Highlights from a panel discussion at Cannabis Science Conference Spring featuring Dr. Alison Draisin PsyD, LMHC, AIMS Institute; Dr. Emily Whinkin, ND, AIMS Institute; and Madeleine Turner, LMHCA, AIMS Institute. During their panel discussion each presenter shared their background and work at the AIMS Institute with patients using psychedelic treatments such as ketamine assisted therapy.
BY MEGAN L’HEUREUX
ONE OF THE FEATURED SESSIONS at the Cannabis Science Conference (CSC) Spring event was a panel discussion in the psychedelics track titled “Ketamine Assisted Psychotherapy from an Integrative Medical Clinic Perspective.” The discussion was led by Alison Draisin, PsyD, Licensed Mental Health Counselor (LMHC), of the AIMS Institute and featured Dr. Draisin’s colleagues Dr. Emily Whinkin, Naturopathic Doctor (ND), MS, Perinatal Mental Health Certification (PMH-C), and Madeleine Turner, Licensed Mental Health Counselor Associate (LMHCA) and Certified Jungian Advanced Motor Processing (JAMP©) Transformational Coach.
To kick off the discussion, Dr. Draisin explained that the Advanced Integrative Medical Science
(AIMS) Institute was founded by Dr. Sunil Aggarwal, a palliative care doctor, and Dr. Leanna Standish, a naturopathic doctor and Fellow of the American Board of Naturopathic Oncology (FABNO). The facility is based in Seattle, Washington. Dr. Aggarwal approached Dr. Draisin in 2018 at Seattle’s annual Hempfest® and shared his plans to create an integrative medical clinic that included cannabis and psychedelic assisted psychotherapy. “Dr. Aggarwal basically told me I could have free rein to do what I wanted. So, I thought that was pretty cool because I have been a clinician for over 30 years and no one has ever said that I could even talk about cannabis or psychedelics with my patients before,” said Dr. Draisin.
Thus, Dr. Draisin joined the AIMS Institute from the beginning and her role has evolved into Lead Psychologist and the Director of Ketamine-Assisted Psychotherapy Provider Training. She explained that providers come from all over the country to their office for training on this type of work. “I have to say, having done this work for five years, I wish I had access to psilocybin and MDMA, but right now, that’s not legal,” said Dr. Draisin. “We work with what we have and we have a really high success rate. And the reason why we have a high success rate is because we have an integrative medical model where we work as a team as opposed to just individuals. Our team consists of medical doctors, naturopaths, psychotherapists, nurses, and acupuncturists. We all work together.”
Dr. Draisin also shared that the AIMS Institute encompasses oncology, chronic pain, palliative care, psychiatry, and chronic neurological diseases. “If I have a client (or patient) that comes to me for ketamine-assisted psychotherapy (KAP) and they’re also an oncology patient, I can work within our group. It’s a holistic model where we’re looking at the whole person,” said Dr. Draisin.
The first step in the KAP program when a patient arrives is to complete a medical evaluation. Each patient must pass the medical evaluation and be screened for cardiac issues, seizures, or any other medical concern, explained Dr. Draisin. Their patients also see a nurse or a naturopathic doctor to evaluate polypharmacy and undergo a mental health evaluation prior to KAP.
Integrative Care Model
As Dr. Draisin explained, the AIMS Institute has an integrative care model with each staff member playing a different role in a patient’s care. To elaborate on this, Dr. Emily Whinkin discussed her role as a naturopathic physician. She holds a master’s degree in integrative mental health from the National University of Natural Medicine in Portland, Oregon. Dr. Whinkin works at the AIMS Institute as the Chief Resident.
“My involvement with the ketamine-assisted psychotherapy program is similar to our psychotherapists in that we really work to promote the role of ketamine-assisted psychotherapy within an integrative treatment model,” said Dr. Whinkin. “That means that I might continue with my naturopathic tools—whether that’s nutrition, botanical medicine, or medication management—I do somatic counseling before and after ketamine-assisted psychotherapy.”
According to Psychology Today (1), somatic counseling or therapy is a form of body-centered therapy that looks at the connection of mind and body and uses both psychotherapy and physical therapies for holistic healing.
Dr. Whinkin shared that a lot of the mental health providers also use individualized, thorough psychotherapy tools for their ketamine-assisted psychotherapy patients. “I think that’s part of what really sets us aside at the AIMS Institute—that integrative model piece,” she added. “I want to emphasize that we use ketamine and ketamine-assisted psychotherapy as another tool in a pretty rich toolbox at the AIMS Institute.”
Dr. Whinkin’s role during the medical evaluations is to make sure that ketamine is safe to administer to clients. “I do some of the mental health evaluations to make sure—to the best of my ability—that I can vouch that this will help and not harm our clients,” she said. “We’re very serious about making sure that patients are in the right place and that we can give them the care that they need.”
