Techniques Qf Lsd Therapy

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Although psychotherapy is a very important component of the approaches in this category, the primary emphasis is on the specificities of the drug experience. The psychotherapeutic techniques involved are modified and adjusted to the nature of the LSD state to form an integral and organic unit with the psychedelic process.

Psycholytic Therapy With LSD

The term psycholytic was coined by the British researcher and pioneer in LSD therapy, Ronald A. Sandison. Its root, lytic (from the Greek lysis = dflsoliition) refers to the process of releasing tensions, dissolving conflicts in the mind. It should not be confused with the term psychoanalytic (analyzing the psyche). This treatment method represents in theory as well as in clinical practice an extension and modification of psychoanalytically oriented psychotherapy. It involves administration of LSD at one- to two-week intervals, usually in the dosage range of from 75 to 300 micrograms. The number of drug sessions in a psycholytic series varies depending on the nature of the clinical problem and the therapeutic goals; it oscillates between fifteen and one hundred, the average probably being somewhere around forty. Although there are regular drug-free interviews in the intervals between the sessions, there is a definite emphasis on the events in the LSD sessions.

The drug sessions take place in a darkened, quiet and tastefully furnished room that suggests a homelike atmosphere. The therapist is usually present for several hours at the time when the session culminates, giving support and specific interpretations when necessary. During the remaining hours the patients are alone, but they may ring for the therapist or nurse if they feel the need. Some LSD programs use one or more co-patients as sitters for the termination periods of the sessions, or allow the patient to socialize with the staff and other clients.

All the phenomena that occur in LSD sessions or in connection with LSD therapy are approached and interpreted using the basic principles and techniques of dynamic psychotherapy. Certain specific characteristics of the LSD reaction however, require some modifications of the usual techniques. These involve a greater activity on the part of the therapist, elements of assistance and attendance (for example, in ease of vomiting, hypersalivation, hypersecretion of phlegm, coughing, or urination), a more direct approach, occasional physical contact and support, psychodramatic involvement in the patient's experience, and higher tolerance for acting-out behavior. This makes psycholytic procedure similar to the modified psychoanalytic techniques used for psychotherapy with schizophrenic patients. It is necessary to abandon the orthodox analytic situation where the patient reclines on the couch and is expected to share his or her free associations while the detached analyst sits in an armchair and occasionally offers interpretations. In psycholytic therapy, patients are also asked to stay in the reclining position with their eyes closed. However, LSD subjects may on occasion remain silent for long periods of time or, conversely, scream and produce inarticulate sounds; they might toss and turn, sit up, kneel, put their head in one's lap, pace around the room, or even roll on the floor. Much more personal and intimate involvement is necessary, and the treatment frequently requires genuine human support.

In psycholytic therapy, all the usual therapeutic mechanisms are intensified to a much greater degree than in single LSD sessions. A new and specific element is the successive, coniplcx and systematic reliving of traumatic experiences from childhood, which is associated with emotional abreaction, rational integration, and valuable insights.3 The therapeutic relationship is usually greatly intensified, and analysis of the transference phenomena becomes an essential part of the treatment process.

The toll that psycholytic therapy has had to pay for its theoretical rooting in Freudian psychoanalysis has been confusion and conflict about the spiritual and mystical dimensions of LSD therapy. Those psycholytic therapists who firmly adhere to the Freudian conceptual framework tend to discourage their patients from entering the realms of transcendental experiences, either by interpreting them as an escape from relevant psychodynamic material or by referring to thein as schizophrenic. Others have identified the psychoanalytic framework as incomplete and restricting and become more open to an extended model of the human mind. The conflict concerning the interpretation of transpersonal experiences in LSD therapy and the attitude toward them is not only a matter of academic interest. Major therapeutic changes can occur in connection with transcendental states, and so facilitation or obstruction of these experiences can have very concrete practical consequences.

Typical representatives of the psycholytic approach have been Sandison, Spencer and Whitelaw, Buckman, Ling, and Blair in England; Arendsen-Hein and van Rhijn in Holland; Johnsen in Norway; and Hausner, Tauterman, Dytrych and Sobotkiewiczova in Czechoslovakia. This approach was developed in Europe and is more characteristic of European LSD therapists. The only therapist using psycholytic therapy in the United States at this time is Kenneth Godfrey of the Veterans Administration Hospital in Topeka, Kansas. In the past it was practiced by Eisner and Cohen, Chandler and Hartman, Dahlberg and others.

Psychedelic Therapy with LSD

This therapeutic approach differs from the preceding one in many important aspects. It was developed on the basis of dramatic clinical improvements and profound personality changes observed in LSD subjects whose sessions had a very definite religious or mystical emphasis. Historically, it is related to the development of a unique LSD treatment program for alcoholics^ conducted in the early fifties by Hoffer and Osmond in Saskatchewan, Canada. These authors were inspired by the alleged similarity between the LSD state and delirium tremens, reported by Ditnian and Whittlesey (23) in the United States. Hoffer and Osmond combined this observation with the clinical experience that many chronic alcoholics give up drinking after the shattering experience of delirium tremens. In their program, they initially gave LSD to alcoholic patients with the intention of deterring them from further drinking by the horrors of a simulated delirium tremens. Paradoxically, however, it seemed to be the profound positive experiences in LSD sessions that were correlated with good therapeutic results. On the basis of this unexpected observation Hoffer and Osmond, in cooperation with Hubbard, laid the foundations of the psychedelic treatment technique.

The main objective of psychedelic therapy is to create optimal conditions for the subject to experience the ego death and the subsequent transcendence into the so-called psychedelic peak experience. It is an ecstatic state, characterized by the loss of boundaries.between the subject and the objective world, with ensuing feelings of unity with other people, nature, the entire Universe, and God.* In most instances this experience is contentless and is accornpanicd by visions of brilliant white or golden light, rainbow spectra or elaborate designs resembling peacock feathers. It can, however, be associated with archetypal figurative visions of deities or divine personages from various cultural frameworks. LSD subjects give various descriptions of this condition, based on their educational background and intellectual orientation. They speak about cosmic unity, unio mystica, mysterium tremendum, cosmic consciousness, union with God, Atman-Drahman union, Samadhi, satori, moksha, or the harmony of the spheres.

Various modifications of psychedelic therapy use different combinations of elements to increase the probability of psychedelic peak experiences occurring in LSD sessions. Before the actual session there is typically a period of drug-free preparation conducted with the aim of facilitating the peak experience. During this time, the therapist explores the patients' life history, helps them to understand their symptoms, and specifically focuses on personality factors that could represent serious obstacles to achieving the psychedelic peak experience. An important part of the preparation is the therapist's explicit and implicit emphasis of the growth potential of the patients, and an encouragement to reach the positive resources of their personalities. Unlike conventional psychotherapy, which usually goes into detailed exploration of psychopathology, psychedelic therapy tries to discourage the patient's preoccupation with pathological phenomena, be they clinical symptoms or maladjustive interpersonal patterns. In general, there is much more concern about transcending psychopathology than interest in its analysis.

Occasionally, patients even receive direct advice and guidance as to how ^hey could function more effectively. This approach is very different from the undisciplined and random advising in life situations against which psychoanalytical-ly oriented therapists so emphatically warn. It docs not involve specific suggestions for solving important problems of everyday life, such as marriage or divorce, extramarital affairs, induced abortions, having or not having children, and taking or leaving a job. Psychedelic counseling operates on the very general level of a basic strategy of existence, life philosophy, and hierarchy of values. Some of the issues that might be discussed in this context are, for example, the relative significance of the past, present, and future; the wisdom of drawing one's satisfaction from ordinary things that are always available in life; or the absurdity of exaggerated ambitions and needs to prove something to oneself or to others. From the practical point of view, the general directions in psychedelic counseling are based on observations of specific changes in individuals who have been successfully treated with LSD psychotherapy. They involve ail orientation and approach toward life that seem to be associated with the absence of clinical symptoms and with a general feeling of well-being, joy and affirmation of the life process. Although the psychedelic philosophy and life strategy were developed quite independently from the work of Abraham Maslow, (64) some of the principles of this approach are closely related to his description of a self-realizing person and his neuroses, major therapeutic changes usually cannot be achieved without systematically working through various levels of problems in serial LSD sessions.

