It is obviously difficult to discuss the role of the therapist without giving some theoretical formulation of the nature of the psychotherapeutic process which utilizes markedly altered levels of consciousness. The basic goal of psychedelic approach is to have the individual experience a transcendental state of consciousness.
This state is defined as one in which the individual no longer experiences phenomena from all ego-state orientation but rather from ego-free orientation which has as its base both biological evolution (achieved for example, through experiencing a uni-cellular state) and cosmic mysticism (typically achieved through the experience of "the void"). In this state, there is a cessation of the experience of duality (the subject-object is an experienced integration of the phenomenon of all organic base (body) of spiritual intelligence (mind). This results, in psychological terms, in a new identity -- an identity with the life process. The psychotherapeutic nature of this process has been nicely captured by Sherwood, Stoloroff and Harman (1962):
"The individual's conviction that lie is, in essence, an imperishable self rather than a destructible ego, brings about the most profound reorientation at the deeper levels of personality. He perceives illimitable worth in this essential self, and it becomes easier to accept the previously known self as an imperfect reflection of this. The many conflicts which are rooted in lack of self-acceptance are cut off at the source, and the associate neurotic behavior patterns die away. (p. 77)"The psychedelic phenomena are most familiar to us in religious concepts and described most completely by theologians and philosophers and communicated in all art forms. The psycholytic model basically utilizes the altered state of consciousness to do the more traditional psycho-therapeutic work of resolution of intrapsychic conflict. The unique contribution of the drugs in this process is to make available to consciousness those core experiences frorn the individual's past which are not available to him in his usual state of awareness.
For example, the base of psychological separation anxiety in the birth trauma can literally be worked through by all experiential regression to that trauma. Through decathecting the resistance to birth, i.e., taking away the energy bound in the pain (resistance) there is no longer an activation of the pain of the birth trauma when the individual, in his present life state, is experiencing a removal of a familiar environment (e.g., home, people a work situation). This decathecting of the pain accomplished through having the individual re-experience that precise and exact pain at his birth while the psychotherapist actively intervenes to aid him develop a psychological attitude of acceptance of that pain. In addition, through this acceptance of a life process (birth) the individual becomes more free to accept other changes in the life process and has less need to tenacious hang on to those states of being with which he is must familiar.
To avoid misconception, we first emphasize that all of those ineffable characteristics of the psychotherapist, in the traditional psychotherapeutic endeavor, are the same as those operating in the therapeutic endeavor with psychodysleptic drugs. We do, however, think that an effective therapist must be one who has wrestled with many of the core phenomena of the human condition.
He also must have had considerable personal exposure to altered states of consciousness and understand the language and symbolism of various levels of integration of awareness. (This attitude is not new - analysts are required to have been analyzed.) For example, it is extremely difficult for a therapist to assist sonicone in going through an ego-death experience until he has been through one himself. It is the therapists knowledge, through his own experience, (all intellectual acknowledgment is insufficient) that the experiences through which the client is struggling are fully meaningful, productive and necessary that allows the therapist to give that support to the individual and it is this support which forms the foundation of the therapist's function.
Thc client's trust in the therapist is central. Fundamental to the client's ability to explore those awe-ful and terrifying antipodes of his mind is the trust that he has in the therapist and the therapist's belief that these explorations are necessary. One important basis for this trust is the therapist's working through his own counter-transference with the client. Again, there is nothing new in this idea. Rogers' description of the unconditional positive regard of the therapist for his client is absolutelly essential to this therapeutic situation as the heightened perceptiveness of the client in a state of expanded consciousness makes the practice, of deceit by the therapist disastrous.
The degree to which the therapist accepts himself is the same degree to which he can accept his client, which contributes to the degree of trust the client can achieve for his therapist which in turn determines the potential for exploration that the client can achieve. This, we realize, is a very simple formula, but one we have found to be quite valid in terms of the therapist's influence in the therapeutic endeavor. We do not, however, believe that those limitations set by the therapist are those same limitations that the client must invoke upon himself.
Often the client outstrips the therapist in the degree of conflict resolution achieved, and then the roles can become reversed with the client giving the basis of support to the therapist to explore his consciousness. Inherent in this attitude of self-acceptance and other acceptance by the therapist is the feeling that the client can achieve those goals which he sets for himself. Consequently, this type of therapy is self-actualization in the primary sense. The client sets the goals for himself, the therapist accepts those goals and accepts the fact that only the client can achieve them.
A dependency transfer relationship to the therapist is not sought, but rather the dependency is placed on that source of inforniation within the client which is made accessible by the drugs so that the client develops a reliance on those aspects of his own developing states of consciousness. The therapist, of course, shares with the client his own states of consciousness as the client asks for and invites his consciousness into his own. It becomes difficult at this point to describe the quality of the communication and relationship.
As the client is exploring totally new aspects of his consciousness, the therapist's function is to be in intuitive contact with those states of consciousness and to be available to him when he vvishes to clarify (either verbally or through non-verbal methods) the meaning of his new information. Basically, the client determines what he wishes to work with and utilizes the therapist as a resource.
When the client, after determining his objective, becomes "lost" in his altered state of consciousness, the therapist then actively intervenes to assist him in returning to his basic intent. For example, if the client becomes absorbed in visual patterns and colors the therapist can ask if he is becoming seduced by the delightful sensory experience and if this it interfering with his working with important material. We do not suggest that it is atherapeutic to be able to experience and enjoy sensory phenoinena and at one stage of development for many people, for example, intellectualized, obsessive-compulsives, this experience is quite therapeutic. We simply point out that there are many forms of resistance to psychological work in psychodysleptic therapy and it is the therapist's function to help the client become aware of this resistance.
Central to psycholytic therapy is the therapist's honesty in the presentation of himself as basically another human being who will share with the client that knowledge, love and compassion which he has. Any attitude that the therapist takes on which separates or distances himself from the client results in a reduced potential for the development of the relationship which forms the basis for the therapeutic work the client can undertake. We have found, for example, that any fear the therapist holds in any particular area of his life will often prevent the client's exploring those same fearful areas in his life.
Consequently, one of the "risks" that the psychotherapist takes in involving himself in working with clients who have expanded states of awareness is his becoming exposed through the client's ability to deeply sense the human condition of the psychotherapist. This, we feel, is undoubtedly the most difficult aspect of this treatment approach with which the psychotherapist must come to ternis.
A brief description of a psycholytic treatment (by J.M) will illustrate some of the philosophy and techniques described.
The patient was a 20 year old male paranoid schizophrenic. Treatment consisted of 24 sessions, each lasting approxiniately 5 hours over a 6 month period. Dosages used were from 50 meg. to 130 LSD. When initially seen he was actively delusional (for example, lie thought that Kennedy's assassination was a sign for him to become leader of the American people), was not able to work and could not live at home since he was afraid of acting out his murderous feelings towards his father.
Patient was extremely sensitive to any remarks from the therapist, thought that she disliked him and was mistrustful of her. Therapist felt that his mistrust was connected with some early breast frustration and it was discovered that be was weaned abruptly when his mother became ill and was hospitalized and no adequate mother substitute was available.
The early sessions were characterized almost exclusively by the following sequential and repetitious behavior: he would roll up in a semi-fetal position and suck his thumb; he then would want the therapist on the couch with him and stroke her arm and breast; he would then become agitated, push her away, jump up and down and beat on the couch; eventually he would quiet down, want the therapist with him on the couch again, and proceed through these repetitious acts over and over again.
In later sessions, he vented his rage towards his mother by shouting, swearing and raving at her and wanting to kill her. He did not attack the therapist as he discriminated between the mother and the therapist and was gratified that the therapist allowed him to feel her body as mother had never allowed. After his abreaction of rage towards mother (which the therapist accepted and interpreted to him as being a result of insufficient nurturance) he developed stronger feelings towards the therapist and wanted her more and to lie on the couch with him with his head on her breast and be allowed to phantasize having a sexual relationship with her.
She permitted this but when he wanted to put it into practice, she firmly refused, explaining how all children experience incestuous desires for the parent of the opposite sex, but that indulgence in incest was not perinitted. She explained that the incest phantasy had to be given up just as the breast had to be given up and that this was part of growing up. Although the patient understood this he was unable to accept it and when the therapist was out of the room, making the tea, he started slashing the wall with his belt and damaged it badly. This was due to his tremendous frustration and rage against the therapist, which he admitted and felt ashamed about and eventually wanted to make restitution and offered to pay for the redecoration of the wall.
Finally, he was able to accept this situation and the following week, he told the therapist that he had met a girl he was attracted to and had dated her. He became more constructive and positive and was able to make sexual advances to this girl and achieved intercourse with her. He continued this intimate friendship for another month until he returned home as he was psychologically well enough at this time to be able to return to live with his familv. He felt happy, secure and integrated and was able to settle down at the University and also to take a part-time job.
It is the therapist's opinion that it was through the trust developed in the relationship that the patient allowed himself to experience his rage towards his mother, to develop tenderness and affection for the therapist, to bear his incestuous feelings towards his mother, to resolve his murderous feelings towards father and to accept the necessity of transferring his sexuality towards another female.
Through the therapist's acceptance of this process and her lack of fear of the intense emotions and the physical aspect of the working through of the dynamics, he was able to achieve a significant integration so that he was no longer schizophrenic, achieved a heterosexual relationship and was able to continue with his education.
Dr. Martin was born in 1905 in India
and obtained her medical degree in London
in 1933. She then trained in psychiatry at
Tavistock Clinic, and subsequently was on
the staff of a number of English hospitals.
She was a pioneer in the use of LSD in
psychotherapy and continued her work until two days prior to her death in 1969.
Dr. Fisher was graduated from the University of Utah in psychology and is currently on the faculty of the University of California, Los Angeles. His mailing address is: P. O. Box 9109, Laguna Beach, CA 92651-0109
Dr. Martin was born in 1905 in India and obtained her medical degree in London in 1933. She then trained in psychiatry at Tavistock Clinic, and subsequently was on the staff of a number of English hospitals. She was a pioneer in the use of LSD in psychotherapy and continued her work until two days prior to her death in 1969.