What Actually Happens During an MDMA Psychotherapy Session? – Marcela Ot’alora – HPP 68
Treating PTSD and other related mental illnesses can be quite challenging for therapists and providers. Each individual is so unique in terms of experiences and how trauma was developed in each case. In a therapy session, there really is no one way to treat clients.
Building trust between us and our clients surely goes a long way towards allowing healing to occur. But doing that can take time and can be extremely costly. But what if there was a faster and a more effective way of achieving that?
In today’s very insightful episode, we are honored to be joined by a deeply respected researcher and therapist, Marcela Ot’alora, M.F.A., M.A., L.P.C. Join us as we have this interesting conversation around psychedelic-assisted psychotherapy using MDMA and how much of an impact it can bring for our clients.
Understanding What Happens In A Therapy Session – 03:40
“And so we can sort of expose that a lot of times people with PTSD don’t really know what that means, and don’t think they have that. But I have never, ever seen in any session that I have done, and I’ve done many sessions over 200 sessions of actual MDMA in clinical trials, that it hasn’t shown up. That this healing intelligence that this drive for the spirit to really go towards healing that it hasn’t shown up”
MDMA In Action – 06:27
“Like sometimes it’s so quiet that even the sound of being in your car can muffle it. And with MDMA, it really speaks really loud. And it’s impossible to ignore. It’s like, it’s right there shows up and we see it, and they see it, and it’s a felt sense”
Healing With MDMA – 11:37
“So it’s almost chronological in a way. I’ve seen that quite a bit. And I don’t know if that’s what you mean, in terms of stages of healing, but that we need to hear that part first. With that sense, to be able to understand if I understand some parts of myself, that don’t have to do with trauma. How did that inform how to work with trauma, and how to begin to dismantle this piece that I think, obviously doesn’t happen with everybody, but I see it in a lot of people with PTSD”
Healing with MDMA: Parts Work Perspective – 14:30
“And so, I think what happens with MDMA is that the parts come up just like the way that healing intelligence comes up. Parts come up too, because there’s an opening, and it welcomes all the parts, right? So it welcomes all the pieces that form that whole, that hasn’t been whole, because it’s been so fragmented”
Into The Session: How Trust Plays A Big Role – 22:28
“And sometimes there’s a reluctance to do that. And then, if you really honor their story, and honor that, they can tell it to you, then there’s more of a trust that can be developed in terms of them going inside. And that sometimes it is that they were always told not to tell the story. And so how incredibly valuable it is for somebody who has been told, you can tell, to be able to tell”
Co-therapy: Working Together Towards Healing – 26:17
“And we can be open to this other way of working, and we can support each other as a therapist. And so I find that it’s a really humbling experience. And in both following my co-therapists and trusting them, but also in what you said, which is checking things out. So I’m not the only one making this decision in the room”
Presence And Dissociation: What We Need To Know – 31:57
“So you have to be you. As a therapist, you have to be so present with that knowing that they’re tracking you as well. And in that tracking is where they find brave space and where they find safety and where they find trust in themselves. So I think there’s less of a tracking of it. And more of a notice when it’s really not there”
MDMA And Ketamine: Understanding How These Medicines Can Work Together – 40:26
“with MDMA, it’s like I get at things from the front door. I come in the front door and I see what’s there, and I explore it, and I’m moving towards the back. And with ketamine, it is almost like coming in from a different place, almost like fooling the Self to come in from this different angle to explore the exact same thing. So instead of diving in, it’s more of moving out to see what’s there with the ketamine, I think. So I see that as the difference and one of them is more and they’re both needed”
Keith Kurlander, Dr. Will Van Derveer, Marcela Ot’alora
Marcela Ot’alora 00:00
In this work, we say trust the medicine and we also say don’t get ahead of the medicine. Don’t think that you need to get somewhere with it. The medicine asks you to sit back and to trust it and to trust its pace. And you have the time to do that, where it’s much more difficult to do it in an hour and a half session or in an hour session.
