The TeleWellness Hub Podcast

Ep 71 Ketamine-Assisted Psychotherapy Unveiled Part 1: Crystal Myers on Revolutionizing Mental Health Treatment and Debunking Myths

• Martamaria Hamilton

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Unlock the transformative power of ketamine-assisted psychotherapy with our esteemed guest, Crystal Myers, a licensed professional counselor and owner of Life Works Professional Counseling. This episode takes you on an enlightening journey through the origins, mechanisms, and modern therapeutic uses of ketamine. Crystal demystifies common misconceptions, such as its notorious label as a "horse tranquilizer," and explains how this dissociative anesthetic, when used at therapeutic doses, can help treat depression, anxiety, and complex PTSD without causing unconsciousness.

In our thorough discussion, Crystal details who might be an ideal candidate for ketamine therapy and who might not, based on specific medical histories. We also clarify the FDA approval status of ketamine treatments, noting the approval of Spravato, a nasal spray version for depression. Crystal walks us through the typical ketamine treatment experience, offering practical advice on managing potential side effects and highlighting the importance of initial acclimation sessions under professional guidance. It's an eye-opening look at a therapy that could offer hope where traditional treatments have failed.

Lastly, delve into the structure and benefits of ketamine-assisted psychotherapy. Crystal breaks down a typical treatment round, emphasizing the significance of integration sessions to reinforce new neural pathways. We explore the substantial positive impacts reported in clinical studies and discuss why ketamine-assisted psychotherapy stands out among other therapeutic modalities. Don't miss this opportunity to gain valuable insights and connect with Crystal Myers, as we continue our compelling series on ketamine-assisted therapy, promising you a fresh perspective on mental health treatment.

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Speaker 1:

Welcome, friends, to the Telewellness Hub podcast, a space where listening is not just a simple passive act, it's an act of self-care. I'm Marta Hamilton, your host, and today you are getting direct access to wellness expert Crystal Myers, who is based out of Virginia and is an expert within the field of ketamine-assisted psychotherapy. This marks part one of a three-part series that we're going to be doing, especially focusing on ketamine, so I'm really excited A little bit about Crystal. Crystal Myers is a licensed professional counselor in Virginia and group practice owner of LifeWorks Professional Counseling. She and her clinicians at LifeWorks Professional Counseling are experienced in many areas of mental health support for over a decade. A particular area of expertise is their work with adult survivors of abuse and trauma tackling treatment, resistant complex PTSD, depression and anxiety. But today we get to talk about the new exclusive focus of crystal Meyers work the transformative power of ketamine assisted. New exclusive focus of Crystal Meyer's work the Transformative Power of Ketamine-Assisted Psychotherapy. Welcome, crystal.

Speaker 2:

Thank you.

Speaker 1:

Marta.

Speaker 2:

I'm so happy to be here with you today.

Speaker 1:

I'm very, very just. I shared this before we hit record on a personal and professional level. I'm very excited to get to know more about ketamine through you. This is not something that I learned in graduate school. It's something that is very new and innovative, and I'm really. Before we dive in into all the questions that I have, I wanted to know first if you could share with us a little bit about why do you do the wellness work that you do if you could share with us a little bit about why do you do the wellness work that you do?

Speaker 2:

That is such a great question. I think, just through personal experiences and coming out of a childhood myself where it was not ideal and my own journey of healing through that, wanted to really offer people some hope and that can be one of the most powerful things as a therapist to walk, I mean, that's our work to walk alongside someone and keep hoping for them until they can internalize that.

Speaker 1:

Yes, yes, I love that. I think the power of hope doesn't get talked about enough sometimes and um, I think I think, as a clinician, a hundred% that resonates so much that looking for hope, what does that client hope for and how can that get? Sometimes it's a day by day. That hope gets them through that day and it's just so powerful and it's such an honor to get to walk alongside clients. So thank you for sharing that. I think that hope is just so powerful.

Speaker 1:

And when you can relate on a personal level, I think, as therapists are also humans, so we also kind of navigate those complex childhoods or life histories and emotions on a day-to-day basis. So what a gift it must be to be in a room with you. So I'm grateful that we get to open up those doors to listeners. Before, I think, we dive into the little intricacies of ketamine-assisted psychotherapy, can you share a little bit about, just let's start with like, what is ketamine? You know, before we hit record we talked about, you know, matthew, when Matthew Perry passed they talked about ketamine. You start seeing it in the media and you hear, like horse tranquilizer, right, you hear a lot. So can you share a little bit about what is ketamine?

