The Exciting Integration of Ketamine Assisted Psychotherapy and Couples

May 10

They sit at opposite ends of the couch, the tension palpable between them. They have been in treatment with me for 8 months and have made huge leaps in insight and awareness but here they are again, coming in after a massive blow out, in despair about their inability to interrupt their negative reactive cycle.

“It doesn’t matter how many times we talk about it. He says he will work on his response. And then he blows up again!” She says, looking plaintively at me.

“I tell her I need to take a break and she ignores me and keeps pushing. I thought she was supposed to respect when I need a break?” He implores me. “That’s when I lost it, after the third time I asked for a break and she steamrolled right over me.”

So here we are again, I think to myself. Two well-meaning people who love each other dearly, having made huge leaps in our work, moved some mountains but are still struggling to dial down their reactive patterns.

This is an age-old couples therapy dilemma. People who show up to the work. They are committed to their partner and hold themselves accountable. Yet, at home, when their emotional brains spike, they are unable to hold onto the learning or hold onto themselves in the face of their partner’s strong feelings or different needs or perspectives.

Self-soothing is a term you hear a lot in therapy. There are many ways to practice self-soothing but when confronted by the Olympic training ground of affect tolerance, primary love relationship(s), the best of intentions can be laid to ruin. Mindfulness based practices and the flexing of new emotional muscle are put to the test. Often, the emotional contagion between two partners proves too great a force to hold back the tide of escalation or the protective shut down that marks the predictable pattern of ‘hot potato” between two partners.

My couple is looking at me, expectantly. The implication is clear: fix this and fast because we only have 45 minutes left to this session and then we have to go home together! While I search my brain for my next intervention, they start squabbling with one another about what happened on the way to therapy.

I surprise everyone when I say, “Have you considered Ketamine?”

“Ketamine?” He says with skepticism, “You mean the stuff I partied with in my twenties?”

“You mean the surgical anesthetic?” She asks.

“You’re both right,” I say, “But Ketamine is FDA approved for a variety of mental health issues and conditions, and has great promise for relational work as well.”

“Say more,” he says, leaning forward.

“Well, you may remember that I am trained as a Ketamine Assisted Psychotherapist (KAP) and can facilitate KAP sessions for couple? Also, in a few months I will collaborate with Sapience in Greenfield to facilitate a three-day long KAP group retreat for couples. I’m seeing very encouraging results integrating Ketamine in relational space, particularly with helping partners lower defenses and enhance connection and intimacy.”

“Really?” They ask in unison.

“What about anxiety? Can it help with anxiety?” He asks.

“What about my trauma, can it help with that?” She asks.

“Ketamine is a tool, when paired with therapy, but it’s not a cure all, and there can be tough stuff that comes up while people are on it. Let me send you some articles so you can start to educate yourselves and then we can talk more if you’re interested,” I say.

Ketamine is a psychoactive drug that was first synthesized in 1962 and has been used in the U.S. as an aesthetic in medical settings since 1970. Ketamine has been used off-label in sub-anesthetic doses for the past 20 years to treat chronic pain, depression and a variety of other mental health concerns. It has been shown to have a cumulative effect, alleviating symptoms in 30-60% of adults with treatment-resistant depression. In low doses, Ketamine can serve as a powerful tool and adjunct to assisted psychotherapy (KAP), as it allows for the softening of psychological defenses and reduction in trauma response, which allows for more profound processing, increased self awareness and improved self-regulation.

Ketamine, sometimes described as an “ego lubricant,” as it helps release defensiveness and create space between our projections and limiting beliefs about self and others, Ketamine develops neural plasticity and the creation of new neural pathways. Using low dose Ketamine with couples work has the powerful potential to create deep and more rapid growth and healing to couples who have been gridlocked for some time.

Flash forward four months and my illustrious couple has bravely signed on for a three-day Couples Ketamine Assisted Psychotherapy Wellness Retreat in the Berkshires. They, along with five other courageous couples, are putting their trust in me, and my two medical doctor partners, as they prepare to journey for the first time on Ketamine.

The clinical scaffolding for the Ketamine journeys will be the integration of the major concepts of the Developmental Model of Couples Therapy, taught by yours truly. We also have six KAP trained therapists who will be sitting for each of the couples while they journey.

Studio 9 is a state-of-the-art music venue attached to Porches Inn that we have chosen as our venue. The building was built with sustainability in mind and is equipped with Meyer Sound’s Constellation System. It is an architectural oval beauty, surrounded by floor to ceiling windows. You couldn’t ask for a more sensational space to hold a retreat.

Day one, my intrepid couple arrive to the opening circle, stiff and reserved. They eschew meditation pillows in favor of sitting on hardback chairs and take furtive glances at the other couples. I know, from working with them, that shared forays into public together have become more and more rare over time, as the disconnect between them has grown. Being here is huge on so many levels.

After introductions, we create a “safe container,” and I present didactic pieces in the Developmental Model. The three main pillars of the model are differentiation theory, attachment theory and emergent research in neuroscience. Differentiation is an excellent match for work in Ketamine, as differentiation allows us to develop new neural pathways that better integrate all parts of the human brain. There is more access to the regulatory functions of the neocortex when you need it. Similarly, Ketamine creates neural plasticity, allowing for the formation of new neural pathways and enlightened ways of relating.

This is followed by a breath work Kriya, or ritual, the setting of intentions and blood pressure checks. Before we know it, the first day has flown by and as we near 5:00, it is time for the couples to experience their first Ketamine journeys. Doses have been predetermined in the required medical evaluations each person had to undergo prior to the weekend. Now it’s time for the couples to take their two inflated mats and find a comfortable nook in the womblike enclave.

Couples are given eye masks, journals, and (optional) ear plugs. They have brought their own blankets and favorite pillows from home to cozy their little camps. Each couple is randomly assigned a KAP trained therapist who will sit with them. All six couples will be taking Ketamine at the same time and will have free will as to whether they journey inward the whole time, eye mask firmly in place, or lean into interacting with their partner.

As I look around the room, my heart swells with excitement and anticipation. This retreat was so long in the planning and my partners and I agonized over all the variables. Seeing it play out live before my eyes is exhilarating and a little anxiety producing. Have we prepared well? Will everyone get what they came for? Will the integration of the Model and the use of Ketamine make as much sense to the couples as it does to me?

One of my colleagues dims the lights and starts to play the most beautiful playlist of world music meets psychedelic trance music. There are soft murmurs throughout the space as couples make themselves comfortable and accept their Ketamine doses. Just as the first lozenges are accepted, snow begins to fall outside the wooden dome. The effect is breathtaking. Within a few moments, as the music swells, a meditative poem is read aloud. The mood in the space is hushed, reverent, pregnant with anticipation and something a bit magical as well.

Earlier that day, the sound engineer who oversees Studio 9 had shared his experience in meeting the Dali Lama in India, showed pictures of himself standing, beaming next to him, and offered us the use of several small statues that had been blessed by the Dali Lama, for use in our makeshift altar. These sacred blessed offerings have added a gravitas to the significance of this, our first couples Ketamine retreat.

I am sitting for a couple who is not known to me. I sit on my mediation pillow, close by, but not intrusive, journal in hand, as I have offered to write down anything either of the partners wishes me to record as they journey. The couple is lying side by side, eye masks on, holding hands. I wonder at what they must be experiencing as my colleague calls the time, “Okay, that’s twelve minutes. You can swish and swallow now.”

My designated couple swallow their low dose Ketamine simultaneously. She adjusts her eye mask and settles in. Ten minutes in, he gets a wide smile on his face and raises his hand. I realize I am being summoned. I lean closer to him and he whispers, “Can you please write this down?” And he shares a poignant insight. I smile to myself, touched that he seems to have internalized some of the teaching on the concept of differentiation I did earlier.

All around the room I see similar interactions going on. I see couples who up until this moment were stiff with one another, an ocean of distance between them, now canoodling, legs and arms entwined as they share insights, some with tears running out of the sides of their eye masks. I see one woman crying, then laughing, as she recounts an image to her partner, as her sitting therapist leans in, to offer support. I see a gentleman, eye mask on, using his arms to demonstrate to his partner, what he is experiencing. He is absolutely beaming. His wife takes her eye mask off and I see her watch him intently, a look of wonder on her face. From the motions he uses, I imagine he is expressing to her the vastness of the universe or some other sweeping vista.

The music swells around us, mostly drowning out the hum of laughter, tears, and whispered insights. Within 90 minutes, all the couples are coming out of their Ketamine journey, eyes glowing bright, bodies relaxed, a sense of comradery among those who journeyed, a sense of awe among those who bore witness. After a nourishing meal, taken sitting on pillows amongst the candlelight, the hushed calm speaks of deep inner processing.

We end the first night with a light integration circle, an opportunity for participants to share, if they choose, aspects of their experience.

Here is a sampling of what participants shared at a the end of day one:

“I feel so much closer to my partner.”

“I accessed and released a deep grief that has burdened me for years.”

“I don’t feel I need to keep my walls up.”

“This the safest I have felt in my body and mind EVER.”

“I just had the first, what I would call, sacred experience, of my life.”

“I can see my part so clearly in things.”

“I can see myself with so much more compassion.”

“If this is day one, I can’t wait to see what happens day two!”

There is so much more to share about this retreat and KAP work, in general, with couples. The Couples KAP Satisfaction Scale, developed by yours truly, is one step forward in starting to gather data on couples, pre- and post-Ketamine journeys. Of note, participants who took the Scale reported an average of 20 points increase in overall relationship satisfaction and emotional safety, pre and post retreat. And an 80% decrease, specifically, in assessment of the judging/criticizing of partner's difference in perspectives or needs. These early findings are encouraging, as are the experiences couples are having in KAP sessions. In summary, coupled with the Developmental Model, Ketamine has the potential to help partners: