The use of prescription ketamine for mental health conditions has spiked sharply in recent years for good reason. Ketamine, combined with psychotherapy, has shown impressive results and promise in the treatment of depression, anxiety, trauma, OCD, eating disorders, substance abuse, and other mental health conditions, including adjustment disorders (short-term disturbances in mental wellness due to life events or transitions). Not only is treatment relatively short-term, its effects are long-lasting. In dosing sessions, the experience of fear is often greatly reduced, allowing clients to approach and work with upsetting material in psychotherapy that was previously too activating. At the same time, ketamine reduces activation of the Default Mode Network, allowing new behaviors to emerge in place of outdated ones.
Clients who are interested in exploring Ketamine Assisted Psychotherapy (KAP) together will be referred to my partner psychiatry team for a comprehensive assessment, determination of fit, and prescription. Those who are determined ineligible for KAP in their psychiatry intake are refunded for the psychiatry intake session. Some conditions are not compatible with Ketamine Assisted Psychotherapy: unstable or uncontrolled medical conditions, uncontrolled hypertension or high blood pressure, acute mania or mixed state mood disorders, and a history of a primary psychotic disorder. Though not necessarily contraindicated for the use of ketamine, uncontrolled substance abuse disorders and active suicidal ideation may require a higher level of care than can be provided by my office.
What Does a Ketamine Assisted Psychotherapy Session Feel Like?
Multiple variables impact the experience of a KAP dosing session. One is referred to as set in the psychedelic community, or the mindset of a client going into the experience. Preparation sessions in which we get clear on intentions and avoiding negative stimuli immediately before a dosing session are two good ways to optimize your set. Another variable in the experience is setting. Setting refers to the context where your dosing session occurs, and having a quiet, dedicated setting with a trained support person is a distinct advantage of participating in KAP in a space like my Folsom office.
A third variable that impacts the experience of Ketamine Assisted Psychotherapy is dosage. The psychiatry team at Journey Clinical eases patients into the dosing experience with a lower, gradual dose for the first session. At its lower doses, ketamine is likely to yield a psycholytic experience. Psycholytic sessions offer a non-ordinary state of consciousness in which clients typically experience physical relaxation, decreased reactivity to challenging material, and an awareness of still being in the room and in contact with their therapist, whether they speak during the session or stay internal throughout. Psycholytic sessions are an excellent opportunity to process material that is too activating in everyday consciousness. Insights and the integration of resources may occur in the psycholytic state, especially with support. Further processing will continue in the subsequent integration sessions, which can be very powerful and transformative, even for longstanding issues. Most clients experience psycholytic dosing sessions as comfortable, calming, and interesting.
At higher doses, ketamine can yield a psychedelic experience. Unlike psycholytic sessions, which involve low-level dissociation, psychedelic sessions can be fully dissociative, transpersonal experiences. Transpersonal refers to an experience that transcends one’s selfhood, as clients experience themselves and the world beyond the labels and categories that we typically adhere to. In transpersonal, psychedelic experiences, you might experience imagery, symbolism, and synesthesia (a merging of multiple senses) that powerfully change your experience and perception of your everyday life. Psychedelic experiences are primarily internal, and as you re-enter ordinary consciousness, you have the opportunity to de-brief your experience with me. In the next few days, during our scheduled integration session, we process and instill what you learned. People who are unprepared or under-supported for a psychedelic experience can find them distressing, especially if unprocessed material emerges. This underscores the importance of preparation and trained support throughout the process. Clients often experience psychedelic sessions as profound and potentially life-changing, especially with psychotherapy to process and integrate what emerged.
For both psycholytic and psychedelic experiences, I find Brainspotting to be an especially powerful and effective way to integrate dosing sessions. I utilize Brainspotting, mindfulness, body-centered therapy, and our relationship as primary tools of integration.
Who is a Good Fit for KAP?
If you are reading along, then you likely already have a sense that Ketamine Assisted Psychotherapy, while incredibly effective, is not for everyone. In addition to the medical screening, there are some personal qualities of potential clients that also help assess for fit.
KAP is best suited to those curious about their inner world and invested in improving their mental health and overall wellness. This therapeutic process insists on intentionality, dedication, and prioritization of your healing. An entire cycle of eight dosing plus corresponding integration sessions of Ketamine Assisted Psychotherapy may take 4 months or more to complete. Yes, KAP can be beneficial after only a single session, but sustained healing requires optimization of the temporary neuroplasticity with targeted integration sessions and follow through.
Be wary of clinics or providers who promise transformative results without client participation outside of the treatment room, as this is a modality that very much rewards you proportionally to your investment in its success. Satisfied clients are those who use this time to implement new behaviors and patterns of thinking, which is made temporarily easier and more rewarding by the medication and malleability of the brain. These same clients engage earnestly in the processing and trauma work relevant to the material that emerges during dosing sessions to make those changes stick.
Many people turn to Ketamine Assisted Psychotherapy as a kind of last resort—they’ve tried anti-depressants, talk therapy, and lifestyle adaptations for decades with little relief. Others just want to try something new. Whether you came to KAP feeling out of other options or eager to be on the cutting edge of mental health treatment, reach out to me to discuss whether Ketamine Assisted Psychotherapy with me in my Folsom, CA office is the next right step for you.
