My Journey to Becoming a Ketamine Practitioner
How Psychedelics Kept Me in Medicine
When I am asked about my background in medicine I always brace myself a bit. I have had a very nontraditional route to psychedelic medicine and I always fear judgement. But, I am also proud of having gone down a unique path and believe it has made me a more well-rounded healer.
I am a Western trained physician (MD) that specialized in Radiology, specifically musculoskeletal radiology. After practicing for about four years in a toxic environment, I was truly unhappy, burned out, and uninspired by medicine. In fact, my view of medicine had shifted to where I felt like my goal was to make money and shift liability to the physician specialists. This, along with the red tape, paperwork, administration overhead, and friction from insurance companies compromised the care I was providing to my patients.
My colleagues also seemed to just be going through the motions. They were unhappy and trying to make as much money as they could so they could retire as soon as possible. It didn’t feel rewarding or fun anymore. I was actually considering leaving Western medicine altogether. During that time, I began focusing more on holistic health and healing. After learning about different kinds of holistic healthcare, I thought I could turn my attention to helping people heal in a new way. While the idea was exciting, I still wasn’t sure how to reignite the passion for my career and patient care.
Then psychedelics found me. I always thought of them as “drugs” and believed the negative propaganda surrounding many psychedelics. However, through trusted friends and a series of fortuitous events, I had my first psychedelic experience. It was euphoric and blissful. I felt light, free, happy, and a sense of ease with myself. As I learned more about these medicines, I dove into some profound personal healing work. I felt like I had achieved more and gone much deeper than I ever had with talk therapy.
After exploring psychedelics, the way I saw myself, my relationships, and the world around me totally shifted. I came to truly know and own the fact that I am a healer. To heal is my purpose and passion regardless of the methodology. I realized that I could use my medical degree to do this healing work in a way that intuitively felt right to me and in a way that positively impacts the lives of individuals and society at-large.
Becoming a Psychedelic Practitioner
My desire to become a psychedelic practitioner came from my own healing experience with these compounds. After my personal immersion with these compounds, I completed a specific training in Ketamine-assisted psychotherapy with Dr. Phil Wolfson, founder of The Ketamine Training Center. During the training, we experienced two types of Ketamine administration: lozenge (taken orally like a cough drop) and intramuscular (injected into muscles and absorbed into bloodstream quickly). The primary difference between these routes is the level of bioavailability, how much of the medicine your body and brain can actually use.
In my opinion, this experiential component of the training was absolutely crucial and unlike the rest of my medical training. I believe that you cannot truly understand what a person is going through during a psychedelic journey if you have not experienced it for yourself. As a psychedelic practitioner, holding space, supporting, guiding or facilitating a journey requires understanding, knowledge, and an intuition to know when and when not to step in. After finishing the program with Dr. Wolfson, I officially became a licensed physician who is also trained in Ketamine-assisted therapy and psychedelic integration.
Training and Preparation
Sitting with someone during a psychedelic experience is truly humbling. Being present with someone in their most vulnerable state, maybe the most vulnerable they have ever been in their life, is an honor. It requires a lot of trust and respect. Depending on your specific role in this type of work, additional training in mental health, therapy, body work, and integration are essential. I am not a therapist, but I do work in conjunction with psychotherapists and am continually expanding my knowledge of integration to support my patients. And, while I believe that a healing energy and intuition are critical in this work, it is also essential to go through the proper training to learn about psychedelic medicine and integration. My experience and education with Dr. Wolfson on Ketamine-assisted therapy provided me an incredibly strong foundation to better understand the compound, the process, and how it works.
What is Ketamine and How Does it Work Therapeutically?
Ketamine is not a true psychedelic by the classical definition, which categorizes psychedelics as those medicines or drugs that predominantly work on the 5HT (serotonin) receptors, specifically the 5HT2A receptors. Ketamine is a dissociative anesthetic that creates a separation of mind and body. Ketamine helps create balance between glutamine and GABA, two major neurotransmitters in the brain. An imbalance in the neurotransmitters are associated with sleep disorders, anxiety, issues with focus, and major depressive disorder. Ketamine acts as an antagonist (blocker) of the NMDA receptor, which is normally stimulated by glutamate. This allows more glutamate to be present in the brain to activate different pathways. We believe this leads to neuroplasticity, the building of new cells, pathways, and connections in the brain. It is believed that this creation of new neural connections is why Ketamine has an antidepressant effect.
Ketamine often produces a euphoric feeling for people. I like to describe it as a powerful disruptor of beliefs, constraints, or labels that people identify with. It allows a person to see themselves as they may truly be and to feel free of the things that previously held them back. Ketamine, when combined with the proper therapeutic experience and integration can become a motivating experience for people to make dramatic life changes that often improve their mental, physical, and emotional health.
My Holistic Approach to Psychedelic Therapy
In the past, the options for mental health treatment have traditionally been antidepressants and therapy, along with more severe types of treatment for resistant conditions. The problem with these conventional methods is that the focus has been on medication and the burden has been placed on primary care providers who may not have the time to truly support their patients. Additionally, the amount and intensity of therapy needed to help people work through mental health conditions is often financially prohibitive. I'm a big proponent of therapy in support with psychedelics, but therapy alone can be much more time-intensive and more challenging to create the same results.
I feel very passionate about the work I am doing with Ketamine therapy and that passion dictates the way I practice. Each patient is a person first and foremost to me. Establishing a relationship and developing a treatment plan is a team decision, which involves the patient. I want everyone I work with to feel safe and supported through the whole experience and I respect that this work can be difficult. I work with psychotherapists who are trained in Ketamine and psychedelic integration to ensure the best health outcomes for my patients.
Different Treatment Methods
With Ketamine-assisted therapy specifically, there are different ways in which treatment can take place. The most common routes of administration include intravenous (IV), intramuscular (IM), oral, and intranasal. The methods of treatment are not a “one size fits all” and all options should be considered depending on the patient’s needs. For example, patients with certain pain syndromes may benefit more from IV therapy. People with complex medical histories may also benefit from IV therapy because there is more control over dosing and usually more monitoring. A drawback of IV is that it does feel significantly more “medical," which may detract from the desired therapeutic setting.
I strongly feel that the decision to use one route of administration over the other should be based on a holistic understanding of the patient. As physicians, our goal is to always “first do no harm,” so I choose to work with my patients as individuals and consider safety first. Sometimes this means that I need to refer patients to another practitioner or advise them that Ketamine-assisted therapy might not be the right fit.
In light of the pandemic, we are seeing an increased demand for at-home Ketamine lozenges as well. While there are a lot of opinions about this, it stands that the mental health crisis continues to worsen and conventional mental health services are out of reach for many. With the appropriate thorough screening, education, preparation, and support I do feel at-home Ketamine sessions can be done in a safe way for some people. I know there are many who disagree, but it does improve access and cut costs for many people. As long as it is done safely it is hard to argue against, especially if our true mission is to help as many people as possible.
Ketamine Infusion Versus Ketamine-Assisted Therapy
Every Ketamine treatment facility is different, but I do not believe that patients should not be left alone during a Ketamine session, which is more typical of an IV infusion setting. Regardless of the type of treatment, it is critical that practitioners pay careful attention and respond to their patients' needs. Of course, integration is also key to complete a psychedelic journey. These medicines can work on their own, but they can also cause confusion, anxiety, or even trauma for people when they have challenging experiences without the proper support.
Right now, there is an ongoing discussion in the community about whether Ketamine-assisted therapy or Ketamine infusions (without therapy) are created equally. In my opinion, having a therapist who is trained in psychedelic work and integration is critical for comprehensive healing experience. In my practice, I encourage people to work with either a therapist I refer them to or their own therapist in the process. I also always make sure to communicate with their therapist of choice so that we are both aware of the patient’s journey. While I don't think it is necessary to have a therapist present at every session, I do believe that whoever chooses to accompany a patient should be comfortable and educated enough to support them throughout the integration period.
Challenges and Victories on the Frontlines of Psychedelic Therapy
As a physician practicing in the new field of psychedelic medicine, there are challenges, risks, and additional steps that have to be taken to ensure the safety of patients. Firstly, using a controlled substance (Ketamine) requires a DEA license, special storage, special recording and documenting, along with added levels of oversight. And, when it comes to protocols and procedures there isn’t a consensus on how to practice or comprehensive guidelines. This kind of structure will evolve as the field of psychedelic healthcare matures, but for now it definitely poses some challenges for me and my colleagues in the field.
Systems and Technology
Another challenge of being on the frontlines of psychedelic medicine is technology or a lack thereof. Electronic Medical Records (EMR) systems are not tailored to novelty of the psychedelic therapy journey. While using these kinds of systems, I know that I'm not comprehensively capturing the unique nature of the psychedelic experience. Of course, without the proper systems and technology in place, we’re limited by the type of data we can generate. Objective, measurable outcomes are necessary in order to support the use and acceptance of these treatments. Research around physiologic shifts in people undergoing psychedelic therapy are essential to inform policy, but also to empower patients by showing them how their health is improving.
Heart rate variability (HRV) is one data point that is being looked at in regards to mental health and stress. Decreased heart rate variability is associated with poor health outcomes. There are now wearable devices that can monitor your HRV, so that you can make behavioral changes to improve health. What if we could show that Ketamine therapy also improves HRV and leads to improved health outcomes in a number of categories? This is just one example, but having a central system that collects data on patients and aggregates this information would provide an invaluable resource for research studies to demonstrate trends and results.
Another challenge I face in my practice is staffing. Hiring the right people to assist during challenging sessions is so important. Staff not only need to be professional and trained on HIPAA-compliance, but they also need to be understanding, patient, and welcoming. There needs to be a calm and comforting atmosphere created in the office, as well as through communications with patients. Staff that will be directly involved in care also need to be trained around psychedelic medicine and feel comfortable with whatever comes up in sessions for clients.
I always prepare patients by telling them that anything may come up, anger, yelling, crying, arousal, movements, but staff must also understand this and be able to remain calm, rather than reacting. The psychotherapists that I work with need to also have an understanding of psychedelic medicine and integration, because it differs from classic psychotherapy and the patient therapist model. I want the people I work with to have first-hand experience with psychedelics, just as I had. My ultimate goal is to support the healing journey of my patients. In doing so, I recognize that it requires me to have first-hand experience and knowledge-of these compounds to provide the highest form of care.
As a physician, I am no stranger to the toll that healing can take on me personally. I have also come to realize that I am an empath, so I am prone to take on other people’s feelings and energy. Often I find myself emotionally, mentally, and even physically drained from doing this work. In medicine sessions, there is a lot of energy that is released and sometimes a lot of pain and trauma that is moved around. Not only do I have to take measures to protect myself from absorbing this energy, but I also have to be aware of protecting my own energy from being drained unintentionally by those around me.
During my sessions, I like to envision a giant bubble of white light surrounding me as a way to protect my energy. Holding space for others in their healing process requires that you also take care of yourself as the guide. As a practitioner, I know I can only give from a full cup, so I have to make sure my cup is replenished. Taking care of myself physically, mentally, and emotionally is very important. Having an outlet to let go of others’ pain is the only way to prevent burn out. Most practitioners know this, but by holding space for yourself, you actually allow others to feel safe and vulnerable, so that they can be free.
I strongly believe this work is meant to be done in community, in a similar vein to the messages many receive during psychedelic experiences about connectedness. Having a community to share and support you in this work will make it even more rewarding. In psychedelic therapy, we are all working together to heal as many people as we can, educate as many as possible, and create a safe and intentional space for this work. For emotional stability, as well as personal and professional growth, it is incredibly important to cultivate a strong community of psychedelic practitioners who feel comfortable sharing observations, challenges, and victories with one another.
What the Future Holds
The future of psychedelic medicine is unknown. Yes, there have been amazing advancements made both in research and policy, but it would be wise of all of us practicing in this space to tread lightly. Given the history of psychedelics, it would be very easy for things to come to a screeching halt. If we do not move forward in an ethical and responsible way, it could all be taken away.
There is also an argument that psychedelic medicine shouldn’t have a place in Western medicine and that there is a lack of respect for the cultures that worked with plant medicines for millennia. While I can see this side of the argument and agree that respecting indigenous wisdom is necessary and beneficial, it is not that black and white. We have to work within the system that we are given and use it to our advantage to move forward. The way in which we are going to inform policy changes is going to be through science. Whether right or wrong, data is needed to make changes. Without high quality research and clinical data, psychedelic medicine will not continue to advance.
That said, I believe that we may never truly understand all of the ways in which psychedelics can help us and that it is meant to be that way. I think there is beauty in not being able to explain it all. However, by documenting and collecting data on what we do know is one of the most important things we can do at the moment. While everyone may not be able to set up scientific studies, we can as a community of providers collect data and document standardized results. By simply doing this, we can generate a large amount of data that can easily be analyzed for trends to support our work. As healers in this space, it is almost our duty and obligation to take part in this if we truly believe these healing modalities should be readily available for more people. Overall, I believe that psychedelic medicine work can still be done in an intentional way within the framework of Western medicine.
I am so thankful for Ketamine and the ability to use this medicine in a safe and legal way to support people with growth and healing. I found the answer I was looking for: continue in Western medicine, and utilize it to practice psychedelic healing.
Maya’s Role in Psychedelic Healthcare
As a physician, we use a number of systems and applications in medicine, but rarely do they feel super helpful. My experience has been that most of these technologies are created by people who clearly do not practice medicine and have not really consulted the people who will be using them. This leads to frustration and often more work.
If there was a way to automate and standardize forms, assessments, and workflows that are specific to psychedelic therapy, it would allow me more time to focus on patient care instead of paperwork and administration. Being able to have everything in one place would be a dream. Having multiple systems for different aspects of my practice, scheduling, medical record documentation, distribution of forms, billing etc. is exhausting, expensive, and allows for the potential of error. The less systems we can have, the better.
As mentioned before, research is going to be one of the most important ways we can legitimize what we are doing. To have a central source of data would be supportive for anyone who wants to do research. Being able to show trends in how this work is affecting the patients we are working with is essential. As providers, we should want to know how we are doing and to identify areas of improvement or innovation with care.
These are just some of the challenges that I know the Maya platform will help me solve. I’m excited about using Maya in my practice, so that I can improve the patient experience, and my own ability to provide high quality care to patients. The bonus is that I get to work with a company that is aligned with my vision to help advance psychedelic healthcare.
Learn More About Me
Whether you are looking for a more personal, holistic approach to improving your mental health and wellbeing, or you want to learn more about Ketamine therapy, please reach out. I offer phone consultations for free and am always happy to answer any questions you may have. If you are interested in learning more about me and how I do my work you can find me at www.stephanielynwellness.com. You can also follow me Instagram @stephanielyncolemanmd. My email address is firstname.lastname@example.org.