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Ketamine Assisted Psychotherapy

What is Ketamine?
Ketamine is a pharmaceutical compound classified as a dissociative anesthetic. It is one of the most widely used drugs in modern medicine because of its rapid onset, proven safety, and short duration of action. It is on the World Health Organization’s List of Essential Medicines. It is the only legal pharmaceutical compound with dissociative qualities being used for treatment-resistant conditions.

In recent years, psychiatric use of ketamine has become more widespread. Administered in lower doses, ketamine has shown promise in treating chronic mental health conditions such as pain, depression, suicidal ideation, addiction, and PTSD.

How Does Ketamine Work?
Ketamine is a dissociative anesthetic, meaning it can produce a sense of disconnection from one’s ordinary reality and usual self. Often, individuals experience non-ordinary states of consciousness, mystical, spiritual, or peak experiences on sub-anesthetic dosages. Imaging studies have shown that ketamine can stimulate neural growth, building connections in areas of the brain that have been impacted by chronic depression or trauma. In addition, ketamine can soften habitual thinking patterns, which allows an opportunity for learning new and healthier thought patterns.

What is Ketamine-Assisted Psychotherapy?
Ketamine-Assisted Psychotherapy (KAP) is a relatively new psychiatric/ psychological treatment approach. KAP is simply the integration of ketamine into the psychotherapeutic process as a path for healing. Ketamine temporarily softens a person’s psychological defenses allowing for deeper self-reflection and processing. In moderate doses, the dissociative and psychedelic effects of ketamine can facilitate profound transpersonal experiences. It is felt that these “dissociative” experiences are instrumental in facilitating deep change by offering important clarity and insight and promoting a greater sense of meaning and interconnectedness.

Ketamine is best applied as part of a comprehensive therapeutic plan to include preparation for the medicine sessions, encouraging the client to explore their mind while within the ketamine space, and assisting the client in integrating their experiences afterward by weaving the insights received from their journey back into their sense of self.

Each client’s experience is unique, just as each session is unique. On some days, the journey may flow with ease. Other days, the journey can be quite challenging. Regardless, it is important that the client relax into the path that unfolds and trust that their inner healing wisdom will lead them into greater insight and subsequent behavioral change.

KAP sessions generally last approximately three hours to allow time for preparation, exploration, and integration. Each individual is unique in the number of KAP sessions needed. Some people find strong relief after 2 to 3 sessions, while others require more (>6 sessions). This is dependent on multiple variables, including presenting symptoms, dosage, and route of ketamine administration. Ketamine can be administered by intravenous, intramuscular, sublingual, oral, and intranasal routes.

Treatment Process
Given the intense nature of KAP, it is important to undergo treatment with a skilled and experienced psychotherapist who has formal ketamine or psychedelic-related training. After an intake has been completed, the psychotherapist will work alongside a medical professional who will complete the medical assessment, determine the appropriate dosage, and prescribe the ketamine medication. Throughout the treatment process, the therapist will remain in close contact with the medical provider and ensure that, as a team, they maintain strong collaboration in order to provide the client with the best treatment and experience.

Formal treatment begins with 2 or 3 preparation sessions. The purpose of these sessions is to focus on rapport building, gathering additional history, and continuing to assess if KAP is the best course of treatment. Preparation sessions are also used to help the client set intentions for the experience, teach strategies for navigating difficult emotions, and review the differences between regular psychotherapy and KAP (e.g., use of music, eyeshades, therapeutic touch). The goal is to take as much unknown out of the experience and to reduce as much anxiety as possible before going into the first session.

Each ketamine session typically lasts three hours. While working with sublingual lozenges, the effects begin to appear after about 15 minutes, peak for about 40 minutes, and dissipate over the following 1 to 2 hours. The therapist follows the client’s lead in how much to engage during the medicine portion of the session and is available to process whatever comes up for the client, or to provide silent support while the client is in an internal journey. Music and eye masks are used to assist with remaining internally focused.

As the effects of the medicine subside, the client will be invited to share about their experience and discuss any insights or alternative perspectives that they discovered. However, some people choose to contemplate their experience quietly and to discuss at a later integration session.

The use of ketamine can impair one’s sense of orientation and coordination, and these effects sometimes persist beyond the scope of the session. Clients will need to remain in the clinic space until effects of the medicine have cleared. They must arrange for a trusted person to pick them up and take them home. Clients must also agree not to drive, operate any machinery, or engage in work for at least eight (8) hours following their KAP session.

It is recommended that the client commit to at least three (3) ketamine sessions, as this medicine tends to have a cumulative effect and is most beneficial after multiple treatments. Overall, ketamine assisted psychotherapy is a significant emotional, time, and financial commitment but can have profound results. Strong preparation, support and integration by a skilled psychotherapist; collaboration with a knowledgeable medical provider; openness to the experience; and trust in inner healing are all important aspects of a quality and nurturing KAP experience.