Marcela Ot’alora works with the Multidisciplinary Association for Psychedelic Studies (MAPS) as the principal investigator for government research into MDMA-assisted psychotherapy. In addition to her role as principal investigator, she also worked as a co-therapist during earlier phases of MDMA psychotherapy research and currently leads the MDMA therapy training for MAPS. Ms. Ot’alora also works as a therapist using both ketamine and fine arts to treat trauma.
Ot’alora approaches her work with a humility learned from years of therapeutic experience: “My clients and the participants in our studies have taught me that their healing looks so different than anything I could have imagined. If I come in leaving that agenda, leaving that bias aside, and being present with whoever is in front of me, they will surprise me every time about how healing works for them.”
In this interview, we discuss her research into MDMA-assisted psychotherapy and how the use of MDMA differs from more traditional substances such as antidepressants. We will also discuss ketamine-assisted therapy, the therapeutic use of fine arts, and the over-prescription of psychiatric drugs.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Richard Sears: Could you tell us a little bit about what brought you to your work both as a therapist and artist? What drew you towards your interest in psychedelics and MDMA?
Marcella Ot’alora: I started first as an artist. I think I came to that from having dyslexia and not understanding things in a way that I felt others could understand. So art was a way for me to really communicate and to be able to feel like I could express myself in that way.
In terms of psychedelics, I was doing my own healing with MDMA-assisted therapy specifically and just realizing how profound that was and how it changed the trajectory of my life. So I wanted to be able to work towards making this accessible for other people.
Sears: Could you talk to us about the research that you have been doing with MAPS. What were you investigating? What did you find?
Ot’alora: So the first investigations were mostly about safety. I wasn’t a part of that. I came in during the phase two studies. We continued investigating the safety and began looking at efficacy, how it was working for the population of PTSD sufferers, and dose-response.
In phase two, we used three different doses to investigate what those three doses would do. We’re doing a phase three study and again looking at safety and efficacy while incorporating the good findings we had with phase two. Could those be duplicated in multiple sites? So we have 15 sites, including two in Canada and one in Israel, and the rest in the U.S. The first study for phase three, published in Nature Medicine, shows very promising results, especially for the PTSD suffering population.
We’re doing another study for phase three, which will be the last study before we apply to the FDA for MDMA to become a medicine for PTSD and hopefully other conditions. We are also doing a healthy volunteer study. In this study, four therapists that we’ve trained to do this work have the option of also having an experience with MDMA as part of their continued training.
Sears: How long do you think it will be before MDMA is approved for use in psychotherapy?
Ot’alora: Our goal is 2023. I’m holding on to that one.
Sears: How do psychedelics, in general, facilitate healing? What is it about these altered states that allow for healing that might not occur otherwise?
Ot’alora: I think the non-ordinary state of psychedelics provides a different perspective. Like looking at your own life from an angle that you didn’t have access to before, and in doing that, you can come home to yourself. So now this is about me, who I am as an individual in this very moment. Looking at yourself a little bit more objectively without the conditioning that we have acquired.
It’s a perfect place to start from, to work with trauma, to work with your issues where it’s not about “something needs to change right now” or “something needs to be different” or “something needs to be gotten rid of.” This treatment is not about getting rid of anything. It’s about realizing that we don’t get rid of anything and that we don’t need to do that to heal.
Sears: MDMA-assisted therapy sounds very similar to ayahuasca ceremonies and other indigenous healing rituals involving psychedelics. Do you think there are some equivalences there between the ancient healing traditions and these new ones?
Ot’alora: Absolutely. I think that it’s important to keep that in mind when we think about MDMA-assisted therapy. Indigenous cultures have used psychedelics and non-ordinary states to create sacred space for a long time. We do the same thing of having intention and really paying attention to the set and setting. What does the space where we’re inviting people to do this work look like? Who is it with you?
