By Jason Schwab

After years of seeking refuge at the bottom of a bottle, Karen Shaw’s experimentation with psilocybin yielded unexpected discoveries… and a fresh start

Not long after Karen Shaw started microdosing psilocybin, a very distinct thought seemed to cry out, louder than the rest.

“One of the things I said to myself is I have to make my life more beautiful. I have to do things to make my life beautiful and happy.”

For months leading up to this point, Karen’s life felt far from beautiful.

Having deviated from her career to start a silversmithing business with her partner of 10 years, the venture turned sour early on as their relationship disintegrated. With both her professional and personal lives entwined in a deepening crisis, the depression and anxiety Karen had struggled with for decades intensified and began to close in.

Laying out the story from her home office in The Hague, at this point Karen paused and looked down at her teacup. A feeble laugh and a pixelated Skype connection did little to disguise her lingering pain.

“I’m a bit surprised. I thought I was over it. But there’s obviously still something there. I’m happy to be talking about it,” she said, lifting her chin. “They were bad days. Feeling like I could spiral into the depths of despair and not come out of it.

“I felt like I was hanging on for dear life sometimes.

“Just trying to keep my sanity and keep going. And of course, relying on drink too much.”

Alcohol had been a toxic ally during ongoing bouts with mental illness. Feeling trapped in a decaying business still reeking of her failed romance, Karen’s reliance on the habit grew.

“I think it was vodka at the time. If I’m honest about it, I was probably drinking between half a bottle to a bottle of it a day.”

***

Karen’s mounting dread and desperation, as well as her dissatisfaction with past mental health treatment, sent her searching for other solutions. Having stumbled across an article on microdosing a few years earlier, Karen decided it was an alternative measure she was willing to try. Living in the Netherlands, this was a significantly easier undertaking for her than it would be for many others.

“I bought a grow kit of magic mushrooms at a shop down the road from me. I grew them, dried them and I started microdosing in March 2017,” she said.

Following a protocol recommended by psychologist and psychedelic researcher, Dr. James Fadiman, Karen took a sub-perceptible dose of psilocybin mushrooms twice a week for six weeks.

“I would weigh out 0.2 to 0.3 of a gram and put it in a little capsule and take that in the morning. I would do that on Wednesdays and Sundays. They were my microdosing days,” she recalled.

From there, it didn’t take long for things in Karen’s life to start rearranging. Within weeks, she was finally able to pry herself from the doomed business and damaging relationship. While walking away was liberating, the reprieve was brief. At 59-years-of-age, having to join the unemployment line offered proof her life would have to get ugly before finding beauty.

“I was on employment benefits and I had the opportunity to do some courses in how to design what you want to do with your life. I remember feeling very insecure walking into those rooms, feeling everybody was looking at me. I didn’t want to be there.”

The early days of her microdosing experiment also proved a little bumpy. With some gentle coercion from the psilocybin she was taking, Karen was forced to embrace a deeper level of vulnerability and openness, which caused her to “feel a lot of anxiety at first. I think it’s because I felt that I actually had to face the problems I was going through,” she said. “It (microdosing) does make you think a lot more. It makes you analyze yourself and why you do things and of course that can make you feel uncomfortable.”

But as the days inched past, anxiety gave way to something else.

“There was a gradual realization that things were getting better. That I could handle things better. I was much calmer.”

Eventually, this shift unearthed another realization Karen would never have thought possible… She was now ready to say goodbye to an old and domineering friend.

“I started drinking less. I’ve not stopped. I might have a glass of wine, or some cannabis, a joint after work. But I don’t drink to excess. I don’t like getting drunk anymore. It’s not something I enjoy.”

***

Following a 10-week break, Karen began her second round of microdosing, and the insights continued to flow, alongside some unexpected opportunities. A few months after making the tough decision to abandon silversmithing, someone approached Karen and offered her work on a small project. Given her background in graphic design and website creation, she decided to take it on. Then, a crazy notion caught her attention.

“I thought, ‘okay, now’s a good time to start my own business.’ Which I did.”

Softly spoken and harboring a gentle temperament, Karen doesn’t come across as the bragging type. But as she described her newfound joy and contentment at growing her fledgling freelancing venture, she allowed herself a confident smile. Progress is going well. Networking events have filled her calendar as she seeks to expand her client base.

“Before, I just didn’t think I had it in me. But I haven’t looked back since.”

Throughout this time, Karen has continued to microdose on and off. She’s recently returned to it again, this time only taking one dose a week. As well as using psilocybin to climb out of a depressive slump, Karen found it’s benefitted her creativity, ultimately aiding her work.

“When you microdose, you sort of go into this flow state and become very, very aware of everything around you. At first, I could get very distracted. But once I could control it and focus it on one thing… well, you just forget everything. You get a sort of childlike delight. It’s difficult to explain,” she said, shaking her head.

“I feel I can enjoy everything much more completely than I have done for a long time.”

Digging into the depths of her artistic potential, Karen has also discovered a love of writing. With the freedom to explore a new passion, she’s since developed it into more than just a pastime, and now offers it as part of her professional repertoire.

“I always thought I hated writing. These days, I can spend hours getting the tone and the message right and enjoying the language. I’d never enjoyed that before.”

