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MDMA ON TRIAL

Psychedelic therapy has a sexual abuse problem

Illustration of a woman in profile with a pill close to her lips
Bárbara Abbês for Quartz
“The loving and trusting feelings that can be induced by MDMA can make patients more vulnerable to sexual pressure,” wrote the head of MAPS. Yet he warned neither patients nor the FDA
  • Olivia Goldhill
By Olivia Goldhill

Science reporter

Over the past five years, scientific interest in psychedelics has boomed, with clinical trials on MDMA leading the way. Now the drug is on the cusp of becoming legal medicine. Early studies testing MDMA combined with talk therapy as treatment for post-traumatic stress disorder (PTSD) are promising, and the nonprofit behind the trials, the Multidisciplinary Association for Psychedelic Studies (MAPS), expects its treatment to be approved by 2022.

Alongside the potential benefits, psychedelic therapy also carries a serious risk of sexual abuse. Patients in psychedelic therapy are intensely vulnerable. They are high, in a power imbalance with their therapist, and dealing with mental health issues. And MDMA, known colloquially as ecstasy and a “love drug,” can create feelings of sexual arousal and emotional intimacy.

A few years ago, a therapist working in a MAPS MDMA study publicly spoke about his challenges dealing with a patient’s sexuality. Early in his career, Richard Yensen was working with a “lovely young lady who became very sexualized in her relationship around the [MDMA] sessions,” he told an audience at California Institute of Integral Studies in 2016. “It got so intense,” said Yensen, that the chair of his department saw him mid-therapy session and told him to leave the room, warning him to always have another therapist alongside him during sessions. “And thank god, because she became more and more and more activated sexually,” said Yensen. “I don’t think I could have handled it.”

Not long after, Yensen was accused of sexually assaulting a PTSD patient, Meaghan Buisson, during a MAPS clinical trial on MDMA. He did not have a license to practice at the time, having let his psychologist license lapse in 2009. Yensen worked alongside his wife, Donna Dryer, who was licensed; MAPS only required that one person per team be a licensed therapist.

In civil court documents, Yensen and Buisson put forth differing interpretations of the relationship; Buisson accused Yensen of sexual assault constituting battery, whereas Yensen said the relationship was consensual and initiated by Buisson.

Therapists are in a position of authority over clients, said Carole Sinclair, chair of the Canadian Psychological Association’s ethics committee, and taking advantage of that authority is abusive. Psychologists in the US and Canada are prohibited from having sexual relationships with therapy clients for two years after completing treatment, due to the power imbalance between the therapist and client. “It’s considered exploitative,” said Sinclair.

Allegations of sexual abuse are not unusual within the field of psychedelic therapy, and the risks are widely known among practitioners. The head of MAPS, Rick Doblin, acknowledged as much in his Harvard University doctoral thesis: “The loving and trusting feelings that can be induced by MDMA can make patients more vulnerable to sexual pressure,” Doblin wrote in 2000.

“The loving and trusting feelings that can be induced by MDMA can make patients more vulnerable to sexual pressure.”

The nonprofit said it reported Yensen’s sexual relationship with Buisson to the US Food and Drug Administration (FDA) after Buisson told MAPS of her allegations and released a public statement describing what occurred as an “ethical violation” in a MAPS-sponsored clinical trial.

But Buisson believes MAPS failed to adequately protect subjects from abuse. The organization didn’t warn the FDA or study participants of the risk until after Buisson’s allegations became public. In January, MAPS said the FDA has approved expanded access for MDMA therapy, meaning that 50 patients with treatment-resistant PTSD will be allowed to access the treatment outside of a clinical trial. As psychedelic therapy swiftly marches towards full legalization, Buisson’s experience suggests there aren’t sufficient protocols to protect patients from sexual abuse.

A clinical trial gone wrong

A member of MAPS Canada’s advisory board, Gabor Maté, said he first referred Buisson to a MDMA study in 2013. “She was a classical case of PTSD, owing to multiple traumas,” he wrote in an email to Quartz. “She had gone through long-term therapy with no resolution of symptoms (which is not to say the therapy was not helpful to her in a supportive sense).” Buisson told Quartz she had PTSD from being abused as a child and violently raped by a stranger in her 20s, experiences that she’s written about previously.

