What is Ketamine Assisted Psychotherapy & How Does It Work

Ketamine, originally developed in the 1960s as an anesthetic, has found a new role in treating mental health disorders like depression and Post-Traumatic Stress Disorder (PTSD). When used in small doses, it has powerful antidepressant effects and works much faster than traditional medications like SSRIs [1]. In KAP, ketamine is administered in a controlled, clinical setting to create an altered state of consciousness—one that helps clients become more open and introspective.

This shift in perception opens a window of opportunity for therapists to work with clients more deeply, exploring thoughts, memories, and emotions that may be difficult to reach under normal circumstances. Unlike traditional antidepressants, which can take weeks to kick in, ketamine can bring relief in hours, especially for those suffering from treatment-resistant depression (TRD) [1].

How Does KAP Work?

Ketamine lies in its impact on the brain’s neuroplasticity—the brain’s ability to rewire itself. Ketamine acts by blocking certain receptors in the brain (NMDA receptors), which leads to a release of glutamate, a neurotransmitter that helps form new neural connections [2]. This process helps "reset" the brain, breaking negative thought patterns and offering new, healthier ways of thinking. Essentially, ketamine helps the brain find new ways to heal itself.

Imagine a client’s brain as a dense forest with paths (neural connections) carved by repetitive thoughts, especially negative ones. Ketamine acts like a bulldozer, clearing space for new paths to be made—paths that lead to healing and mental clarity. [4]

Why Pair Ketamine with Psychotherapy?

While ketamine creates the ideal conditions for emotional and psychological healing, your role as a therapist is to help clients make sense of the experience and guide them through it.

For example, ketamine might allow a client to revisit a traumatic memory with diminished pain; as a therapist, you would then support them in integrating this memory in a way that fosters healing rather than harm. [5]

This combination of pharmacological and psychological intervention makes KAP particularly powerful. It is not just numbing symptoms but addressing the root causes of mental health struggles. [6]

KAP in Action: Real-Life Impact on Depression and PTSD

KAP has shown impressive results, especially for people dealing with treatment-resistant depression (TRD). Standard treatments like SSRIs often take weeks to work. For people battling severe depression or suicidal thoughts, KAP can offer life-changing relief within a day or two. The results aren’t just fast but can be long-lasting, often reducing symptoms for weeks at a time.

In Post-Traumatic Stress Disorder (PTSD), ketamine can help unlock traumatic memories that are too painful to process in a normal state of mind. In the safe environment of a KAP session, clients can revisit these memories without being overwhelmed, allowing them to heal rather than be trapped in a cycle of flashbacks, anxiety, or hypervigilance.

For instance, a military veteran suffering from PTSD might receive KAP to process combat-related trauma. Under ketamine’s effects, they may revisit those memories from a detached perspective, helping them finally come to terms with their experiences in a healthier way. This "distance" creates space for healing, guided by a therapist who helps them reframe and integrate these experiences.

The Importance of “Set and Setting”

One key concept in KAP is "set and setting" essentially, the mindset of the client and the therapeutic environment during the session. Both are crucial for a positive experience. Clients are encouraged to enter sessions with an open mind, free of distractions, in a supportive and comfortable environment. Trained therapists ensure that the client feels safe, which reduces anxiety and makes the process smoother.

The experience doesn’t end when the ketamine wears off. After each session, there's an "integration" phase where the client and therapist work together to discuss the session’s insights and how to apply them in daily life. Without this integration, the profound emotional breakthroughs that happen during KAP might not result in long-term change. [7]

Clients' Experience

The “Ketamine and Me” Project [8] offers a glimpse into the lived experiences of clients undergoing ketamine-assisted psychotherapy (KAP) for treatment-resistant depression. Many participants reported an initial dissociative or "out-of-body" sensation during treatment, often followed by a sense of emotional uplift or relief. Some described feeling "normal" again, with the ability to engage in daily activities that once felt impossible. However, the benefits of ketamine were typically short-lived, lasting from a few days to a week.

For some, KAP was life-changing, allowing them to reconnect with family and rediscover joy in life. Others, however, experienced diminishing effects over time or didn’t respond at all. The therapeutic environment played a crucial role in clients’ positive experiences, with many emphasizing the importance of feeling safe and supported by compassionate staff.

While KAP may not be effective for everyone, most participants viewed it as a valuable option, especially when other treatments had failed, offering a much-needed sense of hope and relief from long-standing depression.

Fictional Case: Jane’s Journey Through Ketamine-Assisted Psychotherapy

To better understand this intriguing therapeutic approach, let’s explore a fictional case study that will shed some light on its process and effects.

Let’s follow Jane, a 35-year-old woman who has struggled with severe, treatment-resistant depression for years. After trying multiple medications and therapies without success, Jane’s doctor recommended ketamine-assisted psychotherapy (KAP). Here’s how her journey unfolded.

The First Session: Setting the Stage

Before her first session, Jane had an in-depth consultation with her therapist to determine if KAP was right for her. During this discussion, they explored Jane’s mental health history, her experiences with previous treatments, and her goals for KAP. Jane’s therapist took time to explain the process, answer her questions, and make sure she felt ready for the experience.

