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- Online Therapy in Seattle, WA and Across Washington
Life can look fine on the outside and still feel ungrounded inside.
You’ve probably already tried therapy, and it hasn’t fully worked. The fear, the trauma, the anxiety, they keep circling back, almost like they’re haunting you. You’re exhausted, drained, and maybe starting to feel like nothing will actually shift.
Ketamine-Assisted Psychotherapy pairs ketamine with real preparation and integration, measured, safe steps that let you go underneath all of it without falling apart, so things can finally start moving forward.
Something deeper is at play, something that talk alone hasn't been able to fully reach.
You already know what the preliminary stages of therapy look like. You’ve done some of that work, and it helped, up to a point. But the same roadblocks keep showing up again and again, and you’re starting to understand that something much deeper is there that doesn’t allow you to fully move forward.
Even when life looks stable from the outside, it can feel hard to find that grounded place inside.
Ketamine creates a window where emotional defenses soften and what’s been stuck has room to surface. That window on its own doesn’t do the work. It’s the preparation before it and the integration after it that turn what surfaces into something you can actually carry forward.
KAP tends to make sense for people who are ready for something beyond where talk therapy alone has taken them:
Preparation and integration are where the real shift happens.
The dosing session is one part of KAP. What happens before and after it is what turns that experience into lasting change. We build enough stability first, then take measured, safe steps into what the ketamine opens up, then spend real time making sense of it together.
Hi, I’m Cuyler Simmons, LICSW, SUDP
I’m a licensed clinical social worker and trauma therapist working online with people across Washington State. The people I work with usually aren’t new to therapy. They’ve already done the initial work and are ready to go underneath the patterns that keep resurfacing. KAP is one of the ways I support that, alongside IFS, EMDR, and somatic work.
What I Offer:
KAP moves through three phases, and each one shapes what the next one can do. Preparation gets you ready. Dosing opens the window. Integration is where the deeper work actually lands.
Before anything else, we get you ready. That means naming what you’re hoping to reach, understanding the parts of you that might come up, and building enough stability that the dosing session feels like a measured step rather than a leap. It typically takes two to four preparation sessions before your first dose. This is what makes the session actually mean something afterward.
What this looks like:
During the dosing session, you self-administer ketamine lozenges that dissolve under the tongue, in a supported setting of your choice. The effects begin within 15 to 20 minutes, and the altered state usually lasts between 45 and 90 minutes. You’ll be lying down, eye mask on, music in the background. Some people encounter imagery, emotions, or things they haven’t been able to touch in regular sessions. Others have something quieter. There’s no right way for it to go. I’m available for integration within 48 hours after the dosing session.
What this looks like:
Not sure which type of ketamine provider is right for you? See the FAQ below on choosing a provider, or reach out and I’ll walk you through the options.
What happens after the dosing session matters as much as the session itself. We meet within 48 hours and then continue in the weeks that follow to work through what came up and connect it to your life. Without integration, what surfaces during a dosing session tends to fade. With it, it becomes part of something that lasts.
What this looks like:
Ketamine clinics that offer dosing without ongoing psychotherapy are a different thing entirely. The preparation and integration I offer aren’t extras around a medicine session. They’re the reason what the ketamine opens up turns into something you can actually carry forward. Roadblocks that keep resurfacing need more than the medicine itself. They need the therapeutic process built around it.
KAP tends to help most when other approaches have taken you as far as they can, and there’s still something deeper at play.
Treatment-resistant depression is depression that hasn’t responded to at least two different antidepressant treatments. You’ve already tried things. It’s not about effort. Ketamine has one of the strongest track records for reaching this kind of depression, often bringing noticeable shifts within days rather than weeks. Paired with integration work, those shifts can go past symptom relief into the patterns underneath the depression.
Complex trauma and PTSD live in parts of the nervous system that talk therapy alone sometimes can’t fully reach. KAP creates a window where emotional defenses soften and what’s been sealed off becomes more approachable, without needing to relive trauma in vivid detail. Integration sessions afterward help connect what surfaced to lasting change, at a pace your nervous system can actually tolerate.
Anxiety that has roots in unresolved trauma or early relational wounds doesn’t always respond fully to skills-based approaches alone. KAP can soften the emotional intensity around what’s underneath the anxiety, so the deeper work becomes possible without flooding. The window ketamine opens isn’t sedation. It’s a shift that can make room to be present with hard material without the usual overwhelm.
