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221: EFT and Ketamine-Assisted Couples Therapy with Kathryn Rheem

Welcome back to The Couples Therapist Couch! This podcast is about the practice of Couples Therapy. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.

In this episode, we’re talking with Kathryn Rheem about Emotionally Focused Therapy (EFT) and Ketamine-Assisted Couples Therapy. Listen to the episode on Apple Podcasts, Spotify, and your other favorite podcast spots, and watch it on YouTube – follow and leave a 5-star review.

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The Couples Therapist Couch 221: EFT and Ketamine-Assisted Couples Therapy with Kathryn Rheem

Learn more about the Couples Therapy 101 course: https://www.couplestherapistcouch.com/

Learn more about the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new

In this episode, Shane talks with Kathryn Rheem about Emotionally Focused Therapy (EFT) and Ketamine-Assisted Couples Therapy. Kathryn is the Director of The Washington Baltimore Center for EFT and the Co-Founder of The EFT Cafe. Hear how Ketamine-Assisted Couples Therapy works, how it can help couples, how long the sessions are, what the conversations look like while on Ketamine, and best practices for a smooth session.

This episode covers everything from Ketamine to EFT. Here’s a small sample of what you will hear in this episode:

    • How does Ketamine-Assisted Couples Therapy work?
    • What are the benefits of Ketamine-Assisted Couples Therapy?
    • Are clients more open to suggestions while on Ketamine?
    • What happened with Matthew Perry & Ketamine?
    • How does Ketamine affect your feelings about past trauma?
    • What changes can Ketamine cause emotionally?
    • How do you learn more about Ketamine?
    • What is Mindbloom?

To learn more about Kathryn, visit:

WashingtonBaltimoreCenterForEFT.com

RheemClark.com

TheEFTCafe.com

 

Check out the episode, show notes, and transcript below: 

 

 

 Show Notes

  • 221: EFT and Ketamine-Assisted Couples Therapy with Kathryn Rheem

 

What is The Couples Therapist Couch?

This podcast is about the practice of Couples Therapy. Many of the episodes are interviews with leaders in the field of Relationships. The show is meant to help Therapists and Coaches learn how to help people to deepen their connection, but in the process it explores what is most needed for each of us to love, heal, and grow. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.

Learn more about the Couples Therapy 101 course: https://www.couplestherapistcouch.com/

Find out more about the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new

Transcript

Please note: this transcript is not 100% accurate.

Kathryn Rheem 0:00
Ketamine is this benevolent disruptor that melts people's defenses and helps really good people who have tried really hard and lots of previous therapies, find their own feelings and share them, take the risk to share them with the safe other. And after all, that's what bonding and love is all about. Is cannot you hold my fear with me?

Intro VO 0:26
Welcome to The Couples Therapist Couch, the podcast for couples therapists, marriage counselors and relationship coaches to explore the practice of couples therapy. And now your host, Shane Birkel

Shane Birkel 0:39
Hey everyone, welcome back to The Couples Therapist Couch. This is Shane Birkel, and this is the podcast that's all about the practice of couples therapy. Thank you so much for tuning in. I'm a licensed marriage and family therapist, and I try to bring you the best in the world of couples therapy. This week, I'm going to share an interview with you that I did with Kathryn Rheem. She's a certified Emotionally Focused therapist and co-founder of the EFT cafe. I'm really excited to talk with her. I also spoke with her on episode number 77 we talked all about EFT, and in this interview today, we actually focus a lot on ketamine assisted couples therapy, which, which is something that's very new, but we also, you know, get into the EFT stuff a little bit. So before we get to that, I just wanted to share with you that there's still a few more days to sign up for the couples therapists inner circle. If that is something that you've been thinking about, or if you're someone who just wants to take your couples therapy practice to the next level, this is a really good opportunity. There's all kinds of bonuses right now, working with affairs, working with high conflict couples, working with Emotionally Focused Therapy, all kinds of different topics related to couples therapy, and you get the personal support from me and everyone else in the group, you can ask questions, and right now, you can try it out for seven days, no risk, no commitment at all. Try it out for free for seven days. If it's not a good fit, then you can just cancel without any penalties. So if that sounds like a good fit, click, click on the link below to find out more details, to get to get all the specifics of everything, and I'd love to have you join but let's shift gears here to the episode for today. Something that you've probably been hearing more and more about, or if you haven't yet, you will be soon, is the using psychedelics in therapy, and it's something that I don't really have a lot of understanding or background to to understand, and it's something that I keep learning more and more about. And Dr. Kathryn Rheem, who I talked to today, does a great job of sort of explaining it and talking about how she uses it, and I learned a lot. So I'm hoping that you'll enjoy that. And she's also a, I think, one of the, you know, most well regarded EFT therapists out there. You know most of you have probably heard of Emotionally Focused Therapy, but you can, you can hear her perspective about working with ketamine assisted couples therapy. So without further introduction, here is the episode with Dr Katherine Rehm. Hey everyone. Welcome back to the couple's therapist couch. This is Shane Burkle, and today I'm speaking with Dr. Kathryn Rheem, one of Sue Johnson's trainers for over 16 years, senior EFT consultant and certified EFT supervisor and therapist and co founder of the EFT cafe. Hey, Kathryn, welcome to the show.

Kathryn Rheem 3:43
Hey Shane, thanks for having me back. Great to see you again.

Shane Birkel 3:46
Yeah, great to see you, too. For those of you who are interested, if you enjoy this conversation, Catherine and I spoke over five years ago on episode number 77 so you can go back and check that out, but tell us a little bit about what you've had going on lately. Wow,

Kathryn Rheem 4:02
that was a while ago. Shane,

Shane Birkel 4:04
I know I can't believe it. Yeah, and 77

Kathryn Rheem 4:07
episode. 77 back then. I What number this is you've been busy?

