An unidentifiable woman wearing a jean jacket sitting with her hands clasped in her lap and her legs crossed while talking to a therapist in the foreground.

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 treatments for depression 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.

What it’s Like to Do Ketamine-Assisted Psychotherapy for Depression

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.

Anxiety about Ketamine-Assisted Psychotherapy

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.

Setting Goals with KAP for Depression

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.”

How IV Ketamine Treatment Feels During KAP

Unlike my usual trippy IV ketamine treatment 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.

Doing Ketamine-Assisted Psychotherapy with a Trusted Therapist

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 imagine this would be more intense if I didn’t already know my therapist well.

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!

Black, grey, and orange alphabet letters scattered around the word therapy

What is Ketamine-Assisted Psychotherapy for Depression?

Some people experience profound mental health breakthroughs with a treatment called ketamine-assisted psychotherapy (KAP). I’ve been treating my depression with IV ketamine infusions for a while, now, but never really considered ketamine-assisted psychotherapy an option for me. I’m comfortable with the arrangement of treatments I have now, and KAP has always intimidated me. I’m about to tackle that fear in my next IV ketamine treatment for depression. So what is ketamine-assisted psychotherapy? How does ketamine-assisted psychotherapy for depression work?

What is Ketamine-Assisted Psychotherapy for Depression?

KAP is a type of mental health treatment in which a person engages in talk therapy while having a ketamine infusion. 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.

My Treatment-Resistant Depression is Gaining Ground

I’m in a rut. Again. My previous ketamine 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 for depression 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.

A person wearing a mustard yellow sweater and bangles on one wrist is typing on a laptop while sitting at a wooden table
Photo by Christin Hume on Unsplash

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.)

Taking Charge of My Mental Health Treatment

Blue pen resting on an open notebook with lined paper on a wooden table
Photo by Daniel Alvasd on Unsplash

I’ve decided to give KAP 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.

Keeping an Open Mind

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 IV ketamine treatment 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 – thinking less is part of the goal for me in this ketamine-assisted psychotherapy 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.

If you’d like to read more about my experience with ketamine for depression, start from the beginning of The Ketamine Chronicles or visit the archives. Click here for mobile-optimized archives of The Ketamine Chronicles.

Tracking My Anxiety

The anxiety began when I was eating lunch and scrolling through youtube, trying to find something interesting to watch. I scrolled faster, considering each thumbnail more and more briefly as the tightness in my chest increased. “Hold up,” I thought. “I’m supposed to be tracking my anxiety for my appointment next week. Let me write this down.”

Here’s how to overthink your anxiety record: First, I spent several minutes considering the medium I should use to document my anxiety; paper and pen seemed reasonable, but what kind of format? List? Table? Stream of consciousness essay? I also considered the kind of paper I’d use, be it sticky notes, that half-used legal pad in my bookcase, small notebook–ugh. Too many choices. Let’s go digital. Thank goodness the Notes app is pretty minimal, or I’d still be waffling on what kind of font to use. (Speaking of “stream of consciousness”, I just realized that I could totally make a PowerPoint presentation, complete with awesome clip art and slide transitions. That would really prove my therapist right when she said I’d probably find a way to make it complicated because I’m an overachiever. Challenge accepted.)

So far, I have written down everyday things like realizing I wasn’t sure if someone introduced themselves as Janice or Janet and imagining the obviously catastrophic embarrassment when I inevitably pick the wrong one. I also have bigger things like my unknown life plans, noticing that Stella had put her sneaky paws on the counter and eaten chunks of chocolate cookies out of the pan (she’s fine), and also seemingly random anxiety with no discernable cause. Some of the “random” anxiety is probably due to sensory processing disorder and my tendency to steamroll over discomfort rather than make adjustments for my nervous system. It’s a work in progress.

I think I’ve spent a long time telling myself that anxiety isn’t an issue for me, which makes it a challenge to be mindful of it. After the OCD mostly disappeared, I guess I went “Well, that’s done. I don’t have anxiety anymore.” If only it worked like that. I keep having to reassess my understanding of what’s a normal amount of anxiety and in what contexts it’s normal. Seriously, I have no idea at this point. Do other people feel anxious when they have to walk by the check-out lanes on their way to somewhere else in the grocery store because they can feel people looking at them? No? What kind of lie have I been living?! I guess I knew that some of my anxiety was unreasonable, but convinced myself that it was minor enough that it didn’t need to be addressed. Now I’m just not sure what should be on my list of concerns. Time to go put “worrying about the amount I worry” on my list.

In case my therapist reads this: don’t worry, I will not be showing up with a PowerPoint detailing my anxiety, although that would be hilarious and probably a new one for you.

 

Anxiety and Doing New Things

In an attempt to fill my time with things that will keep me from slipping back into severe depression, I’ve started doing New Things. One is volunteering and the other is taking a neighbor/friend up on her offer to teach me how to ride horses.

I really want to quit and crawl back into my hermit cave. I am way outside of my comfort zone, which, for me, always leads to near-constant worrying and ruminating. I can’t help but laugh because when my new therapist asked if anxiety was also a problem for me in addition to depression, I said “hmm, no, not really.” She later disagreed, and the more I think about it, the more I realize that yes, yes it definitely is. Now that my depression is easing, I think that anxiety is coming to the surface. (Additionally, when I tell people about this anxiety realization, they look at me like “you…didn’t know that?” So, that’s cool. Everyone knows about this but me.)

When I’m really depressed, I’m so numb and slowed down that I don’t even worry about saying “yes” to new things; the answer is automatically “no”. But when the depression lifts, my natural tendency to overthink everything and fall face-first into crippling indecision has room to become obvious. Because I feel capable of doing more than I did while depressed, I feel like I should say “yes” to new opportunities, even if I’m on the fence.

Rather than deciding to just get out there and demolish the boundaries of my comfort zone, I get…stuck. Really stuck. I want to do new things in general, but when an opportunity comes along, my worry and fear keep me from making a confident decision. It’s tough for me to decipher whether I don’t want to do something because I’m feeling overwhelming New Thing-anxiety or because I won’t like it. And, since I know that this is a problem for me, if I think there’s a chance I might like it eventually, I tend to make myself push through and do it no matter what. Of course, I do that while also continuing to worry about whether or not that’s the right thing to do.

An additional layer of this terrible cake is that I do not like quitting, even if I really want to bail. And even if this hypothetical New Thing has very natural exits where I can decide it’s not for me and stop, it still feeeeels like quitting. This makes me even more indecisive because not only do I need to know if my anxiety is coming from a dislike of the Thing or not, but I also need to know if I can be committed to the entire Thing. No quitting. Approaching opportunities like this is not fun, and I do not recommend it. 0/10.

I imagine the goal is to take each new opportunity and be able to decide, quickly and simply, whether I want to do it or not. I just don’t know how to do that without taking all of the stuff above into account and getting hopelessly tangled up. I guess step one is to remind myself that I can say “no”, changing my mind is ok, and that in many cases, it’s not that big of a deal.

Much easier said than done.

 

What to Consider When Switching Therapists

There are lots of reasons you might go from one therapist to another. You might be moving, looking for another perspective, or simply feel ready for a change. Or, it could be that your therapist is leaving; career change, maternity leave, any number of scenarios in which you must decide what to do with your treatment. And, pretty much no matter what, switching therapists is hard.

I’m in this boat right now, and I’m finding it more tricky than I expected. For one thing, I’ve had the same therapist for almost two years. We’ve gotten to know each other (in a heavily one-sided way), and when I’m not completely shut down with depression, I really enjoy her company. It takes me a minute to be comfortable with someone, so the thought of switching therapists and beginning that process again is daunting.

Online Research

When I began my search for a new therapist, I started with Psychology Today’s therapist directory. You can filter it by issue, insurance, gender, and other factors that might help you narrow it down. I also tried googling a combination of “therapist” with “depression” and my area.

Contact Method

Some therapists provide an email address with their contact information. Text, be it emails or SMS, is BY FAR my favorite way to communicate. Making phone calls is an arduous process, what with the scripting and practicing and heavy sweating. But, leaving a message on an answering machine is, in my experience, more likely to get you a speedy reply. [Pro tip: if you approach phone calls the same way I do, keep a list of potential therapists and the status of your contact. I can just imagine leaving the exact same scripted message for the same person twice and being mortified enough to cut contact entirely.]

Make Appointments with Multiple Therapists

I highly, highly, highly recommend that you make appointments or consultations with multiple people. It’s way more time-consuming, and I’m finding it difficult to tell my story again at each new appointment, but it’s the best way to find a therapist that you like. Your current therapist might give you a list of people to call, you can search the web, and if you meet with someone and it doesn’t work out, ask them if they have any colleagues they can recommend.

Therapists Understand that Switching Therapists is Hard

Switching therapists is an interesting process to go through after being in therapy for a while and having done the search a few times before because I feel much more sure of myself. I know what kinds of approaches I’m looking for and I know roughly what to expect at an initial appointment. But, I also have more of a history within the mental health treatment sphere to explain in a coherent manner. The sequence of events is too long to describe in detail at a first meeting, so I have to decide how to summarize in a way that gets everything across. I don’t always succeed, and then we’re left filling in important gaps that I forgot about. Fortunately, therapists understand that the transition can be a difficult process.

It can be hard to leave a therapist who has helped you through really tough times. They’ve supported you and listened to you, and it’s natural to be sad that your time with them is over. But, it’s not meant to be a relationship that lasts forever. I’m going to miss my current therapist, but I’m also looking forward to getting a new perspective. It might be just what I need to put all the pieces of my recovery together.

woman in orange jacket holding flowers in front of face

5 Tips for Therapy Clients Who Don’t Like Talking About Themselves

If you ever feel like a deer in headlights when asked to talk about yourself, I empathize. Whether it’s one of those dreaded get-to-know-you icebreakers or your therapist asking you a question, having to talk about yourself is uncomfortable for many people. By now, I’ve been in mental health treatment for several years, and I have a few tips for therapy I’d like to offer.

When I first sought therapy for myself, I found it extremely difficult to engage with it fully. If you don’t like being the center of attention, beginning therapy can be overwhelming. After all, the entire point of it is to focus on you. Early on, talking about myself in therapy felt, at times, nearly unbearable. Too many questions too fast made me shut down, and too loose of a structure lead to lots of awkward silences, both of us waiting for the other to say something. Over time, however, I’ve gotten much better at it. Here are some of the ways I’ve found to help me feel more comfortable about talking about myself in therapy.

The essentials

Any list of tips for therapy wouldn’t be complete without a soapbox moment about the therapeutic relationship. It doesn’t matter if you’re just starting therapy or you’ve been in it for a while; it’s vital that you like your therapist. The struggle of talking about yourself will be even worse if you don’t feel understood or accepted in therapy. In fact, research shows that therapy is much more effective when you and your therapist click. Don’t feel bad about shopping around or about switching therapists if it’s just not working out.

Secondly, remember that therapy sessions are for you. Push yourself out of your comfort zone, but go at your own pace. Therapy is your time to do with it what you will.

Communicate what you want to get from sessions

This is a tough one. There’s a lot that falls under this umbrella, but mostly what I mean by it is: tell your therapist if you would like to direct the topic of each session or be given more structure. Maybe it’s hard to talk about yourself because answering questions feels too probative, and you’d rather start off with a narrative. I prefer to have more structured questions because if I’m given free rein, I go blank and have absolutely nothing to say. Regardless of which end of the spectrum you’re on, your therapist is always there to help direct you and keep you on track.

Practice saying how you feel

I struggle hardcore with identifying how I feel. Maybe it’s sensory processing disorder, maybe it’s Maybelline. Sensory discrimination issues have extended into the emotional realm and mean that I often don’t know how I feel about something. If you have a hard time verbalizing how you feel, my advice is to practice. It sounds silly, but just as if you were a little kid, practice saying “I feel ____” and then fill in the blank with something more specific than “okay” or “fine.” Even on your own, check in with yourself; am I feeling excited? Lethargic? Irritated? It really does start to feel more natural over time.

I also find that using metaphors breaks the tension and allows me to communicate more comfortably. For example, my therapist and I talk about “clams” instead of “goals” because the very mention of goals used to make me a sweaty, anxious tear factory. The Potato Scale of Depression is another way that I like to remove a little of the scrutiny from myself and package it up in a statement about mashed potatos or soggy gnocci. There are many ways to get used to talking about your feelings!

Make the Space Comfortable

Of course, it’s not your office. You can’t go swapping out furniture and changing the overhead lights. But you can do some things to make the space more comfortable for you. A therapist I saw in college noticed that I have a very wide bubble of personal space and offered to move her chair a little further away from me. You can ask to close the blinds if it’s too bright for you, bring a small blanket to help you feel cozy, and be sure to wear comfortable clothing.

Stay (Mildly) Busy

Something that I learned in occupational therapy but haven’t put into practice (maybe I should!) is that talking about difficult things is often easier when your hands are busy. Bring a coloring book, a fidget toy, or a craft- if you’re a knitter, crocheter, or have some other portable project. Of course, this is one of my tips for therapy clients that is only good advice as long as your therapist doesn’t need you to be completely present during your work together. It doesn’t hurt to ask.

For us reticent folks, therapy can be scary even just to think about. But, like so many things in life, working on what’s difficult often leads to the best outcomes. With time and practice, talking about yourself in therapy gets easier, especially if you find what will support you and then advocate for yourself.

white sign with black capital letters reading "you are worthy of love" near telephone pole, green bush, and asphalt walkway

Considering Worth and Achievement

I’m going to therapy tomorrow morning. Last week, there was a moment when we were talking about my goals and I became very quiet. Something in my thoughts had made me feel emotional, but as I was enjoying having a normal conversation with my therapist, I pretended nothing happened. (Haha, nice try. I think she knew.) Now that I’ve had a week to think about it, I’m planning on bringing it up when I go to my appointment tomorrow.

Here’s the issue: there were parts of me that I had thought were stemming directly from my depression. Feeling worthless, after all, is a symptom of depression. But now that I’m feeling better, I find that I’m still thinking of myself as less valuable than other humans. Whether that’s a product of having been depressed for a while, or it was there all along, I’m not sure how to change it. Talking about my goals led me to this realization because I started thinking about the value of my accomplishments and the cost of my depression. Treatment for my depression has become expensive, and when I pondered that in therapy last week, I suddenly concluded internally: “I’m not worth that much.” Reaching my goals and accomplishing what I want to is, in my mind, the way for me to become “worth” the expense.

I don’t want to get too philosophical- that’s not my area- but I’m comfortable declaring all human life inherently valuable. Let’s exclude those variables like violent crime and abuse, and consider everyone without any actions in their past. John Locke considered the mind at birth a blank slate, which experience acts upon to form our beliefs and knowledge. This leaves us with two possible conclusions, I think. Either the “blank slate” of human life is worthless until some positive attributes or achievements earn that person value, or all people have innate value by virtue of simply existing with potential.

It’s clear to me, and to most people, I think, that human life is innately valuable. So, why am I so stumped when it comes to believing in my own value?

Sometimes, I try to trick myself by arguing that because I think I am fairly average, there is no reason that I would be special enough to be an exception to such a universal rule like “all people have value.” Then I reach some kind of does not compute error in my brain and start the whole thing over again.

Aaand this is probably the point where my therapist would tell me that I’m very cerebral and maybe should return to feeling feelings. Yeah. I get stuck in existential loops a lot.