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One way to think about how ketamine helps is like using dynamite to loosen up rock in a mine shaft.

Ketamine is often spoken of as letting us get out of ruts in our way of thinking and charting new pathways.

Psychedelics seem to have the most impact on those who have already done a lot of self work in other ways.

I’ve been using ketamine as an adjunct to therapy with my clients for a number of years now and am starting to discern patterns in what it does for people who choose to incorporate it into their work with me. I want to share some of the ways I’ve started to think about this work so you can decide if it might be right for you. Psychedelics are so outside mainstream, consensual reality, I think a number of different metaphors might help point in the right direction to understanding what it can (and can’t) do.

Pickaxe Versus Dynamite

The image that comes first to mind is miners in a shaft. Talk therapy is like working slowly with pickaxes, pulling out small piece by small piece, making slow and sometimes imperceptible progress down the shaft of a person’s unconscious. Adding ketamine is like placing a stick of dynamite in the shaft and blowing loose a whole bunch of material, which we can then slowly examine and integrate into a person’s life. The analogy is a bit inaccurate in that I think some of the material that gets shaken loose by ketamine might never be accessed if we stayed on the verbal level alone, whereas in a mine, a pickaxe would eventually open up the same amount, just much more slowly. That is, it might be better to say that ketamine can also expose a new vein of material whose existence was never suspected and which might never have been uncovered without it.

Disrupting Negative Self-Talk

A frequent metaphor used in discussing ketamine (and other psychedelics) is connected to its capacity to create new neural pathways. Ketamine is particularly effective in disrupting negative self-talk, those reified notions we have that we repeat endlessly to ourselves: “I’m no good at this,” “No one likes the real me,” “I can never live my authentic self.” These oft-repeated narratives are likened to trails in the snow that have been packed down by repetition, making it hard to get out of these mental pathways and think a different way. Ketamine metaphorically lifts you out of these ruts and lets you chart a new path on fresh, virgin snow. What I see repeatedly with people is that this happens because they have a deep experience of themselves as fundamentally good, worthy of love, and healthy. Friends and family can reassure you of that repeatedly, but having an actual experience of that truth is invaluable. It can serve as a touch point in daylight consciousness, and the more this experience is repeated, the more it can be anchored in a person’s inner world. Eventually, a ketamine user starts to see evidence of this new self-concept in the outer world, not just during a ketamine journey, thus further reinforcing the new way of viewing themself.

Another metaphor I heard recently came about in a psychedelic setting when I was expressing my puzzlement as to why psychedelic experiences sometimes can change one’s life in a moment, but more often are very profound experiences we have that we struggle to translate into everyday life. The teacher offered the image that sometimes psychedelics can be like freeing up a logjam, allowing a person’s process to start flowing again. This fits with my experience that the people who seem to have the most dramatic shifts long-term are those who have already done a lot of work in other ways. It’s a little like (yet another metaphor) when someone struggles mightily but unsuccessfully to open a jar and hands it off in desperation to another person, who then opens it easily. Much of the work was already done—it just required a little extra push to break through.

There’s a lot more to say about psychedelics, including balancing out some of the hype that is now common in mainstream media, and why the metrics we use to measure psychedelics are very limited, but that will need to wait for another post. Let me just say in closing that in my experience, ketamine is neither the miracle cure nor the dangerous drug the hype in the media sometimes portrays it as.

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