A visit to a ketamine-assisted therapist

Photos and text by Stacie Joy

I’ve started to notice signs of ketamine therapy popping up in the neighborhood, but I don’t know much about the drug.

Jill M. Twohig, an East Village resident and ketamine-assisted mental health counselor, who practices out of an office on Second Street near Avenue B, agreed to talk to me about the treatment, its use, and its effectiveness , and why people may choose this form of therapy.

For those unfamiliar with ketamine and ketamine therapy, can you walk us through the process? What is the drug, how is it given (injection, lozenge, pill – something else entirely?), and what is it used to treat?

Ketamine can be given by intramuscular injection, IV [intravenous], or a sublingual lozenge. The first two methods have been used in major hospitals and clinics under the supervision of a NP [nurse practitioner]while my practice uses a self-administered lozenge.

Ketamine has been clinically significant as highly effective in reducing and eliminating symptoms of major depressive disorder, PTSD [posttraumatic stress disorder]DOC [obsessive-compulsive disorder]and alcohol addiction (which is a symptom of trauma).

As a therapist, I meet with the individual for a session or two to gain insight into therapeutic goals and prepare them for the effects of the drug. Then, a ketamine dosing session would begin with my guidance of a guided meditation to assist with the transition into a non-ordinary state of consciousness while the patient lays down wearing masks and playing ambient music.

A “sitter” must be physically present to provide anything the patient might need during the administration period; the role of the therapist is to remain present and thus provide integration during and after the session. This process usually takes about two hours. Then, within a 48 hour period, we would meet for a standard 50 minute therapy or supplementation session.

It’s an FDA-approved drug, but she said the insurance won’t cover the cost of it for off-label use. How does the process of applying for a prescription work and what is your role in guiding patients through the process? Is it a single use, a series of treatments or continuous use?

Ketamine was initially developed in the 1960s as a field anesthetic for soldiers during the Vietnam War. It continued to be prescribed in operating theatres, in human prescription form and in veterinary settings. Ketamine has gained popularity as a club drug due to the hallucinogenic and euphoric properties that accompany the drug; the horse tranquilizer reputation arose because it was easier to steal from veterinary clinics than pharmacies.

For those interested in using ketamine to treat mental health issues, they should first consult with a prescriber, such as a psychiatrist or NP. It is not usually prescribed as a first-line drug; individuals should have trials of traditional SSRIs [selective serotonin reuptake inhibitors] or other medications before considering ketamine.

The recommended number of KAP, or ketamine-assisted psychotherapy delivery sessions, is between 6 and 12, starting with a low dose and then increasing to help the patient gradually become comfortable with the effects. People have reported feeling symptom relief after the initial dose, although this is different for everyone.

What are the effects of ketamine and how does it make you feel? How long is the experience?

The effects of ketamine vary according to the individual. Timothy Leary coined the term “set and setting,” which refers to the mindset and context when taking a psychedelic, so it’s important to go into the experience feeling comfortable and supported.

Depending on how the medicine is given and the amount, the effects can be felt quickly or take up to 20 minutes. People report feelings of euphoria, dissociation, and tranquility; side effects can include dizziness and nausea, so an anti-nausea drug is usually prescribed to take along with the dose of ketamine.

The acute effects last for approximately 30-60 minutes. However, the real success of ketamine comes from the lasting and permanent reduction and loss of symptoms of depression, PTSD, OCD, and substance use.

You practice out of an office on Second Street between Avenue A and Avenue B. Do you see mostly local clients and patients? Do you also train on Zoom or telemedicine? Who is a typical customer if such a thing exists?

I see people in the office on Tuesdays, Wednesdays and Thursdays and on Zoom on Fridays and Saturdays. People who tend to seek me out are adults who identify with a segment of the counterculture, including non-traditional sexual/gender expression, prostitutes and people in poly-relational settings, the LGBTQIA+ community, artists and artists. I also work well with those who attribute a more vanilla lifestyle.

How did you get involved in this modality of treatment? You said your slogan was Sex, Drugs and Rock’n’roll Therapy. Can you talk more about it?

I had read about the psychedelic renaissance in mental health treatment for the last few years, and it especially piqued my interest when I attended an online trauma conference in 2020. Top leaders in the field of stress disorder treatment and research were in attendance trauma talking about the overwhelming effectiveness of ketamine, MDMA and psychedelics in not only treating, but also healing the effects of trauma.

In 2021, I was recruited by a start-up offering online KAPs to become a founding therapist and completed specialized training in the modality. At the same time, I decided to pursue AASECT [American Associations of Sexuality Educators, Counselors and Therapists] certification as a sex therapist. I am now finishing up my courses and supervision requirements.

The slogan “Sex, Drugs and Rock’n’Roll Therapy” was coined by my boyfriend [local cartoonist Dave McKenna, who also designed her business card] when he pointed out that I specialize in sex and drugs in my therapy practice and also that I DJ! In my therapeutic approach, I recognize and honor the difficulties, misunderstandings, and stigma associated with discussing sex and substance use, even within a therapeutic setting.

I see a lot of judgment among mental health professionals about substance use and addiction as an illness that can only be cured through abstinence and traditional 12-step rehabilitation programs rather than as a response to trauma and a way to manage the anxiety, depression and the complexity of systematic oppression, to name a few contexts.

My approach is to discover, understand and focus on the reason behind substance use and meet the individual where they are, using a harm reduction or 12-step approach, whatever works for them. Additionally, I also like to incorporate music therapy into the treatment.

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