Ketamine Assisted Psychotherapy (KAP) - Diane Duan, Psy.D. - Individual and Couples Therapy in NY

Ketamine Assisted Psychotherapy (KAP), Plant Medicine Preperation & Integration

Ketamine Assisted Psychotherapy (KAP) is a novel approach that has shown to be effective in treating a variety of mental health conditions. Through partnership with Journey Clinical, I facilitate in-person and remote journeys with ketamine. I also provide preparation and integration sessions to support the safe and effective use of alternative plant medicines.

Depression

While many people benefit from psychotherapy alone, a significant portion continue to experience depressive symptoms. KAP is one option to explore when clients feel “stuck,” or when symptoms remain significant despite different lifestyle and therapeutic interventions. For many clients, KAP can create a sense of "internal spaciousness" where emotional heaviness lifts, numbness gives way to feeling, and the mind becomes more open to new perspectives. This can make therapy more effective, insight more accessible, and meaningful change more sustainable.

Anxiety

KAP can help reduce persistent anxiety symptoms by increasing neuroplasticity, reducing anxiety symptoms commonly associated with rumination, and enhancing the effectiveness of psychotherapy. Anxiety is maintained by predictable patterns in the brain: hyperactive fear circuits, rigid thought loops, and overactive limbic responses. KAP can interrupt these patterns and allow new ones to form. By calming the nervous system, KAP allows for clients to feel safe enough to access emotions, reflect on their experiences, and engage more fully in rewiring the neural circuitry.

PTSD & Trauma

KAP may help reduce PTSD and trauma-related symptoms for some people by supporting neuroplasticity, fear extinction, and psychological flexibility. For people who have tried therapy, medication, or trauma-focused treatment without lasting relief, KAP can open a therapeutic window where processing becomes possible and where the grip of traumatic memory may begin to loosen. KAP can create a sense of distance from traumatic memories — where what once felt overwhelming becomes more approachable, and where the nervous system begins to register safety in a way it previously could not.

Eating Disorders

KAP is emerging as a tool in the treatment of eating disorders, offering clients an opportunity to explore the underlying emotional patterns and traumas that contribute to their struggles. By fostering neuroplasticity and deepening therapeutic breakthroughs, KAP can help individuals develop a new relationship with themselves and their bodies. KAP can provide an opportunity for clients to disconnect from the structure and protection of eating disordered thoughts and behaviors, and recognize they can still feel safe without these long-standing patterns of protection.

Obsessive-Compulsive Disorder (OCD)

Research on KAP for OCD is in its early stages, but there is good reason to believe that its effectiveness in enhancing neuroplasticity and ability to reroute rigid thought loops while maintaining a sense of stability in the nervous system will help in the treatment of obsessive and ruminative patterns. By introducing distance from distressing thoughts, KAP offers individuals an opportunity to step outside the exhausting cycle of compulsions and experience what it feels like to coexist with uncertainty safely.

Chronic Stress & Burnout

Chronic stress and burnout often results in a depletion of internal (and sometimes external) resources that may resemble depression. A chronically-overworked nervous system feels heavy, trapped, and suffocated by the demands of life. For many clients, KAP can create a sense of "internal spaciousness" where this heaviness lifts, clients can then gain more clarity and find movement and freedom where there was only stuckness and isolation previously.

How Does Ketamine Work?

Research has shown that ketamine's effectiveness stems from two main mechanisms of action: Increasing Brain-Derived Neurotrophic Factor (BDNF), and lowering the Default Mode Network (DMN).

Increased BDNF

Ketamine increases Brain-Derived Neurotrophic Factor (BDNF). BDNF is known as “Miracle-Gro” for the brain: it is a protein that acts as a growth factor for neurons and synapses. BDNF supports synaptic plasticity; is crucial for learning, memory, and cognitive function; and aids in repairing and strengthening brain connections. By increasing BDNF, ketamine supports neuroplasticity and opens a window of opportunity for psychotherapeutic intervention. The length of the window is dose-dependent and time-limited (around one week, with peak at 2-3 days).

Decreased DMN Activity

Ketamine has been shown to reduce the functional activity of the Default Mode Network (DMN). The DMN is the brain network that becomes active when the brain is at rest. It is crucial for processes like self-reflection, emotional processing, social interaction, and mental exploration. The DMN is also active in processes of rumination, self-narration, and core beliefs about identity. During a psychedelic experience, the DMN quiets. This allows clients an opportunity to observe habitual thought patterns from a distance and gain perspective.

Where do I begin?

Step 1: Consult Call & Medical Clearance

Book a consult call with me where we can explore your hopes and goals for KAP, as well as any questions or concerns about the medicine, billing, logistics, etc. I will then help you set up an account on Journey Clinical, where you will schedule an intake call to get medically cleared with one of JC's psychiatrists.

