Understanding Ketamine-Assisted Psychotherapy (KAP)
Ketamine-Assisted Psychotherapy (KAP) has gained clinical attention in recent years for one key reason: it reliably increases neuroplasticity, the brain’s ability to form new connections, while creating a temporary state in which clients can engage more effectively in therapy. Ketamine itself is not new; it has been used safely as an anesthetic for over 50 years. What’s new is how it’s being applied in mental health care.
Ketamine’s antidepressant and anxiolytic effects emerge rapidly, often within one to two hours, and can last up to two weeks after a single dose. Unlike traditional antidepressants, which gradually alter serotonin or norepinephrine, ketamine works through the glutamate system. It blocks NMDA receptors and stimulates AMPA receptors, triggering downstream processes that strengthen neural circuits involved in mood regulation and stress response. This increase in neuroplasticity creates a short but meaningful window during which old patterns loosen and new patterns can form.
KAP builds on this neurobiological shift by pairing ketamine with structured psychotherapy. A typical course includes several dosing sessions spaced about two weeks apart to take advantage of repeated plasticity windows.
During the acute phase of a ketamine session, most people enter what is often described as a “non-ordinary state of consciousness.” This can involve feeling slightly removed from the body, experiencing shifts in sensory perception, or noticing thoughts unfolding in a more fluid or less self-critical way.
These subjective effects last for roughly 45 to 90 minutes, depending on the dose. Afterward, clients often report that while the experience itself may have been difficult to fully describe, the emotional insights or shifts in perspective feel surprisingly clear. Research shows that even after the acute effects fade, the mood benefits and neuroplasticity may continue for days to weeks.
KAP is structured and medically supervised. It begins with a prescriber consultation to review medical and psychiatric history and determine eligibility. If ketamine is appropriate, clients participate in preparation sessions with their therapist to clarify intentions, discuss safety, and set the emotional and environmental conditions that support a productive dosing experience.
A dosing session typically lasts 2.5 to 3 hours. After vitals are taken, the client self-administers a ketamine lozenge, and the therapist remains present throughout the session. Once the medicine wears off, the remaining time focuses on capturing impressions, images, emotions, or insights, sometimes through conversation, sometimes through journaling or art-making.
Integration sessions follow in the days and weeks after each dosing appointment. These sessions are crucial. They help translate the experience into meaningful therapeutic work: examining memories or emotions that surfaced, identifying patterns with new clarity, or connecting the experience to ongoing treatment goals. Integration is where the neuroplastic window is used intentionally rather than passively.
Who Can KAP Help?
KAP is most often recommended for individuals who feel “stuck,” particularly those with treatment-resistant depression, chronic anxiety, or long-standing trauma symptoms. It may also support clients who describe emotional blunting, disconnection, or a sense of watching life from a distance. For some, ketamine reintroduces a sense of emotional access that has been muted for years.
While promising, KAP is not suitable for everyone and requires thoughtful screening, medical oversight, and a strong therapeutic framework. When applied appropriately, it can open therapeutic pathways that traditional talk therapy alone has struggled to reach.
The power of KAP lies in the combination of neurobiology and guided psychotherapy. Ketamine quiets the self-protective mental loops that often obstruct emotional processing. In that quieter space, clients can access parts of their internal world that are normally defended or out of reach.
At its core, KAP is less about the altered state itself and more about what becomes possible once that state opens. It supports reconnection, with emotion, meaning, and a more integrated sense of self, and offers a structured pathway for people to use that reconnection therapeutically.