Anticipation and preparation: The road to a first ketamine therapy session

Editor’s note: This is the second installment in “From doubt to discovery,” a six-part series chronicling Eden Prairie Local News contributor Rachel Engstrom’s experience with ketamine-assisted psychotherapy (KAP). In this piece, she shares the steps leading up to her first KAP session – from navigating early appointments to confronting her fears about the unknown.

If you missed the beginning of her journey, you can read the first installment here.

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By the time I walked into my first appointment with Dr. John at Intero Psychedelic, I was grappling with anxiety, cognitive distortions, and deep exhaustion. My baseline mood felt like living on the edge – imagine being hungry, sleep-deprived, and overwhelmed all the time. The thought of embarking on something as transformative as KAP was both exciting and nerve-wracking.

Dr. John greeted me warmly, and we got to work right away. As one of the psychiatrists at Intero, his role was to explain the medical aspects of KAP, assess my health for suitability, and answer any logistical questions. This first appointment laid the groundwork for what was to come.

Two follow-up appointments with Alex, my integration therapist, delved deeper into my personal goals and emotional preparation for KAP. These sessions helped me build trust with Alex, who would sit with me during my ketamine sessions and guide me through integration afterward. Her warmth, clarity, and validation were instrumental in helping me feel ready to begin.

Exploring goals and patterns

During my appointments, both Dr. John and Alex asked why I was pursuing KAP. I shared three main goals:

• To address my displaced anger and reduce emotional reactivity.

• To uncover and process triggers tied to past trauma.

• To learn how to regulate my emotions and establish a healthier baseline.

I also explained how losing my father, compounded by his untreated mental health struggles, had motivated me to take control of my own mental health. Alex encouraged me to reflect on patterns that no longer served me – especially my tendency to spiral into all-or-nothing thinking.

As we talked, I realized how my professional challenges connected to personal struggles with boundaries, vulnerability, and anger. Growing up, anger was more accepted in my family than sadness or other emotions. My father, an aggressive driver, often modeled reactive behavior during our countless car rides to church or my grandparents’ house. These experiences shaped my difficulty regulating emotions, particularly in situations that felt out of my control, like driving or professional conflicts.

Understanding the ketamine process

Both Dr. John and Alex provided a detailed overview of ketamine administration. The clinic uses intramuscular injections, which offer a quicker onset and more predictable absorption. Sessions would involve wearing an eye mask, listening to carefully curated music, and allowing the ketamine to guide the experience while medical professionals monitored me for safety.

When Dr. John mentioned that ketamine could temporarily elevate blood pressure, I nervously asked if this effect was permanent. His reassuring response eased my anxiety, though I felt embarrassed for asking such an obvious question. In true “me” fashion, I joked, recognizing my tendency to overthink and self-criticize.

Both professionals emphasized that the therapy’s plan tends to reveal itself over time. This challenged my need to know exactly what to expect so I could prepare mentally. While I struggled to trust the process initially, I later marveled at how naturally the plan unfolded.

Professional boundaries tested

The Monday before my first ketamine session, I experienced a significant professional challenge with a long-term tutoring client. Matt, the father of one of my students, Hank, texted to cancel a lesson at the last minute because Hank wasn’t feeling well. When he asked to reschedule for the next day, I reminded him of my 24-hour cancellation policy and noted I would need to charge for the missed session.

Instead of agreeing, Matt abruptly reversed his decision, insisting we proceed with the lesson that Hank was supposedly too sick for. The back-and-forth left me frustrated and questioning my boundaries as a tutor.

Within five minutes, I was pacing, my mind spinning with shame and self-doubt. Did I overstep? Was I too firm? Was I overreacting? I recognized the familiar pattern: setting a boundary and then internalizing blame when it wasn’t respected.

Thankfully, I turned to tools I’d learned through an online mindfulness-based stress reduction (MBSR) class that my partner, Andrew, and I had completed in 2023. I practiced self-compassion by speaking to myself as I would a friend. Andrew reassured me: “Anyone would be upset by this.” Finally, I allowed myself to sit with my feelings without judgment.

Recognizing the need to reset, I took a Xanax and went for a walk – a strategy I knew would help calm my nervous system. While the incident ultimately led to losing this client, it reinforced the importance of prioritizing my boundaries and emotional well-being.

Moving forward

With the foundation laid, I scheduled my first ketamine session and integration appointment. Despite my apprehension, I felt ready to step into the unknown, buoyed by the support of Alex and Dr. John.

The journey ahead promised to be transformative, but even the preparation had already taught me invaluable lessons about boundaries, self-compassion, and trust.

Next week: Reflections from the first ketamine therapy session.