KETAMINE-ASSISTED PSYCHOTHERAPY 101
I offer a therapeutic modality called Ketamine-Assisted Psychotherapy (KAP) in partnership with an organization called Journey Clinical. Ketamine-Assisted Psychotherapy (KAP) is a holistic modality in which ketamine is used as a complement to psychotherapy to help those who are eligible experience more frequent breakthroughs and sustained improvement.
Disclaimer: Psychedelic assisted therapy is not for everyone & there are varying levels of success & risk. I always encourage those interested to be well-informed & discuss with an experienced mental health professional doing this work. Ketamine-Assisted Therapy, compared to other more traditional psychedelics, can be considered a more gentle experience. This is not meant to disqualify it’s effectiveness as many experts in the field believe that sustainable opening of the mind & progress is important versus going “too big, too soon” which can be harmful.
I take on the psychotherapy portion of the experience, while Journey Clinical’s medical team supports you on all medical aspects. This includes determining eligibility, developing a custom treatment plan, prescribing the medicine, and monitoring outcomes.
Below is more information about KAP to help you navigate if it is a route you want to go.
What is Ketamine?
Ketamine is a safe & effective medicine used to treat a variety of mental health conditions, including anxiety, depression, disordered eating & body image issues, attachment-related patterns, & PTSD. While Ketamine is legal, the use for mental health is considered “off-label” at this time, although doctors have been prescribing for mental health concerns (initially, major depression) for about 20 years.
Ketamine helps to break up any rigid thought, emotion, & behavioral pattern that might be limiting how you experience life. Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hrs. after treatment and last for up to 2 - 2.5 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.
Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, via nasal spray and using sublingual lozenges. In my work with Journey Clinical we only use the sublingual lozenge form.
How Does Ketamine Feel?
The direct effects of ketamine last for approximately 45 - 60 minutes. These effects can make you feel “far from” your body and facilitate shifts in perception that can often feel expansive in nature. Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience. Once these effects subsided, we’ll spend the remainder of our appointment giving you space to process your experience & begin to integrate it into your healing journey. While it may feel hard to articulate what happened during the experience, client feel like the insights gained are nonetheless clear. Studies have shown that the benefits to mood and neurological growth can last up to 2 - 2.5 weeks after the Ketamine experience.
Why are the dissociative effects of Ketamine conducive to therapy?
"Ketamine, however, dissociates the mind from the body. All of a sudden you can work through a problem—you can really look at yourself—without having all the negative feedback from your body. You’re looking at a situation or a memory without your body giving you unpleasant feedback that you’re ashamed, scared, or sad. But in your mind, you’re fully aware, you’re conscious, you’re present. You’re almost able to make changes to how you think and the way you look at the world while you’re in that state. As the ketamine comes down, people often feel differently—better—about a situation that’s been bothering them for a long time. The memory of the trauma is still there—it always will be—but the context has shifted.“
Will Siu, MD, DPhil, previous psychiatrist at Harvard Medical School & current Columbia University Faculty
How Does Ketamine-Assisted Psychotherapy Work?
1. Initial consultation with Journey Clinical
You schedule an initial evaluation with a clinician from the Journey Clinical medical team via Zoom. They will go over your medical and psychiatric history with you, provide education on the treatment and determine if you are eligible for KAP.
If Journey Clinical’s medical team determines that you are eligible for KAP, they will develop a personalized Ketamine prescription and outcome monitoring plan for you.
Journey Clinical’s medical staff will write a ketamine prescription for you, and a small amount of oral ketamine will be sent to your home, enough for the first 2 KAP sessions. You will be taught to take your vitals and self-administer the ketamine lozenges by Journey Clinical’s medical team in advance of our KAP sessions.
2. Preparation sessions:
Once you receive your ketamine lozenges, we will schedule time together for our KAP preparation, dosing and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. The goal of a preparation session(s) is to align on the process and set intentions for our KAP sessions together.
3. KAP Dosing + Integration Sessions
A typical ketamine dosing + integration session lasts typically 2 - 3 hrs. and can take place either in-person at my office, or remotely via telehealth. I try to streamline the process for 2 hour appointment times to help with expenses. With 3 hour sessions I bring in somatic therapy work to help prep & integrate the healing on a deeper, embodied level.
