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Ketamine Assisted Psychotherapy 2: The Ketamine Chronicles (Part 23)

Compared to my first KAP session, the second one was wildly more entertaining for me, but much less productive in terms of the number of words coming out of my mouth. KAP stands for Ketamine Assisted Psychotherapy. The idea is to utilize ketamine’s ability to lower your mental barriers in order to more comfortably talk about difficult topics with your therapist. I know that I was very nervous for my first session and likely fought the ketamine in an effort to stay in control, but I didn’t expect my slightly more relaxed approach this time to produce such a dramatic difference. I think I remember that there was a slight dose change from last time to this time, but I don’t think it was enough to really impact my experience. But, in a bewildering turn of events, being more relaxed actually led to me saying less. Rather than unleashing a flood of thoughts and feelings, I found myself being washed away by images and colors. My ability to imagine images certainly made my conversation with my therapist more bizarre, and most of the time, quite disjointed.

We started out by talking about bridges. I had tried to create a metaphorical bridge that crossed into my protected mental fortress during a previous infusion, but got stuck with a drawbridge that lifted every time somebody tried to cross. This time, I saw a fraying rope bridge with missing wooden slats. It stretched across a dark chasm with no visible bottom. It was a long bridge with not enough tension, making it sag in the middle. Despite its frayed appearance, the connections to the edge of the cliff on either side were sturdy. It would be a harrowing journey to the other side, but you could do it. Thinking about this as a lucid person, it strikes me that the metaphor breaks down at some point. Clearly, I have a well-protected area of mental privacy. I don’t open up easily, and I don’t tend to rely on many people. But to picture a dry, brittle rope bridge stretching across a dark chasm implies that it would be frightening to attempt to cross it. It’s scary for me to allow people to cross the bridge, but I certainly hope the crossing isn’t scary for them. Perhaps the drawbridge was a better metaphor for me. In any case, I only come up with bridges that are difficult to cross.

I found it extremely hard to stay focused on the topic at hand during this infusion, sometimes pausing and saying things like “the blood pressure cuff makes me think of fish being squished.” (The cuff periodically tightened, which distracted me and produced a feeling of what I imagined felt like raw fish being rolled and squelched under pressure.) If an answer to a question didn’t immediately pop into my mind, I found myself floating away from it – the room and the people within receding into the distance. At times, I remembered that I was supposed to be answering something, but wasn’t at all sure of how much time had gone by since my therapist asked the question.  Is she still waiting for me to answer? Are we still on that topic or did we move on already? I don’t think I remember the question. It was chronologically confusing – seconds slipped by without my notice like water flowing over stones, and yet the small movements of my therapist and doctor in the room were auditory markers of real time. How much time passed between my last thought and this one? It’s too hard to think in words. Better to just float. I don’t usually try to hold onto the real world during ketamine infusions, and it proved to take a lot of effort.

I also don’t usually talk during my regular ketamine infusions, so it was interesting to discover just how hard it is to describe the images I see. I can write about them in detail after the fact, but in the moment, they just escape description. Take, for instance, when I said I was seeing “a bunch of…cleaning things.”

What I actually was seeing was more like a set of rectangular brushes that fit together into a grid. They were a very light pastel range of purples and blues. Why was I thinking about puzzle-piece bristle brushes during my ketamine infusion? I have absolutely no clue. Part of what made it hard to describe was that the image was so enthralling that pulling myself out of it to come up with words was difficult. But part of it was that I knew that what I was saying came across as completely bizarre. Trying to describe why such a mundane-sounding image was so pretty just kind of stumped me.

The random and nonsensical images that I was trying to describe reminded me of “Drinking Out Of Cups“, a video from the mid ’00s of Youtube (contains profanity). I tried my hardest to explain it, but seeing as it’s a video about nonsensical things, I had a hard time putting it into words while lost in my own nonsensical world. I think I slipped into fits of giggles halfway through and had to finish up with “I dunno, I’m not doing it justice, but it’s really funny.” Also, “outta” is a really hard word to say when you’re on a mixture of ketamine and propofol. Just in case you wondered.

