Psychedelic Assisted Psychotherapy is a therapeutic process that uses plant based and synthesized medicines to support therapy and personal growth. These medicines give us access to the sacred ground where healing occurs and are thus wonderful allies in healing.
Currently, of the commonly named psychedelic medicines, off label use of Ketamine is the sole legal method of doing Psychedelic Assisted Psychotherapy in the United States. Ketamine Assisted Psychotherapy (KAP) is a method of using ketamine to facilitate therapeutic processing.
Frequently Asked Questions:
Do you know how I can get treatment with other psychedelic medicines?
Although MDMA and Psilocybin are being studied for their psychological benefits for PTSD, Depression, end of life and other applications and are promising for future treatment, they are only legally sanctioned for use in controlled studies at this time. I am a researcher and therapist for one of these studies: MDMA assisted psychotherapy for treatment resistant PTSD. I am thus working with FDA and DEA oversight and am not able to refer you to any other way of working with these medicines at this time. If the research confirms clinical reports, however, MDMA may be approved by the FDA for use with psychotherapy in a clinic setting (this could be as soon as Summer 2022 for MDMA; and a couple years or so longer for Psilocybin). This will offer a beautiful, safe and effective treatment option for many who are suffering.
There are a variety of clinics and retreat centers that provide plant based medicines in other parts of the world. I have heard many conflicting reports about the experiences people have had with medicine work in retreat centers. Some are excellent and provide needed attention to mental health issues that might arise; others offer no support. So, investigate carefully if you seek to do medicine work in another country and make sure you have a person to talk to about integrating what you have learned. Integration is essential to make the experience meaningful in the context of your life. Also, please do not ask me for recommendations since sadly I am not in a position to suggest possible places to go at this time.
What are the options for Ketamine therapy in the United States?
There are several models for the administration of Ketamine for healing in the United States. One common application is administering ketamine for the physiological effects of the medicine only. Typically this occurs in IV infusion clinics, run by a physician. These treatments are wonderful and transformative for some people, especially for those with treatment resistant depression or acute suicidality. If your depression or symptoms are trauma or attachment based, however, you should know that usually you are left in a room alone and there is often no therapy that accompanies the process, although this is changing. This can be re-traumatizing for some people. So, if you seek this kind of treatment, be sure to ask what the process is like so you can make an informed decision. I do not offer this form of ketamine treatment in my office, but support those who do and this method can be a good choice in some circumstances.
Lozenges and quick dissolve tablets formulated in a compounding pharmacy also offer modes of administration. In my practice, I use these low dose lozenges or tablets that are absorbed in the mouth, under the tongue. Because we can always add more medicine, but not less once it has been absorbed in the body, we always start with lower doses. A series of sessions allow us to fine tune the amount that is optimal for your body and process. Ketamine Assisted Psychotherapy during and in the hours following the peak medicine effect is an integral component of the treatment I offer.
Another mode of administration is Intra-Muscular (IM) injections. This will require an injection by a nurse or physician and can be easily administered in a private office. Typically the effect of the medicine is more immediate, and the experience often more psychedelic or comprehensive in leaving ordinary consciousness behind. This level is just right for some bodies, and too much for others, and may be an experience that you work toward as you have more familiarity with medicine work.
What is Ketamine Assisted therapy, and what can I expect if I come to your practice?
In the doses and setting I use, Ketamine grants access to the deepest part of your being, beyond logic, where there is an inner healing intelligence to guide you in your life. Often we don’t have access to this because we are tossed around by moods and memories, protector parts and avoidance of the most difficult aspects of our experience. The medicine sessions create a window into what is possible, allow you to connect with your vulnerable parts or mind/body states from a place of peace, compassion and wisdom, and point you toward steps you may need and want to take in your life. They allow you to turn toward your trauma and the young parts of you that were not cared for in the way they needed at the time.
EMDR, AEDP, IFS, Somatic Experiencing and other models also offer access to the youngest, most vulnerable parts of ourselves, that have had to go underground for various reasons over our lives. These methods are excellent complements to and preparation for medicine work, and in cases in which those methods come up against internal limits, or when fear overwhelms the system, KAP allows fear protectors to soften in beneficial ways, so that psychotherapy can unfold.
