Clinical psychologist Dr. Genesee Herzberg joins Kyle to reflect on two decades in trauma work and 15 years inside the psychedelic ecosystem—from early MAPS conferences to running Sage Integrative Health. She traces how personal psychedelic experiences set her on a path of service, research at CIIS on MDMA-assisted therapy, and hands-on roles with MAPS: Zendo Project harm reduction, adherence rating, and ultimately serving as an MDMA therapist in clinical trials. Today she leads Sage, an integrative clinic (psychotherapy, psychiatry, bodywork, acupuncture, and functional nutrition) focused on ketamine-assisted therapy while preparing for MDMA’s eventual approval. She also co-founded a sliding-scale KAP nonprofit (now Alchemy Community Therapy Center), co-edited Integral Psychedelic Therapy, and is helping to launch the International Alliance of MDMA Practitioners.
In this episode
- From counterculture to mainstream: What’s been gained—and lost—as psychedelics scaled.
- Accessibility vs. corporatization: Why cutting corners (prep/integration, therapeutic time) undermines outcomes and safety.
- “Myth of the magic pill”: Psychedelics can catalyze change, but healing is an ongoing process anchored by integration.
- What good care looks like: Preparation → medicine sessions → robust integration, individualized cadence, and adding bodywork and functional medicine to address gut-brain links, mineral status, sleep, and somatic tension.
- Ketamine realities: Differences between psycholytic (talk-forward) and psychedelic (eyes-closed, inner-directed) dosing; why some need multiple sessions to build relationship with the medicine; risks of mail-order models (high dosing, poor screening/support), daily prescribing, addiction potential, cystitis, and safety concerns.
- Sitting, not guiding: The therapist’s task is to follow the client’s process; intervene sparingly and with consent—especially in trauma work where attuned co-regulation is essential.
- Multiple access pathways: Support for regulated clinical care and community, peer, and ceremonial models—paired with education and harm reduction (Zendo’s SIT peer training and new crisis-responder training).
- The MDMA pause: Initial devastation at the FDA decision gave way to seeing benefits: time to strengthen ethics, accountability, training standards, and to temper hype-driven investment.
- Pace and ethics: Lessons from burnout; moving at the speed of trust; exploring “psychedelic business models” (stakeholder focus, distributed decision-making, employee ownership, public benefit structures).
Resources & organizations mentioned
- Sage Integrative Health
- Alchemy Community Therapy Center (sliding-scale KAP)
- International Alliance of MDMA Practitioners
- Integral Psychedelic Therapy (edited by Genesee Herzberg, Jason Butler, Richard Miller)
Takeaway: Thoughtful preparation, right-sized dosing, and committed integration—held within ethical, community-minded systems—turn powerful experiences into durable change.
Transcript
This transcript was automatically generated and may contain minor errors or inaccuracies.
Kyle Buller: [00:00:00] Dr. Genesee Herzberg, welcome to Psychedelics Today. Really excited to have you here today, and I was going on our backlog and I, for some reason I thought we’ve already had you on the podcast, but I guess this is the first time. So really excited to dig in with you today.
Genesee Herzberg PsyD: Yeah, thanks Kyle. It’s so great to be here.
And I think I was maybe on one of your courses around ketamine and trauma, perhaps.
Kyle Buller: Yeah. You and Jason.
Genesee Herzberg PsyD: Yeah, that’s
Kyle Buller: right. Yeah. Yeah. Awesome. So, we’ll, I’ll have you [00:01:00] kick off, uh, give a little background so listeners and audience knows a little bit more about you, and then we’ll dig into some topics.
Genesee Herzberg PsyD: Okay.
So yeah, I am a clinical psychologist. I’ve been doing that work for about, geez, I mean, I’ve been in the field of working with trauma for almost 20 years now. And then, uh, specifically a psychologist for the past 13. And I have been also just really immersed in the psychedelic field. Uh, ever since I stepped into my work as a psychotherapist, I was, uh.
Kinda profoundly impacted by my own experiences of psychedelics, and that really opened me up to the path of service that I’m currently on. It helped me to find my purpose in the world and feel like I could make meaning of life by being of service. And so [00:02:00] it’s what, uh, instigated my search for, uh, grad school.
And I, I found CIIS where I ended up doing my, uh. Doctoral research on MDMA assisted therapy. And uh, then I went on after graduating to found Sage Integrative Health, which is the integrative psychedelic therapy clinic that I currently own and run. And so we’ve been around since 2018. We’ve got a team of.
About almost 20 practitioners, psychotherapists, psychiatrists, uh, body workers, acupuncturists, nutritional functional therapists. And, um, yeah, we focus primarily on ketamine assisted therapy right now, but we also offer this range of other integrative services, and we’re setting ourselves up to offer MDMA therapy as soon as that’s legal.
And meanwhile, I also plugged in with a variety of different, uh, [00:03:00] kind of psychedelically oriented positions through maps. So that included everything from working with the ZENDO project, doing harm reduction work at festivals, to working as an adherence rater for the MDMA, for PTSD trials, and then ultimately as a therapist for those trials as well.
Um, so that gave me a. Uh, a foot into, uh, getting to do MDMA work legally, which has been such an honor and a privilege. And, uh, yeah, I’m very passionate about that work in particular and have since been working with a group of folks to found a professional organization for MDMA therapist. Which we’re calling the International Alliance of MDMA practitioners.
Um, and then the last really, I guess a couple other, uh, sort of big chunks of my, my work in the field. One of them is that I’ve always been passionate about accessibility and accessibility to psychedelic therapy in particular, you know, it’s an expensive [00:04:00] treatments, uh, with all of the therapist hours that go into it.
And so back in 2019, I co-founded an organization that at the time was called Sage Institute, and now is called the Alchemy, alchemy Community Therapy Center. And their focus is sliding scale, ketamine assisted therapy.
Kyle Buller: Sweet.
Genesee Herzberg PsyD: And then the last piece is that my partner and I co-edited a book called Integral Psychedelic Therapy, which brings together a number of different, uh.
PR practitioners and researchers in the field who write about how to do psychedelic therapy from a variety of different approaches.
Kyle Buller: Wonderful. And we’re probably gonna hit all these topics a little bit more in depth as we get going here. So excited to, to dig in. Um, I’m curious, since you’ve mentioned, you know, you were impacted by some of your own experiences early on, um, you know, I feel like even.
Yeah, even a few years ago, some therapists might have been like, uh, a little bit more cautious in talking about their own personal use, um, [00:05:00] and maybe how they got involved in the field. And, um, I wonder if you could share a little bit about that. Like, you know, what, how did that open you up and, you know, should professionals be a little bit more open about their personal experiences if they’re starting to get involved in this field?
Genesee Herzberg PsyD: Yeah, I’m happy to share about my experience and I always have been, uh, I tend to be less risk averse than many, and I do think it’s important for us to share about our own experiences so that others can, um, can learn and also can relate and can potentially see like, oh, maybe this is for me. Uh, so, so yeah.
In terms of my experience, I, this was really early on for me, actually. I was about 20 years old and was, uh, going to school at Georgetown at the time, studying international relations. I thought I wanted to be a lawyer or a diplomat and was, you know, just kind of doing the typical college life, enjoying myself, um, doing a little bit too much drinking, uh, that [00:06:00] kind of thing.
Then all of a sudden when I was studying abroad in Madrid, uh, a good friend from high school died in a drunk driving act, and that just turned my whole world upside down. I. I’d never lost someone suddenly like that. And unexpectedly, you know, I lost grandparents, but, but that this was just completely different for me, that someone so close to me could suddenly just disappear off of this earth.
And so it spun me out into a pretty deep existential crisis of like, why are we here? What are we doing here? Just waking up and doing these routine, you know, getting up, going to work, coming home, doing the same thing the next day, if we could just die at any moment. And so I really sat with that question for a long time.
