MAPS is an MDMA therapy cult

On May 23, I submitted this complete analysis as a written comment for FDA's Advisory Committee meeting on MDMA-assisted therapy.

In the official response to our citizen petition, the FDA extended the Open Public Hearing portion of the June 4 Advisory Committee meeting on MDMA-assisted therapy.

This isn’t sensationalizing. This isn’t clickbait. This is a careful, precise analysis of the ways that MAPS (now Lykos) exploited the suggestibility-enhancing properties of MDMA to advance an evangelical mission to spiritualize humanity through the vehicle of its clinical trials.

The MAPS/Lykos clinical trials reveal more about the efficacy of MDMA for cult indoctrination than they do about treating PTSD.

As I’ve said many times before, I believe that MDMA has potential as a therapeutic tool in the treatment of PTSD, but I don’t believe that MAPS designed their trials to effectively demonstrate that. In my analysis below, I assembled evidence that their particular therapy increases the risks of MDMA, especially for those with PTSD related to sexual assault and minority trauma. Those risks are unnecessary and unacceptable.

While many in this field are working overtime to justify acceptable levels of “collateral damage,” I don’t believe in sacrificing the most marginalized groups in the name of healing. We should insist on doing this right.

Before I submitted my written analysis to the FDA, the prospect of a therapy cult guiding a suggestibility-enhancing drug through clinical trials had never been publicly discussed. Since this analysis highlights unique risks for patient safety, I argue that MAPS/Lykos’ clinical trials should be scrutinized as if Scientology or NXIVM had submitted a new drug application to the FDA. Since March, I have been working to ensure that the FDA — and the public — are alerted to these risks.

As I mentioned in my last update, I submitted a citizen petition to the FDA to request an extension of the Open Public Hearing portion of the Advisory Committee meeting in order to accommodate more speakers. That request was formally granted by the FDA on May 30, as we announced in a June 3 press release before the AdComm meeting.

From the moment I conceived of that citizen petition, I organized the opposition to Lykos’ MDMA-assisted therapy application for that June 4 meeting. I worked alongside a small group of collaborators, including my Psymposia colleagues, to ensure that the perspectives of harmed participants were heard by the committee.

At every stage of this process, my closest academic collaborator has been Meaghan Buisson, whose brilliance and friendship have sustained me for the inevitable scapegoating from (one side of) the field.

We chose to do this for the survivors, and to protect others.

Despite (former MAPS Officer) Liana Sananda Gillooly’s claims of a conspiracy, this actually has a name: community organizing. It’s how stakeholders engage in solidarity to support and amplify perspectives with less power:

“Community organizing [is a] method of engaging and empowering people with the purpose of increasing the influence of groups historically underrepresented in policies and decision making that affect their lives.”

In a future post, I’ll provide more thoughts about the committee’s near-unanimous vote of “no confidence” in Lykos’ application. For the time being, I’m sharing my full analysis of how MAPS qualifies as a therapy cult, including implications for patient safety. This is the personal contribution that I’d been planning since the citizen petition. When I called for a longer Open Public Hearing — this is what I wanted to say.

This analysis has explanatory power for idiosyncrasies and allegations that are too consistent to be dismissed as hearsay or coincidence.

It connects everything from the rosy published outcomes, to the organization’s internal culture, to the specific nature of the abuses in its clinical trials, to the allegations of data misconduct, to claims that it's more like a religious movement than a scientific organization.

Given the stakes of the FDA’s upcoming August decision — and since I’m now fielding calls from journalists every day — I wanted to make sure that this analysis is easily accessible.

A PDF version can also be downloaded from the comment I submitted to the FDA’s docket, on May 23.

I’ve worked in psychedelic science — but this is psychedelic humanities.

Docket No. FDA-2024-N-1938 for “Psychopharmacologic Drugs Advisory Committee; Notice of Meeting; Establishment of a Public Docket; Request for Comments.”

I am an academic researcher with specific expertise in psychedelic bioethics and the suggestibility-enhancing properties of psychedelic substances. I am a full-time faculty member at Johns Hopkins University at the rank of Senior Lecturer in the University Writing Program. I have been working in the interdisciplinary field of Psychedelic Studies since 2010, and I completed a two-year Postdoctoral Fellowship in Bioethics at Case Western Reserve University School of Medicine in 2020. I am currently a Research Affiliate with the Petrie-Flom Center’s Project on Psychedelics Law and Regulation (POPLAR) at Harvard Law School. I have firsthand experiences of volunteering with the organizations that developed the trial protocols under consideration here, and I have interviewed participants who have experienced harm in the sponsor’s clinical trials. Since the current sponsor (Lykos Therapeutics) is broadly continuous with the organization that led its clinical trials (MAPS PBC), I will refer to the sponsor throughout this comment as “MAPS/Lykos.”

In my years of researching this group, I have uncovered substantial evidence that the sponsor organization qualifies as a therapy cult that operates on a principle of indoctrinating its therapists and participants into an ideological system of “true beliefs.” The prospect of a therapy cult guiding a suggestibility-enhancing pharmaceutical through clinical trials highlights unique risks for public health, the implications of which have never been publicly discussed. In my full comment, I explore some of the rationale for this analysis, and I discuss specific vulnerabilities in the sponsor’s new drug application that this analysis reveals.

Therapy cults transform therapeutic and personality theories into totalizing ideologies that promise reductive solutions for diverse causes of psychological distress.^[1] While they claim to combine science and spirituality into evidence-based techniques for healing trauma, they are associated with patterns of specific iatrogenic harms as they “remold individuality to conform to the [values] and needs of the cult” while “preclud[ing] doubt and criticism.” Despite these patterns of iatrogenic harm, therapy cults generate enthusiastic loyalty among adherents by cultivating “an elitist mentality in which members see themselves as heroes struggling to bring enlightenment to the hostile forces which surround them,” bolstered by claims of “privileged insight into society’s problems.”^[2] For MAPS/Lykos, the post-approval goal of enlightening humanity is evident in Doblin’s repeated mission of “spiritualizing humanity,” which the Associated Press described as “grandiose.”^[3] (Doblin is a current Lykos board member and the founder of MAPS.)

Many people in the field are protective of MAPS as a global leader in psychedelic destigmatization, but many of these supporters are unfamiliar with the core concepts and beliefs that are shared by MAPS’s inner circle. Nonetheless, some of MAPS’s own employees have publicly expressed concern that MAPS/Lykos is a cult, and this possibility must be investigated in light of its high stakes for vulnerable patient groups: “‘Half the company was like, ‘Oh, this is so inspiring,’ and the other half is like, ‘Jesus Christ, is this a cult?’” one ex-[MAPS] PBC staffer said.”^[4]

Therapy cults never self-identify as a cult, and apologists regularly deny the existence of deceptive recruitment practices along with the destructive consequences of the group’s patterns of exploitation. Such patterns frequently include a range of social, psychological, financial, and spiritual controls,^[5] which mirror allegations that have associated MAPS with elder abuse^[6] and sexual assault and entrapment.^[7] Therapy cults regularly normalize “dual relationships,” wherein therapists and their clients form unusually close relationships. In such cases, therapists often double for their clients as employers, lovers, financial advisers, and/or communal living co-habitants.^[8] Since its inception, MAPS has existed as an organization defined by dual relationships and unclear delineations between professional and personal roles, as documented in a May 2024 article by Anna Silman for Business Insider.^[9] Dual relationships are associated with patterns of abuse in the broader psychedelic underground from which MAPS’s methodology emerged.

