Ketamine-assisted therapy for PTSD
Post-traumatic states are not a mood you can reason with. This page is about what they look like from the inside, and how ketamine-assisted work is paced around them when a medical provider is treating you.
Diagnostic language is thin next to the experience. What people actually describe is some combination of the four states below, cycling, often several in one day, and rarely in an order that makes sense at the time.
- Hyperarousal
- The alarm never fully switches off. Sleep is shallow, noise is intolerable, you scan rooms you have been in a hundred times. People call it anxiety, but it behaves more like vigilance with nothing left to guard.
- Shutdown
- The opposite face of the same thing. Flatness, distance, a hollow calm that other people mistake for coping. You can describe what happened without feeling anything, and that absence is itself frightening.
- Emotional fragmentation
- Feeling arrives out of order and out of scale: nothing for weeks, then everything at once over something small. Parts of the history are vivid, parts are missing, and they do not join into one account.
- Difficulty feeling safe in your own body
- Rest reads as exposure. Stillness produces dread rather than relief. The body carries a verdict about the world that no argument has yet been able to overturn.
People generally arrive at this page after a good deal of effort has already been spent. They have not found relief through traditional therapy alone, often several rounds of it, sometimes with practitioners they liked and trusted.
They have persistent anxiety, depression or reactivity that does not track events. Something small in the afternoon costs the evening. The response is out of proportion to the trigger and entirely in proportion to the history, which is exactly what makes it so difficult to argue with.
And they are living inside cycles that repeat despite insight. This is the part that wears people down. You can explain your pattern accurately, predict it in advance, watch it begin, and go through it anyway. Understanding turns out not to be the mechanism of change, which is disorienting when understanding is what you were told to work on.
None of that means the earlier therapy failed or that you did it badly. It usually means the work was aimed at the account of the trauma while the trauma was being maintained somewhere else: in the body's baseline, and in the arrangement of relationships and demands around you.
Scope of practice
For individuals receiving ketamine treatment from a qualified medical provider, I also offer ketamine-assisted psychotherapy in collaboration with the prescribing clinician. I do not prescribe or administer ketamine, and all medical decisions, including screening, dosing, and medication management, remain the responsibility of the treating medical provider.
That division of responsibility is not a formality. It is the reason this arrangement is safe. Your medical provider owns screening, dosing, medication management and every clinical decision about the medicine. I own the psychotherapy, and I stay in contact with them so that the two halves are not working from different pictures of you.
For clients of this Vero Beach practice, the medical component is provided by Treasure Coast Ketamine & IV Nutrition Center, where Greg McCracken, CRNA, determines the appropriate course of ketamine treatment and administers the medicine. When a client is interested in this work and it appears appropriate to explore, I refer them there for the medical side. My role stays with the psychotherapy: preparation before, support around the sessions, and integration afterwards.
Pacing, when the nervous system is the problem.
With post-traumatic states, the first job is almost never the memory. It is the baseline. If your system spends the week between vigilance and shutdown, there is no stable ground for any experience to land on, and an intense one is as likely to be filed away as more evidence of threat as it is to help.
So the early work is deliberately unremarkable: sleep, the shape of the day, what reliably tips you into either state, what reliably brings you back, who is present afterwards. Only once there is some predictability does deeper material become worth approaching.
During and after medicine sessions arranged by your provider, my attention stays on tolerance rather than depth. We are not trying to reach the worst of it faster. We are trying to end each week with your system slightly more able to register safety than it was, which, with PTSD, is the change everything else depends on.
Where post-traumatic material is bound up with other people, a family, a marriage, a workplace, that context is part of the work rather than background to it. What happened to you did not happen only inside you, and a treatment plan that ignores the field you return to each evening is working with one hand.
What this is not
- It is not a cure for post-traumatic stress, and no page describing it honestly would say otherwise.
- It is not a substitute for medical or psychiatric care, and it does not replace any treatment your prescriber has in place.
- It is not a replacement for a higher level of care where that is what the situation calls for.
- Outcomes vary from person to person.
Therapy outcomes vary from person to person. No result is promised or guaranteed.
Book a free consultation