The Importance of Setting Intention in Ketamine Therapy
Let’s hold space for a fundamental and internally incongruent truth regarding the management of depression: insofar as it can engender a deep sense of vulnerability seeking care for depression often comes with relying on others and on external resources to contain the vulnerability and provide external care for an internal experience. Medications, therapy, community, and (of course) ketamine/esketamine all come from outside of us to treat and soften a deeply personal struggle. Sitting on balance with this extrinsic source of care is the individual’s own reliance on intrinsic resources and self-regard. How do I approach me. This question is complicated as so much of what we regard as self is impacted by depression (not to mention other psychiatric/psychological conditions, as well). It can be difficult to identify the stronger, more resilient, and most compassionate parts of ourselves when set upon by conditions that challenge our sense of autonomy and competence.
As a physician, my training has been predicated on my ability to resource modalities to suggest, prescribe, and provide to patients to treat and (hopefully) resolve episodes of psychiatric infirmity. Implicit to my training has been a narrative thread of my own indefatigable ability to approach illness and quash it. This understanding (in no doubt generated as a compensatory belief to manage the sometimes awful uncertainties of “doctoring” and the truth of my own fallibility), not surprisingly, falls short. Just as patients are looking to ketamine and esketamine to open new perspectives, I admit that providing these medications has opened my mind to a more balanced approach to wellness – to an approach that emphasizes the role of self-activation and self-directed care in the management of what can seem like intransigent illness.
What is Setting Intention In Ketamine Therapy
In treatment with ketamine and esketamine, we activate the self-principle by “setting intention.” This amorphous request can be confusing and it is not always clear what the provider is intending to instruct or what the patient is supposed to do. First and foremost, suggesting to someone undergoing a ketamine or esketamine course of care to “set intention” is, at its core, a request that the person choosing to avail himself/herself/themselves of this treatment take ownership of the experience and participate in it. Rather than be in passive receipt of treatment, we begin the ketamine and esketamine process by setting a frame of affirmation that a person has the capacity to be his/her/their own agent-of-treatment. Anathema to so many elements of my own training, we begin care by acknowledging that medical reach only goes so far and meaningful change is best catalyzed by acknowledging that the person having the experience of change should direct it. Step 1 – affirm that, even in the deepest depressions, a person seeking care is a person who has hope (buried though it may be), resilience, tenacity, is choosing (an active process!) a path to get to better, and self-actualizing that process. Step 2 – acknowledge that setting intention can help provide some guiding principles to the otherwise open space of a psychedelic/psychedelic-like experience.
People coming to care often feel lost as to the particular direction to take to find passage to relief. Why else seek the help of another? It is important to acknowledge this as provider and patient work together to find the voice of the intention to be set. I always start out speaking with patients about setting a global intention of curiosity. The subjective experience of being under the throes of ketamine and esketamine can be wonderous, bizarre, anxiety provoking, stimulating, and so on. If no other intention can be found, then a desire for discovery, of seeing what’s behind the next corner, and of welcoming novelty is a great first platform. Engaging curious experiences requires an implicit belief in one’s own competence (i.e., to manage with strange new things) and capacity for wonder. These aspects stand in sharp balance to the nihilism and self-degradation that can sometimes come with depressions. In this way, the intention of curiosity not only helps a person set a frame for engaging the ketamine/esketamine experience, itself, but the adoption of it as a principle serves to reinforce important self-attributes that may have been challenged by the depression.
The process of intention can continue on: a desire for relaxation, a desire for space from one’s own thoughts, etc. At times, these more open-ended intentions can introduce a person to the experience and the phenomenon of the ketamine/esketamine experience. For those who are interested in a different, more specific sort of intention we recommend cultivating certain questions or directives to put into the experience. Without wanting to impose particular questions (as these should come from the person’s own production, highlighting the personal nature of intention and also the goal of activating self-directed care), it has been my experience that people will look into difficult relationships to see if they can be understood in a different light, for example. Some of ideas of intentions:
· Looking into what motivates them and to what end.
· Seeking creative solutions to manage habituated behaviors of depression.
· Emotional catharsis.
· Practicing mindfulness techniques to engage the experience and learn how to bring this into a daily practice.
· Thinking of ways to grow personally, such as improving self-confidence, self-compassion, or exploring new activities.
· Practicing surrender and acceptance.
What a person originally sets as an intention to partner with the experience may or may not be what ends up being the ultimate theme realized at the end of the experience. The ketamine and esketamine treatment experience can foster creativity and facilitate the introduction of other ideas that can absolutely be played with and engaged. Even while the specifics to the intention set can change from beginning-middle-end, taking a minute to pause, set aside mental space to engage the practice of entering into a different state of mind, and affirm one’s partnership with the medicine and with recovery is a strong frame to engage care.
Benjamin Yudkoff, MD, MA
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