Is Ketamine Assisted Psychotherapy (KAP) for you?
Repeated cycles of anxiety, depression, or trauma can leave you feeling stuck, helpless, and trapped. Yet new hope is very much on the horizon as the promising frontier of “Ketamine assisted psychotherapy” (KAP) offers new options for treatment.
Over the past couple years, more and more therapists have been using Ketamine to help facilitate deeper change, transformation, and healing for clients who experience common but debilitating mental health conditions such as depression, anxiety, OCD, and PTSD.
What is Ketamine?
Ketamine is considered a generally safe dissociative anaesthetic, which also has psychedelic properties, and has been used in recent years off-label for depression, anxiety, chronic pain, self growth, addiction, and PTSD, with very promising results. A plethora of research studies are currently underway to learn more about which conditions can be helped by ketamine, and research to date has been very promising.
How Ketamine Helps:
The mechanisms of change underpinning Ketamine’s high levels of effectiveness for treating mental health disorders are still in the process of being understood, although recent research seems to indicate several components to its helpful effect on the brain.
In addition to regulating glutamate levels in the brain, an important mechanism of Ketamine’s effect on mental health seems to be Ketamine’s dramatic effect on neuroplasticity, which is essentially the brain’s ability to be open to new learning and to creating new pathways of change, thus reversing or overriding long-standing (painful) patterns of thinking, feeling, and behaving that were previously deeply imprinted or ingrained, with new learning.
Ketamine seems to unlock a window of increased neuroplasticity in the brain that can powerfully help clients more easily make changes that previously were very difficult to make.
Ketamine also seems to inhibit the brain’s “default mode network”, essentially helping people “get out of their heads” in ways that previously seemed impossible. And it also appears to help people gain access to previously suppressed or unconscious aspects of one’s memories and life experiences so they can be reappraised and integrated into the overall big picture of one’s life in a new way.
Necessary Conditions for Healing:
Getting unblocked from patterns ingrained deep inside us; accessing memories and unconscious experiences that are normally blocked or repressed; and experiencing non-ordinary states of awareness can all be facilitated by the use of ketamine, and in the context of a trusted psychotherapy relationship, can lead to significant improvements in mental health, as long as certain conditions seem to be met: feeling safe and supported by your therapist; mentally preparing for your ketamine experience by setting goals and intentions for it; creating a proper setting for your ketamine journey together with your therapist; and processing what came up during the ketamine experience in integration sessions that follow. “Letting go” is very important to this experience; your ketamine experience will be most effective if you can allow whatever happens to just happen, without trying to control or fight any aspect of it; for those of you who have trouble letting go, I will also work with you on this.
My overall goal, as both a psychoanalytic and trauma-informed psychotherapist with 20 years experience, is to help facilitate the optimal and unique conditions you need for your ketamine experience to be all it can be as we work through whichever mental health issues you have been struggling with and want to heal from.
How it Works:
First, you and I will meet for 1-3 introductory sessions to build a sense of trust and discuss your goals, struggles, past history of mental health treatment, and hopes for which issues you want to resolve.
During this time, I will also refer you to a Psychiatrist or Psychiatric Nurse Practitioner licensed in New Jersey, who will assess your history, current symptoms, and eligibility for ketamine assisted treatment. If you are deemed eligible (which will usually be the case, unless you are experiencing active substance abuse, recent hospitalization or serious instability, a psychotic disorder, or uncontrolled hypertension), the prescriber will discuss dosing with you, and will order ketamine lozenges to be shipped to you from a compounding pharmacy.
Once your ketamine has been prescribed and ordered, we will go ahead and schedule both a 3 hour Ketamine Assisted Psychotherapy (KAP) session, as well as a preparation session to take place prior to it.
In the preparation session, we will discuss what is known as the “set” and “setting” for your KAP; this refers to your mindset as well as to aspects of the setting you would like to incorporate into the experience (such as music, lighting, comfort objects, etc). We will also discuss what you would find helpful from me in terms of helping you feel a sense of support and comfort from me during your KAP, as well as some safety protocols. In addition, we will schedule some time to check in on the day after your KAP session, as well as schedule an integration session (or several) to take place soon after the KAP in order to process the experience more fully and help you integrate any new insights or changes you are experiencing.
During your KAP session you will self-administer your ketamine lozenge by placing it under your tongue for around 10 minutes and letting it fully dissolve while swishing. (You will monitor your blood pressure with a wrist cuff before and after taking the ketamine as well). I will be with you, either in person or virtually, depending on what we have decided in advance. You will need to have a family member or friend who can be with you as a chaperone during your KAP if your KAP session takes place virtually, or someone who can pick you up after your session if you have your KAP session in person in my office.
After around 10 minutes, you will spit out the medicine, and will then experience the peak psychedelic effects of the ketamine for approximately 30 minutes, which can include such things as possibly feeling out of your body, being in an altered state of awareness, or remembering things from your past from a more detached perspective. Anything you feel or experience in this altered state is both safe and time-limited/will pass. We will then debrief a little about what you experienced, and if you’d like you may eat a snack or have a drink once the Ketamine wears off. We will sit together for a bit, and once you are ready, you will either go home with a chaperone (if we met in person), or will have your chaperone stay nearby if you are home (if your session was virtual). Following the session, you will want to set aside some quiet time at home for the rest of the day for some reflection, calm, and introspection.
I will check in with you on the morning following your KAP session to see how you are doing and we will further process your experience when we meet for our scheduled integration session or sessions.
At times it can be hard at first to put into words what has come up during one’s KAP experience; that’s perfectly normal and ok. You may also feel a little worse before you feel better, as memories and experiences you have suppressed for many years may suddenly come to the surface; however this is a sign of healing and is not concerning. We will work to solidify and integrate any positive changes you are experiencing; review treatment interventions or positive behaviors you may feel more able to make use of following the KAP; and discuss any reactions you are having to what came up for you.
Additional KAP sessions can subsequently be scheduled as needed, and although results are not always linear (although sometimes they can be), you will likely notice over time that you’re feeling better, more hopeful, less stuck, better able to access your memories (including happy ones), and somewhat freed up from long-standing inhibitions.
I am not in network with any insurance plans so payment in full would be expected at the time of each session. I will happily provide you with a superbill to submit to your insurance for all sessions attended in the event you have out of network benefits (with the exception of the full 3 hours for the actual KAP sessions, since much of this time is not active psychotherapy).
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Here are some additional links to articles about the use of ketamine for mental health conditions: