Healing the Wounds Within

Trauma, Addiction, and the Promise of Ketamine-Assisted Psychotherapy for LGBTQ+ Mental Health

by Seaghan Coleman, LCSW-R

Let’s start with something simple — and true: LGBTQ+ folks face the same core mental health challenges as anyone else — depression, anxiety, trauma, addiction, struggles with identity or meaning. We’re human beings, after all. But we often face these issues in a context shaped by rejection, invisibility, and threat —
and that makes a difference.

Even as our society has made progress, many of us carry deep wounds. Some of those wounds come from what’s been done to us. Others come from what was
missing — safety, protection, acceptance, reflection. These are the quiet traumas that shape how we see ourselves, and how we cope.

The Trauma That’s There — and the Trauma That’s Missing

We’re used to thinking about trauma as the big, obvious stuff: assault, abuse, hate crimes, bullying. And yes, that’s real. Many LGBTQ+ people have lived through exactly those kinds of events. But trauma also comes from absence — the things that should have been there but weren’t:

• Lack of acceptance — when being who you are risks rejection or condemnation
• Lack of attunement — when your feelings or identity weren’t reflected back or understood
• Lack of guidance — when no one helped you make sense of your experience
• Lack of protection — when the world felt unsafe and no one showed up to shield you

A child might not remember a single painful moment, but instead remember a long stretch of silence — being left to cry alone, being laughed at for expressing fear, or having no one explain what feelings are, or how to talk about them. A kid who needed protection and got indifference instead learns not to expect care. A child who had to make sense of their identity in a vacuum may grow into an adult who questions whether their experience is real, valid, or deserving of support.

These early absences can show up years later as adult behaviors that seem confusing or disconnected from the past:

• Avoiding vulnerability even in safe relationships
• Working hard to earn love or prove worth
• Numbing out or dissociating when emotions become intense
• Feeling like something is always missing — but not knowing what

In Ketamine-Assisted Psychotherapy, these early relational wounds often emerge in powerful, surprising ways. The parts of the self that went underground to survive — the ones that had to disconnect, adapt, or go silent — may finally find space to be seen, heard, and cared for.

Trauma and Addiction: A Two-Way Street

When trauma is unprocessed, it doesn’t just fade. It lives in the nervous system, shaping our emotions, our relationships, and the choices we make to survive. For many, that includes reaching for substances to take the edge off — alcohol, opioids, stimulants, and sometimes ketamine itself. But what starts as relief can become its own source of pain:

• Trauma during substance use — unsafe situations, lost memories, or harm done
• The shame spiral — addiction often leads to isolation and self-hatred
• More disconnection — substances may dull pain but also suppress healing as well as cut us off from relationships and connection

Addiction and trauma feed into each other. And for LGBTQ+ people who already experience higher rates of both, that loop can be hard to break.

Why Ketamine-Assisted Psychotherapy?

KAP is not a silver bullet. But for some people, it offers a powerful path to begin healing the deeper layers of trauma and addiction — especially when other approaches haven’t gone far enough.

Let’s be clear: Recreational ketamine use is not the same as therapeutic ketamine. In fact, it can be harmful and even deadly when misused. But in a structured therapeutic environment, with skilled support, ketamine can help open doors that were previously locked shut.

What the Process Looks Like:

Preparation Before any dosing occurs, we begin with structured preparation sessions. These meetings help you become familiar with the process, clarify your goals, and build a strong therapeutic alliance. We explore what you’re hoping to heal, shift, or discover, and identify any concerns or internal obstacles that may arise. If you’re navigating trauma, addiction recovery, or identity-related wounds, preparation is especially important for grounding and stabilization.

Two key ideas guide this stage: set and setting. Set refers to your internal state — your mindset, beliefs, hopes, and fears. Setting refers to the external environment — the physical space, the relationship with your therapist, and how safe and supported you feel. Together, they shape the quality and depth of
your experience.

Another vital part of preparation is the development of a clear intention for the work. Intentions aren’t rigid goals — they’re guiding questions or themes that help orient the experience. Some examples:

• “I want to understand why I shut down when people get close.”
• “I want to reconnect with a part of me I feel like I lost a long time ago.”
• “I want to begin healing the shame I’ve carried from growing up queer in a hostile environment.”

