Can my outside therapist sit in on my MCK session?

In some cases, yes, with advance coordination. We review the therapist's credentials, their experience working with patients in altered states, and the medical considerations of the room. If the fit is right, we can build a plan together. If it is not, we will help you decide whether a clinic that runs a formal Ketamine-Assisted Psychotherapy program is a better match for what you want.

What's the difference between KAP and clinical ketamine?

Ketamine-Assisted Psychotherapy (KAP) integrates a credentialed psychotherapist into the dosing session itself, with talk-based work happening alongside or just after the medicine. Clinical IV ketamine is a medical model: a CRNA or anesthesia provider runs the infusion, and any psychotherapy happens in separate sessions before and after. Both are legitimate; they prioritize different things.

Do I need a therapist at all to do ketamine?

It is not strictly required, but the research and our clinical experience both suggest that integration work meaningfully improves outcomes for most patients. Ketamine appears to open a window of neuroplasticity; what you do with that window matters. A therapist, group, coach, or structured journaling practice can all help convert insight into change.

Will Marla act as my therapist during the session?

No. Marla Peterson is a Certified Registered Nurse Anesthetist, not a psychotherapist. Her role is medical: she oversees the infusion, monitors your vitals, and manages anything that needs clinical attention. Therapy is a different discipline, and we coordinate with outside therapists rather than blending the roles.

Can my partner come in instead of a therapist?

Generally no. The treatment room is a clinical environment with monitoring equipment, and most patients do best with a quiet, internal experience during the infusion. We encourage partners and family at drop-off and pick-up, and we welcome them in the consultation. After the session, debriefing with someone you trust can be one of the most useful parts of the day.

Can My Therapist Be in the Room During My Ketamine Session?

What “KAP” Actually Means — and What It Doesn’t

Ketamine-Assisted Psychotherapy is a specific clinical model, not a marketing term. In a true KAP session, a credentialed psychotherapist is present in the room while the patient is under the medicine. The therapist is not just a chaperone. They have training in working with non-ordinary states of consciousness, they hold the frame of the session, and they help shape what comes up during the dosing window itself.

The model has a published evidence base. A widely cited 2019 paper by Dore and colleagues in the Journal of Psychoactive Drugs described KAP as practiced across three large clinics, documenting patient demographics, the workflow of preparation and integration, and outcome patterns across 235 patients. A 2022 systematic narrative review by Drozdz and colleagues in Frontiers in Psychiatry looked at the broader landscape of ketamine-assisted psychotherapy models and concluded that adding structured psychological support is associated with meaningful improvements in clinical outcomes.

What KAP is not: a license for any therapist to sit in on any infusion. The therapist needs specific training. The medical setup needs to support a therapy-forward room. The prescriber and the therapist need a clear scope of practice and a coordinated plan. Run loosely, the model can blur lines that are safer kept distinct.

For a deeper walkthrough of how this is structured in formal programs, see our explainer on Ketamine-Assisted Psychotherapy explained.

The ASKP3 Framing of Therapist Presence

The American Society of Ketamine Physicians, Psychotherapists, and Practitioners (ASKP3) published its Standards of Practice in the Therapeutic Use of Subanesthetic Ketamine in 2020. The document is one of the few professional consensus references in the field, and it is explicit about the dual-role question.

ASKP3 separates the medical role (the prescriber and the person responsible for monitoring the patient’s body during the session) from the psychotherapy role (the person responsible for the patient’s psychological experience). The standards do not require that both roles be filled simultaneously in the same room. They do require that whichever model a clinic uses, the medical floor of safety must be maintained at all times, and that any psychotherapy delivered around the medicine must be done by a credentialed professional working within their scope of practice.

Translation: a clinic can legitimately run a clinical-only model with separate integration. A clinic can legitimately run a full KAP model with a therapist in the room. Both meet the standard. What the standard does not allow is anyone — medical or therapy — operating outside their training.

What MCK Offers: Clinical IV Ketamine Plus Outside Integration

Our model at Music City Ketamine is the clinical IV ketamine model. The infusion is run as a medical procedure. Marla Peterson, CRNA, oversees every infusion, with anesthesia-level monitoring and the equipment to manage anything that needs clinical attention. The room is quiet, dimly lit, and built around a comfortable recliner. Most patients prefer to go inward during the session itself rather than do verbal therapy under the medicine.

For the psychological side, we coordinate with outside therapists. We can talk with your therapist before your first session, share what to expect, and plan integration appointments around your infusions. If you do not currently have a therapist, our guide to finding an integration therapist in Tennessee is a starting point, and we can suggest local providers who have experience with this work.

