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Ketamine-Assisted Psychotherapy

Regarding the Transpersonal Nature of Ketamine Therapy: An Approach to the Work

Jeffrey Becker

Private Practice Westwood, CA, USA

Recent evidence has shown that ketamine treatment can facilitate psychological insight and symptom resolution in various psychiatric disorders. To aid this process, psychotherapeutic support should be considered a fundamental aspect of treatment. The psychedelic experience produced by ketamine can be a deeply meaningful source of enduring change and personal growth. The author has repeatedly observed a rapid realignment of self-perception away from shame, fear, and dread toward authentic self-acceptance and gratitude, offering patients opportunity for insight and the consideration of new potentialities. The experience produced by ketamine is similar in quality to transpersonal experiences described by Jung and induced by various religious practices and near-death experiences. 

Link to full article

Journal of Psychoactive Drugs 19, Volume 39 (1), March 2007

​Single vs repeated Ketamine-Assisted Psychotherapy for heroin dependent people

Evgeny M. Krupitsky, M.D., Ph.D et al.

Psychedelic-assisted psychotherapy utilizes the acute psychological effects of psychedelic, or hallucinogenic, drugs to enhance the normal mechanisms of psychotherapy. Many studies carried out in the 1950s and 1960s suggested that psychedelic-assisted psychotherapy might be an efficient treatment for alcoholism and addictions (Grinspoon & Bakalar 1979). 

One of the insights gained from previous research concerns the transient psychotherapeutic and psychological effects of psychedelic psychotherapy. The effects of psychedelic psychotherapy are often very pronounced within several days or weeks after a treatment session, but then these effects quickly decline (Halpern 1996). This phenomenon was termed a “psychedelic afterglow.” Pahnke and colleagues (1970) described an afterglow as a positive post-hallucinogen state occurring in subjects after they have a transcendent psychedelic peak experience.

If a psychedelic-peak experience has been achieved and stabilized during the session, a clinical picture which we have termed the psychedelic afterglow can be observed in the days after the session. Mood is elevated and energetic; there is a relative freedom from concerns of the past and from guilt and anxiety, and the disposition and capacity to enter into close interpersonal relationships is enhanced. These psychedelic feelings generally persist for from two weeks to a month and then gradually fade into vivid memories that hopefully will still influence attitude and behavior. During this immediate postdrug period, there is a unique opportunity for effective psychotherapeutic work on strained family or other interpersonal relationships.

Ketamine is a drug used for anesthesia that acts as an NMDA receptor antagonist. Sub-anesthetic doses produce profound transformative experiences that share many elements with some near-death experiences (Jansen 2001). Previous studies have found that this experience often causes important insights about the self and the world, and can help people accept a new meaning of life, new values and new purpose in life related to abstinence from drugs and alcohol (Krupitsky et al. 2002; Krupitsky & Grinenko 1997).



Transpersonal Effects of Ketamine

There is no consensual opinion regarding how psychedelic substances might work beneficially within clinical settings. Most of the researchers view the active mechanisms of psychedelic substances solely from a biochemical perspective. Ketamine is often considered a “psychomimetic” (i.e., causing effects mimicking psychoses), prompting some US investigators to use ketamine-induced phenomena as a model for studying psychoses in experimental research (e.g., Krystal et al., 1994). In this model, the psychedelic effects of ketamine are seen as undesirable rather than as a potential therapeutic mechanism.

Contrary to this view, we propose that ketamine’s powerful psychotherapeutic effect is possibly due to its psychedelic-including transpersonal experience generating-properties, as it frequently induces in sub-anesthetic doses feelings of ego dissolution and loss of identity, emotionally intense visions, visits to mythological realms of consciousness, vivid dreams and memories of possible past incarnations, experience of the psychological death and rebirth of the ego, and feelings of cosmic unity with humanity, nature, the universe, and God. These observable facts were initially described as “emergence phenomena” (White et al., 1982) and clearly depict a psychedelic experience. These non-ordinary states of consciousness offer an additional or alternative mechanism of ketamine’s effects over and above purely biological explanations.

One of us (Friedman, 2006) previously speculated that psychedelic drugs such as ketamine are specifically useful due to their transpersonal, rather than solely neurobiological, effects. This is also congruent with the conclusions of numerous researchers that spiritual factors are crucial in treating many psychological problems, such as is frequently discussed for alcoholism (e.g., Robinson, Brower, & Kurtz, 2003; Amodia, Cano, & Eliason, 2005).

Grof (1980) has developed a comprehensive theory of psychedelic psychotherapy from this perspective. He concluded that psychedelic substances facilitate therapeutic experiences of symbolic death and rebirth of the ego, allowing clients to work through deep traumatic fixations in their unconscious. Grof successfully applied this specific transpersonal psychotherapeutic approach to more than 750 patients. He explicitly discouraged his clients from analyzing their psychological problems and instead assisted them in transcending their inflexible maladaptive patterns, placing a strong emphasis on their transpersonal growth potential. Although Grof primarily used LSD as a psychotherapeutic agent, he acknowledged that ketamine holds great promise due to its “affinity for positive dynamic systems” (p. 214). He stated that the psychoactive effect of ketamine is so powerful that “it catapults the patient beyond the point of impasse from the previous LSD session, and can make it possible for him or her to reach the better level of integration” (p. 214).


. 2018 Jul; 70(3): 621–660. 
Published online 2018 Jul. doi: 10.1124/pr.117.015198

Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms

Panos Zanos et al.
Ketamine, a racemic mixture consisting of (S)- and (R)-ketamine, has been in clinical use since 1970. Although best characterized for its dissociative anesthetic properties, ketamine also exerts analgesic, anti-inflammatory, and antidepressant actions. We provide a comprehensive review of these therapeutic uses, emphasizing drug dose, route of administration, and the time course of these effects. Dissociative, psychotomimetic, cognitive, and peripheral side effects associated with short-term or prolonged exposure, as well as recreational ketamine use, are also discussed. We further describe ketamine’s pharmacokinetics, including its rapid and extensive metabolism to norketamine, dehydronorketamine, hydroxyketamine, and hydroxynorketamine (HNK) metabolites. Whereas the anesthetic and analgesic properties of ketamine are generally attributed to direct ketamine-induced inhibition of N-methyl-D-aspartate receptors, other putative lower-affinity pharmacological targets of ketamine include, but are not limited to, γ-amynobutyric acid (GABA), dopamine, serotonin, sigma, opioid, and cholinergic receptors, as well as voltage-gated sodium and hyperpolarization-activated cyclic nucleotide-gated channels. We examine the evidence supporting the relevance of these targets of ketamine and its metabolites to the clinical effects of the drug. Ketamine metabolites may have broader clinical relevance than was previously considered, given that HNK metabolites have antidepressant efficacy in preclinical studies.