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  • Saturday, September 23, 2023 10:02 AM | Anonymous
     Back to Fall 2023 Newsletter

    by Mark Mouro, LMFT

    Almost one year ago I was sitting in my office with a couple and I had noticed the wife was making significant progress and change. I asked her about it and she briefly mentioned her unconventional work with another local therapist named Nick. After the session I immediately reached out to him to find out more. We got together for coffee and then continued to meet since I was so fascinated with what he was doing. I think its important work so I asked him for an interview. Here is my interview with Nick Sanchez, LMFT.

    What is your education, training, and experience with psychedelics and psychedelic-assisted therapy?

    For formal education/training, I received my certificate in Psychedelic-Assisted Therapies and Research from the California Institute of Integral Studies a few years ago. They partner with MAPS (Multidisciplinary Association for Psychedelic Studies) to ensure alignment across certification.

    On a more intimate level, I have worked with numerous licensed and spiritually rooted practitioners to have my own psychedelic experiences to truly understand each compound's impact on mental health challenges and overall life fulfillment.

    Which psychedelics do you work with in your practice and what is most common?

    With the current legal landscape of psychedelics, I provide preparatory and integrative sessions for clients. Many clients use the preparatory sessions to explore what compound suits their needs before seeking it out. It depends on many individual components to find what compound will give the client the result they are looking for. When people initially reach out for a preparatory session, they most often initially inquire about MDMA and Psilocybin.

    I also receive clients looking for "coaching" around how they may use the compounds in microdosing to have smaller experiences.

    As you say on your website, psychedelic-assisted therapy is illegal in the US. But California Senate Bill 58 would decriminalize personal possession and cultivation of plant-based psychedelics and the bill also aims to establish “community-based healing” practices that promote group therapeutic use of psychedelics. As of last week, it is now on the governor's desk for signature and if he signs it, S.B. 58 is set to go into effect on Jan. 1, 2025. In addition, the Zide Door church in Oakland will be providing DMT to its members next month. Will LMFTs be able to do this work legally?

    The last I heard, MAPS has just won its efforts in lobbying with the FDA to allow LMFTs that have received substantial training/certification in psychedelic-assisted therapy to receive direct access to the compounds once they are legal. Their lobbying efforts are a huge win, as the FDA originally planned only to allow psychiatrists (whether or not they received training in psychedelic-assisted therapy) access to the compounds. One of the reasons that I attended CIIS is that it allows me to take 1-2 more courses from MAPS, which would allow legal access to the compounds that can be provided by licensed/certified professionals in a therapeutic setting.

    Can you say more about your belief in the power of these substances to change people's relationship with themselves and the universe.

    I believe the mental health landscape will change drastically once psychedelics are legalized. My first experience with psychedelics felt like eight years of therapy within 7 hours, even after doing my therapy for over a decade and completing graduate school. I believe it provides a much more experiential approach to working with your mental health challenges that leave a far more lasting impact and desire to implement change after having an experience. You also are unable to hide from yourself. You can easily manage what you tell a therapist, whereas psychedelics allow you to confront areas of your consciousness in an intense and loving way.

    Many want to feel a greater sense of meaning and purpose within their lives. We want to feel "a part" of the "bigger picture". I believe psychedelics are one way of very strongly coming in contact with these ideas and allow individuals to experience a profound sense of meaning and purpose while also reminding us of how beautiful life is when our societal thought norms are stripped away.

    Many individuals will continue to use psychedelics to peel back the onion further after they have experienced relief from their mental health challenges. It becomes a powerful tool for finding direction and purpose in life.

    I work with many clients about their mortality and how we can ultimately use our death anxiety to allow us to live our most fulfilling lives. Often, psychedelics bring the experience of your mortality to the top of your mind and let you ask yourself the more significant existential questions about your existence within the universe. I have found that this alone causes individuals to experience tremendous relief from their mental health challenges while guiding them toward their true calling in life.

    I'm very interested in the selection of substance. Can you talk about the process of how you decide which substance is best for each client and their personal goals.

    It truly depends on the experience a client is looking for. We can also think about the different compounds as different intensities of the experience we want to have. Some people seek a gentler introduction to consciousness, whereas some want to dive off the highest cliff and confront the deepest and darkest parts of themselves. I work from an existential-integrative approach, which works beautifully with helping clients identify what they want from the experience, which informs the compound they would like to use.

    I think about it like a toolbox. We have different tools to apply to different scenarios. Like creating a toolbox for clients around CBT skills, I believe the same can be done with each compound.

    Much like traditional therapy, we often receive much more from the process in a slow ramp-up versus going straight into the infinite abyss. Some clients can have a traumatic experience if not approached correctly.

    You've mentioned that there are rituals, outcomes and processes surrounding the use of these substances. Can you elaborate on how the substances differ in this respect and what that means for the client.

    I would think about it like preparing for a competition. You will prepare differently depending on the type of competition you are competing in. If you are going to be running, you will not be spending time swimming, and if you are trying to prepare to pass a licensure exam for your career, you will not spend most of your time mountain biking. The compounds would be similar. We want to prepare for the experience depending on the compound. Someone who is going to be using Ayahuasca is going to have a much different experience than using MDMA. The rituals, outcomes, and processes will be generally similar, with some fine-tuning depending on what compound a client wants to experience.

    I see that preparatory, experience and integration are the main facets of your approach. Can you give an example of how many sessions and how much time each of these take on average?

    Usually, a client does about three preparatory sessions. I conduct these as traditional sessions that run 50 minutes in length. The focus is a mixture of getting a landscape of how to prepare for a journey, identifying material that could show up, and how they could effectively work with it while on the journey. Some clients may need more if they have never been to therapy before and it is their first time unpacking some life experiences.

    For integration, it depends on the experience that the individual has. I often do one integration session and will have another a month later. Integration sessions are more around how to incorporate the material and realizations that came up in their journey, and the length of ongoing sessions will depend on a client's ability to follow through with their identified action steps.

    Integration is vital as that is where the "work" is. The compounds themselves do not "fix" clients. It is the integration they do after that changes their mental health and overall quality of life. The idea of psychedelics "fixing" clients is a common area to address with clients. Many operate from the concept of current psychiatric approaches that believe the medication is where we will see the most significant impact of change.

    Why do you think it’s so difficult for most people to integrate the findings from their experience into everyday life?

    I have found that many individuals like to stay asleep in life. When we have significant experiences with psychedelics, we become awake. We see the areas we are unhappy with and confront the places we have not been paying attention to. Many individuals will have new realizations and understandings in their journeys that can feel daunting to take the first step in creating the change.

    Preparatory sessions are setting the stage for us to be ready to take action directly after an experience. We want to be proactive instead of being reactive to the material that comes up. Many people (especially in Silicon Valley) are comfortable in the rat race. Change takes effort; many of us are tired, sick, and checked out. Getting started always takes more effort than maintaining. We also want to honor the protections many clients have been walking around with for YEARS that have brought them this far in life. It takes a lot of effort, commitment, and action to get a different outcome from the life we have settled into for decades.


    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel, and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

    Back to Fall 2023 Newsletter
  • Saturday, July 01, 2023 4:11 PM | Anonymous

    Back to Summer 2023 Newsletter

    by Mark Mouro, LMFT

    As a therapist who specializes in working with couples, two themes I see come up time and again are stability and change. The need for consistency and the need for movement. Both are necessary in a romantic relationship, and both existed previously in the parent-child attachment.

