By Dr. Charles Silberstein with Laura Roosevelt.
In good psychotherapy, we feel listened to, understood without judgment, and cared for. In doing so, it helps us feel safer, kinder, wiser, and happier. With the help of cognitive and behavioral tools, we can unlearn unkind and untrue beliefs from our past — the idea, for example, that we are unlovable, worthless, or chronically endangered. When this occurs, it is liberating; but sometimes personal transformation takes more.
Because talk therapy often relies on the well-established verbal and logical pathways of the mind, it can fail to tap into underused parts of the psyche that can hold powerful memories, feelings, and beliefs. As part of my training, I went through a Freudian psychoanalysis during which, four days a week for five years, I lay on a couch, told my analyst the random thoughts that came to my mind, described my dreams, and talked about the feelings that arose in my life and toward my analyst. While it was an extraordinary experience to sit with an empathic, devoted listener for that chunk of my life, I only rarely and haphazardly experienced deep emotional states or revelations. I did change, I think for the better, during those five years, but it’s hard to know how much of that had to do with the analysis itself, and how much came simply from the passage of five years of life in general, and medical and psychiatric training in specific.
Now, newer psychotherapeutic techniques that help people to explore and unburden hidden parts of the mind are entering the mainstream. In each of these therapies, it appears that the parts of the brain that don’t normally communicate in usual day-to-day experience are connecting. Here are three alternatives to traditional talk therapy that allow clients to enter altered states of consciousness and heal.
While there are several schools of somatic therapy, fundamental to all of them is the idea that the physical body holds memories, emotions, and beliefs that can be revealed through touch, and through focusing on specific body parts and sensations. In Somatic Experiencing, people have an opportunity to renegotiate traumatic memories from childhood. For instance, a middle-aged man was directed to touch a part of his body. He closed his eyes and rested his hand on his belly. His first thoughts were, “Oh, I am becoming flabby. No one would want to touch me. I wouldn’t want anyone to look at my belly.” As he continued to hold his hand there, memories of himself as a child came to mind, and he remembered his older brother telling him that he had “four spare tires” in his belly, and that no one would ever want to touch him. He recalled that as a 6-year-old, he once bent over and counted not four spare tires, but six!
What could he conclude but that his brother was telling the truth? He was fat and disgusting.
When he opened his eyes, the man told his therapist about the memory. The therapist offered to put his hand on his belly, and when he did, the man was flooded with memories of the multiple ways, over many years, in which his brother had shamed him. Tears streamed from his eyes. He recalled crying alone in his room as a child with such immediacy that he experienced a nasally smell of tears that he hadn’t encountered for decades. When he opened his eyes, he felt exhausted and liberated. He looked at his belly, which was not flabby, and he noticed how good he felt about his body. The shame-filled feelings were inaccurate lessons that he had learned from his brother (who, himself, had been abused by their father). The man felt liberated and was able to let go of the body shame that had burdened him for decades. In my experience as a therapist, focusing on how the body responds to emotions, or imagining touch, can evoke remarkable memories, feelings, and release.
Internal Family Systems therapy (IFS)
In our culture, we are taught to think of ourselves as one person with a unified mind. Other cultures see the human psyche as composed of many separate subpersonalities or modules, each with its own motivations, perspectives, reasoning, and memories. Even Freud divided the psyche into three separate parts — the id, which holds unbridled desires, such as sexual and aggressive drives; the superego, which manages and restrains those impulses; and the ego, which is the reality-based part that mediates between the id and superego. Several (mostly non-Western) cultures see us as having parts that are male, female, demonic, ancestral, and spiritual, to name just a few.
IFS posits that when we are irritable, depressed, fearful, gleeful, or playful, these emotional states are expressions of different parts of ourselves. And all of these parts — even the “negative” ones — are trying to help us, even if they end up doing us harm. An alcoholic part, for example, which might in many ways be wreaking havoc on a person’s life, might be there with the well-intentioned purpose of numbing painful emotions related to trauma. A suicidal part might be trying to help a person escape from overwhelming hopelessness. A rageful part might be trying to protect a lonely inner child who was neglected, humiliated, or physically abused.