Shane Birkel 4:11
Yes, yeah, it's two, maybe 220 something when this comes out. Yeah.

Kathryn Rheem 4:16
Congratulations, fantastic. Thank you. Um, what I've been about. EFT continues to be my beloved theory, my my theoretical home. I love providing EFT to my clients who work so hard in therapy. I'm exclusively a couples therapist, and EFT is so effective, of course, empirically validated. I really love the research that EFT leans on, and its foundation is based in great science. Lately, what I've been doing the last couple of years is something called ketamine assisted Emotionally Focused Therapy, and I'd be happy to talk with you and your audience about ketamine assisted psychotherapy, commonly referred to as. K, A, P, the acronym. I don't want to dive right in, but that's been my main, my primary inspiration these last few years, the leading wave of our field psychedelic assisted psychotherapy. And I was really reluctant to lean into psychedelic assisted therapies as a professional. You know, when I've been hearing about the last six or 568, years, like really wondering if our field was really gonna go this direction. Yeah. And when I started seeing the signs that our field was going in this direction, I was like, I gotta lean in. I gotta learn. I gotta see what this is.

Shane Birkel 5:35
Yeah. Where did you start hearing about it first?

Kathryn Rheem 5:39
I started hearing about it first. I'm not actually sure my first exposure as a professional years ago was with the psychotherapy networks. Networker, so maybe that's my first webinar podcast, even in the magazine like I consider the psychotherapy network or just, you know, they keep up. They work hard to keep us on the leading edge. And their publications, or some of their symposium, they they do a great job naming what's happening in the field. And I trust them, yeah, and so that's probably where I first started, like, really starting to tell myself, asking myself, I think I need to learn. I think I need to lean in and see what this is all about. Yeah,

Shane Birkel 6:26
I think me too. I i read the magazine and I I've seen they had, you know, the psychedelic, whatever organization had a booth at the network or symposium and it and, you know, I've just started hearing more and more about it and and learning that, you know, there are a lot of legislation that's being pushed forward to legalize a lot of these things, because in a lot of research studies about how effective it is and everything. So I'm just, you know, really excited about the potential for this.

Kathryn Rheem 6:57
Yeah, I am too, especially for our clients who have hit the ceiling of talk therapy. Talk therapy is an amazing intervention, and connecting with another human suffering is is invaluable. But of course, we all know that there are clients whose symptoms don't improve as a result of therapy, or they improve a little bit, but not fully. Those symptoms are what medicine tries to help. But of course, in the field of psychiatry, we haven't had new medicines in 30 or 40 or 50 years, and so antidepressants, as we all know, come with side effects. Anti anxieties also come with side effects, fairly, about 30% effective. And so why not broaden open our minds? Perhaps for me, I had to open my mind. Why not broaden the aperture and look from this other angle that used to be so publicly known in the 60s, you know, the recreational use people were having mind altering experience that they said changed their lives before our government started getting aware of it, and then, you know, really clamping down on it, and then really trying to extinguish it. So it's, you know, it's had a long history. Plant medicines have been helping people heal since the beginning of time, and especially in indigenous cultures. And we certainly want to honor the indigenous cultures and their histories of using plant medicines for healing. And then our government got, you know, kind of panicked. I think I obviously, I don't know all the details, and we can all read up on it, but it feels like, if I were to put it in process terms, it feels like people said, Oh, we don't know what this mind altering, these mind altering substances are doing if, unless we can prove they're totally safe, we must eradicate them. And they went kind of probably, again, my words, people might not like this, but like a fear based mentality,

Shane Birkel 8:53
yeah, well, and that's a nice way of looking at it, that doesn't even bring into the the idea that perhaps the pharmaceutical companies realize that they're not going to be able to profit from these, the for the plant medicines as well.

Kathryn Rheem 9:06
Yeah, fair, fair, fair, fair, whole, a whole other, all of

Shane Birkel 9:10
the above, yeah, yeah, yeah, both of the those factors, yeah, yeah,

Kathryn Rheem 9:15
yeah. And not to, not to under, not to discount. I'm so glad you mentioned the pharmaceutical companies, because Big Pharma is a very powerful phenomenon in the US, and it's a very wealthy industry. Big Pharma big money, not to undermine what they have provided medical care. But at the same time, we don't want it to be a one, a one lane show, we have to make other lanes for other medicines that are outside of Big Pharma purview. In my opinion, yeah,

Shane Birkel 9:47
I agree. Yeah. I know medication can be incredibly helpful for a lot of the clients we work with, and I'm not, yeah, I totally agree. But um, tell us a little bit about what this LA. Looks like when you're working with clients using ketamine assisted therapy. How do you know? How does that work?

Kathryn Rheem 10:08
Yeah, great question. Happy to talk about it. So ketamine is a safe and legal dissociative anesthetic, technically not a psychedelic but sometimes, for some people, can have some psychedelic features, and so ketamine has been used safely in every medical clinic around the world since the 1960s and 70s. It was used especially it became very well known in the Vietnam War because it saved lives people who were physically injured in Vietnam, their battle buddy was taught how to inject ketamine into their system while they were waiting to be medevacked out. So a big chunk, I don't know the number anymore, I should look it up again, a high number of people survived that weight for the medevac out of the injury zone because they were on ketamine, which decreases pain. So people, combat veterans in Vietnam had a higher rate of survival because ketamine was injected into them by their buddy, and they could tolerate the pain while waiting for the helicopter to come get them out of harm's way. Wow. And so it that was known back then, and then the FDA approved it, I think in 1973 it's used in the or and in ers around the world every day. It's on the World Health Organization's list of the top six medicines every health clinic, every medical clinic around the world, should have access to. So it's well known by the medical world. It's very safe, and when we start using it for psychology or mental health, it's considered an off label use, so FDA approved in the 73 but off label use for mental health and psychology. But the studies are coming. The studies have been being done. It is, it is well known and well researched for treatment resistant depression and suicide ideation as fast acting and safe ketamine infusions, ketamine injections, ketamine lozenges, ketamine nasal spray to help people suffering from suicide radiation and treatment resistant depression. And so the research is coming, but now we're starting to use ketamine for individual symptomology, not only TRD, treatment resistant depression and suicide ideation, but for depression, for anxiety, for PTS, symptoms, and then we're starting to use it in couple therapy, Because ketamine opens new therapeutic windows. Ketamine is this benevolent disruptor that melts people's defenses and helps really good people who have tried really hard and lots of previous therapies, find their own feelings and share them, take the risk to share them with the safe other. And after all, that's what bonding and love is all about is, cannot you hold my fear with me?

