The Preparation Period
between five and twenty hours. It is understandable that it takes much less time to work with an emotionally relatively stable subject who volunteers for the LSD session for the purpose of professional training, personal growth, or enhancement of creativity, than to prepare a severely disturbed patient with serious neurotic, psychosomatic or borderline psychotic symptoms.
Since every situation is different and every client presents quite specific problems, no concrete and detailed guidelines can be offered for the nature, content and duration of the preparation period. However, it is possible to give some general recommendations and outline certain basic principles and strategies for preparatory work.
If the session is run for therapeutic purposes the therapist should discuss in considerable detail the subject's present life situation, emotional, interpersonal and professional adjustment, and the dynamics of various psychopathological symptoms. It is also important to get sufficiently acquainted with the candidate's biographical data from early childhood to recent past. This will be very useful for a deeper understanding of various episodes of a psychodynamic nature that might occur in the LSD sessions. A therapist who is familiar with the client's developmental history will be able to offer much effective support and guidance. Knowledge of the subject's family dynamics, characteristic interpersonal patterns, and idiosyncratic emotional reactions in different periods of his or her life makes it much easier to recognize specific biographically determined distortions in the therapeutic relationship and deal with them effectively. A particularly important part of the preparatory work is to recognize certain recurrent themes, repetitive patterns, vicious circles, and self-perpetuating elements in the client's interpersonal interaction, since these are likely to be reenacted in the transference relationship.
During the exploration of the subject's life history, the therapist should share any meaningful insights and observations that he has concerning the emerging material. One important task is to develop an effective framework for organizing the subject's understanding of the relationship between his or her traumatic past and the existing problems and difficulties. Another area that deserves special attention is the connection between psychopathological symptoms and interpersonal maladjustment. It is very important to depart at this point from the classical psychoanalytic approach, and conduct the interviews in the spirit of the basic philosophy underlying psychedelic therapy. The psychoanalytic approach is primarily concerned with psychopathology, and thus focuses selectively on the negative aspects of the patient's personality. The Freudian image of man is in-stinctivistic and essentially pessimistic. Psychoanalysis sees human behavior as motivated by primitive impulses of a sexual and aggressive nature, and interprets any higher values as reaction formation or compromise with the repressive forces of society. Unhappiness is the normal human condition; the purpose of psychotherapy is to change the excessive suffering of the neurotic into normal human suffering. The psychoanalyst is basically non-directive; he or she avoids value judgments and any active guidance of the patient. It is very rare that a psychoanalyst trained in the classical tradition gives a clear answer to a specific question.
In the preparation for an LSD session, we also discuss symptoms and life problems. However, the therapist tries to relate to whatever is available of the healthy core of the patient's personality. The basic message is that there is a deep positive potential in every human being that is hidden behind the symptoms, how ever overwhelming and crippling they might seem. The traumatic past is seen as a complex of factors and situations that has alienated the patient from his real self.
The image of human nature on which this approach is based is closer to Hindu philosophy than to Freudian psychoanalysis. Behind the barrier of negative instinctual forces associated with early biographical traumas and the hellish realms of the perinatal matrices there exist vast transpersonal realms of the super-conscious mind, and a system of positive universal values not dissimilar to Abraham Maslow's metavalues. In the psychedelic model the human mind is not limited to biographically determined elements of the Freudian unconscious; it has no boundaries or limits and its dimensions are commensurate with those of the entire universe. From this point of view, it is more correct to see human nature as divine than as bestial. Although the specificities of this philosophy are not communicated to the patient as part of the preparation for the sessions, this world-view characterizes the approach of a psychedelic therapist.
