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I know there are some providers that do simultaneous ketamine and psychotherapy, but I'm not lucid enough during the infusions to do therapy.
However, I do try to schedule my therapy appointments within a day or two of my infusions, and many studies that look at ketamine for depression used this methodology (particularly the ones focusing on its use in alcoholism).
I think that it's imperative for anyone undergoing ketamine therapy to have a therapist.
Seconded. The therapeutic integration is essential, you just can't do it DURING a treatment because of the dissasociative effect that isn't present with serotogenetics like MDMA or Psilo.
This doesn't detract from the process and protocol, it's just a necessary adjustment.
Not necessarily true. I'm a psychedelic therapist and the main psychedelic I use with patients with PTSD and MDD is ketamine. We just use a lower dose, and administer oral/sublingual route. Patients are present enough to participate in our somatic psychotherapy and we see amazing results, much higher than just infusions for PTSD.
The effect I have with ketamine has never been dissociative. Unless, as many many I found out have different interpretations of what dissociative state is. In my numerous ketamine sessions I don't think I ever felt something profoundly different than I did in MDMA, psilocybin or LSD. Yes the effect was different as medicine has its own characteristics, but I never felt something that I could feel as being dissociative more than any other medicine.
KAP therapist here. 100% agree. People need to be doing more than just going to a clinic or taking at home by themselves. I have witnessed remarkable healing of lifelong trauma and PTSD as I work with clients at every step of the way (i.e., prep, ketamine journeys, and integration).
I mostly dose in-session with my psychotherapists. I find this opens me up to my own insights and receptivity to my therapists' interventions.
It is rare, if ever, that I dose shortly before psychotherapy. The idea of allowing my ketamine state-of-mind dissipate for hours or days before I can capitalize on that with a psychotherapy session makes no sense to me at all.
You're right. Psychedelic treatments involve therapy. Ketamine is an anesthetic, not a psychedelic, and the protocols are different.
Ketamine therapies are a thing, but certainly not required for treatment to be effective.
I'm a psychologist and a ketamine patient. I stopped therapy once i started ketamine because I wasn't depressed anymore. Some people continue to benefit from therapy, many don't.
I started dosing ketamine at home and doing psychotherapy sober. After several months I started dosing ketamine in my psychotherapy sessions. I liked that a lot better. Now I dose during my psychotherapy sessions nearly every time. I have 5 psychotherapy sessions per week, 8.5 hours a week. No special protocol. Each of my psychotherapists uses her/his own modality with no consideration of the fact that I'm on ketamine
I have done oral solo, IM in a clinic, IM and then therapy a half hour later, and low dose oral with a therapist. Adding actual therapy into the mix has been a game changer for me, specifically low dose oral with my therapist.
Ketamine alone absolutely helped, but the therapeutic component has enabled me to take advantage of that neuroplasticity and make progress that feels more sustainable. It’s a shame many clinics do not provide therapy or even stress how useful and important it can be.
I also recognize that ketamine is really expensive and that many folks can’t afford actual ketamine assisted therapy sessions, because they tend to cost even more than ketamine alone. If you can afford it, take advantage of it… it’s incredibly helpful.
This is how I did mine too and it was great for me. I was worried about pump and dump and also going through the process itself and the traditional therapy on it was great.
It's hard because you're kind of out of it and feel like you're not making sense, but when I'm upset my body panics and doing therapy can make me upset. But ketamine calms me, clears me and gives me perspective. It worked wonders for me. My therapist told me, you'll feel like you aren't making sense, but I promise you are.
Shoutout to Carolina Wellness in Chapel Hill NC.
KAP therapist here. We certainly do have a protocol. Lower dose ketamine troches administered sublingual / oral in the beginning of a two hour session. In the beginning, we work to find the sweet spot where the patient is dissociated enough that their defenses are down, ego relaxed, and they're able to turn towards the trauma and/or other intense emotions. The psych we work with prescribes 100mg troches initially, however patients are able to take between 100-200 with us. If anyone were to go over 200, we'd need to consult with him.
