Ketamine Assisted Psychotherapy
What is Ketamine?
Ketamine is a psychoactive drug that was first synthesized in 1962 and has been used in the United States as an anesthetic in medical settings since 1970. Much like other compounds used in medicine, Ketamine has been found in the natural world in the fungi Pochonia chlamydosporia. In addition to its use as an anesthetic, it has been used off-label in sub-anesthetic doses for at least 20 years for the treatment of chronic pain, depression, and now more recently for eating disorders, anxiety, and PTSD among other mental health conditions. Relief from depression can be almost immediate for many patients and though these effects tend to be temporary after a single ketamine treatment, multiple treatments have been shown to have a cumulative effect in alleviating symptoms.What is Ketamine Assisted Therapy?
Ketamine Assisted Psychotherapy (KAP) involves the use of ketamine in a supported therapeutic setting with an emphasis on preparation sessions, the ketamine experience itself, and integration sessions afterwards to reflect on insights gained during the experience. Special attention is paid to the "set and setting" - that is - the mindset and intention of both provider and patient as well as the creation of the supportive environment. Ketamine can help soften psychological defenses, allowing for contact with difficult material in new ways as well as deeper self reflection and therapeutic processing. In higher doses, it can induce psychedelic experiences which vary in content but often traverse themes such as access to surrender, profound love and gratitude, unity, feeling unbound by time or space, and out-of-body experiences. These types of experiences can help people in a variety of ways, offering important clarity and insight into one’s struggles, adding a spiritual dimension to ongoing therapeutic work, and facilitating a sense of meaning and interconnectedness. Dr. Sentell does require that patients have a relationship with a primary therapist to help support additional integration during and after KAP treatments. What about other Psychedelics? Many patients also have questions about how Ketamine compares with other psychedelic medicines. Dr. Sentell is able to engage in harm reduction conversations to help patients gather information for informed decision-making about these during intakes for Ketamine Assisted Treatment. Information about Oregon's Psilocybin Services can be found here and here- Most protocols for treatment resistant depression involve 6 KAP sessions spaced over 3-6 weeks, modeled after the spacing of sessions used in IV Ketamine clinics and what most of the research has looked at. This varies case by case based on patient needs.
- We use sublingual Ketamine (dissolved under the tongue) and intramuscular ketamine injections - we do not offer IV or nasal spray ketamine at our clinic.
- Patients are required to have an existing relationship with a mental health therapist (or mental health focused care provider) whom they can continue doing work with during and after the KAP series.
- The series has a 3 part structure: Medical Screening Visit, Preparation Visits, KAP Sessions and concurrent Integration Visits
- Medical Screening Visit – Initial office visit to determine if KAP is a good fit for your circumstances and goals, if Ketamine is medically safe to prescribe for you, and if Dr Sentell feels like a good fit for you to do the work with. This is a one hour visit; in person only.
- Preparation Visits – 2 to 3 office visits to lay the groundwork for the work you will do in the KAP sessions. Usually 45 minutes; can be done virtually.
- KAP Sessions – 3 hour sessions with the Ketamine medication, facilitated by Dr Sentell. Patients must have a ride home following and there is no driving for the rest of the day. For most patients Dr Sentell recommends 6 KAP sessions, 1-2 per week for 3-6 weeks, however, this recommendation will be individualized to patient needs.
- Integration Visits – office visits to assist with integrating the experiences from the KAP sessions. Dr. Sentell typically recommends one integration following the first KAP session and one following the final KAP session. In addition, patients are expected to do additional integration work with their personal therapist. These are usually 45 minutes and can be done virtually.
- We are able to bill insurance for the office visit portion of the treatment only. While insurance has routinely been covering Dr. Sentell’s consultation time before the administration of ketamine, patients are responsible for payment if insurance denies coverage. The ketamine sessions - after the administration of ketamine - are not covered by any insurance and will always carry an out of pocket cost.
- Dr Sentell is currently in network with the following insurance carriers, however this is subject to change: Providence, Pacific Source, BCBS, UHC, Moda, and CareOregon.
- We always advise that you confirm with your insurance that a) she is in network with your specific plan and b) naturopathic office visits are covered under your plan.
- If billing to insurance, the Medical Screening, Preparation and Integration visits will be subject to your office visit copay/coinsurance based on your benefits. The cost for KAP Sessions are $525 per session + cost of the medication (updated September, 2024 and subject to change.)
- If paying out of pocket, the cost of the Medical Screening visit is $273. Preparation and Integration visits are $210. Ketamine sessions are $625 per session + cost of the medication.
https://www.polarisinsight.com/media-news/articles/
https://psychedelic.support/resources/what-i-wish-id-known-before-ketamine-therapy/
PsychEd Episode 34: Ketamine for Treatment-Resistant Depression with Dr. Sandhya Prashad
Psychedelics Today: Veronika Gold- Methods of Ketamine Assisted Psychotherapy
https://psychedelicstoday.com/2019/05/07/veronika-gold-methods-of-ketamine-assistedpsychotherapy/
Crisis Support Resources:Fireside Project: https://firesideproject.org/
-Provides support during and after difficult psychedelic experiences. Available 10AM-10PM PST
988 Crisis and Support Line: https://988lifeline.org/
-24/7 crisis support available nationwide
