Whether we’re navigating long-term partnership, non-monogamy, divorce, sexual identity, or simply longing for deeper connection, intimacy often comes up in the therapy room. Many patients experiencing depression, anxiety, and PTSD who seek Psychedelic-Assisted Psychotherapy treatment come in with an intention to improve their interpersonal relationships.
While most research on ketamine has focused on depression, anxiety, and PTSD, many therapists are exploring how Ketamine-Assisted Psychotherapy (KAP) may also support intimacy, attachment repair, and relational growth for eligible clients.
In a recent Journey Clinical webinar, several experienced psychotherapists shared how Ketamine-Assisted Psychotherapy (KAP) has supported clients working through challenges related to sex, intimacy, identity, and relational rupture. What emerged was a story about shifting the internal narratives that shape how we show up in relationships.
How Ketamine-Assisted Psychotherapy Can Help Heal Trauma That Affects Intimacy
For many clients, relational struggles are rooted in experiences that predate the current partnership. As Samantha Stroeh, PMHNP-BC explained, “Ketamine can temporarily quiet the part of the brain that keeps you stuck in your story and increase the brain’s ability to form new connections. During that window, we can help your brain reorganize around new meaning.”
Sam described working with a woman in her 60s who longed for deeper intimacy with her husband but felt blocked. During her KAP integration session, she felt compelled to share about past sexual violations, saying, “I can’t believe this is coming out. I’ve never actually even shared this with my therapist.”
Sam explained what may be happening neurologically:
“This isn’t just psychological — it’s a literal reflection of network disintegration and reintegration. Ketamine dampens amygdala reactivity, enhances prefrontal modulation, and creates a window of emotional ability with reduced defensive rigidity. Memory can then be reconsolidated with new emotional associations. Shame can shift to compassion. Fear can shift to meaning.”
Neuroscience research supports ketamine’s role in increasing neuroplasticity through NMDA receptor antagonism, AMPA activation, and downstream BDNF signaling pathways (Duman & Aghajanian, 2012; Nature Reviews Neuroscience). Studies also suggest ketamine may reduce hyperconnectivity in the default mode network and decrease limbic overactivation associated with rumination and trauma responses (Abdallah et al., 2017).
For this client, that meant recognizing how past violations were shaping her current marriage.
“She was able to recognize the way that past violations from men had impacted her current partnership… It was almost like she needed to step back and look at these other parts so that she could move forward.”
Months later, she reported increased flexibility and vulnerability with her husband.
Ketamine-Assisted Psychotherapy for Couples: Breaking Painful Attachment Cycles
Kayla Knopp PhD, clinical psychologist and co-founder of Enamory, works specifically with couples and psychedelics. She described a non-monogamous couple who came in after a painful rupture they couldn’t move past.
“They were just getting so stuck,” she shared. One partner would feel shame and panic and move toward the other intensely. The other would feel unseen and unsafe, and pull away. The more one pursued, the more the other withdrew — a familiar attachment loop often described in emotionally focused couples therapy and attachment research (Johnson, 2004).
In preparation, they mapped this cycle clearly. “Helping a couple understand where they’re getting stuck is essential.” Then they participated in a dosing session together. During their ketamine session together, she shared that “they were able to sink into empathy for themselves and for their partner.”
“For the first time,” Kayla said, “each partner was able to feel their own stories and defenses get quiet enough for them to really tune in and hear their partner’s experience.” In integration, they began telling the story of what happened — this time with empathy.
Kayla shared that one of the most common questions she gets—especially from other clinicians—is whether she’s offering KAP for the time being, while waiting for MDMA-assisted psychotherapy to become approved. “Whenever Chandra and I give talks, one of the first questions we always get is, ‘Do you really want to be working with MDMA? Is ketamine just sort of like a replacement for MDMA for now?’”
While MDMA-assisted therapy has been studied extensively for PTSD in large Phase 3 clinical trials, Kayla emphasized that ketamine has unique and underrecognized relevance for relational healing—especially because it’s already legal and available nationwide under appropriate medical care.
“Although, yes, we are very eager to be able to work with all psychedelic medicines, I think ketamine is so underappreciated for its power and potential to do relational healing work.”
As a Journey Clinical KAP provider, therapists like Kayla will be able to support clients with other Psychedelic-Assisted Psychotherapy treatment options once federally legal, including Psilocybin-Assisted Psychotherapy. Journey Clinical has established a research collaboration with Compass Pathways, to inform the training of healthcare providers and delivery model for COMP360 psilocybin treatment, if approved for treatment-resistant depression. You can explore Compass’ latest studies of psilocybin for treatment resistant depression to learn more.
