Ketamine Assisted Therapy with Veronika Gold

My unofficial Vital Study Zine #13 with observations from Vital Psychedelic Training and recent happenings in the space

Noëlle Matip ‘Therapy’

San Francisco’s Veronika Gold set up the Ketamine Training Centre ‘emphasising the skills unique and germane to ketamine assisted psychotherapy.’

The MAPS co-therapist has written K treatment programs already in use across the USA. Her impressive CV includes somatic experiencing and EMDR expertise on top of academic psychology credentials. She works as an independent psychotherapist, and at stand-out San Francisco clinic Polaris Insights. Veronika has even curated a specialist ketamine therapy playlist.

Her overview of the high street K revolution: “People get a series of sessions over to to three weeks which is usually what it takes to get the anti-depressant effect. Then they will come for what are called booster sessions: maybe every two weeks, or every three weeks, for somebody it might be four to six weeks.”

Veronika plainly admits this is “Almost like an indefinite treatment,” but points out “for many people it’s still a preferable treatment compared to being a a daily SSRI.”

We all love to rag on K clinics. But for the sake of successfully treating depression and alcoholism, please put snobbery to one side. Plus set-ups are likely to eventually incoporate MDMA and psilocybin treatments. So what’s happening now is a fascinating precursor to the future. There’ll be DMT on the go eventually.

Precise therapy alongside ketamine (KAP) catalyses long term results, summarises Veronica: “The psychological paradigm has an emphasis is on processing the underlying issues and challenges that are causing the symptoms. We actually see healing and change that the booster sessions are eventually no longer needed.”

Shamanic-style trauma processing with its ‘the only way out is through’ ethos can hit flabby westerners hard though. Not only during the experience itself but afterwards: “They have to face all the losses that were connected to being depressed after it suddenly lifts… perhaps not being able to enjoy relationships, or having relationships that are no longer working for them when they are not depressed.” If that’s anything like my own revelations after going on ADHD medication, it feels like someone else has been living in your body all this time.

Veronika talks about her training program here, and see her on Psychedelics Today’s up to the minute ketamine therapy panel from earlier this summer plus more on the New Psychonaut YouTube Lecture channel.

These five items I pulled from the week’s research are themed along Vital’s natural element-themed structure.

Next issue: Psychedelic Reanissance authour and top-flight global expert Dr Ben Sessa

On the couch 2.0

Approach

Psychedelic snobs like me sniff at ketamine treatment. But patients with lived experience say it works

‘Infused Vocabulary’ by False Negative Art

There are now hundreds of clinics in the USA dispensing psychedelic-style treatment using what we used to call ‘regretamine’ (as in “I regret having that ketamine”) and ‘ROFLcopter’.

Depression, PTSD and addiction, including for cocaine use disorder, are the conditions treated. Novamind’s six clinics in Utah expect a more than 200% rise in patient numbers next year, up to 65,000. Waiting lists are already two weeks long for a single infusion. While Spravato’s inhalers have become synonymous, lozengers are used too and an adjustable IV drip is considered the most workable method overall.

In her lecture covering the K-clinic phenomenon, specialist ketamine therapist Veronika Gold told Vital students that a raft of approaches are required to suit patient needs. Treatment modes range from the purely medicinal, including Mindbloom’s at-home service, to a psycholytic take where therapy takes place during the trip, to the psychedelic approach nailed down by Stan Grof where discussion occurs between guided, internal drug experiences (this is Awakn’s method used in the UK).

However, US insurance codes cover the substance but do not currently include accompanying psychotherapy. Patients’ strong reactions to emerging trauma on early trips have encouraged many dispensers to provide a sitter for inaugural unaccompanied voyages nonetheless.

I’m a complete snob about ketamine masquerading as a ‘psychedelic’. I can’t help but feel gaslighted by the assumption. LSD has given birth to its own rich culture of art and ideology. Even MDMA (also not a psychedelic) gave birth to rave. Where, I ask, are ketamine’s contributions to the collective imagination?

“I was able to go into the outside world without a sense of impending doom”

Moreover. I for one, given my own history with this particular ‘medicine’, have been less than compassionately curious as to ketamine’s therapeutic worth, in comparison to what we now have to call ‘classical psychedelics’ and indeed MDMA. Reports are varied but most are positive compared to existing treatments. Many are euphoric; others a disappointment. I’m heading off for the sharp end of guide training in a month and it feels incongruous not be getting first-hand know-how of ketamine therapy too.

