On the Analyst's Couch With Ecstasy

Sitting on a couch is Melissa, a woman in her mid-20s who has just taken 125 mg of methyllenedioxymethamphetamine (MDMA), or ecstasy, in a glass of juice. Sitting in a rocking chair to the left of Melissa is licensed psychotherapist Dr. Jane, who will work intensely with her patient over the next few hours, as Melissa's brain bathes in the surplus neurochemicals brought on by the MDMA.

Melissa and her therapist aren't part of any currently approved research. They consider themselves to be conscientious, law-abiding citizens, but have decided to augment traditional psychotherapy with what the U.S. Drug Enforcement Agency currently classifies as a Schedule I substance – an illegal drug.

But, illegal or not, Dr. Jane (not her real name) has a rationale for using this drug with her patient: MDMA eases anxiety surrounding traumatic events, allowing them to be recalled with extensive clarity, then amplified by a desire to discuss them, perhaps for the first time in the patient's life.

Dr. Jane is one of an informal network of a half dozen or so psychologists – licensed social workers and psychiatrists practicing in Utah – with the experience and willingness to work with patients who choose to use MDMA in conjunction with other drug-free therapy sessions.

She and her underground clinical colleagues aren't doing anything new. Long before its popularity blossomed under the moniker "Ecstasy" in dance clubs and warehouses across Europe and North America, and long after its first patent by German pharmaceutical company Merck in 1914, MDMA was used by scores of psychotherapists during the 1970s and halfway through the 1980s.

With its relatively minimal side effects, therapists classified the drug as an empathogen for its ability to open the heart, increase awareness and foster sensations of self-love and acceptance. In addition, the drug has the added benefit of keeping the patient firmly grounded and in control, rather than orbiting Pluto as occurs with stronger drugs. From the perspective of the analyst's chair, these are all very desirable traits.

From its ingestion, MDMA takes about 45 minutes to take effect. During this time, Melissa nods her head in affirmation, as Dr. Jane reads aloud the goals for this session and the safety contract, both of which have been developed and agreed upon during six earlier preparation sessions.

It is now 60 minutes past the point when Melissa unwrapped a small triangle of tin foil, emptied the white, powdered contents into a glass of juice and drank it down in one long gulp. Her earlier, tense posture has given way to a more relaxed position on the doctor's leather couch. The pillow she had been clutching nervously in her lap is now resting under her right leg, and her head rests gently on the back of the sofa. Melissa is both alert, and noticeably relaxed, as she talks openly about abuse that occurred early in her childhood. Dr. Jane listens intently, only occasionally asking questions that probe lightly into progressively deeper layers of her memories.

Now two hours into her session, tears fall from Melissa's face and into a white Kleenex she holds in her hand as she recounts one particularly strong memory. Using a succession of questions, Dr. Jane assists Melissa in understanding how her earlier trauma caused her to project certain beliefs into her present relationships – beliefs that are creating some problems.

Toward the end of her session Melissa says: "Reliving this incident helped me free up my emotions in a number of ways. ... I know that I have a lot more to do, but I know now that I molded my views about the world – that I now know are not true – because that one incident caused me to distrust my parents."

Melissa, who works as a computer programmer, seems visibly relieved, and hopeful. Weeks after the sessions, she sent a promised e-mail describing the sum of her three MDMA-assisted therapy sessions: "I was able to dump my file ... the medicine cleared my channels ... insights and memories poured through me ... fragments and pieces of the puzzle all came together. I had a cloud of trauma that had seemed in front of me ... that for almost my whole life had been distorting my beliefs about myself ... it seems behind me now, and I've gotten a new sense of who I am."