Critical Situations In Lsd Sessions

While seriously adverse aftereffects of supervised LSD sessions tend to occur only in individuals who had considerable emotional problems prior to the drug experience, in the actual course of high-dose psychedelic sessions various emergencies can occur in anybody, without regard to his or her emotional stability. It is essential to inform a client during the preparation period that he or she may have difficult experiences during the sessions, and that these represent a meaningful and integral part of the procedure. One of the major problems in the non-supervised use of psychedelics was a false notion that the subject would experience only states of transcendental bliss and have a uniformly wonderful time. The occurrence of difficult emotional states was therefore perceived as an unexpected complication, and easily caused panic in the subject and his or her friends.

The most common problem in psychedelic sessions is resistance to the emerging unconscious material and an unwillingness to "go with the experience." The form this resistance takes is usually indicative of the client's habitual mechanisms of defense. The evasive maneuvers that the sitters have to deal with cover a very wide range. Sometimes, the subject accepts the eyeshades and headphones, but argues against the use of cvocativc music. Here the therapists must be careful to distinguish constructive and appropriate objections front anxious efforts to fence-off the emerging emotions. Constant talking and intellectualizing which does not leave space for deeper experiences is another common escape. Some individuals try to focus in their mind's eye on the external environment and recall the surrounding reality in the most minute details. They try to remember the names of the co-patients, reconstruct the ground plan of the facility, and visualize the form and color of furniture in the room. Sudden sobering-up in the middle of a high-dose session is another common form of psychological resistance against the psychedelic experience.

The next step involves unwillingness to keep the session internalized. Sometimes the subject asks for permission and offers a reason—taking a break, smoking a cigarette, drinking a cup of coffee, having a chat, or going for a walk. Frequent visits to the bathroom are a particularly common technique; sometimes they are physiologically justified, but often they have purely psychological motives. A more serious form of resistance involves removing the eyeshades and headphones and simply refusing to continue, without excuse or explanation. When this happens the sitters should use all their psychological skills to return the client into the original introspective mode. The only exceptions to this rule are situations where the subject wants to explore the external world and there is no doubt that the request is genuine and does not serve the purpose of avoiding the inner experience. While negotiating with the client in these situations, the sitters can refer to the original contract made during the preparation period, when various forms of resistance were explicitly discussed with the subject and he or she accepted the importance of keeping the session internalized.

In an extreme case, the relationship between the sitters and the LSD subject can be disrupted to the point where the latter perceives it as being not cooperative but antagonistic, and tries to act on his or her own. This can culminate in the client attempting to leave the treatment situation altogether. These episodes are not very frequent, but they are extremely critical for LSD therapists. The basic rule here is to keep the subjects on the premises and guard against their hurting themselves or someone else. Various degrees of compromise have to be made between the needs to restrain the subject, and to avoid an open confrontation and fight that would further impair the therapeutic relationship. In the most dramatic situations of this kind, the best one can do is to play for time and keep the subject safe until the receding pharmacological effect makes him or her more amenable to active cooperation. Fortunately, such extreme situations are rather exceptional in therapeutic LSD sessions conducted by experienced sitters.

Before discussing the specific difficulties and complications that can occur during LSD sessions, we will mention some of the general principles. The most important factor in crisis-handling is the therapist's emotional reaction to the emergency situation. A calm, centered, and supportive attitude toward the various manifestations that occur in psychedelic sessions is much more important than anything the therapist says and does. The ability to remain unperturbed while facing dramatic instinctual outbursts, sexual acting-out, hostility and aggression, self-destructive tendencies, paranoid reactions, or extreme emotional and physical pain increases with clinical experience and the number of sessions one has conducted. Participating in a number of critical situations and witnessing their positive resolution is the best training for future emergencies. Working through one's own emotional difficulties in psychedelic sessions conducted for training purposes is equally, if not more important. Any serious unresolved problems in the sitters may easily be activated by participation in other people's sessions.

If the emergency situation evokes anxiety, aggression, guilt or some other inappropriate "countertransference" reaction in the therapists, this can result in a highly dangerous type of interaction with the patient. Since the sitters are the patient's only hold on reality, their reaction is his or her ultimate criterion of the seriousness of the situation. Thus, anxiety manifested by the therapist represents final proof to the patient that the situation is really dangerous. Not only are the sitters sober and supposedly in a state of adequate reality-testing, but in the eyes of the client they are experts in dealing with unusual states of consciousness. Their evaluation of the situation and their emotional reaction thus reflects professional judgment. Whenever the therapists show strong negative reactions to emergency situations in LSD sessions, destructive vicious circles are likely to develop between the clients and themselves. The therapist may be upset by certain behavior or experiences that the patient manifests, and his or her emotional reaction has a reinforcing effect 011 the patient. This intensification of the patient's difficulties causes in turn more emotional distress in the therapist. Because of this snowballing effect, such situations can reach critical proportions in a very short time. Similar patterns have been described in psychodynainic literature as "diabolic circles" (circuit diaboli); although this term might seein slightly exaggerated when used for situations in everyday life, it is certainly appropriate and justified for the dramatic circumstances that might develop in LSD sessions.

Adequate handling of critical situations is one of the crucial problems in LSD psychotherapy. A session in which the process gets out of control is not only fruitless, but harmful; it creates frustration and disappointment in both the therapist and patient, undermines their mutual trust, and can shatter their feelings of personal security. For the therapist adequate experience and training, including his or her own LSD sessions, is therefore of paramount importance. At the time of my LSD research in Czechoslovakia, the training for future LSD therapists more-or-less followed the psychoanalytic model. It required a minimum of five personal LSD sessions under the guidance of an experienced therapist, and thirty therapeutic sessions with psychiatric patients conducted under supervision. LSD training sessions were also found very useful for those psychiatric nurses who functioned as female co-therapists or came into contact with patients under the influence of LSD.

The. use of tranquillizers is an issue of considerable practical significance and deserves a special notice. In general, an experienced therapeutic dyad can handle all, or almost all, situations that occur in LSD sessions by psychological means alone. I have personally conducted more than three thousand sessions over the years, and only three were terminated by tranquillizers. All three occurred in the early years of my LSD research when my experience with drugs was very limited. Thorazine and other major tranquillizers are not specific neutralize« of the LSD effect. Used in high dosages, they have a general inhibiting effect that overrides and masks the psychedelic action of LSD. Detailed retrospective analysis of this situation usually shows that the patient experiences the action of both drugs simultaneously, and that the combined effect is rather unpleasant.

The use of tranquillizers in the course of psychedelic sessions is potentially very noxious. The most dramatically negative LSD experiences have a strong tendency toward positive resolution; if they are well resolved they are extremely beneficial for the subject in the long run. If tranquillizers are administered in the middle of a difficult psychedelic state they tend to prevent its natural resolution and positive integration. They "freeze" the subject in a negative psychological frame and thus contribute to the incidence of prolonged reactions, negative aftereffects, and "flashbacks." The routine administration of tranquillizers in the middle of negative psychedelic experiences is therefore a harmful practice that should be discontinued. This is even more true of their use in the context of LSD psychotherapy, which follows in general the strategy of an uncovering technique. Unpleasant experiences are caused by the emergence of highly-charged emotionally traumatic unconscious material. Since this material is the source of the patient's difficulties in everyday life, negative episodes in LSD sessions, if properly approached and handled, represent great opportunities for therapeutic change.

In LSD psychotherapy, there is a continuity in the content of consecutive sessions. If we terminate an unpleasant experience by administering tranquillizers, the unresolved material will continue to surface in future sessions till the patient reaches the point where he or she is capable of confronting and resolving it. Therefore, the therapist should first exhaust all possibilities of a psychological intervention before considering tranquillizers. If a specific vicious interaction has developed between the sitter and the client, and the situation appears to be irresolvable, another therapist should be called to take over the session; provisions for such situations should always be made in advance.

If all psychological approaches fail and tranquillizers have to be used, it is much better to start with Librium (30-60 milligrams) or Valium (10-30 milligrams), which seem to alleviate painful emotions without interfering with the course of the session. As soon as possible, the patient should resume a reclining position with eyeshades and headphones, to continue the introspective approach to the experience.

The situation that creates the most problems in psychedelic sessions is the experience of dying that occurs in the context.of the death-rebirth process. This encounter with death is so authentic and convincing that it can easily be mistaken for a real, vital emergency, not only by the experient but also by external observers and inexperienced sitters who are in a normal state of consciousness. Because of this confusion between symbolic and biological dying, the resistance against the psychedelic process can be particularly powerful. Deep seated anxiety and activation of survival programs can make the subject fight the effect of the drug with the intensity and determination characteristic of an actual life-and-death struggle.