    In early attachment relationships, infants and young children need to feel safe and secure in order to explore the world around them. They need to know that their caregiver is available and responsive to their needs, and that they will not be abandoned or rejected. When infants and young children feel safe, they are more likely to explore their environment and learn new things.

    In romantic relationships, adults also need to feel safe in order to be able to explore and grow. They need to know that their partner loves and accepts them, and that they can rely on them for support. The feeling that your partner will be there for you when you need them is critical. That sense of dependability is also important for feeling like you can be yourself and not have to worry about being judged. When adults feel safe in their relationships, they are more likely to be open to new experiences and to take risks.

    This is why in my sessions with couples we must establish a level of security first and foremost. This establishes the foundation on which we can build up from. Without a firm footing we are destined to slip and fall. It is one of the reasons I have a very structured approach with couples in the beginning sessions so that we have some predictability built in. It is meant to be a very stabilizing experience in which fairness and equity bolster the relationship.

    But when they go home, what does safety look like? I explain to my couples that this can be found in emotional intimacy, trust, and commitment. In practical terms that could be setting and respecting boundaries, communicating values and priorities or balancing power. When we feel safe in our relationships, we are able to relax and be ourselves. We can also be more vulnerable and open with our partners.

    Once there is sufficient continuity in security, the relationship can begin to shift into motion. Here is where we can be open to newness in the relationship. By taking risks in communication and behavior with your partner, it can lead to feelings of uncertainty. To step outside of your comfort zone and explore the unknown requires some comfort with anxiety. Engaging in novel experiences can be a great way for both partners to see each other in a new light and simultaneously confront vulnerability. This strengthens the relationship with growth and perhaps most importantly, we learn more about our partner. 

    Most recently, I have been working with many men who are trying to figure out whether to stay or leave their marriage. They desperately want their partner to change. And they’re fairly confident that they know their partner well enough that they can’t behave any differently. I work on getting us to a place of determining what they themselves are in charge of. Meaning if they can help their partner feel safer, then it is more likely that they will see some openness and willingness to react and respond differently. When they can create an environment of stability then their partner will feel more ready to extend themselves. Stability comes before mobility.

    When safety is lacking in a romantic relationship, it can lead to feelings of anxiety, and fear. This can make it difficult to trust your partner and to feel close to them. When adventure is lacking in a romantic relationship, it can lead to boredom, stagnation, and resentment. This can make it difficult to stay interested in your partner and to feel like your relationship is progressing.

    The trick for most couples is finding the right balance between these two paradoxical needs: Striking a healthy balance that allows for both safety and growth. To acknowledge and accept these two competing needs can value both partners and validate the relationship. This gets challenging when the need for safety and adventure can vary from person to person. Some people may need more safety than others, while others may crave more adventure. And remember that the need for safety and adventure can change over time. Herein lies the critical importance of both partners working autonomously to identify their own individual needs, communicating them to their partner and embracing a spirit of curiosity.  

    The image of a toddler going back and forth between their parent and the environment reminds me of the ongoing internal struggle between the opposites. Back then it required a balance in order to meet our needs of both freedom and safety. As adults, being able to hold this tension and find comfort in this sometimes liminal space is the beginning of individuation. Just like back then, finding the right middle ground means not too much of one and not too much of the other. I like to think of safety and adventure in romantic relationships as two opposite poles of the connection polarity that can work together to create a stronger and more dynamic bond. When both partners feel safe and adventurous, the relationship is more likely to be fulfilling and satisfying.


    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel, and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

    Back to Summer 2023 Newsletter


  • Saturday, March 18, 2023 7:14 PM | Anonymous

    Back to Spring 2023 Newsletter
    by Mark Mouro, LMFT

    We are now in the last three months of the two year program at PAPPTP and have just completed a case conference course. This class has been very different from all the others and has given a glimpse into the vast possibilities of psychoanalytic psychotherapy treatment. I was amazed by the variety of interpretations my classmates would make reading from the same transcript of a session. And it had me thinking about how different a session can be depending on the unique characteristics of the therapist and the relationship they have with the client. 

    In times like this, I am reminded of the parable of the blind men and the elephant. Then therapists listening to a session and each one giving their own perspective based on personal experience, emotional reactions, and clinical desires. Only when taken as a sum do you really get a more complete picture of the client and a more in-depth understanding of the case.

    I should note that this is not uncommon and I, like most of you I imagine, have participated in similar groups in the past. Before getting licensed, I was in numerous supervision groups with other associates discussing each other’s cases; after getting licensed I enjoyed being a part of consultation groups with colleagues. But this one was different. There were a handful of guidelines that I believe made it possible to benefit from this one in a much different way.

    For six weeks, one classmate was chosen to present an ongoing case each week. Right before class she sent out a transcript of one session that week and then she read it out loud during class. The professor would have her pause every once-in-a-while and ask mainly two things from the students. What thoughts do you have on the nature of the transference and what feelings and reactions does the client evoke in you in this moment? In addition, the rule was no asking the presenter questions and she would hold off on any of her own comments about our discussion.

    Following these principles allowed the discussion to be more about the client and how each one of us can see things differently rather than it being a critique on how the therapist is doing in session and what we think she can do better. The collaboration of each person sharing their observation and insights helped us to identify factors that may have been overlooked as well as potential barriers to treatment. This provided a more rich and nuanced understanding of the numerous dynamics constantly at play that we most likely are not aware of. In particular, how the transference and distinct countertransference in each of us can potentially facilitate the treatment in its own unique way.

    Betty Joseph (1985) defines transference as “everything that the patient brings into the relationship… gauged by our focusing our attention on what is going on within the relationship, how (the patient) is using the analyst, alongside and beyond what (the patient) is saying”. She goes on, “Much of our understanding of the transference comes through our understanding of how our patients act on us to feel things for many varied reasons; how they try to draw us into their defensive systems; how they unconsciously act out with us in the transference, trying to get us to act out with them; how they convey aspects of their inner world built up from infancy—elaborated in childhood and adulthood experiences often beyond the use of words, which we can often only capture through the feelings aroused in us, through our countertransference, used in the broad sense of the word” (p. 447).

    And for the therapist presenting her case and how this class affected the relationship with her client? I recently spoke to her after the course finished and she confirmed that the classes notes subtly affected the direction of her sessions. She also remarked that there were things she never would have noticed about the client and the sessions before this exercise. But it was an intense and rigorous experience for her because she thought about the client so much due to notes after session, reading what her client said, and hearing the client being talked about in class. In the end, though she felt it was a massive amount of learning for her, this wasn't really a process for her as much as for everyone to learn from each other. This collage pieced together illustrated how complex the process of therapy can be.  And it humbled me by showing the expansiveness of the human spirit that we are not always cognizant of.  

    As mental health professionals, it is not uncommon to experience tunnel vision or become overly focused on one aspect of a client’s case. Sharing with a group of professionals with diverse backgrounds and experiences can help to broaden and deepen the understanding of a case; it allows to create fresh insights and ideas to the table. When we can work together to develop a more comprehensive understanding of the patient's condition, then we all benefit from it.

    Reference
    Joseph, B. (1985) Transference: The total situation. International Journal of Psychoanalysis 66, 447-454.

    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel, and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons.

    Back to Spring 2023 Newsletter

  • Monday, January 09, 2023 3:14 AM | Anonymous

    Back to Winter 2022 Newsletter

    by Mark Mouro, LMFT

    I can recall being a grad student and hearing a teacher explain that the job of a Marriage and Family Therapist is to help people with their relationships. Soon after that, I will never forget working as an intern and experiencing the push and pull of transference in relation to my clients. And now, most of my training and experience is focused on the relationship between partners in couples therapy. Perhaps, then, it is no surprise that what has inspired and excited me most about being in the Palo Alto Psychoanalytic Psychotherapy Training Program (PAPPTP) is learning about the relational perspective of psychoanalysis.

