A visit to a Ketamine-assisted therapy practitioner

Photos and text by Stacie Joy

I’ve started to notice Ketamine therapy signs popping up around the neighborhood, but I don’t really know much about the medication.

East Village resident and Ketamine-assisted therapy mental health counselor Jill M. Twohig, who practices out of an office on Second Street near Avenue B, agreed to talk to me about the treatment, its use, and its efficacy, 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 medication, how is it administered (injection, lozenge, pill – something else entirely?), and what is it used to treat? 

Ketamine can be administered through intramuscular injection, IV [intravenous], or a sublingual lozenge. The former two methods have been used in major hospitals and clinics under the supervision of an 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], OCD [obsessive-compulsive disorder], and alcohol dependence (which is a symptom of trauma). 

As a therapist, I meet with the individual for a session or two in order to get a sense of therapeutic goals and prepare them for the medication’s effects. Then, a Ketamine-dosing session would start with my leading a guided meditation to assist with transitioning into a non-ordinary state of consciousness while the patient is lying down wearing eyeshades and ambient music playing.

A “sitter” is required to be physically present to provide anything the patient might need during the dosing period; the role is the therapist is to remain present and then provide integration during and after the session. This process typically lasts around two hours. Then, within a 48-hour period, we would meet to have a regular 50-minute talk therapy or integration session. 

It’s an FDA-approved drug, but you mentioned insurance doesn’t cover the cost of it for off-label use.  How does the application process to get a prescription work, and what is your role in guiding patients through the process? Is it a one-time use, a series of treatments, or an ongoing usage? 

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

For those interested in using Ketamine to treat mental health concerns, they first need to consult with a prescriber, like a psychiatrist or NP. It is not usually prescribed as a front-line medication; individuals would have to have trials of traditional SSRIs [selective serotonin reuptake inhibitors] or other medications before Ketamine is considered. 

The recommended number of KAP, or Ketamine-assisted psychotherapy dosing sessions, is between 6-12, starting at a low dose and then increasing to help the patient gradually become comfortable with the effects. People have reported feeling relief from symptoms 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 does the experience last? 

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

Depending on how the medicine is administered and the amount, the effects can be felt quickly or take up to 20 minutes. People report feelings of euphoria, dissociation, and peacefulness; side effects can include dizziness and nausea, so an antinausea medication is usually prescribed to take along with the Ketamine dose. 

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

You practice from an office on Second Street between Avenue A and Avenue B. Are you mostly seeing local clients and patients? Do you also practice over Zoom or telehealth? Who is a typical client if such a thing exists? 

I see people in the office on Tuesdays, Wednesdays and Thursdays and over Zoom on Fridays and Saturdays. The people who tend to seek me out are adults who identify with a segment of the counterculture, including nontraditional sexual/gender expression, sex workers and people in poly relationship structures, the LGBTQIA+ community, artists and performers. I also work well with those who ascribe to a more vanilla lifestyle. 

How did you become involved in this treatment modality? You mentioned your tagline was Sex, Drugs and Rock’n’roll Therapy. Can you speak more about that? 

I had been reading about the psychedelic renaissance in mental health treatment over the past several years, and it particularly sparked my interest when attending an online conference on trauma in 2020. Major leaders in the field of PTSD treatment and research were present, and they were speaking about the overwhelming efficacy of Ketamine, MDMA, and psychedelics in not only treating but also actually healing the effects of trauma. 

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

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

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

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