Dr. Will Van Derveer 00:23
Thank you for joining us for the higher practice podcast. I’m Dr. Will Van Derveer with Keith Kurlander. And this is the podcast where we explore what it takes to achieve optimal mental health. Today’s conversation with friend and colleague, Marcela Ot’alora is an exploration into what actually happens in an MDMA psychotherapy session. We’ll discuss with one of the world’s most experienced experts in MDMA psychotherapy, what she feels is the most important active ingredients in a successful MDMA psychotherapy session. And we really enjoyed this conversation with Marcela and we hope you enjoy it as much as we did. Marcela Ot’alora is a dedicated researcher and provider of trauma care, through art and through the use of MDMA-assisted psychotherapy. She has worked as a co therapist in government approved MDMA-assisted psychotherapy studies since the late 1990s, and is the principal investigator of phase two and phase three MDMA-assisted psychotherapy trials for treatment resistant PTSD in Boulder, Colorado, sponsored by the multidisciplinary Association for psychedelic studies (MAPS). She received her master’s degree in transpersonal psychology from Naropa University, and her master’s in Fine Arts from the University of Greensboro, North Carolina. Marcela was born and raised in Columbia, South America, and now lives in Boulder, Colorado. Well, we want to welcome Marcela Ot’alora to our show. I’m so excited to speak with you again. It’s been a while since we used to work more closely together. And it’s wonderful to be with you again.
Marcela Ot’alora 02:10
Thank you. It’s great to be with you.
Dr. Will Van Derveer 02:12
Well, we thought we would start by hearing a little bit from you, Marcela. And for our listeners, this is a real treat, because I think more than almost anyone on the planet have a huge amount of experience working with MDMA-assisted psychotherapy in clinical trials. And I think you’ve been at it for more than 20 years, I think now, right?
Marcela Ot’alora 02:35
Yes. A little over 20 years in terms of doing the research part. Yes.
Dr. Will Van Derveer 02:39
Marcela Ot’alora 02:40
And I’m looking forward to this phase ending.
Dr. Will Van Derveer 02:48
Well, I want to thank you for carrying the flag so consistently and with so much determination and care.
Marcela Ot’alora 02:56
Thank you. It had its challenges but definitely it’s sort of like seeing in the horizon the importance of doing the research and how valuable it will be to have the data together. And so I see the value of it. And that is so important. And then I also see so many wonderful things that happen within the work itself. And that’s also a wonderful piece that carries us through.
Dr. Will Van Derveer 03:26
Yeah. I’m wondering if we could talk a little more about what actually happens in the room, and what the elements are that you feel can be the most healing or the most effective in what you’re seeing?
Marcela Ot’alora 03:40
Yes, sure. I think the parts that we find are the most helpful, and this is of course not something that is measurable, but is the belief and the inherent drive of the human spirit to heal itself. You know, to really believe as clinicians that exists in our participants, and that we’re here to help them with that. But it is really characterized by the quality of self trust and of love. And so can we sort of expose that a lot of times people with PTSD don’t really know what that means, and don’t think they have that. But I have never, ever seen in any session that I have done, and I’ve done many sessions over 200 sessions of actual MDMA in clinical trials, that it hasn’t shown up. That this healing intelligence that drives for the spirit to really go towards healing that it hasn’t shown up. And, sometimes I tell the participants that it is sort of like the DNA of a seed is that it only has this purpose to grow and that as human beings we have that purpose as well. And that they just got stuck because of the trauma. And so the beauty of seeing that; I’ve seen the part of the person that has not been tainted by trauma I think is positively the most beautiful piece. And so is this honoring of the person that also then creates, it gets rid of the hierarchy that I’m not the expert in the room, they’re the expert in the room. I’m not the person that knows what they need. I’m the person that is following and is maybe finding out some things that they’re saying that they might not be aware of that they’re saying, and that I can bring to light those pieces. I think that is the premise where we start from.
Keith Kurlander 05:54
It seems like I mean, as therapists we strive for that without medicines assisting us, but it seems like it’s much easier to get in the entanglement of like, is that happening and trying to facilitate something and chipping away slowly? And so is it from your perspective, like the MDMA can just speed that process way up, basically, of seeing and finding that inner innate intelligence that it just creates more space for that to arise quicker?
