Anexo VI: Protocolo LAL SEHOP – PETHERMA 2013

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 = dissolution) 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 case 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 interpreta­

tions. In psycholytic therapy, patients are also asked to stay in the reclining posi­

tion 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, complex 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 treat­

ment 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 them as schizophrenic. Others have identified the psychoanalytic framework as in­

complete and restricting and become more open to an extended model of the human mind. The conflict concerning the interpretation of transpersonal ex­

periences 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 Sobotkiewiczová 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 prac­

ticed 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 pro­

found personality changes observed in LSD subjects whose sessions had a very definite religious or mystical emphasis. Historically, it is related to the develop­

ment of a unique LSD treatment program for alcoholics, conducted in the early fifties by Hoffer and Osmond in Saskatchewan, Canada. These authors were in­

spired by the alleged similarity between the LSD state and delirium tremens, reported by Ditman and Whittlesey (23) in the United States. Hoffer and Osmond combined this observation with the clinical experience that many chronic alco­

holics 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 ex­

periences in LSD sessions that were correlated with good therapeutic results. On

A patient's representation of the dynamic and colorful displays of ornamental patterns which characterize the early stage in a psychedelic session.

seen in her street clothes.

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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 feel­

ings of unity with other people, nature, the entire Universe, and God.⁴ In most in­

stances this experience is contentless and is accompanied 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-Brahman 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 symp­

toms or maladjustive interpersonal patterns. In general, there is much more con­

cern about transcending psychopathology than interest in its analysis.

Occasionally, patients even receive direct advice and guidance as to how they could function more effectively. This approach is very different from the un­

disciplined 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, ex­

tramarital 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 satisfac­

tion from ordinary things that are always available in life; or the absurdity of ex­

aggerated 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 successful­

ly treated with LSD psychotherapy. They involve an 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 in­

dependently 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

concept of metavalues and metamotivations. Another important aspect of the discussions in the preparatory period is exploration of the subject's philosophical orientation and religious beliefs. This is particularly relevant in view of the fact that psychedelic sessions frequently revolve around philosophical and spiritual issues.

The last interview before the drug experience usually focuses on technical questions specifically related to the psychedelic session. The therapist describes the nature of the drug effect and the spectrum of experience that it might trigger;

special attention is paid to the importance of total yielding to the effect of the

drug and psychological surrender to the experience.

In psychedelic therapy there is great emphasis on aesthetically rich settings and a beautiful environment. LSD sessions are conducted in tastefully furnished rooms, decorated with flowers, paintings, sculptures and selected art objects. Wherever possible, natural elements are emphasized. The treatment facility should ideally be located near the ocean, mountain ranges, lakes or wooded areas as exposure of LSD subjects to natural beauty during the termination period of the sessions is an important part of the psychedelic procedure. If this is not possible, examples of natures creativity are brought into the treatment room: beautiful potted plants and fresh-cut flowers, collections of colorful minerals of interesting shapes, a variety of exotic sea-shells, and photographs of enticing scenery. Fresh and dried fruit, assorted nuts, raw vegetables and other natural foods are characteristic items in the armamentarium of psychedelic therapists, as are fragrant spices and incense; these offer an opportunity to engage both smell and taste in the rediscovery of nature. Music plays a very important role in this treatment modality;

a high fidelity stereophonic record player, a tape recorder, several sets of headphones and a good collection of records and tapes are standard equipment in psychedelic treatment suites. The selection of music is of critical importance, in general and in relation to different stages of the sessions or specific experiential sequences.

The dosages used in this approach are very high, ranging from 300 to 1500 micrograms of LSD. In contrast to the use of serial LSD sessions in the psycholytic treatment, psychedelic therapy typically involves only one high-dose session or, at the most, two or three. This procedure has been aptly referred to as a "single overwhelming dose." During the drug experience, patients are encouraged to stay in a reclining position, use eyeshades, and listen to stereophonic music through headphones for the entire period of maximum drug effect. Verbal contact is generally discouraged and various forms of non-verbal communication are preferred whenever it seems necessary to provide support.

The content of psychedelic sessions frequently has a definite archetypal emphasis and draws on the specific symbolism of certain ancient and pre-industrial cultures. Some psychedelic therapists therefore tend to include elements of Oriental and primitive art in the interior decoration of their treatment rooms. The art objects used in this context range from Hindu and Buddhist sculptures, paintings and mandalas, Pre-Columbian ceramics and Egyptian statuettes to African tribal art and Polynesian idols. In extreme instances of this

In the psychedelic approach, not much attention is paid to psychodynamic issues unless they specifically emerge and present a problem in treatment.

The development of transference phenomena is generally explicitly or implicitly discouraged; the limitation of visual contact by the use of eyeshades for most of the session helps to considerably decrease the occurrence of severe problems of this nature. The therapeutic mechanism considered of utmost importance is the psychedelic peak experience, which usually takes the form of a death-rebirth sequence with ensuing feelings of cosmic unity. None of the theoreticians of psychedelic therapy has as yet formulated a comprehensive theory of psychedelic treatment that accounts for all the phenomena involved and is supported by clinical and laboratory data. The existing explanations use the framework and terminology of religious and mystical systems or make general references to the mechanisms of religious conversion. Some authors who have tried to offer physiochemical or neurophysiological interpretations have not been able to move in their speculations beyond the most general abstract concepts. These include explanations suggesting that LSD facilitates the process of unlearning and relearning by activation of stress mechanisms in the organism, or that the therapeutic effect of LSD is based on chemical stimulation of the pleasure centers in certain archaic parts of the brain.

This lack of a comprehensive theoretical system constitutes an important difference between the psychedelic approach and psycholytic therapy, which leans in theory and practice on the systems of various schools of dynamic psychotherapy.

Psychedelic therapy has never become popular in Europe and with a few exceptions has not even been recognized or accepted by European therapists. Its use has remained by and large limited to the North American continent where it originated. Its most noted representatives in Canada have been Hoffer, Osmond and Hubbard, Smith, Chwelos, Blewett, McLean, and McDonald. In the United States, the beginnings of psychedelic therapy were associated with the names of Sherwood, Harman and Stolaroff;

Fadiman, Mogar and Allen; Leary, Alpert, and Metzner; and Ditman, Hayman and Whittlesey. During the last fourteen years, a group of psychiatrists and psychologists working in Catonsville, Maryland, has been systematically exploring the potential of psychedelic therapy in the treatment of various psychiatric problems, in the training of mental health professionals, and in the care of dying cancer patients. This research program, conducted initially at the Research Unit of the Spring Grove State Hospital and, since 1969, at the Maryland Psychiatric Research Center in Catonsville, Maryland, has been headed by Albert A. Kurland, M.D. The basic principles of the kind of psychedelic therapy employed by this group and the methodological approach to its clinical evaluation had been formulated by Sanford Unger. Other professionals who functioned as LSD therapists and researchers in this team were Cimonetti, Bonny, Leihy, DiLeo, Lobell, McCabe, Pahnke, Richards, Rush, Savage, Schiffman, Soskin, Wolf, Yensen, and Grof.

In general, psychedelic therapy seems to be most effective in the treatment of alcoholics, narcotic-drug addicts, depressed patients, and individuals dying of cancer In patients with psychoneuroses, psychosomatic disorders and character

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neuroses, major therapeutic changes usually cannot be achieved without syste­

matically working through various levels of problems in serial LSD sessions.

Anaclitic Therapy With LSD (LSD Analysis)

The term anaclitic (from the Greek anaklinein—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 dimen­

sions 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

The fusion technique seems to provide an important channel between the