Ketamine is FDA-approved as an anesthetic; its use for depression, anxiety, PTSD, and chronic pain is off-label. That framing matters here, because the medical-model versus KAP question is partly a question about how to structure care that is, by definition, not yet protocolized by a regulator.

Why a CRNA at the Bedside Is the Safety Floor Either Way

Whether a clinic runs KAP or clinical infusions, the medical layer needs to be solid. IV ketamine acts on the cardiovascular system, can transiently elevate blood pressure, and produces a dissociative state that requires a trained clinician to interpret and respond to. This is not theoretical — it is the reason ASKP3 lists medical monitoring as a non-negotiable.

A CRNA is a Certified Registered Nurse Anesthetist, an advanced practice nurse with a graduate degree and thousands of hours of supervised anesthesia training. CRNAs administer the majority of anesthetics in the United States and are specifically trained to monitor patients receiving sedating and dissociative medications. If you want to understand the role in more depth, see what a CRNA is and what Marla does during an infusion.

In a KAP model, the CRNA or supervising physician is still in the building and still responsible for the medical floor — the therapist does not replace them. In our clinical model, the CRNA is in the room and the therapist is across town. The medical layer is the same; what differs is who is sitting next to you while the medicine is working.

The Coordinated-Therapist Model: How It Can Work in Practice

Some patients ask whether their existing therapist can come along to an MCK infusion. The honest answer is: sometimes, with coordination, and only after we review credentials and fit. A few things have to line up.

Credentialing review. The therapist needs to be a licensed mental health professional in good standing. Specific KAP training is a strong plus.
Experience with altered states. Sitting with someone in a dissociative state is a different skill than office-based talk therapy. Therapists without that experience can inadvertently destabilize the session.
Clear roles. The therapist is there for the psychological frame. Marla is there for the medical frame. We agree in advance who handles what, and the medical role takes precedence if there is a clinical event.
A plan, not a guess. What does the therapist intend to do during the session? Hold space silently? Use a specific protocol? We want to know before, not improvise during.

For most patients, we end up recommending the alternative: keep the infusion clinically focused, and put the therapist’s time where it appears to do the most work — in preparation and integration.

Pre-Session Prep With Your Therapist

The hours before a ketamine session are leverage points. A 30 to 60 minute call or in-person session with your therapist in the days beforehand can shape what comes up during the infusion. Useful prep work includes naming the intention for this round of treatment, clarifying which themes feel most active, and rehearsing how to relate to difficult content if it surfaces. None of this has to be elaborate. Even a single sentence written down (“I want to look at what is underneath the constant low-grade anxiety”) helps orient the experience.

For patients combining ketamine with trauma-focused therapy, see our note on ketamine and EMDR integration. The modalities can sequence in useful ways when both clinicians are in the loop.

Post-Session Integration: Where the Meaning Gets Locked In

The strongest argument for working with a therapist around ketamine is not what happens during the session. It is what happens in the 24 to 72 hours after, when the medicine is wearing off and the brain is in a state of heightened plasticity. This is the integration window, and it is where insights either get encoded into how you live or evaporate.

An integration session within a few days of an infusion can do several things at once: help you put words on what was largely non-verbal, identify any small behavioral shifts the experience pointed toward, and notice if anything came up that needs more careful attention. Patients who do this consistently tend to describe more durable change than patients who treat each infusion as a stand-alone event.

If a full integration session is not practical, even a structured 15 to 20 minute integration call with a therapist or coach can move the needle. The point is that the experience does not just get filed away.

Choosing the Model That Fits Your Goals

Most patients sort themselves into one of three camps once they understand the options. There is no universal right answer, and the research does not yet definitively favor one model over another for any specific diagnosis.

Clinical IV ketamine plus outside integration. Best fit if your priority is the medication’s direct neurobiological effect, you already have a therapist you trust, or you want a quiet, internal session without verbal processing during the medicine. This is what we run at MCK. Consultation details are in how it works.
Formal KAP program. Best fit if you specifically want a credentialed therapist in the room during dosing, you are working through complex trauma where the therapeutic relationship is central, or you prefer an integrated medical-and-therapy team under one roof.
Hybrid coordination. A small number of patients arrange for a credentialed therapist to attend an MCK session through advance coordination. This is case-by-case, never automatic, and depends on clinical fit.

None of these models guarantees a specific outcome. Research suggests that adding psychological support — whatever its location relative to the infusion — is associated with better results on average. The mechanism appears to involve helping patients use ketamine’s neuroplastic window deliberately rather than passively. If you want to talk through which structure fits your goals, that is exactly the conversation we are built for.