Shane Birkel 13:06
Yeah. So how long are these sessions? And how is it set up? You know, is, if you're working with a couple, are both partners taking some of the ketamine at the beginning, and then there's like, some window of time that you know, you start a conversation. Or how does that work? Yeah,

Kathryn Rheem 13:26
it can work different ways. The use of ketamine with couples is probably the newest application of ketamine assisted psychotherapy. Sometimes both partners are using the medicine. Sometimes one partner is using the medicine. Sometimes partners are using the medicine and back to back, and then we do the therapy. So whether one or both partners are taking the medicine, the medicine is prescribed by a medical, medical prescriber. That's not me. I collaborate with prescribers. Anesthesia is really familiar with ketamine because it's used in the or regularly, and it especially, I know the or medicines for anesthesia keep evolving, thankfully, but ketamine is often still a part of it. And of course, in the ER, it's used every day. So anesthesia is used to ketamine and anesthesia, anesthesiologist, our certified nurse and anesthesis will be able to prescribe ketamine, and they're used to administering ketamine through IV infusions. Mm, hmm. And so there's a formula point five milligrams of ketamine per kilogram of weight. Okay, two, 2.2 kilograms equals a pound, since we use usually not the metric system here in the States. And so there's a formula based ketamine dose, and a person, especially with treatment resistant depression or suicide ideation, can go to a ketamine clinic, which are popping up in many places around the US these days, and get the induction series, which is. Six infusions in three weeks. So ketamine is fast acting and short acting, and so the gains are pretty immediate, but they don't last. That's why the six infusions in a in a two and a half or three week period is recommended, and what the research shows to help really help a person's treatment resistant depression or suicide ideation. So I collaborate with a local ketamine clinic run by anesthesiologist. I collaborate with pain medicine docs. I collaborate with family medicine docs and psychiatrist and we work together on the possibility of them doing an assessment and evaluation of the client for possible ketamine prescription. You know, that's up to them. I don't weigh in on any of that. And then the ketamine prescription is provided if the client qualifies. And then I provide the cap. Ideally, my preference is why the client is actually on ketamine, or very soon after the ketamine dose. Other people do cap the next day or even two days later, okay, but the hard thing for me about a day or two later is on ketamine, our memories aren't great, right? It's a dissociative, uh huh, and so it's a little hard for me to do it a day or two later because a client doesn't really remember much unless they had someone writing down the things they were saying, or they wrote 15 minutes at the end of their dose, and they have notes to bring into session, yeah, yeah. So

Shane Birkel 16:30
if they go in and get the treatment, is the, is there a very significant is it a very significant experience for them, as far as like, feeling the effects of it for some time right after ketamine

Kathryn Rheem 16:48
doses last about 45 minutes to an hour, which for for traditional psychedelic plant based medicines, you need to have four to six hours. If we're talking about psilocybin or MDMA and others, four to six hours, or even a whole day, for the journey I love that. You know, I live and work in a in a busy area, people are busy. They can't take a whole day off. Ketamine is 45-40 to 60-75, minutes, depending on the route of administration. And people come into the clinic and get the IV, and I'm sitting with them and their partner, and sometimes the partner is getting in at the same time and or the im the intramuscular injection, or they're prescribed what's called a trophy, which is a sublingual lossage That you swish in your mouth, in the ketamine is absorbed through your mucosa. And so there are different administration routes. They have pros and cons, from my perspective, for therapy, but I meet clients at the clinic. It also is a safe medicine to take at home, so clients can get a prescription for at home use. And I will provide the session via zoom clients who are safely taking it at home, big informed consent process. Have to have a sitter there. I have to be able to text the sitter. We establish a texting line of communication. Ketamine is very safe. These are very, very low doses. These are psycholytic doses, not even psychedelic doses. So very low doses in order to be able to provide therapy and do therapy while on the medicine.

Shane Birkel 18:26
Okay, great. And so you are, at least for you and your experience, you're trying to be there right at the time that they're taking the medication and it's having the effects and how so, so, what are the benefits? Like, what? How do those conversations go? You know that that are different than if they're not taking the medication? Yeah,

