Expanded Access: Creating a Psychedelic Therapy Center in the Pacific Northwest

Written by Timothy Crespi, LPC, CADC

MAPS Bulletin Winter 2019: Vol. 29, No. 3

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In my own life and in 14 years as a therapist, I have engaged deeply with the suffering of the war veterans in my family living with posttraumatic stress disorder (PTSD), women who have been severely abused, and children who have suffered beyond belief on account of wars, addictions, and intergenerational trauma. One common thread is repeatedly revealed to me in the stories of my family and clients: to walk in this world with severe PTSD is often to feel separate beyond what that person believes anyone could possibly understand or fathom.

This is in large part what fueled me to found Somatic Center Portland (SCP) in March of 2018. My vision was to gather a community of somatically-oriented mental health practitioners, acupuncturists, body workers, and physicians around one foundational principle: that the body and mind are not separate. SCP was also created as a hub for a group of practitioners to collaborate in their pursuit of offering MDMA-assisted psychotherapy for people struggling with PTSD.

Thanks to a special FDA program called Expanded Access, our vision may soon become a reality. Expanded Access allows for the use of an investigational treatment (in this case MDMA-assisted therapy) outside of a clinical trial. If MAPS’ application is approved, the Expanded Access program would allow certain sites with qualified practitioners – such as those found at SCP – to administer open-label MDMA-assisted psychotherapy to patients with PTSD.

At SCP, we are continually shaping our program to incorporate the following principles: supporting our care takers to reduce the potential for burnout, providing our services to people who would not typically have access to them, creating a beautiful setting that aids in the healing process of those being treated, and building a thriving community of support around the work that we do. We believe that these principles can positively shift many aspects of today’s mental health paradigms.

The setting of MDMA-assisted psychotherapy is a very unique type of work environment. It entails creating an environment that is comfortable, nurturing, and that provides ways for the patient to engage with their own experience as content arises in their awareness. As we’ve seen in the research so far, MDMA assisted psychotherapy can evoke a highly sensitive state for the patient. As a result, we believe that the environment plays a key role in the therapeutic process, and the SCP team thus strives to focus on each detail of the setting that is created. Everything from the headphones to the plants and décor will be carefully chosen and considered as part of the therapeutic process. Art that is not suggestive of particular subject matter but that could lend to the process of inner inquiry and deepen a patient’s relationship to their intrapersonal experience will be carefully incorporated in each space.

In fiscal sponsorship with the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS), SCP is preparing to offer MDMA-assisted psychotherapy for PTSD pending approval from the FDA for the Expanded Access program. The protocol for MDMA-assisted psychotherapy requires practitioners to be experienced and well trained in the principles of non-directive and somatic-oriented therapy. Because of our focus on somatic orientation within the context of therapeutic skillsets, SCP serves as vital ground on which to offering MDMA-assisted psychotherapy (once it’s approved for Expanded Access – and beyond).

All of SCP’s therapists have enrolled in MAPS’ training in MDMA-assisted psychotherapy for PTSD (maps.org/training). The final modules of the training for certification are pending Expanded Access approval and entail having the therapists attend a therapist training sub-study, where they will experience the therapy themselves. The final part of the training entails each co-therapy pair conducting one patient through the protocol with supervision from a senior therapist from MAPS’ completed Phase 2 studies. The completion of these final steps in the training serve as the path to certification as a MAPS-approved Expanded Access site.

Our repeated witnessing of the devastating effects of PTSD – coupled with our own grief, our empathy for our clients and loved ones, and our processes of emotional awakening – drives us to seek out effective treatments for PTSD in our work as therapists. In our lives and careers we have peered deeply into the complexities of the individual, familial, and collective traumas rampant in today’s world, and we have subsequently questioned the current paradigms of the mental health system. A myriad of personal, professional, and relational experiences have brought our amazing team together around our vision for healing.

The research to date focusing on MDMA-assisted therapy has forged a path for us, and I give tremendous respect and praise to those who continue to bring this work into the world.

As we are determined to launch our program, preparation for becoming a site offering MDMA-assisted psychotherapy has been quite a journey. Our core group of practitioners has been meeting regularly for almost two years. We have spoken and fundraised at around a dozen events over the past year, organized meetings with prospective partners in the community who want to support our team, and several of us play roles in building and maintaining relationships with MAPS, the Zendo Project, and healing communities local to us in the Pacific Northwest. Along with completing the required training and preparing our site to conduct therapy, our community-building and outreach initiative has served as the focal point of our preparation process. This has been energizing, as fostering relationships with a supportive community has given us the courage and the resources we need to keep moving forward.

As we await the FDA’s approval of Expanded Access, we dream of launching our MDMA-assisted psychotherapy program by treating a few patients at our current site in Portland. Our future aspirations are to expand the program by opening an additional center ideally suited for MDMA-assisted psychotherapy. We have been developing a business plan which could take almost 300 patients through the 15-session protocol per year and which could also serve as a training ground for future psychedelic therapists. This plan entails building an eco-conscious village of therapy spaces – a design that could also serve as a model for other centers in other cities. We aim to build this new center within 20 minutes of the city center, providing easy access to patients to come back each week for integration th
erapy sessions.

We are now excited to enter a phase of fundraising to help us effectively work toward our goal of offering MDMA-assisted psychotherapy. A large part of our fundraising efforts include offering the therapy to people who cannot afford to pay for the full protocol on their own. Other funds raised will be used toward assisting our therapists in completing the required training and for the expenses associated with being in compliance with the Expanded Access program.

While our vision seems attainable, it is also one with no clear precedent. A large part of our challenges ahead entail the groundbreaking work of forming an organization and sustainable business model that upholds our values and principles in offering the highest level of patient care. This is an exciting endeavor and we are honored to move forward with the ongoing encouragement and fiscal sponsorship of MAPS.

Somatic Center Portland