Ketamine-Assisted Psychotherapy: What It Is, How It Works, and Why You Might Consider It
Professor Paul Miller MD explains one of the most significant developments in the treatment of trauma and depression in recent decades, and what to expect if you are thinking about it.
Ketamine-assisted psychotherapy is one of the most important developments in the treatment of trauma and depression in the past two decades. It is also one of the most misunderstood. For something that has generated so much hope, and so many headlines, there is a surprising amount of confusion about what it actually involves.
So if you are someone considering ketamine-assisted psychotherapy, this article is written for you. It sets out, in plain terms, why you might consider it, what the treatment really consists of (which is far more than the medicine itself), how it appears to work in the brain, and what the process looks like from your first expression of interest through to treatment. It is written by Professor Paul Miller MD, and it reflects how we approach this work at Mirabilis Health.
A note before we begin. We are researchers and clinicians, not salespeople, and there is no guarantee with any intervention in mental health. What follows is an honest account of what ketamine-assisted psychotherapy can offer, and what it cannot.
Why consider it? Starting with where you are
It is worth beginning with a simple question. Why are you here? Why might you be considering this at all?
For many people, by the time they arrive in therapy, a great deal of time has already passed. Often it is many years. Sometimes more than five. And here is something worth pausing on. In other areas of medicine, in respiratory health for instance, a condition that had lasted that long would already be thought of as chronic. The implication being that you have it, and you are more or less stuck with it.
So it is entirely understandable that people who have lived with a long history of mental ill health arrive carrying an unspoken narrative. The sense that I have a condition, it is going to be permanent, I cannot get rid of it, and it is simply there. Even some of the language we use clinically, around severe and enduring mental illness, quietly reinforces that idea.
Part of what makes ketamine-assisted psychotherapy worth considering is that it offers a genuine reason to question that narrative. Not a promise, but a real possibility that things can shift, even after a long time.
What is ketamine, and why is it being used this way?
Ketamine itself is not new. It has been used in medicine for over fifty years, originally as a battlefield anaesthetic. That long history is part of why it is so well understood as a medicine.
What is newer is the work of the past fifteen years or so, which has shown that ketamine has a rapid potential to improve depression. In particular, it has shown promise with treatment-resistant depression, the depressions that have not responded to treatment as usual. It has also been shown to have a rapid effect that can help people who have been acutely suicidal, lifting that suicidality in a way that few other interventions manage at speed.
That speed is significant. For someone who has tried treatment after treatment over many years, the idea that change might come rapidly is, in itself, a different kind of hope.
A word about hope
The Czech writer and politician Václav Havel offered a definition of hope that is worth holding onto here. Hope, he said, is not the certainty that everything will turn out well. Rather, it is the sense that no matter how things turn out, they have meaning.
That distinction matters a great deal in this work, because one of the things ketamine-assisted psychotherapy can do is help with meaning making. And meaning making, not just symptom relief, is where the deeper value of this treatment often lies.
The treatment is not just the medicine
This is perhaps the single most important thing to understand, and the point most often missed.
Ketamine-assisted psychotherapy is not simply taking ketamine. The medicine puts you into an altered state for perhaps forty-five to sixty minutes. But the treatment is everything that goes around that experience.
It has three broad phases.
Preparation. Before anything else, there is the work of preparation. This includes the medical modelling and a proper discussion with you about what your difficulties actually are, and what you are seeking resolution for. You go into the experience with clarity and intention, not blindly.
The altered state. Then there is the period of altered consciousness itself, the forty-five to sixty minutes when the ketamine is active.
Integration. And then, crucially, comes what we call integration work. This is where you take the experience you have just had and ask the practical questions. How does this translate into my everyday life? How does it change the way I think about things? The altered state on its own is not the treatment. The integration is where the experience is turned into lasting change.
Without preparation and integration, you have an experience. With them, you have therapy.
How it appears to work in the brain
To understand why integration matters so much, it helps to understand a little about what may be happening in the brain.
