ELLIS KIM 5/23/24 ELLIS KIM 5/23/24

Therapist profile: Rachel Davidow

From time to time I will be interviewing therapist colleagues with various specializations and backgrounds. The purpose of these interviews is to contribute to public education so that therapy clients can be better equipped to find an approach and therapist that suits their unique challenges.

I met Rachel Davidow in 2020 when we were both psychotherapists at a residential eating disorder clinic in the Boston area. Rachel is a native of Massachusetts, and she works full time in private practice serving clients with various anxiety disorders, including obsessive compulsive disorder (OCD), and anxiety related disorders (phobias, social anxiety, generalized anxiety, etc.)

Rachel is a Licensed Independent Clinical Social Worker (LICSW) in the states of Massachusetts, New Hampshire, and Connecticut. She works in private practice both in person (coming soon with office space starting this summer 2024!) and via telehealth in Arlington, just outside of Boston. She is available to work with anyone in Massachusetts, New Hampshire, and Connecticut. You can learn more about Rachel here at her website RachelDavidow.com.

Ellis Kim: Rachel, help our readers understand more about how and why you became a therapist.

Rachel Davidow: I have always been fascinated by psychology and have found that providing services to individuals struggling with their mental health to be extremely rewarding. I went to Boston University for my undergraduate degree in psychology and minor in women's, gender, and sexuality studies in 2015. Afterwards, I earned a masters in social work from the University of Pennsylvania in 2017.

E: I worked with you at a clinic that focused on acute eating disorder treatment, and you left before me and you went on to focus on OCD treatment. Are those two areas of work related, or did you simply find you were more drawn to OCD work?

R: There is definitely a relationship between OCD and eating disorders. Both disorders have behavioral elements that function as a way to alleviate distress and/or feel more in control. Both OCD and eating disorders can involve perfectionistic personality types, rigid beliefs or "rules" with corresponding behaviors. For example believing that one cannot touch doorknobs because they are contaminated and could make them sick could be compared to someone with an eating disorder avoiding foods or entire groups because of fear of weight grain. Both of these behavioral symptoms offer short term relief from anxiety or distress and long term reinforce the narrative of the mental illness. A number of clients I have worked with struggle with both OCD and an eating disorder or disordered eating. While eating disorders are no longer my area of specialization, I'm really grateful to have had the training so I can better assist clients in getting connected to needed services like registered dieticians and other resources.

E: Tell us about how you treat OCD. What modalities and approaches do you utilize, and where did you learn about those approaches?

R: I primarily use Exposure Response Prevention (ERP), Cognitive Behavioral Therapy (CBT), and Acceptance Commitment Therapy (ACT). These are all evidence based behavioral and experiential therapies to treat OCD and anxiety disorders. I worked at an Intensive Outpatient Program/Partial Hospital Program specializing in OCD as well as mood disorders, and received intensive training in these modalities as well as Behavioral Activation (BA) for depression. Working with folks struggling with more severe and functionally impairing symptoms of OCD and/or depression using these behavioral treatments was a really gratifying experience. I also received a certification and intensive training in Prolonged Exposure Therapy (PE) for PTSD, early in my career working at a city funded initiative in Philadelphia for evidence based treatments to be more accessible to the community. This training gave me a deep appreciation for exposure therapy and seeing firsthand how powerful and effective it can be.

E: Besides your focus on clients with OCD, what are other types of challenges you frequently help clients work through? What approaches and philosophies on mental health treatment have influenced you the most, and how do they manifest in your work with clients?

R: I often work with clients with phobias, the most common one I see in my practice is emetophobia or the fear of vomiting. I have seen other phobias as well including but not limited to fear of heights, fear of insects, fear of death, and fear of flying. Many clients also struggle with low mood or depression. A guiding philosophy in my practice is values exploration and helping clients to understand what is most important to them to help them feel like they are leading more meaningful and fulfilling lives. This can be such a powerful tool in feeling empowered to choose values over fear.

E: Give our readers a picture of a common type of client you work with. What kinds of challenges have they faced both historically and also in the present. What have they tried already to get relief, and what kind of work do you do with them that tends to help them make progress they haven’t already made?

