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KETAMINE ASSISTED PSYCHOTHERAPY

Ketamine is a powerful medicine that can be used in several ways to help with a wide range of mental health concerns.

While Ketamine itself has many applications for mental health, leading experts in the field recommend using Ketamine in conjunction with psychotherapy to enhance sustained and lasting outcomes. True Ketamine Assisted Psychotherapy takes this further by directly involving a therapist before, during, and after any experience with the medicine. This collaboration facilitates psychological and emotional safety throughout this process, and also increases the likelihood of experiencing deep therapeutic progress that outlasts the chemical benefits of Ketamine itself.

In a nutshell, Ketamine Assisted Psychotherapy is a holistic option for those who are interested in sustained personal growth and lasting change by addressing the underlying factors that may be contributing to perplexing mental health challenges. These items might include negative thought patterns, emotional blocks, relational patterns, disconnection from meaning or purpose, unprocessed trauma, or unsustainable lifestyle factors. Not only is Ketamine a reliable tool for examining this material, it's also like Miracle Grow for your brain! Combining the neuroplasticity and chemical benefits of this medicine with the intentionality of engaging in deep, personal work makes this an effective tool for depression, anxiety, PTSD, and other pressing concerns.


Because I'm so passionate about this approach, I'm guilty of wanting to share a little too much about it, and I've written a lot below! If this is too much information, I would love to meet for a first consultation appointment to talk through these details, answer any questions, and explore how you may be able to get the most out of this medicine.

If you would like to set up a first session together, please complete this WAITLIST SURVEY, and we can get started soon!

WHAT IS KETAMINE?

Ketamine was designed as an anesthetic with a high safety profile and is commonly used in medical settings, including children's hospitals, to put patients under for various procedures.

In lower/non-anesthetic doses, it's also been shown to provide remarkable benefit around many mental health conditions: depression, anxiety, OCD, PTSD, addiction, eating disorders, existential concerns, relationship patterns, and more.

THIS VIDEO offers a brief summary of Ketamine from Yale University. Among other things, it mentions the importance of engaging in concurrent psychotherapy while utilizing Ketamine for mental health benefits.

Another part of the video notes that individuals must have tried two medications prior to engaging with Ketamine for mental health benefits, and this is not a criteria to participate in this form of therapy together. The reason this is included is that some of the clinical research for Ketamine was designed to illustrate that Ketamine could provide benefit to individuals who did not respond to other medications or forms of treatment. In line with this, a requirement to participate in those studies was that a participant must have had little or no response to two different medications.

While these studies did successfully illustrate that Ketamine can help many individuals who have not benefited from other approaches, there is no mandate to have tried two medications in order to work together in this capacity. Additionally, given Ketamine's fast action and limited side effect profile, it will be interesting to see if Ketamine Assisted Psychotherapy will be utilized more as a front-line approach for mental health concerns in the future. 

MENTAL HEALTH

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HOW IS KETAMINE USED FOR MENTAL HEALTH?

– To simplify this complex medicine, there are two basic ways to apply it for mental health. 1. The first is to view it as a chemical to re-balance the brain. Conceptualizing it this way would be similar to looking at it as an alternative to a psychiatric medication. In this way, it might be seen as a tool that offers relief through symptom management. Without therapeutic support and integration, however, many find that the benefits fade as the Ketamine wears off. 2. Another way of looking at Ketamine is as an accelerant to therapeutic progress, and a tool to break out of feeling stuck. In this light, Ketamine can be viewed as more of a holistic tool that amplifies the contents of the mind. Utilizing this medicine in an emotionally safe context, with adequate preparation and follow through, can allow an opportunity for deep introspection, novel insights, and processing of unconscious material that may be contributing to persistent mental health challenges. Engaging with this newly-uncovered material afterwards and making concrete changes in one's life as a result of various insights that may have emerged during the experience creates an optimal landscape for lasting change to occur. The goal here is to use the medicine sparingly and intentionally to receive the maximum possible benefit, while avoiding some of the risks and complications that can arise with long-term Ketamine use.

HOW IS THIS THERAPEUTIC?

– Considering its therapeutic potential, Ketamine can help in a few ways. First, it can offer a window of relief that can allow enough momentum and clear-headedness to make positive life changes. Like turning on the lights to rearrange furniture, the Ketamine will wear off, but one's life can look different when these adjustments are sustained. Second, it increases neuroplasticity, which is the fancy way of saying that with Ketamine, the brain can make connections more easily than usual. Insights might 'click' a little better under the influence of this medicine, and habits may be easier to change in the days after with increased mental flexibility. Given these effects, it can be useful to have a therapist present during the experience, and also engage in therapy the next day (if possible) to solidify anything you may be working on. During this fertile period, you could additionally engage in a host of other therapeutic activities to process the experience, like spending the day journaling, meditating, painting, or discussing your experience with a supportive therapist, friend, or someone who has experience with non-ordinary states of consciousness. That's the most 'normal' way to understand how Ketamine can help. Ketamine's additional therapeutic value has to do with its psychedelic properties. The word, 'psychedelic,' means 'mind-manifesting' or 'mind-revealing.' That's exactly what Ketamine does. It lowers one's psychological defenses and produces a variety of effects that come from within. Some of the many possible outcomes could involve feelings of joy or relief, access to old memories, having a completely safe 'near-death' or spiritual experience, or an ability to see one's life in a new light. An example could involve someone saying, 'Wow, I feel like I'm out of my body right now. I feel like I can see my depression, my anxiety, and my trauma as if they're way over there! I know this sounds weird, but for the first time, I realize I am NOT my depression, my anxiety, or my trauma.' The goal of Ketamine Assisted Psychotherapy is basically to create a therapeutic context around the medicine; essentially preparing you for what might come up and taking the time to process the experience afterwards with effort and intention.

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CAN KETAMINE HELP WITH SUICIDAL THOUGHTS?

Research suggests a single dose of Ketamine can offer

fast-acting relief for someone experiencing acute

suicidal ideation.

If someone is dangerously suicidal, this can be a much-needed tool for quick relief. With the guidance of a professional team and support network, this could be utilized as an alternative to hospital admission for those who experience recurrent suicidal ideation. THIS STUDY shows that a single ketamine infusion produced significant benefit in acutely suicidal patients.

Working with suicidality within the context of Ketamine Assisted Psychotherapy might also allow opportunities to explore how suicidal thinking may be related to past trauma, the mind's way of coping with suffering, or disconnection from meaning, purpose, or spirituality. Exploring these deep connections in a therapeutic capacity might create opportunities for relief from suicidal thinking in more of a long-term way.

While Ketamine is one highly effective tool for suicidal thinking, other psychedelic medicines may also have a powerful effect in this domain. If you are struggling with suicidal thoughts and feel you have tried everything, including Ketamine, I would love hear from you and potentially discuss other psychedelic medicines you may not have considered!

PSYCHEDELIC THERAPY

IS KETAMINE A PSYCHEDELIC?

– On a technical note, Ketamine is classified as a 'dissociative anesthetic' and some may disagree with labeling it a psychedelic medicine or lumping Ketamine Assisted Psychotherapy into the category of 'psychedelic therapy.' However, this molecule has been reported to have psychedelic properties that seem to mimic many of the 'classical psychedelics,' such as Psilocybin, MDMA, and LSD. Interestingly, the word 'psychedelic' means 'mind manifesting,' and this term was coined to describe the mind amplifying properties of various medicines. Because the subjective effects of Ketamine overlap with the effects of classical psychedelics, and because my focus is on several additional techniques that 'manifest the mind,' such as Brainspotting and EMDR, I consider the term 'psychedelic therapy' to loosely encompass the range of tools that evoke deep emotions, memories, and bodily sensations in a way that may effectively reduce their overall burden.

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WHAT DOES KETAMINE FEEL LIKE AT LOW AND HIGH DOSES?

– At a very low dose of Ketamine, the experience can feel like gently lowering one's emotional defenses. This can make it easier to talk about challenging events, and also create space for spontaneous insights to emerge. This is known as a 'psycholytic' experience. The word, 'lyse' means causing dissolution or breaking through, and 'psycho' relates to the mind. In this dose range, an experience can feel similar to MDMA Assisted Psychotherapy, which has shown impressive results for PTSD due to the increased ability of individuals to talk more freely about difficult memories. While Ketamine and MDMA are very different molecules, the defense loosening properties of Ketamine at low doses can be a powerful tool in a therapeutic context. – At higher doses, individuals may enter a space that might be better classified as 'psychedelic.' While not everyone has a visionary experience, people often report seeing colors, shapes, and dream-like imagery that frequently carry personal significance. These experiences are less about talking and more about allowing yourself to go on a journey with infinite possibilities of what might unfold. Several studies suggest better longterm outcomes for those who have experiences that involve 'leaving the body' or having a mystical or spiritual encounter. Therefore, it's often suggested to gradually increase the dose of Ketamine to achieve this goal. This medicine works differently for everyone, however, and some clients seem to derive the most therapeutic benefit on lower doses. Everyone's journey is different. – It should be noted that throughout these sessions, you are in control of your dose and are always encouraged to trust yourself about how deep into the experience you would like to go. Because Ketamine has different effects at various doses, and because every experience is unique, I recommend engaging in a series of sessions to better explore the full range of what Ketamine has to offer.

