by NuminusFeb 17, 2023
By Greg Ferenstein
Sarah* couldn’t understand why she felt such debilitating depression. On paper, she seemed to be doing everything right. She practiced yoga, ate well, and was raising two well-adjusted children. Her supportive family and healthy lifestyle helped her overcome a difficult cancer treatment, yet she was consumed by dark ruminating.
“I find myself constantly apologizing to everyone,” she recalls, of the crippling self-doubt that led to serious suicidal ideation.
Intuitively, she knew people loved her, but couldn’t stop her reaction to apologize as never being good enough for her family. Sometimes, the mere gentle embrace of her husband would send her into a sobbing fit.
“My kids were scared when I got really suicidal,” she admits.
Traditional therapy and medications had been somewhat helpful. One of the anti-depressants that she tried, specifically, Zoloft, took the edge off of otherwise brutal, constant rumination.
“I was more stable—I was much more approachable.” With Zoloft and talk therapy, Sarah’s relationships were more manageable. She could work, raise her kids, and not break down crying around her husband.
But, eventually, the trade-offs from Zoloft, and anti-depressants generally became too much. First, Sarah’s cancer medications interacted poorly with Zoloft.
Second, it strained relations with her husband in unexpected places like the bedroom. “There’s kind of a sexual dampening effect.”
Her husband wanted to be desired physically, but as an emotional ‘zombie’, Sarah just couldn’t feel it.
“I wasn’t filling that need for him because I wasn’t feeling it within myself,” she recalls. “I wanted to feel well, but I also wanted to feel everything.”
Eventually, Sarah’s therapist proposed a relatively new psychedelic pharmaceutical treatment, ketamine, a widely used surgical general anesthesia known to have potent antidepressant effects. In the dreamlike state of this powerful analgesic, patients can often process memories that are too painful to deal with normally.
Sarah’s initial ketamine treatments were positive, but they did not seem to alleviate her issue, nor did they help her understand the source of the depression.
So, she decided to try a new ketamine provider, Novamind, a growing mental healthcare company specializing in psychedelic-assisted therapy. Having treated thousands of patients using various ketamine therapies, Novamind was uniquely equipped to address Sarah’s challenging situation. In her case, Novamind providers used Emotion-Focused Ketamine-Assisted Psychotherapy or “EF-KAP”. EF-KAP is a special type of ketamine-assisted psychotherapy that focuses on helping patients learn to identify, cope with, and transform emotions related to their mental health condition. It is based on principles found in Emotion-Focused Therapy, an approach to psychotherapy that clinical research has shown is very effective.
A transformational visualization
Initially, Sarah remembers feeling “terrified” of psychedelics. Her fears ran the whole gamut of disaster scenarios, from suffering a hypothetical permanent psychosis to simply not ‘returning’ to her normal psychological state of being able to care for her family.
“I’m kind of a control freak,” she says.
But, she was desperate and willing to trust in the confidence of her mental health team.
Under Novamind’s care, Sarah recalls the trip that transformed her mental health. Sitting in a comfortable chair and dimly lit room, a ketamine IV was placed in her arm and she drifted off into a state that felt like the semi-conscious awareness of waking up from a long sleep.
In her dream, a building stood out in the middle of a big, cosmopolitan city. She peered in and could empathize with the hundreds of families seen through the windows. Soon, she witnessed the glow of different family members dissolving from what looked like divorce. But, it wasn’t a sad occasion, as each person floated into another room with a new, loving family unit.
To Sarah, this was a revelation: as the child of a difficult divorce, she realized how the scars of feeling unloved during her parents’ separation never fully healed. But, in her psychedelic vision, she understood separation as a natural part of life.
“My energy can now leave and go flow elsewhere.” Sarah did not have to take the scars of being unloved from her childhood into her role as a mother. “I equated trying to be perfect with getting love.”
She says that she could choose to accept the unconditional love of her husband and children, even if she is imperfect.
No more apologizing or suicidal thoughts
Sarah recalls feeling unusually pleasant in the days after the experience. Her first assignment was to ditch her knee-jerk reaction to apologize—and it worked.
She was determined to be “more mindful every time I wanted to say ‘sorry’.” Instead, she knew, “I could just show up and be enough.”
Soon, relations at home improved. Before the therapy, Sarah had become physically estranged from her husband, who had stopped being affectionate for fear of triggering a depressive episode. But, now, he could embrace her with a loving hug. It was the little things like this that gave her more confidence and began the road to repairing intimacy in her marriage.
Initiating intimacy ran both ways: now that she felt a fuller and more intense range of emotions, Sarah is comfortable in her body. She is less judgmental about her weight and image. In the bedroom, she enjoys connecting and is less likely to cover under the sheets.
“Years of eating disorders and body dysmorphia, and body shame had prevented me, for a long time, from really being present in my body.”
Sarah still has shaky days, but is staying vigilant in her practice of mindfulness. She finally believes, at her core, “I’m worth being here”.
Exploring the nuances of what worked
Sarah was no stranger to psychedelics; she’d experimented liberally years ago with LSD and psilocybin, both of which are known to have antidepressant properties in therapeutic settings. And, she had come to Novamind recently for ketamine treatments.
So, what was different about this particular transformation experience?
Novamind’s Dr. Stephen Thayer, who oversaw her care, credits two things in particular to the healing process.
First, Sarah was instructed how to ‘recall’ her psychedelic experience in her everyday life as a method of integrating the insights she learned while on ketamine. During challenging times, Sarah takes a moment to breathe and mindfully reflect on these insights, allowing her to emerge fortified and less self-critical. Dr. Thayer describes this process as following breadcrumbs back to insights first encountered during the ketamine experience.
Second, both Dr. Thayer and Sarah credit the unobtrusive talk therapy during the trip with a trusted counselor.
In many ketamine infusion clinics, clients go through the experience without supportive psychotherapy.
Sarah’s case is a fascinating example of why this kind of support may be crucial to the healing process. Ordinarily, she admits, anxiety would get the best of her and she would feel the need to do anything else but sit with her difficult emotions. That guidance involved open-ended questions, invitations to be curious, and reminders that she was safe. Being invited to describe the visualizations mid-trip helped uncover the meaning of the dream-like state and gave her the courage to dive deeper into the experience.
For Sarah, it made all the difference.
*’Sarah’ is a pseudonym. Some quotes edited for clarity.
About the author
Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.
His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.
Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.