Seeing your shrink will never be the same after MDMA-AT

MDMA-AT consists of three ‘blindfold’ experiences each a month apart.

These are punctuated by fifteen therapy sessions dedicated to assessment, preparation and integration. Each stage – indeed, each appointment – includes a detailed, mindful strategy.

The ‘inner healer’ concept is described as a the mind mending itself in the same way the body might gradually heal a graze or cut. The method and therapy is described as the dressing that might be put on a wound, providing the correct environment for the miracle of human evolution to do its stuff.

Homeostatic instinct is the term used by men and women of science for the inner healer. Freud (who isn’t dead, it’s just a headline. Well he is physically of course) said instinct is a ‘demand made on the mind by the body’. Back in the renaissance Spinoza wrote that ‘Joy is associated with a transition of the organism to greater perfection’ as noted by top scholar Antonio Damasio.

Could denial of our human instincts – personal drive, logos, awen, true will, whatever you want to call it – land us in a chronic long-term disease ward? Not serving animal instincts certainly does.

“It’s only when the process begins that they understand”

During the MDMA time itself, patients are encouraged to spend time both talking to the therapists and by themselves processing beneath the blindfold, “although we are focussing on the inner experience” says Michael, and discussions during the experiences are intended to facilitate “a self directed experience. They don’t even have to wear the blindfold if they don’t want to, but often they end up doing so.”

Patients are shepherded towards their own “personal alchemy” to quote Michael, a bespoke therapy style unique to them. This can be cultivated by honing one’s ‘self energy’, a calm, curious and compassionate state that provides an emotional container for patients to open up to themselves. 

“Usually therapists have goals or ideas of where they should go, but the patient directs that,” notes Annie, “which can be difficult for some people – they want to be told how they can cure their PTSD! It’s only when the process begins that they understand.”

The MAPS dyad and MDMA-AT designers quote psychology colossus, emeritus professor at Stanford and When Nietzsche Wept author Irvin David Yalom, who wrote, “The therapist must strive to create a new therapy for each patient, or strive to encourage the patient to create a new one for themselves.” 

Surprisingly perhaps, patients’ individual inner work often has a similarity to popular methods. One that come up in particular is Internal Family Systems (IFS), where patients discuss talking to the ‘parts’ of themselves that play different roles in their ruminations. 

“The therapist must strive to create a new therapy for each patient”

“We see again the value of allowing space and time for something unexpected, terrifying or beautiful, to come through from the inner healing intelligence”

A patient who allowed themselves to be filmed for educational purposes discussed acknowledging, listening to, and comforting his aggressive/defensive self – Jungian shadow work, essentially. I asked Dr Michael Mithoefer in the after-lecture Q&A if he had suggested the method: “if I even had, I wouldn’t have described it as ‘shadow work, which is part of the work of Sigmund Freud’s protege Carl Jung’. I would’ve put it in layman’s terms.” 

‘Imaginal exposure’ – fictional examinations of how thoughts and feelings may play out in reality – and ‘active imagination’ – using fantastical metaphors to better comprehend stark reality in classic ‘psychedelic insight’ style – are two methods patients turn to naturally. Call it a ‘Jungian archetype’ or a ‘spirit animal’, it’s imaginative right brain activity processing complex thoughts to achieve balance. “We see again the value of allowing space and time for something unexpected, terrifying or beautiful, to come through from the inner healing intelligence,” says Michael. 

“We’re clear that the process isn’t designed to suppress their symptoms… but get to the root”

Transference issues can be used to highlight areas of behaviour to work on. Freudian psychodynamics, the examination of unconscious motivations, is still relevant despite me declaring ‘Freud is dead’ last week.

Other methods patients organically, roughly, incline towards range from the practical such as somatic experiencing (feeling trauma in the body) and corrective attachment (establishing a healthy behaviour model) to the totally way-out transpersonal. 

“We’re keen to normalise transpersonal experiences, letting the patent know we won’t think they’re weird. Transpersonal experiences aren’t essential. Patients that don’t have them tend to do very well also.”

What is impressed upon patients is that they will get the most benefit from leaning in to their inner turmoil, not suppressing uncomfortable feelings but letting them flow forth instead. Moreover, this is not entirely linear, themes can wax and wane in importance, and it might be unpleasant and uncomfortable in places: “They might get worse before they get better. We are clear that the process is not designed to suppress their symptoms, but get to the root.”

The celebrated MAPS dyad call processing under the blindfold ‘going inside’.

“They never have to, and we are aware when they are avoiding it and help with that. But we will say ‘maybe now is a good time to go inside’ when we think it’s a good point in conversation for them to process. If they come up with a connection themselves it’s more powerful – for example, ‘I notice every time I start talking about ‘x’ I ask to go to the bathroom.’

We explore that first before prompting them to go inside: ‘Would you like to experiment with that for a little bit?’ We make it clear they don’t have to hang out with something they want to avoid. It’a matter of is it needed at all, timing, and offering the option so it doesn’t sound like we’re pressuring them.”

The hardest part, say the pair, who’ve worked with MAPS for two decades, is not barging into the process. “IFS creator Dick Schwartz [who’ll be talking to Vital students later this year] uses the acronym ‘WAIT’,” says Michael, “why – am – I – talking?” 

The therapist is not the ‘healer’ – that’s inside the patient. Defence mechanisms mean it can be a long struggle to help patients come to the conclusions that would benefit them: for instance, decorated commandos who refusing to believe that their PTSD could have anything to do with all the combat missions, or rape victims desperate to bury their experience. “One patient commented, ‘I now have a battle plan when before I was thrashing about in the undergrowth’,” says Michael.