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“I envision a day where people would be able to choose to do MDMA-assisted psychotherapy in a safe context to be either able to heal from something together or to grow together, and to support the relationship.”
In this episode of the Mindspace podcast, Dr. Joe speaks with Dr. Anne Wagner. Anne is a Toronto-based psychologist and couples therapist, a researcher studying MDMA-assisted therapy, and the founder of Remedy Centre. Remedy is a social venture that provides individual, couples, and group therapy and reinvests the profit from these services into the Remedy Institute, which is “a new charity focused on supporting mental health innovation & research, including with psychedelics, training for aspiring mental health professionals, as well as low to no-cost therapy services for marginalized communities.”
She is the principal investigator on a pilot trial studying the impact of MDMA-assisted Cognitive Processing Therapy (CPT) on PTSD and is planning a study that will examine the impact of MDMA-assisted Cognitive Behavioural Conjoint Therapy (CBCT) on PTSD.
If you’d like to donate to the Remedy Institute, please check out: canadahelps.org/en/charities/remedy-institute
Dr. Joe and Dr. Wagner spoke about:
- The origins of Remedy Centre and the newly created non-profit, the Remedy Institute
- Her research on MDMA-assisted psychotherapy with couples
- Using a form of Cognitive Therapy in her protocols, as opposed to more experiential approaches typically used in psychedelic therapy
- The advantage of couples therapy over individual therapy in the treatment of PTSD
- Transference and counter-transference in couples therapy with MDMA
- Integration of couples experiences with MDMA
- The roles of co-regulation and self-regulation
- How MDMA can be a catalyst for change in couples
Here is more information on subjects mentioned in this episode:
- The MAPS inner direct approach for MDMA-assisted psychotherapy training (“A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder”)
- Cognitive Processing Therapy (CPT)
- Cognitive-Behavioral Conjoint Therapy (CBCT)
- Episode 24 of the Mindspace podcast: Love, Attachment, and Couples Therapy with Dr. Sue Johnson
- Paper that Dr. Wagner wrote on preparing for an MDMA-assisted couples therapy session and how to integrate that experience (“Couple Therapy With MDMA—Proposed Pathways of Action”)
More quotes from Dr. Anne Wagner from the interview:
“We’ve been doing the first trials that have been anything other than the inner-directed supported approach. So there’s a lot to ask, and a lot to investigate.”
“Not only does bringing someone along with you on your healing journey provide support, but it also provides the partner with their own support and healing.”
“It’s been really interesting seeing folks work with MDMA to help as a catalyst for that meaning-making process.”
“People take turns of who is struggling and who is okay. And that can be something that is really nice where they learn to ride the waves of that together.”
“I really try to help people frame their ideas around not expecting to have an expected outcome.”
Here are some highlights of their conversation:
Before we get to the trial that you’re planning, I want to ask you a quick one about the study going on right now. What’s interesting is that you described it as like a meaning making framework and so it’s very cognitive. And the trends and the buzz and all the excitement is around relational therapy, somatic therapy. Like these are the things that are bubbling up for me in terms of what approaches are being used in psychedelics. And this is a very cognitive approach.
I’m just curious how you think about that in the sense that I don’t know how many times I’ve heard like, ‘well, you can’t just do like cognitive therapy with someone doing MDMA. It’s just not somehow adequate to touch the depths of the experiences people are having.’ So just really curious about your thoughts there.
I respectfully disagree with thoughts that are the impressions that are there around it. And I think it’s partly because of the–it is possible to do cognitive therapy in a way that feels stiff and disjointed and doesn’t go into the depths. But I think if you’re delivering it in a way and working with the participant in a way that’s bringing in all of their experiences, it’s an incredibly rich way of working with everything that comes up.
And so of course, like even though it’s cognitively focused in terms of meaning making, we’re working with emotions, we’re working with sensations, we’re working with behaviours. It’s not excluding any of those components.
And it’s helping folks not only work with what has happened and the interpretation of what’s there, but also what’s happening now and what’s going into the future. It allows for the sense of my everyday life. ‘Oh, this is how this is going to change and this is how I can implement it.’ And that we find really effective.
It’s been really interesting seeing folks work with the MDMA sessions to help as a catalyst for that meaning making process because there is so much meaning making that happens in the MDMA sessions. And you’re just providing a bit of a frame to help that continue afterwards. So I always think of that as the catalyst.
I came up with this analogy the other day that has stuck around for me. I’d be curious if you’re on board with it. If you get a bacterial infection like strep throat or something. Your body could probably heal it, right? No problem. You’re healthy, you have a functioning immune system. It might take a little bit longer and you may not feel so great, but you can probably handle it. Or you can go to the doctor and get a medicine to help your body heal some health problems.
And I’ve started to think about maybe psychedelics in general or MDMA for couples where there may be something broken or something challenging happening in the couple that if they were to go for walks and go out for dinner and whatever, take the time to invest in themselves, they could probably heal through it. But MDMA is a medicine that might help speed up or deepen that process in some way. Which means that there may be situations in some future state where you can go to the clinic with your partner and get MDMA couples therapy to accelerate healing that might otherwise happen organically. Your thoughts on that?
Yeah, I do think that that’s a possibility. I think the medicine analogy is an interesting one because I actually had this conversation earlier this week with someone who was raising the point that I think sometimes people think that the taking of the pill is the thing that will cure them and be helpful. And it’s actually nothing. Like as far as we know, there isn’t anything inherent yet in the taking of that pill with MDMA in particular, that would have that effect.
It’s the psychotherapy, the psychological process that happens after that would create that shift. So I do think, though, that the experience, the MDMA session as being something that can help speed it up. It can help you do a good piece of work, a good chunk of work in a quick period of time. That’s true. And so that’s where I think it could exactly be really helpful.
I envision a day where people would be able to do that and choose to do that as something to either–with support and in a safe context–be able either to heal from something together or to grow together in a different way and to support their relationship. That would be fantastic to have that capability and that possibility.
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