Michael Mithoefer: The Non-Directive Approach Takes Actual Work
03/06/25 • 71 min
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.
In this episode...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.
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.
In this episode...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.
Previous Episode
Ketamine-Assisted Psychotherapy for Trauma: Some Healthy Debates
Dr. Signi Goldman, MD, is a board-certified psychiatrist and the Co-founder and Medical Director of Living Medicine Institute, which offers psychedelic-assisted psychotherapy training programs. As a certified provider for psychedelic-assisted therapy and research, she has practiced in various clinical settings, including hospital systems and alternative treatment settings. Dr. Goldman also serves as a Psychiatrist and Psychotherapist for Concierge Medicine and Psychiatry’s Ketamine-Assisted Psychotherapy Program for Mental Health.
Dr. Sandra (Sandy) Newes, PhD, is a licensed psychiatrist and the Co-founder and Programming Director of Living Medicine Institute. With over 25 years of clinical experience as a psychedelic-assisted psychotherapist, she specializes in anxiety, chronic stress, trauma, and recovery. Dr. Newes has provided ketamine-assisted psychotherapy through Concierge Medicine and Psychiatry since 2019. She is also an educator and speaker offering workshops, events, and education on psychedelic-assisted psychotherapy and the intersection of nature connection, trauma, and mental health.
In this episode...Trauma therapy is a complex and often debated field, with professionals holding differing views on the best approaches. Some therapists prioritize exposure, helping clients directly engage with painful memories, while others focus on resourcing to build a sense of safety and well-being. When ketamine is introduced into trauma work, how does it shape the healing process, and what approach leads to the most effective outcomes?
Psychedelic therapy training professionals Dr. Signi Goldman and Dr. Sandy Newes and training students Barbara Connold, Barrie Bondurant, and Amy (Maiima) Nicholson explain that ketamine-assisted psychotherapy facilitates a balance between exposure and resourcing. Clients often toggle between processing traumatic material and deepening into states of well-being without direct therapist intervention. During ketamine-assisted therapy sessions, therapists should practice tethering to ensure clients feel supported, manage disassociation as a therapeutic tool rather than a barrier, and assess a client’s readiness for deeper trauma work. Dr. Goldman, Dr. Sandy, Barbara, Barrie, and Amy also underscore the importance of preparation and integration, ensuring clients develop resilience and maintain stability between sessions.
In this episode of Living Medicine, Dr. Signi Goldman and Dr. Sandy Newes interview Barbara Connold, PMHNP, of Ketamine Psychotherapy Associates, Barrie Bondurant, PhD, LC, and Amy (Maiima) Nicholson, about the intersection of ketamine and trauma therapy. Together, they share insights on managing client dysregulation, the relational aspects of ketamine-assisted therapy, and strategies for balancing exposure with resourcing.
Next Episode
The Use of Touch in Psychedelic-Assisted Psychotherapy: A Tricky Topic
Dr. Signi Goldman, MD, is a board-certified psychiatrist and the Co-founder and Medical Director of Living Medicine Institute, which offers psychedelic-assisted psychotherapy training programs. As a certified provider for psychedelic-assisted therapy and research, she has practiced in various clinical settings, including hospital systems and alternative treatment settings. Dr. Goldman also serves as a Psychiatrist and Psychotherapist for Concierge Medicine and Psychiatry’s Ketamine-Assisted Psychotherapy Program for Mental Health.
Dr. Sandra (Sandy) Newes, PhD, is a licensed psychiatrist and the Co-founder and Programming Director of Living Medicine Institute. With over 25 years of clinical experience as a psychedelic-assisted psychotherapist, she specializes in anxiety, chronic stress, trauma, and recovery. Dr. Newes has provided ketamine-assisted psychotherapy through Concierge Medicine and Psychiatry since 2019. She is also an educator and speaker offering workshops, events, and education on psychedelic-assisted psychotherapy and the intersection of nature connection, trauma, and mental health.
In this episode...Touch in therapy is a complex and often controversial topic, especially in psychedelic-assisted psychotherapy, where clients are in highly vulnerable states. While some therapists fear the ethical risks of using touch, avoiding it altogether can mean missing a critical tool for grounding and healing. How can practitioners navigate this delicate balance while ensuring client safety and trust?
Psychedelic-assisted psychotherapy trainers Dr. Signi Goldman and Dr. Sandy Newes emphasize the importance of clear consent, ethical considerations, and trauma awareness. While some clients — particularly women with trauma histories — may be more cautious about physical contact, others may seek out safe, grounding touch from male therapists as part of their healing process, so therapists should balance masculine and feminine energy accordingly. For clients who are hesitant about direct touch, Dr. Goldman and Dr. Newes suggest allowing them to place a hand on their own body first, with the option for the therapist to add gentle contact on top if desired.
In today’s episode of Living Medicine, Dr. Signi Goldman and Dr. Sandy Newes of Living Medicine Institute discuss the ethical use of touch in psychedelic-assisted psychotherapy sessions. Together, they talk about somatic touch interventions, strategies for working with veterans and first responders, and how to match touch intensity to emotional distress.
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