that it- in this context, the MDMA is allowing us to meet our self or meet our Self, in a capital S, in a very healthy way.  

So, it takes away some of the shame, the defenses, places in us that are stopping us from moving towards in our process of healing and it creates, or it helps integrate a healthy sense of self and an experience of me being love or me being creativity, me being part of some kind of basic, healthy knowing. So, there is a sense of being wise, loving connected, and from there to look at different psychological complexes or difficulties or looking at my vision to where I want to go. So, in a way, I think MDMA is teaching us in the right set and setting how to live life, how to live fully, how to come from places of connection and empathy and how to take responsibility on our wounds and our difficulties and explore them.  

While classical psychedelics, they create and it's, again, a generalization but many times it creates an experience of ego dissolutions. So, the self is actually- there is an experience of melting, the boundaries are melting and the sense of who am I as a Keren, as a person and self is kind of melting and changing and I start experience myself not so much as Keren in this body-mind, but as something bigger than me. It can be nature or the divine or the existence itself or yeah different, different things that are both me but I’m much bigger than my personal identity.  

So, in this sense, while MDMA is teaching us how to live, I think the classical psychedelics teaches, teaches us how to die, how not to be only Keren. And then this process of allowing myself to know life and myself and my personal identity is not so much existing, but it's part of something bigger, allow us to live fuller because if, you know, if we're caught, if we are okay with kind of not being that or in some ways, okay, with dying, we can come without this fear to life itself. Yeah. 

Gisele: Yeah. So, so, MDMA is known as an entactogen, right, a substance that stimulates the feelings of empathy, of openness, of emotional closeness. And it's also known for its empathogenic effects that helps with the self-forgiveness and self-compassion and that in way, it has a good combination for therapeutic work. Now, this effect that this substance does, how does it change the brain? Is it- you want to say something about you know, the temporary or the long-term effect that these feelings, these phenomenas will come about for a participant, a client?  

Keren: So, I'm not a neuroscience but I will say a few words about the brain. So, what we know, we don't know a lot, but we do know that there is much more oxytocin, dopamine, serotonin, all those materials that makes us feel exactly what you named and feeling of connection and love and empathy and forgiveness towards oneself and towards other too. And all of those experiences on one hand, they are temporary. Yeah, there is- maybe eight hours of very strong experience from the beginning to the end of the session of having all those qualities of the experience from which we can not only experience them, but also look at ourself and let out traumas or difficulties and challenges in life, internal challenges, depression, anxiety, different trauma symptoms.  

So, in a way it’s temporary, but, but if we invite the process to continue in an integration process, inside psychotherapy, there is almost a feeling on experience of the empathy, the connection, this way of being is being embedded into the nervous system, into the body-mind system, into our behavior, you know, into our perception. So, the experience itself and the pharmacology qualities of it are definitely temporary but it has a lot of potential to rebuild us or reintegrate us into those ways of being that are based on love and creativity and empathy and connection and compassion which really are so missing in our culture, right? It's not that- it's not how we usually walk in life, unfortunately. Other than CIIS students, of course. [laughing] 

Gisele: And faculty. Hopefully! [laughing] So, let’s get specific with the work that MAPS has been developing because you are a frontline worker, you are a co-founder of MAPS Israel with Rick Doblin and you've been a principal investigator in a number of studies. You are a clinical director, you’re a supervisor, you train people, you have so much experience. And the clinical trial now for the use of MDMA to be used with PTSD is in Phase 3 right, [Keren: Mhm] in the US and Canada and Israel and for the audience, which we’ll clarify the Phase 3 is when you already succeeded with the results in Phase 2, and that's when that gets approved for the general use and in Phase 3 you’re going to then just confirm the effectiveness, right, and the safety so that this treatment can be used against the current standard treatment. So, speak a little bit about your role in this development and what is the specific focus of the research that you are involved in at this moment? 

Keren: So my- what will I start when I- when I finished while I was in the midst of my PhD, but I finish the coursework and move back to Israel from California, which I miss a lot every day, just to say, it's very important, and then I went back to Israel and I met Rick Doblin, who is really, I think will get a Nobel Prize for what he does and I really- is one of the people that inspired me in the work we’re doing in Israel, is really a force of nature, I would say, with the creativity and the energy. Yes, I was very blessed to work with him for many years now and the research was already opened in Israel, but it was done with the psychiatrist, a therapist or psychiatrist that didn't have, say, somatic or transpersonal clinical background. So, it didn't work well. The study did not work well and, and Rick came to Israel, and he had to change the therapist.  