Speaker 2:

So ketamine is actually a dissociative anesthetic and it was developed in the lab in 1962 and has had really broad use since then. It's just come into the scene for ketamine-assisted psychotherapy recently, but the history of it and its mechanism of action? It actually it's used for a general anesthesia, for medical procedures, when you don't need to have the muscle relaxant piece of it, so people are actually still conscious, but it does have an um, a pain reliever, um, so for minor procedures, um, unfortunately there have been some instances of it being used in emergency rooms to help calm people very quickly People that work in the psychotherapy field or emergency evaluations to see if people need to be hospitalized. There are certain drugs that ER physicians will give to a client that's really not able to regulate and maybe is a danger to themselves or others. Ketamine can be used for that.

Speaker 2:

It's not the go to right now, which in some ways is a really good, a really good thing as far as it being a horse tranquilizer. The history of that is also very interesting, so that's more about the slang term on the street and that primarily came out of the idea that it's more accessible in veterinary clinics so people could break in and steal it. So yeah, yeah it so yeah, yeah. And a lot of people say what do you know about ketamine? Isn't that the horse tranquilizer? I don't want to take a horse tranquilizer. Well, the good news is you won't be doing that. The dose that you would take on ketamine-assisted psychotherapy is it's going to be there's a range, but it will likely be enough that you'll have some of the psychedelic effects where you feel the dissociation, but it's not going to put you completely out.

Speaker 1:

That is so interesting. I didn't know about the mechanism and the history and how, how. How is it used then within therapy? So it's interesting to hear you know if you need to calm down or if there's someone's a threat to themselves or others, and the way that it could be used as a for anesthesia. How is it utilized then therapy?

Speaker 2:

That is a fabulous question. So it really is limited at this point to what we would call treatment resistant diagnoses, and you mentioned some of those before depression, anxiety, complex PTSD. And when we say it's treatment resistant it's really that someone has been engaging and trying to find the healing that they deserve For many years. Many options so traditional talk therapy, maybe medications, maybe for extreme depression. They've tried electroconvulsive therapy, transcranial magnetic therapy. Any number of those over maybe a longer period of time, like we, could have an experience of just thinking about PTSD. That may be a good way to talk about it.

Speaker 2:

Someone can have a traumatic event and either not develop PTSD or develop PTSD and it can be resolved fairly quickly. Someone who has complex PTSD usually the abuse or neglect started in childhood and it's just kind of built up. It's become a way of responding to the environment in order to keep themselves safe. So these defenses developed in a young child who was overwhelmed, didn't have resources to be able to process it or deal with it, and so they may have been in and out of therapy their whole life. Tried different modalities that maybe bring a little relief, but they're still really struggling and need a little. They need more.

Speaker 2:

So introducing ketamine into psychotherapy helps them. There's an immediate antidepressant impact and also for people that are experiencing suicidality it also kind of takes away some of that. So there's some positive benefits almost immediately. But it helps. Yeah, it's so impactful. It's beautiful to see and I'll talk a little more about that and hopefully in our time together, hopefully in our time together. But just having the immediate impact of that and bringing down some barriers that might have been in the way from a person actually accessing that material or letting them look even at their therapist in a different way, like this is a safe relationship and they know that. But you have those internal checks and balances for a reason. Then we'll break through those and sometimes that material is a little more accessible for them to process through with a trained therapist who can help them make sense of it.

Speaker 1:

Yeah, I love that you mentioned that. It's beautiful to see because I think what you mentioned earlier brings up the initial why of why you do the wellness work. You know we talked about that hope. It sounds like you know this. For someone who's been holding on to hope and trying different modalities, you know it can be hard to hold on to that hope, and how amazing and beautiful to have something that it sounds like has, in some areas, an immediate effect. Could you share a little bit about maybe what a therapy, a ketamine-assisted therapy session, might look like then in terms of just breaking it down and maybe touch on a little bit of that beauty that you see in a session?

Speaker 2:

Absolutely so. For ketamine-assisted psychotherapy there needs to be a medical doctor or a nurse practitioner involved. So if a person would say, reach out to me and say I'm interested in using ketamine to help with my therapeutic process, I would send them some screening documentation initially, because there are some medical issues and some psychiatric issues that could prevent someone from being a good candidate for ketamine-assisted psychotherapy. So we want to rule those out first, before the person actually engages in a session with me. And after they do all of that screening material, I'll review it and then reach out and say, hey, based on what you've shared, you might be a good fit for ketamine. And then someone we would bring them into the office. I would have at least one session with them and maybe a couple depending on where they're at their comfort level, what they might need, and at that point if we both decide that this is gonna be a good option and they'd like to pursue it further. I partner with a company called Journey Clinical and their part of it is actually providing the medication assessment and prescribing the medication to the client. If the doctor or nurse practitioner that they meet with decides that they are actually send the ketamine lozenges they're also called troches directly to the client's home and the client will call and say I got my medication, let's go ahead and make that first appointment. Then we do that. They come into the office. Yeah, yeah, the office. Yeah, yeah, it's really, it's so. It's it's also this idea of being self-directed and having full control over it.