Buisson was initially hesitant about enrolling in the MAPS study. She’s skeptical of using drugs to treat mental health conditions, she said, and was wary of aspects of psychedelic therapy in particular. “I couldn’t even fathom letting a therapist close to me, much less be touched/hugged, or take any kind of drug that would cause me to be that vulnerable,” she wrote in an email to Quartz.

“I couldn’t even fathom letting a therapist close to me, much less be touched/hugged.”

But when Buisson’s therapist retired and she couldn’t find another supportive therapy program, she was desperate for relief. In 2014, MAPS launched a phase two trial in Vancouver, British Columbia, to test MDMA-assisted therapy for treatment-resistant PTSD. Buisson enrolled in the study in December 2014 and was assigned Yensen and his wife Donna Dryer as her co-therapists. She started receiving treatment in January 2015.

Psychedelic therapy in clinical trials is typically conducted with two therapists per patient, one man and one woman. While this practice has been found to have practical and therapeutic benefits, it was first implemented as a protective measure against sexual assault following a wave of abuse allegations in the ‘80s, according to a paper in Drug Science, Policy and Law.

For their clinical trials, MAPS’ executive director Doblin said he negotiated with the FDA to conduct psychedelic therapy with one license per two-person team. “We do not think it’s necessary or important for both people to have a license,” he said to Quartz, adding that it could make treatment too expensive for patients.

The MAPS Canada website presented Yensen as a psychologist while he was working as a therapist in the trial.

Of Buisson’s therapists, Dryer was the one with a license; Yensen had let his California psychologist license lapse in 2009. In both the US and Canada, a license is required to provide therapy under the title “psychologist,” yet the MAPS Canada website presented Yensen as a psychologist while he was working as a therapist in the trial. “I didn’t realize that ‘psychologist’ was a protected title,” Doblin, head of MAPS, wrote in an email to Quartz. “My father was a doctor and we called him a doctor even after he retired.”

The trial was designed to have 12 subjects, five of whom would take a placebo during therapy, while the others would receive MDMA. In January, Buisson was assigned to the placebo group, undergoing two sober six-to-eight hour sessions with her therapists. Participants who were given MDMA had two psychedelic sessions, each with an initial dose of 125mg of MDMA (to be topped up with an extra 62.5mg if the subject and therapists thought it was necessary.) As in standard therapy, MAPS instructed therapists to “support and encourage the subject in emotional processing.”

Participants then had the option to enroll in a second stage of the study, which involved one more psychedelic session for those participants who had previously been given MDMA, and three psychedelic sessions for those originally given a placebo. The format was similar to the first stage, but with slightly varying doses of MDMA. Buisson started this psychedelic treatment in April, with sessions spaced three to five weeks apart. All patients had follow-up evaluations three, six, and 12 months after their final session.

“Therapeutic breakthroughs occur on the edge of consent. They pushed me hard, my toes curling in protest.”

Buisson described her psychedelic sessions in a nearly 1,800-word essay shared on MAPS’ website in October 2016, four months after her final evaluation. The essay describes both psychedelics’ medical benefits for Buisson and her concern about their expanding use. Her therapists hugged her, “providing the touch I craved as much as feared,” she wrote. “Therapeutic breakthroughs occur on the edge of consent. They pushed me hard, my toes curling in protest. But each time I fell they were there.”

In November 2016, MAPS closed the Vancouver study early. Only six participants had completed treatment, instead of the planned 12. MAPS did not yet know of what it would later call Yensen’s ethical violations.

Allegations of sexual assault

Two years later, on Nov. 28, 2018, Buisson filed a civil court claim in British Columbia, Canada. In it, she alleged that Yensen committed sexual assaults constituting battery while she was enrolled in the study and under his therapeutic treatment. She also accused him of negligence and breach of contract, for failing to provide appropriate therapy and maintain a professional relationship.

