Ketamine-assisted Therapy

Although ketamine is different in chemical structure than other "classic psychedelics," such as LSD, DMT and psilocybin, the experiential effects and therapeutic benefits of ketamine, when taken at appropriate doses, are markedly psychedelic in nature.

Empirical research has shown KAT to be an effective therapeutic modality in the treatment of such mental health conditions as post-traumatic stress disorder (PTSD), depression, generalized anxiety, burnout/adjustment disorder, substance use disorder (SUD), obsessive compulsive disorder (OCD), disordered eating, and disordered sleep. In addition, KAT has demonstrated good safety and tolerability among individuals seeking treatment for mental health issues (Dames, Kryskow & Watler, 2021; Tsang et al., 2023). 

Doing KAT with Deep Awakening can involve working in a "psychedelic" and/or "psycholytic" context. When working in a psycholytic context, I have found that combining KAT with a "Parts Work" approach can be a powerful method of healing. (More information about Psychedelic versus Psycholytic Therapy and Parts Work is provided below.)

The initial phases of therapy - establishing trust, understanding the process, and clarifying your intentions - are done online and without medicine. Medicine sessions generally occur in person (in Campbell River, BC).

You and your therapist can discuss whether working in a psychedelic or psycholytic context may be the best fit for you.

Psychedelic Therapy uses a high dose of a psychedelic medicine (in this case ketamine), along with professional psychotherapeutic support, to induce profound changes in perception, mood, and thought processes. Clients in psychedelic therapy typically have inward experiences in which they do not engage with the external world, but rather have deep encounters with the inner dimensions of the mind, and potentially have profoundly expansive experiences into mysterious realms that could be regarded as spiritual. Psychedelic therapy can involve a single medicine session, or multiple medicine sessions spaced out for adequate integration time.

Psychedelic therapy can promote healing in a number of ways, including: 

1. By disrupting the default mode network (DMN), a brain network associated with self-referential thought and rigid, repetitive thinking patterns common in conditions like depression and anxiety. By disrupting the DMN, the brain's communication patterns become more flexible and adaptive; 
2. By promoting neuroplasticity, the brain's ability to reorganize and form new neural connections. This allows for the development of new, healthier neural pathways and perspectives, which can help break long-standing cycles of maladaptive thoughts and behaviors;
3. By inducing intense, subjective experiences, which can include emotional breakthroughs, reliving past memories with a new emotional capacity, and/or a sense of profound connection or spiritual transcendence. These experiences can be deeply meaningful and provide insights that lead to lasting cognitive, emotional and behavioural changes.

The psychedelic therapy process is divided into three key phases: 

1. Preparation: In sessions leading up to the drug administration, the client and therapist build trust, discuss intentions, and prepare for the potential experiences of the medicine session, including challenging ones.
2. The Medicine Session: The client ingests a carefully measured dose of the psychedelic substance (in this case ketamine) in a safe, comfortable, and monitored environment. The therapist remains present throughout the experience to ensure physical and psychological safety and to provide support as needed.
3. Integration: In subsequent non-medicine therapy sessions, the client processes their experience and the insights gained during the psychedelic journey. The goal is to translate these insights into lasting, positive behavioural changes and a revised understanding of oneself and/or one's relationships. 

Psycholytic Therapy uses a low to moderate dose of a psychedelic medicine (in this case ketamine) over multiple sessions to temporarily soften psychological defences and enable a person to deeply explore and process emotional material, conflicts, and memories within a traditional psychotherapy context. Clients in psycholytic therapy experience a mild, non-ordinary state of consciousness, but also remain fully oriented to their external environment and in relationship with the therapist. In essence, the psycholytic dose of medicine acts as a tool to enhance and accelerate traditional talk therapy by making the unconscious mind more accessible and the client more open to processing and integrating deep emotional material.

Psycholytic therapy typically involves multiple medicine sessions, sometimes interspersed with non-medicine integration sessions. The number and frequency of sessions is variable and depends on multiple factors, including client preference and clinical need. When doing psycholytic KAT, my approach typically involves Parts Work, which is discussed further below.

Parts Work - including, but not limited to, Internal Family Systems therapy (IFS) - is a psychotherapeutic approach that views the human personality as made up of multiple "parts" or subpersonalities, each with unique emotions, beliefs, roles, and traumas. The goal of Parts Work is to  help individuals heal emotional wounds, experience greater self-compassion, better understand inner conflicts, change unhelpful behaviours, and more effectively navigate external relationships by fostering harmony amongst their inner parts and helping these internal aspects release traumatic burdens.

In my experience, psycholytic KAT lends itself very well to Parts Work, with many clients easily accessing and working with their inner parts while in the psycholytic container. The psycholytic dose of ketamine helps to lower psychological defences and foster openness to inner exploration with heightened courage, curiosity and self-compassion.

Dames S, Kryskow P, Watler C. A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression. Frontiers in Psychiatry. 2021;12. DOI: 10.3389/fpsyt.2021.803279 

Tsang VWL, Tao B, Dames S, Walsh Z, Kryskow P. Safety and tolerability of intramuscular and sublingual ketamine for psychiatric treatment in the Roots To Thrive ketamine-assisted therapy program: a retrospective chart review. Therapeutic Advances in Psychopharmacology. 2023;13. DOI:10.1177/20451253231171512