While she’s relishing a fresh start, Karen realizes the difference between her old life and her recent achievements is terrifyingly slim. Asked where she’d be right now, had she not purchased that mushroom grow kit… Karen was adamant she’d be worse off.

“I’d probably still be drinking a lot and just not enjoying life.”

Having come close to snaring a number of helpdesk positions during her time searching for work, Karen is grateful such an opportunity never came to fruition.

“I would have jumped at whatever came along. I’d be sitting behind a computer answering problem emails all day and feeling very bored and very unhappy with myself.”

***

While Karen’s career has enjoyed a kickstart, the most radical transformation has been unfolding internally.

“One thing I noticed is I actually like spending time on my own. I like being in my own head.”

This prospect, as simple as it seems, wasn’t an option for Karen before microdosing. Stuck in a never-ending game of cranial cat and mouse, she spent much of her mental capacity drowning out the pain of her thoughts and problems. When this got too strenuous, liquor was able to finish the job.

“My head was like one of those old telephone exchanges,” Karen said, tensing her hands all talon-like above her light brown hair to emphasize the analogy. “And it was a terrible mess. I didn’t know what my problems were. I didn’t know how to turn my life around. I didn’t know how to stop drinking. I didn’t want to stop drinking.”

The biggest gift psilocybin gave her, Karen said, was a “brain reboot”.

“It’s as if you had all this chaos in your brain then all of a sudden, it sorts itself out and all of the connections are working properly again. You can think more clearly and make better decisions.”

While the phrase “brain reboot” feels as if it was lifted straight from the greasy elevator pitch of a Shake Weight salesman, proof of Karen’s claim goes far beyond her words — it’s written all over her demeanor. The current portrait of Karen Shaw hasn’t a single brushstroke of the anxious scrapheap she spent half the interview describing.

“I think if you spoke to my eldest daughter, she would say that I’m a very, very different person now than I used to be.”

So different, in fact, that talking to this daughter wasn’t something even Karen herself could do back then. Difficulties communicating led to frequent confrontations. The shame she carries about for being inattentive to her children’s needs was just as easy to pick up on as her own emotional scarring.

“When you feel pain inside, it’s very difficult to connect with other people. You tend to lash out at them and not be aware of their situation and their feelings,” she said. “I don’t think I’d ever thought about my role as a mother before. I sort of just became a mother but never thought about what that really means. Which sounds awful doesn’t it?”

As Karen’s relationship with psilocybin deepened, so too did the frayed relationship with her eldest daughter start to mend. Being less swept up in her perceived problems, Karen’s empathy grew. Perhaps for the first time in her life, Karen started truly listening to her daughter.

“She’s much more willing to phone me about her problems and I’m not just able to help her more, but I’m happy to as well. I’m gradually getting this feeling that I want to be a role model.

“I want to show my daughters that you can work for yourself. You can be an independent woman and enjoy your life. I’d never thought that before.”

Admitting this was a completely unexpected development in her microdosing journey, the sheepish excitement that crept into Karen’s features betrayed her gratitude for it nevertheless.

“I’m even looking forward to being a grandmother. Before, that was something I didn’t want to think about. I thought being a grandmother meant you were old!” Karen laughed, but was cut short by the follow up: Is it possible a reconciliation may never have taken place?

“I think if I’d carried on like I was, then I really think we might have grown further and further apart. It’s awful to think that was definitely a possibility.”

***

Beyond the prospect of becoming a grandmother, Karen has much more to look forward to. Chief among all of that is a commitment to spend as much time as possible with herself.

Being at home, enjoying creative pursuits, cooking, and gardening now sit at the top of her list of priorities. The simple pleasures, it seems, are where she’s discovering vitality, as well as that all-important objective she set out to achieve back when her life fell down around her ankles — these days, Karen finds beauty where she’d never once cared to look.

“I can spend hours just watching the birds and the insects… Oh, and the spiders!” Karen added, an overt tinge of enthusiasm taking hold of her voice. Someone imbued with a healthy distrust of spiders might even describe her tone as bearing an irrational relish. “I find myself being blown away by the incredible beauty of their webs and how they made them and what clever little creatures they are.

“I even postponed trimming one of my bushes because a spider had its web up and it was obviously preparing for winter. I wouldn’t have thought that way before. I’m much more empathetic and feel very connected to everything.

“I bet I sound very silly now, don’t I?”

To those scared of spiders, yes. But to those working in certain research labs at Columbia and Yale, not at all.

Last year, a published study out of the Spiritual Mind Body Institute suggested cultivating a belief in being connected to something greater than oneself can “have profound impacts on people’s lives”. Having highlighted exactly where in the brain transcendent states are processed also helped researchers deduce that spiritual encounters aren’t just limited to religious practice, but can be brought about in many varied ways.

Potentially, Karen’s newfound love of spiders, and nature, in general, may be helping her build a brighter outlook and find greater meaning.

“Life is such a great thing. It’s all around us. The world is teeming with life and we’re just a tiny little part of this living entity,” she said, before more muttering about sounding silly again.

As for microdosing, Karen plans to continue with one capsule a week, for as long as she feels is necessary. Lately, the toughest thing about it is actually remembering to take the dose. Without a reminder set in her phone, she’s prone to forgetting it altogether. It’s a much different relationship with substances she’s still getting used to, but understandably, she doesn’t mind the change.

