What KAP actually means
Ketamine-assisted psychotherapy is a clinical framework, not a single protocol. The term refers to a deliberate pairing of two distinct treatments: the medicine (ketamine, given by a medical clinician) and structured psychotherapy (delivered by a trained therapist). The framework was formalized in a 2019 paper by Dore and colleagues in the Journal of Psychoactive Drugs, which described preparation, dosing, and integration phases used across multiple outpatient programs. That paper remains one of the most cited references for KAP today.
The shorthand is useful, but it obscures real variation in practice. Some programs deliver therapy during the medicine session, with a therapist sitting with the patient throughout. Others separate the medical session from the therapy entirely, with preparation and integration sessions happening on different days from the dose. Both approaches use the same name. They are not the same experience.
Ketamine is FDA-approved as an anesthetic. Its use for depression, anxiety, PTSD, and other psychiatric conditions is off-label, and that includes its use in a KAP framework. Spravato (esketamine) is FDA-approved for treatment-resistant depression, but the broader category of generic IV and intramuscular ketamine used in KAP is not. Anyone considering this work deserves a clear explanation of that regulatory landscape upfront.
How KAP differs from ketamine alone
A standalone IV ketamine infusion is a medical event. The clinician administers the dose, monitors vital signs, manages the experience, and discharges the patient when it is safe to leave. Talk therapy is not part of the design. Many patients do well with this model, especially when the goal is rapid relief from severe depression or suicidal ideation. The medicine itself is doing the heavy lifting.
KAP changes the design. The medicine is treated as a tool that opens a window of plasticity, and the therapy is treated as the work that uses that window. The therapist is not incidental to the treatment. The therapist is the treatment, with the medicine as an adjunct. That distinction matters because it changes what counts as success: in standalone infusion care, success is symptom relief; in KAP, success is symptom relief plus the integration of new psychological material.
The American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) has published best-practice guidelines that codify this framework. Their 2023 documents describe screening, provider training, informed consent, and integration as essential elements, not optional add-ons. ASKP3 makes clear that KAP without trained therapeutic support is something different from KAP, even if ketamine is involved.
Three common KAP models
In current practice, three models account for most KAP work in the United States:
- The in-session model. A therapist is present in the room during the dosing session, providing supportive presence and selective verbal contact. The medicine is typically intramuscular or sublingual at psycholytic or psychedelic doses. This is the model most closely associated with the original Dore protocol.
- The bracketed model. The medical session and therapy sessions are separated. A medical clinic delivers the dose with appropriate monitoring, and a therapist conducts preparation and integration sessions on different days. The patient may be alone during the dosing session, or supported by the medical team only.
- The blended model. A medical practice and an outside therapist coordinate care so the dose, the preparation, and the integration are all aligned in time even if they happen in different physical settings. Notes flow between providers with the patient's consent.
Each model has trade-offs. The in-session model offers the most continuous therapeutic presence but is logistically harder and more expensive. The bracketed model is more accessible but can leave the dosing session feeling disconnected from the therapy. The blended model tries to capture the best of both, and it is the model Music City Ketamine fits into when patients have an outside therapist trained in this work.
Preparation: the work before the medicine
Preparation is the phase that distinguishes KAP from a casual recommendation to "go try ketamine." In a structured KAP framework, the patient meets with the therapist before any dose is given. The goals of preparation are practical and psychological: build rapport, set intentions, identify therapeutic targets, review what to expect physically and emotionally, and create an explicit framework for how the medicine experience will be processed afterward.
The Dore 2019 framework describes preparation as one to three sessions, depending on the patient's history and complexity. Patients with significant trauma histories often benefit from longer preparation; patients with treatment-resistant depression and minimal trauma may need less. Preparation is also when screening happens for contraindications such as uncontrolled hypertension, certain cardiac conditions, active psychosis, and pregnancy.
This phase often includes a conversation about what dissociation feels like, why it is not the same as a panic attack, and how to use the experience constructively. For many patients, knowing in advance that they may feel disconnected from their body or have unusual perceptions reduces the fear of that experience when it occurs.
The dosing session: presence, not direction
The dosing session is the medical event at the center of the protocol. In KAP frameworks, the dosing session is structured: a quiet room, eye shades, music chosen for therapeutic purpose, and a clinician or therapist present in a non-directive role. The therapist generally does not lead the patient through specific content during the experience itself. Their job is to hold the space.
