From a first glance, MDMA-assisted therapy may look very different from mainstream therapies such as Cognitive Behavioral Therapy (CBT); patients lying on a futon for up to eight hours with eye-shades and earphones for music flanked by both a male and female therapist. However, a closer look at this therapeutic practice shows that it indeed carries many similar traits to more conventional psychotherapy. So how similar are they?
As with any other therapy, the course of MDMA-assisted therapy is governed by the patient’s innate desire and capability of healing, with the facilitation and guidance of their therapists. In MDMA-psychotherapy however, the pharmacological effects of MDMA occur in conjunction with psychotherapeutic treatment, typically acting as a catalyst towards healing. This of course means that, although many of the basic principles of psychotherapy are maintained, such as establishing a safe and supportive therapeutic setting as well as a mindset conducive to healing, there are some differences in how the treatment roles out (Mithoefer: 2015).
As MDMA is known for making patients feel more at ease in social scenarios, more trusting and less emotionally volatile, it means that people undergoing treatment with MDMA are usually able to establish a rapport with their therapists from which progress can be made, known as a therapeutic alliance, much faster than with other treatments (Lennon: 2019). For example, with CBT, the recommended time for building a therapeutic alliance with patients is 9-12 weeks, with a chance of diminishing returns the longer the patient is unable to form a bond with the therapist. With MDMA-assisted therapy however, the timeframe for building a bond with the therapist is much shorter. The heightened attention in providing a comfortable physical and emotional environment in MDMA-assisted therapy coupled with the psychoactive effects of MDMA in promoting trust, a therapeutic alliance may easily develop within the first 4-6 weeks of treatment, if not before (Lennon: 2019).
Moreover, the effects of MDMA also mean that cognitive restructuring (the identification of irrational thoughts and their solution) usually happens spontaneously in patients. This means that time is saved by both the therapist and the patient in recognising and deconstructing these verbally via the Socratic method as in CBT. It has also been observed that early experience of abuse or lack of support tend to spontaneously come up in MDMA-assisted therapies, alongside insight about their relationship with the patient’s psychological issues. Moreover, unlike in other methods more reliant on the therapist to bring these issues to light, this happens with little to no intervention. This means that, rather than needing to assign the patient homework to mentaly reframe and override certain emotionally triggering situations as in CBT, as the patient is confronted by their trauma mentally from MDMA, they are able to discuss it intermittently as it happens with their therapist during their session, reducing the time needed for the desired effect (Mithoefer: 2015).
To conclude, although traditional therapies and MDMA-assisted therapy share many of the same goals, the way and speed at which they are achieved differs due to MDMA’s role as a catalyst. Whether it’s in building a therapeutic alliance or identifying irrational beliefs and trauma, MDMA appears to grant more agency to the patient in gaining a more profound understanding of themselves, meaning the therapist can take a slightly more passive role as a facilitator, rather than a teacher.
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