HOW CAN 'STAR WARS' HELP ME UNDERSTAND THE IMPORTANCE OF 'SET AND SETTING'?

– In a psychedelic therapy training, I once heard a facilitator say, 'It's less about what medicine you take, and more about the context of where and how you take it.' That comment always stuck with me, because I think it's true. Ketamine, for example, could be taken recreationally at a party, in a medical way at a doctor's office, or therapeutically in a studio space that's specifically designed for psychedelic therapy. One can imagine that the nature of each of these experiences would be quite different. The facilitator's comment also illustrates a key concept surrounding safe and intentional use of psychedelic medicines: 'Set and Setting.' What this phrase means, essentially, is that the two most important variables in having a constructive experience with non-ordinary consciousness are one's mindset beforehand and the environment where the experience takes place. – In Ketamine Assisted Psychotherapy, tremendous emphasis is placed on preparation, environment, and follow through. These variables create an optimal avenue for experiencing the deep potential of this medicine by enhancing 'Set and Setting.' To illustrate why these ingredients are so important, let's take the movie Star Wars. Imagine watching it on your phone, standing in line at the DMV, while some kid throws candy corn at your face the whole time. Cool movie, probably, but did you really see it? Now pretend you're buying a ticket two months out to see the same film on opening night, in the best theater in town, dressed as your favorite Jedi. Not only are you mentally prepared for this event, you're also in an energized room with the sort of super fans who understand how profound this occasion might be. Plus, you coordinated all your best friends to see this with you, and you even set aside two hours afterwards to process every twist and turn. Both times you technically watched Star Wars. But one of these experiences was potentially life-changing. This is the difference between 'taking Ketamine' and engaging in Ketamine Assisted Psychotherapy.

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DO I NEED A THERAPIST FOR THIS?

– A key insight that many people experience during this process is that there's a deep wisdom within all of us that can be harnessed to great effect for a more fruitful relationship to ourselves, others, and the world around us. It can be incredibly powerful to connect with this inner voice and cultivate a more substantial relationship with the most essential parts of ourselves. In some ways, we can all do this independently. At the same time, we're social creatures who need to be witnessed. We need connection and we need feedback. Engaging in therapy before and after these experiences often offers an invaluable container for these universal needs. And having someone with you during the experience who can hold space for anything that might happen – no matter how frightening, sad, funny, or weird – will set you up to openly explore any inner content that might need to come to your attention.

LOGISTICS

WHAT DOES KETAMINE ASSISTED PSYCHOTHERAPY ENTAIL EXACTLY?

– While every therapist may conduct Ketamine Assisted Psychotherapy differently, our process will consist of the following: 1. We will meet for an 80-minute first session to get to know each other, talk through any questions you may have about the services I offer, and make a plan if you would like to move ahead. 2. You would need to make an appointment with a collaborating physician who I work with, or your own psychiatrist, for a prescription of Ketamine lozenges that you will bring to your Ketamine Assisted Psychotherapy appointment. 3. We will meet for a second session to engage in Brainspotting, which is a great trial run for Ketamine therapy and a really cool technique! 4. We can meet for any additional sessions if you would like to talk more, or engage in further Brainspotting or EMDR, to ensure that we have built the necessary trust to engage in a Ketamine Assisted Psychotherapy session together. 5. You will be sent two videos with extensive preparation information that you can watch at your own convenience. 6. We'll set up our first Ketamine session! 7. After the Ketamine session, you are highly recommended to participate in intentional integration work afterwards. Since the integration process can look different for everyone, I encourage trusting yourself about what you may need during this time. I would love to be involved for a session or two of integration work, and any ongoing Brainspotting or EMDR you would like to do. I also highly recommend participating in ongoing therapy work with a primary therapist, as sometimes the material that surfaces during an experience can take months or years to fully metabolize. 8. Once you have processed any insights and observations from the first experience and feel you are ready for another journey, we will set up the next Ketamine Assisted Psychotherapy session! 9. I recommend engaging in this process for a series of four Ketamine journeys, or until you have reached your goals. This can be carried out on whatever timeline feels appropriate.

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HOW MANY SESSIONS WILL I NEED?