Even as warning signs about MAPS have accumulated, the psychedelic research field has largely resisted any serious consideration of the potential that MAPS’s inner circle operates as a therapy cult. In the alleged case of elder abuse, MAPS board chair and treasurer Vicky Dulai exhibited patterns of behavior which correspond with MAPS’s stated goal of getting past individuals’ defenses to gain money for MAPS. Specifically, MAPS developed and deployed strategies to recruit donors who would not otherwise consent to donating their funds. I encountered this messaging firsthand during a training workshop for MAPS employees and volunteers. The workshop — advertised as the “Enlightened Salesman training” — took place in Canyon, CA on July 18, 2011, as corroborated by emails sent to me by MAPS staff. The workshop was facilitated by Elias Arjan, who served as MAPS’s auctioneer for multiple fundraising events during 2011. As supported by my contemporaneous handwritten and dated notes, the purpose of this workshop was to learn techniques from hypnosis and neuro-linguistic programming (NLP) in order to get past the defenses of people who were resistant to giving money to MAPS. Rather than accurately identifying this as coercion, MAPS employees and Arjan presented this as mutually beneficial, on the basis that MAPS’s mission of planetary healing was existentially important for all of humankind. Mind-control tactics were justified, they argued, since some people did not yet realize that MAPS’s success was in everyone’s ultimate interest.

Cult experts have noted that NLP and hypnosis have been used as strategies to indoctrinate new recruits into high-control cult groups, in tandem with other suggestibility-enhancing practices. Examples of high-control groups that have deployed these strategies include Keith Raniere’s NXIVM and the Rajneesh movement, which also utilized MDMA.^[10] In my notes from the 2011 MAPS workshop, which are excerpted below, Arjan emphasized that psychedelics dramatically increase vulnerability to suggestion and undue influence:

“Hypnosis — subject must undergo induction. Trance music - flashing lights w/ particular frequencies. Where is the leadership that is giving the suggestions in these trance states? [...] Long series of inductions may be necessary for people with a lot of walls. The permission always lies with the subject, who must be completely willing to submit. Hypnosis is not a form of unconsciousness — entering a state of high awareness, high sensory acuity - fully awake w/ focused attention. Hypnotist / shaman is facilitator. Participation in psychedelics increases receptivity to hypnosis a thousand fold.”

Among the MAPS inner circle, this enhanced vulnerability to undue influence was known to be a vehicle for financial exploitation. In a 2013 MAPS Bulletin, Michael Mithoefer (MAPS’s lead protocol designer) identifies Torsten Passie as an MDMA therapist and researcher who influenced the development of MAPS’s MDMA-assisted therapy protocol. In The History of MDMA, a 2023 book published by Oxford University Press, Passie acknowledges the longstanding use of MDMA to manipulate suggestibility. Specifically, he describes how historical cults have dispensed MDMA in order to extract funds from people who would not otherwise consent to donating their money. In a section describing the use of MDMA by the international Rajneesh cult movement, Passie cites “a book by the Guru’s bodyguard” that included this admission: “the euphoric mood-altering drug Ecstasy was discreetly slipped into rich sannyasins’ drinks just before fund-raising interviews.”^[11] Passie also notes that the group viewed MDMA as “a useful tool…for business,” and that the group was heavily involved in the international distribution of MDMA to therapists during the 1980s.

In my research, I saw evidence indicating that MAPS board chair Vicky Dulai was part of a community of MAPS associates that was using psychedelics to access holocaust survivor George Sarlo’s wealth and connections by exploiting psychedelics’ known ability to increase vulnerability to “love bombing” and other forms of psychological manipulation. Dulai’s behavior aligned with accounts that MAPS’s business model has centered on introducing high-net-worth individuals to charismatic “underground” psychedelic guides, who would exploit the suggestibility-enhancing properties of psychedelics in order to direct donations to MAPS and its circle. Anna Silman’s investigative article for Business Insider provides additional corroboration of this strategy: “One insider said MAPS had always had a ‘strategy to fundraise around the drug experience,’ including inviting prospective donors to drug-fueled parties. [MAPS founder] Doblin would come to meetings and tell stories about courting donors by giving their family members MDMA therapy, another former staffer recalled.”^[12] Jules Evans, Director of the Challenging Psychedelic Experiences Project, also wrote in Ecstatic Integration that “a senior MAPS source [said that] it was [Doblin’s] strategy to call donors the day after MAPS’ psychedelic parties to ask them to donate, while they were in the afterglow state.”^[13] The alleged use of psychedelics for exploitation supports the notion that MAPS/Lykos poses significant dangers for the public.

In the cult studies literature, the closest analogy to MAPS that I have located is an analysis of “Re-evaluation Counseling” (RC) by Dennis Tourish and Pauline Irving.^[14] They define RC, which evolved from Dianetics (a precursor to Scientology), as “a form of egalitarian counselling between two people who exchange the role of counsellor and client.” Like RC, MAPS/Lykos has never acknowledged the extent to which its therapy “could enable unscrupulous therapists to engineer artificial consent and impose their own belief systems on clients.” Like other experiential therapies that are described as “‘alternative’ or ‘innovative,’” the core of the MAPS/Lykos therapy—based on the spiritual teachings of psychiatrist Stan Grof and Internal Family Systems (IFS)—“lack[s] the deep theoretical foundations and empirical support of...more established therapies.” As a result, “the loyalty of enthusiastic proponents is...based on ideological rather than empirical grounds.”

Both RC and the MAPS/Lykos framework portray emergent distress as enactments or “restimulations” of earlier trauma, with roots in the participant’s formative life experiences. As a result of this orientation, “the possibility that feelings of hurt might be a perfectly natural and [reasonable] response to an immediate external crisis...is downplayed.”^[15]

Although Doblin has repeatedly emphasized that abuse is a statistical inevitability^[16] within all healthcare professions,^[17] these particular patterns of abuse are a direct consequence of the MAPS/Lykos therapy model. Over the past three years, a range of ethicists, former patients, former trainees, patient advocates, and gender-based violence experts have detailed specific ways in which this model fosters conditions for exploitation and abuse. Despite these efforts, MAPS has consistently refused to recognize any potential link between its healing ideology and the emerging boundary violations in its clinical trials.

This refusal to consider potential vulnerabilities in its therapy model reflects the extent of “true belief” among the organization’s core devotees.

