How to Interview a KAP therapist or Prescriber
Are you thinking of trying Ketamine-Assisted Psychotherapy (KAP)? Maybe you’ve done some research on the modality on your own or maybe you’ve found psychotherapists or prescribers through Google or Psychology Today who offer it. If contacting prescribers or psychotherapists feels like the next logical step, I wrote this blog post to help you interview them to determine if they could be a good fit for you as a mental health provider in general for KAP specifically.
KAP is an interdisciplinary mental health treatment because it is psychotherapy with a prescribed medicinal tool. To engage in KAP is to engage with a prescriber and a psychotherapist. Being prescribed ketamine by a prescriber without the direct involvement of a therapist is not KAP. It is a medical model of mental health treatment not unlike being prescribed daily psychotropic medication. Ketamine-assisted psychotherapy is still a very new therapeutic modality, relative to many talk therapy-based modalities. Research into ketamine use in mental health treatment or KAP efficacy with different client populations is growing, but there are many unknowns, including potential risks, long term efficacy, and as of yet no baseline standards of practice for providers who offer it exist.
Ketamine prescription for mental health treatment and KAP were growing slowly until the COVID-19 pandemic, when they exploded in interest, utilization, news, and pop psychology. The number of providers, both prescriber and psychotherapist who seemingly offer KAP has also grown to meet that demand. There is so much information out there now that it has become difficult to sort out what is objective information and what is advertising. It is understandable that many patients look to their providers for expertise, but how do you know if they have the expertise to know the difference between data and ads and to practice this treatment competently?
The following are some key questions to ask a KAP prescriber and/or KAP therapist you are considering working with. I list each question below along with the rationale for asking it. I advise you listen for thoughtful, comprehensive answers to each of these questions. These questions may be pointed and extensive, but they are entirely reasonable given the cost of this treatment, potential benefits, AND risks.
1. What is your training in ketamine-assisted psychotherapy? How long did the training take you? Are you certified in this training? How long/how many clients have you done KAP work with?
As of this writing, there are possibly hundreds of professional training programs for KAP Prescribers and Psychotherapists. They range in length and depth from a weekend workshop with no practice component to a year long certification program that includes “hands on” practice. How much training a provider needs to practice KAP competently and ethically depends on a few factors - their license and professional training and experience up to this point, and what related training and experience they have already completed. It is important to note that legally, there are few standards for KAP competency specifically, if a provider is already a licensed clinician.
KAP prescribers are usually Anesthesiologists, Psychiatrists, or Nurse Practitioners licensed to practice Psychiatry. They should be willing to share with you their training and experience prescribing and administering sub-anesthetic ketamine and other psychotropic medications. Anesthesiologists are experts in use of anesthetic medications, but they often do not have expertise in mental health treatment unless they are duly licensed or board certified. They should seek out the clinical opinion of your current or recent psychiatric medication prescriber as part of your onboarding process. Prescriber trainings vary in length and quality, so getting a sense of their hands on experience prescribing ketamine for KAP is of great importance.
KAP therapists should be already licensed to practice psychotherapy in the state in which they operate. They may have training or expertise in other therapy modalities, such as behavioral, emotion-based, attachment-focused therapies, or experiential therapies. But KAP is a complex and specialized psychotherapy modality. When clients are taking medicines or substances that produce non-ordinary states of consciousness like ketamine, they can be more vulnerable to triggers and suggestion. KAP therapist trainings vary in length and quality as well, but consider how confident you would feel to hear from a KAP therapist that they took one weekend training with no practicum component and they are relatively new to offering it to clients v.s. a therapist who completed a year long certification course that consisted of both trainings, a practicum with KAP clients, and has used KAP with clients for a year or more. To be clear, training is not everything. Therapists who are highly trained can still be incompetent therapists. But the amount of investment a therapist puts into getting the training and experience they need to practice KAP competently and ethically should be an important consideration for you.
2. What can a patient expect from ketamine-assisted psychotherapy? How do you believe it can help treat mental health conditions? How did you form this opinion? (Training, practice, research, etc)
This question is asking a provider what they understand about ketamine, its potential mechanisms of action, and about this relatively new therapeutic modality. Well trained and ethical providers should answer these questions using what is known from research and practice with caveats that convey there are many unknowns associated with this treatment generally and for specific patients and healthy skepticism toward how it has been advertised (e.g: a miracle cure, a rapid replacement for talk therapy, a long term solution to mental health disorders). Most of the existing research on KAP has indicated significant treatment potential for depression, anxiety, and posttraumatic stress disorders. Most of the data observes people over less than 6 months. KAP is a tool like other therapeutic tools for mental health. It may benefit you, it may not. If it does benefit you, as a short term treatment, it is important for you to have reasonable expectations that the theorized neurochemical and neuroplastic effects will wear off, and the onus will be on you as the client to maintain the insights and behavior change it fostered in you for the long term. There are no short cuts on the path of wellness and healing. But there are so many tools out there for you to experience and incorporate!
