Preparation and Integration for Ketamine-Assisted Psychotherapy (KAP)

Introduction

Ketamine-Assisted Psychotherapy (KAP) is a therapeutic modality that combines ketamine treatment with structured psychotherapy. It is a therapist-led mental health care model that integrates psychiatry and psychotherapy, supported by a dedicated care team of experienced clinicians.

In this article, we focus on the psychotherapy components of KAP—specifically the role of preparation and integration, which surround the ketamine dosing sessions and are central to treatment effectiveness.

Preparation helps patients enter the ketamine experience with psychological safety, clarity, and support. Integration helps patients make meaning of their experiences and translate insights into lasting emotional, behavioral, and relational change. Together, these phases form the foundation of ketamine-assisted psychotherapy.

In this article, we’ll explore:

• What preparation and integration are in KAP
• Why they are essential components of psychotherapy
• What preparation and integration typically involve
• How therapists and patients work together in a collaborative, non-directive way

Whether you are a clinician offering KAP or a patient considering it, understanding preparation and integration is critical to engaging in this work responsibly and effectively.

What Is Preparation in Ketamine-Assisted Psychotherapy?

Preparation refers to the therapeutic work that takes place before a ketamine dosing session. Its purpose is to help patients enter the experience with psychological safety, informed consent, and internal resources to navigate non-ordinary states of consciousness.

In KAP, preparation is not about controlling or directing the experience. Rather, it is about creating the conditions in which the patient’s innate capacity for insight, emotional processing, and self-regulation - can emerge.

Preparation typically includes:

• Establishing trust and a strong therapeutic alliance
• Educating the patient about ketamine and the KAP process
• Clarifying intentions (without rigid goals)
• Building emotional and somatic regulation skills
• Screening for readiness, safety, and risk factors (this information will be taken into account by a medical professional responsible for medical clearance)

Why Preparation Matters in KAP

Ketamine can temporarily reduce activity in rigid cognitive networks and increase psychological openness and neuroplasticity (link to research). Patients may experience this openness as confusing or difficult to contextualize within their broader therapeutic work. Preparation helps establish psychological safety, orient patients to the range of possible experiences, and provide a relational and cognitive framework through which new material can later be understood and integrated within psychotherapy.

Preparation can help to:

• Reduce anxiety prior to dosing
• Increase psychological and relational safety
• Minimize distress related to dissociation or loss of control
• Align expectations with the realities of therapeutic change

In short, preparation helps orient the ketamine experience toward psychological safety, coherence, and therapeutic integration, rather than unstructured intensity

“Preparation is the start of the relationship. It is in the space of the relationship that we both hurt and heal. So the most essential ingredient to all of the work that we do as therapists is relational. The preparation begins in the therapeutic dynamic, and all of the research and studies demonstrate that it is the essential ingredient to positive treatment outcomes.” — Lauren Taus, LCSW, Clinical Advisor to Journey Clinical

What Does Preparation Look Like?

While preparation is always individualized, effective preparation in ketamine-assisted psychotherapy (KAP) is an active therapeutic process. Its function is to establish psychological safety, relational clarity, and internal capacity so that the ketamine experience can be held, tolerated, and later integrated within psychotherapy. From a harm-reduction perspective, preparation also serves to reduce avoidable psychological distress, clarify expectations, and support patient agency before entering an altered state.

Preparation does not aim to shape the content of the experience. Instead, it creates the conditions under which the patient’s innate capacity for healing can unfold, while minimizing avoidable confusion, fear, or misinterpretation.

Below are five core elements commonly included in preparation we will explore together:

• Psychoeducation: Orienting Without Overdetermining
• Intention-Setting Without Outcome-Forcing
• Nervous System Awareness and Grounding Capacity
• Relational Safety, Roles, and the Therapeutic Container
• Bring awareness to Transference and Countertransference dynamics

1. Psychoeducation: Orienting Without Overdetermining

Psychoeducation in KAP is not about instruction or reassurance alone—it is about orientation. Patients benefit from understanding enough about ketamine to feel informed and grounded, without being burdened by excessive detail or expectation-setting.

