An emerging approach to couples therapy that brings together psychotherapy, neuroscience, and the exploration of relational experiences.
Long-term relationships have a way of bringing our most familiar patterns to the surface. The same conversations happen repeatedly. One partner reaches for connection while the other pulls away. Attempts to resolve conflict become opportunities to revisit old injuries. Even when both people genuinely want things to change, they may find themselves responding to one another in ways they don't fully understand or know how to interrupt.
For many couples, the difficulty isn't a lack of love or a willingness to work on the relationship. It is that certain emotional and relational patterns have become deeply established over time.
What happens when understanding those patterns intellectually isn't enough to create a different experience of one another?
This is one of the questions emerging in the field of ketamine-assisted psychotherapy (KAP) and its application to couples therapy.
While ketamine-assisted psychotherapy has primarily been studied in individual mental health treatment, researchers and clinicians are beginning to explore how it might complement relational psychotherapy. Early publications have proposed frameworks for integrating ketamine with established couples therapy approaches, and preliminary research has begun examining the experiences and outcomes of couples participating in this work.
At Rooted Healing Sanctuary in Camp Hill, Pennsylvania, we are interested in the evolving intersection of somatic psychotherapy, Internal Family Systems (IFS), attachment, and ketamine-assisted psychotherapy. Understanding the research requires looking beyond the medicine itself and considering the relational experiences, protective patterns, and therapeutic processes that shape how people connect with one another.
What Is Ketamine-Assisted Psychotherapy?
Ketamine-assisted psychotherapy combines the use of ketamine, when medically appropriate and supervised, with a structured psychotherapeutic process. This generally involves preparation, a medically supervised medicine experience, and subsequent therapeutic integration.
Ketamine is an NMDA receptor antagonist that influences glutamatergic signaling in the brain. Its pharmacological effects have been studied extensively in relation to depression, including treatment-resistant depression. Depending on the individual, dose, and clinical context, ketamine can also produce changes in perception, self-experience, emotional experience, and consciousness.
These experiences vary considerably. Some individuals describe greater perspective on familiar thoughts and patterns, while others experience dissociation, changes in sensory perception, or unfamiliar emotional experiences.
In ketamine-assisted psychotherapy, the medicine is not intended to replace the therapeutic relationship or the ongoing work of psychotherapy. Rather, it is incorporated into a broader treatment process that considers the individual's experiences before, during, and after the medicine session.
When considering its application to couples, an additional layer emerges: the relationship itself becomes part of the therapeutic context.
Why Are Researchers Exploring Ketamine-Assisted Couples Therapy?
Couples often develop predictable patterns of interacting that become increasingly difficult to interrupt.
Consider a familiar relational cycle:
One partner experiences emotional distance and begins pursuing reassurance or connection. The other experiences the pursuit as criticism or pressure and responds by withdrawing. The first partner experiences the withdrawal as rejection and increases their efforts to reconnect. The second partner becomes increasingly overwhelmed and less emotionally available.
Over time, both partners begin anticipating the same outcome.
These responses are often connected to attachment experiences, learned expectations, emotional vulnerabilities, and protective strategies. What appears on the surface to be a disagreement about communication may involve deeper experiences of rejection, inadequacy, shame, fear, or disconnection.
Even when couples recognize their patterns, changing them can be difficult. Understanding why a response occurs does not always translate into having a different response when emotions become activated.
Researchers are interested in whether ketamine might temporarily influence some of the cognitive and emotional processes involved in these patterns.
Potential areas of interest include:
Cognitive flexibility and the ability to consider alternative perspectives.
Reduced identification with familiar thoughts and interpretations.
Emotional accessibility and willingness to approach vulnerable experiences.
Perspective-taking and awareness of a partner's experience.
Opportunities for new learning and relational experiences.
These are proposed mechanisms and areas of investigation, not established outcomes of couples KAP. The distinction matters because we do not yet have sufficient clinical evidence to conclude that ketamine reliably changes attachment patterns or improves relationship functioning.
Can Altered States of Consciousness Help Couples Experience One Another Differently?
One of the most interesting questions in this emerging field concerns how altered states of consciousness might influence the way individuals experience themselves and their relationships.
In established patterns of relational distress, people can become increasingly identified with familiar interpretations of their partner.
A partner may be experienced as critical, unavailable, rejecting, demanding, or emotionally unsafe. These interpretations can become so familiar that it becomes difficult to consider other dimensions of the person's experience.
Ketamine can temporarily alter aspects of perception, self-experience, and the relationship individuals have with their thoughts. Some people describe experiencing familiar concerns from a different perspective or feeling less absorbed in their usual ways of thinking.
Researchers have proposed that these changes may offer opportunities for cognitive flexibility and perspective-taking.
In a relational context, this raises an important possibility: Could someone encounter their partner outside of the familiar conflict pattern long enough to become curious about what might be happening underneath it?
For example, a partner who typically experiences criticism may begin to recognize the loneliness or fear underneath their spouse's pursuit of connection. A partner who experiences withdrawal as rejection may begin to understand that their spouse's defensiveness is sometimes connected to shame or feelings of inadequacy.
This does not mean that ketamine creates empathy or guarantees a more accurate understanding of another person. An altered experience is not necessarily an accurate interpretation of a relationship.
Rather, the research invites us to consider whether changes in subjective experience could create opportunities for new perspectives that can subsequently be explored and integrated through psychotherapy.
The Role of Attachment and Protective Responses
Attachment experiences influence how people approach closeness, navigate emotional vulnerability, and respond to perceived threats to connection.
For some individuals, emotional closeness feels comforting and accessible. For others, it may bring up uncertainty, fear of rejection, or concerns about losing autonomy.
These experiences can influence the ways partners respond to one another, particularly during conflict or moments of vulnerability.
In couples therapy, we often explore the protective responses that emerge when people feel emotionally exposed.
One partner may become critical when they feel unheard. Another may become withdrawn when they feel inadequate. Someone may seek repeated reassurance because uncertainty feels difficult to tolerate. Another may rely on intellectualization or emotional distance to avoid experiences that feel overwhelming.
From an Internal Family Systems (IFS) perspective, these responses can be understood as protective parts that have developed in response to a person's experiences and perceived vulnerabilities.
The therapeutic process involves becoming curious about these responses rather than simply trying to eliminate them. We explore what they may be protecting, how they developed, and what happens when they take over during relational interactions.
The application of ketamine alongside IFS-informed couples therapy is an emerging area of clinical interest. A 2026 qualitative study by David O. Avruch interviewed nine clinicians incorporating ketamine into couples therapy, including clinicians working from Internal Family Systems, Emotionally Focused Couple Therapy, Imago Relationship Therapy, and Integrative Behavioral Couple Therapy.
The clinicians described using ketamine in ways they believed could support emotional expression, trust, perspective-taking, and exploration of attachment-related experiences.
These findings offer insight into how practitioners are approaching this work, but they do not establish that ketamine-assisted IFS or any other couples modality is clinically effective. Further research is needed.
What Does the Research on Ketamine-Assisted Couples Therapy Show?
Although the research is still developing, two publications provide an important starting point.
A proposed framework for ketamine-assisted couple therapy
In 2024, Khalifian and colleagues published A Novel Framework for Ketamine-Assisted Couple Therapy in Frontiers in Psychiatry.
The authors proposed a framework for integrating ketamine with established couples therapy approaches. They explored how ketamine's potential effects on cognitive flexibility, emotional processing, and psychological experience might complement existing therapeutic interventions.
The paper also considers the importance of preparation, the medicine experience, and integration within a relational treatment model.
Importantly, this publication is a clinical framework and review, not a randomized controlled trial demonstrating the effectiveness of couples KAP.
Exploring ketamine in group couples therapy
A particularly relevant study was published in 2024 by Cornfield and colleagues in the Journal of Psychedelic Studies.
The mixed-methods study examined 18 couples participating in a four-week group couples therapy program based on Imago Relationship Therapy.
Participants described a range of experiences, including increased vulnerability, alternative perspectives, greater awareness, changes in communication, and experiences of emotional connection.
The researchers also measured relationship satisfaction using the Couples Satisfaction Index. Scores improved following the program.
These findings are encouraging and provide an early foundation for further investigation.
However, the study did not include a comparison group receiving the same couples therapy without ketamine. Therefore, it cannot establish that ketamine itself caused the improvements. The contributions of the therapeutic approach, group experience, and medicine cannot be separated.
What are researchers examining now?
In 2026, Avruch published Approaches to Ketamine-Assisted Couple Therapy, a qualitative study examining how nine clinicians integrate ketamine into established couples therapy approaches.
The study highlights the diversity of clinical approaches being explored and the importance of preparation, relational context, and integration.
Together, these publications suggest that ketamine-assisted couples therapy is an emerging area of clinical interest. However, the evidence remains preliminary. Larger controlled studies are needed to understand effectiveness, safety, appropriate clinical applications, and long-term relational outcomes.