3. Who do you believe is not a good fit for ketamine-assisted psychotherapy and why?
This question also asks the provider to speak to what is known and not yet known based on existing research and their professional (anecdotal) experience. The medical research consistently indicates that the risks to people with a history or familial risk (close relative incidence) of developing psychotic symptoms or disorders outweigh the potential benefits of KAP, and most providers will not accept such clients for KAP. The same is true of people with cardiovascular, respiratory, or hepatic conditions and/or untreated hypertension. Far fewer studies have looked into its efficacy for conditions such as disorders on the bi-polar spectrum, personality disorders, eating disorders, substance use disorders, dissociative disorders, or clinical issues of neurodivergence. KAP therapists in private practice should consider with great care and diligence which client populations are appropriate for KAP in an outpatient, private practice setting. KAP providers who voice specific parameters around who they will and won’t consider conducting KAP with may be an indicator for potential clients that they are aware of the depth and bounds of their own expertise and competence and what the wider medical research currently supports.
4. What protocols are in place to evaluate the potential benefits vs. risks of this treatment for potential patients and to evaluate their response to the treatment as it progresses?
Most providers will point to their use of intake appointments to evaluate a potential KAP client’s history, presenting concerns, current symptoms, and goals. But how much can a psychotherapist really learn about a new patient in one appointment? Psychotherapists who evaluate a client over several sessions prior to beginning KAP work with you can indicate they take seriously the need for comprehensive evaluation. The risks of KAP are believed to be relatively low for most people, but they are not non-existent. The presence of some life stressors may also interfere with your KAP treatment or KAP could worsen the stressor(s). While not all potential risks or contraindications can be uncovered even in several appointments, the more face time a therapist gets with a new client, the more likely concerns or risks will arise and can be addressed. Prescribers who work closely with psychotherapists who get to know their clients over several sessions before starting KAP, or clinicians who evaluate you in conjunction with your other mental health providers can also indicate a provider takes the need for comprehensive evaluation seriously.
Skilled KAP providers consistently evaluate your symptoms before, during, and after KAP. They consistently inquire about how you feel in between ketamine administration appointments and how you are faring with life stressors. Ongoing evaluation is key to helping you make the most of the treatment effect and alerting you and your providers to any issues.
5. How do you deal with “bad trips” if they happen with a client?
Bad trips can happen! And bad trips themselves or how you cope with a bad trip may hold significant therapeutic value. But there are things a KAP provider can do to help patients feel a greater safety even when experiencing scary or uncomfortable effects. Providers must ensure consistent monitoring during the acute effects of ketamine. Providers should discuss in the preparation stage of KAP how they observe for distress and how they may typically respond, so a patient knows what their protocol is. Skilled KAP therapists may only offer gently inquiry, and only if a patient requests, provide more extensive intervention during a “bad trip”. Providers should be willing to discuss feedback or requests with patients who wish for some intervention. “Bad trips” are an important topic of integration sessions.
6. Do you offer post-infusion integration sessions? What is the structure/goal(s) of those sessions?
Integration is an essential component of ketamine-assisted psychotherapy, usually conducted with the psychotherapist. Integration topics usually include detailed processing of what happened during the acute effects of ketamine, but also includes discussion of the setting and your mindset going into the appointment (“set and setting”), your intentions for that appointment, and how you are faring in your day to day routine since. Best practices with integration include conducting it both right after the acute effects have worn off on dosing day and a few days after your ketamine appointment. Integration helps you look deeply at the non-ordinary state juxtaposed with your baseline state and environment. It helps you consider your relationship with yourself and the wider world around you, what shifts or transformations you should consider to build a more authentic and fulfilling life, and how to put idea into action.
A beneficial course of Ketamine-Assisted Psychotherapy, like all psychotherapies, is tied to the power of the relationship between the patient and the provider. It is my hope this article helps you interview KAP providers comprehensively and confidently, so you may find the best treatment team for yourself to work with.
~ Rachel ~