Living Medicine

Michael Mithoefer, MD, is a clinical psychologist and the Senior Medical Director for Medical Affairs, Training, and Supervision at the Multidisciplinary Association for Psychedelic Studies (MAPS). He specializes in treating PTSD with experimental psychotherapy through clinical research and outpatient clinical practice. Between 2004 and 2018, Michael and his wife Annie completed two of the six MAPS-sponsored Phase II clinical trials testing MDMA-assisted psychotherapy for PTSD.

Therapists new to the psychedelic psychotherapy space are often uncertain about how to support clients effectively during altered states. Should they remain silent and allow the medicine to do the work, or should they actively guide the session with interventions? Misconceptions about the "non-directive approach" often leave practitioners unsure of their role, leading to either over-involvement or complete disengagement. How can therapists balance presence and intervention?

As a psychiatrist and researcher specializing in psychedelic-assisted psychotherapy, Michael Mithoefer explains that the therapist’s role is not to impose structure but to follow the client’s inner healing intelligence. He outlines three key principles: only intervene when necessary, provide time for natural processing, and always frame suggestions as invitations rather than directives. Additionally, he highlights the importance of relational safety, regular check-ins, and the integration of somatic interventions to help clients navigate difficult emotional and physical manifestations of trauma during their sessions.

In this week’s episode of Living Medicine, Michael Mithoefer, the Senior Medical Director for Medical Affairs, Training, and Supervision at the Multidisciplinary Association for Psychedelic Studies (MAPS), returns to talk with Dr. Signi Goldman about guiding internal-directed healing during psychedelic therapy sessions. Michael discusses the importance of checking in with clients regularly during sessions, how therapist training and personal psychedelic experiences influence psychedelic therapy facilitation, and when to intervene during MDMA sessions.

Manish Agrawal, MD, is the Co-founder and CEO of Sunstone Therapies, the leader in the delivery of psychedelic-assisted therapies in the medical setting. Dr. Agrawal brings an extensive academic, clinical, and research background and depth of experience to Sunstone that spans medicine, engineering, philosophy, and ethics. Driven by a deep interest in healing, Dr. Agrawal is particularly passionate about whole-person healing and the transformative potential of psychedelic therapies. Manish previously held the position of Co-director of Clinical Research at Maryland Oncology Hematology, where he dedicated 18 years to the care of cancer patients.

Dr. Agrawal completed his Residency in Internal Medicine at Georgetown University Medical Center, where he was also a Fellow in Health Care Research and Policy and Bioethics. He earned his MA in philosophy from Georgetown University and an MSc in clinical research from Duke University. He earned a Fellowship where he was appointed Chief Fellow at the National Cancer Institute, National Institutes of Health, and Hematology and Medical Oncology. He also completed a Fellowship in Bioethics at the National Institutes of Health Clinical Center and was the first fellow accepted into both fellowships.

Psychedelic-assisted therapy is revolutionizing the treatment of mental health conditions, but its integration into medical practice raises significant methodological and operational challenges. How can researchers develop rigorous protocols while addressing the unique demands of this innovative therapy?

Oncology specialist and researcher Dr. Manish Agrawal, MD, pioneers psychedelic-assisted therapy in clinical settings. Conventional clinical trials, focused on standard medical interventions, struggle to accommodate the multidimensional nature of therapy-assisted psychedelics. To navigate these challenges, Dr. Agrawal refined methodologies to integrate therapeutic preparation, ongoing support, and post-session integration into their protocols. Clinical approaches must emphasize patient safety and trust, which are critical for the profound emotional states induced by substances like psilocybin and ketamine. Additionally, trials should incorporate validated scales alongside qualitative insights to bridge the gap between scientific rigor and therapeutic nuance.

On today’s episode of Living Medicine, Dr. Sandy Newes hosts Dr. Manish Agrawal, MD, the Co-founder and CEO of Sunstone Therapies, to discuss clinical trials in psychedelic therapy research. Dr. Agrawal talks about balancing the risks and benefits of psychedelic-assisted psychotherapy, his transition from oncology to psychedelic therapy, and the limitations of this groundbreaking research.

Mel Herbert is the Founder and CEO of EM: RAP (Emergency Medicine: Reviews and Perspectives), which provides engaging, high-quality educational content for emergency care providers. As a renowned emergency medicine physician, he established the nonprofit EM: RAP GO to extend emergency medical training to underserved communities. Mel is also the author of The Extraordinary Power of Being Average.

As the demands of emergency medicine take a heavy toll on clinicians, many struggle with depression and anxiety, often finding little relief in traditional treatments. For medical professionals seeking solutions, could ketamine therapy provide a breakthrough in combating burnout and restoring mental well-being?