And me and Ido, who was my partner and both my professional partner and my husband, Dr. Ido Siemion, came and kind of joined as the therapist with other people too, and we started Phase 2 and was very successful. The results of Phase 2, you know, 68 percent of the people that got MDMA, the participant that came with their very severe PTSD, were not considered to have PTSD, a year, 12 months after the treatment was over. That's also why the FDA declared the study a breakthrough study. So, we did Phase 2 in Israel. One of I think, five sites in the world and after finishing Phase 2, we continue to Phase 3, and we are now in the midst of the study.  

So, my work there was a- I started as a therapist and the supervisor and then there was a need, you know, there are so many people with PTSD in Israel specifically, in the Middle East, we’re in quite a traumatic neighborhood in the Middle East. So, we had quite a long list of people applying to the study for the end of Phase 2. The Phase 3, for sure, and just to tell you an anecdote, at the beginning of Phase 2, we had no people coming into the study. We- which was a problem. We couldn't get participant- people- participants people got scared, you know, drug and research in humans and also in Israel we would do the studies in the hospitals so it's inside the hospital and some of the hospital has a kind of an iffy reputation because it's a mental health institute. So, people didn't want to be connected to it so much.  

So, we didn't know what to do. And then we invited Stan Groff to be our guest in Israel and we spent few weeks together and he went to Israel with us and gave lectures and we did a lot of holotropic breathwork workshop and every time he ends, he was finished speaking, I came, and I said, “and we have this study! About MDMA for PTSD!” And then we got people coming into Phase 2 and we were able to finish the study, the Phase 2 part, and now we have 700 people in our waiting list and more and more calling, really, I'm getting phone calls every day. So, we had the need to train more therapists. So, I slowly- I became a trainer and Ido too and we trained already, it sounds not so many but for us in Israel, which is a small place. It's smaller than New Jersey. We trained 30 people in the first training and now we are the midst of 40 more, they are in the in the midst of the training. And slowly we're developing, and we got- The Ministry of Health in Israel is very supportive and because of that problem of PTSD in Israel, they feel the need too, to find a safe and good model of therapy for PTSD so they got very excited after Phase 2 was over and they saw the results and they all- they approved us to offer the treatment in a open-access, compassionate based use for 50 more people. And that's a project that we are in the beginning of and going to start in the next few months. Yeah. So that's very good.   

Gisele: That's a wonderful story. So, we'll get into the details of that, but I love hearing about Your efforts along Stan Groff and you know really humanizing the field, right, because there has been so much prejudice and stereotypes with mental health and mental illness that there’s some barriers there. And so, it's beautiful to hear you talk about- just to offer the work that- the beginning and wondering, you know, as you reflect back on Phase 2, were there any adjustments made to the research as you move into Phase 3? 

Keren: Well, in Israel in Phase 2, we had a protocol that included two MDMA sessions. So, we had 12 meetings of psychotherapy, two of them were with MDMA and in Phase 3, all over the wall. We added one more session of MDMA. So, we sampled some participants in the second MDMA session in Phase 2. We notice a new memory that showed up especially with complexities, the- so they needed, I think, they needed more time under the MDMA to process and to work with their memories of trauma to create a reintegration. So, we added one more session and I hope and believe to see that the results of the Phase 3 will reflect that too, hopefully. 

Gisele: So, let's talk about more specifics about the research. So, you said the sessions happen in the hospital and Phase 2 was 12 sessions with 2 MDMA sessions and Phase 3 you have a third session because that expanded a little bit the treatment and gave the patients another opportunity with the medicine. So, who are the clients and how did they arrive at the clinic? So, you did a little bit of propaganda and outreach in in the beginning but who did you get, do they come by themselves? Are they diagnosed before they come? Are there psychiatrists sending clients? And then tell us a little bit also how are the sessions being conducted, who is a part of it and a little bit of the standards, the atmosphere, the length; just give us a picture of from beginning to end of what it looks like, the research trial for MDMA-assisted psychotherapy. 

Keren: I'm happy to. So, I would say that the first phone call is usually from a participant of former participant’s family member, people that are in the same boat, difficult boat of the PTSD with the patient, so the people. We also get a phone call from therapist asking about their clients and looking for some kind of hope because PTSD is such a severe wound and the symptoms are awful, especially the people we see that are with severe PTSD. So those are people that suffers from depression, from anxiety, from nightmares, flashbacks, lots of avoidance, not doing a lot of things because things are triggering the inner experience of the fear and the terror.  

