Written by Shannon Carlin, M.A., A.M.F.T.
MAPS Bulletin Spring 2020: Vol. 30, No. 2
This article offers a broad overview of two MAPS-hosted events focused on cultural trauma and psychedelics which took place in 2019. Joseph McCowan, Psy.D., contributed a beautiful article also appearing in this publication, speaking to his experience as a Black therapist entering into the field of psychedelic psychotherapy, and attending the MDMA Therapy Training for Communities of Color retreat in August 2019. Cross-cultural gatherings on racial trauma and healing bring up crucial yet sensitive conversations. This publication shares some of the challenges and opportunities facing research and healthcare organizations in addressing racial disparity and engaging with communities of color. While many insights have arisen, only a few will be highlighted in this article, which is limited in scope and length. Additional perspectives have also emerged, along with the need to tend to the privacy of participants. This article is written through the lens of a white woman working in a predominantly white organization, and may reflect unrecognized privilege or bias. Through inviting, listening, and integrating the wisdom of others, we co-create opportunities to grow trusting relationships, meaningful collaborations, culturally informed practices, and accessible psychedelic therapies.
Two powerful events exploring community, culture, race, trauma therapy, and psychedelic medicine took place in Louisville, Kentucky, in August 2019: Psychedelic Medicine & Cultural Trauma Workshop and MDMA Therapy Training for Communities of Color. Sara Reed, M.S., M.F.T., is a marriage family therapist who worked on the MAPS-sponsored Phase 2 clinical trial of MDMA-assisted psychotherapy for posttraumatic stress disorder (PTSD) in 2018, becoming the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial. Reed is a Kentucky native and welcomed the crowd to her home state.
Due to its history, Louisville is a significant setting for a gathering on cultural trauma. Although Kentucky was a Union state during the U.S. Civil War, many of its white residents still owned slaves. The town of Louisville sits on the southern bank of the Ohio River, where Black slaves risked passage to freedom. The harmful effects of racism compound over time and impact communities of color today. The recent deaths of Breonna Taylor and David McAtee echo a familiar grief in the heart of Louisville. In a 2019 Pew survey on public perceptions about race, 84% of Black respondents and 58% of white respondents believe that “The legacy of slavery affects the position of black people in American society today a great deal/fair amount” (Horowitz et al., 2019). I’m curious what the responses would be today.
Racial, historic, and intergenerational traumas are complex, chronic, and widespread. While these sources of trauma have gained attention in clinical research over the past few decades, their diagnosis and treatment aren’t well defined. It has become clear that in order to appropriately and effectively address identity- and race-based traumas, a culturally responsive approach is needed.
The National Center on Domestic Violence, Trauma, and Mental Health defines being culturally responsive as, “proactively integrating meaningful attention to the cultural identities of participants and staff, and to the ways culture can shape people’s experiences of trauma and healing” (Warshaw et al., 2018).
One of the most direct ways to provide culturally responsive and informed care is to include a diverse workforce. According to the American Psychological Association (APA), 86% of psychologists are white (Lin et al., 2018). Within the therapists currently working on a MAPS trial, 90% are white. As mentioned above, when Reed started working on the MDMA-assisted psychotherapy for PTSD protocol in 2018, she was the first Black therapist to administer MDMA-assisted psychotherapy in a clinical trial. The demographic of clinicians working on MDMA-assisted psychotherapy trials, and psychedelic clinical research in general, falls far short of a racially representative workforce.
Lack of diversity is also reflected in the population of people receiving MDMA-assisted psychotherapy in clinical trials. In six completed Phase 2 clinical trials of MDMA-assisted psychotherapy for PTSD conducted from 2004-2017, 105 participants were enrolled: 88% white, 3% Latinx, 2% Native, 2% Middle Eastern, 6% multiracial. No participants identified as Black or Asian for their primary race, though participant(s) may have identified as one of multiple races. Note that these studies include participants in the United States, Israel, and Canada (Mithoefer et al., 2019). Racial representation in MDMA-assisted psychotherapy trials has somewhat improved in the last few years. In the current FDA-regulated Phase 3 study, 110 U.S.-based participants met initial eligibility: 68% white, 11% Latinx, 4% Black, 8% Asian, 3% Native, 3% multiracial, and 3% did not respond (unpublished raw data). According to 2010 U.S. Census data, 72% of respondents reported their race as white, 13% Black, 5% Asian, 1% Native, 6% some other race, and 3% multiracial. The U.S. Census reports Latino origin separately from race: of the total U.S. population in 2010, 16% of respondents were Latinx, 20% were neither Latinx nor white, and 64% were white alone (Humes et al., 2011). Compared to the demographics of the U.S. general population, Black communities are severely underrepresented in MDMA-assisted psychotherapy studies, with Latinx and Asian groups also not being adequately represented.
One of the barriers to including a racially diverse population is a lack of trust in the medical establishment, especially medical research. The U.S Public Health Service Syphilis Study in Tuskegee and other harmful projects have failed patients of color. A 2002 study conducted by Corbie-Smith, Thomas, and St. George explored race and distrust in research. “Even after controlling for markers of social class, African Americans were less trusting than white Americans. Racial differences in distrust have important implications for investigators as they engage African Americans in research” (Corbie-Smith et al., 2002). “These differences are generally attributed to current and historical evidence of inequitable treatment of Blacks by the health care system, as well as racial differences in patient–provider communication, insurance coverage, and physician characteristics” (Armstrong et al., 2007).
People are less likely to seek treatment if they don’t have trust in health care professionals. A 2011 study by Roberts et al., found that, “When PTSD affects US race/ethnic minorities, it is usually untreated. Large disparities in treatment indicate a need for investment in accessible and culturally sensitive treatment options.” The question about increasing access is inherently tied to rebuilding trust after a history of health care abuse. Research organizations today, especially those with a predominantly white workforce, must take steps to establish trust with communities of color if they wish to serve a racially diverse patient population.
A 2015 interview with racial trauma researcher Monnica Williams, Ph.D., ABPP, caught the attention of Natalie Ginsberg, M.S.W., MAPS Director of Policy and Advocacy (Wortham, 2015). A thorough understanding of racial trauma was missing in the work of MAPS. Williams and Ginsberg quickly became familiar with each other’s work, and Williams attended an MDMA Therapy Training Program course in October 201
5, with trainers Annie Mithoefer, B.S.N., and Michael Mithoefer, M.D. Williams was motivated by simultaneous concern about the lack of racial diversity as well as hope for MDMA’s potential to treat racial trauma. In a moving podcast, Williams shares what inspires her to pursue MDMA-assisted psychotherapy: to make the best treatment options available for people of color (The Nod, 2019). She initiated a MAPS-sponsored MDMA-assisted psychotherapy for PTSD study site at the University of Connecticut, where Reed worked on the study team. To date, Williams has been the only Black Principal Investigator to work on a MAPS clinical trial site, and possibly any psychedelic clinical trial ever. While MAPS and other research organizations work to increase racial diversity of participant populations, we must include more people of color in research and leadership positions within and around the organization.
In 2018, Williams was approached by Open Society Foundations (OSF) with a $70,000 grant to support the development of MDMA-assisted psychotherapy clinics in communities of color. One of the first steps in establishing an MDMA clinic is for therapists to undergo training. The MDMA Therapy Training Program is a prerequisite to working on a MAPS protocol. Williams and Ginsberg reached out to me to initiate our collaboration on the event. To support further scholarship and staffing, we raised an additional $230,000 from Riverstyx Foundation, Libra Foundation, Dr. Bronner’s, and the Psychedelic Science Funders Collaborative (PSFC). Seeds were planted for an MDMA Therapy Training for Communities of Color and a workshop on Psychedelic Medicine & Cultural Trauma.
The Psychedelic Medicine & Cultural Trauma Workshop took place from August 10-11, 2019, with a dozen presentations, performances, and speakers’ panels, and an evening storytelling event at a local restaurant. Over 100 attendees from across the U.S. gathered on the 16th floor of a historic hotel in downtown Louisville, Kentucky. The hotel, with framed portraits of white men riding horses lining the hallways, felt like a strange setting for a gathering of many cultures, yet the community came together regardless. The room was full of therapists, doctors, students, community organizers, patient advocates, professors, researchers, a couple of lawyers, a few journalists, and filmmakers.
Inspiring presentations explored community, culture, race, psychedelic medicine, traditional healing practices, harm reduction, policy, education, research, intergenerational trauma, music, spirituality, and the body’s wisdom. To support community space, Camille Barton of the Collective Liberation Project (thecollectiveliberationproject.com), and Ismail Lourido Ali, J.D., MAPS Policy and Advocacy Counsel, offered an interactive session on mindfulness and connection. Throughout the week, Barton offered presentations and activities for movement and mindfulness. Williams presented a talk titled Marginalized Voices, Racial Trauma, and the Psychedelic Healing Movement. Belinda Eriacho, M.P.H., of Dine’ and Zuni lineage, spoke about intergenerational trauma and its legacy for Native Americans. Reed performed a passionate dance, a somatic expression of racial trauma and healing with MDMA-assisted psychotherapy. Carl Hart, Ph.D., gave a characteristically gripping speech on the real-world impact of the drug war on people of color, and the right to life, liberty, and the pursuit of happiness. Kwasi Adusei, D.N.P., PMHNP-BC, spoke about risk reduction and peer support in psychedelic spaces.
On Sunday morning, Jamilah R. George, M.Div., delivered a passionate message, Let Justice Roll Down: Relinquishing Psychedelic Healing for People of Color, a nod to Dr. Martin Luther King Jr. George described the meaning of the word relinquish: allowing resources and healing to flow into and through communities of color. Bringing the event together towards the end of the workshop, Joe Tafur, M.D., delivered a presentation titled Psychedelic Medicine: Illuminating the Integration of Biology, Emotion, and Spirituality. A dozen presenters in all contributed to an energetic and meaningful gathering. Several panel discussions and breakout sessions rounded out the workshop before the workshop came to a close on Sunday afternoon. As people who came just for the weekend started to depart, the events transitioned to the MDMA Therapy Training Program course.
Fifty-five therapists, doctors, counselors, and nurses attended the MDMA Therapy Training for Communities of Color: clinicians working in and with communities of color. The group was made up of 13 Black, 7 Asian, 8 Latinx, 4 mixed Latinx/Native, 3 Native, 1 Pacific Islander, 1 Pakistani, 1 Arab, 1 Egyptian, 1 Lebanese, 13 Multiracial, and 2 white trainees. It was hopeful seeing almost all people of color in the room of a psychedelic training: hope for strengthening the community of psychedelic providers and hope that psychedelic therapy would become more accessible to people of color.
The MDMA Therapy Training Program is a five-part training, including a week-long retreat, led by two MAPS trainers. The program recently grew from two to seven trainers, though the only person of color on the team is Marcela Ot’alora G., L.P.C. She is also the only Principal Investigator and Supervisor of color working on the current MDMA-assisted psychotherapy studies. The program’s lack of diversity is a challenging reality. Since inclusion of a diverse pool of therapists wasn’t prioritized from the beginning of the program, it will take time for more clinicians of color to gain the experience necessary to become supervisors and trainers.
There was concern about having a white trainer at an event focused on communities of color. After much discussion with Williams and others, I was selected to support Ot’alora G. as an MDMA therapy trainer. As a white woman helping to put on a training retreat for therapists of color, I took this job seriously. Putting on an event about psychedelic medicine and cultural trauma is a major undertaking: racial identity, power, and privilege were going to be central themes. Establishing trust between the trainers, program staff, and the cohort would be essential in creating a container for learning and dialogue. Williams, Reed, Ot’alora G., and I served as the core staff for the event. Two Black women, a Colombian woman, and a white woman stood in the face of racial trauma to create a gathering for cultural healing.
Over the six days of training, Ot’alora G., Reed, Williams, and I delivered case presentations and content centered on trauma therapy and the clinical applications of MDMA. Presentations included lectures, discussions, slides, videos of therapy sessions, demonstrations, and activities. Williams shared insights and strategies during her presentation, Culturally Informed Outreach for MDMA-Assisted Therapy for PTSD. Several people who worked with Williams on the MDMA-assisted psychotherapy for PTSD study at the University of Connecticut shared their research and experiences, including Reed, George, and Terence Ching, M.S.
In a talk titled, MDMA-Assisted Therapy for Participants of Color with PTSD: Does it Work?, Ching presented an analysis of data that seems to indicate that people of color who received MDMA-assisted psychotherapy in the study had equally positive improvements as white participants, though there may be differences in how quickly the change occurred. The sample size was small, so more data is being collected to support a detailed analysis. Ching also shared reflections from his recent publication: “Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities.”
Jamilah George, M.Div., and I collaborated to share information about the culturally informed use of music in MD
MA-assisted psychotherapy, which concluded with a half-hour activity for trainees to experience the music first-hand. Ot’alora G. and I shared several case presentations including video recordings of therapy sessions that took place at various sites, some of our own clinical work, as well as that of therapists who Ot’alora G. supervises. Reed shared her case with the cohort, playing a powerful video of an MDMA-assisted psychotherapy session. The study participant, a man of color, was processing the pain he had endured in his life.
Video case presentations, which are recordings of actual MDMA-assisted psychotherapy sessions, are a core element of the training program. Video helps to convey the core principles of the modality and demonstrate their application, such as how to conduct preparatory, integration, and MDMA-assisted psychotherapy sessions. Several cases are shared through the training retreat to demonstrate different therapists and participants and the various ways MDMA-assisted psychotherapy treatment can look. Many therapists have little or no experience with MDMA and find the video recordings to be an invaluable learning tool.
Before enrolling in the study, participants are informed about video recordings and the use of their video. Videos in MDMA trials are used for clinical supervision, assessing therapist adherence, monitoring safety, and research. Additionally, videos may be used for educational purposes in the MDMA Therapy Training Program run by MAPS Public Benefit Corporation (MAPS PBC). Research staff at the study sites review the Informed Consent Form with each person before they choose whether to give their consent.
Occasionally, a former study participant will reach out to the trainers to inquire about attending the MDMA Therapy Training. Over the years, a handful of former study participants have attended the training, either to speak about their experience receiving MDMA-assisted psychotherapy in the study, or to attend the training as a mental health professional, and sometimes both. In a surprising chain of events, a former study participant, who is also a clinician, attended the August 2019 training, unbeknownst to the training staff and trainers. While the study participant had notified the therapists at the site where they received treatment, the training program wasn’t informed that a former study participant would be in attendance at the event. Out of dozens of study participants, this person’s video was selected to be shown at the August event: a seven-minute clip of a preparatory session.
The participant was shocked to see their therapy session playing in the training room and distressed to be in this challenging situation. The trainers and the cohort were dismayed to learn of this. Already in a tender place of trust building, the group felt this shock as a rupture in the developing relationship between a cohort of clinicians of color and a predominantly white psychedelic research organization. After many discussions, and group processing, the former study participant, the cohort, and the trainers rebuilt cohesion to the point that training could continue. Deeper repair of the rupture and rebuilding of trust would take time. The cohort adopted new mottos: “Move at the speed of trust,” and “Slow down.” Moving forward required re-establishing the container, this time co-created by the community of the cohort.
To prevent this situation from happening again, MAPS PBC has been updating its process for obtaining consent from study participants who choose to include their therapy video recordings in the MDMA Therapy Training Program. The new process will go further to protect participant autonomy and to clarify the participant’s power of choice. The change includes the creation of a separate, stand-alone consent form where a study participant can choose, after the course of treatment, whether they release their videos to be included in the MDMA Therapy Training Program. Additionally, the form provides more detailed instruction for study participants who later wish to withdraw consent for the use of their video in training. Currently, participants are informed to contact the Institutional Review Board (IRB) for questions about consent and other ethical considerations. The process being developed by MAPS PBC would go further to clarify the participant’s choice of using video in training.
The wisdom and strength of the community shone through. Trainees built an altar of natural elements in the center of the room. In the process of slowing down and honoring this gathering of tribes and traditions, there is one plant medicine that deserved special reverence: sassafras. Eriacho shared the background of longstanding Native traditions working with sassafras, including medicinal and spiritual uses. Trainee and Advisory Council member Marca Cassity, R.N., L.M.F.T., of the Osage people, gifted the cohort with the medicinal bark of a local sassafras tree. Several others came forward to lend support, guidance, and encouragement. Music, dance, an outdoor gathering at the Ohio River, and many opportunities to connect wove their way through the final days of training.
Several trainees visited the local Muhammad Ali Center (alicenter.org), connecting with the reality of oppression and Ali’s dedication to civil rights. They brought back bracelets for everyone in the cohort, with one of the Ali Center’s six qualities written on each. Confidence, conviction, dedication, giving, respect, and spirituality emerged as community came together.
The training proceeded through all six days, and Ot’alora G. and I delivered the remaining case presentations. Training content centered around learning the therapeutic approach of MDMA-assisted psychotherapy and discussing ways the modality could be offered in a culturally informed manner in communities of color. On the last night of the training retreat, Reed hosted a Community Celebration, an open-mic style event. Trainees shared jokes, beat boxing, dance, song, and stories.
This gathering called forth cultural trauma and healing, psychedelic medicine, and the cycles of oppression, revolution, and liberation. Amidst the pain and complexity of racial trauma, a group of dedicated people brought forth a training for healing and cultural compassion, challenging as it was.
Evolving as a culturally responsive organization is an in-depth process of assessing power and expanding culture, which permeates through all aspects of program development. A sense of urgency, tokenism, patterns of oppression, abuse of power, and fragility threaten projects. These pervasive patterns take intentional effort to overcome. People working with psychedelic modalities are called to engage in self-assessment and seek honest feedback. To support equity, we must examine the distribution and use of power; support each other in stepping into our power; use our power with and for each other; and be accountable for the times we have abused power. A commitment to act in integrity, cultivate true healing, build relationships with trust, serve community, and examine ourselves and the systems in which we work are what nourish inclusive and impactful projects.
Over the past two years, initial efforts towards diversity and inclusion have developed roots at MAPS and MAPS PBC. Vicky Dulai joined the MAPS Board of Directors as the first person of color on the board. Staff members established a working group focused on diversity and inclusion, called Psychedelic Allies for Intersectional Navigation and Transformation (PAINT). The Catalyst Project delivered a training on anti-racism for collective liberation to staff. MAPS PBC examined participant demographics more closely and continues to track progress on addressing racial disparity. Funds were allocated to offset financial hardship facing study participants, such as lost wages or childcare expenses. MDMA therapists were surveyed about their experience in culturally rel
evant care and provided training in cultural competency. Barton facilitated a conversation on access and inclusion at the MDMA Therapy Training in the Netherlands, setting a precedent to incorporate this discussion in all trainings. At the May 2019 training, Gaia Mika, Ph.D., facilitated a workshop on privilege, power, and oppression. In 2019, MAPS PBC gathered an Advisory Council to consult on diversity, equity, and inclusion and the preparations for the Communities of Color training. Councilmembers included: Barton, Cassity, Angella Okawa, L.M.F.T., Reed, and Jae Sevelius, Ph.D. Several researchers and clinicians, including MAPS PBC Chief Executive Officer Amy Emerson, created the statement “Towards an Ethos of Equity and Inclusion in the Psychedelic Movement” to support a public commitment to inclusion (Herzberg et al., 2019). These initiatives are an important start, though they are not enough alone. These initial efforts shed light on areas for predominantly white psychedelic research organizations to grow in their understanding of cultural trauma and commitment to cultural healing.
At the heart of MDMA-assisted psychotherapy is safety, support, compassion, integrity, and trust. Psychedelic organizations can embody these qualities through self-reflection, ethical evaluation, seeking honest feedback, advocating for and with marginalized communities, prioritizing access and inclusion, committing to collective liberation, broadening networks of consultants and advisors, developing authentic transparency, and taking care of people in and around the organization. Efforts rooted in community are more grounded and informed. Building trust takes time, and an investment in meaningful relationships.
Starting at the beginning of the COVID-19 pandemic, the MDMA Therapy Training Communities of Color cohort initiated a self-organized online gathering, which met once a week starting in March, and is still going strong. On Sunday, August 9, 2020, many members of the cohort and training staff came together to acknowledge and celebrate the one year anniversary of the MDMA Therapy Training Program for Communities of Color that took place in 2019. Thirty-five participants, and many others who couldn’t make it but joined in spirit, came together for the anniversary gathering, a two-hour online call for sharing, celebrating, and connecting. The themes of integration, meaning, purpose, healing, and community wove through as each person shared reflections on and experiences with the group, the training a year ago, racial inclusion and equity in psychedelic therapy, the pandemic, Black Lives Matter, and the current political climate. Many attendees expressed their gratitude for the lasting relationships they developed at the training. Several people shared that the experience of community and the journey of the training had deepened their relationship with their own cultural roots and identity, and nourished a sense of belonging that became a vital resource during the world events that would transpire in the year ahead.
“As a compassionate society, we must find or make ways to reach all segments of our society with promising new treatments, so that everyone has an optimal chance of recovery and an excellent quality of life.”
—Monnica T. Williams, Ph.D., ABPP, and Chris Leins, M.A. (2016)
“MAPS has been a leader in conducting research into MDMA-assisted therapy and to our knowledge has been the first to make a deliberate effort to include people of color in the work. Still more work is needed and hopefully this trajectory of inclusion will continue as other groups begin the work of ensuring that psychedelic research meets the needs of everyone.”
—Monnica T. Williams, Ph.D., ABPP, Sara Reed, M.S., M.F.T., and Ritika Aggarwal, B.A. (2020)
“I have seen how MDMA-assisted psychotherapy has alleviated great suffering and improved the quality of the lives of so many people through MAPS MDMA studies. MAPS is committed to ensuring that this powerful treatment is available to all communities. My commitment is to listen, ask questions, have tough conversations to ensure this treatment is readily available to all, including historically marginalized communities within our society. Working together, our acts towards inclusion become a powerful force towards collective healing.”
—Marcela Ot’alora G., L.P.C., Principal Investigator for Phase 3 and Healthy Volunteer MDMA Studies in Boulder, Colorado
“Training more therapists of color brings us closer to health equity. Health equity ensures that this powerful healing modality will be accessible to people impacted by systemic racism and state-sponsored violence.”
—Ritika Aggarwal, B.A., MAPS PBC Executive Support and Operations Coordinator, and UnCommon Law Therapist Intern
“The best way to make your dreams come true is to wake up.”
“He who is not courageous enough to take risks will accomplish nothing in life.”
The MDMA Therapy Training Program would like to thank the MDMA Therapy Training for Communities of Color trainees, staff, presenters, elders, supporters, and communities who are creating pathways of healing and thriving for people of color.
An altar to set and honor the space during the MDMA Therapy Training for Communities of Color in August 2019
The sun sets over the Ohio River in Louisville, Kentucky, during the MDMA Therapy Training for Communities of Color in August 2019.
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Ching, T. H. (2020). Intersectional insights from an MDMA-assisted psychotherapy training trial: An open letter to racial/ethnic and sexual/gender minorities. Journal of Psychedelic Studies, 4(1), 61-68. Retrieved from: https://doi.org/10.1556/2054.2019.017
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Shannon Carlin, M.A., A.M.F.T., is the Director and Head of Training and Supervision at the MAPS Public Benefit Corporation (MAPS PBC), a wholly owned subsidiary of the Multidisciplinary Association for Psychedelic Studies (MAPS), a 501(c)(3) non-profit. As the Director of Training and Supervision, Shannon oversees the development and implementation of the programs that provide training and supervision to prepare mental health and medical professionals to deliver MDMA-assisted psychotherapy in approved clinical settings. Shannon started working with MAPS in 2011 before joining MAPS PBC in 2016.
In her dedication to supporting people through growth and healing, Shannon has served as a co-therapist on MAPS-sponsored Phase 2 trials researching MDMA-assisted psychotherapy for anxiety associated with life-threatening illness and MDMA-assisted psychotherapy for severe PTSD. Shannon’s direct clinical work continues to inform the development and implementation of the training programs she oversees. Shannon received her master’s degree in Integral Counseling Psychology from the California Institute of Integral Studies (CIIS) and a bachelor’s degree in Cultural Anthropology from the University of California, Santa Cruz.