Marcela Ot’alora 06:27
I do. Sometimes I think, even though the voices are there, in that part it’s there, it’s a little bit like a murmur. Like sometimes it’s so quiet that even the sound of being in your car can muffle it. And with MDMA, it really speaks really loud. And it’s impossible to ignore. It’s like, it’s right there shows up and we see it, and they see it, and it’s a felt sense. And it’s like, oh, here it is. And it’s not about getting rid of the ego, because I think we need the ego structure in order to go towards growth and towards healing. So it’s not about surpassing the ego and getting beyond it. It’s more around, how do I show up as my essential self. And one of the beauties of MDMA is that it gives participants that gift, I am going to give you the gift of showing up in that way, right now. Maybe for the first time in your life.
Dr. Will Van Derveer 07:33
To me, it’s such a hopeful message for humanity that you’ve never seen this not show up. Yeah, it always comes. I feel very impacted by that. It’s a hard time in the world right now. It feels amazing to hear that hopeful message. I’m curious about you bringing forward the idea of the ego and not about going beyond the ego. And I wonder if you could describe, in your own words, how you think about the relationship between this inner healing intelligence and the ego?
Marcela Ot’alora 08:11
Yeah, that’s an interesting question. I think that we need ego structure, in order to learn from the insights that we have, from the experience. And then the ego can be in relationship with the inner healer, and can learn from it, and can put aside that sometimes the ego thinks that we need certain things to monitor ourselves, right? Like, I’m going to critique you so that you can be on your toes. And you can do the things that you need to do, right. Like, it’s almost like it’s an impetus to move forward and what we need. And then it’s the ego learning that is not necessary, that we don’t need to do it in this way of criticizing or judging or thinking that we can be better. It really does happen that we don’t just go to sleep, if that’s not the case. So there is a relationship between the two. And maybe they’ve never met and how do we respond like, how do I respond to my ego and my inner healer in the room, and so if I step out of the way, and allow the relationship to grow, that there’s a trust that gets built to which I think is part of what we value as well, is that to trust that everything that is happening in the session is coming up for healing, and it’s coming up for a reason, even if you don’t understand it? So I think the ego has a really hard time with that. Right? A lot of times in a session, we hear people say like, I just feel like it’s not working. I came here to do this specifically and I’m not talking about that and I’m having this really wonderful feeling. But that’s not what I’m here to do. I’m here to work. I’m here to do this. And so it’s really about the ego saying, Oh, it’s okay. And can we trust that this is here for a reason that I remember a participant having an experience, that was her very first session, and she just had almost like this love fest with herself. And she was just loving herself for the first time ever. And she just thought, What am I doing? What am I doing? I came here to do this other thing, and what am I doing? And even though therapists were kind of feeling a little bit like that, like, should we mention the trauma like, but why don’t you do and it was like trusting that, and then realizing that she needed that, and her ego needed that to then allow for these other pieces to happen later on, and to really address other pieces of it. So it’s that trust piece to right. And that it’s about consolidating rather than transcending and validating the ego rather than transcending the ego.
Keith Kurlander 11:08
Yeah, it makes me wonder, just your takeaways are like the stages of healing that happened, if there even are any stages, or if it’s just sort of everyone’s so unique? Are you kind of seeing like, we can obviously talk about stages of healing and PTSD work in general. But I’m curious about MDMA, if you sort of see overall some themes right now about how people go through different stages of healing with MDMA?
Marcela Ot’alora 11:37
Yeah, I think you’re right. I mean, everybody has a very individualized way of showing up. But I have seen a little bit of a pattern in a lot of people, which is that you do start in that younger self, that we started there, and we start seeing, what is there, what needs to be healed, what was the conditioning that took me away from my essence, from my essential self? And then from there, and that understanding and bringing it forward and having awareness around it, then you’re able to move past that into other parts of the self, until you get to the present moment? And what does that mean Now? You know, who am I now? How do I move forward? So it’s almost chronological in a way? I’ve seen that quite a bit. And I don’t know if that’s what you mean, in terms of stages of healing, but that we need to hear that part first. With that sense, to be able to understand if I understand some parts of myself, that don’t have to do with trauma, how did that informs how to work with trauma, and how to begin to, to dismantle this piece that I think, obviously doesn’t happen with everybody, but I see it in a lot of people were with PTSD, whereas I need to understand something about it, I need to make sense of the trauma, I need to have some questions answered. That’s where I want to begin the healing. But that’s not really where the healing is, because there is no answer, right? There’s nothing that we can understand that we can really say, this is the answer of why that happened, why you had this horrible thing happen to you. And then it’s the realizing that’s not the ground to start from. That’s not the moral compass.
