What is causing you to sound the alarm?
At first, everyone was excited to be able to work with psychedelic substances and I remain convinced that they will revolutionize mental health. But on the ground, you see that, wow, it’s a powerful tool, which can make people emotionally vulnerable. And you understand that you have to be very careful, select clients very carefully, know their vulnerabilities well and establish a good relationship with them. It sometimes takes weeks or months of therapy before ketamine can be administered safely and therapeutically. But this approach is sometimes less profitable. It is therefore not universally put into practice.
Why do some clinics take risks?
The owners of some companies in this field are business people, investors, not scientists or clinicians. The drug pays off, because buying ketamine costs clinics very little, while psychotherapy takes time. It’s normal for a business owner to try to cut costs and increase revenue. But, in my opinion, the outcome of ketamine treatments often depends on the quality of relationships between clinicians and clients.
At first, money seemed to flow freely and clinics with luxurious decor opened in large numbers. Are ketamine treatments very cost effective?
Maybe in some cases, but probably on a smaller scale. The clinics expected to be lucrative at first, but even Field Trip, which dominated the industry in Canada, closed several clinics. They spent millions of dollars, but there weren’t enough people willing to pay. Here, it’s not like in the United States. The volume is small.
How do they survive?
Ketamine-assisted therapy groups were established. This is a great innovation, because they save costs and because customers can support each other. Security, however, must be taken seriously. Firstly, each person should already be receiving psychotherapy, given that we often end up with serious cases. But this requirement excludes people who are unable to find a therapist, and who would otherwise be paying clients, providing an incentive to admit them anyway. Secondly, having a single therapist lead the group is more economical, but it is far too intense and complex as sessions. I did it with another experienced psychologist. It went very well, but without her it would have been a disaster! A person’s trauma is brought up. One of us had to take care of him, while the other looked after the rest of the group, so that he didn’t start being afraid.
Have the excesses observed convinced you to turn your back on ketamine?
No, instead I just launched a platform called Refuge to reduce risk and support therapists, doctors, nurses and clients in implementing psychedelic-assisted therapy and other healing modalities like mindfulness, somatic therapy and holotropic breathing. I also offer training in partnership with other Quebec organizations and I am a consultant to a training organization in the United States. I really believe in the potential of psychedelics.
Do you share the concerns of the experts cited in our report on Monday?
Unlike them, I think we must make these treatments available to people, even in the private sector, because we have a major societal problem in mental health and an accessibility crisis. We simply have to do it as safely as possible, by educating professionals. But I completely agree that the marketing of some clinics is biased and aggressive, and that offering ketamine to treat addiction is risky. Clinics in the United States allow patients to take them home, which seems insane to me! On the other hand, personally, I agree with the use of ketamine to treat addictions, if we take additional precautions, or to treat trauma. There is a conflict between the medical model, which links treatments to specific diagnoses, and the psychotherapeutic model, which is transdiagnostic, and makes more sense, in my opinion.
What is the impact on therapists?
Working with ketamine can be intense. Therapists in this field must therefore pay careful attention to their workload, receive appropriate training, and seek supervision for weak areas of their expertise. They must also ensure that their client can be followed long-term by another therapist, if they themselves are not available to take care of it. Therapists in this field are at greater risk of burnout, clinical errors, and unethical behavior and ultimately it is clients who pay the price.
Read the first part of this report
Visit the Refuge website