Ketamine-assisted psychotherapy Integration
Integration sessions follow the ketamine dosing sessions. The goal is to promote positive outcomes by supplying support, integrating insights, and reinforcing concepts of change as well as assessing things that did not change during the treatment process. Effectively, integration is a process of releasing old information, processing the experience in new information, reclaiming your old self, re-inhabiting older constructs you left behind because of depression and restoring your life to a more effective state.
Integration occurs at a number of different levels including the personal level (ego or biographical level), the somatic level, and the transpersonal level with symbolic, spiritual, transgenerational effects as well.
The goal of integration includes the following:
- Supplying support to a rapidly changing individual. This also includes debriefing from difficult or challenging experiences during the ketamine sessions.
- Integrating new insights and reinforcing concepts of change
- Application of newfound insights and promoting their longevity.
- Emotional processing with release and grieving.
- Enhanced self-monitoring and observing the ego.
- Adapting to new changes in your identity, worldview, and relationships. Learning to embrace these changes and trust them.
- Establishing the meaning of these newfound concepts.
- Somatic integration is also important because experiences are stored in the body, especially childhood adverse experiences. Trauma can be frozen into the body, and it is important to not leave the body out of therapy healing during psychedelic work. Somatic integrations include appropriate nourishment, rest/sleep, embodiment (movement and dance), alignment ( chiropractic work), exercise, and detoxification (fasting, sweating).
- Trauma integration is also critical. Ketamine therapies allow for choice, something that individuals with trauma did not have. It may be difficult for individuals with trauma to trust the experience. The purpose of trauma integration includes transforming pathological shame into dignity, restoring natural responses in the nervous system, empowerment, and connection with a more benign spirituality.
During the ketamine session, it is important to allow for verbalization and recollection of the person’s journeys and to debrief them and allow them to process this information whether it was an enjoyable and enhanced experience or challenging experience. It is also important to allow the person to return into the body and provide support through emphasizing movement, smell, and anchoring. This is called embodiment support. It is also important to ensure safety before the person leaves with appropriate stabilization, especially if the person has had suicidal ideation.
The challenges of integration in KAP Therapy
There are a number of challenges that occur in integration. These include the following:
- Nonlinear improvements: sometimes patients will have amazing KAP sessions and then other ones will not go so well, and the client will question whether they got the correct ketamine dosing when in fact it was just part of the process of nonlinear improvement that we see with KAP therapy. Some sessions may produce neutral or negative ‘results’ while others are very productive.
- Compliance: many individuals will not follow-up after the initial sessions only to relapse back into depression.
- Relationship impacts: sometimes the client will improve so much that their significant other loses their identity as a caretaker now that the client is feeling so much better. This can put stress on the relationship when the partner is overbearing or doting and no longer feels they play a role as a caretaker.
- Negative therapeutic reaction: sometimes individuals would get specific feelings or delusions under the medication and have difficulty deciding if it is real or if it was from Ketamine.
- Rapid changes in lifestyle: some individuals feel so good that they make life changing decisions such as changing jobs or getting divorced.
For integration to work it must provide beyond the goal of just symptom relief. It is important for the individual to:
- Engage with their inner healer and not just take a passive role in their mental health journey
- Individuals must adapt to their newfound symptom relief and not identify themselves as generally symptomatic.
- Focusing on the individual’s life and not the medicine or the journey is important.
- Have an increased sense of well-being
- Increase clarity and self-regulation.
- Connecting with one’s feelings and allowing increased emotionality but maintaining regulation
- Increased socialization with friends and family
- Bring back change a little bit at a time so as to not be overwhelmed. Sometimes, it is important to focus on what has changed as opposed to focusing on what has not changed and to bring back a structured lifestyle a bit at a time.
Integration sessions can start immediately after the dosing session and can be repeated multiple times as each condition necessitates. There are no hard rules as to how many sessions one would need, but more frequent sessions seem to improve results and duration. Integration sessions can take place the following few days after the ketamine session.