Ketamine-Assisted Psychotherapy (KAP)

What is KAP? 

Ketamine-Assisted Psychotherapy (KAP) is a therapeutic treatment that utilizes psychotherapy in combination with ketamine medicine.  Ketamine is a powerful tool in the treatment of mental health symptoms including depression and suicidality, especially when other treatments have not been effective.  It has effects on the body, mind, and spirit.  During a ketamine medicine session, many patients experience a non-ordinary state of consciousness (NOSC); experiencing themselves, their needs, and their connection to the world from a new perspective.  Ketamine acts as a catalyst to change, helping the patient access aspects of their experience, thoughts, and feelings that require therapeutic attention.   

KAP utilizes psychotherapy before, during, and after ketamine medicine sessions to prepare patients for and support them through this powerful experience and facilitate exploration and integration of new insights.  Ketamine expands a patient’s awareness of challenging somatic and emotional content that is otherwise inaccessible in an ordinary state of consciousness.  KAP aims to help the patient expand their distress tolerance, develop a positive and growth oriented attitude towards themselves and their experiences, and make changes in a variety of domains (body, mind, spirit, lifestyle) that are required for long term wellness.   

While there are many care models for KAP, it generally includes three phases: preparation, KAP session, and integration.  It is a client centered approach that seeks to create a therapeutic context grounded in safety and warm support, in which the patient can optimize the benefits of ketamine treatment and move towards long term healing.   

KAP Phases and Components 

• Preparation: The KAP process begins with preparation, during which the therapist and patient review the KAP process, explore expectations and intentions, begin integration planning, and create a plan for navigating any challenging experiences safely.  Core concepts such as mindset and setting, the effects of ketamine, and the role of the KAP therapist are introduced.  The number of preparation sessions is client specific. 

• KAP Session: During a KAP session, the role of the therapist changes from a more directive stance to a supportive, following stance.  Because patients in a NOSC may have access to challenging and meaningful insights that are important for their long-term healing, this stance seeks to ensure that whatever insights arise during the session arise solely from the patient’s perspective and not the therapist’s.

The therapist helps facilitate the patient entering into a NOSC and provides support for challenging emotional and somatic experiences that may arise.  As the patient is emerging from the NOSC, the therapist meets them with warm support and waits for the patient to engage the therapist as they are able and responds in non-directive ways that help the patient consolidate and collect the insights, feelings, and somatic experiences from their journey.  During this phase of the KAP session, patients are encouraged to stay thoughtfully engaged with their experience and may talk with the therapist, journal, do art therapy, or engage in gentle movement or breathwork.  

• Integration: Following the patient’s return to their normal state of consciousness, the patient and therapist meet for integration sessions in which the therapist returns to a more active stance and supports the client as they explore their experience.  The focus of integration is continued consolidation and exploration of the new insights gained during the KAP session, implementing the integration plan begun in preparation, informing the patient’s preparation for future KAP sessions, and identifying those emerging issues that require further therapeutic intervention.  The goal of integration is creating meaningful lifestyle change that supports long term healing and builds resilience against future relapse.  The process of integration is begun in preparation and both phases of the process inform one another as the patient moves through the treatment protocol.  The number of integration sessions is client specific.  

Benefits 

• Helps prepare patients for managing the challenges of NOSC 

• Provides a framework for integrating cognitive, emotional, and somatic experiences 

• Supports patients’ ability to make necessary lifestyle changes that support healing 

• Facilitates patients’ understanding of the roots of psychological symptoms 

• Assists patients with developing a positive and growth-oriented mindset 

• Prepares patients for managing symptom recurrence 

Is It Safe? 

When administered in a clinical setting by trained professionals, ketamine is considered safe.  However, it is not suitable for everyone.  In addition, psychotherapy, including KAP, can create short term discomfort as the patient begins to engage with painful thoughts, feelings and experiences.  A thorough medical and psychological evaluation is necessary before beginning KAP. 

Who Might Benefit? 

KAP is a powerful and flexible resource for facilitating the healing journey.  While not all patients require KAP while receiving ketamine treatment, it can be especially helpful with patients who have PTSD, anxiety disorders, concerns about experiencing non-ordinary states of consciousness, and those who don’t have a current psychotherapist, or access to supportive resources.