We have our model, which uses two therapists at the same time, for example. What we’ve learned from indigenous traditions is its intention, its sacredness, and its nonpathology. We ask, how do we gather the parts of ourselves that have been oftentimes marginalized because of trauma? How do we bring those back in so that you can begin to have a relationship with them?
Sears: What should someone looking at psychedelic-assisted therapy consider? Are there certain ailments (like PTSD) or groups of people that these therapies may be best suited to?
Ot’alora: We haven’t done extensive research on other ailments besides PTSD. We’ve researched anxiety due to autism, social anxiety, and anxiety with life term illnesses. So I think it would be helpful with other conditions. I think there’s a caution around how to do it, where to do it, who to do it with.
People have had experiences on their own that have been incredibly powerful, meaningful, life-changing, healing experiences. However, I have also seen and have had referred to my practice many times people who have had additional trauma because of a psychedelic experience where somebody wasn’t there to hold space for them, somebody didn’t know what to do with what came up for them. Often the people who were having these experiences were not thinking that they would work with trauma. Some might not have even remembered that they had a traumatic experience, and a psychedelic can bring it up.
It is important to know that the people you’re with can hold any kind of space that you might be in because when that doesn’t happen, there can be additional trauma. So we must be cautious about who you’re sharing this non-ordinary state with. It’s a very vulnerable state.
Sears: What would you say to someone that had had a difficult experience with psychedelics? How might they go about integrating it or getting through it?
Ot’alora: Many times, people who have done harm reduction understand how to begin to integrate those experiences and how to help the individual process what they would have processed then but couldn’t because it got interrupted in some way.
A psychedelic experience can be challenging without being bad. I think “bad” happens only if you don’t have the space to work with the experience. The actual experience could be challenging but still very powerful if somebody can help you through it. So it’s important to find somebody that can help you integrate it.
Sears: If someone has already experienced psychedelics in a recreational space, would psychedelic therapy have the same healing potential for them? More? Less?
Ot’alora: I think recreational space can also be a sacred space. And I’m definitely not excluding getting a lot of benefits out of recreational use. But I do think it’s about the intention. If somebody takes a psychedelic and wants to connect and bond with others they trust, that’s a beautiful space for somebody to be in.
When somebody decides to take psychedelics with the purpose of addressing wounds in my life, addressing trauma, working through those in a therapeutic setting with therapists that can hold that space, it’s a very different experience. It’s comparing two very, very different things. So we have had people that have done some recreational use and have worked in this study and report radically different experiences based on the intention.
Sears: Can you describe what a therapy session with MDMA or ketamine would look like. How do you go about guiding someone through that experience?
Ot’alora: Ketamine and MDMA are two very different substances. Ketamine is short-lived. When I do a ketamine session with someone, it takes anywhere between two and three hours for the actual experience and to begin the integration process. A lot of that integration also happens after, When we meet in regular therapy sessions. Ketamine is very non-linear. It doesn’t have a story that can be explained as a beginning, a middle, and an end. It’s more a felt sense of what happens to the body and what happens to your experiences in your life after you have it.
MDMA is a much longer experience. The two therapists stay for eight hours with a participant from the time they take it until way after the drug has worn off to begin that process of integration in the last few hours.
Music is a very big part of both ketamine and MDMA-assisted therapy. In our study with MDMA, the music is there not as a suggestion to try to evoke something but more as support. It matches the tone of what is happening at the moment. If the person is really calm, the music is very calm. If they are activated, the music is more activating. It supports the process that is already happening.
We offer eyeshades and headphones if they want them. We have times where they’re encouraged to focus inward, and they’re really thinking about and feeling into what’s happening for them at the moment, and the rest of the time, they talk to the therapist. So it’s a back and forth. We describe MDMA like a wave; It has these intense periods followed by a rest period. Those waves get less and less intense as the day goes by.
Sears: Could you talk to us a little bit about how using these drugs for therapeutic purposes compares to using something more commonly used in a therapeutic setting like Xanax. What is the harm profile for something like MDMA compared to the harm profile for something like benzodiazepines?
Ot’alora: Of course, there are risks to anything we take. We will continue to investigate and research the safety of MDMA. I think that a major difference is that we’re offering MDMA three times, not something that you take every day and not something that you need to continue to take for the rest of your life. Benzodiazepines and antidepressants have their place for sure. I think that they have helped people be able to live their lives, be able to work, and minimize some of their symptoms.
There’s also a lot of side effects. So when we taper down from benzodiazepines and antidepressants, we can begin to really address some of the other things. When we don’t have the heightened state of suffering, we don’t have the heightened state of joy either. And so what we’re suggesting is taking a psychedelic where you can dive into and really move through the traumas, address them, see what’s there.
The session itself is only the beginning. They have a lot of work to do afterward, but it gives them a felt sense of what it’s like to be connected to self and a way to navigate difficult experiences that don’t stop their life the way some of these other medications can. It doesn’t cripple them. They can really remember that felt sense, and they understand that this is what they need to do in the future when things get challenging.
It is the beginning of being able to be connected to experiences that before they were trying to avoid. Avoiding these experiences can cause both psychological and physical symptoms. So it’s a different kind of therapy. It’s also a therapy that uses a drug but uses psychotherapy with it at the same time.
Sears: Benzodiazepines and antidepressants come with a risk of dependence even when used only therapeutically. Are there issues with withdrawal or addiction or tapering with MDMA used the way that you’re describing?
Ot’alora: No, you wouldn’t need to taper down from it. It’s just an experience. Any negative effect would be nearly gone at the end of eight hours.
Sears: Why do you think we consider some drugs therapeutic and not others?
Ot’alora: I think there’s a lot of fear. There’s a lot of miscommunications, a lot of stigma that happens with especially with psychedelics. There’s been so much appropriation from indigenous cultures. One of the reasons why the first study was shut down was because of all this misinformation that went out about the dangers of MDMA. Some of the false things that were being written are still out there on the internet right now, like MDMA causes holes in the brain if you even take it one time.
MDMA can be dangerous, but most of the dangers we have seen out there are things like, what was it cut with? What are you really taking when you take a psychedelic? I think this is probably the biggest harm that we have with psychedelics now being criminalized. We don’t know what somebody is taking, which can really cause harm and even death. Most of the people that have gone to the emergency room after taking MDMA, go due to anxiety.
Sears: A lot of the drugs that we use in psychiatry are likely over-prescribed. I wonder if you think there’s any kind of risks for hallucinogens in general, but specifically MDMA, in terms of over-prescription?
Ot’alora: Well, I hope not. I do think that when MDMA hopefully becomes medicine to treat PTSD and other conditions, it won’t be that anybody can prescribe it. It would be that they go to a clinic with trained therapists who have a certificate to do MDMA therapy, where they know where the medicine is coming from, and they know what the treatment is like. It can be tailored to individual needs. So I don’t think over-prescription can happen.
I do think that over-prescription is a problem, especially given the children I have seen prescribed antidepressants, Adderall, etc. A lot of the over-prescription I see is due to our aversion to suffering. If somebody is sad and suffering because they’re upset about something that happened, we immediately want to prescribe them something because they shouldn’t be suffering, but suffering is part of life.
For instance, I had a client that came in, and their friend had died. Of course, they’re suffering, and of course, they’re in mourning, and they’re grieving, and they’re in pain. In prescribing something, we’re taking that away. Maybe it’s necessary at some point, but it shouldn’t be our first response. It shouldn’t be our first response. It should be way down the line. How can we actually help people and support people in what they’re going through in a safe way, instead of just immediately saying, take this drug, and then you’re good to go. That’s what we’re doing with MDMA.
A lot of participants say I’m not sure why they call this ecstasy because it’s not necessarily fun. It can have really beautiful moments, but it’s also really challenging and connects us to the fact that suffering is real, and our pain is real, and that’s not going to go away.
Sears: I like that idea. For me, it connects to what you were talking about earlier, just having that space to hold certain experiences. For whatever reason, we don’t have a lot of space to hold other people’s suffering sometimes.
Ot’alora: We don’t, or we think it needs to happen fast. If your family member dies, you get a week or two off of work, and then you should be done with that process of grieving. This is not what happens in other countries. Grieving happens as a process.
Sears: How do you use fine art in therapy? What does it look like when you’re doing sessions with that?
Ot’alora: I think that art is a way to arrive at a process non-verbally which is important because sometimes our experiences don’t have words. Then when we begin to give them words, they don’t do justice to what is actually happening internally. Whereas maybe a color, a splash, something that can be put down on a piece of paper can express that internal state better.
I think it works with any kind of art. I used to work a lot with kids, and sometimes they would say I don’t know how to explain what’s happening for me. I would give them a drum and ask can you explain it on the drum? Then they would go wild with that drum saying, “this is what it feels like.” That has no words, but boy does it explain where they’re coming from. It’s about being able to access another part of ourselves, honoring what we feel that might not have words.
Sears: Do you need to have some background in art to benefit from it therapeutically, or can you come in kind of fresh and still be able to get something?
Ot’alora: I absolutely think a non-artist can benefit. I’m a visual artist, and I use art more autobiographically, having people process some of their ancestry and life experiences through art. I’m not an art therapist, but I do think that it’s not about being an artist at all because we’re not talking about what the end result is. We’re talking about the process; what is the process that is happening? It’s not about creating something different. It’s about having the integrity of what is happening inside of us at the moment.
Sears: I wonder if you can tell us about something you’ve learned in your work that most of us maybe don’t know and could benefit from knowing?
Ot’alora: An important one is humility. I think I’ve learned a lot of humility. And by that, I mean my clients and the participants in our studies have taught me that their healing looks so different than anything I could have imagined. So if I come in, leave that agenda, leave that bias aside, and be present with whoever is in front of me, they will surprise me every time about how healing works for them and what they needed to do within themselves to get to that place of healing.
Humility also allows me to tell a participant or client I don’t know what your healing looks like, but you do, even if you don’t know it at this moment. I am here to discover that with you when to help you in that process. It gives them the freedom to explore something that doesn’t have an ending that is wrapped up in a certain way.
Sears: It kind of reminds me of this discussion I was having with a colleague of mine not long ago about the trauma narrative in general. We have this idea that we know what mental health looks like, that there are certain experiences that people have that must necessarily traumatize them. Then we’re really puzzled if they’re not traumatized by it and how people can come from really different cultures with what we might call traumatizing experiences and be absolutely fine. My wife’s family, for instance, had to flee from Kashmir during partition there, but there wasn’t a lot of PTSD or anything like what you’re describing. It’s a completely different way of healing, almost a completely different system of understanding.
Ot’alora: It’s cultural responsiveness. How can we be open and be curious about the way we respond and about the way others respond, and what is important to them? If their healing comes from being able to work with the ancestors, then let’s go there. If their healing comes from nature, let’s go there. So it’s really about being able to be aware of that. Be curious about it, ask a lot of questions, understand what our biases are, and really put them aside.
Sears: I’m wondering if you have faced any significant pushback, consequences, or criticisms for your work with psychedelics?
Ot’alora: A few years ago, it was like either people didn’t know about MAPS or psychedelic work, and they criticized me for being a part of it. Then all of a sudden, everybody wants to be a part of it. Things have shifted a lot.
A few years ago, I almost lost a job because there was an interview in the paper about this work before many people knew about it. I was a therapist working in the schools, and a lot of people were upset about that. Sometimes there’s so much fear. I have encountered that most in people who don’t ask questions. They have already made up their mind, and they have this assumption in place.
I remember being in a training one time where we all went to lunch. People were talking about their work. Then, after I talked about my work in psychedelics, all of a sudden, there was no one to have lunch with for the rest of the week. Fortunately, that has changed a lot, and I hope that we can continue to correct the misinformation about psychedelics.
MIA Reports are supported, in part, by a grant from the Open Society Foundations