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Innovating Mental Health Care: A PA's Journey in Psychedelic Therapy

    Welcome to The PA Mindset Matters, where psychiatry, medicine, and the human experience converge. This is a space for psychiatric Physician Associates (PAs) and other mental-health professionals to deepen understanding, grow their skill set, and connect within an evolving landscape of care.

    In this episode, hosts Mercedes Dodge, PA-C, and Jessica Spissinger, PA-C, sit down with Sarah Tatko, PA-C—a clinician reshaping the future of psychiatric care through ketamine-assisted psychotherapy (KAP).


    Bridging the Gap in Mental Health

    The Mindset Matters podcast highlights how PAs are advancing access, advocacy, and innovation in mental health. Through meaningful dialogue and shared experiences, Mercedes and Jessica create a community grounded in clinical excellence, personal well-being, and authentic connection.

    Sarah exemplifies that mission—bridging traditional psychiatry with emerging psychedelic modalities while maintaining a focus on evidence-based, compassionate care.


    Sarah’s Journey: From Speech Therapy to Psychiatry

    Before psychiatry, Sarah’s path began in speech therapy and emergency medicine—disciplines that shaped her ability to connect deeply with patients and communicate with empathy. She credits an unexpected mentorship from a radiation oncologist as the turning point that inspired her transition into psychiatry and, ultimately, into psychedelic-assisted therapy.

    Her story reminds us how vulnerability, mentorship, and curiosity can redefine a career—and how the PA role continues to expand in new and meaningful directions.


    The Transformational Power of Ketamine Therapy

    Sarah’s venture into ketamine-assisted psychotherapy (KAP) marked a defining shift in her clinical approach. She describes ketamine not as a cure, but as a catalyst—a medicine that opens the door to healing when paired with skilled psychotherapeutic support.

    She emphasizes the importance of creating safe, intentional spaces that allow patients to process experiences in an environment that feels warm, grounded, and emotionally supported—quite different from the sterile settings that often define traditional psychiatric care.

    For PAs exploring this field, Sarah encourages first embarking on their own therapeutic or reflective journey, ensuring authenticity and groundedness in the work they do.


    Educational Pathways for PAs

    Sarah recommends structured, evidence-based training that integrates medical foundations, ethics, and psychotherapeutic practice.

    Top educational programs and resources:


    Recommended reading list:

    • The Myth of Normal & In the Realm of Hungry Ghosts — by Gabor Maté

    • The Body Keeps the Score — by Bessel van der Kolk

    • How to Change Your Mind — by Michael Pollan

    • The Psychedelic Explorer’s Guide — by James Fadiman

    • Stealing Fire — by Steven Kotler and Jamie Wheal


    Core Research & Clinical Frameworks

    For clinicians wanting to ground their knowledge in evidence-based literature, Sarah recommends:

    1. Zarate et al. (2006) – A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression, Archives of General Psychiatry.→ The landmark study establishing ketamine’s rapid antidepressant effect.

    2. American Psychiatric Association Consensus Statement (2017) – The Use of Ketamine in the Treatment of Mood Disorders: Consensus Statement, JAMA Psychiatry.→ Clinical guidelines on patient selection, safety, and administration.

    3. Dore et al. (2019) – Ketamine-Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data, and Outcomes in Three Large Practices, Journal of Psychoactive Drugs.→ Real-world data supporting the integration of psychotherapy with ketamine.

    4. The Handbook of Medical Hallucinogens – Edited by Charles Grob & Jim Grigsby (2021).→ Comprehensive, peer-reviewed reference on psychedelic medicine and ethics.

    5. Clinical Training Programs: KRIYA Institute, Polaris Insight Center, and IPI Training Programs.


    Vulnerability, Mentorship, and the Human Connection

    At the heart of Sarah’s message is the power of vulnerability—in both patient care and professional growth. She reminds us that vulnerability fosters empathy, deepens connection, and sustains longevity in medicine. Through ongoing mentorship and community, Sarah continues to help shape a generation of PAs who approach mental health with both science and soul.

    Connect with Sarah and learn more about her clinical work at Cantos Psychiatry.


    Final Thoughts

    Sarah Tatko’s story is a powerful testament to curiosity, compassion, and courage in the evolving field of psychiatric medicine. Her work reflects what The Mindset Matters stands for—bridging the gap between medical practice and human experience to create lasting change.

    🎧 Listen to the full episode: “Ketamine Therapy in Psychiatry: A Journey of Vulnerability and Healing” — now streaming on Spotify, Apple Podcasts, YouTube, and Podbean.


    Extra: Here is a PDF with resources curated by our wonderful guest speaker:


     
     
     

    Navigating the Ketamine Landscape: History, Uses, and Myths

      Welcome to an exploration of the evolving world of ketamine therapy. In this episode, we unpack ketamine’s fascinating journey—from its origins in the 1960s to its role today as a rapid-acting antidepressant and a catalyst for transformation in psychiatry.


