Nancy Rhine, MS, LMFT, CPG

As a longtime Marriage and Family Therapist focused on serving midlife and older adults, I noticed early on how few therapists choose to specialize in working with these populations.

This is similar to the medical field where there are very few geriatricians, for a variety of reasons I won’t go into here.

In the last few years, as I began to work in the field of psychedelic-assisted psychotherapy (PAT), I noticed the same phenomenon. That is, a community of practitioners not much interested in older people. At least, not enough to really study aging, with its inherent challenges and opportunities.

Many therapists, doctors and researchers have mistakenly assumed that older people are the same as younger people – an ageist approach in my opinion. Older folks experience unique developmental tasks – check out Erik and Joan Erikson’s book, The Life Cycle Complete, especially the brilliant 9th chapter.) Society-based pressures, shifting physiologies and often misdiagnosed and pathologized emotions push on folks in their third season of life.
Fortunately, things appear to be changing. An acknowledgment of how older people have been underacknowledged and invisible in our Western culture for the past decades is beginning to surface.
Here are two articles, one I wrote and one in which I am quoted:
“Older Adults and Psychedelics”
https://psychedelic.support/resources/older-adults-and-psychedelics/
“Older Generations Are Reclaiming Rites of Passage”
https://www.nytimes.com/2022/08/01/health/ritual-age-rite-passage.html
A Recent research study out of UCSF called “Effects of Psychedelics in Older Adults: A Prospective Cohort Study” puts it like this:
“Importantly, a recent review found that among 1,400 participants enrolled in 36 psychedelic trials since 1967, only 19 participants (1.4%) were 65 years or older. The safety and efficacy of psychedelic treatments in older populations thus remains largely unknown, although several authors have argued for the potential of psychedelics to loosen cognitive habits in old age generally as well as more formally as treatments for Alzheimer’s disease, including mild cognitive impairment and even health cognitive decline and age-related affective changes.
Other studies coming out are publishing results on the clinical use of psychedelics for existential anxiety and depression at end of life and in palliative care situations.
Here is one from Johns Hopkins called “Psychedelics May Lessen Fear of Death and Dying, Similar to Feelings Reported by Those Who’ve Had Near Death Experiences”:

https://www.hopkinsmedicine.org/news/newsroom/news-releases/2022/08/psychedelics-may-lessen-fear-of-death-and-dying-similar-to-feelings-reported-by-those-whove-had-near-death-experiences
My opinion about the growing amount of attention on older adults and research is that it’s about time! And, much more is needed! As usual, boomers are exploring and pushing outdated boundaries.
For the past year, it is my privilege to lead two groups – one for PAT practitioners who are serving this population. We focus on the topics of aging, palliative care and end of life. Our small group includes a psychologist, therapist, social worker, hospice nurse, death doula, somatic sound healer, chaplain and more.
The second group is called EPIC which stands for Elder Psychedelic Integration Café. Participants’ ages range from 67 to 90. Each individual has experienced PAT and this setting is a place to mutually learn from and support each other’s paths of exploration.
In my private practice I work in connection with a licensed clinic, using ketamine assisted psychotherapy (KAP). KAP can be very effective in mitigating depression, anxiety, chronic pain, and end of life fears. The treatments I provide are given in my home office.
I also help clients to prepare for and integrate sessions with psilocybin and MDMA. I do not provide the substances. When people have solid preparation before and integrative support after an experience, the benefits are often profound.
It is heartening and exciting to see older people finally be included in this burgeoning field of healing!

The Notorious “Year Two”

In the world of grief writing and support communities, there is commonly talk about “year two”. Year two being different than year one, and, often it is said, it is worse than year one.

In my resistance towards other people’s opinions and commitment to figuring things out for myself, I resented those proclamations. Grieving is different for everyone, I would say. And true, it is.

Being “in the saddle” of grieving the loss of my decades-long soulmate, I have discovered a whole host of things that reading about the process never truly revealed. I have also lost both my parents, my brother, and best friends. This death, however, has really put me through the wringer.

Year one, the widows in my grief group and I have discovered was full of “firsts”. First holidays alone, first birthdays, anniversaries… It was also a time of feeling very disoriented and surreal. Our brains trying to grapple with this new reality. I highly recommend this book for brilliant insight into this phenomenon: The Grieving Brain: The Surprising Science of How We Learn from Love and Loss.

This extricating ourselves from our deceased partners was taking a lot of effort. More than we had realized it would. We also were, all of us, very tired out from having been caregivers. We agreed that respite times were absolutely necessary during this process. So, we changed the word “distraction” which felt blaming and judging, to “respite” which feels much more real and kind.

