Get Unstuck with Ketamine Assisted Psychotherapy
Ketamine Assisted Psychotherapy (KAP) is on the rise throughout the United States and elsewhere. Perhaps you’ve heard of it or maybe you haven’t. I’d like to share with you a bit about KAP, what some of the clinical studies are finding, what to expect in KAP, and next steps if you’re interested in this treatment option for yourself.
Brief History of Psychedelics
To understand Ketamine Assisted Psychotherapy it is important to understand a bit about the larger framework of psychedelic assisted therapy. Psychedelics have been used in psychotherapy for over ~50 years around the world. There is an ever growing trove of clinical studies researching the effectiveness of these medicines. We must also recognize that psychedelics have been used for thousands of years in nearly every people group by healers, medicine workers, and shamans. We are now in a time where clinical studies and scientific research is closely studying just how healing and helpful such medicines can be for our psyche.
Ketamine is a synthetic dissociation anesthetic first invented in 1962 and approved for use by the FDA in the US in 1970. It quickly became a trusted and reliable anesthetic for medical procedures such as emergency surgery due to it’s relatively quick absorption into the body, safe and consistent effects, low risk, and minimal side affects. This means Ketamine, when prescribed by a medical professional and used as prescribed, is safe, legal, and effective.
Clinical Evidence for KAP
Throughout the years clinical researchers found that when a non-anesthetic dose (meaning you don’t loose consciousness) of Ketamine is used in conjunction with psychotherapy it can help clients obtain truly life changing healing. In the more recent years neuroscientists have found that neuroplasticity plays a vital role in healing from mental health conditions. In brief, neuroplasticity refers to our brains ability to adapt, change, and create new neural pathways based on what we are experiencing, our environment, and what we are consuming. Studies show that ketamine assists in our brain’s ability to heal by creating a fertile environment which encourages neuroplasticity for about two to three weeks. It is during this window that psychotherapy comes into the picture in a pivotal role.
Risks of KAP
It is important to acknowledge that ketamine does come with risks. Ketamine has become an illicit party drug, people do abuse ketamine, and some can become addicted to it. In very rare cases and in individuals with preexisting conditions there can be very adverse reactions to ketamine and there have been fetal incidents - let us not forget how Elijah McClain was tragically murder in 2019 by paramedics and police from an involuntary ketamine injection during a racially motivated forced detainment by police in Aurora, CO. These risks are carefully mitigated and considered by both the therapist and the prescribing medical team before undergoing KAP. Specifically, we look at contraindications, meaning unique conditions and considerations that might determine an individual is not a good candidate for KAP.
Absolute contraindications include:
Uncontrolled hypertension
Unstable cardiovascular disease
Unstable medical conditions
Ketamine allergy
Active ketamine abuse or dependence
Acute mania or mixed state
History of primary psychotic disorder
Relative contraindictions include:
History of ketamine abuse or dependence
Active substance use disorder
Extreme personality disorders
Thyroid disease
Glaucome
Ideal Conditions Treated with KAP
Ketamine Assisted Psychotherapy has been show to be particularly effective in treating treatment resisted depression, PTSD, trauma, anxiety, OCD, Bipolar, suicidal ideations, and addictions. These are some of the most challenging conditions to treat in traditional talk therapy. This is not to say that talk therapy or more targeted techniques such as EMDR, IFS, SFBT, MI, Mindfulness, DBT, CBT, etc are not effective. I want to be absolutely clear - these interventions and many other techniques are incredibly helpful, beneficial, and also evidence based in treating the above mentioned conditions. However, some individuals find only limited progress or none at all when engaging in talk therapy. This is where KAP can really help. The research shows that ketamine is uniquely suited for individuals who have struggled to make progress in treatment or struggled to sustain progress. In my opinion, the key factor is when ketamine is integrated with talk therapy. I am not advising against injection clinics or home treatment but my training and belief in this medicine is when it is integrated with talk therapy. Some individuals even report an entirely unique experience when ketamine is used in the safe and supportive environment of their therapist’s office as compared to using it on their own. Additionally, KAP can be useful for those who have been making progress in therapy, not just those experiencing “treatment resistance”, and want to go deeper and build off their progress. KAP is also a useful tool in couples therapy.
What the process entails
The first step is meeting with a therapist who is trained in providing Ketamine Assisted Psychotherapy. After the initial consultation call to ensure the therapist is a good fit for you personally you should expect one to three preparation sessions wherein you discuss your eligibility for KAP, review the risks, identify goals, and set your intentions. If the therapist determines you are a good candidate they will refer you to a medical prescriber who is trained in treating mental health conditions with ketamine. They will complete a thorough medical evaluation and if they also agree you are a good candidate for KAP they will write you a prescription. The prescription is sent to a compounding pharmacy where the ketamine is compounded into a sublingual lozenge which you will pick up a few days before your dosing session.
You will then bring the medication with you to a dosing session. The dosing session is a two to three hour session wherein you take the medicine in conjunction with the support of the therapist. You will need someone to drive you to and pick you up from the dosing session. The dissociative effects of ketamine will last about 45 to 60 minutes and the following 12 to 24 hours you should expect feeling emotionally drained, perhaps a bit more tender and raw, and tired. The rest of the time during the dosing session is spend in meditation, grounding, and processing what came up. You should also plan to have a clear schedule the day after and not going back to work. Ideally within a day or two you are meeting again with the therapist for the most important part - the integration sessions. These sessions will feel like your regular talk therapy sessions but you will be leveraging that two to three week neuroplastic window for processing and integrating what came up for you during the dosing session.
Some clients will repeat this cycle three to eight times every one to three months though some may choose to only do one cycle and then continue as usual with therapy. It is vital to recognize the importance of integration with psychotherapy. Ketamine is not a silver bullet. It is a catalyst for identifying the inner narrative you want to rewrite, setting goals, and making the changes. Ultimately you are still responsible for doing the work and making the changes in your life.
Next steps to Schedule a Consult
If this sounds like something you would be interested in for yourself I would highly recommend finding a KAP therapist near you. If you are in Colorado I am taking new clients and you can use this link to schedule a consultation call with me to discuss KAP. If you are located outside of Colorado you could use PsychologyToday.com or a Google search to find a therapist near you. Search for Ketamine Assisted Psychotherapy and you should find some options.
Feel free to reach out via email if you have questions about therapy or KAP counseling@jessehuebner.com.
