Practice Policies
Appointments and Cancellations
Please remember to cancel or reschedule 2 days in advance. You will be responsible for the entire fee if cancellation is less than 2 days.
The standard meeting time for Individual Ketamine-assisted psychotherapy is 2 hours. The cost per session is $700 and includes the medicine, a therapist in the room throughout the session, as well as a medical provider available at all times.
Cash or Credit Cards are accepted. We do not accept insurance including AHCCCS, Medicare, Medicaid or any other government insurance program.
Cancellations and re-scheduled sessions will be subject to a full charge if NOT RECEIVED AT LEAST 2 DAYS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.
Telephone Accessibility
If you need to contact us between sessions, please leave a message on our voice mail. Our therapists are often not immediately available; however, we will attempt to return your call within 24 hours. If a true emergency situation arises, please call 911 or any local emergency room.
Social Media and Telecommunication
Due to the importance of your confidentiality and the importance of minimizing dual relationships, our team will not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). We believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.
Electronic Communication
We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so. While we may try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.
Termination
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. We may terminate treatment after appropriate discussion with you and a termination process if we determine that the psychotherapy is not being effectively used or if you are in default on payment. We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, we will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.
Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued
2. Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. OUR PLEDGE REGARDING HEALTH INFORMATION:
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:
-Make sure that protected health information (“PHI”) that identifies you is kept private.
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
-Give you this notice of our legal duties and privacy practices with respect to health information.
-Follow the terms of the notice that is currently in effect.
-We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment, Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
a. For our use in treating you.
b. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
c. For our use in defending ourselves in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. As a psychotherapist practice, we will not use or disclose your PHI for marketing purposes.
3. Sale of PHI. As a psychotherapist practice, we will not sell your PHI in the regular course of our business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:
Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:
1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an Authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on our premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
8. For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
9. Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:
1. Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full. We will say “yes” unless a law requires us to share that information.
3. The Right to Choose How we Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost based fee for doing so.
5. The Right to Get a List of the Disclosures we Have Made. You have the right to request a list (accounting) of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it and receive it promptly.
8. The Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
9. The Right to File a Complaint if you Feel Your Rights Are Violated. You can complain if you feel we have violated your rights by contacting us using the following information: Privacy Official: (602) 550-0175, carlos@thetraumahealingcenter.com. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696- 6775, or visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/. We will not retaliate against you for filing a complaint.
EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on the 26th day in September, 2020.
Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By agreeing to services, you are acknowledging that you have received a copy of HIPAA Notice of Privacy Practices.
3. Informed Consent for Psychotherapy
General Information
The therapeutic relationship is unique in that it is a highly personal and at the same time, a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together. Feel free to discuss any of this with us.
The Therapeutic Process
You have taken a very positive step by deciding to seek therapy. The outcome of your treatment depends largely on your willingness to engage in this process, which may, at times, result in considerable discomfort. Remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures. We cannot promise that your behavior or circumstance will change. We can promise to support you and do our very best to understand you and repeating patterns, as well as to help you clarify what it is that you want for yourself.
Confidentiality
The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:
1. If a client threatens or attempts to commit suicide or otherwise conducts him/herself in a manner in which there is a substantial risk of incurring serious bodily harm.
2. If a client threatens grave bodily harm or death to another person.
3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
5. Suspected neglect of the parties named in items #3 and # 4.
6. If a court of law issues a legitimate subpoena for information stated on the subpoena.
7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Occasionally we may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context without using your name.
If you are to accidentally encounter any of our team members outside of the therapy office, we will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance to us, and we do not wish to jeopardize your privacy. However, if you acknowledge any of us first, we will be more than happy to speak briefly with you but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.
4. Teletherapy Consent, Policies and Agreement
1. You understand that “teletherapy” includes consultation, treatment, transfer of medical data, emails, telephone conversations, and education using interactive audio, video, or data communications. You also understand that teletherapy/coaching also involves the communication of your medical/mental health information, both orally and visually.
