Taking an inward journey: part one

Exploring the world of integrative mental health care.

Ketamine treatments administered by licensed clinicians are becoming a more accepted method of psychotherapy. — Kristófer Rabasca, created with the assistance of DALL·E 2

“Turn off your mind, relax, and float down stream…” 

John Lennon borrowed, modified, and beautified these words from Timothy Leary’s 1964 book “The Psychedelic Experience” for his song “Tomorrow Never Knows,” which appeared as the last track on the Beatles’ Revolver album. It signaled a definitive shift in not only his own consciousness, but a radical and exciting turn in our culture.

Lysergic Acid Diethylamide 25 (LSD) was the vehicle that took A LOT of folks on a mind-expanding, ego-dissolving journey during the 1960s. There were some with a creative bent that took acid and tremendous works of art were the result. Then there were those who had a spiritual awakening during and after their trip.

But this article isn’t a blank-check endorsement of taking acid or other psychedelics — especially when you haven’t done your due diligence about them and don’t have the proper guide. It is, however, a non-threatening alarm to the positive and therapeutic possibilities that so-called hallucinogens and entheogens can have on our psychological and emotional well-being.

Now, more than at any time in recent memory, we are on the cusp of a psychological and emotional healing revolution. Insofar that seeming alternative therapeutic vehicles — namely ketamine, psilocybin and MDMA — have been (and will more than likely be) approved to treat conditions like depression, anxiety, and post-traumatic stress disorder (PTSD). A few of these modalities have already made their way into the practices of mental health professionals in several states across the country. States like Colorado and Oregon have been a step ahead of the curve in this arena. Massachusetts isn’t all that far behind.

In fact, Martha’s Vineyard has its own “inward journey” destination practice in Prudy Carter Donovan’s Inner Journey Wellness in Vineyard Haven.

While Inner Journey Wellness has been up and running for about a year now, specializing in integrative mental health care, Carter Donovan is an Internal Family Systems (IFS) practitioner, and a board certified Family Nurse Practitioner (FNP) who specializes in integrative mental health care and ketamine therapy. 

“Ketamine can be extremely effective in treating depression and anxiety (and to varying degrees, PTSD and addiction). Often when folks are struggling there’s usually more than one thing going on. Untreated anxiety can manifest as depression and is often the root cause of someone’s mood issues as related to untreated trauma. So often we’re treating more than one thing. Ketamine has been studied mostly for use with depression, but has also shown to diminish the symptoms of PTSD,” says Carter Donovan 

She gave a brief history of the varied uses for ketamine. 

“Ketamine is a tried and true, old-fashioned medicine which was initially used as a dissociative anesthetic in veterinary medicine and for surgical anesthesia during the latter part of the Vietnam War. Ketamine can also be used — and HAS been used — as a recreational drug or club drug known as ‘Special K’ for its hallucinogenic and dissociative effects.” 

Ketamine is a Schedule 3 drug — there are five classifications according to the Controlled Substances Act, as determined by the Drug Enforcement Agency and the Food and Drug Administration back in the early 1970s. Schedule 3 means that a drug has potential for abuse, but less so than the drugs in Schedules 1 and 2, and has a currently accepted medical use in treatment in the U.S. Abuse of any drug on Schedule 3 may lead to moderate or low physical dependence or high psychological dependence. 

Just to provide some perspective, drugs on Schedule 1 include heroin, LSD, marijuana, MDMA (Ecstasy), and peyote. Schedule 2 is comprised of cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.

Needless to say, this “Schedule” has not been seriously revisited since 1970, considering MDMA is now under review to be legalized next year for therapeutic use.

Along with other psychotropic drugs, ketamine is on the World Health Organization’s List of Essential Medicines. 

Carter Donovan went on to say, “When we’re administering ketamine in the fashion that I do, it’s an ‘off label use’ of a very safe and known medicine.” 

With integrative ketamine therapy there is a six-session protocol that runs for about two to three weeks, each session lasting around four hours. It’s integrative because it includes pre and post-session IFS (Internal Family Systems) therapy, an evidence-based model of psychotherapy.

“I always like to be sure that people are clear in the fact that ketamine as a pharmaceutical is not meant to be a stand alone treatment for depression, anxiety, and PTSD. It’s meant to allow people to go deeper into the therapy experience by relaxing our ‘protectors’ or ‘managers’ — these are parts we all have — according to the IFS model of psychotherapy.”

Basically, ketamine lowers our inhibitions and allows us to connect with our different inner parts. 

According to the Internal Family Systems Model outline on ifs.institute.com:

It is the nature of the mind to be subdivided into an indeterminate number of subpersonalities or parts. Everyone has a Self, and the Self can and should lead the individual’s internal system. The non-extreme intention of each part is something positive for the individual. There are no ‘bad parts,’ and the goal of therapy is not to eliminate parts but instead to help them find their non-extreme roles. As we develop, our parts develop and form a complex system of interactions among themselves; therefore, systems theory can be applied to the internal system. When the system is reorganized, parts can change rapidly.

But let’s break down the process one can expect upon entering a session with Carter Donovan.

“We do as many prep sessions as necessary for the client to feel a level of comfort, and to make sure all ‘parts’ are in agreement with proceeding with medicine,” she says.

After these sessions have concluded, then comes the administering of the ketamine. There are a few different vehicles for administering ketamine. One is esketamine nasal spray (Spravato), which can be very expensive. Carter Donovan opts for the less pricey, but nonetheless effective, intramuscular doses of the ketamine, which delivers the medication deep into the muscles and allows it to be absorbed into the bloodstream quickly.

As for the actual setting for the ketamine experience, Carter Donovan makes absolutely sure it is as much of an inward journey as possible. “I provide clients with an eye covering called a ‘mindfold,’ and have them listen to very thoughtfully chosen music through headphones. Then following the medicine sessions, we then focus on integration (Integration Sessions). This is the process of making meaning of the journey experience, noticing changes, and applying what was learned in our lives. Integration is an ongoing process.”

While there are cases where a client will experience almost miraculous results in the very first session and won’t feel the need to continue with the remaining five, Carter Donovan explains why completing the six-session protocol is so vital. “We’re getting the brain to enter a state of neuroplasticity, and also to improve neurotransmission. Generally we either do two, four-hour sessions a week for three weeks in a row, or three, four-hour sessions a week for two weeks — always with a day or two in between — this allows for an intensive, deep-healing experience. Because this is all being done in conjunction with the IFS therapy.”

But Carter Donovan emphasizes that not everyone will experience the miraculous results that many clients have. “Many people benefit greatly from the ketamine/IFS therapy, but not everyone does. Unfortunately, there’s really no way to predict who will have what reaction.”

The foundation of psychedelic work is the principle of set and setting. The primary focus of Carter Donovan’s work is to create that “safe and caring healing container where clients can access their own inner healing intelligence.” She refers to her role as more of an “emotional midwife.” She’s there to support and empower clients on their path of healing. 

Finally, there’s that looming “elephant in the room” question: Is this therapy covered by health insurance? According to Carter Donovan, it’s best to check with your insurance company first before deciding to take this therapeutic plunge. At the very least, you may be able to get some form of reimbursement for your sessions depending on who your carrier is.

“Taking an inward journey” is the first in a three-part series about some non-traditional, integrational healing modalities. Next month we’ll hear from a few of Carter Donovan’s clients: their respective experiences and perspectives, as well as their reverence for the Internal Family Systems Model of Psychotherapy, which is a vital part of ketamine therapy at Inner Journey Wellness.