So, it's a severe condition and just, just reminding us about what we talked about the MDMA, about the MDMA about the experience of it, the empathy, the connection, the compassion, the love, it’s exactly the remedy for this inner experience of the PTSD. So those are the people that are calling us and again at this point, although we get so many phone calls really, every day, we already have a long, long list from which we pick the people; they’re waiting on this waiting list for few years now and then they come in and we start a screening process that is led by the team of the, of the research, so psychiatrist and research assistants. And we're trying to see if the research is a good match for them, if they have PTSD, if the PTSD is severe enough for the study and so on, and also if it's safe enough for them, if they're healthy enough, no heart condition and also from a psychological point of view, if they're, if they don't have any inclusion exclusion mismatch, so we need to see that it's a safe and appropriate protocol, clinical protocol for them.  

And if they go through the screening then they meet two therapists, usually a man and a woman in Israel, but it doesn't have to be, we have different options and we start the process. And the first thing we do is they're putting the intention so looking at the mindset and inviting them to look at what they're wishing for and what they want from the therapy. What is it that they're praying for, asking for, and we start working with the intention and of course exploring in a very somatic way with mindfulness, experiential approach of psychotherapy, their inner experience and starting to get to know, to get to know their experience and what is, what is there. So, the intention is very strong and also the setting of the work is very- it's very strong. There is a beautiful room with plants and candles and artwork that is inspiring and when you walk into the room, it feels like you came to a safe, beautiful home. So, it's not hospitalized at all and it's part of the protocol, it’s part of this humanistic approach that we want to offer to our clients knowing that they came to a safe place, non-hierarchical, you know, there are of course boundaries and strong roles, but there is a sense of, of going into a journey together, the two therapists and the- and the participants, of course, focusing on what the participant’s process needs.  

And we start, we start listening to what's happening and giving some tools of how to be with the inner experience and how to trust this really intelligence force of healing and growth that is inside of us. So, we, as the professional, we know, we have the tools that we can guide but really the main force or the main guide of the process is the inner experience of the client, and we really rely on that and trust that. We have three meetings of preparations, 90 minutes each pretty much, and then we have a MDMA session, and they come to this, the same room, this beautiful, nourishing room and they get the MDMA in the morning, usually around nine o’clock and they stay for eight hours just under the influence with the two of us there, listening to what's happening in their body, in their heart, in their process, following it.  

It's beautiful and difficult. It's not a lovey-dovey experience… it’s in most cases, and they're different, you know psychedelics in general is very mysterious in the sense of we don't know ahead of time what is going to happen, and the sessions can look in many different ways, but we follow what's there sometimes, there are memories of trauma and then we process them together. We listen and things are getting more organized, and emotions may show up. Sometimes the body is speaking, movement, shaking. Yes, all the different ways and some people are just into talking their story and talking their experience and we’re just being with them for those eight hours. There is music that is being with the process and the music is- was built for the session and it’s really supporting, going inside and listening and letting the process guide the client and of course, us. And after 8 hours the participant is exhausted and so do us, and we end the closing like a small closing, closing ritual, with ending this ritual and a night attendant is coming to spend the night with the participant in this room. So, we won’t leave them alone, in the night, we go home very tired and satisfied and feeling very grateful and tired, feel the same time.  

And morning after we come back. The therapy team is coming back, and we do the first integral- integrative session. So, we hear where they are, how they are doing. What’s there for them after the day, before with the MDMA. And then we- this is the process. We have a few more sessions and then another MDMA with the 24-hour cycle and then another few sessions for integration and preparation for the third session. And then we have an ending few three sessions for ending and just to say that some people in the study are getting placebo, so they don't get MDMA, they get sugar or something and the process is similar. We do exactly the same. I was just ending a process with the client that I could swear, and I have a lot of experience right, I could swear she got the MDMA, and it was a placebo. And the three of us were like, “really?!” She did such a beautiful, deep process with so many… 

Gisele: The inner intelligence is there even if there's no MDMA right? [Keren: Really.] There's something that gets activated and that intention, in that supportive environment, and that setting and the space and sometimes this, as you're describing, I'm thinking about the intersubjective, feud, you know, that's, it's, so it's what they sometimes is called the therapeutic fourth. There's the set and setting, there's the therapist, there's the medicine, and there's the client. So, it's the combination of these four elements that are coming together, and the magic happens right there. And you know, you mention a few sessions without medicine for psychotherapy, for processing, for intention, for preparation, and then these 24-hour sessions where the client stays over and sleeps and has integration the next day. Do you think that this kind of setting that's been used in the research is something that could be transferable to mainstream offering of MDMA-assisted psychotherapy? How do you see the adjustment of the research into, let's say, when Phase 3 ends and hopefully will get legalized? How would that translate into regular psychotherapists doing this work outside of research settings? 