2. Unless we explicitly agree otherwise, our teletherapy exchange is strictly confidential. Any information you choose to share with us will be held in the strictest confidence. Just like our face-to-face clients, we will not release your information to anyone without your prior approval unless we are required to do so by law. In Arizona, we are required to notify authorities if we become convinced a client is about to physically harm someone, about to harm themselves or if they are abusing or about to abuse children, the elderly, or the disabled.
3. You understand that our teletherapy services are furnished in the state of Arizona and the services we provide are governed by the laws of that state. In a manner of speaking, you are using this modality to visit us in our Arizona office, where we meet to do our work.
4. You have the right to withdraw or withhold consent from teletherapy services at any time. You also have the right to terminate treatment at any time.
5. You understand that there are risks and consequences with teletherapy services including, but not limited to, the possibility, despite reasonable efforts on our part, that: the transmission of your medical information could be disrupted or distorted by technical failures; the transmission of your information could be intercepted by unauthorized persons, and/or the electronic storage of your medical information could be accessed by unauthorized persons.
6. In addition, you understand that teletherapy based services and care may not be as complete as traditional face-to-face services. While teletherapy is a great way to get help with many of life’s problems, overwhelming and potentially dangerous challenges are best met with face-to-face professional support. You understand that teletherapy is neither a universal substitute, nor the same as face-to-face psychotherapy. Finally, you understand that there are potential risks and benefits associated with any form of psychotherapy, and that despite our efforts or the efforts of any such provider, your condition may not improve, and in some cases may even get worse.
7. You understand that you may benefit from teletherapy, but that results cannot be guaranteed or assured.
8. You understand and accept that teletherapy does not provide emergency services. If you are experiencing an emergency situation, you understand that the protocol would be to call 911 or proceed to the nearest hospital emergency room for help. If you are having suicidal thoughts or making plans to harm yourself, you may also call the National Suicide Prevention Lifeline at 1- 800-273-TALK (8255) for free 24 hour hotline support. If you are in Maricopa County and need added support, please contact the Crisis Line at (602) 222-9444 or 1 (800) 631-1314.
9. You will be responsible for the following: (1) providing the computer and/or necessary telecommunications equipment and internet access for your teletherapy sessions, (2) securing or encrypting protected health information (PHI) transmitted to or stored on your computer/telecommunications device, and (3) arranging a location with sufficient lighting and privacy that is free from distractions or intrusions for your teletherapy sessions.
10. You understand that while email may be used as a form of communication with us, that confidentiality of emails cannot be guaranteed due to complexities and abnormalities involved with the Internet, including, but not limited to, viruses, Trojans, worms, and other involuntary intrusions that have the ability to obtain and disseminate information you wish to keep private.
11. You have the right to access your medical information and copies of your medical records in accordance with HIPAA privacy rules and applicable state law.
I have discussed it with my psychotherapist, and all of my questions have been answered to my satisfaction.
5. COVID-19 Informed Consent to Treat
I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I further understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. I understand that I am the decision maker for my health care. Part of this office’s role is to provide me with information to assist me in making informed choices. This process is often referred to as “informed consent” and involves my understanding and agreement regarding recommended care, and the benefits and risks associated with the provision of health care during a pandemic. Given the current limitations of COVID-19 virus testing, I understand determining who is infected with COVID-19 is exceptionally difficult.
I understand my treatment may create circumstances, such as the discharge of respiratory droplets or person-to-person contact, in which COVID-19 can be transmitted.
I understand that I am opting for in-person therapy and that I have the option to seek therapy via teletherapy. However, while I understand the potential risks associated with receiving treatment during the COVID-19 pandemic, I agree to proceed with my desired treatment at this time.
