Ketamine is an FDA-designated Schedule III dissociative anesthetic agent widely used since the 1970s for sedation and pain reduction. In recent years, sub-anesthetic doses to treat pain, depression, or other psychiatric diagnoses is a newer, off-label use of ketamine. While not FDA-approved for these uses, scientific studies support its efficacy. Intranasal esketamine (SPRAVATO) has received FDA approval for drug-resistant depression.

You may have heard that ketamine is mostly used in the clubs, hence the “club drug” name. However, ketamine was used as a medical anesthetic for many years, long before it became known as a ‘club drug.’ Psychiatric use of ketamine has become relatively widespread in recent years, has been studied and promoted by researchers at the National Institute of Mental Health, and has had front-page publicity as an effective antidepressant with a novel pharmacological mechanism of action. Ketamine can be administered by intravenous, intramuscular (IM), sublingual, oral, and intranasal routes. Often, it is used after other treatment approaches have been unsuccessful.

Ketamine is now an “off-label” treatment for various chronic “treatment-resistant” mental health conditions. Ketamine is a Schedule III medication that has long been used safely as an anesthetic and analgesic agent and in recent years is being used as an effective treatment of depression, alcoholism and other substance dependencies, PTSD and other psychiatric diagnoses.

Ketamine is classified as a dissociative anesthetic, dissociation meaning a sense of disconnection from one’s ordinary reality and usual self. At the dosage level administered to you, you will most likely experience mild anesthetic, anxiolytic, antidepressant and, potentially, psychedelic effects.

Ketamine is sometimes called the “medicine of perspective.” It helps people shift their lens—whether zooming out to see the big picture, or zooming in to connect with what’s happening inside. That shift often sparks movement where clients have long felt stuck.

Psycodelics help us move from numbing (symptoms) to evoking (possibilities):

Unlike traditional psychotropic medications (like zoloft, xanax, adderral, prozac, lithium, effexor, or sertraline), which can numb emotions, dull clarity, and sometimes leave you with withdrawal symptoms, ketamine has the opposite effect. It “awakens” the brain, increasing neuroplasticity and helping new connections form.

• Works up to 70% of the time, often within hours or days (vs. 40% with antidepressants, which take weeks).

• Used as a catalyst or short-term treatment, not an ongoing daily medication.

• Can ease depression, anxiety, PTSD, OCD, eating disorders, and more.

• Helps people reconnect with themselves, with others, and with a greater sense of possibility.

KAP blends the biological effects of ketamine with the emotional holding of psychotherapy. The medicine may quiet the brain’s defenses, soften resistance, and dissolve rigid narratives. The therapy provides safety, meaning-making, and gentle guidance so insights become lasting change.

The purpose of the intramuscular and sublingual ketamine experience is to create a non-ordinary (“altered”) state of consciousness in order to facilitate profound transpersonal (“transcendental”, “mystical”, “spiritual”, “religious”) peak experiences. These may prove to be auspicious in resolving your existential problems, accelerating your psychospiritual growth, and leading to a deep personal transformation and optimization of your lifestyle. Such change is best facilitated within a structured, supportive environment in connection with experienced KAP therapists who collaborate with you in working towards your treatment goals and hold a view of your issues, hopes, desires, and struggles.

 As a byproduct of your experience you may feel improvement in your emotional state and reduction in problematic symptoms such as depression, anxiety, and post-traumatic manifestations. You may well notice that you are a bit different after a ketamine experience, and that difference may be liberating and allow for greater access to presence of mind, increased awareness of emotional and cognitive patterns and perspectives, and enhanced ability to make positive behavioral changes.

For best effects from this treatment, new clients are asked to make a commitment to at least 3 sublingual KAP sessions—with the possibility to pursue the full course of treatment as prescribed. This requested commitment is based on both research and clinical practice observations that suggest a cumulative benefit to repeated treatments. Please understand you are able to withdraw from treatment at any time. Your experience will be unique to you, and your KAP therapist will assist you in exploring the possible benefits and challenges that may arise during treatment. It is helpful to keep in mind that each ketamine experience may be different, with possibilities ranging from profound insights to a perceived lack of subjective effects. It is my perspective that each experience contains value to be explored in psychotherapy and integration. The degree of intentionality, curiosity, and openness you bring to this treatment is likely to provide you a greater depth of benefit as the series of experiences unfold.

