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Ketamine-Assisted Psychotherapy

Psychedelic-Assisted Psychotherapy: A Paradigm Shift in Psychiatric Research and Development

Mental disorders are rising while development of novel psychiatric medications is declining. This stall in innovation has also been linked with intense debates on the current diagnostics and explanations for mental disorders, together constituting a paradigmatic crisis. A radical innovation is psychedelic-assisted psychotherapy (PAP): professionally supervised use of ketamine, MDMA, psilocybin, LSD and ibogaine as part of elaborated psychotherapy programs. Clinical results so far have shown safety and efficacy, even for “treatment resistant” conditions, and thus deserve increasing attention from medical, psychological and psychiatric professionals. But more than novel treatments, the PAP model also has important consequences for the diagnostics and explanation axis of the psychiatric crisis, challenging the discrete nosological entities and advancing novel explanations for mental disorders and their treatment, in a model considerate of social and cultural factors, including adversities, trauma, and the therapeutic potential of some non-ordinary states of consciousness.




Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy

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Transpersonal Effects of Ketamine

There is no consensual opinion regarding how psychedelic substances might work beneficially within clinical settings. Most of the researchers view the active mechanisms of psychedelic substances solely from a biochemical perspective. Ketamine is often considered a “psychomimetic” (i.e., causing effects mimicking psychoses), prompting some US investigators to use ketamine-induced phenomena as a model for studying psychoses in experimental research (e.g., Krystal et al., 1994). In this model, the psychedelic effects of ketamine are seen as undesirable rather than as a potential therapeutic mechanism.
Contrary to this view, we propose that ketamine’s powerful psychotherapeutic effect is possibly due to its psychedelic-including transpersonal experience generating-properties, as it frequently induces in
sub-anesthetic doses feelings of ego dissolution and loss of identity, emotionally intense visions, visits to mythological realms of consciousness, vivid dreams and memories of possible past incarnations, experience of the psychological death and rebirth of the ego, and feelings of cosmic unity with humanity, nature, the universe, and God. These observable facts were initially described as “emergence phenomena” (White et al., 1982) and clearly depict a psychedelic experience. These non-ordinary states of consciousness offer an additional or alternative mechanism of ketamine’s effects over and above purely biological explanations. One of us (Friedman, 2006) previously speculated that psychedelic drugs such as ketamine are specifically useful due to their transpersonal, rather than solely neurobiological, effects. This is also congruent with the conclusions of numerous researchers that spiritual factors are crucial in treating many psychological problems, such as is frequently discussed for alcoholism (e.g., Robinson, Brower, & Kurtz, 2003; Amodia, Cano, & Eliason, 2005).
Grof (1980) has developed a comprehensive theory of psychedelic psychotherapy from this perspective. He concluded that psychedelic substances facilitate therapeutic experiences of symbolic death and rebirth of the ego, allowing clients to work through deep traumatic fixations in their unconscious. Grof successfully applied this specific transpersonal psychotherapeutic approach to more than 750 patients. He explicitly discouraged his clients from analyzing their psychological problems and instead assisted them in transcending their inflexible maladaptive patterns, placing a strong emphasis on their transpersonal growth potential. Although Grof primarily used LSD as a psychotherapeutic agent, he acknowledged that ketamine holds great promise due to its “affinity for positive dynamic systems” (p. 214). He stated that the psychoactive effect of ketamine is so powerful that “it catapults the patient beyond the point of impasse from the previous LSD session, and can make it possible for him or her to reach the better level of integration” (p. 214).