This document provides an overview of ketamine-assisted psychotherapy (KAP). It discusses ketamine's rapid onset and safety profile, and its ability to access different states of consciousness for therapeutic purposes. Key aspects of the KAP process are outlined, including medical intake and screening, psychological preparation, low to high dosing strategies, and potential experiences during sessions like empathogenic states. Risks and challenges of KAP are addressed. Major goals of the integration process after sessions are described, such as emotional processing and resolving pathogenic beliefs. The document promotes a multidisciplinary treatment approach and lists training opportunities provided by Polaris Insight Center.

1. Introduction to
Ketamine-Assisted Psychotherapy
COPYRIGHT 2021
.
Eric Sienknecht, PsyD
Veronika Gold, LMFT

2. Ethical Considerations for Training
of all Ketamine Providers
❖ Potential of Psychedelic Experience (OBE, NDE)
❖ Regressed States - Suggestibility
❖ Abreactions
❖ Sensitivity to Dosing
❖ Vulnerability and Potential Enhancement of Trust
❖ Porosity (heightened sensitivity to set and setting)
❖ Kriya Published Ketamine Ethical Guidelines
Journal of Psychedelic Psychiatry (Vol 2, Issue 4, Dec 2020, pgs 19-23)

3. KETAMINE

5. Ketamine’s Signature 1/2
❖ Rapid onset, Rapid metabolism & Excellent safety profile
❖ Dose-related access/flexibilityfor therapeutic process – Psycholytic & Psychedelic
❖ Reduction/Eliminationof external stimuli and sensations & heightening of internal visual
experience (Float Tanks can simulatedissociativeeffects of ketamine)
❖ Preservation of the observer self -observing ego - witnessing self
❖ Outsideof bounded time and space – differentlevels and depth of altered state experience,
biographical and transpersonalexperiences

6. Ketamine’s Signature 2/2
❖ Spaciousness of mind, Freedom of mind, Sense of movement and music essential in the
experience
❖ Reductionof verbal thinking and processing and connection to symbolicrealm of
experience
❖ Reductionin negative, obsessive, and self-referential thinking
❖ Experience of surrender, formlessness,love, interconnectedness,humility,awe, gratitude
and union with Divine Love, Divine Mind
❖ NDE, OBE, Archetypal Experiences/Encounters
❖ Navigating the range of ecstatic to challenging experiences

8. Rick Doblin
Stanislav and Christina Grof
Julane Andries and Phil Wolfson
Raquel Bennett
Annie and Michael Mithoefer

9. Shamanic Roots
Tito la Rosa Maria Sabina Don Jose Campos

10. Paradigms of treatment
❖Medical – neuro-bio-chemical model
❖Psychological
❖Transpersonal
❖Shamanic
Raquel Bennett, PsyD

11. Medical
Setting

12. Ketamine Assisted Psychotherapy
vs
Ketamine Treatment
Treatment room at Polaris Insight Center
Treatment room at IV infusion clinic

13. KAP
Prescriber
Patient Therapist

14. Psychotherapeutic Model
❖Therapeutic relationship as primary container -
physician and medicine support the psychotherapy
❖Emphasis on Set, Setting, Music, Interpersonal
Connection
❖Preparation and Integration built into treatment
plan
❖3-hour sessions allow for plenty of time to process
material
❖Non-Ordinary States of Consciousness are held as
crucial for healing and seen as meaningful

15. Therapy approaches with
KAP
❖Relational Therapy
❖Somatic Therapies – Relational Somatic
Therapy, Hakomi, Somatic Experiencing,
Organic Intelligence, Sensory-motor Therapy
❖Internal Family Systems
❖Acceptance and Commitment Therapy
❖Cognitive Behavioral Therapy, Dialectical
Behavioral Therapy
❖Eye Movement Desensitization and
Reprocessing Therapy
❖Emotionally Focused Therapy

16. Set & Setting

17. Mind-Set

19. Polaris Insight Center

21. Activation of
and
Trust in
the
Inner
Healing
Intelligence

22. Experiential
Learning

23. Stanislav Grof
❖ Biographical
❖ Perinatal
❖ Collective/Mythological
❖ Archetypal
❖ Mystical/Causal
- Based on work with LSD and
other holotropicstates
Typologies of
NOSC
Chris Bache
❖ Personal/Biographical
❖ Collective
❖ Archetypal
❖ Oneness/CausalRealm
❖ Diamond Luminosity
-Based on work with LSD
Eli Kolp
❖ Out of Body experience
❖ Near to Death Experience
❖ Ego Dissolution
Transformational experience
- Based on work with Ketamine

24. Sacredness of the Journey

25. Treatment
Indications
for KAP
• Treatment Resistant
Depression
• Anxiety
• PTSD
• OCD
• “stuck in therapy”
• Gray areas: addiction and
suicidality

26. INTAKE
SCREENING
INTEGRATION
PREPARATION
assessment
KAP SESSION
(set and setting)
OVERVIEW OF KAP PROTOCOL

27. Importance of
Preparation
❖Informed Consent
❖Set and Setting
❖Role of Music
❖Role of Touch
❖Guiding Principles of the Approach
❖Expectations and possible experiences
❖Cartography of the mind
❖Support system
❖Regulation techniques

