Below is an excerpt from the 2019 edition of Internal Family Systems Therapy - 2nd Edition.
Since 2008, Michael Mithoefer and his colleagues have been studying methylenedioxymethamphetamine (MDMA) (called ecstasy on the street) in conjunction with psychotherapy as a treatment for post-traumatic stress disorder (PTSD). More than 1100 individuals have received MDMA in phase 1 or phase 2 clinical trials so far without any unexpected drug-related serious adverse events (Lancet, 2016, p. 4). Because of the remarkable success of these first two studies, phase 3 trials are now underway with a multi-site, muti-million dollar study. The protocol for these studies includes some preparatory sessions before the client takes MDMA, followed by two 8-hour MDMA sessions, followed by some integration sessions and a follow-up session two months later.
Why is this relevant to IFS? Before the first trial, Mithoefer, who is a well-trained IFS therapist, as is his wife and co-therapist Annie, created a manual with his colleagues that instructs participating therapists to allow the individual’s own healing intelligence determine what will happen by following the subject’s lead and maintaining a largely non-directive stance during each 8-hour MDMA session. They soon discovered that, left to their own devices after taking MDMA, their subjects quickly accessed a state characterized by the emergence of what IFS calls Self-energy: curiosity, courage, clarity, connectedness, and compassion. Although it remains to be discovered why this occurs, the effect of MDMA on the amygdala (activity decreases) and the prefrontal cortex (activity increases) may be a factor.
While the study’s manual called for a non-directive approach, it allowed for the therapist to switch to IFS if subjects spontaneously began
working with their parts. As the subjects accessed their Self, the vast majority spontaneously began to speak about and interact with their parts. As a result, training sessions for participating therapists began to incorporate videos of subjects talking about their parts, and the study’s therapists were encouraged to educate themselves about IFS and be open to the psyche being multiple so that when subjects spontaneously identified parts the therapists could continue in an IFS manner.
In a recent study of veterans, firefighters, and police officers with PTSD Mithoefer used a “Parts-work” measure that he developed for an additional internal pilot study to compare the rate at which participants spoke of parts during MDMA sessions. The pilot study revealed that awareness of parts had come in in 78% of the active-dose MDMA-assisted sessions. In addition, the therapists observed marked increases in qualities that signify Self-energy in 92% of active dose sessions compared to 29% of low dose sessions. With the increase in Self-energy came “greater understanding and acceptance of these parts” (2013, p. 14).
This research has several implications regarding IFS. First, it was extremely validating for me. It implies that I stumbled on to a healing process that people do spontaneously and naturally when they access enough Self-energy. Not only do they notice parts, they have spontaneous compassion for the parts they had previously feared or hated and often begin relating to them in an IFS way.
Second, MDMA seems to allow protectors to relax rapidly, which implies that it could be used productively in conjunction with IFS therapy. As Mithoefer said in an interview for this book, MDMA assisted therapy facilitates unblending and often allows the client to condense or even skip the first 6 steps of IFS, which focus on getting protective parts to unblend.
Skipping these steps allows clients to move quickly to witnessing and unburdening exiles. Despite (or, indeed, because of) the speed of unblending with MDMA, Mithoefer emphasized the importance of checking in with and soliciting permission from protectors before going to exiles.
Third, given that the results described earlier in the IFS and PTSD study are similarly impressive to those in these studies and involve similar numbers of therapy hours, it may be that the IFS that occurred in these studies was a key factor in their success.
When we asked Mithoefer if he has learned anything from MDMA-assisted therapy that other IFS therapists could benefit from knowing, he said, “I have learned how well the spontaneous observations and experiences of our participants map onto IFS, including both parts and the Self.” He added, “In my experience, people are hungry for this perspective. Dick didn’t make it up – IFS taps into real phenomena.