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Psychedelic Integration to Get the Most from Ketamine Therapy
Integration is where the magic happens. In this final episode of our season on ketamine for divorce, depression, and dependency, we shift our focus to what comes after the trip—when the medicine wears off and it’s time to make meaning from what surfaced. Whether you’re working with a licensed therapist, on your own, or in a hybrid model, this episode walks through the three essential phases of ketamine-assisted therapy: preparation, session, and integration.
With help from Field Trip Health’s Dr. Bridget Carnahan and returning voices like Kaia Roman and Natasha Lannerd, we explore how to develop a relationship with the “witness” within—your internal observer—and how practices like journaling, meditation, and breathwork can extend the therapeutic benefit of ketamine. This episode is designed to be a guide you can return to whenever you need support in making sense of your psychedelic experience.
🧠 What You’ll Learn
The three phases of ketamine-assisted therapy and what integration really involves
Why low and high dose ketamine protocols serve different but equally important roles
How dissociation helps cultivate the “witness” and increase emotional resilience
Tools and habits to help you carry ketamine’s benefits into daily life
📚 Resources Mentioned
Fantastic Fungi Documentary
The Body Keeps the Score by Bessel van der Kolk
Get SetSet for Your Journey & Beyond
View all
Transcript
Dr. Bridget Carnahan: It's moving beyond this sense of I'm sick and there's something wrong with me, and I'm all alone, and psychedelics can help us do that. But they're not the cure, you know? They're not the only piece of it. It's really taking that sense of connectedness, taking that sense of trust in yourself and being able to then make changes in your life to build beauty around your life and see the beauty in your life, rather than seeing things from a negative perspective.
April Pride, host: Hey, I'm April Pride, your host on the High Guide podcast. This is the show for women who have an open and curious mind. And this is a show all about women changing their lives thanks to altered states of consciousness. At the top of the show, you heard from Doctor Bridget Carnahan, who has been a featured guest this fourth season. In today's episode is the final episode of the season on ketamine for divorce, depression, and dependency. Today, we're focused on integration or integrating your observations during ketamine assisted psychotherapy with the intention you established at the onset of treatment. We'll get into the specifics of different modalities of integration on this episode, including my own ways of continually integrating between intentional tripping, every psychedelic facilitator and expert psychonaut I've spoken with or read or listened to agree that integration is the most important part of a psychedelic induced experience. This episode is intended to be an audio reference you save and come back to so that you can help yourself integrate without assistance, so that you can help your friends integrate meaningfully. Up next is our word of the week, and stay tuned to the almost end for our trip tips. Today's word of the week Golden hour. Depending on the route of administration, the effects of ketamine will be felt for up to two hours, after which patients enter into, you guessed it, the golden hour.
April Pride, host: During this time, about an hour after the effects of ketamine begin to wane, patients report feeling as if they're in a dream state. It's advised to write down what doesn't even make sense during this time. Before the prized and well-earned golden hour sets in. There are three phases of ketamine assisted psychotherapy. As is true for all psychedelic assisted psychotherapy, these three phases include preparation, support or supervision and integration. And for purposes of this information, remember some patients work with a therapist from start to finish in the process. Others complete at home treatments with virtual as needed guidance or others like me, employ a hybrid option. In phase one. It's all about preparation. Setting an intention for your treatment, and making sure your set or mindset is in an optimal state to work with the ketamine. For patients working with a therapist, there could be up to several sessions in which the client and therapist meet, and at which time the therapist collects new patient history and provides pertinent information about the upcoming ketamine sessions. For long time listeners of this show, you may know that season three dives into the way to approach and work with intentions for psychedelic experiences.
April Pride, host: It's this first phase that, while not missing from at home ketamine treatments, it is abbreviated to a 30 minute zoom call with a doctor prior to the final prescription being submitted to a compounding pharmacy in the state in which the patient resides. One way to augment the use of ketamine through a telehealth company is to schedule your own personal therapist, should you have one to work with during your ketamine treatment. Protocol integration isn't only about what comes up while under the influence of ketamine or other psychoactive substances. Each of these three phases offers rich opportunity for emotions, observations, behavior to surface and reconcile. For instance, what if you observe in phase one that your resistant to experiencing the full depth of what ketamine has to offer? In other words, perhaps resistant to losing control? For sure, this is in and of itself before the medicine even enters the picture, worthy of acknowledging and asking, where else in my life am I denying myself the full depth of an experience because I'm afraid of losing control or not knowing what's going to happen next?
Dr. Bridget Carnahan: I would say in terms of people who want to go deep into the psychedelic experience versus go really slow, some people are just more nervous about letting go of control than other people, and I think that's really what it comes down to. You know, there's lots of people who come in initially and are quite nervous about what's going to happen here. They're nervous that they might have a negative experience. They don't know what to expect. People will will have a high heart rate. They'll be, you know, anxious and like we do some breathing exercises to calm down and reassure them. You know, that it's really normal to feel anxious about something that where you don't know what to expect.
April Pride, host: In phase two, taking the ketamine and completing a treatment session. Those who opt for at home ketamine treatment will not have this high touch experienced support. Listen on. As Doctor Carnahan explains on something Kuruman shared in the last episode. And that is the benefit of both a highly potent ketamine dose and a lower dose, the obvious difference in the two being the likelihood of hallucination and dissociation is greater the higher the dose.
Dr. Bridget Carnahan: Having a psychedelic experience in a clinical setting at a higher dose can give you another tool in that toolbox to be able to be like, oh, I understand this differently now, and I can use that to carry forward some of these changes in my neuroplasticity and my the flexibility with which I have for this short period of time. I can integrate my understanding and carry that forward more easily. The higher level dosage, the psychedelic dosage is something special. It is something that can be life changing. And I think it's it's an added benefit, but it's also intensive in terms of having licensed professionals sit with you for hours. You know, it's it's a more expensive treatment model. And the option for people to have home exploration at a lower cost is something that needs to be considered.
April Pride, host: And you may recall from last week's episode that at home, ketamine treatments are intentionally low dose so patients can more safely complete the sessions for more potent forms of administration, like in-clinic, intramuscular, or IV treatments, the experience is likely to be more intense. The therapist is there to provide emotional support, as well as note words or thoughts expressed by the client while in an altered state, so as to help with later recall. Doctor Carnahan, Seattle director of ketamine clinic Field Trip Health, where treatments are administered intramuscularly, shares a practical difference between ketamine protocols that are more hands on and also more expensive, that therapists can also contribute to a feeling of safety that gives patients the confidence to go there.
Dr. Bridget Carnahan: They're kind of witnessing you, and, you know, there's something about letting go into the experience when you know that there's someone there who's going to be keeping track of everything and making sure that you're safe, if you're going to let go of your connection to, you know, this awareness and you can journey deeper. Or I think if you know that you're you have someone there who's responsible, making sure that you're okay.
April Pride, host: Ketamine is employed to lower a patient's resistance to exploring painful past experiences while undergoing therapy. This allows the client to work with and make sense of painful, traumatic experiences to move forward toward a place of acceptance and healing.
Dr. Bridget Carnahan: If we continue to try to push that stuff out of our awareness, then it's potentially going to affect us and undermine anything that we do from a nutritional or a physical wellness perspective. Being willing and able to turn towards the painful material, turn towards what makes us uncomfortable isn't of itself, is in and of itself a spiritual process or a meaning process, because you're trusting that something here that's of value, in something that doesn't feel good, that we're not just valuing happiness and comfort in our lives, but we're we're valuing growth. We're valuing that our life and the meaning that unfolds as we go through the process of life is something that we can trust.
April Pride, host: Growth starts with curiosity about alternatives, amplification, and accessibility. There's a high probability that if you've chosen psychedelic assisted therapy as a path to healing or optimization or both, that you're least willing to be curious in this aspect of your life. Remember Natasha Leonard, our psychedelic integration facilitator, and last season I went through the transcripts for each episode last season and searched the word curious in nearly every instance, with Natasha saying to a sister Tripper. So I'm curious when or I'm curious if or I'm curious how. And it is this at the heart of integration, being a curious human about yourself as a curious human. Go back and listen to season three, episode 46 of this show titled The Trip while you're under the influence to hear more about cultivating the witness while we're in an altered state. In brief, taking this non-committal attitude or third person perspective toward our own thoughts and actions allows us the awareness of just witnessing, not judging, not attaching this can be very rewarding and incredibly powerful. Listen on as Natasha elaborates.
Speaker3: If you really want to make a shift in your life, you have got to cultivate that witness, that part of you that is always coming from a place of compassion and curiosity. Non-judgmental. It's not about ragging on yourself, it's about being endlessly curious with what's going on in your own mind.