Dr. Will Van Derveer 13:36
Yeah, I think that’s such an important piece of looking for answers in the wrong place, you know, the way that we use the cognitive mind or the thinking mind to look for solutions, or answers to trauma, when the deeper, reconnecting between different parts of the cell is such a mysterious and semantic, oftentimes very semantic process that isn’t really that cognitive at all. And I think it also speaks to how MDMA works more in a semantic framework and not so much in a cognitive framework. So I wonder if we could go a little deeper into the concept of different aspects of the self relating with each other. And it’s kind of a parts work perspective.
Marcela Ot’alora 14:30
Yeah. And I think parts work, I tell therapists when we train them, you don’t have to be an IFS therapist to do parts work. Parts are what we all have, and we’ve all used and we’ve all been, I think, we’ve all said, Oh, you know, a part of me really wanted to go to that party and a part of me didn’t want to go, right? We’ve all used that kind of language. We all understand ourselves as different parts. If we actually really look at it, right? And so I think what happens with MDMA is that the parts come up just like the way that healing intelligence comes up, parts come up too, because there’s an opening, and it welcomes all the parts, right? So it welcomes all the pieces that form that whole, that hasn’t been whole, because it’s been so fragmented. And so the wonderful thing I think about parts is realizing that it’s not all of me, it’s not all of me that has felt this incredible pain and suffering. It’s not all of me. And just by doing that, then you get a little bit away from that identifying with the trauma, identifying with the trauma itself, right, that I’m just this traumatized person. And then it’s like, well, there is a part of you that is this traumatized person, and who else is here, right? And it can even be here, the person that is connecting with me, the therapist, who is this part that is connecting with me? And how do I as a therapist, talk to that part, depending on how old they are? What are my responsibilities? How do I relate to this part, if it’s a three year old, I can’t talk to her like a 25 year old, for instance. So parts are just such a natural piece of the human being that I think MDMA allows for that to have. what is it that human beings are made up of, and its parts and ego and this healing intelligence, and It’s so much richer than we think it is that we think it is like, this is who I am? This is the person, this is my identity. It’s just so much. It’s almost like we’re missing half the picture when we see it that way.
Keith Kurlander 16:55
Yeah, well, maybe it would be good to also just break down a little the aspects on the modalities that seem to be working really well with an MDMA assisted psychotherapy session, like what are the modalities that seemed to be working very well? Are there some things that tried to seem to flop it didn’t work out that well?
Marcela Ot’alora 17:17
There are some things that don’t work very well, sometimes.
Dr. Will Van Derveer 17:20
I think Marcela has a video on her training of doing things that didn’t work so well.
Marcela Ot’alora 17:28
I have a little clip, called Bruce rolls his eyes where my co-therapist is just rolling his eyes at me like, Well. I think I’ll talk about the things that work well, first. And so this is what we call it inner directed, right. And it’s a little bit about what I was talking about before, which is a sense of, as a therapist I’m not introducing something into the room. I am maybe addressing things and making connections of what has already been sort of what is presented into the room by the participants. So, it’s not a philosophical stance, it’s more of an attitude. An attitude of bringing forth that I can trust what is happening in the room? So not like a take me to know something that I’m trying to get to but how do we stay with that, even when it may be really painful when we see somebody in a lot of pain. And how do we say this is what needs to be here. And how can we support this happening? So I think that’s also one of the pieces that we do is really trusting that and constantly coming back to the present moment and constantly saying, it’s organized ignorance. It’s like, how do I come to the room, leaving aside what I think I know, to be in this very present moment, and keep bringing the participant back to this present moment of where we are. And, you mentioned, Will about the body and it’s usually done through the body, right? What is it that you’re feeling right now in your body? And in order to answer that question, I have to be in the present moment. So it’s coming back. It’s very body-centered, and very client-centered. And it is about the experience that is happening right now, even if the parts that are happening are something that is remembered. It is about what is happening right now. So then it also gives us a sense of validation. A validation that oh, I shouldn’t be feeling this way because this happened 20 years ago. Why am I still feeling this way? It’s like, this is what you’re feeling right now. Right? So can we stay with that? And so I think that works. Working somatically, working with the parts, working with the inner-directed, having times when people go inside and times when you relate with them. And that is really when they’re inside and not talking to somebody that they get the insights that come from their frontal lobe, you know that it’s really that connection of, I am making all these connections that I’d never made before. And that feels so incredibly inspiring, right? That’s inspiring to have all these connections. And so it’s holding the connections, being able to be with themselves and be in a relationship. And it’s almost like, it’s creating a culture in the room, the two therapists and the participant together are just creating this culture that is based on love and acceptance and respect for each other. So I think like in terms of the setting, how important that is to really bring in as much as we can, a way that is inclusive, that includes all cultures, that we’re not decorating or doing things that is just one culture, and there’s somebody who’s going to be feeling left out, that is really paying attention to what we bring in. And knowing that every detail matters, right? I’m this is your time. This is your time that you’re here with us. And we’re here for you, which is something that a lot of people don’t get and don’t have. People don’t have eight hours for themselves. But let alone people don’t have eight hours where two people are there for them in the sacredness of that right that’s so sacred. So it’s honoring that peace and knowing that whatever is happening in that room, there’s an energetic field around it, that everybody’s feeling that even though the therapists aren’t taking MDMA, right, they feel like there’s an energety. I always feel when the medicine is coming on, I can tell and like, a second later, they say, Oh, I feel something. It’s so open that it allows me to be open. And it allows me when people say why do you love doing this work? Part of it is that it allows me to be unselfconscious, which I’m hardly ever.
Keith Kurlander 22:14
Yeah, that’s beautiful. I’m curious if the healing is ever cognitive and like retelling the story? Do people ever go through just needing to retell the story as part of their healing during the MDMA session?
Marcela Ot’alora 22:28
It’s being able to trust that if they are telling it that you would know, when it does, like if it ever became, oh, this is maybe an avoidance of something and there just telling the story? And how do I check that out? But also, then, not to start there, that you might get to that place, and you might get, oh, this person is really, they are somehow in a loop and their story becomes part of their loop? that’s up to us as therapists to know that, and to question that, but to really start from a place of, there’s a part of them that needs to tell the story right now. And can I listen to that story? And can I respond and be here without judgment? And follow that. And so many times what I’ve seen is, oh, you know, sometimes we tell people if they told their story quite a bit, and we say like, let’s try maybe to go inside for a little while and see what happens. And sometimes there’s a reluctance to do that. And then, if you really honor their story, and honor that, they can tell it to you, then there’s more of a trust that can be developed in terms of them going inside. And that sometimes it is that they were always told not to tell the story. And so how incredibly valuable it is for somebody who has been told, you can tell, to be able to tell. And so as a therapist, to honor that too, that if I tell them not to tell me, I’m doing the same thing that they were told to do. And so sometimes telling that story is incredibly healing. It’s out in the open. It’s sort of like what happens with shame, right? Shame means there’s a secret, and how do we bring it out and be able to share it and get some of that and burn that piece.
Dr. Will Van Derveer 24:26
It’s a lovely way to talk about checking your assumptions at the door in that example, where one person might be in a kind of very disembodied way just retelling the narrative, all as an avoidance whereas another person, it might be really critical for their healing for the therapist to embrace that and meet that with warmth and receiving care.
Marcela Ot’alora 24:51
Yeah. I mean, I think that’s really difficult for clinicians for all of us to do like at some point we have the agenda and we have those stories that we think are going to help. Right? Like, we know this is avoidance, we know this is this, or we know this is that and how do we trust ourselves to know that it’s okay to leave that outside the room, and that it will be there if we need it, right? That toolbox that we have, it’ll be there, it doesn’t go away. And we do use it when we need it. But how do we have that beginner’s mind, it’s so difficult to do. And I realized that in an eight-hour session, we get tired. And when you start getting tired, whatever it is that is difficult for you to do about being present comes in. And like, for me, it is a beginner’s mind. I have a difficult time when I’m tired of having a beginner’s mind. And to really come to it clear, and then I do find myself starting making these assumptions, right. And then I have to check myself, hold on, I’m just tired, I need to step back and hopefully bring compassion to my awareness, sometimes, not so well. But it’s definitely my intention.