At some point, vials of colorful sand spilled into a desert, creating clouds of blowing particles with swirls of color. I was seeing it from above, and the drifts and valleys the wind created were captivating. It was a beautiful but rather lonely landscape. A parrot with no feathers appeared in the foreground, and when I mentioned this, my therapist questioned me for clarification. “Yeah, like a…a plucked chicken” I answered.

“Aw, poor guy,” she said. To which I then said, “No, h-he seems ok, though.” Well. That’s a relief.

I wonder if, despite being more relaxed this time, I had a harder time engaging with therapy because I don’t know how to filter my mental experience. Last time, I may have been so nervous that I just locked everything down indiscriminately and tried to function as “normally” as possible. I was more open to KAP this time, which left me free to be distracted by anything and everything that entered my thoughts. It seemed to take enormous effort to hold on to the real world while holding the door open for therapy. I’m imagining a large wooden door to Ketamine Land, and within the door to Ketamine Land, a smaller door labeled “therapy”. I think I accidentally opened the big door to Ketamine Land and was bowled over by the peculiar sights within. I should have only opened the door-within-the-door and accessed the loosey-goosey-ness of Ketamine Land in a smaller, more manageable way. I’m not sure how to do that, but perhaps it takes practice.

 

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My First Ketamine Assisted Psychotherapy Session: The Ketamine Chronicles (Part 21)

Ketamine Assisted Psychotherapy was completely new to me. I’ve had numerous IV ketamine infusions and I’ve been in therapy for years, but I’ve never merged the two in the same setting. The first goal was to find a dose of ketamine that caused me to dissociate enough to let my defenses down, but not so much that I was incapable of answering coherently. I was nervous beforehand; the unknowns of it were stressful. Once we got started, though, that anxiety faded.

My doctor asked me to tell him when I started to feel the effects of the ketamine, and when I didn’t, he asked me again a few minutes later. “It’s hard to tell with my eyes closed,” I said, “but yes, I think so.”

“Why is it harder to tell with your eyes closed?” My therapist asked. I paused to think.

“I guess because I don’t have any reference points. When my eyes are open, I can see that things are getting fuzzy or moving slightly, but with my eyes closed, all of that is gone.”

This is where my memory of the infusion gets a little foggy. I remember talking about particular topics, and I remember it being easier to answer quickly. In my normal therapy sessions, I take time to think about my answers, which leaves lots of space between our talking points. During ketamine assisted psychotherapy, I found myself answering with less deliberation. The majority of what we talked about flowed fairly well, but then we’d hit a tricky topic and my defenses went up. I’d stop talking, trying to decide if I should speak or not, and if my therapist pushed a little, I’d open my eyes. Opening my eyes seemed to be an indicator of my resistance to an especially uncomfortable topic. I must have been trying to exert some control over the situation, although I wasn’t fully aware of what made me open my eyes.

I had been worried that ketamine would make me incapable of holding back or deciding what I would or wouldn’t speak on. It turns out that the brick wall of lucidity also exists under the influence of ketamine. The presence of that brick wall usually makes me anxious; I worry about it. Why can’t I just talk about this stuff? There’s nothing behind it that’s secret or an enormous revelation. I feel like I’m wasting everyone’s time by being so silent, but I just can’t seem to break through it. Ketamine made me too relaxed to care much about what my therapist and my doctor thought of my silences.

For a few weeks now, Friday has been “Yes Day”. On Yes Day, I make a deliberate effort to say “yes” to opportunities that come my way. It’s a step towards becoming more spontaneous and a way for me to push myself to get out of the house. This ketamine appointment was, of course, on Friday. At some point during the infusion, my therapist mused that we could have No Nap Day in an attempt to combat my excessive sleeping. When asked if I was on board with Mondays being No Nap Day, I jokingly accused my therapist of exploiting Yes Day in order to create No Nap Day. In the end, I said “ok,” which I think counts as “yes”.

Unlike my usual trippy IV ketamine experience, I didn’t “see” anything this time. I think focusing on the conversation kept me from getting sucked into any kind of creative extensions of whatever random thoughts usually pass through my mind. All I saw was the darkness behind my eyelids, although it did seem somehow more dark than what I see when I simply close my eyes. It was deeper than that, as if I were farther away from access to my eyelids. I felt as if I had to swim upwards to reach them.