Speaker 2:

There are some people that will take the step of seeing the doctor and maybe then two months later decide, okay, now I'm ready, because it brings it can bring up a lot for people to think, oh, I'm going to be more vulnerable. Am I ready for that? So we want to support their journey, whatever that looks like At that point. When they decide they're ready, they'll come into the office. We'll do a little prep work, talk about what they're hoping will happen for them. They take their own vitals. The doctor that prescribed the medication will give us thresholds and say their heart rate and blood pressure needs to be at or below this level. As long as that's okay, then we'll proceed. They take, they have their instructions from their doctor about how to use the medication and they'll. They just put it in their mouth. It rapidly dissolves and then they just hold it in their mouth and swish it around for 10 to 12 minutes and then after that they spit it out, and that's when the medication part of the session begins.

Speaker 1:

Wow. Ok, I wasn't aware that there were so many professionals involved and I'm sure that's also very empowering, while simultaneously self-directed decisions about timing and like when you're comfortable and the time that you want to start. About timing and like when you're comfortable and the time that you want to start, I love that. It's so empowering. You shared a little bit about the questionnaire in the beginning to rule out if you may or may not be a good fit for ketamine. Could you share, before we dive into a little bit more about them past the medication portion of the session, a little bit about who is ketamine for and who might not be a good fit for ketamine-assisted therapy?

Speaker 2:

Okay, yes, so it might be a little easier if I start with who would be a concern that we might need to screen a little further. So somebody with uncontrolled blood pressure issues, because ketamine can impact your blood pressure and make that go up. It doesn't typically impact respiration, but they do really monitor your heart rate and blood pressure just to make sure you're OK. Someone who has a history of strokes, someone that has an uncontrolled substance use disorder, is probably not going to be the best fit. Is probably not going to be the best fit.

Speaker 2:

Someone with an active diagnosis of some form of a psychotic disorder, because part of the experience of ketamine sometimes you do experience some people have images, sounds and that can be really upsetting and potentially trigger something for someone that already has an issue with having delusions or hallucinations. I think those are primarily the top diagnoses that would maybe say that would make us take pause and sometimes that just means okay, we need to as a team, contact your neurologist or your medical doctor who prescribes your blood pressure medication. Let's get some more information and see if it is a possibility, working more closely together, that you could actually come in and try ketamine.

Speaker 1:

And is it FDA approved? I know we talked about PTSD or depression and doing my research for this, I saw that a lot of people are wondering if this is FDA approved for depression specifically. Do you know anything on that?

Speaker 2:

I do. Yeah, that's a big topic of discussion and right now it is not approved by the FDA. For depression, there is a nasal spray form of ketamine called Spravato or S-ketamine that is approved by the FDA. So, uh, jansen pharmaceuticals, I think, was the company that. What they did was take the chemistry life right, like they took the molecule of ketamine and and actually flipped it. So it's a mirror image.

Speaker 1:

Oh, and they were able to make a nice.

Speaker 2:

I know right better living through chemistry. Um, so they were able to make a nice. I know right Better living through chemistry, so they were able to make this. It's actually the ketamine molecule itself has two parts. Bravado takes one of those and turns it into a mirror image, so it does have impact in some of the same ways as ketamine, although not all the ways, and it is FDA approved. So if there is this bravado clinic or a physician that offers bravado in someone's area, that might be a good option for them, because insurance most insurances do cover it at this point, because it's that important FDA approval badge that's on it.

Speaker 1:

Okay, that makes sense. Okay, and in what ways would it be different than to do the lozenge? It sounds like that you switch around for 10 minutes. What would happen or I guess we can focus on what that piece would look like if someone were to go into work collaboratively with you, for example, and they go to their doctor, they get the prescription that you have, you partner with Journey Clinical. They have everything they need. They decide they want to come in and they swish it around, the medication around in their mouth. 10 to 12 minutes, if I believe that's what you said. And then what comes?

Speaker 2:

next. So at that point they're probably feeling the effects of the medication. So at that point they're probably feeling the effects of the medication. Most people do choose to wear an eye mask. So because that helps to. Some people feel a little disoriented, almost like the room could be spinning or you know the vestibular effects of a medication, especially if you've never tried it at all. So having a mask on helps to cut back on that. Some people actually feel like a buzzing in their body.

