Module 3: Intermediate Workshop II 2.0 Harvey Schwartz, PhD • Veronika Gold, LMFT • Eric Sienknecht, PsyD • Chris Stauffer, MD

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

2. Ketamine-Assisted Psychotherapy
COPYRIGHT 2020
POLARIS INSIGHT CENTER – 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. Codes 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
• Kriya Institute Ethical Guidelines
• North Star Ethics Pledge

11. Ethics of
Therapeutic Ketamine
Preparation
Setting
• Container and Contained, Secure base
• Winnicott – Going On Being
• Sensitivity to cultural factors
Mindset of Client
• An altered state is a vulnerable state
Mindset of Clinician
• Clinician Know Thyself
• Personal experiences with the
medicine
Integration

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. Descriptive Themes
1. Requires more authenticity/ role flexibility
2. Greater transference/ countertransference
3. Embodiment, nudity, and sexual expression
4. Deep intimacy and connection
5. Mutual benefit in love and care
6. Use of touch
7. Greater need for skillful self-disclosure
8. Greater client vulnerability/ less autonomy
9. Need for broader availability to clients
10. Energetic boundary concerns
11. Natural pull toward multiple
relationships
12. Profound states of regression
13. Client more sensitive to therapist’s material
Descriptive themes refer to ethical challenges
that participants reported facing in their work.
Prescriptive Themes
1. Self-awareness/attentiveness to self
2. Supervision/consultation
3. Attentiveness to client–therapist relationship
4. Personal therapeutic work
5. Therapists must have psychedelic experiences
6. Value of long-term relationships and repair
7. Working within a community of practice
8. Attunement/responsiveness around touch
9. Two-stage consent process for touch
10. Training and scope of competence
11. Redirecting from interpersonal to intrapersonal
12. Grounding in love/service
13. Grounding in spirit/sacredness of relationship
14. Grounding in lineage
15. Adjudicating transgressions nonpunitively
Prescriptive themes refer to ethical practices that
participants have found helpful in navigating ethical
challenges in their work.
Brennan et al., 2021

14. • “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

15. Economics and
Access
• Increased accessibility without scaling and
compromising quality
• Diversity among clinicians
• Dynamics and pragmatics of lower fees
• Assessing economic vulnerability
• Shame and exploitation
• Extracting models vs stewardship models

16. Who We Are
Thank You Life is a non-profit organization that facilitates access to psychedelic-assisted therapies by subsidizing
payment for treatment that is frequently too costly for clients to pay for on their own.
We currently partner with numerous psychedelic treatment clinics in California, Colorado, and Texas. We vet each
clinic thoroughly to ensure the clinic and clinicians have proper treatment protocol and training.
Initially, a good portion of our funds will be used to support people in accessing ketamine assisted therapy. This will
expand to include MDMA, and psilocybin assisted treatments once these become legalized, which is expected to
occur by early 2023.
Our Fiscal Sponsor
New Earth (NewEarthLife.org) helps traumatized youth transform their lives. They support our mission to help a
variety of traumatized populations get the healing they need.
Donations
Donations to Thank You Life will go directly to our Fiscal Sponsor, New Earth.
New Earth receives 5% as administrative costs and then Thank You Life directs all remaining proceeds to the
Thank You Life Fund to support clients in payment for psychedelic therapy.

17. 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 forbidden zone; 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

18. Collaboration with outside providers

19. STEPS
• Requirement of having an outside therapist
• Release of information for outside providers
• Initial contact
• Education around KAP, answering questions
• Establishing collaborative relationship
• Establishing ongoing communication

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

21. 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 treatment

22. 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

23. 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

24. Outside/Primary Therapist in KAP Sessions

25. Group Ketamine Assisted Psychotherapy

26. 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

27. Preparation for Group
• Individual Medical and Psychological Intake prior to joining
• Consent for Group psychotherapy – confidentiality and fees
• Examples of exclusion criteria – logistical issues, low motivation,
poor psychological mindedness, high degrees of defensiveness,
denial and guardedness, anger management issues/hx of violence
• Consideration of initial individual KAP experience, particularly for
higher-risk clients or for those who are new to ketamine
• Preparing members for types of experiences that can come up in KAP
• Discussion of 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

