She reached for the safe word. It wasn't there.
Hello Reader, In a ketamine session, a client later told me, there was a moment she wanted to use the safe word we'd rehearsed and couldn't find it. Nothing had gone wrong. The dose was moderate, she was comfortable, I was watching closely. The signal we'd agreed on simply wasn't there when she reached for it. That moment is why I no longer trust the safe word the way our field does. A person in a non-ordinary state can't reliably notice a boundary being crossed, locate the agreed signal, and produce it on cue. The safeguard we lean on hardest is the one least available exactly when it's needed. So consent in this work has to be a practice, not a moment: set before dosing, documented, conservative by default. And one rule does the most work. Do not expand consent after dosing. When a client asks for more touch mid-session, that request is not permission to give it, no matter how responsive saying yes would feel. Consent can contract during a session at any time. It cannot ethically expand. That's one half of what I've been working through. The other half is structural. A supervisee told me, sincerely, that the abuse cases in the field didn't worry him for his own practice, because he'd never cross that line. I believed him. It doesn't matter, because a safeguard that depends on the clinician's good character isn't a safeguard. It's a hope. Suggestibility widens the therapist-client differential past what ordinary boundary norms were built to hold, and good people misread a room. This week I published two posts, one on each half: There Is No Safe Word at That Depth →: consent, touch, and the practice you build before the medicine. The protections that actually help (supervision, a second clinician, recording, written scope limits) are real, and they're inert without a culture willing to use them. In one MAPS-sponsored trial, the cameras were on and nobody watched the tape for roughly six years. There's also an equity problem hiding inside them: every one of those protections costs money, so safety ends up distributed by ability to pay. The second post takes that apart. Both posts are the short version of something I teach in full. If you want the consent, documentation, and scope detail worked all the way through, with the standards a board expects, that's what our NBCC-approved CE course covers: Ethical Guidelines for Ketamine Clinicians (2 CEs) → — Peter |