The Search For An Effective Technique Of Lsd Psychotherapy

It would be very difficult to describe in a systematic and comprehensive way the therapeutic procedure used in my clinical research with LSD psychotherapy in Prague. When this study began, very little was known about LSD and its therapeutic potential. The purpose of the research was to investigate whether LSD might be a useful tool for personality diagnosis and the therapy of emotional disorders. Since the project was a pilot study designed to collect new observations, in its initial phases it combined therapeutic efforts based on conventional understanding of the psychotherapeutic process with first orientations in an entirely new world of clinical phenomena. As a result, the treatment technique was being developed and constantly modified as the research proceeded. The changes of therapeutic approach reflected my increasing clinical experience, deeper understanding of the effects of LSD, and immediate inspirations from various accidental observations. In the following text I will briefly outline the major trends and stages of development of the new therapeutic technique.

When I started conducting therapeutic LSD sessions with psychiatric patients, as an enthusiastic and convinced psychoanalyst I automatically chose the classical Freudian arrangement. I had no doubts about the conceptual framework of psychoanalysis and the validity of its therapeutic technique. My intention was to explore the possibility of intensifying and accelerating the psychoanalytic process, which I found intellectually fascinating in theory but painfully ineffective in practice. I hoped that the use of LSD as an adjunct to the therapy would yield more impressive results than classical analysis, which requires years of intensive work and offers relatively meager returns on an enormous investment of time and energy. However, in the course of my LSD research I was led by everyday clinical observations to drastic departures not only from the Freudian therapeutic technique, but also from its conceptual framework and basic philosophy.

In the first therapeutic LSD sessions I conducted I asked the patients to lie on a couch, and I sat in an armchair situated near the head of the couch so that they could not easily see me. I expected to get almost continuous accounts of their LSD experiences and occasionally offer interpretations. It soon became obvious that this arrangement was not appropriate for LSD psychotherapy and I was not able to maintain it for more than a few sessions. The nature of the experience and of the process seemed to be incompatible with the Freudian technique and required a more human approach, genuine support, and personal involvement. I first moved my chair to the side of the couch, and later kept leaving it more and more frequently to sit on the side of the couch, entering into direct physical contact with the patient. This ranged from simple support such as hand-holding, reassuring touches or cradling to deep massage, bioenergetic-type maneuvers, or psycho-dramatic enactment of struggle. Because of my training as an analyst, the shift from a detached attitude to direct participation in the process occurred gradually and not without hesitation and conflict. It appeared quite appropriate to offer this degree of support to subjects who were suffering through extraordinary emotional ordeals and frequently showed signs of quite authentic regression to early periods of infancy. However, the description of this process has to be considered in its historical context; it might appear almost comical in the age of growth centers, encounter groups, sensitivity training, neo-Reichian therapies, and nude marathons. Yet I made the first moves to violate the Freudian taboo of touch while attending seminars in which my teachers seriously discussed whether shaking hands with patients presented dangers to the transference-countertransference process. Another major modification of the treatment technique was a shift from extensive verbal interaction and occasional eye contact to internalized sessions with minimal exchange of words, and use of eyeshades, headphones, and stereophonic music.

Even more drastic than the modifications of the therapeutic technique were the changes in the conceptual framework and basic paradigms underlying psychotherapy. Everyday observations from psychedelic sessions put many commonly held scientific assumptions to serious test, and showed an urgent need for revision on such fundamental issues as the cartography and dynamics of the unconscious, the nature of memory, the origin of consciousness, the definition of mental health and illness, the therapeutic goals and hierarchy of values, the philosophy and strategy of psychotherapy, and even the nature of reality and of human beings. We will discuss here only those observations that are of direct relevance for psychotherapy. The ontological and cosmological insights from psychedelic research and their relationship to the revolutionary concepts of modern physics will be described in a future volume.

At present, many professionals recognize the need to acknowledge the wisdom of ancient and Oriental spiritual disciplines, and assimilate it into psychology and psychiatry. Transpersonal psychology is becoming increasingly popular, and obtaining wide recognition. It is hard to expect a professional living in the late seventies to appreciate the difficulties that we faced in the late fifties and early sixties, exploring LSD psychotherapy equipped with the conceptual framework and world-view of Freudian psychoanalysis. Almost every day, we were confronted in psychedelic sessions with new and puzzling phenomena such as sequences of death and rebirth; intrauterine, ancestral, racial, and phylogenetic memories; animal and plant consciousness; or past-incarnation experiences. The therapeutic changes associated with some of these unusual experiences were often much more dramatic than those achieved in the context of biographically oriented work. A typical early LSD researcher, encountering some of these extraordinary episodes, risked having his or her own rationality severely tested, and quickly learned to censor reports of them to avoid having sanity questioned by others. At present, twenty years later, we are much more open to the existence of these phenomena, but still lack a comprehensive conceptual framework to account for them.