I was in Madrid. I had the space to just kind of be with it. And, uh, this friend who had died had also, uh, been talking to me [00:07:00] about his psychedelic experiences, and he had introduced me to cannabis. And so I, I felt, uh, drawn to exploring them to see if they could support me in my process. And so I went up to Amsterdam and I had.
Two or three experiences with psilocybin that were incredibly profound for me. They first of all, opened me up to sensing my friend Ben’s spirit. Um, it was almost as if he was communicating with me and letting me know it’s going to be okay. I’m actually still here. You can access me anytime. I started to kind of see him in the sunsets at times and just like find little ways of accessing him and my grandmother who had passed as well.
And also through that process, I started to find meaning in life, started to find, uh, [00:08:00] just a deeper connection to. The kind of my reasons for being here. And ultimately what that led me towards was a path of service. Um, the sense was if I can do something that’s helping this world become a better place, then it makes sense that I’m here.
And so since then I’ve been really driven to just do whatever I can to create a more beautiful world, and ultimately actually by, uh, uh, starting my own therapy during that time, I, I. Moved in the direction of psychotherapy and, and actually through my psychedelic work, I, I didn’t do psychedelic therapy, but I, I was working with friends in very intentional settings, paying attention to the set and setting, and I started to think, well, why don’t they combine this with, with psychotherapy?
It just made so much sense. And then I did some research and found out that they had been for decades and, um, so that’s actually what helped me to find [00:09:00] CIS as well, is they had a, a scholarship that funded psychedelic research.
Kyle Buller: Yeah. Wonderful. I’m sorry to hear about your friend, and it sounds like it’s been a journey, but it’s also propelled you, um, to be of service and to, you know, share all this, all the gifts that you are.
Working on, uh, to the world and the community that, that you’re in. So thank you for your service. Um, yeah, I think it is important for folks to open up and I have noticed a shift, like some folks like way back when I would hear them, like say, can’t confirm or deny it, or, you know, afraid of professional suicide.
And then in, in the past, like years hearing them come, come out, um, and talking about their personal experiences a little bit more. Um, and I think that just helps to normalize it, right? It’s like a lot of us probably got into this because we’ve had our own personal experiences and they were really profound.
Genesee Herzberg PsyD: Absolutely helps to normalize it. And I think, you know, by telling our stories, people who’ve been through similar experiences can potentially relate [00:10:00] and see that there is a path, you know, towards healing.
Kyle Buller: Yeah. So we titled this 15 years in the field, um, and thinking about some evolutions, some things that you’ve seen, um, and so yeah, being involved in the field for, for such a long time, um, what have you noticed?
Like any themes, any kind of Yeah. Things that emerged throughout the years.
Genesee Herzberg PsyD: Yeah, so my first uh, conference, my first maps conference was in 2010 in San Jose, and it was a small group of people, I dunno how many exactly, but it felt very intimate. Uh, you know, there are maybe two or three tracks happening simultaneously, uh, as opposed to, I don’t know, dozen that they had this last year.
And it. It just felt like a more tight-knit counterculture community, which I really loved at the time. You know, I kind of felt like I finally found my [00:11:00] people and, um, and it was nice to be able to connect with others who were passionate about this thing that wasn’t accepted by the mainstream. And I really felt a sense of, uh, kind of passion around, uh, you know, how do I help this become more widely accepted?
And, and that felt really kind of a, a common experience with those that I was, uh, meeting. And so, you know, fast forward 10 years later, it, you know, feels very mainstream at this point. Probably not in some places, but it certainly is much more widely accepted. Psychedelics in general and psychedelic therapy in particular.
And I, I think that’s a beautiful thing, you know, that it, it. Really provides a lot more access to people who might otherwise be scared or turned off by it. I think people are learning that it’s safe and can [00:12:00] Poten has the potential to be very healing safe when held in the right conditions. Um, and also that there are pathways, many, many pathways to accessing it.
And so I’m, I’m very grateful for the movement in that direction. Uh, the, there have also been some shifts that have left me feeling somewhat disheartened, and that has a lot to do with the corporatization of the field and the ways in which some companies are coming in with a strong drive to profit off of, uh, you know, everything from creating new chemicals.
To, um, the psychedelic therapy itself, to retreat centers and everything in between. And there are many players who are in it for the right reasons, um, but there are others who are not, or others who are maybe in it for the right reasons, but also trying to make a profit. I’m personally a believer that, you know, healthcare should [00:13:00] not be for profit.
Like people should not be making money off of healthcare and like, you know, not beyond like, you know, kind of providing for the people involved so that they can, you know, live a comfortable life. But, um. I see healthcare as a basic human right, and it is just concerning to me. You know, as you, we watch certain companies, like Field Trip was a really good example of this.
You know, they’re no, no longer around, but at first it seemed like, okay, this, this could actually be a good thing. You know, creating multiple clinics across the country, opening up access. On the other hand, we started to see over time that they were cutting out some of what I see as the most essential parts of the work, which include the, the therapeutic process, so the time with the therapist, um, and the time for preparation and integration.
Um, so, and, and [00:14:00] we, we kind of see that across the board, just companies cutting corners basically, or not tending to appropriate set and setting. When we look at some of the, um, you know, mail order, ketamine, clinics that are, or ketamine companies that are out there, um, over-prescribing in terms of dose, I, yeah, I just think that there’s a lot of potential risk on the one hand and also, uh, diluting of the, of the effectiveness of the therapy and all of that alongside, um, something that I call the myth of the magic pill.
Mm-hmm. Like, you know, especially after Michael Pollan’s book, suddenly people are calling Sage. Uh, really excited to do psychedelic therapy, but thinking that they’re going to be able to have one or two experiences and be cured and yeah, that’s not been my experience. Yes, you can have incredibly profound psychedelic experiences that do lead to major healing, and also more often than not, uh, it, it, [00:15:00] it’s healing is a lifelong process.
And yes, psychedelics can speed that up, that process, but still, uh, uh, we, we are constantly growing and evolving and there is no landing place. And, um, beyond that integration is just an incredibly, incredibly important part of, of healing through psychedelics. And if you skip over that, it’s likely not to be all that impactful.
Kyle Buller: Yeah. So many points I want to touch on here. Um, and feel like yeah, we could go over all over the map. Um, when, you know, I. The corporate corporatizing, everything is, it seems complex, right? Because there’s parts of it that helps, like with the evolution of the field in a way, right? Like maybe we need a lot of money to do the research and you know, stuff like that.
So how would you see, like in your ideal world, like what does psychedelic therapy look like? Access to psychedelics, what does that look like? Like if you were able to [00:16:00] like say, this is the ideal model and I don’t know if there is an ideal model, but you know, it’s, it’s fun to explore.
Genesee Herzberg PsyD: Sure, sure. And I love that question.
I do think there’s some great companies out there, Tigen, for example, I, I really respect, you know, looking at novel analogs to MDMA and, uh, you know, Matthew Bagget has been in this field forever. And, uh, yeah, I, so there are companies out there that I think are doing it well. Um, and I’m actually currently in a program with through, uh, the North Star, uh, the, you know, Liana, Golis nonprofits.
It’s called the True North Guild. And it’s a group of, uh, executives in the psychedelic field who are looking at how do we integrate ethics into our work and into our, our companies no matter where they fall, kind of in terms of our particular area of focus or our focus on profit, et cetera. Um, so that aside the ideal [00:17:00] model, um.
Yeah, I mean, I personally think that some level of preparation, psychedelic session and integration is essential for, you know, for anyone doing this work. And in terms of the number of session sessions, it, it, it’s so individualized. So some people I think, actually can benefit from just one really profound deep session, and that’s good for them for some time and they can set it down and move on along with integration support and for others, particularly those with chronic PTSD, for example, or complex PTSD, uh, the it, there’s just so many layers to unpack and to work with.
So for those folks, you know, we found in the MDMA for PTSD research, and this was more just anecdotal, there hasn’t been specific research on this yet, but all of my colleagues seemed to notice that when folks had complex [00:18:00] PTSD, they needed more sessions afterwards and they would’ve benefited from my estimate is, you know, anywhere from six to 10 over the course of years.
You know, this isn’t all happening in a matter of months or even one year. Um, but for some people it, it really, uh, does need to be more long-term work. Uh, I don’t necessarily think that there’s any right cadence. It depends on the medicine, it depends on the person and their needs for integration. So for some people a session once a month or three months, like the maps studies entailed, it makes a lot of sense to me and for others, a lot more time for integration I think is appropriate.
And we’re looking at ketamine. It’s even more, some people benefit from twice a week for a while while others, you know, once a month or even more spread out is great. And then we’re also finding at Sage that bringing in integrative practices, including, uh, functional medicine is a big one. So looking at what is happening for [00:19:00] people on a biological level alongside their psychological process because the, there’s so interconnected and a lot of times through the, the therapy piece or the psychedelic therapy piece, we’re, we’re missing certain essential elements.
That could actually help move the needle a lot. For example, we talk a lot about the gut brain connection and the ways in which our digestive system really impact our, our mood and our sense of wellbeing. And when you look at what’s happening there, it can make a big difference for people. And there’s so much else in terms of mineral levels and nutrition, um, et cetera.
So a lot to be exploring there. And then the body too, the ways in which we hold tension in our body, um, or, uh, the ways in which, yeah, trauma impacts how we, you know, how we move, how we stand, where our chronic pain is, uh, you know, that can be really well supported and addressed through body [00:20:00] work or acupuncture, craniosacral therapy.
Um, so yeah, in an ideal world, we would include those modalities as well. Now what I’m talking about does not include any consideration for cost. So when you get into many prep sessions, as many, you know, medicine sessions as you need integration plus all of these integrative services, most of that is not currently covered by insurance.
You know, the psychotherapy prep and integration sessions, if it’s done by a licensed practitioner is usually the only thing that’s currently covered, um, with the exception of, of a company named in Thea that’s really working to change that. But right now they’re very like small in scope. We work with them, but we just have a couple referrals a year at this point.
So, yeah, I mean, honestly, I think all of this should be covered by insurance. And there are people who are working towards making that happen. I’m not sure what the timeline looks like at this point, but um, you know, certainly the psychedelic sessions needs to be [00:21:00] covered. And then I am a personal believer that these integrative modalities are actually in many ways more effective than conventional medicine, particularly when you’re looking at.
Preventative medicine and ultimately preventative medicine is going to save costs in the long run. So my hope is that over time, the right people can start to show insurance companies that we are saving money in the long time through these modalities and that coverage will start to shift.
Kyle Buller: Yeah, that seems to be the big thing, right?
Accessibility. Um, and how do we make this more accessible to, to folks, um, especially when it comes to costs and it, um, yeah. It makes me wonder like, what are some of your thoughts around like various use context and, you know, I know we’re talking about like psychedelic assisted therapy models, but like, um, you know, thinking about community models, um, peer models, ceremonial models, like Yeah.
Do you feel like that’s also part of the evolution of the field as well for [00:22:00] accessibility?
Genesee Herzberg PsyD: Absolutely. Yeah. I, I believe in all of the various routes towards legalization, whether it is ceremonial religious contexts or whether it’s in more community-based contexts, uh, decriminalization, legalization, certainly we need proper regulation and guardrails.
And also I, I truly believe in, uh, you know, people’s right to explore their consciousness. And with that comes the need for education. And it’s one of the reasons that I have been connected with the Zendo project for over 10 years now. Uh, it just is. I, I think they’re doing a lot of good work in festival spaces, but they’re starting to expand that.
So they currently have a training called the SIT training, which is really around peer support. It’s not for practitioner, it’s not only for practitioners. So it’s to help people learn to sit for each other. [00:23:00] Um, that’s not going to work for everyone. If you’re trying to do deep trauma processing, you likely should be working with a therapist or if you have a, you know, a, a.
More severe or even, uh, you know, kind of run of the mill diagnosis. Like, you know, if you have chronic depression, for example, or OCD or bipolar disorder, um, and most of those are, are rooted in trauma on one level or another. If not, you know, acute trauma, then early relational developmental trauma. Um, so there, there are times and places where it’s important to be working with a therapist.
And there are also other instances where having a friend sit for you is perfectly acceptable, especially when that friend is trained to do that work. And it’s actually how I, you know, first got started was, um, reading. I came across actually at that first. Psychedelic conference that I went to in 2010. I, uh, someone, I won’t name this name, uh, was who’s been in the field for quite some time, was passing around these little cards [00:24:00] with a link to what they call at the time, the En theo Guide.
And it was a, uh, that I think is now published now under a different name, but basically just described, it’s like a, a guide for sitters and Voyager. And I was. So comprehensive and so helpful for me and my learning in terms of how to be with people in a good way. Um, so I, I absolutely support that. And then the other thing that Zendo project is doing right now that I just wanna name or about to do is that they’re also moving into supporting crisis responders and how to respond, how to support people in more of a kind of harm reduction, uh, relationship focused way.
So, very excited.
Kyle Buller: Just so important, right? Because you get called, they don’t really know what to do. I mean, I’ve seen some of those videos online of, you know, first responders responding to people having like, really difficult experiences or doing something erratic in public. And also like the trauma that, that probably causes that person, like once they’re in the midst of a, an experience, [00:25:00] right?
Seems traumatizing, like geez.
Genesee Herzberg PsyD: Absolutely. Yeah. Yeah. It really puts therapists in a challenging position when, you know, suicidal ideation or imminent suicidality shows up. Like if you make a call, which you’re mandated to do, it’s likely going to, or there’s a good chance it’ll be traumatic for the person involved because of the ways that law enforcement is trained to deal with those situations.
So I’m so excited to see that start to shift.
Kyle Buller: Yeah. Yeah. Yeah. And thanks for also mentioning like, yeah, being with friends and stuff like that. I just think about like my early years too, like sitting with friends and then becoming more intentional and kind of like, you know, holding that container for one another and like with that intention and just how impactful that was.
Right. Um, and it sounds like you, you’re also doing something similar in those early days.
Genesee Herzberg PsyD: Absolutely. In those early days. And then also, you know, that was a big part of what I see as my own training was actually with, with colleagues. Um, [00:26:00] we kind of, early on there were a group of different ketamine assisted therapy clinics who, um, we were all launching at the same time, Sage and Polaris and Healing Re realms and Temenos all clinics in the Bay Area.
Um, we were supported by Raquel Bennett of Korea who had trained us all. And so we came together and, uh, had a consultation group and also a practice group, and started to, um, kind of practice using these medicines in kind of novel ways and, you know, understanding better how to sit with folks before stepping into actually doing the work.
And I’m very passionate about this personally, that you really should only be holding space, um, and guiding people in realms that you know yourself. And I realize that that’s complicated. I realize that, you know, there some people have medical reasons for not being able to, yeah. Um, you know, delve into certain realms or explore certain medicines.
And there are also many, many ways to [00:27:00] access altered states of consciousness. And, you know, personally, I only work with the medicines that I have a deep relationship to. And so I, I just yeah. Think, think that that’s an important part of training.
Kyle Buller: Yeah. And I guess on that note, like, um, and maybe it’s like so personalized and individual, like what does that relationship look like?
Like should that be ongoing? Like, is it okay to take breaks and kind of like, you know, not have experiences for a while? Because I know yeah. Some people are like, no, you should really be doing this all the time to develop that relationship with the medicine. Mm-hmm. But I also know people that have had those really profound experiences in the past and they’re really deep in integration for months, years, and they’ve kind of like put it aside and they’re showing up to, to do their work.
I.
Genesee Herzberg PsyD: Yeah, I, I think it’s, it’s important to take breaks sometimes. Actually, what I have found with medicines over the years is that they show up and are important medicines for me for a while, and then at a certain point [00:28:00] I just kind of get to a place where it’s, it’s not right for me in this moment. And either I shift to a place of, you know, taking a break from.
Medicines in general, or there are other medicines that are calling to me. So I think that, you know, different medicines have their time and place in our lives at different times, and we can’t predict what that will look like or, um, and definitely shouldn’t hold expectations that others have any particular trajectory with medicines because it’s, it’s so unique and individualized, and often integration takes years.
And, uh, it, it’s important to respect that. I remember with Ayahuasca, I was sitting in this really sweet, um, monthly gathering, closed group, small group that was intended to support folks in accessing their creativity. And it was very, very helpful for me for some time. And then I kept getting the same message over and over again.
And at that point I was like, okay, I need this. Stop until I can [00:29:00] really integrate that message. The message was to slow down, and at the time I was running both Sage and Alchemy and working on a book, and I was like, I can’t slow down. Can’t do it
Kyle Buller: all. Yeah, I’m
Genesee Herzberg PsyD: gonna need to just pause, get to a place where I can, and then maybe I’ll return to that medicine if it feels right.
And honestly I haven’t yet.
Kyle Buller: Hmm. Yeah.
Genesee Herzberg PsyD: Better in terms of my, my life being slower and more manageable. So I’ve integrated the lesson, but I haven’t felt the call.
Kyle Buller: Yeah. And I think that’s an important message. Um, and I always come back to something, uh, one of my colleagues and friends, Deanna Rogers always mentioned, it’s like, you know, are you in a place where you’re able to shake the ground?
Um, and there’s. You know, I, I had a similar experience where it was just like, I kept going back into that space and getting the same message. And it’s like that classic quote, once you get the message, hang up the phone. And, I mean, that’s the message. It was, it got, it’s like you’ve been here, go do your work in the world.
Yes. And that was like a really challenging, I think, message to hear, but um. That kind of all started around the time I think we started this, this project and I was starting [00:30:00] grad school and doing all sorts of stuff and I was like, yeah, I think I just need to take a break. But it didn’t mean I took a break on the inner work, right?
Mm-hmm. It was like breath, breath work was still involved, still using like cannabis in a somatic way to deepen that experience. Um, therapy and like all those other modalities. But it was like, oh yeah, I think I just need to sit, you know, I keep getting the same message and I think I just need to press, press the break a little bit.
And yeah, as like you’re saying, like it comes in waves and I feel like that’s been my journey too. It’s like it’s here then maybe I need to really sit with the integration process for a while while utilizing other modalities to help me integrate that. Um,
Genesee Herzberg PsyD: yes, and I love the modalities that you named there too.
Those are definitely on my. Your kind of top list of, of integration tools? Psychotherapy for sure. Um, for me, meditation as well. Breath work is great. Time and nature and, and yeah, sometimes other medicines too. Ketamine and cannabis in particular. And for me, ketamine, cannabis and movement have bit like [00:31:00] dance movement have been such an important integration tool.
Kyle Buller: Yeah. So good. Um, we’re talking a little bit too about the like therapeutic process and when you mentioned the myth of the magic pill, um, you know, I’m wondering how are you managing expectations when people are coming in? Uh, because I noticed, like that’s always been a challenge for me too, when like clients have come in, they’re like, I’m gonna have this like profound experience and I’m like.
I know you’ve read Michael Pollan’s book, I know you’ve read the research, but that’s not always how, like, you know, these experiences always go and it’s always hard to kind of manage that expectation. It’s like you wanna be optimistic and hopeful and hold kind of like the potential for those mystical, transformative experiences, but also be realistic too, um, and what could possibly occur with somebody.
Genesee Herzberg PsyD: Yeah. I love how you framed that. It really is holding a pretty delicate balance there, um, of, of those two pieces, both, you know, planting the seeds for the potential for something really powerful [00:32:00] and transformative on the one hand, while also helping people to get, get, portray a realistic picture of what what could in fact happen.
And with ketamine, this is especially important because, um, it’s possible and there are some. Uh, I wanna say Eli Culp is one of them. Past researchers who, or it may have been Kapinsky, who, uh, would do a level of preparation, like six weeks of preparation for one very high dose ketamine experience, which he just kind of.
Supported people in envisioning will be profound. And it was specifically to treat addiction. And so there, you know, there is a way to go about it like that, but more often than not, ketamine actually takes time to develop a relationship to too. I know that was true for me, and it’s true for many of my clients, not all of them, some of them, the first experience, they’re like, oh wow, yeah, this is, this really works for me.
Yeah. I, I’m feeling better than I have in years or, [00:33:00] um, wow. It just really brought me to this place that I needed to go. Um, but for many others it’s. It’s a little bit of a, like a weird place, like
Kyle Buller: weird
Genesee Herzberg PsyD: medicine. Yeah, yeah. What do I do with this? What is this realm? How do I make sense of what just came through?
And so I really wanna let people know, you know, that we don’t know how this is gonna go for you. Um, it’s, it could be, uh, a clearly beneficial experience right off the bat. It also may take, I tell people, it may take up to three sessions to really get us good sense if this is gonna be the right medicine for you.
And, uh, generally people find it to be helpful to their process one way or the other. Um, but for some people it has more obvious biochemical effects where it, you know, shifts your mood pretty immediately. And for other people, it has more to do with the content that comes up, which we can then work with in the integration sessions or process during the session if it’s a lower dose psych psycholytic session.
And so. Uh, [00:34:00] just, just letting them know that it’s, um, it, it may be very profound. It may be something that we need to work together to other understand, and for some people it’s not their medicine. And so just to let them know that right off the bat.
Kyle Buller: Yeah. Yeah. Um, and there’s another question that came up around like the therapeutic process a, a bit ago.
I don’t know if you’ve been digging into any of the research that’s, that’s come out. I’ve kind of dug in a little bit here and there, but not super versed in it about, I don’t know which company is like, looking at just the effect of the medicine and suggesting like, maybe we don’t need like that therapeutic support there the whole time.
Um, or like how impactful is therapy versus like just the medicine. Mm-hmm. Um, since, and since you brought up like there is a biological aspect of, um, you know, ketamine. Being an antidepressant at times. Right. Um, like what’s your take on that? Like, do you feel like with some of that research, like biotech and some of these companies might want to [00:35:00] completely remove the therapeutic process if they have data that the medicine is just as effective?
Um, without that, that therapeutic support?
Genesee Herzberg PsyD: Um, it depends. It depends so much on the medicine and the person. Uh, but I do think there are certain, uh, trends or patterns that, that I would, uh, comment on. One of them is that when we’re looking at high doses of either more classical psychedelics, uh, the tryptamines like LSD or psilocybin and also high doses of ketamine, yes, the sitter.
Um, I think it’s, in my experience, having a sitter there, uh, just to make sure that you’re safe. To make sure that, uh, you know, especially with high-dose LSD or, or psilocybin, people sometimes get paranoid. They get scared, they don’t know what’s happening. Mm-hmm. High-dose ketamine too. So having someone to ground you and remind you that you’re okay, that this is what’s happening, [00:36:00] um, are really important, but there’s not necessarily as much of a therapeutic process that happens at those levels, you know?
Right. If you look at the John Hopkins research, people are for a big chunk of time, uh, they’ve got eye shades on and they’re really having an internal process. So I, I could see an argument for, with those medicines, at those doses having highly trained sitters rather than licensed psychotherapists being okay.
I still think the prep and integration is important. Um, but whether it needs to be with a licensed therapist or with someone who’s very trained and you know how to hold prep and integration, I’m open. When it comes to trauma processing, again, I cannot see removing the therapist. Um, it just, you know, people do in their MDMA sessions, some people anyway have moments, maybe an hour at a time where they’re going inward and having deep [00:37:00] experiences, but then that coming back out and talking with the therapist about what’s coming up and having someone there with you.
To be in the emotion with you rather than being alone in these overwhelming feelings that initially caused the trauma, I think is an essential component of healing. In fact, this is something that’s been coming up a lot with a current client of mine who has a severe trauma history, like very severe childhood trauma.
And, uh, part of our work recently has been just her coming in and going back into these young parts of her who experienced, you know, devastating sexual and physical abuse and being able to express what, you know, just the intense fear, shame, uh, devastation, isolation with me there. And she said time and time again that these things are coming up when she’s at home, [00:38:00] but she just.
She’ll cry and like it’ll just be a looping kind of cry. Uh, and it doesn’t lead her to kind of feel better afterwards, where when we go into those places together, she comes out the other side as if she’s just released something major and she feels, you know, almost like a different person or like she can go back into her life and navigate it in a good way.
So yeah, I just cannot see removing the therapist from any psychedelic work focused on, on trauma therapy specifically. And I worry about it for, for other things too. You know, I think there are specific cases where, you know, say you have someone who’s a little bit more. I don’t know. I hate all the terms for this.
Yeah. Higher functioning or, you know, healthy, normal, um, whatever, who doesn’t have a lot of trauma in their background. Um, this is what Tigen is trying to do, where, you know, just having an MDMA experience can be hugely beneficial. Or like me, you [00:39:00] know, mys Ivan experiencing, I have complex trauma. Um, but I was in a situation where I had the right support, um, that psilocybin experience with, you know, with two friends there, um, without a, you know, full on therapist was very, very healing for me.
So, um, I think there are times and places and people where that may be. Okay.
Kyle Buller: And as you’re talking. And as you’re talking about this, it just reminded me of a session that I had one time with a therapist and asking this question like, could the therapy actually disrupt somebody’s process? Um, and where I’m coming from is I was, uh, doing academy and session with a therapist and it was almost like they were putting on their therapist hat and really wanted to know what was going on.
They wanted to guide me through an experience and I was just doing my work, right. I was like, I, I am doing it. Let me just be internal. And I had to like tell them to like back away. And it was almost like maybe they had to like unlearn in that moment of like, how do I just be a sitter and not a therapist in this space?
And really like, you know, give somebody like [00:40:00] agency to, to work through that. Um, ’cause I know sometimes, yeah, maybe, you know, we’re trained to want a dialogue and get in there and, and understand, but when could that not be so beneficial at times? And just let somebody have their experience
Genesee Herzberg PsyD: such an important point.
And that is one of the most important things that we try to convey. Convey in our training, we offer what we call Integra Integral Psychedelic Therapy Training, um, for practitioners at Sage. And uh, I’ve also been an educator for the Maps MDMA for PTSD training. And we saw time and time again, especially in some of those bigger maps trainings when we had 500 people virtually, um, that there were many folks, especially those who are trained in more.
Active or directive psychotherapies like CBT or DBT, um, that really had to [00:41:00] unlearn their therapeutic method, um, because it in a psychedelic session. It’s so essential to follow the client’s lead and what Zendo calls it, it’s one of their four principles sitting, not guiding. Yeah. So you are not guiding the person’s process.
You’re not directing them. You’re really sitting back and making space for their experience. If they want to engage, then you engage. If they want to share what’s happening for them, you take notes. Um, but I am rarely, you know, kind of leading people in any particular direction. Occasionally, if I notice that someone seems to be kind of bypassing, like staying on a more surface level, this happens semi-frequently with MDMA especially, um, I will try to find a gentle way to.
Redirect their attention inward really is the, the most likely thing there. [00:42:00] And then occasionally, if they’re not talking about their trauma, we may have made an agreement beforehand that I can bring it back to that if, if they have consented to it previously. Um, so there are times and places for direction in medicine sessions, but they’re rare more often than not, particularly during the peak of the medicine experience.
I think it’s so important for therapists. To unlearn, um, their directive tendencies and to really sit back and hold the space. The last thing I’ll say about that is that I think one of the things more than anything that motivates therapists to step in in those moments is their own discomfort, right?
Either they feel like to be useful or they’re feeling uncomfortable with the emotional content that’s present, and they’re trying to soothe themselves by engaging with the client. And so, uh, uh, an important practice for therapists in those moments is really noticing what’s coming up inside them, being with that, processing it internally, and then using the [00:43:00] acronym, uh, weight.
Why am I talking before? Before stepping forward?
Kyle Buller: Yeah, it’s so important. And I know I’ve been there quite a few times and like having to listen to my own advice where I like want to intervene or do something and I have to pull back. I’m like, who is this for? Uh, this is actually for me ’cause I’m like feeling anxious and I wanna be useful.
Or maybe I’m like, quote unquote feeling bored because I’m not doing anything and I feel like I, I need to do something. Um, and yeah, I think that’s a really important reminder. Yeah. Wait, why am I talking, why am I treating, why am I, you know, if we’re talking about therapeutic touch, like why am I touching?
Mm-hmm. Um, you know, that weight acronym is really great. Um, and you know, something else that comes up as we’re talking about this topic is, you know, is it dependent on like, obviously the medicine, the dosing, so like, you know, psycholytic therapy, um, you know, a little bit more engaging than high dose therapy.[00:44:00]
And like, you know, I feel like we’re still so early in this field where we’re like, what is the best protocol, right? Like, how do we like approach this? Like, you know, if somebody with significant trauma, are we doing more kind of like psycholytic dosing where there’s a little bit more engagement and relationship building then going into high dose where we could maybe sit back and, and be that sitter?
And so yeah, it’s interesting as, as the field evolves and like. How protocols are gonna be developed and then, um, applied.
Genesee Herzberg PsyD: That’s really what we found with our, our ketamine work so far, is that when someone’s coming in with trauma, we, in fact, we start all of our clients at a psycholytic dose, whatever that is for them.
And just to see how that, you know, how that works for them. Typically, it’s around a hundred milligrams sublingual for ketamine and. Uh, for some people they wanna stay there. They find, oh, this is really great. It puts me in a place where I can better process my work. Uh, so the therapist is quite engaged often in psych psycholytic work, but even so you’re still following the client’s lead?
Yeah. [00:45:00] They’re maybe a little bit of direction, like bringing their attention back to their body, for example, noticing how whatever they’re talking about is showing up there. Um, but more often than not, you’re still kind of following the client’s lead and then, you know, only moving to psychedelic therapy to higher doses if people find that it’s helpful.
And in those cases, yeah, more often than not, it’s more eye shades, music and the therapist sitting back and just available if anything’s needed and as they’re coming down.
Kyle Buller: Yeah. So you’ve been involved in the ketamine space for a while, and I’m curious to hear some of your thoughts on how that’s evolved because I, I think before we, yeah, before we got rolling, I was just mentioning like I was hearing last night, um, during class, that a lot of people actually got interested in this through ketamine and.
You know, years ago that might not have been the case and how maybe popular or accessible ketamine has become. And you know, we’ve seen all sorts of different things like, you know, there’s lots of different models, lots of different theories and application with ketamine, whether you’re go, you’re going into like an IV clinic and just getting that type of treatment, you’re going into get [00:46:00] more psychedelic assisted therapy model.
