Setting Intentions in Ketamine Therapy

There is a fundamental and internally incongruent truth regarding the management of depression: while we sometimes seek resources from outside of us to treat symptoms, ultimately, our improvement can only be attributable to us – our choices, our perseverance, and our collaboration.  Medications, therapy, community, and (of course) ketamine/esketamine all come from outside of us to treat a deeply personal struggle.  And yet, sitting on balance with this external source of care is the individual’s own reliance on internal resources.  How do I approach me.  

As a physician, my training has been predicated on my ability to resource modalities to suggest, prescribe, and provide to patients treatments that (hopefully) resolve episodes of psychiatric symptoms.  Implicit to my training has been a narrative thread of my own indefatigable ability to approach illness and quash it.  But this is not the full picture… Just as patients are looking to ketamine and esketamine to open new perspectives, I submit that providing these medications has opened my mind to a more balanced approach to wellness – to an approach that emphasizes the role of self-activation and self-directed care in the management of what can seem like intransigent illness.

What is Setting Intention

In treatment with ketamine and Spravato (esketamine), we activate the self-principle by “setting intention.”  First and foremost, suggesting to someone undergoing a ketamine or esketamine course of care to “set intention” is, at its core, an affirmation that the person undergoing treatment is effectively taking ownership of the experience.  Rather than be in passive receipt of treatment, we begin the ketamine and esketamine process by setting a frame that a person has the capacity to be his/her/their own agent-of-treatment.  Anathema to so many elements of my own training, we begin care by acknowledging that medical reach only goes so far and meaningful change is best catalyzed by acknowledging that the person having the experience is also its director. 

How do I set intentions?

“How do I set intentions?”  The question may sound procedural at first — like a checklist item before a session begins. But in truth, the process of setting intentions is deeply personal, psychologically rich, and invaluable for shaping therapeutic outcomes. As with many interventions that straddle biology and experience, the “set and setting” of ketamine work matters — and intention is at the heart of that set.  It also helps to connect to the principle that a person’s control or influence over recovery is present and alive throughout all parts of treatment, a principle that we should honor, identify, and continually activate.

How to Set Your Intentions

So, how to set intentions for a ketamine session?  First, we ask patients to slow down.  Setting an intention is not about “fixing” something or naming an outcome. It begins with reflection. Where am I right now? What emotional currents are stirring beneath the surface? What feels unresolved, or especially alive?

Sometimes, people come in with clear concerns — grief after loss, anxiety that has become unbearable, a sense of disconnection from purpose. In these cases, an intention might sound like:

• “To sit with my grief, without rushing to change it.”
• “To explore the roots of my anxiety with curiosity.”
• “To reconnect with a sense of meaning in my life.”

I like to start out speaking with patients about setting a global intention of curiosity.  The subjective experience of being under the throes of ketamine and esketamine can be wonderous, bizarre, anxiety provoking, stimulating, and so on.  If no other intention can be found, then a desire for discovery, of seeing what’s behind the next corner, and of welcoming novelty is a great first platform.  Engaging curious experiences requires an implicit belief in one’s own competence (i.e., to manage with strange new things) and capacity for wonder. 

Intentions may not always be apparent at the outset.  Sometimes, intentions emerge slowly, even in the hours before the session or mid-session. Gentleness, curiosity, open-ness around experience - an intention should feel like an invitation — not a command.

Examples of Intentions in Ketamine Therapy

There is no single list of “best” examples of intentions ketamine work requires, but some common themes do recur. Over time, we’ve observed intentions that fall into broad categories:

• Emotional processing: “To feel what I’ve been avoiding.”
• Self-compassion: “To soften the inner critic.”
• Insight-seeking: “To understand why I react the way I do.”
• Connection: “To open my heart to people I care about.”
• Letting go: “To release an old story that no longer serves me.”
  
  
  

We also caution against overly concrete or performance-driven intentions like, “To solve my depression today,” or “To fix myself.” These tend to carry judgment and pressure. The medicine doesn’t work through control — it works through surrender, awareness, and the unexpected.

What a person originally sets as an intention to partner with the experience may or may not be what ends up being the ultimate theme realized at the end of the experience.  The ketamine and esketamine treatment experience can foster creativity and facilitate the introduction of other ideas that can absolutely be played with and engaged.  Even while the specifics to the intention set can change from beginning-middle-end, taking a minute to pause, set aside mental space to engage the practice of entering into a different state of mind, and affirm one’s partnership with the medicine and with recovery is a strong frame to engage care.

When Intentions Shift

One of the paradoxes of ketamine work is that sometimes the most powerful moments emerge when the original intention is transcended. A patient may come in wanting to feel less anxious, and instead confront an old memory that unlocks deeper healing. Or they may simply feel peace for the first time in years, and realize that was what they truly needed.

This is why we hold intentions lightly. We encourage patients to revisit them before integration — what felt true? What emerged instead? Did the intention evolve mid-session? These reflections help build the bridge between altered states and day-to-day change.

Integration and the Return to Intention

A session does not end when the effects of the medication wear off. In fact, that’s when some of the most meaningful work begins. Integration — the process of making sense of the experience and weaving it into one’s life — is where intentions often return in full view.

A patient who set the intention to “understand why I keep sabotaging relationships” might not receive a tidy answer in session. But in the days after, a phrase, image, or emotional tone may rise again — and bring with it a new level of understanding. That thread can be picked up in therapy, in journaling, or in quiet contemplation. How to set your intentions is not just a prelude to therapy — it’s a practice that continues through the cycle of healing.

Ketamine Therapy and Intentions

In a world driven by metrics and outcomes, it can feel unfamiliar — even uncomfortable — to engage in a process that values intention over control. But setting intentions in ketamine and esketamine therapy is not about scripting the experience. It’s about bringing awareness to what matters most right now, and then allowing the medicine, the mind, and the body to engage in a dialogue.

As clinicians and patients alike deepen their understanding of this work, we come to see that the power of ketamine/esketamine lies not only in its chemistry, but in the relationship it facilitates — with our stories, our wounds, our wisdom. And it begins, gently, with the question: What is calling my intention today?

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