By Hazel Namponya
There has been much controversy around the use of psychedelics for trauma treatment and healing. Much fear clouds this form of treatment mostly because there is little understanding of it. Equanimity Wellness Centre, based in Johannesburg, is one institution that has braved these waters by using ketamine, a Schedule 6 psychedelic, to treat trauma patients.
Most of the controversy around the use of psychedelics has to do with its pros and cons. We have listed a few for better understanding.
Pros:
Psychedelics such as psilocybin (found in certain mushrooms) and 3,4-methylenedioxy-methamphetamine (MDMA) have shown promise in clinical research as potential tools for treating mental health conditions like depression, anxiety, post-traumatic stress disorder (PTSD), and addiction. They have the ability to produce profound psychological and emotional experiences that can lead to transformative insights and healing.
When used in a controlled and supervised therapeutic setting, psychedelics may enhance the effectiveness of psychotherapy. They can facilitate breakthroughs, increase emotional openness, and provide a different perspective on one’s experiences, allowing individuals to address deep-seated traumas and patterns.
Studies have indicated that psychedelic-assisted therapy can lead to long-lasting positive changes in individuals. It has been suggested that a single psychedelic experience can have effects comparable to months or years of traditional therapy.
Psychedelics have the potential to induce mystical or spiritual experiences, often described as feelings of interconnectedness, transcendence, and unity. These experiences can have profound effects on one’s sense of purpose, meaning, and well-being.
Cons
Psychedelics are classified as Schedule I substances in many countries, which means they are considered illegal and have no recognised medicinal use. This restricts access to these substances and limits research opportunities. Additionally, many of these substances are produced outside of controlled laboratory conditions which can result in diminished quality.
Psychedelics can induce intense psychological and perceptual effects that may be overwhelming for some individuals, especially those with a history of mental health conditions or a predisposition to psychosis. In rare cases, they can lead to psychological distress or persistent negative effects, known as “bad trips.”
Psychedelic therapy is still an emerging field, and there are currently no standardised protocols or guidelines for their therapeutic use. This can lead to inconsistencies in treatment approaches, dosages, and integration practices.
While psychedelics themselves do not produce physical dependence, there is a low risk of psychological dependence or misuse. Without proper guidance and integration, individuals may abuse psychedelics as a means of escapism or self-medication, leading to negative consequences.
The use of psychedelics raises ethical questions about informed consent, participant safety, and the responsible use of these powerful substances. Ensuring proper training and supervision of therapists, as well as safeguards to protect vulnerable populations, is crucial.
It’s important to note that the field of psychedelic-assisted therapy is rapidly evolving, and ongoing research aims to address some of these concerns and expand our understanding of the benefits and risks associated with their use.
THE INTERVIEW
We speak to Brad Kallenbach, a Clinical Psychologist and founder of Equanimity Wellness, about his healing approach.
CAM: Thank you for allowing us to interview you. We’re really excited about this Wellness Centre, Brad, share a bit about you and the centre.
Brad: I’m a clinical psychologist with nine years of private practice experience since qualifying in 2013. I’ve been actively working in the psychedelic-assisted therapy space for the past two and a half years. I’ve been involved in running retreats and working with the Equanimity Wellness Centre, which we’ll discuss further. When I’m not consulting, you’ll find me practicing yoga, reading, spending time in nature with my partner, playing with my cats, and attempting to learn jujitsu.
CAM: That’s interesting. What led you to start Equanimity?
Brad: Being a clinical psychologist for the past decade, I’ve witnessed first-hand the challenges people face and the limited effectiveness of traditional therapeutic approaches. Although rewarding and powerful at times, there is often frustration among practitioners, including myself, regarding the slow progress and the tendency toward relapse. It’s what we call the revolving door phenomenon, where people go through cycles of improvement and regression. I wanted to explore alternative methods that could potentially offer deeper and more lasting healing experiences. This motivated me to start Equanimity.
CAM: That sounds interesting. So, you’re saying that you’re creating new neural pathways, essentially allowing the mind to transcend its limitations. However, in this uncharted area, what are the possibilities? From your experience, are there any risks involved? For instance, when reintroducing trauma, could it lead to secondary traumatisation? How do you handle that? And how safe is the space you provide? How much containment is there for such cases?
Brad: That’s an excellent question, and I don’t want to downplay the risks involved. The fact is that psychedelic medicines are not suitable for everyone. Certain individuals with underlying predispositions, such as schizophrenia or other psychotic disorders, already have a fragile state of mind. Further fragmenting the mind by disabling its defence mechanisms with psychedelic compounds is not beneficial for them. Therefore, there are contraindications for these medicines, and we invest a significant amount of time in screening individuals to ensure their suitability for treatment.
Now, for individuals without these underlying predispositions like schizophrenia, psychosis, or active mania associated with bipolar disorder, these medicines can be extremely beneficial. In conditions like major depressive disorder, chronic anxiety, addiction, severe OCD, or severe eating disorders, we often find that people’s defence mechanisms are too rigid and stuck. The capacity of psychedelics to soften and break down these defence mechanisms is precisely what they need to heal and recover.
However, it’s important to note that even for individuals without contraindications, psychedelic-assisted therapy is only beneficial within a specific and rigorous therapeutic framework. Renowned institutions like Johns Hopkins, Harvard, Yale, and Imperial College London have pioneered a three-part framework that ensures optimal safety during the experience.
The first phase is thorough preparation, where we delve into the individual’s intentions for the plant medicine or ketamine-assisted therapy journey. We deeply explore their background and life story to understand their defence mechanisms, vulnerabilities, and determine what kind of experience would be optimal for them. We also conduct a comprehensive screening and assessment to rule out any contraindications.
The second phase is the medicine journey itself, where we implement certain parameters to ensure safety and meaningful experiences. We modify the environment and create a sense of containment, creating a holding space for the individual and making them feel safe as the medicine ‘manifests their mind to them.’
Finally, the third and most crucial phase is integration. This is where the individual translates the insights gained from the journey into meaningful and lasting behaviour change because, ultimately, that’s what this therapy is about. Psychedelics serve as a catalyst for behaviour change, and it requires a well-trained clinician to guide the integration process effectively. If we’re fragmenting rigid pathways in the mind and dismantling defence mechanisms, we must offer a structured and rigorous program to help individuals put themselves back together in a healthy way.
Unfortunately, this is a deficit we’ve observed in some shamanic or non-empirically verified models. They often lack thorough screening and preparation, pay minimal attention to the setting of the medicine journey itself, and provide little to no integration therapy. In such cases, the medicine journey can become a mere memory of a dream at best or even a traumatic experience at worst.
CAM: Could you give us an example of a typical patient’s journey from beginning to end, showcasing their transformation? I’d like to have a visual understanding of the process.
Brad: Absolutely, I’d be delighted to share a case example and I’ll modify some details to protect the client’s identity.
During the medicine journey, the client encountered a figure, a representation of his inner critic, which he described as this towering, menacing presence that had been tormenting him for years. He confronted this figure and had a powerful dialogue with it, expressing his anger, and frustration, and asserting his right to self-compassion and acceptance. This interaction brought about a profound shift in his relationship with himself and his inner critic.
During the integration phase, which is crucial for translating the insights gained into meaningful and lasting behaviour change, we worked together to process and make sense of his experiences, exploring the symbolism and meaning behind them. We addressed the core wounds and traumas that were revealed and provided support and guidance as he navigated through the emotions that surfaced.
Over time, as we continued the integration work, he noticed significant improvements in his overall well-being. He developed a greater sense of self-compassion and acceptance, letting go of the self-loathing and self-criticism that had plagued him for so long. His relationships improved as he cultivated a deeper connection with himself and others. The depression and anxiety that had weighed him down started to lift, and he experienced a newfound joy and vitality in life.
It’s important to note that this transformation didn’t happen overnight. It was a gradual and ongoing process that required commitment, self-reflection, and support. Witnessing his journey from a deeply unhappy and conflicted state to a place of self-discovery and healing was truly remarkable.
CAM: It’s truly inspiring to see the transformative power of psychedelic-assisted therapy. So, when I listen to this entire process that you went through with this gentleman, I see how valuable your healing modality could be in the GBV space, my question would then be, do you hold space, or can victims of gender-based violence access your services? Is that the right space for them?
Brad: Absolutely, we have worked with victims of gender-based violence and it’s a particularly insidious and horrible form of trauma. As with anybody, we would take the individual through our protocol, we would take them through the screening and our preparation process, we would never take somebody into a journey like this if they weren’t ready and they weren’t prepared, or if there were indications that it would do more damage to them than it would help. Having safely guided hundreds of people through these experiences, we have never had a situation where the process ended up re-traumatising them and was not helpful. So, we can confidently say, because we have invested so much time and so much rigour into the therapeutic framework, this would be a very safe and healing option for people who struggled with overcoming GBV.
CAM: Ok, so I am coming in as a victim, do you have dedicated programmes for victims or is it case by case, like could it be somebody who is struggling with a different clinical psychological problem? Do you have special programmes for GBV victims?
Brad: Absolutely, that’s such a great question. So, the specificity of the protocol of the intervention is completely dependent on the expertise of the therapist working with the person. So, in the same way that no two people will get the same therapy intervention in a traditional therapeutic approach, they will not get the same cookie-cutter approach in this space either. The only thing that is the same is the process of the medicine journey itself. There the process is standard and systematic. They have the same medicine, and they do it in the same space, but the integration therapy will look completely different. The reason for that is because they would have had a different life story and set different intentions; an experienced clinician will know how to craft and tailor the therapy, the integration therapy based on their trauma, defence mechanisms, and underlying history. The beauty of our approach is that it takes experienced therapists to do that, and we make no compromises. That is how we differentiate our work from other modalities.
CAM: Okay, so your integration is custom-made. Can we discuss ketamine, which is standard? What is it, and what does it do?
Brad: Ketamine was originally developed as an anaesthetic in the 1960s and 1970s. It is an FDA-approved medicine with an excellent safety profile. Ketamine was introduced as a safer alternative to the anaesthetic used at that time, called phencyclidine or PCP. Unlike other anaesthetics, ketamine doesn’t suppress the cardiovascular system, which makes it safe for use in children and is still used in medical settings today. Its safety and effectiveness have earned it a place on the World Health Organization’s list of essential medicines.
In the year 2000, researchers at Yale University discovered that administering a sub-anaesthetic dose of ketamine to individuals with treatment-resistant depression resulted in remarkable remission of symptoms. By sub-anaesthetic dose, I mean one-tenth of the dose that might be given to a child in a hospital setting. Ketamine acts on a different neural system called the glutamate system, which plays a significant role in memory, learning, drive, and executive function. This system affects many aspects of the brain and has a broader impact than just the serotonin system targeted by traditional antidepressants.
The researchers realised that by stimulating the glutamate system with ketamine, they could trigger a surge of glutamate in the brain. The results were astonishing. People who were previously suicidal and required admission to hospital reported a complete shift in their mindsets after a 0.5mg/kg ketamine infusion. They described feeling like they ‘had a new brain,’ even experiencing colours more vividly. This breakthrough in depression treatment was hailed as the most significant advancement in 50 years.
However, there was one catch. The benefits of ketamine started to fade after 7 to 12 days. To maximise the potential of ketamine treatment, proper integration therapy is crucial. Cognitive-behavioural therapy (CBT) and structured programs for habit change are essential during this window of opportunity created by ketamine. With the right therapy and changed habits, the benefits can last for months. Maintenance infusions every six months, along with therapy and behaviour change, help sustain the healing process.
CAM: What are the possibilities of people becoming addicted to or dependent on ketamine?
