Ketamine-Assisted Psychotherapy for Depression: A Survey of Current Practices, Rationales, and Future Directions.

A cross-sectional survey of fifty licensed U.S. providers of ketamine-assisted psychotherapy (KAP) for depression reveals wide variability in real-world practices. Ketamine was most often given intramuscularly (42%) or sublingually (40%) at psychedelic doses. Most providers (74%) conducted psychotherapy before, during, and after administration, commonly using Internal Family Systems (74%), humanistic/existential (62%), and supportive (58%) modalities, typically blending three to four approaches. The most endorsed treatment goals were fostering inner healing intelligence, leveraging neuroplastic effects, and facilitating a transformative experience. No significant association between psychotherapy modalities and treatment goals was found, indicating unclear logic for matching approaches to outcomes. The findings underscore the need for comparative clinical trials to establish evidence-based standards for KAP and other psychedelic-assisted therapies.

Study at a glance

Abstract

Ketamine-assisted psychotherapy (KAP) is an emerging treatment approach that may enhance ketamine's antidepressant effects through neuroplastic synergism or transformative psychological experience. Despite growing clinical use, real-world KAP practices remain understudied. This cross-sectional survey examined the practices of fifty licensed KAP providers treating depression, recruited from a U.S.-based online provider network. Participants represented a professionally diverse sample, including physicians, clinical psychologists, social workers, and other practitioners. Ketamine was most commonly administered intramuscularly (42%) or sublingually (40%), often at psychedelic-dose ranges. Most practitioners (74%) conducted psychotherapy before, during, and after ketamine administration. The most frequently used psychotherapy modalities were Internal Family Systems (74%), humanistic/existential (62%), and supportive (58%), with most practitioners employing an eclectic approach blending three to four different modalities on average. The most commonly endorsed overall treatment goals were fostering inner healing intelligence, leveraging neuroplastic effects of ketamine, and facilitating a transformative experience. No significant association was found between psychotherapy modalities and treatment goals, revealing unclear logic for how therapeutic approaches are matched to desired outcomes. Findings reveal broad variability in real-world KAP practices, underscoring the need for comparative clinical trials to establish evidence-based standards. These insights may inform the development of protocols for emerging psychedelic-assisted psychotherapies more broadly.