Integrative psychiatry and psychedelic-informed care, explained

All right, everybody. Welcome back to the podcast. On this episode, we have a very, very special guest, Masha Renoir. Masha, how you doing? Doing amazing. How are you doing, Rich? Thank you for having me over. Yeah, absolutely. Thank you for coming on and sharing a little bit about you and how you help people. With that being said, I'm excited to learn about you. Can you please tell us a little bit about yourself and what you do? Absolutely. I am a dually certified psychiatric and family nurse practitioner, and I practice integrative psychiatry. What that means is that I combine traditional psychiatric care as well as what's considered complementary psychiatric care. I combine modalities like breathwork, mindfulness, psychedelic-assisted therapy, and others with regular psychiatry, which means medication management and therapy. With that being said, it is really a holistic approach to care, where I look at the whole patient, not just their symptoms. Wow. So many threads to pull on with that answer, Masha. But I'd like to get started with what led you into psychedelic-informed and integrative psychiatry to begin with. So my path into psychedelic-informed and integrative psychiatry began with my own reflection of my life in my early 40s. At that time I was going through quite a lot. My communication with my daughter, then a teenager, was not going so well, as well as I was struggling with some of the coping mechanisms that were no longer doing well for me or my life, and also struggling with the self-esteem. So at that time I stumbled on a research that compared Lexapro, which is a very commonly used antidepressant, with psilocybin, which is an active ingredient in magic mushrooms, and their uses in depression. With that being said, that research really kind of hooked me, and I started to research more and more about psychedelics. And I need to mention that I come from a background or a culture where psychedelics were regarded as dangerous drugs, something that was a complete taboo. So for me it was really interesting to discover that research into psychedelics that showed them in a completely different light, something that could be incredibly beneficial in mental health and psychiatry, and incredibly well-regarded institutions were conducting that research, and some of that research is decades long. So I was looking more and more into this research, and it led me into specializing in psychedelic-assisted therapy. So I'm fully certified and licensed in practicing that type of therapy, as well as my own personal healing. So that little research that I found by accident, if you will, really led to a huge change in my own personal life, where now I can definitely say that it changed my life forever. Wow. So you really bring to the table your lived experience into your practice, or at least what led you to study these things? Absolutely, 100%. I definitely embody what I preach. So everything that I suggest and encourage my patients to do, I experienced on myself. So in many ways, the way I practice is showing patients that the inner healer is already inside of them, and my job is just to remind them of that inner healer and then walk the path along with them, rather than healing them myself. Wow. Yeah, that's fascinating. Masha, how do you understand and work with depression and anxiety differently than, say, traditional psychiatry? So the way I see depression and anxiety is really not isolated disorders, but rather symptoms or signals from the nervous system that something deeper might be needing attention. A lot of times people have childhoods where their nervous system was under constant attack or threat. Maybe they didn't get the attention that they needed, or maybe it was physically unsafe. And a lot of times what happens later in life is that they have those symptoms like depression or anxiety showing up as a result of those deeper patterns that actually originated back in childhood. A lot of times, again, it is our parents, our community, our guardians that put those patterns onto our impressional brains, into our minds, and then we carry those patterns for the rest of our lives, unless we do some really deep dive into ourselves and change those patterns. Yeah, that makes a lot of sense, and it's great to know that you bring a lot of nuance to these really sensitive topics. Masha, I'd like to ask what makes your approach, with all this advanced training that you've had, different from conventional, more medication-focused psychiatry. The way I see medications is just one type of tool, and while medications can really work and help in symptom suppression, and I use that specifically, they are really that: they are just something to suppress the symptoms. They are not allowing us to do a deeper work. So again, it's just one type of tool that could be used, yes, maybe for the time being, maybe as a partial response to those symptoms, but not as a root cause analysis of what is happening, and not as something that will allow us to go deeper and change the preset patterns. So the way I work is I look at the entire human, at the entire picture. That's where the whole holistic approach comes in, where yes, we might be using medications, but we're also going to use supplements. We also might use exercise as a tool. We're also going to look at the nutrition. We're going to look at the patterns that patients are carrying from their childhood. We're going to look at the patterns that are maybe evolving now in their relationships and their work environment and the environment of the culture they are living in, etc. So we cannot just take one thing and say this is the only way of addressing a whole human being. Yeah, you know, as you were saying that, I just got this image in my head of you having so