Kathryn Rheem 18:53
the biggest thing for me Shane is that ketamine lowers defenses. And as an emotionally focused therapist, for 20 years now, I'm used to working with good people who have earned their defenses, but who's now, but now, whose defenses have become obsolete. But our nervous systems like our defenses, they keep us safe. We think we're protecting ourselves when protection in our relationships wasn't provided and and the ultimate essence of love is to provide protection, but a lot of love relationships don't end up providing protection. So people provide their own protection by becoming defensive. Defenses over time become rigid in Emotionally Focused couple therapy, I'm used to working with people's defenses so that then I can work below and behind them, because we need to be able to for them, for this, say, a defensive person, we need them to be able to let their partner in. And little bits at a time below and behind their defenses, because emotion is a messenger of love. That's from a general theory of love, the book emotion being the messenger of love, we have to help people share their vulnerable emotions that all humans have, cradle to grave, but my defenses prevent me from sharing my vulnerabilities, and sometimes, over decades, I start believing I don't even have vulnerabilities because I can no longer feel them. So ketamine as a dissociative anesthetic, some people say, Hey, we're therapists. We don't like the word dissociative. Clients who've been word trauma work so hard in therapy to learn how not to dissociate, but what the medicine of ketamine does, what we mean by dissociation, is it unhooks us from our typical defenses, and that's why new therapeutic windows open, ketamine comes into our system and We lose the ability to control our defenses or deploy or employ our defenses, because the medicine, temporarily is more powerful in our brains than anything else, and we have to go where the medicine brings us. And sometimes that's to memories. Sometimes that's to the galaxy and the universe and outer space, sometimes that's too emotion, and people weep. People get mad it. I don't know where the ketamine is going to bring my client or me on any given dose, but I do know that it's benevolent. Disruption helps me heal. It helps to highlight, for me, my leading edges as a human in my continued healing.

Shane Birkel 21:44
And so can I frame this in a different way to just from my own understanding? And you can tell me if it doesn't seem right, but like the way that I might think about it is that, you know, if I if, if somebody grows up in a family that doesn't feel safe, they need to have those protections. You know that that feel that they weren't being taken care of as a child, that I need to learn how to be independent and strong and not let people attack me or something like that. And so they grow up, and they're existing in the world in this way and and part of the way that I see it is that they're not actually living in their conscious, authentic self. It's more of like an ego state, part of them that's a protector that is sort of like looking tough to the world, and they're really disconnected from reality, the truth of the reality, which would be those vulnerable emotions like sadness and fear and hurt, that would take which, in my mind, would take them into their consciousness, their authenticity, which would allow a partner to be able to say, oh my gosh, I really have a chance to know you, to understand you, to see you. And when these protections are up all the time, they think that they're in their conscious self. They think their real self, yeah, right, that this is just, I'm just a strong person or something like that. But their partners, yeah, yeah, but their partner is just feeling disconnected and walled off from them all the time. And so what the when? When you're talking about this, it's like the ketamine is really just take, like, taking those down, those defenses, so they can actually tap in and touch, touch into the that authentic part of themself, which for most of us, when we do for any probably almost 100% of us, is going to feel very scary and going to feel very vulnerable and take us into emotions that we we we try to avoid most of the day.

Kathryn Rheem 23:48
Beautifully said. Shane, absolutely beautiful. Beautiful. Beautifully said, when we don't have access to our authentic self, the Velcro that we need for our love relationships isn't available to our partner. And as as you say, 100% of us, some high percentage of us, grow up not knowing that we had to provide our own protection, when our when our caregivers didn't know how to provide attuned, supportive protection. And so then we come to believe that these defenses are us. This is just me. I don't feel fear. Wait, Catherine, you said hurt. I don't, I don't let, I don't let myself be impacted by hurt. I don't get hurt. And I'm like, Yeah, I know, but that means you're numb. That means you're rolled off. That means you're well defended, and because love requires interdependence, I need to help you find your hurt to share with a safe other, because that's how humans strengthen their connection with a loved one. We have to be able to share, as you said. Sadness, fear, the, you know, the most primary of the primary emotions that all humans have throughout our lifespans. And if we can't share our sadness and fear, then our then our relationships aren't going to have the glue, the bomb, the adhesive that connects us, the velcro and

Shane Birkel 25:18
and so do are people very open to suggestion after they take the ketamine? You know, is, if people are becoming vulnerable, I imagine, you know, there's, you know, the partner has to be very sensitive with that as well. Mm, hmm,

Kathryn Rheem 25:33
such a good point. People on ketamine and other plant based medicines, other mind altering medicines, are more vulnerable, and so a lot of the training I've gotten for ketamine assisted psychotherapy is about how to protect clients from being certainly exploited or being having their vulnerabilities used against them. And so safety between partners, what I'm assessing most for when a client a couple inquires to me about using cap, would I provide cap? Couple therapy for them? My first need is to assess the level of safety between them, because people are very vulnerable. You don't have your regular defenses on ketamine. You might say things that you wouldn't have said, Without ketamine, people will often report feeling like they they're they lose control of, say, holding their bladder. No one's ever peed, but you feel like you might have just peed you haven't, but the our our muscles, throughout our bodies on ketamine, relax in ways that are unfamiliar to us, and it can even on certain higher doses. It can be hard to talk on ketamine as as we're both doing right now. In order to talk, we have to contract our muscles. We we, we contract our muscles in characteristic way. So that's what defenses are rigid contractions in our body that protect us and help give us a modicum of safety when safety through relationships wasn't an option. So ketamine is this amazing facilitator that facilitates the authentic self emerging. And as you said, that can be scary. It is certainly unfamiliar. It can feel out of control. It can be intense, and so being on ketamine, some people like it, some people hate it. I have done bunch of ketamine doses myself for my continued growth and healing. Even just mentioning being on ketamine, my palms start sweating. I have a lot of reverence for the medicine. I know that I want to continue to heal and grow myself and and yet I still feel uncomfortable being out of control, but that's what ketamine, gently, safely allows my nervous system to tolerate what it feels like to not be in so much control or be in charge of all of myself, and in a way, for me, that's one of the reasons I like ketamine, safe, legal, fast acting like I know I can tolerate this for an hour or so, compared to other plant based medicines that take a half a day or a Day and are I just appreciate ketamine's intensity but quickness and so it's hard to voluntarily. It's risky. It's great to voluntarily subject ourselves to a medicine that leaves us feeling like we're not in control temporarily, because we don't know what will happen. We don't know what will come up. We don't know what we'll say, we don't know what we'll think, and that's uncomfortable for humans, but that's exactly the medicine,

Shane Birkel 28:52
yeah, and I think that's why it's so important to have either a sitter, like you said, or a safe environment or therapist, yeah, so that

Kathryn Rheem 29:02
absolutely and if Matthew Perry hadn't done ketamine alone, he wouldn't have died. And Matthew Perry had 75 Matthew Perry's amount dosage was a huge overdose, 75% more than you and I would need if we were having an abdominal surgery in the or he had 75% more ketamine. That is just a massive amount. And I'm really glad that DEA is investigating, because we need to know how he got it all.