      From Battlefield to Breakthrough: Ketamine’s Origin Story

      Ketamine’s story begins in the 1960s—an era of bold medical discovery and psychedelic exploration. Developed by Calvin Stevens, ketamine was first used as an anesthetic and gained prominence during the Vietnam War for its safety and rapid action on the battlefield. Later, it became a staple in veterinary medicine.

      But as its dissociative effects became known, ketamine shifted into the public sphere—earning street names like “Special K” and “Vitamin K.” Its reputation as a party drug overshadowed its legitimate medical value for decades, even as researchers began uncovering its psychiatric potential.


      Clinical Revival: From Party Drug to Psychiatric Game Changer

      Today, ketamine has re-emerged as a powerful tool in the treatment of treatment-resistant depression, PTSD, and chronic pain. The FDA approval of Spravato® (esketamine) in 2019 marked a turning point, providing a regulated, evidence-based framework for use in mental health care.


      Ketamine vs. Esketamine: What’s the Difference?

      • Racemic Ketamine: Contains both R- and S- isomers.

      • Esketamine (Spravato®): Contains only the S- isomer, offering higher NMDA receptor affinity and greater potency with potentially fewer dissociative effects.

      While both forms modulate glutamate and enhance BDNF (Brain-Derived Neurotrophic Factor)—a “fertilizer” for neuronal growth—their dosing routes, onset, and bioavailability differ. Esketamine is administered intranasally (bioavailability 25–50%), whereas racemic ketamine can be given IV or IM, with near-complete absorption.


      Ketamine Myths: What the Science Really Says

      In our conversation, we tackled several common misconceptions:

      1. “Ketamine is just a party drug.”➤ False. Ketamine’s medical applications are extensive and growing, particularly for resistant mood disorders.

      2. “It works the same as SSRIs.”➤ False. Ketamine targets glutamatergic pathways, offering rapid symptom relief compared to serotonin-based mechanisms.

      3. “Ketamine therapy is unregulated.”➤ Partially true. Racemic ketamine infusions are less regulated, while Spravato® is strictly administered in REMS-certified treatment centers.

      4. “Ketamine causes brain damage.”➤ False. When medically supervised, ketamine shows no neurotoxicity and may promote neuroplasticity.

      5. “Ketamine is addictive.”➤ Misuse risk exists, but structured therapy and clinical protocols minimize dependence potential.


      A Catalyst, Not a Cure: Integrating Psychotherapy

      As we emphasize in the episode, ketamine is not a cure—it’s a catalyst. Medication opens the door; psychotherapy walks the patient through it. When paired with therapeutic integration, ketamine can enhance emotional openness, neuroplasticity, and long-term treatment response.


      The neuroplastic window—lasting hours to days—creates an opportunity for deeper cognitive and emotional processing. Structured approaches involving preparation, guided sessions, and post-treatment integration can reduce relapse rates and sustain improvement.


      Looking Ahead: The Future of Ketamine in Psychiatry

      Research on esketamine monotherapy, combination treatments, and long-term outcomes continues to evolve. While it’s still early since Spravato’s approval, data show promise in expanding ketamine’s role in psychiatry and beyond.


      For PAs and clinicians seeking guidance on integrating ketamine into practice, visit the American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3) for resources, certifications, and clinical directories.


      Continue the Conversation

      Stay curious. Stay informed. And keep exploring the intersections of science, empathy, and innovation in mental health care.


      🎧 Listen to the full episode:👉 “Ketamine: From Battlefield Anesthesia to Breakthrough Antidepressant” — streaming on Spotify, Apple Podcasts, YouTube, and Podbean.

       
       
       

      Kathryn Werner, PA-C: From a Rocky Psych Rotation to Thriving Practice Owner — Clinical Pearls, OCD Care, and Building a Sustainable Career


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        Guest: Kathryn Werner, PA-C — Owner, White Pine Mental Health & Wellness; Senior Consultant at CPAC Team


        Quick take

        Kathryn Werner didn’t love her psych rotation. She almost went into surgery. A credentialing snag pushed her into an outpatient psychiatry role with a generous mentor—and that changed everything. Fifteen years later, she runs a tele-psychiatry practice, treats a large cohort of OCD patients, consults on practice start-ups, and speaks nationally on smart prescribing and de-prescribing.


        This post gathers her most useful clinical pearls and career lessons for PAs interested in psychiatry (or already living it).


        How she got here (and why the detour mattered)

        • A rocky start: As a student, Kathryn’s psych rotation offered little patient contact. “Boring” was her word.

        • The pivot: Hired by a psychiatrist to do intake physicals at a psych hospital (2007), she was blocked by credentialing. The win? Joining the psychiatrist’s outpatient clinic instead—where she was taught deliberately, starting with 1–2 patients/day, time to shadow, read, and study.

