By Jeffrey Gianelli, LCSW
The Role of Ketamine in Therapy
Ketamine may play a crucial role in Ketamine Assisted Psychotherapy (KAP) by creating a state of heightened neuroplasticity, which allows the brain to adapt and embrace change more readily. This increased flexibility helps restructure neural pathways that may be rigid in individuals experiencing depression, anxiety, and PTSD. By loosening these often inflexible mental patterns, ketamine can open up opportunities for patients to confront psychological obstacles that once felt insurmountable.
The effect of ketamine on neuroplasticity—its capacity to reorganize the brain by forming new neural connections—is promising for treating various mental health conditions. When administered in controlled settings, it is possible for ketamine to trigger a rapid surge in neuroplasticity. This increased malleability not only supports the rewiring of neural pathways associated with negative mental patterns but also promotes improved cognitive function and emotional resilience.
The Symphony of Parts and Presence
IFS invites us into a world where the mind is not singular but a symphony, composed of protectors, exiles, and a self that, when unobstructed, radiates calm and compassion. It teaches that healing begins when the self becomes a compassionate observer, approaching these parts with curiosity instead of fear.
This is where KAP enters—not as a remedy, but as a key. Ketamine, with its ability to shift perception and foster neuroplasticity, does not diminish the protectors but asks them to pause, to let in the breeze of something different. It’s a pause that, for many, feels like the first deep breath after years of shallow breathing. The mind’s guard relaxes, and exiled parts may be able to emerge not as memories that haunt, but as stories that long to be witnessed.
In an interview between Shiv Gaglani and Richard Schwartz, he is quoted as saying in regards to the use of Ketamine and IFS combined during a retreat intensive “we do get stuck sometimes so I went ahead and did it and I was just amazed at how much it accelerated the work to have the medicine. Again, it just really gave people this tremendous access to this Self, and then that was an invitation for these exiles. We could do in one, like, twenty-minute session what otherwise it might take ten sessions to do, and that’s held up. That has just been amazing to me.”
Healing Through A Combination of IFS and KAP
Combining experiential techniques like Internal Family Systems (IFS), and Ketamine Assisted Psychotherapy (KAP) may offer a therapeutic experience that can help individuals heal from deep-seated emotional wounds and trauma. Here are several ways this integration could be effective:
- Accessing the Subconscious: Ketamine has been shown to facilitate access to the subconscious, allowing clients to uncover and process deeply ingrained emotions.
- Creating a Safe, Non-Judgmental Space: A key principle of IFS is to provide a safe and non-judgmental environment for clients to explore their inner selves. Ketamine may enhance this atmosphere by inducing relaxation and reducing inhibitions, enabling clients to open up and delve into their emotions in a supportive setting.
- Enhancing Introspection and Self-Awareness: Both IFS and ketamine promote greater self-awareness and introspection. When combined, this could potentially elevate clients’ understanding of their internal parts and how these aspects are interconnected, leading to deeper insights.
- Facilitating Emotional Breakthroughs: Ketamine can induce a state of emotional openness and vulnerability, potentially making it easier for clients to achieve significant emotional breakthroughs. When paired with the supportive environment of IFS, this could lead to helpful emotional insights.
- Getting Unstuck: KAP’s potential to decrease symptoms and enhance neuroplasticity combined with IFS’s exploration of the roots of psychological distress could be a catalyst for change in certain clients.
Client who may be good candidates for KAP are those who:
- Are feeling really stuck in a certain area of their lives and are having trouble getting unstuck
- Have difficulty accessing self energy/ unblending from parts
- Are struggling with severe Depression or Anxiety symptoms
- Are seeking a deeper, more intensive sort of inner exploration
Important Considerations and Potential Risks
While the integration of KAP and IFS offers potential, it is crucial to approach it with care. The dissociative effects of ketamine can unlock intense emotional experiences. This can lead to breakthroughs but also risk overwhelming clients, especially when delving into deep-seated trauma. The work must be paced and contained, allowing the client to engage without becoming destabilized.