April Pride, host: It reminds me of a scene from Fantastic Fungi. Legendary mushroom cultivator and advocate Paul Stamets relays his psilocybin trip while in high school that cured him of his stutter. While tripping, he asked himself something to the effect of why do you do that? Really should stop doing that. Doesn't say it in a way that's judgmental. He just a matter of factly, you should really stop doing that. And the reason he wanted to stop doing that was because there was a girl that he liked, and he really wanted to talk to her. He came out of this trip having shed his lifelong stutter. He didn't stay in the loop of all the ways his stutter had held him back and forward trip of how it would always do so and then spiral on what a life with a stutter will look like. He got curious and he cured himself. Just as Natasha has explained in this series, the point of integration in cultivating the witness is to allow us to tap in to the healer within, and trips take our ego offline long enough to assign new thinking to our old shit. Doctor Carnahan continues on about how Ketamine's dissociative properties are uniquely suited to invoke a detached point of view relative to ourselves and our lived experience.
Dr. Bridget Carnahan: I would say it probably is. One of the benefits of ketamine is that there is this dissociative experience that allows you to cultivate the witness, you know, and cultivating the witness is a valuable tool to be able to not take things so personally and to be able to, you know, just not be bogged down in your own emotions to the degree where you can't choose something different. You know, I think we've all had the experience of feeling incredibly overwhelmed by an emotional state of being and feeling like there's no way out of it. And then, you know, the next day we don't feel that way. And we can say, you know, that that went away, that I don't live there all the time, but when you're in it, it feels like there's no way out. Ketamine does give you the experience of witnessing what those emotions are in a way where they don't seem so bad. They don't they don't seem like a big deal. You can see it and be outside of it. And the more that we have that experience and that trust that that being in it is not going to last forever, you know that being in it is one part of the experience. It's part of the human experience. And if you can trust it and know that it's it's passing and it's rich and it's vibrant and it's intense and doesn't feel nice, it's something to appreciate as part of the human experience, then it feels a little less fearful that you're going to be stuck there forever.
April Pride, host: Ah, did you catch that? What Doctor Carnahan just said right there, that being in it is one part of the experience. Being in a psychedelic experience is only one part of the full arc, and the same can be true for other impactful experiences in which there was a lead up and a comedown. The full arc requires processing so you can move forward, having fully absorbed the whole of the experience, like divorce or periods of depression, or periods in which we are particularly dopamine seeking. If we live for 100 years, I hope that 80% of that time I'm in it, and I think we'd all consider it a lucky life if 80% of that time were experiences that were mostly the good kind. How often do you have an experience worth processing? Let's take a transition in life as simple as a move. What do I like about where I live now? What have I learned from my community? What would make my experience better? Reflect my current needs? Right? These are questions that we ask ourselves. We're integrating more than we realize, and it helps us plan for an optimal future. So let's explore the third and final phase of ketamine assisted therapy integration, which begins in the 24 to 48 hours following the ketamine administration. And it is during this time the patients will meet their therapist to make time to externally process their time under the influence. Kuruman sums up why integration is so critical to affect the outcome you desire and make a powerful case for using this post ketamine assisted Therapy session intentionally.
Speaker4: Neural pathways are just words, thoughts, or actions that we repeat over and over again, and then they become habitual. So after a ketamine treatment, you have this window of opportunity where you can create new neural pathways on purpose, you know, to stop using a substance that you might feel you've become addicted to, or stop feeling so sad or stop having these, you know, intrusive, fearful thoughts. But you probably need support. It's not necessarily easy to just do that on your own. I definitely recommend working with an integration coach or some people like ketamine assisted therapy, which doesn't necessarily mean you're talking to the therapist while you're on the ketamine journey. It can mean you're combining therapy with your ketamine journey. So you create this state of extra neuroplasticity, and then you work with your therapist for like, okay, here's how I'm going to move forward with my new powerful neural pathways. But or you work with a group, you know, maybe have group support, but I think some form of support is just absolutely essential for these treatments to be as effective as they can be.
April Pride, host: Doctor Carnahan goes on to explain that there's equal opportunity to work with the medicine, no matter the dose.
Dr. Bridget Carnahan: Yeah, I think the research is showing that even when you don't hallucinate, there is some neurochemical benefit that's happening. There is benefit even when there is not a psychedelic experience. But there seem to be benefits specifically from the psychedelic experience as well. The way I describe it to people, often the psychedelic experience is a tool that you can use to help carry forward neurochemical benefit. Further. You have this new perspective, this new understanding of the things that have been challenging for you, and you can use that to relate to your life differently. Relate to the challenges that you're having in a more positive, trusting way. So the neurochemical benefit does seem to be something that's temporary. That wears off after about a week, and it gives you this window of time where you have. Flexibility to bring in new habitual thought patterns. Having a low dose session once a week for six weeks gives you this extended window where you have this flexibility and you can implement new ways of thinking about things and bring in new practices.
