Thinking Holistically About Ketamine and Psychedelics

When I first started providing ketamine assisted psychotherapy (KAP) as a psychiatrist in my practice, I focused on learning the craft and art of this work. I read every book, listened to every podcast, and frantically wrote notes down from mentors through individual consultation. After I completed by five day training in KAP, I wasn't quite sure what ketamine assisted psychotherapy would look like in my solo psychiatry practice, provided by me. And being the good student I am (hardwired into me from years of medical training) I focused on learning and how to do it right. With that desire to do it right came my perfectionistic tendencies. What I had to learn, as my mentor gently told me, was to let go.

After becoming comfortable and confident in my ability to navigate ketamine assisted therapy and help people through this modality in my practice, my circle of curiosity began expanding. This also happened in medical school: The more that I focus on the micro, the more I have to understand and address the macro. While studying gram stained slides of microbiology in medical school, I realized I wanted and needed to understand medicine and healthcare from macro levels so I enrolled in our schools' Masters of Public Health (MPH) program that I completed concurrently with my medical school curriculum. It didn't make any rational sense and it wouldn't matter from a career sense, but I needed to understand the broader implications of health and medicine in order to be a physician.

Pathology was not in my destiny

So I guess I shouldn’t be surprised that I started shifting toward thinking more broadly about psychedelic medicine—especially ketamine, since it’s the psychedelic tool we currently have access to. In reading Ken Wilber’s book Finding Radical Wholeness, I found a framework that helped me better conceptualize ketamine therapy in a way that honors both the micro and the macro. Wilber doesn’t see healing as something that happens in fragmented parts, but as an integration across multiple dimensions of human experience.

If we look at the four-quadrant model Wilber describes, we begin to see how psychedelic therapy—and ketamine in particular—can be understood as a multi-dimensional process.

Let’s start with the quadrants:

• Upper Left – “I”: The subjective, inner world of the individual. Think: What’s it like to be you?

• Upper Right – “It”: The objective, observable world. Think: What can we see or measure about you? This is the realm of science, biology, and behavior.

• Lower Left – “We”: The shared, inner world of relationships and culture. Think: What do we believe together? What values, meanings, or rituals do we share?

• Lower Right – “Its”: The outer systems and structures that shape our lives. Think: How is everything organized? What systems influence healing and access?

  
  

Now, when we apply this to ketamine and psychedelic work, we start to understand why there are so many different approaches—biomedical, psychological, ceremonial, peer-supported, and solo journeys. Each of these reflects a different quadrant or combination of quadrants.

But here's the key point: the biomedical model, as it's often practiced in the United States and in ketamine clinics, primarily lives in the Upper Right quadrant. It focuses on symptoms, neurochemistry, and data—and while that’s important, it leaves out the personal meaning (Upper Left), the cultural and relational context (Lower Left), and the systemic access and design of care (Lower Right).

If we only operate from one quadrant, we miss the fullness of what healing can be. Wilber’s framework reminds us that true wholeness requires attention to all four dimensions. What is most important to know is that psychedelic medicine has the potential to touch all of them—but only if we intentionally create models of care that do so.

In many ways, my journey with practicing ketamine therapy has mirrored Wilber’s call toward radical wholeness. I began by learning the craft, holding tightly to the tools and techniques I’d been taught. But over time, what became more important than doing it “right” was doing it whole. Not just addressing the neurobiology of depression or the observable outcomes, but tending to the soul of the work—the relationships, group work, the cultural context, the personal stories, and the systems that either support or obstruct healing. If ketamine is to be a medicine of transformation, then our models of care must also transform. We need to let go of the illusion that any one quadrant holds the full truth. True healing, like true medicine, happens when we can honor the complexity, the mystery, and the multidimensional nature of being human.

This fall, I’m teaching a 6-week live training for therapists and clinics who want to practice ketamine therapy in a way that reflects the wholeness of human healing. We’ll dive deep into preparation, integration, parts work, ethics, and the nervous system—not just the protocol.

Let’s stop reducing this work to a molecule. Healing is a sacred collaboration—and it begins with how we show up.

📆 Launching September 2025 – Learn more and register here: https://www.driftlessintegrativepsychiatry.com/consulting