Episode 37: MDMA and Couples with Dr. Anne Wagner

 

“I envision a day where people would be able to choose to do MDMA-assisted psychotherapy in a safe context to be either able to heal from something together or to grow together, and to support the relationship.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Anne Wagner. Anne is a Toronto-based psychologist and couples therapist, a researcher studying MDMA-assisted therapy, and the founder of Remedy Centre. Remedy is a social venture that provides individual, couples, and group therapy and reinvests the profit from these services into the Remedy Institute, which is “a new charity focused on supporting mental health innovation & research, including with psychedelics, training for aspiring mental health professionals, as well as low to no-cost therapy services for marginalized communities.”

She is the principal investigator on a pilot trial studying the impact of MDMA-assisted Cognitive Processing Therapy (CPT) on PTSD and is planning a study that will examine the impact of MDMA-assisted Cognitive Behavioural Conjoint Therapy (CBCT) on PTSD.

If you’d like to donate to the Remedy Institute, please check out: canadahelps.org/en/charities/remedy-institute

Dr. Joe and Dr. Wagner spoke about:

 

Here is more information on subjects mentioned in this episode:

 

More quotes from Dr. Anne Wagner from the interview:

“We’ve been doing the first trials that have been anything other than the inner-directed supported approach. So there’s a lot to ask, and a lot to investigate.”

 

“​​Not only does bringing someone along with you on your healing journey provide support, but it also provides the partner with their own support and healing.”

 

“It’s been really interesting seeing folks work with MDMA to help as a catalyst for that meaning-making process.”

 

“People take turns of who is struggling and who is okay. And that can be something that is really nice where they learn to ride the waves of that together.”

 

“I really try to help people frame their ideas around not expecting to have an expected outcome.”

 

Here are some highlights of their conversation:

Before we get to the trial that you’re planning, I want to ask you a quick one about the study going on right now. What’s interesting is that you described it as like a meaning making framework and so it’s very cognitive. And the trends and the buzz and all the excitement is around relational therapy, somatic therapy. Like these are the things that are bubbling up for me in terms of what approaches are being used in psychedelics. And this is a very cognitive approach. 

I’m just curious how you think about that in the sense that I don’t know how many times I’ve heard like, ‘well, you can’t just do like cognitive therapy with someone doing MDMA. It’s just not somehow adequate to touch the depths of the experiences people are having.’ So just really curious about your thoughts there.

I respectfully disagree with thoughts that are the impressions that are there around it. And I think it’s partly because of the–it is possible to do cognitive therapy in a way that feels stiff and disjointed and doesn’t go into the depths. But I think if you’re delivering it in a way and working with the participant in a way that’s bringing in all of their experiences, it’s an incredibly rich way of working with everything that comes up.

And so of course, like even though it’s cognitively focused in terms of meaning making, we’re working with emotions, we’re working with sensations, we’re working with behaviours. It’s not excluding any of those components.

And it’s helping folks not only work with what has happened and the interpretation of what’s there, but also what’s happening now and what’s going into the future. It allows for the sense of my everyday life. ‘Oh, this is how this is going to change and this is how I can implement it.’ And that we find really effective.

It’s been really interesting seeing folks work with the MDMA sessions to help as a catalyst for that meaning making process because there is so much meaning making that happens in the MDMA sessions. And you’re just providing a bit of a frame to help that continue afterwards. So I always think of that as the catalyst.

 

I came up with this analogy the other day that has stuck around for me. I’d be curious if you’re on board with it. If you get a bacterial infection like strep throat or something. Your body could probably heal it, right? No problem. You’re healthy, you have a functioning immune system. It might take a little bit longer and you may not feel so great, but you can probably handle it. Or you can go to the doctor and get a medicine to help your body heal some health problems. 

And I’ve started to think about maybe psychedelics in general or MDMA for couples where there may be something broken or something challenging happening in the couple that if they were to go for walks and go out for dinner and whatever, take the time to invest in themselves, they could probably heal through it. But MDMA is a medicine that might help speed up or deepen that process in some way. Which means that there may be situations in some future state where you can go to the clinic with your partner and get MDMA couples therapy to accelerate healing that might otherwise happen organically. Your thoughts on that? 

Yeah, I do think that that’s a possibility. I think the medicine analogy is an interesting one because I actually had this conversation earlier this week with someone who was raising the point that I think sometimes people think that the taking of the pill is the thing that will cure them and be helpful. And it’s actually nothing. Like as far as we know, there isn’t anything inherent yet in the taking of that pill with MDMA in particular, that would have that effect.

It’s the psychotherapy, the psychological process that happens after that would create that shift. So I do think, though, that the experience, the MDMA session as being something that can help speed it up. It can help you do a good piece of work, a good chunk of work in a quick period of time. That’s true. And so that’s where I think it could exactly be really helpful.

I envision a day where people would be able to do that and choose to do that as something to either–with support and in a safe context–be able either to heal from something together or to grow together in a different way and to support their relationship. That would be fantastic to have that capability and that possibility.

 

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Episode 24: Love, Attachment, and Couples Therapy with Dr. Sue Johnson

 

“Relationships are the keystone of our lives. They are as important to us as our next

breath.”

In this episode of the Numinus podcast, Dr. Joe speaks with Dr. Sue Johnson. Sue is a pioneer in the field of couples therapy. Alongside Dr. Les Greenberg, Dr. Johnson developed emotionally focused couples and family therapy (EFT), which is a couples therapy based on the newest research surrounding relationships: attachment theory. She is also the author of many books like Hold Me Tight, Created for Connection, and Love Sense and is the founder of the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT), which offers training to therapists in EFT.

Dr. Johnson and Dr. Joe spoke about:

If you’d like to seek services in couples therapy and EFT, please visit our site for more information.

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Here are some highlights from their conversation:

Could you take us through the basics of attachment theory and how that informs emotion-focused couples therapy? 

One way of thinking of what EFT is about and capturing it very fast is that EFT–you could think of EFT as a model, as a conversation between Carl Rogers, which is my basic training as an individual therapist. It’s a conversation between Carl Rogers who believes that it’s the therapist’s job to believe in people’s ability to grow. Who was dedicated to non-pathologizing and to listening to people and believing that acceptance and a powerful safe connection was healing in itself.

So it’s a conversation between Carl Rogers who invited therapists to listen to their client’s experience, to take it seriously, and to reflect that back in a way that allowed their client to continue to process it and engage with their experience in a different way, to create corrective emotional experiences.

And then you have Salvador Minuchin who would come in and say that you have to look at people in the context of relationships. And that you have to look at the dance, the drama in people’s relationships and how those dramas take over people’s lives and define them. You have to find ways to understand these powerful feedback loops that you see people caught in throughout their lives. Where they almost create the interpersonal problems that they have.

‘My only way of dealing with my emotions is to shut down and shut you out. When I shut you out, I alarm you.’ Because you are a bonding mammal, your brain is designed to be alarmed by the person you count on shutting you out. So when I shut you out, you become alarmed and you become angry with me. And then I hear everything I’ve ever been afraid of, which is you’re going to reject me. I’m not good enough. So I shut down more.

And this kind of feedback loop that I’m talking to you about–some folks who are trained just in individual therapy don’t really think in this sort of systems, process oriented level.

So it’s a conversation between Carl Rogers, Salvador Minuchin about how to intervene. You’ve got to look at the relational systems people are involved in and the pattern of interactions, the drama in their–how people move their feet in the dance. And you’ve got to look how people put their emotions together, their emotional life. And you got to look at it in a non-pathologizing way. But that’s still not enough.

If you’re going to work with close relationships in couples and families, and even individual therapy, you have to have this awareness if you’re going to be effective.

You have to listen to John Bowlby who basically said, ‘we’re bonding mammals,’ and gave us a map to our basic needs and basic fears. He basically said–and this has been borne out now by so much science in our world–emotional isolation is traumatizing for human beings and evokes pretty dysfunctional responses because when you’re afraid, your whole world narrows down, and your response repertoire usually narrows down, your ability to explore and open up narrows down. And many, many of us then get completely stuck.

So Bowlby said that we have to understand ourselves as bonding mammals and how these relationships with others are the keystone of our lives. They are as important to us as our next breath.

John Bowlby basically said that all the dysfunction that you see–if you want to call it that–in your clients, all the places that people get stuck, are distortions of things that in other contexts would be perfectly reasonable, healthy responses. I think Rogers would have agreed with that.

Bowlby said that when people feel safely connected, they are able to be expansive and learn and grow. People need safe haven, secure base relationships. They need safe haven people to go to with their vulnerability where they will receive comfort and reassurance and get their emotional balance. We give clients emotional balance in EFT. They need their loved ones to provide a secure base to go out from.

What we understand now is that as adults, there is something called constructive dependency. The strongest among us and the ones that are able to grow and change and be resilient can turn to other people in our minds, and also in our lives, and use those other people as a resource. And that’s constructive dependency.

 

I’d love to hear you talk about these sorts of patterns of disconnection that happen–I believe you called it the tango. Maybe you could just give us examples of the tango. 

Patterns of disconnection in couples in our society–the most popular show in town is that one person starts to tune into the fact that there is emotional disconnection. They’re asking the question: Are you there for me? And somehow the answer comes back ‘No’ or ‘Maybe.’ So they start pushing to change the dance, to change the relationship. So they became more anxious, more demanding. They start sounding critical. ‘Why don’t you…’ ‘You never…’ ‘How could you?’ ‘Can’t you see that…?’ And they start pushing.

The trouble is that neither partner is not often very clear about what they’re pushing for. They might say, ‘I just want you to do chores.’ But when you really hear it, it’s not about chores. It’s about, ‘I want to know if I say something to you that matters to me that you care. I want to know that my pain matters. I want to know that my happiness matters. I want to know that I matter to you.’

So we see this pattern of pursue, withdraw–I get angry with you and more desperate, and you reason with me or don’t become emotionally available. You turn away. You shut me down. You shut down and shut me out. The more you shut down and shut me out, the more desperate I become. We’re obviously reducing a complex phenomenon to something simple. But that’s the most popular dance that creates distress in relationships.

So we help people see that dance. We help them see how it leaves them both desperate and alone. And then we help people move into being more open and connected with each other.

And the tango that you talked about, which is the thing that we do in almost every session across the stages of therapy, whether we’re trying to help people see the negative dance they’re caught in in stage one. Or moving into stage two, helping them create new moves in their dance like really open up to each other and help each other with their fears and needs, help each other so that their feelings of vulnerability have a solution. And the solution is the connection with the other person. The connection with the other person is the solution to the problems.

Once people are connected safely, they can deal with almost any of the other problems they come in with like sharing chores or parenting or finances or what to do in bed. You can’t talk about any of those things effectively if you don’t have some sort of team.

The way the therapist does this is that they do something called the EFT tango. I dance Argentinian tango. So that label is mine [laughs]. But the reason I called it the EFT tango is because most people think of tango in terms of ‘Dancing with the Stars,’ which is horrible. Real tango–which you can see in any city in the world right now–is all about attunement. It’s not about the steps at all. The steps can be amazingly simple. It’s about tuning in, being able to stand up with a perfect stranger, listen to some beautiful music, and tune in to that stranger’s signals, that stranger’s intention, that stranger’s body moves and emotional tone, and then come together and move together with this music as the structure. So that’s why I called it the tango.

If I were to describe it for you very simply, the EFT therapist, whether they’re working with individuals, couples, or families–move one is that you stay in the present moment. You stay in the present moment and you look with your attachment glasses on at the patterns that are happening in front of you. You look at the emotional patterns and the patterns between people if you have more than one person in the room or even if you have an individual person who’s talking about their relationship with mother, etcetera.