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Ketamine has been recognized as an effective antidepressant for nearly twenty years (Mathew and Zarate Jr. 2016). However, its effects typically do not last longer than a week without repeated administration (Blier and Blier 2016, 31). Research on ketamine-assisted psychotherapy (KAP) suggests that the short-term relief patients experience can be extended when ketamine treatment is used in concert with a therapeutic intervention (Wolfson 2016, 340; Drozdz et al. 2022). Given that spiritual experiences are commonly induced by ketamine (Krupitsky and Grinenko 1997, Krupitsky et al. 2002) chaplains could provide a cost-effective and meaningful intervention for patients receiving ketamine. Additionally, since ketamine is considered within, or at least adjacent to, the “psychedelic” family of pharmaceutical medicines (Dames et al 2022) and is the only drug of this kind that is legal and widely available, this program serves as a model for the burgeoning field of psychedelic chaplaincy.
In 2022, the medical director of the Ketamine/Esketamine Program and the manager of Spiritual Care Services at a community, teaching hospital in Boston, MA collaborated with a divinity school in Cambridge, MA, to launch a spiritual care program for patients receiving ketamine treatment. This Ketamine Integration Chaplaincy (KIC) program attends to the spiritual care needs of patients and supports integration of their ketamine treatment to increase therapeutic efficacy.
This paper documents the training and treatment model developed over two consecutive academic years with Master of Divinity students in the KIC program. The elements of the model include 1) selection of students, 2) shadowing of the prescribing psychiatrist, 3) didactics on the patient population and treatment protocol, 4) individual and group sessions with patients, and 5) individual and group supervision. This paper will also review the chaplaincy competencies students can expect to cover in their training, competencies we suggest will be widely applicable to emerging psychedelic chaplaincy programs.
The patients who receive treatment through the Ketamine/Esketamine Program have treatment resistant depression. Care for this vulnerable population in a novel treatment setting has prompted the following pre-requisites for students applying for placement in the KIC program: at least one unit of clinical pastoral education, coursework in spiritual care and counseling, and field work or research in psychiatric and/or psychedelic settings. Although the locus of spiritual care occurs once patients are enrolled in the program and receiving treatment, students shadow prescribing psychiatrists to understand the full trajectory of the treatment experience prior to working directly with patients. Students shadow initial consultations with new patients, pre-treatment preparation for set and setting, and observation of patients undergoing treatment. In addition to shadowing, the training model includes didactics on the etiology, symptomatology, and treatment options for people with major depressive disorder; the biological mechanisms of the antidepressant effects of ketamine; and ketamine-assisted spiritual care. Following training, students meet with patients in one-on-one sessions over Zoom once a week for the first 2-3 weeks and every other week for the remaining 5-6 sessions for a total of 7-9 individual sessions. Following these individual spiritual care sessions, patients are invited to participate in an 8-session group that meets every other week. Alongside the patient sessions, students meet once a week for one-on-one supervision with a supervising Board Certified Chaplain; once a week with the interdisciplinary integration team made up of spiritual care students, the supervising chaplain, and psychiatry residents; and every other week as a group with the supervising chaplain for spiritual care group processing of patient cases.
The field of professional chaplaincy has not yet articulated the core competencies necessary for chaplains engaged in psychedelic training (Beachy and Petersen 2022). In the KIC program, students develop the chaplaincy competencies from the Association of Professional Chaplain’s (APC) Common Qualifications and Competencies along with KIC specific competencies. APC competencies emphasize non-impositional, non-judgmental, empathic care that respects the diversity of the spiritual and emotional dimensions of a care relationship. These competencies provide a strong foundation for KIC and have illuminated areas where further specialized training is required to attend to the spiritual care needs of patients receiving ketamine. Therefore, additional competencies have been created to attend specifically to the psychedelic experience. These include facilitating the care recipient’s development of their mindset and intention in preparing to receive ketamine treatment; facilitating the care recipient’s cultivation of their physical setting while receiving treatment; providing spiritual care that incorporates a working knowledge of the physical, psychological, and spiritual effects of ketamine; and providing spiritual care that engages a care recipient’s temporary, non-ordinary state of consciousness. This paper explores ways that the KIC program and its competencies may be applicable to psychedelic chaplaincy or psychedelic integration chaplaincy programs, including those supporting patients using psychedelics other than ketamine.
References
Beachy, Jamie, and Rachael Petersen. “Chaplaincy and Psychedelic-Assisted Therapy: Opportunities and Barriers.” *Reflective Practice: Formation and Supervision in Ministry* 42 (2022): 88–102.
Blier, Pierre, and Jean Blier. “Ketamine: Clinical Studies in Treatment-Resistant Depressive Disorders.” In *Ketamine for Treatment-Resistant Depression: The First Decade of Progress*. Springer International Publishing, 2016.
Dames, Shannon et al. “A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression.” *Frontiers in Psychiatry* 12 (2022): 803279.
Drozdz, Sandra J. et al. “Ketamine Assisted Psychotherapy: A Systematic Narrative Review of the Literature.” *Journal of Pain Research* 15 (2022): 1691–1706.
Krupitsky, EM, and AY Grinenko. “Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research.” *Journal of Psychoactive Drugs* 29, no. 2 (1997): 165–83.
Krupitsky, Evgeny, Andrey Burakov, Tatyana Romanova, Igor Dunaevsky, Rick Strassman, and Alexander Grinenko. “Ketamine Psychotherapy for Heroin Addiction: Immediate Effects and Two-Year Follow-Up.” *Journal of Substance Abuse Treatment* 23, no. 4 (2002): 273–83.
Mathew, Sanjay J., and Jr Zarate, eds. *Ketamine for Treatment-Resistant Depression: The First Decade of Progress*. Springer International Publishing, 2016.
Wolfson, Phil. “Opportunities and Strategies for a Ketamine Psychotherapeutics.” In *The Ketamine Papers: Science, Therapy, and Transformation*. Santa Cruz, CA: MAPS, Multidisciplinary Association for Psychedelic Studies, 2016.
Abstract for Online Program Book (maximum 150 words)
The psychedelic dissociative ketamine has been recognized as an effective antidepressant for nearly twenty years. However, its effects typically do not last longer than a week without repeated administration. Research suggesting therapeutic interventions may extend patient relief and frequent patient reports of profound spiritual experiences arising during treatment motivated the development of a novel Ketamine Integration Chaplaincy (KIC) program at a Boston teaching hospital in concert with a local divinity school. The KIC program combines one-on-one spiritual care and group sessions for patients with treatment resistant depression aimed at addressing patients’ spiritual care needs and prolong symptom alleviation. In this paper, we present our training and treatment model, including student selection criteria and competencies, interdisciplinary approach, supervision and didactic models, and structure of patient care. The paper reviews preliminary outcomes from the KIC program’s first two years, pathways for program expansion, and emerging spiritual care opportunities within psychedelic assisted therapy.