How Ketamine Therapy Can Improve Self-Worth and Relationship Dynamics
Sometimes the relationship that needs healing is the one we have with ourselves. Shveta Mittal, PhD, a clinical psychologist in New York City, shared the story of a client in an ethically non-monogamous relationship who felt deeply destabilized after his partner could not show up for him during his father’s death. He spiraled into self-doubt: What did I do wrong? Why am I not enough?
In this case, Shveta was providing Ketamine-Assisted Psychotherapy while the client continued working with his primary therapist. This collaborative model is common. Many patients seek KAP even if their regular therapist does not offer it. Primary therapists often refer clients to a Journey Clinical KAP provider for a structured 6–8 session protocol, and then continue ongoing therapy either concurrently or after the KAP series is complete. With patient consent, there is communication between the primary therapist and the KAP therapist to support continuity of care and shared treatment goals.
After his first ketamine session, something shifted.
“He had this really big experience of being able to center himself and see the value that he could have in himself,” Shveta said, “and that he deserved a partner who would communicate more effectively and show up for him.”
Through integration sessions, she began noticing behavioral changes.
“He stopped automatically giving in to everything his partner wanted. He was able to stay firm and ask for what he needed in a more grounded way.”
The impact extended beyond the KAP room. Shveta shared that his primary therapist later reported a “huge difference in his confidence and his ability to challenge negative thoughts.”
Ketamine-Assisted Psychotherapy After Divorce: Grief, Identity, and Emotional Recovery
Not all intimacy work happens inside a partnership. Amy Wilhelmi, a marriage and family therapist, works frequently with clients navigating divorce. She described a 42-year-old woman who felt her identity collapse after her marriage ended, repeating painful narratives such as, “I failed at my marriage. I’m undesirable. I don’t know who I am without being someone else’s wife.” Traditional therapy helped her understand these thoughts cognitively — but emotionally, she remained fused with shame.
During KAP, this client was able to experience grief without being overwhelmed by it. As Amy explained, “She was able to access grief without emotional flooding. She described feeling sadness move through her body rather than collapse or overwhelm her.” In one session, the client arrived at a new recognition: “It wasn’t all my fault. That relationship had limits.”
Amy observed that, “In the expanded state during KAP, she experienced herself outside of the marriage narrative. She reconnected with parts of herself that felt independent, creative, playful, assertive.” Over time, her story shifted from “I failed” to “The relationship ended.”
And eventually, the client reflected:
“The divorce broke my life story, but KAP helped me realize that I am still the author.”
For many people, intimacy challenges are not just relational disruptions — they are identity disruptions. KAP can create enough space to loosen the grip of a collapsed narrative and begin rebuilding a more flexible, compassionate sense of self.
Will Ketamine Therapy Make My Relationship Worse Before It Gets Better?
A common concern people have before starting ketamine work is whether things will get worse before they get better. If long-avoided conversations or emotions surface, will that increase conflict? Will it destabilize the relationship?
As Kayla Knopp shared,
“I think a fear that a lot of people have when approaching ketamine work is, is this going to sort of make me confront something that's gonna really make me shift my life all around?” She noted that this anxiety often comes not only from clients, but from their partners as well.
Part of that fear stems from a misunderstanding of what therapy is designed to do. Kayla offered a reframing that many clinicians recognize: “Therapy is not for feeling better — it’s for getting better at feeling.” In her experience, what keeps many individuals and couples stuck is not necessarily the problem itself, but the avoidance of it.
“What’s keeping us stuck,” she explained, “is our desire to avoid the painful stuff, the hard stuff — to avoid taking a hard look at ourselves and our interests and our needs and wants.”
Psychotherapy research supports this observation. Emotional avoidance is consistently associated with anxiety, depression, and relational distress, while greater psychological flexibility — the ability to experience difficult thoughts and emotions without shutting down or reacting defensively — predicts improved mental health outcomes (Kashdan & Rottenberg, 2010; Aldao et al., 2010).
Kayla described how some couples appear relatively stable when they begin therapy, but that stability may be fragile. “Folks will sometimes come into my practice at a sort of apparently peaceful place in their relationship — which is sort of this fragile stability built on top of a lot of dysfunction that’s under the rug.”
When avoidance decreases, what has been under the rug becomes visible. That visibility can feel uncomfortable at first.
“When we start to reduce avoidance, that can feel like we’re increasing conflict and increasing difficulty at first — but it’s so essential. It’s like flushing out a wound. We need to heal what’s under the surface in order to build something strong going forward.”
“I don’t think about it like things getting worse before they get better,” she said. “I think about it as reducing our avoidance of the important difficult things — and directly working with them in order to heal.”