From the technical point of view this is a most critical and important situation. It is absolutely essential to the smooth course of the session and its positive outcome that subjects stay with the eyeshades and headphones at this point, and keep the process internalized. If the psychological aspects of this experience are projected onto the therapeutic situation, this can result in dangerous acting-out behavior. Subjects may feel drawn to windows and doors, seeing them as escape routes out of the unbearable psychological situation; they may physically fight with the sitters, seeing them as the oppressive element; or be driven to violent self-destructive actions mistaking thein for the liberating ego death. The dangers of the externalization of this process extend beyond the framework of the drug session itself. Unresolved psychedelic experiences of this kind can result in very difficult emotional states in the post-session period, which may last for days or months unless properly treated.

If the client tries to tear off the eyeshades, and create a projective pseudoreal situation of the above kind, this is the time for active intervention. Since the issue has been discussed during the preparation period, the sitters can make references to that conversation to connect the client's intellectual knowledge of the process with the actual experience. This in itself can be helpful, although there is usually a fundamental gap between the death experience and its verbal description. This process can be so elemental and of such unimaginable experiential dimensions that no words in the world are adequate to convey it. In any case, the critical factors in dealing with this situation are the non-verbal aspects of the sitters' approach; under these circumstances, metacommunication is more effective than anything that is said or done.

The sitters should emphasize, repeatedly if necessary, that the client is not facing real biological death, however convincingly he or she might feel this. They should offer reassurance that the feeling of a lack of oxygen is only subjective, and that the breathing itself is adequate. It is also important to encourage the subject consistently to surrender to the process and accept the psychological death. Insistence that the quickest way out of this experience lies in going through its most difficult parts, and references to the positive "other side" can be of great help. However, the sitters' centeredness, familiarity with the process, and trust in its intrinsic trajectory are ultimately the most critical factors, since they supply the non-verbal or metacommunicative components which make their statements experientially real and convincing.

In the course of repeated LSD sessions that focus on the perinatal level, the experiences of dying usually become deeper and more complete. When the process reaches the stages of the final ego clcath, special technical problems can occur. The ego death involves an experience of the destruction of everything that the subject is, possesses, or is attached to. Its essential characteristics are a sense of total annihilation on all imaginable levels, loss of all systems of relation and reference, and destruction of the objective world. As it is approached in different directions and on different levels, the process requires more and more psychological sacrifice. In the final stages, subjects have to face and confront experiences, situations and circumstances that are unacceptable or even unimaginable to them.

The nature of the experiences that represent the final obstacle for the completion of the death-rebirth process varies from subject to subject. For some, it can be certain critical physical conditions, such as a high degree of suffocation, agonizing physical pain, blacking out, or violent seizure-like activity. Others have to face a situation which is psychologically utterly unacceptable to them, and surrender to it. The most frequent of these are vomiting, losing control of the bladder or bowels; sexually unacceptable behavior; confusion and disorientation; making various inhuman sounds, and humiliation or loss of prestige. A very difficult and important experience that occurs in the context of the ego death is the expectation of a catastrophe of enormous dimensions. Subjects face agonizing tension increasing to fantastic proportions and develop a conviction that they will explode and the entire world will be destroyed. This fear of disintegration represents a difficult experiential barrier; in their special state subjects may generate a strong conviction that not only their own fate, but the fate of the entire world depends on their ability to hold on. In this situation it is extremely important that the sitters repeatedly emphasize the safety of this experience. No matter how catastrophic it might appear from the subjective point of view, this explosion is ultimately emotionally and spiritually liberating. What is destroyed in this process is the old, limiting concept of oneself and the corresponding restricting view of existence and of the universe. Once the process reaches this point, it is absolutely essential to complete the experiential gestalt. Unfinished and poorly integrated sessions in this area can result in serious destructive behavior and suicidal ideation.

Another situation that can become a source of considerable problems in LSD sessions is the experience of no exit. Although it occurs most frequently in the context of BPM II, there exist close parallels that can be observed in advanced sessions on the transpersonal level. The transpersonal versions lack the concrete element of mechanical imprisonment and the gross biological dimension, and have a purely metaphysical quality. A person who is in a no-exit state experiences extreme distress of various kinds and is unable to see any end to this situation or any way out of it. Thinking seems to have a circular quality and subjects frequently compare their thought-processes with closed loops running on a tape-recorder. A more appropriate and accurate description of this state is to liken the peculiar circularity of ideas and emotions to a moving Moebius strip that turns into itself while also involving a paradox in regard to the usual spatial and temporal configurations.

The basic strategy in dealing with the no-exit situation should be to emphasize and clarify the distinction between psychological time and clock-time. The feeling of eternal doom with no hope of escape is an essential experiential characteristic of the no-exit situation. In order to work through and integrate this experience one has to accept its full content, including the feeling that it will last forever and that there is no way out.1 Paradoxically, a person who desperately resists and fights what he or she feels would be an experience of endless suffering, prolongs his or her tortures; conversely, if he or she capitulates and accepts staying in hell forever, the very depth of the infernal matrix has been experienced, that particular gestalt is completed, and the process will move further.

A difficult situation that seems to be closely related to the no-exit matrix involves repetitive verbal or motor behavior; in classical psychiatric terminology this is known as verbigeration and perseveration. For a period of time that can last anywhere from minutes to hours the individual behaves like a robot whose mechanism has been broken. Subjects in this state keep repeating the same movements, sentences, or words. There is usually 110 meaningful contact with them, and no external intervention of any kind can break the automaton-like behavior. In most cases, the only solution is to wait until the reaction spontaneously terminates and contact with the client can be re-established. This problem seems to occur when the drug activates unconscious material with excessive emotional charge. Less dramatic forms of this pattern can accompany the emergence of a particularly strong COEX system; extreme cases are almost always associated with the perinatal process. Subjects frequently have total amnesia, or very incomplete memory, regarding episodes of this kind.

One of the common problems in psychedelic sessions is fear of insanity, usually associated with a feeling of losing control. It occurs most frequently in individuals who have a strong need to maintain control and are afraid of losing it even under circumstances of everyday life. The general strategy, discussed during the preparation period and reinforced verbally during the session when loss of control becomes an issue, is to encourage giving up control. The usual misconception underlying this problem is the fear that even a momentary abandoning of control will result in its permanent loss, and insanity of some type would ensue. The new concept offered to the patient is that giving up control creates a situation in which the suppressed material that has been kept in check can emerge and be worked through. After an episode of dramatic and often chaotic release of pent-up energies through various available channels, the problem loses its charge and the individual achieves effortless control. This new type of mastery does not involve stronger self-control, but 110 need for it, since there is nothing to control. The frequent association of problems related to loss of control with concerns about sphincter function will be discussed later in the chapter.

■ In general,, any kind of "psychotic" experience should be encouraged during

7 8 9

The artist Harriette Francis documented an LSD experience during a psychedelic program at Menlo Park, California. Much of it had typical perinatal features and she has expressed many of the symbolic sequences of the death-rebirth process. After the initial visions of geometric ornaments (1), the process gradually deepens (2,3) and the artist faces an engulfing whirlpool drawing her into the world of death (4). In the underworld she is subjected to piercing pains (5) and crushing pressures (6,7), experiences a strange combination of birth and death (8), meditates on mysterious symbols on a cruciform altar (9) and is offered assistance (10). In a sequence strongly resembling shamanic initiation she faces reduction to a

skeleton and annihilation (11), followed by renewal, ascent and return to life (12). After what appears to be symbolic crucifixion (13) and reminiscence of some surgical intervention (14), she experiences rebirth, which is associated with the vision of a peacock (15). The next drawing, of the oceanic womb, suggests that the experience of birth opened the way to the unitive state of prenatal consciousness (16). She returns from tier journey with a sense of rejuvenation and rcvitulization (17).

(From LSD Journals of an Artist's Trip. Drawings l>y Ilarriettc Frances. Courtesy of tlu* International Foundation for Advanced Study, Menlo Park, California.)

the sessions, and in specially structured situations also in the free intervals between sessions, as long as they do not endanger the client or anyone else. We are not dealing here with experiences produced by the drug but with areas of potential psychotic activity within the client that have been chemically exteriorized. It is more appropriate to see such episodes as unique therapeutic opportunities rather than as clinical problems. Psychotic reactions that deserve special attention are those associated with paranoid perception. They present particular technical difficulties since they affect the very core of the therapeutic cooperation, the relationship with the sitters. Problems in this area cover a wide range, from minor mistrust to full-blown paranoid delusions, They also occur in many varieties and can be anchored in different levels of the unconscious. During the work on the psychodynamic level they can usually be traced back to situations in childhood in which the client was actively abused and mistreated, or to episodes in early infancy involving emotional deprivation and abandonment. Important sources of paranoid feelings are BPM II and BPM III, particularly the onset of the no-exit situation. Biologically, this would correspond with the beginning of the delivery, when the intrauterine world of the fetus is invaded by insidious and intangible chemical forces and starts to collapse. Some of the paranoid feelings can be traced back to early embryonal crises, traumatic past-incarnation experiences, negative archetypal structures, and other types of transpersonal phenomena.

Less serious forms of mistrust can be approached by reminding the clients of earlier discussions concerning basic trust, and by encouraging them to turn within and search for the sources of this mistrust in the emerging unconscious material. This is usually possible only where there is enough trust left for the subject to be able to communicate about the loss of trust. In more serious forms the client will deal with the paranoid thoughts and feelings internally, and the sitters might not discover this until the experience is over and the trust bond reestablished. Extreme degrees of paranoia can involve acting-out behavior; situations where an acutely paranoid LSD subject tries to leave the room or attempts to attack the sitters are among to the most difficult challenges of psychcdelic therapy. Here the only resort might be to guard against irreversible damage to persons and objects, and play for time. When the reaction subsides the sitters should return the patient to the reclining position, eyeshades, and headphones, and try to facilitate complete resolution and integration of the problem by the methods described earlier.

On occasion, sexual acting out can present technical problems. When it does not involve the sitters directly, as in the case of genital or anal masturbation, the sitters should be sufficiently open-minded to allow it. Occasionally, one episode of this kind properly handled by the therapists can provide a powerful corrective experience that will heal a long-lasting psychological trauma caused by insensitive parents, who may have drastically punished infantile instinctual activities. If the sitters have difficulty accepting such behavior, this should be an incentive towards and a unique opportunity for exploration of the roots of their own attitudes and reactions.

The situation is more difficult if the acting-out behavior involves sexual activities directed toward the sitters. The general rule here should be to exclude any explicit adult interaction that involves genitals, breasts, or the mouth. The reasons for this are serious and go beyond considerations of a moralistic nature. Sexual activity of this kind on the part of the patient is frequently a manifestation of resistance to deeper issues. typical example would be a male patient who feels the need for comforting contact on the infantile level and, fearing the dependency and helplessness that this entails, attempts to approach a female therapist in an adult sexual way. In situations like this the sitters should always direct the client to a deeper experiential level and discourage acting-out. This can be done in a constructive way and does not have to involve rejection. Reference to the explicit rules agreed upon before the session can make this situation easier for the sitters.

Adult sexual activities in LSD sessions can be very tricky; no matter what the external circumstances are, they are experienced by the client on many different levels since the ability for narrow and accurate reality-testing is impaired by the drug. Frequent involvement of the infantile levels can result in a specific vulnerability, particularly fear associated with the incest taboo. There is danger that such experiences will be traumatic and have lasting negative consequences for the client and the relationship with the sitter. I have seen several deterring examples of this kind outside of the medical context, especially in communes where young people were sharing psychedelic experiences involving free sexual exchange. The result, in some instances, was contamination of everyday interpersonal relationships by deep unresolved transference problems and sexual confusion. In general, there should be no limits to what the client can experience on the fantasy level. However, the sitters should be very clear about their own attitudes and motives, and approach the subject with integrity and sensitivity. In my experience, there is no need or justification for adult sexual activities in psychedelic therapy, and whenever a sitter considers it seriously, he or she should examine his or her own motives. The only place for adult sexual activities during a psychedelic experience should be between partners who have an emotional and sexual commitment to each other in everyday life. Such an approach can add interesting dimensions to sexual interaction, but is not without dangers and pitfalls even under these circumstances; it should occur only between mature partners with deep knowledge of^the nature of the psychedelic process.

It is clear that the question of sexual boundaries is much more problematic in sessions that involve physical intimacy than in those where the sitters maintain a detached attitude toward the clients. Since the use of close physical contact is extremely useful in psychedelic therapy this issue will be briefly discussed here. Deep age-regression in LSD sessions is frequently accompanied by intense anaclitic feelings and tendencies, especially in patients who experienced serious emotional deprivation in early childhood. They might want to hold, fondle, or suck the sitters' hand, put their head in someone's lap, or cuddle up and be cradled and caressed. Sometimes the regressive quality of these phenomena is beyond doubt and the patients show convincing signs of deep regression. At other times these activities can present technical problems because it may not be easy to distinguish whether a certain behavior is an authentic regressive pehnomenon, an inadvertent occurrence, or a sexual overture 011 a more-or-less adult level. This is particularly true in later stages of the sessions when the drug effect has subsided. Sometimes both levels seem to be involved simultaneously, and the client can oscillate from one to the other.

