WHAT IS KETAMINE THERAPY?
Ketamine is a dissociative analgesic that is most commonly known for its use in hospital and out-of-hospital settings to relieve pain and induce sedation. It is less known for its use as a psychotherapeutic agent to treat a wide spectrum of psychological injury.
Although the mechanism of action on the brain is not entirely understood, Neuropsychiatrist Ronald Duman and Neuropsychopharmacologist George Aghajanian hypothesized that ketamine allows for rapid synaptogenesis (formation of new junctions where two nerve cells meet) to occur where alteration in firing mechanisms of synapses linger due to depression and chronic stress.
Ketamine tends to induce hallucinogenic and mystical experiences, leading to alleviation of PTSD symptoms, depression, and anxiety. The practice of Ketamine Assisted Psychotherapy (KAP) uses ketamine as an adjunct to traditional psychotherapy under the premise that the guiding clinical therapist can utilize the dissociative effects of ketamine to help the individual induce a more open and vulnerable state of mind that might not be achievable with traditional talk therapy alone.2
WOMEN IN EMS STATS
Today, EMS is made up of approximately 30% of providers that identify as women, depending on the reporting source. Unfortunately, this demographic is notably missing from research published on the mental health and psychological injuries of first responders.
One paper published in 2024 on the Female Emergency Medical Services Experience4 states that to date, “Little is known if there are gender differences in the experiences among EMS clinicians.”
This study found that of the 22 licensed female EMS clinicians interviewed via focus groups, approximately 70.0% met the criteria for probable anxiety, 53.9% probable depression and 40.9% elevated symptoms of burnout.
Almost 73.0% of these women reported workplace harassment, with most experiences being perpetrated by patients and coworkers. Additionally, over 61.0% reported reconsideration of their career in EMS.3
This should alarm any EMS system currently struggling with employee recruitment and retention, which in our post-pandemic world is many.1 All this to say that it’s not about which gender suffers more, but rather that the data currently available too often overlooks the lived experiences of women in EMS.
While more research may be needed, Dr. Tracy Covington, president of the Wabi Sabi Circle Foundation, decided to provide a treatment intervention for this overlooked population instead of waiting for research to tell her what her female EMS patients were already telling her: they were hurting, and they needed help.
THE WABI SABI CIRCLE
“The only emotion I am allowed to feel is anger,” said one woman on the first day of a week-long ketamine therapy retreat curated specifically for women in emergency medical services (EMS). The newly formed non-profit Wabi Sabi Circle, an organization dedicated to serving female EMTs, paramedics and dispatchers (another often overlooked provider), invited women from this community to apply for a week-long, fully immersive, therapeutic experience.
Participants engaged in guided ketamine therapy sessions, with integration supported by practices such as meditation, five-point acudetox, yoga, breath work, sound bath, and equine therapy.
They also took part in both group and individual therapy sessions, all of which culminated in the creation of a genuine sense of safety to heal in community. A community where women who share similar backgrounds, work experiences, and emotional wounds could come together and find connection.
COLLECTIVE WOUNDS
Based on their applications and interviews, it was easy to see that these women shared similar work-life experiences and traumas accumulated on the job. This was not only from the 911 calls themselves, but also the abuse and mistreatment inflicted by peers and weak managers.
Because it’s not always the call but the lack of support from management in the aftermath that leaves a negative impression on first responders in general. However, when offered opportunities to explore the wounds underneath the depression, the PTSD, addictions and anxiety (to name a few), what was unpacked was much deeper than the traumatic calls they had responded to in their careers.
Instead, what came up was their grief, mother and father wounds, childhood abuse, imposter syndrome, guilt, shame, and fear. These women lacked self-love, and each one were their harshest critics. They collectively shared the experience of having a non-stop chatter and noise in their heads that were relentless in the pursuit of every single thing they did and said wrong or could have done better.
