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Marcella OT’Alora and Bruce Poulter: MDMA Assisted Psychotherapy
227 Plays4 months ago
In this episode I talk with Marcella OT’Alora and Bruce Poulter, two people who have been instrumental in sharing knowledge of MDMA assisted Psychotherapy with 100’s of trainees all over the globe. They have also supported many participants through the process of MDMA Assisted Therapy as part of their work on trials in the USA and continue to provide supervision and consultation to many people engaged in this work all over the world. In this conversation we cover many topics, including: their respective journey’s into MDMA assisted therapy, what MDMA assisted therapy involves, healing through being witnessed, The importance of pacing and tailoring therapeutic approaches, the FDAs decision and how they feel about it and the importance of doing your own work as a therapist.
Marcella OT’Alora has an MA in Transpersonal Psychology from Naropa University in Boulder, Colorado, and an MFA in Fine Arts from the University of North Carolina at Greensboro. Marcela is an Installation artist, researcher, teacher, and supervisor. For 25 years she has been in private practice working primarily with trauma and specifically with PTSD. Her interest and focus on trauma led her to understand the healing journey as an intimate re-connection with one’s innate essence through love, integrity, compassion, and honoring of the human spirit. In addition to private practice, she has dedicated her professional life to training and research. Beginning in 1999, she has worked on various studies sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS) as a Principal Investigator and investogator using MDMA-assisted psychotherapy for the treatment of PTSD. Additionally, she is a lead educator and supervisor for MAPS’ MDMA-assisted therapy training program.
Bruce Poulter has worked much of his career with people in altered states. He was initiated into health care as an ICU nurse at UC San Francisco Moffitt Hospital when the AIDS pandemic first emerged and began devastating our communities. Later he received a MPH from UC Berkeley in Health Planning and Policy. He went on to develop public health programs including one of the first certified nurse-midwife based perinatal programs serving low income women, and a program that identified and provided care for families at risk for abuse and neglect of their children. He has worked extensively somatically with people in chronic pain and was an intimate observer of the first government approved MDMA for PTSD MAPS study in Madrid, Spain in 1999. He has offered harm reduction services thru Zendo and other organizations, was an investigator in the MAPS Boulder MDMA for PTSD Phase 1, 2 and 3 trials, is currently a Lead Educator and Mentor Supervisor for therapists working on studies for MDMA-Assisted Therapy.
keep in touch with me at Insta: dresmedark
Linkedin: www.linkedin.com/in/dr-esme-dark-627156a0/
website: https://www.esmedarkpsychology.com.au/
Find Monash Clinical Psychedelic Lab at www.monash.edu/psychedelics
Find MAPS at https://maps.org
Power threat meaning framework:- https://www.bps.org.uk/member-networks/division-clinical-psychology/power-threat-meaning-framework
Disclaimer: This podcast is for general information only and does not constitute an endorsement or recommendation for psychedelic- assisted psychotherapy.
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Transcript
Introduction to 'Beyond the Trip' and Acknowledgments
00:00:04
Speaker
Hello and welcome to Beyond the Trip, a psychedelic therapy podcast with me, Dr. Esme Ta. During this podcast, I'll be bringing you conversations with thought leaders and other inspiring humans, exploring a wide variety of themes relating to the use of psychedelic-assisted psychotherapy in the healing of human distress.
00:00:26
Speaker
Whether you're an aspiring therapist, already a therapist, or just simply interested in the emerging field of psychedelic therapy, then this podcast is for you. Join me for a journey into the psychedelic world. Before we get started, I want to take a moment to acknowledge the traditional custodians of the unceded land on which this podcast is recorded. The Wadda Wurrung people. I pay my respects to elders past, present and emerging.
00:00:54
Speaker
and I extend that respect to any Aboriginal or Torres Strait Islander peoples listening today.
Interview with Marcelo Altaroua and Bruce Poulter
00:01:03
Speaker
Hi, everybody. In this episode, I'm going to be interviewing Marcelo Altaroua and Bruce Poulter from MAPS. And I recorded this interview not too long before they came over to Australia to offer their teaching program that MAPS and Monash University partnered together to bring to Australia, which is exploring MGMA assisted psychotherapy for PTSD. So I'll be heading off soon to attend that program. And so I'd like to just introduce them to people who are really dear to my heart, who have been really important teachers for me and many, many other people.
00:01:47
Speaker
Marcela has an MA in Transpersonal Psychology from Naropa University in Boulder, Colorado and an MFA in Fine Arts from the University of North Carolina in Greensburg. Marcela is an installation artist, researcher, teacher and a supervisor. For 25 years she's been in private practice, working primarily with trauma and specifically with PTSD.
Marcelo's Background and Role at MAPS
00:02:12
Speaker
Her interest and focus on trauma led to her understanding the healing journey as an intermittent reconnection with one's innate essence through love, integrity, compassion and honouring of the human spirit. In addition to private practice, she's dedicated her professional life to training and research.
00:02:31
Speaker
Beginning in 1999, she worked on various studies sponsored by the Multidisciplinary Association for Psychedelic Sciences, which I will call MAPS, as a principal investigator and an investigator using MDMA-assisted psychotherapy for the treatment of PTSD. Additionally, she is the lead educator and supervisor for MAPS MDMA-assisted therapy training program.
Bruce's Career Journey and MDMA Research Involvement
00:02:56
Speaker
Bruce Polter has worked with much of his career with people in altered states. He was initiated into healthcare care as an ICU nurse at UC San Francisco Hospital when the AIDS pandemic first emerged and began to devastating our communities. Later he received an MPH from UC Berkeley in health planning and policy.
00:03:18
Speaker
He went on to develop public health programs, including one of the first certified nurse midwife-based perinatal programs serving low-income women, and a program that identifies for families at risk for abuse and neglect of their children. He's worked extensively with people in chronic pain using somatic approaches and was an intimate observer of the first government-approved MDMA for PTSD MAPS study in Madrid in Spain in 1999.
00:03:49
Speaker
He has offered harm reduction services through Zendo and other organisations and was an investigator at the MAPS Boulder MDMA for PTSD Phase 1, 2 and 3 trials. He is currently a lead educator and a mentor and a supervisor for therapists working on studies we're using MDMA-assisted therapy in many different places in the world.
Podcast Topics Overview and Australian Program Preview
00:04:12
Speaker
In this podcast, we get into a lot of really interesting topics. We talk about Bruce and Marcela's journey into MDMA-assisted therapy, what it actually really involves, the importance of healing through being witnessed. We talk about the importance of pacing and tailoring therapy approaches,
00:04:31
Speaker
We also touch in on the really challenging topic of the FDA's decision and around the rescheduling of MDMA and not to reschedule it at this time and how they feel about it. And we also talk about the importance of doing your own work therapeutically when you're working with others as a therapist. So let's get into it. I can't wait to share this conversation with you.
00:04:56
Speaker
Hello, welcome Bruce and Marcela. It's so lovely to have you here on the podcast. Thank you so much for taking the time out of your day, your Friday to come and be with ah me today.
00:05:09
Speaker
yeah Thank you for having us. I look forward to the conversation. Amazing. Yeah, yeah I'm really excited and you know it's it feels nice to be recording this and knowing that actually in a few weeks you're going to be in Australia teaching and yes it's coming up so fast. and and like I remember you know you and I, we we met last year at the MGMA assisted psychotherapy training that maps around in Australia with Monash University. And so it feels really great to be having you here just before we do that again. Yeah. And I have to say we were, here I am speaking for two of us. So I was, and I know Marcella was as well. So that's why I can say we were really impressed with the skill and knowledge of the therapists that were at the training. So that was really nice.
