Some of the advantages of psychedelic therapy are practical, others are of a theoretical nature. In general, the therapeutic changes achieved in a single psychedelic session are much more dramatic and profound than those observed as a result of a single psycholvtic session. Certain aspects of the psychedelic treatment technique represent a great acceleration and deepening of the therapeutic process, as well as a definite increase in its efficacy and safety. This approach seems to have fully appreciated the importance of positive experiences, which are usually underestimated in psycliolytic therapy; the latter shares with psychoanalysis a one-sided emphasis 011 psychopathology and traumatic material. Explicit focus on the positive potential in human beings is an important therapeutic factor; so is the emphasis on positive structuring of the set and setting for psychedelic sessions. External circumstances have a profound effect on the termination period of the session and thus on the final outcome of the psychedelic experience. The discovery of the critical importance of this phase represents a major contribution of psychedelic therapists to the LSD procedure.
There seem to be several reasons for the greater efficacy and safety of psychedelic therapy. High dosages and internalization of the process lead to greater depth, intensity, and spontaneous flow of the experience; this results in more emotional turmoil, but also in a better chance for a positive breakthrough. A single psychedelic session can achieve dramatic therapeutic results by penetrating or bypassing the psychodynamic levels and utilizing powerful mechanisms of transformation on the perinatal and transpersonal levels. This is facilitated by full theoretical acknowledgement and validation of transpersonal realities. Careful positive structuring of the reentry is another important factor 'of therapeutic change.
As a result of a favorable combination of the above factors, a good therapeutic outcome can be obtained even if the patient does not explicitly confront certain areas of major difficulty and conflict on the psychodynamic level; in systematic psycholytic treatment these would inevitably have to be faced. Under these circumstances, there is certainly less risk of a worsened clinical condition, even with severely emotionally disturbed patients, than after individual psycholytic sessions.
If we consider the other important advantages of psychedelic therapy, such as reduced time investment, less intense exposure to the drug, and fewer transference problems, it would seem that the psychedelic procedure is clearly superior to the psycholytic approach. It is therefore important to discuss some of the theoretical and practical disadvantages of psychedelic therapy, which should be taken into consideration in the formulation of an integrated therapeutic approach. An important question that would have to be clarified is the nature of the changes observed in psychedelic therapy. The major objection raised against these sudden clinical improvements and personality transformations is that they represent only temporary shifts rather than deep changes of dynamic structures. Frhm this point of view psycholytic therapy, dealing slowly and patiently with various levels of unconscious conflicts, would provide more lasting results. There are no comparative studies that would answer the fundamental question whether deep and lasting therapeutic changes are possible without working through early childhood material, reenacting the original traumatic relationships in the transference situation, and subjecting these anachronistic replicas to transference analysis. Although observations from LSD research strongly suggest that there exist important alternatives, these will have to remain on the level of clinical impressions until they are systematically studied and validated.
A much more serious problem that psychedelic therapy—as presently practiced—has to face is the fact that in spite of the efforts at positive structuring of the LSD sessions, it is not possible to guarantee that all the subjects will have deep transformative experiences. In the Spring Grove program, where the therapeutic potential of psychedelic therapy utilizing just one session was systematically explored in various categories of subjects, the incidence of "psychedelic peak experiences" ranged between 25 and 78 per cent, depending on the population studied. It was the lowest in neurotic patients and highest for narcotic drug addicts, with mental health professionals, individuals dying of cancer, ^nd alcoholics falling in between.
The psychedelic peak experience is certainly an important factor mediating deep personality transformation; however, its occurrence is not a conditio sine qua non of successful therapy. Different degrees of improvement can be observed in many patients who have not reached the transcendental level of consciousness in their psychedelic sessions. Unfortunately, the candidates for a productive and successful psychedelic session cannot be selected in advance with a reasonable degree of certainty by any known criteria. Since the important variables determining the outcome of the session are insufficiently understood, the psychedelic approach, with its extreme "all-or-none" philosophy, still remains very much a "hit-or-miss" procedure.
The theoretical drawbacks of psychedelic therapy are probably more important than its practical shortcomings. This approach may produce very dramatic therapeutic changes with minimal understanding of the underlying mechanisms. The material from psychedelic sessions can offer new insights into some phenomena of a very general nature, such as the dynamics of positive and negative memory systems, the existence of new mechanisms of personality transformation, dimensions of human experience and the human mind, states of consciousness associated with dying, or the mystical nature of the universe. It contributes relatively little to our knowledge of the effects of LSD, cartography of the human mind, psychodynamics of mental illness, or mechanisms of therapeutic change.
This aspect of psychedelic therapy will be seen as a great disadvantage by those who judge the scientific returns of this procedure by Western standards. It will be highly rewarding for those who seek an alternative to linear, rational and logical approaches to knowledge. The insights emerging from high-dose psychedelic sessions are of a global, intuitive and holographic nature. The transcendental "aha!" experience of this kind cannot be dissected easily by the Western analytical mind, nor can it be exploited in a pragmatic sense. It is an illuminating insight . into the very essence of existence. The experient does not gain rational understand-[y1 ing of the cosmic process, but reaches instant comprehension by losing his or her-' separate identity and literallyJ^coming the process. J
This intuitive insight into the universal scheme of things is quite similar to the process described in the Upanishads as "Knowing That, the knowledge of which gives the knowledge of everything." This does not involve a total and all-encompassing intellectual comprehension of the universe, in the sense of causal connections and pragmatic know-how concerning objects and events in the phenomenal world, but a transcendence of phenomena, space, time, and causality.
It is necessary to add that this is frequently accompanied by the conviction that some of the questions that were previously considered important or even urgent are irrelevant in the contcxt of the new system of reference. Instead of finding answers to specific questions, one reaches a state in which those questions do not exist or are not relevant, or where there is no need to ask them; both finding the answers and transcending them represent solutions to the problem, although on different levels and of differing kinds.
The fact that certain questions appear irrelevant to LSD subjects in the context of mystical consciousness will not relieve the frustration of a scientifically-minded researcher trying to draw some genera) conclusions from the observations of psychedelic therapy. The enormous interindividual variability precludes any valid generalizations based on the material from single sessions with many different subjects. The definite spiritual emphasis of psychedelic therapy, its recognition of mystical states of consciousness, and the inclusion of what might appear to a superficial observer as elements of religious indoctrination, will certainly make this approach less appealing to skeptical and critical professional audiences. This will continue to be true until an adequate paradigm is developed that will make it possible to assimilate all the extraordinary new phenomena into the body of existing psychiatric knowledge and general scientific theory.
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