– With the primary goal of chemical intervention, it's recommended to engage in 6-8 IV Ketamine infusions over 2-3 weeks, and then to return every so often for maintenance treatments. Approaching this as an aide to therapy, however, there are fewer guidelines on frequency. Clients generally find the most benefit between three and ten Ketamine Assisted Psychotherapy sessions, and I recommend all clients think about this as a series of approximately four journeys, as each experience can feel like a single puzzle piece in a larger process that's unfolding. My personal hope for every client is to receive the maximum benefit in the fewest number of sessions. And while it is true that some people are greatly helped by a single session, this is not common. Managing expectations about what a single experience can accomplish is important, as well as planning to potentially engage in a series of sessions to receive the full benefit of this approach. – With Ketamine Assisted Psychotherapy, the length of time between experiences can also vary. Doing a series of Ketamine journeys close together could be a way to make a lot of progress in a short amount of time. Alternatively, spacing them out can allow for more space to integrate the experiences and make practical life changes as a result of the insights that may have come about during or after a Ketamine session. Figuring out the timing that works best for you would be an individual decision based on your needs and goals. If possible, I recommend having one Ketamine Assisted Psychotherapy session, taking time to process the experience, and trusting your intuition about when you would like to have your second experience.

HOW IS KETAMINE ADMINISTERED?

– Ketamine can be formulated as a liquid, powder, or lozenge and administered through the nose, mouth, or directly into the blood through intramuscular injection or IV line. While there are some variations around onset and duration, the primary difference between these is 'bioavailability,' or how much of the actual Ketamine the body is absorbing. I work with Ketamine lozenges, which have proven to be very effective in therapy. – In an attempt to learn about these various administration methods, I set out to experience Ketamine myself in an IV clinic, as well as through an intramuscular injection, and with lozenges, during my training for Ketamine Assisted Psychotherapy. Of all these experiences, my most profound encounter happened with the lozenges in an emotionally safe and supportive environment that was conducive to deep internal work. This personal experience allowed me to appreciate the night-and-day difference that one's emotional state and surrounding environment has on the effect of this medicine. Additionally, having now supervised countless sessions with Ketamine lozenges, it appears that individuals can achieve the full spectrum of what Ketamine has to offer with this approach.

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HOW MUCH WILL THIS COST?

More information on the cost of this therapy can be found on the Frequently Asked Questions page HERE.

CHEMICAL BENEFITS

CAN YOU SAY MORE ABOUT HOW THIS CAN HELP CHEMICALLY?

– Tweaking the brain's chemistry is the most common view of Ketamine's usefulness in mental health. While most anti-depressants target the serotonin system, Ketamine works differently— a current hypothesis supports its action on NMDA receptors and the glutamate system. Therefore, those who haven't responded to traditional anti-depressants often find relief with Ketamine. What's also cool is that Ketamine works rapidly. It's effective for approximately 70% of people, and those who respond to it notice effects within 24-72 hours. For anyone in a dark place who can't tolerate six weeks for a pill to kick in, this is a fast-acting alternative. Furthermore, Ketamine is neat because it's safe to use with most medications. Accordingly, this makes it a great tool for many individuals who have been struggling with a wide range of mental health concerns and may be on several medications. Ketamine could also be used as a fast-acting boost for someone who's waiting for an anti-depressant to kick in, as a lifeline for heightened suicidal thinking, or as a tool to navigate emotional turbulence while tapering off of other psychiatric medications. – When approached as something to balance the brain, people often seek Ketamine treatment through IV Ketamine, doctor-administered nasal spray, and at-home lozenge treatment. The most research has been done on IV infusions, and the general recommendation is to pursue 6-8 infusions over 2-3 weeks to fill the synapses with Ketamine, and then to return every so often for maintenance infusions. Research indicates no difference between 2 or 3 infusions a week, but it does support this front-loaded approach for managing psychiatric symptoms. While using Ketamine exclusively for its chemical benefits have helped many people in significant ways, the primary drawbacks of engaging with this medicine in a clinical setting and/or without therapeutic support is that there may be no preparation for the emotional intensity of the experience, no context for the power and potential of what this medicine can do when approached intentionally as a psychological tool, and no support surrounding traumatic and/or spiritual content that may emerge during the experience. Additionally, the cost of ongoing IV infusions or doctor-administered nasal spray is unaffordable for many. And finally, long-term Ketamine use should be approached mindfully given Ketamine's mild addictive potential and risks of various health concerns, such as corroding the lining of the bladder over time. There is limited data on the physical ramifications of using Ketamine in a long-term way, and accordingly, caution is indicated. It should also be mentioned that the majority of existing clinical research on Ketamine was carried out in a clinical context using Ketamine without therapeutic suport within a medical model. While the data on Ketamine Assisted Psychotherapy is limited, and there are no head-to-head studies comparing Ketamine use for mental health with and without theraputic support, a unanimous recommendation for nearly all psychiatric medications is to simultaneously engage in therapeutic work alongside any pharmaceutical intervention for the greatest mental health benefits. Additionally, even though Ketamine's chemical properties are profound, leading experts in the fields psycehdelic thearpy and Ketamine work generally recommend combining Ketamine with therapy for maximum results.