Intentions are explored collaboratively and revisited throughout the process.

Dosing Dosing sessions are typically three hours long and are structured to support both safety and therapeutic depth. Clients self-administer ketamine using sublingual tablets under the therapist’s direct supervision. The tablets dissolve under the tongue, and within 10–15 minutes, the medicine begins to take effect.

This begins what is often called the journeying phase — a period of deep inward experience. Clients may enter a dreamlike or expanded state of consciousness in which they experience symbolic imagery, emotional insight, contact with exiled parts of themselves, or a broader spiritual perspective. Some describe this as a loosening of their usual narrative; others as encountering previously disconnected feelings in a safe, slowed-down way.

Throughout the journey, the therapist remains present, holding the space and offering support if needed. Music may be played to deepen the experience. The final 30–45 minutes are typically devoted to re orienting, grounding, and gentle reflection before departure.

Integration The hours and days after a dosing session are a window of neuroplasticity — your mind and brain are more open to change. Integration sessions help you make meaning of what emerged in the journey. We talk about what you saw, felt, and remembered, and begin weaving that into your ongoing healing work. Integration might include:

• Exploring the emotional significance of imagery or insights
• Identifying shifts in behavior or self-perception
• Noticing changes in your internal landscape — how you relate to yourself and others
• Continuing to tend to parts of yourself that surfaced during the journey

Without integration, the insights of a session may fade or remain disconnected. With it, the session becomes a meaningful step in a larger arc of healing and growth.

Is Ketamine Addictive? Understandably, this comes up a lot. When used properly — at spaced intervals, with preparation, therapeutic support, and integration — ketamine is not considered physically addictive. In fact, for many people, it helps reduce patterns of addiction by addressing the underlying emotional pain and trauma that fuel compulsive behavior (Krupitsky et al., 2002; Dakwar et al., 2014).

That said, ketamine can be misused — particularly when taken frequently, outside a therapeutic context, or as a means of numbing rather than healing. Clinical KAP is designed specifically to reduce that risk through careful screening, structure, and close collaboration between prescriber and therapist.

It’s important to note that while KAP is not a substitute for residential treatment or structured rehabilitation, it is an evidence-based treatment for addiction. Research shows that ketamine can significantly reduce cravings and enhance abstinence in individuals with alcohol, opioid, and cocaine use disorders (Dakwar et al., 2014; Jones et al., 2022; Krupitsky & Grinenko, 1997). The psychedelic state induced by ketamine may also facilitate greater openness, self-reflection, and motivation for change — key ingredients in long-term recovery (Morgan et al., 2017).

For individuals in recovery or those in outpatient care, KAP can be a powerful complement that helps address the roots of addiction, not just the symptoms.

What the Research Shows

PTSD: Studies show that ketamine, especially when combined with therapy, can rapidly reduce trauma symptoms (Wilkinson et al., 2018; Feder et al., 2021).

Addiction: Trials have shown benefit for people struggling with alcohol, cocaine, and opioid use (Dakwar et al., 2019; Krupitsky et al., 2002).

Trauma + Addiction: This is where KAP can really shine. It helps people face the pain that led to addiction — and begin to reclaim the parts of themselves they lost.

Finding Our Way Back to Wholeness

Being queer or trans doesn’t cause mental health problems — but growing up without safety, acceptance, or guidance often does. And surviving that — even if you found ways that hurt you along the way — doesn’t make you broken.

Healing is possible. KAP isn’t for everyone, and it’s not a quick fix. But in the right hands, it can be one of the most powerful tools we have to help people reconnect with themselves — to bring back what trauma pushed away.

For LGBTQ+ people who have been told, in so many ways, that they aren’t whole — this work can be
revolutionary.

About the Author

Seaghan Coleman, LCSW-R is a licensed clinical social
worker, trauma therapist, and founder of Samadhi
Therapy Associates in Buffalo, NY. With nearly two
decades of experience in treating trauma, addiction,
and dissociation, Seaghan integrates Ketamine
Assisted Psychotherapy with EMDR, parts work, and
transpersonal approaches. He offers training and
consultation to other clinicians and is committed to
supporting LGBTQ+ individuals in reclaiming their
wholeness. You can reach him at Seaghan.Samadhi@
Proton.Me.