Unresolved grief often gets stuck when there wasn’t enough safety or space to fully mourn. Parts that had to keep going, stay strong, or hold things together can carry unprocessed grief for years. KAP can help reconnect you with what was set aside, bringing what felt out of reach in ordinary sessions closer to the surface in a way that can finally be met.
Chronic shame is often held by parts that learned to carry blame as a way to make sense of what happened. KAP softens the grip of that internal criticism enough to look at it differently, with more distance and more compassion than is usually available in the middle of a shame spiral. Integration work helps that softer relationship with yourself become something more lasting.
The same roadblocks may have been showing up for years. That doesn’t mean they have to keep shaping the rest of your life.
Your first session is a conversation about the roadblocks that keep showing up, where you feel stuck, and whether now is the right time for this kind of work. We start by understanding what’s been happening and building a clear direction from there. I explain how the process works, what the dosing session actually involves, and what integration looks like.
Here’s what the first session covers:
You’ll leave with a clearer sense of whether this feels like the right next step and whether you’re grounded enough for this kind of work right now. KAP asks for real effort. The first session is partly about figuring out whether you’re ready for that, and what getting ready might take.
A conversation helps us understand where you’re feeling stuck and whether this is the right place to begin.
Ketamine-Assisted Psychotherapy pairs ketamine with real preparation and integration work, not just a dosing session on its own. Ketamine is a legal medicine that’s been used safely in medical settings for decades. At the doses used in KAP, it creates a temporary window where emotional defenses soften and material that’s been hard to reach in regular sessions becomes more approachable. The psychotherapy around that window, not the ketamine itself, is what turns the experience into lasting change.
KAP stands for Ketamine-Assisted Psychotherapy. The name points to what makes it different from a standalone ketamine session: the psychotherapy that surrounds it. That includes preparation sessions before the dosing experience and integration sessions afterward, which is where the deeper work actually happens.
Ketamine acts on NMDA receptors in ways that differ from traditional antidepressants, and appears to stimulate AMPA receptors as well, which is part of why it can bring relief faster than medications that take weeks to work. What matters most for the work we do together isn’t the receptor science. It’s that ketamine creates a period of increased flexibility, where old patterns may not feel quite as fixed, and that window is what preparation and integration are built to use well.
KAP tends to help most with treatment-resistant depression, complex trauma and PTSD, anxiety rooted in trauma, unresolved grief, and chronic shame that hasn’t shifted with other approaches. It’s also relevant for people navigating chronic pain, eating patterns, or substance use where the roadblocks keep resurfacing despite real effort in other kinds of therapy.
KAP tends to be a good fit for people who’ve already done real work in therapy and feel stuck at a ceiling, where insight hasn’t fully translated into change. It works best for people who are grounded enough to go into difficult material, meaning your basic needs are met, and you have enough stability and support to handle what might come up. You don’t need a formal diagnosis. If the roadblocks keep showing up despite the work you’ve already done, KAP is worth exploring.
KAP isn’t right for everyone. It’s generally not appropriate during an active suicidal crisis, for people with a personal or family history of psychosis, during active substance use or withdrawal, or when there isn’t enough stability and support in place to safely do this kind of work. Eligibility is determined by the medical provider you choose, not by me alone. If you’re unsure whether KAP is appropriate for you, the initial consultation is the right place to explore that honestly.
The process moves through three phases. In preparation, we set intentions, get your system ready, and build enough stability to take this on. The dosing session uses sublingual ketamine lozenges to create a temporary altered state, usually lasting 45 to 90 minutes, where defenses soften and old patterns feel less fixed. Integration happens afterward, within 48 hours and in the sessions that follow, where we work through what surfaced and connect it to your life. That last phase is where the deeper healing actually happens.
You self-administer ketamine lozenges that dissolve under the tongue, in a supported setting of your choice. Effects begin within 15 to 20 minutes and the altered state typically lasts 45 to 90 minutes. You’ll be lying down with an eye mask and music. Some people encounter imagery, emotions, or memories they haven’t been able to touch in regular sessions. Others have something quieter. There’s no right way for it to unfold.
Preparation happens over multiple sessions before the dosing session itself. We work on setting intentions, naming the parts that might come up, and building grounding tools you can use after the experience. You’ll also complete a medical intake with your chosen provider, who assesses eligibility and prescribes the ketamine. On the day of a dosing session, eat lightly, arrange for someone to be with you afterward, and give yourself the rest of the day.
KAP isn’t brief. Most series involve six to eight dosing sessions on average, alongside preparation and integration sessions throughout, and the full course can span several months. What takes the time isn’t just the dosing sessions themselves. It’s the preparation that makes each one productive and the integration that turns what surfaces into something lasting. Some people notice meaningful shifts within the first few sessions. Others need more time to work through what comes up in layers.
Effectiveness varies from person to person, and I’m honest about that with everyone I work with. What I’ve seen in my own practice is that outcomes are significantly better when preparation and integration are taken seriously, not treated as formalities around the dosing session. The ketamine opens something. What you do with that opening, in the sessions before and after, is what shapes whether the change actually lasts.
Ketamine has been used safely in medical settings for decades and is on the World Health Organization’s List of Essential Medicines. At the doses used in KAP, it’s generally considered safe for eligible people, though it’s not appropriate for everyone. Certain psychiatric conditions, histories of psychosis, and active substance use can affect eligibility. Safety comes from careful screening through the medical intake, real preparation beforehand, and integration support available within 48 hours after the dosing session.
People who come to KAP have usually already done therapy and understand something deeper is at play. They’re not looking for more insight into why the roadblocks exist. They’re ready to work with what’s underneath them. Some have treatment-resistant depression that hasn’t responded to medication. Some are drawn to psychedelic-assisted therapy but want real preparation and support around it rather than doing it alone.
Yes. Preparation and integration sessions are conducted online via secure telehealth for clients throughout Washington State. The dosing session itself is self-administered in your own space, since sublingual ketamine doesn’t require an in-clinic infusion. Working this way means we can meet consistently without geography getting in the way, wherever you are in the state.
I work with clients across the Greater Seattle Area, the Eastside, and Washington State more broadly, entirely online. There’s no physical office to visit. All preparation and integration sessions happen over secure telehealth, which means where you live in the state doesn’t limit access to this work.
Integration is the work we do together after a dosing session to make sense of what came up and connect it to your life. Without it, whatever surfaced during the dosing session tends to fade. With it, insight has a chance to become something you actually carry forward. This is why preparation and integration matter as much as the medicine itself. The dosing session opens a window. Integration is what you build through it.
No. You don’t need an existing therapist to begin. I provide the psychotherapy side of KAP, preparation and integration, while the medical evaluation and prescribing happen through the ketamine provider of your choice. If you’re not sure which provider makes sense for you, I’ve put together a comparison of different options, at-home and in-person, to help you find the right fit. We work through that together from the start.
Providers generally fall into two categories. At-home providers prescribe sublingual lozenges that ship to you, so preparation, dosing, and integration can all happen without leaving your space. In-person and clinic-based providers offer IV or intramuscular ketamine administered on-site, often with a shorter dosing window but a required trip to a physical location. Some clinics build psychotherapy into the visit itself, while others focus on the medical side only and expect you to coordinate integration separately.
Ketamine has a strong safety profile at the doses used in KAP, but it isn’t risk-free. Short-term effects can include nausea, dizziness, changes in heart rate and blood pressure, and a feeling of being tired or slower than usual for the rest of the day. Most of these pass within a few hours of the session.
Medical restrictions matter too. Uncontrolled hypertension, certain heart conditions, a history of psychosis, and some medications can affect eligibility or interact with ketamine. This is exactly why the medical screening through your chosen provider comes before any dosing session, not after. Clinical administration of ketamine is a monitored process for a reason, and being upfront about your full health history during intake is what keeps that process safe.
Ketamine infusion clinics typically deliver IV ketamine for symptom relief without an ongoing psychotherapy relationship built around it. KAP is a different model. The medicine is one part of a longer process that includes preparation before and integration after, with a therapist involved throughout, not just during the dosing itself. Neither approach is wrong. They’re built for different things.
TMS and ECT are separate treatments entirely, using magnetic or electrical stimulation rather than medicine, and they follow their own protocols through psychiatric providers. KAP isn’t a replacement for those and doesn’t claim to work the same way. If you’ve already tried standard talk therapy and it hasn’t moved the roadblocks you’re carrying, KAP offers a genuinely different route in, built around ketamine’s ability to soften defenses combined with real preparation and integration work.
A comprehensive KAP program has two cost components: my psychotherapy sessions and the ketamine itself through your chosen medical provider. Your full treatment plan, including how many dosing sessions make sense, gets built during the initial consultation.
Visit our complete FAQs page for more questions about KAP therapy in Seattle.
It’s an inside job. Peace starts here.
A free consultation is where we begin understanding the roadblocks that brought you here. We’ll have an honest conversation about whether KAP feels like the right next step, and whether now is the right time for this kind of work.
