How Ketamine and Spravato Treatment Can Support Therapy
By Natasha Behnam, Ph.D. · Endeavour Psychology Group
When depression persists despite treatment, it can become difficult to imagine feeling differently. You may understand your patterns and know which coping skills could help, yet still struggle to find the energy or emotional space to use them.
For some people, ketamine or esketamine treatment can reduce depressive symptoms and make engaging in daily life feel more possible. Psychotherapy offers a place to work with those changes: preparing for treatment, processing the experience, and translating shifts in mood or perspective into practical steps.
At Endeavour Psychology Group, we provide ketamine-assisted therapy support, including preparation and integration therapy, for clients who are receiving ketamine or Spravato through a medical provider. We do not prescribe or administer ketamine or esketamine. Our focus is on helping you connect the treatment experience with your needs, relationships, and everyday life.
If you are in crisis or having thoughts of suicide, call 988 or text 988 to reach the Suicide & Crisis Lifeline, or go to the nearest emergency room.
Ketamine and esketamine are related but different
Ketamine is an anesthetic. It is FDA-approved for anesthesia and is not FDA-approved for any psychiatric condition, although it is prescribed off-label for depression. Off-label means that this use is outside its FDA-approved indications. Esketamine is one of the two mirror-image forms of the ketamine molecule; its prescription nasal spray is called Spravato.
Spravato is FDA-approved for adults with treatment-resistant depression, either alone or with an oral antidepressant. It is also approved, together with an oral antidepressant, for depressive symptoms in adults with major depressive disorder who have acute suicidal thoughts or behavior.
The prescribing medical team determines eligibility, medication choice, dosing, and monitoring. Psychotherapy supports the psychological work around that medical treatment. Receiving Spravato does not automatically mean that psychotherapy is provided during the dosing appointment.
How these treatments work
Ketamine and esketamine block NMDA receptors, part of the brain’s glutamate system, which helps nerve cells communicate. Researchers are still working out exactly why this relieves depression for some people.
Research, including animal studies, suggests that ketamine can influence neuroplasticity—the brain’s ability to form new connections. This has prompted interest in whether treatment can create conditions that support new learning. It is a promising line of research, not a guaranteed window in which the brain can be “rewired.”
Antidepressant effects can emerge within hours or days for some people, although response varies. Improvement may require a course of treatment and ongoing care, and some people do not benefit. Early relief is meaningful, but it is not a guarantee of sustained recovery.
Why psychotherapy can help alongside ketamine treatment
Feeling less depressed can make it easier to return a friend’s call, follow a routine, or approach something you have been avoiding. Therapy helps you decide what to do with that increased capacity and work through the difficulties that remain.
Research on combining ketamine with psychotherapy is promising but still developing. In a small randomized trial, cognitive behavioral therapy after intravenous ketamine improved self-reported depression but did not show a statistically significant advantage on the clinician-rated primary measure. We cannot assume that all forms of integration therapy improve medication outcomes, or that findings about intravenous ketamine apply directly to Spravato.
The practical value of therapy includes a consistent place to reflect, practice skills, and monitor how you are functioning. If medication does not help, that does not mean you failed to integrate the experience or work hard enough.
How ketamine integration therapy works at Endeavour
Our work can include preparation before treatment and integration afterward. Integration means exploring what you noticed and deciding whether it has a useful place in your ongoing therapy. The pace and focus depend on your goals, readiness, and medical treatment plan.
Preparing for the experience
Before treatment, we can explore your hopes, fears, and expectations. Feeling hopeful and feeling nervous can coexist, especially if previous treatments have been disappointing or changes in bodily sensations feel unsettling.
We may identify a gentle intention, such as “I want to notice how I speak to myself.” An intention offers direction without making a breakthrough a requirement. We can also practice grounding, discuss how to communicate discomfort to the treatment team, and plan for support afterward.
Making room for what you actually experienced
After the immediate medication effects have resolved, therapy gives you room to describe the experience in your own words. You might notice emotions, images, a different perspective, or very little that feels psychologically significant. There is no required story to tell.
We can explore questions such as: What felt different? What was uncomfortable? Did anything connect with an existing concern? What do you want to bring into the coming week? We approach images and impressions with curiosity rather than treating them as proof of past events or instructions for major life decisions.
Working with self-criticism and emotional patterns
If you notice a shift in perspective, we can examine it together. For example, “I always ruin everything” might begin to feel like a painful thought you have learned to repeat, rather than a complete description of who you are.
Our approach draws on IFS-informed, somatic, and attachment-based work. A shift in perspective often brings protective parts of you into view, such as an inner critic that has worked hard to keep you safe, or a part that braces against disappointment. We approach these parts with curiosity rather than trying to override them, and we attend to what your body is experiencing as well as what you are thinking.
For someone with a trauma history, this work may also involve noticing overwhelm and strengthening a sense of choice. Trauma processing remains paced to your readiness; medication is not a reason to push through distress.
Turning insights into everyday actions
A meaningful realization becomes more useful when it connects to something manageable. Recognizing that you need support might lead to asking someone for one specific kind of help. Feeling more compassionate toward yourself might lead to taking a break without immediately criticizing yourself for it.
We can use familiar therapy tools, including behavioral activation, cognitive work, grounding, and communication practice, to support these steps. We also make room for setbacks and track changes in functioning over time, rather than judging progress by how dramatic a treatment session felt.
Safety and realistic expectations
These treatments require medical assessment and monitoring. Prescribers screen for medical and psychiatric conditions that can make treatment unsafe. Spravato can cause dissociation, sedation, nausea, blood pressure increases, and respiratory depression, and carries misuse risk. It is administered in a certified healthcare setting with at least two hours of monitoring. Patients must not drive until the next day after restful sleep.
With your permission, therapy can include coordination with your prescribing team about symptoms, concerns, and treatment goals. Changes to medication or dosing remain medical decisions. Neither ketamine nor esketamine is an FDA-approved treatment for PTSD, and trauma-focused work should not be confused with an approved medication indication.
Frequently asked questions
Do I need to be in therapy to receive Spravato?
No. Spravato is prescribed and administered by a medical team, and therapy is not required to receive it. Many people find it helpful to have a consistent therapeutic space alongside treatment, particularly to prepare beforehand and make sense of changes afterward.
When should I schedule therapy after a treatment session?
Timing is individualized. We meet after the immediate medication effects have fully resolved and plan sessions around your treatment schedule.
Can you coordinate with my prescriber?
Yes. With your written permission, we can communicate with your prescribing team about symptoms, concerns, and treatment goals. Medication decisions remain with your medical provider.
Ketamine and Spravato integration therapy at Endeavour Psychology Group
If you are considering ketamine or Spravato, or are already receiving treatment, contact Endeavour Psychology Group to discuss preparation and integration therapy as part of your broader care.
Sources
FDA. Spravato prescribing information, revised January 2025. Read source
FDA. Ketalar (ketamine hydrochloride) prescribing information. Read source
FDA. FDA warns patients and health care providers about potential risks associated with compounded ketamine products, including oral formulations, for the treatment of psychiatric disorders, October 2023. Read source
National Institute of Mental Health. Ketamine reverses neural changes underlying depression-related behaviors in mice, 2019. Read source
Wilkinson and colleagues. Cognitive Behavioral Therapy to Sustain the Antidepressant Effects of Ketamine in Treatment-Resistant Depression. Psychotherapy and Psychosomatics, 2021. Read source