“I’m healing. I don’t know if that process will ever stop, because you’re always growing and changing. But it’s certainly put me on a different path and has me feeling a lot better about myself,” she said. “The world could do with a lot more microdosing, I think there are a lot of people who could benefit.”

About the Author

Jason Schwab: When a 10-week microdosing experiment helped Jason overcome a lifelong struggle with depression and anxiety, he immediately became a passionate advocate for the widespread acceptance of psychedelics. A believer in the power of informed, intentional substance use to foster positive transformation, Jason knows that pulling people’s stories out from the shadow of prohibition is key to inspiring true healing on a global scale. A former journalist, he now travels the world seeking out the everyday men and women taking ownership of their health and wellbeing, making a real difference in their own lives, and consequently, the lives of others.

This interview was transcribed from our Navigating Psychedelics: Lessons on Self-Care & Integration master class with Elizabeth Gibson of Dreamshadow Transpersonal Breathwork. In this interview, Elizabeth shares her insights of integrating exceptional experiences from facilitating and working with Holotropic Breathwork for over 25 years. Elizabeth has a great wealth of knowledge about the integration process and we are honored to present her insights.

Introduction

Kyle Buller: Welcome to the Psychedelics Today exclusive interview for the Self Care and Integration course. Today we are here with Elizabeth Gibson of DreamShadow Transpersonal Breathwork to talk about integration and breathwork. Thank you for joining us today, Elizabeth. It’s great to have you on.

Elizabeth Gibson: Thanks for having me, I’m happy to be here.

Kyle: So, let’s dig in, what does integration mean to you?

Elizabeth: Well, it’s a big topic and a really important topic to me. To me, integration is one of the most important aspects of work with extraordinary experiences. How do you take material that’s come up for you and bring it into your everyday life? That’s where the real benefit of this work comes from. I think it’s a topic that’s often overlooked.

So, how do people go back out into the world and realize the benefits of the intense inner work that they’ve done? That’s what it’s about to me. It’s about how people figure out how to do that and supporting them in that process.

Kyle: To backtrack a little bit, you have been facilitating breathwork for almost 20 years at this point? [25 years as of 2019].

And then you also were part of some MDMA therapy back in the 80s, right? When it was legal? So, you’ve been in this work for a while — working with people with non-ordinary states and doing integration work.

Elizabeth: Trying to, yeah.

Joe: What are some of the most important thing you see people maybe not do adequately to try to integrate?

Elizabeth: Well, I think the basic principle that we always remind people of when they are leaving a workshop or leaving a session that has involved an intense experience of any kind is the ongoing nature of the process. So, a lot of people who are, especially people who are new to this work, tend to think it’s all about the session.

The session, of course, is extremely important, but the process continues after the session is over. The intense emotions or material that has begun to come up during the session, if it’s a very organic process, can continue in the days and weeks after the session has actually taken place.

So, it’s really important to remind people that it’s important to give themselves space and to allow that process to continue and to really respect what’s going on inside and not try to jump right back into everyday life and the demands of work. given that, for many people, that’s a very difficult thing. People have jobs and families and relationships that they’re going back to.

It is important to remind them to remember the ongoing nature of the process and that it’s not all about your hours in the session. I think all of us who have done this work ourselves personally, I mean, I remember after when I did MDMA-assisted psychotherapy back in the ’80s, I can remember for days afterwards just kind of yearning to get back in the space I had been in.

It seemed like such a sweet experience and my life outside of the session seemed pale by experiences. It’s almost if I was trying to get back to where I had been in the session instead of understanding that I needed to pay attention to what was happening to myself right now in the moment and reconnect with myself in that way.

I think that’s really what integration is about — learning to be more present and authentic with ourselves in the moment. No matter what we are doing, whether we’re in an intense session or you know, even something as mundane as washing the dishes.

Kyle: Yeah, you make some really great points. Joe and I put that quote, “chop wood, carry water” in our presentation in this course. But also, it seems like people want to jump back into sessions again, like I think we brought up the fact that people may want to just go back and do ayahuasca ceremonies over and over again.

Maybe not because of the purging aspect, but just continue taking drugs to stay in that state (of consciousness). Or go back and do a bunch of breathwork sessions to move through some stuff. I think it is important to have that downtime and really be able to embody the experience and really understand what that means.

Elizabeth: I agree, Kyle. I think a lot of the changes that come about as a result of doing this work are subtle changes. The traumatic changes are fairly obvious and maybe don’t need as much attention in the sense that with the subtle changes they can be easily overlooked. The long-term changes that take place over time, those are the ones that I think you really want to honor and respect and give space to allow that to happen in yourself.

Developing A Daily Practice

Kyle: Do you have any tips or advice to how to stay in the moment after a session for the next week or a couple months to really embody what just happened?

Elizabeth: Yeah, well that’s the challenge. I think that it really is a very individual thing. There are specific techniques that can be used.  I was looking this morning, and Stan Grof spoke in his book, Holotropic Breathwork, He has a couple of entries for integration. He talks about specific kinds of techniques that can be helpful for people after they do this kind of work. And you know, it’s the kinds of techniques that allow you to tap into yourself, be it whatever kind of form meditation works for you.

