Patient consultation workflow for ketamine-assisted therapy and Spravato

TL;DR:

• A careful consultation process builds safety and helps you arrive at treatment prepared, emotionally and practically.
• Screening combines questionnaires, a medical history and a clinician’s evaluation to decide whether ketamine-assisted psychotherapy or Spravato fits you.
• After a session, integration therapy and regular check-ins help turn what surfaced into lasting change.

When the path toward healing feels uncertain, a clear consultation process can make a real difference. Ketamine-assisted psychotherapy and Spravato (esketamine) offer new options for people whose depression has not responded to other treatment, and ketamine is also used off-label for conditions such as PTSD and anxiety. But stepping into this kind of care without knowing the workflow can feel overwhelming. This guide walks you through each stage of the consultation process as it works at Mystic Health in Santa Monica: what to bring to your first appointment, how screening works, what a session looks like, and how integration and follow-up support you afterward. Our goal is to help you feel prepared, safe and ready to show up for yourself.

Key Takeaways

1. 01

   Preparation matters

   Bringing your medical history, medication list and past treatment records helps your clinician plan safely.

2. 02

   Stepwise screening

   Standard questionnaires and a full medical evaluation come before any treatment is scheduled.

3. 03

   Two related treatments

   Spravato is FDA-approved for depression and often insured; ketamine-assisted psychotherapy is off-label and self-pay.

4. 04

   Session design shapes the experience

   A calm room, a clear plan and a clinician monitoring you make a session safer and easier to work with.

5. 05

   Integration is ongoing

   Follow-up therapy and repeat check-ins help you and your care team see what is changing.

Preparing for your consultation: What you need to know

The first step is preparation, and for ketamine-based treatment it is not just logistical. It is emotional, psychological and personal. When you come to your first medical consultation, the care team needs a full picture of who you are. That means bringing your medical history, a complete list of current medications and supplements, and any prior mental health diagnoses or treatment records you can access. The more honest and thorough you are at this stage, the more safely and accurately your care team can decide what fits you.

Many people start before the consultation itself. At Mystic, you can begin with a free discovery call with our care team, or take our 3-minute questionnaire, which uses the PHQ-9 and GAD-7 screeners and can be shared with the team. If you are considering Spravato, we also run a free insurance benefits check, because coverage usually depends on documenting the antidepressants you have already tried.

It also helps to know how the two ketamine-based treatments differ before you arrive:

Before your consultation, here are the key things to prepare:

• Gather your medical history, including surgeries, chronic conditions and hospitalizations
• Write down every medication and supplement you take, with doses
• List the antidepressants and other psychiatric medications you have tried, for how long, and what happened
• Note any prior therapy, psychiatric treatment or diagnoses
• Reflect honestly on your symptoms and what you hope to gain from treatment
• Think about your support system, including who can drive you home on treatment days

Understanding the screening and assessment process

Once you know what to bring, it helps to understand the screening itself. This part of the process is designed to protect you, not to gatekeep. Think of it as a careful conversation between your history and your future care team. It generally unfolds in three stages.

1. Questionnaires: You complete standard mental health screening tools, either before your visit or with support from staff. These measure symptom severity and how much your symptoms affect daily life, and they give clinicians a baseline.

2. Care team conversation: A member of the care team reviews your answers, clarifies your history and answers practical questions about cost, insurance, scheduling and what treatment days involve.

3. Medical evaluation: A physician or psychiatric nurse practitioner completes a full medical and psychiatric evaluation. This step decides whether treatment is appropriate and which route fits. Nothing is scheduled until a clinician has reviewed your history. A full medical and psychiatric evaluation is a standard part of ketamine-assisted psychotherapy.

Here is a look at what common assessments measure:

The evaluation also checks for reasons treatment may not be safe. These include certain blood vessel conditions, a history of bleeding in the brain, uncontrolled high blood pressure or unstable heart disease, active uncontrolled psychosis or mania, and a known allergy to ketamine or esketamine. If one of these applies, your clinician will talk with you about other options. Sometimes the most useful outcome is a better-run medication trial or a course of psychotherapy first.

Screening also starts a therapeutic relationship. By the time you finish these steps, your care team has begun to know you, and that connection is part of the work ahead. Reading a patient’s guide to ketamine clinics beforehand can help you walk in feeling oriented rather than anxious.

Treatment day: Setting, support, and session design

Once screening is complete and a plan is agreed, you move into treatment. This is where the process shifts from paperwork and interviews to something more personal, and how a session is designed shapes what you carry out of it.