Shane Birkel 29:31
Yeah, and so with the with the doses that you're talking about that people take before you work with them, are the conversation similar to conversations you would have, you know, when people aren't taking the medication,

Kathryn Rheem 29:46
yeah, for me, they are sometimes, you know? So we'll, I'll let the medicine peak before I try to start therapy. And I'll try to start therapy as the medicine is waning in their nervous system and the conversations are. Very similar to what to the typical EFT sessions I have with all my other clients. You know, we're looking to access primary emotions, and we're looking to distill those a little bit on ketamine. People have greater access. There's those beautiful window into their vulnerabilities, just as a human, and what it's like for them to be vulnerable, what it's like to for them to have suffer. And people talk about their suffering differently on ketamine. And so this conversation opens up emotion, and as emotion, it's easier to my you know, I work hard as an EMT therapist, one of our primary interventions is to be evocative, to call forth, to draw out the client's primary emotion, because that primary emotion is so important for bonding, for love, to strengthen love. And as a couple's therapist, there's no greater goal in a generic way. But on ketamine, people talk about their experience, even if it's in the present moment, the intensity of what the medicine is doing in their brain. Ketamine really the neurological function of it is with the glutamate system, and it's really increasing neuroplasticity. It's, it's, it's putting neuroplasticity on steroids for up to 72 hours. And so, you know, we all in a way, you know neuroplasticity, neuroplasticity is happening for all of us all the time, but ketamine hastens it. Ketamine amplifies it. We get new neural pathways as a result of ketamine doses. And that is like the ultimate essence of trauma recovery is to have new pathways in my brain for my coping.

Shane Birkel 31:51
And is, I mean, and you had mentioned before, I think it was before we started recording that you know several people who have had a very hard time connecting with their own emotions all of a sudden are, you know, connecting with them when they're using the ketamine? And, I mean, is the, and maybe this is more of a question of like healing from trauma in general. I mean, as part of that, the ability to go into the the pain and the sadness and the fear and realize that it's that you're okay, like in a safe environment, like experience those emotions and come through it.

Kathryn Rheem 32:32
Yeah, that's a great description, and it is a little different for everybody, as you know you already know. And so for some people, memories resurface, and we are reprocessing trauma memories on ketamine with their partner in the room. For some people, they have access to deeper feelings, and they so say, I don't know why I'm weeping. And I say, It's okay. We don't need to know the why. Just keep trusting the process. You're doing great. Other people, it's like they're they're watching for some people on ketamine, they end up and I can never predict how it's going to go. And even, like multiple doses of ketamine, they're not the same. So if it happened for me on ketamine, one way, it might not always happen me working with my trauma on my subsequent ketamine doses. It might not be the same way, but other people have a more meta experience, and they're watching pieces of their trauma like happen to them back then, but they're able to see it so differently. They're watching from a different angle, and they get a different perspective. And I'm not saying detach from it, but they can talk about it and then heal through it. And so the primary trauma and ketamine can feel hard for people, because we know from trauma, people have lost control. They've been exploited, they've been violated, they've been victimized, and they lost their autonomy, and they lost their ability to control and protect themselves. Ketamine contemporarily bring people to a similar state. I'm out of control. I couldn't get up and run if I needed to, and that's scary for people. But if we in a safe environment with safe others, if you can take the risk to see what happens in your body again when you feel out of control and you have a different outcome that also, as we go, that can help heal trauma. My body, from a Peter Levine perspective, my body got to complete the action that it never could complete when the trauma was happening to me. Mm, hmm. And so as the ketamine dose wears off, I'll even help people go back through, bring their body back through those actions that they were doing a version of on ketamine, but might not be able to make a full fist because it's a dissociative. Your muscles don't contract in the same exact ways. Again, this is not on a lower dose. This is a little bit of a between psycholytic and psychedelic. Dosing was when the muscles start losing their ability. Contract, and I help clients know this, because I'll ask questions and we'll see how hard it is for them to talk, how hard it is for them to formulate a thought. And I say, let's not try to talk. Let the medicine do its healing. Trust the medicine. No need to talk, no need to think. So most people with CAP will have music in their ears and eye shades on, and that's often how I start my sessions. But as the medicine peaks, as I was saying, and it starts to wane, then we take the music out of the ears, and eventually people take their eye shades off so they can interact with their partner, just like in regular EFT, yeah,

Shane Birkel 35:40
and you were saying, I forget what it was, something like six weeks or something often, the like, there's a course of treatment that goes and then three weeks. Do you see the benefits of that just continue, even if, even once they're done taking it, you know? Yeah,