Preparation typically includes discussion of:

• What ketamine does and does not do
• Common perceptual, emotional, and somatic effects (e.g., changes in time perception, imagery, dissociation, emotional fluidity)
• The distinction between experiences, insights, and outcomes
• Why psychotherapy and integration—not the medicine alone—drive lasting change

Importantly, psychoeducation should emphasize variability and uncertainty, helping patients avoid performance pressure, misinterpretation, or self-judgment about the experience.Patients are supported in understanding that there is no “right” experience and that meaningful sessions are not defined by intensity, clarity, or insight.

This framing supports informed consent and helps reduce anxiety, performance pressure, or disappointment if the experience does not match expectations.

2. Intention-Setting Without Outcome-Forcing

Intention-setting in KAP can be misunderstood as goal-setting. In practice, effective preparation emphasizes intentions as open orientations, not demands placed on the experience.

Helpful intentions may sound like:

• “I want to approach this with curiosity.”
• “I want to understand this pattern more gently.”
• “I’m open to whatever feels important to explore.”

Preparation explicitly differentiates this from outcome-driven goals such as:

• “I want this session to fix my depression.”
• “I need to relive a specific memory.”
• “I want to feel better immediately.”

This distinction is clinically important. Outcome-forcing can increase anxiety, narrow attention, and interfere with the natural unfolding of experience. Open intentions, by contrast, support flexibility, self-trust, and tolerance for ambiguity. Therapists may also help patients explore why certain intentions matter, without privileging any specific content.

3. Nervous System Awareness and Grounding Capacity

Ketamine can amplify emotional and somatic experience. Preparation therefore includes building baseline regulation skills that patients can draw on if distress or disorientation arises.

This may involve practicing:

• Breath awareness and paced breathing
• Tracking bodily sensations without interpretation
• Orienting to external anchors (e.g., sound, touch, temperature)
• Simple self-soothing strategies

The goal is not to eliminate discomfort, but to increase the patient’s confidence in their capacity to stay present with what arises (e.g. remain oriented and regulated, which can reduce the likelihood of panic, dissociation, or premature withdrawal from the experience). 

Clinically, this helps reduce fear of “losing control” and supports agency during the experience, even when material feels unfamiliar or intense.

4. Relational Safety, Roles, and the Therapeutic Container

Preparation is also a space to clarify the relational dimensions of KAP. This includes explicit discussion of:

• The therapist’s role during dosing
• What kinds of support are available (and what are not)
• Boundaries around touch, guidance, and verbal interaction
• How moments of uncertainty or distress will be handled

This clarity supports psychological safety and helps prevent misattunement during vulnerable states.

5. Bring Awareness to Transference & Countertransference Dynamics

In Ketamine-Assisted Psychotherapy (KAP), transference is not limited to the therapist–patient relationship. The medicine itself often becomes a salient object within the transference field, given its rapid effects, altered states of consciousness, and associations with relief or insight.

Patients may unconsciously experience ketamine as a healer, rescuer, source of truth, or primary agent of change. While understandable—particularly when effects feel immediate—unexamined medicine transference can externalize agency, increase reliance on dosing, and diminish the role of psychotherapy and integration.

Therapists may also experience countertransference toward the medicine, including overidentification with its perceived efficacy, subtle alignment with ketamine as the driver of change, or pressure to prioritize repeated dosing over therapeutic pacing and uncertainty.

Preparation is the appropriate phase to name these dynamics in a non-pathologizing, clinically grounded way. Doing so reinforces that ketamine is a facilitating tool rather than an agent of change, that experiences arise from the patient’s own psychological processes, and that meaning unfolds over time through integration. Naming these dynamics in preparation functions as a harm-reduction strategy, helping prevent dependency, role confusion, and misattribution of agency.

By addressing medicine transference alongside therapist–patient transference, clinicians help preserve a psychotherapy-led frame, support patient agency, and maintain clarity.

Preparation as Psychotherapy

In summary, preparation in KAP is psychotherapy. It deepens the therapeutic alliance, supports consent and autonomy, and establishes the conditions for later integration. Preparation helps ensure that any content that emerges can be tolerated, reflected upon, and meaningfully integrated within the broader arc of psychotherapy.

