How Spravato and Ketamine-Assisted Psychotherapy Work Together

This article is the second of a two-part series examining how Spravato® and ketamine-assisted psychotherapy (KAP) complement each other in the treatment of depression. Read the companion article: Life After Treatment-Resistant Depression.

Many trauma survivors reach a point in therapy where they intellectually understand what happened to them. They know the event was not their fault, can articulate the experience and explain it clearly. Yet that insight doesn’t relieve the emotional weight of the trauma.

Shame, self-blame, and painful body memories can persist long after the mind understands the truth. For some patients, this is where traditional therapeutic approaches stop short of helping them move towards meaningful change.

 

Spravato and ketamine-assisted psychotherapy offer a different approach

At Keta Medical Center, we often combine Spravato, a ketamine-based nasal spray, with ketamine-assisted psychotherapy (KAP) to help patients move beyond intellectual insight and toward deeper emotional healing.

Spravato works differently from traditional antidepressants. It affects the neural pathways in the brain and increases its capacity for neuroplasticity – the brain’s lifelong ability to reorganize its structure, functions, and neural connections in response to learning or experience. When this biological process is paired with psychotherapy, patients can often look at difficult memories and long-standing emotional patterns from a new perspective.

Ketamine-assisted psychotherapy is an integrated process. Treatment typically begins with one or more preparation sessions, where therapist and patient explore personal history, identify goals, and establish intentions for the work ahead. These conversations help build trust and prepare patients for the experiences that may arise during ketamine sessions.

 

A life burdened by the weight of trauma

During ketamine treatment sessions patients enter a dream-like or altered state of consciousness. Some describe deep relaxation, while others encounter vivid memories, images, or emotional insights. This state can create enough psychological distance for patients to observe painful experiences without feeling flooded by them.

In my work as a therapist, I often witness how meaningful this shift in perspective can be. Here’s an example of what this can look like for a patient. Please note that the story below is not based on the experience of any one single patient. Rather, it’s a blend of experiences I have seen across many patients. I have carefully changed details to protect the privacy and identity of all of my patients.

A middle-aged woman struggles with lifelong feelings of shame after being sexually assaulted as a teenager. She has undergone years of therapy but nothing really helps her move forward. She feels uncomfortable in her own skin, hating her body and overeating to block out the feelings of depression and shame.

Over time, she tries many different things to heal. She joins an overeaters anonymous group. She participates in various therapies where therapists tell her it wasn’t her fault. She also joins women’s support groups. She finds comradery in these groups and appreciates the support, yet the heavy depression and shame remain.

She hears therapists say that what happened was not her fault, and cognitively she is able to agree with it. But her body still feels heavy, and she continues to bury her depression with food. After episodes of binge eating, the shame and heaviness become even more intense.

A new perspective on traumatic memories

Antidepressants help numb the depression, but she still struggles with overeating and a vague sense of unease. She finds support in good friendships and trusts her therapist, but the words “it’s not your fault” never seem to penetrate deeply. Day after day, she feels as though she is simply slogging through life, carrying the same burden while gaining more and more weight. When she begins treatment with Spravato alongside ketamine-assisted psychotherapy, something changes.

During one of her early Spravato sessions, she revisits the memory of the assault in a way she has never experienced, from a distance, almost like watching a movie. She sees her younger self, thin and unprotected. She remembers the smells and the details of the attack. She recalls the physical and emotional humiliation and the pain. She remembers feeling shame, but she doesn’t relive the trauma with overwhelming emotions. It is as if she is observing her former self.

Afterwards, she writes about what she has experienced and brings those reflections into her ketamine-assisted psychotherapy sessions. This is where integration therapy becomes central to the healing process. Integration sessions typically occur within a day or two after treatment, while the brain is still more flexible and receptive to new perspectives. During these sessions, patients explore the emotions and insights that emerged during ketamine treatment and begin translating them into meaningful change.

 

Challenging the story that had defined her for years

Together, we began examining the details that had reinforced her self-blame for years. She remembered wearing a short skirt that day, smiling at her perpetrator, and not reporting the crime immediately.

As her therapist, I questioned the ingrained assumptions hiding behind these memories. Does smiling at someone mean she caused the assault? Does what someone wears make them responsible for violence? Does not reporting immediately mean the experience was somehow less serious? Looking at these details within ketamine-assisted psychotherapy slowly led her to challenge the narrative she has held onto for decades.

 

Shifting from shame to lightness

Within weeks of beginning treatment, the woman noticed a meaningful shift. She ate meals without constantly counting calories, actually enjoying the food. For the first time in years, she wore clothes that fit her body instead of hiding beneath oversized layers. She described feeling lighter overall and free from the shame that had burdened her for decades.

For many trauma survivors, that kind of shift is transformative. Ketamine-assisted psychotherapy offers a structured way to explore painful experiences, process difficult emotions, and reshape long-standing beliefs. When Spravato treatment is combined with thoughtful therapeutic work, patients may find themselves able to release patterns that have defined them for years. And that opens the door to true healing.

If you are struggling with the lasting effects of trauma and treatment-resistant depression, Spravato® treatment combined with ketamine-assisted psychotherapy may offer a new path toward healing. Schedule a free consultation with a clinician at Keta Medical Center to see whether this approach may be appropriate for you.