Close-up of the IV bag used in ‘Infused Vocabulary’ by False Negative Art

Thankfully, trustworthy circle buddies have, both microdosing and the full clinical shebang. Know what? Their verdict is… thumbs-up. 

Kelli Ann Dumas is a psychotherapist in my Vital study group. She received ketamine treatment after two decades working as a first responder in disaster zones, and with the US military abroad. While first responders do not require a PTSD diagnosis to obtain treatment in the USA, Kelli’s career has included the ‘direct threat to life’ instances this usually requires.

“In the completing treatments rose joy. A positive, giving dynamic. Love and fire”

She says of her symptoms, “My intrusive thoughts were of… being killed. I would live in fear of it. All the time.” 

After the first dose, “I was able to go into the outside world without a sense of impending doom. The intrusive thinking went away. Anger was still there though. And so were panic attacks.”

The mental room she free’d up made for a beach head to assault these deeper issues, and Kelli got to work. “Before with PTSD I felt uncommon; only tight and damaged space inside,” she reports, “As my journey went on I was able to claim more of that space internally. When I did feel anger or fear come up, I could back into myself and feel safe.”

Powerful senses of grief and loss followed as Kelli went deeper, taking lozengers alone amongst Louisiana countryside in her beloved RV with a therapist available remotely. 

“Love would arise instead and I saw myself journeying like I had in my earlier life – my energy crossing the land. In the completing treatments rose joy: a positive, giving dynamic… love and fire. This became solid inside of myself, instead of the fear.”

Costly top-ups (weekly blasts add up) haven’t been necessary so far says Kelli: “When the tremble of the trauma comes I remember the call home, and am able to ride over it with my true self of dynamic proportions,” she says. “I don't inward as much: integration with family is getting better, my exterior boundaries are getting better when faced with negativity.”

Consciousness expansion for the masses

Therapy

Do the public care about therapy with their infusion? They do when trips get intense

From ‘K Hole’ by Ted Vasin

Veronika Gold has a front row seat at the new psychedelic healthcare reality.

The family psychologist worked on ketamine treatments at Cleveland’s New Pathways before heading to SF, training with MAPS and co-founding Polaris Insights.

Unsurprisingly, when psychedelics hit the general public it can get quite messy. Never mind your neighbours falling down the K-hole – can you explain that it’s only ego death and it’ll be alright soon? (Encounters with Anne Shulgin’s (RiP) ‘death door’ may be more complex).

“Even if you don’t agree with areas of psychedelic therapy, like the re-living the birth process and perinatal matrices, they can come up in patients. We’ve had girls go through that process,” says Veronica, who’s KAP program has been honed by what she sees in her treatment rooms each working day.

Accompanying psychotherapy for ketamine treatment is not covered by US insurance policies, as things stand. Over here in the UK its benefits aren’t exactly stressed by, for example, London’s Safe Minds. Besides haven’t we all gone round in circles with our psychotherapists enough by now?

“Patients might struggle with things coming up that conflict with their established beliefs”

Compass Pathways exec, psychiatrist and ketamine veteran Dr Steve Levine, who’s treated over 6,000 people with 60,000 infusions, urges caution over ketamine’s efficiency without therapy, and shakes his head over standards on the off-label scene. One Vital student who tried out their local K-clinic said he was very much left to his own devices. “It didn't necessarily engage in what I would consider best practices, preparation and integration, stuff like that,” he tells Veronika in her Vital lecture Q&A, “During the higher doses, I would get lost. I wouldn't know where it was, what was going on, or I just didn't have any sort of focal point, even with the music.”

A study group fellow on a series of ketamine treatments tells me anecdotally, “You get what you pay for.” Veronika is of course appalled at rookies being left alone in drab treatment rooms. Attention is important for first-timers especially, she says. 

Most of all Veronica’s own Ketamine Assisted Therapy (KAP) program stresses flexibility. “The medicine may be too much for psychedelic therapy where they process internally, so you lower the dose and try a psycolitic approach with talk therapy while they are under a lighter influence. Or the patient could pull back from a shamanic experience where they confront the trauma, to discuss insights on a transpersonal level. They might struggle with that as things are coming up that conflict with their established beliefs.”

It seems clinic staff need to stay light on their feet.

“It was exciting to see that for some people, home treatment worked better”

And, prepared.

“We have a long intake questionnaire, we as well ask about trans-generation trauma, we ask about their birth process, we ask about you know relationships in their life, we're asking about religious and spiritual history, discuss how they may want to be held,” says Veronika. Screening patients is key to unproductively disturbing scenes. “We have though, had referrals asking for the medicinal treatment alone who’ve had a difficult time and needed attention,” she warns. 

“We see people moving a lot, kicking, pushing, shaking off trauma physically,” says Veronika, “patients subconsciously feel more able to do this when they‘re not connected to the IV, so switching administrations can be useful too.”

If the unwashed masses crashing down main street on K wasn’t concerning enough, moral guardians gasped when the pandemic struck and ketamine therapy was offered… via Zoom.

“We weren't sure how it's how it's going to work,” says Veronika, “it was really exciting to see that for some people it worked better. They didn't have to end the session at the three hour mark, get everything together to leave the clinic, have somebody pick them up or take a ride home. They were able to stay in their space.” Sounds groovy.

Vital student and first responder Kelli Ann Dumas, who talks about her own ketamine treatment experience elsewhere in this issue of the unofficial Vital Student Zine took her later lozenges accompanied only by her two terriers, snug in her beloved RV surrounded by Louisiana woodland. She thinks it wouldn’t have been as effective without applying her own self-healing skills, which range from to participation in ayahuasca ceremonies to frontline trauma counselling work and a transpersonal psychology qualification. 

“Pulling into the observing ego was my benefit,” says Kelli, “I’ve learned how to access an observing space, but that’s through years of yoga, meditation and eastern studies. Plus from my career I have advanced skills in narrative therapy. I don’t think someone without access to those would have as effective an experience.”

Psychedelic overground

Space

Rugby lads on ibogaine, reality stars in hyperreality and tarot cards swapped for toys. Turns out the revolution will be fun

Inevitably, models gather in St Tropez for a charity fundraiser hosted by Christian Angermeyer’s Aurora Institute

With celebs like Sharon Osborn extolling the virtues of ketamine therapy get ready for the neighbourhood popping their heads through the door of your clinic.

The psychedelic renaissance has flowed beyond the dinner party circuit on to the high street. Ketamine treatment is even more of a talking point than the toad thing. KAP got a shout out from UK TV’s Loose Women co-host Frankie Bridge (the striking one out of The Saturdays who had short hair) and Hello! mag went large.

Dr Leary’s orbiting urn would spin at an angle that defied conventional physics to see trite psychedelic lifestyle design clichés replaced by… trite lifestyle design clichés.

Sports stars have been hot on their daytime TV counterparts’ heels: gridiron megastar Aaron Rogers puts a late career surge down to ayahuasca and other football players extol psychedelic healing for concussion and stubborn injuries. Combat sports are beloved of thugs but played by gentlemen so being miles ahead doesn’t count.

Even the middle market are getting out there. Gen-X footwear designer Patrick Cox spoke about his new life as an Ibizan 5-MEO DMT facilitator to Hadley Freeman in The Guardian this summer. Ever intrepid, Freeman ‘smoked toad’ [sic] despite her editor’s express instructions.

A Vital study group chum undergoing ketamine therapy recently declared that sock puppets had been added to her clinic’s table of tripping props (with the spirit animal cards and crystals). She spent the session happily playing with them. 

Maybe this doesn’t sound ‘mystical’ enough to those of us with well-thumbed copies of The Tibetan Book of the Dead. 

Chatting away to the guides during the medicine experience, or wanting to go outside, can be a distraction from the work you’re there to do apparently. After you’ve come down you could be disappointed you didn’t get any of that done. I don’t disagree that it could feel like a waste of time for all concerned.

“Wit is the ability to find hidden similarities linking two ideas which are contrasted with each other”

But on psychedelics ‘what comes up, comes up’ to use the platitudinous truism. TV’s Dr Bill Richards, the veteran John Hopkins’ researcher featured in Netflix’s How to Change Your Mind said laughter “May be what’s needed” in his own Vital lecture.

I rubbished Freudian psychoanalysis in issue #11 by ranting about how the only therapeutic system that’s been established as ‘fact’ for 100 years has poisoned our intellectual conversation and our mental healing.

