My Experience with Using MDMA for Couples Therapy

Feb 14

Can you imagine going through years of couples therapy in one night? What if I told you that it’s possible, but you’d have to take a mind-altering substance to do it?

When a couple we’re friends with first told us we had to do MDMA together because it’d be great for our relationship, we had little background other than their enthusiasm. Neither of us had taken it recreationally and were semi-uncertain due to our main association of it being the popularized festival culture we aren’t really a part of. Being as our friends are responsible adults who have an incredible relationship and one of the strongest marriages I’ve ever seen modeled in real life, we decided to give it a go. We imagined that if nothing came up to address, we’d just have fun and dance our hearts out. But that is not what happened. Not even close.

What actually happened was better. We went through—what we estimate to be—about three years of couples therapy in a few hours. Instead of dancing, we instead had one of the most meaningful and impactful conversations of our lives. We proceeded to discover and express things that needed to come out for us to heal and grow together and uplevel our relationship. We identified and broke down damaging patterns playing out between us that we otherwise couldn’t see or express with complete understanding and openness. We began to understand ourselves and each other better, and how we can better coexist in a relationship together.

We’ve taken it a couple of times per year since that first time and continue to work through challenges and take back our learnings to integrate in our lives – helping us reach new levels of love, understanding, and growth as individuals and in our relationship. We had no idea of the therapeutic potential of MDMA when we first tried it back in 2017, but as it turns out, there’s quite a history of it.

MDMA was successfully used for individual and couples therapy in the 1970’s and 80’s, but the potential for therapy was lost when it was wrapped up in the war on drugs and classified as a schedule I drug in 1985. Times are changing. The FDA recently designated MDMA as “breakthrough therapy” for PTSD. The Multidisciplinary Association for Psychedelic Studies, or MAPS, is the organization leading this incredible charge. They have published their entire protocol for maximizing the effects of using MDMA for PTSD.

Back when we first started using this as a tool for our relationship, we couldn’t find such a guide, and we originally sort of stumbled upon the therapeutic potential. After that initial experience, we got more intentional, we did our research, and continued to refine our process to get as much benefit out of the sessions as possible. Below is our guide as it stands today.

Obligatory Warning Section

While I truly do find MDMA to be a massively useful and transformative tool for relationships, it’s not a magic pill. As with all mind-altering substances, the intention, set, and setting matter immensely. This is the difference between a potentially dangerous and a life changing event.

Despite the recent revival and clinical studies, MDMA is still an illegal compound, and I am not promoting its use. There are risks to taking MDMA and it is your responsibility to research how it works and understand what the implications are. Individuals with certain physical and psychological health issues are more at risk.

Here are some of the potential side effects of MDMA:

Nausea
Involuntary jaw clenching and teeth grinding
Muscle cramps/restlessness
Blurred vision
Chills
Sweating
Thirst (also dehydration and electrolyte imbalance)
Increased heart rate
High body temperature
Insomnia/trouble sleeping
Decreased appetite

More potential acute side effects and long term side effects (those lasting days or weeks post-MDMA use) can be found here.

We’ve both experienced nearly all of these side effects while on MDMA (as well as some of the potential longer term side effects like depression and irritability for up to a week afterwards). But the therapeutic benefits have been so significant that the risk is worth the reward for us...

In the context of psychotherapy, MDMA has been noted to reduce defenses and fear of emotional injury while enhancing communication and capacity for introspection [1]. Which explains why I feel weirdly connected to myself and my partner while on MDMA. While this guide is focused on the therapeutic benefits within relationship, the introspection it brings is equally important and beneficial to the relationship work. On MDMA we have so much compassion and understanding for ourselves and each other that we couldn’t possibly use our regular defense mechanisms and self protection tactics because our typical negative behavior patterns aren’t accessible. There is no space for shaming, blaming, suspicion, rejection, fear, anger, jealousy, etc. Our inner critics are silenced. We are able to talk about our needs and express ourselves openly, knowing that the other person is going to receive it lovingly without judgement or getting defensive. It helps us to listen from a place of genuine love, trust and respect. Put simply: MDMA helps us understand ourselves and each other better.

