People usually arrive at this question already partway down the road. They have found an infusion clinic and a therapy practice, both offering ketamine, at very different prices, and the websites do not explain why. Sometimes they have already done a round of infusions, felt something shift, watched it fade, and are trying to understand what happened.
The difference is not the drug. In most cases it is the same molecule. The difference is what is built around it, and that turns out to matter more than most marketing suggests.
The short version
An infusion clinic delivers ketamine as a medical treatment. A ketamine assisted therapy practice delivers ketamine as part of a psychotherapy process.
Both are legitimate. They are answering different questions. The infusion model asks whether this medication can reduce your symptoms. The KAP model asks what becomes possible in your therapy when this medication is part of it.
Which one is right depends on what you are actually trying to do.
What is the same
Both use ketamine, a Schedule III controlled substance that is FDA approved as an anesthetic and used off label for depression, PTSD, anxiety, and chronic pain. Neither use is FDA approved for those conditions. Both should involve medical screening, informed consent, monitoring during administration, and a clinician who knows what they are doing.
Both are also working from an evidence base that is real but still maturing. Ketamine’s rapid antidepressant effects are well documented. Whether adding structured psychotherapy improves or extends those effects is an active research question with promising early findings and no definitive answer yet.
Anyone who tells you otherwise, in either model, is selling.
Difference one: preparation
In most infusion settings, the appointment is the beginning. You are screened medically, you arrive, you are dosed.
In ketamine assisted therapy, one to three preparation sessions come first. We talk about what you are hoping for and what you are afraid of. We talk about what you want to happen if grief shows up, or rage, or a memory you have not thought about in fifteen years. We choose music. We plan your ride home. We talk about what your nervous system does under pressure, because that is what is going to be in the room.
This is not a wellness ritual. Preparation is, in my experience over more than six hundred hours of these sessions, the single strongest predictor of whether a dosing session goes somewhere useful. People who arrive prepared tend to meet what surfaces. People who arrive cold tend to brace against it, and bracing against a dissociative medicine is its own kind of difficult.
Difference two: who is in the room, and for how long
This is the question I would ask first if I were shopping.
In many infusion settings, a nurse or physician monitors vital signs and is available, but you are largely alone with the experience. Some clinics use a shared room with recliners. Some check on you periodically. This is appropriate to a medical model, where the intervention is the medication and the job is safe delivery.
In our model, I am in the room for the entire dosing session. Not monitoring from a station. In the room, tracking you, for roughly two hours.
That distinction matters because of what ketamine does. It reduces the ordinary defenses that keep difficult material at a distance. That is much of its therapeutic promise, and it is also why the hour can turn. Someone with a trauma history can arrive at something they have spent decades organizing their life around not arriving at. What happens in that moment depends entirely on whether there is a trauma trained clinician present who knows what to do with it.
When that goes well, it is remarkable. When there is no one there, it is a person alone in a recliner with the worst thing that ever happened to them.
This is the part I spend the most time on when I train other therapists and medical providers in this work. The medicine is the simple part. Knowing what to do when something surfaces is what takes years.
Difference three: what happens in the hours after
Ketamine’s acute effects fade in under an hour. What it stirs up does not.
The hours and days after a session are frequently when the material actually lands. People describe crying in the car, sleeping strangely, feeling raw or wide open, or arriving at a thought they cannot unthink. In a purely medical model, this window typically has no clinical structure around it. You go home and wait for the next appointment.
Difference four: integration, which is where the therapy is
Integration means sitting down with what came up and making something of it. Connecting it to your history, your relationships, your patterns. Deciding what changes.
In ketamine assisted therapy this is a scheduled, billed, non-optional part of treatment. In our practice it may include Brainspotting, EMDR, parts work, or somatic therapy depending on what surfaced and what you respond to.
Ketamine appears to create a window of increased neuroplasticity, a period where the brain is more available to change. What happens during that window is not determined by the medicine. It is determined by what you do.
Without integration, people often report the same arc: something opens, they feel meaningfully better for a stretch, and then it closes and the old pattern reasserts itself. They conclude ketamine did not work for them. In many cases the medicine did exactly what it does. There was simply nothing built to use it.