Anaclitic Therapy With LSD (LSD Analysis)

The term anaclitic (from the Greek anahlinein—to lean upon) refers to various early infantile needs and tendencies directed toward a pregenital love object. This method was developed by two London psychoanalysts, Joyce Martin (62) and Pauline McCririck. (68) It is based on clinical observations of deep age regression occurring in LSD sessions of psychiatric patients. During these periods many of them relive episodes of early infantile frustration and emotional deprivation. This is typically associated with agonizing cravings for love, physical contact, and other instinctual needs experienced on a very primitive level.

The technique of LSD therapy practiced by Martin and McCririck was based on psychoanalytic understanding and interpretation of all the situations and experiences occurring in drug sessions and in this sense is very close to psycholytic approaches. The critical difference distinguishing this therapy from any other was the element of direct satisfaction of anaclitic needs of the patients. In contrast to the traditional detached attitude characteristic of psychoanalysis and psycholytic treatment, Martin and McCririck assumed an active mothering role and entered into dose physical contact with their patients to help them to satisfy primitive infantile needs reactivated by the drug.

More superficial aspects of this approach involve holding the patients and feeding them warm milk from a bottle, caressing and offering reassuring touches, holding their heads in one's lap, or hugging and rocking. The extreme of psycho-dramatic involvement of the therapist is the so-called "fusion technique," which consists of full body contact with the client. The patient lies on the couch covered with a blanket and the therapist lies beside his or her body, in close embrace, usually simulating the gentle comforting movements of a mother caressing her baby.

The subjective reports of patients about these periods of "fusion" with the therapist are quite remarkable. They describe authentic feelings of symbiotic union with the nourishing mother image, experienced simultaneously on the level of the "good breast" and "good womb." In this state, patients can experience themselves as infants receiving love and nourishment at the breast of the nursing mother and at the same time feel totally identified with a fetus in the oceanic paradise of the womb. This state can simultaneously involve archetypal dimensions and elements of mystical rapture, and the above situations be experienced as contact with the Great Mother or Mother Nature. It is not uncommon that the deepest form of this experience involves feelings of oneness with the entire cosmos and the ultimate creative principle, or God.

The fusion technique seems to provide an important channel between the psychodynamic, biographical level of the LSD experience and the transcendental states of consciousness. Patients in anaclitic therapy relate that during their nourishing exchange with the mother image, the milk seemed to be "coming directly from the Milky Way." In the imaginary re-enactment of the placentary circulation the life-giving blood can be experienced as sacramental communion, not only with the material organism, but with the divine source. Repeatedly, the situations of "fusion" have been described in all their psychological and spiritual ramifications as fulfillment of the deepest needs of human nature, and as extremely healing experiences. Some patients described this technique as offering the possibility of a retroactive intervention in their deprived childhood. When the original traumatic situations from childhood become reenacted in all their relevance and complexity with the help of the "psychedelic time-machine," the therapist's affection and loving care can fill the vacuum caused by deprivation and frustration.

The dosages used in this treatment technique ranged between 100 and 200 micrograms of LSD, sometimes with the addition of Ritalin in later hours of the sessions. Martin and McCririck described good and relatively rapidly achieved results in patients with deep neuroses or borderline psychotic disorders who had experienced severe emotional deprivation in childhood. Their papers, presentations at scientific meetings, and a film documenting the anaclitic technique stirred up an enormous amount of interest among LSD therapists and generated a great deal of fierce controversy. The reactions of colleagues to this treatment modality ranged from admiration and enthusiasm to total condemnation. Since most of the criticism from the psychoanalytically oriented therapists revolved around the violation of the psychoanalytic taboo against touching and the possible detrimental consequences of the fusion technique for transference-countertrans-ference problems, it is interesting to describe the authors' response to this serious objection.

