Ketamine Treatment: Treatment Day 10 — Learning to Be Gentle With Myself

Heading into the final few treatments a little nervous.

I do feel lighter. It is an actual physical sensation, oddly from the middle of the chest up. Perhaps more open than lighter? Whatever it is, it feels different. And different, at this point in my mental health journey, is worth paying attention to.

Esketamine Treatment and a Different Response to Overwhelm

There’s another interesting thing happening when I begin feeling overwhelmed—which, of late, has been often.

I’m noticing a simple recognition.

“Well, this is what it is, so I better prioritize.”

Rather than the traditional:

“Oh, my God, there is too much. I can’t handle it. I’m useless.”

That feels like a big win.

Nothing about the circumstances has necessarily changed. The list of things to do hasn’t miraculously shrunk. I haven’t suddenly acquired the organizational skills of a particularly efficient Swiss railway. The difference is in my response.

That may not sound revolutionary to people whose internal monologues are generally conducted by reasonable adults. For those of us whose inner critics have the temperament of a disappointed Victorian schoolmaster, it feels significant.

And there’s some research to support paying attention to this kind of shift. A 2022 systematic review and meta-analysis by Wakelin, Perman, and Simonds examined 19 studies involving 1,350 participants and found that self-compassion interventions produced a moderate reduction in self-criticism compared with control conditions. The researchers also noted limitations in study quality and variation in results, so this isn't a guarantee that any one technique will work for everyone. But it does suggest that self-criticism isn't necessarily a permanent feature of our internal landscape.

Which brings me to today's experiment.

The Limitless “I Am Gentle” Meditation

Today, I may choose the Limitless “I Am Gentle” Macrodose Journey.

The subject is being gentle with yourself, which, God knows, is a personal problem.

If I spoke to any other living human being the way I talk to myself, I would have been ostracized as a horrible human years ago.

Possibly imprisoned.

At the very least, I would not be invited to potato raclette and Rhine wine..

And yet, somehow, I continue to regard this treatment of myself as perfectly reasonable. Other people deserve patience, understanding, and the occasional allowance for being human. I deserve a full internal investigation, followed by a scathing report on my failures.

It's a curious double standard.

So let's see if this particular meditation helps.

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The best esketamine treatment session I've had?

I did, in fact, use the Limitless “I Am Gentle” journey, and it was so freeing that it actually surprised me.

Let me say again that her voice and sense of humor—her insistence that lightness, humor, and silliness are medicine for healing—may be the most powerful aspect of this program.

I cannot overstate how much this matters to me.

There is something wonderfully disarming about being invited to approach difficult emotional material without having to make the whole experience grim and solemn. We can take our pain seriously without treating every moment of healing as if it requires a candlelit vigil and a string quartet.

Sometimes, apparently, we can laugh.

Sometimes we can be silly.

Sometimes the way into a difficult feeling isn't through another round of emotional excavation but through a little lightness that allows us to approach it differently.

I can't say that humor is the key to healing for everyone, or that this particular meditation will have the same effect on anyone else. But today, for me, it was extraordinary.

Internal Family Systems Therapy: Meeting My Inner Critic

That is not to say that all was rose and sweetwater.

There were moments of thistle and brine.

One particularly memorable segment involved thanking my inner critic for his service and allowing him to slide down the grounding tube and away for the rest of the session.

Yes, a grounding tube.

Mental health treatment can be a wonderfully strange place.

My Internal Family Systems (IFS) therapist has been helping me explore the different roles or “parts” within me: the critic, the editor, and the fat woman with the Häagen-Dazs pint, among others.

These parts can be exhausting. The critic has an opinion about practically everything I do. The editor seems determined to revise my existence. And the woman with the ice cream appears when emotional pain needs soothing.

I have spent a great deal of time hating these parts and blaming them for all sorts of my failures.

Why can't the critic just shut up? Why can't the editor leave well enough alone? Why can't I stop using food to soothe myself?

You know. The usual gentle, compassionate questions.

But IFS offers a different way of understanding these internal roles. Rather than treating them as enemies to defeat, the approach encourages us to become curious about what they are trying to accomplish.

The critic may believe that pointing out every flaw will prevent me from making mistakes or being rejected. The editor may believe that if everything is sufficiently polished, I will finally be safe from judgment. The part that reaches for ice cream may be trying to provide comfort when other forms of comfort feel unavailable.

Their methods may be unhelpful. Their timing may be appalling. Their execution may leave something to be desired.

But their intentions, in this framework, may be protective.

That is a very different proposition from believing that these parts exist simply to make my life miserable.

And it is an unbelievably difficult proposition for me to accept.

The Surprising Power of Gratitude for My Inner Critics

My IFS therapy has been focusing on the idea that these roles within me are, in their own way, loving. They are doing what they think will keep me safe.

I understand the concept intellectually.

Emotionally? That's another matter.

