MFA from University of Greensboro in North Carolina.
Marcela is a psychotherapist and an artist working in Boulder, Colorado. In her private practice she works in partnership with clients to nourish awareness and connection to innate essence. Her interest and focus on trauma has led her to understand the healing process as an intimate re-connection to self through integrity, acceptance, and honoring of one’s own human spirit. In addition to working with trauma and PTSD, she has dedicated her professional life to teaching, and research. She uses art as a vehicle for deepening the relationship to self and others through autobiographical storytelling. Marcela worked as a co-therapist in MAPS’ first government approved MDMA-assisted psychotherapy study in Madrid, Spain, served as the Principal Investigator for MAPS’ Phase II MDMA-assisted psychotherapy study in Boulder, Colorado, and currently in the MDMA Healthy Volunteer study. Additionally, she is a trainer for therapists working on MAPS upcoming Phase III studies for MDMA-assisted Psychotherapy and will be the Principal Investigator on a phase III site in Boulder, Colorado.
Ecstasy, Molly, The Love Drug. You’ve heard of 3,4-Methylenedioxymethamphetamine, or MDMA, for short, but you may not have known that the drug synonymous with rave culture had any therapeutic potential at all. When I first heard about MDMA for therapy, it sounded dangerous and potentially illega—we all know a character from a movie who takes ecstasy and things just always seem to end badly. But last year, when ENDPAIN green-lighted the production of MDMA: Stories of Treatment, I was forced to face my reservations about the drug and take an objective look at how it supported individuals healing from severe trauma.
Since its publication, the short film has been one our most-watched to date, and there is no surprise as to why. The subjects, Karen and James, whom both suffered from PTSD, have found remarkable and beautiful results from their experience with MDMA-assisted therapy. They, along with others who have participated in a study led by MAPS (The Multidisciplinary Association for Psychedelic Studies), are part of a larger shift to legalize the use of this medicine in the clinical context—and it’s working. In August 2017, the FDA reclassified MDMA with “breakthrough” status: a designation only given to a drug when trials indicate it as significantly more effective than current treatments and protocols.
But our audience wanted to know more, and so did we! So we decided to go back and interview our subjects, Karen and James, and Marcela, a principal Investigator and MDMA-trained therapist on the study. We hope you’ll find their reflections on their experiences with MDMA and their hopes for the future of the treatment to be as intelligent, insightful, and truly heartfelt as we did.
What were you surprised to learn about yourself after undergoing MDMA therapy?
Prior to the MDMA, I was trying to be James before deployment. For example, a child and into my teenage years in high school I loved fireworks. After deployment, I couldn’t stand fireworks or loud successive noises. I wouldn’t have a flashback in the traditional sense (I never thought I was back in Afghanistan), but I would see a mangled body after an explosion, and then another firework would go off, and I would see another mangled body, until mangled bodies took up my entire field of view. That would be distressing, as one could imagine.
So, I thought with every treatment I tried that if I was being cured, it would mean that I like fireworks again. Logic would say that I liked fireworks before PTSD and if I was cured of it, I would like them again. But then with the MDMA sessions, I realized that I just don’t have to like fireworks. I was so busy trying to be the James I was before deployment that I never tried to just be James after deployment, and James after deployment doesn’t have to like fireworks.
It was the simplest thing and a lot of the insights that I had were childishly simple. I realized—and I believe that this can be extended beyond myself—that I already know the answers to these distressing complexities in my life, I just need to process them in a way to get to those answers. It’s like a math question—if you look at it and don’t know the answer, then you can go to the back of the math textbook and the answer is right there, but you’re not any closer to it than you were before. You actually have to work this problem out and get to the answer for it all to make sense. To bring this all back, someone with a fear of public speaking knows the answer to their troubles, speak in public! But they have to process their situation and logically get to that conclusion themselves. It’s almost as if the answer isn’t the answer, but the journey is the solution.
Do you have any experience or opinions about other types of psychedelics or plant medicine, such as ayahuasca?
