Ketamine-assisted psychotherapy (KAP)

Domain VII · Transpersonal, psychedelic & altered states · Eli Kolp, Phil Wolfson, Jennifer Dore · 2007

What it is

Ketamine-assisted psychotherapy (KAP) is not a single manualised therapy. It is a family of practices in which psychotherapy (preparation, accompaniment during a ketamine-induced altered state, and integration) is combined with ketamine prescribed and medically supervised by a licensed prescriber.…

Format

• Preparation (therapist; ordinary-length sessions). Goal: informed consent, expectations, intentions, trust, touch agreements, orientation to the session day.
• Roots To Thrive also requires a group preparation session, a private physician consultation, and orientation to the room and playlist. All preparation must be finished before the first medicine session.

Who practises it, and how they are trained or regulated

• Roots To Thrive: requires a referral from a licensed provider and runs PHQ-9, GAD-7, PCL-5 and B-IPF, a 45–60 minute nurse interview on trauma-informed readiness and capacity to co-regulate in a group, and a physician evaluation. Psychiatric evaluation is added if indicated.
• Version followed: the office-based community KAP model described by Dore, Wolfson and colleagues (Dore et al., 2019, Journal of Psychoactive Drugs: Helios Psychiatry, Woodside CA; Roots Behavioral Health, Austin TX; Center for Transformational Psychotherapy and Ketamine Research Foundation, San Anselmo CA). Two published frames supplement it: the group format of the Roots To Thrive community-of-practice protocol…
• What it is. Ketamine-assisted psychotherapy (KAP) is not a single manualised therapy. It is a family of practices in which psychotherapy (preparation, accompaniment during a ketamine-induced altered state, and integration) is combined with ketamine prescribed and medically supervised by a licensed prescriber. In community practice this is mostly off-label racemic ketamine; esketamine (Spravato) is an FDA-approved…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• confidentiality preferences.
• reliance on the medicine rather than the skills.
• writing becoming self-critical; adjust the prompt.
• members who cannot co-regulate in a group. Offer individual support.
• comparison ("mine wasn't as deep") and over-sharing. Normalise varied experiences.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.