Breath, Boundary, Being: Ketamine and the Art of Attunement

I’m a psychiatric physician assistant specializing in ketamine-assisted psychotherapy for women navigating perimenopause and menopause. Every day, women arrive in my office carrying what I call iatrogenic psychological burden—the emotional weight of being repeatedly dismissed.

For years, they’ve been told their symptoms are “just stress,” “just hormones,” “just aging,” without proper investigation.

The insidious part isn’t just the dismissal itself. It’s the layering effect.

These women are experiencing real neurobiological changes: brain fog, mood crashes, cognitive shifts. But simultaneously, they’re being told these changes aren’t real or significant.

 

This creates a psychological double-bind.

They’re losing trust in their own perceptions. They’re developing anxiety about advocating for themselves. They’re carrying shame about whether their suffering is even legitimate.

By the time they reach me, they’ve internalized a narrative: I’m overreacting. I’m being dramatic. I’m asking for too much.

That they are, themselves, too much.

 

The Moment Everything Shifts

The breakthrough moment often arrives quietly.

Maybe three or four sessions in, a woman in her late 40s says something simple mid-session: “Wait. This is actually happening in my brain. This isn’t me being weak.”

What makes it a breakthrough isn’t the words themselves—it’s the quality of certainty behind them.

Her shoulders drop. Her breathing deepens. She stops using qualifiers like “I think” or “maybe” or “I don’t know if this makes sense, but…”

She begins speaking in declarative statements rather than questions seeking validation.

And there’s anger. Not at herself anymore, but at the system that made her doubt herself.

Ketamine creates a dissociative state where women can observe their experience from outside the shame-loop. They suddenly see the pattern: how many doctors dismissed them, how much energy they spent trying to prove they weren’t imagining things, how the doubt itself became its own form of suffering.

 

What Comes After Validation

Once women stop asking “Is this real?” a much deeper question emerges: Who am I now?

The validation breakthrough clears space for existential questions that were always underneath but impossible to access while fighting to be believed.

Who am I beyond the roles I’ve been performing? What is my actual purpose now that I’m listening to myself again? What are my gifts when I’m not spending all my energy proving I’m not imagining things?

This matters because perimenopause coincides with midlife—a period ripe for existential questioning. But you can’t engage those questions while drowning in dismissed symptoms and self-doubt.

Ketamine therapy doesn’t just treat depression. It creates the conditions for women to reclaim authority over their own lives and ask the questions that matter most.

 

The Art and Science of Presence

Everything I do in my practice is grounded in evidence-based therapeutic approaches such as DBT, ACT, existential therapy, and trauma-informed care, along with what the scientific literature and latest research tells us about ketamine’s effectiveness in various clinical situations. That’s my foundation.

But knowing which tool to use in any given moment? That’s the art. It’s reading the client and their situation in real time.

During ketamine sessions, I’m constantly reading somatic cues. The body communicates just as much as spoken words—sometimes more.

Productive silence looks like facial softening, tension releasing from the jaw. Breath that deepens, moving into the belly rather than staying shallow in the chest. Hands that open, palms unclenching. Body settling, shoulders dropping, a quality of surrender rather than bracing.

Stuck silence looks different: furrowed brow, clenched jaw, shallow rapid breathing that suggests activation rather than exploration. Hands making fists, gripping, holding on rather than letting go. Body bracing, protective posturing.

When I see the stuck pattern, I intervene through breath—simple, direct, somatic.

“Take a big breath in. Hold it. Now let it out, slowly.”

Sometimes I introduce a scent like lavender. The client instinctively inhales deeper and more slowly in response.

Breath is the most immediate bridge between the autonomic nervous system and conscious awareness. Changing the breath pattern interrupts the stress cycle without requiring cognitive processing. It shifts physiology immediately, activating the parasympathetic nervous system and signaling safety.

It’s the fastest, gentlest way to move from bracing back to openness.

 

When Resistance Shows Up

A woman starts asking “Who am I now?” and then encounters fear or pulls back.

In my work, resistance isn’t a roadblock—it’s an invitation. It’s what we call shadow work, and it’s something to be embraced, not avoided.

The resistance is showing us exactly what needs attention: old protection patterns, internalized beliefs about what she’s allowed to want, fear of disappointing others, anxiety about claiming space she’s never been permitted to occupy.

I invite curiosity rather than override. “Notice that fear that just came up. Can we make space for it? What does it want you to know?”

We practice welcoming rather than wrestling. The resistance often carries wisdom—it’s been protecting her for years, maybe decades.

What is this fear protecting you from? When did you first learn you needed this defense? What would become possible if this resistance could relax, even just a little?

 

Fear and Anger as Allies

I think of fear and anger as friends—as allies that reveal imbalances and opportunities for rebalancing.

For many women, these emotions sit on opposite ends of a familiar spectrum. Fear whispers: “I’m not sure I deserve this.” Anger roars back: “This is unfair. I do deserve more than this.”

A woman starts exploring her new identity and encounters resistance. When we sit with that resistance, fear emerges first: fear of being selfish, fear of disrupting relationships, fear of disappointing others.

But if we stay with it—if we welcome the fear rather than push it away—anger often surfaces underneath. Anger at how much she’s sacrificed. Anger at systems that demanded her silence. Anger at how long she’s been making herself smaller.