We have the at home male, uh, ketamine. And so yeah, just curious to hear like your thoughts on how it, how it’s been evolving.
Genesee Herzberg PsyD: It certainly has changed. We started offering ketamine in 2018 at Sage Ketamine assisted therapy and at the time. It was pretty much, uh, you know, a handful of clinics like ours and a bunch of infusion clinics that existed, but many people didn’t know about.
And we would semi-regularly get referrals or people coming in for ketamine assisted therapy who had previously tried an infusion clinic and had a pretty challenging experience for one reason or another. Uh, I’m thinking of one person in particular who found the ketamine itself useful, uh, but who had been placed in a kind of busy waiting room type area.
She could hear the [00:47:00] receptionist talk. She was just kind of on her own in this reclining chair and, you know, just had a nurse kind of check in on her at the beginning and the end of the session. And then they just let her go to drive back on her own. So at a certain point when they up the dose enough.
She had a, you know, a full on psychedelic experience, had a, an encounter with death. She then was just kind of unhooked from the IV and told to go home and drive herself home. And this was just,
Kyle Buller: she
Genesee Herzberg PsyD: devastating for her,
Kyle Buller: drive herself home too. Wow. Not even needing a ride. Wow.
Genesee Herzberg PsyD: Yeah. And, and she was, you know, about 40 minutes from her home.
Um. Yeah, so she was really, really disturbed by that experience. No integration support whatsoever. So she found me and we were able to do some, you know, trauma work around that experience, um, and then step [00:48:00] into more of a, you know, ketamine assisted therapy treatment. And that was ultimately healing for her.
Um, but yeah, there are a number of people who ended up having this. We also ran an integration group in the past for just anyone who worked with ketamine, and a lot of people from integration or from infusion centers ended up joining us and. Many people had faced challenges like that. So I am, you know, so glad that there are many different alternatives at this point and that I think at least some infusion centers are starting to catch on to the need for more properly held work.
Um, but still, you know, I hear about people using s bravado and often it doesn’t have much in terms of support. And so, yeah, I, you know, it’s, it’s great that there are lots of options out there. I, you know, one thing I’ve been thinking of doing is, uh, you know, reaching out to infusion centers to see if they would like some consultation around how to hold the work in a good way.
’cause I think there is still a lot of work to do there. Um, I don’t think we should get rid of infusion [00:49:00] centers. They certainly are helpful for some people. Um, s bravado is covered by insurance, which is amazing. Um, you know, really ideally. Generic emmic, ketamine would be covered as well. We’ll see if we get there.
Um, and then the mail order companies, yeah, I have a lot of mixed feelings about that. Yeah. Again, I think for, you know, kind of the typical person that, or doesn’t have a lot of trauma in their background and doesn’t necessarily need a lot of support, it’s not a bad option for people to have access to a medicine that can be very helpful.
Uh, on the other hand, it’s. You know, from what I understand, there’s a little bit of preparation and integration support, but it’s, it’s just not the same as working with a therapist ongoing. There is not a therapist present in the session. They say you should have a, a support person present, but they’re, they don’t really monitor that, and so many people [00:50:00] don’t.
They prescribe very high doses. The reason for that, as I understand it, is because they ask people to hold it in their mouth for less time. So sublingual lozenges are, you know, generally held in the mouth for 10 to 15 minutes. It’s a somewhat lower dose. I think they have people holding it in the mouth for five minutes at quite high doses.
But if people confuse that, it’s so easy to just, you know, have a, you know, fall into a deep K hole that you don’t know you’re going into and feel totally overwhelmed and discombobulated with no one there to support you. You know, it can lead to incidences like, um. Matthew Perry, for example, it can also lead to addiction.
You know, I, I’ve been hearing recently that some companies are prescribing daily ketamine, which is super concerning. Ketamine can be, uh, you know, can be used improperly. It can be misused. It’s, um. While it’s not necessarily psychological, or sorry, physiologically addictive, you [00:51:00] won’t necessarily have severe withdrawal symptoms.
It’s certainly psychologically addictive and there are many people who have become addicted to it and even have died because of it. And so it generally not in therapeutic. Settings. Mm-hmm. Um, as far as I know, and like ketamine assisted therapy session settings. Um, but when someone’s being sent a prescription of ketamine and told to use it daily, you know, it, why not just have it, you know, either in the morning or when you’re having a hard time to change your state.
You know, that’s really how things become addictive when you start to grab for it whenever you need to change your state and you lose your other coping strategies. And, uh, yeah, I’m, I’m kind of just concerned about the direction that’s going to head. I think it’s too early to know exactly what that will look like, but it has the potential to turn into something like the opioid epidemic.
And, uh, yeah, I, I don’t know, opiate, you know, opiates are way more physiologically addictive, so I don’t think it’s quite the same. Um, but [00:52:00] yeah, I do have my concerns.
Kyle Buller: Well, when you say, you know, you’ve heard of people dying, is that mostly due to like getting up, falling, hitting their head or in like Matthew Perry’s case drowning, like doing things that like aren’t necessarily appropriate or from like overdosing or, or something like that.
So
Genesee Herzberg PsyD: yeah, it’s really hard. Thanks for naming that. It’s really hard to overdose on ketamine. Yeah, yeah. They use way, way, way higher doses in surgical settings and anesthesiology and you know, not a problem. It physiologically it helps to have your heart rate monitored, but yeah, high dose ketamine is not going to kill you on its own most likely, however.
Yeah, either it’s, you know, probably the biggest risk is getting up and moving when you’re too high and falling and hurting yourself some somehow, or drowning. Or the other possibility is, you know, getting addicted to it and then finding out you can buy it on the street for much cheaper. Getting a source and starting to use powder ketamine and then getting some that’s placed with fentanyl.
That’s actually where I’ve heard of a lot of the deaths happening too. [00:53:00]
Kyle Buller: I’ve heard of that too. Yeah. And do you know if we have any data around like long, like for these folks that might be prescribed daily, like long-term bladder issues? I know it’s mostly like the data that I’ve read seems to be more kind of like in the recreational world where they’re taking like up to a gram all the time and like, you know, doing very high doses.
But, um, is that a concern for you within like daily dosing? Within like a therapeutic
Genesee Herzberg PsyD: It is. And you know, it’s not common. Um, but it’s something that we look out for even in our, you know, therapeutic setting, our clinical setting where we rarely. Dose people like our prescribers rarely prescribe more than a twice a week ketamine experience.
And even then there are some people who start to experience pretty quickly, uh, you know, urinary issues. Uh, so frequent needs to urinate pain and urination, which could be an indication of cystitis. So for those people, we generally just ask them to stop and say, this may not be the right medicine [00:54:00] for you.
You know, let’s see what else. You know, what else is possible? Try to work just with therapy. That kind of thing. I have heard of the occasional person in a clinical setting using not that much developed cystitis and actually contend with the issue of ketamine is so helpful for me that I’m not sure I wanna give it up.
And on the other hand, you know, it’s just really alleviating my depression or whatever it is. And on the other hand, the cystitis is a long-term chronic. Painful issue. And so not really knowing how to manage that, but yeah, more often it’s gonna show up in recreational daily use.
Kyle Buller: Yeah. Do you fear of any sort of like crackdown on like ketamine, and I know this has been going on for a while, like, you know, people not being able to get ketamine because of like manufacturing and distribution hangups and DEA oversight and stuff like that.
Um.
Genesee Herzberg PsyD: I do, I do. Yeah. I think that’s one of the other potential risks as well, beyond people getting hurt, is that there’s some kind of [00:55:00] crackdown, maybe it’s reclassified as a schedule two medicine and just made harder to access for one reason or another. I don’t, you know, it’s on the World Health Organizations list of essential medicines and it’s used in so many different settings.