In working with LSD patients, whether during the preparation or later on, it is not necessary to avoid all value judgments and direct advice. The therapist should not try to give the patient specific guidance on concrete life situations, such as whether or not to get married, file for a divorce, have children, get an abortion, and leave or change a job. Here the psychoanalytic principles are certainly justified. The situations involved are usually too complex and contain many unpredictable factors; the therapist cannot evaluate them objectively enough to suggest the optimal course from the point of view of the client's needs. Under these circumstances, it is very likely that the advice would reflect the therapist's unconscious fears, wishes and needs, instead of representing an "objective professional judgment." However, a directive approach seems to be indicated and useful in regard to a general philosophy of existence and life strategy. Here the LSD therapist can base his or her guidance on a set of values that seems to be intrinsic and universal. These values tend to emerge independently and quite consistently during successful psychedelic therapy with various subjects and appear to be associated with healthy functioning.
One of the basic messages of this existential strategy is the emphasis on life in the here-and-now—the present moment, this hour, today—as compared to rumination of memories from several past decades and indulgence in fantasies or plans for many years to come. At the same time, the awareness of the client is directed from grandiose schemes toward simple and ordinary situations in everyday life, not only as a new and untapped source of potential gratification but as the only real basis of satisfaction in life. The client is not necessarily discouraged from pursuing complicated and involved long-term projects, but is led to an insight that external achievements alone will not bring the expected satisfaction and peace of mind. A deep confrontation with death, which is an important part of the psychedelic process, will inevitably make people realize that a good self-image and positive feelings about oneself, the ability to enjoy the life process, and a deep sense of meaning with regard to one's existence are not contingent 011 complicated external conditions. They represent a primary organismic state and a way of being in the world that is basically independent of the material conditions of life, with the exception of some drastic extremes.
If this fundamental affirmation of existence is present, then even the commonest life conditions can be experienced as worthwhile. In a sense even the simple fact of participating in consciousness and in the cosmic process, in whatever way, appears to be very precious. Ordinary activities such as everyday work, physical exercise, eating, going for a walk, watching a sunset, or making love can become a joyful expression and celebration of life. When this basic appreciation of the fact of existence is missing then external success and achievement of any kind and any scope will not provide it. Under these circumstances, frantic pursuit of what appear to be self- and life-validating goals will trap the individual into a net of vicious circles without bringing the expected satisfaction. The positive life feelings, if absent, have to be sought inside, through a process of deep self-exploration and inner transformation, not by manipulation of external circumstances alone. The philosophy underlying psychedelic therapy thus definitely emphasizes^prien-tation 011 the process, rather than on the outcome or goal. Jiow and wjtlvwh^j.,attitude one performs certain activities becomes very important in this context, not only what the specific choices are and what the final result of one's effort will be.
During the preparation for the session, the above system of values can be explicitly and implicitly communicated to the client whenever there is a good opportunity. It seems appropriate to actively discourage excessive dwelling on the past for sentimental reasons or nostalgia, questioning of old decisions and choices, examination of actions associated with guilt, or retrospective rumination on failures. In a similar way, clients can be warned that they might not achieve the expected happiness by pursuing elaborate plans for the future involving money, power, status, or fame. This is particularly important if the schemes for the future are irrational, unrealistic, and exaggerated, or if the client is obviously wasting time in futile daydreaming and building "castles in the air."
It seems fully justified to emphasize the deep wisdom of the emotional and philosophical (though not necessarily pragmatic) orientation towards the present moment, and of a reliance on ordinary situations for basic life-satisfaction. We can also point to the futility and self-defeating nature of various attitudes and behaviors reflecting desperate needs to prove oneself, to please or convince one's parents, peers or unidentified "others," or to fight irrational authority. Since the above value system and life strategy was derived from the psychedelic process, there is a good possibility that the drug sessions will provide a powerful experiential validation of various issues conveyed during the preparation in a more or less intellectual way.
An important part of the initial work focuses on philosophical and religious issues. Although it has occasionally been done by psychedelic therapists, 1 would not recommend the use of a specific religious system as part of the framework for the sessions, whether it is Christianity, Judaism, Hinduism, or Tibetan Buddhism. This can frequently interfere with a symbolic framework that is emerging spontaneously from the subject's collective unconscious and is the most appropriate form for that person's spiritual experience. In addition, explicit introduction of the elements of a specific religion or church affiliation can be experienced as inappropriate and irritating not only by atheists and skeptics or followers of other creeds, but also by those who have been brought up in that same tradition and have developed serious conflicts about it. However, it seems useful to increase the client's awareness of the aesthetic aspects of the world, his or her interest in basic philosophical questions of life, and recognition of the spiritual dimension of existence in a non-specific way.
