As clinicians are gaining more experience with ketamine and other psychedelics, we’ve realized that integration (therapy before and after treatment) is a key component to the success of treatment. Usually, this takes the form of preparing the patient for the experience, informing them the experience will be better if they don’t try to control the journey. Afterward we talk about the experience and figure out how we can integrate it into our lives. (I say ‘we’ because as the doctor, I’m often powerfully moved by my patients’ experiences)
While every patient has a different experience, some common themes tend to emerge. One of them is self-transcendence. Simply put, self-transcendence is the expansion of personal boundaries. During ketamine treatment, patients may experience a sense of moving beyond their physical body. Some people experience overwhelming love and unity with the universe. Often patients say they stopped existing as a separate, distinct entity.
When people have these experiences, they often have profound relief from the feelings of guilt, shame, and worthlessness that define severe depression. That has made psychedelic therapy an attractive option for many people.
For decades, people have been taking psychedelics with underground therapists or on their own. Also, many ketamine clinics aren’t equipped to help patients re-integrate into the world.
What often happens is people will have a profound self-transcendent experience and not receive the appropriate aftercare. As powerful as these experiences are, they often leave patients feeling ungrounded. It can lead to anxiety, loss of direction, and uncertainty toward the future.
Most people seek ketamine treatment because they want to change how they view themselves. Once they have a self-transcendent experience, though, the familiar wagon-wheel ruts have been obliterated. We want the ruminative thoughts to be gone, but they need to be replaced by productive patterns.
It’s the paradox of psychedelic therapy. How do you help people get out of their minds, while also keeping them tethered to the ground? The answer will likely be different for different people. I’m a big fan of routine– healthy habits that lay the foundation for success. Physically, the big three are exercise, diet, and sleep. What’s important is having a skilled integrator available when you undergo psychedelic therapy. It’s good to explore the universe from time to time, but we still need to live– and thrive– in this often-chaotic world.