Brad: It’s a crucial question, and I’m glad you asked. Ketamine does have some potential for psychological addiction, particularly in recreational settings. However, it’s important to note that in the clinical setting, such as at Equanimity Wellness, ketamine is administered under medical supervision, with controlled and minimal doses. The likelihood of becoming dependent on ketamine through our clinical protocols is virtually nil. We have strict guidelines to prevent individuals from receiving excessive infusions. Our goal is to provide the least number of infusions necessary for improvement and focus on sustaining healing through therapy and behaviour change.
It’s also worth mentioning a landmark study conducted by Professor David Nutt from Imperial College London in 2019. The study compared 22 substances for their potential for harm, including addictive potential and physiological harm. When you examine the rankings, the substances with the highest potential for harm are alcohol, crystal meth, heroin, crack cocaine, and cocaine. Interestingly, ketamine, psilocybin mushrooms, LSD, and MDMA rank at the bottom, even below cannabis. Our perception of ketamine may have been distorted by the recreational scene, where unregulated doses and mixing with other substances occur. The quality of ketamine used recreationally is often not medical grade, and the environment is not suitable. Under those conditions, any substance can become harmful.
CAM: How accessible is ketamine?
Brad: Ketamine is classified as a Schedule 6 drug in America, which means it can only be accessed by medical professionals. It is not legal for possession and use by the general public. Ketamine can only be administered by qualified medical professionals.
CAM: What I find interesting is that highly addictive substances are easily accessible, while substances with restrictions are less addictive. As we wrap up, I want to ask two questions regarding the controversy surrounding psychedelics. You mentioned that there hasn’t been a breakthrough in psychiatry and psychology for the past 50 years, and now you’re introducing this revolutionary approach. What are some of the controversies, and how are you navigating them?
Brad: Some of the current controversies stem from a lack of insight and knowledge about these medicines, even within the medical community. This lack of understanding leads to stigma, myths, and misconceptions about these medicines. One common myth is that psychedelics will induce psychosis or make people see Martians forever. However, any medicine used out of context, without proper protocols and a therapeutic framework, can be harmful. Another misconception is that these substances are not as powerful as people think because a few studies may suggest that the benefits are not long-lasting. But the question is, compared to what? Compared to antidepressants with a 33 to 48% efficacy rate? Ketamine is not a magic bullet, but it is a significant improvement over existing options. To correct these narratives, we are being responsible and thorough with our therapeutic frameworks. We aim to shift the focus from relying solely on the medicine to emphasising integration therapy, where insights gained from the medicine can be translated into behavioural changes.
Psychedelic medicine is not a replacement but an additional tool in a vast therapeutic toolbox. It accelerates and catalyses the work individuals are already doing, complementing existing therapies and interventions developed by experts in the field over the past century.
CAM: It’s important to understand that it’s just a tool, not a remedy or solution. It’s a critical piece of the puzzle. I think that’s essential for our listeners and readers to grasp. As we conclude, I would like to know how accessible your interventions are.
Brad: We have done our best to make our interventions as cost-effective and accessible as possible. Unfortunately, the treatment is relatively expensive, with an infusion costing R3200. However, we have bundled it with integration therapy. In other settings, you would need to go for the infusion and then find your own therapist, paying an additional R1500 for a therapy session. To make it more manageable, we have packaged everything together for R3200, including the journey, preparation, intention setting, and integration therapy. Fortunately, some medical aids currently cover ketamine treatment under specific plans, making it more accessible and manageable for people. Our long-term goal is to find ways to make it even more accessible and affordable. It aligns with our mission at Equanimity, which is to reduce unnecessary suffering in the world by engaging in purpose-driven work and leaving this reality a little better than we found it. If we can achieve greater accessibility over time, it would be a source of great fulfilment.
CAM: Absolutely. Our nation is dealing with significant trauma, so there’s much work to be done. Wishing you all the best. Thank you for allowing us to interview you. How can we contact you?
Brad: The best way to reach us is via our website at www.equanimitywellness.co.za, or by contacting our Head of Operations, Gina Fainman, at Gina@equanimitywellness.co.za.
