Shari Kaplan, LCSW, is the founder of CANNECTd Wellness‚ an integrative health center in Boca Raton, Florida. Her interest in integrative medicine is personal. In 2002, her son was born with a central nervous system disorder. “I wanted to fix him,” she said. “I wanted to get his body up and running.” 

Kaplan successfully developed botanical formulations to help regulate her son’s movement disorder and seizures. Her work led her to partner with the late Dr. Allan Frankel, one of the leading authorities on medicinal cannabis, and Dr. Michelle Weiner, an integrative pain management practitioner—who, in a case of kismet, was looking for office space in Boca Raton.

Together, Kaplan and Weiner combined forces to develop treatment protocols that combine medical cannabis, Kaplan’s botanical formulations, and ketamine-assisted psychotherapy. We spoke with Kaplan over the phone about her work, protocols, and how to individualize integrative treatments.

Trying ketamine in order to develop a treatment plan with Weiner

Kaplan: [Ketamine] is kind of like a cheat into meditation. Instead of taking your time, learning to meditate, and focusing, you take this medicine, and—boom, you’re there. I’ve been meditating since I was 11. That’s what it felt like to me. But it also made me understand that people who don’t meditate, don’t know what it’s like to be in that therapeutic space. 

If this helps neuroplasticity, it would make sense that you would need to do a whole protocol that helps somebody target the negative beliefs they want to eliminate. The neuroplasticity gets in the positive beliefs, and then you develop their behaviors and lifestyles. But what do they really want, and what are they doing? So, I wrote up this whole 36-week protocol. And the patients started getting better. We started tweaking it a little bit more, and more patients started getting better. 

We decided, let’s do a study with the University of Miami, comparing chronic pain patients with depression with microdosing and therapy and chronic pain patients with psychedelic dosing.  Everyone improved. And the pain level of people with the psychedelic dose improved more than the microdose, but it was really close. 

I think the reason is that pain’s origin is psychospiritual. If you’re used to having pain daily, your brain is trained to experience pain. So even if the pain subsides in the body, the brain still signals the body to feel pain. Because I did all this brain training, I developed a way to retrain the brain from pain and deal with the underlying issues. So take away the stress hormones, retrain the brain, and the patient should get better.

The placebo effect and belief systems

Kaplan: I was speaking with a gentleman yesterday, and he said to me, “Well, I don’t know if [ketamine is] gonna work for me, and I’ve had so many people promise so many other things.”

I said to him, listen. This is a real thing. Placebo isn’t over-faking people. You have an entire pharmacy in your body. There are different ways to trigger it. You can trigger it with visualization. You can trigger it with your belief system. And if you align with the fact that something will help you, your body will learn how to produce the hormones and the compounds that it needs to help you. 

So, if you tell yourself nothing ever works for me, then this, too, will not work for you. Because you need to align with what you’re doing. It’s not just taking the medicine. It’s actually working on yourself, doing the brain training, and doing the psychospiritual work accompanying it. What happens if you were to give up your pain? What would your life look like? What would you want it to look like? And he says, “Oh, well, that’s just not possible for me.” 

It’s really important that people understand that the medicine’s not a miracle drug, and you are using it in various ways to help you. But if you don’t think that that’s possible, then I don’t think it’s gonna work. 

On managing patient expectations

Kaplan: My evaluation starts when you’re in the mother’s womb. I want to know what kind of stress she was under, or not, and go from there. But I think that you need to really manage their expectations by telling them that, you know, there’s no miracle cure. The medicine does this part, and then we explain what that is—the glutamate, the GABA, the oxytocin, the dopamine, that it quiets down the limbic system, the default mode network, and that it gives an opportunity for all the other lobes of your brain to open up. 

If we do our preparation session right, we will focus your attention on your areas of trauma or something else we’re trying to accomplish. Are you trying to connect with your soul so that you can have a greater sense of connectedness to yourself? Do we expand from there? We want to release the negative belief that you’re powerless, and we want to move toward taking charge of your life. What does that look like? 

We prepare them with images and details of what that would look like so that when they enter that ketamine session, their brain is focused on empowerment, and release. Even if they only see geometric shapes, the thoughts that are going to come to them—they’re going to experience themselves in a way of, oh, I’m letting go of my pain and I’m taking charge of my life. 

We also talk about how it works biochemically. And we talked about how there’s chronic or traumatic stress that underlies conditions like depression, and so we want to have a better understanding as to what components there are of that. Then there’s the work that you’re going to do once we develop these awarenesses. And how do we put this in motion? 

Just because you had a new awareness, now you have to turn that into a new belief. And that’s when we use EMDR, the internal family systems, ego-state psychology, Gestalt work, music and movement, and somatic experience work. How do you connect to this new belief, get that in there, and get it refired and rewired? … We don’t go into that much detail explaining it, but we give them the Reader’s Digest version.

What comes first: ketamine or another form of treatment?

Kaplan: We’re very much personalized, depending on who comes in the door. Sometimes we’ll just start them out with a CBDA and THC formula, with about six different botanical medicines in it. We’ll start them off with therapy and get them prepared. 

If people are being referred to us, they’re usually being referred to us for [ketamine-assisted therapy]. When they enter the door, I might feel like this person is not ready for a psychedelic experience. We want to give them a microdose. Or we want to start them on cannabis for a week, and then give them a microdose. We’re trying to get rid of a few negative beliefs that might keep them from allowing themselves to go into that therapeutic space, trying to hold on and be frightened. 

We really want to get them prepared. If we feel like they don’t have the self-regulation skills and the coping tools, we’ll go into it from there. But just because someone came for ketamine, if they evaluate where they’re not ready to go into that, we will do some other things first.