Ketamine-Assisted Psychotherapy

Hello! Thank you for joining us! I’m Allison Bratsch, Founder and CEO of Center for Resilience Strategies. Today we are talking to Amanda Talak, one of our licensed professional counselors at CRS, about Ketamine-Assisted Psychotherapy (also known as “KAP”).

I have been wanting to have this chat with you for a long time and record it. We talk about it all the time, but have not yet recorded anything. And I just want everyone to know about KAP. Amanda, I cannot wait to hear more about your experiences as a clinician providing this for clients. Amanda and I have both experienced this personally (therapeutically) so we have the perspective of both clinician and client. Let’s start with your background and your interest in KAP.
Amanda:
Absolutely! Prior to even going to graduate school I was always interested in Psychedelic-Assisted Psychotherapy. I took interest after discovering the organization MAPS – they do a lot of research and training with MDMA, Psilocybin, etc., so I was really fascinated by this concept of cognitive liberty when it comes to therapeutically healing, especially with the populations that I work with. I am so passionate about working with trauma/PTSD, and those symptoms are really pervasive and really can take a lot of time to treat. I found out about ketamine-assisted psychotherapy through a client who was dealing with a lot of suicidal ideation, and this was years ago, and she had gotten ketamine treatment done at a clinic- her suicidal ideation completely disappeared. From then on I thought, okay, I have to know all about this. So I just went down the rabbit hole, learned all about KAP and I was so eager to get trained. It has been amazing ever since- I have been using it a lot with clients and it has been so rewarding. I am just so grateful to be able to use it.
Allison:
That is so cool! I have gotten to hear some of the testimonials from your clients and it is pretty amazing stu􀆀. So what have you been practicing as far as modalities other than KAP? What are your specialties?
Amanda:
I am formally trained in EMDR- a modality that is used to reprocess traumatic memories with bilateral stimulation, and it is great. It is a really awesome modality so I typically use that. I will use a little bit here and there of ACT or IFS, just little things sprinkled in, but mainly EMDR.
Allison:
Yeah, so pretty integrated. But I know you have been practicing EMDR for quite some time and, you know, that is something that you integrate as well. You integrate EMDR with KAP, particularly when people are working through trauma symptoms or chronic anxiety and depression and just really struggling with thought related disorders/OCD, so you really get in there and make this work so that what they are doing is really long lasting.
Amanda: Oh, yeah, they are a great marriage. EMDR and KAP go really well together.
Allison: Awesome! Okay, so let us talk about why ketamine? What is KAP all about? Just give us the overview.
Amanda: So Ketamine itself, I like to refer to, and it is pretty famously dubbed as “the miracle-grow for the brain”, so like brain fertilizer. Essentially it promotes change and growth. KAP promotes healing quicker because it promotes neuroplasticity, which is the brain’s ability to restructure or rewire itself. So with that, you are absorbing new information quicker, you are opening yourself up to new perspectives about yourself and about the world. Which is really important when you are doing talk therapy in itself or any sort of healing journey – being able to open yourself up to a new perspective and kind of rewire long standing cognitions about yourself or other people. It is incredible! It targets root causes and it is really fast acting for antidepressant e􀆀ects and pervasive depressive symptoms, anxiety symptoms, anything that impacts functioning – those are huge barriers in typical talk therapy and so ketamine is a nice tool to break through those barriers to make sure you are healing more e􀆁ciently, and honestly (makes healing) more possible.
Allison:
Wow! So these people I keep hearing about who have just felt stuck for years and years and years and just cannot get out of these emotions, these thought patterns, and even behaviors that are not helping them and people who have just been really struggling to function for many, many years, and using the ketamine just opens something up for them and it creates an instant opening and and something happens there. Talk to us more about who can benefit from KAP – you mentioned trauma, we have talked about anxiety, depression.
