Integration of PACT Couples Therapy with Psychedelic Assisted Therapy: Facilitating Secure-Functioning Relationship

for therapists May 08, 2023

By Olga M. Vera, PhD

PACT Level 3 Therapist

As PACT therapists, we play a significant role in supporting our couples toward secure-functioning relationships. We can also play an essential role in contributing to the growth of psychology, psychedelics, and work with couples. This paper is my observations and insights as a PACT therapist from my work with couples who decided to use MDMA to strengthen their relationship. Many of my clients wanted to see if MDMA could help them identify the barriers that were not allowing them to create a secure-functioning relationship. 

MDMA has been described as the love drug, the heart opener, or the truth pill by various people in the psychedelic community. People who have taken MDMA recreationally reported a sense of openness and connection toward others. Some have described that it gives them the willingness to discuss the topics that scare them, helping them drop defenses and fear. 

Many of my couples experimenting with drug-assisted therapy wanted to find a different approach to understand and work with the barriers that were in the way of getting to the core of their relational issues. They wanted to deepen their intimacy and truly see each other. Couples had a consistent yearning to find the parts of themselves and the relationship they had lost throughout the years. Some of the couples who described too much water under the bridge wanted to see if MDMA could help them get clarity regarding the future of their relationships.  

Though I am not currently participating in formal research, this paper is more of my observations and recommendations based on what I have experienced with my couples. I will describe, in general, what I learned from the couples who decided to take MDMA as a tool to support their therapy. I will also explain how the post-integration process supported behavior changes that helped create security in my couple’s relationships while breaking the barriers that have allowed them to stay stuck. 

Not only will I describe how MDMA facilitated the strengthening of security with my couples who decided to go on this journey, but I will also discuss some of the other shifts that transpired for some of the couples. Finally, I will discuss my observations regarding the importance of preparing clients for such an experience. I have learned that the preparation phase and post-integration sessions are critical for a successful psychedelic journey experience. Based on my observations, this paper will briefly discuss some essential components of the preparation and post-integration phases to prepare couples if they decide to use psychedelics to support their therapy. 

The Journey

Michael Pollan's book, How to Change Your Mind, has dramatically shifted my therapy practice over the last few years. With the increase in psychedelic research from the Multidisciplinary Association for Psychedelic Studies (MAPS), Johns Hopkins Center for Psychedelic Research, UCLA Psychedelic Studies, and other centers, we see significant findings starting to emerge. MDMA and couple research began to surface in the 1980s before MDMA became illegal. For example, Greer and Tolbert (1986, 1998) conducted studies examining MDMA-assisted psychotherapy that included couples. Dr. Anne Wagner, a Toronto-based psychologist, researcher, and couple therapist, is leading current research examining MDMA-Assisted Cognitive Behavioral Conjoint Therapy (CBCT) on PTSD with couples (Wagner, 2020). 

As the research is growing, I have seen an overwhelming desire from many of my couples to have an experience specifically with MDMA. My clients are coming back from retreats and other settings experiencing psilocybin, ayahuasca, MDMA, and other forms of plant medicines. Many of these couples are coming back to my office describing powerful experiences. I found myself trying to support my client’s profound journeys and, at times, painful experiences without much knowledge. I immediately realized that if my clients were venturing off to retreats or working with underground guides, I wanted to ensure that I was adequately informed and trained to support them.  

Their journeys sparked my curiosity, and I decided to venture on my healing journey and get trained and complete the Multidisciplinary Association for Psychedelic Studies Therapist Training. I also became a KAP (Ketamine Assisted Psychotherapy) provider through the Sage Institute. With this experience, I could start supporting my couples’ journey process. Though providing MDMA-Assisted therapy to my clients is not legal, I can support their intentions and integration as they venture out to various settings to have these experiences. So many individuals and couples have these experiences independently without proper preparation and integration work.

Since MDMA is still illegal (Schedule 1 Drug), I cannot obtain, provide, or advise where to get MDMA or where to go to have an experience. What I can do is help clients explore why they want to take psychedelics and process their hopes and intentions. I can explore with my couples what they imagine MDMA would provide them that they cannot do organically for themselves. I can advise clients to make sure they are researching the pros and cons of taking this drug and researching the person/guide thoroughly and the setting they choose. I can explore with my couples their intentions and what they expect will happen when using it. 

As I am very protective of my clients, I also want to ensure how to reduce harm. I can also support them when they return from these experiences to help them make meaning of their journeys and post-follow-ups. Below I describe my experiences and observations with current couples who have explored MDMA as a tool in conjunction with PACT couple therapy. 


Many of the most prominent issues among individuals in my practice were wanting to feel more secure and connected to their partner and finding themselves stuck in old behavioral patterns that were destructive to their relationship. In addition, other relational issues surfaced as many couples were looking at their intentions. Below are some common themes I have observed that led my clients to explore MDMA. Examples of the issues that surfaced included the following:

  • They felt disconnected from each other.
  • They had destructive behavioral patterns they could not stop.
  • PTSD symptoms prevented progress.
  • Security and trust were primary issues. 
  • Some couples were exploring whether they should stay in the relationship.
  • Couples had challenges addressing their lack of emotional and physical intimacy.


     My observation with these couples was that the combination of PACT therapy and their MDMA experience supported their couple bubble by creating a path of openness, safety, transparency, vulnerability, empathy, accountability, fairness, and a deeper level of intimacy. I have found that the MDMA experience helped facilitate and move couples toward a more secure-functioning relationship. Couples found their way back to each other and started talking about how they could cultivate security in the relationship and talk about the barriers that get in the way. Couples were more aware of the behavioral changes they had to implement in their daily life to continue to grow from their journey experiences. 

I noticed more capacity for the couples to co-regulate with each other during stressful moments in the sessions. Many of the couples had more hope for their futures. Even though one of the couples decided to divorce, they were able to do this in a very compassionate way. They agreed on a ritual of conscious de-coupling that allowed them to be loving and understanding with each other. They created solid co-parenting rules and goals, ultimately creating secure-functioning co-parenting. 

The MDMA experience is not a quick fix, and for many of my couples, it sets the tone for more profound work. The behavioral changes they must make to continue strengthening their relationship and create security need consistent tending like a precious garden.

Preparation Phase

A crucial part of my role has been supporting and preparing the couples properly and setting their intentions for a successful experience. As their therapist, I can see their blind spots and shine the light on the areas that need exploration. I typically like to have a couple of prep sessions before they head out to have their experience with a guide. The following are some of the areas of discussion I ask couples to address in order to help prepare them for a successful MDMA experience:

  • Explore why clients want to have this experience.
  • Discuss the pros and cons of having this experience.
  • Support couples doing their research regarding settings that are reputable and safe.
  • Require clients to have discussions with their medical providers to ensure this option is safe based on medical history and current medications.
  • Explore realistic expectations with clients.
  • Help clients set specific relationship intentions.
  • Help clients understand that post-MDMA follow-ups are crucial for any changes to have long-term effects. 

Post-integration Phase

Post-integration care is critical to sustain lasting changes. Many couples communicate later, having more insights during the following weeks and sometimes months after a journey experience. I usually start the first integration session with a form of mindfulness practice that supports my couples in accessing the experience they felt when relating to the medicine. 

I ask my couples to debrief their overall experience. I explore insights, disappointments, or stressful experiences. I remind them that it is natural to experience various feelings as they transition back to daily living and tasks. I review each couple’s intentions and ask if they received any insights related to their intentions. Many times, couples will come back with significant downloads. I also find that couples will mention individual insights and healing that show up for further explorations. 

Client trauma history, attachment woundings, and missing experiences can often show up during their experiences. This is an opportunity for the partners to support each other lovingly and compassionately. If individual therapists are involved, it is good to inform them so they can also support the couple’s growth. 

I remind couples that MDMA-assisted therapy is not a quick fix and that there is work ahead of them.  We discuss the importance of consistently scheduling time, creating a safe space, and a solid container to hold each other’s experiences. I help gather all their insights, organize the work ahead of them, and set up a plan to support them and explore any barriers that may get in the way. 

Many couples decide they want future experiences with MDMA and other plant medicine. We discuss realistic expectations and the importance of allowing time to integrate the work they have done before they go on another journey. Sometimes couples decide that they may need to do individual psychedelic-assisted work, and we explore this further.

As Pact therapists, we can help couples integrate their experiences and help them to return to the couple’s intentions and any behavioral changes they want to make. We can support the steps needed to make lasting changes. The post-integration sessions can help the couple explore how to maintain some experiences that allow them to be closer to each other without the substance. The post-integration phase is critical for any lasting change.


We are just beginning in the field of couple work and psychedelics to understand how MDMA can truly support couple healing. Will this combination of treatments help long-term changes and shifts in our couples' relational landscape? What are the pros and cons of using MDMA as a tool for couple work? What type of couple would be appropriate and benefit from this combination? We still have a lot to learn and understand from a neurobiological and chemical level.

What have I have learned so far? That it is crucial to help clients prepare for such a powerful experience so that they make very conscious decisions about why they want to take the drug. It is also essential to carefully research who and where they want to have the experience (set/setting). Processing couples’ intentions is critical so they have the opportunity to explore their hopes, wishes, and fears. Thorough preparation allows them to go on the journey with realistic expectations. With couples suffering from PTSD, it is important that the psychedelic process be trauma-informed to decrease any potential for re-traumatization. 

Collaboration with other providers for the couple’s care is crucial for successful MDMA pre- and post-sessions. As MDMA becomes legalized, collaborating with medicine guides to understand what unfolded in the experience will be ideal. 

These are fascinating times in the field of psychology and couple work. As PACT therapists, we must be at the forefront of evolving psychedelics research, especially any research related to couple work.  My vision is that as PACT therapists, we get involved in research that combines the PACT approach and MDMA. It will be essential to look at PTSD and how MDMA can support partners. We want to be at the forefront of understanding how MDMA and other psychedelics can support and heal our couples. 

As for me, I will continue my academic training and research in psychedelics combined with my experiential journey with indigenous medicine healers. I will also continue to support my clients with their experiences and learn from them. I hope to get more involved in research combining couple therapy and psychedelics. We, as PACT therapists, are positioned to make a significant impact in the field of psychology.


Greer, G., and Tolbert, R. (1986). Subjective reports of the effects of MDMA in a clinical setting.    

     Journal of Psychoactive Drugs, 18, 319–327. doi: 10.1080/02791072.1986.10472364

Greer, G. R., and Tolbert, R. (1998). A method of conducting therapeutic sessions with MDMA.  

     Journal of Psychoactive Drugs, 30, 371–379. doi: 10.1080/02791072.1998.10399713

Pollan, M. (2018). How to Change Your Mind: What the New Science of Psychedelics Teaches Us About 

    Consciousness, Dying, Addiction, Depression, and Transcendence. Penguin Books.

Wagner, A. C. (2021, November 11). Couple Therapy With MDMA—Proposed Pathways of

    Action. Frontiers in Psychology12



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