Ketamine: 2 Models

In the world of Ketamine, there are two different models of how to treat psychiatric disorders (depression, anxiety, etc…). These are known as the Medical Model, and Ketamine Assisted Psychotherapy (KAP). 

The Medical Model 

The Medical Model looks at the neurochemical effects of Ketamine, which interacts largely with the GABA and Glutamate systems and helps regulate those in an anti-depression, anti-anxiety, and anti-suicidal way. This is really a psychiatric/psychopharmacological perspective, which holds, in essence, that psychopathology is a chemical imbalance in the brain, and thus the treatment is to adjust that chemical imbalance. Many people achieve significant results with ketamine treatment via the Medical Model. Many people, however,  are left desiring more. 

Ketamine Assisted Psychotherapy (KAP)

Ketamine Assisted Psychotherapy (KAP) agrees with everything the Medical Model says, and builds on top of it. KAP views psychiatric disorders not just as chemical imbalances, but understands that neurochemistry is part of a larger phenomenon that contributes to the experience of being human. As such, the neuroplasticity (increased flexibility within the neural functioning) that is created by Ketamine is viewed not just as a way to reset chemical levels, but as an opportunity to explore, challenge, and work with thought patterns, perspectives, past experiences, and ways of relating to yourself. 

The Impetus for KAP

I’ve had many people, both in my professional and personal life, who have had Medical Model Ketamine treatments. A common sentiment is “that was helpful in many ways, but there was so much going on mentally that I wish I had someone to help me make sense of it. I feel like an opportunity was lost.” 

A particular client comes to mind. I’ll paint in broad strokes for simplicity's sake. He had been doing Medical Model Ketamine treatments once a month for the past 5 years (this is an unusually large amount, but was appropriate for his psychiatric profile). He felt a significant amount of stabilization from them. The route of administration was via IV, which allowed for real time adjustment of the dosage. As such, whenever he would come to a particularly challenging emotion, memory, or thought, he would typically express discomfort, and the nurse would lower the dosage, allowing him to avoid that psychological experience. The Medical Model says, “the whole point of Ketamine is to feel better, not worse, right? So why go through the psychological uncomfortability?”

Once we started working together for regular talk therapy, we discussed the possibility of me joining his Ketamine sessions, which his psychiatrist graciously agreed to. This allowed for a Ketamine Assisted Psychotherapy (KAP) model. We would be speaking throughout (he was a particularly talkative man), and whenever he got to a point that he would normally have asked for the dosage to be lowered, I asked if he would be willing to sit with it, and if he still wanted to lower the dosage in a few minutes, to then do so. He agreed, and felt okay to do so because of the strength and trust of our therapeutic relationship. I gently guided him to explore the uncomfortable experience, and out of a shared curiosity, see if we could work through it, rather than avoid it. 

In short, he was able to, which led to a pretty significant relational shift within himself. He was no longer afraid of himself - or, rather, he had now experienced, aided by the combination of Ketamine and psychotherapy (ie/ Ketamine Assisted Psychotherapy) the ability to go towards the elements of himself that he fears or dislikes, and metabolize them. He had the experience of not running from himself, of not fighting with himself, but of actually going towards himself. This provided a template for him, outside of Ketamine sessions, for how to interact with uncomfortability, rather than react out of it.