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In September 2026, I traveled to Italy to participate in an immersive MDMA-assisted therapy training through the Multidisciplinary Association for Psychedelic Studies (MAPS). Over the course of a week, I joined therapists and other professionals from around the world to explore the therapeutic potential of MDMA, the research behind it, and the unique considerations involved in supporting people through this work.
The training was an opportunity to deepen my understanding of a therapeutic approach I've been interested in for years, while learning from clinicians who have helped shape the field of MDMA-assisted psychotherapy.
It was also a reminder of something I continue to appreciate about trauma therapy: healing is rarely just about understanding what happened to us. The conditions in which we feel safe enough to explore, experience, and process difficult emotions can be just as important.
What Is MDMA-Assisted Psychotherapy?
MDMA, short for 3,4-methylenedioxymethamphetamine, is a psychoactive substance that can temporarily influence how people experience emotions, fear, connection, and their relationships with themselves and others.
In MDMA-assisted psychotherapy, the medicine is used within a structured therapeutic process that typically includes preparation sessions, supervised medicine sessions, and integration sessions afterward.
Unlike traditional talk therapy, where someone may spend much of a session discussing their experiences, MDMA-assisted psychotherapy can create opportunities to engage with difficult emotional material in a different way.
Research suggests that MDMA may temporarily reduce fear responses and increase feelings of openness and interpersonal connection for some people. In the context of psychotherapy, these effects may help individuals approach traumatic memories or emotions that otherwise feel overwhelming.
Much of the clinical research has focused on post-traumatic stress disorder (PTSD), with studies examining whether MDMA-assisted therapy can help people process traumatic experiences and experience reductions in PTSD symptoms.
While findings from some clinical trials have been promising, important questions remain about safety, effectiveness, and how these treatments should be delivered.
Learning From the People Who Helped Shape the Research
One of the most meaningful aspects of the training was the opportunity to learn from Marcela Ot'alora and Bruce Poulter, two clinicians with extensive experience in MDMA-assisted psychotherapy research and training.
Their work has contributed to the development of the therapeutic model used in MAPS-sponsored clinical trials, including approaches to preparation, therapeutic support during medicine sessions, and integration.
Throughout the training, we explored the principles underlying this model and the responsibilities that come with supporting someone through potentially vulnerable and emotionally significant experiences.
There was something particularly valuable about learning from people who have spent decades working directly with this approach. Beyond the research and theoretical framework, their clinical experience offered opportunities to consider the subtleties of therapeutic presence, trust, and the relationship between therapist and client.
The Importance of Trust and the Therapeutic Relationship
One of the central themes of MDMA-assisted psychotherapy is the importance of the therapeutic relationship.
Although the medicine may influence someone's emotional experience, the quality of the therapeutic environment remains an essential part of the process.
In the MAPS therapeutic model, considerable attention is given to establishing trust, preparing clients for the experience, and creating conditions that support emotional safety and autonomy.
This is particularly important in trauma treatment, where experiences of powerlessness, betrayal, or disrupted trust may be central to someone's history.
The training reinforced the importance of approaching this work with humility and recognizing that the therapist's role isn't to determine what a person's healing should look like.
Sometimes the most meaningful therapeutic work involves creating space for someone to explore their own experience, without rushing to interpret, direct, or change it.
Inner Healing Intelligence and the Role of the Therapist
Another important concept within the MAPS approach is what is often referred to as inner healing intelligence.
This is the idea that people have an inherent capacity to move toward healing when the appropriate conditions and support are present.
Within the MAPS model, therapists are encouraged to take a relatively nondirective approach, remaining attentive and supportive while allowing the client's internal experience to guide much of the process.
This doesn't mean that therapists are passive or that clinical judgment is unnecessary. Supporting someone through an altered state of consciousness requires careful preparation, responsiveness, and attention to psychological and physical safety.
What I appreciate about this philosophy is the respect it places on the individual. Rather than assuming that healing must follow a predetermined path, it allows room for experiences to unfold in ways that may be unexpected or difficult to explain.
It's a perspective that also resonates with much of my work in trauma and attachment therapy, where helping people reconnect with their own experiences, needs, and capacity for self-understanding is often an important part of the therapeutic process.
Why Preparation and Integration Matter
One of the common misconceptions about psychedelic-assisted therapy is that the medicine experience itself is where all the healing happens.
While a medicine session may be emotionally significant, the therapeutic process extends well beyond that experience.
Preparation helps establish trust, explore intentions, understand potential risks, and develop the resources someone may need to navigate challenging emotions.
Integration involves making sense of what emerged during the experience and exploring how those insights might relate to everyday life.
Someone may have a powerful realization about a relationship, recognize a long-standing protective pattern, or experience a new sense of compassion toward themselves. Yet translating those experiences into meaningful changes in relationships, behaviors, and emotional responses can take time.
This is one of the reasons I'm particularly interested in psychedelic preparation and integration as part of my clinical work.
Whether someone is exploring psychedelic experiences or engaging in more traditional psychotherapy, insight doesn't always translate automatically into change. Often, the ongoing therapeutic relationship provides an important space to explore what those insights mean and how they might be integrated into daily life.
The Value of Learning in Community
Beyond the clinical material, one of the things I appreciated most about the training was the opportunity to connect with other professionals who are curious about the future of trauma treatment.
Our conversations extended beyond formal training sessions, continuing over shared meals, walks, and time spent together in the Italian countryside.
There is something meaningful about being surrounded by people who bring different experiences, perspectives, and questions to a developing field.
Psychedelic-assisted psychotherapy is still evolving, and thoughtful conversations about its potential, limitations, and responsibilities are an important part of that evolution.
I left Italy with a deeper appreciation for the complexity of this work, the importance of continued education, and the relationships that make professional learning so valuable.
Bringing What I Learned Into My Clinical Practice
My training continues to inform how I think about trauma therapy, the therapeutic relationship, and psychedelic preparation and integration.
Many of the principles emphasized in MDMA-assisted psychotherapy are relevant to psychotherapy more broadly: building trust, respecting autonomy, approaching protective responses with curiosity, and recognizing the importance of emotional safety.
My work focuses on helping people understand the experiences and patterns that shape their relationships with themselves and others. I incorporate attachment-focused therapy, parts-oriented work, and other trauma-informed approaches to support that process.
For clients who are exploring psychedelic experiences, preparation and integration can provide an opportunity to approach those experiences thoughtfully and make sense of what emerges afterward.
I'm grateful for the opportunity to have participated in the MAPS training in Italy and to continue learning from clinicians and colleagues who are contributing to this evolving area of mental health care.
As research continues, I'm interested in seeing how our understanding of MDMA-assisted psychotherapy develops and what it may contribute to the broader field of trauma treatment.
Interested in learning more about psychedelic preparation and integration? I offer virtual psychotherapy focused on trauma, attachment, relationships, and psychedelic preparation and integration. You can learn more about my approach at leahhoffmanlcsw.com.
