Psychedelic therapy, and more specifically psilocybin-assisted therapy, have been making headlines recently. Interestingly, ketamine-assisted therapy isn’t talked about quite as often.

Ketamine-assisted therapy is legal. Ketamine is a legal drug to prescribe and is approved for off-label uses such as treating mental health. The drug has shown some incredible promise at treating chronic depression, anxiety, and PTSD

Seattle has a few clinics providing ketamine-assisted therapy. Scott Ross, MA, LMHC’s practice, Salish Seas Counseling is among them. What does ketamine-assisted therapy look like? The Sesh spoke with Ross over the phone to find that out.

The First Sessions

“We do an initial session where someone comes in for an assessment,” Ross explained. “It gives them time to prepare for their intentions, and concerns or fears they might have about it. Going over any of those kinds of details.”

Following the initial assessment, is the ketamine-assisted therapy session. 

“We do it in two forms. Lozenges, so orally,” Ross describes. “We usually start with that because it’s easier to control the dose, and the come up is more gradual.”

This dosage is meant to assist what Ross calls a ‘psycholytic session’. A psycholytic session is where there is an ego or psyche is loosening from psychedelic drugs. That’s the optimal state for a really good talk therapy session, Ross explains. Once the drug is administered, Ross is nearby to offer support and guidance through their experience. 

Clients are put in eyeshades to encourage introspection and prevent distraction. Ross also makes playlists with calming music to help set a tone. Much of the recent ketamine-assisted research has found that music greatly enhances the ketamine experience. 

The Injection Session

Ross administers the ketamine via intramuscular injection for the second session. So, a shot in the arm like a vaccine. Within one to two minutes of intramuscular injection, the effects of the medicine can be felt.

“About 80% of clients, the first time they take it, go into this ego developed state,” Ross explained. “In street terminology, it would be called the k hole. 

What is it like to go into a k hole? 

“How I conceptualize the feeling of it, is that we have this part of ourselves that feels our experience,” Ross explains. “A lot of the time that’s the part of us that holds trauma and suffering and physical pain. It’s also involved with a lot of the worrying voices that are in our heads a lot. When you take ketamine, especially when you take an injection, that all goes away.”

In the recreational drug-using world, going into a k hole is something most people try to avoid. Being that blank of a slate makes you vulnerable. When the purpose is healing deep psychic wounds in a therapeutic setting however, that state is desirable.

“Within two minutes, you’re conscious, but that part of you is gone. With trauma, anxiety, and chronic depression, being free from all of that, can give you a taste of what it’s like to live without it. Of what life is all about.” 

Following the session, the goal is to attempt to integrate that wise, mindful state into everyday life. It can give patients something to aspire to.

The Timing

“We do three-hour sessions. The effects of ketamine, for most people, the main part of the experience lasts about an hour at the most. Sometimes as low as half an hour. Then the after-effects of it, the comedown stage, where you’re not baseline yet, last another half hour to hour. So we like doing three-hour sessions.”

These long session times are not typical in the ketamine-assisted therapy world. Clinics have IV ketamine sessions that last as little as an hour, according to Ross.

“Especially at the higher doses, a lot of material can come up. After an hour, I don’t think it would be wise, or even appropriate to have patients leave at that point.”

The Model

Ross’s approach to healing with ketamine is both scientific and holistic. 

“A big part of our model is that every professional that someone comes into contact with has direct experience with the medicine they’re using.”

But the session isn’t just about the medicine, it’s about the experience and what you can learn from it.

“We’re creating a very supportive therapeutic environment,” Ross stated. “So the focus is moving away from a more medical model. How I would define a medical model is that the drug would do the heavy-lifting. So you come in and you take a passive role and you take whatever the drug is, and see if you feel better over time. What we’re looking at is activating the inner healer.”

The Patient

While I was unable to speak with any of Ross’ clients, writer Sophie Saint Thomas did write about her experience using ketamine-assisted therapy to treat her chronic depression.

In the piece, “You Can Now Get Ketamine in the Mail for Your Depression” Saint Thomas describes her experience treating her treatment-resistant depression and anxiety with ketamine.

“I have tried just about every antidepressant on the market, and nothing has worked as well as my IV ketamine treatment.” Saint Thomas wrote. 

Saint Thomas had been going to a clinic to receive treatments prior but found out she could order oral ketamine treatments from Mindbloom during COVID-19. Having access to this treatment in such a harrowing time helps her cope. 

The Prognosis

Humankind, and those of us in the U.S. particularly, are undergoing a collective trauma. It will take a multitude of methods to help us heal. Ketamine offers a treatment method that is more effective, longlasting, and sustainable than other available treatments.