Ketamine primarily acts as an NMDA antagonist within the glutamate system. This is very different from SSRIs or benzodiazepines. Research shows it:

• Boosts BDNF (brain-derived neurotrophic factor), which improves learning and healing.

• Creates a 36–72 hour “window” of enhanced neuroplasticity where new habits and insights can be anchored.

• May reopen “critical learning periods”—almost like hitting the brain’s reset button.

Some traditions see ketamine (and other psychedelic medicines) as a master key, unlocking flexibility, loosening old constraints, and allowing the psyche to reorganize in healthier ways.

In simpler terms, ketamine floods our brain with glutamate and glutamate is considered the work horse or the master switch to the brain. Glutamate has roles in pain, anxiety, inflammation, memory, and lots of mental health symptoms.

You may experience important changes in personality, mood and cognition during treatment, in the aftermath, and in the days and weeks that follow. Some experiences may be temporarily disruptive or challenging for you. The ketamine experience itself is designed to enable your own healing wisdom to be accessed and support your integration of these experience to gain psychotherapeutic benefits in alignment with your treatment plan and goals. The psychotherapy support you will receive will aid you in making your experience(s) valuable and understandable to you. I will endeavor to assist you in changing patterns of mind and behavior that are of concern and cause you difficulty.

Expected response rates to ketamine treatment for chronic (treatment-resistant) depression are 60-75%, based on available literature exploring a series of treatments using either IV or sublingual routes of administration. While some people do not see a notable remission of their symptoms, most will at least report gaining some valuable insights or improvements. Relapses can occur and may require periodic additional sessions. Over time, a certain number of clients may become unresponsive to further ketamine sessions.

Other benefits include:

• Calms the amygdala (less anxiety, more ease).

• Softens resistance and dissolves rigid ego defenses.

• Helps access deeper corners of the psyche.

• Supports transformation in depression, anxiety, PTSD, OCD, eating disorders.

• Encourages psychospiritual exploration, addiction recovery, and couples/group work.

• Promotes insight and new flexibility after traumatic brain injury.

• Can help people move beyond being “married” to a painful or limiting life narrative.

In my outpatient marriage counseling office in Wake Forest , I offer:

• Sublingual/oral (20–30% bioavailability)

• Intramuscular / IM (95% bioavailability)

I do not offer IV administration.

Ketamine creates an unusual experience of formlessness and a dissolving of boundaries and has novel effects on the mind. Therefore, it is much better to have an initial learning experience using a lower dose. The oral ketamine (either in a lozenge or tablet form) will dissolve slowly, and I wll ask you not to swallow your saliva for at least ten minutes and “swish” the saliva around in your mouth in that time to ensure absorption. Ketamine will penetrate the oral mucosa—lining of your mouth—and will be absorbed rapidly in that manner.. Some clients like to bring orange juice to help with the taste (I can’t provide it for compounding reasons, but you’re welcome to bring your own).

Yes. Ketamine is considered a very safe and forgiving medicine when prescribed and used responsibly.

For more than 50 years, ketamine has been widely recognized and safely used in operating rooms, emergency departments, and pain clinics. At the doses typically employed in psychiatry (0.5–1.5 mg/kg), it has demonstrated a strong track record of safety and reliability. In fact, the Ketamine Treatment Centers have reported administering over 20,000 psychiatric treatments without a single serious adverse event. Globally, ketamine is valued not only as a dissociative anesthetic but also as a versatile medicine. For these reasons, the World Health Organization has included ketamine on its list of Essential Medicines.