The MAPS Ideology: “Inner Healing Intelligence” Meets “Self-Energy”

The public commonly assumes that the MAPS/Lykos therapy is “non-directive” in the sense of allowing the participant to lead. While certain parts of the therapy are non-directive in this sense, the overall method removes significant agency and autonomy from the participant. The organization itself acknowledges that its non-directive label “can lead to some confusion, because the overall approach does include some instances of directive communication.”^[18]This confusion results from the fact that “non-directive” reflects Michael Mithoefer’s belief that MDMA allows the participant to access the Grofian “inner healing intelligence” and the “Self-energy” that knows how to heal the various parts of the psyche.

In a 2015 paper titled “Stan Grof Contributions to FDA Drug Development Research With Psychedelics,” Doblin admitted that “the entire therapeutic approach that we have in the MDMA studies” is based on Grof’s transpersonal spiritual teachings. He noted that MAPS specifically recruited therapists “who have been through the HB training with Stan Grof,” which meant that they were already enculturated into Grof’s spiritual worldview. Doblin acknowledged that “the essence of the [MDMA] treatment approach” is a Grofian “death-rebirth” process, and he argued that MAPS clinicians’ “fundamental trust” in this death-rebirth process stemmed from their “personal process of self-exploration with non-ordinary states of consciousness.”^[19] Doblin ended the paper: “Once it’s a medicine...we’ll move forward with the training of therapist[s]. [...] Then we’ll have world peace, but it might take a little bit of time between those. All of this really comes back to Stan Grof.... And we are coming forward to fulfill the promise.... Stan...is my professional and spiritual father.”^[20]

The Grofian “inner healing intelligence” is a spiritual concept that attributes healing to “ordinarily hidden spiritual dimensions of existence,” which are accessed through non-ordinary states of consciousness. As Madrone Love explains based on interviews, MAPS therapists understood that teaching participants about the “inner healing intelligence” was an essential “spiritual aspect” of their responsibilities as clinicians.^[21] Within the MAPS protocol, surrendering to the inner healer is theorized to be “the method of therapeutic action” that is facilitated by MDMA, which is why adherence raters are asked to monitor therapists’ belief in the inner healing intelligence. Therapists are asked to “trust” that difficult emotions are productive and emerge at the “best time,” according to the wisdom of the inner healer. Participants are encouraged to assume that “whatever arises is being presented at that moment by the inner healing intelligence as an opportunity for healing.”^[22]

In Grof’s spiritual philosophy, the inner healing intelligence unleashes a series of symbolically charged scenes of unconscious material, in the order that is most accessible for processing by consciousness. It is analogous to an energetic birthing process, where the therapist figures in the role of a midwife while the client expels the parasitic imprints of traumatic experience through discharge: “The facilitators create a protective and supportive environment and help the clients enter a holotropic state. Once that occurs, the healing process is guided from within by the clients’ own inner healing intelligence and the task of the facilitators is to support what is happening. This process automatically activates unconscious material with strong emotional charge that is close enough to consciousness to be available for processing on the day of the session.”^[23]

This orientation conditions both clients and therapists to associate distress with healing, even in situations where actual harm is occurring. This orientation even extends into post-trial difficulties, as Mithoefer acknowledged in a 2013 workshop. During this workshop, Mithoefer shared that he educates participants to understand any ongoing symptom fluctuation as evidence of “the unfolding healing process that we expect to happen,” and that this fluctuation may occur “in waves for hours, days, weeks, maybe the rest of your life, you know, decreasing in amplitude, hopefully.”^[24] This instruction primes study participants to interpret any outcome as successful, even in situations with ongoing and distressing symptomatology.

According to the creators of the MAPS therapy manual, the inner healing intelligence facilitates access to the “Self-energy” of Internal Family Systems (IFS): “[Michael and Annie Mithoefer] discovered that, when left to their own devices after taking MDMA, study participants quickly accessed a state characterized by curiosity, courage, clarity, connectedness, and compassion, which IFS calls Self-energy.”^[25] IFS is premised on the notion that individuals are made up of sub-personalities (“parts”) that are independent and autonomous. In a 2020 podcast, M. Mithoefer emphasized that “one of the best ways to describe the effects of MDMA is it brings forth a great deal of Self-energy and makes people, helps people be more aware of their parts and have the Self-energy to work with [their parts].”^[26] Self-energy facilitates healing by understanding and harmonizing the various parts that constitute the psyche. As quoted in the authoritative book on IFS by Richard C. Schwartz and Martha Sweezy, Mithoefer believes and teaches that this model is a true representation of the psyche: “[IFS founder] Dick [Schwartz] didn’t make it up—IFS taps into some very real phenomena.”^[27]

MAPS training videos incorporated “participants talking about their parts,” and trainers recommended that therapists “continue the session in an IFS manner” after any indication of references to parts.^[28] During an interview, Mithoefer admits that therapists could heavily suggest the existence of “parts” based on any reference to competing feelings or ideas: “[Parts were] almost always brought up by the participant, [and] if it was brought up by the therapist, it was only in response to what the participant was talking about. You know, we wouldn’t just say let’s work with parts. If people were basically talking about parts, you might say, it sounds like there might be a polarity between two parts of you. [Does] that feel like that’s what happening? And they'll say, yeah, that’s what’s happening. And then we would work with it [using IFS].”^[29] Just as the MAPS manual enjoins therapists and participants to “believe” in the inner healing intelligence, so does IFS require “belief” in Self-energy: “Faith in Self-energy is probably the single most important quality IFS teachers and supervisors bring to beginners.”^[30]

Mithoefer never acknowledges the influence of strong therapist suggestion and the extensive priming from preparatory sessions on these experiences, preferring to interpret them as confirmations of the model’s theoretical basis.

Mithoefer’s interpretation of participant experiences as evidence for his strong prior beliefs contradicts the field’s longstanding recognition of the potential of psychedelics to heighten suggestibility. As Nicolas Langlitz and Alex K. Gearin noted in a recent paper, “the psychotherapist’s orientation shapes the material that the patient produces” in their psychedelic sessions. His notion of what is good and desirable tend to be adopted by the patient.^[31] (I also found evidence of this phenomenon in my 2022 paper on Johns Hopkins University’s pilot study of psilocybin for smoking cessation, where patterns in participant accounts reflected priming from the treatment manual.^[32])

Langlitz and Gearin note that this acute suggestibility was already recognized in the 1964 writings of psychiatrist Sidney Cohen: “It is curious how under LSD the fondest theories of the therapist are confirmed by the patient. Freudian symbols come out of the mouths of patients with Freudian analysts. Those who have Jungian therapists deal with the collective unconscious and with archetypal images. The patient senses the frame of reference to be employed, and his associations and dreams are molded to it.”^[33] Cohen even noted that patients tended to adopt their therapist’s “notion of what is good and desirable,” including desired outcomes from psychedelic therapy.^[34] MAPS/Lykos never acknowledges the extent to which participants are primed to have experiences that therapists can interpret in an IFS and Grofian approach, which leaves participants vulnerable to manipulation through indoctrination.

Ultimately, cult indoctrination is a significant iatrogenic risk for a therapy model that introduces totalizing ideologies into a context of pharmacologically induced and heightened suggestibility.

Under the MAPS/Lykos ideology, totalistic beliefs are imposed on participants in violation of their rights to self-determination and autonomy. As just one illustration of the stakes of this issue, Jules Evans recently highlighted that demonic exorcism is an essential feature of the IFS model, which describes parasitic parts as “unattached burdens” that must be liberated from the Self. This possibility of demonic exorcism is not disclosed in the informed consent, and—as Evans points out—there is a high risk that therapists could influence participants to believe that they are possessed by a demon.^[35] As with other controversial elements of the MAPS/Lykos therapy, IFS historically cloaked this key facet of their model from the public, relying on the euphemism of “unattached burdens” while limiting instruction on this topic to its advanced Level 3 training. (Mithoefer acknowledges that he completed Level 3 training of IFS.^[36])

Between IFS and the inner healing intelligence, the MAPS/Lykos therapy manual misrepresents the actual protocol (henceforth, the “undisclosed protocol”), which MAPS would gradually reveal to therapists in its trainings and in Mithoefer’s recommendations that trainees enroll in Internal Family Systems, Hakomi, and Grofian Holotropic Breathwork training workshops for the full instructions. The existence of this undisclosed protocol explains why MAPS/Lykos has been so intent on the importance of therapists’ direct experiences with altered states of consciousness. It is through direct experience of non-ordinary states through MDMA and Holotropic Breathwork workshops that therapists are taught controversial elements of the MDMA-AT protocol that MAPS/Lykos does not disclose to the FDA.

Additional evidence that the MAPS therapy training provides incomplete instructions for their methodology can be found in Madrone Love’s 2022 interviews with MAPS clinicians. According to the inclusion criteria, “This study focuses on licensed clinicians trained by MAPS to facilitate MDMA-assisted psychotherapy (MDMA-AT) for the treatment of PTSD and who have facilitated at least one full treatment in the context of the FDA clinical trials.”^[37]One interviewed MAPS clinician, who had not taken external workshops relating to touch, admitted that she was not prepared to offer touch to clients based on the MAPS training itself: “I felt completely unprepared to be able to offer [touch].”^[38] Since MAPS had been informed of the Phase 2 MP-4 clinical trial abuses in 2018, this lack of clear education around touch amounts to negligence.

The outsourcing of controversial techniques for touch to external workshops likely occurred after an incident that Doblin described in 2016, when Doblin acknowledged that the U.S. Department of Veterans Affairs (VA) had canceled a planned collaboration after a VA researcher participated in MAPS training and identified MAPS’s use of touch as “abusive.” As Doblin paraphrased the VA researcher’s perspective, “This [treatment approach] is just so out of the normal bounds of (you know) being able to touch somebody. And then…they [the trial subjects] are under the influence of MDMA and (you know) you’re touching them.”^[39] During the same 2016 conference where Doblin was speaking, Hayden Rubensohn—the co-therapist of Ingrid Pacey, who was principal investigator of MAPS’s Phase 2 MP-4 trial—made references to how their use of touch went beyond the norms of their clinical training: “[Rubensohn] noted that he and his co-therapist Ingrid Pacey ‘would often joke’ in the immediate aftermath of MDMA trial sessions about what their ‘teachers would say’ if they were to have become aware of the actions Pacey and Rubensohn performed ‘in that room.’”^[40] Rubensohn also describes how providing touch to participants is personally healing for him as a therapist.

Significant elements of the undisclosed protocol are more fully described in Integral Psychedelic Therapy (2023). Two of the three editors were MAPS trainers (one doubled as a supervisor), and seven of the chapter contributors had affiliations with MAPS as trainers, sub-investigators, or therapists. Two additional contributors were identified as trainees. The book was endorsed by prominent members of MAPS’s inner circle, including Doblin, Bia Labate, Mithoefer, and Marcela Ot’alora. Doblin identifies it as “a core text for practitioners.”^[41] Mithoefer in particular praised its clinical recommendations relating to the ethics of touch: “Integral Psychedelic Therapy brings needed attention and wisdom to a range of the most important aspects of working with psychedelics.... The more clinically oriented chapters remind us not to lose sight of the ‘core, human elements of the work’ and the richness and depth of the human healing process. The authors draw on their own clinical experience to offer informed and insightful discussions of ethics and consent, therapeutic relationship, safe and mindful physical touch, music, the multiplicity of the psyche, numinous mystical experience, psychedelic group therapy and the immense importance of integration following psychedelic experiences. Case examples bring these discussions to life. This is a valuable resource for therapists and anyone else interested in psychedelics.”^[42] One of those case studies advocates for the type of assault that was filmed during MP-4, as I will explain below.

With all of this information combined, it is evident that the on-camera abuses that occurred during the MP-4 trial were completely in line with the techniques in the undisclosed protocol. Doblin has repeatedly portrayed the media coverage of this abuse as sensationalist, arguing that “the reporters who released the participant’s trial footage did not verbally ‘acknowledge’ Yensen and Dryer were engaging in [the technique of] ‘psychodrama’ within the treatment room.”^[43] Speaking on a podcast with Psychedelics Today, Doblin also indicated that he did not see anything in the tapes that would have indicated concern for the MP-4 participant’s safety.^[44]

There is substantial evidence that MAPS’s inner circle was not alarmed about the participant’s on-camera abuse, and that they interpreted the public’s horror about the abuse as a reflection of how the public still needs to be “educated” about the spiritual benefits of Grofian abreactive discharge via focused bodywork. This would explain why Doblin insisted that the MP-4 participant was “ungrateful” for everything MAPS had done for her, since she is portrayed betraying their trust by alerting the wider public about their controversial practices.^[45] In the Cover Story: Power Trip podcast, reporters asked principal investigator Ingrid Pacey about the techniques employed in the videos, which included “putting a towel in the client’s mouth for her to bite on” and “lying on her and grappling or wrestling with her.” Pacey acknowledged that all of these were elements of the undisclosed protocol: “It’s used in holotropic breathwork. It is. […] [W]hat you’re trying to do is release the tension. Maybe the memory that’s held in the muscles. So you do that, you bite down and you pull the towel.”^[46]

The MAPS/Lykos method’s emphasis on “inner healing intelligence” and “Self-energy” is similar to the therapeutic model in RC, where participants are assumed to “possess an inherent personality which is good, co-operative and highly intelligent.” In both contexts, distressing or harmful patterns of behavior are attributed to traumatic imprints that can be processed through “discharge” via “cathartic re-enactments.” But as Tourish and Irving emphasize, many destructive cult groups rely on cathartic re-enactment to reshape the identities and values of indoctrinees in alignment with the group’s values. In such cases, the intense experience of catharsis (Grof’s “abreactive discharge”) is “reinterpreted [according to] the group’s totalistic ideology” during the period of “integration,” which “escalat[es] members’ emotional commitment to the group.”^[47]

Participants in both RC and in MAPS/Lykos clinical trials have claimed that the therapists’ ideological model prevented the therapists from considering that participants’ articulations of distress could be attributed to real problems in the present moment. In a recurring pattern, ideas that “do not fit neatly into…the theoretical framework are dismissed as ‘restimulations’ of past trauma, rather than addressed in their [here-and-now] validity.” This therapeutic orientation presents a “triple…blow” on the participant’s independent thought, since the client’s perception of reality is invalidated, their right to express their own ideas is rebutted and their attention is [redirected] inward to old traumas rather than current observation and analysis” of present harms. This poses a high risk of retraumatization for PTSD participants with histories of minority stress from traumatic invalidation, especially among racial and ethnic minorities, LGBTQ+ individuals,^[48] and people with disabilities, along with participants with histories of relational violence and coercive control.

Tourish and Irving do not dispute that past experiences can influence present feelings of distress, or that therapeutic benefit can result from attending to that influence. Instead, they contend that these models transform these basic therapeutic principles into a totalistic ideology that “frame[s] all current experience within a simple causal nexus.” As a consequence of this ideology, therapists are conditioned to “miss [important] opportunities for ‘present time’ change,” while it simultaneously “disabl[es] [participants’] ability to challenge therapeutic theory or practice.”

When participants become distressed, the MAPS/Lykos training manual encourages therapists to employ touch through “focused bodywork” to promote abreactive discharge of traumatic material. This “specialized therapist skill” is defined as “giving resistance for the participant to push against.”^[49] According to a publicly available version of an early training manual, this resolution of “somatic manifestations of trauma” is framed as facilitating the participant’s progression towards insight and “spiritual awareness.”^[50] Citing Grof, the training manual’s authors portray psychosomatic symptoms of distress as “energy blockage[s]” that serve as “the entry points for...intervention” by the therapist via focused bodywork.^[51]

MAPS/Lykos presents the unfolding of abreactive discharge as a natural process that is unleashed by the inner healer and facilitated by the therapist. This process is always described factually, and MAPS/Lykos never acknowledges the extent to which participants are primed for these disinhibited enactments during the preparatory therapy sessions. During the dosing sessions, the influence of this priming is amplified by the suggestibility-enhancing properties of MDMA and the strong prior beliefs of indoctrinated therapists.

In the case study from Integral Psychedelic Therapy, MAPS supervisor and trainer Veronika Gold describes her use of Grofian focused bodywork to “provide physical resistance” to Annie—her client—as Annie “started to feel anger.” As the therapy session continues, Annie becomes increasingly distressed and struggles against Gold. Gold assures readers that Annie’s distress and her attempts to fight off the therapist were not real requests for the therapist to stop the physical engagement, even as she acknowledges that Annie’s distress escalated over several minutes:

Annie began to add her voice, expressing anger and saying, “Go away! Get your fucking hands away from me!” The words were clearly meant for her father and did not indicate that she wanted me to go away or stop. Because we had the agreement to use the specific safe word “enough” if she wanted me to stop the touch, there was no confusion in my mind about how to proceed. Over the course of the next several minutes, she pushed my hands with increasing vigor and force.^[52]

It ultimately does not matter if this particular participant claimed to have benefitted from this interaction; vulnerable patients will be hurt by this therapeutic ideology, just as the MP-4 participant was harmed. The fact that so many MAPS therapists and trainers signed off on this description emphasizes that the MAPS ideology is dangerous.Their totalistic ideology is ultimately premised on a flawed model of consent that increases the risk of harm to participants. As a logical extension of rigid belief in the “inner healing intelligence” and the power of “Self-energy,” MAPS/Lykos devotees believe that participants can be more able to provide genuine consent during non-ordinary states of consciousness. This belief contradicts the consensus scientific understandings about executive functioning and the vulnerability of patients to undue influence via psychedelic suggestibility.

Despite this contradiction, MAPS trainee Hannah McLane and colleagues wrote a short ethics article on “Respecting autonomy in altered states” that includes this claim: “The mechanism of change in psychedelic-assisted therapy depends on the individual under the influence being, at times, in better touch with their feelings and needs—perhaps more attuned, more integrated, and more rational than the self mired in mental illness.”^[53] In Integral Psychedelic Therapy, Gold cites this claim to explain why the participant’s consent to touch should be able to change during the dosing session. She claims that “the therapist’s denial of touch may fail to respect the client’s autonomy and agency during the session,” even if the client explicitly denied consent for touch during the intake process.^[54] This orientation also explains Doblin’s stated belief that MDMA should empower patients to fend off sexualized therapists.^[55]

In her case study, Gold insists that her reliance on a “safe word” allows her to know that her client did not really want her to stop the physical altercation. Despite these assurances, it is fundamentally dangerous and irresponsible to put the onus on a traumatized client to recall a safe word—chosen during a non-altered preparatory session—if a client has a panic attack during an altered state of consciousness. Ultimately, the “safe word” recommendation serves as a performative “band-aid solution” for the abuse caused by this methodology during MP-4. It privileges the therapy cult’s ideological perspective, and it allows a distressed client to be dismissed on a technicality: “You didn’t say the safe word.”

In a “The Heart of the Work”—a chapter by editors Genesee Herzberg (MAPS therapist, trainer, and supervisor) and Jason A. Butler (MAPS therapist and trainer)—the authors explicitly acknowledge that “enactments” like the one described by Gold are “paradoxically…a primary source of iatrogenic harm,” even as the authors insist that enactments are “a powerful way in which the client can experience reparative processing and breakthrough insights that help them move toward healing.”^[56] Fundamentally, the MAPS/Lykos ideology is premised on the notion that therapists can cultivate the spiritual capacity to discern when pain is good for patients, and when expressions of pain are genuine or mere tactics that are maintaining the patient’s symptoms. This is a common premise throughout the psychedelic underground, as evident in Françoise Bourzat’s Consciousness Medicine^[57] and Janis Phelps’ “Developing Guidelines and Competencies for the Training of Psychedelic Therapists.”^[58] The therapist’s “embodied knowledge” is endowed with the capacity to feel into the energies of the “relational field” in order to distinguish when a request is coming from the “inner healer” or a protective defense mechanism. A chapter by Eric Sienknecht illustrates the outcome of this ideology in describing a client’s resistance to the musical playlist:

The concept of the inner healing intelligence can be used to prime the client to be open to and curious about whatever [sensation] is arising…. If the discomfort is due to a lack of resonance with their inner process, it may be appropriate to change the track to support their process. However, if the distress is due to the client’s dislike of the music or resistance to the nature of the material the music is evoking, then the client should generally be encouraged to stay with the material and try to move through it.^[59]

Continually, therapist intuition of the client’s motivations is represented as sacrosanct, I have received many accounts of harm from participants whose perspectives were vetoed by their therapists. As a result, this ideology authorizes unintentional transgressions, and it explicitly facilitates predation by more overt bad actors.