This guide is broken down into three sections:

1. Prep

Logistical preparation ranging from planning a few days off the grid to fasting the day of. This is everything we do prior to ingesting the substance.

2. “Session”

How we structure each session. Tips and prompt questions for getting the most out of it.

3. Integration

How we process everything we learned from each session and integrate it afterwards. This is the least sexy part and it’s easy to want to skip it, but it’s ultra important. If we don’t do the work, we don’t make any progress and the same stuff comes up again in the next session.

“How We Get Along” MDMA Couples Therapy Guide

This is not a formal or scientific protocol, it’s just our personal process.

This is not medical or therapeutic advice.

This is not a recommendation for anyone to take MDMA, we’re simply sharing our experience with it. If you choose to follow this guide, it is at your own risk.

PREP

Acquiring the substance

I can’t say how to do this. I can say that it’s important to test it when you do. If we don’t know the source well, we test it first (using various drug testing kits we ordered on amazon). MDMA is often combined with other drugs, which—in my experience—makes the aforementioned acute side effects like insomnia, jaw clenching, teeth grinding, etc., more intense, and the post-dosing side effects like depression more likely and more severe.

Scheduling

After doing it a few times, we began to plan several days to do these sessions. When we can, we go somewhere to get a change of scenery and unplug. Of course, traveling isn’t necessary, we’ve also done it at home successfully—and for some people doing it in a safe, familiar environment might be better.
We like to have at least 2 days (3 if traveling).

Day 1 (if traveling): arriving, getting settled, doing any remaining prep
Day 2: therapy session
Day 3+: integration (processing and planning)

The most important thing for us is that we can get fully offline the day we take it (“therapy” day). Meaning, we shut down our laptops, take off our apple watches (or leave them at home if we’re traveling) and put our phones on airplane mode. We often plan more than 3 months out, as it can be hard to find a good time to do this.

Session Supplies

Gum. Lots of gum.

The jaw clenching/teeth grinding can be more or less intense depending on the purity of the substance, but I’d say that having gum on hand has probably saved my teeth some damage so it’s worth having in excess no matter what.

Water and Electrolytes

Lots of liquids (avoid sugary, carbonated and caffeinated beverages. No alcohol).
We like to have several liters (2 per person) ready and next to us before we get started. This helps us remember to hydrate and sets us up so we don’t need to pull out of the experience to go get water. It’s important to stay hydrated since MDMA can increase heart rate and body temperature, but since we’re not taking it in a party environment and dancing in a hot room full of people for several hours straight, we don’t go overboard (note the risk of water intoxication).
Ultimately we just drink enough to stay normally hydrated, and throw in some electrolytes—we love Ultima and LMNT electrolyte powders (NOT Gatorade or Powerade, they’re full of sugar).

Speaker and Playlist

We like to have a bluetooth speaker nearby, usually on the floor next to us. Before our first session, I made a playlist of music we like but aren’t familiar with—songs that I thought would enhance the experience but not distract us from it. I edit it after each session. But if anything, I recommend “This is Lane 8” playlist on Spotify. Less work and does the trick.
*Using music we hadn't heard before or don’t usually listen to was critical (we didn’t have any emotional connection or memories associated with it).

Notebook and Colored Pens

TAKE NOTES. This is essential. Write down anything you want to remember. Even if you think you could never forget it, write it down.

Recording App

Realizing that while we take pages and pages of notes to record our learnings, we are still in an altered state of consciousness and might miss some things. We’ve been interested in testing out recording our next session using an app that will both record and transcribe the audio (there are several - Otter is one). We’ve also recorded audio only the voice notes app. Highly recommend doing this even if you think you’ll never listen to it.
*Note: even if we were to record a session, we’d still have a notebook and pens on hand, as we’ve found writing and mapping things out can help us think through things as we talk.

