Ketamine-assisted psychotherapy (KAP) is an emerging treatment that can support meaningful improvement of many mental health concerns and can enrich overall personal growth. It involves the therapeutic use of ketamine in combination with psychotherapy.
Ketamine is a legal medication that has long been used as an anesthetic and pain-relieving medicine at much higher doses than those used in this work. It has a long safety record in medical settings and tends to be well tolerated by most.
Although much of the current research focuses on depression, KAP is also being explored for trauma and PTSD, OCD and severe anxiety, end-of-life distress, and other forms of emotional suffering.
Ketamine temporarily increases neuroplasticity-the brain’s ability to form new connections. This can help shift rigid thinking patterns that can keep the mind stuck in cycles of fear, self-criticism, and hopelessness. It also reduces activity in the brain’s default mode network, a system associated with repetitive self-focused thinking, anxious “what if” worries, and other life-limiting patterns. For many this creates an opening to step out of habitual mental loops and to approach difficult experiences with greater perspective. This bigger sense of self and life as a whole can begin to loosen the grip of the stories anxiety tells.
In offering some distance from the usual ways of thinking and automatic avoidance of discomfort, Ketamine opens up more room for curiosity and connection to one’s deeper values and sense of self. This brings a sense of greater aliveness and a loosening of the need to always be in control.
The importance of psychotherapy
KAP can be a very mind-opening experience. It can open the imagination to new ways of solving problems and unexpected insights. Shifts in one’s relationship to self and thinking patterns can take place, and it becomes possible to see through limiting beliefs and recognize a much larger truth.
Traumatic memories and other difficult past experiences can become easier to face and understand in a different, more self-compassionate light. The combination of the medicine and psychotherapy supports bringing these new perspectives into daily life.
My role as a Ketamine-Assisted Psychotherapist
I am a psychotherapist, not a prescriber. I work closely with a medical doctor to assess whether this treatment is appropriate for a given client.
Ketamine-assisted psychotherapy begins in different ways. Sometimes it grows out of therapy we are already doing together. In other instances, sometimes therapy begins with a primary interest in KAP.
In either situation, it is important that we spend some time working together first. This allows us to establish safety and develop a therapeutic collaboration. It also helps build a foundation that supports the effectiveness of the medicine work.
Even when KAP is a primary focus, preparation involves several sessions before starting medicine sessions. This means at least four or five sessions within a month or two. This pace varies based on therapeutic and safety needs.
The medicine session is followed by a series of integration sessions. These sessions help strengthen and anchor what emerged during the experience and support practicing new choices in everyday life. In this way, insights and deeper shifts in understanding can begin to translate into concrete change.
Ongoing therapy
It works best to embed the Ketamine-assisted psychotherapy within ongoing therapy and there are several ways this can happen.
Some clients choose to work with me in ongoing therapy. In these cases we can take time to assess whether KAP is appropriate and prepare for the work.
If you already have your own therapist, we can do a shorter course of KAP while staying in communication with your therapist. This helps support the continued integration of insights and shifts from the medicine sessions when you return to your ongoing therapy.
If you do not currently have a therapist and are interested in shorter-term work, we can assess what level of preparation and integration makes sense.
My private practice setting vs an Infusion clinic
The medicine experience is just the beginning of the treatment. What supports lasting change is our ongoing work together, tailored to your needs and goals.
In most infusion clinics , ketamine is administered as a medical procedure without any psychotherapy. While the medicine may produce temporary improvements in mood, without therapeutic support these changes tend to be short-lived- often requiring frequent sessions, twice weekly or more, just to maintain the benefits.
In our work, I’m present throughout to help you navigate and process what you experience. In the sessions that follow, we will build on what came up for you and explore how to translate it into meaningful changes in your life. In this way the changes can become deeper and more lasting rather than brief or superficial.
Frequency and duration of treatment
Generally, it’s advisable to receive the medicine about four to six times, spaced about one to two weeks apart. This allows you to really settle into the new states and learning that ketamine therapy can open up. Three weeks between sessions can sometimes work just as well if that fits your finances or life better. For some, though, we may find that the benefits aren’t sustained as well at that interval-something we’ll pay attention to as we go.