Unlike in traditional therapy, in IFS the therapist is an active guide who, rather than encouraging random thoughts, helps the client to enter a kind of trance in which they focus on one part or sub-personality at a time. Take, for example, the case of a young woman who entered therapy struggling with self-loathing and shame. When she closed her eyes and focused on the part of her that told her that she was ugly, weak, and stupid, she encountered a powerful voice that told her that if she didn’t keep criticizing herself, she would let herself become unlovable, lazy, and uneducated. When the therapist asked her client to question where this critical part learned to be so harsh, images of her unpredictable, cold, and critical mother came into her mind. With the therapist’s help, she was able to imagine letting her mother know that she didn’t accept her cruel messages. At the same time, she was able to show her own shamed inner child how fulfilling her life had actually become: She had started a successful business, married a supportive and caring partner, and been a loving mother. In the course of therapy, she stopped shaming and apologizing for herself, and became a happier person.
I write further about IFS in this article: bit.ly/MVTMoreThanOne.
Under the influence of psychedelic medications, new connections are formed between brain cells, and new channels for communication between different parts of the brain open up. A graphic demonstration of this can be found in Islander Michael Pollan’s book, “How to Change Your Mind.” To some extent, I imagine that these new channels and connections within the brain are also what happens in spiritual awakenings, mystical experiences, and transformational experiences in psychotherapy. MV Times correspondent Ray Whitaker writes informatively about some Islanders who have had transformational experiences working with ketamine in the practice of Nurse Practitioner Prudy Carter Donovan. See mvtimes.com/2023/02/22/taking-inward-journey-part-two/.
Ketamine is currently the only legal psychedelic, but MDMA and psilocybin are likely to become legal in coming years. All three of these medications can change the mind in ways that relieve and ameliorate (sometimes temporarily, sometimes permanently) peoples’ fears, oppressive self-hatred, suicidal thoughts, bulimia, anorexia, and addictions to food, alcohol, cigarettes, and other drugs.
Ketamine is often given in clinics where patients experience an inner journey with the medication, in the absence of therapy. An extreme example of this practice is acquiring ketamine via telemedicine practices. (See bit.ly/Ket_Telemedicine).
But the best way to experience ketamine is to work with a skilled therapist who helps prepare clients for their psychedelic journeys by setting goals, exploring fears, and creating a setting for the experience that feels safe and right. Studies that have included Internal Family Systems therapy before and after the psychedelic journey suggest that it can greatly enhance the experience. IFS used before the journey helps reassure parts that are wary or frightened, and gives the client a sense of safety before receiving the medication. There is a wonderful expression in the world of IFS: “No medication without the agreement of all parts.” Working with parts that, quite reasonably, have apprehension can make the experience much more relaxed, safe, and beneficial.
During the journey, the IFS therapist takes notes on what is said or shared during the experience. After the ketamine wears off, the therapist helps the client to integrate and reinforce revelations that may have occurred. Sometimes changes stem from intentions, such as the desire to give up cigarettes, but other changes can occur spontaneously.
Many people rank psychedelic journeys among the most important spiritual experiences of their lives. People commonly have a sense of oneness with the universe and with all life on earth. In one case, a client unexpectedly returned from the inner journey having lost interest in eating animals.
There are other therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), hypnotherapy, and past-life regression, that can also be transformative. The same is true at times for traditional therapies such as psychoanalysis, forms of Cognitive Behavioral Therapy, and Dialectical Behavior Therapy. Transformations occur in the setting of powerful emotional releases, trance states, and psychological and spiritual revelations, and all of them involve new activity in parts of the brain that may have remained quiet for a long time. Especially as we age, but perhaps at any age, a little help in rewiring the brain can make a big difference in improving our well-being and our lives.
Dr. Charles Silberstein is a psychiatrist at Martha’s Vineyard Hospital and Island Counseling Center, where he is the medical director. He is board-certified in general, addiction, and geriatric psychiatry. He writes regularly about issues Islanders have with mental health.
Laura Roosevelt is a poet and journalist who writes regularly for the Arts & Ideas and Edible Vineyard magazines. She currently curates the MV Times Poets Corner.
Charles H. Silberstein, MD
Medical Staff, Martha’s Vineyard Hospital
Medical Director, Island Counseling Center / Martha’s Vineyard Community Services