28. Group Structure and Dosing
• Groups are generally composed of 3 – 5 members, with two
facilitators (e.g. collaboration of MD/therapist or RN/therapist)
• Group duration is 5 weeks, not including intake/screening, with
Experiential sessions occurring 1x/week
Week 1 – Prep
Week 2 – Exp 1 (low – moderate dose: 0.5 – 0.8 mg/kg)
Week 3 – Exp 2 and Int 1 (moderate dose: ~1 mg/kg)
Week 4 – Exp 3 (moderate – high moderate dose: 1 -1.2 mg/kg)
Week 5 – Exp 4 and Int 2 (high moderate – high dose: 1.2 – 1.5 mg/kg)
• Prep and integration sessions are 90 minutes (1.5 hours);
Experiential sessions are 240 minutes (4 hours)

29. Ongoing Group
• Closed group
• Full KAP treatment available through group
• Develop relationships over time
• Increase of Accessibility – lower fee
• Bigger commitment, scheduling challenges
Preparation KAP 1 KAP 2 Integration KAP 3 KAP 4 Integration KAP 5 KAP 6 Integration

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

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

32. Polaris KAP Support Group

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

34. 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

35. 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
Projectile vomiting

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

37. Virtual
Ketamine
Assisted
Psychotherapy

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

39. Challenges
of Virtual
Sessions

40. 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)

41. 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

42. 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

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

44. Integration and Working with Intention
• Sharing the experience, reviewing transcript
• Re-visiting insights, visions, experience and relating
to intention, “anchoring” (Wolfson)
• Next-day journaling
• Next 2 days listening to the playlist as a part of integration
• Supporting accountability to integration, verbalizing next steps

45. 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?

46. Integration of Spiritual Experiences

47. 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

48. 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”

51. Humility
Inclusivity
Dialectical

52. Form and Formlessness
Duality and Non-duality

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

55. 7 Stages of Spiritual Development
(Ken Wilbur and Brandon Robertson)
Archaic (Survival)
Magic (Supernatural, Pure Faith, Power-driven; Miraculous)
Mythic-literal (Absolute Truth; Dogma; Correct
affiliations/absolute loyalties)
Rational (Universality; Objective Morality; inclusivity; Inquiry,
De-mythologizing)
Pluralistic (Multiplicity of perspectives; Equality; Social
Justice)
Integral (Includes yet transcends all prior stages- towards
nonduality - nothing excluded, nothing denied)

56. Psychospiritual Healing
Georg Feuerstein, Ph.D.
Spiritual Emergence
Spiritual growth and awakening, which
involves tapping into our higher human
potential (at the transpersonal level of
development). In the course of this
process, the individual is likely to
encounter critical points where he or she
may experience emotional and mental
turmoil as well as unusual physiological
effects. Unless these experiences are
properly understood within the context of
psychospiritual growth, they might be
misdiagnosed and cause the individual
needless worry and potentially damaging
psychiatric or medical intervention.
Spiritual Emergency
Term coined by Stanislav and Christina
Grof.
Dysfunctional state or phase within the
comprehensive process of spiritual
emergence. During spiritual emergency,
the individual finds himself or herself
overwhelmed, in a genuine crisis
involving troublesome emotions,
thoughts (including suicidal thoughts),
and also disruptive behaviors that
clearly need outside help.

57. Spiritual
Emergence/Emergency
• DSM-IV proposal: Mystical Experience with Psychotic
Features (Lukoff, 1985), V code – condition not
attributed to a mental disorder (Lukoff, 1988),
Psychoreligious/Psychospiritual Problem (Frances,
First, Widiger, Miele, Tilly, David, & Pincus)
• Religious Problems – Conversion, Intensification of
belief or practice, loss of faith, joining or leaving
movement/cult, other
• Spiritual Problems – Loss of faith, NDE, Mystical
Experience, Kundalini, Shamanic Initiatory Crisis,
Psychic opening, past lives, possessions, meditation-
related, separation from a teacher, other

58. Spiritual Trauma

59. Future
Training
Opportunities
• Introduction to KAP Webinar
• Intermediate KAP Webinars
• Advanced KAP Webinars
• Role Play Module
• Medical Module
• Music Module
• Self care of therapist Module
• Experiential Trainings; dates TBD after COVID-19 safety is
established
• Polaris Intensive KAP Retreats; dates TBD

60. 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