Some people like sitting meditation, some people like more active kinds of meditation like tai chi. Some people can’t really connect with meditation at all and there can be other kinds of activities like I remembered when I read Stan’s passage that he used to recommend for people who had intense kinds of physical experiences, that aerobic exercise, like swimming, running, for people who might be inclined in that way, who are more physically active, just as a way of connecting with the kind of energy and feelings that are operating at the deeper levels.

So, for me, I always have found it helpful to journal about my experiences in the days afterward. Not right after an experience because I’m not that verbal yet, which is why initially after a breathwork session, for instance, we offer drawing materials so people can just work with shapes and colors and begin to work with their experiences symbolically on that level before even putting words to them.

But then maybe a day or two later, I always find it really helpful to write about my experience. I notice if I keep up the process journaling in the days moving forward from there, I’m apt to stay more connected with the feelings of the experience.

But again, it’s whatever works for an individual person to create space for themselves to just sink into themselves. Basically, that means some kind of ongoing form of practice, daily practice, whatever works. And that’s a very personal and individual kind of thing.

And we’ve all, I know, tried in our lives to stick to some kind of practice. We’ve tried lots of things. What I’ve learned over the years is for me, I have to make my practice manageable. I can’t try and make it too big. So, I’ve learned for me, if I do something every morning for about half an hour, that’s probably the most realistic expectation I can have for myself.

So, I like to do yoga and tai chi, and I like to journal. Some combination or at least one of those, ideally in the morning. But then during the day, I mean, think what you like to do to nurture and support yourself. Get outside, go for a walk, connect with nature, to work it into your daily life as much as you can so it’s not like a separate kind of thing that becomes one more thing to do every day that you may not get to.

Kyle: Right. And then if you start acting that way, then you start beating yourself up that you’re not practicing, so yeah. I know that happens to me. I’m like, “Ah, I should really meditate more.” Then I think to myself, “Well, why am I beating myself up over it?”

Elizabeth: Yeah, yeah.

But do you find that? I mean, I do. I know that if I do something first thing in the morning, then if I wait ’til the end of the day, it’s less likely that it’s going to happen, so-

Kyle: Absolutely.

Elizabeth: My tai chi teacher used to say, “Just do it before you think too much about it. Get up and do it.”

The Importance of Community and Group Process

Joe: Can you think of any things not to do that might impact integration in a negative way?

Elizabeth: That’s a really interesting question, Joe. Things not to do. I think it’s important not to isolate yourself after you do this kind of work. So, that in addition to the whole principle of the ongoing nature of the process, I think the principle of community is really important.

I’ve come to appreciate the community around breathwork over the years — the relationships that we have created and the support that people offer each other. I really think we can’t do this kind of work completely on our own. We need support not just during the sessions, but in the days and weeks, months and even years between sessions.

We need support. We need to be able to talk with people about our experiences. We need to process our experiences verbally. I mean, we’re very social animals as human beings and we thrive in group kinds of settings. Now, some people at first are put off by group experiences and prefer to work one on one, maybe with a guide or a therapist. And that’s fine, but usually, there’s at least one other person involved. Somebody who can help you get through the rough spots in a way that’s supportive and not overly directive. And that can be a good friend as much as a therapist or an experience facilitator.

Kyle: Yeah. What’s Lenny’s saying? “We’re the descendants of very successful tribes.”

Elizabeth: Yeah, we’re all the descendants of successful tribes. So, that’s part of our heritage. I think in our margin, in our modern culture, that’s something that’s missing. And you see a lot of people just yearning for that kind of communal experience.

A lot of people come to our workshops, I see them get so much meaning and joy out of just the personal connections that are made. A lot of people are simply lonely, and you just need that kind of contact and the building of community and relationships.

Kyle: It makes me think a lot about rites of passages, how those are formed, say, in some of those traditional cultures where maybe the adolescent would go out and you’d have this experience, but then they’d have the safety net of the elders, the container, and the community to come back to.

And when we have these really big experiences, I mean, we might have a few people to talk to, but we don’t really have that community to come back to. I know after my near-death experience, I was like, “Whoa, who do I talk to you about this now? I can’t really talk to my parents about it.” And I had to leave to find that. And I found it in Burlington. I found it in breathwork with you and Lenny.

Elizabeth: I remember that about you, Kyle. And that was a process that took many years for you to build that kind of community. So, as a young teenager, that was really … As I understand it, that was one of the hardest aspects of it afterwards was that you didn’t have anybody you felt you could really talk to.

Kyle: Yeah, exactly. And that’s been one of the biggest integration pieces for me when I think about integration — how do you just be okay with the people around you and learn how to just embody that experience even though you might not be able to talk to that person necessarily? How do you continue to be in a relationship with them and not feel so isolated?

Elizabeth: Well that kind of goes back to your last question, Joe, of what not to do. So, Kyle just touched on that really when he mentioned who you can’t talk to about these experiences. So, I think it’s important to search out people who you know will be supportive and understanding, and not share your experiences with people who might discount or trivialize your experience because they just don’t understand this kind of work.

And that can be lonely if it’s somebody important in your life that you can’t discuss these kinds of experiences with. That’s definitely a big dilemma.

Kyle: Do you have any tips or advice to work through anything that arises after a workshop or an experience? We talk about the process continuing, but maybe how to work with some of that stuff that comes up in the next coming weeks to months.

