Ketamine-Assisted Psychotherapy (KAP) is an intensive, powerful, and transformational therapeutic approach that compliments well with a desire for trauma healing, symptom and distress reduction, self-exploration, and inspired change in your life. When used therapeutically, ketamine becomes a transdiagnostic tool; meaning, some common and various themes that often bring people to therapy - including depression, anxiety, spiritual emergence, personal developmental, grief and loss, significant life transitions, the healing of PTSD and C-PTSD, and more - can find benefit from engaging in KAP. In KAP, we combine the Medicine Experience itself, a dedicated Preparation stage before the Medicine Experiences, and committed Integration stage after the Medicine Experiences - all within the trusted, personalized, and relational container of the therapy relationship. With the synergy of many components (all are described below), KAP can help you uncover the source of your pain and distress; find more resolution, wisdom, or inspiration from both challenging and positive experiences in your life; help you to arrive to a deeper understanding of the world and your place within it; help you to develop a healthier relationship with yourself; and help augment your efforts in the present day into a clarified direction.

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Ketamine as a chemical works on the brain by activating the glutamate system, the mTOR Pathway, and the BDNF protein; by blocking NMDA receptors; and perhaps providing anti-inflammatory effects. The combination of these factors can be more easily understood by knowing that ketamine increases the brain's ability to form new connections and strengthen existing ones, two simultaneous processes known as neuroplasticity and neurogenesis.

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A powerful healing mechanism at play with ketamine involves the Default Mode Network (DMN). The DMN comprises your sense of self ("I am..") and your views, attitudes, concepts, and beliefs about your relationships with others and the larger world. Unfortunately, for many people with trauma and other mental health challenges, the DMN is not only quite rigid, but it reflexively slants toward negativism, distrust, overwhelm, criticism, or myopia. Via neuroplasticity, neurogenesis, and the "Relaxed Beliefs Under Psychedelics (REBUS)" hypothesis, the otherwise rigid patterns, belief systems, and perspectives we hold (as part of the DMN) become more flexible, malleable, and impressionable. We often times begin to feel the burdens from the DMN begin to lift, and it can feel as though you are an artist beginning to work on a new canvas of your liking and choosing, or a snow skier at the top of a hill about to create a new path down a freshly snow-covered slope. What I am describing here is that ketamine medicine can conjure a uniquely fertile space to explore, tap into, and re-narrative your sense of self, your emotional world, your felt sense experiences, the narrative you hold about your life thus far, and where and how you would like to direct your life moving forward.

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Another quality about ketamine that brings healing potential is that it softens the limbic system of our brain, which is directly responsible for igniting our "fight or flight" alert system. Often times when we are connecting with traumatic material, tender wounds, or difficult memories as part of trauma healing work, our limbic system responds with a sense of reactivity, intense hyperarousal and hypervigilance, and the flooding of intense emotional and somatic viscera, which can prove very challenging and discomforting. With ketamine effectively dampening the limbic system's alert response, we are likely able to work with challenging material while simultaneously feeling more resourced, more consciously aware of ourselves (called meta-awareness), and with more Self-energy (which includes qualities of connectedness, compassion, calmness, curiosity, clarity, presence, and confidence).

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Additional advantageous qualities with ketamine as a therapeutic medicine include:

 short half-life: the beginning to the end of the acute non-ordinary state of consciousness (NOSC) of the medicine lasts less than two hours; a full KAP medicine session is about 2.5 hours long.

affordability: the prescription cost of the compounded troche form of ketamine is between $30-60; one prescription has enough medicine to last a full round of 4-6 Medicine Experience sessions.

legality: with a valid mental health diagnosis and prescription, ketamine is legal like other psychiatric medicines; all ketamine therapy work can exist "out in the open", even with KAP being "off label use" according to the FDA.​​​​

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KAP is comprised of three stages known as Preparation, the Medicine Experience, and Integration; these stages are highly individualized, tailored to your unique self and needs. Determining the exact amount of time and focus spent in any stage is carefully assessed with the advisement of your prescriber, the clinical judgment of your therapist, the working relationship between you and your therapist, and based upon your unique history, needs, and goals of treatment. By design, KAP is only truly KAP when all three stages are equally valued and faithfully engaged. Thoroughly engaging in all three stages helps ensure that an empowered, clear, safe, ethical, and deeply impactful experience with KAP is most possible. 

 

Themes involved in the Preparation stage include:

• reviewing medical and psychiatric history

• considering side effects, risks, and potential contraindications to ketamine

• connecting you with a trusted psychiatric evaluator and medicine prescriber

• reviewing safety protocols

• reviewing and practicing coping and regulation skills

• reviewing and inviting in personal resources to help anchor and view the medicine experience

• defining intentions and aspirations from KAP

• inviting the supportive presence & language of ritual, movement, poetry, music, or art-making to help explore, process, and integrate the upcoming medicine experiences

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Themes involved in the Medicine Experience may include:

• an easing of everyday worries or habitual thought patterns

• a non-ordinary state of consciousness which dilates and warps the sense of time & space

• altered bodily perceptions: feeling like you are leaving your body, feeling like you are floating, rushes or releases of energy throughout the body