I understand due to the frequency of appointments with clients, the attributes of the virus, and the characteristics of procedures, I may have an elevated risk of contracting COVID-19 simply by being in an office
I confirm I am not experiencing any of the following symptoms of COVID-19:
-Fever
-Dry Cough
-Sore Throat
-Shortness of Breath
-Runny Nose
-Loss of Taste or Smell
I understand travel increases my risk of contracting and transmitting the COVID-19 virus. I verify that I have NOT in the past 14 days:
-Traveled outside of the United States to countries that have been affected by COVID-19
-Traveled domestically within the United States by commercial airline, bus, or train
Trauma Healing Journeys LLC has implemented preventative measures intended to reduce the spread of COVID-19. However, given the nature of the virus, I understand there may be an inherent risk of becoming infected with COVID-19 by proceeding. I hereby acknowledge and assume the risk of becoming infected with COVID-19 and choose on my own fruition to continue in-person therapy.
I understand that I can receive a copy of this consent form if I request it.
I KNOWINGLY AND WILLINGLY CONSENT TO THE IN-PERSON THERAPY WITH THE FULL UNDERSTANDING AND DISCLOSURE OF THE RISKS ASSOCIATED WITH RECEIVING CARE DURING THE COVID-19 PANDEMIC. I CONFIRM ALL OF MY QUESTIONS WERE ANSWERED TO MY SATISFACTION. I HAVE READ, OR HAVE HAD READ TO ME, THE ABOVE COVID-19 RISK INFORMED CONSENT TO TREAT. I APPRECIATE THAT IT IS NOT POSSIBLE TO CONSIDER EVERY POSSIBLE COMPLICATION TO CARE. I HAVE ALSO HAD AN OPPORTUNITY TO ASK QUESTIONS ABOUT ITS CONTENT, AND BY AGREEING TO SERVICES, I AGREE WITH THE CURRENT OR FUTURE RECOMMENDATION TO RECEIVE CARE AS IS DEEMED APPROPRIATE FOR MY CIRCUMSTANCE. I INTEND THIS CONSENT TO COVER THE ENTIRE COURSE OF CARE FROM Trauma Healing Journeys LLC FOR MY PRESENT CONDITION AND FOR ANY FUTURE CONDITION(S) FOR WHICH I SEEK CARE FROM THIS OFFICE.
6. KETAMINE-ASSISTED THERAPY INFORMED CONSENT
Welcome,
It is very important to us that all patients feel welcomed, safe, supported, and respected, and we will address any concerns that might arise in this regard.
Ketamine is now an “off-label” treatment for various chronic “treatment-resistant” mental conditions. Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent. Also, it is now often used effectively for treatment of depression, addiction, PTSD, chronic pain, and other psychiatric diagnoses as well as for existential, psychological and spiritual crises and growth.
This consent form contains information about the use of sub-anesthetic dosages of ketamine for mental health purposes including depression. Ketamine was approved by the FDA for use as an anesthetic agent several decades ago. The administration of ketamine in lower, sub-anesthetic doses to treat pain, depression, or other psychiatric diagnoses is a newer, off-label use of ketamine. Use of ketamine has become relatively wide-spread in recent years, has been studied and promoted by researchers at the National Institute of Mental Health. Ketamine has been administered by intravenous, intramuscular, sub-lingual, oral and intra-nasal routes. Often, it is used after other treatment approaches have been unsuccessful.
Once you indicate that you have understood the benefits and risks of this treatment, you will be asked to sign this form in order to participate in this treatment. You will be given a signed copy of this form to keep for your records. This process is known as informed consent.
By signing this document you indicate that you understand the information provided and that you give your consent to the medical procedure to be performed during your participation in ketamine treatment.
Please read this consent form carefully, and feel free to ask questions about any of the information in it.
KETAMINE-ASSISTED PSYCHOTHERAPY
Ketamine assisted psychotherapy (KAP) is a relatively new and innovative psychiatric/psychological treatment approach, involving the combination of ketamine administration in a safe and supportive “set and setting,” inner-directed and supportive psychotherapy, and ongoing integration. The exact nature of the treatment process varies depending on the particular problems being treated and the specific individual’s needs and goals; we firmly believe in finding the most optimal way to support an individual’s growth, healing, and personal evolution.
Initial sessions will involve an evaluation of a patient’s: current problems, concerns, and needs; prior history and review of current or ongoing treatment; overall health/medical condition; and an assessment of the potential suitability and viability of this type of treatment for that patient. By the end of the evaluation period, we will offer our clinical impressions and a recommended approach to treatment. The goals of therapy are always arrived at by mutual collaboration. These goals will be reviewed during the course of the treatment in order to assess and/or modify them according to changing needs, perspectives, and progress. Participation in this treatment may result in a number of benefits but there is no guarantee that this will occur.
During this assessment phase, it is important that we carefully consider whether or not we are the best provider of ketamine related services, and if Ketamine Assisted Psychotherapy is the best approach for an individual’s specific situation. If indicated, a referral to a more appropriate provider will be recommended.
When appropriate, and according to our counselors’ clinical judgment, Somatic Experiencing (SE) could be used during KAP sessions. SE is a short-term naturalistic approach to the resolution and healing of trauma developed by Dr. Peter Levine and is supported by research. It is based upon the observation that wild prey animals, though threatened routinely, are rarely traumatized. Animals in the wild utilize innate mechanisms to regulate and discharge the high levels of energy arousal associated with defensive survival behaviors. These mechanisms provide animals with built-in "immunity" to trauma that enables them to return to normal in the aftermath of highly "charged" life-threatening experiences.
SE employs awareness of body sensation to help people "renegotiate" and heal rather than re-live or re-enact trauma. SE's guidance of the bodily "felt sense", allows the highly aroused survival energies to be safely experienced and gradually discharged through guided movement and touch. SE "titrates" experience (breaks down into small, incremental steps), rather than evoking catharsis-which can overwhelm the regulatory mechanisms of the organism. Any touch during the session, will be made in collaboration and consent. It will always be appropriate and intentional and administered by a trained professional.
SE can result in a number of benefits to you, such as relief of traumatic stress symptoms, increased resiliency, and resourcefulness. Like any other treatment it may also have unintended negative "side effects." It is important that you are aware that there are other forms of body-oriented and somatic psychotherapy. The United States Association of Body Psychotherapy (www.usabp.org) is a good source of information about other modalities. Obviously, there are also many non-somatic focused forms of psychotherapy and counseling that you can also choose.
For more information about SE please note the following references:
Levine, P. and Frederick, A. (1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. Berkeley, CA: North Atlantic Books.
Kline, M. and Levine, P. (2007). Trauma Through A Child's Eyes: Awakening the Ordinary Miracle of Healing. Berkeley, CA: North Atlantic Books.
For further references and information online about SE go to: http://www.traumahealing.com
Please note that that consent is an alive process, it is your responsibility to inform your clinician when you are uncomfortable with any parts of treatment. If you have any questions about SE or other treatments, please ask and we will do our best to answer your questions in full. Please recognize that SE touch doesn’t always involve physical touch and will involve tracking attention, intention, and various kinds of activation around SE touch. You have the right to refuse or terminate this portion of treatment at all times, or to refuse techniques or interventions your clinician may propose or employ.
As with all medical and psychiatric care, including psychotherapy, there are both risks and benefits to pursuing treatment. Psychiatric care and psychotherapy are not exact sciences. There are no guarantees made as to the result of such examinations, treatments, and/or diagnostic procedures. The use of ketamine in combination with psychotherapy, i.e. KAP, constitutes an off-label treatment for depression, and it is important that the patient understand that KAP may not be effective in treating their depression. This treatment also may not be reimbursed by health insurance due to its status as a new treatment for depression.
When receiving treatment patients may sometimes find they feel worse before feeling better. KAP is a non-linear treatment process and individual responses vary widely. If any questions or concerns about our work together arise at any point during treatment, please bring them to our attention.
MONITORING
Although this is a very safe medicine, it is essential that you be followed very closely during and after your treatment. This may include blood pressure and psychological measures before and/or after each session. You have the option to follow up and be supported by us by telephone, email, and/or in-person contact.
How long will it take before I might see beneficial effects?
You may experience important positive changes in personality, mood and cognition during treatment, in the immediate aftermath, and in the days and weeks that follow. The results may vary between patients and there is NO GUARANTEE OF AN EXACT RESPONSE. Please note, some experiences may be temporarily difficult or disturbing to you. The ketamine experience itself is designed to enable your own healing wisdom to be accessed and to become beneficial to you. The support you will receive will aid you in making your experience(s) valuable, meaningful, and understandable to you. The goal of ketamine assisted psychotherapy is to assist you in changing patterns of mind, feelings, and behavior that are of concern and cause you difficulty.
ELIGIBILITY FOR KETAMINE THERAPY
Before participating in ketamine treatment, you will be carefully interviewed to determine if you are eligible. This will include a medical history, a physical exam if deemed necessary, review of medical/psychiatric records, and possibly administration of psychological tests to assess your state of mind.
Pregnant women and nursing mothers are not eligible. The effects of ketamine on pregnancy and the fetus have not been studied.
Untreated hypertension is a contra-indication to ketamine use as the substance can cause a rise in blood pressure. Similarly, a history or stroke or heart disease may make you ineligible to participate.
Information on the interactions of ketamine with other medicines is only partially available and it will be assessed to help determine your eligibility for treatment.
Ketamine should not be taken if you have untreated hyperthyroidism. There have also been reports of some decrease in immune function in patients receiving surgical doses of ketamine.
Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia without respiratory depression than will be used in ketamine assisted psychotherapy.
POTENTIAL RISKS OF KETAMINE THERAPY
You will be asked to lie still during the ketamine administration because ketamine will temporarily affect your sense of balance and coordination. This effect will generally wear off 2-4 hours after the injection has been administered or lozenges have been taken. It is possible that you may fall asleep. Other possibilities for adverse effects include blurred vision, uncomfortable vision, double vision, rapid eye movements, elevation of intraocular pressure (feeling of pressure in the eyes). You are advised to keep your eyes closed until the main effects have worn off. Other side effects may include slurred speech, anorexia, mental confusion, excitability, anxiety, diminished ability to hear or feel objects accurately including one’s own body, nausea, vomiting, and aspiration. Visual, tactile, and auditory procession are affected by the drug. Music that is usually familiar may not seem to be during the experience. Synesthesia, a mingling of the senses, may occur. The ordinary sense of time may morph into time dilation or other experiences of temporal alterations.
Because of the risk of nausea and vomiting please refrain from eating and drinking at least 4 hours before a session. Eat lightly even before this 4-hour window. Make sure you are properly hydrated before this 4-hour window begins. Please use the bathroom before every session.
If you are unduly nauseated, you may be offered an anti-nausea medication, ondansetron, in pill or oral dissolving tablet forms.
Ketamine generally causes a significant transient increase in blood pressure but usually not the pulse rate. If your blood pressure monitoring reveals that your blood pressure is too high, you may be asked to delay your session.
Agitation may occur during the course of a session. If your agitation is severe, you may be offered lorazepam or midazolam orally or by injection to help you relax.
Driving an automobile or engaging in hazardous activities should not be undertaken after ketamine treatment.
Regular ketamine consumption has been shown to increase the risk of cystitis symptoms by 3- to 4-fold, and cessation of ketamine use is usually associated with improvement of symptoms. Common KIC-related problems are urinary pain and discomfort, bladder epithelial barrier damage, reduced bladder storage and increased pressure, ureter stenosis, and in rare cases, kidney failure.
In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It may also worsen underlying problems in people with severe personality disorders. We recommend those patients with these disorders or any history of psychosis to refrain from ketamine therapy.