That anger isn’t pathology—it’s clarity. It’s her inner knowing saying, “This imbalance isn’t sustainable anymore.”

 

The Question That Changes Everything

When that anger surfaces and a woman recognizes the imbalance clearly, the real question becomes: Are you okay with others being upset with you?

This is where rubber meets road.

Because rebalancing inevitably means disruption: setting a boundary someone won’t like, saying no when she’s always said yes, prioritizing her needs even when it inconveniences others, taking up space she’s been taught to vacate.

We sit with that discomfort in integration sessions—actually sit with it, not theoretically.

When you imagine telling your partner you need time alone, what happens in your body? When you think about disappointing your mother, where does that land? Can you tolerate being the “difficult” one, the one who’s “changed,” the one who’s no longer endlessly accommodating?

The practice starts small. Pick one rebalancing action—maybe it’s leaving dishes in the sink, declining a request, ending a call when she’s done rather than when the other person is.

Then we process: What happened? Who was upset? Could you survive their disappointment? What did you learn about yourself?

The anger reveals the imbalance. But living differently requires becoming okay with other people’s discomfort—and that’s learned through practice, not insight alone.

 

What Makes Someone Ready

When a woman realizes she’s not okay with others being upset with her—when that awareness lands with full weight—I don’t try to make her ready.

Instead, I ask: “If that’s true—if you need everyone else to be comfortable—what does that mean about you?”

This question invites her to examine the belief system underneath. Does it mean you don’t matter as much as they do? Does it mean your needs are negotiable while theirs are fixed? Does it mean love is conditional on your accommodation? Does it mean you’re only valuable when you’re useful to others?

Often, these beliefs were adaptive once. Maybe childhood taught her that keeping others happy kept her safe. Maybe her survival depended on being low-maintenance, agreeable, self-sacrificing.

We honor that history while asking: Is this still true? Does this belief still serve you now?

Readiness emerges when the cost of staying small becomes greater than the fear of others’ disapproval. When the clarity about imbalance becomes unbearable enough that she’s willing to risk disruption.

Readiness isn’t something I create. It emerges when she can no longer unsee what she’s seen about herself.

 

Inner Healing Intelligence

I think of this work as collaborating with an inner healing intelligence. The ketamine session plants a seed—maybe that core question about identity, purpose, or what living well means. But the germination happens in everyday life, in the days, weeks, and months after the experience.

During integration sessions, I ask questions that help her reflect more deeply and examine the attitudes and beliefs she’s carried—often for decades:

What did you notice about how you spoke to yourself this week? When you felt that old doubt creeping in, what was different about how you responded? What would it mean to actually trust that insight you had?

She takes those reflections and translates them into daily life through small, tangible shifts: setting a boundary she wouldn’t have set before, noticing when she’s performing versus being authentic, choosing rest without guilt, speaking declaratively instead of apologetically.

The ketamine creates neuroplasticity and opens a window. But she’s the one doing the rebuilding—answering those existential questions through lived experience, not just insight. The inner healing intelligence guides the process; I’m just asking the questions that help her hear it more clearly.

 

What They Carry Forward

A woman who’s completed this work carries something fundamentally different—not intellectual knowledge, but something you can see in how she moves through the world.

There’s a quiet confidence. Not loud or performative, but solid. She trusts herself now in a way she didn’t before. When she speaks, there’s less hedging, less seeking permission, less apologizing for taking up space.

There’s harmony with her own nature. She’s no longer at war with her body, her age, her needs, her limitations. She understands she’s cyclical, seasonal—that rest isn’t laziness and her worth isn’t tied to productivity.

There’s awareness of her own emotions and wants. She can name what she’s feeling without shame. She knows what she needs and she’s stopped treating her desires as negotiable footnotes to everyone else’s priorities.

There’s attunement to breath. She notices when her breathing shallows, when tension creeps into her shoulders, when fear or anger surfaces—and she has the tools to come back to herself. She’s embodied, present, grounded.

When she first walked into my office, she was asking permission to exist fully.

Now she’s simply existing fully. She’s claimed her own authority. She’s not performing wellness or insight—she’s living from a place of integration.

 

Ripple Effects

I’m one person, working one-on-one, every single day. As a provider, as a mom, daughter, wife, and sister, I can’t shake the larger societal forces that deprioritize mental and physical health, that dismiss women’s experiences, that treat menopause as something to endure rather than a profound transition deserving of support.

But I have two daughters. And I try to practice the same authenticity and self-care that I help cultivate in the women I work with.

I like to think that the ripple effects of the stone of my life make a difference in my community. I believe it takes individual women being informed, taking time for meaningful self-care, and recognizing their self-worth and value to create momentum and meaningful change.

When one woman stops making herself smaller, others notice. When one woman sets a boundary and survives the discomfort, it gives permission to the woman watching. When one woman treats her perimenopause symptoms as worthy of real attention rather than something to power through, it shifts what’s acceptable in her family, her workplace, her friend group.

Each woman who learns to trust her own perceptions, who rebalances her life, who tolerates others’ discomfort in service of her own wellbeing—she becomes a model. She changes what’s possible for her daughters, her sisters, her colleagues.

That’s not grandiose. It’s just real. Change happens in rooms like mine, and then it walks out the door into lived life.

That’s what I hope every woman carries forward: permission to be exactly who she is, without apology.