• altered visual/auditory perceptions: images/sounds being more vivid, dreamlike, or distorted

• encountering emotional experiences: memories or memory-like experiences that are emotionally moving, joyful, unsettling, strange, frustrating, or fascinating

• a desire to have a quiet, minimally verbal, inner-oriented time with the medicine

• a desire to engage in conversation with the therapist about what is arising with the medicine

• spiritual and transpersonal experiences: connecting with void space or universal consciousness; encountering mythical and archetypal energies; experiences of birth, death, & rebirth

•  authentic expressions of laughing, crying, singing, or moving 

• an enhanced perception of beauty & meaning

• ​an enhanced sense of clarity & understanding

• an enhanced sense of purpose & direction

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Themes involved in the Integration stage can include:

• physical, body-based engagement: processing and exploring body sensation experiences; using bilateral stimulation and/or EMDR processing; somatic-focused art making; dancing, walking or hiking; yoga; breathing exploration, etc.

• behavioral changes: creation of SMART goal leading to short-term objectives that align with long-term desires.

• ritual creation: routine conscious reflection as part of your day; listening to the same playlist that was experienced during a previous Medicine Experience; creating an alter with personal meaning that you visit daily; reflecting on items used in the Medicine Experience (oracle card, stone, photo, artwork, figurine, candle, etc.)

• creative engagement: playing an instrument, writing poetry, singing, journalling, and making art to help capture creative, imaginal, and symbolic qualities experienced from the Medicine Experience

• mindfulness: engaging in various meditations that promote self-compassion, radical acceptance, inspired action, values recognition, aspirations, etc,; spending time in nature; connecting with spiritual allies, poetry, and philosophical tenants; reflecting on experiences of awe, reverence, purpose or clarity

• social connection: talking to and processing with *trusted and supportive* others in your life and in your community who can help reduce feelings of isolation, increase feelings of belongingness, help you feel witnessed and understood, and affirm the significance of engaging in psychedelic-assisted healing

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It is important to understand that the ketamine medicine itself is not the source of healing. Ketamine alone will not heal you, and there truly is no single healing remedy, quick fix, or magic bullet (psychedelic or otherwise). Healing is a multidimensional process, and healing does not exist in any solely external tool, item, substance, or practice. Rather, ketamine and other psychedelic medicines are very powerful tools to help you along the healing journey. A helpful understanding of psychedelic medicine work, including KAP, is to consider the medicine as a mirror that reflects back to us what is often necessary to see and feel as part of growing and healing, and often from an angle that is fresh, clarifying, and insightful. We will experience change for the better directly to the extent at which we welcome and honor what is reflected to us in the mirror.

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Because it is not the ketamine medicine itself that is healing you, you must be an engaged participant in every stage of the KAP process. This includes five main components: 1) deeply considering your intentions and aspirations for therapeutic work with medicine; 2) balancing optimism with realistic expectations with the medicine experience and your healing journey; 3) surrendering and being open to whatever occurs during the medicine experience (which is often not what we expect!); 4) working with your therapist and the therapeutic relationship to support "translating" the medicine experience into an understandable, workable language for you; and 5) committing, ongoing, to integrating what was experienced and learned from the medicine experience into both short-term objectives and long-term goals and behavior changes in your life. When engaging in KAP that honors all five components, you are respectfully relating to the medicine, considering the reflections from the medicine being mirrored back to you, taking advantage of neuroplasticity and neurogenesis, and tending to your immutable, innate healing wisdom you always carry within you. Trust that you are thus creating the opportunity to have the most effective and most sustainable impact on your life with KAP treatment.

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The cost of each 2.5 hour KAP Medicine Experience session is $450 ($180/hr), and the standard number of KAP medicine sessions as part of a full battery of KAP treatment is between 4 and 6 Medicine Experience sessions. Know that with KAP, you are receiving the highest level of care in therapy: a therapist who has attuned to your nervous system; is present throughout the entire Medicine Experience; is dedicated to and specially trained in supporting you through a non-ordinary state of consciousness experience; and is informed of your unique biopsychosocial and therapeutic treatment factors. Know that KAP Medicine Experience sessions are not covered by any insurance company; however, all Preparation and Integration sessions (the typical 50-min talk therapy sessions before and after the KAP Medicine Experience sessions) are covered by insurance (or are possibly reimbursed through a superbill if you are using an out-of-network insurance).

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The following books and articles provide ample, trusted information regarding the historical and current research on ketamine medicine, standards of practice and safety guidelines for using ketamine therapeutically, and supporting a most effective, transformational KAP experience:

• The Ketamine Papers: Science, Therapy, and Transformation by Phil Wolfson, MD

• The Ketamine-Assisted Psychotherapy Treatment Companion by Kate Kincaid, LPC & Amy Davis, LPC

• Prepare Yourself, Your Client, and Your Practice for Ketamine-Assisted Psychotherapy by Karen L. Smith, LCSW

• “Guideline for the Personal Use and The Clinical Administration of Ketamine” by Ketamine Research Foundation

• “Ketamine Treatment Guide for Mental Health” by Psychedelic.Support

• “Ketamine 101, Getting to Know How Ketamine and Ketamine-Assisted Therapy Works” by Ketamine.net