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Ketamine-assisted psychotherapy (KAP) and ketamine infusion therapy are two approaches to using ketamine to support mental health. While both methods involve administering ketamine to the client, they differ in their focus and the setting in which they are carried out. Many clients looking for ketamine treatment are confused by the terms ketamine-assisted psychotherapy and ketamine infusions (often called “ketamine therapy”). Understanding the differences between these treatment options is important to determine the optimal approach for healing with ketamine.
KETAMINE-ASSISTED PSYCHOTHERAPY
In KAP treatment, the client is given a subanesthetic dose of ketamine, usually administered sublingually or intramuscularly. Ketamine has been shown to boost neuroplasticity by increasing Brain-Derived Neurotrophic Factor (BDNF), which promotes an enhanced capacity in the brain to alter rigid thinking and behavioral patterns — in other words, increasing the brain’s ability to learn and change.
Ketamine’s proven antidepressant effects are also connected to these brain changes, which can be strengthened and sustained through supportive psychotherapy. Research suggests that a “neuroplastic window” opens following ketamine treatment, typically beginning within hours and lasting a few days or longer. KAP works to leverage this window of brain adaptability; by engaging in “integration” sessions with a KAP therapist, the client works to make sense of insights from their ketamine experience and is supported in making positive life changes to sustain these benefits. Many KAP therapists follow the model of “the inner healer” as the expert in this process, helping the client access a source of wisdom within to find their own meaning and path towards healing.
The KAP therapist may also suggest various integration techniques (such as spending time in nature, journaling, or mindfulness exercises) to help the client process their experiences and insights during ketamine further on their own. This can be especially fruitful during the neuroplastic window, helping clients to establish new neural pathways and “rewire” their brain in more positive ways.
KETAMINE INFUSION THERAPY
By contrast, ketamine infusion clinics focus on the neuropharmacological benefits of ketamine alone. In these settings, ketamine is typically administered intravenously, and treatments are often managed by medical providers certified in nursing, anesthesiology, or pain management. During the medicine administration, clients’ vital signs are monitored by medical technicians. It is not uncommon for clients to be left unattended in these settings and sent home soon after the infusion, while still under the psychoactive effects of the medicine.
Ketamine infusion clinics tend to focus on providing ketamine infusions as a standalone treatment for mental illness. In these clinics, clients are typically given a series of IV infusions several times a week and are not necessarily engaged in any formal psychotherapy. While helpful for acute symptoms such as suicidality, when ketamine infusions are given without therapeutic support, the neuroplastic benefits may be minimized.
KEY DIFFERENCES BETWEEN KAP AND KETAMINE INFUSION THERAPY
Research and Background
Much of the research on ketamine’s mental health benefits has been conducted following the ketamine infusion model. As such, there is substantial evidence supporting the positive outcomes of this approach for treatment-resistant depression, acute suicidality, and other challenging conditions. While more studies are needed to validate the benefits of adding psychotherapy to ketamine treatment, it is reasonable to conclude that KAP can enhance the positive outcomes of ketamine treatment versus infusions alone. This is achieved by creating a safe and comfortable environment (e.g., set and setting) for clients, encouraging them to explore the ketamine experience from a therapeutic lens, and providing support for making the most of the increased neuroplasticity through integration practices.
Neuroplasticity
A key difference between these two approaches is the appreciation of the neuroplastic state. Ketamine infusion treatment prioritizes the pharmacological benefits of ketamine — namely, its antidepressant effects — as the primary mechanism for healing. This can be a life-saving treatment for people in acute depression or suicidal crisis. However, the post-medicine window of neuroplasticity may be under-utilized without additional support.
By contrast, KAP treatment uses ketamine to assist and catalyze the therapeutic process with a client. Preparatory and integration sessions help them identify target areas for change in their lives and work collaboratively with their therapist toward these goals throughout the treatment. Maximizing the benefits of neuroplasticity is key to this approach. Clients engage in psychotherapy during the neuroplastic window (typically 1-3 days following the ketamine session) to explore psychological material that arose during the ketamine experience and encourage positive shifts in thought and behavior. This seems to help strengthen the new synaptic connections created by the enhanced brain plasticity, increasing the client’s ability to make durable changes and find sustained relief from their symptoms.