In my experience, and in the way that I use them, the medicines work as a vehicle, as an ally for healing, not a destination. There is no way to bypass the process of integration, and making choices within our lives; we are bound by that just as we are with meditation and therapy generally. I wish there were a magic pill! But in actuality, the path is one of therapy, and spiritual pursuit, of dipping in to the deep places within, to receive the wisdom that you carry deep inside of you. The beauty, though, is that wisdom and healing intelligence are within us all. As you learn to trust this inside, and connect with your true nature, you will find more harmony internally, and joy and peace, creativity and compassion will naturally emerge.
What do the terms “set and setting” mean?
In order to access this inner wisdom and healing intelligence, we pay attention to set and setting. Set is the psychological mind frame that one holds in entering into the process. This includes holding an intention, framing the themes that might emerge, calling to mind the story of one’s life, trusting the guide, and feeling safety and protection from worldly concerns.
Setting refers to the place and time of the experience, and aspects of the physical space holding the process. Many cultures have a precedent for this, as ancient healing rituals and ceremony evidence. There are many values to ritual and ceremony, including drawing important emotional and physical boundaries for safety, but the framework is unfamiliar in much of western culture. We can use some of the boundaries we do know, however. Boundaries that protect the safety of the space and relationship in the therapy, such as safe touch, confidentiality, COVID safety and solid preparation and integration. You are also welcome to incorporate any meaningful rituals, objects or photos, or any element of ceremony that feels important into your process. We want you to feel comfortable and safe and held as you venture inward.
Where do I get ketamine for the sessions?
We use medicines that are formulated at a compounding pharmacy which you will pick up or have mailed to you and bring with you to the medicine session. Drugs that you obtain from unregulated sources often are laced with amphetamines or inert substances. This is one factor accounting for the differences in response to these substances in recreational versus therapeutic settings.
Another major difference is the presence of the therapist to keep you safe and help you process whatever emerges during the session, including whatever traumatic memories or experiences arise. We take great care in watching over you and helping you through anything that emerges during the course of the session. The focus on inward processing is another significant difference.
People often comment that the experience is entirely different from recreational experiences they have had, and many of our clients have never experimented with psychedelic or plant medicines before for a variety of reasons, including fear of what the experience might inadvertently evoke.
What is the mechanism for healing in ketamine assisted psychotherapy?
Discovery of ketamine as a helpful treatment for depression emerged from the anesthetic world: Ketamine is a great, safe, inexpensive anesthetic at high doses. The psychedelic effects, the qualities of ketamine that we draw on for KAP, were seen as an unfortunate side effect. It is helpful to think of ketamine as a glutamate modulator instead of “dissociative anesthetic” (the description you will often see used for the medicine) since at lower doses, the latter term is misleading and does not characterize the experience that people describe. The fact that ketamine works within the glutamate system in the brain is significant in that it is not the same system within which traditional SSRI’s operate. Thus, taking SSRI’s does not interfere with the effectiveness of ketamine treatment.
With KAP, there is an added benefit to the physiological effects of ketamine. The aim of KAP is to get to the root of the distress through genuine human connection, trust, the absence of judgement and looking thoughtfully and with compassion at the themes that emerge from the session. We look at the historical significance of these themes and how what is learned in a session can guide choices going forward.
Do I need to be concerned about addiction?
Another issue that often arises is the question of addiction. This has not been a problem in the amounts and form of ketamine we prescribe and through the process that unfolds. But we will be paying attention to tracking your use of the ketamine prescription, and if you ever feel that use of the ketamine sessions is coming from a place of avoiding rather than going toward difficult material, please raise that issue with us so we may address it clinically. These medicines are often used, and may be approved for the treatment of addiction, so it is good to notice if addictive protector parts of yourself arise so that we can address their purpose in your life explicitly.
How do I prepare for a session? When am I ready to do a session?