Speaker 2:

One of the great things about ketamine is everyone has a different experience and one person can have a completely different experience every time they come in. So some people talk about feeling detached from their body or just being able to the old joke about the elephant and the three blind men and one feels the trunk and one feels the leg and one feels the and they think that's what an elephant is. Hadamine could be that same way, because it can be. It takes you where you need to go and it can be different every single time. So there is a risk of some nausea. So most of the time the doctor from journey clinical will offer something to help with that that you take before you and just that. Hold the ketamine and swish it around. Yeah, I think I'm trying to think of some, some other experiences, a sense of detachment, watching themselves from the ceiling, having a different perspective on issues that have really been kind of heavy and bothersome.

Speaker 1:

Yeah, yeah, you know you mentioned that Medication that they might give you for nausea medication that they might give you for nausea. I recently had a medical procedure done myself that had to require general anesthesia or anesthesia and they said, just in case, we're going to give you some medication that helps with the nausea. So I just I love just how every step is taken to create a really comfortable it sounds like really comfortable environment for the client and just feeling really safe and as comfortable as possible. And you mentioned that it can be different every time. How many sessions do most people either recommend or come into, or how do people feel after their first session?

Speaker 2:

Yeah, Great question. So with Journey Clinical they will give the client enough medication for two dosing sessions and they do that to help the client kind of experience it and feel a little more comfortable. And then after those two sessions you'll meet with the doctor again and they'll maybe change the dose up a little bit based on what your therapist reported back to them that you experienced and based on what you're telling the doctor. One full round of ketamine-assisted psychotherapy can be six to eight sessions and they do recommend that you do the full six to eight. Some people would choose to do more if they've had some relief and had good, good, um, sustained benefit from it. Um, they meet with the doctor again and get another six to eight sessions.

Speaker 1:

And during that time are you involved as the therapist during the time, the session, after the session and how long does that session last? Typically from start to finish okay.

Speaker 2:

So I do a three-hour session, um and that. So ketamine has a really quick. It eliminates your body pretty quickly and in technical terms that would be half-life elimination. So every 30 minutes with ketamine half of the medication your body's already metabolized half of it. So it is. It's a pretty quick experience.

Speaker 2:

Most people feel the definite impacts of ketamine for an hour to two hours.

Speaker 2:

So when we do a three hour session, that gives us enough time for the ketamine to cycle out of their system as most of it basically and then gives us a little time to process what that was like afterward and help them transition, to feel a little more, uh, grounded, to be able to leave the session.

Speaker 2:

That's an important part that I didn't mention. Um, if you come into the office, you can't drive afterward, so you need to have someone who's who brought you to the session and will pick you up three hours later just to make sure you're safe. And then we do recommend that you would take it easy the rest of the evening, just kind of focus on what your body needs, what you process, do a little journaling, and then we meet again in 24 to 48 hours to do what's called an integration session, and that's the part that they're really finding is making the most significant impact therapeutically for people, because you could have an experience in a vacuum, but if you don't talk about it or process it or really integrate it into your life, then it may not have a lasting impact. And we know this through neuroscience. Our brain works with neural pathways. It's cut into your brain because you've done this over and over and over.

Speaker 1:

So ketamine is so new that we want to take that new pathway that opened up and reinforce that and reinforce it, so it becomes an option yeah, that's really neat because does then that integration session and being able to create those pathways that just reinforce those pathways that were created by the ketamine, by talking about it, processing it with a therapist? I'm wondering that would also guide them those follow-up sessions, right, the follow-up six to eight sessions? I think that's amazing. If that's the case, I'm thinking that might be part of the, the goal in mind, I guess, to be able to process those things.

Speaker 2:

Yes, yeah, absolutely, and I think just in general terms, when you work with people that have experienced significant trauma, you could say someone had a really bad car accident and they, they were T-boned by a red car and they, they were T-boned by a red car. And then every time they go into public they're having this extreme trauma reaction like, ok, I'm in fight or flight right now. My heart is racing, I'm having shallow breaths, I feel like I need to get out of here. All because they saw a red car, that process of let's look at what that is and let's take away the generalization so that we can name that for what it is. But if it's a good thing, like, oh, you just realized what that was. Now you can take that with you. Every time you see a red car now say, oh, that happened, but it's not happening, it's not going to happen again. That's that new neural pathway. You have some decision making between the trigger and how you're responding to it.

Speaker 1:

That is awesome. Are there any long-term effects of ketamine?

