For those who care about equity and justice in this psychedelic revival, there is a clear and shared responsibility to ensure that the field evolves in a way that is safe, respectful, and inclusive of the full range of human experience. Equity is itself a form of safety, and requires everyone—both those who identify intersectionally and their allies—to ask what can be done to improve the personal and therapeutic psychedelic experience.
To that end, we reached out to some of the leaders in the field of psychedelic science to explore their thoughts around gender identity, sexuality, and queerness in their work, past and present. Annie and Michael Mithoefer are two of the world’s leading MDMA-assisted psychotherapy investigators and trainers, and have been actively engaged in the psychedelic space for over 30 years as trauma therapists, breathwork practitioners, and advocates for psychedelic-assisted and experiential approaches to healing. Both are actively involved with MAPS: Annie (she/her) is a registered nurse and Lead MDMA-Assisted Psychotherapy PTSD Investigator, and Michael (he/him) is Senior Medical Director for Medical Affairs, Training, and Supervision. Together, Michael and Annie have been involved in the MAPS-sponsored phase II clinical trials, testing MDMA-assisted psychotherapy for PTSD, as well as a pilot study treating couples with MDMA-assisted psychotherapy and a phase 1 program providing MDMA-assisted sessions for therapists who have completed the MAPS therapist training.
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Based on your decades of experience in the space, how would you describe the role of gender identity and sexuality in psychedelic healing? Did these issues have a place in the early days of the development of your psychedelic healing practices?
You know, sexuality and gender identity really weren’t talked about in those days. The person might have had an internal sense of their sexual identity at that time, but it was not something that was discussed.
Annie: Well, for a lot of the people we have worked with, it simply didn’t come up. But I think this is because of the way we built our preparatory sessions. It has been years since we did these sessions, and looking at them now, we probably would have done it differently. I actually wish that it had been different because there are a couple of participants who subsequently came out, but their sexuality didn’t come up at all during the sessions. I felt like maybe that was meant to be part of their work, but it was missed because we didn’t open the door to this possibility. I am thinking of one person in particular, and it is hard to say, but I think their eventual coming out was facilitated in part by participating in the study and the positive life changes that came from their experience. You know, sexuality and gender identity really weren’t talked about in those days. The person might have had an internal sense of their sexual identity at that time, but it was not something that was discussed. I expect something was brewing underneath, and I wonder what would have happened in the session if we have opened that door.
Michael: Yeah, my guess is that the session allowed this person to gradually feel more empowered and clearer about their own identity, but also empowered to “come out” because the session was healing in a variety of ways that may have strengthened their own sense of self in relation to the world around them. Lots of people make changes in their lives after psychedelic therapy sessions. We had a few people end up getting divorced, for example, and in our opinion, it always seemed to be a good thing. Their healing helped them get clear and get empowered to do what they needed to do as part of living authentically.
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Have you worked with many queer people in your practice?
It is clear that there are topics that people may not feel safe or may be hesitant to talk about without an invitation to do so. We need to get better at making it clear that these topics are safe to bring into the therapy space.
Michael: Honestly, we haven’t had a lot of experience working with LGBTQ+ people. We have worked with gay and lesbian people over the years, but in terms of trans individuals or non-binary people, for example, we haven’t had much experience. Our approach to therapy is that the process is directed by the person’s own inner healing intelligence, and our intention is to make space for the whole person. What we’ve learned in recent years is that more attention is needed to explicitly define what is welcome in that space. Nowadays, we’d be inclined to be more proactive and directly ask about identity and sexuality. It is clear that there are topics that people may not feel safe or may be hesitant to talk about without an invitation to do so. We need to get better at making it clear that these topics are safe to bring into the therapy space.
Annie: Yeah, thanks to Monnica Williams, for example, we eventually brought questions about race-based trauma into the preparatory conversations during the clinical trial process. But, for a long time, there was not much about any kind of intersectionality or identity in any of the questionnaires or preparation sessions. And there is probably still not enough of it. We used to ask a lot of questions about non-ordinary states of consciousness that people had experienced, and their history of psychedelic use, but not much more than this. It’s not that we were actively trying to avoid issues of identity. We wanted to know anything that would contribute to creating a safe space for a person. But the preparatory sessions are relatively short and we had a lot to cover, and the focus ultimately was on the person’s index trauma specifically. At the end of the prep sessions we would ask, “What else do you want us to know about your life that would be useful and help you feel safer when we get to the experiential sessions?” but it wasn’t really a question that signaled safety to talk about one’s gender or sexual identity, or other intersectional experience.
As we look at the difficulties that many people often grapple with in therapy—whether having positive and nourishing relationships with partners, family, and the people around them, or confronting sexual abuse and trauma— interconnection, identity, and sexuality are common issues that come up frequently in the therapeutic space. So, I’m curious about why sexual or gender identity weren’t more present in the conversation and exploration with MDMA-assisted clients.
Michael: I think they are now much more now, and we have been more intentional about creating space for these topics. But it is also a little tricky, because what we try to do is not have an agenda about what a person needs. We may hear their history and think “Well, it sounds like their early family life will be coming up” or “Their combat-related trauma will be the focus of their session.” And it may turn out that it is, but not always. We don’t name what we think the issue is, and instead, we want to remain open and curious for whatever emerges. Similarly, we don’t want to assume, “Okay, this person has a different sexual identity than we do, so it should be a focus of the therapy.” We’re trying to stay away from assumptions or direction. But I also think this everything-is-welcome approach should be tempered by a realization that there are social and interpersonal taboos, and it takes awareness and intention to establish a safe, genuine, and open therapeutic relationship.
Annie: Yes, there is still this idea that you’re just holding space for anything to come up and you don’t have to do anything else. I think this is from the old school way of thinking, and there are definitely people who still think that way. And it’s not that sex or identity didn’t come up sometimes. There were several people who didn’t talk about a sexual trauma in their past until their MDMA sessions, for example. These issues came into the therapeutic space when the person felt safe. I don’t know if they would have said something about it in the preparatory sessions, but if we’d made it more explicit they might have. So, could we have done better? Probably.
To create that open space, it is interesting to explore the explicit and implicit ways that we can signal safety and invite that openness we are trying to establish in therapeutic practice. Whether it is sensitive but direct questions about gender identity and sexuality as part of the preparation process, or more subtle cues of that openness and possibility, such as the choice of art on the walls of the therapeutic room, or using non-gendered language in conversation: There are lots of potential tactics for creating a more inclusive queering of the psychedelic space. What other ideas do you have, based on your years of experience?
Importantly, however, is the need to make these updates while also getting a much more diverse group of therapists trained to provide psychedelic-assisted therapy.
Michael: We are going to continue to make mistakes, but when things are pointed out in the moment it is helpful. Four or five years ago, when we were doing a training, we had given a sample of our study forms for feedback. One person said, “Well, according to your intake forms, I don’t exist.” This was very immediate and concerning, and they helped us redesign our forms on the spot. I think part of it is updating our language and adapting our written materials to ensure people feel seen and included. Importantly, however, is the need to make these updates while also getting a much more diverse group of therapists trained to provide psychedelic-assisted therapy.
Annie: Yes, I think education is essential. The therapists that are working on these studies and taking trainings need more practice and skills to be able to speak respectfully and comfortably. And we also need to ensure the trainings don’t do harm either. In one of the trainings that we attended online recently, the therapist included a video of a trans person, and one of the therapists in it used the wrong pronoun. It was a one-time error and they apologized. And the participant in the video corrected it and didn’t seem to be too bothered. But the impact of that misgendering was triggering for some people in that training who watched the video. We should be alerting people ahead of time, like a trigger warning, to let them know something like that is coming so people can make decisions for themselves about watching the video or not. The other thing I think that’s important in this vein is thinking about our teachers. You know, Stan Grof was one of our main teachers, but there were also many wonderful women who were part of the foundations of psychedelic science and practice. The literature that we encourage people to read is not inclusive or up to date, culturally. And some of our teachers need to update their approach as well. For example, some of Stan’s stuff about birth has been really triggering for some of the younger people coming into the field.
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Identity and sexuality are fundamental to the human psychology, but with all of the social and cultural taboos, they also represent some of the soft underbelly of being human. To close, we wanted to invite you into this shared vulnerable space to explore how your personal understanding of your own sexuality and gender identity has evolved since you started working with psychedelic healing practices?
Annie: I feel like the information I was given during my upbringing was certainly very mediocre when it comes to sex and sexuality, which I look back at with some disappointment. I feel like this affected my life a lot. Not to say that I haven’t had an enriching sex life, but I graduated high school in 1970; so, while psychedelics were definitely around, it was a time of great sexual freedom culturally. I found myself in situations that could have been quite dangerous and traumatizing, and feel lucky that the lack of education and awareness in my upbringing didn’t lead to a more traumatic young adulthood.
Michael: I graduated from college in 1970, and at that time psychedelics, breathwork, and non-ordinary states in general had a big impact on my views on sexuality, well before we started doing research. These experiences didn’t make me question being heterosexual, but they made me feel much more open about sex in general and more open to respecting other people’s choices.
Annie: I am also thinking about breathwork and some of the embodied experiences in that practice. In the training, we had to get comfortable with transference and some of the sexual energies that came up. Michael and I did the breathwork training at separate times, and the experience of sitting for people in breathwork, or being in a group with someone for a week in training, and noticing all those impulses and energies and not acting on them was a huge learning and growth for me. I think a lot about how we can be deeply connected with each other and also hold space and be present with each other in those energies. Breathwork is so energetic and also embodied, and there are lots of different ways to be connected with others as well as oneself.
Thank you for the personal reflections to close out the conversation together, and thank you for sharing your professional and personal insights about the experience of psychedelics with identity, sexuality, and queerness.
Art by Karina Alvarez.
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