Step 2: Preparation Sessions

Once you are cleared by JC's medical team, you will receive your first two doses of ketamine in the mail. While you wait to receive your initial doses, we will have at least one preparation session. We can have as many preparation sessions as you need to feel comfortable moving forward with the dosing session!

Step 3: Dosing Session

The dosing session is when you actually take the medicine! This session typically lasts 2.5 to 3 hours, and includes 30 minutes of grounding and intention-setting prior to dosing, 60-90 minutes of active journeying, followed by a gentle landing and initial integration.

Step 4: Integration Session & Medical Follow-Up

After your initial dosing session, we will meet within the next week while the neuroplasticity window is open to begin integrating your experience. You will also schedule a follow-up session with JC's medical team, where they will adjust the dose accordingly and mail you the remaining 4-6 doses. A complete course of ketamine treatment is 6-8 doses with integration in between each dosing session.

FAQs

How much does KAP cost?

First Time KAP Patients:

Medical treatment: total cost of initial evaluation, treatment plan, and medication for up to 2 sessions: $362. Clients may be eligible for partial insurance coverage depending on the plan. Medical fees can be discussed with psychiatric providers on Journey Clinical.
Psychotherapy dosing session (2.5-3 hours in person or remote): $685-$825. Clients may be eligible for partial insurance coverage.

Ongoing KAP Treatment:

Medical treatment: Total cost of 6 additional treatments: $358. Clients may be eligible for partial insurance coverage depending on the plan. Medical fees can be discussed with psychiatric providers on Journey Clinical.
Psychotherapy integration sessions: $275 / 50-minute session. Clients may be eligible for partial or full insurance coverage.
Self-guided dosing session: $125-$150. After the first two dosing sessions, clients may elect to continue dosing using a self-guided format (without the therapist present). In cases where this is appropriate, the client has a designated chaperone and will check in with me before and after the dosing session.

How long is a ketamine journey?

The journey itself is about 45 minutes. During the dosing session, we’ll start with about 30 minutes of grounding, intention-setting, and mindfulness practices. This preps the body and psyche for the medicine. After the journey, clients will have time to gently land and begin integrating their experience.

How is ketamine different than other psychedelics?

Ketamine, unlike psilocybin (“magic mushrooms”) or LSD is not a classic psychedelic. It is shorter in duration (45 minutes compared to a 4-6 hour psilocybin journey) and the dissociative “out-of-body” qualities may feel more prominent during ketamine compared to other psychedelics. Additionally, you are less likely to experience open-eye visuals, time distortion, jitteriness, and emotional highs and lows during a ketamine assisted psychotherapy journey. Most clients report that the medicinal qualities of ketamine feel more grounding and stabilizing than other medicines.

Am I a good candidate for KAP?

A good candidate for KAP is typically someone experiencing depression, anxiety, or trauma-related symptoms; who is medically stable and willing to engage in structured psychotherapy alongside ketamine treatment.

Conditions Commonly Evaluated for KAP Eligibility

Depression (major depressive disorder & treatment-resistant depression)
Anxiety
PTSD and trauma-related conditions
Obsessive-compulsive symptoms (OCD)
Eating disorders (emerging evidence)
Certain cases of bipolar disorder while other cases are not compatible (needs careful screening by a medical professional)

Who may not be a good candidate for KAP?

People with contraindicated psychiatric disorders

KAP is generally not recommended for individuals with:

Active mania or mixed state
History of primary psychotic disorder
Active suicidal ideation or severe decompensation (e.g. where alternate setting is necessary for patient safety)

People with uncontrolled substance use disorders

Because ketamine has dissociative and psychoactive properties, caution is warranted in individuals with:

Active substance misuse
Recent addiction instability
Poor impulse control
On concurrent central nervous system depressants

Individuals seeking only rapid relief without psychotherapy

KAP requires engagement in preparation and integration. It may not be the best fit for individuals who:

Do not wish to participate in psychotherapy
Are seeking medication-only treatment
Prefer minimal therapeutic involvement

Individuals with certain medical contraindications

KAP may be deferred or avoided in cases of:

Uncontrolled hypertension or some hypertensive conditions
Severe breathing problems
Uncontrolled glaucoma
Other unstable medical conditions (e.g. recent traumatic injury or certain cardiovascular conditions etc.)
Pregnancy
Liver disease
Cystitis
Ketamine allergy or hypersensitivity

I am on SSRIs - will that impact my eligibility for KAP?

No! Since ketamine acts on the glutamate system (instead of the serotonin system), Selective Serotonin Reuptake Inhibitors (SSRIs) are fine to continue during KAP treatment! In fact, all of the following medications should be continued as prescribed during KAP:

SSRI’s (Celexa, Lexapro, Prozac, Paxil, Pexeva, Zoloft)
Lamotrigine (Lamictal)
Bupropion (Wellbutrin)
Antibiotics
Most vitamins and most supplements