Kathryn Rheem 35:58
yeah. So it's six the the induction series that research has validated, I think, four, six years ago, six infusions in three weeks, two to three weeks. And so for TRD and suicide ideation, and it's usually people get pretty instant relief from ketamine. The hard part, though, is that relief doesn't last for long enough, it could last three days, it could last five days. That's why the next infusion is so quickly. We really for for people with TRD and suicide ideation, we really want to saturate their brain with ketamine to really amplify the neurogenesis, to give their brains new ways of coping that take them away from the depression and the suicide ideation, then after, usually after the series, the induction series of six infusions, we have them take at least a week off, sometimes a month, sometimes six weeks to integrate. Therapy continues, and we integrate, and there'll be a time when people start reporting the benefits of the ketamine. I don't feel them as robustly. For some people, it's at three weeks. For other people, it's at three months. Some people get one dose, and that's enough for them other the high that I've heard in my trainings from the good people at Polaris insight in San Francisco is 40 doses of Ken. I myself, and I don't qualify for mental health diagnosis, I myself have had 20 doses, low doses of ketamine for my growth and healing over time, I first asked my doctor to prescribe it a trophy at home for once a week, and then I started doing it every couple weeks, like the the intensity of the need. As you take more ketamine, you then you can space out the doses more. And so then I was going once a month, and every three months, probably now it's been, I don't know, I don't know. I could look at my file the last day, but probably five months. But I can feel in myself like for me, I talk about how ketamine clears out the psychological problems, and I'm a person as an emotionally focused therapist, I'm a person who has a practice of finding and feeling my feelings. And you know, I have been totally impressed how ketamine helps me access deeper feelings that I didn't know I wasn't feeling. Cuz I'm good, I'm not I'm not great, I'm not perfect, but I'm willing to find my fear regularly, like I I've had to heal from my childhood trauma. So anyway, I've been totally impressed with the facilitation of ketamine that has helped me find deeper pockets of feelings that, again, I didn't know were stored in my nervous system. And the relief of that Shane after makes me emotional thinking about some of these doses, again, low dose ketamine. I'm at home with my husband, who's not on ketamine, and when I says my sitter, my safe haven, like, it's just like, I don't know. I just get so much relief. And I like, okay, it's scary. My palms still sweat. I have a lot of reverence, but the relief is just unimaginable. And I I probably tend towards, I know I tend towards anxious, not probably I'm stressed. I'm under professional pressure, and so just that relief that the ketamine provides me. I'm, like, so impressed with it.

Shane Birkel 39:25
Yeah, that's amazing. Well, and it makes sense about the spacing out, because, as you and I are talk therapists, so you know, we have the belief that, you know, when that ketamine is offering you this opportunity, it's really something that's going on inside of you when you're connecting with those emotions. The benefits of that will, you know, continue, whether you're taking it or not. That's right, it makes a lot of sense.

Kathryn Rheem 39:51
And the the benefits of it do eventually accumulate. And I feel like and people I love, and I not just clients, but. Family members, I can see their baseline, my own baseline, improving over time. Mm, hmm, right. People. I did a meet and greet with a couple who wants me to consider providing cap for them, and I'm considering it. And one of them has had two doses. And I asked the partner, have you noticed any changes in your partner after the two doses? And the partner said, Yeah, I think they're less anxious. And that would be true for me too. Like ketamine has has helped me slow my anxious thoughts, brain, way of coping, and I have more of a chance to pause, and I just have, I just have a slowed down reaction. Mm, hmm. And I grew up having to be or learning to be, or becoming whatever is Fairest to everybody in my life, a reactive person, like I had to fight I didn't want to fight. And so my whole life, and I'm 57 now, my whole life has been spent in therapy, becoming a therapist, learning how to how to slow down my own reactivity and therapy has been incredibly helpful on and off over my life. But I might say that ketamine has been the most helpful. Wow,

Shane Birkel 41:12
it's amazing.

Kathryn Rheem 41:14
Yeah, it's been really remarkable. If

Shane Birkel 41:17
people are thinking about this. I mean, what Where is a good place for them to like, like, I don't know if people should just go to their doctor and be like, Hey, can you prescribe me ketamine? Where would be a good place to start, for them to learn, like, start learning more about it, or, or, you know, seeking out a safe way to sort of find information about this.

Kathryn Rheem 41:37
Yeah, that's a great question. I'm thinking from a client perspective, there's some great YouTube videos Doctor Huberman journey, clinical people might already have heard of mind bloom. So there are some online resources that can teach prospective clients about cap and ketamine. The hard part is, ketamine as a medicine can bring people relief, but ketamine as a medicine, by itself, doesn't bring people as much relief as having a therapist there. And so that's why I'm trained in and a huge proponent of cap, because it's very different. We know ketamine is still used recreationally. We know it can be addicted. We know we have to be cautious and thoughtful and clinical about the applications of ketamine, and that's why we know the risk for addiction and overdosing, you know, goes way down when you're doing it in a clinical setting. Mm, hmm. So we really don't want people to go out and to get ketamine on the street. Of course, we have no idea where it comes from and what might be. You know, put into the ketamine on the street, it's super scary these days, but when you get ketamine from a reputable prescriber and pharmacy, and you do it with a safe other, and ideally with a cap therapist. The the gains just are exponential. You know, I can't guarantee anybody anything, but I can say I know the relational possibilities go way up when you're sitting with a safe other. That psychological safety is, as Steve Porges says, the precursor to attachment. We all need safety. And so I'm I am finding how, how to get ketamine is one thing, but doing it without safety is not at all what we're recommend, not at all what I'm talking about. And so go ahead

Shane Birkel 43:38
and is it important to for people like, it depends how you're making sense of the experience, right? Like, like you're talking about, you know, a lot of us, a lot of us, go through our life with a lot of anxiety, right? Which, which, I think is probably most of the time a protector. Part of us going through the world, you know, seeking to see what things could be dangerous for us. But you know, when the when the ketamine takes that away, it's important to like, how am I making sense of the world now? How do I keep myself protected and safe, but but allow myself to go into these healthy emotions when it's appropriate as well? That's