In Ketamine-Assisted Psychotherapy at Journey Clinical, preparation and integration are required precisely for this reason. If ketamine temporarily reduces defensive rigidity, it may create a window where avoided material can surface more clearly. With skilled therapeutic support, that increased clarity can mean greater emotional tolerance, honesty, and the capacity to work through what was already there.
Summary: How Ketamine-Assisted Psychotherapy Supports Relational Change
Ketamine-Assisted Psychotherapy (KAP) is an evidence-informed approach that combines medication with psychotherapy. Ketamine appears to temporarily increase neuroplasticity — the brain’s ability to form new emotional and cognitive pathways — while psychotherapy helps translate that window into durable emotional and behavioral change.
As Samantha Stroeh PMHNP-BC explained, “Ketamine can temporarily quiet the part of the brain that keeps you stuck in your story and increase the brain’s ability to form new connections. During that window, we can help your brain reorganize around new meaning.”
When applied to relational work, this shift can be significant. As the stories in this article demonstrate, KAP may help individuals:
- Reduce shame and defensive rigidity
- Increase emotional tolerance and vulnerability
- Step back from rigid identity narratives (“I failed,” “I’m not enough,” “I always get left”)
- Develop greater empathy for themselves and their partners
- Re-engage in difficult conversations with more flexibility
Importantly, the transformation does not happen in the dosing session alone. The dosing experience may create openness or insight, but meaningful change unfolds in the preparation and integration sessions that follow — where insights are processed, patterns are explored, and relational behaviors begin to shift.
At Journey Clinical, KAP follows a structured protocol that includes preparation sessions, dosing sessions, and integration sessions with a trained, licensed mental health professional. All patients undergo medical eligibility screening, and treatment is delivered within a therapeutic alliance that centers psychotherapy as the core intervention.
KAP is not a quick fix, and it is not appropriate for everyone. But for some individuals and couples, it can create the psychological space needed to move beyond entrenched relational patterns — not by erasing the past, but by loosening its grip and allowing new meaning to take root.
Frequently Asked Questions About Ketamine and Relationships
What is the difference between ketamine therapy and Ketamine-Assisted Psychotherapy?
Ketamine therapy often describes ketamine administered in a medical setting primarily for symptom relief. Ketamine-Assisted Psychotherapy (KAP), by contrast, intentionally combines ketamine with ongoing psychotherapy for long term behavioral change.
Can Ketamine-Assisted Psychotherapy fix my relationship?
KAP does not fix relationships directly. It may help reduce rigidity, defensiveness, and shame — allowing individuals or couples to engage more openly in therapy.
Can couples do KAP together?
Yes. Some therapists offer couples KAP, where both partners participate in preparation, dosing, and integration together. However, eligibility is always assessed individually.
What if my relationship gets worse after KAP?
In some cases, reduced avoidance can surface difficult truths. That’s why preparation and integration are essential. As discussed in the webinar, shifts in clarity require therapeutic support. As case studies highlighted, KAP can increase your ability to communicate with empathy or recognize your self worth and establish boundaries.
Is ketamine FDA-approved for relationship issues?
Ketamine is FDA-approved as an anesthetic and esketamine (Spravato®) is FDA-approved for treatment-resistant depression. In the context of KAP at Journey Clinical, ketamine is prescribed off-label and must be clinically appropriate and medically supervised.
Is there research supporting ketamine for relational healing?
Most research focuses on depression, PTSD, and anxiety. However, emerging neuroscience suggests ketamine increases neuroplasticity and reduces fear circuit hyperactivity, which may support relational processing when paired with psychotherapy.
What Makes Journey Clinical Different?
Journey Clinical delivers KAP through a therapist-led, clinician-supervised care model. What’s different?
- Therapist-first model: Care is guided by KAP-trained licensed psychotherapists.
- Integrated psychiatry + psychotherapy: A world-class medical team partners with therapists to take on comprehensive care.
- Insurance support: Medical consultations and psychotherapy are often covered, reducing overall out-of-pocket costs for many patients when compared with standalone ketamine or clinic-only approaches.
- Safety-focused protocols: Every patient undergoes comprehensive screening, informed consent, and strict dosing protocols plus monitoring of vitals and follow-up checks to ensure therapeutic efficacy and wellbeing. Read more on our dedicated safety page.
In summary, Journey Clinical’s KAP model integrates psychiatric care, therapist-led therapy, and structured protocols to treat anxiety’s roots, not just its symptoms. To learn more, visit our KAP education center or join an event near you.
Related Articles
- What Is Ketamine?
- What Is Ketamine-Assisted Psychotherapy (KAP)?]
- KAP for Anxiety: A Comprehensive Guide
- Listen to the full conversation via our podcast
Are you a psychotherapist looking to integrate ketamine-assisted psychotherapy in your practice?