This is one of the most misunderstood aspects of KAP. People sometimes imagine the therapist guiding the patient through trauma processing during the medicine session, like a hypnosis script. That is not the standard model. The standard model is closer to the way a doula sits with a person in labor, or the way a meditation teacher sits during a long sit. The work is internal. The presence is external. Music, posture, and silence do most of the structuring.
At Music City Ketamine, our medical sessions are designed around the neuroplastic window the medicine opens. Marla Peterson, CRNA, oversees every infusion, with anesthesia-level monitoring of heart rate, blood pressure, and oxygen saturation. We are not a therapy practice and do not provide in-room therapy during the infusion itself. When patients are doing KAP, they bring their own therapist into the loop for the work that surrounds the dose.
Integration: the work after the medicine
Integration is where most of the change actually consolidates. The medicine produces a window during which the brain is, broadly, more flexible: emotional patterns are easier to rework, defenses are softer, and material that has been hard to access can rise to the surface. Integration sessions in the days and weeks after a dose are designed to use that window deliberately.
A 2017 randomized trial by Wilkinson and colleagues in Psychotherapy and Psychosomatics studied this directly. Participants with treatment-resistant depression received ketamine followed by cognitive behavioral therapy. The group that received CBT after ketamine sustained their antidepressant response longer than typical post-infusion timelines, supporting the broader argument that pairing structured therapy with the medicine produces more durable benefit than the medicine alone in many patients. The result is one of the most frequently cited justifications for the KAP framework.
Integration in practice can look like CBT, internal family systems, EMDR adapted for post-medicine work, or general psychodynamic therapy. The specific modality matters less than the timing and the intentionality. The key idea is that the work is structured rather than improvised, and that something is being built session by session rather than reset each visit. Our article on what to do after ketamine therapy covers practical habits patients can layer on top of formal integration work.
What the evidence actually says
The evidence base for KAP is real but heterogeneous. Three reference points are worth knowing.
First, the Dore 2019 paper in the Journal of Psychoactive Drugs reported on 235 patients treated with KAP at three outpatient practices and described meaningful symptom improvement across depression and anxiety measures. It was not a randomized controlled trial, and the data should be read as descriptive of clinical practice rather than definitive of efficacy. Even so, it remains the most-cited clinical framework paper in the field.
Second, the Wilkinson 2017 study in Psychotherapy and Psychosomatics provided controlled evidence that adding CBT to ketamine extended the durability of antidepressant effects. This is the cleanest piece of efficacy data supporting the KAP model. It is one study in one population, but its design quality is high.
Third, the ASKP3 best-practice guidelines do not provide new efficacy data, but they provide something equally important: a clinical standard against which patients and referring clinicians can assess whether a KAP provider is following recognized practice. The guidelines cover screening, training expectations, informed consent, and integration, and they are the closest thing the field has to a standard of care.
What the evidence does not yet show is which patients benefit most from KAP versus standalone infusions, what the optimal dosing protocol is, or how durable benefits are at the two- and five-year mark. Research is active. Headlines often outpace the data. We treat KAP as promising rather than proven for any specific diagnosis.
How Music City Ketamine works with outside therapists
Music City Ketamine provides the medical session. We are a clinic, not a therapy practice. When patients are pursuing KAP rather than a standalone protocol, we work with their outside therapist to coordinate timing, share relevant clinical information with consent, and align the medical sessions with the therapist's preparation and integration schedule. This is the blended model described above.
If you do not yet have a therapist trained in KAP, we can help you think through what to look for. ASKP3 maintains a directory of credentialed providers, and a number of training programs offer KAP certification. The right therapist for this work is often someone you already know and trust, who is willing to add KAP-specific training to their practice. Continuity matters more than novelty.
Cost is a real factor. A single ketamine session at Music City Ketamine is $475, and outside therapy fees are separate. KAP is generally not covered by insurance, both because ketamine for psychiatric use is off-label and because the integration framework does not map cleanly onto standard reimbursement codes. Honest planning includes the full cost of the protocol, not just the medicine.
If you would like to understand how this works in practice for your situation, our team is happy to walk through it on a no-pressure call. How it works describes the medical side; about gives some background on the team and the clinic.