Ketamine-Assisted Psychotherapy & Psychotherapy Coordinated With Spravato®

Ketamine-assisted psychotherapy and psychotherapy provided in coordination with Spravato® (esketamine) treatment are emerging approaches that combine ongoing psychotherapy with separately prescribed medication treatment.

These approaches may create opportunities for deeper emotional processing, increased psychological flexibility, new perspectives, and meaningful therapeutic work. Individual experiences and outcomes vary, and medication treatment is not appropriate for everyone.

Within this practice, medication-assisted approaches are offered only as adjuncts to an established psychotherapy process. Medication evaluation, eligibility, prescribing, dosing, and medical monitoring are provided by an appropriately licensed medical provider and are separate from the psychotherapy services provided by your therapist.

Psychotherapy-assisted treatment can be done in the office, via telehealth (including a KAP dosing), and in your own home with our therapist.  

Ketamine-Assisted Psychotherapy

Ketamine is a medication that has been used in medicine for decades. At lower doses, it is also used off-label by qualified medical providers in the treatment of certain mental health conditions, particularly depressive disorders. Research has demonstrated relatively rapid antidepressant effects in some individuals.

Ketamine primarily affects the brain's glutamate system and has been associated with neuroplasticity-related changes. Researchers continue to study how these changes may contribute to ketamine's therapeutic effects. For some individuals, the period surrounding ketamine treatment may provide an opportunity to examine longstanding beliefs, emotional patterns, relationships, and behaviors from a different perspective.

Ketamine may be prescribed or administered medically in several forms, including intravenous infusion, intramuscular injection, nasal administration, or sublingual lozenges or tablets. The appropriate medication, dosage, route of administration, and treatment schedule are determined solely by the prescribing medical provider.

Clients interested in Ketamine-Assisted Psychotherapy must establish care with an appropriately licensed medical provider who independently evaluates medical and psychiatric eligibility, prescribes the medication when appropriate, determines the dosage and route of administration, and provides all necessary medical instructions and monitoring.

           Your psychotherapist does not prescribe or dispense ketamine.

For clients who have been medically evaluated and prescribed ketamine specifically for use in conjunction with psychotherapy, a Ketamine-Assisted Psychotherapy (KAP) dosing session may be incorporated into the therapeutic process.

Psychotherapy occurs before, during, and following medication-assisted sessions to establish therapeutic goals, prepare for the experience, provide therapeutic support, and integrate material that emerges into the client's ongoing psychotherapy.

During a KAP dosing session, you self-administer your prescribed medication according to the instructions provided by your medical provider while participating in a psychotherapy appointment with your therapist.

You will typically be positioned comfortably in a reclining position and may choose to wear an eye mask while listening to calming or carefully selected music. Although much of the experience may be internally focused, your therapist remains present throughout the psychotherapy session to provide therapeutic support and assist you as needed.

The most noticeable psychoactive effects of ketamine frequently occur for approximately 45–60 minutes, although the intensity and duration of effects vary considerably among individuals. During this period, perception, awareness, visual processing, coordination, emotions, and the sense of time may temporarily change.

Some individuals describe the experience as calming, expansive, reflective, emotional, symbolic, or visual. Others experience a greater sense of distance from habitual thoughts or emotional reactions. There is no single "correct" ketamine experience, and meaningful therapeutic work does not depend upon having a particular type of experience.

Following the medication portion of the session, time is provided to begin reflecting upon and processing the experience with your therapist.

Spravato® and Psychotherapy

Spravato® (esketamine) is an FDA-approved prescription nasal medication used for specific depressive conditions.

For adults with treatment-resistant depression, Spravato® may be prescribed as a stand-alone medication treatment or in conjunction with an oral antidepressant. Spravato® is also FDA-approved, in conjunction with an oral antidepressant, for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior.

Eligibility for Spravato® treatment is determined by the patient's medical provider.

Spravato® treatment differs significantly from Ketamine-Assisted Psychotherapy conducted with other prescribed forms of ketamine.

         Your psychotherapist does not prescribe, dispense, administer, or medically            monitor Spravato®.

Spravato® must be self-administered under direct observation in a healthcare setting certified through the Spravato® Risk Evaluation and Mitigation Strategy (REMS) program. The Spravato® treatment provider is responsible for administration procedures and required medical monitoring. Patients are monitored by the healthcare provider for at least two hours following administration, with discharge determined by the medical provider.

When clinically appropriate, psychotherapy may be coordinated around a client's independently provided Spravato® treatment.

Psychotherapy appointments are scheduled separately from the Spravato® medication appointment and may occur before and following treatment to help establish therapeutic goals, prepare emotionally for the experience, explore material that arises, and integrate relevant insights into ongoing psychotherapy.

Psychotherapy is not required as part of the FDA Spravato® medication protocol. Within this psychotherapy practice, however, services related to Spravato® are provided only within the context of an established therapeutic relationship and ongoing psychotherapy treatment plan. 

Medication-assisted psychotherapy is best understood as a therapeutic process rather than simply a medication experience. Within this practice, treatment generally involves three important components:

Preparation

Before beginning medication-assisted psychotherapy or psychotherapy coordinated with Spravato® treatment, you will participate in psychotherapy sessions focused on establishing safety, developing therapeutic goals, discussing expectations, and identifying intentions for treatment.

An intention is not a particular outcome. An intention would generally not be framed as, "I want to erase this memory," or "I want to forget my trauma. "Instead, it provides a general therapeutic direction and may help focus the work.

Examples might include:

• "I want to experience a greater sense of calm."
• "I want to understand myself with more compassion."
• "I want to become more open to change."
• "I want to better understand patterns that are keeping me stuck."

The purpose of psychotherapy is not to eliminate your personal history but to help you develop a healthier relationship with your experiences, emotions, beliefs, relationships, and behavioral patterns.

Ketamine Medication-Assisted Psychotherapy Session

For clients who have been prescribed ketamine by an outside medical provider specifically for use during psychotherapy, a KAP dosing appointment is generally approximately two hours. When psychotherapy is covered by insurance, coverage may be limited to one 60-minute psychotherapy session per day, depending on the client’s individual plan and benefits. Any additional time not covered by insurance is the client’s financial responsibility and will be discussed in advance.

A session may include:

Approximately 30 minutes of preparation:
Reviewing therapeutic goals and intentions, preparing the environment, discussing your current emotional state, and helping you settle into the experience.

Approximately 45–60 minutes of medication experience:
You self-administer the medication according to the instructions provided by your prescribing medical provider while your therapist remains present to provide psychotherapeutic support.

Approximately 30 minutes of initial processing:
As the medication effects diminish, you and your therapist begin exploring observations, emotions, images, memories, thoughts, or insights that may have emerged.

Individual experiences vary, and the timing of each portion of the session may be adjusted according to clinical needs.

For Clients Receiving Spravato®

Spravato® medication is not administered during psychotherapy sessions in this practice.

The medication is administered separately in the Spravato® provider's REMS-certified healthcare setting, where the prescribing or treatment provider is responsible for medication administration procedures and medical monitoring.

Psychotherapy is scheduled separately and coordinated around the client's Spravato® treatment when clinically appropriate.

Integration

Integration is an important component of ketamine-assisted psychotherapy and psychotherapy coordinated with Spravato® treatment.

Following a medication experience, psychotherapy may focus on exploring thoughts, emotions, memories, perspectives, relationships, or insights that arose during or following treatment.

The goal of integration is not simply to discuss the medication experience but to connect potentially meaningful material to the client's established psychotherapy goals and everyday life.

Integration may focus on:

• Understanding emotional or relational patterns
• Processing memories or unresolved experiences
• Examining longstanding beliefs
• Developing healthier coping strategies
• Strengthening new perspectives
• Translating insights into behavioral change
• Identifying practical changes in daily life
• Preparing for future treatment sessions when indicated

Ketamine and esketamine affect the brain's glutamate system and have been associated with neuroplasticity-related changes. Research continues to examine how these processes relate to clinical improvement. Psychotherapy surrounding medication treatment may provide an opportunity to explore and reinforce new perspectives and behaviors.

Potential Benefits

Research involving ketamine, esketamine, and medication-assisted psychotherapy continues to evolve. Individual responses vary considerably, and no particular outcome can be guaranteed.

Potential therapeutic experiences or benefits for appropriately selected individuals may include:

Improvement in Depressive Symptoms

Ketamine and esketamine have demonstrated relatively rapid antidepressant effects in some individuals, particularly in the treatment of depressive disorders that have not adequately responded to previous treatment.

Deeper Emotional Processing

For some individuals, the altered state associated with ketamine treatment may allow difficult emotions, experiences, or memories to be approached with greater psychological distance or flexibility.

Psychological Flexibility

Some individuals experience a temporary shift in their usual ways of thinking or responding, which may allow familiar concerns or longstanding patterns to be examined from a different perspective.

Increased Engagement in Psychotherapy

Some individuals report greater openness, curiosity, self-reflection, or willingness to explore difficult material following medication treatment.

Working With Longstanding Patterns

When medication treatment is combined with appropriate preparation, psychotherapy, and integration, some individuals may find opportunities to work more deeply with longstanding emotional, behavioral, and relational patterns.

Individual responses vary considerably. Ketamine and Spravato® are not appropriate for everyone, do not guarantee improvement, and may involve risks, side effects, contraindications, and other medical considerations that must be reviewed with the prescribing medical provider.

1. Initial Consultation

If you are a new psychotherapy client, you will begin with a complimentary 15-minute consultation to determine whether the therapist's expertise, services, and treatment approach appear to be appropriate for your needs.

If appropriate, a comprehensive psychotherapy intake will then be scheduled.

Existing psychotherapy clients may discuss whether Ketamine-Assisted Psychotherapy or psychotherapy coordinated with Spravato® treatment may be clinically appropriate as an adjunct to their ongoing psychotherapy.

Medication-assisted treatment is not automatically recommended simply because a client expresses interest. Recommendations are based upon the client's clinical needs, treatment goals, established therapeutic relationship, and medical eligibility as determined by an independent medical provider.

2. Psychotherapy Intake

For new clients, the initial psychotherapy appointment is approximately one hour and focuses on understanding your history, current concerns, treatment needs, previous treatment experiences, and goals for psychotherapy.

Participation in Ketamine-Assisted Psychotherapy or psychotherapy coordinated with Spravato® occurs within the context of an established therapeutic relationship and individualized psychotherapy treatment plan.

3. Independent Medical Evaluation and Prescribing

Clients interested in ketamine or Spravato® treatment must independently establish care with a qualified medical provider who offers the appropriate medication treatment and determines whether the client is medically and psychiatrically appropriate for that medication.

The medical provider is responsible for:

• Determining medical and psychiatric eligibility
• Reviewing relevant medical and psychiatric history
• Discussing medication-specific risks and potential benefits
• Reviewing contraindications and possible side effects
• Prescribing medication when appropriate
• Determining the medication, dosage, and method of administration
• Providing medication instructions
• Providing appropriate medical monitoring and follow-up

Your psychotherapist provides the psychotherapy component of treatment and does not prescribe, dispense, or independently determine medical eligibility for ketamine or Spravato®.

4. Preparation Sessions

Preparation typically consists of one or more psychotherapy sessions focused on developing therapeutic goals, establishing intentions, discussing expectations, strengthening therapeutic safety, and preparing emotionally and practically for the medication experience.

Depending upon the individual, clinical history, therapeutic relationship, and treatment plan, approximately two to five preparation sessions may be recommended before beginning medication-assisted work.

5. Medication Treatment

Ketamine-Assisted Psychotherapy

When clinically appropriate and coordinated with the client's prescribing medical provider, a Ketamine-Assisted Psychotherapy session may be incorporated into ongoing treatment.

For clients using ketamine prescribed specifically for administration in conjunction with psychotherapy, the session is generally approximately two hours and may include preparation and intention setting, self-administration of medication as directed by the medical provider, the medication experience itself, therapeutic support, and an initial period of processing afterward.

OR

Spravato® Treatment

For individuals receiving Spravato®, the medication is self-administered under direct observation and medically monitored at a REMS-certified healthcare facility.

Your psychotherapy appointment is separate from the Spravato® treatment appointment.

6. Integration Sessions

Following the medication experience, one or more psychotherapy sessions may be devoted to integration.

During these sessions, you and your therapist explore memories, emotions, thoughts, images, perspectives, or insights that emerged during or following treatment and connect those experiences to your established therapeutic goals.

Integration may also help prepare you for subsequent medication treatments when additional treatment is recommended by your medical provider.

Length of Treatment

Treatment is individualized.

A course of Ketamine-Assisted Psychotherapy may include approximately two to five preparation sessions followed by a series of medication-assisted sessions and integration psychotherapy.

Some ketamine treatment plans involve an initial series of approximately six to eight medication sessions. However, there is no single ketamine dosing schedule that is appropriate for every client. The number, frequency, dosage, and timing of medication sessions are determined by the prescribing medical provider based upon individual response, medical considerations, clinical needs, and treatment goals.

Psychotherapy frequency is determined separately according to the client's individualized psychotherapy treatment plan.

Typical Spravato® Schedule for Treatment-Resistant Depression

For adults receiving Spravato® for treatment-resistant depression, the FDA-recommended treatment schedule generally consists of:

• Weeks      1–4: Treatment twice per week
• Weeks      5–8: Treatment once per week
• Week 9      and thereafter: Treatment once weekly or every two weeks

Beginning with maintenance treatment, the prescribing provider individualizes the frequency to the least frequent dosing schedule necessary to maintain the patient's response or remission.

The typical Spravato® dose for treatment-resistant depression is 56 mg or 84 mg, with medication dosage and frequency determined by the Spravato® treatment provider according to effectiveness and tolerability.

Spravato® has a different FDA dosing protocol when used for depressive symptoms in adults with major depressive disorder with acute suicidal ideation or behavior. 

That treatment protocol is determined and managed entirely by the prescribing medical provider.

There are typically psychotherapy appointments between medication treatments for integration, continued therapeutic work, goal development, and preparation for subsequent sessions when clinically appropriate.

Your psychotherapy schedule will be individualized according to your treatment needs, while your medication schedule is determined by your prescribing medical provider.

Coordinated Care With Your Medication Provider

Clients interested in Ketamine-Assisted Psychotherapy or psychotherapy coordinated with Spravato® must independently establish care with an appropriately qualified medical provider who offers the medication treatment being considered.

With appropriate written authorization, your psychotherapist may collaborate with your prescribing or Spravato® treatment provider to support coordination between the psychotherapy and medical components of treatment.

The prescribing medical provider remains responsible for all medical aspects of treatment, including:

• Medical and psychiatric eligibility for medication
• Prescribing
• Medication selection
• Dosage
• Route of administration
• Medication instructions
• Medical monitoring
• Medication-related adverse effects
• Medical follow-up

Your psychotherapist remains responsible for the psychotherapy component, which may include:

• Psychotherapy assessment and treatment planning
• Preparation
• Therapeutic support during eligible KAP sessions
• Integration
• Continued psychotherapy
• Ongoing evaluation of psychotherapy goals and progress

An Adjunct to Ongoing Psychotherapy

Ketamine-Assisted Psychotherapy and psychotherapy coordinated with Spravato® treatment offered through this practice are provided as adjuncts to an ongoing psychotherapy process.

They are not offered through this practice as stand-alone medication, prescribing, administration, or medical-monitoring services.

Participation requires an established therapeutic relationship, an individualized psychotherapy treatment plan, appropriate independent medical evaluation, preparation, and ongoing therapeutic work.

Not every psychotherapy client will be an appropriate candidate for Ketamine-Assisted Psychotherapy or psychotherapy coordinated with Spravato® treatment.

Medication eligibility and all medical treatment decisions are made independently by the client's prescribing medical provider. Psychotherapy recommendations are individualized based upon the client's clinical needs, therapeutic goals, and ongoing treatment plan. 

Psychiatric evaluations, follow-up appointments, and medication-management services may be covered by insurance when provided by a medical provider who participates with the client’s health plan and when applicable coverage requirements are met. Coverage for medications and related treatment services varies by insurance plan.

The prescribing medical provider is responsible for determining medical eligibility, prescribing medication, establishing dosage and treatment frequency, monitoring medication effects and side effects, and providing all medication-management services.

Clients should verify medication coverage, prior-authorization requirements, and anticipated out-of-pocket expenses directly with their prescribing medical provider and insurance carrier before beginning treatment.

Spravato® Treatment

Spravato® (esketamine) is prescribed and medically managed by an independent medical provider and administered under direct observation in an authorized treatment setting. Insurance coverage for Spravato®, associated medical appointments, medication management, and required monitoring varies by insurance plan.

Spravato® may be covered by Medicare and other insurance plans for qualifying patients when applicable coverage requirements are met. CMS has specific Medicare billing guidance for Spravato® administered at healthcare sites enrolled in the FDA-required REMS program. 

Psychotherapy provided by Gina Reed, LCSW, is a separate service from the Spravato® medication appointment and is billed separately according to the client’s psychotherapy benefits.

Ketamine Treatment

Ketamine is prescribed and medically managed by an independent qualified medical provider. The medical provider determines eligibility, medication formulation and route of administration, dosage, frequency, and any necessary medical monitoring and follow-up.

Insurance coverage for ketamine medication, medical evaluations, prescribing, follow-up appointments, and medication management varies considerably by provider and insurance plan. Coverage for ketamine used for psychiatric treatment may be limited or unavailable under some insurance plans.

Clients are responsible for confirming coverage and associated medical or medication costs directly with their prescribing provider and insurance company.

Psychotherapy provided in conjunction with ketamine treatment is a separate service from the medical provider’s services and is billed separately.

Psychotherapy Services

Please visit the Insurance section of this website for information regarding insurance plans accepted by Gina Reed, LCSW.

When psychotherapy is covered by a client’s insurance plan, eligible services are billed according to the terms, limitations, medical-necessity requirements, and reimbursement provisions of the client’s individual plan.

A Ketamine-Assisted Psychotherapy (KAP) appointment is generally approximately two hours. Insurance coverage for extended psychotherapy varies by plan. Some insurance plans may cover only a portion of the KAP appointment, while others may provide coverage for extended psychotherapy when applicable requirements are met.

When insurance is used for the covered portion of a KAP appointment but does not cover the additional psychotherapy time, the client may be financially responsible for the non-covered portion.

For clients using insurance, the fee for non-covered additional KAP psychotherapy time is based on the applicable insurer-contracted reimbursement rate rather than the therapist’s standard private-pay rate. Because reimbursement rates vary among insurance plans, the amount may differ by insurer and will be discussed with the client in advance.

This is different from a fully private-pay KAP appointment, in which no portion of the psychotherapy service is submitted to insurance and the practice’s established private-pay rate applies.

Private-Pay Psychotherapy Fees

These rates apply when psychotherapy services are NOT submitted to insurance:

Psychotherapy Intake – approximately 60 minutes: $200
Psychotherapy Session – approximately 60 minutes: $180
Private-Pay KAP Session – approximately 2 hours: $340

KAP Sessions When Using Insurance

When insurance is billed for the covered psychotherapy portion of a KAP appointment, the client’s deductible, copayment, coinsurance, or other responsibility for the covered service is determined by the client’s insurance plan.

If additional psychotherapy time is not covered by the client’s plan, the client may be responsible for that additional time. The charge for the non-covered additional time is based on the applicable insurer-contracted reimbursement rate and is not charged at the standard $180 private-pay psychotherapy rate.

Because contracted reimbursement rates vary among insurance plans, the specific amount will be reviewed with the client before the KAP appointment.