Amanda:
Right. So, just logistics-wise, 18 and older, but for me, I think a sweet spot is adults around the age of 25 and up because at that point, your brain has developed – so things are kind of hardened and you are kind of holding on to some of these cognitions that are hard to break. So yes, adults in their 20’s, 30’s, 40’s – I think that age range is where I notice a lot of generational trauma breakers, essentially they are the first generation of their lineage to do this work and to break some of these patterns and heal from this trauma that has been passed down. It is a lot of work for that age range and so a lot of that and older adults even, that have a longer history of trauma, or just have kind of lived with these pervasive anxiety or depressive symptoms for decades that are just really kind of sick of it.
And so, yes, it is really cool to see the range of people, but as far as diagnoses- originally ketamine assisted psychotherapy was introduced for treatment resistant depression. I am sure a lot of people have heard, when they think about ketamine, that is kind of the standard. But truly, a lot of the work I do is with clients who have complex PTSD, PTSD, generalized anxiety disorder, body dysmorphia and eating disorders, OCD, essentially anything that is connected to a negative self view or really impacting your functioning. Anyone who is dealing with something like that can absolutely benefit from my opinion from KAP.
Allison:
Awesome! So I do want you to talk to us about the actual therapeutic component. We know that ketamine is involved, you take the ketamine, and we can ask you about that process, but what is the actual therapy component? What does that look like?
Amanda: That is a great question and I think what really sets us apart is the therapy component- it is done throughout the whole process. In your preparation for the ketamine dosing sessions, you are establishing a treatment plan with your therapist as far as what your goals are and what modalities you are going to use and things like that, but with integration itself (you will hear hear that word a lot when you are going through KAP), it happens immediately after your dosing session, so in that last hour, and then in between sessions of dosing. Integration itself is therapeutic work- it is tailored to the client’s individual needs. It is kind of the key to successful KAP. Ketamine itself, I do not think it is a cure-all, but I think it is a really helpful tool. And so, integration kind of squeezes the juice out of each journey. In your integration sessions, depending on what clinician you are matched with, you will do EMDR, CBT or coping skills, or IFS – parts work is really cool. It is just a really big emphasis on meaning making from your experience and so you are not just given ketamine and say, okay, make meaning of it yourself and go on to the next session. I think some clinics will really pile on the dosing sessions and they almost overshadow each other, so then you are not getting all the juice out of the journey. What we do here is make sure that we honor each individual dosing session itself and juice it so we are getting the most therapeutic benefit out of it within those integration sessions.
Allison:
Right! And, it is within the context of a safe trusting professional therapeutic relationship. We know that generally in therapy we say the primary vehicle for change is the therapeutic relationship. This feels very di􀆀erent from a Ketamine clinic. Some people do really benefit from that and like you said, the e􀆀ects of the ketamine are also very powerful and it produces those antidepressant e􀆀ects, however, like any other medication, is temporary if you are not actually getting to the root of what is causing those symptoms. You hear about these ketamine infusion clinics and it does not sound like many of those are actually o􀆀ering a therapeutic component.
Amanda:
Yes, it is a lot of medical based [only vs. therapeutic] especially with the nasal ketamine and the Spravato that is administered in the medical set or setting. I do think there is this lack of therapeutic attention and that is where I see the most change. And I think you are so right – the therapeutic relationship in itself is a tool as well. It is like ketamine is a tool, the therapeutic relationship is a tool, the integration setting – it all works together so well. It is not one or the other -it is not ketamine or talk therapy- it is bringing them together to make this superpower of an experience!
Allison:
Yeah! So you hear about people saying set and setting. What does that refer to?
Amanda:
So, set is mindset essentially, and then setting is the physical environment, and so for us mindset kind of starts with establishing therapeutic relationships and being really intentional about where that person is at in their journey- pacing it at the client’s pace. It is all done at the client’s pace- we are not going to rush you into doing ketamine if it is not something that you are not quite ready for yet. And so mindset is important! And then setting- I love the way we navigate setting here just because it is so customizable , which makes it very trauma informed. It is not sterile. It is not medical. It is so customizable to the point where clients of mine bring items from home- they bring blankets, they bring a snack for afterwards, they bring candles or whatever sensory tool that they feel comfortable with. They can customize the space for themselves.
Allison:\ That is really cool! You have done both in person and telehealth ketamine dosing sessions with your clients. Talk to me about telehealth and how that works.
Amanda:
It is interesting. At first I was skeptical as far as the the telehealth component, but truthfully for some of the folks that I work with it has actually been more beneficial for them to be in the comfort of their own home rather than traveling to the o􀆁ce or being somewhere that is not a place that is familiar to them. I think being able to be in their bed or in their living room is beneficial. There is also heavy emphasis on the chaperone component. I am meeting the chaperones, giving them psycho education. It is really cool to collaborate with people that are loved ones in their life.
Allison:
Why do they recommend having a chaperone? Talk to us about that.
Amanda:
So chaperones, especially when it comes to telehealth, they are kind of the arms and legs of the operation because I am virtual. I am monitoring the client the entire time, I am coming through in their headphones and I am able to talk to them. But the chaperone is great because if there is a safety issue, which I have not had since doing this, but it is always good to have just in case and also just to come in, check on them, bring them water if they need it, if they need to go to the bathroom – they are there to help them go. And so literally, they are just the arms and legs of the operation and it is really helpful for the experience.
Allison:
Gotcha. Actually, that leads into another question. What does ketamine feel like? What is the physiological experience like?
Amanda:
It is interesting. I have heard so many di􀆀erent variations of the answer to that, but I think overall something I have really heard is that it is very euphoric. I like to describe it from my perspective, after being the client and having my own KAP sessions, as a gentle introduction to a psychedelic experience. It is not sinister, it is very gentle, and it is reflective. Your body feels heavier, and because it is a dissociative anesthetic in itself, sometimes you feel far from your body. Sometimes you feel like you are in the inner depths of your mind and your subconscious. Overall, from what I have gathered and experienced a really pleasant experience.
Allison:
I would second that. Thinking back to my own experience with it – yes, the feelings of euphoria, and admittedly, I felt pretty nervous about it. I would identify as a highly sensitive person and so my body has always been really sensitive to medications or drugs or that sort of thing. But it was very calming, just a very peaceful contented sort of experience and I have described it as sort of walking around in my subconscious for an hour. I would say that the majority of my experience lasted about an hour and I just kind of got to walk around in there and at the same time my body was very relaxed and just felt very good. It sounds like the experience for the vast majority of people, from everything that I have heard and read, is that it is just described as very pleasant. Now, I think there is also an important distinction here that we have not gone into in detail yet about the route of administration that we use for the ketamine medicine itself and the e􀆀ect that it produces relative to if someone is going to go get an IV or infusion or intramuscular infusion – something where it is a higher dose. Tell us about that.
Amanda:
Absolutely! I love the way we administer [clients self administer]. I love the sublingual route-sublingual oral tablets. The client will take 1 of the tablets and have it dissolve. It takes e􀆀ect pretty quickly, but I think because it is not as intense as an IV administration, they are still very present in the present. I think you can juice more from the experience because you can recall more at the end of the experience- you are not getting total whiplash from what you just went through typically at the doses that the client is self administering during the experience.
Allison:
Yeah, so it is this just really gentle approach and it is relatively short lived, as I said, and you might feel the e􀆀ects for the rest of that day – the next day you feel relatively back to normal. It is not like it is this full on psychedelic experience where you are experiencing auditory or visual hallucinations of any kind. It is really hard to describe, isn’t it? And like you said, the experience is a little bit di􀆀erent for everyone, but, you know, going back to this gentle approach again and the goal being – let us let us crack open that mind, that subconscious. Let us give it some fertilizer.
Amanda:
Yes, exactly. I love that you mentioned no auditory or visual hallucinations- so as soon as you take your eye mask o􀆀 you will possibly feel a little brighter and you might feel a little dizzy but overall, people are relatively back to themselves relatively soon after the journey, and during the journey it is led by music, which I love. It is a beautiful experience and it is not too intense for most people.
