What is MDMA protocol? What are some things to know about therapeutic use? How are some ways you can get involved with this type of work?
In this podcast episode, Joe Sanok speaks with Marca Cassity about treating clients with MDMA assisted psychotherapy.
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Meet Marca Cassity
Marca Cassity is a nurse and Licensed Marriage and Family Therapist in private practice in Portland, Oregon. Marca’s journey as a therapist began by overcoming their own trauma and developing their own resilience and empowerment as a two-spirit, queer, mixed-race Native American who grew up on the Osage reservation of Oklahoma. In addition to a depth of personal work in EMDR therapy, they have found healing in Peyote ceremony in the Native American Church, and in eighteen years of Ayahuasca healing and integration work. Marca trained as a trauma therapist at Crisis Services of Alameda County, Native American Health Center of San Francisco, and the Indian Country Child Trauma Center. Marca is currently a member of the Advisory Council on diversity for the Multidisciplinary Association of Psychedelic Studies (MAPS), and is in clinical training to begin treating clients with MDMA-assisted psychotherapy in 2020.
In This Podcast
- The shift around psychedelics and mental health
- MDMA protocol
- Things to know about the therapeutic use
- Options to look into for getting involved
The shift around psychedelics and mental health
After moving to Colorado, Marca partook in EMDR therapy and started having experiences with plant spirit medicine, such as Peyote and Ayahuasca. This was a traditional and legal use of Ayahuasca and Peyote in the USA for people who have a church status. She was noticing that she was healing from her trauma and noticing how EMDR was similar to what she was experiencing with Ayahuasca. This plant medicine therapy encouraged re-experiencing difficult life events/trauma. All of this led to a curiosity and continued journey into using plant medicine for trauma-reprocessing.
People that qualify for this treatment are people who have treatment-resistant PTSD.
MDMA works with the amygdala and fear factor part of the brain. MDMA aids in building trust and good connections between the client and therapist. These sessions include an eighteen point of contact protocol with medical-grade MDMA. This is carried out by three, eight-hour sessions of MDMA and there are two trained psychotherapists present in the sessions. There are also fifteen other points of contact that are three preparation sessions before your first session of MDMA and then 12 integration sessions.
Things to know about the therapeutic use
Trauma is part of being on the planet. When people used to go out and hunt a buffalo, it’s life-threatening. When you come back to the village from that experience, you have to release that trauma. And there are ways and ceremonies and plant spirit medicines that have helped people from the beginning of time, therapeutically. Fast forward now to modern times we are dealing with PTSD and anxiety disorders, anything that will enhance the ability to work with trauma is beneficial. A lot of the studies that are happening are around veterans and helping them with PTSD.
Options to look into for getting involved
When people go through a psychedelic experience they gain a depth of insight.
- MDMA protocol and doing the training for this so that the clinician is able to be in the room with a client who is partaking in MDMA. There is specific training for this.
- Alternatively, you can start with integration and start doing an intake assessment. People who have gone through a psychedelic experience gain insight and their traumas come up or they learn a lot about themselves, and this is something you can speak with them about and help them integrate.
Books mentioned in this episode
- Psychedelics Series: Davi Rhein Talks About Ayahuasca | PoP 446
- Slow Down School
- Killin’It Camp
- Practice of the Practice Podcast Network
- Next Level Practice
- Free resources to help you start, grow and scale
- Apply to work with us
Meet Joe Sanok
Joe Sanok helps counselors to create thriving practices that are the envy of other counselors. He has helped counselors to grow their businesses by 50-500% and is proud of all the private practice owners that are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.
Thanks For Listening!
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[JOE]: This is the Practice of the Practice podcast with Joe Sanok, session number 447.
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Well, today on the show we’re continuing our psychedelic series. We have Marca Cassity and they are an amazing person that talks about the use of MDMA assisted therapy and what that looks like. So, without any further ado, I give you Marca.
Well today on the Practice of the Practice podcast, we have Marca Cassity. Marca’s journey as a therapist began by overcoming their own trauma and developing their own resilience and empowerment as a two-spirit queer mixed race, native American who grew up on the Osage reservation of Oklahoma. In addition to a depth of personal work in therapy, they have found healing in a Peyote ceremony in the native American church and in 18 years of work with traditional Ayahuasca healing and integration work. Marca is an advisory council member for the Multidisciplinary Association for Psychedelic Studies (MAPS) and is completing training and beginning treating clients with MDMA assisted psychotherapy in 2020. Marca is a nurse and an LMFT with a private practice in Portland, Oregon. Marco, welcome to the Practice of the Practice podcast.
[MARCA]: Hi Joe. Thank you. Thanks for having me.
[JOE]: Oh man, you are doing so much, and this series that’s all about psychedelics and introducing therapists to kind of what’s happening in the world. I would love to just hear, I mean, you have such a background. I wanted to make sure I got through all of your bio there because I feel like it’s really important for people to just know where you start. But talk a little bit about maybe what you’ve observed in regards to the shift around psychedelics and mental health.
[MARCA]: Yeah, it’s been quite a journey as a gender nonconforming to spirit queer Indian who kind of went through a lot of trauma in the eighties. I was born in the sixties and in the eighties were in the height of the AIDS crisis. And so, when I came out, it was not an ideal time. I mean, not, I don’t know when it’s ever an ideal time, but you know, went through a lot of trauma, a lot of loss with my family connection. And so, my personal journey of healing was more into my thirties, I did some EMDR therapy. I also worked as a nurse through my twenties, I became an emergency room nurse, so, trying to prove to people my worthiness of being on the planet as a queer person, kind of another right reason to go into emergency room nursing. But, you know, I did some really good work there, but also experienced some burnout. And so, by the time I was 30, those, you know, all of that kind of trauma history there led me into doing some deep healing work for myself.
And so that started with first of all, I moved to Boulder, Colorado where I partook an EMDR therapy and then started having experiences with plant spirit medicine or POD ayahuasca, more kind of traditional legal, it’s illegal use of Ayahuasca and POD in the United States for church status. People have a church status. So I was hanging out in those circles and getting a tremendous amount of healing around my trauma and noticing kind of the, how EMDR or exposure therapy is very similar to what I was experiencing with Ayahuasca in that the Ayahuasca would take me into re-experiencing of, you know, difficult or adverse life events or trauma in my life. And then we would kind of take me there, re-expose me and then show me insight. And that’s kind of how that medicine works and EMDR or exposure therapy, you know, is similar. So, this led me in later parts of my, I’m 50 now and —
[MARCA]: Thank you very much. I’m a little over 50, but you know, I’m 50 plus now. And so, this led to a continued journey of just, you know my curiosity around, you know, how well, first of all, just how to help people, especially more marginalized communities. I did my interning, actually I ended up in the Bay area in my life and I did my interning at Native American Health Center of San Francisco where I was training in EMDR but also working with native medicine people there who had come to be with our clients. And I would tell them about this EMDR training and yeah, I had one medicine guy, he just laughed at me and he said, “Oh.” He took an eagle feather and he waved it in my face and he said, “You’re not doing anything new.” It was like, you know, that trauma reprocessing is something that’s, you know what medicine people help people do is go through the hard things about being on the planet. And so, if we then also bring in plant spirit medicine or entheogenic or what people call sometimes psychedelics to help the mind and to enhance that process of trauma reprocessing.
[JOE]: Yeah. You know, I’ve heard EMDR being kind of connected to some of the plant-based medicines. What would you say is that connection, do you know, and you may not know kind of all the parts of the brain, and that’s less important to me as just kind of why certain medicines tend to help in conjunction with EMDR?
[MARCA]: Well, this is something that’s kind of, the blending of those two worlds, you know, besides the medicine guy saying, “Yeah, do the EMDR,” but I wasn’t, of course, I was not. Of course, people, my clients there were not partaking in any type of medicine or psychedelic in session with me. I was doing EMDR over here with folks in a clinical setting and then I was having personal use in my own, you know, work in Ayahuasca ceremony and of course, helping and witnessing others integrate their journeys on psychedelics. So that’s a whole another topic there, but so, you know, we are, there are more studies happening in the laboratory of what does Ayahuasca, what does Psilocybin and what do MDMA is. These medicines, what do they do to the brain? And we know that with MDMA it is more, works with the amygdala and the fear factor. So, the MDMA doesn’t actually do the trauma therapy. It just helps the trauma therapist to build trust, to build a connection for the client themselves, to re-experience their trauma, which is necessary for the trauma reprocessing with help of the medicine.
And you know, this treatment through MAPS and this training I’m doing is a protocol. It’s an 18 point of contact protocol with medical-grade MDMA. So, we have three sessions of MDMA, eight-hour sessions where the client is partaking in MDMA with two trained psychotherapists and then there are 15 other points of contact that are three preparation sessions before you take your first session of MDMA and then 12 integration sessions. So, this is a protocol with MDMA, which, so the MDMA is helping us to do the trauma reprocessing in those three sessions. And then we have you know, those many other sessions that help prep and integrate, which I think is just as vital for folks. The people who are qualifying for this protocol are people who have treatment-resistant PTSD. So, this means they’ve had two forms of either psychopharmacology and therapy and they’re still having life-threatening PTSD. And this, the latest study has shown, we had 107 participants, 61% of those folks a year out, or actually it’s gone up a year out, no longer have a PTSD diagnosis.
[JOE]: Well, and I know, I like the point that Michael Pollan makes in his book about how it’s been, what, 40 years since any sort of breakthrough in mental health in many different areas, especially in pharmacology and how we’re doing it, basically the same way we did in the eighties. And this could be that next breakthrough and the results are showing it as well.
[MARCA]: For some people, yes. We’re still, you know, we’re at the point though where the FDA and the DEA, they’ve just approved and expanded access for MDMA, for this MDMA protocol. And what that means is compassionate use so that they, the FDA and the DEA have seen enough positive results to now allow, to come out of that research phase where you give, you know, you get placebo along with the active medicine. So, we’re out of that phase or that research will continue, but the training I’m doing will allow therapists like myself to be part of what’s called expanded access or compassionate use. So, you know, this is really exciting. This is moving forward towards MAPS and Rick Doblin, who’s the founder of MAPS, his vision of, you know, 10,000 MDMA clinics in the States, you know, and he’s seeing legalization of this protocol and you know, under a doctor’s care and under therapist’s guidance, you know in 2020, 2021 starting. So, there’s a big vision at MAPS and you know, this is all along in the clinical side. Of course, there’s lots of going on in the underground world and what people call the underground world or you know, unlicensed clinicians or people partaking in psychedelics and all sorts of ways that are therapeutic as well as for personal use, betterment of happy people, whatever you want to call it.
[JOE]: You know, I’ve heard some really interesting discussions. The podcast Psychedelics Today, I think has done a really good job with it and they were talking about kind of Oregon versus Denver and then kind of comparing some of that to the medical marijuana and also different. What are your thoughts on the ways that communities are decriminalizing psychedelics or Psilocybin? Any thoughts on how people you feel like are doing it right or could improve on that?
[MARCA]: Well, it’s a complex issue. Again, I’m someone who has you know, my native tribe, the Osage had been partaking in POD ceremony since 1890. It was one of the main, it’s one of our main ceremonial ways that have remained through total decimation of our tribal ways, our spiritual ways. And so, this was a way that, you know, this POD in combination with Christianity made it okay for the U.S. government to let that happen. So, I am very happy that anytime there’s decriminalization, you know, that we move forward with that so that people who are doing therapeutic, responsible good work that is helpful to people for being on the planet and being in a good way and being in contact with nature and their self-love and being a good person on the planet, bring it on. Anything that decriminalizes, you know I’m all for it.
Is there going to be misuse or overuse or problems with these drugs, you know, street drugs the way that they’re used, the way they’re cut with other things, you know? Sure. If we head into, you know, Rick Doblin likes to use the word adult use versus recreational use because there’s such a stigma to recreational use, but you know, that’s the complexity of it. So, I’m excited by the decriminalization and then I think that we just have to be responsible. As a clinician, it’s extremely important. I’m very excited to have, I’m a nurse, I was a nurse for many years, worked as a nurse for many years. So I love protocol and I’m really excited about following this protocol and helping people with treatment-resistant PTSD, you know, in a clinically sound way with a medical-grade MDMA where I know also that this MDMA is being made by the MAPS pharmaceutical, their own pharmaceutical company that there are not, they start with the nonprofit and then they just started the for-profit, which is what, who will make the medicine. But all the money coming from this treatment will go from the business of the MDMA. If that takes off, we’ll go back into research. That is MAPS, that is their guarantee to folks there. That’s their vision and I also love being behind that.
[JOE]: For people that are new to this, because I know before I read Michael Pollan’s book, I wasn’t necessarily against psychedelics, but I also didn’t really see the value in them. And through reading that book and just understanding the history and the science and all of it was kind of pushed down in the sixties and seventies, I mean, just the thousands of research studies that had been done, now I’ve kind of come out on the other side, like it is criminal, that there was this kind of outcomes and we didn’t pursue those things. mostly because of, you know, wanting to get people to go to the Vietnam war and the politics of it.
[MARCA]: Yeah. The counterculture scared the powers that be.
[MARCA]: And when you start getting people awake and in their health and in their resilience and their wellbeing and standing up maybe for the environment and for having resilience and like standing up for their wellbeing, that’s going to change the way our, you know, as an indigenous person, we’ve always known this, that our resilience is based in our ceremony and in our plant spirit medicine and our self-love and our resilience and our humor. So, yeah, and that doesn’t bond well often with the U.S. government when it comes to Indians.
[JOE]: Sure. Now, if you were speaking though to those people that they have never heard of, whether we use the term psychedelics MDMA, plant medicine, whatever term they’ve never heard of it, having therapeutic use that can help with trauma or all these other things what would you say to them as someone that maybe is open to it but also just hasn’t had that information?
[MARCA]: As someone who hasn’t heard of, they’re questioning this idea of therapeutic use? Like what is that?
[JOE]: Yeah, that’s just a new idea to them. Like, what would you say are things that they should know, things that they should research? Like what would be a big takeaway specifically for them?
[MARCA]: Well, we can start of course, with the history of entheogenic or plant spirit medicine in the tribal culture around the world from as far back in times. I did a course at the Indian Country Child Trauma Center with Dr. Dolores BigFoot, who’s an amazing psychologist. She’s Caddo and she works with trauma-focused CBT there. She brings native enhancements into the trauma-focused CBT work so that when you work with native clients, you’re pulling cultural pieces in that that really help with their healing. And her takeaway is like, you know, trauma has been happening. Like it’s part of being on the planet. So, like when you go out and you need to hunt Buffalo and you go out and you try to hit a Buffalo and your friends, you know, it’s life-threatening and your friend may die.
And when you come back to the village from that experience, you have to release that trauma. And there are ways and ceremonies and plant spirit medicines and all sorts of ways that have helped people from the beginning of time therapeutically to deal with being on the planet and all the, you know, lightning and nerve endings and the difficulty, right? So fast forward here we are in this modern time with, we have our diagnoses of PTSD and anxiety disorder. I’m a trauma therapist, so most of my clinical work is focused through a trauma lens, and so, you know, anything that will enhance the ability to work with trauma is within, that is what we’re seeing with the, you know, we’ve gone from just the plant spirit medicine world into the research world and there’s controversy around that because a lot of times science is referring to native American use and yet native Americans are some of the people who are struggling the most, you know on the planet.
So, we’re appropriating culture a little bit when we start to head into the research world. But as a native clinician who works with people with PTSD, I’m like, “Okay, there are many ways of handling that and making sure we’re looking out for native folks, hopefully, and I’m very passionate about that. But let’s head into now a clinician who’s asking about therapeutic use.” So, there’s all that history and now we’re in the research and there’s lots of research you can read and there’s lots of research continuing and it’s kind of been suppressed since the eighties. Since all this, you know, there’s a lot of propaganda that goes out that’s anti-drug and against even the MDMA makes holes in your brain and that causes reefer madness and LSD. You know, and I would say, well, okay, if we look at opioids and we look at things like morphine or Xanax or Valium or maybe antidepressants without therapy, you know, medicating someone without also prescribing therapy for them, well, we end up with a lot of problems with those drugs and we don’t schedule, we don’t make them schedule one. We don’t criminalize them.
There’s a complexity in this. So why would we make psychedelics a schedule one? Why would we, with all this research and we’re seeing a long history of therapeutic use for indigenous people and we’re seeing all this great research, it makes a lot of sense. And the FDA and the DEA are agreeing at this point with all this great research, including working with veterans. This is one thing that’s helping to de-stigmatize; is that we’re crossing the political lines now because a lot of folks in the more, you know, more conservative folks who maybe have been anti psychedelic at some point or anti-counterculture or whatever, starting to see the ability to treat veterans like with high turnaround of PTSD, you know, therapeutic use. A lot of those studies that are going on are with vets and they’re getting really great results and veterans are also starting to be known to go to treatment centers in South America with Ayahuasca to utilize Ayahuasca for their healing of PTSD as well.
[JOE]: Now what about say clinicians that say, “I’m with you guys or with you. That sounds great. I would love to get training, get some understanding, learn about set and setting, which we haven’t even talked about of what that means.” [crosstalk] I would love, you know, want to learn how to do a flight plan and, or post-experience. I want to be able to be supportive to my clients, even if my client, you know, goes and has an experience. What should those therapists know? Because you briefly kind of glossed over it and I think it was fine, but there are a lot of people in the underground that are doing this work that have no clinical training and that, you know, it’s kind of the best guess as to whether that person is going to help somebody. For those of us that have clinical training what, where should we go, what should we look into, what are our options?
[MARCA]: Well, so there are two roads there. One is the actual you know, like the MDMA protocol and doing the training for that so that the clinician is actually enabled to be in the room with a client who is partaking in MDMA. Now there’s always a doctor, a medical prescriber in that, and then there’s that IT protocol I talked about and there’s a specific training for that and that is through MAPS. And so, I can point people to, and it’s all across the country, that MAPS is recruiting therapists —
[JOE]: And we’ll put links to that in the show notes for sure.
[JOE]: Once we get those links,
[MARCA]: Yes. Now you have to be linked up with what’s called a potential expanded access site. And so, they need you to find a prescribing doctor and have, there’s some guidelines for the setting that your clinic has to have to bring in a client and do this work. That’s all in that training application. They’ve explained everything that’s needed. They also hook you up with other clinicians around the country. At this point, I think there’s over a hundred, maybe 150, 200 clinicians at this point. The trainings are ongoing. I just completed my in-person training in August. So, there’s a whole realm, they’re breaking into this cutting edge MDMA therapy that is going to be, you know, expanded access and potentially, it’s going to be the first psychedelic that is legalized in those different you know, like first goes research phase, then expanded accents and then we’re hoping for prescribable legalization.
As far as integration, folks can start with integration right now. You can start doing intake assessment on that if people are partaking. And there’s a movement with Michael Pollan’s book with the tech world with, you know, people are really learning more about this. It’s hitting the mainstream, more and more people are partaking, especially in Ayahuasca ceremony going to South America or even in their own cities and it’s coming more into the mainstream. So, I think, by asking folks, assessing and also maybe using some language in your website if you’re a competent with, you know, integration, and there’s a project called Zendo through MAPS as well that’s called Hearts. It’s around harm reduction. So, Zendo is, they go to the transformational festivals and they create spaces in which people are having good or bad trips on their psychedelics at their festival, [inaudible 00:26:43]. Those kinds of things can come into Zendo and get support.
So, the Zendo folks are the ones that are creating these guidelines around how to help people who are on a psychedelic. Now, you can’t do that as a clinician. You can’t legally have someone come in who’s, you know, on a, to work actively with someone who’s on a psychedelic except for the MAPS protocol approved by DEA and FDA. But you can help people, like if people often when they go through a psychedelic experience, they gain a depth of insight. The trauma that’s come up for them maybe comes up on the surface or they learn a lot about themselves and their resilience or they have a bad trip. They have something scary come up. And often those insights or those traumas that come up, you can talk to them about that and help them integrate the insight that they have gotten in that plant spirit journey, just like, let’s say they traveled to India and they went to an ashram and they had a non-ordinary state of consciousness at the ashram and now they’re back in their job and wherever, and they’re wanting to integrate that spiritual journey. You as a therapist can talk to them about that. You can also talk to them about their journeys with plant spirit medicine or psychedelics.
[JOE]: So, one of the last questions I ask individuals that come on the podcast is if every private practitioner in the world were listening right now, what would you want them to know?
[MARCA]: It would be really great for the folks I know who are there, who have had personal experiences of healing with psychedelics to, you know, a lot of us are in a coming-out process.
[JOE]: You get to do it multiple times.
[MARCA]: Yeah, yeah, I do. It’s like, welcome to my life or just come out and come out and come out. But it’s okay to come out. It’s okay to start reaching out to other clinicians who have had psychedelic experiences to start talking about it and to, you know, here in Oregon the folks here that, my peers here, they call, we’ve talked to the licensing board. One of my colleagues called the license board and said we’re doing this thing and the licensing board said, it was scary. We were like, “What do we say?” And they were like, “If the FDA and the DEA approve this, great.” This is an Oregon, you know. They’re just all positive about it. They’re like, “We’re all about it, if you’re doing what’s legal and you’re doing in a clinically sound way that’s therapeutic for folks.”
So that really helped a lot of us to relax. And now we’re starting to really have these psychedelic psychotherapists. We’re having to start to have more like fun with it. And while we’re also really all devoted to keeping this clinically sound and to hold each other accountable for the work as we’re going through it as well. So that’s what I would say to clinicians. If you’ve had an experience and it’s powerful, come out and find other like-minded clinicians or myself to talk to because we, this psychedelic psychotherapy is not for everyone, but it’s going to help a lot of people. It can be really powerful for engaging and creating trust and dropping in with clients at a deeper level where they can heal their trauma. And that’s exciting.
[JOE]: Such good information and I mean, this is one of those things that once you start digging into it, there’s just so much great research that’s out there and knowledge. And thanks so much for being on the Practice of the Practice podcast. If people want to connect with you and your work, learn more what’s the best way for them to connect with you?
[MARCA]: Well you can find me at cassitycounseling.com. So, it’s Cassity, C A S S I T Y counseling or [email protected]. You can say hi to me there and I’m happy to share the MAPS links and any other articles or anything that folks would like.
[JOE]: Awesome. Well, we will put links to all that in the show notes as well. Thanks so much for being on the Practice of the Practice podcast.
[MARCA]: Thank you, Joe.
[JOE]: So, I’m really interested in what you think of this psychedelic series. Did it rub you the wrong way? Do you feel like you have more information? What do you think of it? I would love for you to drop me an email, [email protected]. Let me know what you think. Is this something that you liked? You like kind of going into these areas outside of private practice? Do you wish I did more on just kind of the marketing of a practice? We’d love to hear your thoughts on that because you know, I couldn’t do this without you and if you don’t like it, I want to know.
So also, we don’t have a sponsor today. Our only sponsor is Killin’It Camp. So, make sure you go over to killingitcamp.com. Grab your ticket. At the time of this recording, there are still volunteer tickets left. You just do a five-hour shift and then you get a huge discount on the cost of your ticket. It’s going to be an amazing event. We’d love to have you there and to have you network and connect with all the people that are going to be there. Thank you so much for letting me into your ears and into your brain. Have an amazing day.
Special thanks to the band Silence is Sexy for your intro music. We really like it. And this podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.