Ketamine-Assisted Psychotherapy
Psychedelic therapy using ketamine, with preparation, medicine sessions, and integration.
Ketamine-assisted psychotherapy
Ketamine-assisted psychotherapy (KAP) brings the altered states of consciousness occasioned by ketamine into an ongoing psychotherapeutic relationship. For some people, these experiences allow feelings, memories, conflicts, and possibilities for experiencing themselves to emerge in ways that are difficult to access in ordinary states of mind. The experience itself is not the whole treatment. What matters is what can be understood, tolerated, and worked through before, during, and after it.
A psychoanalytic approach to psychedelic therapy
My approach to ketamine-assisted psychotherapy is psychoanalytic. Rather than treating a psychedelic experience as a discrete intervention that automatically produces insight or healing, I am interested in how the experience becomes part of a person’s psychological life. What emerges may illuminate longstanding conflicts, defensive patterns, traumatic experiences, or ways of relating to oneself and others. It may also be confusing, unsettling, or resistant to easy interpretation.
Psychotherapy offers a place to approach this material with curiosity and care. Sometimes an experience seems to loosen familiar ways of organizing emotion or identity; at other times it brings those very organizations into sharper relief. We try to understand both what becomes possible and what makes change difficult, without imposing a predetermined meaning on what occurs.
People exploring psychedelic therapy more broadly may also be interested in how psychoanalytic psychotherapy can help them understand and integrate experiences with psychedelics. Ketamine is the medicine used in the treatment described here; I do not administer psilocybin, MDMA, or other psychedelic substances.
What treatment involves
Preparation
We begin with at least three to five preparation sessions. These preparation sessions typically take place weekly and follow the structure of regular psychotherapy. They allow us to understand what brings you to treatment, your history and current difficulties, your expectations and concerns, and the emotional meanings that ketamine treatment may hold for you. Preparation also includes discussing the experience itself, practical arrangements, and how we will work together during and after medicine sessions.
Medical assessment
A collaborating psychiatrist conducts a separate medical intake and determines whether ketamine is appropriate. Prescribing, medical screening, dosing decisions, and medical responsibilities belong to the medical provider; my role is psychotherapeutic.
Medicine sessions
Ketamine sessions take place in person in New York City and generally last two to three hours, including time for the experience and recovery. Depending on the individual treatment plan and medical arrangements, ketamine may be administered intramuscularly by a medical provider or taken as a prescribed lozenge. During the session I provide psychotherapeutic presence and support, with attention to the unfolding experience rather than a demand to narrate or analyze it in real time.
Integration
Integration sessions follow each medicine session. Like preparation sessions, integration sessions typically take place weekly and follow the format of regular psychotherapy. Integration involves making sense of what was experienced in relation to your history, relationships, defenses, wishes, fears, and life outside treatment. The frequency of ketamine sessions is individualized: some people have sessions relatively close together, while others return to the medicine less often. Treatment may be time-limited or part of longer-term psychotherapy.
Common questions
Who might consider KAP?
People inquire about ketamine-assisted psychotherapy for many reasons, including depression, anxiety, trauma-related difficulties, emotional constriction, entrenched relational patterns, or a sense of being unable to move forward in psychotherapy. Suitability depends on a careful psychotherapeutic and medical assessment, including consideration of psychiatric history, medications, cardiovascular risks, substance-use concerns, and other factors.
What does the research suggest?
Ketamine has a substantial and growing evidence base in psychiatry, strongest for depression, particularly treatment-resistant depression, where clinical trials have demonstrated rapid reductions in symptoms. The findings for posttraumatic stress disorder are also encouraging. Randomized trials have found meaningful, sometimes rapid improvements in PTSD symptoms. Studies also suggest benefit for certain patients with suicidal thoughts, obsessive-compulsive disorder, anxiety disorders, and bipolar depression.
Is ketamine treatment safe?
Yes. Ketamine is a well-established medication that has been widely used in medicine for decades, including as an anesthetic, and it has a strong safety record when used appropriately with medical screening and clinical supervision. For suitable patients, ketamine treatment is generally very safe. Temporary effects can include dizziness, nausea, a rise in blood pressure or heart rate, dissociation, or fatigue afterward; these usually resolve as the medication wears off. As with any medical treatment, there are important exceptions: certain cardiovascular conditions, uncontrolled hypertension, active psychosis, substance-use concerns, or other medical circumstances may make ketamine inappropriate or require additional precautions. A collaborating psychiatrist conducts the medical evaluation and makes prescribing and dosing decisions.
What might ketamine feel like?
The experience can vary considerably from person to person and even from one session to another. Some people feel deeply relaxed, inwardly focused, or dreamlike; others notice changes in their sense of time, space, body, or ordinary patterns of thought. Images, emotions, memories, or unexpected perspectives can emerge, and at higher doses the experience may feel immersive or transcendent. Other sessions are quieter or less easily described. There is no correct experience and no expectation that you have a dramatic insight. The experience lasts for a limited period, and we will process whatever unfolds in your journey in subsequent integration sessions.
What happens during a medicine session?
Sessions take place in a calm, private office setting and generally last two to three hours. I remain present to support the psychotherapeutic process. Eyeshades may help you direct your attention inward, and music may be used. Some people speak during parts of the experience; others spend much of it quietly attending to what unfolds. There is no prescribed experience or requirement to produce an insight. The acute effects commonly last approximately 45 minutes to two hours depending on dose and administration, followed by a period of recovery and reflection.
What if the experience is difficult?
Most ketamine experiences are manageable, and many people find them peaceful, absorbing, or emotionally meaningful. At times the experience can feel unfamiliar or intense: you might briefly feel disoriented, or feelings or memories that have been difficult to approach may come into view. That does not necessarily mean anything has gone wrong. We prepare together for a range of possible experiences, and I remain with you throughout the session, offering reassurance, grounding, or conversation when useful. In our integration sessions, we can return to anything that felt important or challenging and explore it at a pace that feels manageable. Thoughtful medical screening and attention to psychological readiness remain essential parts of the process.
What is the difference between IM ketamine and lozenges?
Intramuscular (IM) ketamine is administered by a collaborating psychiatrist and generally offers more predictable absorption, onset, and dosing than lozenges. Some patients describe a clearer beginning, peak, and return. Lozenges or troches are prescribed by the psychiatrist and self-administered in the office; they dissolve in the mouth, and absorption can be more variable. They may be less costly and feel less medically intensive, although holding the medicine and saliva in the mouth can be uncomfortable for some people. Neither route is universally preferable. We discuss the practical and experiential differences alongside your goals and preferences, while the psychiatrist determines what is medically appropriate. Descriptions of differences in subjective experience are clinical observations, not established comparative efficacy findings.
Is ketamine-assisted psychotherapy the same as an infusion clinic?
No. The clinical approach is different. In a typical infusion clinic, ketamine is administered primarily as a pharmacological treatment, often intravenously, with the goal of reducing symptoms through the medication's biological effects; psychotherapy may be optional, limited, or absent. In ketamine-assisted psychotherapy, the medicine experience is one part of an ongoing psychotherapeutic process. Preparation, the therapeutic relationship, support during medicine sessions, and integration afterward are central to the treatment, with attention to its emotional, symbolic, and relational meanings. The distinction is therefore not simply how ketamine is administered, but what the treatment is designed to do. Both forms of care may have a place depending on an individual's needs.
Can I do ketamine therapy occasionally rather than in a fixed series?
Yes. The frequency of medicine sessions is individualized. Some patients use KAP occasionally within ongoing psychotherapy, while others undertake a more concentrated period of sessions. Weekly integration psychotherapy typically continues between dosing sessions. Decisions about frequency depend on therapeutic goals, clinical response, and the psychiatrist’s medical assessment.
How many sessions will I need?
There is no universal number. We consider the clinical purpose of treatment, your response, and the role ketamine is playing in the larger psychotherapeutic work. Decisions about additional medicine sessions are made collaboratively and with the prescribing clinician.
Beginning a conversation
I offer a no-charge initial consultation to discuss what brings you to therapy, your interest in ketamine or psychedelic therapy, and whether working together might be a good fit. In-person psychotherapy is offered in Manhattan; medical eligibility and treatment arrangements are considered separately.