Keren: Yeah. I definitely see it being transferred and I think it's important that we keep this quality of set and setting. I think it's not something we want to leave behind. Yeah. So the way I see it and we'll see and it's changing from in different countries because there are different policies, but the way I see it, in Israel, I definitely see psychedelic clinics in which the teams are trained in psychedelic therapy and we can offer not only MDMA psychotherapy, but also work with psilocybin and phyllodium like different, different substances during the years after looking at the studies in the research and I think it's very important that we’ll keep the screening process and we keep the teamwork that I didn't speak a lot about but it's such an intense work, it’s- at least with PTSD and severe disorders that I think it's very important to have team, not to have one therapist but to have two therapists and to have their psychiatrist in the background, if needed and, the night attendant that is usually, usually a beginner therapist or in school and not to mention the logistic help we get. So, I think there is something about having psychedelic clinics in which this exact protocol can, can be transferred that is very important. It will keep the quality, the depth of the work. I do think that not everybody will need eventually all those three sessions, maybe some people, two will be enough for them and maybe some will need more. Yes. That's something I think we need to be flexible in terms of the exact protocol that the client who would need.  

Gisele: And you mentioned that sometimes these sessions are very challenging and unexpected things may happen. Can you give an example of a particular situation that was challenging or something that you, you know, that really needed both therapists to be there or that was so important to have the team holding the space and the client? Was there any situations that were like that, that you really were glad to be in such a robust setting? 

Keren: Yeah, we had a, we had a client that had a very hard or heartbreaking or devastating memory showing up from a very early age. A memory he was not aware of before the MDMA session and then the way we need the container to be strong. It's like none of us- if I'm thinking, if I were there alone, I couldn't go to the bathroom or to drink something, just you know, to go and rest for like 5 minutes with a tea or if you really needed a person there all the time, was crying and sobbing and shaking and just going through such an intense experience for few hours and not for- it wasn't few minutes. So, it was very important to have another person in the room so both of us can hold it. We use touch in a very professional, in a very careful way, but sometimes it's not, it's unethical not to touch, you know, because we talk a lot about if it's ethic to touch or not. But sometimes not to touch, it will be an unethical move. So, we held him like we gave him a hand and we- hand on his shoulder too and we just held him for many, many hours and it was very important to be the two of us there and in the week after the session, which is a week, the week after the MDMA session, we really pay attention to how’s the participant doing. We have a phone call. Few phone calls during the week and we staying in a very close touch and it was very difficult for him, a very difficult way to realize what happened in the family and to have the motions rose up. The body was shaking a lot.  

So we invited him to come back to the to the room, to the clinic and he spend another night there and we invited the night attendant to stay the night there with him again, and I came the psychiatrist came, we came and we had to check if he need some medical- pharmacy like a medication- he didn't need any but it felt safe to know that there is an option in case it's getting to be way too much for him. He didn't need it. We went through the process, continue with the process of crying and shaking and realizing what happened and the whole thing got integrated beautifully, which is what psychedelic really help doing. It’s really going through the experience in a full way, to feel the pain, to feel the grief, to feel- to know the memory and to reintegrate this experience. So, it is so supportive for me to know that I'm not there alone with him, that there is another wonderful therapist and team that is holding this, really, this memory. All of us held this memory together for him, with him, and I think it was very healthy.  

Gisele: Yeah, and you also were mentioning that in the Phase 2, many clients didn't- 60% didn't- they had a reduction of symptoms, right, a remission of symptoms after two sessions and- 

Keren: We have different protocols in different places, but in Israel, it was 2 sessions. Yeah. 

Gisele: Yeah, and I'm here thinking, you know, you're talking about severe PTSD and highly traumatized individuals that meet criteria, diagnostic criterias for this kind of treatment and I'm thinking about clients with complex trauma. With developmental wounding, with detachment disorders, where the clinical work is usually relational. It's usually long-term. How do you see MDMA being used for the treatment of complex trauma if you would join further in terms of what, what you said, you know, how would this transfer then? What is the flexibility and adjustments in how do you see this treatment being also effective for not only PTSD, but complex trauma?  

Keren: Well, we have people with complex trauma in the study- [Gisele: Okay.] Yeah, so we definitely have experience with that, and I would say that for my own personal experience, so it's not about the whole study but my personal experience in this study with my clients. I think it's working very well, but there is a, there is a challenge here. So, it's working very well because the therapeutic relationship are very strong in this study. It's a big, as you said beautifully, it's part of the field in- it's the fourth or the- it's a very important compound and I think there is a lot of attachment to repair and there is- there are missing experiences that for the client is happening in the therapeutic relationship and the MDMA is very much supporting that in the whole protocol the way built- it's based on therapy first. And then the MDMA is allowing the participant to feel connected to, to embody safely in relationship and openness and vulnerability in relationship, which is exactly what was not safe and was actually very dangerous to do in the original relationship that created the complex PTSD. So, I think it's a very good method. It's a very good treatment for complex PTSD.  

