Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists

Psychedelic compounds are re-emerging in Western medicine as possible adjuncts to psychotherapy for disorders such as PTSD, mood disorders, substance use disorders, and end-of-life anxiety. The literature to date is heavily Eurocentric and medicalised, and the authors note a marked absence of people of colour as research participants and as researchers. Little attention has been paid to how psychedelics may interact with racial and cultural trauma, or how existing therapeutic protocols might need adapting to different cultural contexts. This paper reports the written accounts of three African American female clinicians who took part in an FDA‑approved MDMA training exercise (a healthy‑volunteer study linked to MAPS training) and uses an iterative thematic analysis to identify cultural and clinical themes. Williams and colleagues set out to describe what emerged for these therapists during MDMA‑assisted sessions, to consider implications for therapist training and practice, and to suggest clinical approaches (including Functional Analytic Psychotherapy) that might improve cultural responsiveness in psychedelic‑assisted psychotherapy. The work is positioned as a descriptive, practice‑oriented contribution intended to inform culturally sensitive research and clinical practice rather than as an efficacy trial.

The clinical context was the University of Connecticut site’s involvement in MAPS‑sponsored research. Clinicians at UConn who were training to become MDMA therapists participated in a separate, Phase I randomized, double‑blind crossover study in healthy volunteers (MT‑1, ClinicalTrials.gov: NCT01404754). In that crossover design each participant received MDMA during one drug session and placebo during a second session; preparatory, medication, and integration sessions were included in the protocol. At the UConn site the drug sessions were day‑long with an overnight stay, integration the following morning, and a post‑session telephone check‑in. Each therapist‑participant worked with two facilitators; across the three Black women there were four facilitating therapists (three White Americans and one Colombian American). The study was approved by the Copernicus Institutional Review Board and participants gave informed consent. Data for the present paper derive from first‑person written accounts produced by the three African American clinician‑participants. Each wrote about her MDMA experience and condensed the account to about 950 words. The analytic approach was an iterative thematic analysis in which the participants themselves co‑created themes: each read all accounts, generated themes, and revised the final list until there was agreement. The authors emphasise that MT‑1 was not designed to explore therapeutic effects in clinicians but functioned as a training opportunity and a source of safety data in healthy volunteers. The methodology therefore is qualitative and phenomenological in orientation, aiming to identify culturally salient themes that arose during MDMA sessions.

Three therapist narratives yielded overlapping cultural and clinical themes rather than quantitative outcomes. The primary cross‑cutting themes identified were: strength (including the Strong Black Woman archetype), safety (and lack thereof), connection (to ancestors, community, and others), managing oppression and racialisation, and difficulties with vulnerability. Participants also reported growth that included greater acceptance of needs and renewed motivation to help their communities. Therapist 1 (marriage and family therapist) described an initial transcendent experience of ‘‘Home’’ and a felt reunion with her grandmother, followed by an embodied return to racialised wounds. That return revealed internalised narratives of not being enough and the inadequacy of previously adaptive defences; she reported learning to relinquish isolation and accept care. Therapist 1 used the phrase, "I feel like I'm dying but it's okay," to convey the intensity of dissolving defensive structures before encountering racialised material. Therapist 2 (clinical psychologist) experienced a heavy, immovable body and a sequence of insights about living life as a continual checklist and protecting herself through competence. The MDMA session enabled a shift from hatred of a vulnerable child‑self toward compassion, and the imagery of separate colours ("the sun is yellow and the sky is blue, but there's no green") captured a paradox about needing others while resisting dependence. Therapist 3 (psychiatric researcher) reported acute cultural and ancestral imagery, notably a West African lapa that carried her through scenes of ancestral history. She described transcendence above pain and a strong sense of collective identity (Ubuntu), yet ongoing vigilance about safety—both in society and in clinical settings. Integration for this participant continued over months and years, and she noted reluctance to share some cultural material for fear of misunderstanding. The training aspect was rated positively: all three therapists found the experiential training useful for understanding protocol and client perspective. However, two of the four facilitating therapists made culturally insensitive remarks or microaggressions during sessions, and those exchanges directly affected two of the three Black participants. Participants emphasised that racial material is likely to surface in psychedelic sessions and that culturally uninformed responses by therapists can be harmful, especially given participants’ reduced capacity to use usual defensive strategies while under the influence. Post‑study activity included two participants offering culturally informed psychedelic‑assisted therapy in an outpatient setting and the authors note subsequent MAPS efforts (training recordings for independent raters) and a 2019 community training conference co‑organised by two authors.

Williams and colleagues interpret the narratives as evidence that psychedelic experiences commonly surface culturally specific material for Black women, including intergenerational racial trauma, ancestral spirituality, and the tension of the Strong Black Woman archetype. They argue that Western clinical paradigms risk missing or mishandling this material unless therapists are trained to recognise and respond to cultural expressions of suffering. The authors situate their findings within earlier observations that the psychedelic literature is Eurocentric and that indigenous healing traditions and African plant‑medicine practices have long histories relevant to contemporary work. A central implication is the need for enhanced cultural competence among psychedelic therapists. The paper highlights Functional Analytic Psychotherapy (FAP) as a relational approach that may be well suited to MDMA‑assisted psychotherapy with people of colour because FAP foregrounds therapist authenticity, immediate in‑session responses, and the therapeutic relationship as a mechanism of change. The narratives also illustrate a distinct risk: racialised microaggressions or insensitive comments by therapists can constitute a form of harm in the context of psychedelic sessions, when clients are less able to employ usual defensive strategies. The authors acknowledge significant limitations: the sample is three Black women who are clinicians and therefore not representative of African American men, non‑clinicians, or Black people outside the US; findings cannot be generalised. They also note that the MT‑1 study was a healthy‑volunteer training protocol rather than an efficacy trial, and that much of the integration and meaning‑making occurred after the dosing session. As implications for future research and practice they call for more inclusion of people of colour in psychedelic research, evaluation of culturally informed training (including FAP) as an adjunct to existing protocols, investigation of how cultural set and setting influence outcomes, study of potential differential effects of specific compounds across ethnic groups, and broader community education and outreach. The authors emphasise that more therapists of colour and larger‑scale multicultural training are needed to reduce the risk of perpetuating racialised medical trauma within psychedelic research and practice.

The authors conclude that psychedelic‑assisted psychotherapy has potential to address mental health needs in people of colour, including therapies aimed at intergenerational and intersectional racial trauma, but realising that potential requires attentive cultural adaptation. Key needs identified are more therapists of colour, improved multicultural training for all providers (including attention to microaggressions), empirical work on adjunctive approaches such as FAP, and research into cultural influences on set and setting and on pharmacological responses. They close by encouraging efforts to create culturally safe practices and communal rituals that can help the African diaspora reclaim beneficial ancestral healing practices as psychedelic medicines move into mainstream clinical use.