Shaping the Holistic Mental Health Care with Keith Kurlander of Integrative Psychiatry Institute (IPI) Ep.60

Episode Overview

• Episode Topic:
  In this episode of Mastering Counseling, Keith Kurlander, co-owner of Integrative Psychiatry Institute, discusses the groundbreaking use of ketamine, MDMA, and psilocybin in treating mental health conditions. He uncovers the history and science behind these treatments, highlighting their efficacy in addressing treatment-resistant depression and PTSD. Keith also shares insights into the future of psychedelic therapy and its potential to revolutionize mental health care.
  
• Lessons You’ll Learn:
  Listeners will gain a deep understanding of how ketamine, MDMA, and psilocybin work in treating mental health disorders. They’ll learn about the training required for therapists to administer these treatments safely and effectively. Keith also discusses the importance of addressing root causes rather than just symptoms, and how psychedelic therapy can provide profound insights and healing for patients.
• About Our Guest:
  Keith Kurlander is a co-founder of the Integrative Psychiatry Institute and a pioneer in the field of psychedelic therapy. With a background in Gestalt therapy and personal experience with mental health challenges, Keith brings a unique perspective to his work. He is dedicated to expanding access to innovative mental health treatments and educating professionals in the field.
  
• Topics Covered:
  The episode covers the history and use of ketamine, MDMA, and psilocybin in mental health treatment, as well as the unique therapeutic approaches associated with each substance. Keith explains the training process for therapists interested in offering psychedelic therapy and discusses the potential risks and benefits of these treatments. He also touches on the future of psychedelic therapy and its impact on the field of mental health care.

Episode Transcript

Keith Kurlander: Ketamine is been around since the 70s, not as a mental health treatment, as an anesthetic to sedate people during surgeries, at first in the battlefields, either dissociate them from their pain, or now they use it in pediatric medicine all the time to dissociate children from minor patient procedures. What was discovered in the early 2000? A lot of research started getting done around using ketamine in low doses for treatment resistant depression. It turns out that ketamine in low doses is quite amazing. Nearly 70% of people who get ketamine treatments with treatment resistant depression. Their symptoms get cut in half after one session.

Becky Coplen: Welcome to Mastering Counseling, the weekly business show for counselors. I’m your host, Becky Coplen. I’ve spent 20 years working in education in the role of both teacher and school counselor. Each episode will be exploring what it takes to thrive as a counseling business owner. From interviews with successful entrepreneurial counselors to conversations with industry leaders on trends and the next generation of counseling services, to discussions with tech executives whose innovations are reshaping counseling services. If it impacts counseling, we cover it on mastering counseling. Thank you, listeners, for returning to mastering counseling. We’re so happy to continue our show today with Keith Kurlander, who is one of the co-owners of Integrative Psychiatry Institute, which will often refer to as IPI and has had a private practice in the past and is doing a lot of really innovative things for mental illness. Thank you for being on our show today, Keith.

Keith Kurlander: Yeah, thanks. It’s great to be here.

Becky Coplen: We have a lot to cover, and I know the Institute is doing a lot of newer types of treatment, and I can’t wait to hear all about that. Why don’t you tell us about your early path in mental health and how the institute came to be founded?

Keith Kurlander: Sure. That’s a good starting point. I graduated from Naropa University’s counseling program in 2005, so a while ago, and went straight into private practice thereafter pretty quick, and I had a pretty diverse focus. I was trained pretty extensively in Gestalt therapy and more depth-oriented psychotherapies. And then I also, alongside doing that kind of work, was suffering with my own mental health challenges quite a bit on and off in my adulthood. My sort of view on mental health was not only theoretical or professional, it was also personal. So, like many people struggle with mental health, I’m not alone there. That unfolded. And being in private practice was great. I learned a lot. And then eventually myself and my colleague and friend, we decided that we wanted to have a larger impact. We were learning a lot about ways to help people that weren’t being taught in graduate schools or many counseling programs, and we really felt we wanted to impact the field in a larger way and get other really powerful treatments. And interventions to clients and patients. We formed the Integrative Psychiatry Institute, which is an educational institute for professionals. We started with an integrative psychiatry program to really help psychiatrists get more well-rounded outside of medication management only treatment, and to all kinds of things like alternative medicine and supplements and a lot of different treatments.

Keith Kurlander: Looking at the body as a whole, systems work together and a good focus on trauma psychology and looking at that as a root cause. The Institute was founded as a way to really focus providers on understanding the spectrum of root causes of what our clients are dealing with, and then we pretty soon thereafter. This is both a personal history of mine, but professional interest was getting more and more interested in psychedelic therapy and what’s been emerging. And the Institute has grown to be really the world’s leader in training. Psychedelic therapists trained about 700 to 800 a year in a pretty extensive yearlong training, where we go through the three main medicines that will likely be used in the next handful of years. That’s really my focus now. I run the institute with my other co-founder, and we have a Ketamine psychiatry clinic, where we treat patients. We’ve got a psilocybin service center in Oregon, and we’re really focused on training this new modality. That’s really going to be the fifth wave of psychotherapy.

