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.