Set and Setting
A crucial difference between KAP and ketamine infusion treatments is the attention paid to “set and setting.” Set refers to the psychological state and intention held by both the client and the provider; setting involves the physical environment the treatment takes place in. These factors are widely seen as essential components in psychedelic-assisted therapy and are embraced by KAP providers. KAP sessions are primarily held in the therapist’s office, administering ketamine sublinigually or intramuscularly. KAP therapists partner with a medical professional, who prescribes the ketamine (e.g., lozenges for sublingual doses) and may be on hand to administer for intramuscular or intravenous sessions.
KAP therapists work to create a comfortable and supportive set and setting for optimal experiences. Through preparatory and integration sessions, they set the stage for introspective therapeutic work and help clients discover pathways to new patterns of thinking and behavior. They also give thoughtful attention to the setting, creating a safe, inviting space with soft lighting, pillows, decor, music, and eyeshades. KAP also provides the opportunity to integrate ritual into the experience and discuss more existential questions, such as spiritual or mystical experiences catalyzed by psychedelic medicines.
Ketamine infusion clinics, on the other hand, provide intravenous ketamine, which means they must follow regulations for medical facilities providing IV medications, such as sterile environments and medical monitoring devices. It’s not uncommon for infusion clinics to forgo music and eyeshades, and sometimes involve busy treatment rooms with multiple people receiving ketamine simultaneously. These factors may negatively impact the set and setting for the experience, and journeying in an infusion clinic can feel more distant, medicalized, and impersonal.
Trauma-Informed Care
Another difference between the two approaches is their approach to trauma history. Infusion clinics usually have less of an emphasis on trauma-informed care, since they are primarily focusing on symptom relief and not necessarily facilitating psychological exploration or integration.
On the other hand, as trained mental health providers, KAP therapists understand the importance of holding a safe, supportive space for clients to explore and integrate challenging experiences without retraumatizing them. A ketamine journey can provoke repressed memories or past trauma events, which can be destabilizing for clients with a traumatic history if not properly navigated or screened in advance. KAP therapists often have expertise in trauma-informed care and can support clients through challenging experiences.
BIOMEDICAL MODEL VS. HOLISTIC HEALTH
Ketamine infusion clinics traditionally align with the biomedical healthcare model, an approach to medicine that focuses on treating specific symptoms and diseases using medications and other medical interventions. This reductive view of health and wellbeing separates the psychological from the physical — mind and body — and results in a narrowed treatment lens. Medical providers in these settings are often placed in the position of the expert, which can be disempowering for clients and can overlook interconnected aspects of their struggles and lived experience (e.g., biological, social, and spiritual) that can be important for transformational healing.
In contrast, KAP providers often take a more holistic approach to mental health care that takes into account the complexity of the whole person and their unique circumstances, rather than just focusing on specific symptoms to be treated as biomedical problems. This person-centered approach emphasizes the role of the individual in their own health and well-being, empowering them to heal themselves with the guidance and support of a therapist and prescribing physician.
When ketamine is used as a tool to enhance the therapeutic process, the emphasis is on engaging the client in psychotherapy and supporting them in processing the experiences and insights they had during their medicine journeys. This approach embraces the diverse layers of human health and experience—mind, body, and spirit—and leverages the power of ketamine to heal and transform the whole person.
Overall, these differing approaches to ketamine treatment operate in two different paradigms of mental health care—biomedical and reductive vs. holistic and integrative.
PRATI KETAMINE-ASSISTED THERAPY TRAINING
PRATI embraces the holistic paradigm of health in our approach to training medical and mental health providers in KAP. We believe that healing is relational and interconnected; environmental and social conditions can impact individual well-being, and vice versa. By incorporating a model of wholeness into the treatment process, KAP can more effectively support deeper healing and more durable change. While more research needs to be done on ketamine- and psychedelic-assisted therapies, studies have shown KAP to be effective at sustaining long-term benefits due to the combined effect of ketamine and therapy.
Currently, there is no set protocol or firm consensus on the best practices for administering ketamine for mental health care. One of PRATI’s aims is to meet the need for professional competency and standardization of care in KAP by offering a thorough and integrated training program that encompasses research, ethics, experiential components, and psychospiritual concerns essential to advancing KAP practice with thoughtfulness and intentionality. If you are a medical or mental health professional interested in our training programs, please get in touch! If you’d like to learn more about KAP and other psychedelic medicines, we invite you to attend our webinars or explore our bookstore.
