Ketamine Assisted Psychotherapy in San Francisco, CA

 

Ketamine treatment in a safe and comfortable setting, guided by an experienced therapist, can transform your life!

 

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Welcome!

There are a number of reasons you may have found your way here. Perhaps you’re in the midst of yet another depressive episode, after countless hours of therapy and more medication trials than you can even remember? Maybe you’ve spent years struggling to break free from the tenacious pull of anxiety, which leaves your attention constantly divided as you wrestle with an angst in your body shouting, “Somethings not right!”? Did you have a neglectful or abusive childhood that resulted in you having the belief that you’re never going to be enough, or that you’re unlovable? Or maybe you experienced a traumatic event which makes it challenging to feel safe in the world or to trust other people? Others reading these words might be battling to break free from the obsessive weight of an unhealthy relationship to alcohol, despite countless attempts and commitments to do so. Then, there are likely some folks reading these words that are simply curious, having read one of the many recent articles published purporting the beneficial effects of ketamine or after speaking with a friend who shared a life-changing experience; those folks may be wondering, “Could this help me move beyond some of my stuck patterns or foster my spiritual development?”

This page was written for each and every one of you. My name is Chris Restivo, MFT, and I’m grateful that you’ve taken an interest in what Ketamine-Assisted Psychotherapy (KAP) might do to help you to take the next big steps in your life. I’ve done my best to arrange the information here in a manner that is both thorough and approachable. I think you’ll find the answers to many of your questions, both about what KAP is and how it works, as well as who I am and how I provide this unique form of psychotherapy. Please take your time reading through the information below, and if after doing so you feel like you would like to proceed (or if you have further questions), send me an email and we can arrange a free 20-minute consultation call.

Ketamine Assisted Psychotherapy

What is ketamine?

Ketamine is legally prescribed ‘off-label’ for a number of psychiatric conditions. It was approved by the FDA as an anesthetic drug in the 1970s.

In the past 20 years, medical researchers have discovered mounting evidence on the positive effects of ketamine to treat a variety of mental health concerns by conducting randomized-controlled studies with high efficacy rates.

What is ketamine?

Ketamine is legally prescribed ‘off-label’ for a number of psychiatric conditions. It was approved by the FDA as an anesthetic drug in the 1970s.

In the past 20 years, medical researchers have discovered mounting evidence on the positive effects of ketamine to treat a variety of mental health concerns by conducting randomized-controlled studies with high efficacy rates.

How does it work?

Ketamine is a NMDA antagonist, which works on different neurotransmitters than traditional antidepressants, or Selective Serotonin Reuptake Inhibitors (SSRIs) . It mainly functions by increasing the release of a neurotransmitter called glutamate. In effect, this produces analgesic, anti-obsessional, anxiolytic (anti-anxiety) and antidepressant benefits. Other research suggests that ketamine may possess brain protective properties and enhance the ability of the brain to form and reorganize important neural connections. It achieves this by stimulating Brain Derived Neurotrophic Factor (BDNF) production, and has been nicknamed “the brain fertilizer.”

What does it feel like?

The effect of ketamine can vary widely based on several factors, the first being the route of administration. Ketamine can be injected in a patient’s veins (IV) or muscles (IM), taken by mouth, or taken intranasally. I currently limit the way I provide KAP to oral administration of ketamine lozenges, as this process feels more than adequate to achieve the desired effect and minimizes the need for excessive medical oversight.

The second factor is dosing. Low dose sessions may involve mild dissociation, relaxation, mindfulness, lowered defenses, anxiety relief, and empathogenic effects, as well as anti-depressant effects. These ‘psycholytic’ doses can be effective for focusing on particular narratives while remaining coherent and fully verbal. This can be valuable in trauma work, as it allows one to revisit traumatic memories while “keeping one foot in the present”, rather than feeling like the traumatic event is happening again. Moderate dose sessions may involve dissociation, out of body experiences, an expansive sense of self. Sessions utilizing higher dosing may involve full dissociation from one’s body and various transpersonal and mystical experiences. Dosing for each session is determined in collaboration with the client and the prescriber depending on the specific treatment goals. Generally speaking, my treatment protocol begins with lower doses as we build trust and familiarize you with the effects of the medicine and the treatment process. Eventually we move towards higher doses, basing the dosing decisions of your remaining sessions on the observations of your response to the medicine over the first several sessions.