Descriptions of the exciting adventures in early clinical research that led to the development of the present therapeutic technique might be of historical interest, but are of little practical value. Instead of guiding the reader through a complicated sequence of trials and errors I will focus on the final product of this process—a therapeutic technique that has emerged from years of clinical experimentation and crystallized into a more or less standard procedure. In my experience, this approach minimizes the risks and maximizes the benefits of the psychedelic process. It makes LSD-assisted psychotherapy a powerful, effective and relatively safe method of treatment and personality change.

At this point, it seems appropriate to briefly discuss the major existing techniques for the therapeutic use of LSD, and indicate their advantages and drawbacks. This discussion should provide a basis for understanding the rationale of the treatment procedure which will be described later in detail. In an earlier section of this book, I described the techniques and underlying concepts of what I consider to be the four viable approaches to LSD psychotherapy, the psycholytic, psychedelic, anaclitic, and hypnodelic methods. The use of LSD in a hypnodelic context seems to be the least useful of these. It is a specialized procedure, discussion of which would require a considerable detour into the theory and practice of hypnosis. It has been used by only a few researchers in the past and will probably not be widely used in the future. Similarly, anaclitic therapy in its extreme form—the fusion technique—is practiced only exceptionally, although a mitigated version has been assimilated by many LSD therapists. For practical purposes we can focus our discussion on the two most important approaches, psycholytic therapy and psychedelic therapy, with occasional reference to specificities introduced by anaclitic treatment.

At first sight, psycholytic and psychedelic therapies seemed to differ both in theory and in practice to such an extent that most LSD therapists found them irreconcilable. They felt the gap between thein and between their underlying philosophies to be so fundamental that they could not conceive of bridging it; as a result, they committed themselves clearly to one or the other modality. Only a few researchers were able to feel comfortable with both approaches and use them alternately. This dichotomy is quite surprising in view of the fact that both approaches use the same chemical compound, deal with emotionally disturbed human beings, and have the same goal—therapeutic help for the patients. Although extrapharmacological factors, such as the personality of the therapist or the set and setting, play a very important role in the LSD experience, it seems reasonable to assume that psycholytic and psychedelic therapists deal with phenomena that occur on the same continuum and are closely related, if not identical. The differences seem to lie, not in the nature of the experiences themselves, but in the quantitative incidence of certain elements in the sessions, and the therapists' emphasis on certain phenomena and tendency to discourage others.

It is well known that psycholytic therapists frequently see transpersonal phenomena in their clinical practice. However, they tend to discard them, either as an escape from important traumatic childhood material, or as undesirable "psychotic" enclaves in the LSD procedure.1 Within the psycholytic framework, trans-personal phenomena are not acknowledged and their therapeutic value is not recognized. Patients are thus implicitly or explicitly discouraged from entering transcendental states; moreover, the low and medium dosages used in psycholytic therapy are generally less conducive to perinatal and transpersonal experiences than the high dosages employed by psychedelic therapists.

The frequent occurrence of transpersonal states in psycholytic treatment has its counterpart in the fact that many patients in psychedelic therapy relive traumatic childhood memories and are confronted with other material of a clearly biographical nature. Many psychedelic therapists, with their one-sided emphasis on transcendence and on mystical and religious experiences, have very little appreciation of or even tolerance for psychodynamic issues. The implicit or explicit message in psychedelic therapy usually is that a session spent in this way is inferior to one that involves transpersonal experiences. Under these circumstances patients who have predominantly biographical sessions in the course of psychedelic therapy tend to develop a feeling of personal failure. Not infrequently, the sense of "a lost opportunity" is shared by the average psychedelic therapist, no matter how important the biographical material uncovered and worked through in such a session.

As mentioned earlier, my own development was such that I had first-hand experiences of psycholytic, psychedelic, and anaclitic therapies. Being an orthodox psychoanalyst, I started my LSD work in Prague following the principles of psycholytic therapy. When numerous observations in my everyday clinical practice made this orientation untenable, I moved far beyond the narrow psychoanalytic framework to full recognition of the practical and theoretical significance of the death-rebirth process and transpersonal phenomena. During my stay in London in 1964, I participated in the work of Joyce Martin and Pauline Mc-Cririck, and acquired intimate insights into the nature of anaclitic therapy as both experient and observer. Since my arrival in the United States in March 1967, I have practiced psychedelic therapy for a number of years in the Maryland Psychiatric Research Center in Baltimore, working with alcoholics, heroin addicts, neurotics, mental health professionals, and individuals dying of cancer.

In addition, I have met most of the therapists practicing in the psycholytic and psychedelic orientations during various LSD conferences and during my visits to therapeutic facilities in Europe, the United States and Canada. The discussions during these encounters, study of LSD literature, and my own clinical experiences have gradually convinced me that the differences between these two treatment techniques are not as irreconcileable as is usually assumed. I came to the conclusion that it is possible to reduce the phenomena involved in both approaches to certain common denominators and to formulate a comprehensive general theory of LSD psychotherapy. The practical implication of this new understanding of the mechanisms operating in LSD sessions is the development of an integrated treatment procedure combining the advantages of psycholytic and psychedelic therapies, and minimizing their shortcomings.

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