Helpful Reminders:

What Is Integration in Ketamine-Assisted Psychotherapy?

Integration is the therapeutic process that occurs after a ketamine dosing session. Its purpose is to help patients translate experiences—such as emotions, imagery, insights, or bodily sensations—into lasting psychological and behavioral change.

Ketamine may open access to new perspectives, but integration is where change is cultivated.

Integration can include:

• Reflecting on the dosing experience
• Making meaning of emotions or insights that emerged
• Connecting experiences to life history and current patterns
• Supporting behavioral change and embodiment
• Preventing avoidance, fragmentation, or spiritual bypassing

Why Integration Matters in KAP

Integration is a core part of Ketamine-Assisted Psychotherapy (KAP). According to Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice “the goal of integration is to merge the psychedelic experience with the patient's daily life in a way that helps the patient live a fuller life with less distress.” 

From a harm-reduction and psychotherapy standpoint, integration supports patients in making sense of what emerged during a dosing session in a way that is grounded, self-directed, and relevant to their ongoing therapeutic goals. Without this process, experiences may feel interesting or intense but remain disconnected from daily functioning, relationships, and long-term change.

Integration can help patients:

• Reflect on and contextualize their experiences
• Identify what feels meaningful, confusing, or unresolved
• Connect insights to existing patterns, values, and challenges
• Translate experience into realistic emotional or behavioral shifts

Importantly, integration is not about assigning meaning or drawing conclusions for the patient. It is a collaborative process that supports psychological coherence, flexibility, and agency, allowing insights to unfold over time rather than being rushed or fixed.

Integration also plays a protective role. It helps reduce the risk of avoidance, over-reliance on the psychedelic drug, or unprocessed emotional material, and reinforces that therapeutic change occurs through reflection, relationship, and ongoing psychotherapy.

What Does Integration Look Like?

In ketamine-assisted psychotherapy (KAP), integration is an ongoing psychotherapeutic process, not a “debrief" or a meaning-making exercise immediately following dosing. Its clinical function is to help patients metabolize ketamine-related experiences over time, translate them into coherent psychological understanding, and incorporate them into everyday life, relationships, and behavior.

Integration does not aim to extract insight or impose interpretation. Rather, it supports the patient’s capacity to reflect, contextualize, and embody what emerged during the ketamine experience, within the continuity of psychotherapy.

If preparation establishes the conditions for experience, integration establishes the conditions for change.

Below are five core elements commonly included in integration that we will explore together:

• Supporting meaning-making without imposing meaning
• Emotional and somatic processing
• Bridging experience to daily life
• Working with transference, countertransference, and the medicine over time
• Supporting integration as an ongoing process, not an outcome

1. Supporting Meaning-Making Without Imposing Meaning

In many psychedelic therapy models, meaning-making is explicitly deferred until after the dosing session and approached cautiously, collaboratively, and over time.

During integration, therapists support patients in exploring what stood out rather than deciding what it meant. It also supports patients in working with experiences that feel neutral, confusing, or difficult, rather than privileged sessions perceived as meaningful or positive.

Questions are invitational rather than interpretive, allowing meaning to emerge gradually from the patient’s own associations and lived experience.

Integration may involve exploring:

• Salient emotions, images, or sensations
• Moments of resonance, confusion, or ambivalence
• What felt familiar, novel, or unresolved
• How the experience relates to ongoing therapeutic themes

This stance reduces suggestibility, protects patient autonomy, and prevents premature closure. Meaning is treated as provisional and evolving, not as a conclusion reached in a single session.

2. Emotional and Somatic Processing

Ketamine experiences often include affective and somatic material that may not be immediately accessible to verbal processing. Integration supports patients in returning to this material at a pace that allows for regulation and reflection.

Integration may include:

• Tracking emotional responses that arise post-dosing
• Noticing lingering bodily sensations or shifts
• Working with affect tolerance rather than resolution
• Using creative or expressive modalities when appropriate (e.g., writing, drawing, movement)

Rather than privileging narrative coherence, integration prioritizes embodied awareness and emotional processing, particularly when experiences were preverbal or non-symbolic.