Not only as a medic, EMT or dispatcher but as a mother, a daughter, a wife or friend. The difficult calls that they carried with them had just as much to do with the version of themselves that responded to those calls as it did with the traumatic imprint left on them long after they went home.
The weight off these cumulative exposures followed them home and their stressors from home followed them to work which created a continuum of not really knowing where one ended and the other began. To compound the complexity of these types of psychological injuries, they lacked awareness of how compartmentalized and shut down they remained when they went off duty, leaving little room to experience emotions and connect, even when in the safety of their homes with family.
This leads to an experience of always being “on” and never allowing ones guard to be let down so that these traumatic calls could be emotionally felt and processed. Inevitably, this bleeds into other areas of their life that also remain shut down, emotionally contained and unable to be reached.
Instead, Dr. Covington and the Wabi Sabi Circle team chose to approach their wounds holistically and inclusively. It mattered less of where and when their wounds were inflicted and more about healing them now so that they could better show up for their families and the communities that they serve. But most importantly, so that they could better show up for themselves.
THE RETREAT EXPERIENCE
“The agency I work for sees mental health as a weakness. If you ask for help you become verbally abused by co-workers, supervisors and station managers. I needed help and was told, ‘that’s why women don’t belong in EMS. They’re overly emotional.…’”3
As the women arrived at the retreat hosted in the hills of Malibu, California, it was quickly apparent that their natural defenses were up, and not in a way that made them unfriendly or lack warmth to one other when they first met.
But rather, they were hyper vigilant, and you could see them purposefully sitting at the edge of their seat or pause mid-sentence, reminded of their station tones, when the grandfather clock in the entryway went off. They mindlessly held their breath and every smell that resembled a fire (“is that fire on purpose?”) or a cough induced by a sip of water down the wrong pipe caught their immediate attention.
They were always on alert and while this can be convenient to have around at times, their nervous systems are relentlessly paying the price. They seemed to have a hard time receiving and letting themselves be taken care of for a change. Empty plates at the dinner table after a catered meal were held on to when a facilitator tried to take it to the trash for them.
Being asked, “Can I get you something to drink?” was met with hesitation and a loss for words at times. A couple of them even expressed how they could not believe this opportunity ended up being real, admitting that they expected to get an email that the retreat was cancelled.
For a group of women conditioned to brace for impact or for the other shoe to drop, this retreat offered them an opportunity to find safety in a community of other EMS women like themselves.
This six night retreat was thoughtfully curated to include four intramuscular ketamine-assisted therapy journeys, equine therapy, five integration group therapy sessions, yin yoga, a sound bath experience and acupuncture.
In between the fixed points of the schedule, the women filled their time by initiating their own group discussions to share one another’s journal entries, KAP experiences, and even collectively pass around an art book that they each contributed.
JEMS: My Experience with Ketamine-Assisted Psychotherapy
They were both inclusive, naturally gravitating to one another, but also independently taking time and space when and if they needed it. It did not take long for them to establish their own inside jokes and endearingly refer to the facilitators as the “adults” or “aunties,” a subtle indicator that they felt more comfortable being the one taken care of for a change.
Charlene, our “house mom,” shared that she often wondered “what the story was behind the shirt” she was folding when doing their laundry. When she shared this to the group, one broke down in tears saying nobody has ever done her laundry for her before.
During this retreat, even mundane chores began to feel like an act of love. There were tears (lots of tears), pain and sadness but there was also immense joy and laughter that erupted in waves coordinated effortlessly by them in unison. It was amazing to see them find the courage to lean into (and accept) all the spectrum of emotions that come with the human experience.
It was truly inspiring to see these physically strong women exercising their emotional strength, as well. Because this retreat wasn’t just about feeling good but getting good at feeling. For just about all of them, it was a challenge to overcome but they got there- and they did so, together.