Allison:
That is great! So why would someone really benefit from doing KAP at CRS? And obviously we are biased because we are champions for CRS and we know our general approach to things and it being very relationship based, but how do we do things from your perspective and what sets us apart?
Amanda:
I love answering this question because I am so proud of how we have built this program and it has been 2 years in the making. We have truly made all of the necessary edits and have just been so careful of how we approach this KAP program from start to finish – truly intentional care from start to finish, which starts with our intake. Our intake department – they match clients to the clinician that is the best fit and not just the clinician that is available or has their schedule open, it is truly “who would be the best fit?” And the client also has say – they can do consults and figure out who is the best fit for them to go on this journey with. So from the start- amazing! Being able to personally have in depth consults with people prior to them even signing up. I love that I can answer any questions that they have. I think you should have that kind of attention before doing something like this. Skylight – we partner with them and they are prescribers, and their intake process is so thorough. They are doctors so they are taking care of all the medical components and they have so many resources. They are so accessible throughout the entire journey. Overall- CRS is warm and gentle. We prioritize establishing the relationship and moving at the client’s pace, even if that takes several second sessions prior to doing the dosing, we will do it. We are very careful of how we navigate that space. I just love that with CRS the setting is customizable, the whole experience in itself is really customizable and the clients never left alone throughout the experience- not alone in the clinic, not at home alone self dosing without the therapist there monitoring. I find there is a lot of ease in myself when I was the client and knowing that the setting is controlledas controlled as it possibly can be. It is like that when you are doing KAP at CRS.. We are handling everything. You just get to put your headphones on and go inward and we are handling everything outside of that. I just think it is the best. I am so proud to be a part of this program and that we facilitate it this way.
Allison:
Well, we are so grateful to have you as our KAP director. And yes, you have been so integral in developing this program for us. And it actually was Amanda who came to me 2 years ago, well, it was probably longer than 2 years ago at this point that we initially talked about it, and you said, “hey, I am really interested in this, what do you think?” And we started meeting and talking through it and looking into the research and figuring out all the logistics and it really just evolved very organically and has always just felt meant to be. The testimonials that we have received from clients thus far have been just so incredible and it really opens the door for so much healing. What is one of our favorite quotes about the KAP experience that we have heard about it being like years of therapy?
Amanda:
Oh, yes. Yes, it is, “a handful of KAP sessions can equate to years of talk therapy.” That is from my perspective and from what my clients have told me – 100 % like what I have experienced facilitating KAP and receiving KAP. It is the future of therapy. It is just amazing and I am so happy that it is a possibility and it is accessible for folks!
Allison:
Absolutely! The accessibility piece is a big part of how we do KAP at CRS as well. You know, we are able to bill insurance for all the therapeutic and assessment components of the process, and there is a need for that. Fairly recently, this sort of work was only accessible to people who were very financially resourced, but that is no longer the case, and so we are making it possible. We are part of that movement to make it possible for anybody to access this or as many people as possible. I am hopeful for continued evolution in the insurance world and coverage for these types of evidence based therapeutic modalities, psychedelic assisted therapies in general. It is in the research, it is in the science that this is truly e􀆀ective, and so I am hopeful for continued evolution there.
Amanda:
Absolutely! Same here. We are behind the scenes. We are therapists but we are also advocates. Another reason I love CRS is we are constantly looking for all of the updates related to legislation and insurance and all that stu􀆀 that we are constantly trying to advocate for our clients and helping them get the care that they need and deserve. I am so passionate about that component of what we do here.
Allison: So true. Well, we are so thankful for you! Thanks for everything that you do for CRS and for all of your clients. If anyone is interested, you can reach out to Amanda directly and we have lots of other resources on our website on the KAP page. It will tell you how to reach her and set up a free consultation and we would love to support you on this journey if that feels aligned!