00:06:02
Speaker
Thank you yeah yeah and we were really appreciating just learning from your depths of wisdom and in this work you know here in Australia we've moved into clinical use of MDMA assisted therapy for PTSD And you guys have got so much experience from working in that space in Australia. And so maybe this is a good place for us to start. I'd love to hear from each of you, actually. like what What drew you to this work and how did you become interested
Marcelo's Personal Experience with MDMA for PTSD
00:06:34
Speaker
in it? And I know there's so many different stories from both of you, so whoever would like to begin. Yeah, Maurice, do you want to start?
00:06:42
Speaker
Sure. I mean, for me, the interest began a very long time ago. I was actually a young adult and 23 years old. And it was a year before MDMA was placed on schedule one. So it wasn't illegal yet. and And MDMA had been used for a couple of decades in therapy quite a bit with a lot of success up to that point.
00:07:09
Speaker
And I had the opportunity to receive that treatment for my PTSD. And it was a turning point for me and really something that changed and the direction of how I saw my world and my life and healing.
00:07:29
Speaker
And it gave me an opportunity, an opportunity to actually live the life that I wanted to live. So I think when that happened, I just felt like this has got to be more available for other people who need this and who want this. And so at that point I began, it was my it was the beginning for me of saying, yes, I want this. and You know, I ended up going back to school. I was a, I was an artist and an art teacher and I went back to school so I could be a therapist because I just wanted to be ready. You know, I wanted to be ready for when it, when I could get a study. And so then I moved into being a therapist in the study, in the first study in Spain and then, and then had, then got my own, you know, my own studies in Boulder.
00:08:16
Speaker
which was wonderful.
Bruce's Initial Interest in Therapy and MDMA Study
00:08:17
Speaker
And so that's kind of like how it began for me. Amazing. Thank you so much for sharing that. And I was listening to the podcast you did a quite a few years ago now with with Tim Ferriss recently, just as kind of getting into the the zone for this interview. And I think you shared that was in, is it like 1984? Is that where? It was in 1984. Wow. So that is a very long journey to this point, right?
00:08:43
Speaker
Yes, very long journey. And I was very grateful that I had that opportunity at that age, you know, to really begin to work with, to see healthcare in a different way, right? That it wasn't just this way of getting diagnosed and getting medicated and, and nothing to, nothing to work with.
00:09:07
Speaker
what would what the feelings were actually that were there. what How was I experiencing life? There was nothing of that. Those questions never came up. Yeah.
00:09:19
Speaker
I can't wait to get into that because that's something I really would like to speak to more is the kind of shift that this work it it requires and takes and at the change from that diagnostic medicalising approach. But I want to hear from Bruce and we'll definitely talk about that more later. So so Bruce, what about you? like tell um Tell me about your journey into this work.
00:09:41
Speaker
Yeah. Well, so when i so I come to this work as a nurse and I was very interested in therapy, but the pace of therapy was just too slow for me. So I figured I wouldn't actually be a good therapist because I'd be so like impatient. I mean, come on come on, come on, let's go, let's go, let's go.
00:10:00
Speaker
And so I knew that I would not be helpful. So then I did other things. And then the first government approved study was in Madrid, Spain, and Marcelo was asked to be one of the therapists in that study. And so I just wanted to, as an observer, our family moved to Madrid. And that was my first introduction to MBMA assisted therapy specifically for PTSD, but also to see and hear about the the rate at which people were actually to improve able to improve their lives.
00:10:30
Speaker
And so when I observed and heard about that, I went, I could do this this. I could do this in a way that is actually respectful of people, which was important to me. And the fact that it was corrective, as opposed to just damping down symptoms.
00:10:47
Speaker
So that was that was then what got caught my attention. you know Then the rest is, you know, then MAPS gave us a study and in Boulder and Marcello was the principal navigator. So I actually got to to work on the study as a therapist in our phase two study. And then we were able to do a phase we did a phase one actually after that, which is sort of an interesting twist.
00:11:11
Speaker
which is was a healthy volunteer study for therapists so therapists could have but their own self-experience. And so many therapists said, you know, what was so helpful about that is they said, you know, now I actually really have not only the intellectual understanding,
00:11:27
Speaker
But I also have the felt sense of what it's like to be on the receiving end, to therapists, tracking me, understanding me, paying attention to what's important to me, and helping me navigate. and so then And then we got to do a phase three study, which was quite wonderful. And then I also got to do consultation for therapists, actually with people with typically constant revision.
00:11:52
Speaker
And so in the position that both Marcel and I were in, we've been able to see lots and lots of therapists working in Canada, in the US, in Israel, now in Australia, now in New Zealand,
00:12:09
Speaker
And so we were in a pretty unique position in terms of both professionally having a lot of experience working with people with PTSD, but then also seeing all the different ways that therapists work and make this modality work for participants.
00:12:23
Speaker
Yeah, amazing.
MDMA-Assisted Therapy Process and Impact
00:12:25
Speaker
you I wonder how many people you've thought over the years. I don't want to put you on the spot to give you a number, but it must be a lot. It must be a lot. There have been a lot. you know I'm one of those people that doesn't count. you know like when Whenever in in my private practice, therapists would say, well, I have these many clients. And I would go like, I don't know what I have. So I don't know for sure.
00:12:50
Speaker
But yeah, definitely hundreds. Yeah. Well, definitely hundreds of hundreds. I think, you know, and I feel so blessed and so lucky to be one of the people that you taught. So thank you so much. Thank you. Thank you.
00:13:04
Speaker
You know, I'm not going to go into the full story of the biogenetic into this work, but actually to just say that it came through, my interest in psychedelics came through my work with PTSD and in hearing about the work that BAPS was doing with MDMA.
00:13:21
Speaker
for therapy for PTSD because I was working as a specialist in that in in Australia with refugee and ah asylum seeker populations and then also in private practice and so I started hearing about all of the work at MAPS and then that is one part of a big big puzzle of things that led me to be in this work so I'm very grateful and and I think because of what you some of what you spoke to Bruce where it feels It's a different way. It's a different way of working. theres It's actually about healing and shifting and moving into a really different space and being with the emotions that come up as a result of trauma, which which some other psychotherapy approaches do do, but I feel like there's just
00:14:09
Speaker
something very different that happens with MDMA assistance. Everyone will talk more about that later. Maybe it would be good to start sort of just outlining some of that, really. like From your perspective, you've got so much experience, both of you.
00:14:26
Speaker
Tell us a bit about the process of MDMA assisted therapy because some people listening to this podcast will know a lot about that. They will be a therapist, but other people really won't. And here in Australia, we we kind of got to this point where we we have the ability to use this in clinical practice, which is amazing. And it still felt like when I was first interested in MDMA assisted psychotherapy,
00:14:51
Speaker
in what's happening in maps, it felt like there wasn't so much happening over here. Now there's a lot, there are many trials happening, you know, ah Monash clinical psychedelic research lab where I work, they're doing, obviously, as you guys know, they're doing a trial with MDMA assisted psychotherapy for people like first responders and vets, so police and nurses and actually midwives, which feels really an important inclusion to me as well. So maybe from your perspective, and we can all join in, I guess, like what Explain a little bit about what exactly MGMA assisted psychotherapy might look like. Yeah. Can I just say, at this point in time, Australia is the world leader in this work because you guys actually are able to do it outside of research. and So the whole world is watching you. and So you're in a very privileged position. which is and a risk you know Of course, it's kind of edgy, right but it's very exciting. yeah like we are We are so
00:15:50
Speaker
jealous. Totally. I know. I imagine. i Yeah, ah feel it feels. Yeah. So, you know, and it's just, it's, and and not from the standpoint, you know, for me, it's, I care about the people that actually benefit from this work.
