If you've been reading about ketamine, you've probably noticed that the coverage splits into two camps. One treats it as a breakthrough. The other treats it as a party drug with a medical license.
Neither is very useful if you're trying to decide whether to try it.
This post is about what to expect in ketamine-assisted psychotherapy (KAP) as I offer it: who does what, what each step involves, what the dosing session is actually like, and who probably shouldn't do it. I'll be conservative about the medical claims, because that's where most of the overselling happens.
This is general information, not medical advice. Whether ketamine is safe for you is a decision for a qualified medical provider.
First, what KAP is and isn't
Ketamine has been FDA-approved as an anesthetic for decades. At much lower doses, it has been studied for depression, and some people experience relief faster than with standard antidepressants.
A few facts worth having straight:
Generic ketamine for psychiatric use is off-label. That means it's prescribed for a purpose other than the one the FDA approved. Off-label prescribing is legal and common in medicine. It also means the evidence base is still developing, and you should know that going in.
Esketamine (brand name Spravato) is different. It's a nasal spray that's FDA-approved for treatment-resistant depression. It's given in a certified clinic, and you're monitored there afterward under a federal safety program (REMS).
Some people see no significant benefit. That's true of every psychiatric treatment, and it's true here. Anyone telling you otherwise is selling something.
KAP is ketamine plus psychotherapy. The medicine can create a temporary state where your usual defenses loosen and old material feels less fixed. The therapy before and after is what helps that window turn into something you can use on an ordinary Tuesday.
Who does what
In my practice, the medical and therapy sides are separate, and that's deliberate.
Anywhere Clinic (a telehealth medical practice I partner with) handles the medical evaluation, decides whether ketamine is appropriate, prescribes it, sets the dosing protocol, and provides ongoing medical oversight.
I handle the therapy. That's the preparation sessions before dosing and the integration sessions after. (The KAP program overview is here →.) I don't prescribe, and I don't make the medical call about whether ketamine is safe for you.
That division means a medical provider is looking at your blood pressure and medications, and a therapist is looking at your history and readiness. Each of us can say no.
The process, step by step
Here's the general shape. The exact number of sessions varies by person and by what the medical provider recommends
The consultation
This is just a conversation. I want to know what you're dealing with, how long it's been going on, and what's already been tried. KAP is generally considered after other approaches haven't helped enough, so that history matters.
If KAP doesn't sound like a good fit, I'll say so. Sometimes the better next step is a different kind of therapy or a medication conversation. If you've been in therapy a long time and feel stuck, my post on when therapy stops working lays out the other options worth considering first.
The medical evaluation
Anywhere Clinic reviews your medical and psychiatric history and current medications. The screening decisions are theirs. Some conditions commonly rule ketamine out or call for real caution, including:
Uncontrolled high blood pressure
A history of psychosis or mania
Pregnancy
A history of ketamine misuse
That's not a complete list, and I'm not the one who applies it. Be fully honest with them, including about alcohol and other substances. A history of substance use doesn't automatically disqualify someone, but it needs to be discussed openly. If that's part of your story, here's how I approach substance use counseling.
Preparation
This is the part people underestimate.
We talk about what you're hoping to work on, without turning it into a script. We practice grounding tools you can use if the experience gets intense. We sort out the practical details: where you'll be, who's around, what you'll do afterward, and that you won't be driving.
The aim is that nothing about the dosing session catches you off guard except whatever your own mind brings up.
The dosing session
Dosing follows Anywhere Clinic's protocol.
Experiences vary a lot, but some effects are common:
Dissociation. A sense of distance from your body, your surroundings or your usual thoughts. Some people find it peaceful. Some find it strange. Preparation helps with both.
Physical effects. Nausea and dizziness are common. Ketamine can also temporarily raise blood pressure, which is one reason medical screening matters.
Shifts in perspective. Memories, images or emotions may come up, sometimes with less of the usual charge attached.
The acute effects fade over a matter of hours. Plan on no driving and no important decisions for the rest of that day.
Integration
Integration is where the therapy does its work. We look at what came up, what felt different, and what you want to do with it.
Sometimes the most useful material isn't dramatic. It's noticing that a memory you've avoided for years felt survivable, or that a familiar self-criticism suddenly sounded like someone else's voice. The job of integration is to take that and practice it while it's fresh, so it doesn't fade back into the old pattern.
How KAP compares to other ketamine options
People often ask how this is different from Spravato or from an infusion clinic. Here's a general comparison. The details vary a lot by provider, so treat this as orientation, not a spec sheet.
| KAP (as I offer it) | Spravato (esketamine) | Ketamine infusion clinic | |
|---|---|---|---|
| Form | Generic ketamine, per prescriber's protocol | Nasal spray | IV infusion |
| FDA status for depression | Off-label | Approved for treatment-resistant depression | Off-label |
| Where | Either in an office or at home | Certified clinic, monitored after dosing | In clinic |
| Therapy built in | Yes: preparation and integration | Not required | Varies; often not |
| Insurance | Out-of-network for my sessions | Sometimes covered; check your plan | Often self-pay |
The point of KAP isn't that the medicine is better. It's that the therapy is part of the treatment rather than optional.
Who it may fit, and who it probably doesn't
| Probably a reasonable conversation | Probably not the right fit |
|---|---|
| Depression, anxiety or PTSD that hasn't improved enough with other treatment | You haven't yet tried standard therapy or medication |
| You understand your patterns but can't shift them | You're looking for a one-time fix without ongoing therapy |
| Long-standing or complex trauma, with enough current stability | You're in an acute crisis right now |
| You can commit to preparation and integration sessions | A medical condition or history the prescriber rules out |
| You're medically cleared by the prescriber | Active ketamine misuse, or heavy use you're not ready to discuss |
If trauma is the main thing you're carrying, KAP may be one piece of a larger plan that also includes trauma therapy, and for some people EMDR-informed processing is a better first step than ketamine. For many people, regular individual therapy is still the main event, with KAP as a tool within it.
What KAP isn't
It isn't a cure. Some people notice meaningful relief. Some notice gradual change. Some notice very little and decide it's not for them, which is useful information, not a failure.
It also isn't a shortcut around the work. The experience can be striking, and it's easy to mistake that for the change itself. What matters is what you're doing differently three weeks later.
Exploring what to expect from ketamine-assisted psychotherapy with me
I'm Christopher Greer, LCSW, in Soquel (more about me →). I offer preparation and integration for KAP in person at my office, for people coming from Santa Cruz, Capitola and Aptos, or by secure video for adults anywhere in California, with medical care through Anywhere Clinic. Sessions are $200 for 55 minutes; I'm out-of-network and provide superbills.
If you want the overview, it's on my ketamine-assisted psychotherapy page →. If you have specific questions about what to expect in ketamine-assisted psychotherapy and whether it makes sense for you, book a free 20-minute consultation. If I'm not the right fit, I'll tell you and point you somewhere better.
(831) 480-5292 | chris@gcpsychotherapy.com
This article is for general information and isn't medical advice. Talk with a qualified medical provider about whether ketamine is safe for you. If you're in crisis or thinking about harming yourself, call or text 988 to reach the Suicide & Crisis Lifeline.