Roots to Thrive Ketamine-Assisted Therapy (RTT-KaT)

Theory of change

The person changes when a safe community allows them to turn understanding into embodied experience and congruent action, while ketamine temporarily amplifies openness and flexibility.

Core ideas

1. The Community of Practice is the primary intervention

   RTT-KaT situates change within a stable community that offers shared learning, agreements, regulation, vulnerability, compassionate witnessing and continuity over twelve weeks. The 2025 protocol states explicitly that the CoP constitutes the primary intervention and that psychedelic therapy is incorporated as an adjunct; the pilot study comparing the CoP with and without ketamine observed significant improvements in both groups and additional differences favouring ketamine that did not reach statistical significance, reinforcing the need to attribute value of its own to the communal component. (Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice; Tsang et al., 2024, A Pilot Study Comparing a Community of Practice Program with and without Concurrent Ketamine-Assisted Therapy).

2. Ketamine amplifies a therapeutic process already under way

   The medicine is framed as a catalyst of openness, insight and flexibility within a container built before the session and maintained after it. Its value depends on the interaction with preparation, set and setting, relational safety, somatic practices, meaning and integration, so the model avoids reducing treatment to a series of pharmacological administrations and places the ketamine experience within a longitudinal process of learning and change. (Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice).

3. Resilience means increasing awareness, regulation, compassion and purpose

   RTT's architecture of resilience is made concrete in repeatable practices: developing awareness of what is happening, regulating the system, connecting through compassion and orienting life towards purpose. This formulation extends Dames's work on thriving and transforms an abstract notion of resilience into a repertoire that can be practised in a group, in ordinary states and during the integration of psychedelic experiences. (Dames, 2019, THRIVEable Work Environments; Jeletzky, Dames, Kryskow & Tsang, 2025, Ketamine-assisted therapy within a community of practice).

4. Congruence and sense of coherence organise the direction of change

   RTT-KaT combines Rogerian congruence — alignment between inner experience, expression and life — with Antonovsky's sense of coherence — understanding what is happening, perceiving resources for facing it and finding meaning. The model seeks not only that the person should tolerate stress better, but that they should be able to inhabit their experience in a way that is more authentic, comprehensible, manageable and connected with purpose. (Dames, Kryskow & Watler, 2022, A Cohort-Based Case Report; Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice).

5. Deep change must move from knowing to being and doing

   The protocol describes a progression in which a cognitive understanding of patterns and values constitutes only the first moment of change; that understanding must become felt experience, presence and a way of being, and finally be expressed in congruent decisions and behaviours. Integration thus has a structural function: it transforms the psychedelic experience and the group learning into a more stable organisation of everyday life. (Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice).

6. Relational safety allows vulnerability to be practised without losing agency

   The model builds safety through stable small groups, agreements, unconditional positive regard, consistency of the team, consent and facilitators who model vulnerability. Vulnerability increases at the pace of trust and not through obligatory disclosure; in this way the person can experience closeness, support and authentic expression while retaining the capacity to set boundaries, pass or ask for help, which favours co-regulation and more secure attachment experiences. (Dames, Kryskow & Watler, 2022, A Cohort-Based Case Report; Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice).

7. The body is a principal route to knowledge and regulation

   Check-ins of sensations, Pause Practices, breathing, bodily mindfulness and orientation to felt sense reduce exclusive reliance on narrative explanation and teach the person to recognise inner states directly. This somatic priority makes it possible to use the body as an indicator of arousal, safety and need, and offers a point of support for holding emotion and psychedelic experience without requiring everything to be translated immediately into a story. (Dames, Kryskow & Watler, 2022, A Cohort-Based Case Report; Manson et al., 2023, Indigenous Voices in Psychedelic Therapy; Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice).

8. Cultural integration requires relationship, permission and stewardship

   The incorporation of Indigenous elements into RTT-KaT was developed through relationships with Elders, knowledge keepers, the Snuneymuxw First Nation and Indigenous participants, and the authors themselves stress that the boundary between appreciation and appropriation demands humility, consent and accountability. Shared knowledge retains its provenance and conditions of use, some knowledge remains protected, and any adaptation to another community must be built with that community rather than copying ceremonial practices out of context. (Manson et al., 2023, Indigenous Voices in Psychedelic Therapy; Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice).