Year two. There is still a fatigue. We are all finding that grieving is work. All of us are doing our grief work. We participate in our support group, some of us have another, some of us have taken grief classes, and many of us work our regular jobs. Some of us have large families to keep track of. We try to do self-care – we know that is important. We meet monthly and laugh, cry, exchange tips, and generally just nurture these important friendships that have evolved out of our shared experiences.

Year two. Some surprises. For instance, I find myself falling into the mental trap of thinking “Oh, I have been through this phase already. I’m done with that! I’ve learned that lesson.” And then the spiraling aspect of grief comes whirling in and shows you more of that same lesson, whatever it might be.

Year two. Dawning on us that we don’t get “over” grief. We learn to live with it. Our essences, our selves, expand through this unasked-for pain and we find ourselves morphing and changing into new “me”-s instead of “we”-s. This growth and transformation is often unsettling, confusing, disorienting, exciting, familiar, and completely different. A total mish-mash in other words.

One thing I realized, in a new way, in the last few weeks is how important open, unstructured time is. Space and time to sit, walk, contemplate, sleep, hike, call a friend, go play with friends or family… We continue to walk an altered reality. Yes, we walk the take care of business reality too. I sometimes say the expression “Trust in Allah and tie up your camel.” We have to tie up our camels of this human life – paying bills, taking care of our health, working, relating with others, etc.

And, at the same time, this grief work needs respect and honoring – something sorely missing in most of our western culture. We need time to rest, make mistakes, cry, be silly, not know what the heck is going on or what we want to do. This is all part of it. Holding this mishmash with kindness can be supported by others going through this same territory. Only others who have or are traveling this path can understand.

My takeaway? Find others on this path. Ones who will listen and witness. Grief is a tribal experience, in our primal selves. We are not meant to go it as alone as often happens in this culture. You will know when the time is right to reach out for support, perhaps some one-on-one support at first and, eventually, through small groups.

One last topic is about the value of rituals. That ties in, as above, with our primal selves. Rituals are often visceral, not logical. Our healing happens in our bodies as well as our minds. That’s a big topic for my next post.

Thanks for reading.

Wishing you my best,
Nancy

In my previous blog post, I wrote about the abundance of research studies that are reporting the potential healing benefits of the clinical use of psychedelics, including with older people in regard to  things like anxiety, depression, and end-of-life stress.

This research is expanding rapidly and showing amazing results. My services include education about, preparation for, and integration after an individual has a psychedelic medicine experience in a clinical setting, with an underground guide, or on one’s own. I do not provide illegal substances or the experiences with them.

Please consult with your medical providers for referrals to appropriate clinical trials and other guided settings where you can find a variety of treatments, if interested.

I want to talk about the pain of grieving. We all know the expression “You never get over it, you learn to live with it.” Somehow I thought that this was a description of the emotional state of affairs. It is that, I see. But I also am understanding firsthand that there is a physical pain with grief. When we say it hurts, we often mean it actually also hurts in our bodies. We physically feel our feelings.

I think “learning to live with it” involves learning to live with the physical sensation of pain, however it manifests in each of us. To not be afraid of it or to think something is wrong. This is part of the process.

It is of course good to check in with our medical doctors and make sure we are healthy in general. That said, this grief pain is something that comes and goes, arises and subsides and that is what we learn to live with. Like learning to live with waves that come in and go out.

Focusing on our physical health through things like walking, jogging, hiking, dancing, yoga, meditation, singing, massage, playing sports, eating high-quality delicious food – any of these avenues of somatic sensations – are important for nurturing our bodies which are also carrying the physical sensations of grief.

Tenderness towards ourselves, emotionally, spiritually, and also physically, is key on our path of healing.

December 11, 2022

This is the 3-month anniversary of the death of my soulmate and beloved husband, Cliff. These past three months have been a steady path of grief waves mixed in with contentment and awe, friendship, love and laughter. Loneliness, fear, anger. The stages of grief we all read about. We know, at least I think most of us know, that these stages are not linear. They are circular and spiraly. It’s not all dark and painful. And yet we know that some of it is. Turning away from the full gamut of feelings is, in my opinion, a mistake. I think we need to turn towards it, let those feelings run through us, name and acknowledge them, and when possible have them be lovingly witnessed.

This is the path of healing. So much of the early part of grief involves what I call “nature’s anesthesia” – a sense of the surreal, of numbness. This is a gift from nature that allows us to navigate without being completely flooded all of the time. There is an awareness of being in liminal space. Of being in altered reality.

As a longtime grief teacher and hospice volunteer, I have read and taught much of this and walked alongside dear ones who are passing and those who are surviving those losses.

What surprises me as I experience the most profound loss of my life? (and I have experienced much loss over the years). One thing is how visceral grief it is. It is not a matter of thoughts for me. It’s like being outside of thought and just experiencing. Physical sensations, senses of part of me being gone while also feeling Cliff around me all the time. His presence is a felt sense not a logos, conceptual idea. Once I realized that, this felt so very comforting to me.

I don’t know how the next months will go. I tell people I can see as if I am driving in a car at night and can see where the headlights shine. Beyond that I don’t know. I kind of know where I’m heading in a general sense. But the specifics and so much really is completely unknown. And that’s ok. It is how it is. Again, there is something intrinsically built in in our human selves that carries us along.

Patience is key. Accepting the liminal and even embracing it. Living with uncertainty. Breathing through uncertainty is such a big part of spiritual teaching. It’s always the case in our human lives and yet, having experienced a significant loss brings this teaching to the forefront. Illusions are stripped away, and there is something actually liberating at times about this.

I’ll write again from time to time. One thing I know for sure is, reading and teaching about grief and walking with others on their grief paths does not really prepare us for our own descent into despair as our loved one is dying and then passes. I am glad I have experience and know about the landmarks of this territory. That is helpful. However, actually walking this pilgrimage is very humbling. Beautiful and painful. The whole gamut.

Love,

Nancy

I was just checking something on my web page today and noticed again that it’s been a long time since I’ve written in my blog. I knew that but time just kind of slipped away. The counseling practice I do has continued during Covid telehealth times. And it has expanded with me learning more about somatic therapy practices and the weaving of music, art, movement, and meditation into my services in the forms of daylong workshops I lead. I also have trained in and been offering services in preparation for and integration support afterward for individuals and couples taking advantage of the new psychedelic-assisted psychotherapy.

I was honored to be quoted recently by someone I greatly admire – Paula Span – a longtime columnist for the New York Times whose column A New Old Age is something I have read and followed for years. Paula wrote an article recently about the value of rituals and ceremonies in older life – not just birthday parties and memorials – but creative, deeply meaningful celebrations of all sorts. Here is the link to the article called Older Generations are Reclaiming Rites of Passage.

All during this past year and really for many years prior to this I have also been honored to walk alongside and serve the love of my life, my husband Cliff Figallo as he experiences the journey that is Parkinson’s Disease. Cliff is on hospice now and our days together are deeply full and rich with love, challenges, joy, beauty, sorrow, and laughter. 

My family continues to be my source of joy and support with our six local grandchildren always bringing us into the present moment and a sense of wonder and grounding. What a gift they and our children are.

This is my brief check-in. Sending love out far and wide to friends, family, clients, and my fellow explorers of this terra incognita which is our older life.

Love, Nancy

I’ve been realizing it’s time to put up another blog post. I knew it had been some time. But when I checked to see the dates, it’s been a year since I wrote for my blog. And what a year it has been!

Some things I learned this year:

• My clients and I adjusted very well to doing telehealth sessions via zoom or on the telephone. Really, none of us had thought this would work. We have all been pleasantly surprised! We actually prefer the ease of just logging in and not having to drive anywhere. Or get dressed up from the waist down. 🙂
• I like telehealth so much that I will be letting go of my office where I have paid for my space with barely using it for the past year.
• I like doing all morning or all-day workshops or retreats or intensive one-on-one sessions for individuals and have a lovely space in which I can continue to offer those going forward.
• My clients appreciate reminders that as surreal and lonely and bizarre this year of quarantine has been, they are not alone in feeling this way. Each of us has our particular challenges and at the same time, as a society, we share the commonality of going through uncharted terrain of the pandemic with its associated fears and angst.
• I knew that the transition out of the quarantine would be chopping and tension-filled as well as exciting and a relief. I did not realize the extent, though, of this adjustment. My clients report a sense of almost vertigo as they grapple with where to go without masks, whether to go without masks, how to resume their lives and whether they want things to go back to the way things were “in the before times”. 
• There is a kindness I see demonstrated in the public at large as I go about my business and life. We, as a people, have been through something unprecedented in our lifetimes. I see compassion and relief in people’s faces.

We still have a ways to go in integrating this HUGE experience of the last year with all its pros and cons. Some people are grieving mightily the loss of loved ones, the loss of an entire school year, the loss of their businesses and income. There is, yes, PTSD in the population. 

So, please look out for support for yourself and for your loved ones – through therapy, yoga, breathing exercises, gardening, being in nature, eating well, spending time with vaccinated loved ones, petting your animals, meditating, doing art, playing music, hiking in nature, going to the beach – whatever nourishes you. We need to take time to heal and not rush into some imagined lifestyle we are not sure we want to return to. Things have changed. We have changed. Give yourself the gift of time to ease into this new phase of your life.