The Practice of Therapy

Gordon Brewer: Well, hello everyone and welcome to the podcast and I'm So happy and really almost a little bit starstruck to have Keith Kurlander with me here today Keith glad you're on the podcast
Keith Kurlander: Yeah, thanks for having me.
Gordon Brewer: Yeah. So if you've been around a while, you probably have run across Keith's many different hats that he wears, but Keith, as I start out with everyone, why don't you tell folks a little bit more about yourself and how you've landed where you've
Keith Kurlander: Yeah, well, I, I was a therapist for 15, 18 years.
Private practice therapist. Love that work. It was great. And, alongside of that, I also was struggling with my own mental health issues. On and off. Pretty significant mental health issues. I'd say just short of hospitalization. So significant. And I'm I was, my search for answers wasn't only about my clients, which it rarely is, but you know, I had real things I had to solve in my own life.
So I was on a big search and found a lot of things and eventually I realized I want to help more people. I, I I want to help more than the, you know, 20 So people a week I was helping and that led me first to being like, well, let me help people in our profession help more people. So I started, you know, a company to help counselors grow their practices and reach more people.
And then I realized, well, I, I need to really be involved in the training space so that I could really influence how mental health care is practiced. I felt just, I just felt like the way we're approaching mental health care, you know, with what the rising mental health rates, the rise in treatment resistance, like we're just not, we're not doing it.
So then I, that led me with My other co founder of the Forming the Integrative Psychiatry Institute and the Higher Practice Podcast came alongside and now we're training thousands of people a year and integrative platforms to really understand the root causes of mental health issues and it's exciting times for, you know, just making some change.
We, we know a lot more than we've ever known. Known historically, which is cool, too.
Gordon Brewer: Yeah, it is. It's a, it's been an interesting journey as in the years that I've been in, in the therapy practice and just seeing how much things have changed just even, well, you know, of course we'll always say post COVID, but especially post COVID how things have changed with the whole mental health field.
But yeah, and so I, I'm curious, and I think others would be, is that you started out in practice and, and I think like you've already alluded to is, is that so many of us go into this work because of our own issues and things that we're all working on within ourselves and out of a sense of wanting to help others.
So what were some of the things that you took from going just in private practice and what you've learned as far as growing a practice and what makes it works and work and not work and maybe mistakes that you made along the way.
Keith Kurlander: Well, when I was growing my practice you know, I, I think that one thing I didn't know in the beginning is that I'm in a competitive town.
I'm in Boulder, Colorado, and there's a therapist for every person. So, basically so it's a very competitive landscape, but at the same time, a lot of people do therapy here. So there's a lot of demand. But I, I started doing the traditional thing, knocking on doors. And you know, I think that's really important in, in the therapy space is making a lot of connections and networking.
And, but then I was like, wait a second, I gotta, I gotta this was a while ago now, almost 20 years ago, I was like, I gotta get into the whole paid advertising space because a lot of people are going online to find their therapist. And so then I figured that space out. And now that was like, okay, now I had.
You know, 30 percent of my practice was just that and was able to figure that out. And so that was a big thing of just online presence became more and more important as my practice went on. And so I had to learn that whole thing. And that was useful. So I would say that, you know, the combination of networking online presence was a big factor.
And then the next thing later was like, Oh, I have to differentiate more. Like I have to stand out in this community and learn some tricks that other people don't know. And so specialization and things that people want was key. I mean, I would, I'm, I'm a generalist. By nature, but like, I needed to stand out in some way.
So I realized I had to get more specialized over time.
Gordon Brewer: Right, right. What would you say, I know, with some of the folks that I do consulting with, one question that, I guess, questions that come up is, what do you see as the essentials of growing a practice?
Keith Kurlander: Well, I think it's different if you're starting out or you're established, right?
So if you're wanting to start out, you definitely need to network. That's an essential. I think that networking is key. I think the online presence game is important. And it's not going to like get everybody in your door right away, but I think it's important to have that. So I would always say like, you want a nice website right now because Everybody, basically that's like inviting your, a person into your home is your website.
You know, it's like the first impression of who you are. So I think if you're just starting out, you, you want to have a nice appearance and you, and, and not nice, you, you want to get across a message in your website. The messaging is key. Like your message needs, needs to be distinct from the next website and it needs to say something about the type of client you want to attract.
So I think if you're starting out, that's the first basis. If you're growing, then we're in a different conversation of what you're trying to do. You know, are you wanting to have a group practice and what are you trying to accomplish? I think it's a different conversation.
Gordon Brewer: Right, right. What are, what are the things that are exciting you the most about our professions right now?
Keith Kurlander: Well, right now, psychedelic therapy is exciting me the most. That's where I'm pretty focused on, you know, growing awareness. I think it's a, it's essentially, it's an old and new modality. So, but it's a new wave for psychotherapy. Like we will see over the next decade, I think, you know, we'll think of it as a new wave.
Of psychotherapy where a lot of people are practicing it in 10 years from now and a lot of clients are like, that's, I've done that modality. It's a short term modality in the sense that you're not going to be doing psychedelic therapy and taking psychedelics for a year or two. You know, you know, it's probably a couple of months and you're done with your treatment, but That excites me in terms of the modality that actually could have a very large impact.
For this whole treatment resistance issue we're seeing.
Gordon Brewer: Yeah. So why is it I mean, just this might be a very basic question, but why is that working so well for people?
Keith Kurlander: It's a good question. So it works differently than any other modality. is why it works so well. It's not a panacea. I don't want to say that, but it, it works well.
Because it's a disruptor. And so when we go to ordinary consciousness therapy is the best way to say it. Because we talk about psychedelic therapy as non ordinary consciousness. In ordinary consciousness therapy, and that can be a gamut of modalities, it's, you know, doesn't matter what tradition, CBT, depth therapy, whatever you are.
The way you think about things is static, essentially. You're coming in, you think about things in a certain way. And, and there's a slow process of looking at things from a different perspective. But it's a slow process. We don't change our perceptions and our worldviews and our ways we think about ourselves and our belief structures.
That's a slow haul. And it's helpful and important. Also trauma is a slow process there, resolving trauma. You have to, there's a reason to be sensitive with trauma and go slow on one level. But with psychedelic therapy, it's an amplifier and it's a disruptor. It's both. So we amplifying material inside of us.
So you'd like taking the amplifier and turning the volume way up. So it's like if music was very faint in the background, now it's blaring at you. And so that's one thing it does, but it's also like, you're also hearing music you never heard for The first time sometimes Mm-Hmm. because it's so loud. So now we're getting disrupted about the way we th see things and think about things.
And so that can be both a cathartic, positive, transformative process. Sometimes it can be a little disturbing and disruptive and, you know can can be a problem for some people but but mostly the research shows it's actually very helpful And it causes change very quickly As one treatment, you know, it doesn't mean you're not done there Like you still have to go and do the hard work, but it's exciting that we have a tool that Can put a wrench in our you know rigidity
Gordon Brewer: Yeah, yeah, yeah, it's, it's interesting.
I think a lot of us are very familiar with EMDR and kind of the same principle, but just a different way of getting to it is at least my understanding of how psychedelics are working is that whole, as you mentioned, that whole disruption process of really kind of, you know, getting our brains to create new neural pathways in many ways.
Keith Kurlander: Yeah. Yeah. Yeah. And with, and, and like you said, EMDR, which is a good EMDR, which is a good point, which is, you know, in terms of a trauma modality, psychedelic therapy is a trauma modality. I mean, because psychedelics often reliably will amplify trauma in your nervous system. So most people, When they do psychedelic therapy, you're going to contact either implicit trauma memory where it's in the body, we don't know exactly what it is, but it's there, or, or more explicit than direct trauma memories.
So there is trauma, psychedelic therapy is, Especially MDMA is obviously a trauma modality. That's the whole, the whole research behind MDMA assisted therapy. Which we don't have access to yet outside of research because it got rejected recently by the FDA, but hopefully that's coming in a few years.
Gordon Brewer: Yeah. Yeah. So are there any time, any times where psychedelic therapy is really kind of contraindicated or
Keith Kurlander: yeah, I mean, definitely psychosis. We don't see a lot of psychedelic therapy studies on psychosis and it probably would aggravate it most likely. There's some psychedelics that don't play well with bipolar 1 for sure, probably bipolar 2.