In the early years of my therapeutic work with LSD I used to discourage or refuse such manifestations, in accord with my strict Freudian background. Later, it became clear to me that periods of deep regression with strong anaclitic needs are of crucial importance from the therapeutic point of view. I realized that the therapist's approach to such situations can represent a deep corrective emotional experience or, conversely, perpetuate and reinforce old, pathological patterns of deprivation and rejection. Even at a time when I was already using physical contact almost routinely, I tended to withdraw it when the client crossed the sexual boundaries. At the present time, I do not see this as an either/or situation. The boundaries can be defined and negotiated in very subtle verbal and non-verbal ways. If the situation moves into problematic areas, it is possible to restore acceptable limits without withdrawing close contact altogether. The key here seems to be the therapist's clarity about his or her own motives and the ability to communicate clearly with the client, verbally and non-verbally. It is the therapist's ambiguities and conflicting messages that allow or breed problems. This is a complex and sensitive area and it is difficult to establish any fixed rules. The therapist has to rely on intuition and clinical experience in every individual case. The nature and specific characteristics of the therapeutic relationship and the degree of trust in it will remain the most important factors in charting the course.

One of the most important areas for psychedelic therapists to deal with is the various forms of hostility and aggression. If the sessions are conducted in the framework of a good working relationship, real technical problems with aggressive manifestations are extremely infrequent, even in sessions in which destructive tendencies are predominant. In most instances it is possible to maintain a synergistic relationship even in the context of intense psychodramatic struggle. Most of the technical problems occur when the sitters get physically involved with LSD subjects in a playful fight which involves pressing, pushing, restricting, and sometimes inflicting pain. Under these circumstances, it is absolutely essential to redefine the "as if" framework and prevent the situation becoming absolutely real and serious for the subject. A skillful combination of verbal communication and metacomnuinication can keep the play in that territory of experiential ambiguity which seems to be optimal for therapeutic work. On the one hand, the situation has to be sufficiently real for the subject to allow his or her full involvement and release of emotions; on the other hand, it must not be so real as to be mistaken for a dangerous or traumatic situation. Maintaining a trusting relationship has to be the primary consideration.

In contrast to the frequency, intensity and scope of experiences involving aggression, elemental and uncontrolled acting-out of destructive tendencies is extremely rare in supervised LSD sessions. When a situation of this kind seems to be impending, the best approach is to encourage external expression in a cooperative framework, as described above. Another effective technique is to relate to the deeper level of anxiety, hurt, and helplessness usually underlying aggressive phenomena. Thus, comfort and reassurance can sometimes have an almost magical influence on a patient who is aggressive and tries to threaten the sitters with an ostentatious display of power. Most effective approaches to aggression entail identification of the specific problem involved in the case, and finding the appropriate solution. As in other kinds of emergencies, the factor of critical importance is the sitter's own reaction and attitude to the situation. If the patient's behavior evokes anxiety or aggression in the sitter, they can get locked into a

Lsd Psychotherapy

A symbolic self-portrait from a session which was characterized by intense aggression oriented both inward and outward. A stylized bird of prey crushes a helpless mouse witli its right cluw; the left claw is transformed into a emmon turned ngninst its own head. The antique car on top represents a play 011 words (self-portrait = auto-portrait), but also suggests the relationship between the mixture of aggressive and self-destructive impulses frequently encountered in perinatal sessions and also in reckless, perilous driving.

vicious circle of interaction that tends to reinforce the pathological reactions. The following example from our early work in Prague can be used to illustrate some of the above points.

One day when I was conducting an LSD session with a neurotic patient, I was interrupted by loud knocking. Surprised by this interference, which was against the rules, I went to answer the door. An alarmed nurse told me that my presence was urgently needed in the other treatment room where Henry, another LSD patient, had gone "berserk." I left the nurse in attendance and hurried to the place of the emergency. I found the treatment room in a catastrophic condition; the patient had broken a mirror against the wash-basin, overturned all the furniture, and torn several books and journals to shreds. He was standing in the middle of the room screaming and growling; his appearance was reminiscent of an angry ape. In the corner stood Julia, a young colleague who had recently joined our team. She had sat in on LSD sessions before, although this was the first one she had run independently. She was pale, obviously frightened, and her hands were shaking.

I came up to Henry and took him by the hand; this established contact and also reduced the chances for his attacking me. "It's alright, don't be afraid, nobody is going to hurt you," I told him in a reassuring tone of voice, and pointed to the couch. "Can we sit down? I would like to find out what you have been experiencing." We sat down and I started asking him questions, trying to find out what triggered his aggression. It soon became apparent that earlier in the session he had regressed into early childhood and experienced a need for closeness and affection. He was seeking physical contact with Julia and put his head into her lap. She panicked, pushed him away, and admonished him for introducing sexual elements into therapy. This triggered a very painful memory of a childhood situation in which Henry was caught masturbating by his mother. She made a big scene and reported it to his father who punished him in a very cruel way. This sequence of events effectively blocked Henry's access to both the channel of childhood dependency and that of sexual feelings. In addition, the combination of sexuality with punitive feedback and anxiety made the perinatal level of his unconscious experientrally available. At this point, Henry "chose the path of aggressive behavior.

