"Do I Need a Therapist for Ketamine Therapy?" Combining Therapy with Ketamine for Lasting Change

Ketamine Assisted Psychotherapy (KAP) is a powerful tool to improve mental health, but it can be expensive. You may be wondering if ketamine on it’s own is enough or if you really need to combine ketamine with talk therapy. It can be temping to consider a recreational or medicinal approach to cut down costs, but these approaches comes with risks and don’t take advantage of the full potential of ketamine. 

Ketamine has pharmacological properties that can positively impact mental health as a standalone treatment, similar to taking an antidepressant. More and more organizations are offering at-home, self-directed sessions, and even microdosing. Many clinics offering IV ketamine therapy do so under the supervision of a nurse or other medical professional, but fail to provide consistent presence during a journey, psychotherapy, or integration. This can be helpful for those who simply want to feel better, but it doesn't provide lasting change.  

Why Ketamine Alone Isn’t Always Enough

Following a psychedelic journey, many people report an afterglow effect, which includes reduced mental health symptoms and increased feelings of connectedness and positive self worth. Simultaneously, in the 48 hours after a ketamine session, a window of increased brain neuroplasticity occurs. During this period, the mind is more impressionable and it is actually easier to make changes in thinking and behavior. Post-journey integration within this window enables the client to maximize the positive feelings of the psychedelic afterglow toward changed perspectives that lead to intentional and lasting change.  Without the guidance of a therapist to support integration, this window can close without meaningful change. This leaves the client with the same mindset and behaviors they were engaged in before the treatment and once the positive effects of the ketamine wear off, they will need to return for more.

The Power of Integration: The Benefits of Combining Therapy with Ketamine Treatment

Psychedelic Assisted Psychotherapy views the ketamine experience as a catalyst for change instead of the mechanism of change. Rather than merely improve symptoms, KAP has the potential for deeper insight and transformation than can be achieved through regular talk therapy or ketamine use alone. In a traditional approach to psychedelic medicine, it is expected for you to have a profound, healing experience and intention is made to create an environment that fosters this outcome.

While on ketamine, the ego recedes and clients tend to be more open and less protective, creating more potential for insight and connection to ones unconscious experience. In this state the mind is more open and able to process painful emotions and experiences and view them with increased perspective. Clients often have dreamlike or mystical experiences that may feel confusing or disjointed. Without integration these experiences may be shrugged off as “weird” and the opportunity to explore further is lost. Talking through the content of a psychedelic experience with a skilled therapist can help the client make connections to their life, develop understanding and a changed perspective.  Often insights about the problems they are experiencing arise and can be integrated into daily life. Combined with the window of neural plasticity, ketamine integration maximizes the potential for lasting shifts in thought patterns and behavioral change.

While ketamine journeys are most often positive, it's important to note that when taking ketamine at psychedelic doses there is greater potential for a bad trip. This could mean anything from having anxiety that interferes with your session, having negative material arise, or being overwhelmed with fear. Most often this happens when someone does not have adequate support or is alone during the session. Traditional approaches to journey work always involve the presence of a guide. This is someone safe, who helps prepare you for the experience, is present with you to provide guidance and support during the journey, can help you make sense of your experience, and provides support with integration. Having a guide can help shift a negative experience into something more positive, even if it is just have their reassuring presence.

How I Use Talk Therapy in My KAP Practice

Preparation

One of the most important aspects of your ketamine session is the setting. This isn’t just where it takes place, but with whom. If you are feeling uncomfortable or nervous, this can limit your responsiveness to the medication. This is why it’s so important to have a familiar and safe environment with a trusted guide. In order to establish safety, I like to meet a few times before your session. I take a history during our first session, so that I can understand your background and more effectively help you integrate the material that comes up in your ketamine journey. Over the next couple of sessions we’ll build connection as we discuss what to expect during your journeys, your feelings about using ketamine, and explore your goals and work to set some intentions.

Support During your Ketamine Journey

In contrast to a more clinical experience, I hold a respectful blend of more traditional psychedelic practices with modern psychotherapy. I trust that your inner healer has wisdom and insight that can support your growth and want to make space for you to have a powerful experience. Your mindset going into the session and your intention play an important role in your journey. Whether we are meeting online or in person, we’ll start by checking in. If you’re feeling nervous, we’ll talk through your concerns and do some grounding so that you can feel calm and anchored. We’ll review your intention and then get started with the medicine. I create a personalized playlist for each session and will be sitting with you throughout your journey. If you become afraid or something negative comes up, I will be there to support you. While I generally encourage clients to turn inward and allow their inner wisdom to guide them, I am also available to talk if you have something that you would like to process. Usually about 45-60 minutes after you have taken the medication, the effect begins to wear off and we can begin expanding on your experience and explore how it relates to your intention, perhaps gathering some important insights. When you are feeling more aware and alert we will call for your ride. I often leave my clients with something to focus on during their integration period, perhaps a related journal prompt or a specific activity to experiment with. Typical ketamine sessions last 2-3 hours.

Integration

After a ketamine session, it is advised to avoid any activity that requires concentration, but often in a clinical setting there is limited if any instruction for integration following the session. In keeping with traditional practices, I believe it is important to allow some time to ponder your experience and connect with nature in the first 48 hours after your session. Integration isn’t just what we do in our time together, it is also a personal practice of reflection, connection, and embodiment. You are especially vulnerable to outside influences and this time should be protected and used with intention. Utilizing the neuroplastic state, we meet once within this 48 hour window to further process and integrate the material that came up during your session. I often incorporate IFS informed parts work, mindfulness, or EMDR in this process.

Is Ketamine Assisted Therapy Right for You?

There’s no magic pill when it comes to mental health, but sometimes folks aren’t ready to engage the deeper work. If this is the case for you, using ketamine as a medicine could be a great approach. If you’re feeling ready to explore the emotional components underneath your distress, are wanting to connect to greater authenticity, or have been struggling to make progress in talk therapy, ketamine assisted psychotherapy could be a powerful approach for you. It allows some of your protective barriers (ego) to soften so that you can access and work through the underlying beliefs and experiences that are contributing to your emotional, behavioral, and relationship challenges. 

Long-Term Healing Takes More Than Chemistry

Ketamine is a powerful tool to improve mental health, but lasting transformation comes from doing the deeper inner work. Ketamine provides an environment to engage in self-exploration more effectively so that the work of healing may take place. Approaching ketamine treatment in combination with therapy allows you to maximize the positive emotional state following a ketamine session along with the increased neuroplasticity to achieve meaningful change.

If this approach resonates with you, and you’re looking for a therapist trained in KAP, please send me a message to schedule a discovery call. I support Ketamine Assisted Psychotherapy in-person in Los Angeles and online throughout California.

Learn more about ketamine assisted psychotherapy.

Frequently Asked Questions

Do I need a therapist for ketamine therapy?

It is not required and many clinics and organizations offer the medicine experience without therapy, however, therapy combined with ketamine treatment creates potential for more meaningful insight and change that will lead to permanent improvements in mental health.

Can therapy make ketamine more effective?

Yes. Without changes in the beliefs or behaviors impacting mental health, ketamine provides temporary relief. Combining ketamine treatment with therapy allows you to maximize the increased positive mindset and neuroplasticity after a ketamine session to create meaningful change.

What is ketamine integration?

Ketamine integration is an intentional time of reflection and implementation that often involves processing with a guide or therapist, journaling, tuning in to your body, spending time in nature, and contemplating or engaging in decision making and action.