III Conference on Entheogens. Barcelona 1998
The therapeutic dose used with MDMA is 120 mg, although 100 mg may be used for a first session. If the patient wishes after an hour and a half, they may consume a 40 mg supplement; this will not intensify the experience, but it will prolong it.
The preliminary verbal contract
It is crucial that before the session, the therapist establishes a verbal contract with the patient, looking them in the eye and remaining aware that they are speaking not only to the patient’s conscious mind but also to their unconscious, which will absorb the information. The contract must include the following rules:
1) All sexual sensations are permitted and may be verbalized and discussed, but no sexual activity will be initiated during this session.
2) All feelings of aggression, hostility, and anger are permitted and must be spoken about, but without acting against me or my possessions, with the exception of agreements we have previously reached.
3) If you, the patient, were to see the friendly door of death and realize that by taking one step you could pass through it and leave this life, you will not do so during the session. You will not harm life in this way with me because that would hurt me, and we will not hurt each other.
4) You are going to swear to accept these rules without any restriction.
The first rule is obvious and requires no comment.
Regarding the second, the therapist must make it possible to express anger, the desire to kill, and all feelings of aggression and violence when memories arise in the patient. Cushions, pillows, old sheets, etc., can be used, which the patient can strike or tear to express these feelings; how to do this must be agreed upon beforehand. A special room should be available for the session where it is possible to scream and strike.
It is a matter of life and death. By making the verbal contract, it is registered in the unconscious mind; it knows there are rules. The door of death is real, it takes many forms, almost all of them gentle. It is not seductive, irresistible, or trapping in nature, but it is often sweet. Its message is: “Here is the way back home for when you decide to return.” If the patient is severely depressed, they might decide to leave, but the contract they have made is enough to prevent it. Some people have decided to leave and have been brought back, but at least one did not return. This happened in France, and the therapist had not made the prior contract with the patient. This is a disaster for the therapist, as it can ruin their professional and personal life; that is why this point is very, very important.
The session and the role of the therapist
The session lasts about 6 hours. It can even last 8 or 10, depending not only on the type of substance but also on the type of problem, whether psychological or spiritual; often, emotional or spiritual confrontations in the experience begin late in the session.
Most sessions involve intense work during the 6 hours, but if a vital struggle occurs at the last moment, the therapist must continue the session until a resolution is reached.
The psyche moves on its own; it does not need to be directed. The therapist is there to help the patient, dedicating themselves body and soul to being their support and guide when necessary. When the patient says they are tired, that is a sign that their psyche is closing the doors, and then—and only then—should the therapist begin to close the session.
MDMA is an entactogen, meaning it allows one to touch inward; it allows access to the internal. It is a drug of internal vision. One of the ways it acts is by eliminating fear when one encounters shadows, so that a peaceful acceptance of anything, no matter how negative it may seem, and an unusual compassion for oneself appear in its place. Thus, an acceptance of all aspects of one’s nature occurs—the loving and the despicable, the generous and the thief, etc. Its effect can be compared to being cradled in the loving arms of God, and this is one of the most healing experiences that exists.
Once this total validation of who one is is felt, defensive habits begin to fall away. The therapist must remember that the shadow is there in them and in everyone for a reason: self-protection and defense, not only of the physical but also of one’s unconscious image, so that it has a certain degree of acceptance. The child created these barriers to survive. MDMA will suggest changes without rejection or guilt.
Working with the shadow
The degree of interiorization depends on the patient’s willingness to look their shadows—the closed, repressed aspects of their nature—in the face. Throughout the session, they are asked to confront their demons, the guardians of the gate in Buddhist terminology. What one thinks they are going to see—a series of unacceptable entities—can lead to a state of fear that has no parallel in life. No person should be led to that without the therapist telling them that THIS IS NOT THE WHOLE TRUTH OF WHO THEY ARE, EVEN IF IT IS AN IMPORTANT AND ESSENTIAL PART.
Before the session, before entering these territories, there should be much discussion with the patient about not only the nature of the shadow but also compassion for the child, and why they developed a series of patterns and emotional responses in that world. In this preliminary discussion, the therapist’s experience comes into play, as well as their persuasion, before asking the client to undergo a session.
As for the therapist, they must have felt that sensation in their stomach of opening a few parts of their own essence. They should have been helped in turn by a friend or therapist who knows how to lead them through the terror of the shadow and bring them back out; only such a therapist can transmit what is necessary on the journey. This must be discussed with the patient first; it is essential for them to feel safe and comfortable.
Sometimes, when the psyche announces the destruction of an image, when the survivor (the one who remained after the defenses) feels the footsteps of those monsters they have left out of sight, there may be no response to the substance, or a nervous state may be created that covers all effects like a blanket.
There are other aspects in which MDMA therapy differs from other therapies or spiritual growth techniques. The therapist must set aside all preconceptions as much as possible; they must learn from a new part, a new facet of the universe. The patient is a completely new being to them; they must be prepared for a new symbology and pay maximum attention to glimpse the emotional and spiritual structure and the rules of that unique human being in front of them.
It must be remembered that the patient’s psyche, like that of every human being, has a component that helps them—the self-healer, or their higher self, or guide, or superintendent, or whatever we want to call it—and this must be told to the patient, because it will help them activate it.
Another fundamental rule is that, whether with a patient or a friend, one must feel something very close to love for the other person. One cannot be strictly intellectual; there must be something deeper, at a visceral level. This cannot be forced, as we know, and one must have an internal vision sincere enough to see if one has a true feeling. If there are feelings of aversion, the therapist must be prepared to investigate the reasons for those feelings, and if they cannot resolve them, they should refer the patient to another therapist.
That connection with the ability to care for the patient, which one will have experienced on previous occasions, should have led the therapist to take steps within themselves that will have led them to the place of mystical participation. If the session is held in a truly appropriate place, such as a natural space, they will have already felt that brotherhood with every plant, animal, insect, and every living being on previous occasions, and will have felt how everything is related. They will have felt that everything is alive and that everything carries within it that same spark that they carry inside, which all beings share and which is the Source of Life and everything that exists, that we are all highly individualized parts of the same conscious being.
They must have compassion, even love, for that being in front of them, the patient, seeing in them a spiritual being identical to themselves, with an individuality that makes them new and different, unique.
