Ketamine-Assisted Therapy vs. Taking Ketamine

What does a ketamine assisted therapist do? From an active therapeutic guide in a healing journey to simply sitting with a client on ketamine, does it matter?

Ketamine-Assisted Therapy vs. Ketamine Therapy

As a medication, ketamine proves to be a powerful antidepressant, anxiolytic, and have other clinically significant positive effects on many mental health markers. Like most medications, ketamine needs repeated administration for continued efficacy. 

There are many ways to approach the role as a ketamine assisted therapist. They range from engaging in talk therapy while a low dose of ketamine is given, to participating in a more active, physical, somatic therapy led by a specialized therapist, to a more “psychedelic assisted therapy” model where doses are given aimed to get the client deeper into their subconscious to help reorganize automatic thought patterns that are keeping people stuck. 

The Skill of Ketamine-Assisted Therapy

There are many people practicing Ketamine-Assisted Psychotherapy (KAP or KAT) from a more medicalized model. This is more aptly called “ketamine therapy” rather than “ketamine-assisted therapy” because the focus is on ketamine doing the work, rather than the whole process being important for therapeutic outcomes. In this model, a client would simply show up to a therapist’s office, take a dose of ketamine, and then go home. This could also be in the context of an infusion clinic where little to no psychologic support is given.

In the true KAP framework the therapist is called to a more active role. Typically this framework consists of 3 different parts: preparation, medicine, and integration. 

Preparation

The KAP work begins far before ketamine is ever ingested. Most KAP therapists will have at the very minimum 1 true preparatory session (not including an intake session) with many therapists employing a model where at least 3 or more preparatory sessions are given before ketamine ever enters the picture.

Preparatory sessions have many different elements. They prepare the person logistically for the sessions by providing details on some basic physiologic expectations, as well as helping the client figure out how they will get home from the session.

The therapist also starts preparing the client psychologically. There might be traumatic experiences that need some basic work before ketamine comes into the picture. Sometimes, the client may need to do some anchoring and grounding work to help them prepare for difficult material that may come up. A therapist may help the client identify support systems within their family or community that can help them grow during this process.

One crucially important aspect of KAP preparation is intention setting. Intention setting is naming some goals or desires that the person wants to get out of the process. This is good to do before starting a series, but also throughout and before each individual session. Intention setting isn’t about meeting a goal or completely filling a direct expectation, but more having some loose framework about why they are engaging in KAP and being curious about how the healing unfolds during the process. There is a lot that goes into the preparation process that takes some skill over time to maximize the potential for your client to get the most out of their KAP session. 

The Medicine Session

Then there is the ketamine session itself. This is the time when the client is in the therapeutic space using the medicine. This is where you will also see a big difference between a ketamine assisted therapist and simply a ‘sitter’ for a ketamine session.

While the client might see the beginning of the ketamine session as the point when they enter the office, or when they take the medicine, an experienced KAP therapist will have been preparing before the client even gets there.

First, there is the space where the session is taking place. The space is important for the client to feel safe, relaxed, and comfortable. This can include many elements from décor, to layout of the room, noise levels outside, or a cozy couch, mat, or recliner. Some therapists have routines of clearing the energy or burning some sage or palo santo before the client comes in to prepare the space.

The level of emotional regulation that the therapist has coming into the session is also greatly important. They might have a busy day or other things going on in their life, but their ability to ground and manage their own nervous system coming into a session can greatly shape the client’s session as well.

When the client comes in, it is helpful to assess how they are doing. Check in on their mood, how they are feeling physically, and address any fears they are coming in with. They might spend some time grounding or in a light meditation.

Discussing the intention for the session can help guide and give some direction to the client. When the therapist and client feel settled and ready, then the medicine can be taken.

Intentionally chosen music might already be playing or the client might put on their chosen music before this time.

While different in various models, the therapist is actively engaging whether in a low-dose ‘psycholytic’ (talk-based) or more somatic based sessions, the deeper psychedelic model leaves the therapist without a lot to ‘do’ while the client is in deeper states. Some therapists might take this time to catch up on notes, search the web, or do a crossword puzzle. However, it’s important to note that this can be a powerful time for the therapist to meditate and be connected to the process that the client is experiencing, even if they are not communicating with words. Noticing how the clients breathing changes during different stages or how they hold tension in their body when the music changes can help the therapist work with the client after the session.

Once again, the regulation and energy that the therapist holds can affect the experience of the client during this time. After the session it can be helpful to do some grounding, re-orienting, and process about what the experience was like for the client and help them to report anything that came up for them in the session while it is still fresh on their mind. If the client is having a hard time finding words, the therapist can give them guided prompts to help them recall aspects of their journey.

Once the client is safe and coherent and physiological needs are met, the therapist can help them to their ride. When all of these aspects are taken into consideration, the process is not quick. This is why most KAP therapists plan for a 2-hour session at least, with some utilizing 3-hour+ sessions, especially in the beginning when the client is finding their rhythm with KAP. 

Integration

The next stage of the KAP process is integration. This is the work the client does in and out of the therapist office to make meaning and reinforce new pathways and insights discovered from ketamine sessions. These can be activities that the client participates in such as art or journaling to listening to music or spending time in nature.

This can also be a regular therapy session conducted in between medicine sessions. The purpose of integration is to make a lasting impact of insights gained from the medicine. The activity itself is not the most important part of integration, but the intentionality of it. The role of the therapist is to guide the client in making them most of the new networks that were opened up from the medicine session. Kind of like riding a bike or learning a new language, if you don’t use it, you lose it. 

Closing Remarks

Unfortunately, we don’t have a lot of research to back up the evidence for a more engaged therapeutic approach to KAP. Anecdotally, as I have met with probably close to hundreds of KAP clients at this point that have worked with a wide range of therapists, the clients that have the most life changing experiences have therapists that actively engage in the process and work from a KAP framework rather than just a medicine sitter framework.

As ketamine continues to become more and more popular and there are many different models being trained, I will continue to advocate for a role that engages the client to be an active participant in their healing rather than a patient at the mercy of another medicine trial. While the framework I laid out does not encompass the breadth of work that amazing KAP therapists are doing, I hope it gives you a taste of what KAP can be.