When to Consider Ketamine Assisted Psychotherapy
When to Consider Ketamine Assisted Psychotherapy
Ketamine Assisted Psychotherapy (KAP) | Treatment-resistant depression (TRD) | Post-Traumatic Stress Disorder (PTSD) | Anxiety Disorders | Evidence-based psychotherapy
For many people living with depression, anxiety, or trauma, real and lasting relief can be hard to come by. Sometimes traditional treatments like antidepressants, talk therapy, or a combination of both aren’t enough. If you've tried multiple approaches without meaningful improvement, you may be wondering what comes next. Ketamine Assisted Psychotherapy (KAP) is an emerging, evidence-based treatment that is offering new hope, particularly for those with treatment-resistant conditions. If you're in the San Francisco Bay Area and exploring options beyond conventional care, here's what you need to know.
What Is Ketamine Assisted Psychotherapy?
Ketamine is currently the only legally available, FDA-approved psychedelic medicine that mental health providers can use in clinical practice for emotional and psychological treatment (Wolfson et al., 2019). It has rapid-acting antidepressant effects that work through neuroplasticity, promoting the growth of new neural connections. These new connections allow patients to reprocess difficult material in new ways (Batievsky et al., 2023).
Ketamine Assisted Psychotherapy (KAP) works by combining the administration of ketamine with structured psychotherapy. This is delivered in three phases: preparation, dosing, and integration. To prepare for the ketamine sessions, you work with your therapist to create goals, learn and practice any skills that may support you during the healing process. This can include training in mindfulness, self-compassion, somatic awareness, grounding exercises, and more. During the dosing sessions, your therapist will closely oversee, guide, and support you, check in with you, and take notes during the session.
The ketamine itself is a portion of the overall healing process, however, integration sessions are a critical component of the therapy. The integration phase takes place within 48 hours of the ketamine sessions. This is where the psychological work deepens. During this time, patients make meaning of their experiences, shift entrenched patterns, and align with their values. During these sessions, you will have an opportunity to reflect and make meaning of what came up during the medicine sessions. They are also a time where your therapist will help you with reinforcing skills that can aid in maintaining insights and changes that you are hoping to achieve.
Who Can Benefit?
KAP is not the kind of treatment that should be considered before trying other evidence-based treatments. If therapy and medications have not produced lasting results, it may be a good next step. You may be a candidate for Ketamine Assisted Psychotherapy if you are experiencing one or more of the following:
Treatment-Resistant Depression (TRD): If you’ve tried two or more antidepressants and nothing’s worked for you, you may meet the criteria for treatment-resistant depression. Research consistently shows that KAP produces meaningful improvements for those struggling with it. A large study of 1,806 adults found significant reductions in depression symptoms at both 3 and 6 months following KAP treatment, with effects lasting up to 5 months after the final session (Yermus et al., 2024).
Anxiety Disorders: KAP has also demonstrated promise for generalized anxiety disorder and other anxiety-related conditions. The same large-scale study found substantial reductions in anxiety alongside depression outcomes, with lasting effects sustained well after the dosing period (Yermus et al., 2024).
Post-Traumatic Stress Disorder (PTSD): For individuals whose PTSD has not responded to standard treatments such as prolonged exposure or EMDR, KAP is a promising treatment. A 2023 systematic review found multiple studies combining ketamine with psychotherapy for PTSD, with promising early findings (Mollaahmetoglu et al., 2023).
Chronic Pain with Comorbid Depression: Research has explored KAP for individuals dealing with both chronic pain and major depressive disorder. A pilot study found that participants tolerated the treatment well, with no serious adverse events, and both groups showed improvements across clinical measures (Batievsky et al., 2023).
Existential Distress or Serious Medical Illness: New studies suggest ketamine may offer rapid improvements in psychiatric and existential distress for patients with serious or terminal illness (Rothberg et al., 2025).
What Does KAP Actually Look Like?
A typical KAP course involves 4–6 guided ketamine sessions administered via intramuscular injection or sublingual lozenge, combined with preparatory sessions before dosing and integration sessions afterward (Yermus et al., 2024). The guided ketamine sessions last several hours. Since your judgment and reflexes will be impaired, you will not be able to drive after the session.
KAP is distinct from ketamine infusion clinics by its structured psychotherapy component. There’s a difference between just taking the medicine versus taking the medicine alongside a professional whose goal is to help you understand what’s going on throughout the experience. Combining KAP with psychotherapy enhances neuroplasticity and patients are better able to reprocess, adapt, and move toward lasting change (Batievsky et al., 2023).
Is KAP Safe?
Yes! When administered in a clinical setting with appropriate screening and monitoring, KAP has shown to be safe. In Batievsky et al.'s (2023) pilot study, all participants tolerated treatment well, with no drug-related serious adverse events and no clinically significant changes in blood pressure or pulse. Patient selection, thorough preparation, and professional oversight are central to safe and effective KAP delivery.
KAP is not appropriate for individuals with a personal or family history of psychosis, certain cardiovascular conditions, active substance use disorders involving ketamine, or uncontrolled hypertension. A comprehensive psychiatric evaluation is always the first step.
Searching for KAP Therapy in the San Francisco Bay Area?
Interest in Ketamine Assisted Psychotherapy has grown significantly across the Bay Area, with mental health professionals in San Francisco, Oakland, Berkeley, Marin County, and San Jose increasingly offering or referring to KAP services. As with any treatment, it's important to work with a licensed, trained clinician who can guide the full KAP process — from preparation through integration.
If you're in the San Francisco Bay Area and wondering whether KAP might be right for you, reach out for a complimentary 15-minute consultation.
References
Batievsky, D., Weiner, M., Kaplan, S. B., Thase, M. E., Maglione, D. N., & Vidot, D. C. (2023). Ketamine-assisted psychotherapy treatment of chronic pain and comorbid depression: A pilot study of two approaches. Frontiers in Pain Research, 4, Article 1127863. https://doi.org/10.3389/fpain.2023.1127863
Mollaahmetoglu, O. M., Keeler, J., Ashbullby, K. J., Ketzitzidou-Argyri, E., Grabski, M., & Morgan, C. J. A. (2023). Ketamine and psychotherapy for the treatment of psychiatric disorders: Systematic review. BJPsych Open, 9(3), Article e87. https://pmc.ncbi.nlm.nih.gov/articles/PMC10228275/
Rothberg, R. L., Azhari, N., Tanev, K., & Bhatt, M. (2025). Ketamine and ketamine-assisted psychotherapy for psychiatric and existential distress in patients with serious medical illness: A narrative review. Journal of Palliative Medicine. https://doi.org/10.1089/jpm.2024.0346
Wolfson, P., Andries, J., Ahlers, E., & Bismark, A. (2019). Ketamine Assisted Psychotherapy (KAP): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. Journal of Psychoactive Drugs, 52(3), 189–198. https://doi.org/10.1080/02791072.2019.1587556
Yermus, R., Bottos, J., Bryson, N., De Leo, J. A., Earleywine, M., Hackenburg, E., Kennedy, S., Kratina, S., McMaster, R., Medrano, B., Verbora, M., Wolfson, E., & Lo, C. (2024). Ketamine-assisted psychotherapy provides lasting and effective results in the treatment of depression, anxiety, and post-traumatic stress disorder at 3 and 6 months: Findings from a large retrospective effectiveness study. Psychedelic Medicine, 2(2), 87–95. https://doi.org/10.1089/psymed.2023.0021
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