Psychedelics Could Revolutionize Couples Therapy

When Joe, 37, and his wife tried MDMA together for the first time two years ago, he expected to “let loose a little bit and have fun.” Instead, they talked about the trash: why Joe didn’t take it out frequently, why that bothered his wife, and how they could compromise moving forward.

“We just hashed it out,” says Joe, who asked to use a fake name since recreational MDMA use is not legal in the U.S. “It opened up doors that we didn’t even know were there.”

Under the influence of MDMA, the drug also known as ecstasy, Joe and his wife were able to reach new understanding, voicing their true feelings and listening to the other. Now, a few times a year, the New Mexico couple calls a babysitter, goes out to dinner, and spends the night in a fancy hotel room where they take the drug and discuss issues in their almost decade-long marriage, ranging from chores to parenting to sex. “Taking on those bigger issues is just not a big deal now,” Joe says.

Joe and his wife do a DIY version of an emerging mental-health practice: MDMA-assisted couples counseling, which may someday be legally available in a therapist’s office near you. Proponents of psychedelic use expect the U.S. Food and Drug Administration (FDA) to approve MDMA as a treatment for post-traumatic stress disorder (PTSD) within the next two years. If that happens, it could potentially open the door to other therapeutic uses of the drug—possibly including couples therapy.

More from TIME

“There’s a lot of neurobiological reasons to think that this drug would be helpful for couples therapy,” says Albert Garcia-Romeu, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins Medicine who studies psychedelics. MDMA stokes the activity of feel-good neurotransmitters in the brain, while simultaneously quieting parts of the brain that respond to threats, he explains. It can also spark the release of hormones associated with bonding, such as oxytocin. “[MDMA makes people] feel more emotionally open and empathetic and less triggered by threats or difficult emotional states,” he says.

MDMA can build trust, release tension and fear, and erode inhibitions, allowing partners to have hard conversations with compassion and without judgment, says Catherine Auman, a California psychotherapist who coaches clients on how to integrate psychedelics into their lives. And the therapy’s effects may last longer than the drug’s high: research suggests MDMA enables people to revisit difficult or traumatic topics without responding as emotionally, which may explain, in part, why it can be effective for people with PTSD. That’s also a potential perk for couples therapy. “If there’s a long-held resentment or disagreement in a couple and people are too hurt or too wounded or too guarded to talk about that, but then you’re able to use the drug to temporarily get guards down…that can really help clear out a lot of emotional baggage,” Garcia-Romeu says.

But MDMA is no guaranteed love potion, Auman says. Sometimes, MDMA-fueled honesty reveals fundamental incompatibilities and leads to revelations—like, maybe this marriage isn’t for me.

Research on MDMA in couples therapy is limited, but the practice has a long history. Some therapists legally used MDMA in couples counseling in the 1970s and 1980s. One was psychiatrist Dr. George Greer, who published a paper documenting the drug’s effects on 29 people—21 of whom took the drug in couples or groups—treated from 1980 to 1983. Every person who took MDMA with their partner or a group “experienced more closeness and/or enhanced communication, and two found it easier to receive compliments and criticism,” Greer wrote. Everyone Greer treated also reported at least one negative side effect, ranging from jaw tension to fatigue and anxiety.

Other potential risks of MDMA use include high blood pressure, faintness, panic attacks, and impaired perception, according to the National Institute on Drug Abuse (NIDA); in rare cases, it can contribute to serious or fatal complications, including seizures and dangerously elevated body temperature. Some people also report depressed moods following the use of MDMA. Research hasn’t definitively proven whether MDMA is addictive, according to NIDA.

In 1985, the U.S. government made MDMA a Schedule I drug, a category for substances with high potential for abuse and no accepted medical use. (Plenty of critics, including scientists and politicians, argue that classification should be adjusted, given the promising research around MDMA’s psychiatric benefits.) MDMA use didn’t stop, recreationally or therapeutically, but it was driven largely underground.

In recent years, however, there’s been a growing acceptance of the role psychedelics can play in treating complex mental-health conditions, including depression and PTSD. As that acceptance grows, some researchers have also turned their attention back to MDMA-assisted couples therapy. One recent trial focused on six couples in which one partner had PTSD. The couples were led through drug-assisted therapy, then asked how their relationship changed afterward. Not only did PTSD symptoms improve, but couples also reported improvements in support and intimacy, and most of the partners without PTSD said they experienced less conflict in their relationships.

That study was small and specific, but co-author Anne Wagner, a psychologist practicing in Canada who coaches clients about the use of psychedelics in their daily lives, says its findings are intriguing enough to warrant further research. Wagner plans to launch a larger trial on MDMA-assisted therapy for couples dealing with PTSD, before hopefully studying its use for couples without PTSD.