For many, there can be significant benefits within just a few sessions, though the deepest shifts tend to occur somewhere in the range of five to eight journey sessions. Some clients stop there, while others find it useful to have occasional ‘booster’ sessions (every two to three months is common) to reset, regain some perspective or to help shift things when feeling stuck.
It can be scary to do something like this for the first time
It’s understandable to have fear around losing the familiar sense of control that comes with an altered state of mind. For this reason we’ll start at a lower dose and move up gradually to a more effective level. At lower doses, Ketamine can be calming and opening, sometimes making for a smoother therapy process. Generally after this first session, people feel more at ease and ready to gradually increase the dose.
Of course there will still be some unpredictability as there is in all of life! In part this work can become a teacher for developing greater acceptance of uncertainty. The willingness to try something unfamiliar can be a first step in gaining the courage to face other things, leading to greater engagement with life.
Consent puts you at the wheel
Your consent is paramount at every stage of our work together. It is always okay to change your mind about doing this work, even up to the moment before taking the medicine. If you have any hesitations and aren’t a full “yes” we will talk about it and make sure it is right to proceed.
Although the journey will be a different kind of experience than what you’re used to, we will work together to make sure that you have whatever you need to feel safe and supported. We’ll plan ahead for what you might need and anything you wouldn’t be comfortable with. Therapeutic touch-such as having a hand to help you feel grounded-is available but never required, and never done without your consent both before and during the session.
I recognize this work involves a different level of vulnerability, given that the medicine can lower the sense of boundaries for some. If you’ve told me ahead of time that something isn’t okay, I will honor that throughout our session-I won’t revisit that boundary while you are under the influence of the medicine, when your senses of limits might feel different than usual. I also generally won’t introduce anything new that we haven’t already discussed. That said, I will always be responding to what you need in the moment, and if anything unexpected comes up, we can explore that afterwards.
Your vulnerability will always be in the forefront of my awareness as I support whatever you need to feel safe and held throughout.
To be completely clear, our work will always be entirely non-sexual, with all the same ethical parameters that guide any effective therapeutic relationship. Together with our preparation and collaboration, you’ll have a clearer sense of what to expect- making the leap into the unknown less scary.
What happens in the journey
You will dissolve the lozenge or lozenges and hold them in your mouth for 15 minutes, then settle in lying down, eyeshades on with ambient music and a blanket. The medicine usually lasts about an hour and a half, after which we’ll spend an hour or so beginning to integrate the experience-through talking, sometimes art, sandtray or somatic work. You’ll need to arrange a ride home with a trusted driver (not Uber), or plan to stay nearby-both as a precaution and to support staying with the inward experience.
Meeting remotely or in person
It’s best if you are local and we can meet for journey sessions in person at my San Rafael office. This is generally recommended for at least the first few sessions and ongoing if possible.
In certain cases, if meeting in person isn’t possible due to location, we may be able to meet virtually. Some people appreciate the comfort and familiarity of their own space for this work. That said, you would need a quiet, private space that you feel fully safe, and someone present for the duration.
Meeting remotely isn’t always the right fit depending on your therapeutic needs, and sessions done this will generally mean working with a lower dose than we might use in person. We can talk about what makes the most sense for you.
You must be in California as I am not licensed to work with people residing in any other state.
KAP will not be a good fit for you if you currently or in the past have had any of the following:
High Blood Pressure (currently untreated), Seizures, Mania, Psychosis, Vascular disease or stroke, or cystitis.
KAP steps and cost:
To get started, fill out the form below or feel free to email me or call. I’ll be in touch, and if it seems like a good fit we’ll schedule a free 15-20 minute consultation to talk further.
Sessions:-all sessions are $225 per 55-minute hour. Journey sessions run approximately 3 hours to allow time to arrive and prepare beforehand and begin integration afterward. An integration session within a few days of each journey is an important part of the process.
Medical assessment-before beginning medicine work, you’ll meet virtually with the prescriber I collaborate with for psychiatric and medical evaluation, approximately 45-60 minutes, Cost is $350-$450.
Medication-if you’re determined to be a good fit for KAP, a prescription is sent to a compounding pharmacy and shipped to your home. Cost varies, generally around $100-$150 to start. This will be enough for several journeys.
Articles On Ketamine-Assisted Psychotherapy
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