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

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.