When Buisson’s therapy with Yensen and Dryer started in January 2015, she was living in Vancouver. She completed the third psychedelic session in June and, that same month, according to the court document, moved to the tiny island off British Columbia where Yensen and Dryer lived, to continue her treatment. Buisson was still a participant in the trial, undergoing regular follow-up evaluations. Though the therapy portion of the study was over, Yensen and Dryer continued to treat Buisson while all three lived on Cortes Island. The court document does not state what treatment methods they used.

There is no evidence indicating Dryer was involved in the sexual relationship, but Buisson’s civil court filing does list her as a defendant. In the complaint, Dryer and Yensen are accused of “inappropriate, unprofessional, harmful” actions, including “establishing unprofessional and intimate relationship with the Plaintiff, sharing a large amount of personal information about themselves with the Plaintiff and continuing treatment for an extended period of time without regard to whether the treatment was benefiting the Plaintiff.”

Buisson’s civil court document accused Yensen of “sexual assaults,” including “having sexual intercourse with the Plaintiff, inappropriately touching the Plaintiff, inappropriately exposing himself to the Plaintiff, violating the Plaintiff’s privacy, verbally commenting on sexual matters to the Plaintiff, making sexualized gestures, sounds and actions towards the Plaintiff, using inappropriate and sexualized language with the Plaintiff.” The court document did not specify when the sexual relationship started, but alleged that Buisson suffered psychologically as a result of Yensen’s and Dryer’s behavior from “in or about fall of 2015 to spring of 2017.”

In response to request for comment, Yensen wrote in an email to Quartz: “There has been no court case held, no testimony given and a settlement was reached many months ago.” Dryer told Quartz the accusations are “allegations, not established facts.”

Yensen’s response to the civil claim, filed in January 2019, claimed the sexual relationship lasted from February 2016 to May 2017, whereas a statement later released by MAPS in May 2019 claimed the relationship between Yensen and Buisson became sexual “at the end of 2015 or early 2016.” According to either timeline, the sexual relationship began while Buisson was a participant in the trial—after she had completed the treatment portion, but before her final follow-up evaluation in June 2016. Yensen and Dryer continued to treat Buisson once the trial’s therapy sessions were over, and so Yensen was still providing treatment—albeit without a license—during their sexual relationship, according to both Buisson’s court filing and MAPS’ statement.

“In both MDMA and psilocybin studies… a participant may feel very close, or even attracted to their therapist or guide for many months after the study has been completed.”

MDMA therapy has the ability to influence patients’ relationship with therapists even outside of psychedelic sessions. The drug’s effects on the brain, decreasing amygdala activity and increasing oxytocin, “could make it easier for a person under the effects of MDMA to feel empathy toward another person, even someone they might not normally like, and to feel safer than normal, even in threatening situations,” according to Katherine MacLean, a PhD in research psychology who has conducted clinical trials on psilocybin at Johns Hopkins University and has worked on a MAPS MDMA trial. “In both MDMA and psilocybin studies, the effects last for months beyond the sessions themselves, suggesting that a participant may feel very close, or even attracted to their therapist or guide for many months after the study has been completed,” she wrote in an email to Quartz.

Yensen’s civil court response did not deny that he had sex with Buisson, but claimed that Buisson consented to their sexual relationship. In the document, Yensen stated he did not owe Buisson a “duty of care.” This phrase is generally used to describe legal responsibilities to prevent harm; in Canada, for example, psychologists have a duty of care to not “engage in sexual intimacy with therapy clients.” Yensen’s document claimed he had no obligation to uphold that standard. “[T]heirs was not a doctor/ patient relationship,” it stated. “Rather, they were participants within their respective roles in the Research Study.”

“There’s a lot of evidence that this kind of involvement with clients harms them.”

Yensen’s argument claimed that, as he was unlicensed, he did not have to abide by the rules that apply to psychologists. In the United States and Canada, legal standards for health professionals state a patient cannot meaningfully consent to a relationship with their psychologist. A sexual relationship is considered abusive because it takes advantage of the trust and dependence of the therapeutic relationship, said Sinclair, chair of the Canadian Psychological Association’s ethics committee. “There’s a lot of evidence that this kind of involvement with clients harms them,” she said. In both countries, psychologists are prohibited from having a sexual relationship with their therapy clients for at least two years after treatment has ended; psychologists who violate this rule are typically stripped of their license. Yensen, though, did not have a license to be revoked.