Ketamine can bring up traumatic memories, may cause you to re-experience past traumas or cause you to look at parts of yourself that may be uncomfortable. During the experience itself, some people have reported frightening and unusual experiences. These frightening experiences, however, may be of paramount value to your transition to recovery from the suffering that brought you to ketamine therapy in the first place. The challenging experiences will stop usually after a brief period of time and you will also receive support and guidance from your providers.
POTENTIAL FOR KETAMINE ABUSE AND PHYSICAL DEPENDENCE
Ketamine belongs to the same group of chemicals as phencyclidine (PCP or angel dust). This group of chemical compounds is known Arylcyclohexylamines and are classified as hallucinogens. Ketamine is a controlled substance and is subject to Schedule III rules under the Controlled Substance Act of 1970. Medical evidence regarding the issue of drug abuse and dependence suggests that ketamine’s abuse potential is equivalent to that of phencyclidine and other hallucinogenic substances. Ketamine and other hallucinogenic compounds do not meet criteria for chemical dependence since they do not cause tolerance and withdrawal symptoms. However, “cravings” have been reported by individuals with the history of heavy use. In addition, ketamine can have effects on mood (feelings), cognition (thinking) and perception (imagery) that may make some people want to use it repeatedly. Therefore, ketamine should never be used except under the direct supervision of a licensed physician. Repeated, high dose, chronic use of ketamine has caused urinary tract symptoms and even permanent bladder dysfunction in individuals abusing the drug. Generally, this does not occur in the low dose, infrequent use parameters we use in the office setting.
ALTERNATIVE PROCEDURES AND POSSIBILITIES
Major Depression, PTSD and Bipolar Disorders may be treated with anti-depressant medications, tranquilizers, mood stabilizers and psychotherapy. Electroconvulsive Therapy (ECT), and the recently introduced Transcranial Magnetic Stimulation (TMS) are also in use for treatment resistant depression. Ketamine has also been used in the treatment of addictions and alcoholism as part of a comprehensive treatment program.
VOLUNTARY NATURE OF PARTICIPATION
Please be aware that the Food and Drug Administration (FDA) has not yet established the appropriateness of ketamine therapy and its use is considered off-label. Although medical studies have shown benefit in depression and in other areas, the only official indication for use of ketamine is anesthesia. Your awareness of this situation is key to understanding any liability associated with your use of ketamine. Your informed consent indicates you are aware of this situation.
Ketamine and ketamine assisted psychotherapy are new treatment modalities. The primary studies have been with depression, bipolar disorders, alcoholism, and heroin addiction. Ketamine infusion and ketamine assisted psychotherapy are not yet mainstream treatments, although there are now many studies that demonstrate that it may be an effective treatment. There is an expanding array of ketamine clinics across the country and worldwide primarily administrating ketamine without a counseling component. The beneficial therapeutic effect of ketamine treatments generally occur with more than one treatment and is more robust when part of an overall treatment program. These interventions may not permanently relieve depression. If your depressive symptoms respond to ketamine therapy, you may still elect to be treated with medications and ongoing psychotherapy to try to reduce the possibility of relapse. Over time, you may also need additional ketamine treatments and/or other therapies to maintain your remission.
Your decision to undertake ketamine therapy is completely voluntary. Before you make your decision about participating in ketamine therapy, you may ask and will be encouraged to ask, any questions you might have about the process. Your signature of the consent to treatment indicates that you have understood the benefits and risks of this treatment.
TERMINATION OF TREATMENT
You have the right to end treatment at any time without any moral, legal or financial obligation other than those already accrued. And if you wish, we will provide you with referrals to other qualified professionals.
We, too, reserve the right to terminate treatment at our discretion. Reasons for termination include, but are not limited to, untimely payment of fees, failure to comply with treatment recommendations, conflicts of interest, failure to participate in treatment, client needs are outside of our scope of competence or practice, or lack of adequate progress in treatment.