The third panel presenter and team member, Madeleine Turner also discussed her role at the AIMS Institute as a licensed Mental Health Counselor and one of the therapists in the ketamine-assisted psychotherapy program. “Most of my clients have come to me after they’ve done their medical evaluation,” said Turner. “For most of the clients that I work with who are primarily addressing anxiety, depression, and trauma, I find that ketamine-assisted psychotherapy can help them to move through blocks that in ordinary talk therapy we could just be circling around for months, if not years. People are very good at avoiding their own problems, especially if it’s something that is just too painful to confront in an ordinary state of consciousness.”
Turner shared that what she discovered with ketamine-assisted psychotherapy was that people can approach difficult thought patterns, difficult experiences, or traumatic experiences in a way in which they are removed from it. “They can look at it in a more objective way where they are no longer immersed in the pain of the experience, but they can reconcile these experiences. They can lay to rest some of the traumas that they’ve experienced,” she said.
Turner also discussed the various tools she uses in her therapy sessions. “I do a lot of inner child work with my clients, and I found that ketamine is really helpful at reconnecting the adult self with the child self,” she stated. “A lot of my clients work with revisiting the traumatic experience and taking their past self by the hand, being that safe person to escort them to safety, to bring them to a place where they are no longer stuck in that trauma.”
Jungian psychology, created by Swiss psychiatrist Carl Jung, also plays a role in Turner’s work. She explained that Jung’s work ties in really well with psychedelic assisted therapy because it’s all about diving into and exploring the unconscious. “It’s seeing what are those barriers and blocks that are keeping us stuck, what are those patterns that we continually are repeating and reliving that are perpetuating the physical and emotional pain that we are holding. It offers an opportunity to identify these narratives and to rewrite them,” said Turner.
In addition, Turner said imagery has a big role for patients and she has found that tarot can be another tool to help explore and uncover things in the unconscious. “My work with ketamine therapy and in tarot is interpreting these images with the clients, but it’s very much a client-led process. So, I’m not telling them, ‘You saw a house, and this is what the house means, and this is what you need to do.’ It’s very much, ‘What does this house represent to you? What did it feel like to be in this place? If we’re looking at just an image on a tarot card, what is this evoking in you? What sort of emotional experience? What in the image is standing out to you that you’re seeing that is important?’ I may see a completely different picture when I look at this image, but it’s not my unconscious that we’re looking at and exploring,” said Turner.
Another tool that Turner uses in this format is exploring dreams and dream work. She explained that for a lot of her clients, especially clients with a lot of trauma, they may use cannabis or other substances. They may be taking pharmaceuticals that help them sleep. For example, patients with post-traumatic stress disorder (PTSD) can have a very difficult time with sleep and nightmares. A lot of these nightmares can be flashbacks of reliving the traumatic experience, but we need sleep to heal. “I’ve found that for a lot of my clients with trauma, as they’ve been doing the ketamine-assisted psychotherapy process, they start to dream again, and these dreams are no longer nightmares or flashbacks,” said Turner. “They’re able to move forward and approach other issues in their life that may not have been as intense as the trauma, but are still significant and are still things that they need to address to move forward and find healing.”
Turner has also tried a new model of an approach to eye movement desensitization and reprocessing (EMDR) called Jungian Advanced Motor Processing (JAMP). She explained that this modality uses bilateral stimulation, both visual and auditory, along with affirmations. “We get to the root of the complex, the trauma, or the narrative that is perpetuating and keeping the client stuck, and we have an opportunity to rewrite and change this narrative,” she explained. “I find that for a lot of clients this can be difficult if there are really tall barriers built up. This modality can be more effective when people have already had some experience with ketamine therapy because it’s broken down some of those walls and we have a door that we can get into the unconscious now.”
Turner added that these practices apply to patients with anxiety and depression as well. “I’m seeing more and more in the clients that I work with that treatment-resistant depression and anxiety, a lot of it does go back to unresolved issues from early in life. Typically, it comes from childhood,” she said. “Ketamine can help to bring you back to that place where that wound originally occurred and start to heal, start allowing a scab to form. There may still be a scar from this wound, but we’re able to approach it in a way that we’re not digging in—we’re not pouring acid on the wound any further.”
A Brief History on Ketamine
How did we get to a place of using ketamine for this type of treatment? During the panel, Dr. Whinkin shared some background on ketamine as a tool. Ketamine has been legal for prescriptions since the 1970s and it is commonly used in anesthesia medicine. Dr. Whinkin said that there is a lot of data about using ketamine and other medications and it turns out that it can be a safe option for patients who need to continue medications for either physical health or psychotropic medications for their mental health. Dr. Whinkin explained that from a medical perspective there are at least two known mechanisms of action in which the drug’s antidepressant effects are particularly rapid. One is as NMDA (short for N-methyl-D-aspartate) receptor antagonists and the other is that it promotes brain-derived neurotrophic factor (BDNF).
“I usually describe it to my clients as kind of like you’re raking the garden that you have in your mind and then adding some fertilizer,” said Dr. Whinkin. “BDNF really promotes neurogenesis and what that leads to is synaptogenesis—creating new neuronal connections in the mind.”
According to Dr. Whinkin, what’s interesting about ketamine and ketamine-assisted psychotherapy is that there’s a biomedical understanding about how it achieves rapid antidepressant effects, rapid openness as well as access to hope and different thought processes. But, she added, there is also this hugely important experiential aspect that we then integrate with psychotherapy. “I kind of see it in and of itself—it’s an integrative therapy,” she said. “At the AIMS Institute, the work we’re trying to do is to put that in context in terms of what the patient or client individually needs and what healing looks like for them.”
With Dr. Whinkin’s garden metaphor, she stressed that the integration piece is extremely important as well as other medical follow up in terms of what botanicals are being used (for example, cannabinoids or nervine herbs) or other behavioral changes and lifestyle medicine. “The seeds that they’re planting on that fertile ground is an act of them harnessing a new opportunity for new things to grow as they move forward,” she said.
What Sets the AIMS Institute Apart?
“What sets the model used at the AIMS Institute apart from others is that we really wrap psychotherapy around our psychedelic-assisted process,” said Dr. Draisin. “We use intramuscular so that clients can move around, have space, and expand themselves. We have mats that we put on the floor, so if they want to they can roll on the floor—I’ve had people do yoga in the middle of their ketamine journeys. We have chosen to use intramuscular because we don’t want our clients to feel that they are in a medical type of environment where they are connected to tubes.”
Dr. Draisin added that another aspect that sets AIMS apart is that each practitioner brings their own version of extra modalities. “Madeleine Turner brings in dream work and tarot; I bring art psychotherapy,” she said. “My master’s is in art psychotherapy and so my clients will actually create drawings prior to their journey and then they will create artwork after their journey.”
Dr. Draisin explained that oftentimes the use of artwork is to remind patients of the images that have come up for them, especially when they process that in integration. “I really enjoy using their artwork as an integration tool. It’s also something that is tangible and it’s something that’s permanent so that whenever they want to recall those images or that feeling from that journey, they can go back into their journal and they can examine that artwork,” she said.
The AIMS institute also holds their sessions as a series. “We do at least a series of three ketamine journeys with our clients,” said Dr. Draisin. “With the artwork, you can look and see the changes in that artwork over the different series of their KAP journey. It’s really cool because again, it’s a permanent reminder for the client of the change that they’re making through the ketamine journey.”
Dr. Draisin also does a lot of end-of-life work at the AIMS Institute, where they work with the director of the hospice center in Washington. She explained that they recently recently collaborated with a hospice team to provide an end of life ketamine assisted psychotherapy session, which to her knowledge, was the first time hospice paid for a psychedelic journey in a hospice center. “It was the coolest thing I’ve ever experienced—taking a client in their hospice bed on a journey with the director of the clinic coming in and out, just like overjoyed at being able to see this client begin to accept death,” said Dr. Draisin. “We’re working on writing that up for publication—about that experience of working with hospice because everyone who’s dying deserves this opportunity to have an end-of-life experience with psychedelics. That’s just my soapbox because I’ve seen it with my own eyes.”
Dr. Draisin shared that the gentleman that they did the journey with died two weeks later, and it was really a beautiful experience to be able to have done that for him. “Prior to that, he was not accepting death. After that, he was in, I would say 80% acceptance of death,” she added.
Legal Battles and On-Going Research
The AIMS Institute is also involved in lawsuits to get better access to psychedelics, particularly for end-of-life care. They are currently involved in a suit against the US Drug Enforcement Administration (DEA) under the right to try for end-of-life with psilocybin.
Part of the hang up with the DEA is the need for evidence to suggest alternate uses for these drugs. That’s another avenue that the AIMS Institute is working hard on addressing. “Research goes hand-in-hand with our lawsuit against the DEA under the right to try,” said Dr. Draisin.
“We are just building more and more evidence to provide to the DEA of why we should be able to try this with our patients.”
The staff at the AIMS Institute are doing research on their clinic through institutional review board (IRB)-approved prospective clinical outcomes studies to evaluate the safety and effectiveness of their therapy programs (2). They ask all their patients to participate. Dr. Whinkin is currently studying the outcomes of their ketamine-assisted psychotherapy, which is part of two concurrent five-year long prospective outcome studies. One is called the AIMS Medical Outcomes Study (AMOS), and the other is called the AIMS Cancer Outcomes Study (ACOS). “These studies allow us to track how well our clients are doing overall in terms of their concerns related to either having cancer or having other complex medical conditions,” said Dr. Whinkin.