Community Focus

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Interview with Gia Reyes, LMFT by Vidur Malik, LMFT, Director at Large

Vidur: Could you introduce yourself and the work you do, along with any specialties:

Gia: My name is Gia Reyes, I'm a first-generation immigrant and LMFT. I specialize in immigration-related mental health issues such as cultural and generational conflicts, migration trauma like the sense of losing one's identity, culture and traditions, and intergenerational trauma, especially for second or third-generation clients or clients with refugee lineage.

Vidur: What motivated you to specialize in working with clients who are experiencing immigration-related mental health issues?

Gia: Being an immigrant myself and knowing how overwhelming and anxiety-provoking moving to another country can be, I really felt that my life experiences and academic learnings provided me a unique lens through which I could assist similar immigrants make some sense of their new life. First-generation immigrants of a certain age have usually lived a ‘life’ in their country of origin and have ‘paid their dues’ in a certain industry, only to find themselves unable to practice in the US due to lack of accreditation or licensing. That alone can cause severe depression and anxiety, even an existential crisis.

Also, having lived here for a few years in my early 20s as a foreign student, I became acutely aware of the huge difference in my experience then and coming back in my early 40s with two kids below the age of 10. It is really fascinating how as an immigrant you experience the same place very differently at different stages of your life.

As a mom, I suddenly found myself doubling down on making sure my kids understood the Filipino language, ate Filipino food and ensured they were aware of the culture, beliefs and traditions, if not adhere to them. Having had the privilege of being able to travel at a young age and being exposed to different cultures, it was still very jarring to have to raise children with very different metrics from what I knew as a child. I knew that for a lot of immigrants, who probably also had a language barrier to hurdle besides the disparity in cultures, the challenges could turn overwhelming on a dime. I was sure that there were so many immigrants who needed help.

Vidur: Do you find that there are commonalities in the immigrant experience, regardless of where in the world you're immigrating from?

Gia: That's such an interesting question because a lot of immigrants come from collectivist cultures where you basically move as a ‘tribe’, and the goals and well-being of the group at large is oftentimes given more priority than individual goals. Then you come to the US, and it's a very individualistic culture, and the second and third-generation family members experience so much internal conflict because of the opposing views of family vis-a-vis American society.

Yes, I've discovered that there are so many commonalities with immigrants regardless of where in the world they come from. Then as you peel away layers, you start to see the nuances of a specific culture.

I have a lot of clients who, whether first, second or third-generation immigrants, experience and/or inflict intergenerational trauma to the next generation, that my mind is truly blown away. And as I’m sure most immigrant therapists have experienced, there is a unique advantage to having that lived experience of growing up in another culture, especially a collectivist culture. There is an innate understanding of certain ‘rules’, such as unquestioned reverence for elders and how it is almost incomprehensible to go against what the family has always believed in or done, even if your Western mind knows, ‘this is so toxic.’

Vidur: In your experience, how do clients figure out how to preserve their cultural identity from where they lived before while adjusting to where they're living now?

Gia: I try to introduce the idea of the “third identity,” as renowned Indian-American psychoanalyst Salman Akhtar has very brilliantly coined - because it is really a “third identity.”

I still recall what a Peruvian professor of mine in grad school said, “I feel more American when I’m in Peru and I feel more Peruvian when I’m in the US.” It blew my mind because it totally resonated with me! There is this sense of not fully belonging anywhere, of being in some space that is unknown. . . a space with no label. Hence the need to ‘integrate’ all the parts of ‘you’, to have trust and confidence in this “third identity.” That is your core and authentic self.

Almost organically, I have leaned into the therapeutic modalities of Internal Family Systems, Psychodynamic Psychotherapy and Trauma-focused Therapy.

Vidur: What would you say are the best ways for clinicians to ensure that clients who have recently immigrated to the US feel safe in session and feel fully seen and heard?

Gia: I think that in most cases, especially for new immigrants, it is a better fit to find an immigrant therapist. Just because intuitively, an immigrant therapist would know how to address sensitive topics that a non-immigrant therapist may not deem so, and also know the stigma that therapy might have in the client’s country of origin.

I would recommend listening for a couple of sessions, just asking questions and refrain from giving any opinion until you have done some research into the particular culture. Luckily, we live in the Bay Area where the population is so diverse that it is not a stretch to find resources on practically every ethnicity in the world.

Vidur: What has your experience been like in terms of finding your own identity after your immigration experience?

Gia: It has not been an easy road for me either, let me start with that! I had a thriving business in the Philippines but because of the political and economic uncertainty then, I felt the need to seize an opportunity that presented itself, to establish a life with my kids in North America.

Then after my divorce, I seriously thought of going back to the Philippines but my kids, who at that point had spent more than half their lives in the US, were basically opting to stay here. The Asian mom in me kicked in, because I wasn’t going to leave them alone here! And that is when I had to really assess and determine what I wanted to do ‘for the rest of my life.’

So I decided to go back to graduate school, get licensed as a psychotherapist, go into private practice and hopefully help other people, particularly immigrants, find happiness and joy in their life. I want to think that my “third act” is also my way of manifesting the idea that ‘older’ immigrants can reinvent themselves. It takes a lot of gumption, but I believe all immigrants have that.

Gia Reyes is a LMFT in private practice. . . she is also a mom, writer, foodie, avid gardener and energy healer. In her mid-fifties, she decided to pursue a Master’s degree in Clinical Psychology and took on the daunting task of 3,000 hours of internship, getting licensed as her sixth decade was approaching. Gia is a firm believer that her lived experiences of being an entrepreneur, consultant for several multinationals, living in different countries and just “bouncing back when necessary,” greatly complements therapeutic modalities like Internal Family Systems, Psychodynamic Psychotherapy, DBT and ACT.

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Interview with Alex MacKenzie, LMFT by Vidur Malik, LMFT, Director at Large

Vidur: Could you introduce yourself and the work you do?

Alex: I work primarily in private practice. I do a lot of couples work, which is really my favorite thing. I do work with a lot of LGBTQIA+ folks and I also have gotten really interested in working with what I like to call mid-adulthood or “third act” stage of life. I love working with people who are intentional about how they use this last part of adulthood – whether that's retiring, refocusing their career, whatever is meaningful and fulfilling for them. 

The intersection of those – that's kind of my favorite place– when I can work with LGBTQIA+ couples who are in that sweet spot of their life and identifying what that looks like for them as a couple. 

Vidur: How did you realize that was the sweet spot for you?

Alex: Well, honestly, it matches my personal experience. 
I had a sobering experience with getting a cancer diagnosis and so that brought things into sharper focus in terms of recognizing that I don't have the luxury of saying, “Well, maybe I'll do that later.” In mid-adulthood, you're at a time in your life where you don't really have that luxury. But it's an interesting paradox because limitations are really liberating in that they really clarify  this is the time – right now, and either you're going to do it or you're not. 

The third act is a sweet spot in that it’s the wisest, most fearless, most curious point in life. It can be a moment when you have less to prove, and the unneeded armor falls away, treating you to the joy of being the most authentic version of yourself.  

Vidur: What do you particularly enjoy about working with clients in that stage of life in a couples setting? 

Alex: My simple answer to that is I love “love.” I find it really inspiring to help people who may have become a little alienated from each other or who may not be communicating optimally to find that place where they can love each other and support each other in whatever their individual and collective pursuits are, and live the life they truly want. 

Vidur: What drew you to working with the LGBTQIA+ community in particular?

Alex: One thing is identification. Another is when I was going through my graduate program and doing my first internships, it was the community’s moment of reckoning with the AIDS crisis. 

I was in San Francisco at that time and I saw a lot of need and a lot of suffering and alienation. Sometimes crises bring people closer together, and sometimes they push people apart. I really wanted to be a part of the coming together and healing whatever ruptures could be could be healed. At that time, multiple traumas were playing out at the same time. We didn't know what caused AIDS, and gay men were dealing with this horrible question, ‘does my love kill me or kill somebody else?’ There was a lot of division and judgment about, ‘well if those people weren't doing those activities then we wouldn't be having this problem’ and kind of other-ing parts of the community. There was a lot of negative energy pointed at the gay community and even within the community there was a lot of, ‘I'm going to get my safety by differentiating myself from that part of the community, which is seen as objectionable.’

I really wanted to be part of working with people however I could, in groups, individually, and couples to heal some of those ruptures. 

Vidur: How have you found that therapy has helped heal some of those wounds? 

Alex: Therapy helps people who grew up with trauma - including the trauma of having to hide from your parents who you are, the trauma of feeling like society is hostile toward you and that you’re not safe - examine those thoughts and say, ‘well, there are places where I can be safe.’

Realizing that there are relationships where we can be safe and be okay. Accepting that our partners are not looking at us the way that some hostile parts of society does, or the way that a family may have,  if the family was rejecting. So reducing some of that defensiveness where it's not needed by re -examining –   reappraising those kinds of beliefs. 

And of course,  communication, helping people learn how to listen to each other with empathy, and teaching couples how to listen to each other and how to assert themselves heals ruptures and builds bonds. 

Vidur: What are some things that you would recommend for clinicians working with LGBTQIA+ clients to do to make sure that their clients feel safe with them? 

Alex: The first thing I think is that if you identify as LGBTQIA+ to come out to your patients, to let that be visible on your website or however you make yourself known. If you're LGBTQIA+ identified, then one of the first things I would say is to ask your clients if they feel you’re an appropriate clinician for them. It's legitimate to feel like you want to work with somebody who can understand you, and while you don’t have to come from the exact same experience to understand, it’s important to at least open up that conversation. 

I would say the next thing is to explore your own biases and work to expose yourself to information that contradicts those biases and acknowledge how and when they come up. It’s hard not to make assumptions that you understand things that you may not – our biases are insidious in that they just seem true. We all have them.