    Relational psychoanalysis has been defined by the APA as “a psychoanalytic approach incorporating aspects of several theoretical perspectives, such as object relations theory and interpersonal theory. It focuses on an individual’s sense of self and patterns of relating to others as developed in early relationships and in treatment it emphasizes the importance of the relationship between a patient and analyst or therapist in helping the patient understand those patterns and form new ones.”

    This description really did not match up with my image of psychoanalysis: the therapist in the chair behind the patient, the patient on the couch, and never shall their eyes meet. It seems to put the interactions between the therapist and patient front and center with the various forms of communication being expressed. This shift away from the intrasubjective (our inner experiences) to focus on the intersubjective (the space between two persons or the impact of relationships) really appealed to me.

    I had to ask myself why this approach speaks to me personally. In my teenage years, play was a huge part of my life through sports. I expressed a lot of emotions and made close connections through athletics. Upon entering college, I discovered the theater and fell in love with improvisation and co-creation of a new reality. It was both in play and spontaneity that I felt most alive. Both gave me a sense of risk, adventure, and reward. Now, as a professional, I find that vitality exists more often when these elements are present in session.

    In many of these sessions, when the client’s level of trust in me is good enough, improvisation can lead the way. The two of us can play with ideas and feelings. This spirit produces a dynamic space where we build on each other’s contributions. They tell me their version of reality while I add some elements to it that I experience. They acknowledge and disclose additional details that they are aware of. Only together, can we both understand what is really going on. It becomes a sort of negotiation of different perspectives.

    In relational psychoanalysis, interpersonal relationships are seen as the basis of human development. The emphasis is added on the role of relationships in both creating and healing suffering. Therefore, the therapeutic process is seen as a reciprocal system. The relationship between client therapist provides the best opportunity for intervention since the organization of mind is most accessible in the room between two people.


    This two-person psychological model is built on mutual influence and equality. A definite shift away from the expert dictating to the sick person who they are and what they want. Less interpretation and more self-disclosure here. There is not one person in charge of the truth. This approach to psychotherapy demands authenticity on the part of the therapist. A real showing up, coming to the table, and being available in many ways to engage. This makes sense to me given that mutual regulation and mutual influence are always happening at some level or another. I can definitely say that I am a different version of myself with each client and that is due to who the client is and the unique way we connect.

    The difficulty I encounter most often is disrupting the universe. Just like my clients, I have a hard time changing the dynamics of the relationship after the gel has solidified. There are various clients with whom I feel we are locked into certain roles at some point. From the get-go, the client uses me as an object, and over time I start to feel the sessions becoming narrow in scope. My participation feels contained to a rigid frame. As a result, the client restricts themself to cursory explanations. There is no mutual give and take, no openness to exploration, right or wrong. There is no discovery. The sessions have become flat. There is no wondering and much less, any wandering.

    From a relational perspective then, my stretch would be to face it head on with questions that give context to the mutuality of our experience. This means frequently asking my clients what they imagine I am thinking or feeling in reaction to them. Or “I think you think I am feeling….” or “I think you have the impression that I…..”. Taking it even further might be when I tear up and they have a blank face I ask them if they have any thoughts about why I am tearing up and it does not look like they are being affected emotionally. Or even “I wonder why I said that as a therapist, why do you think?”

    This co-creation of interpretations is something I am still struggling with. It feels like a big risk. Yet, I know that most of the time when I venture out there, a big reward is awaiting. And isn’t that part of our work? Leading by example with vulnerability. It is the glue that binds us all together.

    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

    Back to Winter 2022 Newsletter

  • Sunday, October 09, 2022 5:18 PM | Anonymous

    by Mark Mouro, LMFT
    Fall 2022 Newsletter

    It is summertime as I write this, and we are on break from classes at the Palo Alto Psychoanalytic Psychotherapy Training Program (PAPPTP). Therefore, this article will discuss my case consultation for the first year. To receive a certificate of completion of the program as a psychoanalytic psychotherapist, students must treat two patients (one each year) with accompanying weekly case consultation. PAPPTP strongly encourages you to see these cases more than once a week, since increased frequency typically facilitates greater engagement and therapeutic efficacy. The PAPPTP roster of case consultants is limited to analyst members and psychoanalytic candidates of the San Francisco Center for Psychoanalysis (SFCP). Thankfully, case consultants offer reduced fees for candidates.

    From the beginning my consultant stressed the importance of writing down thoughts and feelings immediately after each session. I would take a couple of minutes to note a few impressions that I could return to later. This got me in the practice of sitting for a moment and being mindful of what is left in the wake of a session. What promptly remained at the close of a session may take on significant meaning on further reflection. And that seemed to shape the focus for each consultation. It gave me a starting point to think about why these things stood out most.

    While it is suggested and ideal to have one patient for the entire year, that just did not happen for me. But it gave me an opportunity to try different ways to engage in my case in consultation. For the first patient I was able to audio record our sessions, and not surprisingly, that turned out to be invaluable. This is something I had not done since before I was licensed, and yet, always knew it was one of the best ways to analyze my work and improve as a therapist. First and foremost, just listening to the session afterwards gave me a different perspective. So frequently I found myself catching things that I missed when I listened to the session later. A specific word, an inflection point or a pause the second time around can take on greater meaning. But surprisingly, it was the process of transcribing and reading out the session line by line in consultation that offered me a divergent view at times. Reading my patient’s words forced me to think about them differently. Paying particular attention to the ways in which they constructed their sentences, the tempo in which they expressed their thoughts, and the direction they went with their ideas had me reflecting more deeply on my original interpretations.   

    The second main takeaway in case consultation was the way in which my consultant gave feedback. I was expecting some form of criticism or approval but that never came. Rather, she offered her thoughts on what an analytic response to the patient might sound like. She suggested ways to think differently by how the patient’s words or phrases might be understood. She also gave her own interpretations on the patient’s motivations and emotions. After listening to my reading of what was said in session and my thoughts on what was transpiring in the moment, she then gave an alternative explanation on the meaning of our interaction. This was never done with a comment that my way was wrong or right, just different. And trust me, at times I really wanted a debate! But as you might have guessed, this helped in the beginning to create an environment in which I never felt judged or inadequate. And fittingly, that allowed me to bring forth any of my insecurities.  

    Perhaps the most salient takeaway, though, was how frequently she returned to the theme of the relationship between the patient and me. She spoke about how important it is to look for the opportunities to comment on what is happening between the two of us in the moment. Or inquire how the patient understands what is happening between the two of us, right then and there. For this client in particular, I would be mindful of times in which they might be fearful of disclosing something. This could provide a chance for the patient to reflect on their level of trust in me. And that could help us explore the deep seated shame they experience with me and others around them. Maybe then, in relation, the harsh criticism they have for their self would loosen its hold.   
    Looking forward, another thing in case consultation that I hope to develop more, as I gain more experience, is creating a space for the patient to reflect on how they think. I will be looking for ways to invite my patient to investigate their particular method of relating to others and their self. Just as my consultant is guiding me to shift the way in which I see things, my goal in session is to get my patient interested in being curious about their own metacognition.