A little over a year ago I had the privilege of participating in an Ayahuasca Ceremony at a veterans retreat. To sum it up into a sentence, it was the most physically painful experience of my entire life, and with that, it was one of the more emotionally painful experiences as well. In comparison to the MDMA therapy, I hold it to be just as much a medicine, just as effective, and I hold it as close to my heart as the MDMA sessions. They were just two totally different approaches to healing in my experience. You see, to me, the MDMA was like this armor I could put all over my body, dive into the darkness of my traumatic experience and come out unscathed; whereas with the ayahuasca, I faced my demons eye-to-eye and we fought it out to the death with no mercy. It just depends on the kind of healing you want and how you want to deal with your problems. I have also participated in a couple Native American Peyote Ceremonies. Those are a much more spiritualized experience in a way, and with that comes healing as well, but I’ll end here for the sake of brevity.
You mention that MDMA therapy became your life’s calling after the army—in what ways are you involved now? How often do you undergo the treatment?
After the MDMA therapy, I got involved in various organizations to spread perspective on psychedelics in general, but focused a great deal on psychedelic therapy. A lot of people just don’t know about it. I have encountered very few people that are opposed from the outset, with most hearing about it for the first time and people are more than receptive. During my time as a student, just sharing my story seemed to do a lot to further this cause; if it helps just one person, then it was worth it. My ultimate goal is to get involved with psychedelic research on a professional level. I’m majoring in molecular, cellular, and developmental biology as well as neuroscience at CU Boulder, so I’m laying the groundwork to get involved with it as a career as we speak.
The therapist interviewed in MDMA: Stories of Treatment tells us that many people with PTSD find it hard to have new experiences because they are so guarded. Can you give us any examples of how MDMA therapy has since helped you open up to new experiences?
It has allowed me not be a slave to my fears (within reason of course). When going into a new situation I don’t let my fears be the main driving force. Instead, I ask myself if I’m prepared, if I have the tools to accomplish the upcoming situation in a manner that won’t lead to the death of myself or harm to others. If I do, then I go for it.
As a war vet, it’s understandable how your form of PTSD could benefit from MDMA therapy, but do you think someone who hasn’t experienced the severe trauma of war could also find it helpful? Should it be encouraged for them?
Absolutely. It’s great that you bring this up because I can’t tell you how many times I have been in a conversation with someone about MDMA therapy or PTSD and they bring up their traumatic experiences or say they have experienced trauma, but they always seem to say, “But it’s nothing compared to what you went through.” Listen: it’s not a contest, and it doesn’t matter how it happens. Trauma is trauma—hell, life is a traumatic experience. We experience it differently, but it affects us in the same ways. I experienced this mentality a lot in the military. Coming back from deployment, a lot of soldiers would think they can’t have mental difficulties because they have all their body parts. Then you have wounded warriors who have lost legs, and they think that they shouldn’t have mental issues because at least they have their arms... and the cycle continues in various forms. PTSD is treated like this medal to be won, but my question is... who wants to win that?
I’m grateful for the privilege to have taken part in this study. I’m better, but there are all these people around me who aren’t. That includes veterans and active duty service members, people who have been in horrible car accidents, people who have been mugged, people who have been raped and abused. Trauma is trauma, and we shouldn’t be keeping the most effective treatment for PTSD to date from anyone.
What would you say to someone who is a skeptic of MDMA therapy? Where do you think the societal resistance comes from?
I think that the societal resistance comes from the misinformation that has come from many outlets in the past. The generation before mine (and my generation as well) has been told that drugs are bad, period. We have been told that MDMA is damaging to the user both psychologically and physiologically. To have that crammed down your throat your whole life, it would make sense for you to be resistant to it—to be outright opposed.
But once you start sorting through the misinformation, those aspects of MDMA that initially make one resistant disappear. What’s left is this medicine that was traditionally used for psychotherapeutic purposes, that doesn’t put holes in your brain. Those potential negatives that occur with other treatments don’t exist with MDMA or are minimalized if taken responsibly in the proper setting with the proper dosage.
If someone is a skeptic, I would invite them to look at the objective data of the MDMA phase two trial results and to listen to the stories of the participants. In the end, only the user can determine if a particular treatment is effective, and I don’t see a logical or defendable reason to throw these people that are already suffering in a cage who are trying to heal themselves.
Can you tell us a little bit about where your past therapeutic experiences fell short and where MDMA therapy did not?
I did the regular stuff, talked to a psychologist every other week. I would just repeat these traumatic stories over and over again to the point where all emotional attachment to it was gone and they became difficult to relate to, and I was separated from it in a bad way. It made it more difficult to connect the dots and find root causes for problems or how they related. I talked to a psychiatrist in the weeks between that and it was the same thing. I repeated these stories and got prescribed meds, but it wasn’t working. The meds didn’t make me feel much different and the side effects didn’t make me want to keep doing them.