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FDA

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IS KETAMINE FDA APPROVED?

Ketamine is FDA approved as an anesthetic, and it is not FDA approved to treat or prevent any mental health condition.

Utilizing Ketamine for mental health benefits is an 'off label' use. Writing prescriptions for 'off label' use is a common practice in the healthcare field, however, and you can learn more about 'off label' prescriptions in THIS ARTICLE by the Mayo Clinic.

While much research has already been done to illustrate Ketamine's effectiveness for mental health conditions, it is highly unlikely that we will see extensive and rigorous clinical trials beyond ones that have already been conducted. These trials are expensive to carry out, and are often only pursued by large pharmaceutical companies who intend to pay for the research by marketing the medicine after completing the FDA approval process. 

A related factoid is that Ketamine's patent expired in 2002, before the mental health potential of this medicine was widely known. This prohibits Ketamine from being marketed and sold beyond it's generic form. The inability for any company to claim ownership over this molecule eliminates incentive for any pharmaceutical company to finance rigorous trials beyond what have already been conducted. 

Even though we likely won't see Ketamine become FDA approved for the treatment of mental health conditions for this reason, the good news is that much research has already been carried out that illustrates effectiveness. Additionally, positive results from those who have used this molecule for mental health benefits are too plentiful to be ignored.

WHAT IS SPRAVATO / ESKETAMINE?

– Ketamine is a whole molecule. If you split it in half, there's a left and a right side. These two halves are called R-Ketamine and S-Ketamine. S-Ketamine or Esketamine is also called Spravato. Because the patent for Ketamine (the whole molecule) has expired, no pharmaceutical company can profit from it. Therefore, there's no incentive for any major company to spend the time and money to conduct clinical research and push for FDA approval. However, since there was no patent on S-Ketamine/Spravato, Johnson & Johnson claimed ownership and conducted the necessary research to satisfy the FDA. S-Ketamine/Spravato is now FDA approved for treatment resistant depression and is very well marketed. Accordingly, there is more flexibility for doctors to prescribe it and for insurance to cover it. If you ask your doctor about Ketamine, they might mention Spravato, and a benefit of Spravato is that the FDA has approved this medicine for mental health applications. – For those who are deciding between Spravato and Ketamine, however, it's worth noting that while Spravato has shown some benefit for treatment-resistant depression, and many report that it has saved their lives, the research indicates that it barely outperformed a placebo in the largest clinical trial that has been conducted. In a meta-analysis that looked at all available studies to compare S-Ketamine and Ketamine, the conclusion was that Ketamine is a superior medicine (Bahji et al., 2021). Furthermore, S-Ketamine/Spravato has been reported to offer less of a dissociative or psychedelic effect as Ketamine. Some doctors consider the 'psychedelic effect' to be a negative side effect, but research has shown that for many individuals, having a greater dissociative/psychedelic effect correlates with better long-term outcomes for things like depression, anxiety, and PTSD. We also know that there is immense value in processing these 'psychedelic experiences' for their therapeutic content and the internal wisdom they can bring into focus, which may make Ketamine more suited for therapeutic applications. – Another interesting note surrounds the price of these medicines. The cost of a dose of Spravato is around 100 times more expensive than the same amount of Ketamine. This price does not account for clinician time, however, and clinician time (with a therapist in Ketamine Assisted Psychotherapy and with a doctor or nurse for IV Ketamine infusions or nasal-spray oversight) is often the most expensive element of this treatment. Since insurance does cover Spravato, insurance companies would generally be paying the high price for this medicine. While there are many factors to consider, Spravato might be an excellent option for someone whose insurance will pay for Spravato because it is FDA approved, but will not cover Ketamine. At the same time, making sure that the Spravato is administered in an intentional way to get the best results from this approach is another important variable to account for.

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ADDICTION

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IS KETAMINE ADDICTIVE?