00:16:07
Speaker
I care about it everybody, honestly. But you know the for me, the the grief around us, that our government, not approving it and last in August, is all the people who then don't don't benefit from actually having a life that they can live in a much more meaningful way for them.
00:16:26
Speaker
And so that for me, that's what is exciting to me about this work is how meaningful, how impactful it is in terms of helping people to live the life that they want to live, whether it's going to school, whether it's you know all the things that people want in their lives. It it just becomes much more possible. so yeah But anyway, back to your question, which is,
00:16:50
Speaker
how you know basically how does it work? I mean simply it's so we do an assessment we do a bunch of assessments to make sure you know what what their psychological profile is what their emotional profile is what their medical profile is so safety kind of things and then once they kind of get through that part you know Then we do three preparatory sessions with two therapists, and those are 90 minutes long. and then And that's really kind of like this mutual kind of interview. like For the participant, it's you know are these is this modality something that makes sense to me? So we have those three sessions over you know three or four weeks where we just we're in this kind of mutual dialogue around
00:17:32
Speaker
Who are you? how is this you know What are your hopes in life and what would be helpful for you? and then And are we somebody you can work with? you So at the end of that, it should be pretty clear that what we're that know doing an MDMA session would be in service of that individual. So you know we answer whatever questions they have. And then assuming that everybody thinks that that that's a good idea,
00:17:58
Speaker
then we would do an MDMA session where it's eight hours, roughly eight hours long. And then at that point, whatever comes up for the person is what we work with in the moment. So it requires the expertise of the three of us. My co-therapist comes to the session with a lot of expertise in terms of working with trauma, working with emotional states, working with extreme states, those kinds of things. And then the participant comes with their expertise in terms of knowing who they are and what that they might need. And you for a lot of people with PTSD, they don't actually that's not particularly clear because of the mixed kind of signals that their body gives them, the
00:18:40
Speaker
emotional you know the the range of emotions that come up. And so you know we're we're really working with building kind of capacity for the for this individual to really kind of get to know themselves and get clear about who they are, separate from their conditioning, separate from how they've been told to be or how society thinks they should be.
00:19:04
Speaker
So it's really about finding who they are and also working with what is what they see as being traumatic. So I think I'll stop there and let Marcelo kind of pick up from that point. <unk> Thank you. Yeah, thanks, Bruce. I mean, I think that part of when I think of it as what is it the population that we're treating with trauma, when you think about healing, you know, healing means so many different things for everyone.
00:19:32
Speaker
But one of the things that seems consistent about the way healing has been implemented in terms of the mental health centers and and the way that we treat trauma is we'll try this thing, then you go home,
00:19:49
Speaker
and you and you're in that process of kind of healing, maybe you go to a therapist once a week or once every two weeks and the rest of the time you're you're working on this thing, right? On this healing process. And in that healing process, it's really, really lonely. You're mostly doing it on your own, right? You're you're getting some support, but you're in it You go home, you're activated, you're working with it. You're alone with this healing process.
Relational Healing and Emotional Discoveries
00:20:21
Speaker
And I think what this treatment offers is how do we heal in relationship?
00:20:30
Speaker
hundred you know How do we then say, I'm going to be here with you during during this time when you discover You know, because it's not something, it's it's a discovery where you discover all these pieces about yourself and your experiences and how it has impacted your life. But I'm going to be here with you while you do that. And I'm going to be in relationship to you. So I think that's one of the major differences is that it's relational, but not only relational, but it is
00:21:07
Speaker
how we human beings really were meant to be in a healing process, which is not alone, but being supported in the moment, right? In the moment of the feeling, in the moment of the discovery. So I think that that is that is one one big difference and and that in that discovery then, we are not inventing anything.
00:21:34
Speaker
Right? That it's actually is about being in the unknown, right? Being in the unknown of whatever is happening in the moment, what we don't know about. and And you know, recently somebody said unknown, like when you don't know, it doesn't mean that you're ignorant, right? It doesn't mean that you're ignorant. It just means how am I following something that is happening in the moment here between us?
00:22:04
Speaker
And so we don't, none of us know right what the next moment will bring. right It is unknown. And so how do we sort of put aside the parts that are more predictable, the parts that maybe have a bias or have an agenda or have a judgment? How do we use those and ah become aware of them and then come back to what is actually real in the moment and discover that?
00:22:33
Speaker
And there's so much skill involved in what you're talking about, I think. Skill from us as therapists, but also, you know, the the participant, the client, the person.
00:22:44
Speaker
is has always the one that has the keys. You know, you talk about the inner healing intelligence in maps and there's so many different words for that, but I i really fundamentally believe that the person in front of me is the expert on their own experience, the client in front of me. i was I've always, I was trained like that actually and i and I really feel that and I've seen it time and time again.
00:23:08
Speaker
and that really in psychedelic acid therapy, hopefully in in in other types of therapy as well, but especially in this one, we're really supporting them, their process to unfold, their healing to unfold in the way that is going to be right for them. It's not about doing something too, but it is a highly skilled process to do that as therapists, to be with that, to let it unfold.
00:23:34
Speaker
I found myself feeling a bit emotional, Marcela, when you were talking about that the relational aspect and being with. And I really, something that has stuck with me ever since last year that on the training what that that you both did was the the thing you said around what is traumatic about the trauma to the person. And so often it's being left alone with that pain.
00:24:01
Speaker
if And I always get tearful. I'm i'm just, I've done this a few times now and this podcast is happening again, but you know, being left alone with that pain. And this is about being with someone whilst they go towards their pain or towards whatever else comes. Right. Right. It's a, it's a being and being witnessed, right? Being witnessed in that pain and being witnessed.
00:24:29
Speaker
in their suffering is such, I think is so much a part of healing because it's, i I am being seen in this devastation that I have lived in. And so I am truly being validated in that. I don't have to change it. I don't have to hide it. I don't have to become somebody else. I'm being witnessed in what is here in my, even in my,
00:24:58
Speaker
you know, in my shame and my and my guilt and my regret and whatever else happens, that sense of being witness is so it' such an act of grace, right? Yeah.
00:25:15
Speaker
But it's also difficult, right? To be witnessed is actually difficult. And especially for somebody with PTSD who doesn't who has you know so many people have learned to really you know limit their their exposure so you know in a societal sense, in a relational sense. And so then to have two therapists kind of like looking at them.
00:25:37
Speaker
it's pretty intense. yeah So it's like so it's one of our jobs is actually to help make that possible given the reality of what it's like to live with trauma, having been traumatized and how it really collapses our world. And so these things are incredibly important and That's part of the challenge of being a therapist. and this is like how do you make that how How do we continue to create safety in an environment that's inherently unsaved based on a person's you know life history or traumatic history?
00:26:09
Speaker
yeah
Pacing and Integration in Therapy
00:26:10
Speaker
Right. And I think the other piece that I'll say is the element of time, right? That we have the time that we're saying, let's not do, make shortcuts. Let's say that, you know, being seen is not, doesn't have a shortcut, right? We don't, and so how do we honor that and, and have the time to allow for all those things that we've been talking about to happen, right? To to really be seen and to really be witnesses. How do we allow the time to to be there for that to happen too? So I think that that's also a big consideration that that you know for some people might feel like there's no way. I just don't wanna do that. I don't have that much time or I don't wanna sit with somebody for that long of a time. And so it's not like it's for everybody, right?
