Family members can play a crucial role in psychotherapy, particularly in approaches that involve family therapy or systemic interventions. This involvement helps address relational dynamics and enables better communication, healing, growth, and problem-solving skills within the family unit.
“…The role of the caregiver is very much regarded as important and for so many reasons, not just to create healthier home environments for the person struggling with the mental health issue, but also to leverage the incredible healing potential that exists in families.”
— Adele Lafrance, PhD
In addition, a supportive and understanding family environment can significantly improve the effectiveness of therapy. When referring to family, this could be family of origin, chosen family, or a blend of the two.
What do we know about the roles family members play in psychedelic healing? We spoke with Dr. Adele Lafrance to learn more.
Dr. Adele Lafrance is a clinical psychologist, research scientist, author, and co-developer of various emotion-focused treatment modalities, including Emotion-Focused Family Therapy (EFFT).
Adele is a frequent keynote speaker at professional conferences and has published extensively in the field of emotion and health. The American Psychological Association published her clinical manual on EFFT. She also offers continuing education training and workshops for clinicians and educators.
Adele is a leader in the research and practice of psychedelic medicine, focusing on substances like ayahuasca, MDMA, psilocybin, and ketamine. She has past and present affiliations with MAPS, Imperial College, SoundMind, Vital Psychedelics, and more. Adele is also a founding member of The Love Project.
Her interests include mechanisms and models of healing, such as emotion processing, spirituality, and family-based psychedelic psychotherapy. Adele frequently contributes to media discussions on emotion, health, and the science of psychedelics.
Adele’s Turn Into Family-Oriented Psychedelic Research
We asked Adele to share with us when how she became involved with psychedelic research. At the time, she was a psychologist with a faculty position as well as a clinical role in a hospital. She was working primarily with individuals with eating disorders and developing a family-based model of healing. Adele shared:
“[M]y life took a turn towards the research of psychedelics in part because I was so interested in the exploration of new healing modalities for people struggling with eating disorders.”
Becoming Interested in New Healing Modalities For Eating Disorders
She saw many people—despite everyone’s best efforts—who were not able to free themselves from the grips of the illness. Then she started hearing about the work happening in the psychedelic space and thought it was worth looking into.
She was developing a family-based model of healing that specifically includes close others in healing modalities across the lifespan. Adele advocated for this new approach because she recognized the value and importance of family involvement.
Role of the Caregiver in Eating Disorder Treatment
Adele explained that a caregiver’s role in treating teens and adults with eating disorders differs notably from general mental health. She explained:
“[In the eating disorder world], the role of the caregiver is very much regarded as important and for so many reasons, not just to create healthier home environments for the person struggling with the mental health issue, but also to leverage the incredible healing potential that exists in families.”
Need for Community Models of Care in the Psychedelic Space
When Adele entered the psychedelic space, she was really surprised about the degree individuals were the work’s focus. Adele explained:
“None of the [psychedelic] trials at that time had any systematic involvement of close others, whether a partner, a romantic partner or a family member, despite the fact that we would hear that the person in the trial’s healing trajectory could have a major impact on the system, including activating what I refer to as ‘serious systemic disruptions.’”
Adele shared that conventional healing modalities are evolving from the influence of White, Western, and European dominant cultures. During this time, she emphasized that we need to look at community models of care. She emphasized that we need to leverage the potential benefits of involving close others for everyone’s sake. There are many reasons we need to think about family-oriented psychedelic healing.
Adele explained that people often talk about involving close others as a form of harm reduction. For example, people don’t heal when returning to a challenging environment. However, she wants to extend the conversation a lot further than that.
Support systems must be in place for a loved one who is coming home from potentially life-changing experiences. But it’s also a skill to receive someone in a post-psychedelic session state. With support and direction, family members can do so much to support their loved ones. This support is sometimes in a manner that is more effective than the “experts.”
Furthermore, “When someone really close to us is healing, it can kick start processes within us too. And we need support, and we deserve support,” explained Adele.
What is Emotion-Focused Family Therapy (EFFT)?
Emotion-Focused Family Therapy (EFFT) is a therapeutic approach that leverages the healing power of families to support a loved one struggling with a mental health issue. EFFT integrates principles from emotion-focused therapy and family therapy.
EFFT actively involves family members in the treatment and recovery process of an individual dealing with mental health issues. Some examples are depression, anxiety, or eating disorders with a focus on various home-based interventions. This collective approach can also help address underlying family dynamics that may impact the individual’s well-being. For example, EFFT teaches parents and caregivers to become effective emotional supports for their loved ones of any age. This support involves recognizing, validating, and responding constructively to loved one’s emotional experiences in support of their emotional health and emotional resilience. They are also supported to provide their loved one with behavioral support as needed.
The therapy addresses and works to heal relational wounds within the family. This healing process includes past and present emotional injuries that may contribute to current issues or conflicts. As a result, it can help create a more supportive and understanding family environment. EFFT also identifies and addresses any emotional blocks or barriers caregivers may have in effectively supporting their children. These barriers can include their own unresolved emotional issues or fears.
EFFT aims to create a nurturing and emotionally supportive family environment where each member can thrive emotionally and psychologically. Through this approach, families learn to communicate better, resolve conflicts, and support each other’s emotional growth and healing.
How Emotion-Focused Family Therapy (EFFT) Applies in Psychedelic Settings
We asked Adele to explain how Emotion-Focused Family Therapy applies in psychedelic settings. She first clarified that EFFT isn’t the only way that we can be more intentional about the role of close others in the context of psychedelic medicine. However, it was developed specifically to offer support and skills to family members of someone struggling with a mental health issue. EFFT fits nicely with psychedelic therapy. Adele said:
“[EFFT] is not your traditional family therapy where you might have all members of a family in one session talking about a shared goal of communication…I mean, you can do that with EFFT. But more often its application involves offering specific types of support and opportunities for skill acquisition to people surrounding an individual who is receiving treatment or receiving care of some type.”
Adele shared that they’ve incorporated EFFT into two clinical trials so far. More trials will be coming that aim to increase the potential for optimized outcomes. However, these also decrease the potential for problematic disruptions within the system as a normal side effect of healing. This is especially true when healing happens in quite a dramatic manner.
EFFT Skills for Close Others and Clinicians
Adele explained that the EFFT model teaches parents, partners, and close others a range of skills. These skills include behavior support, emotional support, and skills to strengthen relationships.
Suppose a close other is activated by the healing or struggling with their own processes. In that case, there’s a module whereby they can receive very targeted support. This support aims to help them extricate themselves from that “rock and a hard place.”
Likewise, if the clinician feels activated by the person receiving care or a family member, then there’s a module embedded within the EFFT model for them. This embedded model guides the clinician in processes of self-inquiry, self-supervision, and peer supervision. They can tend to those activations that are more likely to occur with more people involved in the treatment model.
Find More of Adele’s Work:
- Enroll in Family Matters in Psychedelic Therapy: Maximizing Outcomes & Minimizing Systemic Distress
- Learn About Psychedelic Therapy for Eating Disorders
- Watch Adele’s Talk About Family Matters in Psychedelic Therapy in Our Monthly Speaker and Professional Networking Series
The Role of Families in the Psychedelic Healing Process
We asked Adele to dive into examples of the role families and close ones can play in the psychedelic healing process, including the preparation, treatment, and integration phases. Adele explained that one can consider close others to a greater extent in many ways.
Preparation Phase
The preparation phase can include letting close others know what to expect. For example, the clinician can prepare their expectations about the medicine as well as the protocol. This includes that they can expect that healing can lead to potential positive changes, but it can also create challenging situations in relationships and within the system.
Response to Expressions of Healing
Adele shared that in one of the trials, they prepared the close other for the emergence of new ways of being with their loved ones. For example, this may mean that their loved one will connect more to feelings of assertion, empowerment, and possibly anger. They may even notice their loved one standing up for themselves on topics where they didn’t have the courage to do so before. Adele said:
“We let [close others] know that expressions of assertion or even anger can be beautiful signs of healing. And when they’re inoculated, then they’re much better able to respond to such expressions of healing.”
Adele clarified that she does not refer to destructive anger or rejecting anger when she talks about anger. Instead, it’s about healthy, assertive, and empowered expressions of self-worth and self-determination. It’s important to teach close others the difference between them.
Post-Experience Support for Close Others
Clinicians teach close others skills for receiving their loved one post-experience. These skills include what can be helpful and what to avoid during the first 24 to 48 hours and beyond.
They receive skills to respond to emotions or emotional material that might come up. Emotion coaching is one of the modules from Emotion-Focused Family Therapy. It’s a very structured tool offered to help them respond to emotions that might otherwise leave them feeling stuck.
