Many therapists come to ketamine-assisted psychotherapy (KAP) with the same question: is this really something I can do in my own practice? At a recent Journey Clinical Lunch and Learn, hosted by Lizzie Mears of our community and education team, we put that question to the people who live the answer every week.
This conversation featured Sam Stroeh, a psychiatric nurse practitioner on our medical team who prescribes in Wisconsin and Ohio and specializes in substance use, psycholytic dosing, and complex trauma. Claudia Chika, a New York City therapist and longtime member of our community, is approaching her third year of offering KAP in her private practice. Tyson Ford, who leads our community growth team, has walked more than a thousand therapists through the decision of whether KAP fits their work.
What follows are the moments from that conversation we believe every curious clinician should hear, from the science of the medicine to the very human reasons it keeps surprising the people who work with it.
A safe medicine with an unexpected history
Sam began by clearing up a common misconception. Ketamine is a dissociative anesthetic rather than a classic psychedelic, though it earns a place in the conversation because it can alter visual and somatic experience in psychedelic-like ways. It was first synthesized in the 1960s for anesthesia, and its story in mental health began somewhere few would expect.
During the Vietnam War, ketamine was used for soldiers who needed procedures in the field, often without monitoring equipment. Clinicians later noticed that those who had received it shortly after the trauma of combat were less likely to develop PTSD. That observation helped spark the question of how the medicine might support mental health more broadly.
Part of what made field use possible is ketamine's safety profile. Unlike many anesthetics, Sam explained, it raises heart rate and blood pressure rather than suppressing them, and it gently opens the airways. It is used every day in emergency rooms for pain and sedation, even with children, which is a large part of why patients can safely use it in their therapist's office today. A growing body of research now supports its use across a range of mental health conditions.
Why the relationship matters more than the dose
Sam has worked in an IV ketamine clinic herself, so she spoke about the difference between models from experience. IV ketamine is the most researched form, with the strongest evidence for depression and anxiety. It is typically given in a medical setting by a medical professional, at higher doses and closer intervals, and it does not require a therapist or even a psychiatric provider. In that model, the medicine carries most of the weight.
KAP works differently. Rather than relying on the medicine alone, it rests on the therapeutic alliance between prescriber, patient, and therapist, and above all on the bond between patient and therapist. Sam said this is exactly why she chose this work: it gives patients autonomy in their own growth while surrounding them with collaborative support. That pairing of medical expertise and therapeutic skill is the reason Journey Clinical was founded, and it shapes everything we do.
Who KAP can help
Ketamine can support most mental health diagnoses, Sam explained, with a few important exceptions. Schizophrenia is a rule-out, and schizoaffective disorder may be as well. Bipolar disorder is often misunderstood: patients are not excluded, but they need to be stabilized on medication, because ketamine can worsen symptoms during a manic or hypomanic episode. Depression, anxiety, PTSD, and trauma are the most common reasons people seek KAP, and Sam has also seen it help some patients with OCD and eating disorders. Journey Clinical works only with adults.
Where Sam sees the medicine shine most is when people feel stuck. These are the clients who say they have been in therapy for five years and still cannot move past the same wall.
Claudia added something striking from her own caseload. Every client she has worked with who has tried KAP has told her it helped in some way, however different their experiences were. She finds it especially powerful during major life transitions such as divorce, illness, or the loss of someone close, when the medicine offers a broader perspective and a little distance from events that feel devastating.
She shared the story of one client going through a painful divorce. He told her that people had always reassured him he would be okay, and he had tried to believe it, but KAP was the first time he truly felt it in his body. For Claudia, that shift from knowing something to experiencing it is the heart of what this medicine makes possible.
Sharing the work so no one carries it alone
One of the biggest worries therapists bring to KAP is scope. Sam was clear that Journey Clinical's prescribers handle every medical piece, so therapists can stay focused on what they do best. Each patient receives an hour-long psychiatric evaluation, far longer than many prescribers are given, which leaves room to hear the patient's story and review their mental and medical history. Prescribers recommend any medication changes needed before dosing, and patients take their own vital signs during sessions while the therapist simply records the numbers.
