Podcast Summary

What Your Therapist Thinks

Hosts: Felicia Keller Boyle & Kristie Plantinga
Guest: Dr. Shannon York, Clinical Psychologist & Specialist in Ketamine Assisted Psychotherapy (CAP)
Episode Title: What Should I Talk About During Ketamine Therapy? How to Get the Most Out Of a Session
Release Date: October 8, 2025

Episode Overview

This episode explores the nuances of Ketamine Assisted Psychotherapy (CAP), including how it works, common myths, who it's for (and who it's not), and—centrally—how to get the most out of a CAP session. The hosts are joined by Dr. Shannon York, who specializes in identity-affirming therapy, people-pleasing recovery, and psychedelic modalities. Listening in, you’ll better understand how to prep for CAP, what to expect during and after sessions, and how to know whether this transformative therapy might be right for you.

Key Discussion Points & Insights

1. What Is Ketamine & Why the Recent Hype?

• Origins & Classification:
  • Ketamine originated as a dissociative anesthetic in the 1960s, safely used on battlefields as it doesn’t suppress breathing or heart rate (02:58).
  • Unlike psilocybin or ayahuasca, ketamine is synthetic and came from the medical world.
• Surge in Popularity:
  • CAP’s rising profile stems from its legality (compared to other psychedelics), promising research, and public interest in new healing modalities, especially for depression (06:07, 07:27).
• Internet Perception:
  • “Anytime something is taboo, myths are going to arise.” — Kristie (10:55)

2. CAP vs. Other Ketamine Therapies

• Medical Model vs. Psychotherapy Model:

  • In the medical model, ketamine is the direct agent of change (e.g., IV infusions in a clinic).
  • In CAP, ketamine enhances rather than replaces the therapeutic process; the “medicine is the helper, not the healer. The actual... relationship is what is creating the change.” — Dr. York (08:54)

• Different Dosing Experiences:

  • Full psychedelic (higher doses, “trippy”)
  • Psycholytic (lower doses, lucid, “hyperfluent,” talkative therapy)
  • Not all CAP requires a psychedelic experience to be impactful (09:42).

3. Debunking CAP Myths and Common Concerns

• Common Myths:

  • “All the bad press… people are saying they’re using ketamine and don’t look like they’re in the right mind…” — Dr. York (11:09)
  • The experience is not losing control in public or while working; sessions are short and contained (usually 45-60 minutes) (12:04).
  • “I think a lot of people want it to be magic. I want it to be magic. It’s not magic.” — Dr. York (15:53)

• Safety & Customization:

  • It’s crucial to work with a clinician who supports your sense of safety; factors like dose, the presence of supportive people (even pets), and timing are adjustable (12:50).

4. Who Is (and Isn’t) CAP For?

• Cautions:
  • Those with a personal or family history of psychosis should be especially cautious (32:31).
  • People with active or recent ketamine addiction, or those unsure they can safely handle access to the medicine at home, should be closely evaluated and often referred to more tightly controlled settings (20:35, 22:32).
  • It’s not the only or always the best tool. “This is not going to be the only way we get there. So if you are absolutely against it or if you change your mind, I am with you, and we’re still gonna get where you wanna go.” — Dr. York (37:36)

5. How Does CAP Facilitate Healing?

• Mechanisms:
  • Boosts Neuroplasticity: “It makes it easier to learn new things—whether it’s a language or… coping skills.” (16:40)
  • Elevates Mood Rapidly: Especially for treatment-resistant depression. “If you had 40% less hopelessness, it would be easier to do the other things…” (16:40)
  • Quiets the Default Mode Network (DMN): Reduces rumination, making it easier to adopt new patterns of thought (16:40, 42:27).
  • Creates a Neuroplastic Window: For up to two weeks post-session, efforts to make change can be especially fruitful (39:22).

6. Preparation, Intention, and Set & Setting

• Psychological Preparation:
  • Spend time journaling; articulate intentions, but keep them flexible and not too narrow (23:23, 25:29).
• Physical Preparation (“Setting”):
  • Create a comfortable, safe space (bed, supportive person nearby, non-disruptive pets, snacks and water, curated music).
  • “Music plays such a meaningful role in the actual experience. So you’re really thinking about, am I setting myself up to get the most out of this experience?” — Dr. York (24:58)
• Therapeutic Process:
  • On lower doses (psycholytic), talking can occur during; higher doses, experiences are inward, with integration discussed afterward (27:28).
  • Integration sessions 24–48 hours after are key to processing and applying the experience.