• Medical exclusions: uncontrolled high blood pressure, significant heart disease, aneurysm, stroke history, pregnancy and breasfeeding, severe liver disease, untreated thyroid disease, acute angle closure glaucoma, severe/recurrent bladder problems (cystitis)

• Psychiatric exclusions: schizophrenia, active psychosis, recent mania/hypomania, severe substance use disorder

Additionally, a thorough medication review is essential as certain medications and substances may negatively interact with ketamine.

You absolutely can do weekly couples therapy. And if you've already been doing it for a while, you already know what it gets you.

Weekly therapy is built for maintenance and gradual progress. It's one hour, once a week, inside a life that is still fully happening around you. The stress, the sleep deprivation, the resentment that built up on Thursday, the conversation that went sideways before you even got to my office. You're working against your own nervous system every single week.

A couples retreat removes all of that. You carve out two full days, you leave everything else at the door, and you give your relationship the kind of sustained, focused attention it actually needs to shift. Not chip away at. Shift.

Here's what that means practically: in weekly therapy, couples often spend the first year just building enough safety and language to even start touching the real stuff. In a two day Ketamine couples retreat, we can get there in hours. Not because I'm rushing you, but because the format and the medicine together create conditions that weekly therapy simply cannot replicate.

The ketamine itself opens a window, typically 36 to 72 hours of enhanced neuroplasticity, where the brain is genuinely more capable of forming new patterns and connections. That window doesn't exist in weekly therapy. You're working with your brain in its default state, with all its usual defenses fully intact.

Think of it this way: weekly therapy is a slow renovation. A Ketamine retreat is a structural reset. Both involve work. But one of them gets you to livable a whole lot faster.

And honestly? Most couples don't have the luxury of two or three more years of slow progress. Your kids are growing up right now. Your relationship is costing you sleep, joy, and connection right now. The intensive format exists because some things are too important to take that long.

Before participating in ketamine therapy, you will be carefully assessed by a medical professional/prescriber to determine if you are eligible for ketamine-assisted psychotherapy. This may include the following: medical history, a physical exam (if deemed necessary), review of your medical/psychiatric records, a psychiatric history, and administration of brief psychological tests to assess your state of mind.

You will be asked to lie still during the ketamine administration because your sense of balance and coordination will be adversely affected until the drug’s effect has worn off (generally within two hours). It is possible you may fall asleep during the drug effects due to being in a relaxed state.

 Some possibilities for adverse effects include blurred and uncomfortable vision (you are advised to keep your eyes closed until the main effects have worn off), slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to hear or to feel objects accurately including one’s own body, anxiety, nausea and vomiting. Visual, tactile and auditory processing are affected by the drug. Synesthesia—a mingling of the senses may occur. Ordinary sense of time may morph into time dilation.

Because of the risk of nausea and vomiting, please refrain from eating and drinking for at least the 4 hours preceding the session. And eat lightly when you do. Ketamine generally causes an increase in blood pressure (equivalent to moderate exercise) but does not usually affect pulse rate. If you have a history of high blood pressure, it is essential you follow all requirements of your prescribing physician to be in compliance with your prescribed use of ketamine. If blood pressure monitoring is required, you must bring in your own blood pressure cuff and take a reading prior to drug administration. Your KAP therapist reserves the right to cancel a session if blood pressure levels are too high, or any other aspect of the prescription protocol is not met.

Agitation may occur during the course of a ketamine session. The administration of ketamine may also cause the following adverse reactions: tachycardia (elevation of pulse), diplopia (double vision), nystagmus (rapid eye movements), elevation of intraocular pressure (feeling of pressure in the eyes) and anorexia (loss of appetite). However, with low dose oral ketamine, these agitations are less likely.

Driving an automobile or engaging in hazardous activities should not be undertaken after your ketamine-assisted psychotherapy session until the following day. You should have someone who knows your general state of mind drive you home from your first treatment. You will be assessed for safety prior to leaving the office premises. In terms of psychological risk, ketamine has been shown to worsen certain psychotic symptoms in people who suffer from schizophrenia or other serious mental disorders. It may also worsen underlying psychological problems in people with severe personality disorders.

