A guide to solo psychotherapy with MDMA

A friend recently asked me about the therapeutic use of MDMA, which is often used in social settings but also harbours a surprising potential for introspective exploration.

When used responsibly, MDMA can facilitate deep personal insights and emotional healing. However, it’s essential to approach its use with respect and thorough preparation, fully acknowledging its profound effects on both the mind and body.

Preparing for the journey #

Thorough preparation is crucial for a successful therapeutic experience with MDMA, much like with traditional psychedelics.

Starting in the morning helps minimise sleep disruption, but sessions held at night can provide a deeper sense of introspection. Aiming to finish around 1 am offers a good balance.

In line with the dosage guidelines from the MAPS-sponsored MAPP1 and MAPP2 trials for PTSD, I suggest an initial dose of 120 mg, followed by a 60 mg booster two hours later. This schedule effectively prolongs the four-hour primary effect to around six hours. It’s important to measure both doses accurately with a milligram-precision scale beforehand.

There are alternative dosing strategies worth considering. For instance, MDMA Solo recommends tapered dosing for dealing with severe traumas. For those new to MDMA therapy, starting with a lower dose (around 100 mg) can provide a smoother introduction to the experience.

Fasting for a minimum of two, and ideally four, hours before taking MDMA is necessary to enhance its effects and accelerate its onset. While it’s possible to eat after administering the booster dose, it’s generally better to have a substantial meal before starting the journey and then abstain from food for the duration of the experience.

Initiating the experience #

During the session, the connection to reality generally remains intact, making grounding tools less necessary. However, setting a timer for the second dose can be beneficial. This opportunity for a pause serves as a reflective moment and a chance for physical activities like stretching, particularly useful as MDMA can cause restlessness.

Upon taking the first dose, engaging in light breathwork or metta (loving-kindness) meditation can set a serene tone for the journey ahead. Engaging in simple visualisation exercises, such as imagining love radiating both inwards and outwards, aligns well with the onset of MDMA’s effects. The experience can be further enhanced with ambient music, like Brian Eno’s Ambient 1: Music for Airports or Max Richter’s Sleep, though profound insights are equally attainable in silence.

Managing the physical effects of MDMA is key to maximising its therapeutic benefits. Understanding and mitigating these effects is vital for comfort and allows for a deeper focus on introspection. For instance, gently placing the tongue between the teeth can prevent jaw clenching, as the brain naturally avoids biting down. Similarly, being mindful of hydration and body temperature is crucial for maintaining physical equilibrium. This might involve simple steps, such as sipping water with electrolytes and adjusting the environment or clothing for comfort.

Navigating the experience #

As the experience unfolds, memories and thoughts will naturally surface, offering opportunities for introspection and healing. Engaging actively with these memories is an option, but simply observing them as they drift by is also beneficial.

The fear-reducing properties of MDMA create a safer space for exploring difficult experiences. It’s crucial to tune into your body’s needs during this process, allowing for natural movements like shaking, rolling, or flailing to release tension. Techniques such as TRE and yoga postures can aid in releasing emotional reactions or bringing stability during intense moments.

The healing journey typically involves cycles of revelation and deeper exploration of trauma. While not overly common, encountering a ’thought loop’ is a possibility. Should this occur, altering the setting or physical posture can help to disrupt the loop and refocus the mind — for example, shifting from a dark bedroom to a bright, sunlit room, or varying physical activities such as stretching, pacing, dancing, or running in place.

Integrating after the experience #

The period following an MDMA session is often rich in emotional depth and introspection. It’s important to embrace solitude and quiet during this time, giving yourself the space to reflect on the experiences and emotions that surfaced. Often, the most significant revelations and breakthroughs emerge in the days after the session, not during it. This period is crucial for integrating these new revelations.

Post-session emotions can span a wide spectrum, from feelings of tranquillity and elation to moments of sadness and anxiousness. It’s essential to recognise that the healing journey is rarely linear. These emotional fluctuations are integral to the MDMA therapeutic process, each contributing to a broader, more comprehensive process of self-discovery.

The goal of this period is to confront and reconcile with emotions that have previously been suppressed, fostering a renewed sense of wholeness and self-awareness. In this context, introducing a small dose of LSD can be effective. This approach can assist in revisiting and reinterpreting the insights and memories encountered during the MDMA session, thereby enhancing its therapeutic benefits.

Repeating the experience #

While the first MDMA session is often heralded as the most ‘magical’, the compound’s ability to diminish fear and facilitate deep introspection remains effective for repeated use in solo psychotherapy sessions. However, it’s important to approach these repeat sessions with mindful caution, especially considering the potential neurotoxic effects and the emotionally intense recovery period that follows an MDMA experience.

It’s generally recommended to space sessions at least a month apart, with a two to three-month interval being ideal for safety and effectiveness. However, each person’s healing journey is unique. Therefore, the approach to the frequency and timing of sessions should be tailored to individual needs and responses.

In certain circumstances, like needing to untangle complex emotions, I’ve found it necessary to have sessions as close as a week apart. It’s important to stress that this is an exception and not a regular practice. Doing sessions this frequently is not something one should undertake often due to the increased risks and diminished time for integration and recovery.