Clarification is frequently required in regard to the subject's understanding of the term "religion," the role of spirituality in human life, the relationship lie-
tween religion and science, and conflicts between various creeds. For those clients who a priori have strong negative feelings about the religious aspects of psychedelic therapy, it is helpful to emphasize that spiritual experiences in LSD sessions usually do not take the form outlined by orthodox religions. More frequently, they are close to what Albert Einstein described as cosmic religion. This form of spirituality does not involve a personified godhead, a pantheon of intermediary saints, regular church attendance, and formalized divine service. The focus is on the failure of the rational approach to grasp the many mysteries of nature and on the awe and wonder experienced in confrontation with the creative forces of the universe.
In this context, spiritual feelings are associated with such issues as the enigma of time and space; the origin of matter, life, and consciousness; the dimensions of the universe and of existence; the meaning of human life; and the ultimate purpose underlying the process of creation of the phenomenal world. Spiritual experiences of this kind can occur in individuals of high intellectual caliber and rigorous scientific training, in fact, they are fully compatible with observations accumulated by various branches of modern research. An important illustration of this point, for those who emphasize the scientific world-view, is the recent convergence of quantum-relativistic physics and various mystical traditions.
In some instances, perinatal and transpersonal experiences in psychedelic sessions can occur in specific symbolic forms typical of certain cultures and historical periods. Without special training and sophistication in archaeology or mythology, knowledge of the cultural heritage involved, or even adequate general intellectual background, an individual may experience mythological and symbolic sequences from ancient Egypt or Greece, Africa, India, Tibet, China, Japan, Australia, or Pre-Columbian countries. However, images of specific personified deities from these cultures are not usually felt to be the supreme and ultimate force in the universe. Like the endless variety of beings and objects constituting the phenomenal world, such deities appear to be manifestations of a creative principle that is transcendent and beyond form. If the psychedelic experience occurs in the context of one of the traditional sacred frameworks, it is usually congruent with the teachings of the mystical branches of that particular religion rather than with its orthodox mainstream form. It is thus closer to Christian mysticism than traditional Christianity, to the Kabbalah or Ilassidism rather than Old Testament Judaism, or to Sufism rather than the Moslem faith.
The psychedelic experience frequently involves elements totally alien to an individual's own religious tradition. Thus a Buddhist can experience identification with the crucified Christ and emerge from the session with a new understanding of Christianity; a Christian can have experiential sequences in which he or she discovers and appreciates Sufism; a Moslem may get insight into the law of karma and cycles of reincarnation; and a Rabbi may experience a conversion toward Zen Buddhism. In whichever way the subject experiences and conceptualizes the transcendental realities, he or she will usually accept that form as appropriate and fully compatible with his or her personality.
A very important element of the preparation is the development of a trust relationship between the guide and the client. The ability of the subject to let go of psychological defenses and surrender to the experience, which is crucial for successful outcome of the session, is directly proportional to the degree.of trust in the sitters. Trust is thus the single most important prerequisite of safe and effective
psychedelic therapy. In the most general sense it is of great relevance to the course of any LSD session; however, there are certain specific situations in which the element of basic trust plays a particularly crucial role. Any work on the roots of one's distrust of other people and the world at large is critically dependent on the quality of the relationship between the experient and the guides. Similarly, the ability to face the experience of ego death in all its complexity and depth usually requires good external grounding in a dependable therapeutic situation. In view of the importance of the relationship between the guides and the client, the preparation for a session should not be just a one-sided flow of information but should give the subject a chance to get to know the future sitters. Ideally, instead of being a conventional exchange of clichés, the preparation period and the therapeutic process should represent a genuine human encounter.
When the therapists feel that the preparation has accomplished the objectives described above and the client is psychologically ready for the first drug experience, they schedule one last meeting before the session. This focuses exclusively on various technical aspects of the procedure and usually takes place on the day immediately preceding the drug session. The discussion concerns the nature of the psychedelic experience, the range of unusual states of consciousness that can be induced by LSD, and the most useful ways of dealing with the experience. At this point, unless it happened earlier in the process, the therapists should encourage the client to voice all the fears and doubts that he or she might have about the drug and the procedure. This is the last opportunity to answer general or specific questions and to clarify all the misconceptions and half-truths that the subject might have picked up from sensational publicity and even from professional literature. Of these, the most important are concepts of the LSD state as "model schizophrenia" and of LSD as a substance that can cause or precipitate psychosis; the issue of prolonged reactions and "flashbacks"; the danger of organic brain damage; arid the possible adverse influence of LSD on chromosomal structure and heredity.
The "model psychosis" concept was discussed earlier; it is outdated and was replaced by a new understanding of LSD as a catalyst or amplifier of mental processes. The occurrence of transitional psychotic states after some sessions represents one of the risks of LSD therapy even under supervised conditions. However, in supervised LSD work these occur very rarely, and only in people with severe emotional problems and borderline symptomatology. They are not created by the drug but represent exteriorization of important, deep unconscious material. The activation and conscious manifestation of large quantities of such material can present a clinical problem; however, it is also an opportunity for therapeutic change, if approached and handled properly. In a later section we will discuss in detail the mechanisms of prolonged reactions, "flashbacks," and psychotic decompensations associated with the administration of LSD, as well as certain principles of conducting sessions that can minimize the occurrence of these phenomena.
The only serious and unquestionable somatic danger associated with psychedelic sessions is the stress on the cardiovascular system caused by the intensity of emotions and physical tensions typically triggered by the drug. Careful selection of the candidates and screening out of persons with a history of myocardial infarction, decompensated heart failure, malignant hypertension, severe arteriosclerosis, tendency to brain hemorrhage and similar conditions, eliminates this risk. A disposition to seizures may be a contraindication for a psychedelic session unless a well-equipped pharmacy is readily available. In individuals with a history of epilepsy LSD can occasionally trigger a sequence of seizures, or status epilepticus, which can be extremely difficult to control outside of a medical setting.
There are no indications that pharmaceutically pure LSD in the dosages that have been used in psychotherapy (50-1500 micrograms) causes organic brain damage. The allusions to this possibility that have occurred in professional literature were based on two observations. The first of these was the frequent occurrence of tremors, jerks and complex twisting movements in the subjects during LSD sessions. These motor manifestations can be observed even in individuals without an epileptic disposition and they bear a certain similarity to symptoms seen in a variety of organic diseases of the central nervous system. According to clinical observations from LSD therapy, they represent release and discharge of deep, pent-up energies associated with emotional abreaction and actually have a great therapeutic potential. The most dramatic motor abreactions of this kind occur in connection with the death-rebirth process. They tend to diminish or disappear when the individual moves beyond the perinatal level, despite the fact that by then the total amount of the drug ingested is much higher than at the time when they first occurred. Also, the great individual variability and lack of a direct dose-effect relationship weigh strongly against there being an organic basis for the motor phenomena in LSD sessions. In general, testing of LSD subjects during various stages of the psycholytic series failed to detect any indications of brain damage, even in those cases where the total number of sessions was close to one hundred. The techniques used in this context were basic neurological examination, electroencephalography, and psychological tests that are routinely used for establishing organic brain damage in clinical practice.
The second observation that some authors interpreted as indicative of brain damage was the incidence of certain personality changes observed in some LSD users. Among these were loss of ambition, dropping-out from school, growing long hair and a beard, wearing unusual clothes, a lessened concern about personal hygiene, departure from a rational orientation, and preoccupation with philosophical and religious issues. Careful analysis of the "hippie personality" clearly indicates that it cannot be attributed exclusively to the use of psychedelic substances. It is a complex phenomenon which involves important sociopolitical factors and elements of juvenile revolt reflecting the deepening generation gap. It was clearly demonstrated in our patient population that profound personality changes, including philosophical and spiritual transformation, can occur without the external changes characterizing the hippie personality. To equate the personality changes of American LSD users with the deterioration observed in patients with organic brain diseases such as prefrontal tumors shows grave misunderstanding of the problems involved. In addition, the poor quality of many of the street samples of LSD and the overlapping of the psychedelic scene with the use of amphetamines, barbiturates, phencyclidine, STP and other drugs, raises serious doubts whether one can draw any conclusions about LSD from observations made in connection with the non-inedi<paI use of so-called "street acid."
Unfortunately, the negative publicity concerning LSD and other psyche-dciics not only influenced the attitudes of the general public, educators and legislators, but also the opinion of many professionals. The national hysteria of the sixties and sensational newspaper headlines had a greater influence on psychiatrists and psychologists than the results of clinical studies indicating the relative safety of LSD when used under responsible circumstances. As a result of this, many of the statements made about the drug by professionals reflected a strongly irrational emotional bias rather than solid scientific evidence. This is best illustrated by the fact that among the psychiatrists who raised fierce objections to the use of LSD as a therapeutic tool, because they were concerned it may cause some subtle brain damage not yet detectable by our current methods, there were some individuals who did not hesitate to recommend patients for pre-frontal lobotomy.1
The last area that should be mentioned in this context is the effect of LSD on the chromosomes, fetal development and heredity. Sensationalizing has succeeded in programming the general public so thoroughly that this issue is almost bound to come up during the preparatory talks. The problem is of critical importance for psychedelic psychotherapy and its future, and one of the appendices to this book presents a critical review of over one hundred scientific papers on the subject. I will only briefly summarize my own opinion on this matter, based on twenty years of clinical experience and a thorough study of the existing literature. There does not seem to be any indication that the administration of pharmaceutical^ pure LSD has any specifically deleterious effect on chromosomes or heredity. It should not be administered to a pregnant woman, however, because of an increased danger of abortion and possible interference with fetal development.
LSD thus appears to be a very safe substance biologically, if we screen out persons with serious cardiovascular problems and pregnant women, and proceed with caution when there is a predisposition to epileptic seizure. All other dangers seem to be of a psychological nature. To a great extent these are not inherent in the drug itself, but are determined by a complex of extrapharmacological factors, such as the personality of the subject, the set and setting, and the specific techniques used in the process. The most important aspects of this problem are discussed in detail in other parts of this book.
After all the fears, doubts and apprehensions have been discussed with the client, the therapist should convey his or her understanding of the effect of the drug and of the therapeutic potential of the experience. It is important to emphasize that LSD is a catalyst or amplifier of mental processes, a tool facilitating deep self-exploration. Ingesting it does not send one into an alien world of "toxic psychosis" or "chemical phantasmagoria," but mediates an adventurous journey into the hidden recesses of one's own unconscious mind and through it into realms that can best be described as superconscious.
In the early years of LSD research, influenced by the "model schizophrenia" hypothesis, psychedelic sessions were routinely referred to as "experimental psychoses" even when they were conducted for therapeutic purposes. It is important to avoid terminology and metaphors of this kind, since they are not only scientifically incorrect, but involve a danger of heavy negative programming for the session. In such a context, episodes of anxiety, aggression, mistrust and other difficult emotions will be interpreted by the subject as indications of the "psychotomimetic" effect of the drug, instead of being seen as unique opportunities for confronting and working through certain problematic areas in one's own mind. In addition, the allusion to schizophrenia or psychosis has a frightening connotation of irreversible and permanent loss of sanity. More appropriate and useful metaphors are those using the images of an "intrapsychic movie," a "vivid fantasy," or a "waking dream." It is particularly helpful to remind the future candidate for psychedelic therapy that in our sleep we all have episodes of unusual states of consciousness during which we can vividly see, hear, smell, taste, and feel things that do not exist in the phenomenal world. This reference to dreams is a useful emphasis of the fact that all phenomena which deviate from the common experience of reality and the usual logic of things do not necessarily imply insanity.
Another important part of the preparation is to inform the client briefly of the range of experiences that can occur during the session, such as perceptual changcs in various sensory areas, reliving of emotionally relevant experiences from childhood, sensations related to diseases and operations, elements of the death-rebirth process, and various transpersonal phenomena. Since many of these are beyond the conventional frameworks, it is useful to encourage the client to give up intellectual analysis during the session and focus on the experience itself. Otherwise, reason can become a powerful obstacle to exploring new areas of experience. The intensity of psychedelic states also deserves notice; it is important to prepare the client for the fact that the dimensions of the experience will probably be beyond anything that he or she has ever faced before or could even imagine in the usual state of consciousness. Although no words can adequately communicate the intensity of a high-dose LSD experience, such a warning can save the candidate from shock and panic during the session.
It is essential to discuss in advance several situations that are the most frequent sources of difficulty in LSD sessions. The first of these is the experience of dying, which can be so dramatic, realistic and convincing that the subject can easily mistake it for a real physiological emergency. This is particularly true for the confrontation with death that occurs on the perinatal level; it may be associated with ninny acute biological signs that can alarm not only the subject but also an inexperienced sitter. The drastic changes of color, seizure-like motor activity, projectile vomiting, profuse sweating, and fast thread-like pulse that accompany the experience of dying can be very convincing as indicators of physical crisis, and ma)- contribute to the failure to recognize its symbolic nature. There exists another type of confrontation with death that occurs on the transpersonal level. It does not usually have the same heavy biological emphasis or the form of a violent life-threatening assault. The major focus of the transpersonal form of confrontation with death is on the relative ratio between attachment to the world and the desire to leave it. As a process it is much more subtle, and tends to have the quality of relatively free decision-making. It is primarily the perinatal encounter with death that presents problems in the sessions, and it should be discussed with the subject in advance. It is important to convey that the perinatal experience of dying occurs in the context of the death-rebirth process, and that total surrender to it is always followed by feelings of liberation, whereas struggle against it prolongs the suffering.
The second frequent problem in LSD sessions is the feeling that the experience will never end or that permanent insanity is imminent. A special instance of this state is the no-exit experience described earlier. It is of critical importance for the subject to know that the fastest way out of this condition is to accept the content of the experience. No judgments about the outcome of the session made while it is still in progress should be considered valid assessments or predictions; they should be treated as part of the experience. Thus, paradoxically, accepting that one will stay in the hellish experience forever leads to its termination, and total surrender to permanent insanity results in a move to higher sanity. As in the case of the death experience which frequently accompanies the fear of psychosis, fighting the specter of impending doom and insanity prolongs the unpleasant state and keeps the subject in the sphere of its influence.
The third most common source of panic is the fear of becoming homosexual. It is usually initiated by feelings of very authentic identification with representatives of the opposite sex. A male subject can experience not only an authentic female body image, but also a very genuine sense of what it feels like to be pregnant, to deliver a child, or to have a vaginal and clitoral orgasm. The less frequent equivalent experience in the female usually does not involve a sense of having a masculine body, but male psychological characteristics. It is necessary to reassure the subject that this is a very unique opportunity to gain access to the experiential world of the opposite sex. It will ultimately strengthen the sense of one's own sexual identity rather than cause a homosexual transformation. Another source of homosexual fears can be sudden feelings of physical attraction to the sitter of the same sex. These can usually be deciphered as transference of early sensual feelings toward the parent of the same sex. The deepest source of homosexual panic in a male subject seems to be the emergence of frightening birth memories; in this con text the vagina appears to be a murderous organ and the individual cannot imagine ever approaching it again as a source of pleasure.
Various physical feelings that can occur in LSD sessions should be mentioned here. On occasion, they reach sufficient intensity to present real problems. It is important to make it clear to the client that LSD in the dosages commonly used in psychotherapy does not produce any somatic symptoms just by virtue of its pharmacological effect. Nausea, vomiting, headaches, various muscular pains, suffocation, painful cramps of the uterus or the gastrointestinal tract, increased motor activity, arid other physical manifestations in LSD sessions are always of a psychosomatic nature. They are associated with important psychological material and experiencing them fully is of great therapeutic value.
Every preparation for a psychedelic session should involve discussion about the possibility that the client might experience at some point a profound crisis of basic trust, no matter how good the therapeutic relationship seems to be before the drug experience. The essential characteristics of this important crisis were described earlier. It is vital to prepare the client for this possibility and strongly suggest that he or she try to look inside themselves for possible sources of such mistrust before focusing their attention on the external circumstances. It is obviously more reasonable to assume that one's perception was changed by the influence of a powerful psychoactive drug, than to suspect that within half an hour a drastic and unexpected change occurred in the external situation or in the personalities of the sitters. The very fact that the possibility of the crisis involving trust was discussed in advance usually helps to mitigate it when it occurs.
A basic rule that is of critical importance in LSD psychotherapy is to ke6p the sessions internalized. Since the psychedelic experience represents a process of deep self-exploration, a journey into one's own mind, consistent introspective orientation is by far the most productive approach. LSD subjects are therefore encouraged to stay for most of the experience in a comfortable reclining position with their eyes closed; the best technical solution here is the use of soft eyeshades. Exposure to complex stimuli from the external world, especially if combined with moving around, excessive talking and social interaction is, in general, counterproductive. It tends to keep the experience on a superficial level and interferes with the process of self-exploration. On occasion, expressive dancing can be very useful in psychedelic sessions if the subject keeps his or her eyes closed and does not lose the introspective connection with the inner process.
1 would not like to deny that there can be positive value in psychedelic experiences in which the subject is oriented toward the external environment. The drug can open and sensitize all the sensory channels to an extraordinary degree and make it possible for the subject to perceive the world in a totally new way. The ensuing aesthetic, emotional and spiritual participation in the environment can be a very profound and valuable experience, especially if the session takes place in a beautiful natural setting. An externalized psychedelic experience in the mountains, on the seashore, in the woods, or even in one's own garden can become a unique and unforgettable event. However, if one is taking LSD for this purpose, it is important to stay in the lower dosage range, below 100 micrograms. Higher dosages tend to activate important unconscious material that can surface and distort the perception of the environment. For a person who takes LSD in a complex physical and social setting, relevant psychological elements and external sensory stimuli fuse into an inextricable amalgam that obscures the emerging personal material. Under these circumstances, the LSD state tends to become an incomprehensible mixture of external perception and experiences of one's inner world; as a result of this, such situations are generally not very conducive to productive introspection. Sessions using higher dosages for the purpose of personal growth, working through the emotional problems, and philosophical or mystical quest should, therefore, be internalized.
An even more important reason for keeping the focus on the inner process is the element of safety. The ratio between the potential benefits and possible risks is much more favorable for internalized sessions conducted in a simplified and protective setting, than it is for the outward-oriented experiences practiced by many people in the subculture. It is essential for a good outcome of the session that a balance be kept between the lowering of psychological defenses and effective working through of the emerging unconscious material. Whatever deep contents have been released, the energy associated with them should be channeled to the periphery. Maximum awareness of the inner process and its full emotional, perceptual and physical expression is of paramount importance for a good integration of the LSD experience. Sessions in which the drug activates areas of difficult emotional material and the individual tries to avoid facing them can lead to prolonged reactions, unsatisfactory integration, subsequent residual emotional or psychosomatic problems, or a precarious mental balance that becomes the basis for later "flashbacks."
In view of the above observations, much emphasis is placed during the preparation period on explaining to the client how important it is to maintain a reclining position during the LSD session, to keep on the eyeshades and headphones, and to face, experience and express fully whatever is surfacing. Most of the technical problems in the sessions occur when the client, instead of treating the experience as an internal process, projects the emerging unconscious material onto the sitters and the treatment situation. This attitude functions as a powerful defense and represents a serious obstacle to therapeutic progress. Instead of facing the problem in the inner world where it can be identified and resolved, the client creates a pseudoreal situation by projecting and focusing attention on manipulation of the external world. Preventing such counterproductive situations is one of the important tasks of the sitters and it begins in the preparation period with a detailed description and explanation of the basic rules.
One more important aspect of psychedelic therapy should be discussed with the patient in considerable detail. In medicine and conventional psychiatry, there is an implicit rule that in successful therapy the degree of improvement should be directly proportional to the number of therapeutic interventions or to the duration of treatment. In the psychedelic procedure, as in other forms of uncovering therapy that focus on solving the problems instead of relieving symptoms, this is not necessarily true. Here it can happen that the symptoms are temporarily intensified after some of the sessions; this frequently occurs just before a major therapeutic breakthrough. It should be explicitly stated in the instructions that it is not a failure of LSD therapy if after certain sessions the client feels worse. It simply reflects the fact that important unconscious material was activated in the preceding session and remained unresolved. The concept of temporary worsening as an unfinished gestalt helps the patients to tolerate difficult post-session intervals, approach them constructively, and maintain optimism in regard to the final outcome of the treatment.
Before I start describing the actual technique of conducting the LSD sessions, I would like to mention briefly several observations from my European study of psycholytic therapy. They can be used as empirical and theoretical justification of some of the principles outlined later. During psycholytic therapy, the clinical condition of the patients in the free intervals between LSD sessions showed considerable oscillations in both directions. After some sessions, clinical symptoms were alleviated or even disappeared and patients felt "cured," free from conflicts and problems, and ready to start a totally new chapter in their lives. After other sessions the clinical condition obviously deteriorated, as compared to the pre-session period. Sometimes the original symptoms were intensified, at other times entirely new and unexpected forms of psychopathology emerged, after a poorly resolved session. Occasionally, we witnessed prolonged reactions or even temporary psychotic decompensations in some borderline patients. In several instances a striking clinical improvement was reached in patients who had a very dim prognosis, but continuation of LSD therapy with the intention of stabilizing the results in fact opened new areas of problems.
Although there is a general trend toward more positive LSD experiences and better functioning in life with the increasing number of sessions, it seems impossible to eliminate all areas of conflicts and problems. However, the nature of these problems changes successively from psychodynamic, autobiographically determined issues through derivatives of the death-rebirth process to various transper-sonal elements. In the most general sense, and with some reservations, it is possible ,to talk about the Freudian, Rankian, and Jungian phases of psychedelic therapy. It is important to emphasize that the sequence of these stages is not necessarily linear and that there exist many individual patterns of unfolding. However, if we look statistically at a large number of records from serial LSD sessions, the biographical material tends to occur in early sessions, the middle part of therapy is dominated by the death-rebirth process, and advanced sessions tend to be all metaphysical and philosophical in nature. In all these stages, there seems to exist the possibility of the negative outcome of a particular session with an adverse effect on the clinical condition.
Retrospective analysis of the records from psycholytic therapy shows that good, free intervals usually followed sessions in which important partial resolutions were achieved. The termination periods of such sessions were characterized by tension-free, pleasant or even ecstatic experiences of the here-and-now. In this state, there were no unpleasant physical or emotional symptoms and no preoccupation with the past or future; only a sense of pure being with enhanced sensory awareness of the present moment. The achievement of such a condition should be the ideal goal of every psychedelic experience. Since the positive outcome of an LSD session seems to correlate with a good resolution of the activated unconscious material and with a pleasant termination period of the session, the sitters should exert active effort at the time when the pharmacological action of the drug is wearing off to facilitate a successful completion of the experiences.
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