A useful way of thinking about a lot of mental illness comes from the work of Dr Iain McGilchrist, who writes about the imbalance between the right and left hemisphere's view of the world. Often, in mental illness, we see an impairment in the right hemisphere's contribution.
What can happen then is that your beliefs and understandings about why you think, feel or function the way you do become held very tightly by the left hemisphere. And held so tightly that any new information trying to come in, any information that might help you think differently about your depression, your post-traumatic stress, or your OCD, is simply not allowed in. The brain essentially says, I already understand this, and that new idea does not fit my understanding, so I am going to ignore it.
What we see with ketamine is that it appears to improve connectivity in the brain. Broadly speaking, this is referred to as neuroplasticity, the brain's ability to forge and use connections in a new way. In effect, it offers you a different perspective on your own condition. And that fresh perspective, paired with the right therapeutic work, has been shown to be helpful.
This is why the medicine and the therapy belong together. The ketamine opens a window. The therapy is what you do while it is open.
What a course of treatment actually looks like
A few practical realities are worth being clear about.
First, this is not a one-and-done treatment. You do not get a single dose and that is it. A course of treatment would usually be somewhere between four and six sessions, typically at weekly intervals, with the integration therapeutic work woven through as a core part of it. That structure is what gives a person the best potential to think differently.
Second, and this is genuinely good news for many people, ketamine-assisted psychotherapy can often be used alongside your existing treatments.
This is an important point, and it comes from hard-won lessons in the wider research field. Some of the research into psychedelic-assisted psychotherapies ran into a particular difficulty. People were being brought off their existing medication, with the intention of moving them onto these new approaches, and that active discontinuation was itself causing problems and complicating the results.
So, while every case is decided individually, more often than not you may have no changes made to your existing medication while you receive the ketamine-assisted psychotherapy. Only afterwards, once we can look at what changes have taken place, do we consider your medication and whether it could be adjusted or simply needs to stay as it is. That decision is always individualised to you.
What to expect: the pathway step by step
If this sounds like it might be relevant to you, here is what the journey looks like in practice.
Read up first. Visit our website and read what is there about ketamine-assisted psychotherapy, so you have a clear picture before you reach out.
Express interest. When you get in touch, there is an expression of interest form. If you are already working with a clinician, you can have them contact us on your behalf.
Pre-screening and a screening call. There is an initial pre-screening, followed by a screening call. This helps us, at a very early stage, take a look at your situation and consider whether there are any reasons this might not be suitable for you, or whether it might simply not be the right time.
Reviewing your notes. If it is felt there is real potential that this could be a good treatment pathway for you, we will then ask you to obtain your general practice notes, and we will review them. For those of you with a more complex or longer history, this lets us understand the treatments you have already been through.
A reassurance here, because it matters. None of what is in those notes will be a reason to turn you away. Many people who come to ketamine-assisted psychotherapy at this point in their lives will have already been through a range of different medications, and different psychotherapeutic approaches too. That is completely okay. In fact, it is the norm.
From there, the team will help you make an informed choice about whether this could be useful for you, and explain clearly what it would be like. The aim is never to push you into treatment. It is to help you decide, with good information, whether this is the right path.
The honest summary
Ketamine-assisted psychotherapy is not a miracle, and it is not a cure-all. There are no guarantees in mental health, and we would never pretend otherwise. But for people who have lived for a long time with the quiet belief that their condition is permanent and fixed, it offers something genuinely worth considering. A medicine with a long and well-understood history, a rapid effect on depression and suicidality that the research increasingly supports, and, most importantly, a structured therapeutic process of preparation, experience and integration that turns a window of neuroplasticity into the possibility of real, lasting change.
If you have read this far and something in it resonates, the next step is a small one. Take a look at the ketamine-assisted psychotherapy information on our website, and reach out. There is no commitment in starting a conversation.
Mirabilis Health offers the first ketamine-assisted psychotherapy programme on the island of Ireland. If you would like to learn more, or to make an expression of interest, visit our website or ask your clinician to contact us.