    Those of us in private practice have a very unique line of work in which it is possible that no colleague or boss could ever see our work. And I think the longer that goes on, the more reticent we may be to get consultation. Once we get past any initial intimidation, case consultation may be one of the best ways to ensure we are providing the best service we can.  This experience has provided me greater confidence in my ability and an increased competence in my work. 

    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

    Fall 2022 Newsletter


  • Wednesday, June 15, 2022 12:58 PM | Anonymous

    by Mark Mouro, LMFT
    Summer 2022 Newsletter

    The first year of training at The Palo Alto Psychoanalytic Psychotherapy Training Program (PAPPTP) has concluded and I am starting to feel like I am getting a better grasp of psychoanalytic psychotherapy. I began the program with a strong curiosity in utilizing transference and countertransference with my clients. Recent classes covering projective identification have helped me to become more aware of what my clients may need from me and why. And now I am finding myself being drawn specifically to the relational model of psychoanalytic psychotherapy

    In weekly consultations, I have discussed instances when clients speak about how different they feel now in comparison to the beginning of therapy.  It has happened in the past that I expected patients would raise this subject when they were ready to end therapy.  In one recent occasion, however, when this moment arose in session, the feeling was different and unfamiliar compared to the past.  The topic of ending therapy did not come up.  I wondered then why I had felt a sense of rejection this time as opposed to other past occurrences.  

    The emotion that came up for me was important information that would guide me toward what the client may require. So now when something feels out of place, I try to first recognize what is being stirred up in me; then I think about where it could be coming from. Is this my unresolved issues? Is this a feeling that my client has and needs to dispel because it is unbearable? Or is this a feeling my client has about someone else and now it is being redirected towards me? Once I have a handle on what it may be, then I need to mindfully respond to it the way the client needs, rather than react to my raw emotion. I need not simply to dismiss the emotion myself nor heedlessly reciprocate it.  But how would I know whether it is my or their stuff? Or maybe even something in-between?

    For years it had been my assumption that psychoanalysis necessitated lengthy discussions of early developmental childhood. In some ways that contradicts what I am discovering. I am finding I do not need details of my clients experiences from decades ago. In fact, what we need most exists in the here and now. The singularity of the moment. The back and forth, give and take of their expression, and my novel response. Their hidden hopes and my resulting affect. My willingness to be receptive and show how they have an impact on me. This is our dance that moves from my ability to improvise and to be improvised by the music of the session if you will.

    As I began to really tune in to the unique tone of connection, I wanted to know about possible deeper meanings underlying the interactions. One concept from class that stuck with me is reverie. It has been described as our daydreams, fleeting perceptions, bodily sensations, and ruminations. And then elaborated and expanded upon by Thomas Ogden (1997) in San Francisco who said "Paradoxically, as personal and private as our reveries feel to us, it is misleading to view them as ‘our’ personal creations, since reverie is at the same time an aspect of a jointly (but asymmetrically) created unconscious intersubjective construction that I have termed ‘the intersubjective analytic
    third’ (p. 569)". Is this the compass I had been looking for to gauge what might be happening at an unconscious level in the relationship? I wondered how much of this I am aware of, and perhaps more importantly, how much of it is motivating my behavior.

    I was eager to try this in session, and when I did, the irony is that it felt contradictory to what I initially thought I should be doing as a therapist. When the opportunity presented itself, I would break eye contact with my clients, look out the window, listen a little less to their words, and try to capture more of the meaning. I would imagine tuning down one string and tuning up another. If something felt a bit off-center then I would present it to them and see if it resonated.

    Nowadays I look for the repetitive themes in my clients relationships. I search  for patterns of interactions with others and ultimately with me. When they speak of their relationships with others, now I may be thinking of how that could apply to us. I ask myself what part I might be cast in in the narrative that is playing out between us.

    The clients with whom I felt a sense of rejection with, I now take a different view to the process. I imagine they are giving me the experience they feel and have felt so deeply time and time again. This presents a rich opportunity to name, understand, and ultimately change the pattern of how they view their role and others’ in a relationship. If I can recognize it, metabolize it and then offer to them what it feels like for me, maybe they will feel more understood. But more than that, I hope to give meaning to their previous experiences by creating a new one.  

    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

    References:
    Ogden, T. H. (1997). Reverie and interpretation. Psychoanalytic Quarterly, 66, 567-595.

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  • Saturday, March 19, 2022 12:51 PM | Anonymous

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    by Jessica Sorci, LMFT

    Jessica Sorci, LMFT is a Certified IFS (Internal Family Systems) Therapist and a Certified Perinatal Mental Health Professional with advanced training in Intimacy From the Inside Out (working with couples using IFS). In her early adulthood, Jessica devoted her life to her own emotional healing; as a Founding Director of Family Tree Wellness in Silicon Valley, she brings her wealth of compassion and knowledge to the clinical training and supervision of therapists as well as the healing journeys of clients. Jessica blends her love of IFS with her extensive background in creative expression and spirituality to create one-of-a-kind trainings and workshops that reach people's hearts and open their minds. With a view that mothering is the heart of our humanity, Jessica knows that the health of our world depends upon women and families receiving attuned support during their most tender times in life.

    Our Western medical model understands and addresses the suffering that many women encounter perinatally as a disorder. This lens implies pathology. The concept of matrescence provides a more soulful, holistic, and empowering lens to look through when we think about new motherhood. Diagnostically, this territory is known as the realm of Perinatal Mood and Anxiety Disorders or PMADs. About 85% of women experience some type of mood disturbance postpartum and 15-20% of new mothers have a more significant, pervasive or unrelenting suffering, most commonly called Postpartum Depression (PPD) (MGH Center for Women's Mental Health, 2019). If the majority of women experience profound discomfort during the transformation to motherhood, how can we call what appears to be nearly ubiquitous, a disorder? Changing the current patriarchal paradigm in which new moms are “disordered” to one in which new motherhood is widely understood to be the most radical and challenging transition in a female human being’s lifetime is necessary for the health of our humanity.  New motherhood is deserving of more attention, funding, compassion, care, support, and appreciation than it has ever received.

    I am a Founding Director at Family Tree Wellness, a group psychotherapy practice dedicated to reproductive mental health, located in Campbell, California. Most of the new mothers we see in our practice come to us seeking support for PPD or PPA (postpartum depression or anxiety) and are experiencing intense symptoms of insomnia, anxiety, despair, shame and self-criticism. What we commonly call postpartum depression is actually the amalgamation of significant brain changes, hormonal surges and identity transformation that sweeps perinatal women into raw vulnerability, from which they encounter the additional challenges of sleep deprivation, parenting an unsettled newborn and sometimes birth-related trauma, all set against the backdrop of their own attachment histories, as well as the reality of their present-day resources or lack thereof. In that complex equation there are abundant opportunities for essential elements of critical care to fall through the cracks. The biopsychosocial environment of a new mother, met with the inherent vulnerability and dependence of new motherhood, breeds either wellness or an experience of danger and survival threat. The experience of real or perceived survival threat, commingled with shame, produces what we diagnose as PMADs.

