KAP is an emerging field that can be a transformative mode of healing, helping you navigate and integrate your experiences and insights from ketamine. Working with the medical team at Avesta Ketamine and Wellness in Bethesda, I provide personalized support through all phases of your treatment (www.Avestaketaminewellness.com).
The sense of support and connection with your therapist is part of the healing in KAP. Much psychological dis-ease that clients bring to KAP stems from experiences of not feelingsupported, validated, or respected by others. Given the vulnerable state that psychedelic journeys put you in, it is important to feel comfortable and safe with your facilitator rather than replicating these negative experiences.
We will meet a minimum of twice prior to your first trial of ketamine. At least one of those meetings will be in person. I will be with you during your initial ketamine journey, with an opportunity to process immediately afterwards. We will then determine whether you would like me to continue to accompany you for subsequent sessions. If not, we will meet for processing within 48 hours of each session. If you are currently in therapy, we will assess what kind of communication would be appropriate between myself and your therapist or psychiatrist. I will be in communication with your provider at Avesta.
About me
I am a seasoned psychologist with almost 3 decades of providing psychotherapy. I have additional training and experience practicing and teaching embodied practices such as yoga, meditation, and iRest yoga nidra. I am also a SoulCollage® facilitator, a process Stanislav Groff endorsed for integration following non-ordinary states of consciousness. Ongoing education and training around psychedelic-assisted therapy and ketamine treatment are critical to my work, as well as individual supervision from Ben Bregman, MD, an integrative psychiatry specialist at Washington Integrative Mental Health Services (www.washingtonimh.com). While my therapy approach leans toward nondirective, my approach for KAP is to “get out of the way” and let your innate healing intelligence guide your journey.
Conversations about safety
Your prescribing physician and Avesta will determine whether your medications or medical condition are safe to combine with KAP. For example, clients with high blood pressure or other cardiac issues need to check with their doctor before being prescribed ketamine. Our work together focuses on helping you feel safe and open to the experience. I encourage you to ask as many questions as you need to feel like you understand the treatment process and know what to expect. We can discuss power dynamics and privilege (e.g., if you hold a marginalized identity, how might working with me affect your sense of emotional safety?). If you would like supportive touch during your journey, we will discuss what touch will be used and plan how you will communicate around touch. During preparation sessions we can practice forms of touch as well as asking for or rejecting touch.
Your Experience at Avesta
You will have a private treatment room at Avesta, and choice around lighting, where I sit in relationship to you, and what will make you feel most comfortable in the room. Avesta offers fully reclining chairs, blankets and eye shades. I offer a sandbag (similar to a weighted blanket), scented oils and embodiment practices. We will discuss what you might want to bring with you, e.g. a photo, a sacred or tactile object, etc. Ideally, you will create or curate your own music playlist for the journey.
Intention setting
KAP is typically a short-term course of treatment that can amplify, accelerate, or help you get unstuck in work that you may already be doing in traditional psychotherapy. It can be helpful to go into your first session with an idea of the topics you want to explore or the symptoms you want to target. Sometimes these intentions are broad: “I want to be open to what the medicine has to show me.” Other times, they may be more specific: “I want to understand why I criticize my partner when I get stressed.” Ketamine can deliver surprise insights and offer a new roadmap for your work, so it is imperative to stay open to what comes up.
The journey
Each journey is unique. Difficult emotions can arise during KAP. Fear and anxiety are common, especially in the first few sessions. Having go-to stress management and distress tolerance skills are a must. These are skills you practice, to learn how to calm yourself down in moments of heightened stress or anxiety. Common skills include breathing techniques, grounding exercises, meditation, or somatic practices. We will incorporate these skills into preparation sessions and use them at the start of each treatment session.
Subjective Effects
Each experience is unique. You might experience:
Pain relief;
Muscle relaxation;
Altered auditory perception and proprioception;
Mood enhancement;
Feelings of awe and wonder;
Mystical experiences;
Experiences of death and rebirth;
Ego dissolution;
Transcendence of time and space;
Disassociation;
Feelings of disembodiment;
Vivid imagery, visual hallucinations or distortions;
Out-of-body experiences or illusions;
Changes in perception, cognition, and emotion
Difficult journeys
Since each experience is unique, some sessions may feel radically different than others. We have an inner healing intelligence, the intuitive part of us who knows what we need to heal, andknows what kind of journey we need. It can be helpful to think of this inner intelligence as guiding us during journeys that are difficult, or perhaps just different from what we thought they’d be. Often the most difficult journeys are the ones we learn most from. Somatic releases—crying, screaming, shaking, sweating—and challenging emotions or memory can be difficult to sit with, but also cleansing and healing. Of course, blissful experiences are always wonderful, too, but if we had those every time, we may not do some of the hard work needed to heal.
Aftercare and integration
Integration starts the moment you finish the infusion session, so it’s important to be intentional about creating an environment that promotes rest, recovery, and space to integrate.
First, you will be hungry. Avesta has granola bars, but you might want to bring a snack, or plan on having a bite to eat nearby (e.g. The Big Greek Café at 4806 Rugby www.greekcafe.com ). Avesta has a comfortable space to lounge in until you are ready to leave. Please think about: Who will be with you after your session, and do you trust them to take care of you? How will you get home (driving is not permitted following ketamine)? If you feel comfortable, involve your family and friends in your process. Tell them what you are doing that day and explain you might need extra support depending on what comes up. After your journey, you don’t have to share every detail with them, but knowing you might be in a vulnerable and open space can help create a supportive environment for integration.
Integration takes all forms and is an ongoing, unfolding process. This can include talking through your experience with your therapist, friends, partners, and other trusted people. You can journal or review an audio recording of your journey to reflect on what came up. Explore multiple modes of integration and see what works best. You might want to walk in nature, make music, make art (SoulCollage® is a wonderful practice for the non-artistic), pray, meditate, or use practices to help process emotions in your body (e.g., breathwork, yoga, dance, tai chi, somatic practice). Try to do something at least 5-10 minutes each day between treatments.
The journey continues
Reinforce what you learn, and don’t be afraid to ask for support. Healing happens over time. Often in treatment we are trying to unlearn decades of negative patterns in our thoughts, emotions, and behavior. Ketamine is a tool to accelerate and facilitate the rewiring of our minds and bodies into patterns that are more compassionate, loving, and validate our inherent worth and dignity. However, this relearning process is only sustainable if we continue to reinforce these new ways of being with ourselves and others. We do that through being intentional about what will change in our lives as a result of the insights we gain in KAP. Will you take time to practice self-care? Change your communication with loved ones? Set boundaries differently at work and home? Practice self-compassion on a regular basis? Figure out what sustainable change looks like for you.
*adapted from SoundMind
More Information & Resources
https://www.washingtonpost.com/wellness/2022/09/12/ketamine-therapy-explained/
Https://ketamine research foundation.org/
Dr. Lauren Rubenstein, JD, PsyD 