The MDMA session begins with the therapists and participant reviewing the participant's goals for the session, the range of experiences that can occur during the session, and any concerns the participant might have as they prepare for the session. This review allows the participant to disclose his/her feelings about the process and provides the therapists with the opportunity to encourage, reassure, and guide the participant towards maintaining a therapeutic intention.

Participant: "I have this thing about the unknown. It just doesn't sit well with me. I don't do well with it. When I know what to expect its OK. Not knowing and having unanswered questions, I just don't do well with. Like the idea of possibly having flashbacks ... and I don't know, worst case scenario."

Therapist: `It's really natural to be anxious about that. One of the challenges of this approach is being willing to go into it and work with whatever comes up. Your reactions are common. I think it is helpful to remember nothing is going to come up that is not already there. Whatever comes up is something you are walking around with already but not conscious of. It's scary. The paradox is although it could stir memories or even flashbacks, temporarily, it allows you to move through them in a way so that you are actually more apt to be free of them and less likely to have them be a problem for you in the long run. It's possible you could have more symptoms temporarily, like we talked about.

Participant: "Yeah right. Is this one of those things where you won't remember what happened? Like being under sedation?"

Therapist: "You'll remember this. One of the qualities of MDMA is that it makes it easier to face memories and not be overwhelmed and actually work through them and the painful emotions in a way that is healing rather than re-traumatizing. So that the very thing that you are afraid of, flashbacks and memories, come up spontaneously and overwhelm you, is really part of what we are trying to keep from happening to you by inviting whatever comes up to come up in a safe setting and with the medicine helping you to approach it without being overwhelmed. To approach your memories with less fear and less defensiveness.

Participant: (Sigh) "If that can happen ..."

Therapist: "We're here to support you in staying with what you're experiencing and encouraging you to not judge whether it's the right thing or the wrong thing, but experience it as fully as possible."

Participant: "Uh huh."

Therapist: "Ask for support in whatever way you need, if you want us to hold your hand or talk to us or us to hold you. All that we talked about. It's really good to ask for support if you feel you can. I know a lot of your tendency can be to tough your way through ..."

Participant: "Suck it up."

Therapist: "Today is an invitation and encouragement to let go of as much of that as possible. This is a whole day for you to have all the support you need, all the support you are able to accept and allow yourself to feel and work with whatever comes up rather than push it away or suck it up."

As the therapists give the medicine to the participant they explain that MDMA is known to increase feelings of intimacy or closeness to others and to reduce fear when confronting emotionally threatening material (Adamson 1985; Cami et al. 2000; Downing 1985; Greer and Tolbert 1998; 1986; Grinspoon and Bakalar 1986; Grob et al. 1996; Harris et al. 2002; Tancer et al. 2001; Vollenweider et al. 1998). They remind the participant that in the context of psychotherapy, a combination of drug effects may all serve to facilitate the therapeutic process and bring the participant closer to his/her treatment goals. These effects include enhanced positive mood, changed thoughts about meaning, increased access to distressing thoughts and memories, reduced anxiety and increased feelings of empathy or closeness to others, and decreased self-blame and judgment. This combination of drug effects should allow the participant to confront and examine memories of traumatic events and the effects these memories and related thoughts and feelings have had on his/her life without being overwhelmed by fear, anger, or shame. In preparation for the effects of the medicine, the participant is guided towards a relaxed state, encouraged to focus his/her attention on abdominal breathing and to set aside any expectations about what will or should happen during the session.