Choosing the Right Ketamine Clinic for You with Katie Fassbinder, MD

In this episode of the Psychedelic Medicine Podcast, Katie Fassbinder, MD joins to explore how to choose the right ketamine clinic. Dr. Fassbinder is the Faculty Medical Lead for ketamine-assisted psychotherapy training at Elemental Psychedelics and a practicing psychiatrist based in Wisconsin with over 20 years of experience. She also directs mental health and KAP programming at Promega and has worked extensively in public-sector mental health systems. In this conversation, Dr. Fassbinder explores how patients can make informed decisions when choosing a ketamine clinic, emphasizing that safety, therapeutic support, and personal fit should guide the process. She discusses the differences between medical ketamine treatment and ketamine-assisted psychotherapy, highlighting how factors such as trauma history, treatment goals, medical complexity, and access to integration support can influence the most appropriate model of care. The conversation also examines the strengths and limitations of various routes of administration, including IV, intramuscular, sublingual, and at-home ketamine programs. Throughout, Dr. Fassbinder stresses the importance of preparation, integration, set and setting, and finding a treatment environment that feels safe and supportive, noting that ketamine's benefits are often maximized when paired with meaningful therapeutic relationships and ongoing psychological support.   In this episode, you'll hear: Key factors to consider when evaluating the safety of a ketamine clinic How medical and psychological needs influence the type of ketamine treatment that may be most appropriate The differences between ketamine-assisted psychotherapy and more medically oriented ketamine treatment models How IV, intramuscular, sublingual, and at-home ketamine approaches compare Why set, setting, preparation, and integration are critical components of successful treatment Who may be a good candidate for at-home ketamine programs and what risks to consider The distinction between psycholytic and psychedelic ketamine dosing and how each supports different therapeutic goals Resources and community-based options for psychedelic integration when ongoing therapy is not available   Quotes: "[Ketamine] is one of those medicines that's very much a shape shifting medicine and it can meet people for different types of concerns or goals at different levels and different routes. So it's so good we have such a breadth of options—and very complicated if you're a patient trying to figure out where to begin."  [7:55] "Those challenging psychedelic experiences, when well integrated, typically provide even more benefit for the person than the sort of bliss journeys that we all hope everybody gets to have, you know? So having a challenging journey, if well supported and integrated, is also a gift that's very potent for somebody that's really ready to do that work." [21:52] "Ego dissolution or that sort of loss of concept of self can be extremely liberating for some people. For others, coming back from that can be very discombobulating and even traumatic. So this really comes down to patient selection and helping people make a safe choice for what they're looking to do in their recovery and also what they're bringing in as risk factors for helping choose that safe dose range." [31:15]  "While we don't have clarity about cognitive impacts of ketamine in the long run, it seems like when done therapeutically in pulses it's pro-cognitive. … But when done daily, what we've seen in recreational ketamine use—or misuse—is that it does have some cognitive impairment that's perhaps difficult to reverse." [42:58] "The dose of ketamine has so much to do with the preparation of your system more than the number of milligrams. … If you've done the at home course and you're not getting the sustained benefit or you're not journeying, it might be that that's a cue that you need more support for your actual sessions." [45:01] "Psychedelics and ketamine included, create a nonspecific amplification of everything. Everything feels bigger. And part of meeting with the ketamine provider is for them to really assess: Is this a good time in your life? Do you have the outside support, the inner resourcing to do this work safely?" [47:09]   Links: Elemental Psychedelics website Elemental Psychedelics on LinkedIn Promega website Healing Maps website Fireside Project website ACER Integration website Journey Clinical website Usona Institute website "Psilocybin vs. Ketamine Training: Which is Right For Your Practice?" blog by Shannon Hughes and Dori Lewis Previous episode: Fireside Project: The World's First Psychedelic Hotline with Joshua White and Hanifa Nayo Washington Psychedelic Medicine Association Porangui