Turns out Freud wrote about the importance of humour in 1905’s The Joke and its Relation to the Unconscious. Before putting pen to paper he took the opportunity to discuss the subject with hilarious cards from his Viennese social whirl.  The many positive conclusions included, ‘Wit is the ability to… find hidden similarities… linking two ideas which in some way are contrasted with each other.’

Laughter is the yang of meditative, non-dual understanding’s yin. The unconscious plays a leading role both in devising clever quips and responding to them in real time, without conscious analysis. On top of healing relational trauma, laughter and play in adults are also ‘positively correlated’ with increased sociability, spontaneity, tension release, innovation, de-stressing, longevity, immunity, energy levels, teamwork and parasympathetic nervous system activation. 

“Whether I was crying or laughing, was not too important”

And never mind the cave paintings, because psychedelics gave us jokes. The 2021 research paper Psychedelics, Sociality, and Human Evolution says, ‘In particular, the interpersonal and prosocial effects of psilocybin may have mediated the expansion of social bonding mechanisms such as laughter, music, storytelling, and religion.’ 

LSDExperience.com a compendium of the finest, trip writing includes this anonymous quote: “Whether I was crying or laughing was really not too important, except on the conventional level. The important point was that the tree of my emotions was being vigorously shaken and liberated of some withered leaves which had hung on too long.”

Spiritual emergencies, fearful reactions, and sudden life changes are likely to be of more concern for ketamine entrepreneurs and therapists than the number of mystical versus humorous experiences per week going down in their clinic. But not for nothing does the Bible call humour ‘the best medicine.’ It could be comparable to spirituality, or philosophy for coming to terms with complex and contrasting themes.

At dinner, or on the high street.

It’s legislators who seem out on the fringes now.

War and peace

Medical

Ketamine’s been used as an anti-depressant for decades. Its effect on neurotransmitter glutamate may hold the key to understanding mental health

Vintage war poster from Antikbar Art

Ketamine’s actually been used as an antidepressant for many years, even in the NHS.

With D-list celebrities queuing up for ketamine, it’s even easier to write it off as a D-list consciousness expander. But that’d be both distastefully othering and ignorant of ketamine’s rich heritage.

Ketamine’s disinhibiting dissociative ‘emergent states’ comparable to psychedelic visions were noticed during its use as a battlefield anaesthetic in the Vietnam War. As were similar visions caused by its predecessor PCP AKA angel dust. The effects were studied in humans back in 1964.

Loads more scientific double-blind investigations have been conducted into ketamine compared to proper psychedelics. Ketamine could work even better when combined with a designer drug in the same family, cycloserine, used to treat tuberculosis and kidney disease. 

But ketamine’s authentic heritage treating mental health issues, plus its clarifying insights, aren’t all that’s worth bearing in mind before cocking any more snoops at the ketamine crew. 21st century neuroscience – and mycology – have dug up some astounding K-facts that endorse its use as a bio-psychological healing too.

According to the superb Psychedelic Science Review, ketamine causes and mediates release of neurotransmitters in a ‘glutamate surge’ that essentially causes neuroplasticity.

Ketamine could be “the most neuroplastic drug” as a psychiatrist commented in the Q&A after ketamine therapist Veronika Gold’s Vital lecture. Market anti-depressants only prompt limited aspects of this cascading process known as ‘brain derived neurotropic factor’ which isn’t dissimilar to the effects derived from healthy actives like cardio-vascular exercise. Un-mediated glutamate causes auto-immune and neurodegenerative diseases like ADHD, Parkinson’s and a raft of other conditions that psychedelics are associated with treating. Proper psychedelics are thought to do something similar but haven’t been lab-tested nearly as much as ketamine, so scientists can’t say for sure.

As above, so below

Integration

A fungus using K to clear parasites could hold the secret to the brain-body disease connection

Bacteria operating in fracal patterns observed by the late Dr Eschel Ben-Jacob

Pochonia Chlamydosporia is a fungus recently discovered to use ketamine for flushing parasites out of its host plant’s roots.

Discovered and hyped only recently, there are two eyebrow-raising elements to this. 

Firstly ketamine is a ‘designer drug’, or as elite space commando and neuroscientist Andrew Gallimore wrote on Twitter, “a perfect example of a purely synthetic molecule. The arylcyclohexylamines, of which ketamine is the prototypic example, are a product entirely of the human mind... Oh wait…”

Did the fungus get hold of it via the mycelial network? Is biology categorisable to the extent that a substance arrived at in lab tests can be naturally occurring but not yet discovered? Or did the Reality Switch Technologies Gallimore writes about come into play, somehow?

Some ketamine killing parasitic worm eggs

Secondly: Pochonia Chlamydosporia uses ketamine as an anti-microbial agent. A robust two-parter in Psychedelic Science Review dug out a 1987 study where ketamine did a great job killing bacterial heart lining infections in rabbits – and stopped the rabies virus breeding in rats.

In 2002 ketamine was tested against market antibiotics and crushed Staphylococcus aureus, a common opportunistic bacteria that causes all kinds of nastiness, from pimples and impetigo to MRSA and pneumonia… and has become 80% resistant to antibiotics since penicillin was invented in 1943.

The 2020 report from the un-putdownable Parasites & Vectors journal tested ketamine against agricultural anti-wormer ivermectin, which used to be advertised on TV back in the West Country to give you an idea of how widespread its farming use is. Ketamine performed equally well.

But what has actually captured the imaginations of many in the space is that this means ketamine counts as a ‘plant medicine’. I eagerly await the complex mythologies, concept albums, groundbreaking scientific discoveries, artistic genres, philosophical insights, and bespoke geometric fabric designs that shall surely now emerge from the ketamine subculture, such as it currently is.

Kool-Aid Corner #13

To finish: trippy clippings, merry pranks, and psychedelic student life

Graph of the Week

How a glutamate ‘surge’ (it’s more of a mediation than a wave) works through the nervous system:

From: Ketamine and Serotonergic Psychedelics: Common Mechanisms Underlying the Effects of Rapid-Acting Antidepressants, by Bashkim Kadriu, Jessica R Gilbert, Ioline D Henter, Christoph Kraus published in The International Journal of Neuropsychopharmacology November 2020

My bookshelf weighs a ton

Notable new purchases for the occult library. Strictly second hand snap-ups only. This week: The Trials of Psychedelic Therapy

Grabbed it for £16 price now pushing £37 but bargains exist

‘The First Lady of LSD History’ Dr Erika Dyck says, “There is no other historical account that offers this degree of breadth on the topic.” Psychedelic Renaissance author and medical thought leader Dr Ben Sessa wrote in the British Journal of Psychiatry, “Shines a fascinating light on a discipline that is neither pure pharmacotherapy nor pure psychotherapy… Oram shows how LSD's unique position has been, and still is, its potential undoing when it comes to obtaining formal licensed approval.”

Published by John Hopkins University Press during the dark days of the early 1980s, Matthew Oram’s examination was undertaken away from hype or disapproval. The writer points out that the issue with approval is not only the ‘randomised controlled trial’ process that insists on a placebo, but also statistical compromises that arise from therapy provided alongside. 

That’s still causing issues to this day. Imperial College’s PsiloDep 2 is criticised because 35-plus hours of therapy were provided alongside the psilocybin. Oram writes that researchers were concerned about this in the early 1960s, when treatments combined physical, psychological and psychiatric methods as a matter of course. 

That didn’t last. Speaking in an interview for historian Andy Roberts’ book Acid Drops, 1950s British LSD researcher Dr Ronnie Sandison says, “When I started using LSD in therapy over 40 years ago the split had already started between general psychiatry and psychotherapy, and that divide has gradually widened into psychotherapists and psychoanalysts and an increasing number of lay-psychotherapists, all doing very good work. And then you have the general psychiatrists who have become more and more a victim of the drug companies. I really believe you can be a psychiatrist these days without having much knowledge of the mind, if you hand out the right pill to a patient.”

Maybe he’s right. But psychedelic evangelists in the therapeutic frontlines are also better off considering why psychotherapy might not appeal to the customer, at least initially. I’d posit that expense and time off work are the main reasons, followed closely by disappointment in non-psychedelic assisted talk therapy sessions, where narrative psychoanalysis insists on a universal worldview that contradicts a patient’s lived experience. 

Next issue: Psychedelic Renaissance author Dr Ben Sessa of Awakn Life Sciences speaks, and we listen