Everything from the battlefield to surgical settings to, um, you know, sur surgery with children and animals, that it is most likely never going to be criminalized completely. Um, but I, I could see a situation where it’s, it’s much harder to obtain, which would be a real, um, just really unfortunate for the many, many people who are benefiting from it.
Kyle Buller: Yeah. Yeah. So I guess on this topic, and I’m just seeing the time is flying by here, I’m like, oh. Um, so it feels like ketamine has really exploded in, in the past few years and, you know, lots of different kind of modalities, the way people are using it. And then the whole thing with like mail, uh, at home, uh, ketamine use.
And then [00:56:00] we had, um, you know, the MDMA decision last, uh, last summer with the FDA, and we’ve been talking about this like slowdown, this hangup with approval and, you know, it’s, yeah, you’re just talking about like potential crackdown, you know, is that on, on the horizon for ketamine? Is there a benefit of like, you know, maybe that, that MDMA decision, um, you know, getting denied for right now and, and talking about a slowdown in revaluation of how psychedelics are, um, you know, maybe becoming more mainstream.
Genesee Herzberg PsyD: So when I first learned about the FDA decision, and in fact the, the group that I mentioned earlier, the International Alliance of MDMA practitioners, we were working and we’re basically, uh, the founding group is about 40, uh, trainers and supervisors from the maps research and, uh, training program. Uh, we were devastated by the decision.
We’d done so much work around advocacy [00:57:00] when, um, you know, people started speaking out against MDMA and, and the, the research itself in ways that, uh, largely didn’t make sense. Some of it did, you know, there certainly were. Um, a couple of ethical violations, one in particular that was very problematic, very disturbing, um, and also that kind of ethical violation happens in every field.
Um, so it’s, it’s not outside of the norm as much as, as it is a problem, and as much as we, we do need to do whatever we can to prevent, you know, therapists from crossing sexual lines with their clients. Um, but yeah, a lot of what was being said about the research was, uh, unfounded and, uh, ultimately the decision itself.
The FDA’s decision itself went against a lot of what they had specifically recommended to maps as they were developing the protocol. [00:58:00] Um, so the FDA had worked really closely with maps to develop this research protocol, and then they were coming back with all of these critiques of the protocol they had helped develop.
So it was very confusing to and disorienting to all of us. And it also made some sense in that, uh, based on some of the criticisms that were coming up, I think the popular opinion was starting to shift around this medicine. And so it was important for the FDA not to make a decision that would be unpopular to the mainstream.
So I, I kind of get where they were coming from on that level. Nonetheless, I was very disheartened, primarily because I’ve just seen how powerful that work can be for some people, especially those with trauma. And I have. A number of clients who had been waiting for years to be able to access that medicine legally and now will have to wait longer.
And yeah, just watching some of them, uh, really, really [00:59:00] struggle and not be able to find something that really gets to the core of what they’re struggling with. Despite, you know, the deep experience that I have and my colleagues have in working with trauma and the, you know, the power that, that ketamine has to support people as well.
MDMA just brings something different to the table that, for some people is needed. So I was, I was, uh, really upset to see the decision and it took me and my colleagues some time to recover from it. And over time, I am starting to feel a little bit differently, particularly after going to the psychedelic Science conference in June of this year and seeing the ways in which there were less folks attending.
And, uh, the people that were, there were, many of them were people who had been in the field for a long time or who had a personal relationship to the work and are deeply con committed to bringing it out in the world in a good way. And then it seems like a lot of, or a number of [01:00:00] the kind of larger companies who were in it mostly for profit.
Had kind of stepped away or seen that this isn’t necessarily going to be as quick moving and profitable and imminent as they thought it was going to be. So it felt like a little bit of the kind of, uh, riffraff, for lack of a better word, was um. Was not there. And it was more focused on those who are, you know, truly in it for the right reasons.
And you know, on top of that, I’m also feeling like this is giving us more time to really get some good, uh, guardrails and systems of accountability in place to protect people and to ensure that the work is held in a good way. And you know, that’s something that we’re doing with the MDMA alliance right now is working on a set of clinical and ethical standards and, you know, considering what other organizations we can work with to support systems of [01:01:00] accountability and, uh, you know, thinking through what training is going to need to look like for folks.
And, you know, we don’t know. What, uh, Lycos, or I guess they’re now calling themselves Resilient Therapeutics, is going to, um, ask for, or the FDA is going to ask for in terms of the rems or the requirements in terms of how the work is, uh, prescribed. So, you know, kind of training may depend a lot on what that ends up looking like.
And at the same time, we can set standards as a group of professionals and, uh, you know, help potential clients find ways to access folks who are, you know, truly trained in, in how to hold the work in a, a good and robust and ethical way.
Kyle Buller: Yeah. Yeah. It’s interesting that you brought up, um, the MAPS conference.
’cause I was having a lot of conversations with colleagues and it did feel like, I [01:02:00] think for those that have been working in the space for a while, there was a different energy there and it, it was almost like maybe two experiences I was hearing. It was like the people I’ve been in the space for a while, it was like a little bit of like, yeah, there’s like a shift in energy and then the people, it was like their first time, it was all the excitement there still.
But for like, operators were like, yeah, something feels different. And I did hear that from quite a few folks where almost like this decision and, and maybe there’s other factors at play too that may have like shaken up like investment and corporations a bit more around this stuff and like has. Kind of contracted the height bubble.
Um, and I do think that there is a benefit in that contraction, right? Maybe it’s helping us to like, ’cause it feels like, you know, if anybody’s been working in this space, it feels like a rocket ship. Like, you know, it’s just been like so crazy over the past few years and all the developments and, and things and it, it has felt like it’s been moving fast.
But there’s also that like. Sense of urgency that we need to get this to market. And I, you know, I just, I skimmed through, uh, the [01:03:00] letter that maps just published, um, around, uh, the, the letter that the FDA just, uh, made public, um, that that urgency is still there, right? Like people are, are dying. We need new tools in mental health, but um, like how are we doing that in an appropriate way and, and maybe kind of slowing down and having a little bit of that reflection time can be really important.
Um, so I don’t know, do you feel that urgency that we do need to like speed this up to get it out for new mental health treatments or, you know, yeah. Do we really need this time to maybe sit and reflect and see like where the field and wants to develop and go?
Genesee Herzberg PsyD: I have had a real trans inner transformation around that sense of urgency.
I stepped into the field with just being driven by it intensely, and that led me to found two businesses, one after the other, and write a book and just to everything I could, not just to create a, you know, a psychedelic [01:04:00] clinic that holds the work in a way that I think is, um, you know, ethical and truly going to help people, but also create access and also get my model out there.
And, um, and, you know, glad glad that I did on some level and also it. There’s a number of things I learned from that process. One is that I totally burned myself out in the process and it led me to be, you know, kind of much worse at what I did for some time period, particularly in terms of running the organizations.
And, um, I, I really, you know, I ended up burning myself out and needing to go through some, um, it’s, it’s how I got really interested in functional medicine actually, is learning that there are, you know, one of the many kind of issues that’s not recognized by western medicine, adrenal fatigue, um, but is deeply supported through functional medicine.
And, and so ultimately ended up being helpful for me, but it also, um, I think led me to make some decisions that I [01:05:00] would wouldn’t have or I would’ve done differently otherwise. And to, um. Yeah, I, I think that had we moved at a slower pace and let go of that sense of urgency, things would have been built in a much more sustainable way.
You know, we’ve been able to correct course and Sage is doing great and I’m, you know, just really happy with the organization and the direction that we’re going. Alchemy as well. And also it, uh, I, I just, as much as there are many people out there that need to be helped also, when you move too quickly into something, mistakes are made.