Difference five: coordination between prescriber and therapist
In an infusion clinic, medical and psychological care are usually separate. You may have a therapist elsewhere who is not in contact with the clinic and may not even know you are doing this.
In our model, the prescribing provider and I are working from a shared treatment plan. They handle medical screening and administration independently, as is appropriate to their license and mine. I handle the therapeutic work. But we are coordinating about the same person, adjusting the plan together, and neither of us is guessing about what the other is doing.
When an infusion clinic is the better choice
I would not send everyone to KAP, and it would be dishonest to write this without saying so.
If you are in acute crisis with severe treatment resistant depression or active suicidality, the speed and medical intensity of an IV infusion protocol may be the right call. IV administration allows precise titration and immediate adjustment. That is a real clinical advantage.
If your primary need is symptom reduction and you already have a strong therapeutic relationship elsewhere, an infusion series coordinated with your existing therapist can work well.
If cost is the deciding factor and the choice is between an infusion series and nothing, an infusion series is not nothing.
And if you have a complex cardiac history or medical complexity that warrants a physician-led setting with full medical resources, that is where you should be.
The question is not which model is better. It is which one matches what you need right now.
A word about at-home ketamine
There is a third model that has grown quickly: telehealth companies that mail compounded ketamine lozenges for use at home, sometimes with a video check-in on the first dose and little clinical contact after that.
The FDA has issued warnings about compounded ketamine products, noting that use without a health care provider monitoring for sedation, dissociation, and changes in vital signs may put patients at risk of serious adverse events. Compounded products are not FDA approved, which means their safety, effectiveness, and quality have not been evaluated before marketing.
Beyond the medical concerns, there is a clinical one. The entire argument for ketamine assisted therapy is that the medicine opens something and a trained person helps you work with it. A subscription model strips out the trained person and keeps the drug. For someone with a trauma history, that is the arrangement I would worry about most.
How our process works
Consultation and treatment planning. Independent medical screening by the prescribing provider. One to three preparation sessions. Dosing sessions of about two hours with me present throughout, medicine administered intramuscularly by the prescriber. Integration sessions after each dosing session. Ongoing adjustment of the plan.
Costs are listed on our ketamine assisted psychotherapy page, along with contraindications and financial assistance resources.
Frequently asked questions
Is ketamine assisted therapy more effective than infusions?
The honest answer is that head to head research is limited. Existing studies on combining psychotherapy with ketamine are promising but mostly small and not yet definitive. What can be said is that the two models are structured to accomplish different things.
Why does ketamine assisted therapy cost more?
You are paying for clinical time, not just medication. Preparation sessions, two hours of a therapist present during dosing, and integration sessions afterward. The medicine is a small fraction of the cost in either model.
Can I do infusions and see a therapist separately?
Yes, and if your therapist is trauma trained and you coordinate deliberately, that can work well. What tends not to work is doing infusions with no therapeutic structure and hoping the effects hold on their own.
Does either one work for PTSD?
Ketamine is used off label for PTSD in both models, and the FDA has not approved it for that use. Research is ongoing. What we can say from clinical experience is that trauma material surfaces frequently during these sessions, which is precisely why we think the presence of a trauma trained clinician matters.
How do I know if a provider is legitimate?
Ask who is in the room during dosing and for how long. Ask what preparation and integration are included. Ask about their specific ketamine training. Ask what they do when something difficult comes up. Vague answers are informative.
If you are weighing these options in Nashville, we are glad to talk it through, including telling you if we think a different model would serve you better. Complete our client prescreen or email Admin@TraumaTherapyNashville.com.
Melanie Reese, LMFT, is a Certified Clinical Trauma Professional and Certified Brainspotting Consultant in Nashville with more than fifteen years of experience as a trauma therapist. She has guided over six hundred hours of ketamine assisted therapy sessions and trains therapists and medical providers in ketamine assisted therapy through Groundwork Trauma Education. She has guest lectured at Vanderbilt School of Nursing on psychedelic assisted therapy in clinical practice and offers trainings to help therapists support clients in preparation and integration of non-ordinary experiences.
Medically reviewed by Nora Cheney, MSN, APRN, PMHNP-BC
Related: ketamine assisted psychotherapy, trauma and complex PTSD, Brainspotting, IFS parts work.