There’s a thin line between being open to learning from clients about their culture or their experience versus having them have to do the emotional labor of teaching you. I would advise just being aware of that line. It’s important to continue to check with yourself and your clients about how you're navigating that line. 

Vidur: As a gay man, I'm wondering whether you've noticed a parallel process in terms of the trauma that you might have had to deal with and whether that comes up when you support your clients with their trauma? 

Alex: Yeah– Isn’t it for all of us the lifelong unwinding of our own trauma?. There are some times when clients are talking about something that stimulates my own triggers in some way, and I have to use what I know about managing my own trauma response. I might feel tearful, for example, or even angry on their behalf.

Sometimes, something comes up that I'll just disclose, ‘I really relate to what you're saying, this is kind of triggering for me. Let me just acknowledge that and we'll work through it as best we can,’ and I try not to make that the client's job, of course. 

Vidur: How meaningful has it been to support the LGBTQIA+ community and the healing that you wanted to contribute to? Is that something you think about? 

Alex: Thanks for asking that because it's really something that's part of this life stage - looking back and asking, ‘how satisfied am I with what I've done?’

I feel rewarded, validated, and happy when I think of where the community has come and what we’ve achieved. Most of us of my age and many who are a bit younger never thought we'd have a serious conversation about marriage equality, and the fact that we today have marriage equality is quite amazing. 

I do like to think that our work as therapists has contributed to where the community has come to today. The fact that young people –  12, 13, 14 years old are self-identifying and there's growing understanding that gender is on a spectrum is amazing. We’ve created the safety to have some of those conversations. 

Part of satisfaction is acceptance of my own limitations. I sure wish I’d come pre-loaded with all the learning of these years, because I could have helped more, could have done better. 

Occasionally I'll run into a client or a couple (I worked with), and just seeing that they made it is just amazingly satisfying. 

As a community, we still have a long way to go. We are evolving, growing, encountering new challenges, and having to re-fight some old battles. I’m still here for it.  

Alex Mackenzie, MFT is a psychotherapist in private practice who has been licensed for more than 30 years.  He works with a diverse population, and has special interest in working with the LGBTQIA+ community of which he is a member, with age 50+ persons making the most of their "third acts", and with couples.  Alex volunteers as a board member for SCV CAMFT, and as a clinical consultant for Almaden Valley Counseling. He is an avid reader and writer, and rabid downhill skier and spends as much time as possible in the healing natural environment.   His website is alexmackenziemft.com

References:  

10 Principles for Doing Effective Couples Counseling -- Gottman Julie and John\
The Courage to Be Disliked -- Kishimi, Ichiro and Fumitake Koga
Learning to Love Midlife -- Conley, Chip
Stonewall Generation: LGBTQ Elders on Sex, Activism, and Aging -- Fleishman, Jane and Kate Bornstein

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Interview with Siobhan Cassidy, LCSW by Vidur Malik, LMFT, Director at Large

Vidur: Could you please introduce yourself and the work you do?

Siobhan: My name is Siobhan Cassidy. I'm a licensed clinical social worker. I'm originally from New York. About five years ago, I moved to California and transferred my license. Originally, I was in San Diego. I just got to the San Mateo County area in October of last year. I'm excited to be a part of this chapter and get to know people as I’m moving my practice here. I specialize in young people, kiddos, and teens, and specifically grief and life transitions. Sometimes that comes up as a formal grief, but many times it also comes up as grief of friendships, transitions from elementary to middle school, or in thinking that their college journey didn't turn out.

Vidur: What initially drew you to working with a child population? Within that, what drew you specifically to supporting children with different types of grief?

Siobhan: It was by accident. I was in graduate school in New York, working with addictions, family members, and high schoolers. It was during a time of significant heroin and opiate abuse, and the dying part of it and the people who are left behind. With my second practicum, I always wanted to work in health care, so I worked at the Cancer Institute in New York. That was all ages. I loved working with kids. I find it to be easier. They are little superheroes.

Vidur: What in particular makes working with kids easier than other populations?

Siobhan: Kids just want to play. There is this innate curiosity about them, whereas when we grow older, we get stuck in our ways. With kids, I just find it a little bit more approachable, and maybe that's also my personality.

Vidur: I noticed your website is really refreshing in terms of the language and acknowledging that much of therapy terminology can feel condescending or not very real. What was it like for you to come up with your descriptions of who you are and the work you do?

Siobhan: Thank you for that. It came from my patients. Ever since the pandemic, there's been this influx of therapists on social media. Now kids are coming in and they're saying, ‘my parents are narcissists’ and things like that. How can I get something that could be complex down to the nitty gritty so you know what you're getting in session? This is also how I speak, so I wanted that to flow over my marketing so they know what they're getting.

Vidur: I would imagine that working with death and really heavy issues like cancer, you have to just be real about it, and you can't really beat around it.

Siobhan: I’ve actually had feedback from my patients saying they need the directness in death. For example, if I have a patient who lost their wife, that person is no longer married, and saying it directly gives language for something that's new.

Vidur: Do you think that that shows up in working with kids too, acknowledging the elephant in the room?

Siobhan: It's interesting with kids because it's almost like they're already there. Kids are in these environments are surrounded by adults telling them how to think. Instead, they want the truth and they want to talk about things that are real for them. I almost find that if you just give them permission, welcome it, or model it, they themselves will then come out and find the words. If they don't have the words, that's okay because then we can do expressive arts or we can make words up.

Vidur: What else has come up for you as unique challenges of working with child populations that maybe aren't there with adults or other populations?

Siobhan: It's very difficult to be a young person. They're this individual human being that was born into this world. Then they're around these adults who have to say no a lot to keep them safe. They also have to maybe go to a school that they don't want to go to, be around people they don't want to be around. There's a lot of “no.” The way I approach that is by giving them permission to be themselves. They can tell me ‘no’ and practice saying ‘no.’ Here is a ‘yes’ area.

Vidur: We've all had some experience working with kids, and  a lot of clinicians get nervous about it. What are some things that you’ve found are the best ways to make therapy engaging and relevant for kids as opposed to an obligation?

Siobhan: I think it's rolling with the resistance. It's rolling with the idea that some of them might not want to talk. and they might want to sabotage it. I've also had children test me, ‘who are you? what do you like? why are you going to ask these questions and I don't know anything about you?’ I have an open book with appropriateness. I share that I'm a member of the queer community, I like to watch this show, my favorite color.

I have done so many CPS reports in my time. I use that approach of, ‘this is because I care about you.’ Sometimes if I'm getting information that might be reportable, I don't make them shut up right away. I want them to tell me more, tell me more of your experience, and know that maybe I'll sit with that for a session, and I'm not going to do anything. Then it might build, and then I'll bring to them because this is a working alliance. And I say,  I'm going to do this CPS report, but what is our goal between me and you?’

I have this rule that I tell them in the beginning, they're the driver, and at the halfway mark, I always check in: ‘How's it going? Do you want to continue? Are you over it today?’ Because otherwise, why are we trying this out for 45 minutes if they're checked out? Might as well just do half the time.

Vidur: Are there other things that you wanted to share about yourself or about working with kids that you think would be relevant?

Siobhan: I know this is an area that a lot of clinicians suffer with. Unfortunately,the context (of working with kids) sometimes is very upsetting, so it's constantly checking in with yourself.

I have this way now where if a child is telling me something that their safety is at risk and something's going on, where I just sit with my feelings and slow down and tell them, ‘okay, let's take a breather.’ Having one safe person in the world is so important to them, so if a kid is not engaging with me, and they don't want to be here, they might just be testing you to see if you will be there because no other adult might be there for them in a safe way. It might take a long time to get their rapport going.


Siobhan Cassidy’s biography

Siobhan Cassidy is a cis-gendered, queer woman, who is a first generation Irish-American. She is a licensed clinical social worker and is licensed in California and New York. Siobhan's specialties include grief and loss, sexual education and sexuality/LGBTQA+ folks, neurodivergent/ADHD struggles, and college/early career support. She has much experience with grief and loss after a decade of work in clinical hospital settings with children and adults.

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Interview with Taylor Barragan, LMFT by Vidur Malik, LMFT, Director at Large

Vidur: Could you please introduce yourself and the work you do?  

Taylor: I'm Taylor Barragan. I am an LMFT and a psychiatric mental health nurse practitioner (NP). I work most frequently with conditions like  anxiety, depression, bipolar disorder, and adult ADHD. I’m primarily working as a therapist right now, but in the summertime I plan to relaunch my practice with an approach including medication management integrated with psychotherapy, as well as complementary interventions and lifestyle recommendations tailored to each patient's unique needs. Personalized treatment will be guided by the patient's history, specific lab results and grounded in evidence-based medicine.

Vidur: What originally inspired the shift to pursue the psychiatric nurse practitioner program?

Taylor:  It was a culmination of things. Around the time I got licensed,  my husband moved to Ohio for nursing school, and I found myself so interested in everything that he was learning. I was asking him so many questions. At some point he was like, ‘you should just go back to school.’ Around that same time, I had a few therapy clients that had tried medication and within a couple of weeks, they were not as anxious and could actually tap into the emotions or insights that they couldn't previously access in session. I realized that was like the missing piece for this client. I wanted to know more - why did a provider make that decision with that medication or how are these other lifestyle things impacting how effective that medication is?

I just really love school too. Part of that I think too is having ADHD myself. School provides a structure, and I like learning. I interviewed some colleagues who were psychiatric nurse practitioners and after researching how I could integrate my background as a therapist, I decided to make the leap.

Vidur:  What type of work do you envision doing with your background in therapy and psychiatry?