During the experience itself, some people have reported frightening and unusual experiences. These frightening experiences, however, may be of paramount value to your transition to recovery from the suffering that brought you to your KAP work. They will stop! You will receive psychotherapeutic help and ongoing guidance from your therapist.

Other side effects may include:

• Nausea or dizziness

• Mild increase in blood pressure

• Headaches or migraines

• Vertigo, fatigue, sensory sensitivity

• Temporary insomnia or tinnitus

• Emotional or “transformational” intensity

Please keep in mind that you may not experinece any of these at at all (and many people don’t).

Preparation for a ketamine session requires assessment by your therapist of your readiness and a sense of trust, safety, and rapport between you and your therapist. We are engaging in a therapeutic endeavor to benefit you and those who are affected by you. Together, we are creating a supportive “set” (state of mind) and “setting” (environment) to maximize the benefits of this treatment.

• Practice grounding: box breathing, meditation.

• Plan for aftercare: arrange childcare, meals, rest—think of it like a “birth plan” (it won’t go perfectly, but preparation matters).

• Support your body: some clients like acupuncture, sauna, or massage beforehand.

• Set an intention: intentions might be big (“Help me connect with myself again”) or simple (“Show me calm”). And sometimes the medicine answers directly; other times, it takes you on a winding backroad. Both are valid.

• Spiritual or cultural support: if your faith, cultural background, or ancestral traditions are important, bring them into our conversation so the space is tailored for you. Some rooted in indigenous traditions even choose to “pray with their medicine,” holding it for a moment before beginning.

• Allow yourself to quiet your mind and acknowledge your journey as being a

  time for you to be with yourself. Minimize distractions such as your phone,

  social media, or news. Make a list of anything that you might need to do in the

  future or that is on your mind from the past. Bring your awareness to the fact

  that there will be a time to address these items later. This is your time to

  receive, to allow, to accept what is.

• Avoid alcohol, cannabis and benzodiazepines (e.g., clonazepam, lorazepam,

  alprazolam) for 24 hours prior to the treatment. The day of treatment, please

  follow your prescriber’s instructions regarding psychiatric medications.

• Fast from food for 4 hours prior to your treatment. Reduce intake of liquids for 2

  hours prior.

• Secure a safe ride home (you are not allowed to drive for the rest of the day)

• Comfortable clothing

• Eyeshades, pillow, and blanket (I recommend Mindfold eyeshades, as these allow you to open/close your eyes freely during your session, while maintaining total darkness)

• Any other items that may increase your sense of comfort and safety during your session

• Photograph of loved ones or pets, favorite blanket or stuffed animal, rock, candle, or other objects of comfort

• Water bottle

• Bluetooth headphones (optional)

• Snack (salty can be a good option)

• Sunglasses (optional) – light sensitivity is possible for a short time post ketamine treatment.

Prepare for any potential discomfort; as you will experience a non-ordinary state of consciousness, your normal perception of reality will be altered. Whenever you feel discomfort, allow yourself to let go and embrace the challenge as a learning experience rather than reacting to it.

“Trust, Let Go, Be Open” is a commonly used mantra in psychedelic therapy.

Trust your clinician to prepare and guide you through this experience, as well as your own Inner Healing Intelligence: your inherent capacity for resilience and ability to obtain wholeness and well-being.

Let go of any expectations about what should or should not come up during your experience; open yourself up to whatever may be unfolding during your journey – positive, enlightening, difficult, or scary. Know that whatever is happening is okay, and that the experience will end.

Be open to wherever the medicine takes you. Your journey may be centered on your intentions, or not, and that is okay! You may not be able to make sense of what is occurring during your journey at the time. You may have a mystical experience and gain deep insights into yourself or your way of life, or you may not. Do not be disappointed with wherever your journey leads you – you will see benefits as you progress through treatment, and your therapist is there to help you make sense of the experience.

No, many couples are driving and flying from different states here.

Gives way to increased clarity and depth in your experience while supporting your strength and ability to persevere through your journey.

It may be helpful to ask yourself:§ What am I grateful for?§ What are my fears? My worries?

• § Who is an ally or support person(s) I can call on (internally) during my journey?

• § What might I let go of? Who might I let go of?

• § Who might I forgive?

• § What dreams do I have for my life?

• § What are my desires, intentions, or expectations for the experience?

• § What parts of myself do I wish to know more?

You may practice setting intent by placing your hands at your navel area, breathing deeply, and imagining that you are receiving the medicine in a way that is healing for you.

During the ketamine administration session, you will be asked to make the following agreements with the therapist(s) to ensure your safety and wellbeing:

1. You agree to follow any direct instructions given to you by the therapist(s) until it is determined that the session is over;

2. You agree to remain at the location of the session until the therapist(s) decides you are ready to leave; and

3. You agree you will secure return transportation following your ketamine treatment and will not drive for the remainder of the treatment day.

What will happen?

• You’ll settle into a cozy “nest,” often with weighted blankets (especially helpful if you experience vertigo).

• You’ll wear an eye mask and headphones, journeying inward while I support from the outside.

• Every session is unique—like weather passing through. No two journeys are the same.

What will you do while I have my eye mask on?

• Take notes on what I observe.

• Write down the music track names.

• Gently remind you of your intention or mantra if you drift.

• Step in only if necessary for safety, containment, or grounding.

We’ll review touch consent ahead of time. If you need to go, we’ll use a signal, and you’ll place your hands on my shoulders as I carefully walk you there and back. Please don’t lock the door.

The length of ketamine sessions varies from person-to-person and from experience-to-experience. You are likely to be mostly internally focused for the first 45 minutes to one-hour-and-a-half following oral absorption of ketamine. You can expect to continue to feel the effects of ketamine at a lesser level for an hour or more beyond this time.

• A rosewater spray gently signals when we are nearing the end.

• A soft shoulder tap after ~100 minutes lets you know it’s time to begin reorienting.

Integration is the act of processing and reflecting on any material that arose during your journey in a non-ordinary state of consciousness (insights, feelings, body sensations, etc.) through self-care activities (journaling, art, yoga, conversations with your therapist or other trusted person, etc.) once you have returned to your ordinary state of mind. These steps will help you increase your understanding of the experience and support your ability to use this material to create lasting, positive change in your life. Ideally, the integration process should begin immediately after your journey to maximize your ability to positively integrate the experience.

Most individuals find journaling or sharing about the experience with a close friend or loved one to be a good way to do this.

As you integrate and spend time reflecting on your experience, consider journaling or making art that explores the following prompts:

o What did I feel emotionally and physically during the session?

o What did I see during the session? What did I hear?

o Do I need to talk this through with someone or ask for support?

o What is one thing that I feel gratitude for after this session?

o How do I feel now after the session?

o What messages am I continuing to receive from my body d and emotions?

o Which parts of myself did I become more aware of? Did these parts share any messages with me?

o What do I hope to explore in future sessions?• One of the best ways to promote lasting benefits and healing from your experience is through behavioral change. This may include the following:

o Starting a daily practice of mindfulness (meditating, listening to music, yoga, prayer, spending time in nature)

o Committing to a daily practice of creative expansion (drawing, painting, dancing, journaling)

o Making time to process insights (talk with a trusted friend or family member, schedule non-medicine therapy sessions)

o Committing to dietary changes (eat healthy meals, cut down on sugar processed foods, reduce alcohol/drug use)

Please remember that integration is where the real work happens. Medicine can open doors, but integration helps you walk through them.

Here's the straightforward breakdown:

Initial Medical Screening with the collaborating prescriber is around $400 for 75 minutes, paid directly to them.

Day One Preparation Intensive is $3,000 for 6 hours.

Day Two Medicine and Integration Intensive is another $3,000 for 6 hours.

The ketamine medicine itself runs about $40 to $80 per package, shipped directly to your home from a compounding pharmacy, and covers 4 sessions.

So your total investment for the full two day experience lands around $6,400 to $6,500.

