Frontline clinical psychologist answers the big question: when the patient’s tripping balls, when does the therapist definitely need to get involved?

‘This level of reality should be the new standard being applied to therapy in general’ says a Vital cohort colleague in praise of Dr Lafrance’s theoretically informed approach.

“It’s different to how we were trained!” replied the respected frontline clinical psychologist. Like you can read about in the Approach section this issue, she combines emotion-focussed therapy with a ‘theoretically informed’ style taking cues from lived experiences received in the treatment rooms.

This not only contrasts with bureaucratic doctrine, that favours centralised top-down wisdom… which can take decades to catch up with what’s happening on the ground.

It’s also at odds the non-directive or ‘inner directed’ approach pioneered by Dr Stanislav Grof (for it is he) which insists on more delicate interaction with the therapist during the psychedelic experience itself, to encourage a more detailed internal dialogue. 

“I do warn them in advance that they’ll be more aware than I am”

That’s the the way psychedelic therapy is going though, Dr Lafrance claims.

Those of us who were only just getting the hang of being non-directive may be left a-flutter by this sudden change in er, direction. So Dr Lafrance has kindly detailed the when’s and why’s of sticking your oar in during the voyager’s experience. 

“We still intervene in a relational, emotion-focused, and inner-directed way,” she comments in her Vital lecture profiling the emotion-focused, theoretically informed style. 

Dr Lafrance’s reasons for chipping in? Conflict with parts of the self. Maladaptive emotions like anxiety and self-criticism. Anticipated shame and regret, along the lines of ‘I can’t believe I told you that, it’s supposed to be a secret.’ And, reluctance. 

Each must be handled gingerly, and always in the context of the medicine experience – hence ‘inner directed’ still, prompting the patient to look inside themselves, still.

To confirm if your planned intervention is indeed worthwhile, confer with the handy acronym WAIT – ‘why am I talking?’

“We make a deal in the container that I’m always fine”

For instance: when confronted by the thought of a sober therapist and spangled patient, an old tripping pal of mine asked, “What happens when they realise they’re taking care of you?”

He was offering up a psychedelic riddle-cum-truism. But it does happen according to Dr Lafrance albeit more prosaically. 

“I do warn them in advance that they’ll be more aware than I am,” says Dr Lafrance, “We make a deal in the container [agreed-upon boundaries of behaviour while tripping] that I’m always fine.” Because when patients suddenly start insisting that you go outside for a smoke, grab a coffee, or take some time to yourself “it can be reassuring to just say that you are” says Dr Lafrance.

“But it can be more rewarding to go into that place,” she advises, “is there a process of caretaking that needs looking into?’ Tell them that you’re always comfortable, they don’t need to worry if you’re hungry because it’s been four hours.”

Otherwise, go get that brew now “Or it may feel like a violation.”

Uncharacteristic behaviour can be examined by gently pointing out that “It’s so wonderful to get to know this part of you… feels like it’s a part that really need to show itself?”

That attentive, experience-led vibe seems to be sweet spot of ‘theoretically-informed, inner-led, emotion-focussed therapy.’