They also talked about the importance of “set and setting”—her mindset and the environment during the session. Her therapist reassured her that creating a calm and supportive space would be crucial in helping her feel safe and open to the experience.

Administering the Ketamine: Entering the Altered State

On the day of the first treatment, Jane arrived at the clinic and was led to a quiet, dimly lit room with soft music playing. The atmosphere felt peaceful and non-clinical, designed to put her at ease. After settling into a comfortable chair, her therapist administered the ketamine intravenously.

Within minutes, Jane began to feel the effects. She described the sensation as “floaty” and dreamlike, as if she were disconnected from her body. At first, this dissociation felt strange, but as it deepened, she felt an unexpected sense of relief. The usual weight of her depressive thoughts seemed distant, and for the first time in years, she felt able to explore her emotions without being overwhelmed by them.

The Therapeutic Process: Exploring the Mind

As the session progressed, Jane’s therapist gently guided her through the experience, encouraging her to simply observe whatever emotions or memories came to the surface. With the effects of the ketamine helping her feel detached from strong anxiety, Jane was able to revisit difficult moments from her past that had contributed to her depression.

At one point, she found herself confronting feelings of deep guilt tied to a family trauma. Normally, these thoughts would send her into a downward spiral, but in this altered state, she felt less emotionally consumed by them. Her therapist helped her process the emotions, asking open-ended questions and offering reassurance when the feelings became intense.

After the Ketamine: Integration and Reflection

When the ketamine started to wear off about one hour later, Jane felt more grounded. Her therapist encouraged her to rest and reflect on the experience. They spent the next hour discussing the insights she had gained during the session, helping her unpack the emotions she had explored.

This integration phase was crucial. Jane’s therapist explained that without reflecting on the session, the emotional breakthroughs she experienced might not translate into lasting change. Together, they worked on ways to apply her new perspective to her daily life.

For Jane, the session had revealed a new way of seeing her guilt. She realized that much of her depression stemmed from carrying emotional burdens that weren’t entirely her own. This insight helped her begin to reframe how she viewed her past, offering a sense of clarity she hadn’t felt in years.

Subsequent Sessions: Building on Progress

Jane’s KAP treatment didn’t end after one session. Over the course of the next several weeks, she underwent four more sessions. Each one built on the progress from the last, allowing her to explore different aspects of her emotional landscape.

As the sessions continued, Jane’s depressive symptoms began to lift more consistently. Between treatments, she noticed small but significant changes in her daily life—she felt more motivated, was able to reconnect with friends and family, and even began to take on hobbies she had abandoned during her years of depression.

For Jane, KAP wasn’t a one-time fix but rather a tool that helped her unlock new pathways to healing. The combination of ketamine and therapy gave her access to emotions and memories she had long suppressed, and the integration process allowed her to make meaningful, long-term changes in her mental health.

A New Frontier for Mental Health

Ketamine-Assisted Psychotherapy isn’t a miracle cure, but for people who feel stuck with traditional treatments, it can be a lifeline. Whether they are dealing with depression that won’t lift or trauma that continues to haunt, KAP offers a promising new way to tackle mental health issues at their core.

The combination of ketamine’s fast-acting effects and psychotherapy’s ability to foster deep, emotional healing makes KAP a powerful tool for those seeking a breakthrough. With more research and growing availability, KAP may soon become a cornerstone in modern mental health treatment, helping more people break free from the grip of debilitating mental illness.

References

[1] Riggs, L. M., & Gould, T. D. (2021). Ketamine and the Future of Rapid-Acting Antidepressants. Annual review of clinical psychology, 17, 207–231. https://doi.org/10.1146/annurev-clinpsy-072120-014126

[2] Kang, M., Hawken, E., & Vázquez, G. (2022). The Mechanisms Behind Rapid Antidepressant Effects of Ketamine: A Systematic Review With a Focus on Molecular Neuroplasticity. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.860882

[3] Kang, M. (2021). Ketamine's potential mechanism of action for rapid antidepressive effects: A focus on neuroplasticity. In Ketamine for treatment-resistant depression (pp. 13-32). Elsevier. https://doi.org/10.1016/B978-0-12-821033-8.00002-2

[5] Feder, A., Rutter, S., Schiller, D., & Charney, D. (2020). The emergence of ketamine as a novel treatment for posttraumatic stress disorder. Advances in pharmacology, 89, 261-286 . https://doi.org/10.1016/bs.apha.2020.05.004

[6] Muscat, S., Hartelius, G., Crouch, C., & Morin, K. (2022). Optimized Clinical Strategies for Treatment-Resistant Depression: Integrating Ketamine Protocols with Trauma- and Attachment-Informed Psychotherapy. Psych. https://doi.org/10.3390/psych4010012

[7] Muscat, S., Hartelius, G., Crouch, C., & Morin, K. (2021). An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.710338

[8] Griffiths, C., Walker, K., Reid, I., Maravic da Silva, K., & O'Neill-Kerr, A. (2021). A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’ project. Journal of Affective Disorders Reports, 4, 100079. https://doi.org/10.1016/j.jadr.2021.100079