The danger of this MAPS/Lykos ideology is heightened by its framing of post-psychedelic participant distress. “The Heart of the Work” emphasizes the role of expressing real love and intimacy through touch during psychedelic therapy sessions, under the assumption that the therapist can discern when the participant wants to receive expressions of genuine physical intimacy. The therapist’s embodied intuition is framed as “merging” with the client’s energy to “support emotional metabolization”:

The therapist can implicitly support emotional metabolization by empathically attuning to and compassionately relating with the client’s transference feelings. In this approach, the therapist takes in aspects of the client’s inner world and experience, with attentive receptivity to the reverberation evoked within, such that the therapist is able to feel herself to actually be that unwanted part of the client’s self or that unbearable inner figure…. From this place of deep emotional resonance, the therapist can help contain and metabolize overwhelming, unformulated emotion and cultivate a compassionate connection to these unwanted and unbearable parts.^[60]

This description would still qualify as “non-directive” according to the MAPS/Lykos manual, since the therapist is represented as “responding” to a real symphony of energies that the client is unleashing. Based on the therapist’s ability to “read” these energies, the therapist is authorized to “empathetically attune” to what the client really needs to “metabolize” their trauma. Since this capacity is based on a literal ability to perceive spiritual dimensions of existence, participant accounts of harm in psychedelic therapy are prefigured as inauthentic expressions of traumatic symptoms. Recurrently, “intellectualizing” is framed as a clear sign of inauthenticity on the part of the participant, as in this example from the MAPS treatment manual: “If the participant seems to be intellectualizing, then the inner experience is probably not resolved and needs more time to unfold.”^[61]

As a logical consequence of this ideology, clients whose boundaries were transgressed by therapists are instead perceived as acting out in embarrassment, unable to face the fact that they consented to a real moment of mutual intimacy with their therapist. “The Heart of the Work” explains this perspective:

The deep relational safety and emotional intimacy present in the medicine session may later be experienced by the client as threatening; they may begin to doubt the authenticity of the therapist’s care and trustworthiness, and question whether the feelings of intimacy were mutual. The client may feel they have done something inappropriate to the therapist or the other way around. They may feel shame for sharing feelings of love and affection, or generally expressing themselves in an unfiltered and openhearted way—what some call a “vulnerability hangover.”^[62]

In the same chapter, this same articulation of a boundary violation is framed in IFS terms as a “backlash” from the client’s “self-parts”:

This “backlash” of protective self-states comes in many forms and may be experienced and expressed directly as anger or mistrust toward the therapist for guiding them to an unsafe place.... [“]When the fail-safe protective system is softened by a moment of genuine self-reflectiveness, the parts of the self that are the guardians of affective stability become outraged, and the part that holds the unprocessed affect of developmental trauma caused by attachment failure becomes fearful, depressed, or both, causing distress to all parts—for which the therapist’s idea of “success” is then blamed.[”]^[63]

In describing his work in the MAPS/Lykos clinical trials, Mithoefer alludes to precisely this framework when he asserts that “sometimes there’s a backlash [from participants] and you get…very challenging protectors.”^[64]

Unfortunately, in combining the therapist’s spiritual discernment of energies alongside the narrative of “vulnerability hangovers,” the MAPS/Lykos ideology systematizes a logic for boundary violations along with a vocabulary that invalidates participant articulations of harm. Simultaneously, as Tourish and Irving point out, the MAPS/Lykos therapy’s emphases on therapist self-dislcosure and physical intimacy with vulnerable patients poses a high risk of “manipulat[ing patients] into signing up for the wholel [MAPS/Lykos] ideology and experience, regardless of its real capacity to effect positive change in their lives.” This risk is not merely theoretical, since MAPS has already demonstrated a pattern of mobilizing participants as spokespeople for its world-healing mission. As an additional risk of this therapy’s emphasis on physical intimacy, Tourish and Irving argue that “by encouraging people to engage in physical forms of closeness that would ordinarily be expected at a much deeper stage of relationship development, it is also possible that [this ideology] undermines the capacity of participants to assess the real levels of closeness in relationships within and without [the therapy context], thereby rendering them more vulnerable to manipulation.”^[65]

As with RC, the MAPS/Lykos ideology privileges direct experience over reason in a manner that obscures the operations of influence and indoctrination in its methodology. Their method induces “artificially engendered peak experiences” that have long been associated with engendering “extreme [and uncritical] conformity.” In such cases, “the [participant] hurtles along an emotional roller coaster, and has an increased prospect of retreating…into doctrinal and organisational [beliefs].” These extreme experiences can lead participants to “feel tremendously liberated and endowed with superhuman insight into themselves and the surrounding world,” even as they decompensate. As Tourish and Irving emphasize, extensive research on hazing and other group dynamics suggests that individuals will often “exaggerate the benefits to be gained from group membership” after they “engage in embarrassing [or disinhibited] behaviours in front of a group.”^[66] This phenomenon can be exploited as a vehicle for manipulation, leading vulnerable patients to identify with the organization’s values at the expense of their own.

When a therapy cult promotes grandiose claims about discovering the key to world-healing, its ideology exerts pressure on indoctrinated therapists and participants “to proselytize their beliefs” about the methodology’s efficacy. In such cases, the group’s assumed importance for averting global catastrophe creates a sense of urgency, such that “a small group of…activists bear an inordinate responsibility for saving the planet in the immediate future.” This urgency serves as the “primary lever for extracting maximum commitment (alongside a minimum critique of the group’s analysis) from the [indoctrinated] members.” It can also incentivize members to justify ethical lapses, including sexual abuses and clinical trial misconduct.

When Hurting Means It’s Working

Because the full MAPS/Lykos methodology has not been publicly acknowledged, unaffiliated researchers and ethicists have not yet scrutinized its full safety risks. Although methodologists have interpreted the protocol’s menu of 13 separate modalities as problematic because it provides too much variability,^[67] outside researchers have not yet understood how the modalities connect into a unified ideology. Much of the scholarship on the ethics of touch in psychedelic therapy has focused on handholding for reassurance; ethicists outside of the therapy cult have not recognized the extent to which the Phase 2 MP-4 participant abuse directly resulted from the MAPS/Lykos ideology.

This is not a situation of a few bad apples. This is a totalistic healing ideology that is incentivizing predictable patterns of harm. Since these harms are predictable, they are preventable. A significant barrier to preventing these harms is the healing ideology itself, which is held as dogma by much of the community. As a consequence, the community is disincentivized from correlating harms with that underlying ideology. Like with other therapy cults, MAPS/Lykos has exhibited a pattern of stigmatizing and ostracizing those with genuine concerns about the underlying ideology, as I have experienced firsthand. Under these conditions, the organization’s responses to safety concerns have amounted to band-aid solutions, leaving intact the underlying conditions that give rise to harm.