Clinicians often talk about “set and setting.” Set refers to your mindset coming into the session. Setting refers to the physical and relational environment around you. Many clinicians in the field consider these, along with the therapeutic relationship, to matter alongside the medicine itself, which is why preparation and the room you are in get so much attention.

For ketamine-assisted psychotherapy at Mystic, a session takes place in a private room with a comfortable chair, eyeshades and music. A licensed therapist is with you throughout, and a clinician doses the medicine and monitors you. For Spravato, you take the nasal spray yourself under supervision, then rest in a private room for at least two hours while a clinician checks your blood pressure, as the FDA’s REMS safety program requires.

Here is what a typical ketamine-assisted session day might include:

• Arrival and a blood pressure check
• A brief check-in with your therapist to revisit your intentions for the session
• Settling into the room: lighting, music and anything you have brought for comfort
• A conversation about your boundaries and how you would like to be supported
• The medicine, given by a clinician
• Your therapist present throughout, with monitoring of your vital signs
• A gentle return, with quiet time before talking things through
• Going home with a driver, since you cannot drive for the rest of the day

Safety note: Your consent shapes every part of the session. If you have questions about what support will look like, including how your therapist will check in with you, ask before the day of your appointment.

Session design is not one-size-fits-all. Some people prefer a deeply inward, eyes-closed experience with music. Others feel steadier with a therapist nearby who speaks softly or offers grounding. Telling your team your preferences ahead of time lets them adjust the experience for you. Our conversation with Dr. Nick Schiavoni explores how clinicians think about the ketamine experience, and how to prepare for ketamine sessions covers practical steps.

After the session: Integration, follow-up, and tracking progress

After a session, the focus moves to making sense of what came up and getting ongoing support. This phase is often underestimated. The session may open a door, and integration is how you walk through it in daily life.

Integration in ketamine-assisted psychotherapy means processing the emotional and psychological material that surfaced during your session, with a therapist who helps you connect it to your life. It is not something to rush. At Mystic, each ketamine session is followed by a dedicated integration session, usually within 72 hours. You can read more in what integration is and why it matters.

Here is an after-session checklist to guide your follow-up:

1. Rest, and give yourself at least a day before making major decisions or returning to stressful responsibilities
2. Do not drive until the next day, after a full night’s sleep
3. Journal or voice-record any images, feelings or insights from the session
4. Attend your integration session within 72 hours
5. Notice your mood, sleep and emotional state over the following two weeks
6. Contact your care team if distressing symptoms come up or you feel unsettled

Ongoing care depends on how you respond. Your team looks at what has moved, using repeat questionnaires, clinical check-ins and your own sense of how life is going, and adjusts the plan. Treatment continues only while it is helping. Many people also continue psychotherapy or psychiatric care alongside or after a course.

Other ways to support integration include:

• A daily mindfulness or breathing practice
• Movement such as walking, stretching or yoga
• Creative expression through art, music or writing
• Conversations with people you trust
• Working with your therapist on where insights can be applied in daily life

Support from the people around you matters. For many people, it is the bridge between a meaningful session and lasting change. The goal is not only fewer symptoms, but a life that feels more manageable and more your own.

What most guides miss about consultation workflows

Most guides focus on the medicine: dosing, session length, contraindications. Those things matter, and they are your clinician’s job. But as a co-founder who has spent years building mental health services, and as someone with my own lived experience of ketamine therapy, I have come to believe that the medicine works best when the relationships and preparation around it are strong.

Approaches to ketamine care vary. Some put therapeutic presence and emotional support at the center. Others focus mainly on the medicine, with little psychological support around it. At Mystic, our clinicians build ketamine-assisted psychotherapy around preparation and integration with a therapist, because that structure is what helps people make use of the session.

What people need is a workflow built around them: their history, their pace, their culture and their support system. The consultation workflow is not bureaucracy. It is care in action.

Start your consultation with Mystic Health

If reading this has stirred something in you, whether readiness or just curiosity, that is worth honoring. Taking one small step toward exploring your options takes courage.

At Mystic Health, our physician-led team offers ketamine-assisted psychotherapy, Spravato, psychiatry and psychotherapy in Santa Monica. Whether you are just beginning to explore or ready to be screened, you can book a free discovery call and our team will meet you where you are. If Spravato turns out to be the better fit for you, that is what we will recommend.

Frequently asked questions

Recommended

• Step by Step Ketamine Therapy: A First-Timer's Guide
• Your Guide to Spravato Treatment: What to Expect
• How to Prepare for Ketamine Sessions: 2026 Guide