Integrating EMDR Therapy with Ketamine-Assisted Psychotherapy: A Guide for EMDR Therapists

Guest Blog Post by Janet Bayramyan Generales, LCSW

As both an EMDR therapist and someone deeply invested in trauma recovery, I have spent years exploring different modalities to help my clients heal. One emerging approach that has caught my attention is ketamine-assisted psychotherapy (KAP). Over the years, I’ve worked with clients who felt stuck in their trauma processing, unable to move past certain barriers even with traditional EMDR. In my search for solutions, I started exploring the role of ketamine, which research suggests can facilitate trauma processing by reducing fear responses and enhancing neuroplasticity (Dore et al., 2019; Feder et al., 2021).

What drew me to ketamine assisted EMDR work was a continued curiosity and desire to continue to enhance my EMDR practice and to answer the call and need from my prospective clients. Many, many clients expressed a growing curiosity to incorporate psychedelics into their EMDR work, and I thought it would be a beautiful opportunity to explore this much more deeply.

This article aims to provide EMDR therapists with a clear, research-backed framework for integrating ketamine into trauma treatment. I will share both clinical insights and empirical evidence to help guide ethical and effective implementation.

Understanding ketamine’s role in trauma treatment

Ketamine is a dissociative anesthetic that has been used in medical settings since the 1960s. More recently, it has gained attention in psychiatric treatment for its rapid-acting antidepressant effects (Berman et al., 2000; Zarate et al., 2006). Unlike traditional antidepressants, which target serotonin and dopamine, ketamine works through the glutamate system, promoting synaptic plasticity and enhancing cognitive flexibility (Duman & Aghajanian, 2012).

For clients with PTSD, ketamine’s ability to temporarily reduce fear and hyperarousal may allow them to engage with traumatic memories in a way that feels less overwhelming (Feder et al., 2021). Studies have also shown that ketamine can significantly reduce suicidal ideation and depressive symptoms, which can be crucial for clients who feel hopeless in their trauma recovery (Wilkinson et al., 2018).

Why combine EMDR with ketamine?

Enhanced processing of traumatic memories. Many clients struggle with intense distress during EMDR’s desensitization and reprocessing phases. Ketamine’s calming effects can help reduce this distress, allowing them to process traumatic memories with greater ease (Dore et al., 2019). What I have found is that there may be instances where clients have walls or resistant parts of themselves that prevent them from going deep into their subconscious to really process the past memory. I have found that with ketamine assisted EMDR, those “protectors” are able to calm down and not inhibit the client’s process.
Increased neuroplasticity. EMDR therapy helps clients to access adaptive information and bolster existing adaptive neural pathways through reprocessing traumatic memories. Ketamine’s ability to promote synaptogenesis (the process by which new connections, or synapses, are formed between neurons in the brain) may enhance this process, potentially leading to faster and more profound healing (Duman & Aghajanian, 2012). Essentially, ketamine helps to create new neural pathways to promote healthier ways of thinking after trauma reprocessing for memory reconsolidation.
Expedited relief from PTSD symptoms. For some clients, particularly those with complex trauma or treatment-resistant PTSD, standard EMDR can feel slow or even ineffective. Ketamine’s rapid antidepressant effects may help alleviate symptoms more quickly, making it easier for clients to engage in therapy (Wilkinson et al., 2018). Ketamine can help accelerate the process and reduce the number of EMDR sessions needed to work through one target.

Best practices for integration

Collaboration with medical providers. As an EMDR therapist, I do not prescribe medication, and it is essential to collaborate with licensed medical professionals when integrating ketamine into therapy. Psychiatrists, anesthesiologists, or nurse practitioners trained in KAP can help determine whether ketamine is appropriate for a client and monitor for potential risks (Dore et al., 2019).
Preparation phase: Setting intentions and psychoeducation. Before client sessions where they have taken the prescribed ketamine, I spend time helping my clients develop grounding techniques to manage dissociation and understand how ketamine works and what to expect during a session. I make sure that clients understand the role of the ketamine and that they understand what their prescriber shared with them about how the ketamine needs to be administered. I also support the client in helping them identify their target and engage in the preparation stage of EMDR. Setting intentions for their experience is also incredibly important.
Choosing the right ketamine delivery method. Ketamine can be administered in different ways, each with its own therapeutic implications:
- Intramuscular (IM) or Intravenous (IV) – Provides a rapid and intense dissociative experience, requiring structured integration afterward (Dore et al., 2019).
- Sublingual or Oral Lozenges – A gentler, longer-lasting experience that can be more easily incorporated into EMDR sessions (Dore et al., 2019).
- Intranasal (Spravato®) – FDA-approved for treatment-resistant depression, but not specifically for trauma work (Wilkinson et al., 2018).
Consider the timing of EMDR reprocessing within ketamine sessions.
- During the peak experience (30-45 minutes post-administration): Some therapists use gentle bilateral stimulation (eye movements, tapping) to help clients explore emotions and insights.
- Post-ketamine integration (24-72 hours later): Clients often experience increased cognitive flexibility after ketamine (Feder et al., 2021), making it an ideal time for deeper trauma reprocessing through EMDR. With this flexibility, individuals may have an easier time working through feelings of shame, negative thoughts, and negative core beliefs and move into more accurate ways of thinking.
Adapting EMDR protocols for ketamine sessions. In my practice, I have adjusted the standard EMDR protocol when working with ketamine. I received training in Ketamine-Assisted Psychotherapy through Journey Clinical, as well as training in ketamine assisted EMDR work through an EMDRIA-approved continuing education program by Danielle Ciccone. It is important that if you combine ketamine assisted work with EMDR, you receive the appropriate training and supportive consultation. It can also be beneficial for you to do your own work with ketamine assisted EMDR and experience it yourself to know what your client will be going through. Key modifications include:
- Assessment phase: Helping clients identify key trauma targets before ketamine sessions.
- Desensitization phase: Using bilateral stimulation in a way that matches the pace of the altered state that ketamine induces.
- Body Scan Phase: Encouraging clients to integrate ketamine-induced insights into their somatic experience.

Addressing potential challenges

Managing dissociation and grounding: While ketamine can help clients access trauma, it can also induce dissociation. To mitigate this, I ensure my clients are trained in grounding techniques before beginning KAP (e.g., sensory awareness, anchoring affirmations). I also make sure that clients have enough of a window of tolerance to be able to tolerate distress and also tolerate positive affect, which are both required when engaging in trauma reprocessing.

Client selection and readiness: Not every client is a good candidate for ketamine-assisted EMDR. Important considerations include:

The client’s ability to integrate the experience
The absence of active psychosis or untreated mania
The presence of a strong therapeutic alliance
Consider medical contraindications such as uncontrolled hypertension and other heart conditions
Psychological contraindications also include clients with bipolar disorder, uncontrolled substance use, psychotic symptoms, and extreme dissociative symptoms

Ethical and legal considerations: Because ketamine is a controlled substance, therapists must:

Work within their scope of practice
Obtain informed consent that clearly explains the nature of this work
Follow legal and ethical guidelines surrounding psychedelic-assisted therapy (Dore et al., 2019)
Engage in regular consultation and supervision, particularly if this work is new to you and your practice

Case Example: Integrating EMDR and ketamine in practice

A 42-year-old woman with complex PTSD had tried multiple forms of therapy, including traditional EMDR therapy, but remained stuck and unable to work through negative core beliefs. After consulting with a psychiatrist, she began ketamine lozenge sessions, with EMDR integration 48 hours post-administration. Over eight weeks, she reported reduced emotional reactivity to traumatic memories and increased cognitive flexibility. From my perspective as her therapist, the shift was profound—previously unresolvable memories, memories that appeared to loop, became more accessible, and she was finally able to move through her trauma processing.

KAP and EMDR offer new possibilities

The combination of EMDR and ketamine-assisted psychotherapy offers exciting possibilities for trauma treatment. While more research is needed, early studies and clinical experiences suggest that ketamine can enhance EMDR therapy by reducing fear responses, increasing neuroplasticity, and accelerating symptom relief. As EMDR therapists, we have an opportunity to collaborate with medical professionals to offer clients innovative, evidence-based healing modalities.

Janet Bayramyan is a licensed clinical social worker in California, Flordia, South Carolina, Texas, Connecticut and North Carolina as well as an EMDRIA Certified Therapist™. With a cultural background of Russian, Armenian, and American influences, she carries the blief that culture plays a significant role in overall wellness. Bayramyan has over eight years of experience as a trauma therapist and carries training in Ketamine Assisted Psychotherapy, Brainspotting, Attachment Focused EMDR, Havening Techniques and IFS level 1 and 2.

References

Berman, R. M., Cappiello, A., Anand, A., Oren, D. A., Heninger, G. R., Charney, D. S., & Krystal, J. H. (2000). Antidepressant effects of ketamine in depressed patients. Biological Psychiatry, 47(4), 351-354. https://doi.org/10.1016/s0006-3223(99)00230-9

Dore, J., Turnipseed, B., Dwyer, S., Turnipseed, A., Andries, J., Ascani, G., Monnette, C., Huidekoper, A., Strauss, N., & Wolfson, P. (2019). Ketamine assisted psychotherapy (KAP): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. Journal of Psychoactive Drugs, 51(2), 189-198. https://doi.org/10.1080/02791072.2019.1587556

Duman, R. S., & Aghajanian, G. K. (2012). Synaptic dysfunction in depression: Potential therapeutic targets. Science, 338(6103), 68-72. https://doi.org/10.1126/science.1222939

Feder, A., Costi, S., Rutter, S. B., Collins, A. B., Govindarajulu, U., Jha, M. K., Horn, S. R., Kautz, M., Corniquel, M., Collins, K. A., Bevilacqua, L., Glasgow, A. M., Brallier, J., Pietrzak, R. H., Murrough, J. W., & Charney, D. S. (2021). A randomized controlled trial of repeated ketamine administration for chronic posttraumatic stress disorder. The American Journal of Psychiatry, 178(2), 103-206. https://doi.org/10.1080/02791072.2019.1587556

Wilkinson, S. T., Ballard, E. D., Bloch, M. H., Mathew, S. J., Murrough, J. W., Feder, A., Sos, P., Wang, G., Zarate, Jr., C. A., & Sanacora, G. (2018). The effect of a single dose of intravenous ketamine on suicidal ideation: A systematic review and individual participant data meta-analysis. American Journal of Psychiatry, 175(2), 95-192. https://doi.org/10.1176/appi.ajp.2017.17040472

Zarate, C. A., Jr., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R., Luckenbaugh, D. A., Charney, D. S., & Manji, H. K. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856–864. https://doi.org/10.1001/archpsyc.63.8.856

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Integrating EMDR Therapy with Ketamine-Assisted Psychotherapy: A Guide for EMDR Therapists