Why Preparation and Integration Matter
An important consideration in ketamine-assisted psychotherapy is that a meaningful medicine experience does not automatically translate into lasting change.
A couple may experience moments of emotional openness, increased perspective, or a profound sense of connection during treatment. But what happens when they return to their everyday lives?
Can they approach conflict differently?
Can they recognize their protective responses before acting from them?
Can they communicate needs without criticism or withdrawal?
Can they remain curious about one another when their experiences differ?
Can they take responsibility for the ways they have contributed to relational injuries?
These are questions that belong to the ongoing work of psychotherapy.
Preparation provides an opportunity to establish intentions, understand individual needs, discuss consent, and assess whether this form of treatment is appropriate. Integration helps individuals and couples explore their experiences without assuming that every sensation, image, or interpretation carries a specific meaning.
The goal is not to recreate an altered state or preserve a temporary feeling of closeness. It is to understand what was experienced and consider whether anything meaningful can be translated into everyday relational behavior.
Ketamine also carries medical and psychological risks and is not appropriate for everyone. Individual medical screening, qualified prescribing and monitoring, and careful assessment of relational safety are essential. Couples experiencing coercion, intimidation, or abuse require particular care, and conjoint altered-state work may be inappropriate.
Somatic Psychotherapy, IFS, and the Relational Experience
At Rooted Healing Sanctuary, our interest in couples therapy extends beyond communication strategies and conflict resolution.
We consider how individuals experience themselves physically and emotionally, how their histories influence their relationships, and how protective responses shape their interactions with the people they love.
Somatic psychotherapy brings attention to bodily experience as one avenue for understanding emotions, internal responses, and relational patterns.
Internal Family Systems offers a framework for exploring the different parts of ourselves that emerge around vulnerability, connection, conflict, and protection.
Attachment-informed couples therapy helps partners understand the relational patterns that develop between them and work toward greater emotional accessibility and responsiveness.
These approaches offer different ways of understanding the complexity of human relationships. When integrated thoughtfully, they can support a therapeutic process that considers the individual, the relationship, and the experiences that shape both.
Ketamine-assisted psychotherapy introduces additional questions about how altered states may influence these processes. It is an area that deserves continued research, clinical discernment, and thoughtful application.
Couples Therapy and Ketamine-Assisted Psychotherapy in Harrisburg and Camp Hill, PA
At Rooted Healing Sanctuary, located in Camp Hill, Pennsylvania, we work with individuals and couples navigating relationship distress, intimacy concerns, communication difficulties, emotional disconnection, and patterns that have become difficult to change.
Our approach integrates relational psychotherapy, somatic awareness, and Internal Family Systems-informed work. We are particularly interested in helping individuals and couples better understand the experiences underneath familiar patterns and develop new ways of relating to themselves and one another.
For couples in Harrisburg, Camp Hill, Mechanicsburg, and the surrounding Central Pennsylvania area, finding a therapist who understands the complexity of long-term relationships can be an important part of the process.
Ketamine-assisted psychotherapy is an evolving area of mental health treatment. It should be approached with careful consideration of the available research, individual suitability, medical oversight, and the therapeutic context in which it is offered.
We believe that meaningful relationship work requires more than learning how to communicate differently. It involves developing a deeper understanding of ourselves, recognizing the ways we have learned to protect ourselves, and becoming more intentional in how we participate in our relationships.
Healing in a relationship does not mean that we stop having difficult experiences. It means developing new ways to meet ourselves and one another within those experiences.
Rooted Healing Sanctuary offers couples and individual therapy in Camp Hill, PA, serving the greater Harrisburg and Central Pennsylvania community.
Learn more about our couples therapy and ketamine-assisted psychotherapy services at Rooted Healing Sanctuary.
References
Avruch, David O. “Approaches to Ketamine-Assisted Couple Therapy.” Frontiers in Psychology, vol. 17, 2026, article 1843151. https://doi.org/10.3389/fpsyg.2026.1843151.
Cornfield, Mark, et al. “Exploring Effects and Experiences of Ketamine in Group Couples Therapy.” Journal of Psychedelic Studies, vol. 8, no. 2, 2024, pp. 233–247. https://doi.org/10.1556/2054.2024.00302.
Khalifian, C., et al. “A Novel Framework for Ketamine-Assisted Couple Therapy.” Frontiers in Psychiatry, vol. 15, 2024, article 1376646. https://doi.org/10.3389/fpsyt.2024.1376646.
