Considerations for a Successful Ketamine and Psychedelic Practice

As some may know, I support physicians with the establishment and growth of their integrative medicine and psychedelic therapy practices.
At SXSW this year, in a panel discussion about Canada’s contribution to the field of psychedelics, we discussed the evolution of ketamine clinics across North America. I thought to then develop this into a list of 10 things to consider when building a successful and ethical psychedelic therapy practice. This list is a little more geared towards clinical models, and encompasses patient care, the practice as a business and the team itself.

In this clip from SXSW 2024, I describe what I think are some crucial considerations for a successful ketamine/psychedelic practice.

Here we go!

1. Preparation and Integration: to foster a receptive and resilient state of mind
   These therapies require adequate preparation, especially for those who haven’t had an experience with psychedelics. Even with adequate preparation, these experiences can be challenging to navigate, where novel sensations and even intense feelings of joy can be destabilizing to some. It is crucial to take the time to equip your patients’ mindset to align expectations, manage overwhelming moments, and engage productively with these powerful substances. 
   Integration therapy sessions following ketamine sessions are also necessary to help individuals make sense of their experience and apply their insights to their everyday lives. Integration ensures safety and stability. Consider integration an opportunity to help them translate new insights into action and create a plan for a path forward. 
   An example of a patients experience would be:
   Initial consultation > Preparation > Ketamine Session > Integration (<72h)

2. Establish your identity: Is your practice medical or wellness oriented? What’s the difference?
   People pursue psychedelic-assisted therapy for diverse reasons, ranging from situational yet challenging issues to more severe, treatment-resistant diagnoses. Consider who you aim to serve: Are you focusing on individuals seeking to break through personal barriers and achieve greater well-being, or those grappling with more complex disorders? And, are you prepared to support patients with complex medical histories requiring a nuanced understanding of both their mental and physical health conditions?

   With conditions like cancer, traumatic brain injury (TBI), and even chronic headaches, treatment becomes more complicated and effective therapy for such cases demands a team skilled not only in mental health, but also in the specifics of these underlying conditions. Managing pharmacotherapy and drug interactions becomes critically important. If you intend to address the mental health needs of patients with complex medical profiles, then you should structure your psychedelic therapy practice more like a medical practice. This approach will also influence how you build your clinical team and define your practice’s scope and capabilities.

   This segways well into my next point.

3. There’s no such thing as a psychedelic doctor! But we do need therapists and providers with different areas of specialty
   Whether or not you plan to provide care to very medically complex patients, having access to practitioners with varied specialties and expertise is important for a patient’s success. There’s no such thing as a psychedelic doctor! The expertise and skills your clinicians possess, notably the therapists, are going to make a world of a difference for your patients.

4. Do not over protocolize treatment and care
   Having robust and ethical protocols for a variety of diagnoses as well as for safety is important, but do not try to standardize everything. This work is deeply personal and requires individualized, high touch care. It is just as important to build in flexibility to allow for unforeseen responses, changes, and even set backs.

5. Offer adjunct services for holistic patient care, but also for your business
   One modality of care is rarely sufficient. We require varied healthy practices and modalities of care to ensure we are not only integrating the therapeutic experience into our lives, but also building sustainable habits that will serve us well passed the end of a psychedelic treatment protocol. I’m talking about nutrition, supplementation, body work, exercise, breathwork, journaling etc. This isn’t just an amazing way to support your patients, but it’s also going to provide your practice with other revenue streams, as you can partner with providers who offer these services, and even offer some of these in house (ie IV supplements, acupuncture, classes, workshops, etc).

6. The client/patient journey: every detail matters
   From the initial interaction with a staff member to the moment patients first step into your practice, this journey shapes their perception and ultimately, their level of trust and comfort with the care they receive. Each touchpoint, whether it's a phone call, the ambiance of the waiting area, or the personal demeanor of the healthcare provider, plays a crucial role in reinforcing the practice's commitment to patient care and safety. Ensuring a positive, reassuring, and seamless experience can significantly impact the effectiveness of treatment and patient satisfaction.

7. The collective is just as important as the individual
   Keep in mind that psychedelic-assisted therapy is not just about novel drug therapy. It is reshaping patient care by transcending the bounds of traditional drug therapy for mental health. This approach emphasizes the importance of pairing therapy and integration with pharmacological support. We have an opportunity to evolve the conventional model which typically only involves therapist and patient/client. By inviting a client’s loved ones, family, and broader community into the process, we are ensuring more successful outcomes.
   Offer community and group services, as this can also grow and develop your caseload by creating more accessible and affordable sessions.
   And because community plays a vital role in healing, wellness, and the human experience, offer education, workshops, and social events to the public. This might also inspire people to reach out for a consultation.
   (The psychedelic community is a bubble, we have much work to do to educate others about the safety and efficacy of these treatments, and how to integrate them into a journey to healing). 

8. Case reviews: Do it often
   Case reviews are essential for enhancing safety, improving patient care, and leveraging team expertise. This process supports ongoing refinement of therapeutic methods in response to evolving research, insights, and outcomes. Furthermore, engaging the whole team in these reviews harnesses diverse perspectives, enriching treatment approaches and fostering a collaborative, learning-focused environment. This comprehensive approach not only optimizes patient outcomes but also enhances the team’s relationship.

9. Peer 2 Peer Education: Lead from an abundance mindset
   Whether or not you work at the same practice, involve your peers to share best practices, workflows, and engage in training. There is a wealth of knowledge to be shared. Do not gate keep. It is not in the best interest of your patients, your team, or the general health of your practice. These are new frontiers and we have much to learn from one another. Do not be shy to ask each other questions! Get creative with your education and host fun peer 2 peer learning experiences. Educational workshops, whether in person or online, can be free or can require a reasonable fee to compensate for time investment and expertise. Offering training to the provider community can be an excellent revenue stream as well.

10. It takes a village! Prioritize provider partnerships 
    #TherapyAwareness through lunch-and-learns, webinars, symposium, educational materials, and resources!
    We have a duty to educate other healthcare providers who aren't involved in psychedelic medicine or research to demonstrate how psychedelic therapies can complement traditional treatment approaches. Primary care physicians and pharmacists are pivotal in guiding patients—when patients are unsure of their options, these professionals can suggest alternative therapies and direct them to reputable providers like you. There is a great opportunity with specialists as well. Think of oncologists and palliative care physicians, for example.

    Building strong relationships is essential. Start by introducing yourself—perhaps bring along some coffee or snacks to break the ice. Arrange a time to discuss the potential benefits of psychedelic therapy, armed with the latest research, educational materials, and your business cards. If they're receptive, consider hosting a lunch-and-learn for their team to provide deeper insights and keep them informed about new developments. By consistently updating them and sharing valuable information, you'll establish yourself as a reliable expert in a field they may not be familiar with, making it easier for them to refer patients confidently to you.
    
    This outreach extends beyond physicians—consider connecting with therapists, counselors, physical therapists, and bodyworkers as well. Cultivate a broad and robust network founded in trust, ensuring that there is mutual support amongst a diverse range of healthcare professionals.

BONUS: Collect data, measure outcomes, and contribute to growth of this field.
If you are motivated to publish your findings, there are many fruitful collaborations that await you. Your publications will contribute to this rapidly evolving field and also bring you recognition, elevating your practice. You can even enroll as a trial site, giving your patients access to groundbreaking therapies through a clinical trial model.
And if you choose not to conduct formal research that’s ok! But tracking the progress of your patients will help you offer them better care, and make your practice stronger and more successful!

I hope there’s at least one item in this list that inspires or helps you. I’d love to hear from you if you have additional insights to share, or if you wish to go deeper into some of these points.

Feel free to reach out through the contact page or write to me directly at look@beyondthebench.life