Episode 240: This week on Real Health Radio, I'm speaking with Dr. Adele Lafrance. We cover Emotion-Focused Family Therapy, which she co-developed, as well as the research and practice of psychedelic medicine, where we cover ayahuasca, MDMA, psilocybin and ketamine.
Dr Adele Lafrance is a clinical psychologist, research scientist, author and co-developer of emotion-focused treatment modalities, including Emotion-Focused Family Therapy. She is a leader in the research and practice of psychedelic medicine, with a focus on ayahuasca, MDMA, psilocybin and ketamine. Currently, Adele is the clinical investigator and strategy lead for a MAPS-sponsored study of MDMA-assisted psychotherapy for eating disorders. She is also a clinical trainer and supervisor for Imperial College Center for Psychedelic Research.
Dr. Lafrance has a particular interest in mechanisms and models of healing, including emotion processing, spirituality and family-based psychedelic medicine.
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Chris Sandel: Welcome to Episode 240 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/240.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist that specialises in recovery from disordered eating and eating disorders and helping anyone who has a messy relationship with food and body and exercise.
Today on the show, it’s a guest interview. My guest today is Dr Adele Lafrance. She’s a clinical psychologist and research scientist, author, and co-developer of emotion-focused treatment modalities, including emotion-focused family therapy. She is a leader in the research and practice of psychedelic medicine with a focus on ayahuasca, MDMA, psilocybin, and ketamine. Currently, addle is the clinical investigator and strategy lead for the MAPS-sponsored study of MDMA-assisted therapy for eating disorders. She’s also a clinical trainer and supervisor for Imperial College Centre for Psychedelic Research, and Dr Lafrance has a particular interest in mechanisms and models of healing including emotion processing, spirituality, and family-based psychedelic medicine.
I have been a fan of Adele’s work for a while now. I think I first heard her on Tabitha Farrar’s podcast and have been following her work since then. As part of this conversation, we talk about how Adele got into working in eating disorders, and she talks about some of the negative biases that she had prior to commencing this work, but then falling in love with it. We go into detail about emotion-focused family therapy and how Adele uses it with eating disorders. She believes in the importance of involving family and caregivers in recovery and explains how and why this can be so helpful, and she goes through the five components of emotion-focused family therapy.
Then we spend the rest of the conversation talking about psychedelics and how she became interested in them as a healing modality and the studies that she has and is involved in. Adele really is at the forefront of so much of the research with psychedelics and eating disorders, so it was super exciting to get to chat with her about this.
We had to wrap things up a little abruptly, as Adele had to shoot off for a Covid test. Despite all the time we had, there was just so much that we didn’t get to cover either at all or we only mentioned in passing. Adele has set up the Love Project, looking at research around love and the healing power of it; she has written and worked extensively with parents around raising children; she has a site called Mental Health Foundations that has a ton of information on it; she’s done work with schools with emotion-focused school support. So if you enjoy this conversation, just know that there are so many other wonderful things that Adele is doing that we didn’t get to cover, but I will put links in the show notes to her various sites and where you can find out more information about her.
During the call, I made reference to a documentary on MDMA-assisted therapy but blanked on the name of it. It’s called Trip of Compassion, and I’ve added a link to it in the show notes. I think it is well worth a watch. Adele also mentioned that the trial that she is involved in at Imperial College in London is still recruiting participants, and this is a pilot study looking at the use of psilocybin as a treatment for anorexia nervosa. I’ve put a link in the show notes to the study application page, which also covers the inclusion and exclusion criteria. So if you’re female and have been diagnosed with anorexia and you think you might be interested, then please check out the show notes for the link.
That is it for the intro. At the end of the show, I have one new recommendation for a book to check out, but for now, here is my conversation with Dr Adele Lafrance.
Hey, Adele. Welcome to Real Health Radio. Thanks for joining me on the show today.
Dr Adele Lafrance: Thank you so much, Chris. Happy to be here.
Chris Sandel: You are someone who has such a depth and breadth of knowledge when it comes to eating disorders, so I’m really excited to be able to chat with you today and share this information with listeners. There’s two areas I’d love to spend a good chunk of time on today. One is the emotion-focused family therapy and how helpful this can be in eating disorder recovery, and then the other area is psychedelics and their use in eating disorder recovery. I know you’ve been involved in a number of studies in this area, and it’s something I’m really interested in, so I’d love to find out more. But I want this to be a conversation, so let’s just see where things go.
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To start with, I think it would be good to give listeners a bit of background on yourself. Are you able to give a bio of sorts – who you are, what you do, what training you’ve done, that sort of thing?
Dr Adele Lafrance: Yeah, of course. I became a psychologist in 2008. At that time, I had finished a PhD in school and clinical psychology, school and child clinical, so I really expected to be working more in educational settings. But when I was doing my internship, I had to do an internship in an area I knew nothing about, so they put me in eating disorders. I thought, “Oh gosh, I don’t know if this is going to be a good fit for me. I’m really not into the therapy part so much.” I was much more focused on assessment.
And oh my gosh, Chris, I just fell in love with the work. And I really saw how much more was needed in this area. So my first job out of school, I decided that I wanted to work with an eating disorder programme, so that’s what I did. Then I guess within six months of working within higher levels of care, I started to think about how we could improve on some of the treatment programmes, and over the next five years or so developed emotion-focused family therapy for eating disorders.
Chris Sandel: What was it about the eating disorders that you fell in love with? What is it about that work that surprised you and then you fell in love?
Dr Adele Lafrance: I had a very negative bias towards eating disorders. When people talk about stigma with eating disorders in our culture, I know what they’re talking about because I had internalised that stigma myself. I really thought negatively, honestly, about the illness – but also about the people’s willingness to recover or seek treatment and so on. I’d been exposed to all the stereotypes, and unknowingly internalised some of them.
When I met these people and I started working with these people, these mostly young women and their families, what I saw was these were people who had love for life, but who were also struggling so much, but they were trying to find ways to get through tough times or get through difficult experiences. It completely reshaped my view. Often people talk about eating disorders and control, particularly in anorexia nervosa. Like “It’s a disease for control.” I just feel like, looking back, I thought, gosh, we really shouldn’t use that language. If I said to you, “Hey Chris, I heard you’re kind of a controlling guy”, I don’t know that you would take that very positively. In fact, I’m pretty certain you would take offense to that.
Chris Sandel: Yeah.
Dr Adele Lafrance: That in particular, I was interested in, what’s this whole control thing about? And what I realised, both through practice but also through research, was that this desire for control is about controlling one’s experiences of suffering. It’s not about controlling one’s environment or one’s loved ones. It’s that “I am suffering. I’m suffering so much that my nervous system is feeling out of control and it’s really hard to be in my body, so I need to find some way to get some relief.”
So those were some of the things that made me feel very passionate and very committed to helping. And then the other piece was the family piece. In the past, families were really seen as causal factors, in particular parents. I was being trained right at the beginning of the movement towards increasing family involvement for support, for symptom interruption and so on. Again, I had internalised that same bias, especially when I reflected on my courses early on in developmental psychopathology. A lot had to do with parents. When I was working in eating disorders, that field seemed to be more evolved than the other fields of mental health where it’s like, yes, there are factors that can contribute, but no, these are not causal factors. And yes, parents can be a huge part of the solution.
Anyway, the more I worked with parents, the more I saw how they were treated also, it thought, okay, we really need to do something here. So anyway, there began my commitment to working with eating disorders and trying to find better ways not just for individuals, but for families too.
Chris Sandel: It’s interesting; your comments about the control piece really make me think of the Gabor Maté comment around addiction. Rather than asking why the addiction, asking why the pain?
Dr Adele Lafrance: That’s right. Exactly.
Chris Sandel: Just using that as a point of reference and starting to really understand that this thing that can be completely debilitating for someone and can be causing huge amounts of issues for physical health, mental health, etc., is also someone’s solution. It’s a solution that in many ways works very effectively for someone despite all the collateral damage that is being caused. And being understanding of that and really trying to get a sense of, what is this really doing for someone?
Dr Adele Lafrance: Yeah, and also to underline, it’s never someone’s first solution either. People don’t just go to that solution first, consciously or unconsciously. It’s when people are feeling desperate and out of control and in serious pain.
Chris Sandel: With your biases, were they things that you’d had through growing up? Or they were more cemented when you started studying psychology?
Dr Adele Lafrance: I think it was a combination of media and also when I started studying psychology. Because I didn’t have any exposure to eating disorders growing up. I lived in a really small, very homogeneous village in northern Canada, so I don’t know that I would’ve adopted those ways of thinking that way. But I think for sure media messages would’ve played a role, and my training. My training for sure, in particular around the parenting piece.
Chris Sandel: You’ve been out of school for quite a while now; do you think that training has changed, or do you know if that training has changed?
Dr Adele Lafrance: I don’t know because I haven’t been exposed to other educational programmes for some time. I know that up until a few years ago, I was a faculty member teaching clinical psychology students, and I certainly was ensuring that the curriculum was evolved. So I think it’s getting better, but I think we have a long ways to go because when I do trainings in emotion-focused family therapy, I have the opportunity now to be exposed to thousands of clinicians each year in these settings, and I can tell from those experiences that we’re not quite there yet. People are working really hard, and we can only do the best we can given the information we have and the training we have, but we’re not quite there yet.
Chris Sandel: You said you had originally done a PhD. Were you thinking that you would be a research scientist and that would be your main thing?
Dr Adele Lafrance: No, in Canada you can do a PhD in clinical, which then prepares you for all different pathways. You can be a research scientist or you can be a registered clinical psychologist. I started off as a clinical psychologist working in eating disorders, but then after a few years I actually took an academic position so that I could do research in particular around eating disorders and emotion-focused family therapy.
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Chris Sandel: Doing research for “I have a real calling for research” or “I think this would be very practical to help me be a better clinical psychologist”? Or what was the reason for that?
Dr Adele Lafrance: Oh, I really had a strong call for research. I really see the value of research in terms of being able to change the landscape on a broader level. I also, of course, believe strongly in the reciprocal influence on clinical practice. But I see research as a vehicle for change, a vehicle for advocacy, and I really felt like there were some studies that I wanted to do in order to help change the conversation and eventually the way we practice, in particular with parents.
There’s one study in particular that I was really happy about that showed that when parents of kids / teens / adults with eating disorders engage in accommodating or enabling behaviours, they’re not doing it because they don’t get it. They’re not doing it because they’re not motivated to help. My research showed that when they engage in those practices, it’s because they’re terrified that if they don’t, their loved one will suffer so much that they might consider suicide, or they might totally block them from their lives.
That was the piece of research that I was the most happy about because it was scientific evidence that there’s no such thing as an unmotivated parent who doesn’t get it. There’s a parent who’s afraid and who’s paralysed by their fear and who’s engaging with their loved one in a way that makes them feel like it’s less risky than potential loss of relationship or death. And that’s huge. That’s so huge.
I was just on a consult call two weeks ago to do a little training for this group, and they were talking about a case and they were talking about it in the way that I really would like to evolve from. Like “Parents just don’t get it” or “They’re enmeshed” or this or that or whatever. I’m like, no, no, no, let’s not talk about it like that. Let’s talk about it more accurately, and thankfully, more compassionately. These parents are stuck in a bind. If you were presented with two choices – whether or not they’re real – do you want a sick kid or a dead one? Anyone would choose the same thing. Anybody.
Anyway, that piece of research was the one – I’m so glad I went back into academic for that period of time just for that study.
Chris Sandel: That’s huge. And I don’t work with kids; I work with adults, but I often have conversations with partners. I just feel for someone who is a partner of someone suffering with an eating disorder because it is so complex, and it’s so difficult to get your head around, what is the right thing to say and do? And there is the fear of saying and doing the wrong thing. So yeah, even with parents who have the best of intentions – I have a four-year-old child and I know how difficult it is.
Dr Adele Lafrance: Exactly.
Chris Sandel: So I do think less of the blame – and that research showing that there shouldn’t be the blame I think is all for the better.
Dr Adele Lafrance: And honestly, not just no blame, but many programmes – and by the way, this research was conducted along the lifespan, so it wasn’t just kids. It was partners, parents of adults as well. So number one lesson is no blame; number two lesson, though, is we tend to start working with parents / spouses with providing them with education. But what my research is showing is they’re scared. When someone’s scared, their capacity to learn is limited because the emotion is strong, and therefore it’s impairing their capacity to encode new information.
So when I look at psychoeducational groups or friends & family support groups, most often the first session or the first few sessions are psychoeducation. From an emotion-focused point of view, that doesn’t always make so much sense because if anything, we should be starting with tending to their fears. And really allowing them to speak those fears so that those fears can lose some power and they can regain some cognitive flexibility in the face of some of those more challenging situations.
That study that I talked about wasn’t just fear; it was also concerns around blame, how much they felt people blamed them, how much they blamed themselves, how worried they were about being to blame if they did take on a role in their loved one’s healing and it didn’t go well. That’s something that I feel like we don’t talk about enough, especially when we talk about parent empowerment programmes or caregiver empowerment programmes. It’s like, if it doesn’t go well, and the programme is based on empowering parents and spouses to support their loved one, how does that leave the family and what can we do to support them so they don’t end up internalising the blame?
Chris Sandel: Thank you so much for saying that. I’m going to keep this in mind any time that I’m having a conversation with a partner or a loved one and start there. That’s a really important point.
Dr Adele Lafrance: I’ll tell them that if it doesn’t work, it’s on us. We didn’t support them right, we didn’t have the timing right. We’re supposed to be the professionals figuring out the right algorithm for the right family, and if it doesn’t work, it’s on us. That’s one of the things I do.
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Chris Sandel: You’ve touched a little bit already on the emotion-focused family therapy. I guess it would be good to go into this in more detail. What is emotion-focused family therapy?
Dr Adele Lafrance: It started off as an adjunct to family-based treatment for eating disorders. I was working with teenagers in a day treatment programme, and I’ll never forget when the mom of one of our patients came in and talked to us about plates flying in the kitchen. There was just so much stress and distress around the mealtime. It was so uncharacteristic of this young woman, who was a straight A student, mild-mannered, never said boo to authority figures, and she’s throwing plates in the kitchen, for real, seriously. Like, danger. [laughs]
I remember feeling like, oh my gosh, I have no idea what to do here. What we were trained, or what I understood from my training, was just be bigger, stronger than the eating disorder. Just be a brick wall. But I did not feel good about that because I really worried, actually, about some families then having to eventually heal from the trauma of treatment. You’d see some families would drop out because they’re like, “No, this is traumatising. We can’t also be dealing with this.”
That’s when I really started seeking out, what else, what else, what else? I was learning about emotion-focused therapy at the time and I was being trained in emotion processing skills to support clients in individual therapy to move through big, intense, powerful emotions. I thought, okay, we need to teach parents these skills, and specifically we need to teach them in a way that will support mealtime.
So I worked with other people over the years, and we tried to language it in a way that would be appropriate for all levels of education, experience, so on. We developed this adapted model of what we call emotion coaching. For eating disorders, we start with the application of emotion coaching for meal support and symptom interruption because that ends up being one of the most important things. Then as that moves along in a good way, then we’ll start to target some of the emotion processing difficulties that are fuelling the symptoms.