A similar evasion of root issues was apparent surrounding a 2017 death at the Zendo Project, a harm reduction service that was operated by MAPS. Although MAPS was ultimately found partially responsible for the death, the community framed the lawsuit as a threat to harm reduction services. No one publicly acknowledged the possibility that the Zendo’s training manual might have conditioned its volunteers to perceive medical distress as a sign of healing, even though the lawsuit alleges that volunteers missed obvious signs of suffering and clear medical distress. In my view, this is an inevitable consequence of an overly rigid healing ideology that associates pain with growth. As the Zendo manual emphasizes, “Even the most frightening and bizarre behavior, when explored and worked with, will turn out to be beneficial and enlightening.”

The field should take note of important parallels with adverse events in meditation groups. For a small subset of participants, extended meditation can give rise to serious adverse effects. Although many groups tell participants that the solution is to keep meditating, that is often the exact wrong solution. In the psychedelic field, a totalistic ideology of healing similarly hinges on a rigid model that frames the solution to distress as endurance of suffering (and often, taking more MDMA).

At scale, people will get hurt by this reductive approach.

Beyond unintentional harms, people who are gratified by harming others will often create life circumstances that provide access to vulnerable people, which this therapy model enables. The MAPS/Lykos therapy empowers such figures to cause harm, in a manner that parallels Eve Rickert’s description of the NXIVM cult:

Pain is a signal. Sometimes—very often, in fact—it’s a signal that you’re being hurt, and need to stop what you’re doing.... [This healing ideology] led me to experience harm without ever realizing what was happening to me, because I believed that if my relationship hurt, it was because I was unlearning conditioning, or needed to fix something in myself, or just get through it.... [I was being] trained to accept the unacceptable. To respond to real, legitimate distress at things that no one should ever be okay with with a desire to further “improve” themselves.... [T]he processes, I believe, are the same [in NXIVM and here]: Someone experiences something distressing. They have a reaction. Someone calmly watches, perhaps even displays some empathy, and then says, “Now…what do you need to work on there?” The words and the context may vary, but the dynamic is the same.... The problem is that the social and psychological milieu that is reinforced [by this healing ideology] deadens our ability to tell the difference between these kinds of pain—between the psychic equivalent of a nice, deep stretch, and the pop of a tendon tearing or shoulder dislocating.... And then when someone is abusive? When someone genuinely wants to undermine your ability to trust yourself, to believe in yourself, to say “ouch!” and “stop!”? When someone is genuinely more invested in getting what they want from you and others than they are in mutual co-creation of well-being? Then we’ve handed them just the weapons they need.^[68]

Due to ideological pressures, there is a high likelihood that the MAPS/Lykos research under review does not accurately reflect the safety or efficacy profile of its MDMA-assisted therapy. Under these conditions, additional research by unaffiliated and ideologically independent scientists is warranted. If the FDA does decide to approve the medical use of MDMA, it should decouple administration from the MAPS/Lykos therapy. As I have argued, their specific therapy increases the risks of MDMA in a manner that will disproportionately impact vulnerable patient groups.

Sincerely,

Neşe Devenot

Senior Lecturer

Johns Hopkins University

---

^[1] Margaret Thaler Singer, “Therapy, Thought Reform, and Cults,” Transactional Analysis Journal 26, no. 1 (January 1996): 15, https://doi.org/10.1177/036215379602600105.

^[2] Dennis Tourish and Pauline Irving, “Group Influence and the Psychology of Cultism within Re-Evaluation Counselling: A Critique,” Counselling Psychology Quarterly 8, no. 1 (January 1995): 35–50, https://doi.org/10.1080/09515079508258695.

^[3] Jesse Bedayn, “Aaron Rodgers Talks about Taking Ayahuasca at a Psychedelics Conference,” Associated Press, June 21, 2023, https://apnews.com/article/aaron-rodgers-psychedelics-conference-bae8c5ae3f221770fb84b123a92cf2d2.

^[4] Anna Silman, “MDMA Therapy Could Be Legal by Summer. Why Are so Many Advocates Sounding the Alarm?,” Business Insider, May 13, 2024, https://www.businessinsider.com/mdma-therapy-maps-lykos-rick-doblin-fda-legalization-trials-2024-5.

^[5] Singer, “Therapy, Thought Reform, and Cults,” 16.

^[6] Olivia Goldhill, “A Psychedelic Therapist Allegedly Took Millions from a Holocaust Survivor, Highlighting Worries about Elders Taking Hallucinogens,” STAT (blog), April 21, 2022, https://www.statnews.com/2022/04/21/psychedelic-therapist-allegedly-took-millions-from-holocaust-survivor-highlighting-worries-about-elders-taking-hallucinogens/.

^[7] David Nickles and Lily Kay Ross, “Cover Story: Power Trip,” New York Magazine and Psymposia (blog), 2022, https://www.psymposia.com/powertrip/.

^[8] Singer, “Therapy, Thought Reform, and Cults,” 17.

^[9] Silman, “MDMA Therapy Could Be Legal by Summer. Why Are so Many Advocates Sounding the Alarm?”

^[10] Steven A. Hassan and Alan W. Scheflin, “Understanding the Dark Side of Hypnosis as a Form of Undue Influence Exerted in Authoritarian Cults and Online Contexts: Implications for Practice, Policy, and Education,” in The Routledge International Handbook of Clinical Hypnosis, ed. Julie Hope Linden et al., Routledge International Handbooks (New York, NY: Routledge, 2024), 755–72.

^[11] Torsten Passie, The History of MDMA, First edition (Oxford, UK: Oxford University Press, 2023), 107.

^[12] Silman, “MDMA Therapy Could Be Legal by Summer. Why Are so Many Advocates Sounding the Alarm?”

^[13] Jules Evans, “MAPS, Massachusetts & Deep Meditation,” Ecstatic Integration, May 14, 2024, https://www.ecstaticintegration.org/p/maps-massachusetts-and-deep-meditation.

^[14] Tourish and Irving, “Group Influence and the Psychology of Cultism within Re-Evaluation Counselling.”

^[15] Tourish and Irving.

^[16] A Journey Through the Psychedelic Revival: Access to Psychedelic Medicine, 2022, https://www.youtube.com/ watch?v=ja9JIPo5Xg0, 56:35-57:38.

^[17] Rachel Nuwer, I Feel Love: MDMA and the Quest for Connection in a Fractured World (New York, NY: Bloomsbury Publishing, 2023), 222.

^[18] Michael C. Mithoefer et al., “A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder v.8.1” (Multidisciplinary Association for Psychedelic Studies, May 22, 2017).

^[19] Rick Doblin, “Stan Grof Contributions to FDA Drug Development Research With Psychedelics,” Journal of Transpersonal Research 7, no. 1 (2015): 109.

^[20] Doblin, 110.

^[21] Madrone Love, “Fellow Travelers: The Experience of Facilitating MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder” (Berkeley, CA, The Wright Institute, 2022), 58.