Plenty of couples—and therapists—aren’t waiting around for the research.

After reading How to Change Your Mind, Michael Pollan’s bestselling book on psychedelics, David Ford, a 55-year-old entrepreneur based in Los Angeles, started looking for experienced practitioners offering psychedelic-assisted couples therapy. Ford and his wife ended up flying to New York City, where a pair of clinicians agreed to lead them through an MDMA-assisted session.

First, the couple separated and met with individual practitioners while under the influence; in that session, Ford remembers talking through his childhood memories and how his past made him into the adult he is today. Then, with guidance from their clinicians, they came back together to dissect their emotions, personal histories, and how to navigate marriage, love, and family.

“Imagine if you could have a conversation with your partner where you could talk about all the hard parts of your relationship, but you could talk about them unburdened by resentment or expectations or any of the things that typically, at least in my case, derail those conversations,” Ford says.

Those effects were “transformative” for the couple’s marriage, which Ford says was strong but tested by the complexities of combining their families. After a few more MDMA-assisted sessions, he says, they have the tools to tackle challenges with love, gratitude, and honest communication—even when they’re not taking MDMA.

Despite MDMA’s reputation as a club drug, “there’s this whole subculture of use that’s responsible adults with families and kiddos,” says Shannon Hughes, an associate professor of social work at Colorado State University. Along with Colorado-based counselor Rob Colbert, Hughes co-authored a 2022 paper about couples who informally use MDMA together, which found that most couples reported stronger bonds and better communication following their sessions.

But, Hughes notes, the people in her study were healthy adults working on general relationship maintenance; she says she’d have more reservations about unsupervised use for people trying to work through significant trauma or mental-health issues. (Most therapists don’t recommend that people use psychedelics when experiencing active psychosis, suicidal behavior, or bipolar mania, among other issues.) “That is a different level of care than, ‘We want to celebrate our love together and enhance our communication,’” she says.

Garcia-Romeu adds that couples may not experience the drug’s full benefits without coaching from an expert, and that it’s difficult to know the exact dose and contents of MDMA purchased for recreational use.

Talea Cornelius, a social psychologist at Columbia University, is also anonymously surveying people who have taken psychedelics while in romantic relationships. Cornelius is most interested in learning about the effects of so-called “classic” psychedelics like psilocybin (the psychoactive component in “magic” mushrooms), ayahuasca, and LSD. These drugs intrigue her because they’re less obviously suited to use among couples, in that they don’t necessarily foster loving moods and communication, but can still open people’s minds to new possibilities.

“If you give someone a five-gram dose of mushrooms, you’re not going to have them talking together,” she says. “But afterwards, or maybe during the journey, they [may] see things or feel things or [be] open to things” they weren’t before.

Sarah Tilley, a psychedelic therapist who offers psilocybin-assisted couples counseling in the Netherlands, was inspired to start after going through a divorce. She found couples counseling unsatisfying and, as a longtime alternative-medicine practitioner, thought psilocybin could improve and deepen the experience.

When working with clients, Tilley starts with sober preparation sessions to talk through their family backgrounds, trauma, and relationships. On “medicine day,” as she calls it, Tilley guides couples through rituals like listening to music, meditating, and breathing together, then monitors them as they go on hours-long trips, usually while blindfolded and listening to music—experiencing the drug separately, but together. After their trips, she helps them sort through their experiences and how to work on their relationship in the future.

Tilley hasn’t published data on the efficacy of her approach yet, though she is working with researchers to get a study off the ground. But she says many couples experience increased closeness, compassion, and a desire to let go of past issues. “We are really redefining intimacy here,” she says.

Effective as they can be, though, experts say it’s a mistake to think that psychedelics offer a one-way ticket to marital bliss.

Auman says both partners need to be on the same page about what psychedelics can and cannot do. Once bonds of trust have been broken, for example, drugs may not be enough to mend them.

Some couples even break up as a result of psychedelic-fueled breakthroughs. That’s not necessarily bad, Wagner says, though it may not be the outcome couples are hoping for. “Psychedelic work tends to speed up whatever is going to happen,” she says. “It may be that people are able to reach the natural conclusions of something more quickly, and hopefully with more kindness.”

MDMA-assisted therapy is not like being “lobotomized with some happy pill,” Ford agrees. He and his wife still fight, and their relationship isn’t perfect. But, he says, it is fundamentally stronger.

“There were just these rocks in our relationship that we would stumble over again and again,” Ford says. “Those rocks are still there, and occasionally they get stumbled over, but we’re much better at recovering.”