Ketamine-Assisted Psychodynamic Psychotherapy.
Psychodynamic psychiatry December 1, 2023 John G Cottone
A 54-year-old woman with multiple traumas and a recent diagnosis of primary lateral sclerosis (PLS) had relied on extreme idealization of important people as a primary defense mechanism. During a ketamine-assisted psychotherapy (KAP) session in January 2023, she discovered the consequences of this tendency, including creating double binds for idealized individuals and fomenting conflict between them. She also recognized unconscious secondary gain from escalating physical symptoms—resolving conflicts among those she idealized—which increased symptom exacerbations during conflicts. After this insight, she avoided extreme idealization and experienced fewer physical symptom exacerbations. Achieving a psychedelic trance state appeared necessary for the treatment's success.