Michael Mithoefer, MD, is a clinical psychologist and the Senior Medical Director for Medical Affairs, Training, and Supervision at the Multidisciplinary Association for Psychedelic Studies (MAPS). He specializes in treating PTSD with experimental psychotherapy through clinical research and outpatient clinical practice. Between 2004 and 2018, Michael and his wife Annie completed two of the six MAPS-sponsored Phase II clinical trials testing MDMA-assisted psychotherapy for PTSD.

Therapists new to the psychedelic psychotherapy space are often uncertain about how to support clients effectively during altered states. Should they remain silent and allow the medicine to do the work, or should they actively guide the session with interventions? Misconceptions about the "non-directive approach" often leave practitioners unsure of their role, leading to either over-involvement or complete disengagement. How can therapists balance presence and intervention?

As a psychiatrist and researcher specializing in psychedelic-assisted psychotherapy, Michael Mithoefer explains that the therapist’s role is not to impose structure but to follow the client’s inner healing intelligence. He outlines three key principles: only intervene when necessary, provide time for natural processing, and always frame suggestions as invitations rather than directives. Additionally, he highlights the importance of relational safety, regular check-ins, and the integration of somatic interventions to help clients navigate difficult emotional and physical manifestations of trauma during their sessions.

In this week’s episode of Living Medicine, Michael Mithoefer, the Senior Medical Director for Medical Affairs, Training, and Supervision at the Multidisciplinary Association for Psychedelic Studies (MAPS), returns to talk with Dr. Signi Goldman about guiding internal-directed healing during psychedelic therapy sessions. Michael discusses the importance of checking in with clients regularly during sessions, how therapist training and personal psychedelic experiences influence psychedelic therapy facilitation, and when to intervene during MDMA sessions.