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Terence Ching became interested in MDMA-assisted psychotherapy as someone who identified as Singaporean Chinese and queer. He is also a clinical psychologist-to-be; operating within the scope of this approach, Ching’s objective is to create more avenues of access for participants and providers of color and underrepresented groups to collectively heal from cultural traumas and discrimination-related stress accrued from living in a racist and heteronormative world. Most recently, Ching completed his dissertation examining “the differences in the efficacy and safety of MDMA-assisted psychotherapy between non-White participants and participants of color.” Diversifying psychedelic research, in general, lies at the heart of Ching’s pursuits.
As Ching is both a health care provider and participant in the Western medical model, he understands that sensitivity and care are required when recruiting people from underrepresented groups for MDMA trials and training programs. “Right now, I’m actively working on how to pitch psychedelic therapy to people of color and underrepresented groups,” Ching says. “We can’t just hand out flyers and hope people will read them. We have to go into communities and talk to community leaders and gatekeepers so that they can then spread the word about the MDMA trials. People prefer to hear from sources they trust about these things. I know I would.” Therefore, Ching dedicates his efforts in finding effective outreach strategies.
Ching was trained as a study therapist in a MAPS-sponsored open-label trial of MDMA-assisted psychotherapy for PTSD. He worked to ensure that the recruitment and assessment procedures in this study were culturally-informed. As part of being trained in MDMA-assisted psychotherapy by MAPS, Ching participated in an MDMA session “to navigate the murky waters of what it meant to be gay and Asian in Singapore and in a family that always had heteronormative expectations…” He continued, “I wanted to share with others what MDMA inspired in me personally and professionally.”
In this interview, Terence Ching and I discuss his work regarding MDMA-assisted psychotherapy and building sensitive therapeutic models for MDMA-assisted psychotherapy for LGBTQIA+, people of color, and other marginalized groups.
In this interview, Terence Ching and I discuss his work regarding MDMA-assisted psychotherapy and building sensitive therapeutic models for MDMA-assisted psychotherapy for LGBTQIA+, people of color, and other marginalized groups.
My lived experiences didn’t reflect the expectations of the people who belonged to heteronormative society. I wanted to do the MDMA work, because it was so taboo in Singapore.
MM: How did your upbringing in Singapore inform your decision to become involved in MDMA-assisted psychotherapy?
TC: I grew up in Singapore as someone who identifies as gay, or more broadly, as part of the queer spectrum. My lived experiences didn’t reflect the expectations of the people who belonged to heteronormative society. I wanted to do the MDMA work, because it was so taboo in Singapore. In some way, it was almost like embracing being “different.” At the heart of it, I wanted to see if I could show others like me what was possible. For me, it is a huge privilege to be able to do this work aboveground.
MM: In the areas of research and clinical trials, your interests are at “the intersections of obsessive-compulsive disorder, anxiety, PTSD, and cultural diversity in psychedelic-assisted therapy.” What does that mean?
TC: I lived with people with OCD. I’ve seen how devastating it can be having any form of mental illness in Singapore. It’s basically equated to being psychotic. It’s an all or nothing situation.
In Singapore, if you have an occasional period of anxiety and depression, for example, it’s frowned upon. You’re expected to suck it up or risk being viewed as psychotic and in need of intensive care in an inpatient facility. There is no middle ground. Whatever is out of the norm is very stigmatized.
A lot of my research draws from the lived experiences of people who actually have mental health problems or demonstrate the full spectrum of what it means to be human. Saying yes to MDMA was me saying yes to what was possible.
I want to convey the message that mental health does not discriminate. We, too, suffer from mental illness. We need more information about how that shows up differently in cultural groups and tailor assessment and treatment for them.
In the predominant literature about OCD and PTSD, White cisgender, straight individuals are always used in clinical research. I want to convey the message that mental health does not discriminate. We, too, suffer from mental illness. We need more information about how that shows up differently in cultural groups and tailor assessment and treatment for them.
Do we still want to maintain a male to female facilitator pairing in MDMA therapy? Can we also have queer and same-gender therapists, or whatever combination there could be in terms of diversity, sexual, and gender identity?
MM: Why is it important to have more gender- and sexually-diverse people participating as clinicians?
TC: In an MDMA dosing session, for a gender-diverse individual, you’re probably going to talk about your gender dysphoria and the stress and trauma you’ve experienced as a result of not fitting in with gender norms. It’s hard to do that when you see a cisgender male or female therapist across from you. Maybe it’s about revolutionizing the way we conceptualize how we set this up. Do we still want to maintain a male to female facilitator pairing in MDMA therapy? Can we also have queer and same-gender therapists, or whatever combination there could be in terms of diversity, sexual, and gender identity?
MM: As a clinician, how has the outreach been towards finding people and inviting therapists of color and those who identity with an underrepresented population to participate in training and trials?
TC: In August of last year, MAPS held the first MDMA-assisted psychotherapy training for therapists of color. It was so nice to see an entire room filled with people who identified as part of the “global majority,” as we called it. (Laughter) Why was it only now, in 2019, that such an opportunity was available to therapists of color? That outreach piece is certainly a very early work in progress for the psychedelic movement.
Not only do we want to reach out to providers from underrepresented groups, but we also want to reach out to participants from underrepresented groups. How do we get people of color to participate in these trials?
Not only do we want to reach out to providers from underrepresented groups, but we also want to reach out to participants from underrepresented groups. How do we get people of color to participate in these trials? We can’t just recruit people. We have to make sure that that they can complete the trial.
MM: Why is it difficult to retain people of color or other people from underrepresented groups, such as the LGBTQIA+ community, in clinical trials?
TC: A lot of people from underrepresented groups don’t necessarily have the privilege of being able to stop working for three months to complete the study trial. They might be juggling multiple jobs, a large family, and they might not even have transportation; so, how can we think about a more compassionate model of care?
I’m very inspired by the work Brian Anderson, who conducted a study with psilocybin-assisted group psychotherapy to target demoralization among long-term survivors from the HIV/AIDS pandemic in the San Francisco Bay Area.In this study, they didn’t exclude people with substance abuse and personality disorders, which are typically exclusionary criteria for other clinical trials. This signals something to the community they are recruiting from, that the entirety of their real-life difficulties and suffering matters, not just the symptoms of interest.
When the MDMA program is on the cusp of approval, maybe we could do this in community mental health clinics where we could guarantee recruitment of people from underrepresented populations.
Maybe we could have a special ancillary clinical trial where we reduce the laundry list of exclusionary criteria. When the MDMA program is on the cusp of approval, maybe we could do this in community mental health clinics where we could guarantee recruitment of people from underrepresented populations. I imagine, with a dedicated team of researchers and therapists, there can be ways to set up such a clinical trial. The expanded access program gives me hope that this may one day be possible
MM: What’s the expanded access program in a clinical trial?
TC: The expanded access program is a subdivision within a clinical study where people can pay money to receive the same services as in a clinical trial. The EA program allows for early access to these innovative therapies for individuals with severe or life-threatening conditions who, for various reasons, are not able to participate in the main clinical trial. You’re basically doing the same thing as everyone else, except you’re just paying for it. Under the auspices of that, how can we guarantee that those not as privileged can access the treatment too?
How do we scale down the costs? How do we create scholarships for people who are severely disadvantaged? Can we charge people who can pay more and then use that money to fund services for people who can’t afford it?
MM: Why are people of color and those from underrepresented groups apprehensive of engaging with the Western medical model; for example, by participating in a clinical trial?
TC: There are differences in the racial and ethnic makeup of every large geographical region in the US. That aside, people are becoming increasingly aware of the historical medical atrocities committed against communities of color, which have continued to this day, such as the involuntary sterilization of women of color in the prison system. That’s an example of systemic racism positioning people of color as being less than human.
The US doesn’t have a good track record of being respectful to all bodies that participate in research. In fact, for certain studies, the US has gone out of its way to abuse underrepresented people.
It appears that the people of color that participated in the MDMA trial that I was involved in were much younger than the White participants. It signaled to us that there may be a generational stigma among older people of color towards the use of psychedelic substances or, in this case, MDMA, for healing. The US doesn’t have a good track record of being respectful to all bodies that participate in research. In fact, for certain studies, the US has gone out of its way to abuse underrepresented people.
My dissertation looks at whether there are differences in the efficacy and safety of MDMA therapy between non-Hispanic White participants and participants of color in an open-label trial.
MM: What does your dissertation investigate?
TC: My dissertation looks at whether there are differences in the efficacy and safety of MDMA therapy between non-Hispanic White participants and participants of color in an open-label trial. While the findings have not yet been approved for public release by MAPS, I can say that I am now more interested in examining ways in which we can increase access to traditionally underrepresented groups for future trials.
Right now, I’m actively working on a project about how we pitch psychedelic therapy to people. We can’t just hand out flyers and hope people will read them. I’m talking about going into the communities and talking to their leaders so that they can spread the word about the MDMA trials. It seems to be the most effective recruitment strategy in getting people of color into clinical trials. If a reputable person in their community says MDMA safe, then they’ll be more likely to join the study.
MM: What are the particular needs of the LGBTQIA+ community that psychedelic therapy can help with?
TC: For two years, I worked at the Institute of Living in Hartford, CT, and had the opportunity to participate in therapy groups exclusively for sexual and gender minorities. What I learned is that affirmation, whether internally or externally, is so important. It validates who you are, how you identify sexually and gender-wise, where you are in your transition, etcetera. As providers, we are your cheerleaders. We want you to keep on exploring what it means to be you. We, in some ways, become the family they choose. In many ways, it is the same kind of care and attention we strive to bring to clients in psychedelic-assisted psychotherapy. That’s my hope for psychedelic therapy moving forward that it can be a means of building new meaningful relationships with LGBTQIA+ clients that propel them to be their own sources of validation and affirmation.
Art by Mariom Luna.
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