Ketamine-Assisted Threshold Exposure with Response Prevention (TERP) Priming, Values-Based Framing, and the Charged Interval
Year: 2026
Type: article
Abstract: This paper introduces Ketamine-Assisted Threshold Exposure with Response Prevention (TERP), a proposed clinical integration of ketamine treatment with a psychoanalytically informed, values-based approach to exposure and psychological development. Building upon the broader TERP framework and Psychoanalytically Informed Acceptance and Commitment Therapy (PACT), the paper examines whether ketamine-associated neuroplasticity might create a temporary opportunity for psychological learning in patients who struggle to engage with consequential emotional, relational, or identity-bearing realities. The central distinction is between pharmacological priming and psychological priming. While ketamine may temporarily alter the conditions under which learning becomes possible, it does not determine what is learned or whether such learning supports meaningful development. The paper proposes that psychological preparation, values-based framing, and carefully structured exposure during the post-acute period may help patients develop capacities that remain available after the pharmacological effects have subsided. The paper also explores the charged interval, a psychological organization in which anticipation, suspense, crisis, or intensity become necessary for sustaining a sense of aliveness. It distinguishes charge from vitality, suggesting that meaningful therapeutic progress may involve learning to participate in ordinary life without continually recreating the conditions of emotional intensity. Drawing upon psychoanalytic theories of addiction, defensive organization, and temporal continuity, the paper positions continuity of participation as a central developmental objective: the capacity to remain psychologically present and able to act meaningfully while consequential experience remains unresolved. Ketamine-assisted TERP is presented as a provisional research hypothesis, not a validated treatment. The paper emphasizes medical supervision, appropriate patient selection, avoidance of exposure during acute dissociation, and evaluation of whether psychological change persists independently of the drug experience.
Author: Bollas, Sacha
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7225453770