How Spravato and Ketamine-Assisted Psychotherapy Work Together

This article is the first of a two-part series examining how Spravato® and ketamine-assisted psychotherapy (KAP) complement each other in the treatment of depression. Read the companion article: When Insight Isn’t Enough: How Ketamine-Assisted Psychotherapy Helps Patients Heal From Trauma.
Severe depression takes away joy, identity, connection with others, and any sense of progress in life. Many people living with treatment-resistant depression (TRD) find they are enduring life rather than participating in it.

I have worked with patients who have spent 10, 15, even more than 20 years trying different antidepressants. The medications may help them function — they manage to get to work, pay bills, attend family events — but inside, they feel exhausted and emotionally absent. This long-term survival mode can profoundly affect marriages, parenting, friendships, and self-esteem.

 

Ketamine treatment creates a window for change

When we begin treating them with Spravato®, a nasal spray based on the ketamine derivative esketamine, something often begins to shift. Unlike traditional antidepressants, esketamine works through different neurobiological mechanisms that promote neural plasticity and cognitive flexibility.

Simply stated, the brain becomes more open to change. Research suggests this creates a temporary “window” in which psychotherapy can take a deeper root. Combining ketamine treatment with ketamine-assisted psychotherapy may enhance and sustain the beneficial treatment effects, as the same study finds. In my experience with patients, this is absolutely the case.

We often see the first signs of relief within days of beginning treatment. But after years, even decades, of emotional numbness, many patients find themselves asking: Now what? This is where ketamine-assisted psychotherapy comes in.

 

A man living with 15 years of severe depression

In my work, I often see a pattern like in the following story, which is a composite drawn from many patients: Imagine someone who’s lived with treatment-resistant depression for over 15 years and has tried every antidepressant available.

The medications help him drag himself through each day. At work, he does enough to get by, then closes his office door and rests his head on his desk between meetings. He stays in his office because he doesn’t have the energy to chat with colleagues.

Pushing down a granola bite for lunch is an effort. He feels the sensation of hunger but has no appetite. After work, he comes home and forces a weak smile to his wife and young daughter before heading straight to bed. His wife has gotten used to doing everything at home, from household chores to childcare.

On Sundays, his daughter asks for “daddy time.” He takes her to the park out of guilt, but every step feels like climbing a mountain. All he wants is to get back home and get into bed.

This all changes with Spravato. After a couple of sessions, he feels lighter. Small things begin to improve. At work, he notices that the food his colleagues bring smells good, and for the first time in years, he wants to try it. Two weeks after starting Spravato, he eats a full deli sandwich and can’t believe how good it tastes.

When a colleague knocks on his door during his break, he is able to smile and engage in small talk without it feeling like a huge exertion. Then he comes home from work and sits at the table with his wife and daughter for dinner. They can’t believe it.

Yet unexpectedly, the improvement also makes him feel overwhelmed. For years, he has been in survival mode. While he now feels relief from his depression, he doesn’t know what to do first, how to re-enter the life he’s been absent from, and how to repair the relationships that have adapted to his emotional distance.

 

Rebuilding connection after years of absence

Ketamine-assisted psychotherapy (KAP) helps him contain his feelings and figure out which part of his life he wants to address first. As his depression lifts, his first priority is being there emotionally for his daughter and wife. But how does he do that?

With the help of KAP, he finds the language to explain to his daughter what it meant that daddy was depressed, and what it means that he is getting better. He talks through how to reconnect with his wife.

When symptoms improve, patients often become aware of the patterns they’ve cemented around the burden they’ve carried. The patient has to relearn how to show up emotionally, how to communicate openly, and how to rebuild trust with his loved ones. The medication has energized him, and ketamine-assisted psychotherapy is helping him find his way forward.

 

From symptom relief to long-term recovery

Ketamine treatment may open the door. Therapy helps patients walk through it. In my work, I integrate cognitive behavioral therapy (CBT) and internal family systems (IFS).

Without additional support, the benefits of ketamine treatment may be short-lived, according to a clinical study. In the study, those receiving intravenous ketamine treatment who engaged in concurrent cognitive behavioral therapy (CBT) had lower relapse rates. In another study, patients who received ketamine infusions alongside psychotherapy showed more pronounced symptom reduction than those who received infusions alone.

CBT helps patients examine long-standing thought patterns, such as “I’m a burden,” “I’ve wasted my life,” “It’s too late to change”. It helps reframe those beliefs while building concrete behavioral changes. IFS helps individuals understand and integrate parts of themselves shaped by trauma, shame, or self-criticism.

The neuroplastic window created by Spravato presents an opportunity, but it can feel disorienting. In that space, ketamine-assisted psychotherapy helps to reflect deep insights gained in ketamine sessions and integrate them into daily life, creating lightness, connection, a sense of fulfillment and calm, and even joy.

If you’re struggling with treatment-resistant depression, Spravato and ketamine-assisted psychotherapy may offer a new path forward. Schedule a free consultation with a clinician at Keta Medical Center to explore whether this approach is right for you.