This supports consolidation of learning during periods of increased neuroplasticity, without overwhelming the patient or bypassing affective work.

3. Bridging Experience to Daily Life

A central function of integration is to bridge the ketamine experience with ordinary life. Without this bridge, experiences may remain psychologically isolated or idealized. It also helps counter a tendency to privilege peak or dramatic moments over subtler shifts in perception, affect, or relational capacity.

Integration helps patients explore:

• How insights relate to existing patterns, relationships, or beliefs
• What feels different - or unchanged - after the experience
• How shifts might be expressed in behavior, boundaries, or self-care
• What feels realistic and sustainable to carry forward

Importantly, integration does not assume that change should be immediate or dramatic. Small shifts in perspective, relational stance, or emotional flexibility are often more clinically meaningful than large declarations of transformation.

This grounding function aligns with harm-reduction principles by supporting stability, coherence, and continuity rather than escalation or repetition.

4. Working with Transference, Countertransference, and the Medicine Over Time

Just as preparation names relational dynamics prospectively, integration is where these dynamics are worked with longitudinally.

Patients may continue to relate to:

• The therapist as a stabilizing or meaning-making figure
• The medicine as a source of relief, truth, or authority

Integration provides space to reflect on how these dynamics evolve, soften, or reappear over time. This includes noticing shifts in dependency, disappointment, idealization, or ambivalence toward both therapist and medicine.

Therapists, in turn, may track their own countertransference responses, particularly urges to:

• Reinforce dosing as progress
• Privilege ketamine-related material over other clinical work
• Resolve uncertainty rather than tolerate it

Attending these dynamics within integration helps preserve a psychotherapy-led frame and supports clarity around agency and responsibility.

5. Integration as an Ongoing Process, Not an Outcome

Integration is not a single session or a discrete phase that can be “completed.” It unfolds across weeks or months and is interwoven with the broader course of psychotherapy. Integration respects that meaning and change may emerge gradually, sometimes well after the dosing session, and cannot be forced into a predefined timeline.

Integration supports:

• Consolidation of emotional and cognitive shifts
• Revision of self-narratives over time
• Relational repair and re-patterning
• Development of new coping strategies and choices

From a harm-reduction perspective, integration also plays a protective role. It reduces the risk of chasing repeated experiences, spiritual bypassing, or locating healing solely in altered states rather than lived change.

Integration as Psychotherapy

In summary, integration in KAP is psychotherapy. It is where experiences are contextualized, agency is reclaimed, and insight is translated into lived change.

Rather than privileging the ketamine session itself, integration centers:

• Relationship
• Reflection
• Embodiment
• Continuity

When approached with care, integration helps ensure that Ketamine-Assisted Psychotherapy supports change that is grounded in the patient’s life.

Helpful Reminders:

Preparation and Integration Are Core Components of KAP

In Ketamine-Assisted Psychotherapy, preparation and integration are central clinical processes that shape how ketamine-related experiences are understood, processed, and carried forward. 

The therapist—marked by presence, attunement, and restraint—often plays a significant role with KAP. Preparation establishes the psychological, relational, and regulatory conditions that allow patients to engage altered states with orientation and support. Integration supports the gradual translation of experience into coherent understanding, emotional processing, and meaningful change within daily life.

When preparation and integration are limited or absent, experiences may feel fragmented or difficult to contextualize, and therapeutic gains may be short-lived. By centering these phases, KAP remains grounded in psychotherapy—prioritizing relationship, reflection, and continuity over the dosing experience itself—and supports change that is integrated, sustainable, and clinically meaningful.

Common Questions About KAP Preparation and Integration

How many preparation sessions are typically needed? Many patients engage in 1–3 preparation sessions, depending on clinical complexity and history.

Is integration recommended after every ketamine session?
Yes. Best practices strongly recommend integration after each dosing session, especially early in treatment.

Should preparation and integration be with the same therapist?
Yes. Continuity supports trust, coherence, and deeper therapeutic work.

Is journaling enough for integration?
Journaling can be helpful, but therapist-led integration provides relational, emotional, and clinical support that self-reflection alone cannot replace.

Are you a psychotherapist looking to incorporate Ketamine-Assisted Psychotherapy into your practice?