Kathryn Rheem 44:18
right. I mean, again, I might be being repetitive, but we are meant as a nervous system. We are meant to get our safety by being in safe relationships. That's Bobby's attachment theory. That's Jim Cohn's social baseline theory. That's Louis cozlino in the neuroscience so much science these days has confirmed that fact, but for so many of us, our relationships didn't provide that safety and protection. So we as we've already just discussed, we got defensive, we get anxious, as you're saying. So the whole point about lowering our defenses or trying ketamine isn't to go out and do it by myself. The whole point is to bring the potential. Possible intervention of ketamine to my relationship that ideally is already growing in its safety. Mm, hmm. And then we use ketamine. It's well paced that dosing is appropriate to lower our defenses, to improve our emotional communication with, you know, with, with the people I love. And so I'm not talking about it on a on a as a party drug at all. I'm not talking about it as a reckless overdose, scary situation. All medicines have side effects. And so what we're talking about is the clinical application of low dose ketamine to improve mental health for individuals and in their relationships.

Shane Birkel 45:46
Yeah, yeah. Great, good. Yeah,

Kathryn Rheem 45:49
yeah, yeah, that, that piece. I'm really glad we got a chance to talk about this last bit Shane, because this piece is really important. It's not about going and finding the medicine. Just just say, Oh, I heard this podcast. This is safe, yeah,

Shane Birkel 46:05
right, right. And like we're saying, like, I totally agree with what you're saying, that I think that having a good therapist to help you along that journey is going to be really important, or some kind of provider

Kathryn Rheem 46:21
at least. Yeah, yeah. So going back to your other great question that I haven't really answered. I'm sorry, long winded, but you knew

Shane Birkel 46:28
that about me. No problem. No, this is great.

Kathryn Rheem 46:33
Where can people find let's if you don't mind me revising the question a little bit, yeah. Where can people find ketamine assisted psychotherapy, because as a cap psychotherapist, I help people get connected with prescribers that I've built a collaborative relationship with, and so we together collaborate on finding or getting if, if the patient qualifies for prescription for ketamine. And again, that's not up to me, thankfully, I don't want that decision, but that's an evaluative process and an assessment done by a medical prescriber, and then they prescribe, literally on the prescription for use in cap or use with cap and Catherine Green. And it's always interesting to me when my client says, Oh yeah, your name is on my bottle. Like, oh, okay, that's how that doctor did that. Okay, good to know. Yeah, interesting, yeah. And so that's the importance of the relationship. This is not medicine you go off and take by yourself. Mm hmm. This is medicine used in conjunction with therapy and so people. So there are online places called Mind bloom and journey clinical, and there are many others at this point. And then there, there's a growing like I'm in the Washington, DC area, we have a local listserv ketamine and psychedelic assisted providers that we are in touch with. So you want to access your local therapist and ask them if they provide cap, and who that do they know? And I've, I've started a little group of efters who are interested or who are already providing ketamine assisted EFT. So we're coalescing. We're finding each other. Yeah, and what's been, not underground, because it's been illegal, but just a very on the down, low, quiet growth in our EFT community. We're now finding each other and connecting and collaborating and helping each other, because it is so new. Yeah,

Shane Birkel 48:34
yeah. And hopefully that'll be the case more and more as time goes on, in whatever the communities people live in that it'll become more known who can do that kind of thing. Mm, hmm,

Kathryn Rheem 48:46
you know, I have, you know, I belong to a couple different cap listservs, and we all are connecting and building networks. And hey, who is in Des Moines, Iowa, or who was in wherever we happen to hear from someone. So we help good people try to find a great, not only prescriber, but therapist that can collaborate with each other for the client's benefit. Yeah, yeah. I wish I had a go to resource to name for people interested in finding cap. That's a need in this new in this leading edge of our field, we don't have a resource that I know of, I know resources for professionals.

Shane Birkel 49:25
Yeah, and what is something like a company like mindbloom? What is that

Kathryn Rheem 49:30
mindbloom is part of them, but, yeah, mindbloom is an online platform where people in the US, I think I don't know if it's in every state, but you can pay money to get assessed, and if you qualify, get a prescription for ketamine, and then they will provide some therapeutic support. I've actually lost track of how it works. I don't, don't know that they actually provide the the cap while you're on the medicine, but they're, they make sure that you're. A sitter, which is the minimum standard for safety, a sober sitter that is sitting with you or nearby you say you have to get up and go to the bathroom. Well, on ketamine, it's really hard to walk safely. The last thing we want you to do is take ketamine in your bed. But think, you know, feel like you need to go the bathroom and try to get up and walk to the bathroom, fall and hit your head. Mm hmm, that is realistic, and that needs to be prevented. Yeah. And so, if nothing else, you have someone to help you get to and from the bathroom. Mm hmm, or to ask you okay. I know you feel. You know, medically speaking, I listen to the nurses at the ketamine clinic, where I collaborate and see clients there. And we even warn them, please go to the bathroom the last thing you do before you get the IV of ketamine. But don't be surprised if you at some point on the dose, you feel the need to go to the bathroom, and we'll ask you to wait for a minute to see if it goes away. Yeah, because, as we highlighted a few minutes ago on ketamine, your body relaxes in uncharacteristic way. And people feel like we're used to holding our bladders. We're used to holding our bowels. And so when people feel that deeper relaxation, it's like, oh, do I need to go, Mm, hmm. And you sometimes don't need, oftentimes, on ketamine, you'll have the feeling, but you don't have the biological need, right and so, but needing, but, of course, sometimes people do need to go and getting help to and from the bathroom. That's a simple example of why we have to have sitters so mind bloom and journey clinical and other online places will make sure that, I hope I don't know all their details. I've looked into them on and off over the years, we'll make sure that you have a sitter and that there's a therapeutic check in. Again, I don't know what they offer, what that all means, but what I do is, when you're actually on the medicine, that's where I feel like somebody like me can have the greatest potential for helping get therapeutic gains. Okay, yeah, increasing the potential for therapeutic gains is have the therapy while you're actually on this.

Shane Birkel 52:04
Yeah, yeah, that's great. Well, I know we're getting close to the end of our conversation. Any anything else that you would mention about this before we start to wrap it up?

Kathryn Rheem 52:13
Wow. I just appreciate your interest the opportunity to talk about it again. It is a leading edge in our field, it does have to be done really safely. We all, all of us providing cap, have had hundreds of hours of training and personal experience. So it's really important to find therapist who's actually been trained in providing ketamine assisted psychotherapy. I've loved how it's helped my clients in EFT. It has really opened up new windows for them. And I used to think one last thing, and I'll end here. Shane one ketamine at first was taught as an assist for the clients. And I thought, cool, like, yeah, the limits of talk therapy are real. I've noticed that over the years myself, there are certain clients that came to mind where we did really good work. We all worked really, really hard. But the gains of therapy, I've I've done three rounds of EFT with them over 12 or 13 years, like they keep needing to come back. But they worked hard. They did well. We were in the model we were doing pure EFT as best as any one human can apply it. But not only is ketamine an assist for the clients, which it is, because we know the limits of talk therapy for lots of good people, but what I realized over the last few years, and I felt a little sheepish realizing this initially, it's an assist for the clinician, Mm, hmm, and that's okay. I feel I even feel sheepish mentioning it now, because my first thought was, oh, gosh, do I need an assist? Does that mean I'm not capable or competent or well trained or good enough at my job? But then I also think I've been burned out three times in 20 years. I work really hard. I feel like session by session, I'm doing microsurgery to help people find their fear in a gentle and kind way. I'm always interested in helping people befriend their inner world so they can have an authentic life and relationships based on who they really are, each of them authentically. Adamine assists clinicians as well as it does clients, and I'm grateful for that.

Shane Birkel 54:22
Mm hmm,

Kathryn Rheem 54:23
that's an amazing, yeah, that's an amazing gift that I didn't expect when I saw that started becoming a ketamine getting trained in ketamine assisted psychotherapy. I was doing it for my clients, but then I'm like, Wait, this is helping me. Mm hmm,

Shane Birkel 54:37
yeah, absolutely. And why wouldn't we want to use it everything we possibly could? You know exactly? Yeah, that's great.

Kathryn Rheem 54:44
Yeah, yeah. So I feel less sheepish about this, even though I still feel a little sheepish, even just mentioning it with you now. But why wouldn't we want to use something that helps clinicians and clients? Yeah, absolutely

Shane Birkel 54:57
and before. To end here. Do you want to mention the EFT Cafe as well or in your website and things like you? Yeah,

Kathryn Rheem 55:06
yeah, I do. Thank you so much for the opportunity. I'm a co founder and co director of something called the EFT Cafe, which is an online class for mental health clinicians who want to do better public therapy. My dear friend and colleague and co founder of the cafe, Jennifer Olden, we teach EFT twice a month in live webinars, and the first webinar of every month is working from a videotape of one of my real couples, and sometimes the client is on ketamine. And so we have been adding ketamine assisted EFT to our cafe offerings to show our cafe members, our cafe community mental health clinicians who have joined the cafe, how to use this adjunct intervention of cap. So the cafe is my most beloved professional opportunity these days. I love teaching EFT. I'm grateful I get to teach it every month, and I get to teach in real creative ways, using videos of real couples who are struggling, like a lot of us do, and we slow down. We talk about things that worked, interventions that worked, and interventions that didn't work. And then the second webinar of every month in the cafe, we answer your questions so you can submit any question about EFT you want to submit, and we call it office hours, much like the old school ways of being on a campus, and your professor or your TA offering office hours. So we love our EFT cafe. The website is just the name.com, TheEFTcafe.com. Thank you very much, Shane for the opportunity to mention,

Shane Birkel 56:43
yeah, that's great. What a great opportunity for people to learn. Yeah, so

Kathryn Rheem 56:47
everything's recorded. You don't have to join us live to get the learnings. We record all of our webinars. We have people all around the world as part of our community. And yeah, if you're interested in joining, go toTheEFTcafe.com and we will send you an email that tells you how to join.

Shane Birkel 57:03
Okay, great, great. Sounds good.

Kathryn Rheem 57:07
Thank you for letting me mention that. Yeah, absolutely,

Shane Birkel 57:09
yeah. Well, thank you so much for coming on. Kathryn, it's so great to talk to you again. Likewise, let's talk again sooner than we did this last time.

Kathryn Rheem 57:19
Oh, man, I would welcome that, Shane, thanks again.

Shane Birkel 57:22
Yeah, absolutely. All right. Take care. All right. Thank you so much, Kathryn, and thank you to all you listeners out there, definitely go to the couples therapist couch.com to learn more about the podcast and other episodes. We have all kinds of topics, and if you're interested, right now is a great time to join the Couples Therapist Inner Circle. That's a group, a membership, that you can join to get support and education on becoming a better couples therapist, taking your couples therapy to the next level. We have people asking questions all the time, getting support, answering each other's questions, giving feedback and insight, and also you get access to the content library, which has workshops on all kinds of different topics, over 100 hours of content from over the last few years. So I'd really love to have you join there's a no risk guarantee right now, seven days for free, you can check it out, get in there, see if you like it, and if it's not a good fit, then you can cancel. So click on the link below. There's all kinds of details there. You can learn more. Definitely reach out to me if you have any questions. I'm Shane Birkel, and this is The Couples Therapist Couch. Thanks, everybody. Take care!

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