00:27:04
Speaker
No. And I think, absolutely, you know, you're sitting with someone sometimes for eight hours or often for about that long. As a psychedelic-assisted therapist. and And I think, you know, it I think what we've just spoke to around how difficult it is for the person to go towards the things that aren't traumatic or to be with the emotions, like sometimes it's not the thing, it's the feelings, the shame, like, I am defective is something like here,
00:27:32
Speaker
Clients say to me all the time. There's something to happen to me because there's something wrong with me and that's shame And of course shame makes you want it lives in the dark, doesn't it? It makes you want to hide it makes you want to move like and and actually It's really really scary and it can take years in regular therapy for people to be able to say this is what I feel this is what happened and I think the MDMA really helps reduce the fear of emotional injury and around being able to do that. I don't know if that sounds right to you, but that's how I understand it. yeah Allowing a different kind of processing that is possible without it and a different kind of processing particularly in relationship that is possible that is possible without it.
00:28:18
Speaker
yep Yeah. and you know the And the other part is actually that this <unk>s it's really important this work is choice. So you know here we are talking about you know going towards the pain and like, what? Are you guys crazy? you It's like, no. Like, I don't know. Bad idea, right? No, I've been there like in so much like every time I get triggered. It's like, there I am right back there.
00:28:41
Speaker
And so so the other part about this work that's so important is that we only every step of the way is kind of the meter. Is is this the is the participant or the client, ah is this are they ready for this? does this And from their standpoint?
00:29:00
Speaker
So it's like constantly checking to make sure that they're in a place that feels right to them, even if it's scary, even if they don't know, even if you know but but it's really making sure that we always have their consent every step along the way. And then when people know, when they really get that that, I'm not going to push them. If somebody like starts to go into a memory and they want to stop it, we stop. Absolutely.
00:29:28
Speaker
So it's that pacing piece along with consent, then people's capacity really just starts to grow. Absolutely. And then with with MDMA in their system, then their fear, they can still feel fear, but it's proportional. it's not you know it's not way It doesn't go you know way to the extremes that they typically would experience it in their more everyday life. So MDMA as a medicine is very helpful for them to actually experience fear in in a zone that's that feels right for them for the most part. And so it's very protective that way. So it gives them actually the capacity then to go into these difficult places that in in anon in an ordinary state are not accessible to them. Yeah, absolutely. And thanks for saying that, Bruce, because I can remember when I was first sort of learning about this work and being kind of i've happily sort of surprised. And it's it's different to say, you know, traditional approaches where you may be exposure-based approaches to trauma work, where you have your index trauma and you kind of go through that with a client.
00:30:43
Speaker
And actually, that's not what you this work is about. The person may not name or go towards their index trauma in a session, and it might still be incredibly healing. And whether that's it's not an expectation, it's not forced ever, it's that they'll bring it up if they wanted when they're ready. Often it does come up, but sometimes it doesn't. Because sometimes what needs to happen is actually working with the different emotions around things as well, which doesn't actually need to be the thing. You know, in my refugee work, I very rarely did traditional exposure around traumatic events, it just wasn't appropriate. And so I feel like really heartened that this approach isn't like that. And I think
00:31:25
Speaker
and maybe I'm leaning into the next question, but that that feels like one of the misunderstandings that I think people have about this work is maybe they think that that is what happens, and sometimes it does, but it doesn't always. And it's very important. Choice is – regaining choice is such a huge part of trauma therapy, isn't it? Trauma work. Mm-hmm. Yeah. Can we go – but your original question was what are – what's MDMA such a therapy like? Yes. Let's go back there. So I got up to the MDMA session yeah and then I thought maybe Marcel would pick it up from there. But Marce, do you want to pick it up from that point or do you want me to go on? Well, I think that, I mean, I guess I i saw the question a little differently, which was more what it was that therapy was about, not necessarily this process that that we do. so but you know But in terms of that, sure. you know then
00:32:16
Speaker
it and the integration part, which is so important, right? That I think ah what happens in an MDMA session needs to be both digested and integrated. And there's a digestion piece around, I'm sort of swallowing it. All these things that I'm feeling and that are coming up and connections that I've made and perspectives that might be different and maybe doors that are open and doors that are closed and grief and all the things that can come up. And it's just digesting all of that and then seeing its impact. what How does this impact my life? And that we can also then be in relationship and support that process of integration because so often participants, even though there's something that feels
00:33:11
Speaker
really great, like maybe I won't have PTSD anymore, is so wonderful on the one hand, and on the other one, so scary of how do I live my life now, right? And so then the fact that they're not alone in that either, that we can be there with them, helping them discover how to be in their lives now,
00:33:35
Speaker
without the way that the story that they had with an updated version of that story and how that can be pretty scary, right? Not knowing who you are now when you've been so used to something. yeah and And even the joy, right? That sometimes the joy itself is so unfamiliar that somebody then all of a sudden feels, what? What do I do with feeling good and feeling joy and and what is at stake for it to be taken away, right? So I do think that the integration then is part of this work. It's such an essential part of this work to help navigate that and not be alone with
00:34:23
Speaker
needing to figure it out all you all yeah all on your own. Yeah. Absolutely. I had a bit of a, you know how sometimes, I don't know, like ah in my therapy practice, I have kind of themes of the week. Like I don feel like sometimes every client wants to talk about the same thing. and It's just this strange thing that happens. Yeah. And this week, the theme of the week was kind of what you're speaking to.
00:34:44
Speaker
which is, oh, I am feeling like I'm no longer in this traumatized state. And I have lots of feelings about that. I've spent 20 years in this state. I feel, why did I get, what how can it take this long? And the grief and the anger sometimes around that yeah is is also important to process. yeah And then, oh,
00:35:07
Speaker
how do I take this into the world? Like how do I be in the world? yes and And so that's been something that I think four different people have spoken to me about this week, which is really interesting. wow I don't know how that happens. it always It's a bit like that for me, but it it really it's a really important thing. yeah Yeah, it can be very scary. Yeah. And you know another piece of this puzzle, Marcy, you mentioned joy. So it's not all it's not that people just connect with their pain, but they also connect with the parts of themselves that have been like joy and delight and you know frivolity. and you know that they get they They often get connected to parts that just it that were happening, but they weren't
00:35:54
Speaker
they couldn't take them in, in a sense. And so they the the fullness of who they are begins to re-emerge. And so that's it's not just pain and suffering. So that's an important piece. And then the other thing is around relationship. And so one of the ah the skills of the therapist is actually relationships are are individually dependent. And so we it's not It means different things to different people, so it's the role of the therapist to really understand what does it mean for this person to be in a relationship.
00:36:27
Speaker
And then for us to try to figure out how how to match that, to attune to that. So there isn't one way of doing relationship. There's so many different ways of doing relationship. yeah And so kind of the richness of the human experiences, it's one of the things I really like about doing being a therapist. And this is that really just getting to see and be with people in all these different ways and for me to learn how to do that. yeah And I learned that from the from the people that we work with.
00:36:55
Speaker
Yeah, absolutely. I think I agree. That's so important. and And I think, you know, I guess it's ah it's a longer it's a longer term process. mg associate therapy you know I think it's helpful to see this question in both ways and to speak to the structure that that you you we've developed or that MAPS has developed, as well as the process part, which I think we're doing. And You know, usually there's three MDMA sessions, right? with With how many therapy sessions would you normally have in between each one? Just so I want to make that right. Three. Three. So three three integrative sessions of 90 minutes in between. And also check-ins, like phone call check-ins to kind of see how the person is and if they need more connection. And
00:37:40
Speaker
And always a choice that you could add another integrated ah integration session if needed. yeah And so the process itself, and we did it about once a month in our study, but it was you could do it anywhere between three to five months, at three to five weeks in terms of the.
00:37:58
Speaker
at the MDMA, the experiential session. So the whole process lasted anywhere between four and a half to six months, more or less, and with about with about maybe 42 hours of therapy of of actual contact with the participant. Yeah.