But, but it's very important when the legality is, will come and hopefully we see it in the next maybe two, three years that the therapy will continue. So now we have to end in a few months and that's it. The protocol is ending, the study is ending, the participant is finishing. Our exit plan is very, very meaningful. We’re creating a continuance to our participants. We invite them to continue to therapy. We help them find the therapist. Many time doing the work in the, in the research. They find different practices that are meaningful for them. They’re realizing movement is an important part for them or mindfulness practices. And so, we strongly encourage them to go, and you know find 5Rhythms or any kind of internal somatic movement or start meditate and go to more like spiritual so we create an exit plan that supports that but it's not enough for complex PTSD. The ideal way will be to continue the therapy and I hope that with the legality, we could do that too.  

Gisele: Yeah, so that's I guess what my question was leading that for complex trauma, the psychological treatment, the psychotherapy would have to continue. So, while the MDMA has immense potential and effectiveness in treating and in opening up this, the perceived sense of trust is enhanced, right, qualities of self-forgiveness, of self-support, openness. It really brings about a whole lot of feelings and experiences that it’s a tremendous asset to the healing of traumatic experiences. However, traumatic experiences sometimes take longer than just a few journeys and it would be- so the idea here that as I ask you that question, I'm also affirming that for the audience that is, to think about healing in a long-term treatment and to think about psychotherapy as an adjunct to medicine assisted sessions. For some cases, it will be necessary and it's what actually allows for that full transformation to be utilized by the client on a day to day, which is a lot of times what it's called the integration, what happens after the session for some clients. The integration is, it takes a long time and takes a continuation of a psychotherapeutic process and continuing to be held in that format for the changes to be really in place, would you agree? 

Keren: I'm so much agree and also to say that I think for all clients, not only with complex PTSD, I think the integration piece, really ideally, I would recommend continuing it because even if we had treating the PTSD, which is a specific kind of wound in a specific place in the brain with the nervous system is participating in a specific way, when the PTSD is transformed in somewhat major ways, there is still a lot of psychological work. So, which is different than working on the PTSD. So, I would strongly, strongly recommend to all the participant to continue with therapy.  

Gisele: Yeah, and this treatment, I imagine, would be very expensive. So, what are the ideas of just kind of treatment being affordable, being accessible, are there ideas of having health insurance or group therapy? What are the thoughts around making this kind of treatment, that is so well held, so safe, so effective, be widely available?  

Keren: So, in terms of the actual method, group therapy is the next thing we would like to check because it makes it more affordable. So, we are planning to start a research in Israel with two MDMA sessions, and then the third one would be a group session. And then maybe the study after will be one MDMA session that is for like a personal MDMA and then the second and the third maybe would be in a group. So that's still to be studied. There was another group study that we start in the US too. And we're also looking at different modalities of therapy. So, we're looking at prolonged exposure. We have a study starting with Professor Edna Foa, and we look at PE with MDMA and see if it's maybe we can do it in a shorter time for the PTSD part not for the psychological, it needs to, as we said as we're trying to look at different modalities in the studies now, that would be our future studies. But you know in Israel, we would like to go to a place where the, where the state is, is paying for this kind of treatment, this part of the, the social services. So, in Israel, many of the medical services, they're being offer pretty much for free and that's one protocol that we think, and The Ministry of Health agree with us that this point that would be good to offer it as part of the free services and definitely in places where the social system, medical system is different, it needs to be covered by the health insurances.  

Yeah, and I think it's also wise for the health insurance companies because people with severe PTSD, they have- they consume a lot of services. You will see them with more heart problems and blood pressure problems and definitely therapy and it impact their families and their ability to work, their ability of their families to work and it impacts the whole community. So, I think for the long run and that's something we are starting now, we're starting to ask the participants in future studies were going to ask to look at what were their medical expenses before the study and then in the years after to see what the benefits for the larger system. What, what are they and my guess is that it would be very- it would be wise financially to offer this treatment and to save all those, you know circles of expenses. 

Gisele: The impact and the system and the families in the community. Yeah, and in terms of the modalities, what is the ideas of the different modalities; I know of the conjoint therapy for PTSD and couples with the cognitive behavior conjoint therapy. Are there any other diagnostic criterias, any other ideas of expansion for the study with MDMA-assisted psychotherapy?  

