Patients can become more self-aware of old and rigid negative beliefs and start to question whether these beliefs are helping or hurting them now. They can confront past traumas or difficult emotions and experience a positive shift in their perspective about it. Not all information revealed during a ketamine treatment is understood immediately; however, observing and making note of it in a non-judgmental way is helpful during the integration process.
In our practice, we have begun to look at symbols and images with patients during the integration process to help develop creative imagination, explore new insight and perspectives and to make changes in life. This methodology was developed by Lauren Z. Schneider, MA, MFT and is part of a larger psychotherapeutic practice known as Tarotpy™. Dr. Wolfsohn along with several other ketamine psychotherapists affiliated with her practice have learned and become certified in this modality from Lauren to strengthen our own inner resources which indirectly complements the work we do every day with ketamine patients.
We have found that using symbolic imagery with patients can deepen a person’s ability to understand the information that is revealed during ketamine treatments. This often helps them to talk about difficult issues and work towards finding creative solutions.
The images used often come from Tarot cards, soul cards, oracle decks or other playing cards used as psychotherapeutic tools; not as a means to predict the future. If you have read this far down the page, hopefully you have noticed some examples of Tarot and oracle cards that have been used with patients already for integration. These digital images portrayed are for educational purposes. For more information about Tarotpy™ please ask when you come in to the office or visit: dreamsandtarotpy.com
Integration conversations using picture cards
Both ketamine therapy and Tarotpy™, when used independently, are potent tools to awaken the imagination and gain new insight and perspective. We have found that using the two modalities together within a short period of time can help patients achieve greater self-awareness and a greater capacity to discuss difficult issues with therapists and/or loved ones.
Here are some examples of a short exercise I have done either before or after ketamine treatments or during a separate integration appointment with patients. Patients were asked to choose a caption to describe each problem or idea that was on their mind at the time of this activity. The short version of this exercise usually involves looking at 1-3 images. Patients were given multiple card decks to find an image that best fits above each caption. Cards were laid out in whichever order or shape they wanted. Patients usually selected their cards after looking through different images within the decks; however, cards can also be shuffled, randomly selected and placed face down before looking at them. The images were discussed in whichever order the patient wanted; usually beginning with the card that they were drawn to the most.
Patient One
Coming out of Ketamine
My Depression
Patient Two
During this patient’s initial ketamine treatment series, he noticed he was becoming more confrontational during visits with his elderly and dying father to the point that he would explode and stop talking to him for several days at a time. Following these arguments, the patient would also binge drink and spiral down into a path of guilt and self-loathing. We decided to look at some images to help describe what he was feeling and what he could do to make things better. In this case, the images were chosen first and the captions were created second. We looked at two images “Anger” and “Childhood” before deciding to choose a third image to help the patient come up with a possible solution.
On Childhood… the patient described the man with the swords as someone who is scared and hiding in the dark. He said “the man in the image is trying to protect himself with armor and swords.” The patient described his childhood as one big lie that he had to protect himself from. Growing up in a small town, his parents were public figures in allaspects of the community. To the outside world, they painted a picture of the perfect happy family; however, inside the home was a different story. From a very young age, his father would ask him to keep secrets from his mother about his extra-marital affairs and poor spending on multiple bad investments. Everyone in the community knew aboutit except his mother. The patient was not allowed to express any negative emotions about his father’s behavior without repercussion. His father had a bad temper and there had been multiple instances where verbal altercations became physical.
On Anger… “Every time I see a dad out playing with his son, it makes me angry and I want to hit something. I am jealous of how happy they look. I feel like a horrible person for even saying that. I hate my dad for what he did to our family. I don’t think he even realizes how much he screwed me up. It is because of him that I don’t want to ever have kids. I would not be a good father.”
The images used did not necessarily show the patient anything he did not already know;however, with the help of using imagery right after a ketamine treatment, he seemed more willing to discuss his recent behavior toward his father and engage with the process of understanding the source of his anger and shame and to start to come up with ideas for what he could do about it.
On Closure… I prompted him to choose a third card that could represent a way to approach his father about his anger. He chose from a deck that actually has two decks, one with words and the other with pictures. He chose to combine the “Apology” verbal card and the watercolor image of two people hugging to represent what he needed mostfrom his father right now. He wanted his feelings to be validated and to hear some form of an apology from him. The patient continues to work with his therapist on healing this parent-child relationship. Interactions with his father have gradually improved. There have been no recent episodes of binge drinking.