What Is Ketamine-Assisted Therapy — And What Does a Therapist Have to Do With It?
Ketamine is having a moment in mental health. But the conversation rarely gets to the most important part: it’s not the drug that does the healing. Here’s what you need to know.
If you’ve spent any time around me, you’ve probably heard me talk about ketamine. It’s woven into how I think about treatment, and it’s rapidly becoming one of the most meaningful tools in my therapeutic practice. But I understand why that might raise an eyebrow. What business does a therapist have talking about ketamine?
A lot, as it turns out.
First — a bit of history
Ketamine isn’t new. It has a decades-long track record of safe medical use as a surgical anesthetic, a pain management tool, and a sedative in both human and veterinary medicine. It’s been a reliable fixture in operating rooms and emergency departments around the world.
What’s newer is its application in mental health — and that shift has been driven by the same properties that make it effective for people in acute pain or agitation: its ability to produce dissociative, psychoactive effects when carefully dosed.
Conditions currently being treated off-label with ketamine include treatment-resistant depression, severe anxiety, post-traumatic stress disorder (PTSD), substance use disorders, and other mood and trauma-related conditions.
Is it legal?
Yes — and it’s worth being clear about this. The FDA has approved ketamine as an anesthetic, and medical providers are legally permitted to prescribe it for conditions beyond that original approval. This is called off-label use, and it’s a common, well-established practice in medicine. Ketamine-assisted therapy is entirely legal.
There’s also a related drug worth knowing about: esketamine, sold under the brand name Spravato. It’s a ketamine-adjacent nasal spray that has received direct FDA approval as a treatment for depression and anxiety — further legitimizing the role of ketamine-based medicine in mental health care.
What actually happens in a session?
When used as a therapeutic accelerator, ketamine works by quieting the noise. It can slow racing thoughts and gently loosen the grip of entrenched mental patterns — the ones that talk therapy alone sometimes can’t budge.
The subjective experience varies widely from person to person, and is shaped significantly by set (mindset), setting (environment), and dose. Some people describe a floating, out-of-body sensation. Others experience something closer to ego dissolution — a temporary softening of the boundary between self and everything else. Many describe a profound sense of connection: to the earth, to something greater than themselves, to what some might call the collective unconscious or God.
The experience isn’t uniform, but the underlying mechanism is. And understanding that mechanism is key to understanding why this works.
The neuroscience (in plain language)
Ketamine works by blocking NMDA receptors in the brain, which triggers a release of glutamate. That release revives dormant neurons and helps them communicate more freely — essentially opening a window of heightened neuroplasticity, the brain’s ability to form new neural pathways.
You may have heard neuroplasticity discussed in the context of memory loss, dementia, or cognitive recovery. In therapeutic contexts, it means something particularly powerful: for up to 48 hours after a ketamine session, the brain becomes more receptive. Complex emotions that have felt walled off, patterns that have felt immovable become more accessible.
So where does the therapist come in?
This is the part that often gets lost in the headlines about ketamine: the drug alone is not the treatment.
Ketamine opens a door. Therapy is what you do once you walk through it. That window of neuroplasticity — those 48 hours of increased receptivity — is when the real therapeutic work happens. The insights surfaced during a session need to be integrated, explored, and anchored through skilled clinical support. Without that, the experience may be interesting, even profound, but it won’t necessarily translate into lasting change.
That’s why I talk about ketamine so much. Not because the drug is the answer, but because when it’s paired with intentional, trauma-informed therapy, it can transform what might otherwise be a slow, frustrating climb into something that actually feels like a return to wellness.
The keystone isn’t the ketamine. It’s what happens after.
Interested in ketamine-assisted therapy at Koru Wellness? We offer ketamine-assisted therapy as part of a comprehensive, integrative approach to mental health. Reach out to learn whether it might be right for you — koruwell.com