Becky Coplen: We haven’t talked too much about these types of treatments, so I’m super thrilled to hear more about that, that Colorado seems to be a hub for this type of exploratory learning, and I’m sure a lot of it has to do with your institute. Any thoughts on why there, or is it mainly from your organization, or why do you think so much is coming out of there?

Keith Kurlander: Colorado is the Wild West and was one of the first states, I think the first to bring recreational marijuana at the state level, not just medical marijuana. It’s a political atmosphere in Colorado. That is what you’re referring to. There’s enough political mindset in Colorado to be thinking differently about some of these things. And psychedelic therapy. Psilocybin was decriminalized in Denver, but that’s not really what we’re talking about. But psychedelic as a therapy passed in Colorado, we will see psychedelic psilocybin therapy in the summer of 2025, in Colorado, because they’re just writing the rules right now. Oregon was the first state to pass using psilocybin as a personal development treatment, but Colorado is the first state to pass it as a mental health treatment.

Becky Coplen: Let’s talk a little bit for our audience about ketamine. How does the science of that treat patients and how can it help your clients?

Keith Kurlander: Let me just start a little higher. There Are three mains. Essence to be aware of right now that’s ketamine, MDMA and psilocybin. Ketamine is been around since the 70s, not as a mental health treatment, as an anesthetic to sedate people during surgeries, at first in the battlefields, either dissociate them from their pain, or now they use it in pediatric medicine all the time to dissociate children from minor patient procedures. What got discovered, really, in the early 2000 to mid 2015, a lot of research started getting done around using ketamine in low doses for depression treatment resistant depression. And it turns out that ketamine in low doses is quite amazing. With treatment resistant depression, nearly 70% of people who get ketamine treatments with treatment resistant depression, their symptoms get cut in half after one session. And also, people who are suicidal, their suicidal ideation can go away in one session after months or years of suicidal ideation. ketamine was not thought of necessarily as a psychedelic, but it was also obviously used recreationally a lot in the 90s. But it still is because it does have psychedelic properties. And so, what also happens when you use ketamine for treatment resistant depression? There are biological things going on.

Keith Kurlander: There’s biological mechanisms that aid in reducing depressive symptoms, but there’s also a psychedelic mechanism that isn’t often talked about. When you pair that session, that treatment with a therapist in the room, and you do psychedelic therapy with proper preparation and integration and all of these things, you can really amplify the effect. Because psychedelics, some of them have biological properties that help us with these issues. But the psychedelic itself, the psychedelic properties, really allow us to do a number of things, from uprooting trauma and working through trauma in a session, from creating new meaning, new narratives that our default mode networks wouldn’t allow us to do previously. And we can create new generative meaning within the session. Psychedelics can really speed up the process very quickly when it’s appropriate. ketamine is mainly used for treatment resistant depression. There are other uses of ketamine. It is currently used off label in most settings, meaning that it’s generic ketamine. And it gets prescribed by a prescriber and it’s not indicated for treatment resistant depression. That’s not what the original studies were for, but there’s enough data now to support that. It works really well for that.

Becky Coplen: While you were talking, I had so many different thoughts, and I want to talk about the other two medicines as well. But I’m guessing your institute must work very closely with medical doctors and hospitals and that type of work as well. Can you talk to us about that?

Keith Kurlander: I think the best way to think about our institute is it’s a continuing education institute. The institute is really there to train people in a modality. And we do other training too. We have a large network of places that people come from to get trained. And a lot of people are in private practice who get trained, but many are not. Psychedelic therapy is starting to move into health care systems. Now you can find ketamine therapy in some mental health centers. It’s slow arising in those spaces, but it’s happening. You can see people using ketamine therapy in the ER for treatment resistant depression sometimes. It’s emerging more. A lot of people find us because they’re getting interested in wanting to know more. What is this about? How do I get involved with this new modality that honestly, the buzz about it is mostly really real and positive? They’re obviously things to be aware of and cautions, but I think as a whole we’re going to see really great things from this modality over the next ten years.

Becky Coplen: Let’s talk about if you feel like it’s probably a different approach, the other two medicines I’m going to try are the one psilocybin, okay. Talk to us. How is that different from ketamine or used in a different way? Yeah.