Communication flows both ways. Sam shares a summary of her evaluation with the therapist and reaches out directly when something needs attention, such as confirming a safety plan for a patient with a history of suicidality. Therapists, in turn, can flag preferences in their referral, like a wish to use psycholytic dosing. Patients return for follow-up appointments after their first two doses and again at the end of a six-to-eight session cycle, with clinical scales tracked along the way.
Claudia described how much this partnership means in practice. She emails prescribers when a client starts a new medication or develops a medical question, and she sometimes shares those notes with clients so they can see their care team at work. She also praised how quickly questions get answered on the member forum, recalling prescribers replying late on a Friday evening. For clients, especially in a trauma-informed practice, knowing that everyone is working together offers real comfort.
For patients who need ongoing psychiatric care, Sam also described Journey Clinical's medication management program. It lets patients receive their medications through the same team, either alongside KAP or on its own, while respecting any strong relationship a patient already has with an outside prescriber.
The many shapes KAP can take
How a client experiences KAP is a shared decision, shaped by their own goals, input from the medical team, and the modalities their therapist offers. Sessions can happen in person, remotely, or even at home. They can be one-on-one, with couples, in groups, or on retreat. Dosing ranges from fuller dissociative experiences to lower psycholytic doses.
Claudia offers nearly all of it. Home visits suit some clients beautifully, especially those with significant anxiety, and they remove the need for travel or a chaperone, though others prefer to leave the responsibilities of home behind. She also works virtually and in person, both individually and in small groups, and noted that many members weave in other approaches such as EMDR. Psycholytic dosing, she said, is a gentle entry point for clients with complex trauma or anxiety, since they remain awake and talking rather than turning inward behind an eye shade.
She admitted she once wondered how remote KAP could possibly work. Journey Clinical let her sit in with an experienced provider during a virtual session, and seeing it firsthand made it click. Today her weeks might include rolling her bag of supplies to a client's home in Brooklyn on a Saturday and holding a virtual session a few days later, and she loves how that range makes the work more accessible.
From "Can I really do this?" to a practice transformed
Claudia's own path began with personal experience of psychedelics and a documentary series that sparked something in her. She went on to complete IPI's year-long psychedelic-assisted psychotherapy training, where a fellow participant who was already a Journey Clinical member introduced her to the community. She laughed that she had assumed you needed a medical degree to do this work, and discovering that her license and training were enough felt like a revelation.
The work also fit who she already was. Much of her practice had centered on intuition and inner wisdom, and she sees ketamine as something that helps people finally hear that voice within themselves. Even after her formal training, she said, there were missing pieces, and Journey Clinical filled them. She leaned on the Friday drop-in calls, peer consultation groups, the member forum, and on-demand training videos she still revisits, along with ready-made consent forms, email templates, and marketing resources that spared her from reinventing the wheel. Members can also take part in a peer experiential program to undergo KAP themselves alongside fellow therapists.
Asked how the work has changed her, Claudia said her vision for her practice kept evolving. Early on, she was surprised by how many people reached out to process frightening psychedelic experiences, which opened an entire niche of integration work she had never anticipated. She has learned a deep respect for the medicine and for each client, having been proven wrong more than once about how a low dose would land. Above all, she has come to appreciate research showing that the relationship between therapist and client is central to outcomes, a responsibility she described as humbling.
She also sees herself as part of something larger. As more states open access to psychedelic medicine and people take greater ownership of their healing, she feels grateful to be helping shape that future, and she plans to be in it for the long haul.
We grow in community
A quick poll during the session showed our audience split almost perfectly into thirds: those just beginning to learn, those curious with questions, and those actively considering adding KAP to their practice. Wherever you find yourself, there is a next step that fits.
- Talk it through with our team. Book a free call with Collin to explore what KAP could look like in your practice: https://calendly.com/collin-butler-journey/30-minute-meeting-sp
If there is one thing this conversation made clear, it is that no one has to learn this work alone. Claudia found her way in through a peer who was a few steps ahead of her, and today she is the one helping others find their confidence. That cycle is what makes this community special, and we would love for you to become part of it.