FAQs for Therapists
By offering ketamine assisted therapy to your clients, not only will you expand your practice offerings, but you will also allow your clients to continue treatment with you; they will not need to find another therapist and start over!
The age of psychedelic medicine and psychedelic assisted psychotherapy is here! This cutting-edge treatment offers hope to clients who have thus far not fully benefited from traditional treatments.
At Skylight Psychedelics, our physicians medically evaluate every client, and we prescribe ketamine to those who:
1. Meet clinical criteria;
2. Agree to receive ketamine assisted therapy, in their therapist’s office with providers who are certified by us.
At Skylight, we differ from other companies who prescribe ketamine for clients to use at home, alone, without guidance and supervision. Our clients are never alone during a ketamine session, they are with you, their trusted therapist. Many clients who are candidates for ketamine assisted therapy are already engaged in long-standing therapeutic relationships. Preserving continuity of care is critical during ketamine assisted therapy in order to provide the safest, most valuable clinical experience; we do not want clients to have to start over with a new therapist in order to receive ketamine assisted therapy.
Here is how the collaboration works: Once you, a licensed therapist, completes our training course and becomes trained by Skylight, you will be ready to treat clients with ketamine assisted therapy. We will continually be available to you by phone or email with any questions or concerns you may have along the way. Also, you will have access to a bi-weekly zoom meeting held by Skylight where we discuss various ketamine-related issues with therapists.
Should you decide that you would like Skylight Psychedelics to prescribe ketamine to your clients, we will send you a collaboration consent form which indicates that we (Skylight) will medically evaluate the client, prescribe ketamine if deemed appropriate and that you, the therapist, will perform the ketamine assisted psychotherapy in the office with the client.
Once your client is approved for treatment, we will send them ketamine directly from our team of pharmacists. We will only prescribe ketamine to be sent to the client, we never send ketamine to the therapist’s office. It will be up to you and your client to schedule the treatment sessions. Skylight Psychedelics does not support the use of ketamine in an unsupported environment.
You and your clients will have unlimited access to Skylight via email or phone and our partner pharmacy is also readily available to answer any of your questions about the medicine itself! You will get to know our staff and we will be continually available. We value human connection!
Skylight is owned by medical doctors! We are a physician owned and operated organization, and our mission is to get affordable ketamine assisted therapy to clients who are likely to benefit. Our founding physicians have extensive training in psychedelics, and each doctor operates their own ketamine practice.
At Skylight, we understand that our clients have established long standing relationships with their therapists, and this is who they should continue to work with while doing ketamine assisted therapy. Unlike our competitors, we do not support the use of ketamine in the home, alone totally unsupervised. We are also the only group that has psychedelic integration yoga and our own virtual reality program all in-house.
The team at Skylight is also here for you, if you have an issue, question or concern reach out and a live human will get back to you [email protected]
There are no robots here!. We will be hosting in-person retreats in the coming months in the foothills of the Rocky Mountains in Colorado!
In order to ensure our clients are guided by experts in mental health at this time we only work with those therapists with one of the following degrees.
Ketamine is a dissociative anesthetic that has been used since the 1970’s in many different ways. Due to its excellent safety profile and the fact that it does not suppress breathing, Ketamine was used in war times as an anesthetic to help with trauma on the battlefield. It is used extensively in emergency rooms and it also has a role in veterinary medicine. Ketamine is most often used in hospital settings by anesthesiologists during major and minor surgical procedures as an anesthetic. Recently, lower dose (subanesthetic) ketamine has shown great promise in the treatment of mental illness, most notably depression and suicidality.
Ketamine is one of the safest and most widely used anesthetics in the world according to the World Health Organization. Researchers at Yale have been studying low-dose ketamine since 2000 in controlled clinical settings for patients with severe depression who are unresponsive to other antidepressants. In several studies, more than half show a significant decrease in depression symptoms in 24 hours and approximately 4 out of 5 went on to find significant improvement.
Ketamine is now used extensively for many chronic mental illnesses such as difficult-to-treat depression, suicidality, anxiety, anxious bipolar depression (without mania), post-traumatic stress disorder (PTSD), obsessive compulsive disorder, and chronic pain. Many clinicians, including us at Skylight Psychedelics, classify ketamine as a psychedelic, however it is not a classic hallucinogen like psilocybin, the compound found in psychedelic mushrooms, also with many promising mental health benefits.
If you already received certification in ketamine-assisted therapy you do not need to pay for our training program, we will gift this to you, but we do require our collaborating providers to take our training course as there are Skylight specific things we want to ensure you know.
Any client of Skylight Psychedelics who identifies as having suicidal ideation will be referred to a setting in which either intravenous (IV) or intramuscular (IM) ketamine in conjunction with supportive psychotherapy will be available. There is data to support the use of ketamine in these ways for suicidal clients.