7. Reddit Q&A: Real-Life CAP Experiences

• On Talking During Ketamine:
  • It’s normal to feel unable to talk; pressure to converse can feel disruptive, and support people should avoid initiating conversation unless invited (28:05–31:24).
  • “If talking feels good to the client, yes, we’re going to do that. If it doesn’t feel good, we’re not.” — Dr. York (29:19)
• On Breakthroughs for CPTSD:
  • There’s no single definition—clarity, relational trust, ability to invite in “exiled” parts (from the IFS model), and integrating new micropractices can be breakthroughs (39:22–41:59).
  • “The breakthrough is what you want it to be. And let’s be intentional about getting there.” — Dr. York (40:19)
• On CAP Making Therapy More Effective:
  • Many find ketamine increases openness and receptivity. However, “winning at therapy” is usually less effective than letting go and being present (46:48–48:19).
  • “Therapy is not exorcism. We’re not here to get rid of any parts of you…we want to invite more people to the party…” — Felicia (50:10)

8. Internal Family Systems & Parts Work

• CAP and IFS Synergy:
  • CAP can make it easier to meet and integrate exiled parts of the self (53:06).
  • “What they found is that people literally had this internal experience of confronting and meeting death… Can you ask what it’s there to teach you? Can you lean in instead of running away?” — Dr. York (52:15)

9. Integration and Healing Mindset

• Letting Go of Control:
  • CAP can be a powerful practice for safely experiencing surrender and for developing self-trust (36:13–38:13).
• Agency and Choice:
  • You’re not more “evolved” for trying CAP—it should always feel like your own choice, and practitioners should never be pressuring clients (36:43–37:36).

10. CAP: Not a Magic Wand, but a Powerful Hammer

• Memorable Summary:
  • “It is an incredible tool. If it’s a hammer, not everything in therapy is a nail. It’s a wonderful addition to a toolkit. A fantastic option… not a magical solution that is necessary to get to the change that you want to have.” — Dr. York (56:12)

Notable Quotes & Moments

• On Magic vs. Reality:

  “I think a lot of people want it to be magic. I want it to be magic. It’s not magic.” — Dr. York (15:53)

• On the Power of Integration:

  “The actual… relationship is what is creating the change.” — Dr. York (08:54)

• Letting Go and Openness:

  “Really, the set is just, what does it feel like to let go?” — Kristie (37:50)

• On Therapy as a Process:

  “Therapy is not exorcism… we want to increase the range of possibility, the flexibility and the integration of the self.” — Felicia (50:10)

• On CAP and Self-Trust:

  “My specialty is helping people retire from people pleasing... is this coming from you? Are you feeling pressured?” — Dr. York (36:53)

• On Meeting Difficult Parts:

  “If you find something scary, one, know that it’s you. It’s part of you…can you ask what it’s there to teach you? Can you lean in instead of running away?” — Dr. York (52:15)

• CAP as a Tool:

  “It’s more like a hammer, less like a wand.” — Felicia (56:37)

Timestamps for Important Segments

• [02:58] What is ketamine? How does it work medically and in therapy?
• [06:07] Why is CAP suddenly everywhere? The resurgence of interest.
• [08:54/09:42] Medical model vs. CAP model; distinctions in administration & experience.
• [11:09] Myths, “bad press,” and safety in CAP.
• [15:53] The “magic” myth; examining realistic expectations in psychedelic therapies.
• [16:40] Three main neurobiological effects of ketamine in therapy (neuroplasticity, mood boost, DMN).
• [20:35/22:32] Cautions and contraindications (addiction, psychosis, self-trust for at-home use).
• [23:23] How to prepare for a CAP session; importance of set & setting.
• [27:28] What to expect during CAP (inward vs. talking, integration sessions).
• [28:05–31:24] Reddit Q: Trouble talking during ketamine.
• [32:31] Adverse reactions—who should avoid CAP.
• [36:43–38:13] Finding readiness, especially with family/personal history of addiction & need for control.
• [39:22–41:59] Reddit Q: Breakthroughs with ketamine, especially for CPTSD.
• [46:48–48:19] Reddit Q: Did CAP make you more receptive to therapy?
• [50:10/53:06] “Parts” work, IFS, and CAP.
• [56:12] Dr. York’s unfiltered take: “CAP is a wonderful tool, but it’s not a magic solution.”

Further Resources

• Dr. Shannon York: inalignmentwellness.com
  • Blog, information on people pleasing, emotionally immature parents, kink, polyamorous relationships.
  • Free guide: Supporting a loved one during their CAP journey.

Takeaways

• Ketamine Assisted Psychotherapy is a promising, customizable tool—powerful when integrated into a thoughtful therapeutic relationship, but not a cure-all.
• Preparation, intention, and integration are critical for meaningful and safe experiences.
• CAP is not for everyone; choosing it (or not) should always be client-centered, without pressure.
• Healing is not about “winning” at therapy or finding quick fixes, but about curiosity, flexibility, and expanding the sorts of emotional experiences and parts of the self you can access and understand.
• Openness, safety, and a supportive context are as important as the medicine itself.

For more on CAP or to connect with Dr. Shannon York, visit inalignmentwellness.com.