Another question that often arises involves who benefits from this treatment. It is highly valuable for people who have already done a lot of personal work, already have an intellectual understanding of their personal narrative and are seeking to then drop below that story for healing. It’s essential to have ongoing support for the integration, a longterm therapist or spiritual practice or self-care practice to hold what emerges.
It seems that the next few years will be about establishing whether and how these medicines contribute to healing. The years that follow then will be looking at various populations and diagnoses and trying to tease out what dosage and type of medicine works for what purposes and for whom. If you are vulnerable to psychosis or have had a psychotic or manic break before, please discuss that with your provider; at this time, medicine work is discouraged in most cases where psychosis could result. Similarly, if you have been diagnosed with DID, this is something your provider should know, and it is probably too soon to know if and how this treatment will be helpful to you. The research shows promise for PTSD, depression and anxiety based disorders as well as end of life and relationship distress. It seems most important to work with someone who knows your condition well and has added medicine work as a supplement to what they already know is helpful for your condition. Over the next few years, options for providers should increase significantly as more people are trained in the work.
No matter your suffering or intention for healing, it is helpful to allow an ongoing process to guide and support integration. Sometimes this naturally arises from the work, other times it leads to the work. A meditation practice, a spiritual practice, a long time therapeutic relationship or ongoing therapy, a supportive group, Holotropic Breathwork, any of the ways in which you refuel in life- friendships, writing, creative expression- all will support your process of integrating what you have learned from the medicine work.
Ketamine Assisted Psychotherapy Step by Step:
- Evaluation of timing and readiness for KAP~ If we decide KAP would be beneficial and you are already seeing me for EMDR or IFS, we will spend some of our time preparing for a KAP session. If you are referred for adjunctive treatment by your ongoing therapist, I will do an initial evaluation via zoom or in person with an interview that allows me to get a broad overview of your life and the themes that may emerge in the therapy. In both cases, we will begin to set an intention and plan the session, and focus on meeting any needs you have in advance of the session.
- If everything looks fine at this stage, I will send an email introduction to you and one of our prescribers who will schedule a virtual medical evaluation with you. They will ask you questions about your medical history, current medications, and psychological history, and if everything looks fine, they will send a prescription to our preferred pharmacy.
- You may pick up your prescription at the pharmacy or have them mail it to you. We use Maida Pharmacy in East Arlington.
- I will speak with your ongoing therapist if you grant permission for open communication between me and your provider. I am most interested in what they have learned about working with you that might facilitate the therapeutic process.
- We will schedule and meet for our 3 hour in-person medicine session. This will take place at my office: 263 Concord Avenue in Cambridge. I am on the second floor, third door on the right. With COVID we are asking clients to come just before the session, wear masks in the building, and wash hands before entering the office. You may take your mask off during the session once we are seated. If you or I have symptoms, we will reschedule the session. I will be seated 10 feet away from you during the session.
- Bring to mind your intention for the session, or the theme you wish to explore.
- Dissolve the tablet in your mouth for 12 minutes. I will be keeping track of the time. Do not swallow the tablet. Instead, swish the dissolving tablet in your mouth. Then you may spit the saliva into a cup we will keep handy.
- As you lay down, put on your eye shades and let go into the music and experience of the medicine carrying you where you need to go, showing you what you need to know.
- You may be focused inwardly for 45-90 minutes. Then, you may feel moved to share some of your experience. I will write down what you say so you won’t have to try to remember. You may speak at any time throughout the session, but often there is a period of inward focus first, and I may encourage you to turn back toward your inner experience.
- Toward the end of the session you will able to slowly get up. We recommend that you move slowly and carefully just after the session. Ideally, you preserve this sense of moving slowly for the rest of the day. You may take a walk in nature, journal, express yourself and your process artistically, generally ease back into your day to day life. Be sure to drink plenty of fluids afterward.
- I will call you sometime during the next day to check in and we will schedule an integration session within a few days following the medicine session. Try to maintain the spirit of openness and receptivity to whatever arises in the days that follow.
"Wild Geese" by Mary Oliver
You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert, repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting—
over and over announcing your place
in the family of things.