Let’s explore a few important layers to this question.

When I talk with clients about considering KAP, I think about three different things:

Interest → Appropriateness → Readiness

What is drawing you to KAP? Is ketamine medically and psychologically appropriate for you? And are you ready to engage in the therapeutic process that accompanies it?

Why Are People Interested in Ketamine-Assisted Psychotherapy?

1. They have been in therapy for a long time but still feel stuck.

Some clients have been in therapy for years and have gained significant insight into themselves, yet they continue to experience the same painful emotional patterns.

They may understand why they feel anxious, depressed, ashamed, or disconnected. They may have explored their childhoods and relationship patterns. Yet, despite all that insight, a part of them still feels unchanged.

Perhaps there is a belief that keeps returning:

“I am not enough.”

“I am unsafe.”

“I have to hold everything together.”

“I cannot trust others.”

These clients may begin to wonder whether ketamine could temporarily loosen the grip of deeply established patterns and create an opportunity to experience themselves differently.

2. They are considering psychiatric medication but feel uncertain about long-term use.

Some people reach a point where they wonder whether psychiatric medication might help with symptoms such as depression or anxiety, while also feeling hesitant about ongoing medication or potential side effects.

Ketamine treatment differs from traditional daily medication. It is typically delivered in a limited number of sessions rather than taken daily. My clinical approach is to recommend a course of 6 to 8 KAP sessions, followed by a pause or discontinuation of KAP treatment.

3. They are curious about the experience itself.

Some people seek KAP because they feel disconnected from their bodies or emotions and struggle to know what or how they feel. In regular psychotherapy, I prioritize helping clients reconnect with their feelings. Adding ketamine to psychotherapy can make that process of reconnecting with one’s emotions a different experience.

Other clients have difficulty imagining their minds ever slowing down. They live in a constant state of doing—thinking, planning, achieving, or managing. Underneath it all, they may carry a quiet sense of emotional activation and wonder whether ketamine might allow them to experience themselves differently.

Interest in KAP Doesn’t Necessarily Mean KAP Is Appropriate for You

 

As a psychotherapist, my scope of practice doesn’t allow me to fully assess whether a client is medically appropriate for ketamine. I conduct an initial screening and then refer clients to trusted medical providers who perform the medical evaluation and determine whether ketamine treatment is appropriate.

There are several areas that require particular consideration.

Medical conditions

Ketamine can cause temporary increases in blood pressure and heart rate, so people with certain cardiovascular conditions may require additional medical evaluation before treatment (U.S. Food and Drug Administration, KETALAR Prescribing Information).

If you have a significant medical condition, your ketamine prescriber and other medical providers should help determine whether ketamine is appropriate for you.

Psychosis and difficulty with reality testing

Clients with schizophrenia, schizoaffective disorder, a history of psychosis, or current difficulties with reality testing require particularly careful psychiatric and medical assessment, and KAP may not be appropriate.

Ketamine can temporarily alter perception, thinking, and one’s sense of reality (U.S. Food and Drug Administration, KETALAR Prescribing Information). Clients therefore need enough psychological and cognitive stability to experience these temporary changes without becoming overly confused and to reorient to ordinary reality afterward.

At my practice, I provide psychotherapy in conjunction with ketamine only when ketamine treatment has been determined to be appropriate by the client’s prescribing medical provider.

Bipolar disorder and a history of mania or hypomania

Bipolar disorder requires especially careful consideration. Ketamine can cause significant changes in mood and perception, and there is a potential risk that it could contribute to a manic or hypomanic episode in someone vulnerable to mood elevation [1].

At the same time, a diagnosis of bipolar disorder does not necessarily mean ketamine is universally inappropriate. Careful psychiatric and medical assessment should consider the person’s history of mania or hypomania, current mood stability, medications, and level of clinical support.

In my practice, I take a particularly cautious approach with clients who have a history of bipolar disorder or manic episodes and would want their prescribing provider to carefully assess whether ketamine is appropriate.

Substance use disorders

I am also particularly careful when considering KAP for clients with a history of substance use disorders. Ketamine has potential for abuse and misuse, making careful assessment particularly important when considering treatment for someone with a current or past substance use disorder [2].

Someone with a past substance use disorder who has maintained stable recovery may still be considered for KAP in some circumstances, but this decision should involve careful individualized assessment, attention to the person’s current relationship with substances, and appropriate medical and therapeutic support.

I would be especially cautious about KAP for someone with an active or unstable substance use disorder. It would be important to explore the client’s current relationship with substances and become very clear about the purpose of the KAP sessions.

Comfort with altered states

KAP may also not be the right fit for someone who simply dislikes altered states of consciousness [3].

If the idea of temporarily experiencing changes in perception, thinking, emotions, or your usual sense of control feels deeply uncomfortable, KAP may not be the best approach for you—and that’s okay.

Being Appropriate for KAP Isn’t the Same as Being Ready for KAP

Someone may have depression, PTSD, or another condition that could potentially benefit from ketamine treatment and have no medical or psychiatric conditions that would prevent them from trying it—and still not be ready for KAP.

KAP is not simply about receiving ketamine and hoping the medicine will solve a problem.

The experience can bring up unfamiliar emotions, memories, bodily sensations, imagery, or shifts in perspective. You don’t need to know exactly what will happen during a session, but it is helpful to have enough emotional stability, curiosity, and willingness to stay open to your experience rather than needing to completely control or predict it.

Questions to Ask Yourself Before Considering KAP

Before moving forward, I invite you to think about these questions:

• • What is bringing you to KAP right now?

• • What are you hoping will change in your life?

• • Are you seeking KAP primarily to avoid or escape difficult feelings, or are you willing to become more curious about your inner experience?

• • Do you have enough stability and support in your life to process what may emerge?

• • Are you willing to prepare for the experience and spend time integrating what you learn afterward?

• • Can you tolerate some uncertainty and temporary changes in perception, emotions, or your usual sense of control?

• • Are you able to participate in an ongoing therapeutic relationship rather than viewing ketamine as a quick fix?

You do not need to be perfectly emotionally regulated or know exactly what you want to discover in KAP. Many people come to therapy—and to KAP—precisely because they feel confused, stuck, or disconnected from themselves.

Readiness is more about having enough stability and capacity to engage with the process safely and meaningfully. It means being willing to prepare, practicing openness and curiosity about your experience, and continuing to explore and integrate what emerges afterward.

At Marta Kem Therapy, I like to spend at least six psychotherapy sessions with a new client before conducting medicine sessions.

Interest → Appropriateness → Readiness

As you think about trying ketamine-assisted psychotherapy, it may be helpful to return to these three considerations:

Interest: What is drawing you to KAP, and why now?

Appropriateness: Are there medical or psychiatric considerations that need to be evaluated by your prescribing medical provider?

Readiness: Are you willing and able to engage in preparation, psychotherapy, and the integration process that follows KAP sessions?

Being curious about ketamine is a starting point. Determining whether it is appropriate for you—and whether you are ready to engage meaningfully with the therapeutic process—is what comes next.

If you are interested in learning more about ketamine-assisted psychotherapy and whether KAP might be appropriate for you, I invite you to contact me and ask more questions.

References:

[1] Fancy, F., et al. (2023). Ketamine for bipolar depression: An updated systematic review. Therapeutic Advances in Psychopharmacology, 13.    Read the study.

[2] U.S. Food and Drug Administration. KETALAR (ketamine hydrochloride) prescribing information. View prescribing information

[3] Smith, 2023. Prepare Yourself, Your Clients, and Your Practice for Ketamine Assisted Psychotherapy: A Step-by-Step Guide. Platypus Publishing.      Read the study.