ketamine assisted psychoTherapy
"The real voyage of discovery consists not in seeking new landscapes,
but in having new eyes." - Marcel Proust
Ketamine-assisted psychotherapy is a groundbreaking, integrative, trauma-informed experience that can be used to improve a wide range of mental health symptoms. Ketamine has a completely different mechanism of action from any other antidepressant medication and offers hope to the millions of people who have not found adequate help through therapy and medication alone.
Ketamine is a medicine that helps you access deeper parts of your psyche, and in the context of therapy, may help you understand this material in ways that may have been inaccessible in traditional talk and trauma therapy. Ketamine-assisted therapy is effective because we will create a safe and intentional “set and setting,” which refers to the environment and context in which you take the medicine, as well as the preparation and integration experiences.
What is Ketamine?
Ketamine is an FDA-approved "dissociative anesthetic", since 1970, for the purpose of surgical anesthesia in high doses. Since the early 2000’s, when used in low dosage, Ketamine has been found to be extremely safe and highly effective in treating depression, anxiety, PTSD, and addiction as an FDA “off-label” use, in combination with psychotherapy. Similarly, ketamine supports personal growth and self-exploration, tapping into one’s inner healing wisdom.
Ketamine normalizes the brain’s default mode network (DMN) activity. Think of the DMN as your brain’s usual mode of operation. The DMN is active when you are in wakeful rest such as daydreaming or mind wandering. It is also active when you are thinking about others, thinking about yourself, remembering the past, and planning for the future. Resetting the DMN can create an opportunity to get unstuck from negative thinking patterns and establish hope for a healthier future.
Ketamine also enhances neuroplasticity by significantly increasing Brain-Derived Neurotrophic Factor (BDNF). Increased neuroplasticity can help undo the loss of neural connection commonly caused by long-term depression. Ketamine also blocks receptors for glutamate, a neurotransmitter associated with brain inflammation and excitotoxicity. Inflammation is another common factor in people with long-term depression.
These mechanisms are not found in other antidepressants and appear to help explain the rapid, powerful antidepressant effects of ketamine.
What is a session like?
Initially, we will meet for several preparation sessions as we identify your goals and create a safe, trusting relationship. The experiential medicine sessions (when you take ketamine) are planned for three hours, with most medicinal effects usually lasting 1-2 hours. The experiential session is primarily an internal experience, where you may choose to wear an eye mask and listen to music with headphones. You will lay on a comfortable mattress as I provide therapeutic support the entire time, ensuring your safety and comfort.
There are different ways to take ketamine. I offer sublingual sessions, where you bring your prescribed ketamine lozenges into the session and hold it in your mouth until it dissolves. I also offer an IM (intra-muscular injection) with a collaborating nurse who can join the session to administer the injection (for an increased cost). Both methods are effective but can differ in intensity and duration of the medicine's effects.
In the low doses used for mental health treatment (around 5-10% of what is typically used in anesthesia), ketamine can promote a dissociative “psychedelic experience,” often described as a deeply relaxing, “floating” or tranquil state, affording clients a new or distanced perspective of their life situations or struggles. A “quieting of the mind” occurs, allowing for shifts in consciousness, allowing an opportunity for new insights and awareness. You might revisit memories from your past, experience emotional release, or gain insight into your life situations. With the proper preparation and dosage, people can encounter a mystical experience. Many report feeling connected to a higher power and have deep personal, mystical, or transpersonal insights.
This is not like a psychedelic "trip" that many have experimented with at a concert or with friends. This is a highly focused, therapeutic process. My role as a therapist is to help my clients deeply integrate the discoveries they've made in their journey—rather than simply experiencing "a good trip." I work to incorporate meaningful change in your lives.
Within 24-72 hours of your experiential session, we will schedule one or more integration therapy sessions. The brain has increased neuroplasticity during this time frame, so we take advantage of this crucial period for enhanced growth and awareness. We will aim to stabilize positive behavioral changes, consolidate psychological material, resolve psychological issues, improve relationships, catalyze new insights, and enhance self-awareness.
Any consideration of ketamine-assisted psychotherapy is in collaboration with a prescribing doctor, who will independently assess the appropriateness for and administration of the medicine on an individual basis. Clients often experience progress within 2-6 sessions, when conducted intermittently with integrative psychotherapy sessions.
The KAP PROCESS
INTAKE & Preparation sessions
We begin with a free phone consultation, and if appropriate, will begin meeting for further assessment. If determined that you are a candidate, you will be referred to my collaborating psychiatrist for further assessment and your prescription while we begin our preparation sessions.
Meet with prescriber
As I am not a prescriber, you must first meet with one of my collaborating psychiatrists to complete a medical assessment and receive your prescription for ketamine. You will be responsible for bringing your prescription to the session and administering it to yourself.
