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Ketamine-Assisted Psychotherapy (KAP)
We are called 360 Medicine because we take a 360-degree view of your health. We believe considering all aspects of a person is vital to healing, and our ketamine-assisted psychotherapy (KAP) service is no different. Each person is unique, and together with your treatment team we’ll develop a comprehensive treatment plan based on that uniqueness.
Ketamine has been used safely for over 50 years in emergency departments and operating rooms worldwide for surgical sedation and pain control. As with many effective medicines, experts aren’t precisely sure how ketamine works, but the current understanding is that ketamine is what’s called an NMDA antagonist, working through the glutamate neurotransmitter system. What’s noteworthy about this is that ketamine works on a totally different pathway than psychiatric drugs such as SSRIs, SNRIs, anti-psychotics, anxiolytics, benzodiazepines, etc., and so has a different action. Ketamine impacts the parts of the brain involved in rumination, preoccupation, day dreaming, and our sense of self, often providing a space between you and your ordinary reality and usual self. It’s been widely found to be a potent antidepressant in treatment-resistant depression and has indications for intractable pain syndromes as well as other treatment-resistant psychological issues such as anxiety, mood disorders and PTSD.
Please note ketamine has not been approved by the Food and drug Administration (FDA) to treat depression, anxiety, PTSD or chronic pain. Because of its potential benefits, ketamine is being used “off-label,” a designation given to an FDA approved drug when it’s deemed medically appropriate by qualified healthcare providers to be used in ways other than its originally approved purpose. Off-label use is common.
As powerful as it can be, ketamine is not a “cure” that “fixes” you, but rather a potent catalyst. I believe you and your innate healing wisdom are the agents of change. Your body and mind have immense powers to heal if given the right tools, and ketamine is a powerful tool in an integrative treatment plan.
The ketamine experience can create a state of openness, sometimes shifting a longstanding, fixated mind-set. This may allow you to revisit things that were previously too difficult to access. Or, it may uncover additional areas of exploration that an established depression has kept hidden in body and/or mind. It’s vital to provide the appropriate preparation, setting, and integration before, during, and after a treatment to support and maximize your ketamine experiences and insights. Taking these experiences and insights and mindfully translating them into meaningful action in daily life is a vital part of integrative, empowered healing. Along with the clinical experience of a multitude of KAP practitioners across the country, studies have shown psychotherapy is a powerful ally in assisting you with this.
First and foremost, expect kind, caring treatment by a skilled treatment team. We provide a safe, respectful space for you to be you.
You’ll have initial medical intakes with both Dr. Canfield, our integrative medical doctor, and Carol Norris, MFT, our integrative psychotherapist, to make sure KAP is the best fit for you and your needs. Both practitioners will have intake and consent for treatment forms, as well as some self-report assessment tools to fill out. We acknowledge it’s a lot of paperwork. But it’s necessary for your safety, to assess if KAP is the right treatment for you, and to ensure you’re properly informed. Some of the forms and assessments will be emailed for you to print and fill out in the leisure of your home. Your medical assessment paperwork will be filled out while you wait for your appointment, so we'll ask you to arrive a bit early.
If KAP is right for you, you’ll then have Preparatory Sessions (1-3 sessions) with Carol to establish the trust and comfort level necessary to allow you to explore the multiple layers of your experience. We'll look at your intentions and goals for treatment, explore some of your history so we can best be with you through this process, go over what to expect and how to prepare, and give you the room you need to ask all the questions you have.
Once you’re prepared, your KAP session will be scheduled and you’ll be given an Informed Consent document to read, be sure to fully understand, and sign.
There are a few ways to do Ketamine-Assisted Psychotherapy. We'll decide together which is best for you. Regardless of which kind of KAP you do, we suggest an initial series of six sessions with the Integration Psychotherapy Sessions occurring either during your ketamine experience, as the effects of the medicine are waning, or in a few cases, in the next day or two. Typically, we schedule either 1x/week for six weeks or 2x/week for three weeks. Integration Psychotherapy can extend well beyond this. It’s an organic process and how we proceed with sessions is mutually agreed upon based on your experiences with the medicine and your ongoing needs.
All first sessions are exploratory. We use a low dose lozenge to determine how you respond to the medicine and from there we adjust or maintain.
On the day of your session, there are some important things to remember to ensure a safe, comfortable experience, such as not eating four hours before a session and making sure you have a trusted person to drive you home. You’ll be given that information in detail.
It's useful to set an intention for your journey, and equally as useful to hold that intention lightly. The medicine and your innate healing wisdom will take you where you need to go. Resisting that tends to be when anxiety comes up. “Letting go” and “allowing” are overarching concepts for your experience. We'll explore all this together in the Preparatory Sessions.
Low-dose Interpersonal Session
During this interpersonal session, you’ll take a lower (yet impactful) dose of ketamine and stay interactive with Carol through the entire experience as feels right to you. In this mild trance-like state when your mind is less fixed and more open, profound and powerful psychotherapy sessions often happen. You’ll be reclining comfortably with an eye mask either on or off, and may choose to have wordless music in the background to support the experience. You’ll be given a ketamine lozenge that dissolves in your mouth. The effects of the ketamine depend on your nervous system and dosage, but typically start five to 10 minutes after administration. Peak effects vary, but typically last around 20 to 30 minutes and then diminish, in total taking about an hour to 1.5 hours. (Some effects, like speech, motor ability, and sensory perception may continue up to five hours, and are normal.) We start with the lowest dose based on your weight, history, sensitivities, and needs. This session typically lasts 90 minutes.
Inner Experience with Integration Session
During this session, you’ll take a slightly or moderately higher dose than in the Interpersonal Session. On a moderate dose, some report a more psychedelic experience where you may leave your body and experience visions, different realms, and encounters of varying kinds. While Carol is right there with you to provide support and guidance if and when needed, the psychedelic experience tends to be more of an inward journey with little or no interaction until the effects of the medicine are beginning to wane. As that happens, people tend to want to process their experience and that’s when the psychotherapy session begins.
As with the Interpersonal Session, you’ll be reclining comfortably, but wearing an eye mask during your inward journey until the medicine starts to wear off. Music has been shown to be an integral part of the process. You’ll be given headphones and can choose from a variety of music from ambient to cello adagios to trance. You may bring your own music (and headphones), but we request that the music be word-free and that it allows you the freedom to go on a unique journey that your wisdom and the medicine offer. The medicine will be given by one of our nursing staff in lozenge form or via an intramuscular injection (IM) either in the upper arm or hip, depending on which you prefer.
The effects of the ketamine depend on your nervous system and dosage, but typically start five to 10 minutes after administration. Peak effects vary, but typically last around 20 to 30 minutes and then diminish, in total taking about an hour to 1.5 hours. (Some effects, like speech, motor ability, and sensory perception may continue up to five hours, and are normal.) We start with the lowest dose based on your weight, history, sensitivities, and needs. This session typically lasts between two and 2.5 hours, including the psychotherapy.
Next Day Integration
On occasion, after an Inner Experience with ketamine, patients have an Integrative Psychotherapy Session in the next day or two while the experience is still fresh.
Regardless of the type of KAP session, people report all kinds of experiences during their ketamine journey. There’s no “best” or “right” journey. A session can be light or dark, blissful or challenging, playful or serious, or all of the above. Regardless, it’s short and everyone comes through it. And there’s always something to learn.
After you’ve had your KAP session, we’ll make sure you’re medically cleared to leave. You will NEVER be allowed to drive yourself home. You'll be asked to check in briefly by email within 24 hours of each KAP treatment. Your post-treatment experiences are vitally important not only for the insights you may continue to gain, but to understand how the medicine interacts with you so we can adjust and modify the treatment plan if needed.
We hope this brief overview gives you an idea of the experience.
What ketamine may help:
• Depression
• Mood disorders
• Anxiety
• Suicidality
• PTSD
• Cancer patients
• End of life support
• Chronic pain
• Neuropathic pain
• Loss/Grief
• Fibromyalgia/Late Stage Lyme Disease
• Creativity and self-actualization optimization
Ketamine is not appropriate for the following people who experience:
• Psychosis or dissociation
• Current manic episode
• Untreated hyperthyroid disease
• Current clinically significant substance abuse
• Unstable cardiac illness/untreated hypertension
• Seizure disorders
• Taking MAO inhibitors
• Recent bladder inflammation (cystitis)
• Nursing mothers and pregnant women
*Our protocols have changed since Covid-19. Please see below what to expect currently.
Covid-19 has impacted us all in different ways. Some moderately, many profoundly. In addition to the challenges and issues you may have been dealing with prior to the pandemic, it’s important to consider the ongoing stress of Covid-19 not only as it relates to processing what you're experiencing, but in terms of the ketamine dosage that might best support you right now.
While the bulk of the psychotherapy Carol Norris, MFT is currently offering is virtual, we’re excited to offer modified KAP sessions that are both virtual and in-office. The intakes, assessments, preparation, interpersonal and integration sessions are all the same process. The location and safety precautions are different. All of us at 360 Medicine take these precautions seriously and enforce them strictly. No exceptions. You’ll get a document detailing the guidelines and, as always, We'll answer any questions you may have.
All virtual sessions will use lozenges as a deliver method and none of the sessions will aim for a more psychedelic experience.
Low-dose Interpersonal Session
During this interpersonal session, you’ll take a lower (yet impactful) dose of ketamine and stay interactive with me in a video session the entire time as feels best to you. In this mild trance-like when your mind is less fixed and more open, profound and powerful psychotherapy sessions often happen. You’ll be comfortably in your bed (slightly propped up), on a couch or a comfortable chair with an eye mask either on or off. You may choose to have wordless music in the background to support the experience. You’ll self-administer a ketamine lozenge that has been prescribed to you by Dr. Canfield after you’ve undergone medical and psychological assessments. The effects of the ketamine depend on your nervous system and dosage, but typically start five to 10 minutes after administration. Peak effects vary, but typically last around 20 to 30 minutes and then diminish, in total taking about an hour to 1.5 hours. (Some effects, like speech, motor ability, and sensory perception may continue up to five hours, and are normal.) We start with the lowest dose based on your weight, history, sensitivities, and needs. This session typically lasts 90 minutes.
Low-dose Inner Experience with Integration Session
During this session, you’ll still take a lower dose, but you’ll have a supported, more inward journey. Carol will be there with you virtually to provide support and guidance if and when needed, but there will be minimal or no interaction until the medicine wanes. This is when the Psychotherapy Integration Session begins. This session typically lasts 2 to 2.5 hours.
You can also choose to have a Solo Inward Journey, experiencing most of your ketamine session alone, and then connect with Carol virtually for processing and Psychotherapy Integration Session as the medicine is waning. This session typically lasts an hour to 75 mins.
A third option is to have a Solo Inward Journey and have an Psychotherapy Integration Session the following day while the experience is still fresh.
(Mostly Virtual/Partly In-Office)
With Hybrid KAP, the Intake, Preparatory Sessions, and the non-ketamine Integration Sessions are done virtually, while only the Ketamine Session is done in the office with special safety accommodations. (You’ll receive a copy of the safety guidelines.) The in-office Ketamine Session can be with either a low or low-moderate dose delivered via lozenge or intramuscular injection (IM) in the upper arm or hip, depending on your preference. During Covid-19, we are defaulting to giving lower doses of ketamine, but this may shift some if your clinical indications and needs warrant it.
We'll explore if a Low Dose Interpersonal Session or a Low-Moderate Dose Inner Experience with Integration Session best meets your needs.
You'll be asked to check in briefly by email within 24 hours of each KAP treatment. Your post-treatment experiences are vitally important not only for the insights you may continue to gain, but to understand how the medicine interacts with you so we can adjust and modify the treatment plan if needed.
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