00:38:16
Speaker
But, ah and so what we were looking forward to, it's someday when the FDA gives us the green light, is really tailoring it. So we had to, you know, so doing research when the limitations is you have to come up with this kind of set sequence. yeah And so that for a certain group of participants that actually didn't didn't actually work that well for them. Because by the third MDMA session, they're just beginning to to feel safe enough with the therapist. And so they're justt so there's a certain um certain thing that happens at that point.
00:38:51
Speaker
And then the study was over. And so we had to say, and I'm sorry, but now we're done. And and there and so it was for folks with a certain kind of attachment dysregulation, it was very, very difficult to have the study done.
00:39:05
Speaker
and so what we were looking forward to is the ability to really individualize. so you know Marcela mentioned three to five weeks between MDMA sessions. and so Post-approval, what we were hoping for is like you know some people's everyone's pace is different. and so to be able to like Some people could do really well. like Every three weeks, they might benefit from the session, the MDMA session.
00:39:28
Speaker
other people might want two months or three months between sessions. So to be able to really kind of tailor our work with somebody to meet how they, as Marcel mentioned, digest information and integrate it and bring it into the world is something that I understand that you guys have that freedom, if I'm not mistaken.
00:39:49
Speaker
yes Yes, we do. Although it's still because of it's been rescheduled, but the way in which it's been rescheduled, we still have to go back to the Human ethics Research Ethics Committee if we want to make too many changes. But we do have more flexibility definitely than before. And we had the same issues as well with our ah but with our study with psilocybin-assisted psychotherapy for anxiety, which has finished now, as you guys know, within two years.
FDA's Decision on MDMA Therapy and Reactions
00:40:16
Speaker
And for some people, it was really challenging i don't to finish when they did. yeah yeah you know we We were able to find a list of therapists that could continue to work with people, but it was really hard for us
00:40:28
Speaker
yes not be the ones to do that, right? I found it really difficult. right And because it's so difficult for people sometimes to build trust, and then they have, and there is something really powerful in the dyadic model, having the two therapists holding the space as well, which people don't get in the real world with therapists usually. But no, we rap we absolutely do. And and also we we we have The other thing that's been really great about the rescheduling is different types of research are are starting to happen. So in like actually kind of on the ground in clinics, but also in mental health services, they're able to do more flexible research that kind of is in within the clinical space, which is really great and really important as well. So that feels really good.
00:41:16
Speaker
But Bruce, you alluded to and I'm wondering if now is actually a good time to talk about the FDA decision or at least how you're feeling about all of that. I was really heartbroken for you guys over there and also for everybody, like you said, for the people who dedicate their lives to researching this as and the people who are not going to be able to access this treatment in the America but as a result. How are you both doing?
00:41:44
Speaker
o Yeah. So when we got the news, it was devastating. I just i felt like I'd been actually kicked in the stomach. It was just very strong visceral, just profound disappointment. and I feel like I've how I speak about the FDA decision is that they were not following they're not actually doing following the science. The science is very clear from my standpoint. MBMA assisted therapy for PTSD is safe and effective. It's very disheartening to me because I feel like the our data means 71% of participants in Phase 3, I'm sorry, 70.1,
00:42:24
Speaker
participants in our phase three trials no longer had a diagnosis of PTSD. I mean, nobody is getting those results in any modality. And then if you if you take out the PTSD you know that they no longer have a diagnosis, if you then look at significant clinical outcomes, which means they had a cap score improvement of 10 or more, it goes to 88%.
00:42:48
Speaker
So we're talking about it you know the the possibility of somebody actually getting feeling better from doing this modality his quote is almost 90%. So I'm profoundly disappointed by ah the decision of of our government entity, FDA. They just weren't following the data.
00:43:10
Speaker
And it you know it could be that it's so, dare I say, revolutionary you know because we're taking you know the FDA has never been confronted with a drug combined with a therapy. yeah And so one could argue that you know just from a societal standpoint that our society that's represented by the FDA in this situation just needs more time to really kind of get what it is that you know for us, the three of us,
00:43:36
Speaker
you know We're kind of in it. you know this is and so so That's what I would say. and and the What made it easier for me is we happened to then be with a group of our colleagues so we could kind of grieve together and feel the the difficulty. so that was ah It was a Friday that we heard about it and then we were together for the weekend and that really helped with the sting a bit. So, you know, we're just kind of reinforcing this idea that grieving and pain and suffering benefits from being in a community. Absolutely. yeah absolutely I mean, i think I think for me, it was a little bit different in terms of
00:44:17
Speaker
the shock of it. I think I actually like, ah if I look back on it now, I think I dissociated. I just kind of dissociated from the whole thing. And, and part of me was like, I didn't, it's like, I didn't care. Like, I didn't care. And, and so i I do think it was kind of dissociation until then I was able to grieve. And, but a place that I got to,
00:44:44
Speaker
you know, after I did all the things that were like, I got mad, I said, why? I i had an opinion about what it was and and how we got there and and the criticism that people, this create the you know this articles that have come out where we, like Bruce said, we don't recognize, like I don't recognize what they're talking about. And so when all that kind of settled,
00:45:12
Speaker
And I was able to stay with my feelings and move through them. I got to this place of the gym in it, which was we needed more time and maybe now we can slow down a bit of what was it going to look like? Maybe it was going to be too fast and we didn't have that those pieces right in place. And that now we have an opportunity to to learn more to understand better, to maybe slow down a bit and do it more like an MDMA session, like really kind of slow down and what is this? And then and then where that took me was it wasn't a halt. There's not a stop to it. I still very much believe in this process of doing therapy and it is what I do in my own practice.
00:46:08
Speaker
and what I will continue to teach and what we will continue to do in Colorado with psilocybin, for instance. So I think it's that the modality, this way of of being seen and this way of honoring our participants continues and continues to be something that is really helpful. And so that doesn't stop, right? And we can keep learning. We have time to keep learning that and keep understanding What is the best way to teach this? What is the best way to have a felt sense of of what it really is all about? So I think that's where I'm where i'm at, that is that it wasn't necessarily a halt and that I am heartbroken for the people that were waiting. You know, i had I had clients who were just waiting, have been waiting for years and years and years who didn't get into the study and are just waiting and, you know,
00:47:08
Speaker
Like, for instance, I have this woman, it's ah it's a parent of a young adult that when I first, when she first got in touch with me, he was maybe 16 and he couldn't be in the study because he was 16 and very suicidal and has been suffering for so long.
Client Impact and Finding Growth Amidst Setbacks
00:47:27
Speaker
And she would always write to me like, okay, where are you? Where are you at? And what is it when is it going to happen? And how much longer? And, you know, and this has been happening for,
00:47:38
Speaker
probably like seven years, right? And then, and then waiting and waiting and then to hear this devastating news. It's like, Oh, no, right. And how many people are feeling that that are feeling like, if you say maybe this will happen in three years or four years or five years, that that is a long time for somebody who's suffering and and is not living the life that they feel that they want to live. And so that is a long time. And for some people, they don't feel like they have that time, right? So I i am heartbroken for that piece, for sure. Yeah. And I think
00:48:19
Speaker
You know, i'm as I'm listening to you, I'm just hearing so much of your wisdom and the way that you work coming through in both of your processing ah roll of all of this. And it's almost like you describe almost almost like an MDMA process both of you in different ways.
00:48:37
Speaker
It's like you go through all the big emotions like the anger and the grief and then you get to the gem and and that's ah I'm kind of in awe of that like I'm I don't know if if I would be able to be where you are knowing your history and how much you've worked on this and And so yeah, I think it's amazing and and a community as well Bruce that kind of coming together with community is also because we we were also very upset here, very distressed and there was a lot of big emotions and grief and anger.
00:49:10
Speaker
And we actually, we have a WhatsApp group of all that of the trainees from the maps training that you did. And it's just been such a beautiful supportive network that's Australia wide where everyone was just so able to just say how they felt and to really put it out there. And it's not even in person, it's it's on messages, but it really felt you know, so containing and so helpful, which was great. And yeah, I really hope, I think it's, it's this it's you know, where we I hope that we'll always be learning, you know, here, it feels like we we are able to use it clinically, which is amazing.
00:49:52
Speaker
And I think a lot of us would have would have liked a little more leading time in terms of when it happened and when it became so that we could slow down a little bit. But in reality, what's happened is that the rollout is very slow anyway because of the process and everything. And so it feels really, really good in many ways now. But there is I hope that we're always going to keep learning about humans, about human relationships and about this work for as we would with any therapy, really. Mm hmm.
00:50:21
Speaker
Yeah, it's so true. i mean you know And what we've learned is just one way of doing this work. you know That's what we research. That's what we are familiar with. And you know we are looking forward to, you know like as you mentioned, in terms of in Australia, different clinics can't help but do the work differently. yeah And so to learn from to you know for us all to be learning from how what works best with what populations and what configurations of therapists. And that's such an important piece of of what I love about this work is it does require me to keep learning. I get to keep you know like trying to figure out how to work with this individual who is different from this individual, who's different from this individual.
00:51:07
Speaker
and yeah But but i do I want to add one more important information. So we in the States, we actually don't know yet what the next step is, the FDA is going to require. So Lycos Therapeutics is in negotiation with the FDA over what the next steps are. And hopefully sometime late this month, or early next month, they'll make that information available so that we actually know what they've... So once they got this kind of letter that said no,
00:51:38
Speaker
then that begins a negotiation process between the FDA and in this case, Lycos Therapeutics. And so that's that's in flux. so yeah you know That's important. though The worst case scenario was that the FDA was going to require a whole other phase three study using more traditionally more traditional evidence-based therapies. And the complication with that is, even with you know should they should that be the requirement, you know just from an and intellectual standpoint,
00:52:08
Speaker
evidence-based therapies don't have never been used with MDMA. So if you think of you know the ones that are for PTSD, it's like you know prolonged exposure, CBT, etc. So they'll have to modify them. So it's not it's intellectually incongruous. Like, well, wait a second.
00:52:26
Speaker
if you want to use other evidence-based modalities, you can't actually practice them with MDMA. So you're going to have to come up with a hybrid. So how is that helping to address whatever questions the FDA has? And so, you know, it's going to be interesting to see what they actually negotiate in terms of next steps.
00:52:47
Speaker
Yes. And that kind of brings me to a question which way maybe we've started to to to get into
Addressing Misconceptions and Therapist Influence
00:52:55
Speaker
a bit. which Because you I think that that idea of trying to say that we should use evidence-based therapy like CBT is such a huge misunderstanding of how this work actually works and there's very good reasons why somatic psychotherapy and internal family systems or parts work are such a good fit for this work and important and also why CBT wouldn't be a good fit. I can't even imagine trying to do that with someone in this process
00:53:29
Speaker
So what do you think are some big misunderstandings that are out there around and MGMA assisted psychotherapy? Because I could speak to Australia a little bit, but I'd love to hear from you about what you think. Yeah, you know, I find it interesting that people will say, well, ah you didn't like you didn't practice something that was evidence-based or you were kind of trying to do something new. And yeah, we were trying to do something new. And the truth of the matter is that we've been doing it this way since the beginning of phase two, phase one, phase two, phase three studies, right? Like we've been doing this modality. If that's not evidence-based, I'm not sure
00:54:18
Speaker
I'm not sure what is, right? So that that you have to go through a process, yes, but there's a lot of evidence-based therapies that have a lot less research and a lot less data into understanding how they work. And so I do think that there's this piece that gets forgotten in a way that it is it is new in the ways that we're doing it.
00:54:45
Speaker
and but But one of the things that I find that is one of the biggest misunderstandings is that you know there's a lot of criticism that says, well, every all the therapists kind of just did what they wanted. And so it's not the same because ah it it wasn't the same because everybody just kind of did what they wanted. And so what I find interesting is how how there's not room to say, no, I wasn't using another modality.
00:55:16
Speaker
But I can be, but my frame might the way that I think about it is influenced by that modality, or by other experiences that I have had in my life. And that doesn't mean that we still that we all still didn't follow a format, right? Like we had People had to go through training. We had adherence criteria. We had adherence raters that were looking at all of the videos to make sure that the adherence criteria was being followed. We had a lot of supervision with all the therapists to make sure that they were following this interdirected approach. And so the part that doesn't get understood is
00:55:59
Speaker
How do we take out our ourselves? Like, I think that it's like saying, well, you're supposed to take out yourself then and not do that particular modality. And, you know, I was explaining to somebody this morning how even not even as a therapist, but as an artist that I also am.
00:56:18
Speaker
I'm influenced by that so that in the moment, in the way that I inquire, I'm going to inquire based on what I know, right? And I, for for many times, I remember countless times where I would tell a participant, so paint me a picture. Paint me a picture of what it is that you're seeing.
00:56:39
Speaker
And that came from me being an artist, right? And that doesn't mean that I was using this other modality or that i was that I wasn't doing the same thing that everybody else was doing is we were all following the modality and bringing ourselves into it.
00:56:57
Speaker
so that as somatic therapists, the way that they were inquiring was through the body, that an IFS therapist, the way they were inquiring was through parts, right? And that that doesn't mean that the fidelity of the modality is not being held. Absolutely. And you know, what misses what's missing for me is,
00:57:20
Speaker
is not only the piece about the therapist, but all of, if we would like to talk about our research evidence, like all of the research evidence that I've read speaks to the importance of the therapy around therapy speaks to the most important thing is the therapeutic relationship.
00:57:37
Speaker
Actually, the stuff that you do, whether it's CBT or ACT or somatic is important, but the most important thing is that. So that's one thing I want to say. Yes. and And also that everybody is and in is different. Every single pu client that I work with is different. Sometimes I use, in my ivo a private practice, that I do online one-on-one regular therapy, not non-psychedelic therapy. Sometimes I do use CBT because the person in front of me And what a particular presentation requires that. And to be a skilled therapist is actually about learning when to bring in different pieces of your training and your experience to match the person in front of you. yes That is what we are taught. That is what we teach other people. That is what supervision is for. And you spoke to it earlier, Bruce, around like, you know,
00:58:27
Speaker
the the art of being a therapist is building different kinds of relationship and learning that. And it's also knowing when, for example, to maybe in ah you know in a one-on-one to use CBT or when to do pathwork, when to do somatic work. And so, you know, I have a lot of grief about something that happened in the UK because I'm from England originally.
00:58:48
Speaker
and they tried they i was I was trained there. And then they bought out this kind of evidence-based CBT model that was kind of based on randomized controlled trial evidence and it because CBT fits really well into a randomized controlled trial approach. It's quite reductionist. And then they kind of started to prescribe that that's what everyone should be doing with everyone.
00:59:11
Speaker
And it was really, really sad for me because it's not how I was trained. I happened after my training. And it felt so in inauthentic to being a good therapist, which is what I was just talking about. And I would hate to see us go that way with this. It feels that would just be going against what we know about how to do therapy well.
00:59:32
Speaker
Right, right. You're absolutely right. I mean, it's ah it's about seeing the individual, right? Like, you know, I mean, I remember sometimes in the study, telling somebody about thought stopping. Here, here's a way to kind of like, okay, here's a tool that might work for you in terms of stopping the rumination.