Elizabeth: Well, so if there’s somatic stuff coming up in the body, it can be really helpful to go get some bodywork after a session. A really good deep tissue massage or any kind of work that’s going to help resolve things that might still be coming up in the body. We’re fortunate now in this day and age, there are so many different kinds of bodywork.

Bodywork can be extremely helpful.

And then those of us who are holding the space for people and supporting this kind of work, I think it’s on us to make ourselves accessible to people after the sessions and to say that we can be available for them to reach out and contact us if they’re having trouble — so that they know there’s somebody who understands what they’ve been through who’s there for them to listen to them.

I mean sometimes people just need to talk. It’s not like you have to do much else than just listen and support them with your attention. People need to be heard and feel that what they’re experiencing isn’t totally abnormal but it’s just a normal part of their process. That can be all they need maybe. Just a friend or a person who understands that they can talk with.

Joe: That ties into a lot of what we’ve been talking about lately where, maybe you have these integration groups, but that’s the essence of it right there is just to talk and be heard.

Elizabeth: I love the idea of the integration groups that you guys are doing. I mean, I think that’s exactly the kind of format that will help fill in the space in between experiential sessions and give people the sense of community and belonging.

I mean look at the whole AA thing, the fact that that’s done as group work. I mean, people struggling with in the addiction field, they go to groups that meet regularly where they can talk about their experiences and share them and feel that kind of support.

That has been an incredibly successful approach over the years. So, I think your idea of having these integration groups is exactly the kind of approach that’s going to be helpful for people who are struggling with integrating extraordinary experiences. I’m really happy you’re doing that.

Kyle: Thank you. Yeah, part of it too is we come to your workshop for a weekend, have these really close connections, have these really powerful experiences, and then in between it’s like, “Oh, where’s that community?”

So, part of it for me is how do we keep it going? How do we keep the conversation going and finding those people that we can support and hold space for so the process can continue and it’s still healing with it.

Elizabeth: Technology has made that easier too. I mean, look at what we’re doing right now. And the fact, even as an email group, you can continue sharing. It definitely has its limitations, but it’s better than nothing.

Don’t Make Any Big Changes Right Away

Joe: You often speak about not making any big changes in the next six months. Can you speak about that?

Elizabeth: Yeah. Well, a lot of times people take material that comes up in their sessions, there’s a tendency maybe to take it literally and think that to interpret their session in a certain way that makes them think, “Oh, that means I need to leave my job right now, or I need to end this relationship now.”

We encourage people to sit with that for a little while before they act on it, to be sure that things have settled and that they’ve had some time to process their experience a little more before making any major life decisions.

But there are no hard and fast rules about that. It’s just something to be aware of. People can have amazing insights and extraordinary experiences that are … Can be taken literally. But sometimes as you know, there are many levels to these experiences, and you have to treat them symbolically or metaphorically. So, it’s just a caveat, but not a hard and fast rule.

Final Thoughts

Joe: Is there anything, any additional points you might want to raise before we kind of wrap up here?

Elizabeth: I would just encourage people to reach out when they feel like they’re having difficulty or trouble understanding something that might be going on, and knowing that there are all kinds of groups out there. And to be sure that when they do this kind of work, they do it in a safe setting, and that they have access to people who will be able to support them afterwards.

The MAPS website is a really good resource for understanding this aspect of the work. I think there’s material there about safety set and setting. So, to keep all of those considerations in mind, I would just end with that reminder.

Joe: You’re never alone and people do want to help you.

Elizabeth Gibson, thank you very much. You can find her website at dreamshadow.com.

Elizabeth: Thank you.

About Elizabeth Gibson

Elizabeth Gibson, M.S., holds a bachelor’s degree in literature and a master’s degree in biology from The University of Tulsa. She has completed Herbert Benson’s Clinical Training in Mind/Body Medicine at Harvard Medical School. Previously she worked as a consultant at Arthur D. Little, Inc., and Radian Corporation in the areas of environmental protection and food research. She is a writer, editor and homemaker with interests in environmental literacy, yoga, music and gardening. Elizabeth is the editor of Stanislav Grof ’s The Ultimate Journey: Consciousness and the Mystery of Death and a contributor to the teaching manual MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder, both published by the Multidisciplinary Association for Psychedelic Studies. For the past 12 years, she has been responsible for local news for the Town of Pawlet, and from 2008 – 2014 she was the editor of the weekly environment section for the Rutland Herald and Montpelier Times Argus newspapers in Vermont.

By Dr. Jessica Katzman

For the first time in nearly three decades, novel classes of medication are being offered to those suffering from chronic refractory mental health conditions. Studies have shown that 60% to 70% of people with treatment-resistant depression respond positively to ketamine, and some encouraging results are being found with OCD, PTSD, and alcohol dependence. 

Though this discovery has been hailed as a massive boon to those living with persistent mental health concerns, their loved ones, and clinicians alike, it may also behoove us to explore the potential unintended consequence of these effective, fast-acting antidepressants.

Many welcome rapid recovery with relief and gratitude in being able to return to their lives; however, in our work with Ketamine-Assisted Psychotherapy, we have noticed that a small percentage of clients also experience a period of disequilibrium and difficulty in adjusting to these changes.

These reactions can range from over-reliance on older coping styles that no longer match one’s current state, to the distress that comes from the loss of a habituated identity (“I don’t even know who I am anymore, without my old buddy, Depression”).

I have come to refer to this response metaphorically as “the therapeutic bends,” as a way to suggest the effects that can occur when we ascend rapidly from great depths.

In two decades of clinical work, I have seen a variety of ambivalent-to-negative reactions to the prospect of “getting better.” Psychotherapy generally offers recovery as a gradual process, with adequate time to adjust and be supported; the “instant cure” has been seen as both unattainable and potentially illusory. The advent of these new treatments requires a shift in how we guide people through this work.

I would like to discuss here some possible layers where distress can occur, and interventions for both clients and providers to consider at each level.

Confronting Reality: Cognitive-Behavioral Layer

Ketamine infusion pioneer and psychiatrist Dr. Steven Levine has been noting this reaction for some time; in a recent blog post, he encourages providers to set expectations with clients that “even good change is stressful (marriages, moving homes, new jobs, and the birth of children are some of life’s most stressful events).”

More dramatically, he describes a process in which one emerges from a depressive episode, then becomes overwhelmed by the herculean tasks ahead:

[W]hen one looks around, one sees with new eyes the surrounding devastation and the casualties from an incapacity to do anything about the growing problems…[this] is akin to a poorly prepared survivor of a nuclear apocalypse stepping out of his bunker into a lonely world of destruction.

Dr. Raquel Bennett, a psychologist and founder of the KRIYA Institute, has also been observing the effects of therapeutic ketamine on one’s sense of self for many years. She echos Dr. Levine’s observations that:

Resistance can come up for some people; they get a little better, and then can get scared, sometimes retreating back into a remission, which is actually more psychological than chemical… People wake up and realize how much time was lost to their illness, how much money was spent, how many relationships ruined, how many opportunities missed… We need to think about how painful it is to just be with that, what this condition has done to one’s life (personal communication, August 12th, 2018).

Additionally, those accustomed to very brief respites from symptoms may have a habitual tendency to throw themselves headlong into intense task completion mode the moment remission begins, in an effort to “get everything that piled up done before the storm hits again.”

FOR PROVIDERS: Dr. Levine writes that “even a ‘magic bullet’ leaves a wound that requires a period of recovery,” and that key components to this recovery are social support and ongoing therapy. Therapy should, in part, focus on “teaching new skills to challenge and combat depressive thoughts, and working towards achieving successes that help rebuild self-esteem.“

Similarly, Dr. Wesley Ryan states that he frames ketamine treatment as something that can provide a catalyst for change, transiently lifting depression, and allowing people to more easily engage in other activities that will protect against relapse. He encourages “regular exercise, healthy eating, socialization, behavioral activation, structure/volunteering/work, work/life balance, addressing activities or relationships that clash with personal values (such as work, for some people), potentially setting better boundaries” (personal communication, August 13, 2018).

Providers may want to focus here on slowing the work down so as to not trigger overwhelm, cognitively reframing approaches to task completion, and teaching new ways to manage the demands of life. Psychotherapists may also invite expressions of regret and grief around the sense of lost opportunities as a way to work through these feelings effectively.

FOR CLIENTS: As stated above, it is important to not overwhelm yourself at this stage. Trust that you will have the opportunity to make repairs and address life tasks over time, and please access as much support as possible to assist you in this undertaking. This is an excellent time to begin practicing new self-care habits that will ensure longer-term change.

Additionally, you may benefit from making space in your life to acknowledge and feel any difficult emotions you may have around what has happened and talking to someone you trust who can listen without judgment. You may want assistance from a therapist, support group, or a good self-help guide in shifting how you think about yourself and your life.

Readjusting Roles: Interpersonal Layer

Dr. Bennett notes that often people’s intimate relationships become organized around the care-giving other people provide, and that “as soon as they start to improve, expectations and the relationship dynamics start to change.”  

In family therapy perspectives, the “identified patient” (also “symptom bearer” or “scapegoat”) is a member of a dysfunctional system that has been unconsciously selected to express the distress of that system. Other members may profess concern for the identified patient, but may also react instinctively (and unintentionally) to any improvement by working to reinstate the status quo.

What once seemed like an entirely biochemical illness can often be revealed as multiply determined when we notice loved ones’ discomfort with their ward slipping out of “sick role.” I have often felt concern in watching someone achieve remission, and then return to the same stressful environment in which the initial problems flourished.

In less pathologizing terms, let us remember that there is a social expectation in the continuity of the self over time. People around us have adapted to how we typically act and express ourselves, and react with surprise when that shifts. Those reactions may subtly encourage us to return to our previous baseline. This is rarely intentional, but is extremely important to recognize.

FOR PROVIDERS: Potential interventions to navigate through this period might include family therapy, couples therapy, or psychoeducation on the nature of family systems or group dynamics. We can assist clients in setting appropriate boundaries, and support them in having difficult conversations.

FOR CLIENTS: If this is something you would like to address in your life, please talk to your providers about your specific situation and best practice interventions. It may be helpful to talk through how your relationships might change if your mood improves, or any fears of what might be expected of you if your condition shifts. In general, reading about and practicing Nonviolent Communication is a good way to improve relationships with the people around you.