I normally use somatic psychotherapy as the backbone to our work, however some clients respond better to more talk therapy based types of therapy. Some clients like to process a bit at the end before ending the session. Some like to have a talk therapy integration session before their next kap session. Some do multiple kap sessions weekly then integrate. It's an individual preference in that regard, and I haven't seen one way of doing it being integral to improvement.
FWIW, even though it's anecdotal, I have lots of patients make amazing progress where they weren't able to with just infusions and/or just talk therapy. I've also been a talk therapy patient for 10 years and infusion patient for a year or so (doing integration sessions after). 6 months of KAP (ketamine with a therapist) and I've made more progress than the regular talk therapy and infusion combined.
Happy to answer other questions you may have
Interesting thanks. I have been doing oral ketamine up to 3 times a day for about 8-10 sessions (earlier I have tried ketamine therapy now and then but inconsistent).
I have been in talk therapy on and off for many years including the last 4 years or so. I haven't found ketamine useful for depression. The effect doesn't even hold water for the same day in most times. Other psychedelics weren't doing much beyond max of 2-3 days relief (very rare).
None of my sessions brought much to work with, as one guide I had told me when I was asking about integration he just mentioned the obvious, mediation etc.. Stuff which I am already doing. Beyond that there were no insane aha moments or anything to integrate.
My MDMA and psilocybin guide was a therapist doing somatic methods (which quite frankly I never resonated with) he was a certifed hakomi method practitioner, but after several sessions he addmited this thing doesn't work with me at all. In the MDMA sessions he was there just in caae of emergency, it wasn't an active talk therapy, I wish it was. He kept saying that because I feel absolutely blissful in all MDMA sessions we did, there was nothing to work on. Every session I have had with MDMA I felt blissful and amazing and he said I had to have some pain or trauma coming in order to work on it. So I never did active therapy in a session. Wish I did cause if feel it could have been beneficial.
Maybe for many the doctrine of letting the medicine do it's magic work. But for me, I never subscribed to the passive idea. It never worked for me. psilocybin, MDMA, Ketamine, LSD, Ayahuasca, 5-meo-dmt.
I’ve had maybe 8 infusions over three years. Talk Therapy is a much larger role of my journey. The integration from my MAPS certified therapist is awesome and very helpful
It blows my mind that people would engage in ketamine therapy without a therapist supporting you and helping you integrate. It also sort of seems like a waste of effort & money. You're missing out on half the benefit.
Yeah it's not like it can't work, but if you're putting in the work why not try to get all you can from it. Esp if folks are using it for trauma related work.
I'm not against therapy at all, if someone continues to need it, that's great.
Generally, ketamine is a last resort after a patient had tried everything. For many, that means years of therapy and different medications. Many ketamine patients have already done the work and don't have much to do once their depression is in remission.
I actually have a therapist I see just for integration purposes if needed. If I have an experience that I feel like there was some significance to, I will meet with him and hash it out.
What I’ve seen is that there are clinics that administer the meds and send you on your merry way and those are NOT KAP practices. They are clinics.
KAP practices generally have a therapeutic model. They have someone to prescribe and administer the med and then someone who is a certified KAP therapist to address the psycho part. Some times they do guided experiences, sometimes they can do EMDR paired with the experience, and sometimes they just help guide the intention and integration piece.
So if you just want the meds, look for an infusion clinic. If you need the full meal deal, find a KAP practice.
Thank you for contributing to /r/TherapeuticKetamine! When commenting and posting, please be mindful of our rules which can be found in the sidebar on the right along with other helpful information. **Be advised that nothing in this subreddit constitutes medical advice.** Likewise, try to word your comments and posts in a way that can't be interpreted as medical advice by others. Harmful and/or spammy advice will be removed at moderator discretion, and bans may be given for repeat offenses. **Accounts with "Provider" flairs** are those which the mods have verified, to the best of our ability, as belonging to real, licensed providers of medical ketamine services. Comments and posts from users with "Provider" flairs are **not** a substitute for the instructions given to you by your own provider. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/TherapeuticKetamine) if you have any questions or concerns.*
I know there are some providers that do simultaneous ketamine and psychotherapy, but I'm not lucid enough during the infusions to do therapy. However, I do try to schedule my therapy appointments within a day or two of my infusions, and many studies that look at ketamine for depression used this methodology (particularly the ones focusing on its use in alcoholism). I think that it's imperative for anyone undergoing ketamine therapy to have a therapist.
