The APS’ Dean Wright with Annie and Michael Mithoefer
Today I was told exactly how to conduct the sessions to treat post-traumatic stress disorder, using MDMA-assisted psychotherapy. We sat in the conference centre at the Marriot Hotel in Oakland, California, as part of the world’s largest conference about psychedelics – Psychedelic Science 2017.
The seminar was conducted by Annie and Michael Mithoefer, a husband and wife duo who conducted the MDMA-assisted psychotherapy sessions in the MAPS studies. The Mithoefer’s literally wrote the manual on how to conduct psychotherapy using MDMA.
This therapy involves four stages: introductory sessions, preparatory sessions, the MDMA-therapeutic session and integration sessions.
In the introductory session, the aim is to establish trust and rapport with the patient. This involves being completely transparent about what the patient can expect from the sessions, and how they will be conducted. The therapist encourages the client to ask any questions and bring forth any worries they have about the process, so any anxieties can be addressed and put to rest prior to the therapy. The therapist then lays the ground rules around what is required of the client – including time requirements and behavioural boundaries.
This is the beginning of the therapy, where therapists begin to understand the nature of the trauma and its presentation. During these sessions the therapist seeks to understand what the traumatic events are, what are the triggers that remind the client of the trauma, and how does the trauma affect their everyday life. Very often these patients will have concomitant depression; will suffer from nightmares, constant anxiety and panic attacks. After learning as much about the patient’s particular experience of PTSD, and after the patient feels as though they know exactly how the sessions will be conducted, they proceed to the MDMA-assisted session.
The session is conducted in a comfortable environment. The patient lays on a bed, a male and female therapist sit either side. An 8-hour playlist of music is played, and after ingesting the MDMA, the patient is invited to lay down with eye-shades and headphones on. When the patient feels the need to discuss or disclose information, they are invited to do so.
Both male and female therapists are used to provide balance, as very often during these sessions, the patient will undergo some transference. Transference is when the patient transfers some parts of their personal relationships onto the therapists. For example, if their mother was caring and their father did not show love, then they may feel more comfortable to disclose information to the female therapist and show resistance with the male therapist. In this context, as healing occurs you might see the patient begin to open up to the male therapist, and actually convey some of their painful feelings. This transference is an essential part of the therapeutic relationship.
The therapists communicate in a non-directive manner. This means they do not force the patient to think about their trauma and they do not decide if a topic brought up by the patient is important or not. That is because when people take MDMA, they will often bring up events which they previously have not remembered or considered important. In reality, these events may have shaped their current state and may be important – MDMA is a great tool for bringing to the surface the issues which are important.
This non-directive approach involves active listening, empathy and compassion. This involves reflecting what the patient is going through. Acknowledging how difficult it might be, and normalising and difficult feelings they might be having. It may involve soothing the patient during difficult times with physical touch such as a hug or stroking the patient’s hair. To treat PTSD it is important not to tell the patient how to think better, but just to allow the patient the space to relive the trauma.
MDMA is such a great tool for treating PTSD as it allows the patient to relive the trauma without being overwhelmed by difficult feelings. Normally when a person with PTSD recalls a traumatic event, they become overwhelmed with anxiety and pain that all they can do is think of ways to escape the pain and stop thinking of the trauma. By being able to relive all the trauma in the context of MDMA, they no longer feel the overwhelming anxiety anymore. Eventually with integration they will be able to recall these traumatic memories without any imposition on their function.
Integration is highly important in the therapeutic process. This is because MDMA may enable the patient to recall events which were previously inaccessible to the patient. These memories may keep coming days, weeks or months after the therapy. For this reason the patient needs a lot of aftercare, with access to a therapist to talk to at all hours for several days afterwards, and with regular therapy for the coming months. These therapeutic sessions will continue until the patient no longer brings up new memories, and these memories no longer cause dysfunctional feelings in the patient. The patient may need to undergo several more rounds of MDMA and integration therapies. However, the time invested is well worth it, particularly since these patients were previously considered untreatable, and had to live this debilitating existence for the rest of their life. With MDMA therapy 70-80% of patients no longer suffer from PTSD (Mithoefer et al, 2010).