        • Generalist roots, specialist vision: Stints in GI/hepatology research (as a sub-investigator on early HCV-curing regimens) and later in family/internal medicine sharpened her “whole-patient” lens before returning to psych full-time.

        “When you see patients as frequently as we do in psych, you can catch medical issues earlier—BP trends, thyroid, anemia—then treat the right problem.”

        Why primary care skills supercharge psychiatric care

        • Better differentials: Fatigue + low mood? Don’t miss iron deficiency or thyroid disease.

        • Right-sized workups: Vitals, brief focused exams, and targeted labs prevent both under- and over-referrals.

        • Function first: Frequent, longer visits (her standard follow-up is 30 minutes) let you track outcomes and adjust care without rushing.


        Pro tip: Normalize sensitive topics (sexual function, substance use, sleep). Patients expect you to ask—especially when they’re on meds where side effects matter.


        Treating OCD: ask better questions, treat to target

        Kathryn deliberately markets a niche in OCD and partners closely with therapists trained in ERP.


        What she sees often

        • Under-recognition (both providers and patients): “Relational OCD” can sound like “normal anxiety” until you ask how many hours/day are lost to rumination or checking.

        • Sub-therapeutic trials: Patients discouraged after SSRI at “depression” doses (e.g., sertraline 100 mg). OCD often needs higher doses and longer trials, combined with ERP.


        What helps

        • Education with a simple model: intrusive thoughts → distress → compulsions/neutralizing → short-term relief → loop

        • Normalize that everyone has intrusive thoughts. Pathology = time lost + impairment + compulsions/avoidance.

        • Collaborate early with ERP therapists; set expectations about dose ceilings and duration before declaring non-response.


        Smart polypharmacy: when to add, when to peel back

        Kathryn will co-presents at Psych Congress (PA Institute) on a practical framework:

        • Add when a clear, untreated target symptom remains after an adequate single-agent trial (right dose, right duration, right diagnosis).

        • De-prescribe when side-effect burden, duplication, or unclear indication accumulates; taper methodically with patient-centered goals.


        Reality check: laws, logistics, and practicing across states

        • State variability is real: Prescriptive authority (especially controlled substance), payer credentialing, and allowable codes differ widely.

        • Example: She’s practiced in states where payers wouldn’t credential PAs as psych providers (even with a CAQ) or wouldn’t pay psych assessment codes for PAs.

        • Clinic policy: Her current practice avoids controlled substances in one state due to cumbersome rules; she prioritizes access + safety over administrative burden.

        “When PAs ask how to start in psych, my first question is: what state are you in? The plan depends on it.”

        What she actually uses (and recommends to new psych PAs)

        • DSM (full): Use the decision trees/flowcharts to parse tricky differentials (e.g., OCD vs anxiety vs psychotic spectrum).

        • Stahl’s Prescriber’s Guide: Bread-and-butter pharmacology and dosing nuance.

        • Interview guides: “The First Interview” style texts (any solid edition) to sharpen diagnostic interviewing.

        • Free CME she likes:

          • MGH Psychiatry (esp. OCD-related topics)

          • Sheppard Pratt OCD CME (a 1-hour psychopharm talk she calls “practice-changing”)

        Practice design = clinician well-being

        • Visit length: 30-minute follow-ups reduce adrenaline-driven days and errors.

        • Schedule control: Telemedicine + owner flexibility (e.g., blocking time for a midday yoga class) preserves longevity.

        • Self-care that actually happens: Counselors for clinicians, chiropractic, massage, pizza night—Feel-Good Fridays.

        • Micro-check-ins: “Habit stack” a 60-second self-scan every bathroom break—breathe, ask: What do I need in the next 3 hours? Food? Water? A reset?


        Advocacy & the next 5–10 years

        • More psych PAs in leadership and ownership

        • Cleaner statutes on PA mental health services, prescriptive authority, and payer recognition

        • Curricular emphasis on psychiatry across PA programs

        • Team-forward conferences: The PA Institute at Psych Congress brings PAs, MDs, and (sometimes) NPs together—because care is collaborative.


        Work with Kathryn / learn more

        • Consulting & practice start-ups (any specialty): CPACteam.com

          • From “Can I even do this in my state?” to launch, growth, and operations

        • Clinical practice: White Pine Mental Health & Wellness (telepsychiatry; OCD-informed care)


        Shareable takeaways

        • A generalist foundation makes you a sharper psychiatric clinician.

        • OCD is common and fixable—if you ask the right questions and treat to target.

        • Good care design (visit length, schedule, collaboration) is burnout prevention.

        • Laws and payers vary; advocacy is part of the job.


        Enjoy this conversation? Catch the full interview on Mindset Matters and pass it to a PA who’s curious about psychiatry or practice ownership.

         
         
         
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