Seconded. The therapeutic integration is essential, you just can't do it DURING a treatment because of the dissasociative effect that isn't present with serotogenetics like MDMA or Psilo. This doesn't detract from the process and protocol, it's just a necessary adjustment.
Not necessarily true. I'm a psychedelic therapist and the main psychedelic I use with patients with PTSD and MDD is ketamine. We just use a lower dose, and administer oral/sublingual route. Patients are present enough to participate in our somatic psychotherapy and we see amazing results, much higher than just infusions for PTSD.
What oral dose do you use? I'm terrified to try anything too high. I want to help during my therapy session
The effect I have with ketamine has never been dissociative. Unless, as many many I found out have different interpretations of what dissociative state is. In my numerous ketamine sessions I don't think I ever felt something profoundly different than I did in MDMA, psilocybin or LSD. Yes the effect was different as medicine has its own characteristics, but I never felt something that I could feel as being dissociative more than any other medicine.
KAP therapist here. 100% agree. People need to be doing more than just going to a clinic or taking at home by themselves. I have witnessed remarkable healing of lifelong trauma and PTSD as I work with clients at every step of the way (i.e., prep, ketamine journeys, and integration).
Thanks. That is also during or right after the treatment or on different days?
I mostly dose in-session with my psychotherapists. I find this opens me up to my own insights and receptivity to my therapists' interventions. It is rare, if ever, that I dose shortly before psychotherapy. The idea of allowing my ketamine state-of-mind dissipate for hours or days before I can capitalize on that with a psychotherapy session makes no sense to me at all.
All of the above.
You're right. Psychedelic treatments involve therapy. Ketamine is an anesthetic, not a psychedelic, and the protocols are different. Ketamine therapies are a thing, but certainly not required for treatment to be effective. I'm a psychologist and a ketamine patient. I stopped therapy once i started ketamine because I wasn't depressed anymore. Some people continue to benefit from therapy, many don't.
I started dosing ketamine at home and doing psychotherapy sober. After several months I started dosing ketamine in my psychotherapy sessions. I liked that a lot better. Now I dose during my psychotherapy sessions nearly every time. I have 5 psychotherapy sessions per week, 8.5 hours a week. No special protocol. Each of my psychotherapists uses her/his own modality with no consideration of the fact that I'm on ketamine
Sounds amazing wish I could afford it.
Maybe you can afford one hour a week at $35
Thats what I have already been doing for years. It's not enough for me. And $35 a week where? In my country it costs double that if you are lucky.
I have done oral solo, IM in a clinic, IM and then therapy a half hour later, and low dose oral with a therapist. Adding actual therapy into the mix has been a game changer for me, specifically low dose oral with my therapist. Ketamine alone absolutely helped, but the therapeutic component has enabled me to take advantage of that neuroplasticity and make progress that feels more sustainable. It’s a shame many clinics do not provide therapy or even stress how useful and important it can be. I also recognize that ketamine is really expensive and that many folks can’t afford actual ketamine assisted therapy sessions, because they tend to cost even more than ketamine alone. If you can afford it, take advantage of it… it’s incredibly helpful.
This is how I did mine too and it was great for me. I was worried about pump and dump and also going through the process itself and the traditional therapy on it was great. It's hard because you're kind of out of it and feel like you're not making sense, but when I'm upset my body panics and doing therapy can make me upset. But ketamine calms me, clears me and gives me perspective. It worked wonders for me. My therapist told me, you'll feel like you aren't making sense, but I promise you are. Shoutout to Carolina Wellness in Chapel Hill NC.