THE EXPERIENCE AND THE RESULTS
Collectively, the ketamine journeys took these women to the depths of their psyche where they sat and “had tea” with their wounds, a metaphor introduced to them by Dr. Covington on arrival night. There were intense waves of emotion released and embraced during their ketamine sessions while all five facilitators held space for them and monitored their vital signs while reminding them to lean into whatever came up for them.
These emotions were not just tears but also laughter- so much laughter- as if a release valve was finally allowed to open and decompress. They described feeling ‘lighter’ and finally having a quieter mind, even admitting that as inviting as it may be, it was also a bit uncomfortable at times because it was such a foreign experience.
They learned to accept compliments, often having to playfully (but firmly) be prompted by their peers. They learned to feel safe in their bodies and were offered opportunities to practice agency and body autonomy.
They were reminded to breath and be in their bodies with one woman stating, “I can breathe into parts of my lungs that I didn’t know existed before.” They learned what it feels like to expand and take up space, learning that their expansion only created space for others to do the same and not the opposite, which they feared.
They felt what it’s like to not shrink as a defense mechanism and hide who they are to the world around them. They allowed themselves to be truly seen by one another and they became familiar with the strength that comes from being vulnerable in the right setting.
The women collectively experienced reductions in depression, anxiety, and PTSD scores, as assessed through surveys conducted one month before the retreat and two months afterward. They also reported improvements in mood that were noticeable not only to themselves but also to their spouses and families.
While these results are not guaranteed to last indefinitely, since the effects of working with ketamine can vary from person to person and requires subsequent treatments, the retreat proved to be a solid foundation for them to build off when they returned back home.
CONCLUSION
On the last night of the retreat, some of the women admitted their fears about leaving and going home, back to the jobs that contributed to their collective wounds they arrived with. They were dreading the act of “armoring back up” when they when they left this place that had taught them how to let their guard down and let the emotions flow through them.
They were reminded that it was that armor, and their excellent compartmentalization skills, that have actually helped them perform their duties at work. Its ironically what has kept them safe and able to do this job as long as they have.
As they departed from this retreat, they were now equipped with the tools needed to take that armor off so they could experience and process their feelings when they clock out and not subsequently block the ability to connect with their family when they are home again.
What began with their emotional tolerance being limited to anger, transmuted into, “I don’t have to hold my pain to make space for others’ pain. If I feel my feelings and move through them, it makes me stronger and grow bigger, creating more space for others to share and heal together.”
The facilitators of the Wabi Sabi 8 intend for this testimony to reach other organizations that seek to model the same offering for an underserved population in their community.
Wabi Sabi and our participating EMS Women thank our generous donors, Lisa and Chris Kane for helping bring Dr. Covington’s vision to life. This retreat and healing experience for our women could not have been offered without the joint effort of our facilitators (Tracy J Covington, PhD, AAPM | Elizabeth Wolfson, PhD, LCSW | Samantha Lau, PMHNP-BC, FNP-BC | Alexandra Jabr, PhD, EMT-P | Ruby Segovia, MS, LMFT | Charlene Varela, MSW) and the Wabi Sabi Circle. Dr. Covington can be reached at circle@wabisabicircle.org for any questions, comments or collaborative opportunities.
References
1. Fitch, J. (2023, November 21). What paramedics need to persevere. https://www.ems1.com/ems-advocacy/what-paramedics-need-to-persevere
2. Jabr, A. Y. (2023). Rescuing the Firefighter’s Psyche: An Analysis of Ketamine-Assisted Psychotherapy to Treat Posttraumatic Stress Disorder (dissertation).
3. National Association of Emergency Medical Technicians. (2016). 2016 National Survey on EMS Mental Health Services.
4. McCann-Pineo, M., Keating, M., McEvoy, T., Schwartz, M., Schwartz, R. M., Washko, J., Wuestman, E., & Berkowitz, J. (2024). The Female Emergency Medical Services Experience: A mixed methods study. Prehospital Emergency Care, 28(4), 626–634. https://doi.org/10.1080/10903127.2024.2306248