April Pride, host: So what are these new practices at home? Telehealth company Wonder Med offers 28 days of wonder to support patients integration over the course of a four week treatment protocol. The program is designed to encourage patients to take 15 minutes a day for 28 days to be introspective, and it includes guided meditations, journaling prompts. Breathwork practice. Other forms of integration outlined on Wonder Med's website include try new skills trying and practicing new and challenging skills like learning to play an instrument or speak a new language. Novel experiences such as traveling and exploring a new place can also drive Neuroplastic gains exercise. Exercise enhances brain function in health. Aerobic exercise has been shown to increase neurogenesis and influence the survival and maturation of neurons in humans. Meditation. Meditation enhances neuroplasticity and increases levels of BDNF. Meditation disrupts negative thinking patterns associated with stress, anxiety, and sadness and replaces them with more positive thoughts and emotions. Regular meditation results in continual reinforcement of these positive pathways, strengthening them over the long term and leading to greater brain health and overall well-being. Sleep. Sleep is another important component of maintaining healthy brain plasticity. Chronic sleep deprivation has been shown to decrease BDNF levels in the brain and decrease neurogenesis. Adequate healthy sleep has been shown to reverse these impairments. Breathwork engaging your parasympathetic nervous system. This reduces your heart rate. Your blood pressure puts you in a relaxed state. So how often? How long? What does a course of ketamine treatment look like? Kai Roman shares what she witnessed with Kedah MD patients and guiding.
Speaker4: And just speaking to lots of people about protocols and helping to develop the protocols for Kedah, MD Is most people need 4 to 6 treatments pretty close together in the beginning, and then they wait and then they wait.
April Pride, host: Wait for the integration to start to pop up in your life in big and small ways. Remember when we talked about being resistant to losing control, taking control of a situation rather than sitting back and trusting that what happens is for the best? Doctor Carnahan follows up with ketamine as a modality to invite receiving what will be rather than fighting it.
Dr. Bridget Carnahan: I think women are sometimes more introspective in certain ways than men, and interest in my mind about the different energies that are sometimes called masculine and feminine energy, or yin and yang energy, and how society has developed in a way where the masculine or yang energy is more valued in certain ways in terms of action, getting things done, being organized, doing something is very much valued in our society. So it's not just based on male or female gender, but there I'm curious about the potential for something like ketamine to make more space for the receptivity, the yin or the feminine force, because I think ketamine has sort of that quality inherent in it. In some ways, I think it can be beneficial for both men and women to experience that receptivity, that trust and sort of letting go of needing to do anything but that things are okay the way they are. It's moving beyond this sense of, I'm sick and there's something wrong with me, and I'm all alone, and psychedelics can help us do that. But they're not the cure, you know? They're not the only piece of it. It's really taking that sense of connectedness, taking that sense of trust in yourself and being able to then make changes in your life to build beauty around your life and see the the beauty in your life, rather than seeing things from a negative perspective. The best integration, I think, is building more connections with other people, with other living things, with nature. And that is really where we start to move into wellness.
April Pride, host: I leave you with today's trip tips. Today's trip tips were inspired by what Doctor Carnahan was saying just right there. The best integration is building more connections with other people, with other living things, with nature. A few ideas to support what I call external integration. Number one other people. Just this weekend I read the results of a Harvard study from the first half of the 20th century that found that relationships were the number one driver of lifetime happiness. Ways to foster these connections include going on a vacation together, family dinner, breakfast with friends, camping, hiking, cooking together, spending a day at the park. Number two other living things. Do you have a dog, a cat, or a house of plants like me? In the show notes, I linked to a list of 20 ways to spend time with your dog, like visiting a pet friendly store or scheduling play dates with other dog owning friends. Number three. Take walks, hikes, swim in a river, a lake, kayak. You know what? Time and nature looks like. Go do that. Better yet, go do that with your friends and your dog. Thank you for listening to this episode of the Hai Guide. I'm your host, April Pride. Please check out our website, The Hai Guide for our Shroom Strain reviews and guide to psilocybin. Tune in next Friday for another episode of The Hai Guide, a show all about women changing their lives thanks to altered states of consciousness.