Therapists perceptions of the therapist's role in psychedelic therapy incorporating MDMA for the treatment of PTSD

In recent years, we have witnessed a flourishing of research in the field of psychedelic research, particularly with MDMA and psilocybin. The research revealed such promising results that in 2017, the FDA designated MDMA-assisted therapy for PTSD as a "breakthrough therapy." MDMA has been found to significantly reduce the symptoms of Post-Traumatic Stress Disorder (PTSD), and research results indicate significant improvement in symptoms of the disorder (Workman & Amoroso, 2016). Additional studies suggest that substances such as MDMA and psilocybin represent a significant and innovative development in psychotherapy, and predict that in the coming years they will undergo a process of integration into traditional psychiatric treatment (Chabrol & Oehen, 2013; Mithoefer et al., 2011; Mithoefer et al., 2018). All these indicate extensive research engagement, but while many studies have successfully examined the psychedelic experience of patients and its outcomes in relation to treatment goals, research about the therapeutic process and the therapist's role within it remains largely unformulated (Penne et al., 2021). There are hypotheses in the literature regarding the beneficial impact of therapist skills on clinical outcomes, and in fact, this issue was identified as valuable even in the first wave of psychedelic therapy research in the 1950s (Phelps, 2017). However, there is a lack of more specific research on the roles of therapists and their significance for the success of psychedelic-based therapy, especially MDMA. This research focuses on how therapists within the MAPS trial, which uses MDMA for treating PTSD, perceive their experiences as therapists, as well as the principles of treatment and skills required of them. Research participants are therapists who treat patients within the framework of the MAPS treatment protocol. Data collection was conducted through semi-structured in-depth interviews, followed by thematic analysis. The research findings highlight the unique nature of the therapeutic relationship and the special interaction that develops with a patient under the influence of MDMA. Additionally, four main aspects characterizing the therapists' practice were identified: co-therapy, bodywork, non-directive approach, and role-taking. These findings led to the development of a model describing the unique therapeutic space created within the framework of 'set' and 'setting,' where the intersubjective encounter between the therapist, the patient, and the MDMA substance takes place.