This document provides an overview of ketamine-assisted psychotherapy training at Polaris Insight Center. It discusses ethical considerations for ketamine therapy including codes of ethics, the importance of set and setting, preventing misconduct, and ensuring access. It also covers conducting group ketamine sessions, virtual ketamine therapy, integrating spiritual experiences, and future training opportunities.

1. POLARIS INSIGHT
CENTER
SAN FRANCISCO
Ketamine-Assisted
Psychotherapy, Training &
Consultation
www.polarisinsight.com

2. Ketamine-Assisted Psychotherapy
COPYRIGHT 2020
POLARIS INSIGHTCENTER– SAN FRANCISCO
.
Focused Clinical Issues
Module 3

3. KETAMINE

5. Polaris Insight Center

7. Attachment and
Psychedelic
Assisted
Therapy

8. Countertransference

9. Ethical Considerations

10. Code of Ethics
• MAPS – Codes Of Ethics
• Code of Ethics for Spiritual Guides from the
Council for Spiritual Practices
• Usona Code of Ethics for Entheogen Guides in a
Research Setting
• Ethics for Holotropic Breathwork Practitioners
• The Conclave

11. Ethics of the Set and
Setting
• Value: Ketamine as transformative
medicine
• Value: An altered state is a vulnerable
state
• Container, Secure Base, Safe Haven,
“Going On Being” (Winnicott)
• Value: Therapist's personal experience
- Clinician Know Thyself
• Some clinics require therapists NOT to
have had experience with ketamine –
clinician bias

12. Misconduct Prevention
and Recovery
• Open communication about psychedelic
assisted therapy
• Open discussion about negative experiences
• Ongoing consultation/supervision/case
conferences
• Continuing education
• Co-therapy pairs
• Challenges around Secrecy and Shame

13. • “Right use of power”:
1) Informed, 2) Conscious, 3) Caring, 4) Skillful (from Hakomi)
• Awareness of power differential
• Race, gender, LGBTQ, SES
• Domination and abdication
• Clinician’s training and history (ethical proactivity)
• Dangers of gratification and frustration
• Mutuality

14. Economics and
Access
• Increased accessibility without scaling
• Diversity among clinicians
• Dynamics and pragmatics of lower fees
• Assessing economic vulnerability
• Shame and exploitation

15. ADDITIONAL RESOURCES
• Chacruna – Towards An Ethos of Equity and Inclusion
in the Psychedelic Movement
• Developing Guidelines and Competencies for the
Training of Psychedelic Therapists – Janis Phelps
• Power in the helping professions- Adolf Guggenbuhl-
Craig
• Sex in the forbiddenzone; when therapist, doctors,
clergy, teachers and other men in power betray women’s
trust – Peter Rutter
• Ethics in Psychotherapy and Counseling;a practical
guide– Kenneth S. Pope

16. Collaboration with outside providers

17. STEPS
• Requirementof having an outsidetherapist
• Releaseof informationfor outsideproviders
• Initial contact
• Educationaround KAP, answering questions
• Establishingcollaborativerelationship
• Establishingongoing communication

18. Why Therapists refer Clients to KAP?
• KAP is well suited for client’s treatment plan
• Client failed many other treatments and KAP is “the last resort”
• Primary therapist feels “stuck” with the client
• Primary therapist wants to stop seeing client
• Primary therapist is following client’s lead but is not familiar of
does not agree with KAP
• Primary therapist if following client’s lead and is supportive of
KAP

19. Obstacles to Referring
• Naivete; Lack of information, knowledge, exposure
• Biases from clinical training and residue from war on drugs
• “Brand loyalty”/ “Party loyalty”
• Possessiveness
• Protectiveness of client
• Fear of being perceived as abandoning/rejecting
• Desire to evade, eject, or “dump” client
• Acting out of helplessness/desperation in countertransference
• Difficulty collaborating with other professionals
• Lack of healthy humility and limits of the

20. POSSIBLILITES
• Positive collaborative Relationship with primary therapist
• Mutually supportive, ongoing, long-term support in integration
process
• Primary therapist invested in the wisdom of inner healing
intelligence
• Potential, initial exacerbation of symptoms is understood in the
context of the healing process, rather than as a failure of treatment

21. CHALLENGES
• Primary therapist (PT) is not familiar with KAP
• PT is not able to trust the inner healing intelligence
• PT has a different agenda how tx should look like
• Client is experiencing crisis and PT “blames” KAP
• Not enough/established communication with PT
• PT impacted by war on drugs, or other clients who had negative
experiences with psychedelics
• “Splitting” in the psychotherapy field and team
• Including/Not including PT in experiential session

22. Group Ketamine Assisted Psychotherapy

23. Principles of
Group Work
• Confidentiality
• Irvin Yalom's Therapeutic
Factors of Group Work:
Universality, instillation of
hope, altruism, interpersonal
learning input and output,
imitative behaviors,
catharsis, self-understanding,
and existential factors

24. Preparation for Group
• Individual Medical and Psychological Intake prior to joining
• Consent for Group psychotherapy
• Consideration of individual experience before first group
• Collaboration of a dyad MD/therapist, or RN/therapist
• Preparing members for types of experiences that can come up in
KAP and how disruptions will be managed
• Separate room needs to be available in case one of the members
goes into deeper process needing individual attention; one co-
therapist designated to be with client and other co-therapist
stays with group

25. One-time Group
• Lower commitment
• Easier scheduling
• Preparation Session
• Experiential Session
• Integration Session
Preparation KAP 1 Integration

26. Ongoing Group
• Closed Group
• Bigger commitment
• Increase of Accessibility
• Full treatment available through group
• Develop supportive relationships over time
• Scheduling challenges
Preparation KAP 1 KAP 2 Integration KAP 3 KAP 4 Integration KAP 5 KAP 6 Integration

27. Booster Group
• Regular Intervals
• Unique Interpersonal Experience
• Accessible
• Maintenance Treatment
• Open Group
KAP

28. Polaris KAP Support Group

29. Integration Therapy
Group
• Shared Experience
• Accessible
• Support of members with similar
interests and experiences

30. Peer Support
Community Circle
• Discussion around psychedelic
experiences and integration
• Not specifically focused on clinical
issues BUT confidential/anonymous
• Often, non-violent communication
skills are encouraged (e.g. “I”
statements rather than “You”
statements)
• Engenders sense of
connectedness, community, and
grounding

31. Examples of Breakthroughs and Challenges
Loud client
Aggressive client
Hyperverbal Client
Client who triggers other peoples’ trauma
Client who is moving around a lot
Client acting out experience
Agitated client
Silent Client
Client calling for attention
Client engaging with other group members during experience

32. Future
Possibilities
• Long-term group
• Retreat continuity (retreat group that meets
2x/year)

33. Virtual
Ketamine
Assisted
Psychotherapy

34. Opportunities
• Geographical Accessibility
• Financial Accessibility
• Health Safety during COVID-19
• Connection during COVID
• Decrease of Nausea after session
• Improved after-care during come down
• Increased Physical Comfort

35. Challenges
of Virtual
Sessions

36. Challenges
• Increased risk in case of emergency
• Decreased ability of provide support
• Not possible to use physical touch by therapist
• Internet challenges
• Issues that are out of control of the therapist (e.g. intrusion by
others, navigating interpersonal dynamics with sitter)
• Increased preparation and setting demands on the patient
• Transition after difficult session (no recovery room)

37. Preparation
• Consent for KAP, Telehealth, and At-Home Lozenge Use
• Support person designation
• Appropriate Location Crisis Numbers
• Set and Setting
• Safety
• Protected time and space
• Phone set up
• Zoom set up
• Music set up
• Planning for possible challenges (internet, music)
• Planning for possible side effects
• Planning for integration

38. Spotify Set Up
❖Paid version
❖Cross Fade set to 12 seconds
❖Shuffle Off
❖Auto-play Off
❖Adjusting Volume of Spotify and Computer
❖Using headphones
❖Avoid sharing sound through Zoom if possible

39. Session
• Room set up
• Preparation
• Virtual Flight Instructions
• Music set up
• Ceremonial transition
• Interaction over Zoom
• Integration

40. Integration and Working with Intention
• Verbalizing of the experience
• Resting
• Next-day journaling
• Next 2 days listening to the playlist as a part of integration
• Re-visiting insights, visions, experience and relating to
intention, “anchoring” (Wolfson)
• Supporting accountability to integration, verbalizing next steps
• Body, Mind, Spirit, Community and Environmental paradigms
of integration (Bourzat)

41. Polaris Insight Center – At-Home Session
Date of session: Number of lozenges:
Describe your set and setting going into the session: How were you feeling before
the session? What had you been doing that day prior to the session? How did you
prepare? What music did you use?
What was the experience in your body?
What feelings have you experienced during the session?
What images have you experienced during the session?
What messages/insights have you received from the session?
Please note any plans for integration:
Notes about the environment and ideas for next session:
Do you have any questions for the therapist?

42. Integration of Spiritual Experiences

43. FIVE TRUTH CLAIMS
THAT RESULT FROM
MYSTICAL EXPERIENCES
(Richards, 2014)
1. The primordial reality of the spiritual dimension of
consciousness
2. The indestructible nature of consciousness
3. Interrelatedness within the great unity of all human
beings and perhaps all life forms
4. Agape (pure benevolence, goodwill, transpersonal love)
as the ultimate energy at the core of reality
5. The incredible awesome beauty of these states in design,
visuals, wisdom and meaning

44. 1) Confirmation of spiritual beliefs
2) Positive new view of spirituality
3) Perspective dystonic to one's spiritual beliefs
a) Family’s Response to the spiritual experience
b) Outside therapist’s response to the spiritual
experience
c) Ones’ response to the experience or
”non-experience”

45. Form and Formlessness
Duality and Non-duality

46. Humility
Inclusivity
Dialectical

47. Awakening/enlightenment
experiences
Level of
personality/moral/spiritual
development

48. Spiritual Trauma

49. Future
Training
Opportunities
• Introduction to KAP Webinar
• Intermediate KAP Webinars
• Advanced KAP Webinar
• Role Play Module
• Experiential Trainings; dates TBD after COVID-19 safety is established
• Polaris Intensive KAP Retreats; dates TBD

50. Polaris Insight Center
4257 18th St.
San Francisco, CA 94114
415.800.7083
polarisinsight.com
info@polarisinsight.com
harvey@polarisinsight.com
eric@polarisinsight.com
veronika@polarisinsight.com
chris@polarisinsight.com
THANK YOU