Dr. Will Van Derveer 26:17
And that’s one of the things that I think is so interesting about having two therapists in the room, because I remember, on a number of occasions with you, as a co therapist with you, checking out one of these assumptions, like, you know, with a quick little note on the notepad is this avoidance question mark? And then you might be able to sort of co-regulate me in a way or relax, I think this is actually really necessary and important. Let’s trust this, it’s very different from having to make that judgment call as an individual therapist.
Marcela Ot’alora 26:48
Yes. And it’s also I mean, you bring really beautiful piece about co-therapy, which is that helps with that piece of not thinking I know better, which is if I have a story in my head of where I want to go with this particular thing, and then you as my co-therapist, bring in something first. And I follow that, and that can lead into this beautiful place, right, that was so different from where I was thinking, that is a very humbling experience of being able to say, there’s just not one way, right? And we can be open to this other way of working, and we can support each other as a therapist. And so I find that it’s a really humbling experience. And in both following my co-therapists and trusting them, but also in what you said, which is checking things out. So I’m not the only one making this decision in the room. And maybe I’m not the only one thinking this and how wonderful that feels. Right? If you pass me a note, and it’s like, I just go, yes, I was thinking the same thing, too. It’s just so validating to have that other person validate that. Yeah.
Keith Kurlander 28:01
Yeah. What’s really interesting to me is like, what the differences are, as the role of the therapist between, if we just call for the moment psychedelic-assisted therapy and non psychedelic-assisted therapy, so there’s obviously similarities, it’s therapy, but there also seems to be like you’re pointing out, there’s some differences here about the position the therapist takes when there’s this extra helper online with this medicine. I wonder if you could just kind of tease that out a little like, what’s the difference you see when the medicine is there and when we don’t get to use that medicine to help people?
Marcela Ot’alora 28:38
Well, the beauty of medicine is that you can drop in very fast. So almost like all the pieces that in non psychedelic therapy to get to that dropping in can take a really long time, and can take many sessions, and back and forth. And the next time they come in, you have to take another step back because you’re all you’re no longer there in that spot. So there’s a difference between seeing someone for an hour or an hour and a half and seeing somebody for eight hours. So that’s in itself a big difference. But with MDMA is that you do drop in and by dropping in, I mean, to that place where you have an intimate connection with Self. I’m intimately connected right now. Right? And there’s all these possibilities that come up from that, and I have all these resources, I can titrate myself, like the therapist doesn’t have to titrate me. I know how far I can go. And yes, I can push myself further. Oh, I need to take a break. And I need to just settle in and just maybe listen to music. So there’s this resource rich area that happens and then there’s the dropping in into this intimacy. And that’s not just for the participant. There’s also the intimacy between the therapist and the therapist and the participant of we’re here from this place of non-judgment, right? Like we’re here together in this connection that is happening. And so it’s something that takes such a long time to do without it, if it ever happens, to really drop in, in that particular way. And also as a therapist to be witness to that dropping in that maybe we see it. If I think about my private practice, I have little moments of it right? Little inklings of it, of dropping in, and like he has, there you are, and in their wonderful and they accumulate and healing takes place for sure. But to see it in the moment, in this very moment, in front of my eyes, I see you dropping in and I say, Oh, the medicine is doing its work. In this work, we say trust the medicine. And we also say Don’t get ahead of the medicine, don’t think that you need to get somewhere with it, the medicine asks you to sit back and to trust it and to trust its pace. And you have the time to do that, where it’s much more difficult to do an hour and a half session an hour session.
Keith Kurlander 31:17
Yeah, the follow up for me here is when I think about non psychedelic-assisted therapy, at least a lot of the somatic training that I’ve been through, there’s a lot around trying to track presence in the therapist as well as in the client, right and seeing if, for instance, do we believe the client is what degree of presence is going on right now for healing to occur? That sort of there’s a premise that healing can occur in a state of presence more than in a state of, let’s say, dissociation as the opposite. I’m just curious, like from a psychedelic assisted therapies perspective, is that it just like there’s just more presence naturally, or you’re still tracking presence and dissociation?