Speaker 2:

So, because each person is different, right, and it I mean and, and. So a couple of studies that I read, um, actually demonstrated that 70 of the participants actually had a increased positive mood. Uh, two sessions in the academy, wow, that big. Yeah, right, especially someone who's been struggling with depression their whole life finally see some of that hope and feel like, oh, this, I'm feeling better, I can, I can do this. Yeah, as with any, even when you do trauma therapy or try an ssri, there's no guarantee that it's gonna hold you for the rest of your life.

Speaker 2:

So even if you have that initial positive impact, we're not sure how long that's going to hold. If someone comes in and has an experience that maybe is a little more difficult, or doesn't experience that lift in mood after that first and second session, that doesn't mean that they're not going to have that if they continue with the full round. So it really is like we talk so much about nurture nature Okay, did you come this way or was it because of your experiences? So if you are connected with your therapist and really processing these things at a deep level, then even experience that maybe isn't as positive as you went into it hoping it would be. You're still going to be making meaning of it, you're still going to be talking about wonder why that was, wonder, what would help you to step a little bit this way and look at it from a different perspective, just so they can start incorporating those different avenues into their experience and and even those shifts can actually create positive change for people.

Speaker 1:

For someone who is so experienced in so many areas in mental health like you are you. I remember reading your bio and seeing your background from everything from different forms of expressive art therapy, emdr, cbt, I know you have. You have a lot of modalities. You have a toolkit ready to go. Why ketamine assisted psychotherapy? What makes this so exciting, in your opinion? What, what, what is it about it that makes it so special, in your opinion? What is?

Speaker 2:

it about it that makes it so special, in your opinion the impact of watching a client who I've been working with for years trying to weed through all of the trauma they experienced and we have trusting relationships. They will process pretty much anything that comes up with me but there sometimes is a block that neither of us can really work through. We're working on, you know, doing EMDR or doing more attachment therapy or interpersonal process, you know, trying to create a container where they can really be curious about things, but still feeling like there's a barrier there and neither of us know what that is. And so the promise or the opportunity to give them something that might be able to break through that barrier that neither myself nor they have been able to do, it just is so amazing and I don't know if I shared this with you, marta, but I actually am doing ketamine myself too, just for personal working through my own PTSD and just the shifts in perspective of oh, I never really thought about it that way before, or it took me to a level where I can think about some of the things that I experienced and not certainly there's some anger there still, but that anger isn't preventing me from doing things that could be good for me.

Speaker 2:

That's one of the ways that I've heard trauma explained that it keeps you from doing the things that are good for you and takes you toward things that maybe are not. So when you have relational trauma, you tend to turn away from relationships because it doesn't feel safe, and your brain is telling you this, even though it's not a conscious process. So just that thing of being able to be a little more vulnerable with my therapist or with my husband or a good friend like that in and of itself is a gift that is worth taking the risk to do a ketamine session yes, I mean thank you for sharing with me, because I you know, being able to open up about not just your expertise but your own experiences, I mean, what a gift of a more deeper, richer, meaningful life through the ketamine.

Speaker 1:

I'm so grateful that this exists, that you could, that you could experience it, because if, if, if you're experiencing that healing, I know that's just a butterfly effect for all those that you help in their healing journey as well.

Speaker 1:

So I think that's a beautiful gift to yourself and also an empowering thing that has lasting effects for others too. So I think I think, as therapists, it's important that we also do our own work. So I think that's wonderful that you're modeling that for so many. So thank you for sharing that and being open Cause that's also a hope in this podcast, right, that we're opening up the doors, that we're those things that are private or you know, typically you can't sit on a session you don't know what that's like and being able to share openly and take away from that stigma when it comes to mental health and seeking wellness, and that health is a big mission in this. So I appreciate you sharing that. How can people connect with you? I know you accept clients in Virginia. So, especially if you're listening and you're from Virginia, but also for those outside of Virginia that may want to just connect with you, what's the best way for them to reach you?

Speaker 2:

Yeah, so if you call our office? Yeah, so if you call our office, our phone number here is area code 434-990-1744. And the ladies that work in our front office are amazing. They're also welcome to take a look at our website, which is wwwlifeworksprofessionalcounselingcom, and they can send us an email through our website if they'd like to connect in that way.

Speaker 1:

Okay, great, I will make sure that that's all in the notes the show notes. So, if you're listening, check out the show notes. So it's easy to connect with Crystal Myers and all the team there at LifeWorks Professional Counseling. Crystal, thank you so much for being a part of our wellness journey and I look forward to part two of this series where we're going to get to talk more with other clinicians, with people who have gone through sessions. So I really thank you so much for being a part of our wellness journey today.