00:59:52
Speaker
It doesn't mean anything else except what you're saying, which is I am being attuned to the participant and what they're asking for in that moment and what might be helpful for them in that moment, right? Absolutely.
01:00:06
Speaker
So what we've done to try to address this issue kind of within the literature is the group of us wrote an article that will be coming out in Frontiers in saop Psychotherapy, hopefully in the next month or two, on kind of the intellectual underpinnings of the modality called MDMA-assisted therapy as practiced by in these studies.
01:00:30
Speaker
So they'll begin to kind of articulate like just the lineage of knowledge. So is it new? I mean, it's, it's Rogerian. So Carl Rogers, big influence of our work. So it's client centered. I mean, that's, there's a long tradition with that. And so many different disciplines actually apply that. So, so it's not more. So I would probably disagree a little bit that it's new. You were saying that well it's new in, in the configuration,
Essential Qualities for Psychedelic Therapists
01:00:59
Speaker
right? of like me to match it with MDMA. To match it with MDMA. It's new in the way that we started it, right? that we That we did the studies. not But of course, the modality, it's like any other modality, right? It it borrows from so many things in history in traditions and and we bring them, if you think of IFS, you know, IFS,
01:01:24
Speaker
Dick Schwartz wasn't the first person who talks about parts, you know? So I remember being three years old and having parts and and and talking about parts as a three-year-old, right? And that was, you know, I don't want to say how old. Well, I mean, it was like 60 years ago.
01:01:42
Speaker
But I actually remember that, right? So it's like, no, like, there's a lot of different ways that parts work has happened. And then, you know, he, he brought it into a certain way of doing it, and borrowing from all these different places. That's exactly what we've done. You know, we've borrowed from all these different ways and put it together ah in a new way, is what I meant. Yeah. Yeah.
01:02:09
Speaker
And so many modalities have so much crossover and similarity as well, don't they? Because of that. Yes. Yeah. Yeah. yeah I can't wait to read that article. I will look forward to it. Were you about to say something, Bruce? Yeah, cool.
01:02:23
Speaker
yeah it's Yeah, it was exciting for me to read because, it you know, really just in its specific kind of to the our lineage, which is Marcella Bruce, the mythophores, Michael and Annie mythophore, and then and some other folks as well in terms of what influenced us and then how then, you know, we filtered that into then how we practiced. Yeah.
01:02:45
Speaker
It was very yeah was nice to read. And then we'll do we're going to do a follow-up one, which is on an updated treatment manual. So there's a thing called the maps treatment manual that forms the basis for a lot of this work. that will And so that's that's kind of the next step of of updating that to reflect what we've learned. And then there's one more that's coming up. Can't remember what it is, but... Yeah, that's all right. Well, you know, this we can...
01:03:13
Speaker
but By the time this is out, this episode, we can probably link at least the first article in, I think, or we can do that. Or we can at least maybe I can, if it's not out, I can just say that people can find it when it is. Yeah. I think people would love to read that, which is kind of brings me to another question if that's all right. Is that, are we ready to go to normal? Sure. Yeah. So you, a lot of people listening to this podcast, I think are going to be people wanting to become psychedelic assisted psychotherapists and What qualities, or maybe they already are, what qualities or skills do you think are important for NGMA assisted psychotherapists? Given where we are in Australia as well, it feels really important to speak about that. yeah
01:03:56
Speaker
hey
01:03:59
Speaker
We have lots of ideas about that. Yeah. You teach that. Right. And this is, I mean, this could be a whole podcast on itself. So I just want to say podcast episodes. So like let's just, yeah, we'll, we'll see where we can go today. Yeah. I mean, the two words that came up for me right away were awareness of what are our biases and the ways that we've learned how to be in the world and the ways that we judge our environment and the people that we're around. And when we are able to have awareness of our biases, then we can do something about it. not It doesn't mean not having them because we're always going to have them. It means if I'm aware of them,
01:04:50
Speaker
How do I not, how do I open up so that that doesn't interfere with the way that I am trying to understand another human being, right? Like I'm not going to put them into a box. If I'm not aware of those biases, I will, you know, they will interfere because I'm not, I don't have that awareness. And so, which means doing a lot of our own work and really understanding What triggers us? What is ours? you know What is ours and not theirs? And how do I understand that so that I can really work with it beside my beside me instead of in front of me? So so I think that's ah that's a huge piece of of being able to know that if I do my work, I do know that whatever is happening in this session at a particular time, I can be aware of
01:05:47
Speaker
even aware of the fact that something's happening that is mine and I'm not even sure what it is, but I better just really sit here and just take a step back, right? So I think that that's a ah crucial piece of our own understanding and our own awareness and how much work we need to do with ourselves. And then I think another one is attunement.
01:06:11
Speaker
you know, really being able to work on, I think, I think attunement we can learn. We can learn attunement and we can, and and we all attune to a part of something or a part of someone, right? We attune to a part, but we, but it's harder to attune to a whole. And, and that if we can begin to practice that and begin to say, am I, who am I attuning to here?
01:06:41
Speaker
And what are the other parts that maybe I'm not attuning to and then I'm not being in relationship with, right? So I think those are two that are really essential to work with and and to and to explore and to exercise and to build that muscle.
01:07:01
Speaker
Yeah, thank you. I so agree with that. And I think, you know, that's why I lean on my somatic therapy training so much in my psychedelic work is because I think it taught me that I think that's where I learned that is is how to really attune to another person's whole body and whole process yes as well as my own body and process as well as also keeping track of the person my diet partner and I feel like that that's that takes training and practice and it's something that you know this work
01:07:36
Speaker
is it's really important in this work. Yeah. And I absolutely agree. I think the first thing I would to ever say to anyone who wants to become any kind of therapist is even more so in this kind of work is you have to do do your own work. You have to know yourself. and I feel like I was called to level up that. I've always had done my own therapy. I had to as part of my training. It was a requirement. I've continued on and off throughout my career, my life. But this work could be to go to an even deeper level because it's so important to understand yourself in a really deep way, I think. Yeah. Yeah. And and and I think when you mentioned attuning to the body, to your body, to your co-therapist, and it's also to
01:08:22
Speaker
the people that they have brought in and by their experience, right? Like if if if somebody is bringing in the person who harmed them, you're attuning to them as well, right? You're attuning to whatever the participant is bringing in about them. And so all that influences the session and how we move in it, right?
01:08:49
Speaker
hey see yeah but so yeah Yeah, I mean, going back to what you said earlier, Esme, around looking at what modalities are the most effective, it's actually the it's the relational piece. So everything that supports that. And so the things you guys have both mentioned are really important or critical, I would say. And the other thing that comes up is is being very sensitive to power, power dynamics and power differentials.
01:09:17
Speaker
and you know And I'd say that that's a social issue, that's a political issue, it's an economic issue that to be aware of those forces as well. And you know because when two therapists walk into a room and sit down and then the client comes in,
01:09:34
Speaker
there's a power imbalance right off the bat. And so our ability to to name, navigate, and keep tracking that process that it is fluid and should be fluid, like at any point in time anybody can kind of be the force in the room, so to speak, and so to wreck to make room for that and to recognize when there are those imbalances and do what we can to help the room navigate that.
01:10:01
Speaker
That was one thing. And then the other thing that came up is is this is sort of a funny thing, but the ability to take responsibility for our our transgressions in a sense are when we cause a, you know, therapy, what we call referred to as a rupture or what's called a microaggression.
01:10:19
Speaker
you know The ability to genuinely hold ourselves responsible and accountable without expecting anything to in return is not an easy thing to do. you know We're not in a kind of individualistic, colonizing, capitalistic community. It's like, no, I don't apologize for stuff.