R: Most clients I work with struggle with anxiety and/or OCD. They can feel plagued by intrusive thoughts and doubts often around safety, harm, health of themselves or their loved ones. They engage in behaviors to typically avoid or alleviate distress around triggers and work to prevent a feared outcome. These behaviors can become consuming of one's time and energy and interfere with functioning to work, have relationships, or even take care of oneself like eating, hygiene, or other activities of daily living. For example, an individual with superstitious OCD may have a "rule" they need to pass through a doorway a certain amount of times and repeat other activities for fear that if they do not they or a loved one may have harm come to them. To not engage in this compulsion feels risky and irresponsible for this client. I use a collaborative and structured approach with the client to learn new information and skills through exposures to challenge OCD's rule. For this client we could practice first decreasing the number of times they are going through a doorway and then process how to tolerate feelings without engaging in a compulsion. We would explore how the expected outcome may or may not have occurred after an exposure to help reinforce this learning process.

E: What else is important for readers to know about you?

R: I am a big believer that every individual is different and can benefit from different approaches and tools in therapy. I do not think one size fits all individuals and strive to practice flexibility and creativity in my own practice to meet clients’ needs. Clients usually describe me as positive, compassionate, and sometimes silly. Humor is one of my favorite coping skills and I find a lot of joy in bringing it into my practice as well.

E: Rachel, thank you so much for the work that you do, and it’s a pleasure to be your colleague in the great city of Boston.

ELLIS KIM 12/16/23 ELLIS KIM 12/16/23

Therapist profile: Clare McBee

I know Clare McBee (they/she) from my time as a psychotherapist in Boston. They and I met when we were both in the Multidisciplinary Association for Psychedelics Studies (MAPS) MDMA assisted therapy training program. They also have training in multiple “bottom up” therapies including Sensorimotor Psychotherapy, Eye Movement Desensitization and Reprocessing (EMDR), and ketamine assisted therapy (KAP). Clare remains an informal mentor and colleague to me and is a dear friend.

Clare is a Licensed Independent Clinical Social Worker (LICSW) in the state of Massachusetts. They work at the Meeting Point in Jamaica Plain, a co-operative of therapists and bodyworkers focused on serving the LGBTQI+ population, people of color, people who have experienced trauma, and people identified as having disabilities. Clare is available to work with anyone in Massachusetts and you can learn more about them here.

Ellis: Clare, let our readers know a bit about how you became a therapist.

Clare: I didn’t start out my career as a therapist, I actually thought I was going to become an academic (anthropology/gender studies)! In the early 2000s, I was doing field research in the Boston area, interviewing trans/gender non-conforming people who had survived transphobic hate crimes in an effort to both raise awareness, and contribute to the discourse on gender-based violence in the U.S. As I was sitting with people who were sharing their stories of trauma and oppression, I came to realize that I was more drawn to the “sitting with” part than anything else. I started volunteering at a hospice agency, where I sat with people in end-stage dementia. I then started working for the only domestic program of Partners in Health, a program called the PACT Project, which worked with people living with HIV/AIDS who were struggling to maintain adherence to their medical treatments (PACT is now part of JRI Health). From there, I went to social work school at the University of Chicago, where I focused my clinical training on trauma-informed therapy for LGBTQIA+ people. Before I went into private practice in 2016 at The Meeting Point, I was working in HIV/AIDS services organizations primarily serving chronically homeless people and those in recovery from addiction.

Ellis: What type of psychotherapy do you practice, and which types of clients do you most frequently serve?

Clare: Once I got into private practice, I increasingly focused my clinical work and training on trauma treatment for LGBTQIA+ adults. Working with depression, anxiety, chronic pain/illness, addiction and relationship issues are also inevitable clinical aspects of working with trauma survivors. I began learning more about complex PTSD, a diagnosis that (despite concerted efforts) is not included in the DSM, but is a common cluster of symptoms and experiences that I see in my practice. On my own healing journey, I was also diagnosed with and began treatment for complex PTSD. These simultaneous personal and the professional processes challenged me to understand that talk therapy was simply not enough to gain traction for myself or others. We had to go to the deeper, subcortical, somatic, exiled places where this type of trauma had gotten stuck, and which often left us at the whim of what Pete Walker calls “emotional flashbacks'' in our present-day lives. To that end, I got training in more “bottom-up” modalities, like IFS (Internal Family Systems), Sensorimotor Psychotherapy, EMDR (Eye-Movement Desensitization and Reprocessing), and psychedelic-assisted therapy for the treatment of trauma. I currently provide ketamine-assisted psychotherapy (KAP) to my clients, and intend to offer MDMA-assisted therapy for the treatment of trauma once it is legalized some time in 2024.

E: Tell us about some of the unique challenges you come across as you specialize with queer clients facing the effects of complex PTSD or developmental trauma? Is there any connection between your queer client focus and your background in bottom up approaches like Sensorimotor Psychotherapy, EMDR, and KAP?

C: In my experience, bottom-up approaches are simply more effective in treating trauma, regardless of the person’s identities. But my effort has always been to think about any particular concerns/needs that LGBTQIA+ folks might face when accessing trauma treatment, and to adapt these bottom-up approaches to better serve my community.

Some of the unique challenges that I see for those of us who are LGBTQIA+ and who are living with C-PTSD/developmental trauma are brought on by transphobia/homophobia–both interpersonally in our families of origin/communities, and structurally in forms of ostracism, pathologization and discrimination. For a person who might already be experiencing abuse/neglect during childhood, the threat of anti-trans/queer violence, rejection, and stigma generates even more stress, toxic shame, and survival defenses to their nervous/attachment systems. This increases the likelihood of developing attachment issues as adults–codependency, and possibly retraumatization through abusive or toxic relationships. For LGBGTIA+ survivors of childhood sexual abuse or assault, which may have occurred prior to their coming out as queer or coming into their trans/nonbinary identity, the sexual violence/abuse may contribute to further dissociation or fragmentation in their internal system. It’s a big ask for an LGBTQIA+ person with C-PTSD to bring down some of these survival defenses, and overcome toxic shame, when society at large is still cosigning a message that their queerness or transness is “wrong” and needs to be erased.

Healing for LGBTQIA+ people living with C-PTSD is a journey into authenticity, self-leadership, coming safely back into our bodies, and re-parenting wounded parts of Self. It’s ending learned patterns of self-abandonment (e.g. through fawning behaviors) and toxic shame. In addition to growing up in a family of origin with a lot of abuse, I then wound up reenacting that pattern in a very abusive queer relationship in early adulthood. The more that I re-parented and healed my relationship with my fearful or deeply critical/shamed parts, the more I was also clearly hearing a greater truth about my gender nonconformity and queerness that was previously too shameful or scary to acknowledge or express. If that isn’t queer liberation, then I don’t know what is!

E: Give us a simplified example of a client suffering from complex trauma. How have you and would you use your therapeutic skills or toolkit to help them in ways you could not have helped them earlier in your career?

C: In both my personal and professional spheres, I've found that a combination of various bottom-up approaches yields the most effective results. Personally, I've fostered success by establishing a trusting relationship with a relationally-oriented EMDR therapist. Our sessions also integrate my personal use of psychedelic-assisted treatment. The targets I address in EMDR often correlate closely with material accessed or shifts initiated during psychedelic-assisted treatment experiences. This personal course of treatment significantly influences my approach with clients.

For instance:

Consider a queer, nonbinary adult in their early thirties who endured emotional neglect, abuse, and parentification during childhood. They also faced sexual trauma in adolescence before identifying as nonbinary. In early adulthood, a sexual assault occurred within a queer dating context. Seeking treatment due to chronic patterns of freezing, dissociation, and a hyperactive fear response, they also experience somatic distress (e.g., chronic pain, digestive issues). A strained relationship with their non-accepting family triggers them frequently. Stress and insecurity persist in their relationships, particularly in dating, with past experiences of codependency or partners exhibiting narcissistic or disorganized traits. Interactions with family or partners often trigger intense states of overwhelm, leading to various survival coping mechanisms.

In initial sessions, I focus on building rapport, understanding, safety, and collaboration. I introduce frameworks like parts work/IFS and resources such as strategies for grounding within their window of tolerance. I explore the person's feelings about complex/developmental trauma and educate them about emotional flashbacks and nervous system dysregulation. Identifying survival defenses in the body and internal protector parts provides insight into the landscape of toxic shame, fear of vulnerability, or self-abandonment.

I prepare the person to explore bottom-up modalities, potentially combining parts work/IFS exploration, EMDR reprocessing, and ketamine-assisted psychotherapy (KAP). KAP sessions are spaced approximately 4-6 weeks apart, to allow plenty of time for regular 1-hr sessions to integrate, and continue IFS and/or EMDR processing. Continuing EMDR reprocessing at the tail-end of KAP sessions capitalizes on the grounded, expansive state that clients enter with post-peak drug effects. Structured approaches like EMDR, boosted by KAP's neuroplasticity and mood-lifting benefits, offer clarity on the client's progress. In my experience, this combination can reduce the frequency, intensity, and duration of emotional flashbacks, fostering a sense of safety in the body and relationships, and enhancing self-trust and self-compassion in the ongoing healing journey of C-PTSD/developmental trauma.

E: What else is important for readers to know about you?