many tools in your toolbox, so to speak. And it's really cool that you really are holistic, in that you consider all of these things in the environment and other resources to help your clients really maintain progress and see meaningful change. So that's really cool. Masha, I'd like to ask, who do you help in your practice? Who do you see, what does your demographic look like? Oh, absolutely. I love this question. So I help adults, anyone 18 and over, and usually those are the people who've tried medication, sometimes multiple medications. Sometimes they tried therapy as well, and in fact some of them tried years of therapy, and yet they feel that something is still missing. They still feel that the patterns are still there. They're still repeating the same loops of behaviors, if you will, and they want to dive deeper, or maybe they want to look at a different approach or a different modality or a combination of modalities and get help this way. Yeah, thank you for that, Masha. You know, one thing that I've picked up on is that ketamine-assisted therapy is becoming a little bit more popular. There's more conversations being had about it. What do you think people misunderstand about it? I love this question, thank you so much for asking it. So one of the biggest misconceptions about psychedelic-assisted therapy, and ketamine-assisted therapy specifically, is that the treatment is the experience itself. People sometimes imagine that ketamine therapy is simply about having the altered state, and it is not. A lot of times preparation and integration are even more important than the journey itself. And ketamine-assisted psychotherapy, just like psychedelic-assisted therapy, begins with a psychiatric evaluation, which is about 90 minutes to two hours, then a preparation, at least one to two sessions of preparations, and then the journey, and then the integration. And sometimes the integration can take months, years, or lifelong to really truly integrate all of the insights and the downloads that people receive during the journey. So journey is just a part of the treatment, and again, the whole treatment includes preparation, journey, and especially integration.

Yeah, thank you for that, Masha. I really appreciate you shedding some light on ketamine-assisted therapy. What are some of the changes that people experience when they go through this kind of work? Yes, that's another really great question. A lot of times people notice really subtle changes. So the changes are in the details, and the more integration happens, the more changes they notice. A lot of times they notice that they are kinder to themselves. They are less reactive with others. They allow themselves the space, the freedom, so to speak, to allow them to step away from a situation where they usually react right away, but now they allow themselves the space to step away and assess, reassess the situation, and really to see it for what it is, and then respond in a much more mature way, if you will. So those changes, no matter how small they are, they compound with time, and the more integration that happens, the more practices that people practice in their daily life, the more changes that they see in the long run. Yeah, wow, that's interesting. Masha, so a lot of these individuals are finding information about ketamine-assisted therapy on the web, you know, like most of us find information, right? YouTube, they're going to Google, stuff like that. What does the process look like when they partner with you to do ketamine-assisted therapy? Yes. So the process starts usually with a free consultation, and it's usually 10 to 15 minutes, where the patient and I meet over video and we see if we are a mutually good fit. So for me, it's very important that the patient feels safe working with me. So that's one of the main reasons I offer that 10 to 15 minute free consultation. So that's step one. And then we proceed to scheduling a psychiatric evaluation that is really a deep dive into a person's background. We go through their childhood, their school years, what currently is happening in their life. And that evaluation usually is 90 minutes to two hours. Then we proceed to scheduling our prep sessions, and prep sessions, again, it could be one or two sessions, depending on the need, depending on the person. It is really kind of driven by both the patient and myself, and we constantly collaborate on that. And then the last preparation session is for intention setting for the journey itself, and then we proceed to the journey, where with ketamine-assisted psychotherapy the journey is usually two hours long, and it is of course a supervised journey. And with other psychedelics the duration of the journey could be different. For example, with psilocybin it is 6 to 8 hours and absolutely must be in person, and only in those states where psilocybin is legal, such as Colorado and Oregon right now. And then after the journey itself, we're meeting again within the two to three days maximum after the journey for integration sessions. And integration sessions, again, could be one to two after the journey itself, and we go through and discuss what happened in the journey itself: the insights that the patient received, the emotions that came up, and what is happening as they live their life after the journey. Wow, that's super interesting. Masha, I'd like to switch gears a little bit and ask about your style. There's some clinicians that are, you know, very direct. They're solutions focused. They kind of tell people what to do, more or less. And then there's other clinicians, other providers, who are a little more laid-back, you know, and they just kind of allow the patient or the client to lead. Some involve humor, some don't. Some do a lot of self-disclosure, others are like, no, let's keep it super professional. So with