During this discussion, Julia recovered from the shock of her psychedelic baptism. With my psychological support, she allowed Henry to put his head on her lap and held his hand. However, another difficult test was yet to come. About half an hour later, Henry, by that time back in the experience with his eyes closed, started playing with his penis. While doing this he occasionally opened his eyes, obviously checking our reaction. When the expected feedback was not forthcoming, he gradually unzipped his pants and started to masturbate by pulling his foreskin back and forth. His ejaculation brought a dramatic relief of Henry's physical and emotional tension; its psychological impact went far beyond that of the physiological J: release. Henry felt that being able to masturbate in the presence of surrogate t parental figures without being rejected had helped him to overcome a sexual | trauma from his childhood and brought about a lasting liberation of his sex-f ual life.

This session was also quite important for Julia's development. In retrospect, she appreciated this difficult experience as a great learning opportunity. It helped increase her tolerance of various unconventional manifestations in LSD sessions and, subsequently, she became a better and more effective therapist.

To complete the list of difficult situations that can occur in LSD sessions, we should discuss various physical manifestations that are common concomitants of psychedelic experiences. In their milder form, they usually do not present a particularly serious technical challenge, but their extreme forms can be quite alarming. As I mentioned earlier, none of them are simple pharmacological effects of LSD; they represent complex psychosomatic manifestations. The general strategy toward somatic aspects in LSD sessions should be to experience them as fully as possible; clinical experiences have repeatedly confirmed the therapeutic value of this approach.

Probably the most common physical manifestations in LSD sessions are various motor phenomena, such as generalized muscular tension, complex postures and twisting movements, and a wide variety of tremors, jerks, twitches, and seizure-like episodes. The'subject should be encouraged to let these happen; they represent extremely valuable channels for effective discharge of deep, pent-up energies. It is important that the sitters watch for any attempts on the part of the subject to control such phenomena, for aesthetic or other reasons. They should consistently encourage uninhibited discharge of energy, even if full manifestation takes the form of a violent temper tantrum or an epileptiform seizure. If the drug effect is not strong enough to bring about a spontaneous release of tension, this can be induced by the subject forcefully tensing-up the areas involved, and holding sculpture-like postures for long periods. Intense external pressures and deep massage are also quite useful for this purpose.

Breathing difficulties are very common in psychedelic sessions. On occasion, they can take the form of genuine asthmatic attacks; these usually occur in persons who have had problems of this kind in the past. In the context of LSD sessions it is important to encourage full experience of the unpleasant feelings of suffocation, at the same time reassuring the subject that there is no real danger, since the breathing difficulties are only subjective and respiration is adequate. It is essential that the^sitters give the experient honest and objective feedback on this issue. Frequently gagging, coughing, or screaming, if it forms an integral part of the experience, can bring dramatic release. It should be encouraged if the process moves in that direction, but not mechanically suggested as a specific remedy.

Physical pain is an important and integral part of the psychedelic process and should also be experienced fully if it starts emerging in the session. It usually occurs in the context of reliving actual physical traumatizations such as diseases, accidents and operations, or the birth trauma, although it can also have various symbolic connotations. Intense physical pain may sometimes be associated with various transpersonal phenomena such as past-incarnation memories and ancestral or phylogenetic experiences. In later stages of the sessions, when the pharmacological effect of the drug is not strong enough, it is useful to increase the sensations by pressure or deep massage in the places indicated by the patient. In working with pain the sitters should always emphasize full experience of the pain, and the physical or emotional expression of the emotion that is inevitably behind it. Quite commonly patients themselves ask for more intense pressure, sometimes considerably beyond the point which the therapists feel comfortable with. Under unsupervised conditions individuals inay actually try to hurt themselves to exteriorize the pain. This seems to be the mechanism behind some of the self-mutilations and self-inflicted injuries in LSD sessions which have received so much publicity in the media.

Nausea and vomiting usually occur in individuals who have suffered from this problem in childhood or in whom this is a habitual reaction to stress in everyday life. Nausea should not be alleviated by any means and the sitters should encourage vomiting whenever the patient seems to be fighting it. Breakthrough vomiting has a powerful purging effect, and in many instances means a positive turning point in a difficult LSD session. It can be of particular significance in persons who have a very strong negative charge about it in everyday life. Unwillingness to vomit can represent a very important block and may be associated with powerful emotional material on various levels. After having thrown up in the middle of an LSD session, some patients talk about having dumped generations of garbage. Others feel that they rid themselves of the introjected image of a bad parent or step-parent. In some instances, projectile vomiting can be associated with a sense of expelling alien transpersonal energy forms, almost in the sense of exorcism.

Problems related to urination and defecation are unusually frequent in psychedelic sessions. They either take the form of urethral and anal spasms and an inability to evacuate or, conversely, an intense physiological urge in these areas and fear of losing control over bladder and bowels. Difficulties with urination typically occur in persons who in their everyday life respond to various stresses by frequent micturition (pollakisuria), or show the classical Freudian characteristics of a urethral personality, such as intense ambition, concerns about prestige, a disposition to shame, and fear of blunder. If the LSD subject had problems with enuresis (wetting the pants or bed) at some point in his or her past, one should expect the problems in this area to be reenacted sooner or later in the sessions. This is also true for women who suffer from an orgastic insufficiency or frigidity that is associated with fear of losing bladder control at the same time as sexual orgasm is supposed to occur. On the psychodynamic level, urethral problems are associated with specific traumatic biographical material in agreement with psychoanalytic descriptions. However, they always have deeper roots on the level of the birth process; there exist quite specific associations between urethral dysfunction and certain aspects of perinatal matrices. Thus, a block of urination comes in the context of BPM II, a painful urge to void and conflicts about it is an almost standard component of BPM III, and loss of bladder control characterizes the transition from BPM III to BPM IV.

In the early years of my LSD work, patients with the above problems often delayed confrontation with the urethral material for weeks or months by interrupting the experience and leaving for the bathroom. Some of them made fifteen to twenty visits to the toilet in a single session, most of them unnecessary. When I recognized that this was a very powerful form of resistance, I made the necessary provisions for involuntary urination in the form of a rubber sheet and discouraged the adult approach to urethral urges. Patients who had strong objections to this arrangement and an insurmountable resistance to it were advised to use surgical rubber pants. With this approach, severe urethral conflicts and blockages could be resolved in a few sessions, whether or not involuntary urination actually occured. When a patient loses control of the bladder during an LSD experience, it is usually associated with reliving traumatic incidents from childhood which involved ridicule by peers or parents for urethral accidents. This release opens the way to the libidinal pleasure originally related to unrestricted urination, removes the psychological block, and facilitates letting go. On a deeper level, it frequently connects the patient with the moment of birth, where a fundamental relief after hours of agony can sometimes be associated with reflex urination.

Problems related to defecation follow a similar pattern. They typically occur in obsessive-compulsive patients of both sexes, in males with latent or manifest homosexual tendencies, and in anal personalities. On the psychodynamic level they are usually associated with conflicts around toilet training, gastrointestinal disorders in childhood, and a history of enemas. Deeper perinatal roots of anal retention are in BPM II; an urge to defecate and conflicts about it characterize BPM III, and explosive bowel release or loss of anal control is psychologically associated with the ego death and the moment of birth. Although anal problems of various kinds are very common in LSD sessions, actual uncontrolled defecation and manipulation of feces has been extremely rare; I have encountered it only about ten times in over five thousand LSD sessions I have studied. This may be an artifact of cultural programming and therapeutic technique rather than clinical reality. Our taboo against feces is much stronger than that against urine, and the common unwillingness of the experient and the sitters to deal with the aftermath of anal letting-go is also a factor that should not be underestimated. I realize retrospectively that for many years we discussed with LSD candidates the possibility of loss of bladder control and tried to alleviate their concerns about it; at the same time, however, similar reassurance was never offered in regard to defecation. In 1972, I saw a dramatic improvement in a patient with severe obsessive-compulsive neurosis which had resisted classical psychoanalysis for eighteen years; it occurred in an LSD session in which he lost control of his bowels and in a deeply regressed state played for several hours with his feces. That made clear to me some of the factors that might have been responsible for our chronic therapeutic failure with patients with severe obsessive-compulsive neuroses. If problems of an anal nature keep occurring in LSD therapy, the patient should be encouraged to give up adult concerns and be willing to abandon control if it becomes necessary during the experience. As in the case of urination, surgical pants can be a great psychological help, for the patient as well as the sitters.

Continue reading here: Adverse Aftereffects Of Lsd Psychotherapy

Was this article helpful?

0 0