The last factor to consider when discussing the variations that occur in one’s experience is ‘set and setting’. It has been well-acknowledged and thoroughly studied that the mental and emotional landscape (set)–including fears, expectations, beliefs and even internalized stigma–of the person ingesting any psychedelic compound has a profound impact on their experience. This, in tandem with the environment one is in during their journey (setting) interact with one another in a combination of ways to alter the overall feeling produced by ketamine. Because careful attention to set and setting are so critical to ensuring beneficial effects from the medicine, I welcome my KAP clients into a comfortable, quiet, and serene office space and focus diligently on answering any questions they might have to alleviate fears that might negatively impact their experience. In other settings, for instance those receiving ketamine infusions (IV), the client might hardly know the staff administering the drug and overseeing the treatment. Furthemore, rather than steeping in their journey in a tranquil space, IV infusions in a more traditional medical office will likely involve limitations of movement due to the IV drip in their arm (not pleasant!), and consistent interruptions from medical staff to monitor vitals, etc. Needless to say, set and setting are largely disregarded in this scenario. **For more on set and setting, please see the articles below.**

Is ketamine safe?

For the vast majority of the population, yes, ketamine is extremely safe. So much so, in fact, that it is an anesthetic commonly used with young children and the elderly. However there are some reasons why ketamine may not be right for you. This is why you will undergo a full medical assessment with the prescriber to determine whether or not there are any medical or psychological reasons for you not to pursue this treatment.

The following conditions would disqualify you from this treatment:

~ Pregnant women and nursing mothers
~ Poorly controlled or untreated hypertension and other cardiovascular problem
~ Poorly controlled or untreated hyperthyroidism
~ Acute Mania/Hypomania
~ History of psychosis or schizophrenia
~ Allergy to ketamine or past addiction to ketamine
~ Recent Traumatic Brain Injury
~ Severe Obstructive Sleep Apnea or Respiratory Disease
~ Obesity >300#
~ An ongoing substance abuse disorder or addiction
~ History of bladder or cystitis

What are the side effects?

The most common adverse effects include lightheadedness, dizziness, blurred vision, or inability to think clearly. Sometimes nausea, vomiting, or headaches can occur. It is important that you avoid driving and doing other tasks or activities that require alertness or clear vision immediately after treatments. On rare occasions hallucinations, high blood pressure, and transient muscle shaking have been reported. Increased risk of a bladder infection is another rare potential.

Warnings

Ketamine is not for everyone. It must be delivered in the proper dose and in an intentional setting (i.e. with the guidance of a well-trained clinician) to ensure safety and efficacy.

In order to participate, you will need to have ongoing psychological support while undergoing KAP and plans to continue after treatment has ended.

Ketamine is a Schedule III drug, which means it is approved for medical and clinical use and requires a prescription. Drugs are classified as Schedule III if they are designed for medical use but have a risk of dependence. In the case of ketamine, the risk of physical dependence is low to medium. However, the risk of developing psychological dependence is very high.

How does Ketamine-Assisted Psychotherapy (KAP) differ from other ketamine treatments (e.g. intravenous (IV) infusions or web-based ketamine companies)?

“It is an insult to the potency of this work to not take the time to
integrate what has been revealed.”
- Françoise Bourzat

The KAP treatment process sets itself apart from other forms of ketamine treatment in that it is far-and-away the modality of ketamine treatment which provides the most attention to the client’s psychological processes–a unique opportunity to move through ‘stuck places’ in novel ways with expert guidance. While IV treatments often aim to administer large therapeutic doses of ketamine to quickly alleviate severe symptoms (focused solely on the pharmacological impact), KAP treatment can provide equivalently high doses through a different ‘route of administration’, (either orally or via intramuscular (IM) injections) but greatly enhances the purely neurobiological impact of the chemical by addressing the psychological roots of the presenting problems via the additional psychotherapeutic component. Web-based ketamine services advertise ‘guidance and support’, however in reality this is often minimal and generally not provided by a licensed mental health professional.