Snacks (for afterwards)

Since we go into it fasted (see below) we like to have healthy food on hand for afterwards in case we're hungry. Sometimes we are, sometimes we aren’t, but either way we do not want to have to go in public or deal with finding food post-session.
Our favorite snacks: berries, macadamia nuts, coconut chunks, nut butter, avocado, cheese… Just for reference. (Get whatever snacks you love -- we’re not trying to tell you what to eat!)

Fasting

We like to go into it fasted (food can significantly lessen the effects and I’ve heard too much food, or taking it on a full stomach, can possibly render it ineffective altogether).
The day before, we’ll have dinner at a normal time and fast until we take it the following afternoon. In the morning we have coffee or tea (but no milk, nothing with sugar, fat or protein).

Setting

It’s important to create a super comfortable environment that’s conducive to talking, connecting, cuddling, etc.
A lot of this is subjective but our set up starts with a clean, picked up space (it’s more pleasant and less distracting).
Lighting is also critical for us—we prefer a dark room that’s dimly lit. We like to make a little nest on the floor with every blanket and pillow we can get our hands on, or climb in bed.
Dark room with dim lighting is our personal preference (more on that below)

Timing

The first time we took it in the evening, around 6pm.

Evening dose pros:

Something about nighttime makes it feel extra intimate.
Nice to watch the sunset (which gave us a sense of time, a friend told us this was also really helpful for her)
Easy to relax and unplug (less worry about someone trying to reach us)

Evening dose cons:

We were awake until 4am which was not ideal (you don’t want to be wrecked the next day if you only have a couple days for the whole process).
We also guessed that the lack of sleep might make the comedown worse as we felt more irritable and depressed the next few days as we got back to normal.
Have to fast all day (at least 8 hours prior to taking the substance)

Now we take it during the day, starting as early as noon.

Day dose pros:

Doesn’t interfere with your sleep schedule.
Smoother comedown (less irritable, depressed, etc.)
Better integration—it helps to be well rested the following day to process everything.
Easier fasting time frame. Once we wake up, we’ve technically already fasted for 8ish hours, so it’s a matter of when we want to take it.

Day dose cons:

More visual stimulation. I found it a little harder to relax and stay in the experience when it was light out (but we solved this pretty easily).
Requires a little more work to create the setting. We use room darkening shades, curtains, etc. to get the vibe.

Overall it's personal preference, but for us, sleep wins over lighting.

Supplements

Albeit being a euphoric experience, MDMA is unfortunately messing with our neurotransmitters. Here’s a thorough supplement regimen (pre, during and post) you can follow to help with the imbalance.
If you’re going to take the “during” supplements, portion them out in advance, and set timers as a reminder to take them. Do not try to figure this out during, it will take you out of the experience and waste time.
NOTE: the week after taking MDMA we can feel more emotional, irritable and sometimes depressed (especially if the substance we took was less pure). This can mean we have shorter fuses, are more easily triggered, and might argue more. It helps to keep in mind that we’re not 100% ourselves and try not to react in the moment. We take notes of anything that upsets us and wait to address them until the week is up (at which point we usually don’t need to anymore ;).

Dosing

Best to google this and decide what’s best for you. We take a measured first dose and time a booster between 1-2 hours later.

“SESSION”

Our first time we went in blind. Since then we’ve gotten more and more intentional. Here are some things we do to help us stay on track and get the most out of each session.

Exercise 1: Pre-Dose Reflection Exercises. Journal separately and reflect on your relationship. We make a list of anything we want to talk about and set one or two intentions to keep coming back to if we get stuck.

Make a list of things to talk about. What’s been on your mind lately?

