Therapeutic Approaches for Change (Based on Dr. Katzman’s Rapid Depression Remission and the “Therapeutic Bends” with Ketamine-Assisted Psychotherapy)
When we begin to change, there are different levels or aspects of self that we need to consider, because potent inner experiences such as those promised by psychedelic medicine are of little use if they are not translated into a life better lived. This is where therapies that accommodate change become important.
The overarching psychological model of Sub Rosa, which is also applied in research settings, is called the Psychological Flexibility Model, or PFM. The model consists of three steps: Accept, Connect, and Embody. PFM draws from Mindfulness-Based Stress Reduction (MBSR) and Somatic Experiencing (SE).
In SE, clients learn to become aware of felt-sense states in their body as they arises. Different felt-sense states are the amalgamation of past lived experiences that are encoded in the implicit memory–they are what you would call “emotion” or an “emotional state.” The implicit memory is not accessed through voluntary cognitive action but through training in body awareness and experiencing felt-sense states. MBSR is training in giving pause to automatic thought processes and behaviors. This pause then allows us to make the space to process emotion at a bodily level, which SE teaches us to do.
The Cognitive Layer of Self
Mindfulness-Based Cognitive Therapy can help with difficult emotions derived from sadness due to loss. Emotions like regret, guilt, and shame are particularly damaging if they are allowed to recirculate without resolving. Applying Byron Katie’s 4 Questions is a powerful way to earn back the few seconds needed to check a thought process involving regret, guilt or shame that in turn is causing an overwhelming felt-sense emotional state.
The Questions are:
Is it true?
Can you absolutely know that it’s true?
How do you react—what happens—when you believe that thought?
Who would you be without that thought?
Eventually in life, we have to make peace with the opportunities for connection and presence that we have missed, or bury the awareness with addictive strategies. We must learn to find solace in the gratitude we feel for the awareness we now begin to possess and the choices we now make. 12-step group work is a powerful community-based organization of people supporting each other in real-time and real ways to choose gratitude in the choices we can make today. (For more information on the science of gratitude see: The Science of Gratitude & How to Build a Gratitude Practice | Huberman Lab Podcast #47 .)
The Relationship Layer of Self
When we experience change, we also shift in our interpersonal relationships. In our families and intimate relationships, we have accepted roles and put roles upon our loved ones in processes occurring beneath conscious awareness. The ways we expect each other to talk, behave, and even feel are tacitly given and received much of the time. (There are also roles that are consciously taken, but that is a different phenomenon.)
When we shift into a new understanding of ourselves, it naturally shifts how we interact and want to interact in our relationships. But when we make these adjustments–even if we think we are doing it subtly–we often meet resistance from those with whom we are in a relationship. This may require extensive conversations about where we are headed and what we want and need.
The above assumes fairly healthy relationship systems in which, when we discuss the issue of change, we can get on the same page with partners and family members. But some relationships and family systems are dysfunctional. In family therapy, dysfunctional systems are understood by identifying who is playing the role of the “identified patient” (also known as, the “symptom bearer” or the “scapegoat”). This role allows the family system to express distress through one member who has been unconsciously selected. Other members in the system may profess concern for the identified patient while at the same time reacting instinctively to any improvement in that person. This may seem malevolent, but it is simply an unconscious way of managing anxiety and stress.
The Identity Layer of Self
If we are open to change, we must open ourselves to shedding the layers of who we thought we were. Change can happen much more rapidly with the insights gained through psychedelic medicines like ketamine, which require deeper evaluation of who we truly are and new decisions about where we are headed. This is not always easy, because we have likely built an identity around believing that we are the roles we play and the ways we think, feel, and behave. When these start to shift, it can be unsettling and require adjustment and reorientation.
Internal Family Systems (IFS) techniques can guide people to have productive dialogues with different parts of their psyche. This can illuminate why we played the role we are now ready to shed—it protected us in a way that nothing else could, but it is no longer necessary to be in that role so much. A great self-help resource for IFS-style work is Jay Earley’s Self-Therapy .
The Emotional Layer of Self
If depression is understood as anger turned inward, then when we start to move beyond depression, it is understandable that healthy aggression, previously repressed out of necessity, should start to arise. We may find ourselves no longer depressed but appropriately angered at the past trauma, abandonment, or loss we have experienced. SE has a powerful framework for understanding this emergence of healthy aggression and how to allow it to come forth in our lives in productive ways. These tools and a therapeutic relationship can allow a person to express this energy in a way that is self-protective and ultimately healing.
SE provides education about different levels of nervous system activation. At the most distressed level, freeze, we find ourselves paralyzed and literally unable to function. This felt-sense state is rightly associated with what has been described since Freud as depression—or, perhaps more accurately, freeze is depression streaked with anxiety. It is an icy, dysfunctional state. When our nervous systems begin to climb down from this level of activation, what awaits is fight or flight, which can definitely look like anger or express like anger. It is important to have a therapist with an understanding of these physiological states and how to navigate them.
Within therapy, clients can safely and non-overwhelmingly express emotional states that might otherwise be intimidating to navigate. In developmental trauma, the anxious attachment pattern, called “codependency” in 12-step literature, may be involved with the physiological freeze state. Anxious attachment presents as a constant monitoring of the other person, the person with whom we are in a relationship, because it has been learned that the attachment is insecure and thus requires constant monitoring to ensure it does not rupture. It is one thing to understand this cognitively and another to renegotiate the feeling of anxiety that ensues around relationships. This renegotiation is what SE allows us to do.
In SE, we use grounding techniques to establish safety while we are engaged with the felt-sense experiences that arise from past traumas. Over time, this healing process renegotiates our memory of those traumas for good.
The Transpersonal Layer of Self
The spiritual layer of self is deep and idiosyncratic. At this layer, which may be described as mystical, we directly and uniquely encounter the source of meaning for ourselves. At Sub Rosa our approach is to honor each person’s encounter with the unconscious as singular, beautiful, and without need of endorsement or enhancement from outside influences.
The deep structures of the self are laid down early in our life in a process of interplay between our temperament and environment. With curiosity and over time, this layer of self can come forth. Our approach is one of curious inquiry and a desire to hear about any potential meanings that may arise. Journaling can be a way of integrating personal mythology, bringing forth potent inner experiences into conscious understanding that provides us with deep internal guidance.
Ketamine sessions can produce psychedelic, dissociative states that can bring forth a deep transpersonal or mystical experience and expand our sense of who we are. This encounter can be disorienting and so full of meaning that therapy becomes an ideal place for exploration and incorporation of meaning into daily life, also known as the integration process.
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Katzman, J. (2018, September 8). Rapid depression remission and the "therapeutic bends" with ketamine-assisted psychotherapy. Psychedelics Today. Retrieved September 1, 2021, from https://psychedelicstoday.com/2018/09/08/rapid-depression-remission-therapeutic-bends-ketamine-assisted-psychotherapy/
