What Comes After the First 6 Sessions?

Approaching the end of your first program with Mindbloom brings up real questions. You may want to keep going but aren't sure what continuing actually looks like, or how much further it could take you. You may be wondering whether staying on ketamine therapy long term is safe. Or you may not have decided whether to continue at all, take a break, or wrap up here. This article covers all of it: your options from here, what continued treatment looks like and whether it's safe, and how to figure out which path is right for you.

The three paths

Broadly, people finishing a first program take one of three paths:

• Continuing treatment: carrying on, either to maintain the progress made or to go deeper on what came up.
• Taking an integration break: pausing to let the first program settle before deciding anything.
• Completing treatment: finishing here, having gotten what they came for.

Continuing treatment

Not everyone needs to continue, and finishing after a first program is a perfectly good place to land. But many people do keep going, and for good reason. In Mindbloom's 2024 peer-reviewed study, 84% of clients who had improved and returned for a second program held onto or recovered those gains.¹ Continuing tends to play out in one of two ways.

Moving into a maintenance phase

For some people, an ongoing rhythm is simply what works best. That usually means regularly scheduled sessions, spaced farther apart than a first program, that keep this kind of care a steady part of how they look after their mental health.

Going deeper on what surfaced

For others, a first program does as much revealing as it does relieving. It can bring the thing that most needs attention into focus for the first time. A follow-up program then becomes the place to do that deeper work: not just feeling better, but working directly on what the first program brought to the surface.

Either way, continuing is a decision made with a clinician. It's an option many people find valuable, not a requirement for holding onto the progress already made.

Taking an integration break

The second path is a deliberate pause to integrate what came up in a first program.

A break might last a few weeks, months, or even years. For many people, giving new insights time to settle into daily life is where a meaningful amount of the lasting change actually happens. Support is available in the meantime, including Group Integration Circles and additional direct integration sessions with a guide. When the time feels right to resume, a clinician can help plan the next step.

Completing treatment

For people who feel they got what they came for, this is a legitimate finish line. A goal was set, it was reached, and that progress carries forward. The door stays open for anyone who later decides to return.

How continued treatment works

For many, continued treatment follows a natural arc. A first program is a focused course of sessions relatively close together, built around a specific goal. From there, sessions tend to space farther apart as things stabilize, at a flexible interval set with a clinician rather than on a fixed schedule. Along the way, clinician and client periodically reassess and adjust, including stepping back when that makes sense.

Anyone who takes a break and later returns reconnects with their clinician first, to confirm continued treatment is still the right fit before picking back up. Returning clients may also purchase programs at a reduced cost; current pricing and returning-client options are here.

Is it safe to keep going long term?

The concerns people have about long-term treatment tend to trace back to a very different pattern of use than a spaced, supervised program. Here is what the research says on the three questions that come up most.

Am I going to need to increase my dose over time?

Generally, no. The worry is the tolerance trap: needing more and more medicine to get the same effect, the way some substances and daily medications work. Research on intermittent, therapeutic dosing points the other way. Studies have found that the effective dose generally stays stable and that tolerance is uncommon.² In one maintenance trial, spaced sessions sustained their benefit at a fixed dose, with no escalation over time.³ The distinction that matters is intermittent versus daily: tolerance concerns cluster around near-daily use, not sessions spaced weeks apart, which is how Mindbloom's model is built.

Could I become dependent?

"Dependence" is worth unpacking, because it can mean two different things. The clearest evidence comes from a 2025 systematic review of 2,174 patients treated with ketamine for depression: fewer than 0.2% showed clear signs of tolerance or dependence, and the most serious of those cases involved people escalating their own dose outside a supervised protocol.⁴ A separate scoping review of the preclinical and clinical evidence drew the same line: the abuse potential that concerns clinicians concentrates in frequent, high-dose recreational use, not medically supervised treatment.⁵ The through-line in both is structure. Defined dosing, spacing between sessions, and clinical supervision are what keep the risk low, and they are built into how a Mindbloom program runs.

What about the long-term health risks I've seen online?

The most alarming findings, especially bladder damage known as ketamine cystitis, come from studies of heavy recreational users taking far larger amounts far more often than any therapeutic protocol. Dose and frequency are the drivers. A 2025 review of 14 clinical trials found no convincing evidence of ketamine-associated urinary problems in therapeutic contexts, with no meaningful difference between comparison groups.⁶ That does not make it something to ignore. It makes it a dose-and-frequency question, which is what separates recreational use from supervised care. For anyone on a long-term plan, a periodic urinary check-in with a clinician is a reasonable, low-effort safeguard.

How to decide which path is right

There is no formula, but the way people describe where they are is often a good tell. A few examples, and what each tends to point toward:

• "That was really helpful, and there's clearly more here to explore." Often a sign to continue, whether that means deeper work or a steady maintenance rhythm.
• "Things are better. It would help to let this settle before doing anything else." Often a sign an integration break would serve best.
• "This was what was needed. Maybe worth returning down the road." Often a sign it's a good place to complete treatment, with the door open.

There is also no need to wait until the final session to sort this out. Bringing it up with a clinician while a program is still underway is common, and it keeps the choice, whether that means continuing straight through or taking an intentional break, from being made by default. Either way, that conversation is the best next step, and a clinician can weigh what fits a person's specific goals.

References

1. Mathai DS, et al. J Affect Disord. 2024. Sublingual, second-course analysis; among clients who improved in their first course. Individual results vary. https://doi.org/10.1016/j.jad.2024.05.131
2. Smith-Apeldoorn SY, et al. Lancet Psychiatry. 2022. https://doi.org/10.1016/S2215-0366(22)00317-0
3. Phillips JL, et al. Am J Psychiatry. 2019. https://doi.org/10.1176/appi.ajp.2018.18070834
4. Le TT, et al. J Psychiatr Res. 2022. https://doi.org/10.1016/j.jpsychires.2022.04.035
5. Ingrosso G, et al. J Psychopharmacol. 2025. https://doi.org/10.1177/02698811241303597
6. Andrade C. J Clin Psychiatry. 2025. https://doi.org/10.4088/JCP.25f16083