At InnerMost, our mission is to bring the highest standards of safety, compassion, and clinical excellence to psychedelic-assisted therapy. Today, we’re proud to share a milestone that reflects this commitment: our Chief Medical Officer, Dr. Casey Paleos, has co-authored a pivotal chapter in the American Journal of Psychiatry, one of the most respected and influential psychiatric journals in the world.
Co-authored with Michael D. Alpert, M.D. and Chantelle Thomas, Ph.D., the chapter, titled “Inner-Directed Therapy in MDMA-Assisted Psychotherapy,” arrives at a decisive moment for the field. As MDMA-assisted psychotherapy continues to be evaluated for federal approval, this work provides critical clarity on the therapeutic model at the center of decades of clinical trials: Inner-Directed Therapy (IDT).
For years, IDT has served as the therapeutic backbone of clinical trials investigating MDMA for PTSD, including the Phase 3 studies that demonstrated remarkable outcomes and comparably low dropout rates. Yet the model has recently come under scrutiny from outside commentators, many of whom misunderstand its foundations or conflate it with isolated incidents of unethical practice that violated—not exemplified—the model.
The chapter addresses these misconceptions head-on, offering a rigorous, evidence-based synthesis of IDT’s safety, structure, and clinical impact. Notably:
Rather than encouraging specific types of experiences, IDT equips patients to meet whatever arises—emotional, somatic, relational, or nonlinear—during MDMA or placebo sessions. The model honors autonomy, builds resilience, and supports individuals in connecting with their own capacity for healing.
This chapter goes beyond clarification. It lays groundwork for the future.
As the field stands at a crossroads—especially following the FDA’s 2024 request for additional data—this comprehensive, scientifically grounded articulation of IDT will influence how future studies are designed, how safety and ethics are taught, and how therapists are trained for years to come.
Educational programs, training institutes, and clinical researchers will look to this chapter as a reference point for what safe, effective, patient-led care looks like when paired with MDMA.
Dr. Paleos’s contribution to the American Journal of Psychiatry is more than a publication—it’s a testament to the standards we uphold at InnerMost: integrity, scientific rigor, and a deep respect for each person’s innate healing capacity.
As we continue providing ketamine-assisted therapy in New York City, we remain proud that our work is guided by leaders shaping the very future of psychedelic medicine.
👉 If you’re curious about whether ketamine-assisted psychotherapy is right for you, you can explore our services here or reach out to schedule a consultation.
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