Episode 50 - Beyond Cookie-Cutter Protocols: Inna Zelikman's Comprehensive Approach to Ketamine and Psilocybin Therapy
MAPS-certified psychiatric nurse practitioner Inna Zelikman shares how her personal psychedelic healing journey transformed her approach to individualized ketamine and psilocybin patient care.
What happens when a 20 year mental health veteran has her own existential crisis then undergoes her own psychedelic therapy? In Inna Zelikman's case, it completely transformed how she practices medicine.
Inna Zelikman, RN, MS, ANP, PMH-NP, is the Director of Integrative Mental Health at Recovery Without Walls and a MAPS certified MDMA practitioner. Five years ago, her own psychedelic healing journey changed everything about how she sees and treats patients. Now she's challenging the cookie cutter protocols that dominate our field in favor of what she calls an "organic" approach to treatment.
In this conversation, Inna shares her comprehensive patient assessment strategies, the medication categories that secretly block healing (even though they're not contraindications), and why some patients have profound psychedelic experiences but can still struggle.
From consulting with psilocybin centers in Oregon to treating ketamine addiction, Inna offers a nuanced perspective on the complexities of psychedelic medicine and why proper preparation, support, and integration actually matter for lasting results.
What You'll Learn in This Episode:
Why doing your own healing work changes how you practice: Inna's personal journey and how it transformed her ability to truly see patient needs
Comprehensive assessment before treatment: evaluating family dynamics, support systems, and trajectory of care
The hidden medication barries: CNS depressants that don't contraindicate psychedelics but stall healing and integration
Set and setting beyond the treatment room: why the therapeutic container includes entire support systems
Real world psilocybin consulting: challenges and solutions for complex patients seeking therapy in Oregon
Psychedelics in recovery landscape - Understanding the historical bias in traditional recovery communities and emerging shifts toward acceptance of psychedelic therapy as legitimate treatment
Key Takeaways:
Healthcare providers who address their own trauma may provide more effective patient care
Ketamine therapy dosed based on individual patient response could benefit patients who don't improve with standard twice-weekly protocols
Sleeping pills and benzodiazepines may prevent psychedelic therapy success even when not contraindicated
Patients may need 1-4 weeks of integration support during the neuroplasticity window for optimal results
Comprehensive patient assessment including family dynamics and support systems may improve treatment outcomes
Traditional recovery communities may be slowly shifting attitudes toward psychedelic therapy, though bias still exists against viewing these treatments as legitimate healing tools rather than drug substitution
Listen to the episode on Apple Podcasts, Spotify, Overcast, or on your favorite podcast platform. Watch the discussion on YouTube here.
Episode 50 show notes:
00:00 Teaser - How Healing Informed Patient Care
00:28 Episode Introduction
02:16 What Drew Inna to Psychedelic Medicine
04:38 The Problems with Modern Psychiatry
07:38 Inna's Personal Transformation Story
11:53 The Hero's Journey to Healer's Journey
16:02 How Personal Healing Transformed Patient Care
17:08 Comprehensive Assessment Process
20:20 Beyond Cookie-Cutter Protocols
22:32 Ketamine Therapy Dosing Philosophy
26:00 Psilocybin Work and Vision Story
28:52 Oregon Psilocybin Industry Challenges
31:33 Set and Setting Beyond the Room
33:07 Patient Screening and Assessment Criteria
35:17 The Hidden Medication Problem
42:31 Managing Complicated Cases
49:33 Patient Examples
55:43 Psychedelics in Recovery and AA
1:00:04 Rapid Fire Personal Questions
1:03:18 Contact Information and Services
1:04:49 Closing Thoughts
1:05:56 Resources
Thanks for Listening
Medical Content Disclaimer: The following information is for educational purposes only and does not constitute medical advice. Individual patient circumstances and local protocols should guide all clinical decisions.
Frequently Asked Questions
How do I transition from protocol-based to individualized ketamine dosing?
Ketamine therapy providers may consider starting with one session at a time, observing patient response and integration capacity before scheduling the next. Some patients might benefit from twice-weekly sessions initially, while others may need weeks between sessions to process what emerged. Clinical judgment and ongoing dialogue with patients could help determine optimal frequency rather than following rigid research protocols.
What medications may block psychedelic therapy success?
CNS depressants including sleeping pills (Ambien, Lunesta), benzodiazepines (Klonopin, Ativan), opiates, and kratom might prevent healing even when not contraindicated for safety. These medications could interfere with the brain's ability to integrate insights during the 1-4 week neuroplasticity window, potentially leading to beautiful experiences without lasting therapeutic outcomes.
How can I assess if a patient is ready for psychedelic therapy?
Comprehensive assessment might include emotional regulation capacity, support system stability, family dynamics, current medications, and trajectory of care. Patients who appear highly dysregulated benefit from stabilization before psychedelic experiences.
Why might some patients fail psychedelic therapy despite profound experiences?
Patients may have meaningful journeys but lack proper integration support during the critical neuroplasticity window. Without adequate processing help, insights could become overwhelming or disjointed. Additionally, certain medications or unstable life circumstances might prevent the brain from consolidating therapeutic benefits even after powerful psychedelic experiences.
How should providers prepare complex or high-risk patients for psychedelic therapy?
Complex patients may benefit from extensive preparation including medication optimization, family involvement, therapeutic support, and coordinated care teams. Consider establishing safeguards and crisis management plans before treatment. Some providers collaborate with multiple specialists and ensure adequate aftercare resources are in place for patients who might experience challenging integration periods.
Consulting with experienced psychedelic practitioners who specialize in complex case assessment could provide valuable guidance for high-risk patients. These consultants might help evaluate medication interactions, assess patient readiness, coordinate with treatment teams, and develop comprehensive safety protocols. For patients traveling to legal psilocybin centers, specialized consultants may also facilitate communication between healthcare providers and treatment facilities to ensure continuity of care.
How do psychedelics fit into traditional addiction recovery programs like AA?
Traditional 12-step communities might have historical bias against psychedelic therapy, sometimes viewing it as "replacing one drug with another." However, attitudes could be slowly changing as more research emerges. Some important distinctions may help: psychedelics like psilocybin and MDMA generally aren't taken daily and don't create dependence, unlike traditional substances of abuse. Additionally, Bill W., AA's co-founder, reportedly had meaningful LSD experiences. Some recovery communities are developing "Psychedelics in Recovery" groups that provide supportive spaces for discussing these experiences.
Ketamine presents unique considerations since it could be therapeutic in proper clinical settings but potentially addictive in unsupervised use. Providers working with patients in recovery might consider discussing these treatments with addiction specialists and exploring how psychedelic experiences could support rather than undermine recovery goals.
Connect with Inna Zelikman RN, MS, ANP, PMH-NP:
email: info@innazelikmanhealth.com
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Links Relevant To The Episode:
If you enjoyed this conversation, check out Episode 039 - Pain, Addiction, and Medical Practice with Dr. Howard Kornfeld, who Inna works with at Recovery Without Walls, for a deeper dive into psychedelics in recovery and addiction medicine.