What helps me is imagining that I can say anything and my partner won’t get upset, they’ll be able to lovingly receive what I’m saying and understand it without getting defensive. (Worst case: even if they did get upset, it’s still better to get it out in the open and start problem solving together than to suppress it).
Here are some of the most common repeating fights couples have:

Commitment. One partner feels like they’re more committed than the other. They want to "move the relationship forward" by moving in together or getting engaged but feel resistance.
Household chores. One partner feels like they do the majority of the shared household tasks. One partner feels nagged, attacked or like they don’t get enough credit.
Relationships with exes.
One partner feels like the other is often distracted and on their phone when spending time together. Or they might be frustrated by their partners' overuse of social media.
Finances. One partner is more of a spender and one partner is more of a saver.
One partner prioritizes work over the relationship. One partner feels neglected and the other feels smothered.
Physical intimacy. Too much? Not Enough?
Infidelity. In current or past relationships. This could involve repairing the relationship after infidelity or a fear of it happening. Perhaps one partner was cheated on in the past and now struggles with trust issues, jealousy etc.

The point is to understand what’s underneath these feelings, so asking your partner why and how helps. So often the pain isn’t from what the argument is about, so use this time to get to the bottom of the things you frequently fight about.
Set 1-2 Intentions: this isn’t necessary but it can be helpful. Here are some examples of intentions:

I want this to be a magical experience that brings us closer together.
I want to make sure he/she understands how much I love and appreciate him/her.
I want to dissect and better understand our communication breakdowns and identify ways to prevent them.
I want to identify when we are at our best, understand why, and how to increase the frequency of it.
I want to heal any old wounds and make sure we don’t have any leftover resentments.

Exercise 2: Question Prompts. We each make a list of questions we have for each other—and answer those questions ourselves.

I start with questions that support my intention(s) and then expand to anything else I want to talk about. For example, if my intention is “I want to learn something about myself and identify a way I can grow,” my support questions could be:

What are you tolerating in your life that’s not serving your higher vision?
What do you most want that you might be afraid to admit?
Encourage yourself and your partner to “speak your truth, even if it’s hard.”

This might be unnecessary or too intense for some people. The therapy process doesn’t have to be rigid. Generally, we do these exercises beforehand and then just let it flow during the session. The purpose of this process is to help us get clear and identify anything important we want to cover, and then we have it to reference if we get stuck. We do not pressure ourselves to cover everything. Sometimes we go back and reference it, sometimes we don’t.
The endgame here is identifying any old wounds that need healing—clearing out any hurts that may be hindering connection or keeping deeper intimacy at bay.
If you don’t have anything you want to address or aren’t exactly sure what you want to get out of it, here’s a general list of prompts that may be helpful:

Have you felt hurt or rejected by me lately?
Do you feel resentment towards me or for anything I’ve done?
What do you need from me that you’re not getting?
See additional optional prompts towards the end

In between sessions:

Nowadays I keep an ongoing list of things I want to talk about. Big and small. If it bothers me, I make a note. I usually bring these things up during our weekly check-ins, so there’s not a lot left by the time we have our MDMA sessions. But it’s nice to keep a list, sometimes I’ll see something on there and realize I wrote it when I was triggered and it was more of a “me-thing” than a “them-thing,” and I take it off the list.

INTEGRATION:

The following day we do a full debrief. First we go over all of our notes and talk through them together. If we had a recording of the session we would listen to that together and/or read the transcript.
Write out what we learned from each other, make a list of the information we got from the session. This could be anything

Olivia’s stress has been manifesting in negativity, feeling insecure and blaming the people close to her.
John’s stress is making him more easily frustrated and lashing out.

Identify anything each of us wants to work on, separately and together
Come up with a plan on how we're going to work on those things and a way to track it
Hold each other accountable to working on the things we said we would. We have weekly relationship check-in meetings where we do just that: check-in on our relationship. This includes addressing any issues from the past week. A helpful question to ask is “is there anything left unsaid”? Were there any little seeds of resentment planted by not being spoken? Get those out.
We started out doing MDMA 2-3x year, give or take. We padded for long stretches of integration. After a few sessions we didn’t feel the need to plan the next one for a long time. We’d gotten better at communicating, understanding each other, and reducing the time it took to repair our fights. Now, when something flares up, we're more often asking “what is this really about?” and addressing it instead of suppressing it or letting it fester.
MDMA is a tool we will still use, perhaps annually, or only when we think we really need it (which will hopefully be even less frequent).

Session Day Sequence Recap

Wake up fasted. Only consume water, black coffee, tea and electrolyte powders (I like LMNT).
Have a low-key morning, do anything we need to do before we go offline.
Finish any prep (create setting, make our space the way we want it, set out water, speaker, etc.)
Turn off computers, and put phones on airplane mode
Journal for 30min-1hr (however long we need)
Take the first dose and either talk or continue journaling while we wait for it to kick in (which is usually 1-1.5 hours). We like to be together for the come up, so once it’s nearing the hour mark we usually drop what we’re doing, put on a playlist, and settle in together.

Tip: I have a lot of anxiety waiting for it to kick in, so I usually write to distract myself. Chatting and cuddling help a lot as it gets nearer.
Tip: Recently a couple we’re friends with tested out this guide and said that one person was starting to peak while the other wasn’t (and was still experiencing some anticipation anxiety). They said smoking a bit of their juul vape pen helped get them there.

Once it kicks in, start with positive affirmations. I’m so proud of you for… I’m so grateful for you because… I love you for your… Then just let it flow! If you get stuck or confused, refer back to your journal notes or the list of prompt questions.
Optional: take the second dose 2 hours after the first dose kicks in.
Come down: as we’re coming out of it we like to hydrate, have light snacks, take a shower, or switch up our environment by moving into a different room. Then we keep talking. Referring back to our journal notes from earlier and sharing anything we want to share that we didn’t get to earlier.

Additional Prompts

It’s unlikely you’ll need these. I am including them because a few people have asked and some shared that it was comforting to know they had this as a backup reference. These prompts are also great to talk through outside of this container.

When do you feel most connected in our relationship? How can we strengthen our relationship?
What are you most afraid of within our relationship? Why?
What’s one thing you discovered about me recently that you love?*
Have you ever felt rejected by me? When did it happen? What did I say or do that made you feel rejected?
Do you resent me for anything? What for? How can we eradicate that and prevent it from happening again?*
Do you have any sexual fantasies you want to share with me?
What is the one thing we’ve argued about the most in the past few months? What do you think is the root cause and how can we resolve it?*
When do you feel respected by me? Disrespected?*
Do you feel I am there for you when you need me? What can I do to show you I am there for you?*
What’s the number one area, in our relationship, you want us to improve? How can we do this?*
How can we communicate better?
What are you tolerating in your life that’s not serving your higher vision?
Do you find it difficult to trust me completely? What is something I do now, or could do in the future that makes you not trust me? How can we build trust with each other?*
How do you feel about our sex life?
What do you love doing most right now? What activity brings you pure, unencumbered joy?
What makes you attracted to me? Physically, emotionally, intellectually, spiritually?*
When do you feel most loved by me?
Is there anything I do that causes you to question my love for you?*
What turns you on sexually? What turns you off?*
Is there anything around sex or sexuality that makes you uncomfortable? Anything you want to ask for or talk about?*
What does love look like to you? Feel like?
Do you feel that you have to be right when we have an argument? Why?*
Do you feel attracted to someone other than me?*
What is something we can both work on doing better the next time we have a disagreement? How do we remember to do these things?
Do you feel accepted by me in every way?*
Can you think of a time you lost your patience with me? What was the trigger? How can you do better next time?*
How did your family resolve conflicts when you were growing up? Was that a good method or not? *
How long do you usually wait before you talk to me about any feelings of anger or frustration? What is the best way for me to communicate difficult feelings I have about you, so you are not offended?*
How do I make your life better or inspire you?*
What does a perfect day look like for you?*
When was the last time you felt lonely or neglected? What do you think made you feel that way?*
What do you value most in our relationship? What do you need to feel happy and secure?*