All of these modalities offer the possibility of administering high doses of ketamine used to induce a non-ordinary state of consciousness, and all may result in an experience that facilitates major shifts of perceptions in a manner similar to classical psychedelics; mystical-type experiences and feelings of ego dissolution are relatively common when using these higher doses. As is the case with similar experiences produced in spiritual practices (e.g. meditation, chanting, yoga), one’s perception of themselves, their relationships, and their understanding of reality can undergo sudden and profound shifts. Ultimately this is generally a positive occurrence that facilitates change, however these effects can be extremely negative if a person is not well prepared and supported during and afterwards. Many patients who have experienced ketamine treatments and report negative experiences have done so in either an under-supported web-based treatment process or in a medicalized setting where there is little attention paid to their emotional experience and, on occasion, emergent trauma; in both of these approaches therapeutic rapport and felt safety in the midst of extremely vulnerable and disorienting experiences is often absent. In the end clients who proceed without the set, setting, safety, and integration intrinsic in KAP may be left to interpret and digest these provocative experiences on their own–this is a tall order!

Ketamine-Assisted Psychotherapy addresses this potentially troubling lapse in support with consistent contact and felt safety. Integration sessions (unique to KAP work and not present in the IV model) help clients understand the insights they have experienced and conceptualize how to use this material to make significant changes in their lives. Many web-based companies advertising through social media platforms purport to offer similar possibilities for integration via ‘coaching’ sessions, yet the individuals one might be paired with do not necessarily have degrees and licenses and may not have undergone much training at all. In the community of KAP providers, there is a reverence for this work and the courage of the client’s who chose to endeavor on this path. With the other options out there, one may unfortunately find that the outcomes fall short of the potential total benefit.

man sitting down in a city

What does this process actually look like?

20-Minute Consultation

Once you have established that you are sufficiently interested in this type of work and believe you might benefit from it, we will arrange a call to discuss your reasons for seeking this form of therapy. We will also cover your past treatment history, current support system, and some basic screener questions to make sure there are no contraindications. This call is free of charge.

20-Minute Consultation

Once you have established that you are sufficiently interested in this type of work and believe you might benefit from it, we will arrange a call to discuss your reasons for seeking this form of therapy. We will also cover your past treatment history, current support system, and some basic screener questions to make sure there are no contraindications. This call is free of charge.

Assessment Sessions (In-person or virtual)

Over the course of the next 2-4 (depending on need) hour-long sessions, we will focus on developing rapport and a felt sense of safety and trust while getting to know more about your history and goals. I will reach out to any relevant providers, including your current therapist, to coordinate care and discuss how to adjust to your shifting psychological needs while undergoing this treatment.. ($250/hour)

Medical Intake with External Prescribing Provider

Once it has been determined that you may potentially benefit from this treatment, a 30-60 minute medical intake will be conducted virtually with a psychiatric nurse practitioner who will review your medical history to ensure safety. Next, I will collaborate on a treatment plan with the prescriber to determine the number of sessions and dosing ranges that might suit your needs. After the first two medicine sessions, you will schedule another 15 minute phone call to check-in on the effects thus far and how well you are tolerating the medicine before the rest of the prescription is filled. ($350)

Filling Prescription (x2)

Your prescription covering the first two sessions will be sent via mail to your home. After your followup phone call with the nurse practitioner ensuring things are going as planned, the rest of your medicine will be delivered (Approximately $70/ Rx)

Preparation Session (In-person or virtual)

Before your first medicine journey, we will spend an hour covering safety concerns and a more in-depth review of what you might expect. We will also discuss how to take care of yourself afterwards and make the most of your experience ($250/hour)

Ketamine Assisted Psychotherapy Sessions

Depending on the needs determined in your treatment plan, a commitment of no less than 4 sessions, but generally in the realm of 6-8 sessions total will be agreed upon.

Once arriving in the office you will have time to settle and check-in. We will use certain somatic (body-based) and ritualistic practices to help you fully arrive and emotionally prepare for the inward journey you are about to embark on.

Eventually you will self-administer (holding a dissolvable lozenge in your mouth) the medicine dose prescribed by the nurse practitioner while I read you a poem or passage uniquely chosen to match your intentions. The shades will be drawn and you will place an eye mask on as I turn on music specifically created to facilitate your journey. I’ll assist you in lying down on a comfortable tri-fold mattress with a weighted blanket and ensure you are comfortable.

As the medicine takes effect and your journey begins, you will do your best to share what you can about your experience with me, knowing that sometimes it can be difficult to put into words. Along the way I may ask you questions to facilitate your curious attention in specific ways, but in essence we will aim to create space for whatever arises. During the whole process I will be taking diligent notes to reference later during our Integration work. Throughout your journey, I will never leave your side, and will provide whatever type of appropriate support you may need.

Generally after 45-90 minutes (depending on the individual and dosing) the effect of the medicine will wane and I will gently encourage you to move to the couch, at which point I’ll offer you tea and a snack. The remaining time will be used to ‘anchor’ the aspects of the experience that you felt were particularly impactful, and I may remind you of other portions of the journey that occurred but were forgotten due to the intense nature of the experience.

Eventually you will head home, either via a family member,friend, or ride-share service and attempt to rest, journal, or enjoy a nice meal. We will have our Integration session scheduled within the next 48-hours, as the medicine is still interacting on your brain, body, and psyche for an entire day even if the intensity of the initial effects are not fully felt. ($900/3-hour guided session)

Integration Sessions (In-person or virtual)

Interspersed between each medicine journey, “Integration” sessions are an essential part of the work where we engage in a session to discuss your journey and make sense of it. Within the framework of your life history, personal goals, and intentions, we will come to understand the impact and implications of what arose in the midst of your journey. This psychotherapeutic process aims to stabilize positive behavioral changes, consolidate psychological material, resolve psychological issues, improve relationships, catalyze new insights, and enhance self-awareness. ($250/hour)

Testimonials

“To say that Ketamine therapy is transformative with Chris’ expert supervision, would be doing it a great injustice. There is no real language that can express the experience appropriately. Chris is more than a psychotherapist in this regard, he is a true guide on an inward journey that will help you gently contact emotional trauma that was buried deep long ago. His professional approach and warm guidance will help you find the toolsets to unlock, contact and find acceptance internally. I would highly recommend the work, journey, and experience under Chris’ amazing care!”

There seem to be a lot of therapists starting to offer KAP, why would I choose to work with you, Chris?

This is a great question to be asking. In ‘traditional’ forms of psychotherapy “rightness of fit” between a therapist and client is one of the three main indicators of the success rate of therapy. Though it has not been studied, I would presume that this same measure is even more applicable in KAP work due to the level of trust required in such a vulnerable state. If a potential new client had hesitancy about working with me for one reason or another, I would hope we could discuss it and if that conversation did not resolve the ambivalence, I would be happy to help you find another provider that is a better match.

My approach to KAP is entirely different from my way of working with clients not undergoing this process, and yet it is also entirely informed by my years of training in various other psychotherapeutic models. In a metaphysical sense, I hold a frame captured most accurately by Depth Psychology (based on the work of Carl Jung, with an understanding of the Collective Unconscious). This perspective helps me interpret the archetypal nature of the dream-like phenomenon that often emerges in medicine journeys–this occurs intuitively for me, almost without effort. It is the natural lens through which I interpret what I see and experience. One might think of this as the realm of spirit. My 20+ years spent studying Zen Buddhism (as well as other spiritual practices) and cultivating a daily meditation practice further compliment this mode of perception. Needless to say, one need not have any spiritual beliefs whatsoever to participate in KAP, but oftentimes the ‘transpersonal’ experiences that arise on higher doses lend themselves to being understood with greater insight from this perspective.

That said, my master’s degree in clinical psychology emphasized “Somatic Psychology”, which focuses on the indivisible nature of the mind-body (e.g. when I’m anxious my chest tightens and my stomach gets upset). As the experience of being on a ketamine journey often presents strong bodily sensations, rich with information and potential transformation, working with a clinician steeped in these approaches may be helpful.

After completing my masters degree, I began to embrace extensive training in a variety of evidenced-based practices, participating in consistent training, supervision, and consultation all the while. While some are more relevant than others to KAP, my current means of conceptualizing the various intrapsychic dynamics of those I work with is best described as a combination of Schema Therapy and Acceptance and Commitment Therapy (ACT)–the Schema Therapy approach helps myself and my clients to understand how they view themselves and their place in the world, while ACT informs an understanding of the issues as they present themselves currently, and the means of breaking vicious cycles of ‘stuckness’ to move forward in novel and fulfilling ways.

Finally, for most of my career I have worked with individuals who experience extreme states as a result of their mental health concerns (often with diagnoses of psychosis or Bipolar Disorder). Rest assured, more common forms of anxiety, depression, grief, life-transitions, self-esteem issues, and trauma are ‘presenting complaints’ I am entirely familiar with and successfully help the client’s I work with to navigate on a daily basis. However, unlike many clinicians, I have focused much of my career on being the grounded presence in the room with clients in extreme states of paranoia, delusional grandiosity, catatonia, and euphoric bliss. In other words, I feel well-prepared to provide a safe, non-judgemental container for whatever arises during your KAP session, and to help you curiously welcome and learn from it.

All that being said, I’m a real person. I show up with authenticity and minimize pretense. I hope that you will feel supported but never ‘therapized’. I keep a watchful eye on not exacerbating power dynamics and I do my own personal work to examine my privilege so it doesn’t interfere with your process. I don’t claim to have all the answers, but I do hope to create enough safety to inspire you to curiously examine the dusty corners of your psyche so that we can creatively view your concerns with fresh eyes, or ‘beginner’s mind’.

And how much does it cost?

20-Minute Consultation

Once you have established that you are sufficiently interested in this type of work and believe you might benefit from it, we will arrange a call to discuss your reasons for seeking this form of therapy. We will also cover your past treatment history, current support system, and some basic screener questions to make sure there are no contraindications. This call is free of charge.

I’m excited to start, but how will I afford this?

As a form of short-term intensive treatment, KAP is a labor-intensive process that requires many clinical hours/week and thus is expensive by many standards. However, though I do not bill any insurance companies directly, depending on your plan and deductible (which you are responsible for assessing), many clients find they receive the same out-of-network reimbursement rates they would for general psychotherapy. If seeking reimbursement is important to you, please inquire about that in your initial consultation so we can discuss it further. While you are responsible for payment, if you provide me with your insurance information I can submit your bill for reimbursement on your behalf to minimize the administrative burden.

Overall Costs
Procedure Cost
20-Minute Consultation Free
Assessment Sessions
(In-person or virtual)
$250/hour
Medical Intake $350
Filling Prescriptions (x2) Approximately $70/ Rx
Preparation Session
(In-person or virtual)
$250/hour
Medicine Journeys $900/3-hour guided session
Integration Sessions
(In-person or virtual)
$250/hour
Commitment to the Full-Treatment Plan

It is important to consider that while many individuals have quite pleasant experiences during the course of treatment, for some there are moments of emotional challenge. Understandably, in the wake of such experiences there may be a tendency to want to discontinue treatment. While ultimately, the choice is always yours, by engaging in this work you are acknowledging a willingness to continue with my support despite potential challenges, as there is often great value in completing the full-treatment even if difficulties arise along the way.

How do I take the next steps?

If you’re interested in taking the next steps or have questions about whether or not KAP may be a helpful compliment to your healing journey, please feel free to contact me to set up a free 20 minute consultation. In your email, please provide me with your reasons for seeking this treatment at this time. Space is extremely limited, so if we determine we are interested in working with one another, your patience is appreciated as you may be placed on a waitlist.

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