Marcela Ot’alora 31:57
Well, you know, it’s interesting about dissociation, because dissociation can come in and can be part of the session. But there’s presence in the dissociation. So I think that you don’t need to track it in the same way. It is self manifesting. By nature, because it’s so relational. The participant is also tracking the therapist, right? They’re way more aware of, if you’re stressed, they’re going to pick up on that stress, if you’re distracted, they’re going to pick up on that distraction, right. So you have to be you, as a therapist have to be so present with that knowing that they’re tracking you as well. And in that tracking is where they find brave space and where they find safety and where they find trust in themselves. Right. So I think there’s less of a tracking of it. And more of a notice when it’s really not there. It’s very obvious. It’s very obvious when it’s not when you’re not being present, and how do we return to that present moment experience? So it’s much easier to do because it’s so obvious when it’s not there. So like when we work with dissociation, it’s a very different way of working with dissociation, because there is a presence to it. That generally doesn’t happen with dissociation so that you’re able to then explore further, what is the dissociation? What is happening there? Because it’s happening in the present moment. And I can see it from that point of view. Does that make sense?
Keith Kurlander 33:28
Yeah, yeah, that makes a lot of sense. And I’m assuming to like it, different medicines are different, like we’re talking about MDMA, and there’s ketamine and psilocybin. But I’m assuming, too, that you could speak to this with MDMA, there’s maybe less of these incredible states of overwhelm that can happen in trauma work, where it’s just a flooding and trying to get people to just calm down or is that not true? Do we see those that overwhelm states and MDMA where we’re just trying to help people resource to downregulate?
Marcela Ot’alora 33:58
So we do see overwhelm happening, but I’m not sure if I would call it overwhelm. And it’s more because there’s so much resource happening in the person, then they’re not out of control, and they don’t feel like they’re out of control, which I think is when we need to help regulate and find resources for them to regulate, right? There is no need to regulate it. Because there is an understanding that my body can actually handle this, you know, my body has so many resources right now that it can move through it. So if you imagine that you have, you’re in a state of what looks like overwhelm somebody who is just really activated and having tremendous pain, and it’s just really suffering. But at the same time that they’re doing that they have a part of them. That feels a total sense. of well being a belief that this is where I need to be, I belong in this body, I belong in this experience. I feel this bonding with myself with the world with my therapists, there’s a sense of ease in the body like relaxation in the body. So imagine that you feel that at the same time as this overwhelm, if you do well, then it doesn’t become overwhelming, then I can work with this. This has a purpose, this has a reason to be, and how do we support it so we can move through it?
Dr. Will Van Derveer 35:36
Yeah, it’s sort of like what you were saying before about inside the dissociation, there’s presence, or with the dissociation, there’s also presence. And when these two things, it’s sort of like the MDMA, I remember hearing a number of participants say things like, it gave me an ability to see over the trees or a perspective, and that kind of metaphor, to me, is a way of describing this level of contact with inner resources, while you have also a deep contact and awareness with the wounding or the dissociation, which I think is a way of describing a resilient state, where you have a very high level of challenge and a high level of resource in your system at the same time.
Marcela Ot’alora 36:22
Yes, I like the way you’re saying. And I think that it really describes it really well, that is, you know, if you think about a window of tolerance, I don’t think there is a window of tolerance with MDMA work, because when you go past that window, you can still work in either direction. If you start numbing out, if you start activating that numbing, like, what is that part of you that is numbing, and let’s explore that part of what is the part of you that is fueling this activation, right. So it sort of breaks apart that idea of working within the window of tolerance? I don’t think it works. I don’t think that model works with MDMA work because there is not a fine line.
Keith Kurlander 37:06
Right. And it sounds like the organizing self. If we look at parts work, or IFS, like the self can come online, more, even in the states where there’s a lot of expression and sensation in the body itself can come online more when sometimes without the medicine that we see these heightened states of activation, the body, the cells really goes away, and they can’t show up in the space. Yeah, without turning the volume down on the expression of that passion.
Marcela Ot’alora 37:36
Exactly. And so, you know, what I was saying earlier, in terms of like, there’s a self titration, that happens, so that the therapist doesn’t have to do that, the therapist doesn’t have to put a stop to it, because something is happening that is going to harm the person, right? That is because they feel so much resilience and in resources. They know where they can go, and they know how far they can go. And I haven’t seen anybody who hasn’t done that in an MDMA session where they haven’t just gotten Okay. Well, like that was intense, or even the fear of it, right? Like, this is really intense. This is like, powerful. I don’t know if I can work with this. And then work with them.