Both Martin and McCririck seemed to concur that they had experienced much more difficulty with transference relationships before they started using the fusion technique. According to them, it is the lack of fulfillment in the conventional therapeutic relationship that foments and perpetuates transference. The original traumatic situations are continuously reenacted in the therapeutic relationship and the patient essentially experiences repetitions of the old painful rejections. When the anaclitic needs are satisfied in the state of deep regression induced by the drug, the patients are capable of detaching themselves emotionally from the therapist and look for more appropriate objects in their real life.,

This situation has a parallel in the early developmental history of the individual. Those children whose infantile emotional needs were adequately met and satisfied by their parents find it relatively easy to give up the affective ties to their family and develop independent existence. By comparison, those individuals who experienced emotional deprivation and frustration in childhood tend to get trapped during their adult life in symbiotic patterns of interaction, destructive and self-destructive clinging behavior, and life-long problems with dependence-independence. According to Martin and McCririck, the critical issue in anaclitic therapy is to use the fusion technique only during periods of deep regression, and keep the experience strictly on the pregenital level. It should not be used in the termination periods of the sessions when the anaclitic elements could get easily confused with adult sexual patterns.

The anaclitic technique never achieved wide acceptance; its use seemed to be closely related to unique personality characteristics in its authors. Most other therapists, particularly males, found it emotionally difficult and uncomfortable to enter into the intimate situation of fusion with their clients. However, the importance of physical contact in LSD psychotherapy is unquestionable and many therapists have routinely used various less-intense forms of body contact.

Hypnodelic Therapy

The name of this treatment technique is a composite derived from the words "hypnosis" and "psychedelic." The concept of hypnodelic therapy was developed by Levine and Ludwig (58) in an effort to combine the uncovering effect of LSD into an organic whole with the power of hypnotic suggestion. In their approach the hypnotic technique was used to guide the subject through the drug experiences and modulate the content and course of the LSD session.

The relationship between hypnosis and the LSD reaction is very interesting and deserves a brief mention here. Fogel and Hoffer (27) reported that they were able to counteract the effects of LSD by hypnotic suggestion and, conversely, at a later date evoke typical LSD phenomena in a subject who had not ingested the drug that day. Tart (100) conducted a fascinating experiment of "mutual hypnosis," in which two persons trained both as hypnotists and hypnotic subjects continued to hypnotize each other into an increasingly deep trance. From a certain point on they became unresponsive to Tart's suggestions and shared a complicated inner journey that bore many similarities to psychedelic states.

In Levine and Ludwig's hypnodelic treatment, the first interview focused on the exploration of the patient's clinical symptoms, present life situation, and past history. Subsequently, the patient was trained as a hypnotic subject; high fixation of the eyes was used as the principle method of trance induction. Ten days later the psychiatrist conducted a psychedelic session using 125 to 200 micrograms of LSD. During the latency period, which usually lasts thirty to forty minutes when the drug is administered orally, the patient was exposed to hypnotic induction so that at the time of onset of the LSD effect, he or she was typically in a state of trance. Because of a basic similarity between LSD experiences and the phenomena of hypnosis the transition from hypnotic trance to the LSD state tends to be relatively smooth. During the culmination period of the LSD session, the psychiatrists tried to use the effect of the drug for therapeutic work while also utilizing their hypnotic rapport with the patients. They helped them to work through important areas of problems, encouraged them to overcome resistances and psychological defenses, guided them to relevant childhood memories, and facilitated catharsis and abreaction. Toward the end of the session, the patients were given posthypnotic suggestions to remember all the details of the session and to continue thinking about the problems that emerged during the session. A special isolated room was provided for them for the rest of the session day.

Levine and Ludwig explored the efficacy of the hypnodelic technique in narcotic-drug addicts and alcoholics. According to their original report, the combination of LSD administration and hypnosis proved to be more effective than either of the components used separately.

Aggregate LSD Psychotherapy

In this form of LSD therapy en masse, patients experience their LSD sessions, usually with medium or high dosages, in the company of several co-patients participating in the same psychedelic treatment program. The basic difference between this therapeutic approach and the LSD-assisted group psychotherapy described earlier is the absence of any effort at coordinated work with the group as a whole during the time of the drug action. The most important reason for giving the drug simultaneously to a large number of individuals is to save time for the therapeutic team. Despite the fact that they share the same room, patients essentially experience their sessions individually with only occasional, unstructured encounters and interactions of an elemental nature. A standard program of stereophonic music is usually offered to the entire group, or several alternative channels might be made available on different headphone circuits. Sometimes the projection of slides of emotionally relevant and provocative material or aesthetically stimulating pictures and mandalas can form an integral part of the program for the session day. The therapist and his helpers provide collective supervision; individual attention is given only if absolutely necessary. On the day following the drug session or. later on, the individual experiences of the participants are usually shared with other group members.

