Why do you recommend I do therapy along with my ketamine treatments, isn’t the ketamine supposed to be enough?

Hello,

This is Dr Justin Yanuck MD and I’ve given myself 10 minutes to answer this patient question. This weeks question centers on why we recommend therapy for our patients.

Answer:

Both the literature and my extensive clinical experience both support this recommendation. The analogy I like to use for patients is would you recommend someone with high cholesterol just take a medication for their cholesterol or would it be more effective if they both took a medicine and changed their diet too? I think we intuitively all know the answer to this and the same is true for therapy paired with ketamine. The difference is, there is an implicit bias in the healthcare space, and there always has been, that therapy is a “soft science,” and isn’t evidenced based. This could not be further from the truth. If therapy came in a pill, no one would question it. Wind is real right? We feel it right? But where is it?

Anyway, I digress, but my point is therapy is always an afterthought for people. The vast majority of our patients have done therapy, often for many years and felt little to no relief with it. That’s valid, and I would never question that. However, in my clinical experience and in a growing body of literature, those that do ketamine paired with psychotherapy, often find the therapy more elucidating, authentic and effective. Whether it is trauma focused therapy, somatic work, CBT, psychoanalysis or others, the key is the patient becoming a more open and a more reliable narrator of their own life and feelings. This is the critical part of ketamine and how it pairs best with therapy. Ketamine’s action on the brain, which allows for remodeling of the neural connections both opens you up to thinking about things in a different way, but also can give you access to repressed feeling, emotions, memories that can be the key to unlocking why you are the way you are, and how to escape the fixed negative thought spirals. A skilled therapist can help you explore these discoveries, make sense of them, and create a plan not just for treatment, but for living more fully.

When it comes to which therapy is best and exactly when to time the therapy with each session, we will leave that for another post. For now, let’s just all agree that if you want to maximize your chances at durable (long lasting) relief of your symptoms, give therapy one more try!