9. Repairing ruptures forms part of the communal work

   Relational trust is demonstrated above all when conflicts arise and the team responds accountably. In the published experience with Indigenous participants, a rupture between non-Indigenous facilitators and the group led to a resolution circle initiated by an Elder, in which impacts were acknowledged and trust rebuilt; this episode shows that relational accountability entails the capacity to repair and not an idealised expectation of permanent harmony. (Manson et al., 2023, Indigenous Voices in Psychedelic Therapy).

10. Set, setting, ceremony and music are active components of the protocol

    The safety and meaning of the session rest on a deliberately predictable environment: circular organisation, low stimulation, physical comfort, inner focus, defined contact boundaries, a flexible ceremonial script and carefully selected music. These elements help contain uncertainty and orient the experience without imposing content on it, making the setting an active part of the treatment and not a neutral background for the administration of ketamine. (Dames, Kryskow, Tsang & Argento, 2025, A clinical protocol for group-based ketamine-assisted therapy in a community of practice; Kaelen et al., 2018, The hidden therapist).

Influences

• Lave and Wenger's Community of Practice
• Person-centred therapy
• Salutogenesis and sense of coherence
• Self-compassion
• Humanistic psychology and self-actualisation
• Trauma-informed care
• Somatic approaches
• Polyvagal theory
• Ketamine-assisted therapy
• Psychedelic-assisted psychotherapy
• Indigenous Ways of Knowing and culturally situated practices shared by Indigenous collaborators

Key references

• Dames, S. (2019). THRIVEable Work Environments: A Study of Interplaying Factors That Enable Novice Nurses to Thrive. Journal of Nursing Management, 27(3), 567–574. https://doi.org/10.1111/jonm.12712.
• Dames, S. (2022). Root Strength: A Health and Care Professionals Guide to Minimizing Stress and Maximizing Thriving. Elsevier.
• Dames, S., Kryskow, P., & Watler, C. (2022). A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression. Frontiers in Psychiatry, 12, 803279. https://doi.org/10.3389/fpsyt.2021.803279.
• Tsang, V. W. L., Tao, B., Dames, S., Walsh, Z., & Kryskow, P. (2023). Safety and tolerability of intramuscular and sublingual ketamine for psychiatric treatment in the Roots To Thrive ketamine-assisted therapy program: a retrospective chart review. Therapeutic Advances in Psychopharmacology, 13, 20451253231171512. https://doi.org/10.1177/20451253231171512.
• Tsang, V. W. L., Ragazan, D. C., Kryskow, P., Walsh, Z., & Dames, S. (2024). A Pilot Study Comparing a Community of Practice Program with and without Concurrent Ketamine-Assisted Therapy. Journal of Psychoactive Drugs, 56(5), 627–636. https://doi.org/10.1080/02791072.2023.2253798.
• Manson, E., Ryding, E., Taylor, W., Peekeekoot, G., Gloeckler, S. G., Allard, P., Johnny, C., Greenway, K. T., & Dames, S. (2023). Indigenous Voices in Psychedelic Therapy: Experiential Learnings from a Community-Based Group Psychedelic Therapy Program. Journal of Psychoactive Drugs, 55(5), 539–548. https://doi.org/10.1080/02791072.2023.2258120.
• Dames, S., Kryskow, P., Tsang, V. W. L., & Argento, E. (2025). A clinical protocol for group-based ketamine-assisted therapy in a community of practice: the Roots To Thrive model. Frontiers in Psychiatry, 16, 1568017. https://doi.org/10.3389/fpsyt.2025.1568017.
• Jeletzky, L., Dames, S., Kryskow, P., & Tsang, V. W. L. (2025). Ketamine-assisted therapy within a community of practice: a novel approach to disordered eating. Therapeutic Advances in Psychopharmacology, 15, 20451253251356980. https://doi.org/10.1177/20451253251356980.
• Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95–103. https://doi.org/10.1037/h0045357.
• Rogers, C. R. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client-centered framework. In S. Koch (Ed.), Psychology: A Study of a Science, Vol. 3. McGraw-Hill.
• Antonovsky, A. (1979). Health, Stress, and Coping. Jossey-Bass.
• Lave, J., & Wenger, E. (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge University Press.
• Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032.
• Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton.
• Johnson, M. W., Richards, W. A., & Griffiths, R. R. (2008). Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology, 22(6), 603–620. https://doi.org/10.1177/0269881108093587.
• Kaelen, M., Giribaldi, B., Raine, J., Evans, L., Timmermann, C., Rodriguez, N., Roseman, L., Feilding, A., Nutt, D. J., & Carhart-Harris, R. L. (2018). The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology, 235, 505–519. https://doi.org/10.1007/s00213-017-4820-5.