that being said, I'd like to ask, how would you describe your style in your work? So mine is a bit eclectic. I kind of combine all of those aspects, and I do disclose quite a bit about myself, because I believe that if I'm vulnerable with patients, it allows them to be vulnerable back. Another thing that I use quite a lot is curiosity and non-judgment. In fact, one of my agreements with a patient is that we do not use judgment in our interactions. So with that being said, I ask a lot of questions, and I really allow them to lead their own healing. Again, that's the whole concept of the inner healer within each and single one of us. And I remind them that they can really let that healer lead them. So a lot of times I ask questions where we are shedding light on the patterns of behavior and where those patterns originated, and then allowing the patient to really lead the healing process themselves. And I hope I answered that question. Oh yeah, you did. You know, it sounds like you really approach your work with a lot of nuance, your style. Sometimes you can be a little bit more directive, other times you allow them to lead. You self-disclose when appropriate, and you kind of model what it looks like to be successful in therapy, and that is by being vulnerable, you know, because you got to be vulnerable to share. So yeah, I really appreciate that. 100%. Yeah. Masha, so let me start at the beginning with the client's journey. How do you ensure that you are a good fit for them and that they are a good fit for you? Yes, love this question. That's where we use that complimentary consultation. Again, it is a completely free consult, it's usually 10 to 15 minutes. Some patients actually enjoy it so much that it spills a little bit overtime. We try not to do that, but sometimes it happens. And what it leads to is ensuring that we are a mutually good fit. So again, my goal is to ensure that the patient is feeling safe and understood, even in that 15-minute consult. So I want to make sure that they are feeling comfortable with working with me. So that's the first step, and if we are feeling like that's a mutually good fit and we are ready to move forward, then the next step would be scheduling a psychiatric evaluation. Yeah, thank you for sharing that, Masha. Can you tell me a little bit more about the first session that involves the psychiatric evaluation, please? Absolutely. So psychiatric evaluation is anywhere between 90 minutes to two hours. I usually tell my patients that it is 90 minutes; however, I book myself for two hours, so if it goes above 90 minutes, we still have the time. And we really explore and deep dive into the patient's life from pretty much conception onward. So I ask questions like how their mom's pregnancy was, if there were any circumstances affecting the mom at the time of pregnancy, and then how their birth event went, and then we go through their early childhood, elementary school years, middle school years, high school years, all the way to where they are currently. And this way it really helps us to understand where they possibly picked up certain behaviors or certain self-beliefs even, or issues with self-esteem, etc. So this is really a base that we build over that time of understanding, and then of course we go through all of the symptomology required to assess as far as psychiatric wellness as well as physical wellness. We go through anything that possibly is running in their families, and something that they are suffering from, or maybe they are noticing in their life, that was not diagnosed. So it's really a deep dive into patients' lives, where we look at their lives from multiple different perspectives. It could be environment, it could be physical health, mental health, their upbringing, as well as their spiritual beliefs. Wow. So it sounds like there really is a comprehensive view of the whole client. Why is that important, Masha? Why do you want to go all the way back and know as much as you can about the client? Love this question. So that's where I apply my holistic or integrative lens: in knowing where they're coming from, from different perspective, and all of the details of their life, then we can use all sorts of different tools that could potentially help them get better as well. So it's really in understanding and knowing the picture that we can then apply different modalities and have a truly personalized plan of action. Oh, that sounds amazing. Masha, so let's say somebody partners with you and they do the first session, the psychiatric evaluation, and then they start doing the work. What does progress look like for that client? So progress can be in many different ways. It can look like, again, allowing themselves a little space, a little freedom from reactivity. It also being kinder to self, and allowing self some mistakes, and stepping away from perfectionism that might be running in the family, or they might have adapted, or maybe stepping away from people pleasing. So sometimes the change can look very subtle in the beginning, but then it compounds as the integration therapy continues, along with possible journeys; then that change can really compound over time. Yeah, that's really awesome. Masha, so let's say a client works with you and they're progressing and they're doing the work and they're coming regularly to sessions with you. How do you know when it's time to terminate or kind of graduate a client? I think it's again a collaborative reply, in the sense that it is not necessarily that I am feeling that they are done and this is the end of the therapy for them, but rather it's a mutual thing that comes up, and now we know, both the patient and I agree, that this is the place where they feel comfortable to possibly put the therapy on hold. So not necessarily terminate, but that is enough of progress for right now. And some patients quite literally say, this is enough, I want to live my life a little more before continuing on. So what it means is that they just need to integrate that by themselves. Now that they've woken up the inner healer, they want to do the work themselves, and if they feel stuck, come back. And I of course agree with them on that. So it's really an individualized process. So for people who realize that's where they are, this is exactly what they need. They need a pause. They need to, quote, live their life for a little bit, and then if necessary, come back again. That's awesome, Masha. So let's say somebody's watching this episode and they really like how you present yourself, they like what you've said so far, but maybe they're reluctant to reach out, because maybe they've never worked with a provider or even done therapy in the first place. What would you want them to hear? I want to let them know that being hesitant about therapy is completely normal, and I feel that's something that we all go through. It can be incredibly uncomfortable to really take that first step. So it is completely normal, there's nothing wrong with it. And beginning therapy sometimes is really the hardest part, kind of like beginning to work out: it's really making the decision, and getting yourself to the gym sometimes is really the most difficult part. Similarly, starting therapy or starting psychiatric care is really that most difficult part, getting yourself to it. And once that begins, I feel that it really opens up a window to look into parts of ourselves that maybe we haven't looked so closely at. And it is uncomfortable to really look at those parts that maybe we hid from ourselves. Wow, that's really interesting. And I think that's a really great thing to say for people that are reluctant, because you're right, you know, it could be intimidating, it could be scary, it's something new, it's something different. But based on the feedback that I've heard from my own practice, it is one of the best decisions they've made: being able to really allow somebody into their most intimate parts of themselves, and being able to share some of that intimacy with the clinician, that can be really relieving, you know, and really meaningful to them. Masha, I'd like to ask, what has been the feedback from the clients that have worked with you about their experience working with you? A lot of patients say that psychedelic-assisted therapy, and ketamine-assisted therapy specifically, has been life-changing for them. A lot of people that I see have suffered with depression, anxiety, sometimes treatment-resistant depression with suicidality, for years. And what psychedelic-assisted therapy can bring is it can bring some welcome change. It can bring some soothing to parts of ourselves that have been suffering for a very long time. It can also soothe the nervous system that's been on alert for a very, very long time. Wow, that's interesting. Masha, I'd like to shift gears and ask a little bit about you. Is that okay? Absolutely. So I'd like to ask, outside of your clinical work, what helps you stay grounded and connected in your own life? Oh, I love this question. I absolutely love it, thank you so much for asking it. So I do yoga nearly daily. I also meditate, and I use mindfulness techniques on myself, so I do quite a lot of visualization. I also do journaling, but not necessarily just words on paper, but also fingerpainting and painting and just expressive arts, if you will. So once in a while I dance in my bathroom, and that's my form of journaling, and if a feeling needs to come through somatically, it just does. So I am using all of those practices to create that groundedness in me, but I also teach those practices to my patients. Another thing I absolutely love doing is being outside. I want to say nature, but in reality sometimes nature is kind of far away, and I don't want to drive 45 minutes to nature. So I just take my dog and we go on long walks around the neighborhood. So that's actually something that helps me a lot as well. It's just the repetitive motion of moving one foot in front of the other. It's really a meditation in action for me, and also being outside of my office and outside of my home, that helps quite a lot. Yeah, that's awesome. Masha, what's on the horizon for your practice? Are you maybe opening up a different location, hiring some staff, maybe a coaching program, anything like that? No coaching programs, but I am expanding my practice into Colorado and Oregon. I'm transitioning from California, so I am aligning myself with more liberal natural medicine laws; that's why Colorado and Oregon. I am also developing an integration circle that's going to be meeting once a month, so that like-minded people can feel in community. It's going to be a place where people can come in and talk about expanded states and how they are integrating after their journeys. And again, expanded states are not necessarily just psychedelics. The expanded states could be achieved through meditation, through mindfulness, breathwork. And some people, including Maslow, have experienced those states. He called them peak experiences, just out of the blue, out of nowhere. So he had them spontaneously. So he had something that he called spontaneous peak experiences, which is technically an altered state of consciousness. So that's what's on the horizon for me: the integration circles, as well as the practice in Colorado and Oregon. Wow, that's awesome. Masha, this has been great. Thank you so much for coming on the show, and maybe we could do it again in the future. How does that sound? That sounds amazing. I look forward to it already. Thank you for having me. Yeah, absolutely. All right, everybody, thank you for tuning in on this one, and until the next one, signing out. Bye.