I’ll give you an example. Many individuals with anorexia nervosa have really a very hard time with anger. So we would teach the parents, spouses, alternate caregivers these emotion coaching scripts to respond to resistance at mealtimes. Then we would also teach them emotion coaching scripts to support their loved one in their capacities to express anger. It’s pretty magical; when someone who has anorexia develops comfort and skill with the expression of anger, restriction is not as necessary.
We see the same thing as dramatically in individuals who self-harm. Anger ends up being a very powerful healing tool. But we have to do prep work with the family because in our culture, anger is seen as harmful, hurtful, or disrespectful. We do a lot of work with the family to be like, okay, this is why we want to work on this emotion, because physiologically it’s the opposite of anxiety, it’s the opposite of hopeless despair, and there’s this emotion theory that shows that if you activate two opposing emotions, they can neutralize one another. So anger is thrusting forward, anxiety is sulking back; if we can work with both of those emotions, then we can neutralize this experience, create calm, create inner peace.
So we’re teaching them the emotion theory as well as teaching them skills on how to work with anger in particular in a good way. So that’s one area of EFFT, the emotion coaching.
Chris Sandel: And are you doing this with both the parents and then also the client or the patient?
Dr Adele Lafrance: Well, we developed EFFT so that the client did not have to be involved at all if they didn’t want to. For a number of reasons. Many clients did not want to be a part of this work, so we needed to find a way for it to be okay. The other piece is that in Canada and the US, a client has to give consent to reveal personal health information to their parents and caregivers. It’s not like in the UK where you have legislation to protect caregivers’ rights. So we needed to develop a treatment that could be delivered to caregivers without any personal health information of the client being given, just in case. So it can be done with, it can be done without.
Chris Sandel: So you said that was the emotional support piece.
Dr Adele Lafrance: Right, the emotion coaching is the one module of EFFT. The other is behaviour coaching, but it’s most well-known in eating disorders where we encourage caregivers to support with the behavioural symptoms. That’s the meal support, the symptom interruption. But those two modules need to go together. The emotional support needs to go with the behavioural support so that we can avoid that need for the brick wall or high-conflict situations or even violence, aggression at the dinner table. And to preserve the relationship, frankly. It’s really tough to go through this kind of treatment.
So those are the first two modules. The third module is called therapeutic apologies. This is such a fascinating module for me because at first, we developed it to help heal relationships that were strained or estranged between parents and children so that the parents could then get more involved in the hands-on stuff. If the relationship was estranged, naturally we needed to do a little bit of that healing work to open the door for the other stuff. So that’s what we did.
But what we found was really beautiful. What we found is that when we supported parents to engage in a therapeutic apology with their child or their loved one, somehow not only did it strengthen or heal the relationship, but it also healed both parties from narratives of self-blame. The kid felt less to blame for the eating disorder, the parent felt less to blame for the eating disorder, and they felt more connected. That was very unexpected. So I’ve been working on that module maybe the most over the last five years, just tightening it up, strengthening it. It’s very powerful, and it’s very short. It’s not like weeks and weeks of work. It’s two to three sessions.
The other thing we found – and I’m sure some of your listeners who work with eating disorders can relate to this – even if a parent-child relationship was strong, if the child had an eating disorder that was really, really sticky, the one that’s more entrenched at the brain level, much more rigid – even if the relationship was strong, if the parent facilitated a therapeutic apology to strengthen the already strong relationship, it actually improved or made more efficient the parent’s efforts.
If you imagine a roadway between the parent and the child, and the roadway represents the relationship, if it’s a dirt road or a regional road or a highway, the efforts traverse more easily or with more challenge. If you think about it that way, it’s the relationship. I worked with a family where the relationship was like a highway. It was really wonderful. Parents’ supportive efforts would zoom over really well, really beautifully, really efficiently. But their kid had a very, very sticky eating disorder, so when we did the therapeutic apology, it upgraded the highway to a superhighway. Which meant that when the parents, even the therapists, were engaging with the patient, their efforts were more effective. It’s like a brain hack.
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Chris Sandel: In real terms, what does a therapeutic apology look like? How does that happen, what is it?
Dr Adele Lafrance: It’s an apology, as the name suggests, and it’s an apology that the parent or caregiver delivers to their loved one. There’s five specific steps, and they identify a pattern or an event that they feel could have impacted their loved one in a significant way, and they basically communicate an apology for how it went down, including validating different types of feelings: sadness, fear, shame, and anger.
Now, some people at the very beginning are like, “Wait a minute, how could you have a no blame approach but then ask parents to apologise for something?” I think that’s more of a cultural thing. In different cultures, apologies mean different things. In North American culture, apologies often mean responsibility, fault, whereas in some Asian cultures, apology means an expression of deep validation.
That was the first thing I needed to work out for my audience. I was like, okay, how am I going to communicate to a mostly North American culture that this therapeutic apology has nothing to do with blame, it has nothing to do with responsibility, it’s a deep validation?
So one of the conditions of doing this therapeutic apology is that the parent or caregiver must be able to hold in their heart that they did the best they could given their circumstances, given the information they were exposed to, given their own experiences, given the state of the literature, given the state of our clinical practices. They have to be able to hold that truth. So when we’re trying to help them to identify what they could apologise for, we’ll say, “Imagine on the day your child was born, they were given a crystal ball. With that crystal ball, you’re able to see the unfolding of all things, and you’re privy to all of the most up-to-date scientific information that we now have, and you have access to all the financial and social support resources that you could need. What would you have done differently?”
So it’s fantasy. It’s not reality. We’re not asking parents to say, “Man, I really should have done that, for real.” No, they did the best they could with what they had. This is an expression of deep validation.
Chris Sandel: And that makes complete sense, because you don’t know how things are going to turn out, and you are doing the best that you can. Hindsight is a wonderful thing, like, “Oh, I would now do this differently, but I now do this differently because I’ve seen the outcome that has occurred, I’ve now read a ton, I’m now experiencing all of these things that I had no idea were going to occur.”
Dr Adele Lafrance: That nobody knew. If you look at some of the advice that eating disorder professionals were giving 10-20 years ago… [laughs] Not so good. Or the medical community. No-one is spared here from this notion of ‘when we know better, we do better’. It truly is no blame, especially when we zoom out and look at the last three generations and our culture.
And also, these really deep validations can be so powerful. In fact, I wrote a standard apology that any human in a relationship in our cultures can deliver to another. I wrote that because, number one, I really believe in giving parents and caregivers scripts to be guided by so they can make it their own. I wrote that for that reason, but I also wrote it for them to see, this is really no blame. Anyone could deliver this apology to anyone else, and it’s about emotional unavailability.
At this time in our evolution as humans, it is impossible for us to be there for our loved ones in all of the ways because we need to feed ourselves, we need to void, we need to sleep in order to recharge, and then add the other pieces of our world – we have to work, we have to relax. So it’s’ actually physically, physiologically impossible for us to be there for our loved ones in all the ways they need, want, and deserve.
So I constructed this standard – ‘universal apology’ is what I call it – because we can all communicate it, and when someone receives an apology like that, it feels so good. The other side of this coin around apologies is that our culture has an aversion to apologies. Instead, they want to explain. Like, “Here, let me explain to you why this happened so that you see it wasn’t personal.” Unfortunately, the brain doesn’t work that way, at least not yet.
Chris Sandel: Yeah. I think the word before of ‘validation’ – when you hear an apology, you just feel understood and validated. Even if that’s not the other person taking full responsibility, it still hits you very differently.
Dr Adele Lafrance: That’s right. And the cool thing about the brain is that when we’re having a strong emotion, when we’re having a painful emotion, if someone else, if the external environment, can speak our internal experience, then automatically the brain’s alarm bells start to reduce in intensity. That’s why validation is so important and why I believe it’s such a worthwhile skill to learn, because that’s how the brain works.
If my brain is really scared, it becomes less flexible, it becomes more tense. But if you say, Chris, to me, “Adele, I can understand why you’d be scared because this is the first time that you’re doing this, and because the last time you did something similar, it didn’t go so well, and because you’re really worried about not being able to handle it” – some people think that has the risk of increasing the feeling of fear. But actually, the neuroscience of validation is showing it has the opposite effect. Speaking the fears creates a sense of togetherness, and it brings them down.
Now, you don’t end there; you then want to offer some emotional support, practical support, and that’s all in the EFFT model. But it’s a really different way of looking at response to emotion based on what we thought we knew.
Chris Sandel: Yeah, I know just the way you phrased it there is how I speak with clients as well. When I was reading through Emotion-Focused Family Therapy as part of the prep for this, the thing that jumped out at me as the big meta piece with this is just learning perspective-taking, and feeling like the other person genuinely gets a sense of what you’re going through.
And it doesn’t mean that you then have to jump in with that other person and both of you are then drowning, but where you have a sense of “I can get why this is so monumentally difficult for you, and that this feels like the scariest thing you’ve ever had to do, and that it completely sucks that you’re in this situation.”
Dr Adele Lafrance: That’s right, exactly.
00:37:23
Chris Sandel: And then there’s a fourth domain, which is the fears and obstacles.
Dr Adele Lafrance: Oh right, there are two more. So those are the three modules of intervention that we teach the caregivers: behavioural support, emotional support, therapeutic apologies. But then there are two more modules.
One relates to caregiver blocks. Remember I talked about earlier, when parents engage in ways that are problematic, it’s not because they don’t get it, it’s not because they don’t care, but it’s because they’re paralysed with fear or shame or in grief, some emotion that’s impairing their capacity to engage differently.
Whenever an emotion like that emerges and is interfering with their capacity to offer behavioural support, emotional support, or therapeutic apology, then we take a pause and we work on that block using different tools and techniques from the model. There’s almost a dozen different ways that we help parents and caregivers extricate themselves from that rock and the hard place. I think that’s the greatest value in EFFT – well, at least from what I’ve seen – there are few other models that tell you what to do when what’s supposed to be happening isn’t happening. [laughs] There are a lot of options.
But to take it one step further, the fifth and final module of EFFT is called clinician blocks. That module gets activated when the clinician is losing faith in the parent’s capacities or the client’s capacities for change, or they’re experiencing negative feelings or having negative reactions to the family, or they’ve lost courage to bring up the module on therapeutic apologies because they’re worried that it’ll be taken the wrong way, so they’re avoiding it. Any way that clinicians, consciously or unconsciously, interfere with potential recovery efforts or treatment.
And we’re all human. We all have the same kind of brain. It functions similarly. So of course if parents can get paralysed by fear and that affects the way they care for their loved ones, clinicians can, too. We see it all the time; we just don’t talk about it as much. So one of my goals with EFFT, in particular with the clinician domain, is to make it totally normal to talk about. Like, “Yeah, I got triggered by that family. And when I got triggered, this is how I behaved in a way that wasn’t necessarily so good for them.”
I feel like we’re doing a much better job as clinicians being able to talk about being triggered, but we don’t talk about the things that we do when triggered that are not flattering. Not nearly enough. I don’t hear enough clinicians saying, “You know what? I tried to discharge them early because I was really activated by them and frustrated by them.” So I feel like we have some work to do.
And that’s not the clinicians’ fault. That’s a cultural thing. We’re trained to be self-reflective but perfect. [laughs] I remember in PhD, I remember where I was sitting in the classroom because it stuck with me so deeply – the professor said, “You’ve got to leave your shit at the door.” First of all, I was kind of like, oh, she said ‘shit’, okay. Like, “Yeah, of course, you’ve got to leave your shit at the door, of course.” But then I remember having a moment five seconds later: how do you do that?
Now that I know a little bit more about the nervous system, it’s actually not possible to do that. For decades, clinicians have been ill-equipped to recognise triggers, but also to respond to triggers in a way that is compassionate, because if anything – for the first, I don’t know, few years, I felt totally ashamed. So we have work to do there, too.
Chris Sandel: Yeah, definitely. What you said there reminds me about some of the stuff that Brené Brown’s talked about with the shame response and how much that can completely hijack the way that you are in certain situations and the way you react. You’re completely right; the nervous system just takes over. I think we as humans are less in the driver’s seat than we like to think that we are.
Dr Adele Lafrance: [laughs] Yes.
Chris Sandel: And we are so at the mercy, so often, of things that are connected to things when we were growing up and the way we were parented, the way we got attunement or attachment – all of these things that we just don’t recognise how much they are having an impact, and we are then just in the situation. We are just in that state, and we feel like “Okay, it makes sense to be here” or whatever and that we’re in the driver’s seat and taking us there. But I think we are much more reactive than we like to think that we are.
00:42:56
Dr Adele Lafrance: And also, I’m going to point out something really subtle – I hope it’s okay. When you talked about what we’re affected by, you basically said our childhood and our parents. I would say our cultural conditioning.
Chris Sandel: Yeah.
Dr Adele Lafrance: Because then it takes it off the parents.
Chris Sandel: Sure.
Dr Adele Lafrance: It’s so subtle. But it really is about the cultural conditioning, because that’s how parents learn to parent, from their own experiences, but also, how did they get their own experiences? By the cultural demands that shaped their parents, etc., etc.
But you’re absolutely right. I feel very strongly that if we’re working in eating disorders, because they are high stakes, because they are high stress, clinicians need to be engaged in contemplative practices. Preferably some sort of psychotherapy, because you can’t be in those kinds of stressful situations where some people really are at risk of death. Because we get way more activated, and like you said, when we’re activated, we’re not in the driver’s seat.
Chris Sandel: Yeah. I take your point, and yes, what I was trying to say was just the environment we grow up in.
Dr Adele Lafrance: Totally.
Chris Sandel: It’s definitely not just parents. It’s school, it’s the media, it is everything. Yes, that has an impact on us in ways that we fail to see.
Dr Adele Lafrance: Yeah, and it’s war, too, it’s socio-politics. There are all kinds of things that have shaped us for generations that are not currently active right now. Look at the impact of war on emotion processing. People who are on the frontline are taught not to show vulnerability. And it’s good advice. But when those people go home and they’re traumatised and they see their toddler, their child, is crying or feeling scared, what’s their knee-jerk response from that trauma response? “Don’t show fear. Don’t cry.” And then these practices end up infiltrating the parenting context, and then they get passed down.
So it’s not just what’s currently active; it’s what’s come before us also. I think about people of colour who were marginalised or worse. If they showed anger, it could be a matter of life and death for them. So of course it would make sense that, through the generations, they would have transmitted these practices from a place of survival. So there’s a lot of clean-up to do in aisle 5 for all of us. [laughs] In terms of how we work with emotions. And it’s nobody’s fault. It really is nobody’s fault.
Chris Sandel: Yeah. It’s amazing how when we think about time, the generations aren’t that long ago. My grandfather was in the Second World War, and his dad before him was in the First World War. We’re not going back that far to hear about what happened as part of that and how horrific all of that was, and we knew so little about trauma and everything. That was just basically everyone’s experience. So yeah, it’s had such an impact for so long, and it feels like we’re at the real starting point of beginning to grasp this.
Dr Adele Lafrance: That’s exactly right. I wrote this quote to try to communicate what you’ve just communicated so beautifully for parents / caregivers around the therapeutic apology. I can’t remember exactly; it’s on one of my slides. But it’s: Apologising doesn’t mean you are to blame. It means you are willing to shoulder some of the burden of the generations past.
Chris Sandel: Yeah, that’s lovely.
Dr Adele Lafrance: To create that change for the generations to come. That’s what it means.
00:47:19
Chris Sandel: One of the things that is used I think as part of EFFT is block chair work. I saw on your site that you were doing training on that and talked about it as being one of the fundamentals or really important as part of it. So what is block chair work?
Dr Adele Lafrance: It’s an intervention that takes about 25 minutes, and it helps a parent or a caregiver who’s stuck in fear, who’s stuck in a problematic pattern of supporting their loved one, to get unstuck. We use chairs just because we need to activate different emotions so we can use their transformative power. It sounds kind of silly talking about it like that without seeing it, but the first thing – if a parent said to me, “I really don’t want to insist that my child eats the snacks in between. I’m worried that it’s going to be too much for her, that she’s not going to want to eat at all anymore, so I think I just want to do breakfast, lunch, and dinner.”
I’d be like, “Okay, come over here. Come sit in this chair. Picture yourself in the other chair and be the part of you that tells you, ‘Don’t do it. It’s too risky.’” And within 10 or 15 seconds, the caregiver reveals to us their deepest fear. “Don’t do it. It’s going to be too much for her. She’s going to get way too upset, and when she gets upset, she gets completely overwhelmed. She might kill herself. She’s tried before, and this time she might actually go all the way.”
So when we’re having the parent express their deepest fears like that in the presence of a supportive other, it naturally has an effect of reducing that fear. Then we’ll ask them to picture their child in the chair opposite them and let them know, “Sweetheart, I love you too much. I’m too scared. I can’t lose you. I’m not going to push you further than those three meals. We’re not going to do the snacks.” Then we have them switch to embody their child, to see what it’s like for their child to hear that. Oftentimes, it would be like “Oh, thanks, great. I don’t want that either. I appreciate you respecting my wishes.” [laughs]
But then when we ask the parent to see if there’s anything underneath that, to dig a little deeper, what’s often revealed is their child’s true wishes, which is “Yes, I need help. I will never be able to do this by myself. There’s a part of me that just can’t let myself eat, so I need you to really help me with these snacks, but I need you to do it in a way that is less like a brick wall or less forceful or less jarring.” So they get to the nuance of what the child needs in a way that I haven’t been able to replicate using other interventions.
Chris Sandel: Wow.
Dr Adele Lafrance: Then what happens is when the fear is out of the way, when you’ve named it, you’ve had it validated by your therapist – we’re not problem-solving it, but we’re just really, really deeply allowing that fear and validating it – what happens is the person has a capacity for flexibility once more, and for creative problem-solving and for empathy. And through that process of embodying their child, they get to re-engage with their caregiving instincts.
There’s many more steps, but there’s no part of me that’s saying, “I don’t think what you’re doing is right” to the parent. It’s like, let’s see why this is important and let’s see if we can’t find a third way. So that’s the objective: to work through the emotions that are driving the problematic pattern, but also resume flexibility and access to caregiving instincts so that they can find a third way, a fourth way, a fifth way.
Chris Sandel: Nice. In a sense, it’s “Let’s get all the cards out on the table and have a look at all of these different aspects.” I think the more you take the approach of “I’m going to tell you all the reasons why you need to do this for your child”, the natural human instinct is to then find the counterpoints and be like, “No, these are all the reasons I shouldn’t be doing this.” It then leads to more butting of heads or more of someone feeling more entrenched in that view as opposed to “Let’s explore this”, and as you say, “Let’s look at what’s underneath and why this is driving the desire to go in this direction.”
Dr Adele Lafrance: That’s exactly right, and it becomes even more intense when you as a parent think that the interventions the clinicians are suggesting might lead to your child’s death by suicide. I use that example because it’s the most powerful one, but yeah, it’s not just butting heads at that point. It’s like, “Stop trying to convince me to do something that I feel will lead to a much worse fate.”
Chris Sandel: It’s great that you’ve got a method of being able to do that. What you’re talking about here reminds me – I had a podcast interview with Josie Geller. Do you know Josie Geller?
Dr Adele Lafrance: Yes.
Chris Sandel: There seems to be a lot of overlap in terms of the way you guys speak and the way you think about this. She’s done a lot of great research around how to be supportive for the child as the parent and also as the provider and a lot of stuff on compassion. It was a really great conversation. It sounds like a lot of what I talked about with her is also what you talk about, but having it in a more practical way of like “This is the steps of being able to do this.”
Dr Adele Lafrance: That’s right, and teaching the parents those very same steps.
Chris Sandel: Nice. This is great. I also remember you saying that by doing this as well, from the eating disorder sufferer’s perspective, it then starts to decrease the alarm within them and that validation piece is so helpful in regulating their nervous system. As counterintuitive as that may sound, by speaking the fear, it actually helps to reduce everything.
Dr Adele Lafrance: Exactly, yeah. There are many different definitions out there of what it means to validate, so I just want people to know that this definition is a very specific, step by step technique. That’s what we encourage people to learn, for sure.
Chris Sandel: I know when looking at the research that you had on your site about this, a lot of it talked about a two-day intensive course. Is that how it’s normally taught, or is that how you’re normally teaching it?
Dr Adele Lafrance: No, we do all kinds of different formats because we do believe that a little bit can go a long way. For parents and caregivers, they can participate in three- or four-hour workshops or they can do the full two-day workshop or they can do a full course of therapy. And for clinicians, same. They can start off with a three- or four-hour workshop, do a couple days. I feel that this model is best learned with repetition over time. You do a little piece, integrate it, do another little piece, integrate it. Do a couple days, integrate it. Then it becomes much more internalised.
Chris Sandel: Nice. I think that’s great.
00:55:32
I want to now switch and talk about the second topic, which is psychedelics. How did you become interested in psychedelic research and the resurgence in psychedelics?
Dr Adele Lafrance: It’s funny because I have no history with psychedelics whatsoever. [laughs] I was not one of those teens or young adults who experimented with psychedelics. In fact, they scared the crap out of me. I wanted nothing to do with them because I knew that my brain was going to be my biggest asset in life. I wasn’t athletic, I wasn’t artistic, but I knew how to do school, so I really stayed away from any of those things.
But much like I developed EFFT – through desperation. Like I was saying earlier, I didn’t know how to handle these situations. They were serious situations. So that drove me to learn as much as I could about different aspects of the field of psychology. And then even with EFFT, we’re not able to reach everybody. I feel like we’re doing a really good job, but not everyone responds in the way we would like.
You mentioned Gabor Maté earlier; I was a huge fan of his, and I’ve read all his books, and he was presenting in my hometown. So I went to watch him present, and then someone in the crowd asked him a question about ayahuasca during the Q&A. He responded in an interesting way. He’s like, “I’m not really here to talk about that. We’re here to talk about trauma” – whichever topic it was, I can’t recall – he’s like, “But if you’re interested, there’s going to be a documentary airing this Tuesday on The Nature of Things” (which is a well-respected science show in Canada) “so you’re welcome to view that.”
I thought, oh my gosh, I’ve never heard that word before. I’d read every single one of his books. I went home, set the recorder for Tuesday, and I watched this documentary on ayahuasca, which is this Indigenous and very psychedelic plant medicine from the Amazon that’s been used for centuries. And he was using it with people suffering from really severe drug addiction and having some pretty miraculous results, from what I was observing. I thought, oh my gosh, this could work for eating disorders.
So I emailed him and I told him, “I’m a professor in Canada. I work with eating disorders, working on developing new treatments”, told him about EFFT. “I just saw this documentary. I need to know more. People with eating disorders and their families are suffering so much. We need new treatment options. Can you help?”
Chris Sandel: And how long ago was this? What year was this?
Dr Adele Lafrance: That was in 2013.
Chris Sandel: Okay.
Dr Adele Lafrance: He didn’t respond, so I wrote him again, because I could not stop thinking about it. Especially every time I went to work and saw patients. And he responded, and he invited me to attend a retreat he was going to be facilitating abroad. He invited me to attend both as a participant, so that I could experience it, but also as a mentee, as a trainee.
I was so scared. [laughs] I’d never done anything like that before. But I was actually going through a really hard time personally because I was struggling with going through IVF treatments, in-vitro fertilisation. I thought, well, okay, I’m going to give it a shot. So I went.
I had a very, very powerful experience – life-changing, as many people say. But the other thing that happened was that I observed that at least one-third of the people who were at this retreat had either full-blown eating disorders or a history of disordered eating, and the kind of healing I was witnessing in that eight-day retreat was mind-blowing.
I remember saying to Gabor at the end, “We need to do research for eating disorders.” He looked at me and he’s like, “No, you need to do research. That’s not what I do anymore.” [laughs] He’s advancing in his age / career. So I went home and I put together a research team of well-respected psychologists and policymakers and conducted our very first study on eating disorders, looking at people’s experiences with ayahuasca when they’d already been diagnosed with an eating disorder.
It was really great. Got a lot of press and got a lot of interest. Then Rick Doblin from MAPS, the Multidisciplinary Association for Psychedelic Studies, heard about my work and asked me if I would be the lead on a study for MDMA-assisted psychotherapy for eating disorders. Then through that work, I got connected with Imperial College to join as a collaborator on their study on psilocybin-assisted psychotherapy for anorexia nervosa. And then somewhere in between conducted a study on the potential of emotion-focused ketamine-assisted psychotherapy for eating disorders.
So you see, it was all very organic. [laughs] And now I’m involved in all this research. People consider me one of the leaders in psychedelic medicine for eating disorders, but it’s actually not true because we don’t know anything at this point. I shouldn’t say that; we’ve done a lot of work preparing for these studies. But they’re just now launching, so at this point we have speculations, we have theories, we have a lot of optimism, but we’re still at the very, very beginning of understanding what this potential might be.
Chris Sandel: Yeah. I’m very interested in this just because I have a huge amount of hope for this and see the potential for how useful they could be. I’m glad that there is this resurgence, I’m glad that they are starting to do studies around this. But yeah, you’re right, it is very much the beginning stages and doing studies with small amounts of people in the whole scheme of things. It’s going to be a number of years or more than that as things progress, but I’m hugely optimistic and excited about this.
Dr Adele Lafrance: Me too. I think we need to keep talking about the potential issues, that we can do it in a good way. Just this week I got an email from a group in Europe who want to start a study with young adults and one of the psychedelic compounds and they wanted my advice. I got a little flash of worry because I didn’t get the sense that anyone on the team was really embedded within the eating disorder field, and it sounded to me like they were developing a protocol that was just for the individual with the eating disorder.
The field of eating disorders has done so much in the last 25 years to show, demonstrate scientifically even, the importance of systemic involvement of families, loved ones. So I am a little tiny bit worried that we’re going to repeat some of those mistakes. So I guess what I’m saying is it’s a call to action for folks who are in the eating disorders field and who have been for a number of years to see if we can’t convince those in the psychedelic sciences to partner with us so that we can combine the best of what we’ve been able to learn and do in our field with these new compounds that are showing such great potential.
Chris Sandel: Yeah. I think that’s the thing people maybe need to understand. It doesn’t matter how powerful these substances are; it’s not just the substances. It’s that in conjunction with therapy. So yeah, I think that’s the thing people need to really get. And as you say, incorporating it into what you’re already doing and then having this be something that can, in the best case scenarios, really smash the doors wide open and speed things up.
Dr Adele Lafrance: Yeah, or gently open the door.
Chris Sandel: Or gently open the door. [laughs]
Dr Adele Lafrance: When someone’s been terrified of what’s on the other side of it. But both could be true. We just don’t know. That’s one of the things I’ve incorporated in all of the studies, or I’ve advocated for the incorporation of in all the studies I’m a part of: family involvement having a role. Because if the door does get smashed open, that’s really hard for the system, because there’s such a dramatic change, even if it’s positive. The system needs to be supported to adjust to that major change. So yeah, there’s still so much to consider and so much to reflect upon.
But like you, Chris, I’m very hopeful, in particular because I’ve gotten to know most of the researchers who are conducting these studies and not only is their heart firmly in the right place, they are really, really smart people who want to do this the right way. So there’s a lot of reason for optimism.
01:05:32
Chris Sandel: I think it would be useful to go through each of these separately and talk about what some of the studies are or what are some of the things you’ve seen as part of this. Let’s start with ayahuasca because that was your first experience with this. What research has been done so far with ayahuasca and eating disorders?
Dr Adele Lafrance: My team and I have published a couple of research studies on ayahuasca and eating disorders. We interviewed men and women who experienced ayahuasca and as a result of their experience of ayahuasca also experienced healing from an eating disorder.
Just broad strokes, what people talked about was that they experienced deep healing that was very meaningful, but that also was biopsychosocial and spiritual. The healing was not only embodied in that they experienced the healing throughout their body – and I’ll give you an example of that – but it was also holistic. It touched upon physical issues, it touched upon psychological issues, relational issues, but also spiritual issues.
I’ll give you an example. One woman shared that she’d had experiences in treatment of employing positive affirmations to help her get through difficult times, like “I am lovable, I am lovable, I am lovable.” Then she had an experience with ayahuasca where every cell in her body lit up with the knowledge “I am lovable.”
What she shared was that ayahuasca moves these truths from our minds into our bodies, into our hearts, so that they can never be shaken from us. That’s how she described it. Another way to describe it could be it reconnects us to our truth in our bodies, in our cells, in a way that can never be shaken. That was really wonderful.
There were some issues, though. Ayahuasca, you have to do a preparatory diet that is quite extreme for some. It also mirrors a diet that someone with an eating disorder might want to follow. Some of the participants did say that it was triggering, and I’ve since observed that over the years. People have struggled with the triggers of the diet. I’m always thinking about the practicalities, like, okay, when we’re able to lead our first ayahuasca retreat legally, then we’re going to have to build in some really good supports around the prep diet. Or we’re going to have to work with the ceremonial leaders to see which aspects of the prep diet are absolutely necessary and which ones we might be able to work with differently in light of these individuals’ challenges.
Then we did a follow-up study where we looked at interviews where the men and women had been in formal treatment and we asked them what was different about ayahuasca. A couple other highlights were that they talked about it being a lot deeper and a lot more efficient. Many, many, many people talked about the emotion focus of the symptoms also, and the fact that they couldn’t escape. One woman said it was the first time in her life that she was experiencing such profound emotional pain, including grief, and she couldn’t run away from it. She had to ask for help. She had to find her way through. And being able to move through that experience with support made it so that it kind of broke her phobia in some ways of these really, really challenging emotional experiences.
But again, the flipside of that anecdote is that it also speaks to the need to have really good support in place, and that’s not always the case. One woman we interviewed revealed that she was sexually assaulted at the end of the ceremony.
Those studies were really important because I feel like they showed us a lot about the potential, they showed us a lot about the risks and the potential dangers, which then will inform how we can create interventions that are safe and potentially extremely powerful. We’re just in the process of publishing a couple of other studies, one of which we interviewed ceremonial leaders of ayahuasca, so shamans, and we asked them about their experience treating eating disorders with ayahuasca, and what they see and what they know about this illness from a shamanic point of view.
This study has been absolutely fascinating because there’s actually a lot of overlap in terms of how conventional health care understands these illnesses, but there’s also some pretty significant disparities that I think we can learn from. The biggest one was around spirituality. Most of the shamans that we interviewed talked about eating disorders representing a spiritual void. When we look at eating disorder treatment centres around the world, very few have a specific and deliberate focus as a primary pillar of spirituality. I think in part it’s because there’s a lot of religious trauma around the world, so we don’t want to impose spirituality on people because of the harms that some religions have done to many people.
But in a way, we’re really, really missing out on a very important aspect of healing, and that’s the connection to something greater than oneself. When we look at the recent research that’s coming out of Johns Hopkins, Imperial, when we’re looking at end-of-life anxiety, smoking cessation, alcohol cessation, people who have these peak experiences are having experiences that are considered spiritual, that are considered transcendental, that help us connect to universal love or this experience of oneness. And that seems to be a big predictor of symptom reduction.
So whether or not we use psychedelics compounds, we’re already learning from the psychedelic research that conventional psychotherapy – conventional health care, even, not just for mental health issues but for physical health issues as well – we are missing this focus on spirituality in a way that feels comfortable for people.
Chris Sandel: I wonder if that connected to science feels like it’s the opposite of spirituality in talking about things like oneness or love or whatever feels – and it shouldn’t feel this way, but it feels like “That’s not scientific.”
Dr Adele Lafrance: That’s right, and that’s what we’re trying to change. That’s why I’m really active in this Love Project, looking at the scientific inquiry around love as a healing technology. Spirituality has already benefitted from this renaissance in terms of being seen as unscientific; now there’s several studies that are happening in the psychedelic world and outside of it showing this can be quantified in a way that makes sense to us, and it is predictive of possible health and mental health outcomes. So I’m really hoping, along with my colleagues, to do the same thing for love.
01:13:54
Chris Sandel: With ayahuasca in particular, because it has this long history and it’s done in a ceremony, is there going to be a situation where it becomes more Westernized? I don’t know what the goal is. Is it to move it into a different context, the way that you’ve been able to do research now with psilocybin or MDMA-assisted therapy? Or is it always like, “No, we need to keep it in that context”?
Dr Adele Lafrance: I think we can’t afford to exclude any and all possibilities. I think it’s the way we do it that will determine its integrity. I do think that we need to be informed by our native peers who use these medicines as part of their culture ceremonially to help us to figure it out. But I don’t want to exclude any possibility, because people are dying from eating disorders every day.
There’s controversy around laboratory experiments of ayahuasca versus ceremonial, and I’m thinking, yeah, we do need to consider how we do this; we don’t want to repeat the mistakes of our colonial past. And also, there must be another way. There must be a third way, a fourth way, a fifth way of bridging these medicinal contexts to be able to support our fellow humans who are suffering.
There’s this really, really beautiful prophecy. It’s called the Prophecy of the Eagle and the Condor. I really encourage your listeners to Google it. The prophecy states that after destruction from the Eagle People, who represent science, industry, productivity, and harm upon the Condor People, who represent heart and community and connection, that there will be a time where the Eagle People who took over will have become sick and in need of the Condor People’s help. That the Eagle People will go to the Condor People, with humility, asking for help, and that the Condor People, despite all that was done to them, would be willing to share their wisdom and their medicine.
This prophecy was written many, many, many years ago, and we’re actually at the beginning of the prophecy in terms of its coming to fruition. And we’re seeing it, which is really cool. The Indigenous people are opening up their hearts to Westerners to help us heal. They are wanting to teach us. Most of the ceremonial leaders that I interviewed for the ayahuasca study were trained by Peruvian elders. And right now, I’m learning a ton from Navajo elders here in the United States. These people, despite everything that has happened to them, are wanting to help. We just have to do it in a really, really good way.
And we’re learning how to do that. There are many more conversations about this topic than there have ever been. There need to be more, obviously. But it’s moving in a positive direction.
Chris Sandel: Nice. It’s interesting to hear you say that, because I recently read Michael Pollan’s new book on This Is Your Mind on Plants, and the final chapter is about mescaline, and a lot of that focused on the tension of “Should this be done by Westerners? Should we be even talking about this and focusing on this? Should they be allowed into ceremonies?” It felt, from reading that book, that it was a lot more guarded and there wasn’t as much openness.
Dr Adele Lafrance: I’ve had a different experience, and I don’t know why that is, but I’m hopeful.
Chris Sandel: Nice. That’s nice to hear, and is really positive.
01:18:27
Then what about MDMA? I know you’re the clinical investigator and the strategy lead for the MAPS study. Talk about your role in the study and what’s happening with that.
Dr Adele Lafrance: We’ve identified three study sites, two in Canada, one in the United States. We’re going to be exploring the potential of MDMA-assisted psychotherapy for anorexia nervosa but also for binge eating disorder, which I’m really excited about. We have FDA and Health Canada approvals. Unfortunately, because of Covid, we experienced some pretty significant delays, but we’re hoping to enrol our first study participants this spring.
There is a caregiver component, which I’m very happy about. Every study participant is also going to be accompanied by a caregiver – a family member or a close other who is also going to be involved in the study. Not receiving drug, but they’re going to be part of the prep session, some of them, and integration sessions. They’re also going to be provided with education and support, informed by EFFT, throughout the study protocol.
Chris Sandel: Nice. Will you be in sessions with people as part of that, or it’s more of an organisational role that you’re having?
Dr Adele Lafrance: I wear a few hats. One is in the study design. I’m also going to be a study therapist and providing some supervision to the team.
Chris Sandel: As part of this, with MDMA-assisted therapy, my sense from what I’ve read – there’s a documentary I watched which I’m blanking on the name of that was I think set in Israel looking at MDMA-assisted therapy. Do you know the one I’m talking about?
Dr Adele Lafrance: Yes, I do.
Chris Sandel: Do you know the name of it?
Dr Adele Lafrance: Yeah, it’s something about compassion.
Chris Sandel: It’s fine, I’ll add it in later. But from watching that, my sense is that the therapist is much more involved when someone’s on MDMA, and it’s much more involved with the therapist than with the ayahuasca. Is that an accurate take on it?
Dr Adele Lafrance: Yes, absolutely. With ayahuasca, it’s much more of an internal experience unless someone needs support. With MDMA, the relationship with the therapist is actually one of the most potent mechanisms of healing.
Chris Sandel: And how far off do you think it will be before MDMA is legalised for use in therapy? Are you thinking the next 5 years, the next 10 years? If everything goes –
Dr Adele Lafrance: MAPS has forecasted that in 2023, it will be legal for use in certain healing settings. We’re very close. We’re very, very close.
Chris Sandel: That’s awesome.
01:21:46
And then the psilocybin study at Imperial College, can you talk about that?
Dr Adele Lafrance: Yeah. I’m a collaborator on that; I’m not one of the main players. Meg Spriggs is our fearless leader, and oh my gosh, she’s been doing an amazing job. I can say what’s been said publicly is that they have completed a few participants. I can’t say more, though, about it, but I can tell you that we’re excited about things that are being learned as a result of that study. And I believe they’re still enrolling, so if people in the UK are interested and they believe they meet criteria, they can check it out online.
It’s a psilocybin study, like you said, and they’ve also included a caregiver, a support person as part of that protocol, which is wonderful. It’s going to be really great to have these two studies because MDMA and psilocybin are very different substances. We’re going to learn a lot about potential new treatments for eating disorders – more than what the field has seen in, I don’t know, maybe ever. In a very short while.
