What to Talk/Think About in Ketamine Therapy

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Takeaway: Ketamine therapy works best when you bring your full, honest self into the room. While there’s no “wrong” thing to say, knowing what can move your healing forward—and what may distract from it—helps you get the most out of each session.

You’ve been in therapy. You know the coping skills. You’ve unpacked the family patterns. But something is missing, leaving you stuck in a groundhog-day feeling at each weekly appointment.

Cue: ketamine-assisted psychotherapy (KAP), an approach that pairs the medicinal power of ketamine with the tried-and-true work of talk therapy.

I’m Dr. Shannon York (she/her), an identity-affirming psychedelic psychotherapist who helps folks retire from people pleasing. I’ve been so moved by the long term benefits of ketamine that I’m on a mission to get the word out!

If you’ve hit a wall with traditional treatments and are curious about this approach, you’re in the right place. Read on to learn more about what to do during ketamine treatment and how to get the most out of ketamine therapy.

Quick overview of what to think/talk about during ketamine treatment (and what might not be as helpful)

Preparation is one of the most important parts of ketamine treatment, so congrats! By reading this, you’re already getting started.

I’m here to help you learn a little more about what to think about when beginning your journey with ketamine treatment. This list is a starting point to give you some guidance about how to make the most out of your sessions so you can get the lasting change you’ve been seeking.

✅ DO talk about

• The many parts of your internal experience
• Your questions or worries about ketamine
• What kind of ketamine treatment is best for you

❌ DON’T focus on 

• Needing a trippy experience, dude
• Misinformation about ketamine in popular media
• Accepting the only form of ketamine treatment offered by the first practitioner

Now you’ve got the big picture about what kinds of thoughts are helpful to bring in and which ones can get in the way. From here, it’s worth getting a little more specific. Knowing what to do during ketamine treatment can shift a good session into a truly transformative one. Let’s break down some of the key areas to think about.

A deeper dive into what to talk or think about in ketamine therapy

So, what exactly should you bring into the ketamine space? And why might these topics be particularly helpful? Below are some guideposts to orient yourself.

The more clarity you have about your goals, what’s happening in your inner world, and how this treatment can support you, the more room you create for the medicine and therapy to work together. Come along to dive into some of the most helpful things to consider when beginning your journey.

DO talk about your internal experience

• Why I recommend it: It’s probably fair to say that all therapy encourages you to get curious about your internal experience in some way, whether it’s your thoughts, feelings, or physical sensations. But when wrestling with the question of what to think about during ketamine therapy, I’m inviting you to consider how this process of being with your internal experience is different with the help of this medicine.
• How ketamine therapy can help: One of the potential effects of ketamine is having a psychedelic or mystical experience, including visuals, colors, or sounds that are outside of the ordinary. A therapist trained in understanding this medicine can assist you in translating these internal experiences to lifestyle changes that support your goals.
• Therapist insight: Y’all, I’m biased as a ketamine-assisted psychotherapist and I think an essential part of maximizing benefits long term is the “so what?” after your ketamine session. Whether you saw the color blue, imagined yourself turning into a deer, or felt bored by your lack of thoughts, it’s my job to help you figure out how to use that to support your sustainable symptom relief.

DO talk about questions and worries

• Why I recommend it: It would be pretty tough to relax in a vulnerable, altered state if your therapist did not address your anxiety about the treatment. You deserve to have all the information needed to make an informed decision about whether or not ketamine treatment can help you find relief.
• How ketamine therapy can help: This medicine has been shown to boost mood more quickly than a traditional antidepressant, quiet the anxious and depressive rumination of the default mode network, and help the brain form new neural pathways that make therapeutic change easier. And it’s not a miracle drug. Having your questions answered will help you assess if it’s your best path to better mental health.
• Therapist insight: A good clinician will listen to respond to your concerns with information, not to convince you. With all the amazing therapy and other treatments we have in the mental health world, I tell all my patients that they can probably achieve their goals without ketamine. I’m here to empower you with data to see if ketamine is the best treatment for you at this time.

DO talk about pros and cons of different ketamine treatments

• Why I recommend it: This medicine is not one-size-fits-all. Personal and family mental health background, physical health history, and current symptoms all inform the decision about what kind of treatment is right for you.
• How ketamine therapy can help: Treatment comes in so many forms including a nasal spray, rapidly dissolving oral tablets, intramuscular (IM) injections, and intravenous (IV) ketamine. It also comes in very different doses, from higher “psychedelic” or “dissociative" doses associated with IV ketamine to low doses (also known as “psycholytic” doses) that feel more like a wine buzz than a rave. Your provider can give you more information about which type of ketamine experience could be the best match for certain mental health conditions or symptoms.
• Therapist insight: In collaboration with your provider, consider what elements of this treatment seem most important to your path toward mental wellness. Maybe you prioritize ketamine infusions because it has the most supportive research for treatment resistant depression. Or you decide that a low doses are ideal to address your current level of anxiety. Perhaps support groups that include ketamine preparation, dosing, and integration are the best fit. The possibilities are endless!

More on what to not talk or think about in ketamine therapy

Just as important as knowing what to bring into the room is knowing what you can safely set down. Some mindsets and expectations sound useful on the surface but actually get in the way of the deeper work. Think of this list as a gentle invitation to let go of the extra weight so you can stay attuned to what really helps your healing unfold.

DON'T put psychedelics on a pedestal

• Why I don’t recommend it: It is absolutely not necessary to have a psychedelic experience in order to reduce symptoms or find the calm you’re seeking. Regardless of whether or not you have an “epic trip,” you can still receive the brain-based changes of increased neuroplasticity, boosted mood, and quieting of ruminating thoughts.
• What I recommend instead: Be curious about whatever comes up for you during dosing. It’s all interesting, even if the biggest takeaway is greater calm and a quiet mind.
• Therapist insight: Whether it’s psychedelic or not, interpreting what you experienced during dosing is just one part of the process during your ketamine treatment. Setting intentions before dosing and follow up during integration sessions are equally valuable on the path toward better mental health.

DON'T rely on misinformation and myths

• Why I don’t recommend it: Some of the misinformation out there has the potential to scare people away from a treatment that could be life-changing.
• What I recommend instead: Focus on the questions you want answered, like learning about potential interactions with other medications, common side effects, and how ketamine might reduce your specific symptoms. Drama sells, but a professional will help you sort out fact from fiction.
• Therapist insight: It’s okay to take your time with the mythbusting. You deserve to have the answers you need to make an informed choice.

DON'T settle for what is offered

• Why I don’t recommend it: There are soooo many different ways to engage in ketamine treatment; please feel free to shop around!
• What I recommend instead: Ask your provider about the differences between different doses, settings, and routes of administration. Most importantly, get information about what is the best fit for your specific needs.
• Therapist insight: There isn’t one “right” way to approach ketamine for mental health, even if you’re looking to address a very specific concern (e.g. treatment resistant depression). What matters is that you feel comfortable with the provider(s) and the rationale makes sense to you.

The role of integration in ketamine treatment

Once the medicinal session ends, the real work of ketamine treatment is just beginning. This is where “integration” comes in: maximizing the benefits of your insights, feelings, or shifts by connecting them with the goals from your treatment plan.

You’ll discuss ways to translate this information into actionable steps during the two-week window where your brain is more open to change. That could include adding a practice like gratitude journaling, taking a risk like asking a friend to make plans, or engaging in more self care to soothe your emotions. Lifestyle changes are what help you move from temporary relief to sustainable freedom from symptoms of depression, anxiety, PTSD, or other mental health conditions.

How to prepare for ketamine therapy

It’s almost time for the main event! But before we get into ways to prepare, it might be helpful to address one of the most common questions I hear over and over: “What do you do during ketamine therapy?”

For moderate and higher doses (IV ketamine infusions, IM injections, and many forms of nasal and oral ketamine), you will be lying in a reclined position with an eye mask and headphones.

Your only job for the next 45 to 60 minutes is to notice what comes up in your internal experience. You may want to share what you notice out loud with your therapist if you’re taking a lighter dose.

Most patients, however, silently observe any thoughts, feelings, visuals, sounds, and body sensations. There will be plenty of time to talk more about your experience afterward.

Here are a few ways you can prepare to get the most out of your dosing session:

• Engage in intention setting; journaling can help you gain clarity both before and after dosing.
• Listen to a guided meditation prior to your session to help you get into a calm headspace.
• Wear comfortable clothing and tidy your room to create a safe space if you’re dosing at home.
• Get supplies ready, including charging devices for music, and having eyeshades and headphones nearby. Tissues can come in handy as many patients feel emotional during and after their journey.
• Talk to loved ones about what they can do during support your progress in ketamine treatment, whether that’s caring for pets during dosing, taking you to and from appointments, or just lending an ear.

I recommend enjoying a little self care for the next few hours post-ketamine therapy to make space for reflection, rest, and journaling. Whether you formally practice mindfulness or simply take time for a deep breath, allow yourself to slow down enough to be with your experience. It’s a journey to be savored.

Final thoughts

Ketamine works best when you combine your openness and curiosity with a little guidance about where to focus your energy. Knowing what to lean into and what to leave at the door helps you clear the path forward toward lasting, meaningful change.

Of course, no article can replace the support of a trained ketamine clinician who knows you and your story. If you’re curious to learn more about whether this treatment could be right for you, I encourage you to schedule a free 15-minute consultation. You deserve to have the support you need to build a life that lights you up.