– It is true that Ketamine has mild addictive potential, and discussing this risk is an important part of safely engaging with this medicine. When this powerful molecule is approached with the preparation, intention, and disciplined follow through involved in Ketamine Assisted Psychotherapy, however, the likelihood of addiction drops close to zero. Nevertheless, the risk still remains, and if there are any personal vulnerabilities to addiction, such as a history of substance abuse, we would need to explore this in detail and create a plan to engage in this work safely (i.e., possibly including a supportive person in your life to hold the medicine between sessions). – Accounting for Ketamine's mild addictive potential is one of the reasons I always recommend a conservative approach towards the number and frequency of Ketamine sessions, and why I generally encourage client to consider 'Plan A' with Ketamine as a limited number of Ketamine Assisted Psychotherapy sessions, rather than any long-term or at home use. Additionally, I encourage clients to take time between sessions to reflect and fully integrate every experience before proceeding to the next one, as this emphasizes the importance and discipline of integration work after any experience with non-ordinary consciousness. Another way I've found to mitigate against over-valuing Ketamine, the molecule, is by requiring all clients to engage in a therapy technique called Brainspotting during one of our preparation sessions. Brainspotting is a little like a collaborative meditation experiment and can feel like a mild psychedelic experience without taking any medicine. In my view, this effective technique emphasizes the idea that 'You are the medicine,' and it illustrates that the answers and insights we may be looking for are inside of us already. While medicines that amplify the contents of the mind are incredible tools, it's essential to refrain from putting Ketamine, or any other psychedelic, on a pedestal.

CAN KETAMINE TREAT ADDICTION?

Interestingly, Ketamine Assisted Psychotherapy has actually been used to treat addiction. While addictions can take many shapes and sizes, the work of Dr. Evgeny Krupitsky and colleagues explored using Ketamine to address alcohol addiction and other substance use concerns. THIS PAPER summarizes ten years of clinical research in this domain. Even though this work took place in the 1990's and may be considered outdated to some, the results are promising nonetheless.

– Another fascinating aspect of Ketamine and other psychedelic medicines is that they lower blood flow to the part of the brain called the Default Mode Network. This is the region that's responsible for our looping thoughts and persistent beliefs about ourselves and the world. Having a break from this incessant mental noise may offer new perspectives and a window of opportunity to change addictive habits. 

– While Ketamine Assisted Psychotherapy may be useful for the treatment of addiction, I'm personally excited about the potential of Psilocybin Assisted Psychotherapy for this application— particularly for addiction to substances. Clinical research on Psilocybin has shown tremendous results in the treatment of this kind of addiction, and it's worth highlighting that Psilocybin has never demonstrated addictive potential, as it is not a drug of abuse. This makes Psilocybin a potentially safer option for someone with a history of substance abuse. 

There are other psychedelics, such as Ayahuasca and Iboga/ Ibogaine, which have also show impressive results in the treatment of addiction and may offer neurochemical benefits that other psychedelics do not. However, because both are indigenous medicines that are not sustainable, these medicines must be conservatively used, only when more environmentally friendly options have failed.

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MISCONCEPTIONS

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I HEARD SOMEONE DIED FROM KETAMINE. ISN'T IT DANGEROUS?

Ketamine is a very safe medicine when used appropriately.

 

It is administered to countless adults and children around the world every day. If you've had a surgery of any kind, you may have already taken Ketamine without knowing it. Furthermore, it's applications for mental health have been lifesaving for many who struggle with PTSD, depression, anxiety, and suicidal thoughts.

However, like any medicine or prescribed medication, it can become dangerous when misused.

Misuse of Ketamine can involve taking it in or around water (such as a hot tub or bath tub, which increases risk of drowning), using it with a heart condition or high blood pressure, ingesting unprescribed 'street' Ketamine (which can be mixed with other substances), combining Ketamine with alcohol or other medications, and more.

The safety protocols around Ketamine Assisted Psychotherapy are meticulous to account for all potential risks. In addition to my extensive training as a Ketamine Assisted Psychotherapist, I also collaborate with a team of medical providers so that we can offer this highly effective form of therapy at the highest level of safety.

Matthew Perry's tragic death made national news at the end of 2023 surrounding the misuse of Ketamine. I wrote a longer Facebook post addressing this HERE. If this is a personal concern, I hope you can read the entire post and article before making an assessment.

– To get a sense of how dangerous Ketamine is compared to other drugs, the chart on the left comes from a 2010 study that ranked drugs according to 'harm to self' (blue) and 'harm to others' (red). A similar study was conducted on psychoactive substances in 2020, but it omitted tobacco, which I felt was important in this comparison. 

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ISN'T KETAMINE A HORSE TRANQUILIZER OR A PARTY DRUG?

Ketamine is a tool, and like any tool, it has many applications.

 

In the same way that a hammer can be used to build a house or misused to hurt someone, Ketamine can be utilized in a variety of ways.

 

Because Ketamine was designed as a safe anesthetic, it has been utilized in many contexts, including veterinary medicine. It has also been used and abused in recreational settings. And now that we've learned of its potential in the treatment of mental health conditions, this medicine is becoming increasingly respected as an agent for change across a wide range of mental health difficulties.

WHAT IS A 'K-HOLE' AND WILL I EXPERIENCE THAT?