It depends on, you know, what's for the bipolar 2 spectrum different, like, for instance, there is some small research with ketamine assisted therapy and some bipolar. So that, that's a possibility. Personality disorders. You know, back in the day, there was some research with LSD and working on personality disorders and things, but it's, it's, we don't know.
So, there's that but in terms of like contraindicated, there's medical contraindications and I would say dissociative stuff, like depersonalization, and if you're like living with that kind of thing. The psychedelics could amplify that and that wouldn't feel good to a person. So sometimes if we're very dissociated, it doesn't play well.
It depends what the flavor of the dissociation is. So, so, but, but when you look generally speaking, it does play well. You know, depression, anxiety, trauma. Yeah. Kind of the big three things that it plays pretty well with, generally speaking,
Gordon Brewer: right? Right. Yeah. Yeah. If somebody was, you know, one of the things kind of going a little bit full, full, full circle to what we were talking about earlier is having a specialty or a niche.
within your practice is so important in growing it. And I think with this new research and the new evidences there around psychedelics, if somebody wanted to start down the road of, okay, I'm going to start offering this as a service, how do they go about doing that?
Keith Kurlander: So right now, the way that, well, first of all, they should get trained because it's a whole, it's a whole different animal.
There's lots in all around ethics around. You know, what happens to a client on psychedelics. You don't want to you gotta be very careful with suggestibility and things, and there's things you have to know and get trained in, and so that's one thing, and I, I always recommend, you know, comprehensive training.
Six months to a year minimum because it's a, it's a big deal. Like you could see some crazy things of what people will say or kind of look like on psychedelics and be like, whoa, I've never seen this before. But then outside of that, they're going to get started right now, outside of Colorado and Oregon, you're going to be using ketamine assisted therapy right now.
That's the only, You know, it's a prescription medication there's, you have to get connected with a prescriber who's working with the client patient also but that would be the only way to get involved right now, outside of research, outside of those two states. And, and it's a great medicine actually for psychedelic assisted therapy because it's short.
It's, it's a two hour session. So it's a great way for someone who's like, I want to be able to offer these interventions, but I don't want to be doing six, eight hour sessions all the time. I don't want to make it my whole career. I want to have it in my toolkit. You know, two hour session. That's very manageable for for me.
For a therapist who's not going to make it their whole thing. So that's how they would get involved.
Gordon Brewer: Yeah. Where, where are the, where are the places to get the training?
Keith Kurlander: Well, I mean, us, I guess I would say, I mean, there's others, but there are others, but we're definitely the most comprehensive training.
You know, our training has the most hours. It's the most comprehensive. It has the most hands on actual. practicum experience that you could do. So I would, you know, check out our website, psychiatryinstitute. com forward slash apply. That's the, that would be the page to check out for the psychedelic assisted therapy training.
Gordon Brewer: Yeah, so to kind of walk us through the, that training process, I'm, I'm, I'm assuming there's some kind of classroom time and that sort of thing. And then, like you said, practicum. So what does that typically look like and what is the time commitment for people?
Keith Kurlander: So our training is a 10 month training. It's mostly online.
It's about a four to five hour commitment a week. Three, I would say three to five hours a week, over 10 months. You know, you're training in a full modality in our training. There are weekend ketamine trainings, but like, I don't think that's personally like you're gonna go hold space for someone and after a weekend, like there's so much you really need to know to do this well.
So I don't think it's a great idea personally. You can do it that way. So, so it's three to five hours a week. It's everything from most of it's online. So it's everything from your Lord, you're having lectures every week. The live lectures that are available to interact with the faculty covering, you know, all the different areas from science to ethics to therapy processes to, integration of preparation history, all this research.
And then we're doing home group discussions. So you're in a small group of 10 people with a F with our, you know, faculty where they're facilitating discussions of the material. We have large group seminars where you're in. Breakout rooms and your role playing and you're, you're actually trying this in an online format.
And then we bring you out depending on how you choose your program, there's different options, but you'd go to Oregon for a four day or six day practicum with psilocybin. We have a center out there, Oregon past psilocybin services in 2020 or 2020. 21. I can't remember the year they passed it.