The College of Psychologists of British Columbia (CPBC), the licensing body that oversees psychologists in the region where Buisson participated in the trial, told Quartz it has a “zero tolerance” policy towards psychologists having sex with clients. Psychologists practicing in British Columbia are permanently banned from having sex with former clients, even beyond the standard two-year limit applied in much of Canada and the United States.

MAPS’ public statement noted that Dryer, who did have a license, didn’t report Yensen’s sexual relationship with Buisson to MAPS or any regulatory agencies. Dryer has a legal obligation to report psychologists’ sexual misconduct to their licensing body under Canada’s Health Professions Act. But because Yensen was not a licensed psychologist, there was no licensing body to whom to make a report.

Buisson’s allegations did not go to trial; in June 2019, Yensen, Dryer, and Buisson resolved the case out of court.

Quartz asked Donna Dryer to comment on the allegations contained in public court documents. “Just know that the information that you have is not factual nor complete. It is a set of allegations, not established facts,” Dryer wrote in response. “We are bound by legal constraints and cannot make any comments at this time.”

Quartz also asked Yensen if he had any comment on the civil court documents or standards for licensed psychologists. “The tone of your letter is assaultive in nature and obviously political in intent,” wrote Yensen. “Because we do have the ethics you accuse us of lacking your questions cannot be answered.”1

1
Quartz’s initial email to Yensen reads: “Dear Richard Yensen, I'm writing a Quartz article on sexual misconduct in psychedelic therapy. The article includes details of the court case claiming that you had a sexual relationship with your patient, Meaghan Buisson. It includes details of both Buisson's allegations and your response in the court case, and notes that the case did not go to trial as you and Buisson agreed to dismiss the case. The article notes that licensed psychologists are banned from having sexual relationships with their patients in the US and Canada even after therapy has ended. And the article states that you did not have a license to practice as a psychologist, though you were listed on the MAPS website as psychologist. The article also includes comments you made at California Institute of Integral Studies in 2016, including that the chair of your department once warned you to always have another therapist alongside him during sessions. You added: “And thank god, because she became more and more activated sexually...I don’t think I could have handled it.” Some people who practice psychedelic therapy suggest it's concerning for a therapist to have difficulty responding professionally to a patient being "activated sexually" during psychedelic therapy. Do you have any comment you'd like me to include? Please send me any comment preferably by the end of 24th December, or by the end of 27th December at the latest. I'm also happy to talk on the phone if you'd prefer. Best, Olivia”

Yensen and Dryer continue to do “healing” work, according to a website advertising their services. In August 2019, they ran a 10-day, C$3,000 ($2,314.50) “heart of the shaman” retreat, offering, “a trusting atmosphere, a sacred vessel for profound personal exploration and spiritual growth.” Yensen and Dryer promised to “lead participants through a crafted sequence of experiential vignettes, where a sense of safety, belonging and emotional depth is formed and then deepened.” The retreat included an all-night ceremony that moved people to “a place of overflowing love and nurturing.” Yensen and Dryer don’t offer psychedelic therapy, Yensen told Quartz. The couple, “make no public offerings without disclosure to participants of the accusations levelled by MAPS and the person in question against us,” he wrote in an email. Their website cites Dryer and Yensen’s work in the MAPS MDMA trial among their qualifications.

Illustration by Bárbara Abbês for Quartz

Not a one-off

Sexual abuse is an old problem in psychedelic therapy. The pattern was evident in the early 1980s, before the substance was made illegal as a schedule 1 drug in the United States. In cases well-known among psychedelic practitioners, two psychiatrists who gave their clients MDMA, Richard Ingrasci and Francesco DiLeo, were separately sued by former patients who accused them of abusive sexual behavior. Ingrasci allegedly told one patient that sexual contact would help cure her cancer, while DiLeo said that touching a patient was a “partial fulfillment of [her] oedipal wishes,” according to court documents. In a 1990 lawsuit, DiLeo was required to pay his patient $500,000 for pain and suffering and $150,000 for PTSD treatment. Ingrasci’s lawsuit was settled out of court.

