Educating Yourself About Psychedelic Medicine
One Ketamine Therapist’s Perspective
Below is an email I sent to the participants of a lecture on psychedelic medicine I was invited to speak at. I know a lot of people have an interest in the subject so I thought I’d post one psychedelic therapist’s thought about the field.
Please know the info expressed is all MY take on things. It is based on my personal and professional experiences, a lot of training and observation after being a therapist for nearly 20 years and working with psychedelics for over 5 years. It is not the only opinion. What is most important when considering doing psychedelic medicine is to LOOK WITHIN, generally avoid medicines that terrify you or that you don’t feel a deep calling to, and do your due diligence when finding practitioners, above or below ground.
As you can tell the landscape of psychedelic medicine is quite complex and as Dr. De La Garza said, there are yet to be best practices in place. Since our time was short during the presentation I wanted to offer some additional details to help clarify some basic information.
Classic psychedelics include plant medicines such as ayahuasca (DMT), San Pedro (mescaline), and mushrooms (psilocybin). Each one of these medicines has a unique duration, ingestion, preparation process, and experience. However, they are more similar to each other than to other medicines. By contrast, other classic psychedelics such as Iboga (ibogaine) and 5-MeO-DMT are not like each other or any other classic psychedelic.
Other non-classic psychedelics include MDMA and ketamine. MDMA is close to being approved as a legally describable medicine for therapeutic use. MDMA is actually classified as an amphetamine but does not behave in the same way as most amphetamines, except as it elevates heart rate and raises blood pressure. Instead, the experience of MDMA is primarily “empathogenic.” It has no psychedelic effects (such as intense visuals or distortion of time). MDMA is a physical experience and increases tactile awareness and empathy for self and others. In contrast, ketamine, is currently legal and widely used and can also increase compassion for self and others. It is HIGHLY psychedelic and in higher, or “dissociative” doses, can illicit intense psychedelic visuals, entheogenic awareness, and even a complete disconnect between awareness and the sense of self as located in the body.
I also want to clarify five ways ketamine is used currently. There will be variations to these four depending on clinic, philosophy and provider.
1. At ketamine clinics are where people go into small rooms, either alone with other patients, but usually alone, and sit in a chair with music playing on headphones, and an eye mask on, to promote in inner exploration. They usually receive medium to high doses of IM or IV ketamine. Please understand, this is not a therapeutic setting, it is a clinical one. Most clinics employ PAs or NPs to administer the ketamine. The clinic may or may not have provided adequate (or any) preparation to the patient for the experience. The prescribing clinician may help the patient set an intention for the journey and provide a handout with journal prompts and recommendations for consolidation of gains, post experience. This by the way is not ketamine-assisted psychotherapy (KAP), it is ketamine-assisted therapy (KAT). This type of use can be effective for appropriate patients.
This is the medical model of ketamine administration and is based on a belief that medicine, not experience, is the agent of change. Unfortunately for many people, especially those with PTSD and C-PTSD, this experience is confusing at best, and re-traumatizing at worst. I have received many calls from people who have had concerns ranging from, “I don’t know what I was supposed to do or get out of that.” to “ I feel worse than before.”
2. Patients do high-dose ketamine as outlined above but with the addition of adequate preparation and immediate integration with a therapist (within 24–48 hours while neuroplasticity is at its peak). Solid preparation involves 1–2, hours of discussion, if not more, depending on the degree of trauma the patient has experienced and the degree of support and resources they already have. I ask my client’s to prepare to do 1–5 prep-sessions. The more prepared, the more the patient is likely to get from the experience.
This model is very effective for people who can safely experience high-dose ketamine alone. We have seen amazing results after just 6 sessions for many people. Having a trusting relationship already established with a therapist for pre and post-sessions also go a long way in helping them feel safer while alone in the experience.
3. Patients do a high dose, at a ketamine clinic or in a therapist’s office, but the therapist is there the entire time. This is the original model from Phil Wolfson, one of the grandfathers of Ketamine Assisted Psychotherapy (KAP).
This model is ideal but because ketamine lasts 1- 3 hours, there is the added expense of employing the therapist. This type of work may have as many sessions as the patient needs, often between 3–6 or more. The patient and therapist will evaluate together to determine when the work is complete and it is time to terminate or pause. This should be largely dictated by the patient’s inner wisdom. The therapist simply acts as an observer to alert if there is obvious material hidden in the shadows. It can be appropriate for a patient to do a “chunk” of work and then take a break to integrate. The therapist should be sensitive to deferring to the client’s perspective and not interject too much of their own biases. No one can be in another’s inner world or know what is best for someone else. If you work with a prescriber or provider who tells you what you need, please run. You are the expert on you. The therapist is simply there to offer professional guidance and experience. Do not defer your healing on to anyone. It simply will not work.
4. Patients use “psycholitic” doses (non-dissociative, lower doses) of ketamine with a therapist, at the therapist’s office. These sessions last around 90 minutes. The patient may stay mostly engaged with the therapist the entire time, or go into an internal meditative process and then process with the therapist at the end. At lower doses, ketamine has both empathogenic and the psychedelic effects. It also quites the “default mode network” so the patient can relate to themselves and the therapist from a non-habituated, generally, deeper experience of themselves and the memories they process.
I generally work with patients using psycholitic ketamine in two ways.
The first is to have ketamine sessions twice a week, for a limited amount of time. The advantage here is the brain has 6 out of 7 days of neuroplasticity with which to make the changes they want, as opposed to 3 days, with 4 left in the week to lapse more easily back into old patterns. The drawback to this is model, is the patient will benefit most if they commit to blocking out time from their usual patterns and activities in which to foster the new. Not everyone has the resources of time or money to do this. Any old patterns reverted to will simply get reasserted (this is true of all ketamine use or changes to neurobiolical habits).
Another other way I use ketamine is once a week, for a series of 6 or so sessions with a non-augmented sessions for integration in between. In this case, we work similarly (but not exactly) to a regular “talk” therapy session and with more time for integration and practice.
Regardless of whether we are doing bi-weekly, time-limited, or weekly, ongoing sessions people usually begin seeing changes after 2-6 ketamine sessions.
I always rrequest 2–5 unmedicated sessions for preparation and to get to know each other. The safer a patient feels, the faster and deeper the work will go, and I request we have an unmedicated, “check-in” session about 3 ketamine visits. The purpose of unmedicated “check-ins” is to explore from an unaltered consciousness perspective, how things are going and evaluate what changes we want to make to the process.
Some people will benefit from unaugmented integration sessions after each ketamine sessions to help anchor and consolidate gains.
5.I now believe group ketamine to be the most powerful and fastest route to healing. Working in a safe, small group container has the added benefits of processing in the presences of others who can witness and share their experiences. Having multiple mirrors helps us feel less alone and see the universality to our painful experiences. It also helps us learn from others about healing and growth. I have continually been in awe of the rapid and transformative changes that can occur in as little as five weeks, in a safe and healthy, group experience.
As you can see education about psychedelic medicine is quite an endeavor. For this reason some clinicians do not believe a provider should refer patients to these resources without having experienced or studied them, to some degree. This of course, is not everyone’s perspective. My advice is to be mindful and diligent about educating yourself and managing expectations. Look for referrals to sources who have solid reputations from patients who have used their services. Resources on group ketamine can be found in your area by doing a simple google search but again, make sure to do your own vetting.
Also, know that any psychedelic consultant, such as myself, does not have equal knowledge of all psychedelic topics. For instance, there are people who specialize in psilocibyin micro-dosing procedures, or ayahuasca but don’t know about Iboga or ketamine. I am more of a generalist but with the most knowledge of ketamine. There are also people who specialize only in ketamine and know more than I do. Just as doctors specialize, most people don’t know all there is to know about all psychedelic medicine’s or considerations. And like doctors, sometimes it is helpful to get multiple opinions as once again, THERE ARE NO BEST PRACTICES as yet, and opinions will vary.
Do you due diligence, these medicines are powerful healers but don’t believe the hype. Nothing can cure you, they can only help you on your journey to doing your own healing work.
If you would like more information about psychedelic consultations or group ketamine work in the Salt Lake City area, please feel free to contact me at the Contact Us at www.BeewellSLC.com