Theophylline or Aminophylline – can lower seizure threshold.
Benzodiazepines, opioid analgesics, or other CNS depressants (can cause profound sedation, respiratory depression, coma or death, they can also interfere with the mental health benefits of ketamine).
Lamotrigine (trade name Lamictal).
Sleeping aids and sedatives such as Ambien, Benadryl, Remeron.
There are other medicines that may interact with ketamine and therefore your clients medications have been thoroughly reviewed by Skylight Psychedelics physician team prior to their prescription being authorized.
We also recommend clients refrain from using the following substances during treatment as they can interfere with the benefits of ketamine and some can lead to dangerous interactions:
All Illegal substances such as cocaine, etc.
Patients have an agreement with Skylight Psychedelics that they will not use the above substances during ketamine treatment weeks. We do not recommend mixing ketamine with other medicines including using ketamine with psilocybin, MDMA, Kambo, DMT, ayahuasca, mescaline, iboga, etc.
Combining medicines has an increased risk of adverse events, notably hypertension, and is not recommended unless the combination is being studied in a clinical trial. Further, if a client is on a benzodiazepine we may ask them to taper off under the care of their prescriber prior to a prescription for ketamine being authorized. Rapidly tapering off benzodiazepines is NOT recommended and can result in severe withdrawal and potentially death.
Ketamine hydrochloride, trade name Ketalar, is a Schedule III controlled medicine that is FDA approved for general anesthesia in intravenous or intramuscular formulations. Ketamine is a racemic mixture, made up of two molecules that are mirror images of one another, R-ketamine and S-ketamine. Ketamine does not have FDA approval for any psychiatric illness.
S-ketamine, derived from ketamine, called esketamine, trade name Spravato, was approved in 2019 in nasal spray form, for treatment resistant depression in adults with major depressive disorder with acute suicidal ideation or behavior, in conjunction with an oral antidepressant. Most ketamine being used for mental illness is being used legally by healthcare professionals off-label. Sublingual ketamine used by Skylight Psychedelics is off-label.
A small percentage of clients will not respond to ketamine, even at higher doses. Additionally, some clients with rigid personality structures, including those with severe OCD or personality disorders and possibly those with profound PTSD, won’t be able to go into a trance-like state and may find it challenging to maintain the benefits of the treatment experience, if they find any relief with the experience at all. We don’t yet know enough about who won’t benefit and recommend attempting this treatment if no contraindications exist as the medicine is incredibly safe and well-tolerated.
Skylight Psychedelics uses a specialized sublingual formulation of ketamine that is rapidly dissolving with an onset in less than 3 mins. Our protocol was formulated by a multidisciplinary team of physicians board certified in internal medicine, anesthesia, and psychiatry in conjunction with doctors of pharmacy. Our protocol was developed with client safety and the medicine’s efficacy as top priorities. We provide our clients with client specific dosing based on their weight and body mass index (BMI). Our formulation is associated with less nausea and has a pleasant taste compared to other alternatives.
We chose to work with sublingual ketamine as, not only is it safe but it reliably promotes communication between client and therapist while the client is in a trance-like state. It also allows people to tap into difficult states of mind with decreased fear. Further, it affords clients the ability to integrate healing after the acute phase of medicine starts to wear off. Our team at Skylight Psychedelics believes that the trance-like state is an ideal state of mind for psychotherapy. We find that most often the peak experience on the medicine lasts approximately 25-60 mins and the medicine becomes much less intense after this initial wave.
The most common side effects from ketamine include:
- Blurry vision
- Diminished ability to see/hear/feel
- Dry mouth
- Lip tingling and/or heaviness
- Elevated blood pressure
- Elevated heart rate
- Elevated intraocular or intracranial pressure
- Loss of appetite
- Nystagmus (rapid eye movements)
- Slurred speech
- Synesthesia (overlapping of the senses, for example seeing sounds)
- Dissociation (feeling out of body)
- Tinnitis (ringing in the ears)
- Hypoesthesia (partial or total lack of sensation in a body part)
- Lethargy (fatigue)
- Sedation (somnolence)
- Vertigo (room spinning)
- Feeling drunk
- Rarely a client can experience a feeling of paralysis
Note: There have been no cases of persistent neuropsychiatric sequelae, medical effects, nor increased substance abuse in clinical practice.
Note: Skylight Psychedelics firmly believes that the dissociative and/or psychedelic effects of ketamine treatment are a critical piece of the therapeutic process and should not be avoided. We believe this part of the experience can be extremely beneficial to our clients when supported in a trusted healing container.
