Ketamine-Assisted Psychotherapy (KAP)
I offer a therapeutic modality called Ketamine-Assisted Psychotherapy (KAP), the use of ketamine as a complement to psychotherapy. I deliver KAP in my practice in partnership with psychiatric prescribers, who can evaluate my client’s eligibility for KAP, prescribes their ketamine and supports us in monitoring outcomes.
If you would like to explore KAP with me, please reach out via my contact form to discuss eligibility and next steps, or email me at info@liminalbodies.com.
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KAP is an evidence-based therapy for healing.
You have probably noticed the increasing buzz around psychedelic therapy, and the potential healing that can come from this modality. My interest in KAP stems from my existing experience as a trauma therapist who provides “bottom-up” reprocessing interventions (like EMDR, IFS, Sensorimotor Psychotherapy). I view psychedelic-assisted treatment as another tool for helping individuals be with the sources of their distress in ways that can be transformative. KAP (like any psychedelic-assisted treatment) induces a nonordinary state of consciousness, which can provide us opportunities to work with wounded parts of ourselves, to support the development of new neural connections, and connect with more adaptive perspectives about ourselves and our suffering.
My collaboration with psychiatric prescribers like Journey Clinical and Whitley Wellness makes it possible to provide KAP in my private practice. As your psychotherapist, together we will evaluate whether KAP could be a beneficial treatment for you and discuss any questions/concerns you have. If you decide to move forward with KAP, I will refer you to one of these prescribers for evaluation and a prescription. The prescriber handles the medical aspects of evaluating your medical appropriateness for KAP, determining the proper dosing, and prescribing the ketamine to you.
We meet for preparation sessions to explore your intentions and goals with KAP and to form a safe working alliance. On the day of your KAP session, you bring your prescription to my office and self-administer your dose. Following your KAP session, we also have integration sessions to support you in the most important aspect of psychedelic-assisted treatment—the meaning-making and behavioral changes that can be possible in the days and weeks following a medicine session. In collaboration with you, myself, and your ketamine prescribers, it may be recommended to have more than one KAP session, spaced out over time. Your decision to engage in KAP, or in more than one KAP session is always your choice.
KAP FAQs
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Ketamine is an FDA approved “dissociative anesthetic” agent originally developed in 1962. It has been used primarily as an induction agent for general anesthesia in surgery for children, adults, and animals. Ketamine has a remarkable safety track record, hence its use in the pediatric population. Over the past few decades, ketamine has also been researched and used clinically “off label” as an effective treatment for depression, PTSD, anxiety, and addiction. The use of ketamine off label for mental health needs is legal in the state of Massachusetts.
While ketamine technically induces a dissociative state, it is quite different from the type of trauma- or stress-related dissociation that many experience. This is a link to an extremely helpful video by Dr. Mark Cornfield explaining the “Six Faces of Dissociation.”
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While research into ketamine treatment is still ongoing (see below for some links to full- text research), it is understood that it works on a neurotransmitter called Glutamate (known as our “brain fertilizer”), which leads to the production of an important growth factor that helps the brain repair damaged neurons affected by stress and mental illness. This creates a neuroplastic window after a ketamine treatment, which people can use to shift internal patterns and behaviors/relational dynamics that maybe previously felt much more stuck.
Ketamine treatment can improve mood within hours/ days and cause the regeneration of nerve cells over time. I talk with clients about the idea of “seizing the neuroplastic window” after a KAP treatment to try doing some reprocessing work (e.g. EMDR, IFS, somatic, or if they’re working with other providers, any other modalities that have helped them), because the shifts one makes during that neurplastic window will help the brain/body establish new, more adaptive patterns that are more likely to stick.
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Ketamine has a demonstrated efficacy in treating depression, particularly treatment- resistant depression and suicidal ideation. Ketamine has also been shown to alleviate symptoms of chronic anxiety and PTSD. There has been emerging research that suggests Ketamine can also help those experiencing addiction, bipolar disorder and obsessive-compulsive disorder.
Psychedelics Today has several great podcast episodes about ketamine...one of their recent episodes explores the use of ketamine for trauma treatment.
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This will be explored with the Journey Clinical medical team. But KAP is not recommended for folks who are actively experiencing psychosis or mania/hypomania, as it can exacerbate these symptoms. If you have high blood pressure or cardiac/ pulmonary issues, you may need to get medical clearance (through management of these conditions) before engaging in KAP. You will not need to taper off antidepressant medication before undergoing KAP, but benzodiazepines should be avoided on the day of your medicine session.
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While research into this question is still ongoing, there does not appear to be any evidence that ketamine is physiologically addictive. But for folks with certain risk factors, ketamine can become intensely psychologically addictive. Those risk factors include: recreational ketamine use/abuse in club/rave scenes, and concurrent use/ abuse of other substances (e.g. alcohol, cocaine, MDMA). Because ketamine is a dissociative, it can be quite psychologically addictive to some people who are struggling with remaining in their current realities, and becomes a means of escape. Another risk factor appears to be intranasal use of ketamine, rather than sublingual, oral, intramuscular or intravenous routes of administration. Extreme ketamine abuse (e.g. daily use of high amounts) can lead to bladder complications and total bladder removal, or to accidental death due to impairment while attempting to bathe, drive or move around while under the effects of ketamine.
There is currently no evidence to show a risk of addiction in Ketamine-Assisted Psychotherapy models, where clients are carefully evaluated by both their KAP therapist and psychiatrist to determine any risk before proceeding, the amounts prescribed are limited, and where a client’s experience and interaction with the substance is closely monitored by their therapist. People who have a history of ketamine abuse would likely not be eligible for KAP. However, if you have any concerns about your personal risk levels regarding addiction to ketamine, we can discuss that thoroughly before deciding whether to proceed with KAP.
This is a link to a 2022 literature review entitled Non-parenteral Ketamine for Depression: A Practical Discussion on Addiction Potential and Recommendations for Judicious Prescribing.
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This is very individually based, but KAP can be a short-term psychotherapy treatment. My usual approach is to schedule at least three 1-hr preparation sessions together, where we will discuss informed consent, your background and presenting issues, preferences for working together, questions/concerns about KAP, and your goals/intentions for undergoing KAP. Following your KAP medicine session, we will also have at least three 1-hr integration sessions, the first of which will be scheduled the morning after your medicine session. KAP focused treatment can take anywhere from 2 months (including the prep/medicine/integration sessions for a single course of treatment) to several months, depending on whether you’re in a multi-dose treatment plan. Following a course of treatment, some folks elect to return for KAP treatment after several months to a year, to gain further benefits.
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A typical KAP medicine session is approximately three hours long. You will come to my office with your prescription which will be shipped directly to you from the compounding pharmacy. We will check in, do some intention-setting and ritually create the container for your medicine work. When you are ready to proceed, you will self-administer your ketamine dose. Per prescriber guidelines, we will be doing sublingual ketamine, which means you will will hold the ketamine in your mouth for approximately 20 minutes and then spit the medicine out. I am here to support you with grounding and often offer readings or music during your sublingual dosing period. Most people begin to feel the effects of the medicine after about 15 minutes, and experience a period of about 45-60 minutes where they “go inside” themselves while resting on the couch. I have a music playlist that I use for KAP sessions and eye-shades which you can use to support your internal work. I am with you during your entire experience and provide non-directive support and reassurance, as well as making sure that you are having a safe experience. Following the period of active medicine effects, people usually spend about an hour in quiet reflection and discussion about their experience. I will assess you to make sure you are safe to return home, and we will have a follow-up session the following morning.
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Only portions of your KAP treatment will be covered by insurance.
Journey Clinical and Whitley Wellness are able to bill some forms of insurance for their ketamine evaluation sessions. If you do not have an insurance plan that they can bill, this session will be out-of-pocket, but they can provide a Superbill for you to try and get full or partial reimbursement by your plan if you have out-of-network benefits. You will also need to pay the compounding pharmacy directly for your ketamine, plus shipping. The estimated cost for the ketamine is $50-100.
Our one-hour preparation and integration sessions will mostly be covered by your insurance plan, if it’s a plan that I’m paneled with (please see my insurance info). I will be able to bill the first hour of your KAP medicine session to your plan, and then will need to charge you for the additional time we spend past that hour, because the extended session is a treatment that is not covered by your plan. My hourly rates and sliding scale options are listed here, and we can explore this option further, if necessary. The estimated out-of-pocket cost is $400 - 500 per KAP session, depending on whether you also have copayments for your first hour.
There are efforts to advocate with the AMA to create billing codes that therapists can use to bill insurance plans for the full 3-hr KAP sessions. Those efforts are still in process and may not fully materialize for a few years.
In the meantime, I have partnered with Thank You Life, a non-profit that is working to reduce barriers to psychedelic treatment by raising funds to support treatment for folks who cannot afford it. If you feel you would benefit from KAP, but cannot afford some of the out-of-pocket aspects of KAP treatment, please let me know and we can explore whether Thank You Life can assist you. If you have the means to support KAP treatment for others, please consider donating to the treatment fund!!
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Yes! Our preparation and integration sessions can be totally virtual. While some prescribers that I work with will approve prescriptions for KAP sessions that take place virtually, my preference is that your KAP medicine session be in person in my office. I feel I can best support you if we are in the same space together during your medicine session.
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For further exploration, below are links to full-text research articles about Ketamine:
2020 - The role of dissociation in ketamine’s antidepressant effects
2021 - Ketamine therapy swiftly reduces depression and suicidal thoughts
2021 - Repurposing Ketamine in Depression and Related Disorders: Can This Enigmatic Drug Achieve Success?
2022 - Toward Synergies of Ketamine and Psychotherapy
2022 - Ketamine treatment for depression: a review
2022 - Active mechanisms of ketamine-assisted psychotherapy: A systematic review
An important note about power and ethics
For a long time, folks have been accessing psychedelic-assisted treatment underground. Many of the underground therapists who have been navigating this work have done so ethically and have taken personal legal risks to make these treatments available and accessible. I have personally known and worked with some of those highly ethical folks and am grateful for them. But there have been numerous cases of abuses of power, boundary violations, and outright emotional/physical/sexual violence committed by therapists in the psychedelic space. The mental health field that I operate in also has a long history of pathologizing and oppressing BIPOC, LGBTQI+, female-identified, poor, currently or previously incarcerated, and disabled people. No one who is coming to therapy to heal from the pain and suffering of trauma and mental health issues should ever be made to feel unsafe by the very person that they hope will help them. It is a tremendous responsibility to sit with someone in a vulnerable nonordinary state of consciousness. I take that responsibility seriously, and want to make sure that our work together feels consensual, safe and ethical. We will be openly discussing my role as your therapist and the boundaries that I operate within, as well as any concerns you have about working together.