– Ketamine is a 'dissociative anesthetic' and can generate experiences that may feel detached from the body. In a therapeutic context, or in a safe and intentional setting, this can actually be quite profound. Many people have reported life-changing spiritual or mystical experiences in this state, and others have been able to view their depression, anxiety, trauma, or life circumstance through an entirely different lens at this vantage point. Because Ketamine has been used unsafely in both recreational and clinical settings without adequate psychological preparation for what the experience of this medicine can feel like, or what it might mean at a deeper level, some people have been extremely frightened by the dissociative nature of Ketamine. The term 'K-Hole' came about because this experience can vaguely feel like one has fallen into a hole or a space that seems disconnected from the body, or from regular reality. This can be traumatic for someone who may have taken Ketamine at a party or in an environment that is lacking in emotional preparation and support. However, that same experience might be considered the key to a profound breakthrough for someone who engages with Ketamine in a safe setting, with adequate preparation beforehand, and sufficient support during and after the experience. – If you decide to move ahead with Ketamine Assisted Psychotherapy, it's important to note that you are always in charge of how much Ketamine you take. We will start with a low dose, which may feel a little weird but will not generate a fully dissociative state. If you decide you'd like to go deeper into the journey, you are in control of taking (or not taking) more Ketamine during two boost opportunities.

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AM I GOING TO HAVE A 'BAD TRIP'?

– The importance of psychological preparation, supportive supervision, and an emotionally safe environment when experiencing any state of non-ordinary consciousness cannot be underlined enough. While it is possible to have a 'bad trip,' such as taking a psychedelic medicine and then experiencing some kind of violence without one's mental faculties in tact, or being suddenly confronted with old psychological trauma and/or a powerful mystical experience in a crowded, public setting after taking a mind-altering substance without consent, this is completely different from Psychedelic Therapy. In a controlled and supportive environment with adequate psychological preparation – before, during, and after any experience with a psychedelic medicine – there's' really no such a thing as a 'bad trip.' It is possible for challenging material to surface. Yet in an intentional setting, we want to welcome this content, explore it with curiosity, and use any information that arises to improve our lives afterwards. Many people have reported that some of their most difficult experiences with psychedelics were the most helpful, long-term. – There's also a neat concept in the psychedelic arena, which is the idea that we all have something inside of us that knows how to heal itself and is automatically moving in a growth-oriented direction. Sort of like how if you get a cut on your finger, your skin cells know how to put themselves back together. This concept also applies at a psychological level, in that the mind prioritizes what we need to work on. Some people get worried that if they take a psychedelic medicine in a therapeutic setting, every past trauma will surface all at once, and it will be far too much to handle. However, the mind has an interesting way of presenting only the amount of material that we're ready to work with, and continuing to hide other content that we may not be ready for. Remaining open to every possible experience is important in this work, while also exploring the possibility that something inside of us might actually want us to be well and is attempting to show us the way.

SAFETY

WHAT ARE THE FIVE S'S OF PSYCHEDELIC SAFETY?

– Engaging in psychedelic work is not something to take lightly, and safety cannot be stressed enough. In Psychedelics 101, 'Set and Setting' are often discussed. This describes the mindset one has when going into the experience and the physical surroundings during the journey. Both are extremely important, and the '5 S's of Psychedelic Safety' add three more dimensions: 1. Screening 2. Set 3. Setting 4. Skill 5. Support SCREENING makes sure that there are no medical or psychological factors that might increase risk. The Waitlist Survey that every client must complete before a first appointment also serves as a screening tool. It asks several questions to make sure we cover any relevant risk factors in our first meeting. (As a sidenote, Ketamine carries risks and cautions but generally has the fewest exclusion criteria, compared to other psychedelics.) Again, SET is the mental state and intentionality one approaches this with. Since psychedelics are often amplifiers of what's happening inside, the results will certainly vary if one approaches Ketamine as 'a drug' compared to 'a powerful tool for growth and healing.' During our initial meeting, I will send out an integration guide with ample activities to prepare the psyche for this experience. SETTING is the physical location a person is in during the experience. The mind is incredibly sensitive in these states, and being in an emotionally safe environment with intentional surroundings can have a tremendous impact on what occurs. I have gone to great lengths to design an optimal space for work with Ketamine. SKILL includes the psychological tools required to successfully navigate challenging moments in a non-ordinary state of consciousness. This can include meditation training, deep breathing, intentional body postures, and distress tolerance. One reason I require a Brainspotting session before engaging with Ketamine Assisted Psychotherapy is that it begins to develop the skill of inward focus and engaged curiosity during an experience that amplifies the contents of the mind and body. Finally, SUPPORT involves the physical presence of someone during a journey and the friends/family/others who are around afterwards. These medicines can unlock deep emotions, memories, and even worldview changes, and having the support of few people (or, better yet, a community) afterwards can be a gamechanger. This is one reason I require that clients bring a support person to Ketamine Assisted Psychotherapy sessions. This is also why I recommend engaging in one or two integration sessions together after any experience with Ketamine, and why I encourage all clients to actively participate in ongoing work with a primary therapist.