Many people in a trance-like state from sublingual ketamine often describe positive feelings. This has been described as euphoria, empathy, forgiveness, calmness, total relaxation and reduced mind chatter. With intravenous and intramuscular dosing clients more often report dissociative effects and can experience the feeling of falling, flying, feeling out of their body, they can relive a past events, they can feel paralyzed, they often cry, laugh, smile, breathe very deeply and quickly, moan, and rarely, some can kick and scream. Each session is completely different from the one prior and also differs significantly from client to client. There is no way to predict what a session will be like for someone.
- Experiences with IV or IM Ketamine can often lead to any one of the following and more:
- Feelings of gratefulness, calmness, acceptance
- Feeling of flying
- Feeling of falling
- Seeing God
- Feeling out of body – looking down on oneself
- Feeling of being reborn
- Re-experiencing past events, including traumas
- Ego dissolution/Ego loss – a complete loss of one’s sense of self or self-identity (less likely to occur with sublingual ketamine)
- Falling asleep
- Feeling of paralysis is a rare occurrence, but possible
Ketamine-induced cystitis, a bladder pain syndrome due to chronic ketamine use is associated with ulceration of the bladder lining and chronic inflammation. This condition is typically found in people who abuse street ketamine. Studies have demonstrated that certain concentrations of ketamine were toxic to the cells of the bladder wall, causing damage to the urinary barrier. Further there is data to suggest that some factor in urine (rather than something affecting the whole body) is responsible for the ulceration–most likely ketamine itself or its metabolites. Symptoms include pelvic pain, frequent urination, urgency, hematuria (blood in urine), nocturia (frequent urination during the night) and urinary incontinence. This condition is often reversible once the medicine is stopped. For clients who develop this condition complete ketamine cessation is recommended.
Ketamine tolerance can also develop. Concerns arise over addiction but when used at low doses and with infrequent dosing models, as used in mental health, this is less likely to occur. Neurotoxicity has been identified in ketamine abusers and rodents impacting brain structure and function and reports of liver toxicity have also been found in the literature.
The duration of benefits is variable and depends a lot on why the client sought out ketamine to begin with. Many clients will return for further courses of treatment, especially those with long standing depression, failing multiple medications.
Ketamine is routinely given in sterile clinical settings for various mental health indications. Oftentimes there is no therapy provided with this service and clients are left trying to make sense of the experience and to navigate challenging experiences on their own. The lack of therapy short changes people seeking ketamine treatment as they are less likely to be able to integrate the experience into their everyday life.
In 2015, Stephen Hyde published a paper Ketamine for Depression, demonstrating ketamine’s ability to be used successfully via routes other than intravenous and intramuscular, promoting easier use outside of a clinical setting. Incorporating psychotherapy into ketamine treatment sessions was first described by Wolfson and Hartelius in 2016. By the mid-2000s many clinicians were using ketamine in conjunction with therapy. It has become increasingly more apparent that prescribers aren’t required at the bedside, but someone should be there to guide and hold space for clients on ketamine and that’s you.
When used for mental health, ketamine is typically given six times over a 2-3 week period. Some patients may require booster doses, typically 4 weeks or more from their last session, but this should not be a blanket recommendation for all patients as many may not need additional doses.
After six sessions a patient may reach out to Skylight Psychedelics for further ketamine doses if they had further trauma or other setbacks and an additional six sessions may be recommended. Again, we do not have patients on a standing “autopilot” schedule without checking in with them first to ensure they need further treatment. This is a very client specific medicine and the need for booster doses should be determined on a case by case basis by the prescribing physician with input from the patient and their therapist.
If you aren’t sure if your client meets criteria, direct them to register with Skylight here: SkylightClientPortal
Once registered, they will receive an online questionnaire to fill out. Once that is submitted, we will let them know after they complete our online questionnaire.
1- Interested clients should register with Skylight here: SkylightClientPortal fill out our online questionnaire and our physician team determines eligibility.
2- We contact eligible clients and schedule an appointment to connect. All non-eligible clients will receive an email conveying non-eligibility.
3- We confirm the client has a therapist who is trained in psychedelic-assisted therapy either via our training program or with the Integrative Psychiatry Institute or the California Institute of Integral Studies.
4- The client and therapist will schedule the appointments for treatment and integration.
5- Our partner pharmacy will ship one dose of the medicine to the client.
6- After the initial ketamine session, the client will contact Skylight via email and we will connect with the client to access the response to the dose and will make any needed adjustments on future dosing.
7- The client will log on to our virtual psychedelic yoga integration program and do their first class.
8- The remaining five doses of the medicine will then be shipped priority overnight to the client.
9- The client and therapist will schedule the remaining five medicine sessions and integration sessions.
10- The client will complete the remaining psychedelic integration yoga classes online. There are 7 total, one to follow each medicine session and an additional two hour workshop with yoga and meditation.