This approach has its advantages and disadvantages. The possibility of treating a number of patients simultaneously is an important factor from the economic point of view, and could in the future represent the answer to the unfavorable ratio between mental health professionals and psychiatric patients. On the other hand, the lack of sensitive individualized support might make this treatment .less effective and less conducive to working through some especially difficult and demanding areas of personal problems. There is also, in such a collective situation, a danger of psychological contagion; panic reactions, aggressive behavior and loud abreactions of individual patients can negatively influence the experiences of their peers. If the group approach is sensitively combined with individual work when necessary, however, its advantages can outweigh its drawbacks.

The best-known treatment program of this kind was a multidimensional approach to psychedelic psychotherapy developed by Salvador Roquet, (87) a Mexican psychiatrist and founder of the Albert Schweitzer Association in Mexico City. Although his therapeutic program utilized other psychedelic drugs and substances of plant origin in addition to LSD, it deserves more detailed discussion in this context. Roquet combined his training as a psychoanalyst with his knowledge of the indigenous healing practices and ceremonies of various Mexican Indian groups and created a new approach to therapy with psychedelic drugs that he called psychosynthesis. This should not be confused with the theory and practice of the original psychotherapeutic system also called psychosynthesis developed in Italy by Roberto Assagioli. The latter approach is strictly a non-drug procedure, although it shares with psychedelic therapy a strong transpersonal emphasis. In Roquet's approach, therapy was conducted with groups of ten to twenty-eight patients of differing ages and sexes. The members of each group were carefully selected to make the group as heterogeneous as possible with respect to age, sex, clinical problems, the psychedelic drug received, and length of time already spent in treatment. Each group included novices just beginning therapeutic work, individuals who were in the main course of treatment, and patients about to terminate therapy. An important goal of the selection process was to offer a broad spectrum of suitable figures for projections and imaginary roles. Various members of such a heterogeneous group could then represent authority figures, maternal and paternal images, sibling substitutes, or objects of sexual interest.

Following the example of Indian rituals, the drug sessions took place at night. All the participants met in a large room for a leaderless group discussion that lasted about two hours. These meetings allowed the patients to meet new members and discuss their fears, hopes and expectations; they also gave the participants ample opportunity for projections and transferences that had an important catalyzing influence on their drug sessions and frequently provided valuable learning experiences. The treatment room was large and decorated with paintings and posters with evocative themes. A wide spectrum of psychedelic substances were administered in these meetings, including LSD, peyote, a variety of psilocybin-containing mushrooms, morning glory seeds, Datura ceratocatdum, and ketainine.

The patients spent most of the time in a reclining position on mattresses arranged along the walls, though they were allowed to move around freely if they wanted. Two stereo systems were used and a wide variety of music and sounds was available to influence the depth and intensity of the group's reactions. An important part of the psychedelic sessions was a sensory overload show using slides, movies, stereo effects, and intermittent flashes of colored floodlights. Several themes considered to be of crucial relevance were interwoven in the otherwise erratic and confused barrage of unrelated images and sounds; these included j birth, death, violence, sexuality, religion, and childhood. The sensory overload portion of the drug sessions lasted about six hours and was followed by a reflective phase that lasted until sunrise. Following this, the therapists and all participants rested for an hour.

The integrative session involved group discussions and sharing of experiences. The main objective of this phase was to facilitate integration of the material uncovered in the drug session and to apply the insights to the problems of everyday living. Depending on the nature of the interactions this process took from four to twelve hours. The course of therapy consisted of ten to twenty drug sessions, depending on the nature and seriousness of the clinical problems involved. The patient population consisted mostly of neurotic out-patients, although Roquet also described various degrees of success with some antisocial personalities and selected schizophrenics.

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