Taylor:  I have some clients that would prefer to see one provider for medication management and psychotherapy in an ideal world. What's coming down the line in the summer is relaunching my practice to include medication management.

But if somebody is already working with a therapist and that is established, I would love to be able to better collaborate with therapists and make that a cornerstone of how I practice. I don’t think school provides enough training  on how to collaborate with a patient’s psychiatrist or psychiatric nurse practitioner. I also don't think that medical schools or psych NP schools do that very well either. There is often confusion about things like “What cadence should we be talking on? How should that communication go? Who leads that? What are we reinforcing in each other's work because this is our common goal for this client?”

Vidur:  What are some ways clinicians can maintain relationships with psychiatrists and ensure coordination of care?

Taylor: It can be really hard to get a hold of psychiatrists or psych NPs. They may not have a direct number. I think that there's just a natural grittiness to the beginning of even making contact, and that takes a little bit of persistence. That gets difficult too because then you might spending a lot of time trying to get a hold of this person's psychiatrist outside of session that you’re not necessarily getting paid for. So you can reserve that time in the session with the client, because it is really important. You can use one of those sessions as a case consultation with the client there.

You can also talk through the main concerns, what you’re working on, and what would they would like you to reinforce during sessions. Getting an understanding about if that client is prescribed something, why that was the choice, and side effects that you should be looking out for. And if you are noticing that somebody is having side effects, being able to have a secure way to send a message to the provider.

In addition, psychiatric providers may only be seeing a client once a month, and then sometimes down to once every three months. So as the therapist, you're getting way more face-to-face time with that client than the provider is most likely. I don't think that everybody involved oftentimes appreciates just how much insight the therapist has; if somebody's doing well or not.

Also, if somebody is not sleeping well and they are on a medication that can cause issues with sleep. The psychotherapist can ask, ‘Hey, did you talk with your psychiatrist or psych NP? Can you take that in the morning?’ Just understanding how you can play a role in reinforcing things, being able to report back key things that you discussed with the psychiatrist.

Vidur:  It sounds like there is a lot more insight clinicians can provide to psychiatrists than we might realize.

Taylor: So much, like sleep habits and quality, medication compliance, or substance use. If somebody is having side effects from a medication and they don’t like taking it but don't want to tell their psychiatric provider, it’s important to have the conversation with the patient about how important it is to let their provider know. It’s importance to reinforce, “Hey, we’re all on the same team. Your provider should know how you’re feeling about the treatment or they have no way of knowing what is or isn’t working.”

 I think that's where things get really messy. Patients may be on a few different medications, and you can't tell if they've had an adequate trial of one because maybe they weren’t taking it because they were having side effects. If we had a better structure for how the therapist could feel empowered to help monitor and relay some of that information, it would be way less confusing and ultimately lead to better patient outcomes.

Vidur: Are there particular topics related to psychiatry that clinicians should like keep ourselves educated on in order to support our clients?

Taylor: Reducing stigma about medication can start just by referring a patient to a psychiatric provider. Patients trust us as psychotherapists, and reiterating that going to a psychiatric provider does not mean they have to immediately take what is recommended is really important. It just starts the process. I was talking to a psych NP a few weeks ago and she said that she always refers patients to psychotherapy, but not every therapist is willing to refer to psychiatry early on in treatment.

Depending on how severe somebody's symptoms are, early intervention is key. Research shows that for conditions like moderate to severe MDD, schizophrenia and bipolar disorder, the longer the delay in treatment, the more treatment resistant they do become. There is also much discussion in the field whether “treatment resistant depression” is actually a case of missed bipolarity, specifically type 2. So for patients who are seeking therapy for mild depression, for example, if symptoms are not improving and instead getting worse, it’s important to refer for an integrative psychiatric medication evaluation.

The other important thing is to remind patients to not start and stop their medication on their own. Again, therapists see the client so much more frequently than a psychiatric provider, so its important to encourage the client to discuss this with their provider and also update the psychiatric provider about any issues with medication consistency. Research on MDD, for example, shows that symptoms should be first treated to remission, and then continued at maintenance with the medication, and psychotherapy, for 6-12 months before tapering (Altamura et al., 2007; Altamura et al., 2008; Kato et al, 202; Paquin et al., 2022). So it’s important for patients to know that for everyone, medication doesn't have to be forever, but it’s really important to decrease stigma about taking medication, reinforce and provide hope for patients, and collaborate with their provider during treatment. Therapists should also be aware of new and exciting emerging treatments like esketamine, and rapid acting antidepressants that are not monoaminergic like conventional antidepressants.

About Taylor

Taylor Barragan, LMFT, PMHNP-BC, APRN, PMH-C is a Licensed Marriage and Family Therapist and Board-Certified Psychiatric Mental Health Nurse Practitioner. She earned her Master of Arts in Counseling Psychology from Santa Clara University and her Master of Science in Nursing in Advanced Practice Psychiatric Nursing from Case Western Reserve University. She is a member of Sigma Theta Tau International Honor Society of Nursing, Postpartum Support International (PSI), American Nursing Association (ANA), and SV-CAMFT.
With a focus on integrative and holistic treatment, Taylor's telepsychiatry practice, which will launch in Summer 2024, offers medication management, complementary and supplemental therapies, and psychotherapy services for teens and adults. As a Perinatal Mental Health Certified (PSI) provider, she has a particular passion for supporting neurodivergent parents through the perinatal period, from preconception through postpartum. Taylor also earned a certification as a lactation counselor to better understand the mental health impacts of lactation and related challenges during the postpartum period.
Taylor's expertise also extends to executive functioning challenges at work and during the transition to parenthood. Her strengths-based and relational approach integrates psychodynamic and cognitive-based psychotherapies, emphasizing enhancing daily functioning and quality of life. Taylor is committed to providing affirming, culturally competent care tailored to each client's needs.

Recommended resources for therapists:

Psych Meds Made Simple
Handbook of Clinical Psychopharmacology for Therapists
Clinical Psychopharmacology Made Ridiculously Simple

References

Altamura, A. C., B. Dell'Osso, Mundo, E., & L. Dell'Osso. (2007). Duration of untreated illness in major depressive disorder: a naturalistic study. International Journal of Clinical Practice (Esher), 61(10), 1697–1700. https://doi.org/10.1111/j.1742-1241.2007.01450.x

Altamura, A. C., B. Dell'Osso, Mundo, E., & L. Dell'Osso. (2007). Duration of untreated illness in major depressive disorder: a naturalistic study. International Journal of Clinical Practice (Esher), 61(10), 1697–1700. https://doi.org/10.1111/j.1742-1241.2007.01450.x

Bobo, W. V., & Shelton, R. C. (2010). Efficacy, safety and tolerability of Symbyax® for acute-phase management of treatment-resistant depression. Expert Review of Neurotherapeutics, 10(5), 651–670. https://doi.org/10.1586/ern.10.44
Kato, M., Hori, H., Inoue, T., Iga, J., Iwata, M., Inagaki, T., Shinohara, K., Imai, H., Murata, A., Mishima, K., & Tajika, A. (2021). Discontinuation of antidepressants after remission with antidepressant medication in major depressive disorder: a systematic review and meta-analysis. Molecular psychiatry, 26(1), 118–133. https://doi.org/10.1038/s41380-020-0843-0

Paquin, V., LeBaron, N., Kraus, G. E., Yung, E. C., Iskric, A., Cervantes, P., Kolivakis, T., Saint-Laurent, M., Gobbi, G., Auger, N., & Low, N. (2022). Examining the association between duration of untreated illness and clinical outcomes in patients with major depressive and bipolar disorders. Journal of Affective Disorders Reports, 8, 100324–100324. https://doi.org/10.1016/j.jadr.2022.100324

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Interview with Jeremiah Knight, LMFT and host of the Therapy House podcast, and Vidur Malik, Director-at-Large, SCV-CAMFT

Vidur: Could you introduce yourself and the work that you do? 

Jeremiah: I’m Jeremiah Knight. I’m a licensed marriage family therapist heading into my eighth year as a clinician. I graduated from Santa Clara University. I was born and raised in San Jose. I’m very happy to be back in the community. I currently run a private practice here in San Jose, working with parents on child custody and visitation within Santa Clara County. I’m also a podcast host, producer, promoter, man of many hats.

Vidur: In terms of the clinical work that you do, would you say that you have a particular specialization or area of focus? 

Jeremiah: Right now in private practice, I mainly focus on anxiety, depression, and trauma within youth and adults. I’m very fascinated with hearing stories that come from their experiences of adversity and assisting them in finding meaning through it all.

Vidur: In addition to the clinical work that you do, I know you do a lot of multimedia work. Can you share just sort of what projects you currently have going on in the multimedia realm and what drew you to just doing that work? 

Jeremiah: I produce the Therapy House podcast, which is a podcast that focuses on helping professionals as they breakdown their process and philosophy behind their work..

I had done a podcast before on Black mental health. I am really big on educating the population about therapy, especially in the Black community and trying to normalize it. I was able to learn how to develop a podcast, how to market it, all the pieces that went into it. 

Therapy House came in with the same question of how other professionals did their work, what went into it, and what happened behind the scenes. I love the idea because we don't get to see other people do therapy. I wanted to create a space where people could share what went into their craft and be vulnerable enough to get the support they needed. A couple of friends of mine from grad school, Jon Tong, Jorge Meza, Luis Abbott, and Jeremy Ramos were open to the idea. I knew how to set up the podcast and be able to distribute it on all platforms. 

A couple of them had some experience generating or working on a podcast. For the most part, we then began to create something that was unique in the podcast sphere. 

We have an upcoming episode on therapist anxiety, describing the angst within our journey and craft. We've just completed an episode on eating disorders, an episode on the experience of queer and trans clinicians, and many more that I’m really excited to share with listeners. Content and stories that I, myself, have either been curious about or have been waiting to hear. 

