Ketamine can reduce depression symptoms within hours. That speed is real, and for patients who have spent years waiting for medications to work, it matters. But rapid symptom relief and lasting change are not the same thing — and confusing them is one of the most common misunderstandings about what ketamine treatment actually is. At Nomad Therapeutics, our treatment model is built around a structured three-phase approach that uses ketamine’s neurobiological effects as a catalyst for durable improvement, not a temporary fix.
Why Structure Matters
Ketamine promotes neuroplasticity — the brain’s ability to form new neural connections and adapt existing ones (National Institutes of Health). It also increases brain-derived neurotrophic factor (BDNF), a protein essential for neuron growth and long-term mood regulation (National Institutes of Health). Together, these effects create a brief window in which the brain becomes more open to change. Rigid patterns of thinking that have felt immovable become temporarily more flexible. Emotions that have been out of reach become more accessible.
That window is the opportunity. But windows close. Without intentional therapeutic work before and after each session, the neuroplasticity ketamine creates has nowhere meaningful to go. Research supports that combining ketamine with structured psychotherapy may produce deeper and more durable improvements than ketamine alone (National Institutes of Health). The three-phase model is how we put that research into practice. To understand more about how our ketamine-assisted psychotherapy program is structured, visit the full service page.
Phase One: Preparation
Preparation happens before each medication session. You work with your therapist to set intentions for the upcoming experience — to identify what you want to focus on, what you hope to access, and how you want to approach the session. This isn’t logistical planning. It’s therapeutic groundwork that directly shapes what happens during the ketamine experience.
Patients who arrive at a session with clear intentions and a grounded sense of direction tend to engage more meaningfully with what emerges. Those who arrive without preparation are more likely to experience the session passively, or with ambient anxiety that narrows what the experience can offer. The preparation phase is also where your therapist helps you build the psychological safety needed to stay open during the session — particularly important for patients managing trauma or severe anxiety.
At Nomad Therapeutics, you can complete preparation sessions with your existing therapist if they’re trained in ketamine-assisted psychotherapy. If not, our Nomad Network connects you with KAP-specialized therapists in Seattle who can provide this support.
Phase Two: The Medication Session
The medication session is administered by one of our registered nurses, who comes to your home or your therapist’s office at the appointed time. The nurse confirms your identity, checks baseline vital signs, reviews key safety questions, and sets up monitoring equipment before the session begins.
Ketamine is administered via intramuscular (IM) injection, most commonly in the upper arm. Patients typically begin feeling the effects within three to five minutes. The experience that follows is difficult to describe precisely because it varies considerably between individuals — but common themes include a sense of distance from habitual thought patterns, increased emotional accessibility, and what many patients describe as perspective: the ability to see their lives, relationships, and challenges from an angle that wasn’t available to them before.
Throughout the session, your nurse monitors your vital signs periodically and remains present to support you. Common temporary side effects can include nausea, dizziness, or a dreamlike state of dissociation. These are expected, manageable, and typically resolve as the acute effects fade — generally within 20 to 30 minutes. After the session, your nurse confirms your vitals have returned to baseline before completing discharge guidance and wrapping up. The full visit typically lasts 60 to 90 minutes. Our at-home ketamine therapy page covers what the home-visit experience looks like in more detail.
This phase is not a standalone event. It is the middle of a three-part cycle, and its value depends significantly on what happens before and after.
Phase Three: Integration
Integration is where the lasting work of ketamine-assisted psychotherapy happens. It takes place after each medication session — ideally within 24 to 72 hours, when the neuroplasticity window is still active and insights from the session are most accessible.
In integration sessions, you work with your therapist to examine what emerged during the ketamine experience. What thoughts arose? What emotions surfaced that are usually out of reach? What did you see differently? The goal isn’t to analyze the experience for its own sake — it’s to identify what was meaningful and build a concrete bridge from that insight into your daily life. New ways of thinking don’t take root automatically. Integration is the process of deliberately planting them.
For patients with depression, integration often focuses on interrupting the patterns of negative self-regard that have become automatic. For PTSD patients, it may involve gently processing material that felt more approachable during the session. For anxiety patients, it frequently centers on identifying avoidance behaviors that have been reinforced over time and beginning to challenge them while the nervous system remains in a more flexible state.
Without integration, the ketamine experience remains just an experience — vivid, sometimes moving, but disconnected from lasting behavioral change. With it, the three-phase cycle becomes a genuine mechanism for the kind of improvement that persists well beyond the treatment protocol itself.
How the Full Protocol Works
Our standard course of treatment involves six sessions over three weeks, administered twice per week. This protocol has the most supporting clinical evidence for treatment-resistant conditions. Across those six sessions, the three-phase cycle repeats — creating multiple opportunities to prepare, experience, process, and integrate.
The six sessions are structured in three phases at the protocol level as well. Sessions one and two focus on orientation and dose finding: establishing safety, confirming tolerability, and identifying the right therapeutic dose range for each patient. Sessions three and four leverage the momentum built in the first phase to disrupt negative symptom patterns and deepen the window for cognitive and emotional shifts. Sessions five and six consolidate the gains made and prepare the patient for what comes next — whether that’s maintenance sessions, return to their primary provider, or an ongoing therapeutic relationship.
We currently do not accept insurance. Payment is made through our electronic health record system and we accept credit and debit. A Good Faith Estimate is available upon request. Results vary by individual, and ketamine-assisted psychotherapy is not appropriate for everyone. We encourage you to discuss your options with our clinical team before beginning treatment.
FAQ
Do I need to do all three phases every single session?
Yes. Preparation and integration are required components of our treatment model, not optional add-ons. Integration therapy is incorporated as clinically appropriate rather than mechanically after every session, but the therapeutic relationship with your KAP therapist is a requirement throughout the protocol.
What if I don’t have anything specific to focus on during preparation?
Your therapist will help you develop that focus. It doesn’t require a precise agenda — it requires a direction. Most patients find that the preparation process itself surfaces what matters most, even when they arrive uncertain of where to start.
What does the ketamine experience actually feel like?
It varies. Many patients describe a dreamlike quality, a sense of emotional openness, or a shift in perspective that makes habitual thought patterns feel less automatic. Some experience vivid imagery; others experience a quieting of mental noise. The experience is shaped in part by what you bring into it — which is why preparation matters.
How soon after a session should I do integration therapy?
Within 24 to 72 hours is ideal, while the neuroplasticity window remains active and the session is still fresh. Your Nomad Therapeutics representative will help you coordinate the timing of your medication and integration sessions when you schedule your treatment.
Can I do integration therapy on my own, without a therapist?
Journaling and reflective practices in the hours after a session can be valuable complements to formal integration. However, working with a trained therapist for integration sessions is a clinical requirement of our treatment model, not a suggestion. The structure and expertise a KAP-trained therapist brings to integration is what translates the ketamine experience into lasting change.
Key Takeaways
- Ketamine promotes neuroplasticity and increases BDNF, creating a temporary window in which the brain is more open to change — but that window requires intentional therapeutic use to produce lasting results.
- The preparation phase shapes what emerges during the medication session; patients who arrive with clear intentions and therapeutic grounding tend to have more meaningful experiences.
- The medication session is administered by a registered nurse in your home or therapist’s office, with full vital sign monitoring throughout, and lasts 60 to 90 minutes in total.
- Integration therapy — ideally within 24 to 72 hours of each session — is where insights are translated into concrete behavioral change; without it, the experience doesn’t become lasting improvement.
- Nomad Therapeutics’ standard protocol involves six sessions over three weeks, structured across three protocol phases designed to orient, deepen, and consolidate therapeutic gains.
Understanding the three phases is understanding why ketamine-assisted psychotherapy works when ketamine alone often doesn’t. If you’re in the Seattle area and want to know whether this model is right for your situation, reach out to Nomad Therapeutics for a free consultation. Call or text 425-598-7088, or complete the form on our website.
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References
- National Institutes of Health. Ketamine and neuroplasticity. https://pmc.ncbi.nlm.nih.gov/articles/PMC8190578/
- National Institutes of Health. Ketamine increases BDNF. https://pubmed.ncbi.nlm.nih.gov/39684808/
- National Institutes of Health. Ketamine-assisted psychotherapy. https://pmc.ncbi.nlm.nih.gov/articles/PMC9207256/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine-assisted psychotherapy should only be pursued under the supervision of a licensed clinical provider familiar with your full medical and psychiatric history. Results vary by individual. Only a qualified provider can determine whether this treatment is appropriate for your specific situation. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline, available 24 hours a day, seven days a week.