C: I used to struggle with the decision of whether to disclose my experience with C-PTSD, but influential figures like Pete Walker have shown that openness about our trauma experiences can profoundly contribute to building trust with clients. I have personally engaged in any therapeutic approach that I recommend to a client. While my experiences may differ, and what worked for me may not be universally applicable, I understand the intense fear of going towards this stuff. When I encourage a client to try a particular approach, it stems from my belief that, within them exists a healing Self capable of navigating this journey. I believe this, because I’m doing it too.

E: If readers and prospective clients want to learn more about your approach to therapy, besides contacting you directly, can you share any resources, readings, or talks that have helped inform your work?

C: These are some books that I highly recommend:

Complex PTSD: From Surviving to Thriving, by Pete Walker – check out all the free resources on his website, linked in the book title. In particular, consider checking out (and practicing!) Pete’s 13 Steps to Managing Emotional Flashbacks. Also check out this recent podcast episode with Pete, in which he explains what C-PTSD is.
Trust Surrender Receive: How MDMA Can Release Us from Trauma and PTSD, by Anne Other
A Queer Dharma: Yoga and Meditations for Liberation, by Jacoby Ballard - a queer trans person who explores Buddhist teachings from a queer intersectional anti-oppression lens.
Self-Therapy Workbook: An Exercise Book For The IFS Process by Bonnie J. Weiss - this is a great tool for starting to learn about and apply IFS/parts work concepts to your own healing practices.

Some other resources:

Lama Rod Owens - A Black queer activist and Tibetan Lama who has written some fabulous books, and also offers some great meditation resources (If you have the Calm app, check out his Radical Self Care Series).
The Sentur app - this is a really cool app you can download to really work with your own internal system, including ways of mapping out parts and guided meditations
Tara Brach - A psychologist and meditation instructor who has a wealth of free resources on her website (you can also search for her meditations on Spotify). In particular, the RAIN meditation is a great one for working with emotional flashbacks.
You are welcome to check out some recordings I have made of guided EMDR resourcing exercises, I intend to add more!

E: Clare, thank you so much for your fabulous work, your continued mentorship, and for serving the queer population of Boston with such dedication.

C: Ellis, thank YOU for your thoughtful questions, support, friendship and guidance. Thank you for spotlighting these issues and concerns!

ELLIS KIM 9/23/23 ELLIS KIM 9/23/23

Mindful Masculinity: 8 Week Boston based Men’s Group- October 10 - December 5, 2023

My colleague Marlo Pedroso and I will be co-leading an 8 week Boston based Men’s group starting this October 2023. Marlo has been running Men’s groups for years, and his work helping men reimagine their masculinities is one of the many reasons I deeply admire his body of work. For more information on this group, please see here or reach out to either of us by email.

From time to time I will be interviewing therapist colleagues with various specializations and backgrounds. The purpose of these interviews is to contribute to public education so that therapy clients are better equipped to find an approach and therapist that suits their unique challenges.

I know Marlo Pedroso as a fellow Massachusetts based Licensed Independent Clinical Social Worker (LICSW) and trauma informed, somatic therapist. Marlo has training in Sensorimotor Psychotherapy, Somatic Focusing, Mindfulness Based Stress Reduction (MBSR), and psychedelic assisted therapy, among other modalities.

Marlo is an LICSW and licensed to work with anyone in the state of Massachusetts, and you can learn more about him at his website.

Ellis: Marlo, let our audience know a bit about how you became a therapist. Also, what type of psychotherapy do you practice, and which types of clients do you most frequently serve?

Marlo: The simplest answer to how I became a therapist is curiosity and suffering. I'm someone with endless curiosity, always reading and learning, especially in regards to questions of meaning, healing and relationship. I'm an empath and feel things deeply. I'm drawn in by depth, rather than surfaces.

I have also struggled with my own mental health challenges and childhood trauma. This has led me on a lifelong process of healing. Along the way I've amassed an ecology of practices, frameworks and wisdom that comes from doing my own "work". In part because of this, something in me has always felt attentive to and called to alleviate suffering and oppression. Being a therapist turned out to be a good way to use my gifts and experiences in a way that I believe is of benefit to others.

I think about what kind of psychotherapy I practice in different ways.

On one level there are the technical and philosophical frameworks that inform my work. While my influences are numerous, here are some of the most prominent.

