Ketamine therapy in Seattle: KAP & KA-EMDR
Preparation, support during prescribed ketamine sessions, and integration. KAP and KA-EMDR within a therapy relationship.
Practice details
When progress feels incomplete
Many people reach a point where traditional therapy helps, but only to a point. You've done the work. You understand the patterns. You can narrate the history. And something shifted — but not all the way. There's still a shutdown that won't open, a layer of emotion you can't reach, a numbness that hasn't lifted, or a sense of living behind glass.
If that is where you are, we can talk about what has helped, what hasn't, and whether ketamine belongs in what comes next. That decision includes an assessment with a medical prescriber and a conversation about uncertainty, risks, and other options.
Two approaches I offer
KA-EMDR (Ketamine-Assisted EMDR)
I combine prescribed low-dose sublingual ketamine with EMDR. The intention is to work actively with memories, body sensations, and emotions during the session. A lower dose does not guarantee alertness or the ability to participate. We discuss what this work would involve before deciding whether to include it; the prescriber sets the dose and medical plan.
When EMDR feels stuck, we look at what has been difficult and what else might help. The evidence for combining EMDR with ketamine is still limited. Difficulty with EMDR does not, by itself, establish that adding ketamine will help.
My training: Introduction to Ketamine-Assisted EMDR Therapy. More about my EMDR practice →
Traditional KAP
In traditional KAP, I provide support during a session with prescribed sublingual ketamine, generally at a higher dose than in KA-EMDR. The experience varies. It may involve changes in perception, emotion, or your sense of yourself. My role is presence, grounding, and attention to what you are experiencing. We are not planning active EMDR processing during that session. In integration afterward, we talk about what happened and how it connects to your life.
Shame, numbness, and questions about identity may be part of what brings you to therapy. They do not, by themselves, tell us whether ketamine is appropriate. These are things I work with in ongoing therapy, whether or not we include KAP.
My training: Professional Certificate in Ketamine-Assisted Psychotherapy (KAP), Fluence, plus Essentials of Psychedelic Therapy (Fluence).
Some clients use both approaches at different points. We consider each choice together, with the medical prescriber, rather than assuming a particular sequence will be useful.
How ketamine works
Ketamine is an NMDA receptor antagonist. Researchers are studying how its effects relate to changes in mood and learning. Accounts of increased neuroplasticity do not tell us exactly what will happen in a therapy session or establish a deadline for integration. I schedule integration close to the dose so we can work with the experience while it's still fresh.
What I'd want a client to know: the strongest depression evidence is for intravenous ketamine and intranasal esketamine. That research does not establish the same benefits for sublingual KAP or KA-EMDR. Research on combining ketamine with psychotherapy is still developing. KA-EMDR’s research base is small and early; we still need controlled studies to learn whether adding ketamine improves outcomes beyond EMDR alone. Whether adding psychotherapy extends ketamine's benefits remains uncertain. You can read the 2026 systematic review of ketamine-assisted psychotherapies.
You can read more about how I think about learning and change, including the limits of that account, in How Therapy Changes Memory.
How sessions work
My KAP work includes four phases.
1. Medical evaluation — with a licensed prescriber, not with me. I currently work with three: Gail Dawson, PMHNP; LoAn Pham, DNP; and Isha Health, a physician-led telehealth platform. Which one fits depends on the protocol, your insurance, and their availability — we sort that out in preparation. They determine whether ketamine is medically appropriate for you, screen for contraindications, set the dose and route, and handle all prescribing. I am not a medical provider. I do not prescribe ketamine. All medical decisions sit with the prescriber. The prescriber and I have distinct roles in your care.
2. Preparation — with me, before any medicine session. We work through your intentions, your history, what helps when things become difficult, and what the practical experience of a session involves. We discuss whether KA-EMDR, traditional KAP, or another approach fits what you need, alongside the prescriber's assessment and medical plan.
3. Dosing — with me, in my office or by telehealth, depending on what your prescriber agrees to. The shape of this session depends on the approach. KA-EMDR is intended to include active EMDR work when you are able to participate. In traditional KAP, I provide presence and grounding without asking you to talk through everything as it happens. In both, I attend to your experience and adjust the therapeutic pacing. Medical decisions remain with your prescriber.
4. Integration — with me, in the days following. We talk about what came up, what it means to you, and how it connects to daily life. Integration is part of the KAP service I offer.
I work with a separate prescriber. They are responsible for medical assessment and prescribing; I am responsible for psychotherapy. Each of us is accountable for the part we're trained in.
Who this is right for, and who it isn't
We consider your goals, treatment history, current circumstances, and the prescriber's assessment. Having tried therapy before does not mean you need ketamine, and feeling stuck does not establish that it will help. We can discuss what other forms of care might offer, too.
KAP is not right for everyone. The prescriber assesses medical risks and suitability; I assess whether the psychotherapy support I offer fits your needs. Some circumstances call for a different setting or level of care. My service includes preparation and integration. If you are seeking medication treatment without ongoing psychotherapy, a medical provider can discuss those options with you.
If you're not sure where you fall, that's something we work out in consultation. Part of preparation is considering whether to include KAP or continue with trauma therapy without ketamine.
Research and further reading
- Ketamine-assisted EMDR: a chart review (Topel & Ciccone, 2025) — records of eight clients with PTSD showed symptoms and impairment improving after four KA-EMDR sessions. There was no comparison group, so it can’t show that ketamine added anything to EMDR, and the authors developed the approach and train clinicians in it.
- Ketamine-assisted psychotherapy: a 2026 systematic review (Veraart et al.) — outcomes were promising, but protocols varied and few studies compared ketamine plus therapy with ketamine alone. Much of the strongest ketamine evidence comes from IV ketamine and esketamine, not sublingual KAP.
KAP vs. infusion clinics
Infusion clinics provide intravenous ketamine in a medical setting; their psychotherapy offerings vary. I provide psychotherapy preparation, support during prescribed ketamine sessions, and integration. If you've tried infusions and they helped during but the effect didn't hold, we can talk about what happened and whether integration has a place in what comes next.
For support after psilocybin, MDMA, or ayahuasca experiences, I also offer psychedelic integration as a separate service.
Common Questions
Do you prescribe ketamine?
No. I am not a medical provider. Prescribing, medical evaluation, and safety screening are handled by a separate licensed medical provider — I connect you with one of the prescribers I work with: Gail Dawson, PMHNP; LoAn Pham, DNP; or Isha Health. I provide the therapeutic support: preparation, presence during dosing sessions, and integration therapy afterward.
What's the difference between KA-EMDR and traditional KAP?
In KA-EMDR, the intention is to combine prescribed ketamine with active EMDR work during the session. In traditional KAP, I provide support during the experience and we explore it in integration afterward. The prescriber determines the dose and medical plan. A lower dose does not guarantee alertness or an ability to participate in EMDR. We discuss the differences and the limited evidence for combining these methods before deciding what to try.
What if I get overwhelmed during the session?
During sessions I support, I stay with you, attend to your experience, and offer grounding. We can pause the therapeutic work rather than press ahead. Distress can also continue after the acute effects of ketamine have passed. We discuss support and the response to medical concerns in preparation; my psychotherapy support does not replace medical care.
How much does KAP cost?
Preparation sessions are 90 minutes at $300. Dosing sessions are $500 for two to three hours and are private pay. Integration sessions are standard 55-minute sessions at $175. All of it is on my Rates page. Whether preparation and integration can be billed to your insurance plan depends on the plan; ask me before we start. The medical provider I connect you with bills separately for their services, and the prescription itself is a separate cost.
What is the difference between ketamine-assisted psychotherapy and a ketamine infusion clinic?
Infusion clinics provide intravenous ketamine in a medical setting, and their psychotherapy offerings vary. I provide preparation, therapeutic support during prescribed ketamine sessions, and integration afterward. In therapy, we work with what came up and how it connects to your life. A medical provider can discuss infusion treatment and other medication options with you.
Is ketamine therapy legal in Washington state?
Yes. Ketamine is FDA-approved as an anesthetic, and licensed medical providers can legally prescribe it off-label for psychiatric conditions including depression, anxiety, and PTSD. (Esketamine, sold as Spravato, is a related but distinct medication with its own FDA-approved psychiatric indications and monitoring requirements.) In my practice, all prescribing is handled by a separate licensed medical provider I connect you with. I provide the psychotherapy component—preparation, therapeutic support during sessions, and integration.