11- If clients are interested in further ketamine treatments they can reach out to us anytime.
Please reach out to us via email @ [email protected] OR call us at 720-930-7528. Please note any medical or psychiatric emergency should be directed to 911. If you or your client has any questions about the ketamine they can call our partner pharmacy at 303-707-1500.
It is up to the client and therapist to schedule all appointments for ketamine-assisted therapy and integration sessions.
Integration is when a client takes the experience from their medicine journey and weaves it into their daily life. Integration is a critical part of psychedelic medicine. While the medicine sessions are very important, a time where people get many messages, without the integration, many of these messages can get lost or be fleeting.
There is no set schedule for integration. Many therapists decide to do it the hour following a medicine session. This can be a nice time to connect further however many people aren’t able to commit to this length of time.
Please make sure your client has a safe ride home. They have an agreement with Skylight that they will not drive the day of treatment and that they will arrange a ride.
If you are concerned your client is not using the medicine as intended please call or email us immediately.
The founders of Skylight Psychedelics are yogis and understand the power of yoga and its inherent psychedelic nature. We have developed the first of its kind psychedelic integration yoga series and are excited to share this with your clients. Therapists also have access to these carefully crafted 8 hours of yoga bliss.
More of Jackie Smith’s Yoga Classes can be found here:
Ketamine-assisted therapy sessions can be billed at whatever rate you see fit. These sessions are typically 1-3 hours. The first hour the client takes the ketamine and the second-third hour can be used as an integration time, a period for the client to reflect on their journey and how these reflections can be incorporated into one’s life. Integration sessions can also occur on a different day. Many providers increase the fee for this service as it requires some additional training and is a different service than traditional therapeutic modalities.
We recommend therapists looking to provide ketamine-assisted therapy reach out to their insurance provider to inquire if additional coverage is needed. We have confirmed with some insurance companies that it may cost approximately $400 per year to add this coverage to an existing policy. In the PDF version of this course we provide you with a template to use when connecting with your insurance provider.
Please consider using the below example when connecting with you insurance provider:
Insurance Inquiry Template
I am reaching out because I am looking to provide ketamine-assisted therapy to my clients suffering from various mental illnesses including depression, anxiety, PTSD, OCD and existential distress. I have received certification from Skylight Psychedelics, a physician run psychedelic training program. The Skylight Psychedelics team are also the prescribers of the ketamine for my clients. The prescribers manage all medical aspects and I will provide therapy for clients in an altered state of consciousness. The ketamine prescribed by Skylight Psychedelics is sublingual and low dose. I will not be providing any medical care outside the scope of my practice. Please provide me information on how my policy will change, if at all. Thank you for your time.
We believe that healing requires a holistic approach which includes therapy, diet, exercise, nature and community in addition to exploring altered states of consciousness. Find the time for yourself, as we better ourselves, we better one another.
Recommended Daily Practice by Skylight Psychedelics
Nature: Spend 15-30+ mins outside doing anything, walking the dog, having your morning tea, etc.
Yoga: This can be an in person class, guided virtually or on your own. We recommend yoga with Jacqueline Smith @ https://www.livekick.com/en/c/jaquelynsmith
Affirmations: Look in the mirror and say something nice to yourself.
Breakfast: Decaf tea, small bowl of fruit
Lunch: Salad, light piece of fish or eggs, small bowl of fruit, water to drink
Snacks: Unsalted nuts, fruit, veggies, hummus, frequent water throughout the day
Journal: Journal your thoughts, draw if that speaks to you
Dinner: Salad, light piece of fish or eggs, small bowl of fruit, water to drink
Meditation: Insight Timer app – best done right before bed! Gets your meditation time in and allows you to quiet the mind to promote a restful night’s sleep.
Drop into one of our weekly virtual sessions or join us on a retreat in Colorado where you will meet other clients on a similar journey who are dedicated to healing and wellness. Look out for our Wellness Retreats in the foothills of the Rockies in Colorado, coming soon!
This program developed exclusively by Skylight Psychedelics can be used in many different scenarios. When using it in a therapy space it can be used in normal and altered states of consciousness. Many therapists who practice ecotherapy find this tool to be an amazing addition to their practice. Our VR program will be available Fall, 2022.
Body Keeps Score by Bessel van der Kolk, MD
No Bad Parts by Richard Schwartz, PhD
How to Change Your Mind by Michael Pollan
This is Your Mind on Plants by Michael Pollan
The Psychedelic Explorer’s Guide Safe, Therapeutic and Sacred Journeys by James
Our proprietary training course allows therapists to learn the crucial information needed when providing ketamine-assisted therapy to their clients. It is comprehensive yet can be completed in a day. Oh and it’s affordable! Only $499.
The link to our Ketamine Assisted Training Course is available here: