I’m happy to offer ketamine assisted psychotherapy (KAP) in conjunction with local prescribers when clinically indicated. I studied with Psychedelic Therapy Boston and Fluence and continue my education with consultation and supervision groups and other continuing education. Read on to find out more about ketamine and ketamine assisted psychotherapy!

What is Ketamine?

Ketamine is a dissociative anesthetic medication initially developed in the 1960s for surgical anaesthesia which has also been used for procedural sedation, pain management, and more recently for treatment resistant depression and other mental health concerns. When it was developed it was prized as an anaesthetic for its safety profile and mild side effects compared to other drugs like it. Research into its utility for treatment resistant depression and other psychological concerns emerged much later, in the 2000s. 

What is it used for?

Most of the research on ketamine and ketamine assisted psychotherapy has focused on treating depression that has not responded to traditional antidepressant medications (treatment resistant depression or TRD). In fact, a version of ketamine (esketamine or Spravato) has been FDA approved to treat TRD since 2019! Research is also showing promising results for treating other mental health issues including post-traumatic stress disorder (PTSD) and other anxiety disorders, addiction and suicidality.

Many of the studies that investigate ketamine for mental health use an infusion model; ketamine is administered intravenously 2-3 times per week for 2-3 weeks. The repeated infusions have been shown to increase the duration of the antidepressant effect. These studies may or may not include preparation and integration with a therapist.

Ketamine assisted psychotherapy (KAP), where ketamine is administered in the context of work with a psychotherapist, is more difficult to study given the challenge of standardizing the psychotherapy process. However, research in this area is promising. Engaging in psychotherapy alongside ketamine treatments may help enhance and consolidate the benefits of the ketamine experience itself. 

How does it work in the brain?

Researchers are still working to fully understand how ketamine works to relieve mental health symptoms. However, there are some things we know about how ketamine works in the brain to interrupt patterns of thinking, feeling, and experiencing.

Ketamine, like other psychedelics, opens up a period of neuroplasticity in the brain. Throughout our life our brains are forging new neural pathways and getting rid of old, unused ones. This kind of activity is especially intense early in life and tends to diminish into adulthood. Stress or trauma further restricts the growth of new neural connections, making old pathways more entrenched. 

Ketamine acts to radically increase the connections between different neural pathways for a short period of time. If these new connections are used, they persist and can even strengthen! If not, they will wilt over time. This is the process of neuroplasticity. In KAP, we can take advantage of this state to try out new behaviors, new ways of thinking, and even new ways of relating to our emotions. Those that we practice during this period of increased connectivity are more likely to stay with us after the window of increased neuroplasticity closes. 

What does ketamine feel like?

While there are many ways ketamine can be administered, in my practice I collaborate with prescribers who use sublingual troches or lozenges. These are dissolved in the mouth and held there for 15 minutes, then spat out. This method of ingestion lends itself to a more gradual onset of effects. On a lower dose you might be more alert and interactive but with more relaxed defenses. On higher doses, you might experience a more inwardly focused ‘journey’ that might involve perceptual changes and alterations to your experience of yourself. Either way, the journey typically lasts 30-60 minutes, and while you should not drive following a ketamine session, you will likely feel back to normal within 1-2 hours after taking the medication.

During the journey, you will likely experience increased openness and reduced defenses. You may encounter feelings or memories in new ways; this is one of the ways that ketamine can be useful in treating trauma. Your experiences may be expansive and beautiful or challenging and dark. I will be beside you the whole way and I’ll encourage you to stay open to whatever comes. All journeys end, the experience will pass, and even very difficult experiences can be a powerful catalyst for growth.

What are the risks?

Most of the side effects of ketamine are mild and transient – they will often pass within an hour or two of taking the medication. 

Your vision may become blurry and your physical coordination will be impaired. For this reason I recommend lying down with an eye mask on until the drug effects have lessened. 

You may feel nauseous. To manage the risk of vomiting and nausea, I recommend eating lightly the day of your medication session and no food for 4 hours before your session. Hydrate well the day before your session but limit fluid intake 4 hours before your session as well. You may bring snacks to your medication session for after you emerge from the effects. You may also use over the counter nausea remedies on the day of your medicine session and/or talk with your prescriber about prescription anti-nausea medication options.

Other potential side effects include increased blood pressure, agitation, worsening of psychotic symptoms in people with schizophrenia and other serious mental health conditions. Your prescriber and I will both be happy to answer any questions about these risks. 

Besides these effects, there is the risk that you may have difficult, anxiety-provoking, or scary experiences during the ketamine journey. These experiences, while challenging, may in fact be a valuable part of the treatment. The preparation and integration sessions will help create a context to hold and be curious about these experiences, and I will be alongside you throughout your journey for support.

 How does KAP work?

Intake and preparation sessions

I will meet with you for one or more intake and preparation sessions. During these sessions we will discuss your history and your goals for this treatment. We will review the procedures for the medicine session(s) and work together to create a safe and productive set and setting for your ketamine experience. Your hopes, expectations, and concerns – in short your mindset or ‘set’ – is a powerful shaper of your experience while under the effects of ketamine. We will also discuss aspects of the setting – the office environment, music selection, meaningful or comfort items you may want to bring with you to prepare for your experience.

Screening with prescriber

You will meet separately with a prescriber (I have recommendations) who will medically evaluate you and prescribe the ketamine lozenges. 

Medicine session(s)

You will bring the medicine to the office on the day of your medicine session. We’ll schedule 3 hours to allow time for settling in and preparing together, your journey which will likely last 30-60 minutes, and time afterward for some initial integration.

I will provide music on speakers and an eye shade. After swishing the medication for 15 minutes and spitting it out, you will lie down and I’ll encourage you to focus inward and be open to whatever experiences come. I’ll be beside you the whole time and you can talk to me whenever you wish. 

When you emerge from the medication’s effects, we will have some time to talk about your experience, or to sit in silence together. You are also welcome to journal, draw, or reflect in any way you choose. 

At the end of our session, I will hand you off to your pre-arranged ride home. I suggest clearing the rest of the day of responsibilities as much as possible.

Integration

I will offer an integration session as soon as possible after the medication session (preferably the next working day). Integration sessions are a chance to process your experience and to build bridges between your journey and everyday life. Remembering the period of neuroplasticity you are experiencing, we will discuss how you might explore some of the new pathways that are now more available. What modes of feeling, thinking, or relating would be useful to try on now, and how might you do that both in session and in your life? What are the feelings or experiences from your journey that you’d like to hold onto? How might you remind yourself of them when you need them?

Integration is a process that can continue in sessions with me, with your individual therapist, and in your daily life in a variety of ways. In our integration session(s) we will think together about how you can carry this work forward.

How many sessions?

At minimum, a round of KAP involves a preparation session, a medicine session, and an integration session in addition to your meeting with a prescriber. One of both of us may decide that additional preparation or integration sessions are needed,  in which case we will collaborate to determine the best course of action.

As mentioned before, the durability of ketamine’s effects can be extended with repeated administration, so depending on your needs and scheduling availability, we may agree to meet for a series of medicine sessions. Again, this decision will be made collaboratively and can include consultation with your current therapist.

What does KAP cost?

For preparation and integration sessions, my fee is $250 per 50 minute hour. The medicine session is $750 for up to 3 hours. I’m happy to provide superbills for insurance reimbursement for the preparation and integration portions of our work, however insurance typically will not cover the entire medication session. 

If you have questions or are interested in pursuing KAP, please get in touch!