28. Medical Intake
and Screening
❖Collaborative - Physician,
Therapist, & Patient
❖ Review medical history and
medications and screen for
contraindications
❖Education about safety of
ketamine and drug interactions
❖Answer patient’s questions

29. Psychological Intake
and Screening
• Developmental/TraumaHx
• Psych Treatment Hx, Dxs, risks
• Hx SA, Use of psychedelics
• Religious/SpiritualHx
• Current support system
• Psychoeducationaround KAP
• Address questions aboutKAP
and Consent Forms
• ROIs for outsideproviders
• Prep for first KAP session,if time

30. Psychological Intake
and Screening
Psychological Testing:
❖PHQ-9
❖GAD-7
❖PCL-5
---------
❖ACE
❖Resilience
❖Change of State (after treatment)
❖MEQ, EDI (after treatment)

31. Sublingual Lozenges
and Troches
• Office relationshipwith KoshlandPharmacy
• Introduces patients to KAP while minimizing
medical invasiveness
• Allows for at-homeuse in some patients
• Empowers patients in their own healing
• Can be used in conjunctionwith IM administration

32. INTRAMUSCULAR
• Active collaborationbetween physician, therapist,
and patient
• Better tolerated by some patients – less side effects
• Allows for more precise dosing and stacked dosing

33. Dosing Strategy
❖Low dose: 0.25 mg – 0.5 mg/kg
❖Moderatedose: 0.5 mg – 1.2 mg/kg
❖High dose: 1.2 mg – 2.0 mg/kg

34. Treatment Approaches
Low Dose
• EmpathogenicExperience- Trance-like
state
• Psycholytic Therapy
• Allows for ongoing communication
• Induces mild dissociation,mildly
anesthetic, yet present and relaxed state
• Generallylow-risk; low side effects
Moderate to High Dose
• Out of Body Experience (OBE)
• Near-DeathExperience (NDE)
• Ego-Dissolving Transcendental experience
• Moderateto profound dissociative
sedation, may be like high dose classical
psychedelics
• Potential for side effects; not suitable for all
clients

35. Empathogenic Experience

36. KETAMINE RISKS
and SIDE EFFECTS
❖Nausea and Vomiting
❖Transientincrease in BP and heart rate
❖Dizziness, disorientation,blurred vision,
headache,dry mouth
❖Increaseor decrease in energy (fatigueor
restlessness)(rare)
❖Neurotoxicity-only in chronic and high
doseusage
❖Potential for tolerance& abuse and
dependence
❖Urethral cystitis and bladderpain with
chronic and long-term use
❖Non-compliance

37. Addiction
❖Ketamine can be
psychologically addictive
❖No evidence of physical
dependence, but withdrawal is
possible

38. CHALLENGES AND CONTRAINDICATIONS
❖ Medical Contraindications
❖ Psychological
Contraindications
❖ Not sufficient preparation
❖ Resistance to Integration
❖ Not wanting to let go
❖ Not wanting to face the
problems
❖ Not adequate collaboration
with other providers of
the patient

39. Transference and Countertransference
Challenges and Opportunities
AMPLIFY
REDUCE
NON-LINEAR
POROSITY/SUGGESTIBILITY

40. Transference Patterns

41. Transference Patterns

42. Integration

43. MAJOR GOALS OF KAP INTEGRATION (1)
Safety/stabilization: Smooth re-entry, prevention, ongoing monitoring
Attachment: Relationshipcontinuity and repair & deepen collaboration
Enhanced self-monitoring: Observing ego, neutrality,disentanglement
Debriefing: Emotionalprocessing,meaning-making, releasing,grieving
Resolving: Pathogenicbeliefs and conflicts among parts of the self
Durability: Accrual of benefit & consolidationof gains

44. MAJOR GOALS of INTEGRATION (2)
Dedicated application of newfound wisdom; support behavior
changes
Understanding challenging experiences: psychological &
archetypal/spiritual
Effective use of transference and countertransference experience
Coping with changes in identity and worldview and social system
Process traumatic memories & meanings, and navigate spiritual
emergency
Improved navigation of interpersonal challenges and intimacy

45. Integration Challenges
Katzman & Schwartz, Kriya
2019
Rapid Relapse
Zig-zagging
The Therapeutic Bends
“Dropping the Ball” / Insufficient Follow-up
Spiritual Bypass
Flight into Health
Survivor Guilt
Unearthing Unanticipated Feelings and Memories
Negative Transference/Negative Therapeutic Reaction/Clinical Error
Challenging Transpersonal/ArchetypalExperiences
“Splitting” the Clinical Team
Prevention of Enacting Premature Life Changes/Decisions

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

47. Training
Program
• Introduction to KAP
Webinar
• Intermediate KAP Webinar
• Advanced KAP Webinar I, II
• Role-Play Webinar
• ExperientialTrainings
• Polaris Intensive KAP
Retreats

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