I did group therapy from 9am to 3 or 4pm five days a week for three months like it was my job, essentially. There I met other service members through all branches that were going through the same problems I was (many much worse than me). We became close friends, one I even knew from Afghanistan which was a bitter-sweet reunion, and we helped each other overcome obstacles, but once I was feeling good enough to leave the program, it was an immediate relapse, like I had never gone to group therapy.
I did other treatments like Alpha stimulation, which is not as scary as it sounds. They put these electrodes on your earlobes and shoot an electrical impulse through your brain. It’s quite relaxing and soothing, but it didn’t help me with my mental problems. I also did hypnosis, which I was surprised the DOD (Department of Defense) sponsored, but the things that came up in those sessions were too abstract for me to work with, and it was difficult for me to sort through it all. Lastly, I did prolonged exposure where they take what sets you off and put you in those situations. It sounds counter-intuitive, but it’s not what you think about it. When you are put in those situations, your anxiety, fear, etc., keeps rising and elevating, but at a certain point, those feelings level off and then drop down, which helps you overcome it. I can’t dismiss this approach as a couple men that were in group therapy with me greatly benefited from it, but I didn’t, and I could never get myself to stay in that situation long enough.
MDMA took all the short-comings of my past therapeutic sessions and righted the wrongs. I felt love come out of every cell of my body (not physical ecstasy, but love), and it was like this armor I could put all over my body and dive into the darkness of my traumatic experiences to come out unscathed. I could remember these traumatic events more clearly as well as the feelings associated with them and I could pull these events apart, process what I needed to process, and move on from them. Even though some of the feelings and thoughts about myself and the events themselves were negative, it was ok, because it was the truth, and that was good enough.
You, and others who have participated in MDMA-assisted therapy, describe your sessions with such vivid and intense richness. Was any of your experience visual in nature or was it feelings based? Was it at all important in the process to put identifying and descriptive language to the emotions or visuals of your MDMA experience?
I didn’t have a visual experience per se, though there was a minor visual element to it. This is a good question but difficult for me to accurately answer. It was almost as if my imagination and memories were easier to visualize and process. I’ll take a stab at describing this.
I study molecular, cellular, and developmental biology at CU Boulder, and throughout my college career, we have anthropomorphized everything within the cell. We talk about what the cell “likes,” what it “wants to do,” and what it “knows,” but the cell doesn’t “know” anything; it’s not sentient. I’m not saying that unicellular organisms don’t seemingly display some sort of intelligence if you want to call it that, but the words we are using to describe the events is not what is happening in actuality. We describe DNA as this “code/language” and these “supercomputers” called ribosomes that translate the instructions to build these “miniaturized robots” called proteins and enzymes that construct and maintain the cell. During the MDMA sessions, these life experiences would pop into my head and they would describe what I was feeling/thinking/working through to the best of my ability. These visual components obviously were not happening in actuality but the simplified visual descriptions could not only help myself, but help others get a better idea of what I was experiencing and working through. This was important for me because it helped me flesh out what was going on which made me understand it better, it helped the therapists by giving them an accurate and step by step picture of my progress, and it helps others who are interested because using such descriptive language can allow them to experience these feelings and insights with me.
Since your MDMA therapy, what does it feel like when you recall painful memories?
I had a difficult time recalling painful memories from deployment to begin with. It was like taking ten frames from a movie and only having that to remember the movie by—I only remembered those frames. The MDMA therapy allowed me to process those painful memories and leave the negative baggage behind, which for me, made those painful memories harder to remember. This is the only drawback that I can think of in my particular case with the MDMA therapy. In a sense, I was closer to those patients that either died or whose lives were changed forever, and now I don’t feel as close to them and those memories are quickly fading (though some frames will be etched in my memory forever).
This is a really interesting point for me because I made the assumption that forgetting these painful memories may be very freeing because perhaps you could assume that some of the imagery associated with these experiences could not possibly be purposeful (even though that goes again what we believe at ENDPAIN!). But it appears that you see it in a different way, which I would love for you to expand on. Do you ever wish that you had these memories back, even if they are part of a very traumatic past? Do you see them as purposeful experiences that you could reflect on?
I wish I could remember every detail of every one of those traumatic experiences. I don’t think it’s necessarily the memory of those painful memories that’s the problem, just an unhealthy response to them. There is wisdom and lessons to be learned from treating people that beg for you to let them die, or beg for you to save them, from treating children who will be physically maimed for the rest of their life, and watching men, women, and children die in front of you, to forget that is to forget the lessons learned from them. Those experiences are what made me into the man I am today, they are what helped me realize what is important in life, what I should prioritize, what I should let fall by the wayside, and so much more.
Did the experience entice you to explore other modalities to support your healing?
Yes, it opened me up to the idea that I knew all along: that I am the only person that can heal myself. I am always open to trying new techniques that allow me to establish greater control over how I react to certain situations and how I process certain experiences (positive or negative). An example that I have found helpful (it’s a simple one, see a pattern yet?) is exercising control over my breathing. When you’re anxious, when you’re angry, even when you’re in pain, your body reacts by increasing your heartbeat, you may start perspiring, and you start to breathe faster. But if you maintain control over your breath, and start breathing as if you’re calm and relaxed, your body will follow suit and become relaxed; your heart rate slows down, you stop perspiring, your mental landscape becomes clearer. All by breathing... simple as that.
What’s your life like now? How are you doing since we filmed the video? What are your aspirations for the future, personally and professionally?
My life right now is just like anyone else’s, I have good days and bad days, up’s and down’s. In general, I am doing great. I am fortunate enough to be going to school, supporting a family, and contribute to society in a meaningful way. In the future I would like to get involved with psychedelic research to some degree, these substances hold a lot of promise, and not a lot is known about them, it would be my dream to research the what is going on in our brain that produce the effects that are so closely tied to the psychedelic experiences.
How have you been feeling since the film was shot?
Honestly, I had quite a bit of anxiety after I was interviewed for the film. Prior to that, I had shared my written story with MAPS and on Facebook publicly. I really believe in the process and want to do anything I can to facilitate it moving forward towards legalization and helping other people. In writing my experience, I could take my time and edit it until I felt it really said what I intended, as opposed to the documentary, where I found that anything I had prepared to say went right out the window when the cameras were rolling. Not only that but afterwards, I really couldn’t even remember what I said. I was very relieved once it was finally out.
How many sessions of MDMA-assisted therapy have you had?
The process consisted of three (monthly) all day (eight-hour) MDMA-assisted psychotherapy sessions. Once a week for the three weeks prior to those days, I had a one-and-a-half-hour regular therapy session with my assigned team (always the same two therapists—one male and one female), then on the fourth week, I would have the all-day session.
I spent the night (with an attendant available in case I needed anything), then my team would return the following morning for another one-and-a-half-hour session to integrate what came up during the previous day’s session. This really took a lot of hard work, focus, and commitment.
Can you tell us a little bit about where your past therapeutic experiences fell short and where MDMA therapy did not?
I believe that all the steps I took along the way were important and helped me in my life. I overcame addiction, raised two amazing children and have been married for 33 years; a miracle these days! But it all took too long and wasn't quite enough. It's very likely, if I had been given this opportunity in my teens or 20s, I would have been able to do all of that work and more in a years' time instead of decades it took. That’s the thing about this process, it really speeds up the healing. It’s like doing years of therapy in a day. Maybe I could have enjoyed more of the life I worked so hard to create and spent less time (and money) working on my issues. But that's water under the bridge, and I am just grateful for having had this opportunity and that it helped me so much.
What practical tools or ideas did MDMA treatment give you that you can apply to your life on a day-to-day basis?
Here is an excerpt from a letter I wrote to my friends and family after the first MDMA assisted session:
“The great thing is that I was able to take the principles that I have intellectually known after decades of therapy, and make a huge gut connection that feels permanent... in part due to the medicine, and partially due to the gentle and supportive way the therapists were with me on the journey. It’s like a big ‘AHA! moment’ happens and is reinforced by the medicine and the therapy style. What I experienced during the active treatment is what I always kind of knew, but what I now not only KNOW but BELIEVE. AMAZING! The core of that for me is that I felt broken and unworthy and now know that I am whole and worthy. All the things that happened still happened, but I was am broken. And the things that happened to me had nothing to do with me. And dammit—I made it! A beautiful bud on a strong stem, some outer leaves crushed and bruised, but still able to bloom. Don’t get me wrong, this is not a totally instantaneous process, it will take some time and continued work on my part to rewire my reactions to things. But it feels so doable, and I can only imagine how much more I will get out of the remaining two sessions."
MDMA also gave me a new perspective that allowed me to explore the traumatic events and the impact they had on me in a way that I was unable to do with traditional therapy and antidepressant drugs. MDMA-assisted psychotherapy helped me to see my parents and sexual perpetrators as their own people on their own journey with their own issues. To realize that the ways in which they were not there for me, were not capable of being there for me, the ways in which they were horrible to me and could not control their behaviors, had nothing to do with me—that it wasn’t personal. It was not so much to forgive them, but to let go of them—to move on and enjoy my day-to-day life.
Did the experience entice you to explore other modalities to support your healing?
I have started meditating every day.
What would you say to someone who is skeptical or apprehensive about MDMA therapy? What was it that ultimately made you feel “safe” enough to try the therapy?
I think the biggest thing that made me feel safe to try this was the fact that it was in a controlled setting with professional support. And that is key, because without that, not only are you risking the medicine being something other than pure MDMA, but the guidance and the preparation are so important. Taking the time before to explore the issues that I wanted to address during the MDMA sessions and having the therapists there to guide me through that. Just as important was the session the next morning where again they guided me to go back and look at the connections I made to help reinforce them. Without the integration sessions, it would be easy to forget a lot of the insights I had the day before.
In your opinion, who could benefit most from MDMA therapy? Do you feel it’s strictly beneficial for PTSD?
I can from experience say that anyone with PTSD will greatly benefit from this therapeutic process. And though I am not a specialist, it sure seems like the same therapeutic process could be applied to people struggling with many issues, from addiction, to end-of-life grief and fear, to couples issues.
You talked about “shutting down” as a mechanism to survive traumatic experiences. It’s been documented that MDMA therapy assists patients in opening up these memories and actually “rewires” the brain to detach them from fear and shame. Since your MDMA therapy, what does it feel like when you recall painful memories?
There is little to no anxiety around the memories now. When they do come up (more when I chose to look at them, as opposed to before when they would often pop up without invitation), I can face them instead of trying to repress and avoid them. Which I really believe was a big part of my drug and alcohol use decades ago. The trauma does not trigger self-hatred anymore.
How did the actual experience of MDMA therapy measure up to what your expectation of it would be?
I thought it would be overwhelming and I would feel more out of control, but I didn't. The effect of the drug was actually very mild and I was always in control. If something came up and I didn’t want to look at it, I could turn away from it.
Why do you think there is societal resistance to MDMA being used as a healing tool?
People are afraid of what they don't know, and understandably so. Being that the stigma around this drug is associated with the 60s hippies and more recently the rave scene, it will take some work to see this medicine through a new lens. I also think that people like me, who have experienced trauma, find great comfort in being in control. And the thought of entrusting yourself and your psyche to a medicine and a team of therapists can be very frightening. Again, that's what surprised me the most: how in control I was during the process. Hopefully, the work that is being done around the world in different locations with amazing therapists and people like me will help to change how society sees this particular medicine and the potential it offers for great healing.
What’s going on for you now? What are you looking forward to?
Since finishing treatment over a year ago, I don’t wake up dreading each day. Overall I’m feeling happier, more secure, and able to enjoy my life. I’m experiencing fewer intrusive thoughts, and a reduced startle reflex. Even when I get frightened, the adrenaline doesn’t spike through my body like it used to. No more waking up at night in a sweat with my heart pounding. Less need to try to control everything—my kids, my husband, holidays. It’s easier to make decisions and I have less anxiety. When it does come up I can face it instead of trying to repress and avoid it. I don’t hate myself anymore, a.k.a., I love myself. I just turned 60, and I still have a lot of things I am working on changing and other things I’m learning to accept about myself as they are. But what stands out is my dramatically increased ability to enjoy my life, figuring out who I am, what I like and don’t like, without the PTSD ruling my moods and behaviors. Here’s to enjoying and being present for my journey through the next 30 plus years!
What drew you to studying MDMA? How did you get involved with MAPS, and what has been your role in the study?
I received MDMA-assisted therapy in 1984 to work with a traumatic past. It was life saving and the experience inspired me to go back to school to become a psychotherapist. I have been involved with MAPS since its inception. My role in the study was as Principal Investigator.
