How ketamine-assisted psychotherapy is transforming the way patients with serious illness find peace and emotional relief

Rochester, New York – A little more than two years ago, an idea began taking shape at the University of Rochester Medical Center that would challenge the boundaries of traditional palliative care. The vision, led by Rob Horowitz, MD, was not just about treating pain or physical symptoms, but about addressing something often harder to reach—the deep psychological and spiritual suffering that can come with serious illness. His proposal combined conventional medical, psychological, and spiritual support with something unconventional: a guided psychedelic experience using ketamine.

That vision became reality in June 2023, when the first patient entered the Palliative Care Ketamine-Assisted Psychotherapy (Pal-KAP) clinic. This first-of-its-kind program in the United States has since been offering a unique path for patients to find peace in the face of serious, and often terminal, illness.

“People with serious illness struggle with psychological or spiritual uncertainty, from mild anxiety to overwhelming despair,” says Horowitz, the Georgia and Thomas Gosnell Distinguished Professor in Palliative Care at the University of Rochester Medical Center (URMC). “Conventional treatments can help, but resources are limited, and suffering is profound. Ketamine-assisted psychotherapy is potentially a powerful additional resource. In the context of a trusting human relationship, it can catalyze profound exploration and relief.”

Meeting Needs Conventional Care Can’t Always Reach

Patients with advanced cancer, heart disease, or progressive neurological conditions often endure more than just physical pain. They face what clinicians call psychospiritual distress—a heavy blend of anxiety, hopelessness, and fear of death. Traditional palliative approaches can ease some of that burden through medication, counseling, and spiritual care. But for many, the ache goes deeper, beyond the reach of those methods.

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For those patients, Pal-KAP offers another avenue. Ketamine, long known as a safe anesthetic, has in recent years been recognized for its ability—at much lower doses—to shift consciousness, soften mental barriers, and open emotional doors that had long been locked.

The Three Phases of the Pal-KAP Journey

The program’s structure is carefully designed to make the experience safe, supportive, and transformative:

1. Preparation. Patients meet with trained facilitators in a calming, art-filled space. Here, trust is built. Patients learn what they might feel during the session and set personal intentions—anything from making peace with mortality to reconnecting with loved ones or rediscovering meaning beyond illness.

2. Ketamine Session. The medication is administered in a low dose. Patients lie back with eyes covered, listening to a specially curated playlist through headphones. The session, lasting 45 to 60 minutes, is not about conversation. Facilitators remain close, offering quiet presence and reassurance if needed.

3. Integration. In follow-up meetings, the experiences are unpacked. These conversations help patients process imagery, emotions, and insights—transforming a temporary altered state into lasting emotional and relational change.

Stories That Numbers Cannot Capture

While the team began by measuring outcomes like anxiety levels, depression scores, and fear of death, they soon found that personal stories revealed far more about the therapy’s impact.

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Some patients describe their relationship with death changing completely. Fear gives way to calm acceptance, and moments once filled with dread now hold peace. One individual, looking at a photo of their grandchildren after treatment, felt only love and warmth—no trace of fear about leaving them behind.

Others report sensations of floating outside their own bodies, seeing life from a new vantage point, and feeling connected to something larger. Many experience what they describe as spiritual renewal.

Perhaps most importantly, some gain a sense of control over their suffering. They learn to separate their identity from their illness, reclaiming the ability to choose how they respond to pain, panic, or fear. One patient with terminal cancer, initially consumed by terror, declared after three sessions that they no longer feared death—they had done the inner work to say goodbye on their own terms.

Building for the Future

The program’s growth depends on both financial and scientific foundations. A generous $1 million philanthropic gift, divided between patient care and research, has allowed Pal-KAP to remain focused on its mission without compromising accessibility.

On the research side, Marc Swogger, PhD, associate professor of Psychiatry and Palliative Care at URMC, is leading a four-year study to map out ketamine-assisted psychotherapy practices nationwide. This research ranges from low-dose, no-therapy approaches to fully integrated models like Pal-KAP. The aim is to identify what works best and to seek FDA approval for broader use, including in other serious and psychiatric conditions.

Training is another key component. Earlier this year, the team hosted a workshop focused on serving deaf patients—a population often excluded from such care. This September, a new immersive course will bring together clinicians from multiple disciplines to learn the Pal-KAP approach, spreading its principles beyond Rochester.

Quiet but Steady Progress

To date, just 25 patients have gone through the Pal-KAP program. The slow pace is deliberate—each patient receives deeply personalized care. But the stories emerging from those sessions point toward a quiet revolution in how palliative care is practiced.

This is not about promising miracles or erasing pain entirely. It’s about making space for peace, for reconnection, for a shift in how life’s final chapter is experienced. Ketamine may be the chemical catalyst, but the true medicine, the team emphasizes, lies in human connection—compassionate guidance through the unknown.

As the program evolves, the hope is to see it replicated in other regions, offering patients everywhere the same chance to face serious illness not just with medication and medical devices, but with dignity, acceptance, and even moments of joy.

In the end, Pal-KAP is as much about living fully in the time that remains as it is about preparing for what comes next. For patients and providers alike, it is a reminder that even in the shadow of life’s end, there is still room for healing.