Chris Sandel: Do you know the study at Imperial College, is it similar to the one at Johns Hopkins? I had Natalie, who is the lead for the Johns Hopkins one for eating disorders on the podcast before, so she was talking about that and where they were up to. Is it a similar study?
Dr Adele Lafrance: Yeah, there are similarities for sure. The great thing about this is that sometimes in research, people hide their protocols, they don’t share their protocols, they stick to their own little corners – but with this, actually, we’ve had a couple – maybe more than that – meetings where we’ve come together to share, “What do you think about this? Which measures are you thinking about using? Which timeline are you thinking about using?” So whether it’s been as a group or in dyads or triads, it’s really been super collaborative, which I’m really proud of. I think that’s the way to go.
So yes, there are some similarities. Important to have similarities. But there also are differences, and that way we’ll be able to glean more from the studies because of that shared and unique potential variance.
Chris Sandel: Nice. Has MAPS given an estimation of when they think psilocybin will be legalised for therapy?
Dr Adele Lafrance: MAPS’s primary focus is on MDMA, so with psilocybin we don’t know. But last week in Canada, there was a major move by the government to approve psilocybin-assisted psychotherapy in some specific cases. I really think that if we predicted, we’d probably predict too far off because things are moving rapidly.
Chris Sandel: Wow. That is very encouraging.
01:24:52
Then the final psychedelic is ketamine. What research have you done around this? Or have you used it in therapy in your current practice?
Dr Adele Lafrance: I conducted a study with colleagues last year looking at a model that I developed, emotion-focused ketamine-assisted psychotherapy. It involves aspects of emotion-focused therapy, but also emotion-focused family therapy, so naturally we had caregiver support. It was a short-term protocol for people with anorexia nervosa. We also did a study with depression. People participated in ketamine, but they also participated in emotion-focused therapy. Their caregiver participated in a couple of EFFT sessions.
It was a safety, feasibility, and preliminary outcome type study, and what we found was that the ketamine was very well-tolerated. Participants found it to be very beneficial. But the caveat there was that they really found it to be beneficial in conjunction with the psychotherapy, and that the involvement of their loved ones was very much appreciated, and most of the loved ones who were involved talked about major benefits that they themselves experienced, personally.
We’re in the process of looking at that data and writing it up. It’s encouraging because ketamine, though it’s not considered a psychedelic – it’s a dissociative anaesthetic – at the right dose, it can offer psychedelic experiences, which can be meaningful if held in the right way. And it’s much more accessible. I would say, though, that from what I’m seeing more broadly in clinical practices, ketamine is being used more as a medicine, not as a substance that assists psychotherapy. So I’m really hoping that as time goes on, as we continue to evolve, it steers more clearly in that direction.
Chris Sandel: When you say more as a medicine, you mean the ketamine is being administered and then it’s like the ketamine does the work and that’s it?
Dr Adele Lafrance: That’s right.
01:27:20
Chris Sandel: So far we’ve talked about psychedelics and eating disorder recovery, but obviously they can be used for so many other things. I know your focus so much is on eating disorder recovery, but you’ve obviously had your own experience with ayahuasca. Do you feel like this will be something that will become – again, if all the research goes in the right direction – much more commonplace in psychotherapy or psychology more generally?
Dr Adele Lafrance: Absolutely. There are so many studies that are being conducted in different areas of psychology. Right now, in order to get FDA approval, you need to have a diagnosis. You have to have a clearly specified diagnostic indication. But I’ve been seeing it in all kinds of different ways; the potential is far broader.
However, not everyone needs psychedelics. Not everyone responds well to psychedelics, either. So I think that our work is going to be in identifying what works for whom and having algorithms to establish that. Even I think about people who have a high, high level of anxiety. I probably wouldn’t suggest ayahuasca as a first step. I’d probably suggest something like MDMA so that they can cultivate inner safety and trust with others.
So I think we’re going to be having to think about all these questions. But first we need to look at safety and then feasibility, and then we’ll start to look at outcomes and how to understand the outcomes based on different clinical populations, but also personality characteristics, inner/external resources, factors like that.
Chris Sandel: I think it’s the same as with lots of different types of therapy. There’s lots of different things you can do for trauma. It’s not to say that we need to find the one to rule them all; it’s more like what people respond best to this one versus this other one, and having that as a tool available.
Dr Adele Lafrance: That’s right.
Chris Sandel: Again, from reading Michael Pollan’s work and from my own personal experience, I do think this would be useful for – I think it’s also a strange thing to say ‘healthy normals’ because the reality is everyone has their own shit that they’re dealing with. Just because it hasn’t reached some degree that is diagnosable or they haven’t been able to articulate it in a way that means that they’re getting labelled in a certain way, doesn’t mean that everyone’s not walking around with stuff they’re dealing with.
Dr Adele Lafrance: Yeah. I just participated in an MDMA-assisted psychotherapy study as a healthy normal. I was the participant. I took the drug. And there was not a shortage of material. [laughs]
Chris Sandel: [laughs] Exactly. But there is a part of me that wants it to then be available for that as well. It’s not just at the extreme end of things.
Dr Adele Lafrance: That’s right.
Chris Sandel: This has been a fascinating conversation. I feel like we’ve barely scratched the surface on so many things, and there are so many other areas I had that I would love to have chatted with you about. But thank you so much for your time. Where should people go if they want to find out more information about you?
Dr Adele Lafrance: They can check out my website, www.dradelelafrance.com. There are links to the descriptions of the different studies, links to the different resources, including trainings if they’re interested. That’s probably the best place. Thank you so much for having me, Chris. It’s been a delight to chat with you. I really appreciate your openness and your enthusiasm about these alternative treatment models.
Chris Sandel: Perfect. Thank you so much for your time. I hugely appreciate it.
So that was my conversation with Dr Adele Lafrance. She is doing just incredible work, and I highly recommend checking out the show notes for all the links to her books, her various websites, and the link for the psilocybin trial at Imperial College for anyone who may want to apply.
01:31:48
I want to make a recommendation for something to check out. There was a while when I was doing this at the end of every podcast episode and then it fell away, but I want to bring it back. A couple of weeks ago I released my end-of-year roundup for 2021, looking at my favourite books and documentaries, and as part of this I made a request for listeners to get in contact and share with me your favourites. Many of you did, and it’s been awesome to hear what you enjoyed. I bought some of the suggestions so far and added others to my Amazon list. So I intend to get through many of them this year.
One of my clients actually shared with me her reading list for the last two years and asked if I had read One Long River of Song by Brian Doyle. I hadn’t, and I wasn’t aware of who Brian Doyle was, but I bought it this week. It turned up, and I have been blown away by it. It is a collection of short stories and essays and poems, and it is just simply beautiful.
He has this unique way of writing with very long sentences – sometimes a whole page is just one sentence – but his choice of words and his descriptions are just gorgeous, and the content is beautiful as well, talking about the natural world and parenting and love and grief and nostalgia and so much more, and just weaving all of these things in together. I had many moments of reading it being on the verge of tears, and then moments later having genuine laugh-out-loud moments.
He really has a style all to his own, or at least that’s the way it appears to me. Maybe I just need to read more and then I will find other people that he is like, but at this stage, I can’t think of another author to really compare him to. I’ve nearly finished the book in a matter of days and will be ordering more of his writing as soon as I’m done. So if you’re looking for something beautiful and moving to read, then please check out One Long River of Song by Brian Doyle. And thank you, Elizabeth, for your recommendation. I will definitely be making my way through more of the books on your list.
So that is it for today. I will be back next week with another episode. Have a good week, and I’ll catch you soon.
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