During a dosing session, you will self-administer your ketamine lozenge either in my office or in your home. You will be in a comfortable, reclining position wearing an eye mask and listening to calming music. Although a KAP dosing session may be largely an internal experience, I will be present with you the entire time to hold space and provide support as needed.
After you come down from the Ketamine (45 - 60 minutes approximately), we spend time in the integration process. Essentially this means to review the memories, thoughts & insights that arose during your dosing session as it relates to your healing. We make sense of it all together & the meaning & significance to you. We also discuss how you can further this experience in your day-to-day.
I cannot emphasize enough that Ketamine is a conduit to allow for change to happen, yet the openness to your experience & the consistency with integration practices is crucial. What you get out of it can depend on how self-disciplined you are during the integration period between sessions.
You may be thinking can this therapy really be done virtually?
It may feel anxiety-inducing to think about doing it virtually, but there are protocols put in place, including having a chaperone on call, & we oftentimes start with a conservative dose to help you acclimate. Being in your own space where you feel the most comfortable can also be a plus.
5. Follow-up consultations with Journey Clinical:
After our first KAP session, Journey Clinical’s medical team schedules regular follow ups with you to monitor outcomes and prescribe ketamine lozenge refills, as appropriate. The frequency of follow ups depends on your unique treatment plan, at a minimum of once per quarter.
Follow-up Consultations with Journey Clinical :
After our first KAP session, Journey Clinical’s medical team schedules regular follow ups with you to monitor outcomes and prescribe ketamine lozenge refills, as appropriate. The frequency of follow ups depends on your unique treatment plan, at a minimum of once per quarter.
Success Stories
Click to hear from other KAP Therapists & Providers about the amazing transformation they’ve seen with their clients. Link: Ketamine Assisted Therapy Success Stories
What is the Cost of Treatment?
Ketamine-Assisted Psychotherapy has the potential to be more effective & cost effective overall versus engaging in years & years of talk therapy which has it’s limits on efficacy. Talk therapy alone cannot rewire patterns in your brain like Ketamine can assist with. Although the medical intake and follow-ups are not covered by insurance, they are eligible for out-of-network reimbursement.
Journey Clinical Medical Costs: Medical Intake: $250 (One time fee, reimbursable through out-of-network): Follow-up Sessions: $150/Session (minimum of 1/quarter, reimbursable through out-of-network)
Cost of Ketamine Lozenges: initial 2 sessions: $85
Additional lozenges after follow-up (to ensure dosing is customized correctly): $145
Ketamine-Assisted Psychotherapy: My hourly rate is $165/hr; can submit reimbursement as out-of-network provider
Suggested # of Sessions & Frequency: 6 - 8 dosing + integration sessions every 2 weeks
From lead prescriber at Journey Clinical:
“On average, 2 weeks is a good anchor for cadence considering the neuroplastic boost, which lasts from 2-2.5 weeks. As noted, most protocols call for 6 dosing sessions, so this is what we'd state would be a good "trial." Ideally, these dosing sessions are happening in a regular cadence.
All that to say, it's so highly personalized, and there are some that have 1-2 dosing sessions and spend a fair bit of time doing integration work with positive outcomes. Some might do much more. So it seems reasonable to plan for the 6 sessions and check in after that point.
The first two dosing sessions are ultimately meant to get a client accustomed to the medicine and to ensure that the dosing is appropriate, in addition to the benefit they might receive, which would then be followed by the additional 4-6 dosing sessions they get access to at follow-up.”
Reminder: I can provide receipts as we go for reimbursement as an out-of-network provider. We also can discuss conditions for self-administering & taking ketamine without me present as a guide as an option to reduce cost. We would still do the integration therapy together as that is necessary for lasting change.
How Do I Sign Up?
If you would like to explore the possibility of working with me on KAP, please call at 469-573-2672 to discuss eligibility & next steps. If ready to schedule your first intake & prep session with me, feel free to self schedule click here.
Helpful Resources:
1. An Introduction to Ketamine Assisted Psychotherapy by Psychology Today
2. Paradigms of Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS
4. Ketamine for Depression and Mood Disorders by Erica Zelfand, ND for Townsend Letter
5. Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression by goop
6. Yale University: How Ketamine Works
7. How To Change Your Mind (about psychedelics for mental health in general)