Ketamine-assisted psychotherapy in palliative care

Domain VII · Transpersonal, psychedelic & altered states · Campolina, de Oliveira · 2025 · São Paulo, Brazil

What it is

What it is: a short, time-limited psychotherapy course for people with advanced or life-limiting illness and existential distress (loss of meaning, death anxiety, demoralisation, grief, anxiety or depression), in which a small number of medically supervised ketamine sessions are embedded in…

Format

• Other published formats:
• Pal-KAP (Rochester): a preparation session (about 60 minutes) in a calm, art-filled room to build trust, explain the experience and set intentions; medicine sessions (about 3 hours, patient lying back with eyeshade and curated playlist, two trained facilitators present); an integration session…

Who practises it, and how they are trained or regulated

• How change is thought to happen (the authors' account): ketamine is framed as a catalyst for psychotherapy rather than only a drug. The altered state is described as an "experiential opportunity", not something required for benefit, so preparation and integration carry the therapeutic weight. The model names two experiential registers: an earlier session framed as acclimatisation to a milder, mainly embodied…
• Legal and regulatory status (as of the sources; check locally):
• USA: esketamine (Spravato) is FDA-approved for treatment-resistant depression and for depressive symptoms with acute suicidal ideation in adults, is Schedule III, and may only be given within a REMS programme: REMS-certified treatment settings with a healthcare provider on site to monitor patients; the most recent REMS modification found (April 2026) only added Spanish materials. Esketamine is not approved for…

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

• split messages between teams; agree one plan.
• claustrophobia under eyeshades; offer to remove them.
• the urge to interpret or guide; resist unless the patient asked for guidance.
• confusion, unsteadiness or lingering distress (tell medical staff); pressure to make meaning too fast.
• patients with death anxiety who may read dissolution as "dying"; explore and normalise this in advance.

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.