Vidur: There are therapy podcasts out there, but it sounds like the thing that makes Therapy House different is just that it takes you behind the scenes on the process from the clinician's perspective. 

Jeremiah: Yeah, the therapist gets a therapist, and there's a mic in front of them. Helping is a growing process and the therapist changes just as much as the client on this journey. Here we illustrate it. If you have an idea or you've been mulling something over or you felt alone in it, you’ve got an opportunity to ask another clinician. 

Vidur: What advice do you have for clinicians, even if they're not necessarily doing a multimedia project, on how to put their name out there and market what they do? 

Jeremiah: Create things. Beyond it being a nice outlet, it adds marketability. Whether it is with a soundbite or video or a clip, or a blog or worksheet, all of that helps clients either find you or at least get what they need in some way. You just have to at least try to put out something. Try to get over the piece of creating that makes you feel uncomfortable. “Create for the joy of creating and sharing it with others” has been a mantra that I've been able to remind myself of on the days where I worked all week, and the last thing I want to do, on a Sunday, is sit in front of a camera.

Vidur: Is there a particular message or idea that you'd want somebody to walk away with after they listen to an episode of Therapy House?

Jeremiah: The initial message was that therapists are human too. There are things that go on behind the scenes. We have personal lives. It's not that we're these all-knowing beings that do everything immaculately. Being able to encourage clinicians and help them to be vulnerable, be open, and to ask “what comes up within you when life outside of therapy is chaotic?” 

Vidur: Thank you so much for your time. Where can people find your podcast?

Jeremiah: People can find us on www.linktr.ee/therapy_house and Instagram at @therapyhousepodcast.

References:

Brown, T. E. (2014). Smart but Stuck: Emotions in Teens and Adults with ADHD. Jossey-Bass

Davis, P. (2021). Dedicated: The Case for Commitment in an Age of Infinite Browsing. Avide Reader Press

Siegel, D. and Bryson, P. (2021). The Power of Showing Up: How Parental Presence Shapes Who Our Kids Become and How Their Brains Get Wired. Ballentine Books Trade Paperback Edition

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Back to Winter 2023 Newsletter
Interview with Ashwini Addala and Liliana Ramos, LMFT, Director-at-Large

Liliana:  Welcome! Can we please start with an introduction of yourself.

Ashwini:  My name is Ashwini Addala; I’m a licensed marriage and family therapist who is a spiritual coach, energy healer, and spiritual seeker, with a practice in downtown Willow Glen where I see adults, families, and couples. My approach with clients is centered around self-discovery, where the Self has many parts and aspects. Self-discovery, or more specifically self-awareness, is a fundamental building block of the healing work we do in sessions.

I specialize in areas of childhood trauma, generational trauma, immigrant issues. My work differs from some other therapeutic modalities because I address the mental self, emotional self, physical self, social self, sexual self, etc., and spiritual self. My approach is about seeing a person for ALL their parts, from across lifetimes and on a path of evolution. I incorporate energy healing, grounding and protection mechanisms and guided journeys (visualizations) with clients. Although I worked with children during my training I found later that working with adults and their inner child resonated with me.  

Liliana:  What made you decide to use spirituality during therapy?

Ashwini:  As a spiritual seeker myself who underwent massive healing and transformation through my own therapy work as well spiritual and energy healing, I saw the connection between the spiritual and therapeutic healing I was doing and the improvement of my mental health. That being said, I made an honest attempt to stay true to traditional therapy but ultimately felt ineffective and inauthentic. As I experimented with slowly incorporating some techniques, I saw how effective and powerful it was, not only for treating depression and anxiety, but also in every aspect of the client’s existence, including their patience levels, their interpersonal skills, their romantic relationships, parenting of their children, and their career and professional success. I soon gained the confidence to break out of the mold of what therapy should be and made it fit to who I was as a person. I began to combine other things, such as energy work like Reiki or MotoKi to teach clients to ground or shield themselves in a different way.  Guided meditations, or journeys, as some people call them are another powerful skill and tool I’ve used to help clients heal things like childhood or generational trauma.

People often confuse spirituality with religion, but it is not necessarily the same. Sometimes spirituality can mean self-awareness or seeing the “bigger picture”. Spirituality is the evolutionary trajectory that you’re on. It holds the assumption that life has meaning, and the spiritual aspirant or in my case, the therapist, helps realign ones self to be in congruence with the big picture and one’s personal meaning or purpose of life. To me, spirituality is the mindset and the evolution of what one is aiming for in life.


Energy work is just a tool, but it isn't spirituality itself. It is just a tool some people use towards their spiritual practice. So it's like a therapist that works on trauma, but is also special, has training in yoga and does yoga-based trauma work. Likewise, a person who works with spirituality can use crystals and stones, chant mantras, use dance and movement, sing songs, or practice meditation or mindfulness, etc. When we talk about spirituality is, we can get it confused with the tools. We need to remember that the actual journey of life is the spirituality.

Liliana:  We've had numerous tumultuous years, politically and race -wise, COVID, world politics and wars. How can spirituality help as we end the year and begin a new one?  

Ashwini:  This is a wonderful time of year to take stock of our goals and desires for our lives and be actively engaged in becoming realigned with them. If we want to build a particular type of business, ask your self, “what am I doing that is aligned with building said business, and what is blocking, sidetracking, sabotaging or distracting you from this goal?” Then, with much grace and leeway we realign, adjust, and trim so that we are back on track. It is important to remember that we are in the middle of the journey and not at the end, so even if there are setbacks and detours, it’s okay. We’re not done yet. There is no judgment day.

Liliana: People might have had a crazy year personally.  How do you say your goodbyes to this year so that you can open up to a clean slate in the new year?

As we close out the year, we can look at the goals that we've set for how we want our lives to look, what we want to acheive, and what kind of experiences we want to have. We just take stock, compassionately, slowly, gently, asking, “what have I been able to accomplish and where do I still need to work on it?”

Liliana: Why do you think this is important work?

Ashwini:  This is such important work because it helps people redirect their entire life into being a conscious active participant who is living the life of their dreams now, not just not the present experience one is having. Not just surviving the present moment but thriving. It is important because whether or not we are aware of it or care for it, we are all on a spiritual journey. It is an essence of the human existence and we get to choose whether we engage and drive the boat or be swept up by the waves and tides.

Liliana: What would be the takeaway for a therapist reading this article?

Ashwini:  To try and incorporate some questions about clients’ spiritual orientation into therapy because these are really fundamental existential things that people consciously or subconsciously follow. If someone believes that there is a hell or that there are demonic possessions, that is a good indication of how they function in the world and what their moral compass is made of.

Some questions to ask:

1. What is your spiritual or religious orientation? Some folks may need more prodding with more specific questions about their relationship with the universe or God or a higher power. There is no right answer, it just helps to understand a client’s orientation in their world. It’s also informative if someone says that there’s no belief in a higher power.

2. What do you think is the purpose or your purpose in life?

3. If your life were to end tomorrow/month/year/etc, what do you want to make sure you accomplish so you don’t have regrets?

4. What do you believe happens after death?

5. How do you feel about death? About life?

Liliana:  Ashwini, thank you for this inspiring interview.  Thank you for sharing with us that as we end the year, it is a good time to look at the meaning of our life; reflecting on what we want in our life as we evolve as spiritual beings.  

I'm Ashwini, a psychotherapist and energy healer. With a deep-rooted belief in the power of holistic healing, I've spent over a decade helping individuals find healing, well-being and themselves.
My journey in the healing arts has led me to study and practice various modalities, including Reiki, chakra balancing, and mindfulness meditation in addition to other proven evidenced-based healing techniques such as CBT and DBT. I'm passionate about guiding my clients on their path to self-discovery and thriving, helping them tap into their own inner wisdom and abundance.

My work is not just a profession; it's a calling. I'm here to support clients in their quest for physical, emotional, mental and spiritual harmony. When I'm not facilitating psychotherapy or reiki healing sessions, you can find me connecting with nature or making art with my family.

Back to Winter 2023 Newsletter

Back to Summer 2023 Newsletter
Interview with Michele Barbic and Liliana Ramos

Michele:  I’m a marriage and family therapist. I always knew I was going to be a therapist, but I didn’t go to grad school, JFK, until later in life. The story about being in graduate school in my 50’s is interesting. I told my professor, ‘I’m not going to be an LMFT until I’m in my 60’s. Is this crazy?” The professor stated, ‘Michele, you are going to be 60 anyway. Wouldn’t you rather be doing something that you are passionate about?’ That has served me through the rest of my life.  I think it has served clients as well. We are never too old to pursue our dreams and our passions.  I am 72, a wife of 44 years, and have one son and two grandchildren. My experience in those roles comes into my sessions. Our experiences support what our clients are going through, especially the aging and grieving. I work with clients on how to age gracefully: in the course of the last 14 years, I have studied Hakomi and Sex-Positive therapy, Transpersonal therapy, IFS, and trauma. My newest passion is Psychedelic-Assisted Therapy, especially for aging, chronically ill, and end-of-life grieving.

I see myself more as a guide than a therapist, especially with the work I do with aging and grief.  It’s a different therapy method than when someone comes in with a diagnosis. Both grief and aging carry spirituality. To delve into those two topics, we must delve into what we believe in with grief and aging.  I bring in different therapeutic modalities such as IFS, Hakomi, and somatic work. In addition, I hold hope for my clients when they can’t hold hope themselves.

Liliana: Jumping off from what you said, because of how society has shifted its perspective towards mental health, some older adults might not have dealt with their trauma as children.  How do you deal with that?