Clients may unearth memories or emotions that require skilled, thoughtful processing. If these experiences are not adequately supported, the result can be more disorientation than clarity. Moreover, individual responses to ketamine vary significantly; while some clients find profound insight, others may encounter confusion or limited shifts.
Therapist readiness and training are essential to facilitate this complex work. Effective use of KAP requires a deep understanding of both ketamine’s effects and the principles of IFS. Without this dual knowledge, sessions risk being ineffective or, worse, retraumatizing. Furthermore, ketamine comes with medical considerations: side effects and contraindications must be evaluated thoroughly, and collaboration with medical professionals is vital to ensure safety.
The Importance of Integration
The true power of IFS-guided KAP lies not only in the ketamine session but in the preparation and integration that bookend it. These elements create the framework within which profound insights become not fleeting glimpses but enduring guides. Integration work invites the client to make sense of their experiences, to weave newfound understanding into the fabric of their daily life, and to build trust within their internal system.
This process ensures that what is revealed during the ketamine session is honored and made actionable, turning emotional revelations into behavioral shifts and resilient change. It is in these moments of post-session reflection that the self can engage with protectors, fostering an environment where growth continues long after the ketamine has worn off.
A Portrait of Healing: Samuel’s Unfolding
Samuel, a 42-year-old artist, carried the weight of his trauma like an unfinished canvas—layers of paint, haphazard and dark, that refused to dry. He spoke in circles, touching the edges of his pain but never daring to step inside. His protectors, fierce in their loyalty, warned him at every turn: Stay back; it’s too much. Weeks turned into months of stilted progress, until he found himself yearning for a way to move beyond the edge without falling.
Samuel’s first KAP session was preceded by careful preparation. Together, he and his therapist mapped his internal world, forming alliances with the parts that had kept him vigilant for so long. When the day arrived, ketamine offered him a moment of reprieve—a softening of the fortress walls. For 45 minutes, Samuel traveled into a space where the echoes of criticism quieted, and he encountered his younger self, huddled and alone, not as a phantom of trauma but as a child worthy of comfort. Guided by the principles of IFS, Samuel extended a hand, whispering words that dissolved years of silence: I see you. I am here.
The integration sessions that followed were not merely therapeutic exercises; they were ceremonies of understanding. Samuel and his therapist unpacked this meeting, inviting protectors to share their fears and learn that safety could be found not in isolation but in shared presence. Over time, what was once stuck became fluid. The canvas of Samuel’s mind shifted; where darkness had layered thick, new strokes of light began to form.
My Process in Working with Clients Using IFS and KAP
I start out getting to know the parts involved in the client’s system. It is crucial for the client to have built some sort of a relationship with the protectors before starting KAP. After this, we will discuss the risks and benefits of working with Ketamine. If the client decides they want to proceed, I will refer them for a medical consultation. Protectors should always be on board with the process. Even after initiating a medical consult/ prescription, I will always check in with the client’s protectors the day of a KAP session and make sure they are giving the green light. Otherwise, we will hold off on having the session.
If all parts of the clients system are on board, we will proceed to the preparation, which may take 1-3 sessions. During this, we will discuss what to expect during the ketamine experience, set and setting, intentions, and what to expect after the experience.
On the day of the experience, we will schedule a 3 hour block. We will begin with some calming meditation, review the intentions, make sure everything is comfortable and set up properly, and then the client will administer the ketamine as prescribed by their medical provider. Their journey typically lasts 45 minutes, after which we process and integrate whatever came up with an IFS informed lens. Sometimes, parts will have been involved in the journey that we will explore further.
Afterwards, we will have at least one integration session where we process the entire experience. This may also involve more parts work. From there, we decide if further journeys would seem to be helpful to the treatment. A typical course of ketamine treatments are 6-8 sessions.
A Path Through the Unseen
Therapy is not about erasing pain but about bringing loving awareness to it. The integration of IFS and KAP, although not for everyone, holds promise in the possibility of helping clients open more deeply and fully. Intention setting and integration may help carry the work forward in a directed way that feels tangible. There are many ways to navigate through the inner landscape, these tools offer a possible synergy in doing so.