    We introduce these women to the concept of matrescence as a way of describing the normative adaptation to motherhood, with the recognition that this transformative phase of life is wild, dramatic and difficult, without pathologizing them. The term matrescence was coined by medical anthropologist Dana Raphael, PhD in the 1970’s (Zimmerman, 2018) to capture the reality that new motherhood is simultaneously stressful, growth-inducing and inherently full of ambivalent feelings. Ambivalence can be very triggering for people who have been indoctrinated to believe that good mothers feel only positive feelings about themselves and their babies. In fact, ambivalence is natural and is viewed as an inevitable aspect of growth and change through the lens of matrescence. Matrescence refers to a phase of life, not unlike adolescence, in that it describes an uncomfortable and critical physiological, developmental transition that entirely reworks one’s biology and identity. Polarized feelings are common in this time of life—immense love for the new baby as well as opposing feelings about dislike of the job itself. Women are given a forgiving, expansive lens through which to look at their experience, where they are allowed to feel and express their grief and loss along with their pride and confidence. The normalization of these feelings of ambivalence, grief and loss supports the growth of self-trust and resilience that are crucial to a mother’s healthy development.

    In our experience, we see that a large portion of the suffering in matrescent women is shame-based and stems directly from taboos around acknowledging the dark side of mothering. “One study found that mothers feared that disclosure of depression would meet with an unsympathetic response, and would imply that they had failed as mothers” (Kumar & Brockington, 1989, p. 174). This feeling of failure and its accompanying shame are a backdrop to nearly all perinatal mental health struggles. As informed clinicians, we can understand and anticipate this dynamic, and destigmatize the shadow side of motherhood to help relax and soften the way new moms feel about themselves.

    Body Changes, Brain Changes, Loss
    The biological and physical changes of new motherhood are undeniably challenging, but the dynamics of matrescence on a woman’s psychological and spiritual existence are even more earth shattering. In less than a year, a woman’s former body and her familiar sense of her physical and psychological identity are gone, and an entirely new, rather shocking constellation of experiences emerge. The typical biology of pregnancy and new motherhood include the rising and falling of reproductive hormones that dramatically color mood and perception in mothers. During pregnancy, estrogen and progesterone levels have increased 10 to 100 times, but within 24 hours of giving birth, those hormone levels crash down to roughly zero (Colino & Fabian-Weber, 2021). These hormonal fluctuations are designed to facilitate the symbiotic relationship between mother and infant, and along with measurable changes in mom’s brain, these hormones equip her to bond with and feed her baby. Much of mom’s biology gets behind this critical symbiotic mandate. Her nervous system must essentially download and replicate itself in her infant, and the shared identity and oneness help mom intuit and prioritize the baby's needs, even over her own. Margaret Mahler (as cited in Koenisberg, 1989) defined symbiosis as “that state of undifferentiation, of fusion with mother, in which the ‘I’ is not yet differentiated from the ‘not I’” (p. 1). This biological imperative for mom to bond and for baby to attach to mom as an auxiliary nervous system forces new moms into what we refer to as “the portal'', an inner dimension that houses mom’s implicit knowledge of what it is to be human, to be close, to be dependent and vulnerable. This portal sensitizes moms to their own early attachment knowledge, which is essentially implicit survival-related experience, most of which was laid down in the right brain, in her first years of life.

    In looking at the neuroscience underlying perinatal experiences, we see that the brain changes significantly in matrescence, to enable symbiosis and right brain, portal access. According to Allan Schore (1994), it is the emotional right hemisphere that is more connected with the emotional state of the fetus and later the baby—not the left hemisphere. Babies are right brain dominant until their second year, meaning they experience the world non-verbally, somatically, and emotionally. The shift away from the verbal, logical and linear world of left brain dominance is necessary for new moms to make sense of their nonverbal baby, connect deeply with that baby, and ultimately wire their implicit attachment system to that baby. Studies show that these significant brain changes “predicted the quality of maternal bonding and the absence of hostility toward their newborns in the postpartum period. These reductions continued for at least two years post-pregnancy and prepared women for the transition into motherhood” (Gholampour, Riem, & van den Heuvel, 2020).

    What does it feel like for mom to shift into right brain dominance?
    As the right hemisphere of mom’s brain comes actively online and engages in its non-verbal dance with her baby, mom can feel awash in evocative emotional material that might be destabilizing, depending on its content. There is an experience of being more present, less connected to time, less verbal, less logical, and more emotionally alive. This phenomenon is sometimes referred to disparagingly as “mommy brain”, but rather than being a diminution in function, these profound changes are in fact a heightened kind of functioning, designed to connect moms to their babies. And yet…that does not always feel so good for mom.

    As it turns out, a huge component of matrescence involves contending with one’s attachment history and weaving that history into the present-day relationship with this precious new baby. Sleep deprived, emotionally raw moms become more aware of ways they could falter, and so they often double down, becoming perfectionistic in an effort to not “screw up my baby”. It's a monumental task for many moms with preexisting emotional wounds, to do that weaving in a way that feels, in the words of Donald Winnicott (1953),  “good enough” (page 89). And it is common for anxious new moms to forgo self-care and become very preoccupied with this task of not screwing up (which never produces good results). For most moms, nothing has ever felt so critically important as being a good mom, and they have never been so exclusively responsible for a dependent being. This territory is ripe for feelings of high-anxiety, failure, shame and despair!

    What Supports Best Outcomes?
    Moms can only relocate to their right brain and move into symbiosis with their babies when they feel safe and well supported, when their environment allows them to exist peacefully in a less verbal, linear, logical world, while they symbiotically merge with their baby and begin to download their (hopefully) calm, attuned nervous systems. Moms who do not feel safe and well supported (inside and/or outside) will get caught in an experience of survival threat, will automatically shift out of right-brain connection mode, and into a more defensive position, or “protection mode”. When moms mother from protection mode, families do not thrive.

    Matrescence, as a holistic paradigm, acknowledges the growth and expansion of new motherhood, and also the extensive losses new motherhood brings to women. Women certainly disproportionately experience losses around career, power, influence, and earning (Sandler & Szembrot). Less measurable are all the personal losses: her body, sex drive, sleep, freedom and time to herself. Even when things are going well in matrescence, there is loss, which often comes as a total surprise and a deep disappointment to new mothers, who commonly work very hard to avoid the reality of their grief and the shame associated with feeling such loss in the wake of the beautiful new life they have created. Culturally, women are steeped in intense critical messaging that has a lot to say about how new moms SHOULD feel. As a result, these common and natural feelings of loss, regret and loneliness, seem to walk hand in hand with shame and isolation.

    Thriving in matrescence, like thriving in adolescence, requires steady, attuned support from outside. Unfortunately, in current American society, women in the perinatal phase of life are subjected to oppressive burdens unique to motherhood, full of high-pressure, high-stakes messaging around how to mother best: breast over bottle, cloth vs. disposable, home birth vs. hospital birth, sleep training, how much weight you should gain, how fast you should lose it, etc. This messaging permeates our families of origin and our larger culture, which in turn, sets new moms up for immense disappointment and failure. Experiences of disappointment and failure in new moms morph quickly into symptoms that constellate around perfectionism, self-doubt, guilt, inadequacy, intrusive thoughts and shame. It is in this painful soup that new moms start to identify as “bad moms” and lose trust in themselves. There is so much shame in feeling like you are not a good mom and when new moms lose trust in themselves, they inevitably disconnect from their babies.

    Building Self-Trust and Healing Humanity’s Wounds
    A primary developmental task of matrescence is developing trust in one’s self as a good enough mother. The development of self-trust is delayed or challenged by preexisting traumas, legacy burdens (racism, oppression, poverty), inadequate resources, and biological dysregulation. On the whole, mothers are highly motivated to mother well. As the challenges and difficulties of matrescence emerge, new moms tend to be more open to deep inner work and more receptive to help and to change than in more stable phases of life. When the portal is open, we have an opportunity to access the deepest implicit matriarchal wounds humanity carries—and heal them. Growing self-trust in mothers infuses their mothering with confidence, calm, compassion, curiosity, clarity, creativity, courage and connectedness (Schwartz, 2020), all of which nourish her baby, who then grows up to propagate those qualities. When a new mom learns she can trust herself, she has natural resilience and moves successfully through the challenges of matrescence, toward a sense of greater wholeness. Trust and self-compassion are antidotes to the self-doubt and self-criticism that fuel so much perinatal suffering.

    At Family Tree Wellness, we know that mothers are the greatest influencers for the next generation. Helping mothers find calm and confidence gives society our best shot at future peace and wellbeing. Techniques and models that we find helpful are those that acknowledge and honor matrescence inclusive of its shadow side. Family Tree Wellness is an Internal Family Systems informed practice, and we deeply appreciate the model’s holistic, nonpathologizing and validating nature. Along with affirming new mom parts and helping women unblend from harsh inner critics and other extreme protectors, we also offer psychoeducation and facilitate support groups that are respectful of the unique needs of this developmental time. We hold a feminist stance that values the work of mothers and acknowledges that our social policies fall abysmally short. We also know that it is equally important to help fathers, partners and our larger communities understand the support new moms need.

    When motherhood has not been valued or respected, women have forged through these difficult years isolated and depleted, judging ourselves and other women, stripped of the soulfulness and sisterhood that was our birthright, missing the celebration of ourselves as matrescent—as brand new moms being birthed right alongside our babies. In a world where matrescence is not recognized and respected, new moms look for ways to measure some sort of success and validation, often landing on things like material acquisitions, the shape and weight of our bodies, our babies’ achievements and milestones and our ability to juggle 1000 things simultaneously as proof of our worth. The result? Mommy wars. Maternal depletion. Auto-immune disease. Helicopter parenting. Loneliness. Depression and anxiety.

    Matrescence is a powerful and unique developmental phase of life that forces new moms to reckon with individual and collective pain and trauma. By showing up in an informed and supportive way, clinicians can affect fundamental security in a woman, in her baby and ultimately in society as a whole. This is a critical shift in our cultural paradigm. Mothering is, in fact, the very heart of our humanity; the developmental phase of matrescence deserves to be held with reverence and extreme kindness for the ultimate development of a benevolent society.  

    References:

    Colino, S., & Fabian-Weber, N. (2021, July). Postpartum anxiety: The other baby blues we need to talk about. Parents. Retrieved from http://parents.com/
    Gholampour, F., Riem, M. M. E., & van den Heuvel, M. I. (2020). Maternal brain in the process of maternal-infant bonding: Review of the literature. Social Neuroscience, 15, 380-384. doi:10.1080/17470919.2020.1764093
    Koenisberg, R. A. (1989). Symbiosis and separation: Towards a psychology of culture. New York: Library of Social Science.
    Kumar, R., & Brockington, I. F. (1989). Motherhood and mental illness. Cambridge, MA: Academic Press.
    MGH Center for Women's Mental Health, Reproductive Psychiatry Resource & Information Center. (2019, June). Postpartum psychiatric disorders. Retrieved from https://womensmentalhealth.org/
    Sandler, D. H., & Szembrot, N. (2020, June 16). New mothers experience temporary drop in earnings. Retrieved from https://www.census.gov/
    Schore, A. N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsadale, NJ: Lawrence Erlbaum Associates.
    Schwartz, R. C., & Sweezy, M. (2020). Internal family systems therapy. (2nd ed.). New York, NY: Guilford Publications.
    Winnicott, D. W. (1953). Transitional objects and transitional phenomena: A study of the first not-me possession. International Journal of Psychoanalysis. 34, 89-97
    Zimmerman, E. (2018, May 25). The identity formation of becoming a mom. The Cut. Retrieved from: https://www.thecut.com/

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  • Saturday, March 19, 2022 4:56 AM | Anonymous

    by Mark Mouro, LMFT
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    It was not very long once I started private practice that I had two strong feelings. One, there are many different ways to do this work. And two, learning how to do them well will be a lifelong process. That notion motivated me to enroll in a 2-year program at Palo Alto Psychoanalytic Psychotherapy Training Program (PAPPTP). And what I’ve gotten out of it so far has deepened my work and given me more of an appreciation for what we do.

    Therapy is a second career for me so I when went back to school to get a master's degree I was still working a full time job during the day. I bring this up because my classes in school and some of the internships sort of felt like a blur to me.  There were many times I recall coming across some really interesting material but not having the opportunity to delve further into it. Recently I’ve had some flexibility in my schedule, so learning psychoanalytic psychotherapy in a different venue while working as a therapist seemed like a good fit.

    As you may know, psychoanalytic psychotherapy developed out of the field of psychoanalysis but the objectives, setting, and technique vary. The objectives for psychoanalytic psychotherapy are more focused and limited, the setting is once or twice a week with the patient sitting up, and the technique may be much more active on the part of the therapist.

    But why psychoanalytic psychotherapy specifically? Before the pandemic I had been in a consultation group led by a psychoanalyst. He suggested we read some recent psychoanalytic journal articles and they struck a chord with me. I had been aware of research articles but this was the first time I had read theoretical articles. The authors introduced and discussed abstract ideas and principles that I experienced in sessions but hadn’t been able to put words to. They explained and predicted the phenomena I was struggling with at times. It was exciting to see what direction our field was going in and feel an intellectual kinship. This wasn't a textbook informing on modality. This was one person's personal exploration of what works and doesn't work for him. And that spirit of learning through experimenting, hits and misses really resonated with me.

    But perhaps most importantly, I was starting to feel that I was coming up short in my ability to use transference as an intervention. In my experience as both a therapist and client, I had seen how powerful transference and countertransference could be when used properly. And I wanted to sharpen my ability and understanding of it. But I didn’t want to become a psychoanalyst necessarily, I just wanted the ability to apply analytic thinking if need be.  
    Here are the basics of the program. The training at PAPPTP offers concepts and theory of contemporary psychoanalytic psychotherapy which include child development research, attachment theory, therapy process and outcome research, psychodynamic diagnosis, and neuropsychoanalysis. The class consists of 10 students made up of MFTs, social workers, psychiatrists and psychologists. There are 2 classes from 8:30am-12pm every Friday. The topic of the classes change every couple of months and we take the summer off between year 1 and 2.

    It has been about 6 months since I began the training and I’ve definitely come away with an appreciation for just how much contemporary psychoanalysis has evolved. While there are similarities, the material is much more applicable than what I learned in school. Contemporary psychoanalysis is attempting to incorporate many different theories and as someone who enjoys contrasting perspectives, this felt right for me.  More specifically, the classes achieve of a good balance of reading theories rooted in the past and also ideas on the frontier.

    While doing classes over Zoom isn’t my preferred method, we are getting by and everyone is making the best of it with hopes to begin meeting in person on the Stanford campus soon. It is nice to have a group of clinicians to meet with over 2 years to develop a rapport with and learn from. Another significant element is mentorship. Each year we meet with one consultant on a weekly basis to discuss a case. I’ve just started this process but I can already tell it’s a great opportunity to examine the evolution of a client and how to best work with them. And last but not least is the teachers. All of them are working therapists and or professors at Stanford and each sees and approaches the work differently. But they all have in common a passion that drives them to volunteer and improve how we work with our clients, or patients.

    Mark Mouro, LMFT is a psychotherapist working in private practice in San Jose. He specializes in working with couples and many of his clients are parents with young children. He is currently in psychoanalytic psychotherapy training at PAPPTP. Previously, he was a therapist on staff at The Couples Institute in Menlo Park. He lists his experiences with Vipassana meditation, foreign travel and lobbying with CAMFT as being most influential. Mark lives in Willow Glen with his tech working wife and two young sons. 

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  • Friday, March 18, 2022 11:54 AM | Anonymous

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    by Geetha Narayanan, LMFT
    Geetha Narayanan is a first generation immigrant and parent working with teens, adults, and families to renegotiate and rediscover meaningful connections. Geetha has experience treating anxiety, depression, and life transition issues. Apart from English, Geetha is fluent in Hindi and Tamil. She has a private practice in San Jose, and can be reached at https://therapistsinsanjose.com/geetha-narayanan-mft/


    Raise your words
    Not your voice
    It is rain that grows flowers,
    Not thunder - Rumi


    In his book Brainstorm: The Power and Purpose of the Teenage Brain, neuropsychiatrist and UCLA clinical professor Daniel Siegel describes the changes in the structure and functioning of the brain during adolescence. In one of his interviews for a teen magazine, Dr. Siegel talks about an architectural restructuring of the teenage brain and an emergence of the adolescent mind that is wonderfully creative, adaptive, and vibrant.  According to Siegel, "the adolescent brain is a construction zone: creativity, innovation, the capacity for abstract thinking, and the need to experiment are traits that drive this period. Unfortunately, as adults, we sometimes see the adolescent drive towards experimentation only as a negative, a sign that the teen is being ‘crazy’ or ‘immature’”.

    Raising kids is tough and parents are not born with a manual for raising their children. Teens go through social, emotional, and psychological changes between 12 and 18. No two teens are alike, and the values, culture, beliefs, and the environment they grow up in all play a vital role in their wellness and health. The reality is a teen's brain is in the process of remodeling.

    Indeed, adolescence can be a challenging time, to say the least, while seeking a secure emotional base or a container where they feel loved and accepted as each teen is going through changes so rapidly. Family can assist in building and supporting a teen's confidence, help shape their identity and be available during their trying times.

    In India, summer meant playing outside for hours with occasional breaks for food or snacks. We never had many toys, including digital games or social media. Today's generation of teens, on the other hand, do not have any time for free play. Their days are packed with structured activities, even in summer, to build up a portfolio for the so-called top schools. When my daughters were in high school, they would share how their peers were planning to take many AP courses, online classes, internships over the summer, and more: schedules were packed. Many parents want their teens to go to their chosen top schools only. They have an unrelenting focus on academics at the expense of everything else, including mental health. These expectations and wishes put so much stress on teens, resulting in a growing epidemic of anxiety disorders, migraines, panic attacks, to name a few, and even auto-immune conditions, in some cases.

    How can parents help
    Create a stress-free zone: Parents and teens can develop a zone out time together. It could be watching their favorite buzz feed videos/TV, cooking/baking: a time of leisure without judgment or life lessons.

    Efforts versus grades: We can counsel them without an obsessive focus on scores. It can be a life lesson that will help them focus on what they need to do and not stress about outcomes beyond their control. Constantly setting stretch expectations, leading to a relentless pressure to meet them, is toxic for teens’ health.

    Sharing your past: Share your college experiences more as an understanding and awareness for your teen, not necessarily to communicate only how your (parent) generation's methods are correct. Such communication would make any teen feel that they never measure up and can damage their long-term self-esteem.

    One-on-one: Celebrating your teen's accomplishments, sharing their disappointments, and supporting their hobbies helps your teen know you are  interested in them. You do not have to make a big deal of this. Sometimes it is just a matter of showing up to watch your child play a sport or music, reading together, or cooking or baking, and arts and crafts activity or giving them a ride to extracurricular activities.

    Treats: Treats worked in elementary school, and they still do, such as a Starbucks drink or a Jamba Juice. Some parents feel that appreciating their teen's effort or journey would defocus them and stop putting in their efforts. However, research has shown that positive encouragement is vital for teens to succeed in any environment. It is not a bribe but an acknowledgment of their effort. In addition, an encouraging comment along with the reward will help make the message clear to your child how much you appreciated their efforts.

    Be empathetic: Using active listening when you are conversing with your teen without interrupting with your own opinions or judgments, being curious and open-minded about their point of view, and having patience as they solve their problems can be the best thing you offer your teen. You need to increase your capacity to listen actively, be open, and provide a non-judgmental stance. For example, when a teen comes home heartbroken as they did not get their desired result in their quiz, a parent could respond, "I saw how much you worked on that; I am so sorry to hear that." This kind of empathy is powerful to hear someone say and soothes them.

    Only STEM mindset: There are some misconceptions that only a few majors guarantee a job. Other than STEM majors, there are other majors in public health, global health, economics, nursing, etc., leading to great jobs and careers. Parents should encourage their children to create a career path that brings them joy as well as a paycheck.

    Chores/jobs: As parents, we would like to rescue and complete our kids' activities and chores. However, it is an excellent time for teens to develop and mature with independent living skills. Managing simple tasks like laundry, cooking, or running errands for the house once they start driving, teaches them accountability/responsibility and time management.

    Limit setting/boundaries: By setting up rules, boundaries and standards of behavior, you give a teen a sense of stability and predictability. Regular family meetings and explaining the benefits and consequences of following rules/boundaries would help. It also helps them internalize the concept of delayed gratification. Of course, there will be pushbacks, yet this practice is integral in a time of chaos.

    Conclusion
    Trust and respect are earned not by doing only heroic, victorious deeds, making significant changes, saving lives around you, but also by paying close attention to your teen's emotions and feelings. Dr. Siegel reemphasizes the importance of how young adults need to be seen and soothed by their parents. Relationships with our teens provide a template for relating with people when they step outside our homes. Developmental relationships are connections that help young people become their best selves.

    For Parents:

    Goleman, D. (2010). Emotional intelligence: Why it can matter more than IQ. New York, NY: Random House Publishing.

    Siegel, D., & Payne Bryson, T. (2011). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. New York, NY: Random House Publishing.

    Siegel, D. (2013). Brainstorm: The power and purpose of the teenage brain. New York, NY: Penguin.  

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  • Wednesday, September 15, 2021 12:59 PM | Anonymous

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    Dominique Yarritu, PhD, LMFT in conversation with Kelly Yi, PhD, LCP

    A few years ago, at the beginning of my doctoral coursework, I became interested in the work of psychedelic-assisted therapy and have been fascinated by it since. As a student of somatic approaches and theories of healing the ills of humanness, such a work feels the ultimate somatic undertaking. If you have been following the development of this new addition to talk therapy, you may be familiar with the work done with MDMA at Johns Hopkins Center for Psychedelic and Consciousness Research, and you may have heard of psychiatrist Stan Grof’s use of LSD in clinical settings in the 60s, and his immense contribution to the research in the healing potential of various psychedelic compounds. You may also have heard—through the grapevine or from friends or acquaintances—about sessions with Ayahuasca in South America. Psychedelic medicines come in various forms: synthetic, like MDMA or LSD and as plant medicines. Some of the best known plant medicines are psilocybin or mushrooms, Ayahuasca, Ibogaine, San Pedro, and Peyote. And if you find it appealing, you may even experience a psychoactive journey with toad venom.