Firstly, I am profoundly influenced by the elegance, practicality and universality of Buddhist psychology. I love Richard Schwartz's map of the internal system (internal family systems, or IFS), and it has been a huge aid in understanding the complex and multi-faceted nature of the personality. Lastly, my mentors Sharon Bauer and Joan Klagsburn have given me the gift of Somatic Focusing as a means of accessing the wisdom of the body and a way to release its trauma.

On a spiritual level, I believe my primary task is bringing my full presence and compassion to bear witness to a person's suffering, and to reflect back the reality that they are fundamentally whole, beautiful and sacred. This goes beyond any technique or modality. In fact, in my experience, when I've over-relied on technique it usually falls flat.

Most of the people I work with have experienced some kind of trauma or attachment wounds. There's a spectrum of intensity, with some of the trauma being related to social, ecological and economic conditions. I also work with many men, LGBTQ+ people, and individuals invested in building a different type of world.

E: At some point in your therapist career, you started getting extensive training in what I would describe as experiential modalities - Mindfulness Based Stress Reduction (MBSR), Sensorimotor Psychotherapy, and Somatic Focusing. What led you to these ways of working? Why are these approaches important to you?

M: All of my experience has shown me that insight and cognitive understanding is not enough to heal, especially with trauma and attachment wounds. I believe only direct experience of something new can change us. But in order to experience something new, we must integrate and discharge painful feelings - such as grief and rage - in a space that is compassionate and loving.

Mindfulness lays the foundation for being aware of our thoughts, emotions and sensory experiences with greater equanimity and without causing more harm. Without self-awareness no change is possible, but it must be non-judgemental awareness to be helpful. I know of no greater set of technologies than those found in Buddhism for this loving witness.

I've found, however, that mindfulness approaches don't always offer much in terms of what to do with the traumatic material that can arise in this process. Sensorimotor Psychotherapy, Internal Family Systems, and Somatic Focusing are trauma-informed approaches that give me and my clients ways to work with and meet painful material. These approaches facilitate and support access to undigested pain and trauma directly, compassionately, and experientially without flooding and re-traumatizing the client. In my experience this is where profound and lasting transformation occurs.

E: When did you first start doing specific Men’s work, and what inspired you to begin serving this specific population?

M: Once again this is a case of wanting to pass along something I've benefited from. At some point in my healing journey I recognized I had a distorted and painful relationship to masculinity. This limited my ability to connect to the men in my life with the kind of intimacy I wanted. It also got in the way of me appreciating my masculine qualities. My experiences in men's groups fundamentally transformed this for me.

I end up working with a lot of men. As has been well documented, there is an epidemic of loneliness that is particularly intense for men. I see this in a lot of men I work with. They suffer in isolation, afraid to share their struggles for fear they will be shamed, which sadly happens to many men when they open up, particularly with other men.

I decided to start a men's circle to provide a space where men could practice sharing openly and bearing witness to each other's pain. Men caring for men. In many ways this is a radical notion. Emotional caretaking is often feminized and devalued in our patriarchal culture. I think compassion comes naturally to all humans, but it gets beat out of men metaphorically and literally.

I find this work is deeply moving and I hope that it contributes to shifting some men away from violence and isolation, towards solidarity and mutual aid.

E: When we co-lead this Men’s Group together, what do you hope the participants will be able to take away at the end of the 12 weeks?

M: I hope they will feel less alone and less shame about their struggles. I hope they will see and appreciate that there are many ways to express masculinity.

I also hope they come out of it with a respect for the gifts and sacredness of masculinity. Men and masculinity have been maligned, understandably, for the harm we've caused. I believe harmful behavior must be interrupted, but I don't think the problem is men or masculinity. I think it's the lack of mentorship, rites of passage, and outlets for the expression of the gifts of masculinity in modern society. Given that our culture has largely abandoned these practices, the best we can do is try to offer these to one another and to the next generation.

ELLIS KIM 7/16/23 ELLIS KIM 7/16/23

Self Leadership: What’s Inside Gets Reflected Outside

I was recently interviewed by a longtime friend and college classmate Rob Kalwarowsky. Like me, Rob transitioned out of his first career after MIT - engineering - into leadership coaching, while I became a psychotherapist. In this discussion, we reflect on our own and each other’s personal journeys through the lens of Internal Family Systems (IFS) - an experiential approach Rob and I are both passionate about. I also discuss the interactions between people’s internal worlds/systems and their external worlds. In particular, people in positions of power and leadership tend to have their internal systems reflected into their external systems, such as workplaces, families, and other social organizations. Given this reality, it is critical that people in positions of leadership work on themselves and move towards a place of “Self leadership.”

Apple Podcasts: link

Spotify: link