While there is no doubt that ketamine does something helpful on a chemical level, this may not be the whole story. The problem with this paradigm of treatment is that it puts the patient in a passive position; the patient is not called upon to participate in their own treatment (except to show up for the appointment), and all of the “magic” is attributed to the chemical action of the medication.
A different way of working with ketamine is to use it as a lubricant in the psychotherapy process. The basic idea here is to offer the ketamine session(s) in the context of an ongoing psychotherapy relationship, in order to help the patient talk about material that is too painful or shameful to discuss otherwise.
In the MAPS Bulletin Spring 2019: Vol 29, No 1, Raquel Bennett, Psy.D., discusses the paradigms of ketamine treatment: