Ketamine Assisted Psychotherapy
In addition to psychodynamic talk therapy, I also offer a therapeutic modality called Ketamine Assisted Psychotherapy (KAP), which makes use ketamine as a complement to psychotherapy. I offer KAP in my practice in partnership with an organization called Journey Clinical, which has a specialized medical team that determines eligibility for KAP, creates customized treatment plans, prescribes ketamine lozenges, and supports me in monitoring outcomes. Through our partnership, Journey Clinical handles all the medical aspects of KAP, and I provide the psychotherapy side of KAP.
There’s been an explosion of websites offering ketamine and KAP. I want you to know I see ketamine as a very powerful medicine and takes its use as a part of treatment very seriously. Even for those medically eligible for a ketamine prescription, KAP is not a fit for everybody and we would have a thoughtful assessment period before starting KAP.
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Ketamine is a legal, safe, and effective medicine used to treat a variety of mental health conditions, including depression, anxiety and PTSD. Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hour after treatment and last for up to 2 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.
Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, via nasal spray and using sublingual lozenges. In my work with Journey Clinical we only use the sublingual lozenge form.
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The effects of ketamine, which most patients find pleasant, last for approximately 45 minutes. These effects can make you feel “far from” your body, and facilitate shifts in perception that can often feel expansive in nature. Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience. Once these effects subside, we’ll spend the remainder of our appointment giving you space to process and discuss your experience. While it may feel hard to articulate what happened during the experience, patients feel like the insights gained are none-the-less clear. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the ketamine experience.
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1. Initial psychotherapy consultation
You and I will have an in-depth, thorough conversation about your interest in KAP. We’ll explore what you are looking to get out of it, your expectations and hopes, your history with therapy and substances, family dynamics, your support system, and much more. If KAP seems like a fit for you, I will refer you to Journey Clinical for a medical evaluation and potential prescription.
2. Initial medical consultation with Journey Clinical
You’ll schedule an initial evaluation with a clinician from the Journey Clinical medical team via Zoom. They will go over your medical and psychiatric history with you, provide education on the treatment and determine if you are medically eligible for KAP.
If Journey Clinical’s medical team determines that you are eligible for KAP, they will develop a personalized Ketamine prescription and outcome monitoring plan for you.
Journey Clinical’s medical staff will write a ketamine prescription for you and a small amount of oral ketamine will be sent to your home, enough fo the first two KAP sessions. You will be taught to take your vitals and self-administer the ketamine lozenges by Journey Clinical’s medical team in advance of our KAP sessions.
3. Preparation sessions
Once you receive your ketamine lozenges, we will schedule time together for our KAP preparation, dosing, and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. The goal of a preparation session(s) is to align on the process and set intentions for our KAP sessions together.
4. KAP Dosing Session
A typical ketamine dosing session lasts between 2-3 hours and can take place either in-person at my office, or remotely via telehealth. If we are just beginning a course of KAP, I ask that we meet in my office for in-person sessions.
During a dosing session, you will self-administer your ketamine lozenge either in my office or in your home. You will be in a comfortable, reclining position wearing an eye mask and listening to calming music. Although a KAP dosing session may be largely an internal experience, I will be present with you the entire time to hold space and provide support as needed.
5. Integration Sessions
After our KAP dosing session, we will meet for multiple integration therapy sessions to review the memories, thoughts, and insights that arose during your dosing session, and to prepare for the next dosing session.
6. Follow-up consultations with Journey Clinical
After our first KAP session, Journey Clinical’s medical team schedules regular follow ups with you to monitor outcomes and prescribe ketamine lozenge refills, as appropriate. The frequency of follow ups depends on your unique treatment plan, at a minimum of once per quarter.
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It can be hard to estimate the total cost of a course of KAP as your treatment plan will be specific to you. However, I can provide some general fees and durations that you may find helpful.
Ketamine-Assisted Psychotherapy
My typical hourly rate is $225/hr. Before a KAP dosing session we would have several preparatory meetings; these are very important to make sure you have a helpful experience with KAP. The dosing session itself is typically 3 hours. After the dosing session, we will have a follow up (integration) session while the window of neuroplasticity is open to try to “lock in” the gains that can come from KAP. Typically, a course of KAP is 6-8 dosing sessions with integration sessions in between.
Journey Clinical Medical Costs
First-time patients
Initial medical consultation with Journey Clinical: $250
Cost of medication: $85 (enough for 2 sessions)
Ongoing treatment
Follow-up medical consultation with Journey Clinical $150 (at least 1X per quarter)
Cost of medication: $145 (enough for up to 6 sessions)
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Journey Clinical is a platform for licensed psychotherapists to incorporate science-based psychedelic therapies in their practice safely and effectively, starting with Ketamine-Assisted Psychotherapy (KAP). Journey Clinical’s in-house medical team takes on patient eligibility, prescriptions and outcome monitoring, while I take on the therapy. Their collaborative care model is designed to deliver personalized treatment plans to meet your individual needs and improve long-term outcomes.
As a word of caution: regardless of who you see for KAP, I believe strongly that providers should only be working within their scope of practice. Your KAP therapist should not be making decisions about your medication dosage, timing, frequency, or medical eligibility (unless your therapist is also a licensed medical professional). We will be working within the treatment plan Journey Clinical has developed for you, and I may distinguish some questions as being medically-related and will refer them to your medical team.
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If you would like to explore the possibility of working with me on KAP, please e-mail me at dr.nicholashack@gmail.com to discuss eligibility and next steps.
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Paradigms of Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS
Huberman Labs Podcast: Ketamine - Benefits and Risks
Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy - research study by Jennifer Dore et al, 2018
Ketamine for Depression and Mood Disorders by Erica Zelfand, ND for Townsend Letter
Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression by goop
Ketamine Assisted Psychotherapy with Jonathan Sabbagh of Journey Clinical - Psychology Talk Podcasttion