I'm not in Seattle — can I still work with you?
Yes, if you're located in Washington or Colorado. KAP is offered in person at my Capitol Hill office (226 Summit Ave E, Office B-03) and by telehealth across Washington State and Colorado; I hold licenses in both, and one of the prescribers I work with is based in Colorado. Dosing sessions can happen in my office, over telehealth, or independently with a chaperone present — which option is available depends on what your prescriber agrees to. Telehealth dosing carries added safety requirements set by the prescriber: a chaperone must be physically present, you'll need your own blood pressure monitor and take readings per their protocol, and we'll confirm your exact location at the start of each session. I'm not providing medical monitoring; that layer stays with the prescriber. If you need a higher level of medical care than this therapy-centered model provides, I can refer you to a ketamine infusion clinic. You need to be physically located in Washington or Colorado at the time of every session; which prescriber fits depends partly on where you are.
How many sessions does KAP involve?
A typical arc is six to eight dosing sessions, but the full structure includes more than that. New clients begin with three 90-minute preparation sessions before the first dose — covering clinical intake, KAP-specific education, intention setting, and resourcing skills. Existing therapy clients who add KAP need only one preparation session. Each dosing session runs two to three hours and is followed by multiple integration sessions before the next dose. Integration is where we work with what surfaced during dosing. We adjust the pace together, within the medical plan set by your prescriber.
What do I need to do on the day of a dosing session?
Follow your prescriber's individualized preparation and aftercare instructions, including directions about food, liquids, medications, alcohol, cannabis, and other substances. Ask them about anything unclear; do not stop or change medication based on this page. Arrange the chaperone and transport required for your session, and follow your prescriber's driving restrictions. Wear loose, comfortable clothing and plan a quiet evening. Bring a comfort object if it helps; an eye mask, blanket, water, and tissues are provided. The session itself runs two to three hours.
Who is KAP not a good fit for?
KAP isn't right for everyone. The medical prescriber reviews your health and psychiatric history, medications, substance use, and current circumstances to assess risks and medical suitability. I consider whether my psychotherapy support fits your needs and whether another setting or level of care would be more appropriate. We can wait or pursue other therapeutic work.
Can KAP help with anxiety?
Anxiety is not the first thing I would consider KAP for. We start with what you're experiencing, what you have tried, and what other options are available. Anxiety alone does not tell us whether ketamine is appropriate. If we consider KAP, we discuss the uncertainty, risks, and alternatives with the medical prescriber.
I don't feel depressed — I feel nothing. Can KAP help?
Maybe. Feeling nothing doesn't tell us, by itself, whether ketamine is a good fit. People describe it as flat, going through the motions, watching their own life from a distance. We start by understanding what you're experiencing and what you've already tried. If we consider KAP, that includes an assessment with the medical prescriber and a conversation about the risks, uncertainty, and other options. Afterward, we look together at what changed, what didn't, and what would be useful next.
What's expected of me between dosing sessions?
Active integration. Each dosing session is followed by one or more integration sessions where we discuss what happened and how it connects to your life. Between sessions, you'll be asked to journal, take voice memos, or capture images of what stays with you. Time in nature, gentle movement, or creative practice are possibilities too, if they suit you. We discuss giving major decisions time rather than treating an intense experience as an instruction. You decide what to share with other people; you do not need a finished interpretation before seeking support.
Is KAP the same as psychedelic therapy?
They overlap, but the terms are not interchangeable. Ketamine is a dissociative anesthetic, not a classic serotonergic psychedelic such as psilocybin or LSD. Some experiences can feel similar, but that does not make their effects, risks, or treatments the same. The service I describe here uses prescribed ketamine with psychotherapy preparation, dosing-session support, and integration. Other psychedelic-assisted approaches have different evidence and legal frameworks.
How I think about this work → Approach
If you are experiencing a difficult psychedelic or ketamine experience and need immediate support, contact the Fireside Project at 623-473-7433 (62-FIRESIDE). For all crisis resources, see my FAQ page.