Grofians Unauthorized
Discussion Group
Grofian Peyotists
Critical Situations in Psychedelic Sessions - Part I
The following excerpt is from
LSD PSYCHOTHERAPY. Grof, S. 1980
ISBN 0-89793-166-1
http://www.promind.com/bk_lps.htm
-- excerpt from Chapter 5:
[GENERAL PRINCIPLES]
"While seriously adverse aftereffects of supervised . . . sessions tend to occur only in individuals who had considerable emotional problems prior to the drug experience, in the actual course of high dose psychedelic sessions various emergencies can occur in anybody, without regard to his or her emotional stability. It is essential to inform a client during the preparation period that he or she may have difficult experiences during the sessions, and that these represent a meaningful and integral part of the procedure. One of the major problems in the non-supervised use of psychedelics was a false notion that the subject would experience only states of transcendental bliss and have a uniformly wonderful time. The occurrence of difficult emotional states was therefore perceived as an unexpected complication, and easily caused panic in the subject and his or her friends.
The most common problem in psychedelic sessions is resistance to the emerging unconscious material and an unwillingness to 'go with the experience.' The form this resistance takes is usually indicative of the client's habitual mechanisms of defense. The evasive maneuvers that the sitters have to deal with cover a very wide range. Sometimes the subject accepts the eyeshades, but argues against the use of evocative music. Here the therapists must be careful to distinguish constructive and appropriate objections from anxious efforts to fence-off the emerging emotions. Constant talking and intellectualizing which does not leave space for deeper experiences is another common escape. Some individuals try to focus in their mind's eye on the external environment and recall the surrounding reality in the most minute details. They try to remember the names of the co-patients, reconstruct the ground plan of the facility, and visualize the form and color of the furniture in the room. Sudden sobering-up in the middle of a high-dose session is another common form of psychological resistance against the psychedelic experience.
The next step involves unwillingness to keep the session internalized. Sometimes the subject asks for permission and offers a reason--taking a break, smoking a cigarette, drinking a cup of coffee, having a chat, or going for a walk. Frequent visits to the bathroom are a particularly common technique; sometimes they are physiologically justified, but often they have purely psychological motives. A more serious form of resistance involves removing the eyeshades and simply refusing to continue, without excuse or explanation. When this happens the sitters should use all their psychological skills to return the client to the original introspective mode. The only exceptions to this rule are situations where the subject wants to explore the external world and there is no doubt that the request is genuine and does not serve the purpose of avoiding the inner experience. While negotiating with the client in these situations, the sitters can refer to the original contract made during the preparation period, when various forms of resistance were explicitly discussed with the subject and he or she accepted the importance of keeping the session internalized.
In an extreme case, the relationship between the sitters and the . . . subject can be disrupted to the point where the latter perceives it as being not cooperative but antagonistic, and tries to act on his or her own. This can culminate in the client attempting to leave the treatment situation altogether. These episodes are not very frequent, but they are extremely critical for . . . therapists. The basic rule here is to keep the subjects on the premises and guard against them hurting themselves or someone else. Various degrees of compromise have to be made between the needs to restrain the subject, and to avoid an open confrontation and fight that would further impair the therapeutic relationship. In the most dramatic situations of this kind, the best one can do is play for time and keep the subject safe until the receding pharmacological effect makes him or her more amenable to active cooperation. Fortunately, such extreme situations are rather exceptional in therapeutic LSD sessions conducted by experienced sitters.
Before discussing the specific difficulties and complications that can occur during LSD sessions, we will mention some of the general principles. The most important factor in crisis-handling is the therapist's emotional reaction to the emergency situation. A calm, centered, and supportive attitude toward the various manifestations that occur in psychedelic sessions is much more important than anything the therapist says and does. The ability to remain unperturbed while facing dramatic instinctual outbursts, sexual acting-out, hostility and aggression, self-destructive tendencies, paranoid reactions, or extreme emotional and physical pain increases with experience and the number of sessions one has conducted. Participating in a number of critical situations and witnessing their positive resolution is the best training for future emergencies. Working through one's own emotional difficulties in psychedelic sessions conducted for training purposes is equally if not more important. Any serious unresolved problems in the sitters may easily be activated by participation in other people's sessions.
If the emergency situation evokes anxiety, aggression, guilt or some other inappropriate 'countertransference' reaction in the therapists, this can result in a highly dangerous type of interaction with the patient. Since the sitters are the patient's only hold on reality, their reaction is his or her ultimate criterion of the seriousness of the situation. Thus, anxiety manifested by the therapist represents final proof to the patient that the situation is really dangerous. Not only are the sitters sober and supposedly in a state of adequate reality-testing, but in the eyes of the client they are experts in dealing with unusual states of consciousness. Their evaluation of the situation and their emotional reaction thus reflects professional judgment. Whenever the therapists show strong negative reactions to emergency situations in LSD sessions, destructive vicious circles are likely to develop between the clients and themselves. The therapist may be upset by certain behavior or experiences that the patient manifests, and his or her emotional reaction has a reinforcing effect on the patient. This intensification of the patient's difficulties causes in turn more emotional distress in the therapist. Because of this snowballing effect, such situations can reach critical proportions in a very short time. Similar patterns have been described in psychodynamic literature as 'diabolic circles' ('circuli diaboli'); although this term might be slightly exaggerated when used for situations in everyday life, it is certainly appropriate and justified for the dramatic circumstances that might develop in LSD sessions.
Adequate handling of critical situations is one of the crucial problems in LSD psychotherapy. A session in which the process gets out of control is not only fruitless, but harmful; it creates frustration and disappointment in both the therapist and the patient, undermines their mutual trust, and can shatter their feelings of personal security. For the therapist adequate experience and training, including his or her own LSD sessions, is therefore of paramount importance." (pp.154-156)
"If a specific vicious interaction has developed between the sitter and the client, and the situation appears to be irresolvable, another therapist should be called to take over the session; provisions for such situations should always be made in advance. . . .
As soon as possible, the client should resume a reclining position with eyeshades and music, to continue the introspective approach to the experience." (p. 157)
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