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Grof on LSD Therapy 5

From “Complications of LSD Psychotherapy” in LSD Psychotherapy (1980):

Pure LSD is biologically safe, though it causes emotions which may require screening out patients with heart problems. Pregnancy is contraindicated for the trip because LSD may cause uterine contractions. Anyone with liver damage will have extended LSD trips, so people with cirrhosis or hepatitis may be screened out.


Grof informs us, “the training for future LSD therapists more-or-less followed the psychoanalytic model” with “a minimum of five personal LSD sessions under the guidance of an experienced therapist, and thirty therapeutic sessions with psychiatric patients conducted under supervision” (168).

The biggest source of problems is “resistance to the emerging unconscious material and an unwillingness to ‘go with the experience’” (166). This resistance is bound up with the refusal to keep the LSD trip internalized. Remind the patient that they have agreed, prior to the session, to keep the trip internalized for the sake of self-exploration. If the patient becomes aggressive, make sure to keep them inside and away from anything that can be used as a weapon. “The most important factor in crisis-handling is the therapist’s emotional reaction to the emergency situation” (167). We should be “calm, centered, and supportive” (167). Be sober, but remember what it was like on LSD training trips. Remember that your status as subject-supposed-to-know (to know reality, to know LSD, to know the path to health) is a crucial tool for handling the patient’s LSD trip.

Grof opposes the use of tranquilizers in an LSD session, “If tranquilizers are administered in the middle of a difficult psychedelic state they tend to prevent its natural resolution and positive integration. They ‘freeze’ the subject in a negative psychological frame and thus contribute to the incidence of prolonged reactions, negative aftereffects, and ‘flashbacks’” (168). So “by administering tranquilizers, the unresolved material will continue to surface” (169). If you must you tranquilizers, use Librium (30-60mg) or Valium (10-30mg).

“The situation that creates the most problems in psychedelic sessions is the experience of dying that occurs in the context of the death-rebirth process” (169). This is “liberating ego death” (169). Remind the patient that they are “not facing real biological death” (170). Encourage the subject consistently to surrender to the process and accept the psychological death” (170). In this case “ego death involves an experience of the destruction of everything that the subject is, possesses, or is attached to. Its essential characteristics are a sense of total annihilation on all imaginable levels, loss of all systems of relation and reference, and destruction of the objective world” (170). The ego death experience may include “agonizing physical pain, blacking out, or violent seizure-like activity” (170). We should note that “special caution is indicated in persons who have an epileptic disposition, especially those with a history of grand mal seizures” (164). LSD may trigger “entire chains of seizures following each other in rapid sequence” (164). Oddly Grof adds, “However, certain forms of epilepsy and other types of seizure-like motor activity have responded favorably to LSD treatment in the past” (164). LSD may lead to extreme “tension, tremors, cramps, jerks and complex twisting movements” (164). Closely related to this physical acting-out, the patient may adopt “repetitive verbal or motor behavior” which is “automaton-like” (171). From minutes to hours, “the individual behaves like a robot whose mechanism has been broken... repeating the same movements, sentences, or words” (171). In fact “the most common physical manifestations in LSD sessions are various motor phenomena, such as generalized muscular tension, complex postures and twisting movements, and a wide variety of tremors, jerks, twitches, and seizure-like episodes” (183). We “should consistently encourage uninhibited discharge of energy, even if full manifestation takes the form of a violent temper tantrum or an epileptiform seizure” (183).

The “experience of no exit” is a major issue in LSD trips (170). The patient may think they are trapped or that the trip will never end. In this case “emphasize and clarify the distinction between psychological time and clock time” (171). The patient must “accept its full content, including the feeling that it will last forever and that there is no way out” (171). The same solution goes for the “fear of insanity,” psychosomatic breathing problems, and psychosomatic pain (171). People may become paranoid, which may indicate regression. It is important that the therapist act as a parental figure who corrects the abuse or abandonment experienced by the patient. If the patient engages in “sexual acting out” we can correct previous parental insensitivity by being supportive, though you should not have sex with your patient (174). If the patient becomes aggressive, treat them with comfort and assurance in order to facilitate a corrective emotional experience. You may need to be supportive while the patient wets their pants or poops somewhere that is not a toilet, because “explosive bowel release or loss of anal control is psychologically associated with the ego death and the moment of birth” (185). “In 1972, I saw a dramatic improvement in a patient with severe obsessive-compulsive neurosis which had resisted classical psychoanalysis for eighteen years; it occurred in an LSD session in which he lost control of his bowels and in a deeply regressed state played for several hours with his feces” (185).

On one hand “It is the therapist’s ambiguities and conflicting messages that allow or breed problems,” but on the other hand Grof wants us to create a “territory of experiential ambiguity which seems to be optimal for therapeutic work” (180).

“The four major complications of LSD sessions that are of great practical relevance and should be specifically discussed are activation of preexisting symptoms, prolonged reactions, psychotic decompensations, and ‘flashbacks’” (194). These indicate “the weakening of the defense system and incomplete resolution of the unconscious material that thus made experientially available” (194).

Grof seems to have an ambivalent relationship with anaesthesia, since on one hand, “Major or minor tranquilizers should be avoided, since their effect is contrary to the basic strategy of any uncovering approach” (198). “By inhibiting the process, blurring the experience, and obscuring the nature of the underlying problem, they prevent its resolution” (198). But on the other hand, Grof finishes with a promotion for “ketamine (Ketalar)” as a hallucinogen that acts as a “general anesthesia” (198). “This anesthesia is of a dissociative type, which is very different from the one induced by conventional anesthetics” because “consciousness is not obliterated but deeply changed and drastically refocused” (198). In this case “the patient loses contact with and interest in objective reality and gets involved in various cosmic adventures, to a degree that makes surgical operations possible” (198).
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