Clinicians also offer family members support, skills, and resources so they know where to turn if they experience issues with what’s going on. For instance, their loved one’s healing work may inadvertently activate something inside them. They may really struggle with their own process of integration. Adele adds:
“We support [close others] for their sake, but we also support them for their loved one’s sake. So it’s very much a dual focus.”
Important Considerations For Involving Family in Psychedelic-Assisted Therapies
We asked Adele to share some risks and considerations when involving family and close others in the psychedelic healing process.
Psychological and Physical Safety
Adele stressed that psychological and physical safety is number one when considering the involvement of families in psychedelic therapy. This priority includes cultivating safety through various means:
- Engaging in a deliberate process of deciding who, what, and where for family involvement
- Requiring specific clinician skills, including prior education and/or training in systems theory and interventions
- Ensuring the loved one and their family member are adequately resourced and supported
Clinician Training
There is another factor that needs to be considered when involving family members in psychedelic sessions. This consideration is whether or not the clinician has the skills and experience to navigate the therapy. When you have more than one person involved in healing, challenging dynamics can often emerge.
“When someone really close to us is healing, it can kick start processes within us too. And we need support, and we deserve support.”
— Adele Lafrance, PhD
Adele clarified that it doesn’t mean there aren’t characteristics in family members that would make their involvement more or less risky. However, she sometimes hears clinicians discuss who is appropriate or not for family-supported healing work. There tends to be an overemphasis on client factors like these for those who don’t have training in systems work. Adele gave the example that her marital and family therapy colleagues wouldn’t experience the same challenges as other clinicians trained solely in individual modalities. Adele said:
“So I feel that training is essential…we can benefit from learning from our colleagues who have more conventional training, let’s say, in marital and family therapy to help bridge some of those gaps. That being said, regardless of the clinician’s level of training experience or expertise, safety always has to be number one, and that refers to psychological safety, and that refers to physical safety.”
Deciding on Which Family Member to Involve
Adele explained that someone may feel like the involvement of a specific close other is too risky. In such an instance, we invite them to consider bringing in a close other who doesn’t feel so risky. It doesn’t have to be the person with whom they are the closest. However, she shares some of her experiences with doing this. Adele added:
“I have observed and experienced individuals who participated in powerful and life-changing retreats without the support of their primary caregivers or the support of their primary relationship, and it didn’t always go so well.”
The pre-work can be incredibly helpful whether or not a family member or a close other will be involved in any significant way.
Adele’s Thoughts On the Evolution of Mental Health Interventions
Lastly, Adele shared some thoughts on how mental health intervention will evolve towards a more family-oriented approach. Adele shared:
“I think part of re-indigenizing mental health interventions, at least in the global north, is going to be a movement towards being more intentional about learning from other cultures who are more family-oriented and enacting those teachings into how we provide care, whether it’s formal clinical care or in the context of personal use.”
She spoke about the contrast between Western approaches in mental health delivery and traditional Indigenous models of healing. Adele adds:
“It can be really helpful to contrast where we’re at in North America with traditional indigenous models of healing…to really allow ourselves to sit with those tensions to not just decolonize our practices, but also our minds. In North America, there are so many rich family-oriented cultures from which to learn.”
Individual Models and Group Models
Adele hopes that the individual models of healing with the doctor or expert will fade away. Adele adds:
“We are seeing more group models emerging. And many people are touting their benefits, not just in terms of the psychological benefits of group work, but also the economic benefits of group work.”
However, she wanted to offer some words of caution in this transition. For instance, we bring people together who were strangers not long before. They then go through these vulnerable and powerful experiences of healing and growth together. They create this beautiful community which is—as some people say—just as much the medicine as the medicine they’re taking. Then they go back to their partners, families, and/or friends, who they may experience as more disconnected in contrast. This potential creates more dramatic opportunities for systemic disruptions and even relational breakdown.
Adele shared that in some conventional couples literature, this is referred to as iatrogenic divorce or therapist/therapy-induced divorce. Sometimes, we rationalize it. For instance, we often say that the relationship wasn’t meant to be. Or, we may say that the partner wasn’t invested in our healing or was unconsciously invested in our pathology. Adele explained that sometimes those elements may be present, but there are other factors to consider. Adele shared:
“When we do not prepare systems for dramatic change, then we may be unintentionally increasing the likelihood of systemic disruptions at the minimum and relational breakdowns at worst.”