Keith Kurlander:  ketamine psilocybin and MDMA is the medicine that is closest to approval for psychedelic assisted therapy. It is currently under review by the FDA after completing a phase three trial recently. The answer will be given by August 9th if it gets approved, and it most likely will. MDMA is likely going to get approved for psychedelic assisted therapy this year. Psilocybin is not as far along, but it’s pretty far along psilocybin, which is called magic mushrooms or different names. But it’s in phase three right now. And if that all goes well, probably the earliest would. B 2027 for an approval. But there are state initiatives going on that are using psilocybin services.  MDMA is the indication is PTSD and it works really well for PTSD doing MDMA assisted therapy. About 70% of people after a treatment series on MDMA will get better. And these are treatment resistant people who have tried everything under the sun. It works really well for PTSD and then psilocybin more so the focus on the research is depression. There Are other aspects of psilocybin research that’s worth noting. End of life distress is in the research right now. That’s looking very strong. That’s another piece I think we’ll see. They all have different applications and work a little differently. These are three very different psychedelics. The psychedelic experience is very different between all of these three medicines and working with them as a practitioner, you need to understand the differences and how to work with your clients under these different medicines and how that all works.

Becky Coplen: This episode is brought to you by Masters in Counseling. Org. If you’re considering enrolling in a master’s level counseling program to further your career, visit Master’s in counseling. Org to compare school options via our search tool that allows you to sort by specific degree types, tuition, our costs, online flexibility, and more. I was thinking about if you were a clinician and using these methods, would the drugs be used only in the session, or is it like something you practice with the client in session and then they would use at home as well? How does that work?

Keith Kurlander: MDMA will be in the session. It will be highly controlled. We don’t know the rules yet on MDMA, which we’ll know in August likely, but it will be controlled. It will probably be at some centers that are allowed to distribute it during the session. Ketamine is different in that you could go online right now through an online telemedicine service as a patient and get prescribed ketamine as an institute. My personal philosophy is you want a therapist with you when you’re doing these things, because the material that gets surfaced, if you’re alone, could first of all, be traumatic. If you have a trauma surface, which happens a lot, and you’re alone, that can be retraumatizing. We know that one of the ways that it’s really important to heal trauma is through social connection. Having that other co-regulator in the space with you. Our way of teaching, and the way you’re going to see most of this come into the field more and more is there’s going to be a therapist in this space. Ketamine is largely being practiced that way at this point, but it’s a very nuanced thing. There’s anesthesiology clinics that don’t do it that way, that just they put them in a room alone with the ketamine. There are at home teletherapy services. There’s a lot going on in that space.

Becky Coplen: So, let’s talk about the training of someone who had a private practice and they wanted to come to you. How does that look as far as time training? Is it online in person? Do you have a supervisor?

Keith Kurlander: Our training a year and it is 90 plus percent online. There are 1 to 2 in-person events depending on what you choose. It’s a whole combination of different learning activities. We have a lot of asynchronous material. We have weekly live online material that’s required. There are different formats for that. We have a large room learning 200 people in zoom, where they go into breakout rooms and you’re doing exercises and experiential exercises and things, and you’re discussing video recordings that you’ve watched of people on these medicines and therapy sessions. We have small groups where what you’re talking about, which has more of a feel of getting more mentored. It’s called home groups facilitation. Then we have an in-person practicum that everybody comes in small groups out to Oregon to practice with psilocybin. We have other companies that we own that the students, if they want to, can engage those other companies so they can actually experience psilocybin. There’s an observation going on, there’s practicing. Then we have a ketamine practicum, which is optional, where you can come out and experience ketamine and practice with that. There’s other nuances and exams and all kinds of things going on in there. We have 30 to 40 faculty teaching in this program, and we’ve been really fortunate. We have all the thought leaders in the space really teaching in our program. It’s super interactive and fun. Obviously, this modality is challenging, but it’s also fun. It’s very dynamic and exciting, but it’s for clinicians who are ready for that. Working with clients on these medicines is very different from ordinary state consciousness therapy. People can go through a lot and clinicians really have to want to do that work. You have to really be able to sit with a lot of intensity, and it’s exciting if you can, because there’s such rich things that can come from those.

Becky Coplen: Sessions with this type of treatment. Are the sessions longer because of the use of the drugs and talking to us about the time frames?

Keith Kurlander: Yeah, ketamine is a two-hour session. Typically, MDMA and psilocybin are typically a six-hour session. So, they’re long. They’re a whole day. If it’s MDMA or psilocybin with MDMA or psilocybin, you’ll usually have a co-therapist, particularly MDMA. We’ll see how psilocybin shakes out over time. They’re long and it’s a deep dive for those hours. And sometimes you’re sitting in silence for a long time. People are just internal. And the work happens when they start coming out of that space. So, a lot or a little can happen during times and.

Becky Coplen: When they are under the influence of them. Do they ever feel like the therapist like they’re completely asleep? Or is it like you’re in that in-between state of consciousness.