01:10:42
Speaker
you know so to So there's this this cultural force that works on us that we really need to be mindful of in terms of what we you know what are you what we refer to in the States as, what is our social location? So what is our identity? how you know So i'm you know I'm a white, cisgender male. And so when I work with somebody who doesn't identify that way, it's really important to really, to to that's part of attunement, to recognize who is in the room, and those kind of political forces that that inform our identity. And we had the good fortune of teaching in Sarajevo with a group of, we had 20 Arab speakers in the and the group. And in the United States, there's you know such Islamophobia and Arabophobia, and that you know that that's the soup i I'm bathed in. And I had to work with
01:11:38
Speaker
my cultural training, you know which is being a a North American, and to make that you know so that hence my bias, to get past that and just to be able to actually see the person in front of me. So it's so important, I would say, especially in this work, because PTSD and trauma affects all walks of life, every segment of society.
Cultural Sensitivity and Client Distress Framework
01:12:04
Speaker
And so, you know for me, it's um it's really important. I want to be able to work with, be effective at working with many different ah traditions and cultures and values. so and that well And that you are also, because of history and because of the way the experiences of different cultures being treated, that you were also then in that position of like, you are the white male,
01:12:32
Speaker
yeah who has harmed, right? And so then also being able to take that, also being able to to hold that role, to stand and say, i I see how you can see me that way, right? Like, I can experience that, and I can hold that, that position. yeah So I think that that also happens in the sessions, right? That we are we are put in these positions that is not always the very, the the caring therapist, right? That is, all of a sudden, I become the, you know, the bystander mother. And how can I hold that position, which also calls for doing our own work so that we can really hold on to that, right, without falling apart and not being able to be present in the session.
01:13:20
Speaker
Yeah, absolutely. You know, I've become i'm a mother or a father actually at different times. And and that's been, it's the reason that people who are non-therapist listening, the reason that that we might do that, that might happen is because the person might project onto us their feelings about that particular person in their life. And the reason it's helpful to hold that is because you can be so healing. And it can be such an important part of the healing process.
01:13:47
Speaker
Yes, for the client. Yes. Yes, but absolutely. Probably a lot more I could say about that, but I'm still there. but But thank you for speaking to power, Bruce, because it's something that I think is really important. And I was listening to you and thinking about my my training, which was with a woman called Lucy Johnston in the UK.
01:14:07
Speaker
who wrote an alternative to the medical diagnostic model of of distress or like the medical model, which she wrote with someone called Mary Boyle. It's called the power threat meaning framework. And it basically talks about it's a formulation approach to how we might understand someone's difficulties in a way that is tailored to them and it it looks at power. So how is power operated in your life? And what was your threat response? How did you try to survive that power that's operated in your life?
01:14:36
Speaker
And then what meaning did you make from that? And they co-developed it with a whole bunch of service users from different mental health systems. And I i use it a lot. I think about it a lot in this work because it's so, it's so important. Yeah. Yeah. Say it again. What is the the power threat meaning framework? I can send it to you both. So I think you would find it really. Oh, that'd be great. Yeah. Yeah. And I'll put it in the show notes. Yeah, that would be great. I'll put it in the show notes. It's free. It's a free resource, which is amazing. So I will send it over.
01:15:07
Speaker
Is there anything else that we haven't, I'm mindful of the time, and the is there anything that we haven't talked about that you would both really like to say? I feel like we could continue on this particular topic for so long and maybe there's another episode in this, but yeah, is there anything to kind of close off that you feel like you would really like to get into? Well, I guess what comes to mind is, strangely, as is the kind of radical revolutionary nature of this work.
01:15:36
Speaker
love that. Because it because it's it's really about people becoming who they were kind of supposed to, who they were born to be, like trying to find find that out, as opposed to who like what class they were part of, or what race they were a part of, or what gender they were born with. you know We have all these ways of classifying people and are categorizing them, and but who is it that's actually trying to emerge? And so you know So some people find that to be dangerous. you know So if you have a very you know i would say a narrow view of humans, this could be very scary. and so But what we know, if we actually really look at people, people are just different. No matter how they appear, we're pretty unique and pretty individual. And so
01:16:29
Speaker
And what I've seen in this work is even people with, what I would say, so seemingly similar trauma histories, how they come to terms with that is so specific to them. And so for me, that's always been you know from my early you know training, so I was first as a nurse and there as a therapist,
01:16:49
Speaker
How individual you know like that care or you know what we call refer to as care it be it truly be individualized that's the gold standard and so. You know for us to be criticized for the therapist to be like they can do whatever they want.
01:17:06
Speaker
Part of that is they're trying to respond to a different person every single time. So there is a certain amount of variation that we that is important to actually care for people in the in with respect for who they're trying to become.
01:17:22
Speaker
Because we're all trying to become, I would say, you know just from a human developmental standpoint, we're we're actually trying to develop as humans, has ended you know as a part of this incredible collective. And so what I think is helpful about this work is, yes, it's helpful for people with PTSD, but it's also helpful for people without PTSD. So you can you can use this work for a very specific issue like PTSD, but you can also use it for if you have a developmental viewpoint. And even people with PTSD, we're doing developmental work. We're helping them to develop as humans on their
01:18:01
Speaker
path of becoming who they are. And so for me, that's very it's a wonderful... So it's not just pathology-based, which is you know how it's MDMA-assisted therapy for PTSD. So that's one one you know that kind of communicates a certain thing, but it's actually so much more because it's really about the development of them as a human being.
01:18:25
Speaker
Yeah. So I just like to emphasize that. That's beautiful, Bruce. And I mean, I think that there was something that I had wanted to bring up a little while ago and I forgot it at the moment. So, but I do think that it's important to also know that there, that, you know, of course, that there are other ways of working with psychedelics, with MDMA, and that this is not the only way and that this is the way that we, that we study did, and so that we can talk about it from that standpoint. But I do think it's important to also know that it's not going to be for everybody. And not everybody is going to find healing. You know, when Bruce, you mentioned 83%, which is such a great eighty eight number, 88%, which is such a great number, there's still that 12%, right? So then it's how that we can continue to explore
01:19:22
Speaker
and to see what what are the conditions that we need, what are maybe, maybe somebody needs to do some work before they do the MDMA, assisted therapy, right? That we can continue to learn what are the best conditions and who does it best serve and maybe understand who it doesn't serve and, and you know, learn from that as well.
01:19:49
Speaker
Absolutely. And that's why we need to keep doing research, but also that that's why I'm so excited about the research that I was talking about that's emerging in clinical settings, like as in you know they're doing it as part of their treatment models. Because I think that yeah out there in the real world, which it's been very challenging to do that because of the scheduling of of the medicine, right? Right. so now we can I think ask different questions and get some more in-depth answers and I hope that that there's going to be more of those research trials that kind of can start because I completely agree like who is this knock and nothing works for everyone we're all individual people with our own histories our own stories
01:20:31
Speaker
And so I think you know people would love, like our society would love there to be a magic pill that fixes trauma. And we would really love it. So I would love to be able to just take away the pain from my client in some respects. But then they ah they would miss getting to the gym as well. right And so yeah, there's nothing. Right. right and And I think also that, and like you said, because it's not a magic pill,
01:21:00
Speaker
then maybe some sometimes we can lose the nuance of a healing process that took place because we imagine the healing to be a certain way of like, I am free of this completely, and I'm done. And so if that doesn't happen, it didn't work, right? So I think that there's also those pieces of how do we help participants understand, clients understand that there are sometimes nuances and it's not going to,
01:21:29
Speaker
It's not always going to be with this big, loud fireworks, right? That it could be so subtle and that that too is important and part of the healing. So, yeah. If you're interested in following along on the journey with me, check out my Instagram or website details listed in the show notes.
01:21:54
Speaker
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