Ketamine-Assisted Psychotherapy (KAP)

What is Ketamine?

Ketamine is a legal, safe and effective medicine used to treat a variety of mental health conditions, including depression, anxiety and PTSD. Ketamine has rapidly-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hrs. after treatment and last for up to 2 weeks. It works by blocking the brain’s NMDA receptors as well as by stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting symptom improvement.

Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, via nasal spray and using sublingual lozenges. In my work with Journey Clinical we only use the sublingual lozenge form.

How does Ketamine feel?

The effects of ketamine, which most patients find pleasant, last for approximately 45-60 minutes. These effects can make you feel “far from” your body, and facilitate shifts in perception that can often feel expansive in nature. Your motor and verbal abilities will be reduced, so you’ll be lying down in a comfortable position during the experience. Once these effects subsided, we’ll spend the remainder of our appointment giving you space to process and discuss your experience. While it may feel hard to articulate what happened during the experience, patients feel like the insights gained are none-the-less clear. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the Ketamine experience.

What is Ketamine-Assisted-Psychotherapy?

While the medical benefits of Ketamine have been known and validated for many years, as is validated by its inclusion in the WHO list of essential medicines, it’s use in psychotherapy is more novel and has had a resurgence during the last two decades as part of the psychedelic renaissance. This framework is based around a tight coupling of the therapeutic container and techniques with the expansive nature of ketamine experience. Together they seem to be highly effective for people experiencing anxiety, treatment resistant depression and recovering from PTSD.

What benefits may I expect from KAP?

While each persons experience is unique, it is common for clients to report:

  • A “time out” from ordinary mind and reality

  • Decrease in negative or obsessive thoughts and negative self-talk

  • Profound shifts in perspective on self, relationships, and worldview

  • A more positive outlook on challenging life situations and relationships

  • Increase in self-esteem and self-compassion

  • Enhancement of creative problem-solving abilities

  • Greater motivation for lifestyle or behavior changes

  • Relief from existential distress

  • Potential of having a spiritual or mystical experience

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How does Ketamine-Assisted Psychotherapy work?

I work with a local clinician that provides medical assessment, prescription and followups. We’ll do the journey work together in a series of preparatory, guided journey and integration sessions.

  1. Medical Assessment:

    • You schedule an initial evaluation with a local clinician. They will go over your medical and psychiatric history with you, provide education on the treatment and determine if you are eligible for KAP.

    • If they determine that you are eligible for KAP, they will develop a personalized Ketamine prescription and outcome monitoring plan for you.

    • You will be taught to take your vitals and self-administer the ketamine lozenges by in advance of our KAP sessions.

  2. Preparatory Sessions:

    Once you receive your ketamine lozenges, we will schedule time together for our KAP preparation, dosing and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. The goal of a preparation session(s) is to align on the process and set intentions for our KAP sessions together.

  3. KAP Journey Sessions:

    A typical ketamine dosing session lasts between 2-3 hours and can take place either in-person at my office, or remotely via telehealth. During a dosing session, you will self-administer your ketamine lozenge either in my office or in your home. You will be in a comfortable, reclining position wearing an eye mask and listening to calming music. Although a KAP dosing session may be largely an internal experience, I will be present with you the entire time to hold space and provide support as needed.

  4. Integration Sessions:
    After our KAP dosing session, we will meet for multiple integration therapy sessions to review the memories, thoughts & insights that arose during your dosing session, and to prepare for the next dosing session. It is important to have an Integration session within 24-72 hours after dosing.

What is the Cost of Treatment? 

Ketamine-Assisted Psychotherapy is an affordable, accessible modality. Although the medical intake and follow ups are not covered by insurance, they are eligible for out-of-network reimbursement as are the individual therapy sessions. (coverage varies depending on your insurance plan and you should always check with them directly).

3 KAP Journeys - 6 week protocol

  • Week 1: Intakes (Medical and Psycholoogical)

  • Week 2: Prep #1

  • Week 3: Journey #1 + Integration #1 / Prep #2

  • Week 4: Journey #2 + Integration #2 / Prep #3

  • Week 5: Journey #3 + Integration #3 / Prep #3

  • Week 6: Closing Integration

Psychotherapy Costs

  • Psychology Intake = $250

  • Preparatory / Integration Sessions : (5) = $1,000

  • Journey Sessions : (3) = $1,800

Total Psychotherapy Costs : $3,050

Sliding Scale: $2,500 - $3,000

Medical Costs

  • Medical Intake: ~$250 (One time fee, reimbursable through out-of-network) 

  • Cost of Ketamine Lozenges: $75 for approximately 4-6 lozenges (not covered by insurance) 

Total Medical Costs : $325

*Actual fees may vary according to treatment plan. Please review and ask any questions as needed about specific treatment plans.

Frequently Asked Questions on KAP

How do I get started?

Please e-mail me at: kap@naturalbridgestherapy.com to discuss eligibility and next steps.

Do you offer IM? 

Yes, working with Intra-Muscular administration for KAP works well and may be a preferred route of administration for some clients. This does require an additional cost associated with the medical practitioner who will do administration.

If someone is on anti-depressants, will they need to be off them for treatment, or be able to stop taking them afterwards?

One of the benefits of Ketamine is that it can be safely taken while on some SSRI medications. Also many clients are able to recover from depression through this treatment and stop taking some medications. While I cannot provide any medical recommendations around this, the highly skilled medical team will work with you on assessing your particular case before, during and after treatment as needed.

Do you offer a sliding scale fee?

Yes, I provide a sliding scale treatment modality upon request which ranges in a discounted rate between 20 - 50% off the full rate. This is only for my psychotherapy fees, please know that all medical costs must be paid fully and directly the MD/Pharmacy.

Where are these sessions held?

We offer these sessions in person at my office in Downtown Santa Cruz for new clients. For those that have completed an in person series of sessions, there is the possibility of holding these online moving forward.

What kind of music or ceremonial elements are involved in these sessions?

Music can be an important part of the set and setting for these journeys. You can find some of our journey music on my Spotify profile. We also invite mindfulness practices and any other ritual or ceremonial element that clients wish to bring into their journeys. We’ll discuss this in the prep sessions, but in general we are very flexible in meeting you where you are with this.

Other Helpful Resources: 

1. Paradigms of Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS 

2. Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy – research study by Jennifer Dore et al, 2018 

3. Ketamine for Depression and Mood Disorders by Erica Zelfand, ND for Townsend Letter 

4. Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression by goop 

5. Ketamine Assisted Psychotherapy with Jonathan Sabbagh of Journey Clinical – Psychology Talk Podcast