Exploring Identity: Personal Layer

Much like our intimate others, we also have an expectation in the continuity of the self. When one has lived with a longer-term condition, there are ways in which it can get woven into one’s own identity.  We become habituated to our capacities for activity and relating, and depend on our ability to predict how we might think and feel in any given situation.

It can be incredibly disorienting when a cluster of your regular experiences disappears overnight, and can foster a sense of not knowing yourself at all anymore. (This may be partly responsible for the “rubber band effect”–the tendency to return to our usual modes of being–that Dr. Phil Wolfson discusses in The Ketamine Papers.)

Participation in online forums and support groups can provide invaluable insight and camaraderie; as helpful as this can be, it may also reify one’s social role as a fellow sufferer. We come to define ourselves as a depressed person, as someone struggling with fibromyalgia, as a recipient of Social Security or disability benefits.

(Perhaps this is not such a novel occurrence, after all, as a similar phenomenon emerged with the advent of SSRIs. Peter Kramer noted in his 1997 book Listening to Prozac how his perspective on the nature of temperament was altered by witnessing responses to medication: “I was used to seeing patients’ personalities change slowly, through painfully acquired insight and hard practice in the world. But recently I had seen personalities altered almost instantly, by medication.” He reported similar disorientation and adjustment periods.)

FOR PROVIDERS: Just as we would allow space for someone to discover new aspects of the self during a coming-out process, recognize that the remission period is also a fruitful period for exploration. Identity-making is an ongoing conversation throughout the lifespan. Acknowledge that with every new gain made, there are losses, and parts of our selves and lives that we are saying goodbye to. Inquire about the feelings that might arise during this phase.

In our practice, we draw upon Internal Family Systems (IFS) techniques to help people have productive dialogues with different parts of their psyche, and discover (without judgment) what attachment to a depressed identity might mean for them.

FOR CLIENTS: This is a time to look deeper at the beliefs you hold about yourself, and question their accuracy. You may consider getting reflections from someone who can listen neutrally and without agendas for your direction. A great self-help resource for IFS-style work is Jay Earley’s Self-Therapy.

If you are concerned about returning to the workforce, many communities offer peer and professional support for those returning to work after a period of unemployment. This type of support should encourage autonomy, allow exploration of ability and identity, and avoid perpetuating disempowering ideas about what those with mental health struggles are able to contribute.

Letting it Out: Emotional Layer

Classic psychoanalytic conceptualizations regarding depression as “anger turned inward” can help frame the irritability or distress that may surface unexpectedly when symptoms remit.

We have supported clients who, once they were relieved of depressive burdens, were then able to confront and feel appropriate anger stemming from past trauma, abandonment, or loss.

This can be an incredibly healing process if one is supported by providers who understand the emerging emotional responses in context, but can be difficult to navigate on one’s own.

Dr. Bennett has also observed anger and/or grief reactions, with people suddenly feeling “angry at God for making them sick, or at the situation, or all the doctors that didn’t help them previously…[W]hen this is buried or held down in the depression, and then starts to come up and out following treatment, people need therapeutic support to address that.”

Though we think about depression as “sadness” and recovery as “happiness,” the reality is often not as simple. Depression can present with a numbing or flattening of emotions, and recovery may mean regaining access to a wide range of different feeling-states. Learning to navigate these states is essential.

FOR PROVIDERS: Set expectations for all involved that recovery may involve unearthing unanticipated feelings and memories. Trauma-informed treatment is essential when working with some of these frozen states. Encourage safe expression of affect in session, and offer psychoeducation around appropriate assertiveness, boundary-setting, and anger management techniques. Teaching and practicing grounding exercises, such as the ones in the Seeking Safety protocol, can help people learn to re-regulate themselves when distressed.

Additionally, Dr. Bennett notes that some continue to have suicidal ideation, but a critical shift occurs in its source, moving from a ruminative, painful “voice in your head that tells you that you’re better off dead,” to a response of grief, loss, or anger. She emphasizes the critical importance of attuned listening by clinicians to differentiate these sources, rather than assuming that the treatment was unsuccessful.

FOR CLIENTS: If strong feelings are emerging during your treatment, please talk to your providers and request specific support for these states. If you are feeling suicidal, please reach out for help from your support network, call a hotline, or access urgent/emergency care. We recommend you do not navigate this process on your own.

If you would like to learn techniques to manage anger, you may find an Anger Management Workbook useful. Interpersonal process groups and assertiveness trainings may also be appropriate. We highly recommend the grounding techniques from the Seeking Safety protocol for those looking to manage the overwhelm that results from a history of trauma.

Digging Deeper: Unconscious Layer

Above all, we must make space for the deeply personal and idiosyncratic responses people have to both their symptoms and the remission of those symptoms.

We can not assume that this process has identical meaning for everyone we see. Honoring the uniqueness of the self and its adaptations to life’s challenges is part of what gives this work its beauty and depth.

Furthermore, meaning is held both consciously and unconsciously. Deep structures of the self are laid down early in life, in the interactions between temperament and environment, and are rarely available for immediate reflection. It is the work of ongoing inquiry in the therapeutic relationship to bring these templates into awareness.

