Integration Of The Drug Experiences
The morning after the session the client should be able to sleep as long as is necessary. The general suggestion for the day is to rest, relax and stay in a meditative state of mind. Quiet walks in nature, basking in the sun, or swimming are highly recommended. Listening to music, especially to the pieces that were played during the LSD experience can be particularly useful. Later that day the sitters should schedule a long interview with the client. This is an opportunity to share in detail the experiences of the preceding day and also to discuss any puzzling aspects of the psychedelic session; it also serves to facilitate the integration of the material and its application to everyday life. Special attention should be paid to transference phenomena that occurred during the session, and to their analysis. At the Maryland Psychiatric Research Center both treatment units were equipped with closed-circuit television. Those subjects who requested or agreed to have their LSD sessions videotaped usually watched the tape the following day. We found this procedure extremely useful; it provided a unique opportunity to complement the subjective dimension of the experience with a more objective point of view.
The subject should be encouraged to write a detailed account of his or her psychedelic experience. This process involves concentrated attention and seems to facilitate recall of otherwise forgotten episodes. Intense emotions can emerge during this work, and the client might have an opportunity to complete an unfinished gestalt. In general, it seems that the work on the account greatly facilitates the integration of the session and later this write-up becomes a basis for a deeper and more detailed discussion of the psychedelic experience with the sitters. If the sessions are continued detailed records become essential, since old material can frequently assume new dimensions of meaning in view of later psychedelic experiences.
The clients should also be given ample opportunity to express their experiences in various artistic forms, such as paintings, mandala drawings, poems, written stories or plays, sculptures, dancing, or musical compositions. In addition to their aesthetic, cathartic, and documentary value, these creations often provide valuable material for a deeper understanding of the session. In several of our patients, impulsive drawing and painting became an important channel for coping with difficult unconscious material.
Sometimes the integration of the session takes days or weeks. It is important to encourage the client to keep the emotional channels open and continue the uncovering process, rather than try to shut them off prematurely by psychological means or with tranquillizers. Belated completion of an unconscious gestalt is most likely to occur in the intermediate states between waking consciousness and sleep that characterize the hypnagogic and hypnopompic periods. Another important opportunity of this kind is the dream life. After a well-integrated session, the nights tend to be dreamless and sleep very deep and refreshing. Conversely, a session in which the subject did not reach emotional and psychosomatic closure is usually followed by extraordinarily rich and intense dream life. A powerful dream can often mediate completion and final integration of material that had been activated by the drug but remained unresolved.
When the spontaneous process does not have enough dynamic strength to complete itself, the sitters should do intense activating work with the client, following the principles outlined earlier for the reentry period. An interesting alternative to the approach that encourages exteriorization and abreaction is the use of prolonged hyperventilation. This technique, based on the Indian science of breath, pranayama, was recently rediscovered by Leonard Orr (72) and adopted in his rebirthing programs. Intense breathing, continued for a period of about thirty to forty-five minutes, tends to collect the tensions in the body into a stereotyped pattern of armoring and eventually release tlieni. This is associated with activation of important material from various levels of the unconscious. The muscular tensions concentrate in the arms and legs (the so-called carpopedal spasms of medical terminology)-1 and in several circular constrictions of the head and body corresponding to the levels of the different chakras in the Indian system of Kundalini yoga. In this technique, vocalization and conventional abreaction is generally discouraged, and the subject is asked to continue breathing until all the tensions are released. This is a very effective way of clearing residual problems after a psychedelic experience. Even without previous administration of the drug this method can mediate access to deep and dramatic experiences of a biographical, perinatal and transpersonal nature in a very short time. The use of this technique requires certain background information and special instructions, and it will be discussed in greater detail in the following volume.
If neither of the above techniques brings a satisfactory psychological resolution, another psychedelic session should be scheduled as soon as possible. The general principle applied here might seem paradoxical to a conventional psychiatrist: Psychedelic therapy can be discontinued at any time after a successful session that was well integrated. If it resulted in an intensification of clinical symptoms or a prolonged reaction, continuation of therapy is indicated. The basic idea is that this is not due to some unpredictable effect of LSD, but represents an unfinished unconscious gestalt that should be completed.
The use of group psychotherapy as part of a comprehensive LSD treatment program deserves special discussion. After several unsuccessful attempts at using LSD as an adjunct in group psychotherapy, we moved away from this model. However, it proved extremely useful to combine individual LSD treatment with drug-free group work in the context of a therapeutic community. The atmosphere of collective responsibility and support, opportunities for mutual help, and the specific power of the group process represent extraordinary therapeutic potential. In the context of a therapeutic community, LSD patients spend the late hours of the sessions in the company of their eo-patients. At this time they can have various interesting perceptions of other people and of their interaction; conversely, others make valuable observations of the persons coming down from LSD sessions and of their own reactions toward them. In the next meeting where the patient shares his or her psychedelic experiences, this material becomes an important addition to the group dynamics. The subject's interaction with other members in the group can contribute considerably to a deeper understanding of the material from the LSD session, and also provides new insights into the problems of other patients in the group. These group meetings typically have such evocative power that some patients, instead of communicating verbally, are moved into deep emotional states that can lead to experiential therapeutic sessions.
The use of the material from psychedelic experiences in meetings of the therapeutic community results in an unusual deepening and intensification of the group process. LSD sessions regularly bring forth powerful unconscious material which would otherwise rarely appear in group work. The spectrum of experiences discussed in these meetings ranges from episodes involving various sexual perversions, murderous aggression, sadomasochistic drives, incestuous tendencies, and primitive indulging in biological material, to states of ecstatic rapture, feelings of cosmic unity, and past-incarnation memories. This provides fairly unique opportunities for indirect corrective emotional experiences for group members, in terms of the therapist's reactions toward potentially objectionable unconscious material emerging in the LSD sessions of their co-patients. The therapist's matter-of-fact approach to issues such as sadistic tendencies, grandiose fantasies and day-dreams, forbidden sexual wishes, or loss of control over bladder or bowels which may have occurred in the sessions of various members of the group, helps others to accept such elements and to allow themselves to experience such situations if they start emerging in their own psychedelic sessions. In this context, unconscious material that is usually anxiety-, guilt-, and conflict-laden can be treated with lightness and even humor. In addition to the advantages described above, the use of group work also saves time for the LSD therapist; many of the general principles of therapy, experiential strategies, and interpretive possibilities can be communicated to the entire group instead of having to be repeated for each participant individually.
In the above discussion 1 have outlined only the most general principles of a comprehensive program of LSD psychotherapy. The detailed therapeutic strategy and tactics in each individual case depend 011 many factors and have to be creatively developed by therapists on the basis of their clinical experience and their own first-hand explorations in LSD training sessions. The actual practice of psychedelic therapy is ultimately based as much on intuition as it is 011 knowledge of therapeutic principles, and it will probably always combine elements of art and science.
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