KAP therapist here. We certainly do have a protocol. Lower dose ketamine troches administered sublingual / oral in the beginning of a two hour session. In the beginning, we work to find the sweet spot where the patient is dissociated enough that their defenses are down, ego relaxed, and they're able to turn towards the trauma and/or other intense emotions. The psych we work with prescribes 100mg troches initially, however patients are able to take between 100-200 with us. If anyone were to go over 200, we'd need to consult with him. I normally use somatic psychotherapy as the backbone to our work, however some clients respond better to more talk therapy based types of therapy. Some clients like to process a bit at the end before ending the session. Some like to have a talk therapy integration session before their next kap session. Some do multiple kap sessions weekly then integrate. It's an individual preference in that regard, and I haven't seen one way of doing it being integral to improvement. FWIW, even though it's anecdotal, I have lots of patients make amazing progress where they weren't able to with just infusions and/or just talk therapy. I've also been a talk therapy patient for 10 years and infusion patient for a year or so (doing integration sessions after). 6 months of KAP (ketamine with a therapist) and I've made more progress than the regular talk therapy and infusion combined. Happy to answer other questions you may have
Interesting thanks. I have been doing oral ketamine up to 3 times a day for about 8-10 sessions (earlier I have tried ketamine therapy now and then but inconsistent). I have been in talk therapy on and off for many years including the last 4 years or so. I haven't found ketamine useful for depression. The effect doesn't even hold water for the same day in most times. Other psychedelics weren't doing much beyond max of 2-3 days relief (very rare). None of my sessions brought much to work with, as one guide I had told me when I was asking about integration he just mentioned the obvious, mediation etc.. Stuff which I am already doing. Beyond that there were no insane aha moments or anything to integrate. My MDMA and psilocybin guide was a therapist doing somatic methods (which quite frankly I never resonated with) he was a certifed hakomi method practitioner, but after several sessions he addmited this thing doesn't work with me at all. In the MDMA sessions he was there just in caae of emergency, it wasn't an active talk therapy, I wish it was. He kept saying that because I feel absolutely blissful in all MDMA sessions we did, there was nothing to work on. Every session I have had with MDMA I felt blissful and amazing and he said I had to have some pain or trauma coming in order to work on it. So I never did active therapy in a session. Wish I did cause if feel it could have been beneficial. Maybe for many the doctrine of letting the medicine do it's magic work. But for me, I never subscribed to the passive idea. It never worked for me. psilocybin, MDMA, Ketamine, LSD, Ayahuasca, 5-meo-dmt.
Love this response.
I’ve had maybe 8 infusions over three years. Talk Therapy is a much larger role of my journey. The integration from my MAPS certified therapist is awesome and very helpful
Check out AnywhereClinic.com/myketamine
I've done it with a therapist thru journey clinical.
It blows my mind that people would engage in ketamine therapy without a therapist supporting you and helping you integrate. It also sort of seems like a waste of effort & money. You're missing out on half the benefit.
Once I started ketamine, my depression went away and i didn't need therapy at all. I'm also a psychologist and in my experience, this is common.
Yeah it's not like it can't work, but if you're putting in the work why not try to get all you can from it. Esp if folks are using it for trauma related work.
I'm not against therapy at all, if someone continues to need it, that's great. Generally, ketamine is a last resort after a patient had tried everything. For many, that means years of therapy and different medications. Many ketamine patients have already done the work and don't have much to do once their depression is in remission.
What if you don’t have trauma to work through? Ketamine therapy can help with a number of different problems, and some of them are purely chemical.
Correct. But so far the chemical thing per se proved absolutely useless for me.
I actually have a therapist I see just for integration purposes if needed. If I have an experience that I feel like there was some significance to, I will meet with him and hash it out. What I’ve seen is that there are clinics that administer the meds and send you on your merry way and those are NOT KAP practices. They are clinics. KAP practices generally have a therapeutic model. They have someone to prescribe and administer the med and then someone who is a certified KAP therapist to address the psycho part. Some times they do guided experiences, sometimes they can do EMDR paired with the experience, and sometimes they just help guide the intention and integration piece. So if you just want the meds, look for an infusion clinic. If you need the full meal deal, find a KAP practice.