Michele: As people come in to work on their grief they often are able to go to a deeper understanding of themselves because they are so raw. One intricacy of working with older clients is that they were brought up in a generation where you only went to a therapist if you had severe mental health illness. In addition, language and experiences have changed for mental health, sex, and gender. Often older adults are misunderstood because they do not have the currently accepted words when talking about sex, gender, race, and culture. They don’t mean to be hurtful or disrespectful.

A second intricacy is that the word older is relational. They’re older than me. If you are 50 and see a 60-year-old, they’re an older person. There is often no acceptance of being old.  Also, there is a difference between chronological and biological age. Biology is based on how well we take care of ourselves. How vibrant are we. I know a 90-year-old extremely active psychiatrist who seems biologically 60 and walks 2- 4 miles a day. When someone comes to therapy, you see their age, you can’t assume how an older adult will appear in your office. Older people can be 65-85 and still be vibrant. There’s a book by Louise Aronson called Elderhood: Redefining aging, transforming medicine, reimagining life, that every therapist should read about how even our medication needs change as we get older. I encourage my clients to work with their doctors and I encourage all therapists to work with the doctors and psychiatrists of their older adult clients. That is important with all clients, but it’s even more important for older clients.

Another intricacy is that therapists working with older adults must have done their own work. If we still have a fear of aging and of death that’s going to come across to our clients. We get very little education in grad school about aging and grief.

Liliana:  In summary, the intricacies are language, spirituality, chronological/biological, medical issues, and our own work.

Michele:  Another part is that older clients might be on anti-depressants. Often, they do not need anti-depressants: instead, they need to process their grief. As an older adult, you have had losses: Lost relationships, career, connection with people, health, and youth.  Grief underlies many mental health issues. I search where the loss is in their life. Whenever we find a loss, I wonder if this is depression or grief and ask the client, ‘Were you depressed as a younger person?’ If they say no, can explore the grief they may be experiencing.  

Liliana:  How do you incorporate grief work when they have depression? Any other ways that you incorporate grief?

Michele:  When I worked at Hospice I noticed that older adults often had unprocessed grief from the past because they weren’t inclined to seek a therapist for grief therapy. An example was a 95-year-old woman who was grieving for her husband, aged 100. She could not get over it: Several sessions into it, she revealed that she had a son who died at three years old. She didn’t dwell on the death because she had two other young children. She didn’t have the time to grieve and address the loss of her child. It was amazing: She was able to cry and talk about how that helped! When she processed it in session, she was a different person. She had let go of something she had been carrying for years. So as we age and dig deeper, we discover more profound loss and trauma.

Liliana:  I want to capture why you think this is important work.

Michele: We all have losses and we are all going to die. Our society doesn’t talk about it. In indigenous cultures, the elders were elders of the community and wise ones. Our society is going in the opposite direction: We don’t want to deal with older people. We don’t want to look at our older people. In fact, I was deadly scared of death until my life-changing experience with my mom’s death. I don’t know how I would have been a therapist if I had not dealt with my own fear of death. Death and aging are so important. We approach it as if, if we ignore it, it will go away. As for myself, I’m not totally free of fear of death, but I thank my clients and my own work for getting me closer. I think that’s a really important message. Since I got involved in grief work, I have a desire to bring it to the forefront. A friend of mine and I organized a couple of Death Cafes: we advertised that we were going to meet for 2 hours to talk about death. People wanted to talk about their own thoughts of death or the death of someone in their life. People want to talk about it, but there is no venue for it.

Liliana: How do you bring up death and how do you talk to people about death?

Michele: What is your belief? What are your emotions around dying? When you ask about this and talk about death, people want to talk about it, especially older people who are sick. Ask ‘Are you afraid of dying?’ ‘What is it like to be in your place right now with your illness?’  For people coming in with anticipatory grief encourage them to ask questions: Are you afraid of death Mom?’ Most recipients of that question are grateful.  

Liliana: To capture two things that you said: you knew that you wanted to be a therapist when you were real young and that you can talk about death because you worked through that. How did you work through that so that you can guide your clients? Are these two questions connected?

Michele: I was an only child, shy, and a good listener. As a child, the kids in the neighborhood would always come to me with their problems because I would listen to them. My mom would tell me, ‘Michele, you always have friends with problems.’ I would say, ‘No, everyone has problems. It’s just that I listen to them.’  My mom always pushed me and encouraged me with this ability to connect with people. When she was in her last days, the hospice nurse said to me that this was going to be an incredible experience. I was upset to hear that this was going to be an incredible experience when my mom was dying, being afraid of death and not knowing how to handle all this. The nurse opened the door for me to something I was not anticipating.

I transitioned my mom. It was like I was birthing my mom into a new life.  It went from giving her spoonful of water, rubbing her head, and doing things for a newborn, except I was doing this as she was going out. The nurse told me that my mom was passing: I held my mom and all of a sudden, I felt this loving energy come out of the top of her head. The whole room was filled with her love energy. It felt like her energy was going into my pores. It was like I was consuming my mom’s love. My husband came into the room.  He said, ‘Michele, there is so much love in this room. Then my son came in and said the same thing. I get emotional just recalling it as it was 13 years ago. It totally changed my outlook on death because she didn’t die: Her energy and love remained. That changed it completely for me.

My mom’s body is buried in the ground but I absorbed her. As I was caregiving with my mom, she encouraged me to go back to school. With my experience with grief, I studied and read more. I did my practicum at Hospice. If you had told me 15 years ago that I was going to be a grief therapist, I would have told you that you were crazy because I was afraid of death. Yet, here I am. That experience was the biggest shift for me. I now run grief groups or have long-term grief clients that have stayed with me, and shared with me what they’re going through and the transpersonal experiences that happen around grief. People come in and say ‘Don’t think I’m crazy, but this crazy thing happened’: How can you deny it? One hundred years ago, it was normal that deceased Grandpa showed up last night. We really need to look at what modern technology and medicine have done to this area of our life.

Liliana:  Thank you for that.

Michele: There is a quote from Carl Jung* that says “Embrace your grief. For there your soul will grow.” I approach clients with the wonder of the gift of grief. I don’t do it initially because they’ll get upset with me, but later, we look at how their life has changed because of the grief they experienced.  

Liliana:  In working with the older adult population, is grief the most prevalent topic that you run into.  

Michele: Yes, grief is the most prevalent. Purpose is the next issue. No matter what age, if we don’t have a purpose, what is life about? As we get older and we don’t have a job or a passion, we get older quickly because we don’t have a purpose anymore. We have to find a purpose. What really excites you? What do you get up in the morning for? In a study where patients got up and watered flowers every day while the other group did not do anything showed that the patients who had a purpose did much better. Viktor Frankl (2006) quoted Friedrich Nietzsche in his book: “He who has a why to life can bear almost any how.” Frankl was responding to hope when he was in the concentration camp. Same thing with aging and grief: clients can respond with hope.  

Then there is the other side. I am the happiest I have ever been: I feel more myself now than since I was a little kid. There are all kinds of research that show that the demographic of women over 60 are the happiest group. One of them is Silver Sparks: Thoughts on Growing Older, Wiser and Happier.

One-third of our aging gracefully is our genes, and 2/3 is our lifestyle. Chronologically Gifted: Aging with Gusto talks about this. Jane Fonda also has a couple of really good YouTube videos about aging. We don’t have many mentors to help us know how to do this.  

Liliana: As we wrap things out, what do you want therapists to know about working with older adults.

Michele: Top of my list is to have them do their own work on aging and death, learning more about seniors, and search for experiences where we do a life review. Francis Weller is a writer and teacher of grief who works with rituals. I did a ritual the other day: It was a grief service for a client carrying the grief for his pet. He had a traumatic experience as a child from the way his parents dealt with his pet’s death many years ago.  We lit candles, played music, and had a ceremony honoring his pet. As he grieved, I could see the difference in his face. It’s never too late to process the grief we may be carrying.

Another take away with grief and aging, is to remember that older people have lots of stories they tend to ruminate on. The therapist should focus on the client’s inner emotional experience rather than the story.

Liliana:  Thank you so much for this hour. What you do for your clients feels so beautiful and so giving. I hope the article captures the essence of you and your work. When I say this, I also think of the essence of love of your mom.

Holding a Master's in Holistic Counseling Psychology, Michele is a psychotherapist licensed in Marriage and Family Therapy. She has worked in the mental health field for many years in various settings, including hospitals, residential care homes, schools, Hospice, and non-profit organizations. Her personal and professional experiences prompted a profound re-evaluation of her understanding of life and death, leading her to specialize in loss, grief, aging, and transformation. Michele was a bereavement therapist at Hospice, Educator for Death and Dying Classes at JFKU, Host for several “Death Café” events, Guest speaker at San Jose State on “Aging Career Changes,” and Organized “Women’s Day 1998” at Santa Clara University while in their graduate program, Spear Headed the opening and supervision of a boy’s group home in New York City and was an onsite counselor for Girls Ark Residential Home for Girls. Michele has a private practice in San Jose, CA and currently facilitates individual therapy and group counseling both for Grief and Senior Women. She also co-founded a Women’s Retreat business where she has held retreats focusing on Women's empowerment nationally and internationally for over 25 years. At this stage of her life, she is passionate about helping shift the paradigm of aging. She invites us to be curious about our true nature and purpose at any stage of life and be open to expanding our understanding of our changing world. Michele is currently studying Intergeneration Trauma and is passionate about bringing Psychedelic Therapy to chronically ill, end-of-life, and grieving clients.

Michele lives in the Santa Cruz Mountains with her husband of 44 years and has a son and two grandchildren. She is an avid hiker, having recently walked the Camino De Santiago, is a Bay Area Ram Dass Satsang member, and practices meditation and yoga daily. 