And but they came on line where people were able to use it last year. And so we sent you out there and then we also have Academy Assisted Therapy Practicum in Colorado where these are hands on things.
Gordon Brewer: So I'm curious how, what, what, with the difference of effectiveness, I kind of, if I'm reading between the lines, sell it in your mind.
Psilocybin is more effective than ketamine. And you want to say
Keith Kurlander: it that way? No. Oh, okay. No, it's so, so there's three main medicines to know about right now in the moment, and that's MDMA, psilocybin, and ketamine. MDMA's indication is PTSD upward to 70 percent of people with treatment resistant PTSD are getting better after the protocol.
Now, again, the FDA said we need more research. We're not ready to. give you the green light there when they put their drug application in this summer. So we have, we'll see, we have a few more years, I think. But I'm, I still feel pretty confident. I think it's going to happen. Cause the FDA didn't give an outright denial.
They said they wanted some more safety data and a couple other nuances that were problematic in the study. So that's, that's MDMA. Ketamine, you can see up to 50 to 70 percent for treatment resistant depression. Now what's really cool with ketamine is it's two hour session. The protocols are not as standardized.
We didn't do a FDA phase three trial for that, but there's hundreds and hundreds of and so with that you see sometimes symptoms are cut in half for up to 70 percent of people. And so that's big for treatment resistant depression.
Gordon Brewer: Sure.
Keith Kurlander: And you're gonna also see sometimes within one two hour session suicidal ideation going away.
That's crazy, right? One session. And then psilocybin. So, but, but ketamine protocol, generally speaking, is four to six sessions over the course of a month. Generally speaking, and then there's preparation and integration sessions. Psilocybin. The data, I wouldn't say it's more compelling than ketamine, but it's, but a lot of the research is, is treatment resistant depression.
There's end of life anxiety research, there's others. But it depends what's where, which studies you're looking at. We're in a phase three study now. With compass pathways, you still want to institute. I don't know if they've officially started or phase 3 study or not. Anywhere from 30 to 50 percent with treatment, resistant depression, reduction in symptoms.
So, yeah. So it's across the map. But when you look at antidepressant research, you know the psychedelic research for depression is very compelling. So it's as good or better sometimes. Now, durability is a different question of how long does it last? And you know, that, that's, there's, there's, there's, That's not fully known yet, I would say across the board.
There's good, there's good evidence to say that it's, it's fairly durable with psilocybin and ketamine. But and then PTSD, I would say that evidence is good. That evidence is stronger of like, okay, we've actually resolved some trauma here. Yeah.
Gordon Brewer: Yeah. Yeah. That's great. Yeah. That's fat. It's, it's really fascinating research.
And I Yeah, it's I remember my of course not, you know, as we've kind of alluded to EMDR being similar kind of works in similar ways and that you're kind of re It's not a clinical term, but rewiring the brain a little bit. I know by my sister in law, who's a psych psychologist, she just recently finished her EMDR training.
And she says, she said to me, Gordon, it's just witchcraft. It's just witchcraft. And so I was just, I was just thinking with you know, with psychedelics and that kind of thing, you know here being on the tail ends of Halloween, it's kind of tongue in cheek. You think about it that way, but it is so effective.
Keith Kurlander: Yeah. Well, it definitely has a witchcraft element. Yeah. Yeah. Yeah.
Gordon Brewer: That's great. I have to be respectful of your time and tell folks how they can get in touch with you. And if they want to find out more from you.
Keith Kurlander: Oh, yeah. They definitely, the psychiatry institute. com. That's our, the integrative psychiatry Institute's website.
I said you know, you can find the psychedelic therapy training page there. The higher practice podcast. Come check out our podcast is a great place to just get connected to the conversation. And that's where we're just really talking a lot about what causes mental health issues. How do you solve them?
How do you live a better life? How do you live a more optimal life? Get what you want in life. Feel well inside. So those are great places to check out.
Gordon Brewer: Yeah. I will have links here in the show notes and the show summary to get to those easily and the higher practice podcast is really a great podcast.
It's one of the better ones out there, I would say. Yeah. So well, Keith thanks again for being on the, on this episode and look forward to hopefully having more conversations in the future.