Once we've created the right "set and setting", we will schedule your medicine session(s). "Set" refers to carefully cultivating your mindset, intentions, and goals to create a therapeutic, healing experience in your ketamine session. The "setting" is a safe, therapeutic containter in my office where you will have your medicine journey. The session itself typically lasts for about 3 hours.
Your brain has increased neuroplasticity in the 24-72 hours after your session, so you may be more open and able to make changes or see things from new perspectives that weren't available in the past. We will always try to meet within this timeframe after your medicine session to integrate. We will also discuss ongoing self-care and integration you can do between sessions.
Is Ketamine Safe?
Ketamine has been widely used as an anesthetic since the 1960s, in amounts much higher that what is used even in the highest doses within a ketamine assisted therapy context, without respiratory depression or cardiac complications. The safety profile of ketamine is robust enough that it is often the first choice of anesthetic to be used in the treatment of children and within an emergency medicine context. Before beginning ketamine therapy, a thorough medical clearance exam is required to assure that ketamine is a safe choice for you as an individual.
Who is eligible for ketamine assisted psychotherapy?
Before participating in ketamine treatment, you will undergo a thorough medical and psychological history to determine if you are eligible. Pregnant women and nursing mothers are not eligible for ketamine treatment. Untreated hypertension is a contraindication to ketamine use as it causes a rise in BP. Similarly, a history of heart disease may make you ineligible to participate. There may be some other mental health conditions that may not also not be appropriate for ketamine. **Screening for substance abuse will be evaluated prior to treatment. I do not condone unsafe, recreational use of ketamine. All treatment is done in a controlled and clinical setting.
Ketamine does not cause tolerance and withdrawal symptoms and therefore does not meet the criteria for chemical dependence. However, “cravings” have been reported by individuals with the history of heavy use of “psychedelic” drugs. Due to the nature of the ketamine experience, there is the possibility of psychological dependence if large amounts of ketamine are used for an extended period of time without the oversight of a licensed physician. These amounts are generally much higher than what is prescribed or administered during ketamine therapy. Ketamine is a schedule III controlled substance, and should never be used without with oversight.
Is ketamine addictive?
What are the side effects of ketamine?
The side effects of ketamine may include dizziness, a change in depth perception, nausea/vomiting, blurred vision, slurred speech, euphoria, confusion, anxiety, and a change in perception of time and space. A rise in blood pressure may also occur when using ketamine. For this reason, uncontrolled hypertension is a contraindication for ketamine therapy. Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction is individuals abusing the drug. This has not occurred within this framework of treatment and at the doses used in ketamine assisted psychotherapy.
How long does treatment last?
Varying with route of administration and your personal therapeutic needs, an induction period of 4-6 weeks of weekly or biweekly treatments is recommended to bolster the antidepressant and neuroplastic effects of ketamine. Length of ketamine therapy is highly individualized. It is safe and within your ability to withdraw from ketamine therapy at any time, without a withdrawal period as is often the case with traditional antidepressants.
Is ketamine covered by insurance?
Although ketamine has been used for anesthetic purposes for decades and is considered an essential medicine by the World Health Organization, it is still not approved by insurance for this type of treatment at this time. I can provide a superbill that you may be able to submit to your insurance for reimbursement but can make no guarantees that it will be covered by your specific plan.
Ketamine requires a prescription from an authorized medical provider. Your eligibility to be prescribed ketamine is at the discretion of a medical professional. If you are already working with a psychiatrist or doctor that is open to prescribing ketamine to you, you are welcome to get your prescription from them. If you aren’t currently working with a psychiatrist, I will connect you to a trusted prescriber.
Do you provide the ketamine prescription?
What is the cost?
My rates are as follows: $475 for each ketamine medicine session (up to 3 hours) and $190 per 50-minute preparation or integration session. If you prefer to use an IM route for ketamine, this is an additional charge (and can be discussed in our intake). It may be helpful to consider that KAP is not usually a long term therapeutic approach. You may invest a larger sum of money up front to achieve significant results, vs. attending weekly therapy for months or years.
Do you offer IV ketamine infusions?
No, this is not an IV clinic. The difference between ketamine-assisted psychotherapy (KAP) and receiving a ketamine infusion at an IV clinic is trauma-informed care. In KAP, the medicine is used as a catalyst for deep healing and change when paired with trauma treatment and talk therapy as part of your integration. IV clinics tend to offer little to no integration with the medicine.
What is your background and training?
I have a certificate in Ketamine and Psychedelic Assisted Therapy from PRATI, the Psychedelic Research and Training Institute. I have been guiding clients through experiences and integration of non-ordinary states of consciousness for many years as well. I have 30 years of clinical experience and trauma treatment that is woven into our work together.