Ingrasci allegedly told one patient that sexual contact would help cure her cancer, while DiLeo said that touching a patient was a “partial fulfillment of [her] oedipal wishes,” according to court documents.

Once MDMA and other psychedelics were made illegal during the ‘80s, the criminal nature of psychedelic therapy contributed to the risk of abuse. “It prevents people from having systems and accountability and recourse that are normally available in other communities” said Kevin Balktick, founder and director of Horizons, a conference about psychedelics.

Tourists who travel to countries where psychedelics are permitted are also at risk by virtue of being in a new place with an unfamiliar culture, language, and legal system. Many psychedelics lower inhibition and create a sense of interpersonal intimacy; ayahuasca retreats in the Amazon, for example, are rife with accusations of sexual assault and rape.

For as long as psychedelic therapy has been an underground practice, the field has contained several ingredients that contribute to sexual misconduct. Practitioners often informally take on the role of therapist or guide for colleagues or friends, meaning that the roles between therapists and patients aren’t always clearly defined, complicating issues of power and influence. At professional conferences, established figures can use illegal drugs to undermine medical and collegial boundaries and enable potentially predatory behavior. As scientific research pushes psychedelic therapy towards legality, though, there are growing demands for protocols to protect against and discipline sexual misconduct.

In 2017, Daniel Pinchbeck, who has written extensively on psychedelics and shamanism, acknowledged his “sexually fixated, creepy, predatory” behavior, including “the use of substances as tools of seduction.” Pinchbeck said he believed his statement helped men see the errors in their own behavior. “Unlike many well-known men, I not only openly admitted to past misconduct and expressed genuine remorse, I also reached out directly to women I felt I had wronged,” he told Quartz. In January 2019, The Third Wave, an organization dedicated to “safe, structured, and responsible psychedelic use,” created an event with Pinchbeck as guest speaker, but later canceled after several people in the field publicly condemned the decision.

In February 2018, Oriana Mayorga, a community organizer at the nonprofit Citizen Action of New York, emailed Balktick the Horizons conference director, and told him that a board member at Horizons, Neal Goldsmith, was widely seen as someone who commits sexual misconduct. Balktick acted quickly, hiring an attorney as neutral mediator to listen to complaints and creating an online form for people to file concerns. “It was really clear that there were so many consistent and credible reports of sexual misconduct on Neal’s part,” said Balktick. Horizons released a public statement, announcing Goldsmith’s termination. All of the accusations were private, and there are no known allegations formally or publicly brought against Goldsmith regarding the abuse of patients or the use of psychedelics to enable abuse. Goldsmith did not respond to requests for comment.

Concerns about Goldsmith had circulated for years before official action was taken. In December 2017, Neşe Devenot, a postdoctoral researcher at Case Western Reserve University’s department of bioethics, was speaking on stage at a psychedelic symposium when she referenced a senior figure in the psychedelic community who was known for sexual misconduct. “Afterwards, Rick Doblin came up to me and said, ‘Are you talking about Neal Goldsmith?’” said Devenot. “It’s one of those open secrets.” Doblin said he remembered speaking with Devenot but wasn’t sure if he did anything after learning of concerns about Goldsmith. “You can hear stuff about all sorts of people,” said Doblin. “I don’t know…what did I do about it? I probably spoke to Neal about it. I don’t recall.” Balktick says he was unaware of the allegations until he heard from Mayorga.

Several women, including Mayorga and Devenot, said the psychedelic community was slow to show concern over the risk of sexual abuse. “There’s this narrative that reports of sexual misconduct are crying wolf or overexaggerating,” said Leia Friedman, host of The Psychedologist podcast.

“There’s the idea that psychedelics are so important and so wonderful that the train has to keep going. We can’t slow down to get the rapists off the train.”

Lily Kay Ross said she felt compelled to leave work in psychedelics after she spoke out about her rape by an ayahuasca shaman in the Amazon. “I was told explicitly that I might single-handedly re-instigate the war on drugs and undo all of the advancements in the field of psychedelic research since the 1960s,” she said. “There’s the idea that psychedelics are so important and so wonderful that the train has to keep going. We can’t slow down to get the rapists off the train.”

Ross said she was once speaking with a psychedelic community organizer about the risk of sexual abuse that women face during psychedelic therapy. “The person turned to me and said, ‘I know,’” said Ross. “And then they kept on their rant about how we couldn’t risk this kind of thing tainting the image of psychedelics.”

In the course of reporting this story, one psychedelics researcher Quartz reached out to said they didn’t want to be interviewed and warned that this article could have negative consequences for the field. “I’m a bit worried that mainly some very vocal people will be interviewed that will blame MAPS or the mainstreaming of psychedelic therapy for this incident, while these things are always much more nuanced and definitely not exclusive to psychedelic therapy,” the researcher wrote in reply to Quartz’s email. “I think it is important to have a constructive dialogue around these issues and challenges, but it can easily become polarizing and potentially damaging to the current developments as well. I hope that you are aware of that and are approaching this carefully.”

Institutional failings

Sexual abuse in psychedelic therapy is not an aberration, according to Buisson. “The tree itself is rotten to the core,” she said. “Psychedelic therapy will never come under as much scrutiny as during a clinical trial. There’s nothing I’ve seen that says it won’t keep happening.”

“Psychedelic therapy will never come under as much scrutiny as during a clinical trial.”

Buisson said she first reported the sexual allegations in January 2018, to MAPS’ director of strategic communications Brad Burge; in an email to Quartz, Burge denied that Buisson reported “any sexual experiences with her therapists to me or to MAPS” at that time. All US clinical trials are overseen by an independent review board (IRB) and, in the trial consent documents, MAPS told trial participants to contact the IRB with any concerns or complaints. Buisson did so in January 2018, but says the IRB told her it could not investigate as the trial was over. The IRB did not respond to requests for comment. MAPS said it first learned of Buisson’s experiences nine months later, when she informed Michael Mithoefer, a clinical investigator for MAPS’ MDMA studies, of her complaints in October 2018.

After that, MAPS submitted reports to the FDA, the clinical trial’s review committee, and Health Canada; Doblin said he has yet to see formal findings from any of these organizations. MAPS also agreed to help Buisson to cover the costs of therapy.

In the Vancouver trial’s informed consent document, MAPS states it will cover “any costs” that arise from treating an injury caused by participating in the study. Doblin said Buisson’s case was the result of malpractice rather than a problem with the trial itself, and so the costs should therefore be the responsibility of her therapist team. “I believed that MAPS bore no legal liability to pay anything to Ms. Buisson but agreed to pay something to her on a compassionate basis so she knew she could pay for a certain amount of therapy while her lawyer worked out an arrangement with Yensen and Dryer,” Doblin told Quartz. Buisson says she pressed the nonprofit to honor its commitment to cover the costs of counseling; after two months of negotiating, MAPS agreed to pay C$15,000 ($11,570), transferring funds only after Buisson waived her rights to sue.

Meanwhile, reports of Yensen’s sexual relationship with Buisson spread throughout the psychedelic community. In April 2019, Buisson asked Doblin to make a public statement. Doblin initially refused the request; he told Quartz he did so because Yensen and Dryer were no longer working for MAPS and the organization had reported allegations to regulators. But he changed his mind after a group of around 10 people, including MAPS Canada board members, academics, and therapists, drafted their own statement condemning the incident.

On May 24, 2019, MAPS released a statement on its website describing both Yensen’s and Dryer’s actions as “ethical violations.” “We intend our making this information public to be part of our effort to eliminate future ethical violations by these and any other prior, current, or future therapists working for MAPS,” the statement declared.

“MDMA helps people open up in very intimate ways. I think that safeguards need to be established, so that MDMA is not used in that way.”