Keith Kurlander: Each Madison is different? Ketamine. People can fall asleep, but more so you might be like, where is this person? And this is where training comes in of knowing how to know that everything seems to be fine and you have to give them their space. It can get uncomfortable when someone is, you’re like, are they here? Are they in the room? What’s going on? They’re probably not in the room consciously a lot with ketamine because they’re associated with their body. MDMA is different. Sometimes it is more verbal. People want to connect, but it can also be very physical and a lot of sensation. Psilocybin is a classical, psychedelic-like hallucination and all kinds of things like that. And it can be all over the spectrum, really.

Becky Coplen: Does a person ever begin to reenact or feel violent or know if they’re going through a past trauma?

Keith Kurlander: It’s very rare for someone to get violent. You can’t say it hasn’t happened, but that’s very rare. If you look at the research, you don’t see that very often. It can happen, but that’s rare to actually get physically violent. People can reenact some things and do things that you wouldn’t expect to see in ordinary therapy immediately. Be like, that can’t happen here. What are you doing over there? Like, people can do things. They can touch their bodies in ways and have to be really trained on this stuff, because people are under the influence of a very powerful psychedelic. But mostly what’s happening almost all the time is like people are just really getting in touch with deep psychological insights, doing a lot of somatic releasing, processing memories, processing their identity and processing the meaning they have in their life. And that’s the majority of what’s going on in a psychedelic therapy session.

Becky Coplen: You’ve taught us a whole lot in this short amount of time. I’m sure you feel like we barely skimmed the surface, but I know, I feel like I’ve learned a lot. Maybe we’ll think about a broader scope and then more focus on this type of therapy. But people just generally go into the mental health field. What would be some advice you would have for our listeners?

Keith Kurlander: I’ll go abroad first. I think it’s really important to be asking the question, what are the root causes of people’s struggles? And getting very educated on the wide spectrum of what those could be? I think that’s essential because wherever you go to school and whoever your supervisors are, they’re going to have a narrow view of what those are. They’re not going to share all of them and go really deep into all of them. It’s really important to just get a really good education on what all those causes are. Then it’s really good to specialize in helping people solve one or many of those causes. Trauma, for instance, which is one of the most ubiquitous root causes of any mental health disorder, I think is essential for any counselor to have a very deep understanding of trauma, because it’s almost there every time. There may be other root causes, but that one is going to probably be there with someone struggling with significant mental health issues. That’s what I would say. And then the other thing I would say is I would be paying attention to psychedelic therapy, because this modality is coming in a big way, there’s no doubt. And the pharmacological interventions we’ve had are not great. They’re okay. They’ve helped a lot of people. They’ve helped me at times, but they’re not great. And psychedelic therapy is going to be a major component of a modality in terms of what’s going to be around and available and what people are going to be using. I would pay attention, and if you’re curious about it, I would get trained because a lot of people around you are going to be trained within the next ten years. That’s going to happen. And it’s a really dynamic, different way of working. But you probably wouldn’t only be doing psychedelic therapy. That’s a lot. You’re not going to be doing 20 hours a week of psychedelic therapy. Most people won’t be. Some would, but that’s a lot to do.

Becky Coplen: Is there anything that you feel like we didn’t cover that we don’t have a whole I don’t want to keep you too long, but anything that you really feel you’d want to share before we close out today.

Keith Kurlander: I would say to the listener that I think that we can box in what we think mental illness is to these disorders that we only know about since the 1960s and 50s that we’ve categorized these disorders. And that’s helpful to some degree. This categorization process in the DSM, it can help, but it tells us nothing about why they’re dealing with those symptoms. Nothing. I think that the more we can keep trying to look at what these signals are telling us, these symptoms in the body, what they’re telling us, where they’re coming from, we’re going to help more. And the symptom suppression model that arose from focusing too much on diagnosis isn’t working. We have way too many people getting more and more treatment resistant over time. We really need to focus on the root cause model of mental health issues and help people with the causes of their pain. That’s what I would leave people with.

Becky Coplen: Thank you so much. You are doing a whole lot of work. Organization that’s leading this cutting-edge modality. We really are thankful for your time. Thank you for giving that to us and for all the information you were able to share.

Keith Kurlander: Thanks so much for having me. And people can come visit us at our website, psychiatry institute.com. See what we’re doing. We’d love to connect with you.

Becky Coplen: Yeah, thank you for mentioning that. Yeah, because I’m sure people are going to be very interested and want to ask more questions to our audience. I hope that you do continue to ask questions. Check out the website for IPI. They have podcasts on there as well. Please leave us comments and questions for the future episodes. For today we’re signing off of Mastering Counseling. Have a wonderful day! You’ve been listening to the Mastering Counseling podcast by Masters in Counseling. Org. Join us again next episode as we explore what it takes to be a business success in the counseling industry.