In this episode of the Psychedelic Medicine Podcast, Dori Lewis, MA, MEd, LPC-S returns to discuss the differences between psilocybin and ketamine. Dori is the Clinical Director of Elemental Psychedelics and Owner/Operator of Reflective Healing in Fort Collins Colorado. As a clinician, she blends transpersonal psychology, depth work, and psychedelic-assisted therapy within a model that centers the therapeutic relationship. To date, she has stewarded over 100 ketamine therapy sessions, more than 200 mushroom sessions, and numerous group ceremonies.
In this conversation, Dori explores how clinicians and facilitators can thoughtfully decide when ketamine or psilocybin may be the more appropriate therapeutic option, emphasizing that the two medicines are complementary rather than competing approaches. She explains how factors such as current medications, trauma history, substance use, prior experience with altered states, therapeutic readiness, and available social support all shape this decision. Throughout the discussion, Dori argues that ketamine often serves as an accessible and effective introduction to psychedelic-assisted therapy, while psilocybin may be especially valuable for addressing grief, attachment and religious trauma, and deeper existential questions when paired with sufficient preparation, integration, and a strong therapeutic relationship.
In this episode, you'll hear:
- Why ketamine is often recommended before psilocybin for people new to psychedelic therapy
- How SSRIs and other medications influence the choice between ketamine and psilocybin
- What personal history, symptoms, and therapeutic readiness clinicians should evaluate before recommending either medicine
- Which conditions and life experiences may be particularly well-suited for psilocybin-assisted therapy, including grief, attachment trauma, and existential distress
- How cannabis use, substance use disorders, and suicidal ideation can affect treatment planning
- Why community support, integration resources, and a trusting relationship with a facilitator are critical for successful psychedelic experiences
- The importance of cultivating self-awareness before engaging in psychedelic-assisted therapy
Quotes:
"How do we help somebody who is on these [SSRI] medications, has been on them for a really long time and is actually doing well with them? The answer is not to get someone to stop taking their meds just to have a psilocybin experience. That's actually really reckless, in my opinion. What I would say is, why don't we start with ketamine and see how that affects you." [7:59]
"There's another important piece here: What [does the patient] want? If this person says, 'Dori, I really don't want to do ketamine. I want to work with a plant medicine. That's what I'm feeling really called to.' I might say, 'okay, then let's explore that.' But if they're open [to either], I might say, 'why don't we start with [ketamine]?'" [15:50]
"There are very few cases that I would say, 'don't start with ketamine' unless somebody says 'I've already done ketamine' … or they say 'I don't want to do ketamine' but in most cases I'm going to recommend just start with ketamine" [23:05]
Links:
Dori on LinkedIn
Elemental Psychedelics website
Elemental Psychedelics on LinkedIn
Reflective Healing website
Reflective Healing on LinkedIn
Reflective Healing on Instagram
Fireside Project website
Previous episode: Common Psilocybin Myths & Misconceptions with Dori Lewis, LPC
Previous episode: How Psychedelics & Pharmaceuticals Can Both Aid Healing with Erica Zelfand, ND
Psychedelic Medicine Association
Porangui