For example, I have had the experience of working with people who were eventually able to articulate their depression as the only link remaining with a lost loved one; there is a way in which these symptoms served as tributes to the depth of their connection. Rapid removal of these mood states may then trigger responses of loss and abandonment.

Other clients have also formulated depressions as a coping tool itself: as a protective layer that prevents one from having to engage fully in life, an escape from having to make difficult choices, or an avoidance of confronting painful realities.

Another example is indicated by psychoanalyst Patrick Casement in On Learning from the Patient:

I have noticed, with a number of patients, that the experience of feeling better is sometimes treated by the patient as a signal for further anxiety. Some analysts might treat this as a fear of losing the “secondary gains from illness.” Others might regard it as “negative therapeutic reaction.” However, I believe there are some occasions when a patient is indicating that an unconscious link has been formed between an earlier experience of trauma and the prior sense of safety, as if that “safety” had been a warning signal for the pending disaster. Perhaps an unconscious set is formed in which feeling safe and the subsequent catastrophe are seen as forever linked (1992, p. 364).

FOR PROVIDERS: Although psychoanalytic and psychodynamic frameworks are fundamental to understanding the operation of these deep templates, dogmatic adherence to any one theoretical system forecloses the open exploration of individualized responses. Curious inquiry and a desire to hear about any potential meanings that may arise go much farther than the most brilliant textbook formulation. In essence: “what does this mean for YOU?”

It can be helpful to explore the relationship someone has with their depression, and how that relationship has changed over time. Narrative therapy ideas and practices can assist people in re-writing the stories of their lives into a more integrated personal mythology.

FOR CLIENTS: Part of recovery inherently involves an investigation into the myriad internal, interlocking factors that keep us stuck in old ways of being. Though your situation will be completely unique, you are in fine company with the rest of humanity, as we all struggle to move out of safety and towards growth.

If you sense that there have been ways in which depression has protected you from confronting difficult aspects of life, please make sure you begin to discuss this with your providers. Together, you may begin to re-author the tale of your history in a way that conveys respect for your resilience, as well as hope for the future.

Spiritual Crisis: Transpersonal Layer

We know that higher-dose journeys with ketamine can produce psychedelic, dissociative states, facilitating a profound transpersonal or mystical peak experience and expanding one’s sense of self and understanding of existence.

Dr. Bennett shares that for some, this “contact with the Divine” can be intense and overwhelming, especially if there has not been much preparation for this self-expansion, and if one has been “out of touch with God for 30 or 40 years.” She also notes that the changes one can be called to make in one’s life following a peak experience can be disorienting.

Psychic and spiritual content–especially following the use of psychedelics–can be mistaken for symptoms of psychosis in our highly secular culture. It is extremely important to differentiate between an illness process, and an enhanced sensitivity to transpersonal material. When held in a supportive context, these experiences can be extraordinarily meaningful to people.

FOR PROVIDERS: Have conversations during the preparation phase about your client’s existential concerns, spiritual encounters, and beliefs about the nature of reality or the universe. Familiarize yourself with the techniques and mindset necessary for supporting someone during a spiritual emergence or crisis process. Contemplate the differences between a dark night of the soul vs. depression. Work to bracket your own belief systems in order to allow for free expression.

FOR CLIENTS: Again, adequate preparation for working with ketamine, especially at higher doses, is essential. Please choose your guides wisely, and work closely with them to help you navigate these experiences.

If you are troubled by existential or spiritual concerns following a journey and could use a framework for integration, contact the Spiritual Emergence Network for more resources, including spiritual coaches and helpful reading material. You could work with a provider that specializes in psychedelic integration, or attend a community integration circle. You may also want to seek spiritual guidance within an organized or non-organized tradition (whether Western, Eastern, indigenous, or other). The above linked material on grounding can be helpful if you are experiencing a great deal of energetic activation following treatment.

In practice, these layers are obviously intertwined, and interventions at one level may affect all others, as we present as whole beings, bringing surface-to-depth concerns to every interaction.

As a final note: please know that none of this is intended to frighten you away from obtaining ketamine treatment, but rather to assure you that should you have these experiences, you are not alone, and that there are many ways to move through this phase without necessitating a relapse or causing untoward effects in your life.

Being prepared for the possibility of the therapeutic bends often helps people feel less surprised or destabilized, and collaborating with your support team on how to handle this, should it arise, is of paramount importance.

Thank you so much for reading this post, and we welcome your questions and comments!

About the Author

Dr. Jessica Katzman is a licensed Clinical Psychologist with 19 years of experience as a therapist, and was trained at California Institute of Integral Studies (CIIS) in both traditional and transpersonal perspectives on healing. She is also certified as a Spiritual Emergence Coach, and approaches altered states of consciousness from a nonjudgmental, exploratory stance. 

In her private practice, she specializes in integrating psychedelic experiences, supporting LGBTQQIAAP communities and gender-creative folks, addressing alcohol and substance use from a harm reduction perspective, body image issues, mood/anxiety disorders, social justice conversations, and navigating non-traditional relationships and sexuality.

After assisting a local ketamine infusion clinic with psychotherapy program development, she and our medical doctor joined forces to provide integrated Ketamine Assisted Psychotherapy for Healing Realms. She is supported by information received at the KRIYA Conference, an advanced training in therapeutic ketamine, and ongoing consultation with her colleagues in the field.