^[22] Mithoefer et al., “A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder v.8.1.”

^[23] Stanislav Grof and Christina Grof, Holotropic Breathwork: A New Approach to Self-Exploration and Therapy, SUNY Series in Transpersonal and Humanistic Psychology (Albany: State University of New York Press, 2010), 19–20.

^[24] Sasha Sisko, “Omission Of Serious Adverse Event(s) Within MAPS-Sponsored Clinical Trial  Publications Examining MDMA-Assisted  Psychotherapy For PTSD” (OSF Preprints, April 23, 2024), 35, https://doi.org/10.17605/OSF.IO/VEFZQ.

^[25] Richard C. Schwartz and Martha Sweezy, Internal Family Systems Therapy, 2nd ed. (New York, NY: Guilford Publications, 2019), 257.

^[26] IFS Talks, “MDMA Assisted Therapy - with Michael Mithoefer,” IFS Portugal, December 3, 2020, https://internalfamilysystems.pt/multimedia/webinars/mdma-assisted-therapy-michael-mithoefer.

^[27] Schwartz and Sweezy, Internal Family Systems Therapy, 258.

^[28] Schwartz and Sweezy, 257.

^[29] IFS Talks, “MDMA Assisted Therapy - with Michael Mithoefer.”

^[30] Schwartz and Sweezy, Internal Family Systems Therapy, 176.

^[31] Nicolas Langlitz and Alex K. Gearin, “Psychedelic Therapy as Form of Life,” Neuroethics 17, no. 1 (April 2024): 2, https://doi.org/10.1007/s12152-024-09550-9, emphasis added.

^[32] Neşe Devenot et al., “Psychedelic Identity Shift: A Critical Approach to Set And Setting,” Kennedy Institute of Ethics Journal 32, no. 4 (2022): 359–99, https://doi.org/10.1353/ken.2022.0022.

^[33] Langlitz and Gearin, “Psychedelic Therapy as Form of Life,” 2.

^[34] Langlitz and Gearin, 3.

^[35] Jules Evans, “Internal Family Systems, Unattached Burdens, and Spirit Possession,” Ecstatic Integration, April 19, 2024, https://www.ecstaticintegration.org/p/does-internal-family-systems-implant.

^[36] IFS Talks, “MDMA Assisted Therapy - with Michael Mithoefer.”

^[37] Love, “Fellow Travelers: The Experience of Facilitating MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder,” 92.

^[38] Love, 152.

^[39] Sisko, “Omission Of Serious Adverse Event(s) Within MAPS-Sponsored Clinical Trial  Publications Examining MDMA-Assisted  Psychotherapy For PTSD,” 13.

^[40] Sisko, 14.

^[41] Jason A. Butler, Genesee Herzberg, and Richard Louis Miller, eds., Integral Psychedelic Therapy: The Non-Ordinary Art of Psychospiritual Healing" (New York, NY: Routledge, 2024).

^[42] Butler, Herzberg, and Miller.

^[43] Sisko, “Omission Of Serious Adverse Event(s) Within MAPS-Sponsored Clinical Trial  Publications Examining MDMA-Assisted  Psychotherapy For PTSD,” 7.

^[44] PT327 – Rick Doblin – Confronting Abuse in Clinical Trials and the Future of Psychedelic Medicine, 2022, PT327 – Rick Doblin – Confronting Abuse in Clinical Trials and the Future of Psychedelic Medicine, 2022, https://www.youtube.com/ watch?v=sZpQi5qEYXc.

^[45] Silman, “MDMA Therapy Could Be Legal by Summer. Why Are so Many Advocates Sounding the Alarm?”

^[46] The Cut, “Political Science,” The Cut, March 8, 2022, https://www.thecut.com/2022/03/cover-story-podcast-episode-7-political-science.html.

^[47] Tourish and Irving, “Group Influence and the Psychology of Cultism within Re-Evaluation Counselling.”

^[48] Nicole D. Cardona, Ryan J. Madigan, and Shannon Sauer-Zavala, “How Minority Stress Becomes Traumatic Invalidation: An Emotion-Focused Conceptualization of Minority Stress in Sexual and Gender Minority People.,” Clinical Psychology: Science and Practice 29, no. 2 (June 2022): 185–95, https://doi.org/10.1037/cps0000054.

^[49] Mithoefer et al., “A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder v.8.1.”

^[50] Michael C. Mithoefer et al., “MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder: A Revised Teaching Manual” (Multidisciplinary Association for Psychedelic Studies, November 30, 2011), 64, https://maps.org/research-archive/mdma/Manual_MDMAPTSD_30Nov11.pdf.

^[51] Mithoefer et al., 63.

^[52] Butler, Herzberg, and Miller, Integral Psychedelic Therapy, 115.

^[53] Hannah McLane et al., “Respecting Autonomy in Altered States: Navigating Ethical Quandaries in Psychedelic Therapy,” Journal of Medical Ethics Blog, December 22, 2021, https://blogs.bmj.com/medical-ethics/2021/12/22/respecting-autonomy-in-altered-states-navigating-ethical-quandaries-in-psychedelic-therapy/.

^[54] Butler, Herzberg, and Miller, Integral Psychedelic Therapy, 115.

^[55] A Journey Through the Psychedelic Revival.

^[56] Butler, Herzberg, and Miller, Integral Psychedelic Therapy, 81.

^[57] Françoise Bourzat and Kristina Hunter, Consciousness Medicine: Indigenous Wisdom, Entheogens, and Expanded States of Consciousness for Healing and Growth: A Practitioner’s Guide (Berkeley, CA: North Atlantic Books, 2019).

^[58] Janis Phelps, “Developing Guidelines and Competencies for the Training of Psychedelic Therapists,” Journal of Humanistic Psychology57, no. 5 (September 2017): 450–87, https://doi.org/10.1177/0022167817711304.

^[59] Butler, Herzberg, and Miller, Integral Psychedelic Therapy, 244.

^[60] Butler, Herzberg, and Miller, 85.

^[61] Mithoefer et al., “A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder v.8.1.”

^[62] Butler, Herzberg, and Miller, Integral Psychedelic Therapy, 92.

^[63] Butler, Herzberg, and Miller, 87.

^[64] IFS Talks, “MDMA Assisted Therapy - with Michael Mithoefer.”

^[65] Tourish and Irving, “Group Influence and the Psychology of Cultism within Re-Evaluation Counselling.”

^[66] Tourish and Irving.

^[67] Grace Browne, “The Therapy Part of Psychedelic Therapy Is a Mess,” WIRED, April 6, 2023, https://www.wired.com/story/psychedelic-therapy-mess/.

^[68] Eve Rickert, “The Book More Than Two Turns Ten—and Gets a Second Edition,” Brighter Than Sunflowers, February 9, 2024, https://brighterthansunflowers.com/2024/02/08/the-book-more-than-two-turns-ten-and-gets-a-second-edition/.