    Among other questions that I will be touch on in this short article, I wondered how the work with one medicine or the other would differ. Would having a session with LSD be very different or produce different results than one with MDMA? What about psilocybin? In Michael Pollan’s book, I learned that the length of each medicine’s effect differs: a few minutes or a couple of hours (with DMT), a little over half a day with MDMA and probably a good full day with LSD. And in this psychedelic treasure trove, which one to choose? To answer these questions, I reached out to Kelly Yi, PhD, who has been practicing psychedelic-assisted therapy with Ketamine for treatment-resistant depression and anxiety at My Doctor Medical Group in San Francisco.  Dr. Yi is experienced and trained in various forms of psychedelic medicine in contexts and countries where it is legal. Our long conversation offered me a new understanding of this therapeutic approach as it took us to various realms of the work with psychoactive agents.  

    Dr. Yi says that his view is “a little different than a lot of people in the field” because he puts “less emphasis on the particular agent.” He continues to say though that “there are differences. MDMA and San Pedro are not as challenging to the ego structure. Both of those are going to leave the ego fairly intact but bring up a lot of different aspects [of the person’s current psyche]. However, other medicines like LSD, mushrooms, Ayahuasca typically challenge the ego structure. People have to go through deep ego surrenders, as well as disorientation to reality.”  Therefore, it seems that although the agents or the medicines are different and the effects on various parts of the psyche differ, “the medicine is going to activate what is in the particular person; mostly at the beginning, the biographical material. If there’s a lot of structure around the ego and unprocessed developmental experiences, that’s likely going to be activated more.”  Dr. Yi also emphasized and reminded me that “the dosage is another important aspect” of the work with more intense activation with higher quantities, in particular for new psychonauts.

    I would be remiss to tackle the topic of psychedelic-assisted therapy and not mention the transpersonal aspect of this work, what depth psychotherapists, theorists, and Robert Romanyshyn in particular, call soul work or work with soul in mind. Again, Dr. Yi’s “big thing is the metaphysical assumptions around psychedelics because most people will reduce these experiences down to the chemicals and the neurochemistry. That’s a very reductionistic view. I think that once people have worked through their biographical material, their soul shines through. And, in my world view, each person has a very unique soul nature: they’re on this planet to do a very particular thing, unique to them. Beyond this, there can be a lot of mystical oneness experiences and unions [during journeys] that start coming in.” Hearing Dr. Yi speak about the transpersonal aspect of this process reminded me that many of these plant medicines are connected to indigenous traditions, most often used in shamanic journeys, and have been used for millennia by primary peoples. I asked about the cultural aspect of the medicines, and how we can respect the traditions that we are now transferring to the Western model of healing. According to Dr. Yi, “all you can do is have humility. I think that’s the problem for mainstream Western psychology: there’s too much arrogance about their views of other cultures, around knowledge. And yet, if you look at these other cultures, they’re really complex, vast, and profound psychologies. Usually, it’s in the spiritual traditions and often, it is sadly reduced to superficial Western concepts of religion, which it is not. And when I think of psychedelic medicines: they’re profound at illuminating all of this.” In a nutshell, psychedelic journeys are likely to become also transpersonal and mystical experiences if the setting lends itself to it and the psychonaut is ready for the revelation.

    The research done with MDMA and other psychedelic medicines promises healing for a wide variety of dis-eases or mental illnesses: from PTSD to depression, end of life anxiety, and other pathologies that are being tested for. The one advantage of using psychedelics in therapy is, at a time when the world pace is ever faster, the speed at which healing can happen could likely be quickened: “this is where I see the power of psychedelics; traditionally, you would have to practice meditation for 10 to 20 years to have the some of the same experiences. But here, you can get this whole reality reorientation. So, that’s very profound. They are indeed very powerful agents” says Dr. Yi. I agree and see these medicines—or agents as Dr. Yi calls them—as conduits, a dynamic link between the outer and inner world and the transpersonal world, an opening to another inner dimension of the Self. Once a psychonaut has experienced the depth of their inner world, Dr. Yi says, it can “lead them to operate differently in the world [of ordinary consciousness]. When you use these agents, you see reality through these different perspectives and lenses experientially: it’s not an intellectual experience but it’s fully experiential.” From the accounts of so many well-known psychonauts, and in particular the accounts of Christopher Bache’s multiple journeys with LSD, it is an extremely somatic experience. It is all about the body, the energetic and subtle body. Therefore, the work itself does not end at the closing of the journey or the ceremony but continues through the integration of the material one has accumulated during the process. To me, says Dr. Yi, psychedelics are “important to open up doorways and then, it’s like ‘how do  you integrate'?

    If there is a sequential process associated with the work with psychedelics, does it mean that the journeys follow a strict structure: the sessions focus on developmental issues only until the psychonaut has reached a certain level to access the transpersonal? According to Dr. Yi, that is not necessarily the case and speaks of the “MAPS training, and Rick Doblin, PhD, in particular, founder and CEO of MAPS, who was influenced by Stan Grof, MD, the founder of Transpersonal psychology. One of Grof’s views was the concept of inner healing intelligence. So, basically, we as therapists, from that model of inner intelligence, don’t know the ideal healing sequence. The client has an inner healing intelligence that’s going to guide them to exactly whatever they are ready for. That’s what they’re going to get. That inner intelligence, when you work with the medicine, can start opening up. Maybe one person needs to experience vast oneness in order to process their trauma at 5 years old. Therefore, the experience will not be so linear, it won’t necessarily go directly to the trauma. It’s like a looping fashion: let’s go to the resource of unity consciousness and let’s bring it to your traumatized self, which is very similar to something like IFS and the more transpersonal foundation of that work: access the Self, first, and then relate to the parts like protectors and exiles. There is some kind of iterative loop.”

    Psychedelic-assisted therapy is on its way to becoming more mainstream and features increasingly in non-professional media. From my readings and studies, and from Dr. Yi’s experience working with Ketamine and other psychedelic medicines, two things come to mind in closing this article. First and foremost, this type of therapy is not for everyone. There have been cases of extreme self-harm recorded in professional publications and in mainstream media (mostly when using these compounds in a more recreational way). In the introduction to his book, Scott Hill, PhD speaks of his decades long struggle after a bad trip on LSD. And yet, when used within the strict confines of a ceremony and accompanied with a guide who can prepare the psychonaut and help them integrate the experience, psychedelics hold a powerful key to healing. As Dr. Yi says, “psychedelics have the potential to be a major wave to global healing—especially in the industrialized world.”

    Kelly Yi, PhD is a licensed clinical psychologist. He currently is the Associate Chair and Director of Clinical Training for the PsyD program at The Institute of Transpersonal Psychology at Sofia University. He is former adjunct clinical faculty and clinical supervisor at Stanford and Palo Alto University. He studied comparative mysticism previously at UC Santa Barbara. He is the chair of a Transpersonal Psychedelic-Assisted Therapy certificate program through The Association of Transpersonal Psychology. He currently is completing a book titled, Multi-Dimensional Psychology, that explores many of these topics. If you would like to be notified when the book is released, feel free to email multidpsych@gmail.com

    References:

    Bache, C. (2019). LSD and the mind of the universe: Diamonds from heaven. Rochester, VT: Park Street Press.

    Grof, S. (2008). LSD psychotherapy: The healing potential of psychedelic medicine. (4th ed.). Ben Lomond, CA: MAPS.

    Hill, S. J. (2019). Confrontation with the unconscious: Jungian psychology and psychedelic experience. London, UK: Aeon Books.

    Pollan, M. (2019). How to change your mind: What the new science of psychedelics teaches us about consciousness, dying, addiction, and transcendence. New York, NY: Penguin RandomHouse. 

    Romanyshyn, R. D. (2013). The wounded researcher: Research with soul in mind. New Orleans, LA: Spring Journal.


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