I have to imagine that all mental health workers like me encounter times when our clients, no matter how motivated and consistent they are with treatment, continue to experience their negative symptoms, feel stuck, or sense there’s more out there but can’t seem to reach their potential. As professionals who know the value of persistence and therapeutic relationships for healing, we keep moving forward regardless of how difficult.
The American Psychological Association reports that an average of 15-20 therapy sessions are needed for just 50% of the patients to self-report relief from PTSD.1 For some patients taking SSRIs, this response may even be harmful due to the long treatment protocol of 6+ months,2 numerous potential interactions,3 negative side effects,4 and limited efficacy.5
There appears to be a new, (really an old) intervention that’s come around, possibly contraindicated to most of us as we deal quite often with substance and behavioral addictions.
Despite its [fading] reputation as a tranquilizer and party drug, I believe ketamine may help.
Most LMFTs would agree: There’s no shortage of therapies6 and medicines7 used to treat mental health. One area gaining lots of publicity is Psychedelic-Assisted Therapy or PAT.8 This combination therapy joins various psychotherapy modalities with controlled administration of psychoactive substances such as MDMA, psilocybin, and ketamine. Research into psychedelics and their ability to improve mental health is growing rapidly and results9 are10 promising.11 Further, while MDMA12 and psilocybin are on the cusp of widespread regulatory approval,13 ketamine (and its s-enantiomer esketamine14) are both FDA-approved.15 In fact, ketamine has been a staple of the World Health Organization’s Model List of Most Essential Medicines for decades.16
Utilizing ketamine for the treatment of mental health is widespread17 and18 popular.19 And while in context of mental health, ketamine’s use is, and will continue to remain, off-label—due to high regulatory approval costs and unpatentability—it appears to be a relatively safe option to treat various mental health conditions, especially when administered by a licensed medical provider.20
Through a friend and fellow therapist I became aware of Dr Rivas, CEO and founder of Innerbloom Ketamine Therapy (IKT) in downtown San Luis Obispo, California. I popped on to their monthly newsletter glanced through it; my eye caught on “semiretired” general surgeon who does pro bono work. Anybody that does pro bono work and whose dog Eli has her own bio is good in my eyes.
Then I began to read about the medicine where Dr Rivas summarized evidence-based research showing how and why ketamine helps alleviate conditions like Treatment Resistant Depression (TRD) and migraines. As I read with clients in mind I wondered if ketamine might be something I could benefit from. And if so, what more credibility it would lend to others if I had a positive experience.
After a phone consultation and medical exam with Dr Rivas, I scheduled a series of six ketamine infusions to take place over three weeks. Before I started, I researched as much as I could about ketamine and even performed my own version of preparation, a critical step before using psychedelics.
Each session consisted of a 40-minute IV infusion (40-60 mg) of ketamine HCL. During my visit, I was seated in a comfortable recliner with an eye mask, blanket, and noise-canceling headphones which played a ketamine-inspired playlist of instrumental and classical music. While I did not experience any commonly reported side effects like nausea, ondansetron was available.
I was accompanied to my very soft comfortable chair by Dr Rivas, Nina (an RN who never leaves the room), and Eli. We nailed down my intention before each infusion. Next, Nina gave me eye shades and Dr Rivas put the headphones on and bid me a good journey.
I am the proverbial control freak and actually thought the medicine would have “trouble” making its way past my consciousness. About a minute later I was at zero gravity floating in some heavenlies somewhere, experiencing a sense of peace and well-being that felt more real than reality. The music was perfectly choreographed to the landscape. Rather than vivid colors and shapes that a lot of people experience I heard, saw, and sensed nothing but words, whether written across the sky or a running dialogue throughout all six Infusions. It was as if I was reading a book and saw my life in six chapters.
I am very fortunate. Before I did ketamine, I sought out and found a local therapist who supports healing therapy through non-ordinary states of consciousness (which include psychedelics, EMDR, somatic work, mindfulness, hypnosis, neurofeedback). She worked with me in preparation for and continued integration of my ketamine experience.
Psychological and emotional relief from all the negative consequences of mental and physical issues are at the top of the list that we therapists want to help alleviate. With ketamine there can be more. It can help clients who:
Most surprising and unexpected were shifts and paradigms in how I see and interpret the world. For someone whose baseline is fight or flight, most pronounced was, and still is, the experience of amygdala downregulation. If not for the preparation and ongoing integration work I surely would have missed these benefits. I can sum up the whole by what my husband said, “Hon. You’re so much nicer now.” As they say in the psychedelic world: If you don’t continue the practice, it'll just be an experience.
Of course, ketamine is not a cure-all. It may, however, help some people get unstuck or accelerate their healing journey. And yes, like most of pharmacology, there are some risks associated with ketamine. For example, it should not be given to people with uncontrolled high blood pressure. On the other hand, ketamine may be an effective treatment for people with Alcohol (or other substance) Use Disorder which I admit sounds counterintuitive to a professional who’s been trying to help people avoid problematic substance use.21
LMFTs should continuously yet cautiously explore and evaluate new treatment options. As one such promising example, now may be the time to look into Ketamine Assisted Psychotherapy or KAP for your patients. If you or your patients have experience with ketamine or KAP, we would love to hear from you.
Please email me at Cindy@innerbloomketamine.com with your basic contact information but without personal details or protected information 😊
Important Disclosure: After successfully completing my series of ketamine infusions with IKT, I began to collaborate with Dr Rivas by offering Ketamine Assisted Psychotherapy or KAP to new patients of IKT starting in March 2023.
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