References:

Aronson, L. (2019). Elderhood: Redefining aging, transforming medicine, reimagining life.  New York, NY: Bloomsbury Publishing.

Frankl, V. (2006). Man’s search for meaning. Boston, MA: Beacon Press.

Haight B. K., & Haight, B. S. (2007). The handbook of structured life review. Baltimore, MD: Health Profession Press.

Miller, E. (2017). Chronologically gifted: Aging with gusto. Pasadena, CA: Best Seller Publishing.

Selig, M (2020). Silver sparks: Thoughts on growing older, wiser and happier. Saint Louis, MO: JETLAUNCH.

Weller, F. (2015). The wild edge of sorrow: rituals of renewal and the sacred work of grief. Berkeley, CA: North Atlantic Books.

(*Quote attributed on the Web to Jung but unable to find the source.)

Back to Summer 2023 Newsletter 

Interview with Jim Arjani, LMFT by Liliana Ramos, LMFT, Director-at-Large

Back to Spring 2023 Newsletter
Liliana: Hi!  Thank you for doing this interview.  Can you please tell us a little about yourself and your private practice.

Jim: I am an LMFT. I have a group practice, Mountain View Therapy, where I employ a few other LMFTs. We do a lot of trauma work and that’s partly because of my background. I used to work with veterans and the 129th Rescue Wing, which is part of the California Air National Guard. There’s a training at the VA—PTSD Clinical Training—that enhanced my knowledge and interest in the area of trauma. Before licensure, as a trainee and intern, I used to work at a therapeutic preschool, Building Blocks, which was part of Seneca Center. Many of these children had backgrounds marked by emotional, physical, and sexual trauma. So, when it came to my private practice, I had experience and interest in working with people who have experienced trauma.

Liliana: How many in your group practice?

Jim: I’m thinking of adding to my group practice. Right now, I have two other licensed therapists in my practice, and am planning to add associates; I have  started supervision training.

Liliana: Where did you go to school and how long have you been an LMFT?

Jim: I went to JFK University and graduated in 1997 when they had a campus in Orinda. Some of the internship sites were elementary schools. It was a nice small university. I was in the school of holistic studies, the transpersonal psychology program. That appealed to me: It was interesting to learn about the similarities between spirituality and psychotherapy.

Liliana: Do you still use it or have you headed a different direction?

Jim: I still use it. The program required us to have a spiritual practice. I was already interested in spirituality before graduate school. It reinforced this idea of taking care of yourself, working on yourself, and the value of some of practices like yoga and meditation.

Liliana: Certifications or specialties? You talked about the VA.

Jim: I have some training in hypnosis but I’m not certified in it. There is an interdisciplinary association called ASCH, American Society of Clinical Hypnosis, the gold standard for hypnosis training. Dentists, doctors, therapists, social workers, and nurses all learn hypnosis together. They also have a certification program.

Liliana: You are certified in EMDR also?

Jim: I’m trained in EMDR. Certification is a more advanced level of training through EMDRIA. Once you have completed the basic training, you need additional hours of working with patients using EMDR and supervision. I plan to do it: One more item on my list.

Liliana: You said you used to work with veterans. Who do you work with now?

Jim: It tends to be tech workers because of the area. Regardless, they have had difficult events happen whether it’s recent or in the past. I consider using EMDR with them if it’s appropriate, especially if I think some of these past situations are impactful, and they’re ready for it.

Liliana: So if I heard you right, you don’t use EMDR with everyone.  

Jim:  Yes, that’s correct. Some clients are not interested in doing EMDR therapy. Other clients may be interested but current stressors may prevent them from addressing the past trauma.

Liliana: What should the patient be ready for?

Jim: When we do the EMDR, we are often bringing up some intense thoughts, feelings, sensations, and memories. This has to be the right time for them to do that work. Maybe we go back to their childhood trauma or some significant event in their life. We want to do that, but we don’t want to overwhelm them if they don’t have the resources to address these issues. So we resource them as preparation. We do interventions such as a safe place and container exercises. Sometimes, we’ll just do the resourcing for people. I find it to be very effective. EMDR uses different modalities combined in one.

Liliana: Can you explain that more.

Jim:  In EMDR, we have someone bring up an image. Now bringing up an image is something we can do in hypnosis or imagery work. Then we help them look at the negative cognition, which is similar to CBT. What is that negative belief you have about yourself or the world? We also try to find out what would they like to believe instead of the negative, which is similar to solution focused therapy. What would be a more rational way to say things to ourselves. So, we get the image, the negative cognition, and the positive cognition.

We also ask them emotions that they are feeling now and where they feel them in their body.  We get a Subjective Units of Distress (SUDS) level—how disturbing does the memory feel for you now. We also measure how truly they feel about their positive cognition. If their positive cognition is “I am a good enough", we ask them whether bringing up this image of being good enough is truly how they feel on a scale of 1-7 (where 1 is completely false and 7 is completely true). We do these measurements as part of the assessment for each target.

We do this bilateral stimulation of the brain. The client brings up the negative thoughts and sensations in their body which is similar to somatic therapy and mindfulness.  We follow with the bilateral stimulation: it’s a very organic process. We ask “what is coming up for you now?”  The client comes up with their own memory, feeling, or thought. The therapist relies on the client for thoughts and emotions to come up. It’s really powerful as they create the insights, images, emotions, and sensations.

I think it can help people with anxiety, depression, and trauma. People think of it as trauma because it came out of that work, but it can be helpful for other disorders too.

Liliana: How have you seen it work with people who have anxiety, depression, or anger?

Jim: Sometimes the anxiety and depression are related to an event or emotion that happened.  I don’t feel good enough about myself so I’m depressed. There might be some events that they have experienced where they learned to feel not good enough. We have a process in EMDR to help them figure out what those experiences could be. What am I (the client) feeling now and link it back to what they’re feeling and where it originated from. It might not be Big T trauma but the event affected them. For example, it might be something that a teacher might have said to you. People don’t realize how these traumatic events have impacted them. In EMDR, we can often help them figure it out. While using the analytical part of their brain during EMDR, they have a chance to look at this more objectively. So they, in turn, may realize why they think, act, or feel a certain way.

Liliana: Let me just go back to the bilateral stimulation. Can you explain that a little bit more for our readers?

Jim: I’ll give you the more technical way of explaining it for therapists. These traumatic memories are locked in a dysfunctional storage state in your mind. Through EMDR, we move the memories out of this dysfunctional state into a more functional storage state. Then you can use your adult resources and experiences to process them and release them from the state they were prior to EMDR therapy.  

But for clients, I explain this as self-healing. We are going to let whatever comes up happen without judgment. You can’t do this wrong. We’re trying to integrate the adult part of you with the child part of you or the thinking part of you and the emotional part of you.  

Liliana: Thank you for that. So the bilateral connects the two?

Jim:  With bilateral stimulation, we are stimulating both sides of the brain. We can do that in a number of ways: Through eye movements (although some people find it distracting), or the client can do butterfly tapping on their shoulders, or tap the just above their knees. There is a variety of ways to do the bilateral stimulation.  

Liliana: Why do you think EMDR is important?

Jim: I think that talk therapy has a lot of value. EMDR therapy can give clients an experience of reprocessing something painful without having to talk about every detail of it. In hypnosis we use different parts of the brain. Similarly, In EMDR, we also use different parts of the brain because we are working with thoughts, emotions, body sensations, and images. It’s a different experience from traditional talk therapy. Here we are setting up the conditions so that something can get reprocessed.  

Liliana: When you talked about having worked with the techies and the veterans, is there a difference in treating these two populations?

Jim: There is clearly a difference. With veterans, because of their training, it can be difficult for them to show weakness and vulnerability. They expect so much from themselves. They’re often very resilient so it has to get really bad before they come into therapy. They may use substances, or their marriage is on the brink, or something else, before they seek support. I’m overgeneralizing of course: Many veterans don’t believe in therapy or see it as a threat to their career.  

Liliana: Are people in the tech world more ready to talk about their emotions?

Jim: The issues are different. Some of these veterans, who were in Afghanistan and Iraq had life threatening situations. They experienced explosions, had to rescue people, events that are often life threatening.

Liliana: In the tech world, are many of them immigrants and might have had trauma?

Jim: Yes, definitely. Some of them are still dealing with those immigration issues. Will I lose my job? Will I lose my visa? Will I have to leave this country? Will I lose my friends and everything I have built for myself here?

Liliana: Is there an issue that is prevalent with trauma?

Jim: In EMDR therapy we say the earlier the better when identifying trauma targets. Trauma tends to be linked in our brain. If we can identify that original situation, that can make a big difference in the healing process. We help clients process present triggers. There is also a  future template to prepare people: We have them play in their mind a situation that could potentially be triggering for them in the future to try and help them deal with issues.

Liliana: Building them up so they have the confidence to know what to do when they encounter the situation again. Where did you get your training?

Jim: I got my training at the EMDR Institute. That was started by Francine Shapiro, the founder of EMDR. They have good training that counts for certification.

Liliana: I have a question that our readers might also have. The PESI EMDR courses are more for knowledge than certification?  

Jim: I think so. However, it’s still good knowledge.  

Liliana: If there was one takeaway for readers, what would that be?

Jim: EMDR is a way for clients to make connections and integrate some memories that they may have some difficulty integrating in other therapy modalities. With EMDR, clients can connect past situations and trauma with the present day struggles they experience. The trauma is in their thoughts, images, body, and feelings. It can be eye-opening to them as to how much something still bothers them: the small T traumas that EMDR can help them understand and resolve.

Liliana: Is there something else that you would like to tell us about EMDR?

Jim: I didn’t go through the nine phases of EMDR because I think it is too much detail. One other thing: In one of the phases of EMDR called installation, people bring up the negative experience with the positive cognition. We have them do the bilateral stimulation to strengthen that, which is similar to Rick Hanson’s neuroscience research: Something else I found interesting.

