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About Ketamine-Assisted Psychotherapy

Recently, I have begun integrating the use of ketamine in my psychotherapy practice.


Though, at first glance, taking a dissociative anesthetic to alter one’s consciousness may sound outlandish or even ill-advised as a treatment modality, the more we learn about the potentially healing qualities of this molecule (and other "psychedelics"), the more it becomes clear that adding ketamine treatment to psychotherapy can result in breakthroughs that are otherwise persistently elusive with more traditional approaches.


In my opinion, the introduction of the ketamine molecule into our systems seems to work to relieve deeply engrained patterns of depression and/or anxiety in at least two ways:


Firstly, the mere introduction of ketamine into our biochemistry seems to have reliably neuroplastic and regenerative properties that, for many people, serve to relieve longstanding symptoms of depression, trauma and anxiety.  Although the mechanisms involved are still only vaguely understood (again, in my opinion), the fact is that 5 or 6 administrations of ketamine over a period of weeks often has a remarkably healing effect for many people who suffer from PTSD and/or treatment-resistant depression.


Hence the recent emergence of “ketamine infusion clinics” all around the country in the last few years.  Typically, in such clinics, one goes for 6 or more weekly or bi-weekly “infusion sessions,” where one is basically left in a comfortable room with a device that gradually administers a measured amount of ketamine intravenously.  For the 60 to 90 minutes of such a treatment, one simply lies on their back in a comfortable recliner, typically listening to some form of soothing, non-verbal music through headphones.  Though hard to articulate, the experience is usually described as pleasant, relieving — and sometimes even deeply moving and spiritually "profound."


With this approach, there is little personal interaction between the attending physician or psychiatrist and the client or patient — on the far end of this spectrum, many believe that what one “experiences” while on ketamine is more-or-less irrelevant to its potentially curative physical effects.  From such a point of view, the important thing is that the introduction of ketamine into our bran chemistry seems to allow for certain kinds of neurological growth and regeneration at a physical level that results in the reduction of, for instance, depressive symptoms.


In my opinion, however, this approach leaves a lot on the table from a healing perspective.


Though complex and still only vaguely understood, my experience is that the nature (and content) of the expanded states of consciousness one experiences while under the influence of ketamine ALSO has potentially powerfully healing properties for us humans.  


The term “default mode network” has emerged in the field of psychology and neuroscience of late to denote the global pattern of thinking and feeling that tends to take place when a human being is not engaged in a specific, focused activity (whether within or outside one’s self).  One way to describe this network of thought and feeling is “The Story of ME” — the remarkably sturdy narratives about ourselves that we repeat with amazing consistency throughout our days.  For instance, to pick some low-hanging fruit, stories such as “I’m not good enough,” “there’s something wrong with me,” "it’s MY fault that I feel depressed” — or, alternatively, “nobody ever gives me a break,” “you just can’t trust people,” “I’m a victim of the cruelty/stupidity of others,” etc.


[Ring any bells?]


When properly administered, ketamine can have a powerfully (though temporarily) quieting effect on such ruminations — which results in a temporary (though often profound) freedom from the emotional pain and fear that so tenuously accompanies these habitual thoughts and beliefs.


Remember the allegory of the fish that doesn’t know what water is until it is somehow lifted ABOVE the waterline?  The ketamine experience can be like that — in the ABSENCE of our familiar thoughts and beliefs and engrained emotional states, we finally SEE that we have been “swimming” in them much (or all) of the time, believing our “trance of unworthiness” to be “just the way it is.”  The dissociative properties of ketamine allow us to “get above the waterline” for long enough to (re-) discover what it’s like to NOT be “submerged” in such deeply familiar negative feelings and assumptive self-concepts.


As has long been the basis of many psychological treatments, the temporary breaking or interrupting  of such old patterns and cycles of thought can elicit a kind of awakening from the (often severely negative) feelings associated with such deeply engrained (and often only partially conscious) beliefs and conclusions about ourselves.


In this sense, ketamine can “pop us out" of our familiar and often unquestioned (i.e., “swimming beneath the waterline") narratives and conclusions about ourselves (and about life in general) that keep us -- pardon the perhaps overly-extended pescian metaphor -- swimming in the same old mental and emotional circles.


Although I am favorably impressed by the purely physical beneficent effects of ketamine induction on long-standing symptoms of depression and addiction, I feel strongly that the expanded perspective ketamine induces in most people is perhaps equally or even more powerfully beneficent when consciously integrated into one’s thinking and behavior.


Thus the term “ketamine-assisted psychotherapy” (or “KAP,” for short) means, for me, the broader process of learning to consciously and deliberately apply and integrate the expanded perspectives that ketamine-induced “journeys” can provide to our conscious thought and our daily lives.


If you are contemplating ketamine-assisted therapy with me, please understand that, except under exceptional circumstances, the actual introduction of ketamine into our work would only be an option after at least a month or two of non-drug-assisted preparatory psychotherapy, to establish the “container” of safety and mutual respect and understanding that I feel is essential to any deeply useful psychotherapeutic relationship.

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