Carl Spitzer, MD, CPTR

What Category Provider type are you? Emergency Medicine
What board certifications do you hold? Emergency Medicine
How many years have you been in ketamine practice? 2
What percentage of your work is clinical versus research? Thus far, 100% clinical. Our site is one of 10 MAPS Expanded Access sites for MDMA-assisted Psychotherapy for PTSD, starting up soon. I will be Principal Investigator for our site, with an estimated 20% of my time being research.
Please describe any connections you have to major universities, research institutions and pharmaceutical companies, both financial and advisory/board? None
What are your views regarding desirability and appropriateness of including and fostering the variety of practitioners who presently administer ketamine for mood disorders? “It takes a village.” Just as there are many styles, modes, and theoretical frameworks around psychotherapy, there is evolving a variety of practice styles around the use of ketamine for mood disorders. I see the role of ASKP3 as providing a big tent for practitioners to congregate, collect data, share information on practice styles, and ideally to drive best practices as these emerge from the field. Some of us will be biological ketamists, others will use ketamine for its psycholytic properties in depth-oriented work, and still others will draw on ketamine’s visionary/psychedelic properties to facilitate transcendental experiences. All of this is welcome if it is in the service of the client’s (patient’s) psychological healing, and if the practice is delivered with integrity, due caution, and respect.
What is your preferred route of administration of ketamine for mood disorders. What are your thoughts about the appropriateness or therapeutic value of other routes? I use primarily sublingual administration via compounded oral-dissolving tablets, as well as IM administration in the 0.5-2.0mg/kg range, often with divided doses. It’s not uncommon for relatively low-dose sublingual sessions to provide profound psychological insights for our clients– and it’s not uncommon to hear the comment, “Wow, that was like 10 years of therapy in 3 hours!” after a deep session. I work dyadically with psychologists and am very drawn to depth work. I plan to enter psychoanalytic training in 2021.
Re: other routes, see my “big tent” comment above. I think there is place for IV racemic and IN esketamine. Many people need a rapid-acting antidepressant, but are not up for insight-oriented psychotherapy. If it’s beneficial to the client/patient, legal, and ethically delivered, I’m good with it.
How do you approach the problem of integrating the transient altered state we induce into the patient’s overall psychic economy? What is the practitioner’s responsibility in this regard? For some clients, the visionary ketamine experience is where the transformation lies. To have the veil lifted, entering an expanded consciousness beyond the day-to-day machinations of our ego-selves, can be a profoundly spiritual experience. Such experiences can reframe long-held ideas about mortality, our place in the universe, and the very meaning of our lives. It’s hard to overstate the profundity of this type of experience.
And– not all ketamine experiences till such rich psychospiritual soil, at least not right off the bat. Some experiences can be very difficult, some experiences can engage us in reliving long-repressed traumas, some can be confusing, some funny, some frightening. With proper preparation, and an experienced practitioner to help hold space and navigate and integrate the non-ordinary states of consciousness, all of these experiences– even the difficult ones– have the potential to unlock insight and personal growth for our clients.
Please describe your present clinical practice. How will it look different in 5 years? Currently I work dyadically with psychotherapists in a ketamine-assisted psychotherapy model. In 5 years, I will have completed analytic training, and will be seeing more clients individually. Ketamine will be one tool I can deploy (as I hope will be MDMA and psilocybin) in doing depth work that is based in each client’s unique biography and circumstance.
In the near future, Temenos is also looking to develop group therapy models in ketamine, as well as training for other ketamine practitioners. We will be expanding our scope of practice to include brain health and somatic modalities in our offerings.
How do you envision ASKP3 growing over the next 4 years? As ketamine’s use in mental health becomes more ubiquitous, it will be important for ASKP3 to assert its role as the de facto professional organization for practitioners in the space. In keeping with the “big tent” philosophy, ASKP3 will need to grow its membership by attracting practitioners across disciplines in a way that we each find a “home” among colleagues who share our practice styles and interests, cross-fertilized by others who practice in different models. We do this by setting a tone of collegiality and mutual respect at the Board level.
The conference can grow to have different tracks for practitioners of different interests, with main tracks that are relevant across ketamine cultures.
We need to promulgate standards of care that ensure safe delivery, practitioner integrity, and ethical standards. And we must advocate for ketamine practitioners who practice according to those standards, through ASKP3-issued statements of support or legal means if necessary, where there may be misunderstanding, suspicion, ignorance, or malice towards our members from regulatory or outside bodies.