Ketamine Assisted Psychotherapy Doesn’t Require You to Trip Your Brains Out
Tell me if you have heard this story. You have a friend curious about trying psychedelic-assisted psychotherapy. They have watched tons of documentaries, deep-dived blogs and YouTube, and talked at parties to anyone who has ever tripped, trying to ascertain if they should give it a go. They almost seem desperate to try it — and yet it has been months, maybe even years, and they still haven’t looked into actual treatment options.
This is an everyday story in the world of ketamine-assisted psychotherapy. There are a bunch of reasons for this ambivalence, but a big one is fear. Given the wide range of information people encounter about psychedelics, that fear is completely reasonable.
The good news: if the work is psychotherapy, we aren’t going to start by launching you into the cosmos on a psychedelic dose. That is not how it works.
We Start Small. Intentionally.
Some people come to ketamine-assisted psychotherapy with some familiarity with ketamine or other psychedelics. Some folx interested in this treatment have never even dabbled. In all cases — but especially with people new to altered states of consciousness — we start super slow, with pre-psychedelic doses. Low dose ketamine is a good way to learn how to use the experience, and they immediately offer something valuable: a nervous system that is gently, temporarily quieted, and a fluid, neuroplastic mind derailed from its default-mode processing.
That’s it. That’s where we begin.
For most people, this first contact with the medicine feels like a soft landing. The anesthetic quality of ketamine muffles the edges of things — not in a scary, disorienting way, but in a way that lets you breathe differently. Your defenses, the ones you’ve spent years building for very good reasons, loosen just slightly. Enough to get curious. Enough to notice things you usually scroll past inside yourself.
Why This Matters Therapeutically
Ketamine is a dissociative anesthetic. One of its genuinely unusual gifts is that it creates what I describe as two selves during a session: the one having the experience, and an observing self who stays quite present and aware. You don’t lose yourself. You get a slightly different angle on yourself. That is precisely where the therapy work lives.
In the days following even a low dose ketamine session, your brain has neuroplasticity — an actual, measurable increased capacity to form new neural pathways. The well-worn grooves of old thought patterns become temporarily less sticky. New connections are easier to make. This is when we do the integration work, and it is some of the most interesting therapy you will ever do.
The Fear Is Part of the Story
Here’s something I’ve noticed with almost everyone who eventually does this work: the thing they were afraid of was rarely what they encountered. The fear is almost always about losing control, disappearing, not being able to come back. And what they find instead is that the medicine gives them more access to themselves, not less.
But we don’t rush there. We build to it together, at a pace that honors your nervous system and your history. Your inner healing intelligence — the wiser, deeper part of you that knows exactly what you need — gets to set the itinerary. We just create the conditions for it to do its work.
If you’ve been sitting on the fence about this, I want to gently suggest that the fence is not the most comfortable long-term residence. Come talk to me. We can start with a conversation, not a trip.
Smith is an analytically oriented psychotherapist with 35 years in practice. She is Founder/Director of Full Living: A Psychotherapy Practice, Co-Founder of Ketamine Kollaborations and author of Prepare Yourself, Your Clients and Your Practice for Ketamine Assisted Psychotherapy: A Step by Step Guide
If you were interested in this blog post, check out some of these:
Ketamine for Psychotherapy? Yes!
Psychedlic Psychotherapy: A Novel Tool for Our Stuck Places (a video blog)
Psychotherapists are like Dance Archeologists
Attending to the Unconscious in a Psychotherapy Session
Myths about Psychotherapy (a video blog)