top of page
Profile of bearded man with symbol neurons in brain. Thinking like stars, the cosmos insid

KETAMINE-ASSISTED
PSYCHOTHERAPY

(Currently wait-listing for KAP)

Connecting science, psychology, and soul for the most progressive type of psychotherapy

                                                                                                                                                                                                 

  • Do you struggle with chronic depression that has failed to respond to multiple forms of medication or other treatment?                                                                                               

  • Have you failed to make or sustain progress for another type of mental health disorder? ​

  • Are you motivated to maximize your psychological and emotional growth in a safe, legal, controlled, and supportive setting?

  • After a lifetime of coping with challenges and stressors well, are you struggling with emotions more than ever in mid life or later?

What is ketamine? Is it safe?

 

​Ketamine is a drug that was developed in the 1960's and FDA-approved as an operative and military field anesthetic, as it suppresses the respiratory system less than opioid-based anesthesia. While uncontrolled hypertension and cardiac problems are contraindications, and ketamine treatment may not be advisable for anyone with an existing urogenital or bladder condition, it's been demonstrated as generally safe across a wide variety of medical applications (including pediatric anesthesia). 

Although traditional ketamine isn't FDA-approved for mental health treatment, a molecular variation in intranasal form (esketamine) has been FDA-approved for Treatment-Resistant Depression (TRD). Furthermore, there's a large body of research demonstrating the efficacy of off-label IV infusion for TRD. Evidence that it also treats PTSD and other mental health disorders is mounting.

 

Despite the general safety and efficacy profile of ketamine, one goal of this Ketamine-Assisted Psychotherapy (KAP) approach is to make it psychologically even safer--and more comprehensively effective--as a mental health treatment by:

  • Shifting ketamine treatment from a medical, pharmacological model (symptom-reduction and maintenance) to a psychotherapeutic, psychedelic model (targeting underlying roots of depression, anxiety, or other mental health issues)

  • Preparing and individually pacing the process for effect to the autonomic nervous system, which is both an under-recognized benefit and risk of ketamine and psychedelic treatment (read more about how ketamine behaves like a psychedelic here

  • Creating more strategic and measurable outcomes

  • Adding psychological frameworks suitable for the often transcendent nature of psychedelics, elevating ketamine treatment to a holistic approach that addresses the complex, relational, and sometimes spiritual nature of human struggles

I offer KAP at Wellward Medical, where an MD will provide medical evaluation following psychological assessment and approval. Administration will be via IV infusion or intramuscular injection, with vital sign monitoring. 

Additonal key information:

  • This approach is based on intensive preparation therapy along with integration sessions, so it may not be the best choice if you feel extremely high urgency to begin ketamine treatment for any reason. It is also still too high-risk for some conditions.

  • Although IV ketamine infusion or injection is always an out-of-pocket cost, the preparation and integration therapy sessions are insurance-billable (virtually all insurance types accepted) as are the initial psychological and medical assessment appointments. Contact me for information about ketamine treatment cost.

  • This is not a ''trip-sitting'' or guided therapy approach, as 1) the methods used in preparation therapy generally achieve the same level of depth as the lower ketamine dosing required for guided therapy (see more about this below) and 2) the preparation therapy is designed to prevent the risk of negative or overwhelming experiences that would necessitate support. However, you are always welcome to bring someone to sit with you during the treatment. 

 

How is Ketamine-Assisted Psychotherapy different from regular ketamine treatment?

It's widely recognized within the psychedelic-assisted therapy field that ketamine shares the unmeasurable, but no less important phenomenon of response to ''set and setting:'' a difference in outcome depending on the environment (setting) and user intention (mindset). As the historic psychologist and psychedelic advocate Timothy Leary was quoted: ''The drug dose does not produce the transcendent experience. It merely acts as chemical key--it opens the mind, frees the nervous system of its ordinary patterns and structures. The nature of the experience depends almost entirely on set and setting.’’ The therapeutic term commonly being used for the phenomenon that somehow regulates this is ''inner healing intelligence.'' Just as the body knows how to fully heal a broken bone once it is set properly, the mind-body (mind and nervous system) knows how to heal itself optimally when the treatment conditions are right.

Within the standard medical approach to ketamine, which doesn't promote or acknowledge the psychedelic nature of the dissociative effect, outcomes typically stay in the range of a neurotransmitter mood boost and reduction in the most intense symptom or thought process (such as suicidal ideation). Because the treatment intention is one of pharmacological symptom reduction and maintenance, depression generally eventually returns, and booster treatments are necessary. 

 

Nevertheless, the medical, symptom management approach is nevertheless useful for many people. It can be a better choice when there is inadequate environmental or relational support for the vulnerability psychedelic intention can create. One should not combine a hope to resolve trauma, or otherwise achieve deep healing, with the desire for rapid, straightforward depression relief offered by standard IV ketamine treatment. Both goals are totally valid, but they aren't entirely compatible. To understand this better, read more about the risks of psychedelic intention for ketamine here

What is Ketamine-Assisted Psychotherapy? Comparing approaches

''Ketamine-Assisted Psychotherapy (KAP)'' is currently an unregulated term being applied to various approaches nationwide. 

 

KAP often refers to:

 

  •  A psycholytic, or guided approach. This uses ketamine’s dissociative effect at a relatively low dose that preserves a certain amount of consciousness, enabling the client to dialogue with the therapist. Psycholytic treatment is often used to create more openness, while allowing perceptual distance from overwhelming feelings that may surface through that openness. It may also be used to help someone begin sensing parts of their psyche within the Internal Family Systems approach. It can be the best choice for someone who is newer to therapy, or for someone who struggles to open up in regular therapy.

KAP sometimes refers to: 

  • A minimal-preparation model that makes it logical to sit with a client during a higher dose, and support them through any emerging difficulty. This resembles the classic non-clinical, ‘’trip-sitter’’ approach to psychedelic use: wait to see what comes up, intervene only as necessary, and sort out the effects later during integration sessions. This level of dissociative effect is sometimes referred to as middosing, which refers to the midway point between psycholytic and operative anesthetic dosing. It creates an interiorized, often ‘’hallucinogenic’’ experience that isn’t conducive to therapeutic dialogue.

My KAP approach refers to: 

  • ​Use of intensive preparation therapy that creates a safe roadmap and strategic intention for the psyche to follow with middosing, plus integration therapy sessions that further refine intention as you go. This typically eliminates the need for a sitter, therapist or otherwise. However, this does not mean that the goal is for the client to independently achieve a certain outcome during the ketamine experience itself, which may feel disjointed. Instead, the treatments amplify psychological change already being initiated within the preparation therapy, which involves a combination of modalities that culminate in a bridge approach. A bridge approach approximates the psychedelic effect without medicine, penetrating layers of consciousness enough to access feelings and nervous system reactions repressed beneath. (Note that for this reason, the preparatory bridge approach alone can cause greater vulnerability than standard talk therapy approaches.) I use EMDR, Somatic Interactional Therapy, and Jungian ''active imagination'' (guided imagery journeys) to create sensory awareness of Internal Family Systems ''parts'' before ketamine treatment.

 

By beginning movement through the layers of your psychological structure, bridge therapy preparation accomplishes much of the work that psycholytic or integration-only approaches begin. This has multiple benefits:

 

  • It allows for the deepest, most efficient pace of progress that your nervous system can tolerate, an often overlooked drawback of psychedelic work in retreat settings or integration-only models.

  • Because it creates awareness of your nervous system tolerance, it avoids the risk of challenging or uncomfortable ketamine treatments, ''non-response,'' (a blocked effect), or spiritual bypassing--a mystical experience that feels profound, but creates little to no actual psychological growth.

  • It allows the power of ketamine (or other psychedelics) to be used for greater depth of work.

  • The specificity of intention created by bridge therapy allows a more measurable and enduring outcome. You will revisit your issues and triggers as you spiral away from decline or stasis, but with a framework for understanding how progress continues.

Is this treatment approach right for me?

If you've already been diagnosed with a mental health disorder, please read this detailed list of psychological contraindications and precautions. If you're uncertain about diagnosis or none of those apply, below are considerations that may help you decide whether to proceed with consultation and assessment.

 

This KAP approach may not be best for you if:

  • You are new to therapy, struggle to open up in therapy, or feel skeptical about it

 

  • You currently have inadequate time for multiple daytime therapy appointments, as well as ketamine treatments

 

  • You would struggle to engage in learning about psychological concepts related to the approach

 

  • Due to the current intensity of stressors or lack of outside support, it is the wrong time to ‘’unpack’’ your issues

 

  • You struggle with high-risk behavior and/or are in early substance addiction recovery


This approach may be a good fit for you if: 

 

  • You’re ready to deeply excavate and face issues underlying your symptoms and/or relational patterns

  • You have daytime schedule flexibility for preparation therapy prior to ketamine treatments, and integration therapy sessions between treatments. A minimum of three preparation sessions is required after the initial assessment appointment, but more is recommended. 

  • You have previous experience with therapy, especially approaches beyond talk therapy such as EMDR, ART, or somatic therapy

  • You would enjoy learning about psychological concepts related to the approach, or don't have a significant barrier to doing so

It is so rewarding to help clients with this deep work. I would be honored to hear your story and facilitate your change.

     Ketamine-assisted psychotherapy in Lexington, KY
bottom of page