Dr. Smith is a pseudonym for a well-established and experienced Californian
therapist with a private practice.
Dr. Smith is one of those psychotherapists who believe that MDMA is such a
valuable tool that they are prepared to take the enormous risk of being
prosecuted and of losing their licenses by administering MDMA to clients.
However, MDMA often takes the therapy onto a deeper level, so its use may
prolong rather than shorten treatment.
He believes that E is an ideal tool as an aid to psychotherapy in a wide
area, and if it were illegal he would use it more widely. It can be used as
a spiritual awareness tool, and in fact he sometimes meditates and breathes
on low doses, or before the drug has taken full effect. MDMA is also an
ideal tool for couples, simply by allowing them to talk. As it is, with the
risk of being informed on and struck off the register, he uses it only with
clients who he completely trusts and have no serious problems, such as
towards the end of a long series of sessions.
Not all clients are suitable for treatment using MDMA. Suitable people
should have a strong sense of themselves and a strong spiritual sense. Out
of 35 clients treated, one reacted in a negative way, seeing herself and
her surroundings (which was her home) as dirty and ugly. He is now far more
careful in selecting clients for MDMA sessions, as he believes that there
are a small proportion of people who may react badly. However, it was a
matter of mis-diagnosis, as the client's neurosis was not obviously
apparent.
Neurotic people are not helped by being opened up by MDMA, he believes,
because their base problem is that they do not believe in themselves which
is the cause of their defensiveness: to open up by the use of MDMA adds to
this problem. For them, it is safer to remain defended as it feels so alien
to be opened up that they may deny that the experience is real. This may
result in them forgetting the experience a way of avoiding the threat of
being undefended, and they may deny to others and themselves that they were
ever opened up by the drug. To help remind them, Dr. Smith records their
session on tape which he gives to them afterwards, and sometimes uses
photos.
Dr. Smith also believes the dose is important, and that body weight must be
taken into account, 2mg per Kg being about right. [He used to use 3mg/Kg
plus a booster of 1mg/Kg. The 'normal' therapeutic dose is 2.5mg/Kg.] If
the dose is too strong, some people become scared and fight off instead of
yielding to the effect, whereas too weak a dose may not overcome their
defensiveness.
Dr. Smith has experimented with a wide range of doses on himself. He does
not find that high doses produce speedy effects, and thinks such effects
may be due to impurities. But on high doses his "mind runs away, becomes
too busy, and is unable to hold onto thoughts".
While administering MDMA to a client, Dr. Smith prefers to take a light
dose such as 50mg MDMA, or better still, 6-8mg 2CB (he weighs about 50Kg).
This makes it easier to join in and stay with the client. He prefers a
non-clinical setting such as in the client's home with music and sometimes
earplugs.
Dr. Smith, who is a neo-Reichian, starts by asking the client to identify
what the agenda is for the session. He may then begins with evocative music
or perhaps simple drumming, and may ask his client to breathe deeply with
his hand on their belly. Sometimes the clients use earplugsand eye shades.
He encourages them to tell him what is happening, and reminds them if they
wander from their agenda but without condemning it, as he believes that
clients tend to "go where it is rich for them" - ie, tend to get involved
in whatever is their most important issue. This may not have been
anticipated, as for instance someone focusing on a superficial issue may
see a deeper one. For example, one client suddenly remembered being raped
as a child. Towards the end of a session, Dr. Smith uses an anchoring
technique borrowed from NLP: he asks the client to go over what happened
and to relive the highlights with the intention of holding onto them. At
the same time, he asks the client to squeeze together their finger and
thumb, with the idea that this physical action will help them to remember
the experience at a later date. He always holds a normal session soon after
an MDMA session to integrate what was learned.
The primary effect of MDMA is to lift anxiety, but it is important to
accept that it plays an important role in life and can't simply be
dismissed. He sees anxiety as fear neurosis which produces defensiveness
which can be useful in some situations, but can be an obstacle in others.
Dr. Smith suggests his clients to "respect your anxieties but ask them to
stand aside ready to be called upon when needed."
Asked whether he believes in self therapy using MDMA on one's own, Dr.
Smith replied that this only works for people without serious neuroses who
are pretty good at self direction, otherwise the session is likely to be
wasted. It is also important to establish a clear sense of direction before
a self-session, and one way is to use the I Ching. The advantage of a guide
is to interact and to bring one back to the issue rather than allowing the
mind to wander. However, the helper need not be a fully qualified
psychotherapist as most of the skill required is instinct.
Dr. Smith is a specialist in sexual problems. He uses imagery (sometimes
with hypnotic trance) such as sap flowing with women who have difficulty
achieving orgasm, and to treat pre-ejaculation the image of a bow being
slowly pulled back.
I asked Dr. Smith whether he thought that MDMA would become acceptable in
therapy. He doubted it would be as freely prescribable as he would like in
his lifetime, but thought that its acceptance would start with well defined
hospital programs.
Asked about possible problems due to inappropriate bonding, he said it had
never happened in his experience. If at all, it seemed to him more likely
that the therapist would fall in love with clients since they become so
attractive.
Exhaustion depends on the dose and also the amount of emotional work done.
To reduce fatigue he avoids secondary doses, gives 20mg Prozac at the end
of a session, and he also recommends calcium and magnesium. At the end of a
session he encourages clients to eat simple food such as soup, bread and
sweet tea.
Asked if he thought the E experience may be false sometimes, he said it
could sometimes be 'tunnel vision' but was always true. However, ways of
relating on E may not be appropriate in the real world and insights have to
be tested to be of any value.