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HOW CAN I MANAGE EXPECTATIONS FOR THIS APPROACH?

– Ketamine and its mental health applications are exciting! However, we must be careful not to over-hype, over-promise, or over-expect what it can offer. It is true that some people have experienced powerful shifts after a single Ketamine Assisted Psychotherapy session, and my hope for every client is to experience the best possible outcomes in the fewest number of sessions. However, the majority of people who engage with these tools require multiple psychedelic journeys and ongoing processing in between to see the kinds of shifts that might be hoped for. Individuals also often tend to get more out of these experiences when they have already participated in therapeutic work beforehand. With this in mind, Ketamine is best looked at as a boost to make constructive life changes, or arrive at useful therapeutic insights, and not a remedy in and of itself. It works most effectively when clients take it seriously. And many clients find that the most benefit comes from completing a series of sessions, rather than a single experience, which is why I recommend thinking of this as a series of approximately four journeys with integration in between. Additionally, it is not a cure. And unfortunately, it may not work at all. 30% of people don't respond to Ketamine, and many who do respond relapse afterwards. It cannot be overstated how important it is to manage expectations for this treatment to avoid despair on the backend. – If this approach doesn't work, there are other options. Some of these include EMDR, ACT, DBT, CBT, IFS, TMS, neurofeedback, polyvagal theory, meditation, reiki, energy healing, acupuncture, biofield tuning, float tank therapy, dark meditation retreats, somatic experiencing, holotropic breathwork, The Tapping Solution, The Wim Hof Method, Vision Quest, Muse Alchemy, sensorimotor psychotherapy, the Hakomi method, psychic mediumship, hypnosis, regression therapy, holistic yoga, Qi Gong, Tai Chi, wilderness therapy, forest bathing, salt rooms, Vipassana meditation retreats, sweat lodges, herbal remedies, psychotropic medication, and so on. New drugs and treatments are being developed daily. There are also legal ways to pursue a wide range of psychedelic medicines (Psilocybin, MDMA, LSD, Ayahuasca, Iboga, Ibogaine, etc.) and many avenues to explore other non-chemical practices to find some relief.

CONCLUSION

DO YOU HAVE ANY CLOSING COMMENTS?

– After my first experience with psychedelic medicine in 2020, I've been on a mission to learn as much as possible about all psychedelic compounds and about Ketamine. Despite exhaustive efforts to absorb information through trainings, books, personal work, and clinical experience, I want to acknowledge that there will always be more to discover about these infinitely fascinating molecules and their various applications! It should also be noted that even though the intentional use of non-ordinary consciousness for personal growth dates back thousands of years, the incorporation of psychedelic medicines in our modern mental health system is a novel approach with tremendous room for innovation, and great need for ongoing clinical research. As a lifelong student and relentlessly curious person, I intend to always be learning and exploring new ways to become a more knowledgeable and effective practitioner in this growing field. I hope you'll join me in the effort to continue educating ourselves about the constructive uses of Ketamine, and other psychedelic medicines, so that we can integrate these powerful tools into our culture at the highest level of intentionality, effectiveness, and care. – While we always want to remain open to new discoveries, and continue adapting to new research as it emerges, what excites me most about Ketamine Assisted Psychotherapy (and the constructive use of any psychedelic medicine) is the aim towards personal growth. As fellow human beings trying to navigate the complexity of being a person, I'm so glad you found your way to this page and may be considering working on yourself in a deep and holistic way. I'm not sure if there's anything more important than developing a sturdier relationship with ourselves, our histories, and our personal hang-ups— not only for our own benefit, but for others in our lives, and society as a whole. The intentional effort to deeply listen to oneself and make changes in one's life – alongside shifts in perspective and behavior – is a courageous undertaking. If this approach feels like a good fit, I would love to support you in this process however I can!

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WHERE CAN I FIND MORE RESEARCH AND RESOURCES ON KETAMINE?

Check out the RESEARCH section of this website!

FURTHER QUESTIONS

While I've done my best to summarize, this is a lot to take in.

 

I'm happy to answer any questions you may have during a first appointment, as you explore next steps in your mental health journey. To get started, if you can please complete this WAITLIST SURVEY, we can find a time to talk soon!

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