Liliana:  Thank you so much for doing this interview.  The information that you shared about EMDR will be informative and helpful for our readers.  

 
References

EMDR Institute, Inc., Eye Movement Desensitization and Reprocessing (2020). https://www.emdr.com/

EMDRIA, EMDR International Association (1995-2023). Creating global healing, health & hope. https://www.emdria.org/

Shapiro, F. (2018). Eye movement desensitization and reprocessing therapy (EMDR): Basic principles, protocols, and procedures. (3rd ed.). New York, NY: Guilford Press.

Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR. New York, NY: Rodale. 

Jim Arjani, LMFT, is the owner of Mountain View Therapy, a group private practice that works with teens, adults, couples and families. He graduated from JFK University in 1997 and has been a licensed therapist for the past 21 years. After starting a private practice in 2002, he joined SCV-CAMFT and really values how much he has received from the chapter. Since 2018, he has been the facilitator for the SCV-CAMFT Pre-Licensed Support Group.  

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Interview with Nina Reyna, LMFT and Liliana Ramos, LMFT, Director-at-Large

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Liliana: Welcome! Could you please introduce yourself, who you are, what you do?

Nina: My name is Nina Reyna and I’m an LMFT, licensed in California and Texas. I’m also a veteran and the wife of a retired police officer. I joined the Navy in 2001 and served during 9/11 as an intelligence specialist. One of the most exhilarating, yet frightening assignments I had while serving, was being in Guantanamo Bay, Cuba interviewing detainees. After my time in the navy, I resided in California with my husband, who was a police officer and detective for 15 years, before being medically retired. I met my husband of 18 years while I was stationed in California. We lived through deployments apart, long separations, and acclimating when trying to live together again. Even for officers in the Bay Area, it was typical to live in a lesser expensive area. We lived the military and first responder lifestyle of living apart. I now have my private practice in Texas, but do telehealth work in California. I am EMDR trained working on my certification.

Liliana: Can you please address the intricacies of doing therapy with veterans and first
responders?

Nina: As you know, these populations are a dynamic culture. They choose to join and embrace
this culture, which requires the immersion of the first responders, military, and their families,
something important to understand in order to understand the culture. Sometimes, there is a
culture clash and there is a need to bridge that culture. This is why I thought it was important
to become a therapist, having been a veteran.

Liliana: When you say culture clash, are you saying the clash after they leave the military?

Nina: When I say culture clash, I mean society and therapists. Veterans and first responders
work more from a collaborative and directive approach. Therapists are used to think about
helping them gain autonomy. Yet, they’re used to being told what to do. We are more
empathetic, while they thrive from a directive approach. They also have a fear of being
misunderstood or judged by society. I get a lot of clients who have a hard time being
vulnerable. The other complex parts of working with first responders and military is trauma
versus complicated grief. They don’t always experience trauma. Sometimes it’s complicated
grief from the loss of significant relationships. They’re moving around, getting deployed,
transferring, leaving their families, missing out on important events, and obviously losing
comrades in the line of duty. I find myself talking a lot about military, but find this with first
responders, too.

Liliana: I was going to ask you about the missing out on family events. Is that true for first
responders too? Do they not have a choice of their duty times?

Nina: Absolutely. Their shifts often range from 12+ hours for several consecutive days a week, sometimes only getting one day off. They miss important events, such as the birth of children, birthdays, graduations, and holidays. Even when they’re physically present, they’re oftentimes not mentally present. This is true about first responders, military, and veterans. This is also the case for the veterans who go through loss of identity when they get out. They have to learn how to live outside their service and how to acclimate to civilian life.

I read an article stating there is 1% of military versus civilians. They feel alone much of the time.
The other part of that is survivor’s guilt; not just survive in life but to survive with loss of limbs and the loss of the support that they had in the military. Those are all important to keep in mind. This is a population exposed to continued and extreme levels of stress that keep their system in a hyper-arousal state, which makes this population unique. Even when they’re home, off-duty and have taken off their uniform, they are still in that high level of hyper-arousal. They’re not aware of this. Sometimes they’ve been retired from the military or department for years and still don’t understand the connection, or disconnection rather between their body and mind.

Liliana: Do you ever work with their families?

Nina: Yes. The families are immersed in this culture. I have experienced this firsthand. It’s equally important to provide them the necessary support to be a successful unit at home.

Liliana: You’ve been on both sides.

Nina: Yes, I’ve been on both sides at the same time as an active-duty service member, while my husband was an active-duty law enforcement officer. It’s stressful because the family of first responders and military are often in a constant state of distress themselves. The need to want to support and fix their partner, but don’t know how to do it and don’t have the tools to connect. They’re physically together, but unable to emotionally connect. This is true for the children of the members as well.    

Liliana: So what made you decide to do this work – changing from military to therapy and then
helping veterans and first responders?

Nina: I was most influenced in my boots on the ground, being in the military, and being the
wife of a police officer. My undergrad was criminology and restorative justice because I
thought I was going to become a cop like my husband. My internship was on mediating: I was
intrigued by that. It was through the mediation part that I saw people connecting and healing
from experiences. This is when I decided that I was going into therapy. I have this level of
empathy and compassion for all my clients. I also have this personal experience with this
population. Not all my clients are veterans and first responders, but a number of them are.

Liliana: I would think that having experience in both gives you more credibility.

Nina: Yes, having the experience of being in the military, understanding the demands and the stress that is endured, as well as being my husband’s wife while he was serving on the police force. Additionally, not only did I experience my own difficult transition to civilian life, but also witnessed my husband’s shift in him becoming a civilian after his retirement. It was really difficult to watch him struggle with depression and anxiety. We rarely talked about work while serving, so we were really great with bottling our emotions and pushing forward. As a mom and wife, I just tried to keep things calm while he was doing his job and I was taking care of the kids. Most of our first responders and military are not just dealing with the stress of their jobs and the aftermath of that, but the stress of life and the world. That’s the complicated grief part that has so many layers.

Liliana: Why do you think this is important work?

Nina: This population has a duty to protect and serve: both first responders and military. Even
veterans walk away with that mentality. Not just for their community but their family as well.
They are not able to fully do this if they are suffering in silence, which is what most of them are
doing. They need a safe place to be able to be vulnerable. It’s important as therapists, we provide them with that safe space.


Liliana: This might be a good time to talk about EMDR. There are lots of ways to treat trauma,
what made you decide on EMDR?

Nina: My first experience with EMDR was as client many years ago. I found it to be an effective treatment in reprocessing my own trauma to repair the mental injuries I had endured. After I became license, I decided to complete the EDMR training. It has been a great tool to add to my practice as it has proven to be effective for treating my clients with PTSD and trauma as well as depression, anxiety and panic disorders.

Liliana: What other techniques do you use with your clients?

Nina: There are a variety of techniques that I use in therapy with my clients. The most appropriate techniques depend on the individual needs. Cognitive Behavioral therapy, dialectical behavior therapy, solution-focused therapy, psychodynamic therapy and mindfulness-based interventions are all techniques I utilize, to list a few. It’s important to remember that therapy is a collaborative process, and the most effective technique will depend on the individual’s unique needs and preferences. It’s essential for a client to find a therapist who is trained and uses techniques that resonate with them.

Liliana: Is there one issue that is really prevalent in one or both?

Nina: Suicide is a serious public health issue that affects individuals, families and communities. Suicide is a complex issue that can have multiple causes, including mental health conditions, substance abuse, trauma and social and economic factors. First responders, active-duty military and veterans are at a higher risk of experiencing suicidal thoughts and behaviors due to the nature of their work. They are often exposed to traumatic events and high-stress situations, which can lead to mental health problems such as depression, anxiety and PTSD. These mental health conditions can increase the risk of suicidal thoughts and behaviors among first responders. It is important to reduce the stigma surrounding mental health and seeking help for mental health issues. First responders should feel comfortable seeking help for mental health problems without fear of being stigmatized or discriminated against.

Liliana: What is the takeaway that you would want therapists to have.

Nina: The takeaway for therapists is to be aware of their biases and how that might affect their clients. Show your clients that you want to learn from them, not just teach them what you want them to know. Our clinical judgment is important, but our clients know their experiences. It might be helpful to ask during their intake paperwork if the client has served in the military, or if they know someone who has served in the military. Even though not every military member has experienced trauma, checking in with that part of the client’s experience can be helpful to be aware of. They might be coming in with a present issue they want to work on, but not realize that their present issues are carried over from the past.

Liliana: Yes because during the whole military service you’re trained to not think about
yourself, rather about the mission. I’m guessing it’s the same for first responders. Families are
trained to go along with it to support that person. So when it comes to therapy you can miss
that whole rich background.

Nina: Absolutely. They might not think to bring that part of them into therapy. Although it’s embedded into their identity, they try to get away from it and don’t bring it up. It’s important to screen for it and meet them where they’re at. They might not want to talk about it, but at least you have that information.

Liliana: Is there anything else you would like to add?

Nina: I just wanted to thank you for giving me this opportunity. I will say that I take random
trainings. I know that the need for culturally competent therapists for this population is high:
they need more therapists. There is an abundance of online and in-person training (PESI and
Psychotherapy Networker), take the time to learn about them.

Liliana: Thank you for doing the interview and for all of the information. This was great. As a
retired military veteran, I appreciate the work that you do. Thank you for your service and for
your work.

Nina Reyna is a Marriage and Family Therapist, licensed in the state of California as well as Texas. She is also a United States Navy veteran and the wife of a retired police officer. She has almost 8 years of clinical experience working with family/relationship issues, trauma survivors, anxiety, depression, and addictive disorders. She is dedicated to providing safety to those she serves and utilizes her expertise to help active-duty military, veterans, first responders and their families deal with the stressors they must endure on a daily basis, including PTSD and deployment/reintegration issues. She is also trained in Eye Movement Desensitization and Reprocessing (EMDR) Level II.

References:

Schaeffer, K. (2021, April 5), The changing face of America’s veteran population. Pew Research Center. Retrieved March 17, 2023, from https://www.pewresearch.org/fact-tank/2021/04/05/the-changing-face-of-americas-veteran-population/

Resources:

COPS – Concerns of Police Survivors:  https://www.concernsofpolicesurvivors.org/national-conference

Veterans Administration - https://www.vacareers.va.gov

Military One Source:  https://www.militaryonesource.mil

Suicide and Crisis Lifeline:  988 

Crisis Text Line:  Text BADGE to 741741

COP 2 COP:  1-866-COP-2COP (267-2267); https://njcop2cop.com

FIRESTRONG:  1-844-525-FIRE (3473); https://www.firestrong.org

Back to Spring 2023 Newsletter

Interview with Jyoti Nadhani, LMFT and Liliana Ramos, LMFT, Director-at-Large

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Jyoti:  I am a tech entrepreneur turned psychotherapist. I have always been passionate about working with people and mental health has been a big part of my life. After my software company got acquired, I chose to go back to school, study, and I became a therapist. Due to my professional experience, I work mostly with people who are in tech, founders, tech-entrepreneurs, and employees from tech companies. My focus is mostly on couples, although  I work with families as well: teenagers or adult children and their parents. I have an integrative approach to psychotherapy which focuses mostly on Emotionally Focused Therapy (EFT) for couples and family therapy. Internal family systems, Somatic Experiencing & Mindfulness based practices, Ketamine Assisted Psychotherapy etc.

A couple of years ago I contracted Bell’s palsy, which is a facial paralysis: I felt lost and I felt clueless. I tried Western medication. Allopathic doctors told me it could be due to stress. I tried Chinese medication and went to India for Ayurveda treatment. As a Vipassana meditator, I believe in mind, body, spirit or soul. I was perplexed as to why I had this facial paralysis. When I read about Michael Pollan’s (2017) research on psychedelic psychotherapy, I realized I needed to investigate that avenue. I got this opportunity to get psychedelic assisted psychotherapy and it was immensely helpful. From that point, I started training with MAPS (Multidisciplinary Association for Psychedelic Studies) for MDMA-assisted therapy; I moved on to  train with Fluence for ketamine-assisted therapy, and now I am in training at Berkeley University. The UC Berkeley  program emphasizes psilocybin facilitation and its applications for spiritual and psychotherapeutic care, focusing both on traditional uses of this globally recognized medicine and current Western approaches to mental health.

Liliana:  What a journey! In the spiritual world it seems that things happen for a reason. You chose to explore and went for this journey that has helped you grow personally and professionally. How do you see this in your life?

Jyoti:  Yes. I would say that the medicine found me instead of me finding the medicine. It has been a profound experience. I’ve a better understanding of myself and others. I feel more connected and not isolated.

Liliana:  How does psychedelic assisted therapy help clients?

Jyoti:  Psychedelic therapy refers to the proposed use of medicines such as psilocybin, ketamine, LSD, and others to treat mental disorders and has been helpful in spiritual and personal growth. Indigenous communities have been using psychedelic medicine for centuries. Psychedelics offer a treatment that shows best for medication and psychotherapy in a short period of time. Generally when you do psychotherapy, it might take years to see results.  When it comes to psychedelics, you only have to take the medicine a few times: changes happen and last for a long time. This type of therapy is incredibly powerful because the whole sense of self and world view shift in such a way that people often feel they have the self-efficacy and free-choice they had not recognized they had before. Our body has an innate ability to heal. Similarly, our psyche has the ability to heal if the appropriate conditions are present. Clients can access more memories or memories that lie deep in the unconscious. So that helps them change their world view for themselves or even for others. They have better clarity and understanding. Where there is awareness, change happens. They feel connected, which helps to facilitate the reconsolidation of the memories.  Humans are interconnected, so the healing has to happen for everybody. Rather than feeling lonely and isolated the clients feel the connection with family, and others. Psychedelics allow them to revisit the trauma without being emotionally charged. It helps them have greater clarity and create a new narrative about what happened; it relieves the stuck energy.

Liliana:  As a South Asian therapist, what are the main issues that other therapists need to be aware of?

Jyoti:  First, I would say that mental health is still a stigma in the South Asian community. Psychedelics is further stigmatized. Drugs are perceived as dangerous. In fact, years ago, when I first heard Michael Pollan, I thought “Oh this is drugs. I’m going to avoid it at all costs.” People might not be comfortable with using psychedelics. Basically, we have to educate people to show them that psychedelics, when used in a ritualized and contained environment, are safe.

Liliana: Does  most of your practice deal with psychedelic psychotherapy?

Jyoti: I have a mixed practice.  I have my traditional psychotherapy,  30% of which is psychedelic-assisted psychotherapy.  

Liliana: Is there anything a non-South Asian therapist should know that might be helpful to better assist the South Asian community?

Jyoti: I would say that most of the South Asian community is immigrant and immigration does impact mental health. Mental health challenges are way higher than we are willing to accept. I had lost my support system when I immigrated, I’m still trying to balance between two cultures. Racism, being a minority, being an outsider and not feeling accepted is emotionally draining. For most South Asians, children have to balance between collectivist culture and individualistic culture. So, I would say that mostly South Asian people are living two lives and acculturation can be heavy and stressful. I noticed that for adolescents and young adults it is challenging because according to country of origin cultural rules, the parents decide what the child should be doing, but the child might be wanting to do different things. The parents project on their children the hard work they had to do to settle in the US. As one loses the support that they were used to it becomes overwhelming for the parents and of course brings pressure on the children.

Liliana: What is the takeaway that you want from this article?

Jyoti: The takeaway is the benefits of psychedelic assisted psychotherapy. Psychedelics like MDMA allow one to be empathetic towards self and others. In traditional therapy, the client might be protective or guarded and might not be open. But MDMA helps the therapeutic relationship and helps the client to trust and share their struggles freely.  Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance.

Liliana: Is there anything else you would like to share?

Jyoti:  The core mystical experience is one of the interconnectedness of all people and things, the awareness that we are all in this together. It is precisely the lack of this sense of mutual caretaking that puts our species at risk right now, with climate change and the development of weaponry that can destroy life on the planet.

Liliana:  That’s beautiful how you interconnected everything.  When you said that you did EFT, IFS and Somatic Experiencing, are you certified, did you take Level 1?

Jyoti:  I did Level 1 for Somatic Experiencing.  I have also done an Internal Family System circle . I am an IFS informed therapist.  I have done advanced EFT training.  With Somatic Experiencing, when we do psychedelic work, the clients have access to the body.  It is easy for us to help the client focus on their body to relieve the tension or even to open up.  That is how Somatic Experiencing is helpful.  

Liliana:  I love how you integrated EFT, IFS, Somatic Experiencing and psychedelics.

Jyoti:  I love being a psychotherapist.  Now with psychedelics, I love it even more.  I see deep rooted issues being addressed and changes happen so quickly.  I hope it motivates more therapists to come into the field. 

The views expressed in this article are those of the speaker and not, necessarily, of SCV-CAMFT. SCV-CAMFT cannot be held liable for any damages arising from recommendations, advice, or points of view given by our contributors or any actions or decisions arising out of the content of this article. 


Jyoti Nadhani is a tech entrepreneur turned psychotherapist.  She did her Master in Business in India, then did her Master in Psychology in the United States.  She is a South-Asian LMFT who has trained in 3.4- methylenedioxy-methamphetamin (MDMA) from Multidisciplinary Association for Psychedelic Studies (MAPS) by Rick Doblin and Ketamine assisted psychotherapy from Fluence.  She is currently pursuing a certificate program in psychedelic facilitation from UC Berkeley.  In this training she will learn Psilocybin facilitation and its applications for spiritual and psychotherapeutic care focusing both on traditional uses and this globally recognized medicine and current Western approaches to mental health.  She is also trained in Emotionally Focused Therapy (EFT), Internal Family Systems, and Somatic Experiencing.  

References:
Hanagan, K. (2021, February 20). Resetting the brain and mind with ketamine. Kathleen Hanagan. https://www.kathleenhanagan.com/resetting-the-brain-and-mind-with-ketamine/
Mac, G. (2017, March 9). The psychedelic miracle: how some doctors are risking everything to unleash the healing power of MDMA, ayahuasca, and other hallucinogens. RollingStone. https://www.rollingstone.com/culture/culture-features/the-psychedelic-miracle-128798/
Pollan, M. (2018). How to change your mind:  What the new science of psychedelics teaches us about consciousness, dying, addiction, depression, and transcendence. London, UK: Penguin Books.
The ultimate guide to ketamine. (n.d.).  The Third Wave. Retrieved December 4, 2022 from https://thethirdwave.co/psychedelics/ketamine/
Trope, A., Anderson, B. T., Hooker, A. R., Glick, G., Stauffer, C., & Woodley, J. D. (2019). Psychedelic-assisted group therapy: A systematic review. Journal of Psychoactive Drugs, 51(2). 174-188.
doi: 10.1080/02791072.2019.1593559
Yale News. (2012, October 4). Yale scientists explain how ketamine vanquishes depression within hours https://news.yale.edu/2012/10/04/yale-scientists-explain-how-ketamine-vanquishes-depression-within-hours
Ziegler, M. (2016, December 2). Ketamine: A transformational catalyst. MAPS. https://maps.org/news/bulletin/ketamine-a-transformational-catalyst/

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