Can you explain the mechanism by which MDMA works within the therapeutic context? What is happening in the brain during and after this type of therapy?
MDMA affects the brain in several ways to support the therapeutic process. It deactivates part of the amygdala (where fear responses originate). This is important because it allows for the exploration of trauma without fear blocking the flow of emotions. Participants are able to connect to the core of their emotions and sensations of traumatic events in a way that feels safe and productive. The pre-frontal cortex remains active, which helps with insights and new perspectives. MDMA also releases oxytocin, aiding with bounding and trust. The combination of these effects is ideal for openness, discovery and for working through and processing difficult experiences.
What makes MDMA different from more traditional forms of therapy?
The methodology we use involves staying with the participant for the duration of the effects of the drug, and a few hours after the effects have worn off. This is not a traditional therapeutic format. Set and setting are an important consideration and an essential part of the work. The process is not about finding solutions, interpretations, or managing symptoms. It is about trusting that patients already possess the qualities they need in order to heal. It is about helping the patient see that they are the experts on their healing process, not the therapist.
What does safe space look like? How do you prepare a patient for this type of therapy?
Safety involves different elements. The first one is the safety of the actual space. We make sure that the room is comfortable, cozy—more like a nice living room and less like a clinical space—private, and prepare it with soft lighting. We always have fresh flowers and candles if the participant is comfortable with them. The second piece involves safety with the therapists. Before the treatment, the therapists takes time to get to know the participant and answer any questions they might have about the process or about the therapists. Among other things, this work asks of the therapists to be present for long periods of time, able to hold difficult experiences, suspend agendas and outcomes, and stay out of the way of the participant's process. It is important that participants do not feel like something is being done to them, but rather that they have free will. Being seen for who they are also creates safety.
What does a typical course of MDMA-assisted therapy look like? How long are the sessions and how many sessions does it take to see improvement in the patient?
In the MAPS studies we have conducted, treatment is anywhere between three and six months, with three to five MDMA sessions which last about eight hours. During the course of treatment, we also have preparatory sessions and multiple integrative sessions. Integrative sessions are an essential component to the treatment as a whole. It is during the integration sessions that participants begin to understand how to implement into their daily lives the insights and healing that has taken place during the MDMA sessions. Improvement varies from person to person but we have seen remarkable results so far.
What has been the most surprising thing you have learned in the study?
When given the opportunity, people naturally move towards health, and what is on the other side of the walls people build for protection tends to be connection and love, regardless of what the trauma has been.
The traditional use of plant medicine is having a resurgence in some healing communities. Have you explored plant medicine? Do you believe all psychedelics should be legalized or should they be restricted exclusively for clinical use?
My work is about advocating for the approval of MDMA and other psychedelics for therapeutic use. There is plenty of evidence that plant medicine and psychedelics are powerful healing agents and have been used as such for thousands of years, but they are not without risks and have the potential for abuse. Their danger escalates the more they get criminalized. I believe these medicines have great potential for personal growth when taken in a safe setting.
Now that the FDA has given MDMA breakthrough status, what are the next steps to make this drug more widely accessible to those who need it? What type of special training will administrators need in order to safely deliver MDMA in therapy?
Last year we trained 83 new therapists in the US. Many of them will be working on phase three of the trial. More trainings will become available and more therapists will continue to be trained. In the near future, I believe psychology students will be able to choose psychedelic therapy as a focus, and more universities will offer it as a track.
What would you say to someone who is a skeptic of MDMA therapy? Where do you think the societal resistance comes from?
Scientific research shows results in an objective way and can alleviate skepticism. However, MDMA therapy is not going to be for everyone. Hopefully it can be another choice available to people seeking help.
What have you enjoyed most about your experience with this study?
For me, witnessing participant's journey towards wholeness has been an incredible experience—it feels sacred.
If someone is interested in pursuing MDMA-therapy for PTSD or other related conditions, where can they look to get help? What are you working on right now?
At the moment, the only legal, available avenue is to participate in a study. At the moment I am working on a study called MT-1. It is a study for healthy volunteers that includes therapists that will be clinicians on phase three and have gone through our training program. They receive one placebo and one MDMA session with integrative sessions in between. It gives therapists a chance to experience first-hand what they will be doing on in Phase III and to have their own MDMA experience. This is so valuable for therapists who will be administering MDMA. It also adds to safety with participants if they know the therapists doing this work with them have had their own journey with the same substance.