What is Ketamine Assisted Psychotherapy (KAP)?
And how do I know if Ketamine Assisted Psychotherapy (KAP) can help me?
5 min read | Illustration by Marcelo Clapp
In the last few years, the use of psychedelics as a tool to facilitate long-lasting emotional relief has gained steam in mainstream therapeutic circles. While psychedelic medicines like MDMA and psilocybin are undergoing final clinical trials to be approved for legal use, ketamine is currently the only psychedelic medicine that can be legally used to treat emotional pain. In recent years, ketamine has been prescribed off-label to treat chronic mental health conditions like depression, anxiety, and PTSD. A 2010 study showed that 70% of participants felt the anti-depressant qualities of ketamine within a day of use, which lasted for up to two weeks.
Wait, I’m confused. Isn’t ketamine a party drug?
Your first image of ketamine might be of an illicit drug used and abused at raves. Yet ketamine has been safely and legally used for anesthesia in medical settings with adults, children, and animals for well over fifty years. Developed in 1960 to support surgical sedation, doctors inadvertently discovered ketamine’s antidepressant qualities when patients receiving ketamine reported significant mental health benefits. Since then, psychiatrists have prescribed ketamine intravenously or intramuscularly in higher doses and through the nose or under the tongue (via lozenge) in lower doses for the treatment of mental health conditions.
So what is ketamine-assisted psychotherapy (KAP)?
Pairing psychotherapy and ketamine in a process called ketamine-assisted psychotherapy (KAP) can facilitate incredible long-term healing. Dr. Raquel Bennett likens ketamine to “a lubricant in the psychotherapy process.” In 2019, researchers concluded that when taking lower-dose ketamine administration in conjunction with regular psychotherapy, patients experienced a clinically significant reduction in depression and anxiety. A few KAP sessions can have long-lasting emotional improvements. In conjunction with weekly psychotherapy, some individuals have experienced lasting benefits from as little as one KAP session while others experience lasting results within 3-5 sessions. And unlike most other psychedelics, ketamine is short acting, and its mind-altering effects last between thirty minutes to one hour, which makes it agreeable to our modern schedules.
We tend to move through the daily humdrum of experience with our emotional walls up high, because it hasn’t always felt safe to tune into what’s really going on beneath the surface. General talk therapy supports a gradual undoing of this armoring, so we can access these deeper-seated emotions and get to the heart of our suffering as well as our potential. DST therapist Tina Tacorian says, “KAP can jumpstart this process and creates moments of emotional transformation.” With KAP, many patients take a ‘time out’ from depressive thoughts, move through difficult experiences, and transform their pain into acceptance, hope and resolve. In the presence and safety of a trusted therapist—one who is already deeply attuned to a patient’s intentions, hopes and pain—healing can happen much more quickly.
For some, visions and past memories may emerge in the KAP process. DST therapist Melanie Berkowitz says, “As a ‘dissociative’ medicine, ketamine allows many patients to process emotional waves in a way that offers them helpful separation from emotional pain that might normally feel intolerable.” From this new birds-eye view and in the presence of a trusted therapist, individuals can observe their emotional suffering from a distance and reflect on their lives with an attitude of equanimity and curiosity instead of shutting down from feeling overwhelmed. Some have described the lower-dose KAP sessions to be dreamlike, deeply spiritual, accessing new sensations or visions. Many feel that such mind-altering ketamine experiences have facilitated a process of emotional release. These experiences continue to deepen in the following sessions with their therapist, where individuals focus on how to integrate their KAP experiences so they can impact long-term, healthy emotional re-patterning.
As a ‘dissociative’ medicine, ketamine allows many patients to process emotional waves in a way that offers them helpful separation from emotional pain that might normally feel intolerable.
From this new birds-eye view and in the presence of a trusted therapist, individuals can observe their emotional suffering from a distance and reflect on their lives with an attitude of equanimity and curiosity instead of shutting down from feeling overwhelmed.
What might a KAP process look like and are there side effects?
An initial session at Downtown Somatic Therapy would involve clarifying your intentions for KAP with your therapist. If KAP seems like a good fit, we would then connect you to a consultation with a clinical prescriber at Journey. In the meantime, in our sessions, we will prepare you for your first KAP experience and unpack expectations.
During the ketamine dosing session itself, your therapist will support you to relax. Patients generally recline and take their low-dose ketamine lozenge, which takes about ten minutes of swishing to dissolve. You’d be encouraged to use an eye mask, tune into your internal experience, and listen to relaxing music. The therapist will take notes on what you share so that you can drop into the moment and further integrate this experience in future sessions. After the initial KAP dosing session, you would meet weekly with your therapist to debrief and integrate any emotional shifts into your day-to-day life.
Risks and Side Effects
For over fifty years, ketamine has been safely used in hospital and office medical settings, and medically, the risks of ketamine use are quite low. There is a brief increase in blood pressure, and a very small percentage of individuals experience nausea. And while recreational use of ketamine can be addictive, problems with addiction have been rarely seen in the KAP setting due to its therapeutic use and such limited access to the medicine.
Like any other mind-altering experience that may lower your defenses, there are some emotional risks to ketamine. If difficult emotions emerge and you don’t feel you have the support to contain them, you may feel worse. That is why we promote the use of KAP with a trained KAP therapist who you can trust to hold whatever experiences or emotions may arise within you.