Keren: Well, there was a very beautiful study for social MDMA therapy for social anxiety for autistic adults, but just to be clear we, we worked on the study was exploring the reduction or the influence of the social anxiety. It's not treating autism, but it's treating that social anxiety, the results were good. So that's something to look at, social anxiety. We’re also starting to look at eating disorders and we're starting studies with that, so it didn't start yet, but we plan to do that, and we are also starting in Israel, at least, to look at specific kinds of trauma. So we're going to have a study with victim of tortures in the- actually Palestinians, victim of torture to see what, because it's a specific kind of trauma and to see what MDMA psychotherapy is doing for that and in the other side of the political spectrum, we are going to do a study with soldiers that were walking inside the occupied territories and were in costumes in the world, part of the population, they're kind of hiding so their trauma is very much about shame and guilt of what's happened, what happened and other than the sometimes life-threatening situation they wear and experience. So, we're trying to look at different populations from, for me personally, it was also important to have different, you know, like to go both to the Palestinians and the Israelis and to try to look at all those awful things that happening all over the world really but specifically in the Middle East and to see how can we contribute and how we can work with those traumas that are again influencing so many circles.  

Gisele: Absolutely, very important to recognize the political trauma, the social trauma, the historical trauma. [Keren: Exactly] And as the- in your context, you're talking about Israelis and Palestinians and you are beginning to plan for MDMA treatment for the specific instances that you're describing. I know that MAPS has already been involved in some political reconciliations between Israel and Palestine with the help of psychedelic medicines. Not MDMA. Could you tell us a little bit about that research and its outcomes? Just as we're on this topic.  

Keren: Yes so, we work with Dr. Leo Rothman, with a part of the team of Imperial College in London, and he's very much into exploring reconciliation in groups and to see what psychedelic in group is- how it’s influencing conflicts and social conflicts. So, one research that it was already finished and is going to be published soon, he interviewed, I think 31 participants in ayahuasca ceremonies, Palestinians and Israelis. And he kind of asks about the, the aspects of the relationship between the Palestinians and the Israelis.  

So, one thing we discovered that there is a unity-based connection that people explored so they explored one, like Palestinians explores Israelis and Israelis Palestinians in a way that beyond this political or, or national or social identity so they felt themselves as humans, that are more than just this and that identity, kind of a unity quality. And at the same time, which I think is really important to kind of name and discover, we also saw that there is a different base connection. So, they actually recognize the differences between them, and they got connected to the foreign culture. So, to hear an Arabic prayer and to feel like, “Oh! That's part of life for me too, as an Israeli,” yeah, and the opposite. And also, we also saw that people met in the psychedelic and ayahuasca, they met different experience that are related to the conflict because of the presence of the other, so memories from their personal traumas. Personal and social traumas, so they met the wounds also because the context was bi-cultural, bi-national, so a very interesting study and it continues and we support, of course, the study as MAPS continues to explore it in different ways.  

Gisele: I would love to see some of those efforts to address historical trauma in the United States. [Keren: Yeah] So as we're coming back to you know, our main topic here and we're looking into the licensed legalization of psychedelics, specifically MDMA, as it’s in Phase 3 of the clinical trials. And you've described some here tonight that the conducting these psychedelic sessions is not a classical, clinical experience right, there- it takes more out of the clinician, it takes a team, but it also takes a specific skills. So how do you see the development of training? And since you are also a trainer and have trained already a number of people in Israel? What are the important elements that you think it's important for people to be able to do this work?  

Keren: I think the team and it can be divided into two people, right? It's not just specifically one person, but I think the therapy team should have like I would say three legs for the psychedelic therapist or therapy team should have three, three legs. The first one, I think we need to have more like a traditional clinical background. So, to know about PTSD, to know about it, to be a psychotherapist that are trained in clinical modalities, one piece. The second piece that I think is very important, is to have some kind of body, body-mind-spirit orientation. So, for me, it's Hakomi, but there are many wonderful modalities that knows how to invite a person to experience themselves. So experiential based, that it- therapy that is open to mystical experiences or to somatic experience and allow those to be part of the therapy. I think, I think it's important. And the third piece is that psychedelic training to learn about the specifics of psychedelic therapy. About countertransference and that they're specifically important in psychedelic therapy, they are very strong about the intensity of the experience, about boundaries, that they are a bit different. Person is lying and catches there- about ethics, the ethics of psychedelic, which is so important. So, to learn specifically about the techniques, about the beingness of the therapist, about learning to trust the unknown. Like psychedelics asks us to do because it's not that we tell the client what to do. We invite him or her to be- to go inside and to listen and then to follow what's there. Yeah, so I think those three are very, very important.  