After struggling with severe depression and suicidal ideation and failing to find relief with conventional medications, emergency medicine physician Mel Herbert turned to ketamine-assisted psychotherapy, which he describes as life-changing. Ketamine lifted his depression and reshaped his brain’s neural pathways, allowing him to experience joy and gratitude in ways he hadn’t for decades. However, Mel warns against the dangers of unregulated ketamine use, stressing the importance of controlled administration with a professional therapist, proper dosing, and integration therapy.

In this episode of Living Medicine, Dr. Sandy Newes interviews Mel Herbert, the Founder and CEO of EM: RAP (Emergency Medicine: Reviews and Perspectives), about his experience with ketamine therapy for professional burnout. Together, they discuss training considerations for professionals entering the ketamine-assisted psychotherapy field, how providers customize treatment to patient needs, and the ideal candidates for ketamine-assisted psychotherapy.

Dr. Keith Heinzerling, MD, is the Director of the Pacific Treatment and Research in Psychedelics (TRIP) program at the Pacific Neuroscience Institute, where he develops psychedelic-assisted therapies for conditions such as addiction, depression, anxiety, and PTSD. He is also an Internal Medicine and Addiction Medicine Specialist at the Pacific Brain Health Center at the Pacific Neuroscience Institute, focusing his clinical research on treating alcohol, drug, and substance use problems. Before joining the Pacific Neuroscience Institute, Dr. Heinzerling was an Associate Professor in the UCLA Department of Family Medicine and a founding member of the UCLA Comprehensive Chronic Pain Integrated Practice Unit.

Psychedelic-assisted psychotherapy offers a paradigm shift to treating mental health conditions beyond traditional pharmacotherapy. However, integrating these treatments into mainstream medicine presents challenges, including regulatory hurdles. How can professionals balance scientific rigor with the profound and spiritual experiences that psychedelics induce?

Dr. Keith Heinzerling believes that psychedelics offer more than just symptom relief; they provide a pathway to deeper healing and consciousness expansion. These medicines facilitate access to core psychological and emotional issues, allowing patients to process trauma, reconnect with their sense of self, and cultivate a greater awareness of their place in the world. Unlike conventional psychiatric treatments that focus on symptom suppression, psychedelic medicine fosters transformation by dissolving rigid mental patterns and opening individuals to new perspectives. Dr. Heinzerling maintains that this approach requires careful guidance, integration, and a framework that respects both the scientific and spiritual dimensions of these experiences.

In this week’s episode of Living Medicine, Dr. Keith Heinzerling, the Director of the Pacific Treatment and Research in Psychedelics (TRIP) program at the Pacific Neuroscience Institute, joins Dr. Sandy Newes to talk about psychedelic healing as an alternative to traditional medicine. Dr. Heinzerling discusses his psychedelic spiritual activation retreats, the barriers to FDA approval for integrating psychedelic medicine into clinical settings, and how to conduct research for ketamine-assisted psychotherapy.

Dr. Signi Goldman, MD, is a board-certified psychiatrist and the Co-founder and Medical Director of Living Medicine Institute, which offers psychedelic-assisted psychotherapy training programs. As a certified provider for psychedelic-assisted therapy and research, she has practiced in various clinical settings, including hospital systems and alternative treatment settings. Dr. Goldman also serves as a Psychiatrist and Psychotherapist for Concierge Medicine and Psychiatry’s Ketamine-Assisted Psychotherapy Program for Mental Health.

Dr. Sandra (Sandy) Newes, PhD, is a licensed psychiatrist and the Co-founder and Programming Director of Living Medicine Institute. With over 25 years of clinical experience as a psychedelic-assisted psychotherapist, she specializes in anxiety, chronic stress, trauma, and recovery. Dr. Newes has provided ketamine-assisted psychotherapy through Concierge Medicine and Psychiatry since 2019. She is also an educator and speaker offering workshops, events, and education on psychedelic-assisted psychotherapy and the intersection of nature connection, trauma, and mental health.

Touch in therapy is a complex and often controversial topic, especially in psychedelic-assisted psychotherapy, where clients are in highly vulnerable states. While some therapists fear the ethical risks of using touch, avoiding it altogether can mean missing a critical tool for grounding and healing. How can practitioners navigate this delicate balance while ensuring client safety and trust?

Psychedelic-assisted psychotherapy trainers Dr. Signi Goldman and Dr. Sandy Newes emphasize the importance of clear consent, ethical considerations, and trauma awareness. While some clients — particularly women with trauma histories — may be more cautious about physical contact, others may seek out safe, grounding touch from male therapists as part of their healing process, so therapists should balance masculine and feminine energy accordingly. For clients who are hesitant about direct touch, Dr. Goldman and Dr. Newes suggest allowing them to place a hand on their own body first, with the option for the therapist to add gentle contact on top if desired.

In today’s episode of Living Medicine, Dr. Signi Goldman and Dr. Sandy Newes of Living Medicine Institute discuss the ethical use of touch in psychedelic-assisted psychotherapy sessions. Together, they talk about somatic touch interventions, strategies for working with veterans and first responders, and how to match touch intensity to emotional distress.