Dr. Will Van Derveer 38:19
It’s like a function that in ordinary therapy, the therapist has to sometimes step in or provide, or help turn down the volume, that titration function actually can happen internally, with the resource of medicine. Yeah, yeah. And I feel like, in my limited experience, just so much trust that you can have as a therapist, when you begin to have those experiences and you watch people be able to do that on their own.
Marcela Ot’alora 38:49
Oh, Absolutely. It’s the trusting that presence is guiding the way right is guiding is shining the light on whatever it is that they need to go. And so we can think in a way, that’s why what I mean by not being self conscious in a session, because there is no conscious self of me that needs to be present, right? Like I’m here to step into somebody else’s point of reference into somebody else’s life and guide myself in there or like, not guide but understand them from that place of their point of reference, not my own, and so I can leave mine. Yes. Which I think sometimes in therapy without MDMA, I’m not able to do that.
Keith Kurlander 39:42
Well, we’re wrapping up soon, but one more question for a few minutes here. Before we wrap up. I believe you’ve done ketamine assisted psychotherapy, is that correct? Yes. Okay. So I’m curious about your take on the differences here, and it We’re really looking at trauma for the moment, we have a clinic providing ketamine assisted psychotherapy. And predominantly we see use for depression, our clinic, but we do see results for PTSD. I’m just curious about the differences that you’re picking up on, in terms of these medicines. And obviously ketamine right now is the one that is not in the clinical trial that we can actually use. And so I’m just curious what you’re seeing here between the two medicines.
Marcela Ot’alora 40:26
Mm hmm. They’re such different medicines. And the part that they have the same is the softening part, the softening part of the self. And I think that they approach it from different doors. So I think with MDMA, I don’t know if this is going to work this analogy, but with MDMA, it’s like I get at things from the front door, I come in the front door, and I see what’s there, and I explore it, and I’m moving towards the back. And with ketamine it is almost like coming in from a different place, almost like fooling the self to come in from this different angle to explore the exact same thing. So instead of diving in, it’s more of moving out to see what’s there with the ketamine, I think. So I see that as the difference and one of them is more. And they’re both needed. I think they’re both my ultimate goal would be to use ketamine as preparation for MDMA, and as integration for MDMA, that I think they would make great bookends in terms of observing and working at trauma from this different angles from this different perspectives from this different parts of themselves, right, like this different non ordinary states, that they each provide a very different non ordinary state. And they’re both needed.
Keith Kurlander 42:01
Thanks for saying Marcela that was a great explanation. Well, we end with everyone the same, we haven’t given you this question. So you’ll have to come up with an answer, if you. So basically, we ask every guest this question, which is that if there was a billboard, that you could put a paragraph on that every human being would see once in their lifetime? What would you want to tell people?
Marcela Ot’alora 42:26
I’m trying to do something without being cliche, that’s really hard. With that question, I think that we move towards having the presence of something rather than the absence of something, can we approach ourselves and our growth from the presence of something that is there and it is loving, kind and compassionate, and not in the absence of something that we need to get rid of?
Keith Kurlander 43:00
That wasn’t cliche.
Dr. Will Van Derveer 43:04
That’s great. Thanks. very profound. Thank you. Merce.
Keith Kurlander 43:07
Thank you. Well, thanks so much for being on the show.
Marcela Ot’alora 43:10
Thank you for having me. It’s always a pleasure. And what an honor, thank you so much for the opportunity.
Dr. Will Van Derveer 43:22
Well, I want to thank Marcela Ot’alora for taking the time out of an incredibly busy maps researcher schedule to dive into the inner details of MDMA assisted psychotherapy sessions to reveal some quite significant differences between this revolutionary therapy model and more traditional forms of therapy. We really feel that we’re on the cusp of a major revolution in the treatment approach to post traumatic stress given the progress that maps are making through phase three studies. And we want to thank Marcella for her decades of dedication to bringing this new method forward. It’s a very exciting time. Thank you. We look forward to connecting with you again on the next episode of the higher practice podcast where we explore what it takes to achieve optimal mental health.