And there is a debate in the field, but I'm very clear about the need for the therapist to have his or her own or their own personal experience with psychedelics. Otherwise for me, this is like teaching yoga without doing yoga, without knowing yoga, yeah? So, I think it's very, very important that we take it, challenging. It's challenging because we have many people we need to train and to have a psychedelic experience is not a- of course, it's not legal yet. So, we have studies that are specifically for the therapist of the trainings so they can experience MDMA psychotherapy, but I think it's a very, very important that the last piece will be supervision. After they finishing their psychedelic training, having some kind of body oriented transpersonal orientation and the clinical, professional background. I think it's very important to have in the first few experiences supervision and to get feedback and to learn. 

Gisele: Very good. So, a number of core skills here. It should develop that empathic abiding presence to be able to work with the trust and the enhancement of the trust in the process, in the client, in the medicine to work with that spiritual intelligence that such processes bring about, to have knowledge of the physical and psychological effects that drugs have, the therapist’s self-awareness, the integrity around ethics, a good solid clinical training, and some competency and complementary techniques that would be also important because of for integration for also for the beginning and all of that.  

And what you are highlighting here is that you think it's important that the therapist has familiarity with mystical states of consciousness. That a person facilitating the sessions have had an opportunity to contact themselves in that space so that they know how to make meaning out in that existential space. They are familiar with the transcendence nature of the self. They have that feeling of experience of love or impermanence or change a lot of sometimes ego dissolving a lot of experiences that the psychedelics would bring about. And what you are highlighting is also that there is a challenge in training people because of the nature of the prohibition around the use of substances that have not always, people have access to experiences that are safe and legal so that they can actually develop those capacities, and so that's an important aspect of the training would you say for the development of the field?  

I'm wondering when we're going to be able to do this at CIIS because we train therapists a lot and we have a so many of these other ways and we do use meditation and contemplative practices and spirituality and somatic oriented techniques in order to develop some of these qualities, but what we don't have yet is an opportunity for students to undergo medicine and I'm wondering if that is what you see as a future development of the field. 

Keren: Definitely and we work on that with the Ministry of Health. So, we want our therapists to experience the MDMA at this point, but I think slowly, slowly with the psilocybin and more substance. And at this point we do it only in clinical trials. So, there is a clinical trial for their trial for therapies to come and experience and we look at self-compassion about -we look at different qualities of therapy and we see -we’re looking to see if there is any influence on that and of course on safety. But for the long run, I think we need to have to have it as part of the training and I know that MAPS department of the training department, which is a wonderful one in creating wonderful training I think is all the time thinking about ways to embody the work and ways to offer that and hopefully it is well, the minister of health will allow us. I hope soon sooner than later to have a clinic for the psychotherapist that are you know training so they can know that. One of the…the woman that is in charge of trauma in the Ministry of Health, her name is Bella Bengelshael and she was invited to our study in the US actually to experience MDMA psychotherapy because we wanted her to know what it is about. And she got it because she understood it and she had a very meaningful experience and became a big supporter of the work. 

Gisele: Wonderful. That's a wonderful story. I love to hear that. And how about for you Keren, as we're coming to the end of our time here today, but I was wondering for you personally, professionally what have been some of the major influences that led you to this work.  

Keren: Definitely, you know, CIIS. I think it's a very meaningful -it's an important place I think for many people and for me personally, I really deepen into who I am both personally and professionally through the somatic program and the East-West. Yeah, different teachers and mentors I found there. I also found Hakomi at CIIS, one of my teachers there was Rob Fisher, who became a colleague and a friend. He taught Hakomi in the somatic program and then I went into the Hakomi Institute of California, which is very meaningful, another meaningful place for me where I learned Hakomi, was trained as a trainer for Hakomi and we -Ido and I we open the Hakomi Institute of Israel when we came back. So that's another foot I have that is they're very meaningful for me. I also, I was blessed, part of my family are working with psychedelics in Mexico for many years, so Francois Bourzat and Allen... They kind of exposed me to their Mazatec tradition and I learned a lot about psychedelics, about life really, and I'm very grateful for them. Ido, you know, is a kind of helps me in body, you know life, different learning and passion, you know that we have to somatics, to transpersonal, to psychedelics, raising our kids together.  

Gisele: And coming out of that personal vision, that personal path into a larger vision. Do you have a larger vision of what psychedelic assisted psychotherapy could become? Could be? 

Keren: You know, I really hope to see psychedelic clinics, specifically all over Israel and Palestine eventually, in the Middle East in general and to have them outside of the hospital because right now we are doing it only in the hospital in Israel, you know, all these all the studies everything is inside the hospital. In the states it's not like that some of the clinics of the studies outside of the hospital. So, I would like that to be nature or in beautiful places with great trained teams and people can come when they need to you know to see what exactly what kind of medicine they need. Is it MDMA? Is it psilocybin? Is it ayahuasca? So, my vision includes different kinds of medicines because I think we are still exploring it, but each medicine is working on specific dimensions or and can work well with specific challenges. We don't know a lot about that yet and we still exploring it but MDMA, ayahuasca, mushrooms with psilocybin, N-DMT and different things I think can be very just help us, you know to suffer less and to live life in a full way with more freedom and happiness.  

You know and especially after the COVID, I'm saying after because in Israel most of us are vaccinated, and it feels like we're in the hopefully in starting the after party [laughing gently] But I think many people are deeply traumatized, you know from reasons financial reasons, and it was really exit -exit -exit -exit -exit -intention [Gisele: existential.] Thank you, I'm telling you, the English! [Both laugh] So I think people are in real need and I think psychedelic can help with that and maybe one thing to say about that, I feel it very strongly in Israel in the political, you know atmosphere, but I think it's also true for the states, that people are very much focused on themselves, their need, what’s good for them, maybe to their kids and family. And what psychedelic knows to do well with the right setting, with the therapy before and after is to help people recognize that they are part of something bigger, part of the community, part of the culture, part of society, part of the Earth of our Earth that is you know, not in such a good place to say the least ecological situation. So if we'll slowly with the help of psychedelics will know our self as part of something bigger and I hope and believe that the commitment to help to those other dimensions to be active and to be to be socially active to be generous to be creative to be, to think about it to feel it to sense some in all dimensions of who we are how to participate in life and in reducing all this damage and suffering that is all over I think that's really important and that's really my motivation. 

Gisele: Wonderful, so a more embodied, a more connected, and more sustainable fully participatory way of living and being with one another and the planet and clinics that are connected to nature and that have available medicines for different people in different moments and possibility for healing in an integral way, in a sustainable way. 

Keren: Yeah, a clinic that helps people to remember who they are. That we are both individuals with this body mind systems, but we are also bigger than that. We are connected to this spirit. We are connected to nature. We're connected to all other human beings around the planet. I think if those clinics can flourish and offer this vision, I think we will be in a different space, state as humanity.  

Gisele: That’s beautiful. Hope for planetary transformation and improvement of humanity. Right and we have to, if there is something that we know we have to, it’s to become better humans. [Keren: Yeah.] Yeah. So, thank you for that.  

Gisele: All right well, Keren, it was so wonderful to have you with us tonight. We were at sunset here, you were at sunrise in Israel, I can see it's daylight there. So, I'm going to wish you a wonderful rest of your day. And so heartwarming to see you again, a dear friend, and I'm so proud of you and Ido and your collaboration and your leadership, your innovation in Israel alongside the Hakomi Institute, alongside MAPS and serving the development of the field in such a profound way. So, I want to say congratulations to this time in life, to this work, and I hope that our audience felt inspired and feel a connection to a lot of what you shared through what could be applied here in the United States as well. And yeah, thank you so much. Any final thoughts that you want to have for us to close our night together? 

Keren: Just to thank you. It was lovely and just really nice to feel our sisterhood through the years and thank you for inviting me and yeah. 

Gisele: Yeah, so many hugs and kisses [kiss sound] to you.  

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Thank you for listening to the CIIS Public Programs Podcast. Our talks and conversations are presented live in San Francisco, California. We recognize that our university’s building in San Francisco occupies traditional, unceded Ramaytush Ohlone lands. If you are interested in learning more about native lands, languages, and territories, the website native-land.ca is a helpful resource for you to learn about and acknowledge the Indigenous land where you live. 
 
Podcast production is supervised by Kirstin Van Cleef at CIIS Public Programs. Audio production is supervised by Lyle Barrere at Desired Effect. The CIIS Public Programs team includes Kyle DeMedio, Alex Elliott, Emlyn Guiney, Jason McArthur, and Patty Pforte. If you liked what you heard, please subscribe wherever you find podcasts, visit our website ciis.edu, and connect with us on social media @ciispubprograms. 
 
CIIS Public Programs commits to use our in-person and online platforms to uplift the stories and teachings of Black, Indigenous, and other people of color; those in the LGBTQIA+ community; and all those whose lives emerge from the intersections of multiple identities.  

 
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