Therapist Meta Competence in MDMA and Psychedelic-Assisted Therapies: Adapting Treatment for Adult Survivors of Childhood Trauma: Trauma Informed Care & Practice

Both MDMA-assisted psychotherapy (MDMA-AP) and psychedelic-assisted therapy (PAT) are new treatments, and they are fast moving from clinical trials into clinical practice. Both treatments show potential for treating adult survivors of childhood trauma who suffer high rates of complex post-traumatic stress disorder (C-PTSD), depression and other mental health difficulties. However, there is limited information about the skills, knowledge or training therapists need to develop competence using MDMA-AP or PAT with adult survivors of childhood trauma. Given the need to train therapists in how to offer these novel therapies to different clinical populations, an understanding of therapists’ experiences working with clients with childhood trauma histories has a vital role to play in developing an understanding of what is required to work safely and effectively. A qualitative analysis of therapy session recordings of PAT practice in a clinical trial with clients with childhood trauma histories was carried out, and semi-structured interviews were carried out with 12 therapists using MDMA-AP and PAT across a range of settings, including individual therapy, therapeutic retreats, and clinical trials. The study aimed to better understand how therapists are using these treatments with survivors of childhood trauma, what opportunities and challenges they encounter and how they find delivering the interventions. A grounded theory model was created from the findings to describe a process of therapists’ flexible responsiveness to the individual and relational needs of adult survivors through the MDMA-AP and PAT treatments. Therapists drew on a range of personal qualities, professional skills and trauma-informed principles to guide flexible decision-making in response to challenges and opportunities in the therapeutic process. Grounded theory is a method which can generate new hypotheses, and we present here a hypothesis that therapists’ flexible delivery of the MDMA-AP and PAT models is associated with better outcomes for adult survivors of childhood trauma.