MAPS would have been aware of the risk of sexual abuse in psychedelic therapy long before Buisson made her complaint. Doblin, who sponsored and oversaw the Vancouver trial, previously spoke of this concern in interviews. “There’s a long-established awareness in psychotherapy that the intimacy of the relationship sometimes shades into sexual relationships between patient and therapist that are not to the advantage of the patient…. MDMA helps people open up in very intimate ways,” he told Julie Holland in an interview published in her 2001 book, Ecstasy: The Complete Guide. “I think that safeguards need to be established, so that MDMA is not used in that way.”

Yet neither the FDA nor patients were warned of that risk ahead of the trial. In all clinical trials, subjects must sign “informed consent documents,” which lay out the risks they accept by participating. Quartz has seen the informed consent document given to participants in MAPS’s Vancouver trial, which lists possible risks including dry mouth, fatigue, feeling cold, anxiety, and numbness. It does not mention that MDMA can increase sexual arousal, or warn of the history of therapists abusing patients.

Only after Buisson’s allegations reached MAPS did the organization warn subsequent patients about the potential for sexual abuse, listing “emotional openness” as carrying risks. The document now reads: “You may also feel closer to your therapist or more trusting of them, or you may even feel love and sexual feelings toward your therapist(s). This can happen with any psychotherapy but may be heightened by MDMA. Your therapists are aware of the effects of the drug. They have been through training on how to appropriately care for someone who has taken MDMA and on a code of ethics that prohibits any sexual relations between therapists and participants, including after participation in the study has ended.”

Shortly before publishing its statement, MAPS created a Code of Ethics to explicitly prohibit sexual contact between participants enrolled in the study and the professionals providing their care. For some, that’s too little too late. “I cannot say that MAPS has done enough to work around issues regarding sexual violence and ethical complications with their therapists,” said Mayorga. From the outset, she said MAPS should have had, at the very least, infrastructure such as a human resources department available for people to report sexual violations. MAPS is currently “continuing to develop appropriate channels for receiving and addressing grievances,” Doblin said in an email to Quartz.

A problem for psychedelic therapy

Sexual abuse is endemic throughout society, and occurs in standard therapy as well as psychedelic therapy. But even though psychedelic therapy has the added risk of drugging patients, it does not have the same protections in place as mainstream, non-psychedelic therapy.

Crucially, psychologists in the US and Canada are required to have a license, whereas not all psychedelic therapists in clinical trials have to meet this standard. Licensing provides a system of accountability: It takes considerable work and training to get such a license and, if a psychologist has a sexual relationship with a patient, the licensing board will strip them of their qualification and the right to practice.

MAPS, meanwhile, wants the FDA to approve rules that would allow psychedelic therapists to work in teams with only one license per pair, meaning some psychedelic therapists could practice in the US without a license. Should MDMA therapy be legalized, the FDA will approve a risk evaluation and mitigation strategy (REMS) for the treatment, which will be informed by MAPS’ clinical trials. Doblin said that MAPS has negotiated terms in its REMS that state anyone who conducts psychedelic therapy must first go through a MAPS training program. “It’s a requirement,” he said.

The FDA approved expanded access, meaning 50 PTSD patients who haven’t benefited from existing treatments can now legally access MDMA therapy.

MDMA therapy to treat PTSD has been granted “breakthrough therapy” designation by the FDA, meaning it will be fast-tracked through the drug development process. In January 2020, MAPS claimed the FDA approved expanded access for MAPS’ MDMA therapy, meaning that 50 PTSD patients who haven’t benefited from existing treatments can legally access MDMA therapy. The FDA refused to confirm this, stating that the agency can only comment on approved treatments and, as MDMA therapy is not yet fully approved, it will not comment on whether expanded access is in place. MAPS announced that treatment under expanded access must follow MAPS’ protocol, with only one therapist per pair required to have a license.

Others in the field are dubious of MAPS’ plan to create unlicensed medical professionals to deliver psychedelic therapy. “I think it’s good that medicine is licensed. If you’re offering treatment for depression, treatment for a clinical disorder, I think it’s good that those people are held to a standard of training and accountability,” said Balktick.

MAPS is a nonprofit. It also owns a for-profit subsidiary, the MAPS Public Benefit Corporation (MPBC), focused on carrying out MAPS’ clinical research. All profits from MPBC are returned to MAPS’ nonprofit organization. The training program has the potential to generate income for the organization; so far, Doblin said, MAPS’ revenue has gone toward the group’s research and education programs. MPBC’s MDMA therapy training program has already enrolled more than 500 clinicians. If the FDA were to grant MAPS’ request to be the sole training program for any legal MDMA therapy, potentially thousands more would enroll.

Many of those advocating for the creation of legal psychedelic therapy would like to work as psychedelic therapists themselves; Doblin, for one, describes it as a professional goal on his own MAPS website biography. His goal is far more accessible if he only needs to be trained by MAPS, which involves 13 days worth of training plus supervision of the first patient treated, rather than obtain a license. To be a licensed psychologist in California, where MAPS is based, Doblin would need to get a PhD in psychology, accumulate two years (3,000 hours) of experience supervised by a licensed psychologist, take various pre-licensure classes, and pass both the Examination for Professional Practice in Psychology and the California Psychology Law and Ethics.

MAPS has some safety measures in place. All therapy sessions in MAPS studies are videotaped and randomly reviewed, and MDMA therapists receive ongoing training and supervision, which focuses on “building therapist self-awareness and competency, especially around sexual countertransference, and supporting spaces where it is safe for providers to address therapeutic challenges in order to prevent ethical violations,” Doblin wrote in an email to Quartz. “In addition, our therapist training team is exploring the creation of an advisory board of people who are not MAPS employees for ethical matters that come to our attention.”

“It’s not ethical for MAPS to be the people running their own ethics board.”

Unlike many organizations involved in similar ethical violations, the nonprofit did not force Buisson to sign a non-disclosure agreement. But several women told Quartz that for psychedelic therapy to be safe, there should be an independent organization, such as the Association of State and Provincial Psychology Boards, to respond to complaints of sexual abuse in psychedelic therapy. “It’s not ethical for MAPS to be the people running their own ethics board,” said Friedman. For a board to be truly independent, she said its members should be collectively appointed by the community, not chosen by the organization. “Psychedelic therapy has nuances that existing licensing boards are not competent to understand and appropriately respond to, in my opinion. I thought that by now MAPS would have gotten more done towards making this happen but they haven’t,” she added.

Ross, who since her rape by an ayahuasca shaman, has worked as a consultant for several workplaces and universities on how to ethically respond to concerns of sexual violence, agreed: “Institutions of all kinds are concerned first and foremost with their reputation. They will always have an incentive to curb and curtail instances of reporting,” she said. Investigations should only be carried out by external bodies with legal expertise, she argued. “There’s too many conflicts of interest otherwise.”

Doblin refuted this critique. “MAPS’ reputation is based on focusing on subject safety so prioritizing safety is the best way to prioritize MAPS’ reputation. I don’t see the conflict between the two,” he wrote in an email to Quartz. “For everybody who’s licensed there are already external boards,” he added in a phone call.

The results of MAPS’ Canada trial, where Yensen practiced, have only been published in combination with MAPS’ five other phase two trials, creating a total sample size of 105. Amid that broad a dataset, it’s impossible to determine whether the Canada trial’s six participants benefited from psychedelic therapy. A MAPS-funded study involving 12 subjects in Switzerland showed no statistically significant reduction in a clinical measure of PTSD symptoms.

The paper citing the trial where Buisson had treatment was submitted by Mithoefer, Doblin, and other MAPS collaborators in November 2018—one month after Buisson reported concerns to Mithoefer directly. Both Yensen and Dryer are included in the acknowledgements.

Despite her experience, Buisson recognizes the potential benefits of psychedelic therapy. But her optimism is qualified. “They’ve created such a belief in MDMA that people forget that it has not been proven,” she said. Meanwhile, MAPS is training hundreds of new therapists in preparation for legal MDMA therapy.

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