It's hard to move past hating them and blaming them for so much of my internal chaos. Even if I can see that they might be trying to protect me, I still want to ask why they have to be so bloody unpleasant about it.

Today, though, my esketamine session gave me a full hour and thirty minutes without them.

An hour and a half.

No running commentary from the critic. No relentless editing. No familiar internal scramble to manage discomfort.

It was pretty incredible.

What really grabbed me, though, was a suggestion my therapist has been making for some time, without much movement on my part: perhaps I actually owe these parts some gratitude.

In IFS, these protective roles are often described as managers and firefighters. Managers try to prevent distress by keeping things under control, anticipating problems, or pushing us to perform. Firefighters jump in when emotional pain breaks through, attempting to put out the fire as quickly as possible. Their strategies can sometimes create problems of their own, but the underlying intention is protection.

The distinction matters. Understanding why a behavior developed doesn't mean approving of every consequence or abandoning the work of changing it.

It means considering that there may be something worth understanding before rushing to condemnation…I guess

And today, something shifted.

There was a deep, deep sense that I did, in fact, understand it. More than that, I felt genuine gratitude for those three parts that seem to cause so much internal chaos and emotional crunchiness.

Bad crunch. Like a tooth on an unseen walnut shell.

Not the delightful crunch of a crème brûlée.

For once, I wasn't simply being told that these parts might be trying to help me. I could actually feel the possibility of it. I could recognize that the critic, the editor, and the woman with the ice cream might all be trying to protect something vulnerable in me.

And I could feel grateful for that intention without having to pretend that their methods were always helpful.

That distinction feels important.

I don't have to love every behavior to appreciate the part of me that developed it. I don't have to keep doing something that hurts me to acknowledge that it may once have served a purpose.

Perhaps I can stop treating these parts as enemies and start treating them as members of a very dysfunctional committee that desperately needs better leadership.

I suspect the committee will continue to meet.

I would simply prefer that it stop scheduling emergency meetings every time I make a mistake.

What Does the Research Say About Self-Compassion and Depression?

My experience today is personal, and I don't want to confuse a powerful session with proof that I've permanently changed. Still, the themes emerging from this work—self-compassion, reduced self-criticism, and a different relationship with difficult emotions—have some support in psychological research.

Revisiting the 2023 Han and Kim report, “Effects of Self-Compassion Interventions on Reducing Depressive Symptoms, Anxiety, and Stress: A Meta-Analysis,” from my “Ketamine Therapy Day 9” post, they provide evidence that self-compassion can help reduce depressive symptoms, while offering a plausible reason to explore self-compassion as a complement to your treatment— but is not proof that it makes ketamine or esketamine more effective.

The key discovery to remember is that learning to treat yourself with less judgment and more kindness may help reduce some of the symptoms associated with depression.

My experience involves several overlapping elements, the esketamine treatments, including medication, psychotherapy, and the work I'm doing between sessions.

And I’m wondering if that…what…cocktail or elements has allowed me the emotional room to be kind to myself. I was certainly unable to do it earlier..

Perhaps learning to respond to ourselves with less hostility is not simply a feel-good exercise. Perhaps it can be part of how we reduce the total emotional burden we carry.

As for Internal Family Systems therapy specifically, my experience should not be mistaken for proof that the model works for everyone. The broader research base for IFS is still developing, and the evidence for self-compassion interventions should not automatically be treated as evidence for every component of IFS.

We are all different. And we must find our own solutions.

What I can say is that the combination of ideas I'm exploring is giving me a different way to think about my own internal life.

And today, that difference felt substantial. 

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Is This a Turning Point in My Ketamine Treatment Journey?

Today feels sea-changey.

I know better than to declare victory based on one session —or ten, for that matter. Depression doesn't operate according to a satisfying dramatic arc, with a crisis in Act Two and a triumphant resolution before the curtain falls.

If only.

And right now I would settle for a well-placed intermission.

I know there will be more difficult days. There will almost certainly be moments when the critic returns with his clipboard, the editor starts redlining my existence, and the ice cream lady might move from the pint to the gallon.

But today, I experienced something different.

I felt lighter—more open.

I noticed that overwhelm didn't have to turn into self-condemnation.

I experienced ninety minutes without the usual internal sniping.

And I felt something approaching gratitude for the very parts of myself I've spent so much time hating.

That's a lot for one session.

Whether this becomes a lasting change remains to be seen. Esketamine treatment is not a guarantee of remission, and one particularly meaningful experience cannot tell me what the longer-term outcome will be.

But I don't need to turn today's experience into a promise about tomorrow.

For today, it was enough to experience a different possibility.

Perhaps I can be overwhelmed without becoming useless. Perchance I can change without declaring war on myself. Maybe even the most obnoxious parts of me deserve a little understanding.

Today does indeed feel sea-changey.

I hope that is the case.