CONSENT TO PARTICIPATE IN RESEARCH
Testing data may be used in research to determine the efficacy of KAP treatment. We will make every effort to use only the most essential demographic information for this purpose. No identifying information will be used. By signing this document, you are agreeing that your testing results and basic demographic data can be used for research.
PSYCHOTHERAPY CONSULTATION, RECORDS KEEPING,
AND RECORDING OF SESSIONS
Professional consultation is an important component of medical and psychotherapy practice. In order to provide the best possible treatment for you we regularly participate in clinical, ethical, and legal consultation and training with appropriate professionals. During such consultations we might talk about the content of our work together, but we will not reveal any personally identifying client information without an individual’s written permission. We as well collect data measures to track your progress in therapy and we might use this data anonymously in research data collection for efficacy of KAP.
The laws and standards of our profession require that we keep treatment records. These may include information about a patient’s diagnosis, therapy goals, progress in treatment, documentation of mandated disclosures, and other information. All patients have a right to view their records or receive a treatment summary, unless doing so would be likely to cause substantial harm, endanger a patient’s life or physical safety, or pose a significant risk of harm to another individual.
CONTACTING THE CENTER
Although we might not be always available immediately by phone, you can leave us a voicemail anytime at (602) 842-9919. We check voicemail on a regular basis. We will make every effort to return your call on the same day, or by the next business day at the very latest, with the exception of weekends, holidays, and periods that we have pre-arranged to be unavailable. If you have an emergency, call the Arizona Crisis Hotline 1-844-534-HOPE (4673), dial 911, or proceed to your nearest emergency room.
INFORMED CONSENT
By signing this form, I agree that:
1. I have fully read this informed consent form describing ketamine therapy and agree to its terms holding harmless the practitioner(s) involved in my care. I am waiving, releasing, and discharging all claims, rights and/or causes of action which may arise out of or in connection with my participation in ketamine assisted therapy. No oral or written statements, representations, or inducements have been made to cause me to enter into this agreement.
2. I have had the opportunity to raise questions and have received satisfactory answers concerning ketamine therapy in all regards.
3. I fully understand that the ketamine session(s) can result in profound change in mental state but that this is not guaranteed. I also fully understand that ketamine may result in unusual or difficult psychological and physiological effects.
4. I give my consent to the use of lorazepam or midazolam if deemed necessary for agitation, to ondansetron for nausea, and clonidine for high blood pressure.
5. I have been given a signed copy of this Informed Consent form, which is mine to keep.
6. I understand the risks and benefits. I freely give my consent to participate in ketamine assisted therapy as outlined in this form and under the conditions indicated in it.
7. I understand that I may withdraw from ketamine therapy at any time up until the actual injection or lozenge has been given.
FAQs
Curiosity encouraged.
In time, we will work through many questions. But first, let’s start with these. Please don't hesitate to contact us if there’s something you’d like to know beyond what’s covered on this list.
Do you take insurance?
No, because Ketamine is considered an off-label treatment and therefore not recognized by insurance companies.
What are your rates?
Rates are based on individual or group.
2 hour individual sessions = $700
4 hour group sessions=
What's your Cancellation/Missed Appointment Policy?
We require 2-day-notice for all cancellations. If you fail to cancel within that time frame you will be charged your full session fee.
What are the confidentiality standards you are required to meet?
Everything we discuss will be kept strictly confidential. Detailed Confidentiality Policy information can be found here.
Are you available outside of business hours?
We understand that crises happen. You can contact us at any time, and we will do our best to respond within 24 hours. If this is a counseling emergency, help is available right now.
Emergency: 911
Maricopa County Crisis Response Network: 602-222-9444
Empact Crisis: 480-784-1500
Do you work with children or families?
We only work with individuals 18 and older.
How do I book an appointment?
It’s easy. You can book by calling us at 602.842.9919 or by email at info@traumahealingjourneys.com