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An excerpt from my recent publication Prepare Yourself, Your Clients and Your Practice for Ketamine Assisted Psychotherapy: A Step by Step Guide Karen L. Smith MSS, LCSW

I am an exceedingly opinionated person and feel quite comfortable expressing my opinions in most settings. But given the nature of a guidebook, it seemed this project was not a particularly appropriate venue for my snarky opinions. It was important to me that readers have available the standards and common practices in this emerging field. So, rather than eliminate my views from the book, I wanted to offer them in a sequestered way that allowed them to be taken for what they are: very strong opinions, delivered without as much careful professional packaging, but still only opinions.

Music in Psychedelic Assisted Psychotherapy is an Industry Standard

Client use of some form of music during ketamine medicine sessions has become an industry standard. This is the best evidence to me that psychotherapists were not at the helm when treatment protocols were being established. Neither I nor any psychotherapist (other than music therapists) I know has ever curated or asked a client to curate a playlist to set and manage the mood for a therapy session. I would never imagine before a therapy session of any sort that I knew the topic, tone, or energy that would be a good accompaniment to the work my client and I were about to do.

One of my first classes in a program on healing with psychedelics focused on the use of music in medicine sessions. I found myself flooded and overwhelmed, thinking about the responsibility inherent in curating a playlist for my various clients’ ketamine sessions. The teacher was lovely, talented, and knowledgeable. He talked about avoiding music with drumbeats, unless the goal was to help the client access anger. He reviewed how using unfamiliar music helped people access unfamiliar internal terrain, how familiar music might help ground a client who needed to go into a particularly dark place, and how vocals from male and female voices could elicit rich transferential or archetypal material. He described ways the therapist could curate a playlist, beginning with a slow building of intensity, then weaving in moments of sadness, exaltation, and longing, a crescendo for the height of the session, and then a taper down.

While riveted by this information, I was also flooded by thoughts of the overwhelming skill set I would need to learn to curate a soundtrack for my clients. I then realized my angst wasn’t a response to all I would need to learn: my system was actually alerting me to a clash in clinical objectives.

Psychedelic Assisted Psychotherapies’ Gold Standard is a Non-Directive Clinical Stance

The continuously declared stance of psychedelic-assisted psychotherapies is for the therapist to be as non-directive as possible. The essential position is that the medicine and the participant’s inner healing wisdom are the guides, and it is crucial we don’t influence or disrupt that wisdom. There is little in this world as directive as music. We all use it in our lives to set or alter or improve or accentuate a mood. The idea that we, or the client, prior to the medicine session, would predetermine the mood we wanted to establish and facilitate through the ebbs and flows of the session is wholly and completely counterintuitive and counterproductive. It does not match anything we know as therapists about our job, which is to track, not create, the movement of thoughts/ feelings/ energy/ soma/ aliveness/ tension/ joy in each session.

With my own clients, I do not work with music. This isn’t a punishment or denial of pleasure. I count on the medicine to provide relevant soundscapes, just as the medicine sometimes offers clients visuals behind their eye masks. There is a particular deliciousness to the quality of the silence when one is on ketamine. It can feel very containing. It is a supported way to be with the self. And that is the goal—to be with the self.

Consider Silence

Every person I know who has done ketamine themselves has done it almost exclusively with music, and they have very strong reactions to my “no-music” stance. They insist the music is both lovely and useful. The best I can say to anyone who is eager to use this medicine to know more about themselves is to try silence. Try being with yourself. Try a handful of sessions without music, where you sit with your own thoughts and feelings, find your own mood, discover stillness, and be with yourself.

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)



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