San Francisco therapist Veronika Gold was in the waiting room of her doctor’s office when she discovered an email she had been waiting for. It was an invitation to participate in a program sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS), and it had been sitting in her junk mail for weeks.
The program is part of an FDA-approved study of MDMA assisted therapy for patients with treatment-resistant PTSD, and it would certify Gold to administer this new treatment once it is approved. But the interview was scheduled for the day she discovered the email.
“I was beyond excited and horrified that I had almost missed the opportunity,” She says, “immediately, I called the interviewer.” An hour later, she was at the MAPS office; just in time.
That’s how she became a co-therapist at the San Francisco Insight and Integration Center, joining the training for clinical trials.
MAPS is currently in Phase 3 of the FDA’s approval process, which has set MDMA on course to be accepted as a new treatment by 2021. In that time, MAPS aims to train 300 therapists to have the option available to patients on day one.
In her private practice, Gold specializes in the treatment of trauma. Like many other therapists, she is well versed in a variety of techniques for which are commonly employed for patients with PTSD. None of which have proven to be as effective as the current MDMA trials.
“I have struggled with the idea that some of my patients – even if engaged in these therapies – continued to struggle with their symptoms,” she says.
MDMA offers a unique route to wellness. In previous trials, testing on 107 patients showed that after just two sessions 66 percent of participants no longer qualified for PTSD.
Results like these are the reason MAPS studies received special protocol assignment and breakthrough therapy designation last summer; which places them on a fast-track for approval and implementation.
“I dreamed of being able to do this kind of work.” Gold says, explaining how MDMA allows patients to face their trauma without the anchor of the fight or flight response to hold them back.
While the previous Phase 2 trials were small, treating between 18 and 24 participants, the team had wait-lists that topped 700. Phase 3 has upped the number of participants to 300 and enthusiasm for the program keeps growing as they see more results.
For therapists, the prospect of seeing their patients finally break through the barriers of PTSD is certainly inspiring. But the training program also comes with a rigorous amount of work that goes far beyond taking a few hits of Molly at a rave. “Around here we often say that therapists have to do a bit of unlearning,” Says MAPS Program Manager, Shannon Carlin.
Everything from working with another therapist in the room to the idea of eight-hour sessions can stray from the more traditional approach for therapists, and it’s all centered around creating the most comfortable environment for the patients. Something which is known as Set and Setting in the psychedelic world, referring to the patient’s mindset and their environment.
“We do have some sites that are located in hospitals and we have to do a lot of work to make it feel like it’s not a hospital.” Carlin explains, “We spend a significant level of focus on creating a setting that feels comfortable.”
It’s a process which is designed specifically around the MDMA experience, but it’s also known in psychiatric circles as a non-directive or client-centered approach. This almost free-form brand of therapy allows the patient to roam around the room, explore their thoughts, their surroundings and even sit in silence and listen to the music if they choose.
The current studies are always conducted with co-therapist teams to allow the patient to feel a sense of comfort and give them a greater possibility to build a connection. It also helps the therapists to have a colleague in the room aiding with the session.
“To have another therapist there, and the ability to support one another, that is a very beautiful model.” Says Cole Marta, a Santa Barbra psychotherapist and co-therapist in the program. Marta has studied the use of psychedelics in psychotherapy, ranging from Ketamine to Ibogaine, throughout his time as a student. He’s also worked with Veterans Affairs on PTSD, and that was where he discovered MAPS.
Of course, what you’re probably dying to ask is, how do they administer MDMA to the therapists? Is it the EDM free-for-all of pastie-clad psychiatrists that we all picture when we read the headline? Well, not exactly.
“We can’t ethically require that somebody take a drug as part of their training,” Says Carlin, though they do recommend that therapists experience a session. Through an FDA approved protocol called MT1, researchers can undergo the treatment in which they receive one placebo therapy session and one MDMA session.
And it’s certainly endorsed by the therapists in the program, as a way of understanding just what their patients will go through. So much so in fact that, the MT1 program is booked through to March of next year. Both Gold and Marta are currently waiting their turn.
“[T]here would be an advantage to those who are providing the treatment,” Says Marta, “the same way there would be an advantage to having been in the military if you’re trying to help veterans.” But while he looks forward to his own session, Marta doesn’t believe that it’s necessary for the therapy itself to work for patients.
To date, MAPS have trained 125 therapists to administer MDMA, and 82 of them will now be working with them on the Phase 3 trials. In addition to those they are currently training in the US, Canada, and Israel, MAPS are navigating the legal labyrinth to make the program available in Europe.
It wasn’t always this complicated for these substances. In 1985, the decision to place MDMA under Schedule I in the US, which implies that it has no medicinal benefits, denied the intimate history of psychedelics and psychotherapy. MDMA, in particular, was used as an aid in couples’ therapy, which is part of the inspiration behind using co-therapist teams to administer the treatment.
“Certainly before they were made illegal, there was a lot of work combining psychedelics with therapy,” Says Marta, “In fact, a lot of that work is the foundation for the psychotherapy model here.”
Gold too is well aware of the history her profession shares with altered states of mind. “I always felt how unfortunate it was that many of these substances became illegal,” She says, “when they had been used for centuries.”
She was born in the Czech Republic where she first entered the field of psychology and participated in over 50 Holotropic Breathwork sessions with Dr. Stanislav Grof. The method is one which Grof developed with his wife to simulate altered states of consciousness without the use of substances which had been made illegal.
MAPS itself was founded a year after MDMA became a Schedule I drug. Its founder, Rick Doblin, was asked to consult the DEA on scheduling and understood in advance that MDMA was likely to be outlawed. Knowing this, he proceeded to mail it to rabbis, psychologists, politicians, anyone likely to testify about the substance’s effects. The idea was that if it was to be prohibited, it ought to at least be Schedule II to ensure it was still available for research.“Were picking up the ball where it was dropped,” Says Marta, “We’ve lost fifty years, and we’re still trying to catch up.” Those testimonies were largely ignored by the DEA, leaving MAPS with decades of work to restore MDMA’s reputation.