Ketamine-assisted psychotherapy is an emerging treatment that combines ketamine administration with psychotherapy. It is distinguished from ketamine infusion clinics by its emphasis on set and setting, the therapeutic relationship, and preparation and integration into the treatment plan. Ketamine has rapid onset and metabolism, and produces dissociative states from psycholytic to psychedelic. Its mechanisms of action involve glutamate and neuroplasticity. Risks include nausea, increased blood pressure, and potential for abuse with chronic use. Polaris Insight Center provides ketamine-assisted psychotherapy following screening, dosing, integration processes to maximize benefits and safety.

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

2. Introduction to Ketamine-Assisted Psychotherapy
COPYRIGHT 2020
POLARIS INSIGHT CENTER – SAN FRANCISCO
.
BACKGROUND AND FUNDAMENTALS
June 11 and 13, 2020

5. Ketamine Assisted Psychotherapy
vs
Ketamine Treatment
Treatment room at Polaris Insight CenterTreatment room at IV infusion clinic

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

7. KAP
Prescriber
Patient Therapist

8. KETAMINE

10. FULL DISSOCIATION: THE “K-HOLE”

11. Ketamine’s Signature 1/2
• Rapid onset, Rapid metabolism & Excellent safety profile
• Dose-related access/flexibility for therapeutic process – Psycholytic &
Psychedelic
• Reduction/Elimination of external stimuli and sensations &
heightening of internal visual experience
• Preservation of the observer self -observing ego - witnessing self
• Outside of bounded time and space – different levels and depth of
altered state experience

12. Ketamine’s Signature 2/2
• Spaciousness of mind, Freedom of mind, Sense of movement and
music essential in the experience
• Reduction of verbal thinking and processing and connection to
symbolic realm of experience
• Reduction in 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

13. NEUROBIOLOGICAL
“BROAD STROKES”
This Photo by Unknown Author is licensed under CC BY-SA

14. Neurobiological Mechanisms of Action 1/2
• Increased Glutamate Ketamine is an NMDA glutamate receptor antagonist: transmission
–prefrontal cortex
• “Master Switch:” Glutamate - most abundant and important excitatory neurotransmitter,
aka “Workhorse of the Brain”
• Glutamate Roles: Pain, Anxiety, Inflammation, Stress, Fear Conditioning, Depression,
Neurological/Psychological Resilience, Learning, Memory
• Changes in cell signaling, synaptic plasticity and strengthens neural circuitry

15. Neurobiological Mechanisms of Action 2/2
• Reverses Neuronal Atrophy
• Supports Synaptogenesis & dendrite spine morphogenesis
• Strengthens synaptic connections – learning/memory consolidation
• Reduces brain activity in areas involved in rumination and self-monitoring
• Disrupts DNF (default mode network), creates hyper-connectivity
• Regulates downstream to other neurotransmitter systems

16. This Photo by Unknown Author is licensed under CC BY-SA
This Photo by Unknown Author is licensed under CC BY-SA

17. •War on Drugs/Disinformation vs. Psychedelic Research/Practice
•Big Pharma vs. Little Pharma vs non-profit (Healthcare, Insurance)
•Ketamine World: Anesthesiology vs. Psychiatry (K infusion vs. KAP)
•Psychedelic World: Underground vs. Credentialed Professionals
•Biological- Psychological - Shamanic/Transpersonal Models
•Medical vs. Nonmedical Practitioners vs. Multi-modal tx protocols
•Addiction Issue: safety, efficacy, prevention/management

18. • Neurotoxicity Issue - safety vs. risk management vs. disinformation
• Goals of Tx: Symptom relief, personality/character change, life quality
• Relevance of standard clinical measurements for transformational Tx
• Training psychedelic therapists with/without direct experience?
• Drug regulation/restriction criminalization, incarceration- versus drug
education and personal freedom, consciousness freedom
• Essence of Healing? - molecule vs. relationship vs. both
• Changed Role of the Therapist and Role of the Patient

19. •Role and value of pleasure, awe, wonder in healing
•Role, value and risks of physical touch and contact
•Significance of dissociative, mystical, transpersonal experiences in tx
•Racial, ethnic, economic divisions regarding ACCESS and availability
•Cultural appropriation vs. Cultural honoring in treatment protocols
•The worried well vs, the Psychologically distressed - is it kosher?
•Psychedelic Naivete, Psychedelic Narcissism, Psychedelic Fascism

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

21. Psychological
Intake and Screening
• Psychological Testing:
• PHQ-9
• GAD-7
• PCL-5
• ACE
• BDI-II
• Change of State (after treatment)
• Resiliency
• MEQ, EDI (after treatment)

22. 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

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

24. Empathogenic
Psycholytic
Out of Body Experience
Trance
Perinatal Matrices
Near Death Experience
Ego Dissolution
Moderate Dose
High Dose
Low Dose

25. Dosing Strategy
• Low dose : 0.25 mg – 0.5 mg/kg
• Moderate dose: 0.5 mg – 1.2 mg/kg
• High dose: 1.2 mg – 2.0 mg/kg

26. • Office relationship with Koshland Pharmacy
• Introduces patients to KAP while minimizing medical
invasiveness
• Allows for at-home use in some patients
• Empowers patients in their own healing
• Can be used in conjunction with IM administration
Sublingual Lozenges and Troches

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

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. Medication
Interactions
Benzodiazepines
Opiates
Alcohol
Lamotrigine
Calcium channel blockers

30. KETAMINE RISKS
and SIDE EFFECTS
• Nausea and Vomiting
• Transient increase in BP and heart rate
• Dizziness, disorientation, blurred vision,
headache, dry mouth
• Increase or decrease in energy (fatigue or
restlessness) (rare)
• Neurotoxicity- only in chronic and high
dose usage
• Potential for tolerance & abuse and
dependence
• Urethral cystitis and bladder pain with
chronic and long term use
• Non-compliance

31. Safety and Monitoring
• Logging medication
• Medication cabinet
• CURES
• In-office visit required for medical
evaluation
• Emergency Medical Response Plan
• Rescue medications

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

33. Risk management
• Patients required to
communicate with therapist
after every at-home session
• No automatic refills
• Prescribing limited number
of lozenges for trial period
• Lozenges - difficult to abuse

34. THE HEALING
POTENTIAL OF
NON-ORDINARY
STATES OF
CONSCIOUSNESS

35. Activation of -
and
Trust in -
the
Inner
Healing
Intelligence

36. Experiential
Learning

37. NEAR DEATH EXPERIENCES

38. Set & Setting

39. Mind-Set

40. Polaris Insight Center

42. Integration

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

44. MAJOR GOALS of INTEGRATION (2)
• Dedicated application of new found 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. Future
Training
Opportunities
• Intermediate KAP Webinars on
6/20, 7/11, 8/15
• Advanced KAP Webinar for
practicing providers
• Experiential Trainings in fall
2020; dates TBD after COVID-19
safety is established
• Polaris Intensive KAP Retreats
in late 2020; dates TBD

46. 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
THANK YOU