And when you’re able to take it more slowly, move at the, the speed of trust, right? That may be Adrian Marie Brown’s term, I’m not sure. But, um. Just really take things one step at a time. Make sure you’re understanding best practices before you dive in head, you know, head first. It, it really makes a [01:06:00] difference.
I remember a common phrase at the time had to do with building the plane as we fly and we were all building the plane as we flew and it was like, that’s never a good idea. That plane is not gonna fly.
Kyle Buller: Yeah. Let’s make sure we have landing gear and all the safety stuff in, in place. First. I had an old, uh, I worked at a company and, and they used to use that term all the time ’cause they were like kind of in startup.
They’re like, oh, we’re just, you know, flying the plane building. And I’m like, that seems really dangerous.
Genesee Herzberg PsyD: Totally. Totally. And then the other piece that I think is, is helpful here is around ethical business practices. You know, it’s so easy to go into. The, the known to just keep going with what we know, you know, this kind of hierarchical corporate profit-driven structure, because that’s what’s most common.
That’s what folks are used to, where I am really excited about, uh, psychedelic businesses. Really using, you know, what I think Dave McGuffey called the, the psychedelic business model, you know, in which we’re, you know, we’re, we’re holding things differently. [01:07:00] We’re really thinking about how can we change and refine business so that it’s truly supportive of all stakeholders involved, of the employees, of the folks we’re serving, of leadership of the community itself.
And so integrating things like, um. You know, more distributed decision making. For example, I’m very excited about the, the teal model of, uh, organizational structure or, um, you know, purpose-driven, uh, companies, uh, you know, benefit, uh, public benefit companies, um, employee ownership as something we’re really exploring right now.
So, how to help everyone, uh, to participate in the success of the organization and everyone feel empowered to do the work they’re most passionate about and to make the decisions that they’re most, uh, you know, informed to make.
Kyle Buller: Yeah. Yeah. Beautiful. Um, and thanks for sharing that vulnerable part about burnout.
Um, you know, I, [01:08:00] that was I think a consensus I was hearing too, amongst a lot of colleagues when we all got together that people did, yeah. And feel really burnt out with like, how fast things have been going. Mm-hmm. And I think that’s really important to be honest about, like, how much are we taking on? Can we continue to move at that speed?
Because if we’re all burning out, then we’re not gonna be able to show up for our clients for the development of everything. Um, and to really, yeah. Maybe, and I, I feel like I’ve heard this too. It’s like, it, it’s really been a time of like self-reflection the past few months for a lot of people. They’re like, how do I wanna show up?
Um, like, where do we want to go? And it’s. Sounded like a, a bunch of people were like, yeah, coming back to basics, like, why did I start this? Why did I get involved here? Um, and where do we want this like ship to go? And so in some sense, I think this kind of self-reflection period is really helpful for a lot of the folks that have been involved in a bid and feel like, yeah, we’ve been on a rocket ship and like.
Okay, like, let’s, let’s slow down and self-reflect and, and see, and also [01:09:00] maybe hold a little bit of that urgency, right? Like we do have like this mental health crisis. What are new tools and interventions that we can have to help people? ’cause that is a very real thing. Um, but yeah, also just balancing the reality of like, yeah, moving too quickly.
Genesee Herzberg PsyD: Definitely, definitely. And I would say self-reflection and healing. You know, one of the things that burnout does is it leads us to, it can often lead to mental fog. We don’t think as clearly it can lead to fatigue. We just aren’t able to show up as much. And it can also lead to loss of passion and motivation.
So we’re not, as we lose track of why we got into this in the first place, or we, we don’t have things that we’re really excited or inspired about. So, you know, a big part of my healing has been regaining all of those things. And it’s, it’s so good for me to feel this renewed sense of passion around, you know, how to continue to steer the field in a good way and bring forward treatments that are truly gonna help people.
Kyle Buller: Yeah. Yeah. Beautifully [01:10:00] said. Well, we’re getting at time here. Um, I feel like we could go for another hour and digging into all these wonderful topics. Um, do you wanna talk a little bit about the book that, uh, you guys published a while ago before we wrap up here?
Genesee Herzberg PsyD: Great. So it’s called integral psychedelic therapy.
The, let’s see, I have been ordinary art of psychospiritual healing and uh, yeah, it’s, it was really a passion project that was developed with my partner Jason Butler at Wilber Hot Springs is where we first started thinking about it. And it initially was gonna take the form of a conference there, kind of like an unconference of gathering together a bunch of psychedelic practitioners to think together about how to continue to evolve the work.
You know, at the time it felt like the conversation around psychedelic therapy was not very nuanced and was really, you know, kind of staying it like kind of. Top level, just the basics. And we wanted to [01:11:00] get more deeply into what does this therapy actually look like and
Kyle Buller: mm-hmm.
Genesee Herzberg PsyD: How do you hold these more nuanced and challenging moments that people aren’t really talking about at this point?
You know, it, it, while there is either, you know, there are certain circumstances where someone without a psychotherapy license, you know, can hold space. There are also, it can be really challenging in certain moments. And so, you know, how do we work with erotic transference? How do we work with the body? How do we work with this really delicate topic of touch and consent?
How do we work with the imaginal realm and what comes through on that level and really help people to ground and integrate. The images that come through, what is real true integration actually look like, and what are the challenges that can come up around integration? Um, what is decolonizing therapy and how do we hold the space from a, you know, culturally humble and, uh, decolonizing lens?
So yeah, it’s, it was, uh, really [01:12:00] the, the, the conference itself ended up getting transformed into a book because of COVID. We had the conference all ready to go. Tickets were sold out. Bummer. And then COVID happened two months before, so we canceled it, but we invited a number of folks who were going to speak to write chapters, uh, including about music.
We had just so many amazing minds contributing to this book. And, uh, yeah, it’s, it’s now available. Uh, just an amazing resource for psychotherapists or for guides doing psychedelic work, but also it could be interesting to anyone who’s interested, interested in psychedelic therapy in general. And yeah, it was just a real honor to get to put this out there into the field and start to deepen the conversation.
And we’re actually now working on a, a second related book that’s going to be more of a, a handbook, like talking about a little bit more of the basics, but also from a more nuanced perspective. So that one gets into specific, our, the currently published book gets into more specific, uh, topics. And this one’s more like, what are the [01:13:00] basics of holding, uh, psychedelic therapy in a nuanced and effective and, uh, heartfelt relational way.
Kyle Buller: Wonderful. Yeah, I was skimming through some of the chapters, um, before and yeah, there’s some really great, um, essays in there. Um, so I’m excited to, to dig into it more. Um, sweet. Well, we’re getting at time here, so anything that you wanna close with, where can people find your work? Um, how can people learn more about Sage and, and yeah.
Genesee Herzberg PsyD: Great. Thanks so much, Kyle. It’s been such a pleasure to talk with you. Yeah, I just feel like our conversation’s go in so many fun directions. Um, yeah. And in terms of finding me, so I’m at Sage Integrative Health, and, uh, the website for that is Sage integrative health.org. I’m sure that’ll be in the show notes.
We also have an Instagram and Facebook page. Um, you can also find, uh, alchemy Community Therapy Center, uh, by googling that. And, um, the m let’s see, the International Alliance of [01:14:00] MDMA practitioners. I believe the website for that is MDMA alliance.org. But yeah, we’ll add all of these to the show notes. The book itself, integral Psychedelic Therapy by myself, Jason Butler and Richard Miller are the three editors.
Um, so yeah, hope that you are able to explore those various resources and, uh. Get some benefit from them. And then again, thanks so much, Kyle. It’s really
Kyle Buller: wonderful. Well, thank you Dr. Herzberg. Really appreciate all your insights here and for the wonderful conversation. And thank you to everybody that’s listening today.
So we’ll catch you next time. All right. Take care.
