Is Ketamine-Assisted Psychotherapy Right for My Client?

Many of us are now in the position of being asked about ketamine. Sometimes by clients. Sometimes by colleagues. Sometimes just by our own curiosity.

The question usually isn’t “Is ketamine legit?”

It’s more personal than that.

Is this right for my client?

I want to offer a way of thinking about Ketamine-Assisted Psychotherapy that stays grounded in evidence and ethics, without turning it into either a miracle story or something to fear. KAP is not a replacement for therapy. It is not a shortcut around the work. At its best, it is a support to the work we are already doing.

Ketamine has a strong and growing evidence base as a rapid-acting antidepressant, particularly for people with treatment-resistant depression. For many, symptoms that have been immovable for years begin to shift within days. That alone is meaningful. But what makes KAP especially interesting for therapists is not just symptom relief. It is the way ketamine appears to open a brief window of flexibility in the nervous system.

I often think of it this way:

• Ketamine does not create insight.

• It creates conditions where insight, movement, and new learning are more likely.

• It offers a temporary softening of rigid patterns.

• Therapy is what helps translate that window into lasting change.

There are two broad lanes where I most often see KAP be genuinely helpful.

Lane One: Treatment-Resistant Depression

These are clients who have:

• Tried multiple medications

• Engaged earnestly in therapy

• Lived for years under the weight of depression

• Begun to believe, “This is just who I am”

In these cases, referral is not an admission that therapy failed. It is an acknowledgment that biology may be limiting what psychotherapy can reach right now.

Ketamine can:

• Lift the floor just enough for hope to become felt rather than theoretical

• Interrupt entrenched biological patterns

• Create space for therapy to work in a new way

Lane Two: “Stuck” in Therapy

These clients are often:

• Thoughtful, consistent, and motivated

• Insightful about their patterns

• Committed to the work

And yet:

• Shame spirals repeat

• Freeze states dominate

• Grief stays intellectual

• Parts remain rigid no matter how gently we work

• Therapy feels like it circles without landing

For some of these clients, ketamine functions as a catalyst. Not because it delivers truth, but because it temporarily loosens the grip of protective rigidity.

Clients may experience:

• Greater emotional range

• Less defensive structure

• New associations or meanings

• A felt sense of possibility that had been missing

It is important to stay honest here. The strongest research supports ketamine as a rapid antidepressant. The data on psychotherapy added to ketamine is still emerging and mixed. We should not overclaim. 

A grounded stance sounds more like this:

• Ketamine has a strong evidence base for depression

• KAP may help clients use that window more effectively

• Especially when preparation and integration are clinically solid

Good candidates tend to have a few things in common:

• Basic grounding under stress

• Some capacity to tolerate emotional intensity

• Openness to collaboration between therapist and prescriber

• A life container stable enough to support change

• Ongoing therapy for preparation and integration

The referral question is not, “Would ketamine be interesting?”It is:

• What is the stuck loop?

• What new learning would need to occur?

• What will we do in therapy if flexibility increases?

In Part 2, I will walk through when KAP is not the right next step, including hard rule-outs, red flags, and how to think ethically about risk and timing.

Autumn Starks is a Licensed Clinical Social Worker (LCSW), Internal Family Systems Certified IFS Therapist, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), special interest in Complex PTSD and other disorders resulting from religious trauma and spiritual abuse, Certified in Psychedelic Assisted Psychotherapy through the Integrative Psychiatry Institute, and is the founder of Starks Therapy Group in Oak Park, IL where she partners with Richard Clark, CRNA, APRN, to provide ketamine-assisted psychotherapy and they host together the Ketamine Collective for therapists.

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