With my eyes closed, I sort of forgot that there was a person attached to the voice I was hearing. Not entirely – I knew somewhere that I was talking to my therapist, but it was easier to just focus on the disembodied voice without any of my usual curiosities. In our normal sessions, I often wonder what she’s thinking about my answers, but during KAP, all I could think about was responding to the question immediately at hand. It was an interesting change.

Being able to remember only parts of the infusion is odd. The gaps in my memory that I notice after an infusion usually feel like how dreams disappear when you wake up. I’m often left with the impression that I’m forgetting something rather inconsequential. This time, however, the knowledge that we were talking about real things has left me feeling slightly raw. I feel sort of scrubbed at in a nonspecific way, and it’s mildly uncomfortable.

I also feel like this ketamine infusion consisted of a lot of work. Usually, they’re relaxing and somewhat meditative; I just float along and let whatever comes into my mind pass by. This time, the effort of speaking and of thinking in sentences made it feel a lot less restful, but a lot more purposeful.

If you’re thinking about ketamine assisted psychotherapy, remember that this post is only my experience, and only of my very first one. Apparently, I’m tenacious in my resistance to open up; it may be easier for you to let your defenses down. While parts of it were uncomfortable, it was never scary.

I now have to think about how I want to proceed. Choices, choices!

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Ketamine Assisted Psychotherapy

Some people experience profound breakthroughs with ketamine assisted psychotherapy (KAP), in which a person engages in therapy while having a ketamine infusion. I’ve been getting IV

ketamine infusions for a while, now, but never really considered KAP an option for me. I’m comfortable with the arrangement of treatments I have now, and KAP has always intimidated me.

Cut to this week, when it seems a whirlwind swept through my plans for my upcoming ketamine infusion. Here’s what happened:

I’m in a rut. Again. My previous infusion didn’t seem to have a large effect on my mood, so discussions began to circulate about how to adjust things. My doctor suggested a ketamine assisted psychotherapy session and directed me to the release form that would allow him to talk to my therapist.

At this point, my alarm bells were going off, urging me to slow the KAP train down, but alas, here we are. My therapist had a conversation with my doctor, in which it sounds like they agreed that I am, indeed, in a rut. My therapist got some information about what ketamine assisted psychotherapy entails and then brought her thoughts to me at our regular session.

For context: One problem that I consistently run into during therapy is the brick wall between my mouth and certain emotional topics. Sometimes I can plow through it, but sometimes, I just shut down and the words don’t come out. There’s no fixing it until I go home and, often, write down what was happening on the other side of the brick wall.

Ketamine assisted psychotherapy is effective partly because the dissociative state that ketamine puts you in can make you less inhibited. It lets you separate yourself from your emotions. A therapist can then help you through topics that might otherwise be too difficult to talk about. The conclusion that everyone reached upon discussion of KAP was something like “Well gee, KAP would probably improve that problem where Gen makes like a mollusk and clams up.” (It’s likely that that particular wording only happened in my own brain.)

I’ve decided to give it a try. Despite constantly feeling like I don’t do enough, I do recognize that I work hard at improving my mental health. Beyond keeping up with the everyday tasks that seem to pile up to colossal proportions in my depressed mind, I also routinely push myself to leave my comfort zone. And yet, I continue to slog through quicksand. I sometimes feel like I “should” be able to heal myself with the tools I already have at my disposal, and if I can’t, it’s because I’m not working hard enough. This is garbage thinking. I’m allowed to add things to my treatment, and I’ll try something new if it seems like it could help me, even if it does sound scary.

My therapist asked me, “What’s the worst that can happen?” when I expressed my reluctance to do KAP. We decided that the worst is probably that I could embarrass myself or cry a lot, both of which I have already done in front of my therapist. Still, I know how I feel during a ketamine infusion, and that knowledge makes the idea of having a therapy session at the same time feel uniquely invasive. The sensation of talking while under the influence of ketamine is something I’ve written about before because it is just so bizarre. I’m always struck by how quickly thoughts go from my mind to coming out of my mouth; there’s no time to deliberate on whether or not you’ll say it. Again – this is part of the goal for me in this KAP experiment, but man, as a guarded person, the idea really provokes anxiety. Somehow, I’m also worried that I may not say anything. There is no way for me to enter into this with no worries other than to accept that there is no wrong way to do it.