How Ketamine Helped When My Therapist Couldn’t…

One time, my then roommate found me in tears hunched over the coffee I was making in our kitchen. It’s actually one of the more intense experiences I have felt in my life up to this point. And it’s just because in that moment, I wasn’t thinking about anything other than making my coffee. And the inside of my head had never been so quiet…

“Your Thoughts are Valid”

At one point in time I know I found comfort in that statement. I know I did, I’ve got a memory of it. I know it’s why I kind of liked my second therapist. The validation he gave really did seem to do something. Looking back, it really was impactful for me to be open about some of the things going on in my head and not get wide eyes or nervousness as a response. It really did help me feel less sick. I remember that it helped, I don’t remember what it felt like, but I do know I felt it at the time. 

But there were a few problems for me in depression. I was in a rough time of my life, to start with. I went through a lot of loss in my early 20’s. I had quite a few loved ones that passed away during those years, and I had some struggles in connecting with other people that left me feeling pretty alone. I had this internal understanding that I was always going to end up alone and isolated. And a decent few things outside of my control kept happening that let me know, I was not too far off base.

Another problem for me was that I was actually supposed to be philosophizing about everything. In a previous life, I went to school to be a pastor. So all I really knew how to do was think about the nature of existence, eternity, suffering, all that jazz. So here I am all set up to believe that values, beliefs, and world views were supposed to be how we all navigate the world. Except no one told Little Ryan that acting in line with your values is a point of privilege and everyone has to go against their own beliefs at some point. 

So I was in this constant process of becoming more cynical because no one seemed to have any self-awareness. It really started to get rough when the two started to come together. Like I think most of us experience, I started noticing how many BIG changes were happening around me. The “Marriage is just an institution” crowd all got married. The “I could never handle kids” crew all had their third child before they turned 30. One of the friends that always was talking about living in connection and community moved to a part of town none of the rest of us could afford. Everyone bailed on the people or relationships they had as soon as there was difficulty.

I got so cynical and jaded and every experience felt hollow. I did not really have connections, everything just felt very surface. The more that feedback loop ran away the more isolated I felt. How could I invest in connection if I know that person just is not going to work to keep it if it gets hard? 

I remembered sitting in one session with Therapist 7, running them through all of this. Telling them about the place that I had landed, where I was fairly certain that people are not good, I am probably not any good, and nothing I do really matters because I will always be alone. And the response I got, validation in spades. The problem is that this was Therapist 7, and a very simple thing had changed since Therapist 2: I had felt the same way for a decade. It really was that simple, I had 10 years and I had so much evidence at that point. In response to all that validation and connection, the message being that I had been through so much and that my pain made sense and I was so resilient, and I remember just saying, “I know,” in response. There was not even a memory of what that validation felt like with Therapist 2. All I knew is that it wasn’t there with Therapist 7 anymore. In my experience at the time, therapy had revealed to me just how broken I was, and I was only getting worse. My ruminative thinking had become a symptom… 

“I work with people, not symptoms…”

I think that most of my therapist friends might have some kind of a  reaction to the word “symptom”. I know that I had a very particular view of how I should view and interact with my clients’ symptoms. My grad program had a very particular lens that they saw those things through. Symptoms are supposed to be a sign of something deeper. Therapy focused on the symptoms is shallow therapy. 

It made sense to me in grad school, but the more time passed, the less it kept making sense. I even started to notice that when I reflected on my grad training, I had been getting conflicting messages the whole time. In one class, I might have been getting the message that if I focus on a symptom, I’m missing the big picture. Then in the next class we might end up talking about how Milton Erickson was the best even though no one fully understands why. Looking back, why was he the best?! Sure, it was through these very interesting, strange hypnotherapy interventions, but all he ever did was take away a symptom.

I was taught to think of things in terms of first and second order change. First order change happens within the rules of system. Second order change is the creation of a new system or a change to the rules of the system. I was taught that if I wasn’t working toward second order change, I was not really doing anything. The symptoms will take care of themself at that point. If you're focusing on first order change, it’ll help for a while. Ultimately, the problem will just come back. 

So that is exactly what I did. I just kept going for the deeper work. And I think I was able to kind of help some people some times with no real clue as to why it worked for some and did not for others. Cracking the code to that deeper work just kept elluding me. Then I learned something about myself as a client, that taught me so much about being a therapist…

“Have You Seen Long-Term Results?”

I started to get that question from colleagues the more I started to talk about providing Ketamine-Assisted Therapy. It was especially frustrating because it always came as a leading question. So my answer is almost rote at this point. Short answer: Yup. Long-answer: Faster symptom reduction, lower dropout rates, lower distress at time of discharge, higher rate of response at 3 month follow-up. The whole thing felt frustrating to me because it felt like all of those points, which felt incredibly significant to me, are kind of just brushed to the side. Essentially, the message was that it’s just symptom management and no “deeper” work was happening. 

I have written already about how I had a pretty difficult time getting any of the help that I needed from therapy. I found those conversations so frustrating because by time I was engaged in this as a provider, I had already benefited from Ketamine Therapy. And I say it that way purposely. Ketamine Therapy or also referred to as Ketamine Infusions do not involve a therapist, it is different from ketamine-assisted therapy (In most professional writings it is referred to as KAP, Ketamine-Assisted Psychotherapy). I went this route because I was in pain, and therapy was making it worse. My last two goes at therapy were very focused on healing old wounds, Therapist 7 in particular. Aren’t these supposed to be what help me get to my core issues? Aren’t these the ones that are supposed to help me heal?

But I could never figure out how to navigate my inner-world. It was shaped by my symptoms. My thoughts never started with death, but it never took much to get me headed down that track. An unanswered text, unexpected bill, honestly just an inconvenience was all it could really take to open the flood gates. Those ruminating thoughts were always right at the surface. And they were such a source of shame for me. I knew what I sounded like too! It was some real blackened-heart, dead-soul type crap. I also knew that this pain was going to outlive the empathy of my social circles, it had already started to in some relationships. It took nothing to bring it on; those thoughts were so bleak; I couldn’t stop it once it started; and nothing I could do made a difference. With that being the shape of my symptoms, I think it is understandable that all my thoughts at that time pointed to the same place. I never took any specific steps toward suicide, but if I hoped for anything it was death. 

Ketamine therapy helped with my symptoms. And I cannot say this with enough passion, and I can not emphasize enough that this is not hyperbole when I say this. Symptom alleviation did more to help me stay alive than those 7 therapists. Those conversations with those colleagues frustrated me because I knew they did not care about the symptoms. I came to realize from my experience that I was healthier having gone for the option that could be considered the most surface. 

This aversion to thinking about the symptoms that so many of us are really trained with can make it really difficult to help some clients. But I think it goes without saying that when one of the symptoms is suicidal ideation, symptoms are a matter life and death. And symptoms do not always behave like in textbooks, sometimes they just don’t take care of themself no matter how much healing has happened. Sometimes, symptom relief is what makes healing possible and that is what happened for me. I got a very particular message as a client, the symptoms just don’t matter. But what kept getting missed is that my symptoms were the only felt experience I had at the time. I’m really grateful that I get to use a form of therapy with my clients these days that helps with both, because for some people, they have more of an experience of their symptoms than they do of themself. And I can say that it has been a powerful, positive experience to be able to better manage my symptoms. I’m grateful that I have a way of working with my clients that allows for us to not just move to healing but also to alleviate the some pain. So these days, I am more than happy to be present and work with whatever my client is experiencing. Symptoms and all…

If you are needing help or are curious about KAP, please reach out…

Best, Ryan