Advantages And Drawbacks Of The Psycholytic Approach

An unquestionable advantage of psycholytic therapy is its heuristic value. The slowly progressing unfolding of various levels of the unconscious has been compared by some patients to chemoexcavation, the careful archaeological work that sequentially explores layer after layer and studies their mutual interrelation. Other subjects refer to this process as "peeling the onion" of the unconscious mind. THe richness of the material obtained in repeated sessions using medium dosages of LSD provides unrivalled insights not only into the nature of the LSD reaction, but also into the dynamics of emotional disorders and the functioning of the human mind in general.

This aspect can be important not only for the therapist, but also for many scientifically, artistically, or philosophically oriented subjects. In addition to therapeutic benefit, these individuals receive unique lessons about human nature, art, philosophy, history, and the natural sciences. Psycholytic therapy usually takes much longer than psychedelic therapy to achieve comparable results; however, it gives an individual a much better knowledge of the territories of the mind and the mechanisms through which the change was achieved, and it may be the preferred treatment for subjects with less serious and urgent problems who have deep intellectual interest in the nature of the process. As an open-ended situation, psycholytic therapy gives a better opportunity for the patient to work through and resolve important problems of his or her life than the hit-or-miss approach of psychedelic therapy, which is limited to just one or a few high-dose LSD sessions.

At the present stage of development, psycholytic therapy is more understandable and acceptable in conventional professional circles and to the "scientifically-minded," since it leans in theory and practice on widely accepted psychotherapeutic concepts. This seems to be true despite the fact that many observations from psychedelic research clearly and unequivocally demonstrate the limitations of the existing paradigms and the need for their revision and reformulation.2 However, the psycholytic emphasis makes it possible to ignore or disqualify most of these challenging discoveries.

An obvious disadvantage of psycholytic therapy is that it is much more time-consuming. Although according to one of its foremost representatives, Hanscarl Leuner, psycholytic therapy can shorten the psychotherapeutic process to take approximately one-third of the time required by psychoanalysis, it still requires an enormous amount of the therapist's time. The first statement is based 011 clinical impressions; no comparative study of psycholytic and psychedelic therapies has ever been conducted. Any attempt to compare the efficacy of these two approaches on the basis of the existing literature runs into considerable difficulty. In addition to the general problems related to the evaluation of psychotherapeutic results, which have been discussed in the literature over the last two decades, one encounters certain complications specific to LSD therapy.

Whereas psychedelic therapy has been used in the past primarily with alcoholics, drug addicts and terminal cancer patients, psycholytic treatment has focused on other categories of emotional disorders, such as psychoneuroses, character disorders, and psychosomatic diseases. It has been pointed out that the result of psycholytic therapy is more solid and permanent, because the underlying material gets thoroughly worked through, than the dynamic shift or trans-modulation that occurs in psychedelic treatment. If the results of the two methods could somehow be compared, the time aspect would be very much in favor of psychedelic therapy. My impression is that the use of higher dosages and internalization of the process, as practiced by psychedelic therapists, deepens the effect of LSD and is much more productive therapeutically. However, I would still like to see an open-ended situation, which would allow for a series of such experiences if necessary, instead of the all-or-nothing philosophy of the psychedelic approach. As mentioned above, a systematic and well-controlled comparative study, though ' highly desirable, does not exist at present.

For those who want to take a conservative stance, the number of exposures to LSD and the overall amount of the drug used in psycholytic therapy can represent an important issue. Although none of the suspicions about the biological dangers of LSD have been substantiated, it should still be considered an experimental substance whose long-term physiological effects have yet to be fully determined.

Another aspect of psycholytic therapy that should be discussed is the use of low and medium dosages of LSD. as compared to the high or very high dosages used in psychedelic treatment. Although this might be contrary to popular belief, high-dose sessions are generally much safer. There is no doubt that high-dose sessions present more real or potential problems at the time of the actual pharmacological cffcct of the drug. Under the circumstances of unsupervised use, the collapse of psychological defenses, the massive emergence of deep unconscious material, the loss of effective control and the resultant lack of reality-testing occurring in high-dose experiences present grave potential dangers. An experienced therapeutic team, however, can usually handle these quite easily. In the long run, the very aspects of high-dose exposures that make them a greater risk at the time of the drug action turn out to be their advantages. Lessened ability to fight the effect of the drug and more complete surrender are conducive to better resolution and integration of the experience. Low and medium dosages activate latent unconscious material very effectively and bring it closer to the surface, yet they also allow an unwilling subject to avoid having to face it fully and deal with it effectively. Sessions of this kind can result in feelings of excessive fatigue after the experience, a sense of incompletion, various unpleasant emotional and psychosomatic aftereffects, and prolonged reaction or a precarious emotional balance conducive to later recurrences ("flashbacks"). In the next chapter we will discuss various principles and techniques of conducting psychedelic sessions that lead to better resolution and reduce the incidence of prolonged reactions and flashbacks.

Psycholytic therapy involves series of medium-dose LSD sessions, (sixteen to eighty or more, depending on the nature of the clinical problem) and thus presents numerous opportunities for temporary activation and insufficient completion of unconscious gestalts. In the course of psycholytic therapy, the patient's clinical condition undergoes dramatic changes in both directions, and sometimes the therapist has to face a serious transitional worsening of the symptoms or even decompensation, when the patient is approaching an area of deep and important conflicts. This intensification of symptoms sometimes occurs after earlier therapy had brought about a considerable improvement, and the therapist continues the sessions with an intent to "insure the result and prevent a relapse." Although psychedelic therapy does not eliminate the possibility of activation followed by an incomplete integration of unconscious material, it certainly considerably decreases the probability of such an occurrence.

A potentially negative aspect of psycholytic therapy is the enormous intensification of transference that almost inevitably develops in its course. This presents unique therapeutic opportunities, and also considerable dangers and difficulties. The issue of transference and its analysis is an important theoretical and practical problem in LSD psychotherapy and in psychotherapy in general. There is no doubt that the quality of the therapeutic relationship is one of the most important factors determining the course and outcome of LSD sessions. However, it is much less certain that the development of transference and its analysis is essential for therapeutic progress. This is something which is taken for granted in classical psychoanalysis and in psychoanalytically oriented psychotherapy, but that does not exclude the possibility that there exist other effective mechanisms of therapeutic change. Observation's from LSD psychotherapy suggest very strongly that the intensity of transference is directly proportional to the resistance to facing the original traumatic material. In a certain sense, therefore, an LSD therapist who puts great emphasis on identification and analysis of transference phenomena, instead of acknowledging them and directing the patient's attention beyond them, is cooperating with the defense mechanisms. It happens quite regularly in the course of LSD psychotherapy that various transference problems clear up automatically after the subject has been able to face and work through underlying unconscious material of a psychodynamic, perinatal or transpersonal nature.

A definite disadvantage of psycholytic therapy is its theoretical dependence on conventional dynamic psychotherapy. For this reason, it does not offer an adequate framework for many experiences that occur in the LSD sessions. Some of them have extraordinary therapeutic potential, such as the death-rebirth process, past-incarnation memories, various archetypal phenomena and, especially, the experiences of cosmic unity. The latter are closely related to, although not identical with, the oceanic feelings experienced by the infant at the breast and in the womb. They seem to have as fundamental a significance for the success of LSD therapy as the natural experiences of symbiotic unity with the mother have for the development of an emotionally healthy and stable personality. A tendency to discard and discourage perinatal and transpersonal phenomena, or to interpret thein in terms of more superficial levels, limits the therapeutic potential of LSD psychotherapy and frequently confuses the patient.

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