Insurance doesn't cover this. I won't pretend otherwise.

What I will say is this: most of my clients have already spent years in weekly therapy, sometimes thousands of dollars, circling the same pain without it actually moving. A Ketamine retreat isn't another thing to try. It's a fundamentally different level of work, compressed into two days, designed to get you somewhere you haven't been able to get on your own.

When you do that math, two days versus two more years, it starts to look very different.

Your relationship is worth this. You are worth this. And the version of yourself your kids get to grow up watching? That's priceless.

Weekly therapy is like watering a plant one drop at a time. It can work — slowly — but you're also fighting against everything that happens between sessions. You come in, open something real, and then the hour ends. You go home, the kids are loud, someone says the wrong thing at dinner, and by Saturday you've already undone half of what you worked through on Tuesday. Then you start over next week.

A Ketamine retreat works completely differently. Instead of one hour a week, you get two full days, twelve hours total, of uninterrupted, deep, focused work. No stopping right when something important starts to crack open. No spending the first twenty minutes catching me up on what happened since we last met.

And then there's the ketamine itself, which changes everything about what's possible in that room.

Weekly talk therapy lives almost entirely in the thinking brain. You talk about the fight, you analyze the pattern, you try to understand why you react the way you do. That's useful but it only goes so far. Because the stuff that's really driving your cycle? The fear of not being enough. The shutdown that happens before you even know it's coming. The wall that goes up the second you feel criticized? That doesn't live in your thoughts. It lives in your nervous system. And talking about it doesn't always touch it.

Ketamine quiets the brain's default mode network, the part responsible for those relentless, repetitive thought loops, and calms the amygdala, your fear center. Defenses soften. The walls that have kept you safe but alone start to come down. Suddenly you're not defending your position anymore. You're actually feeling what's underneath it. And that's where real change lives.

The result isn't just a better conversation. It's a different nervous system experience of your partner and yourself. That's something weekly therapy, even really good weekly therapy, can take years to get to.

• You may take any daily prescribed medications and resume normal food/liquid intake after your session.

• DO NOT drive for the rest of the day following your treatment. Please plan to have a family member or close friend provide you with transportation home. You may take

a taxi/Lyft/Uber if needed, however I encourage you to avoid doing so after your first KAP session.

• If possible, it is recommended to take the rest of the day off after your ketamine treatment to allow you time to engage in resting, self-care, and integration. During this time, suggested activities include taking a bath, going for a nature walk, listening to music, journaling/writing about your experience, making art, or getting a massage.

• Feel free to go back to your normal work/activity schedule the day following your session.

Avoid big legal, or financial decisions for at least 1-3 months post your ketamine session

Avoid alcohol, cannabis, kratom, or kava for at least 48 hours before and after.

Some clients don’t have the “big” experience they were hoping for. This is completely normal. Every journey is different, and there is always something to learn. We can also talk with your prescriber about dosage adjustments. Remember: you didn’t do it wrong.

The first step is simple: book a free 30-minute consultation call.

No commitment, no pressure, no intake paperwork before you even know if this feels right. Just a real conversation where you can tell me what's going on, ask whatever questions you have, and get a sense of whether working together feels like a fit.

Here's what that call actually looks like: I'll ask you a little about what's been happening in your relationship, like what brought you to this point, what you've already tried, what you're hoping for. I'll share how I work and which approach (EFT Intensive, Brainspotting, Ketamine-Assisted Psychotherapy, or some combination) might make the most sense for where you are right now. And if it feels aligned, we'll talk about next steps.

You don't both have to be fully on board to make that call. A lot of the time, one partner reaches out first, maybe the other one is skeptical, exhausted, or just not sure couples therapy can actually help at this point. That's okay. We can talk about that too.

What you don't need to do is have it all figured out before you reach out. You don't need to know which service is right for you. You don't need to be able to articulate exactly what's wrong. You just need to be at the point where you know something has to change, and you're willing to take one step toward that.

That step is the call. Everything else follows from there.

Book your free 30-minute consultation here.