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8/3/2019 Marianne Kaspersen and Halvard Hårklau- Emotional processing - Psychotherapy and altered states of consciousne…
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P S Y K O L O G I S K T I D S S K R I F T • N R . 3 • 2 0 0 8 19
ARTICLE
Emotional processing - Psychotherapy and altered
states o consciousness: Principles, therapeuticpossibilities and challenges
Marianne Kaspersen and Halvard Hårklau
Emotional processes are by means o almost any psychotherapeutic intervention regarded as difcult or patients
to enter. Such work may involve the delving into memories so anxiety provoking that patients oten seek to avoid
them, in therapy as well as in lie in general. Therapy that provokes emotional material and subconscious processes
thereore oten requires a special therapeutic setting, and patient- and therapist characteristics especially suited or
this kind o work. What seldom is discussed is whether the consciousness state that most therapies work through is
suited or working with subconscious processes, especially i trauma material is involved. This article seeks to discuss
this.
This article presents principles,
possibilities and challenges involved
in therapeutic interventions using
non-ordinary states of consciousness
(NOSCs). It is argued that certainNOSCs may be more suited forcertain therapeutic workings than the
ordinary state is. NOSCs can be arrivedat through a variety of ways, among them meditations, expressive therapies,breathing techniques, hypnosis, and
through the use of certain psychoactive
substances, mainly the so-calledpsychedelics1. In all these techniques,if there is a wish to induce a NOSC,this state is best described as a type of
mindfulness meditation with increasedawareness of emotions as a centralfeature.
Although NOSCs can be induced
in a variety of ways, in a therapeuticcontext, there are reasons why suchstates preferably may be induced by
the use of psychedelics. First, mostpsychedelics are non-toxic, they arenon-addictive, they never cause drug-
seeking behavior (Vetulani, 2001; Gable,2006; Halpern, 1999; 2003), and they quickly lead to a very distinct NOSCthat demands an effort to master. Dueto the fact that they are distinct NOSCsand because they are demanding tomaster, this makes psychedelic-inducedNOSCs suitable for therapeutic work. They provide possibilities formaking use of therapies from severalschools of thought, such as behavioral
therapy, insight-oriented therapy,
psychodynamic disciplines, and Gestaltoriented therapies. In order to illustratethe main points in therapeutic work with NOSCs we therefore restrict thispresentation to therapeutic work with
psychedelics in western and shamanictherapy practices. Three traditions thathave used psychedelics in therapeutic
work will be presented and compared tothe western drug-paradigm. Thereafter we outline principles in which NOSCscan be used in therapeutic contexts,as well as therapeutic possibilities and
challenges. To dene a NOSC is demanding, andit is beyond the scope of this paper
to provide such. Tart (1969) denedthe analogue term altered state of consciousness (ASC) as a state in which a given individual ”clearly feels a
qualitative shift in his pattern of mentalfunctioning, that is, he feels not just a
quantitative shift (more or less alert,more or less visual imagery, sharper orduller, etc.), but also that some quality or qualities of his mental processesare different”. Other researchershave used the term mind-body state
(Roberts, 2008) to denote that mindand body can exist in different states,each of which is more or less suited
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for the performance of specic tasks.Grof (1990) has proposed the termholotropic state to denote a condition
in which the conscious mind movestoward a more integrated state that alsoinvolves a more complete understanding of the self. In Tarts denition an ASC
is separated from altered states of alertness, although ASCs in some casesmay involve enhanced clarity. Someauthors have proposed that certain
human activities, such as for instancecreative work and problem solving may be better performed in certain NOSCs(Roberts, 2008). The claim that ourordinary waking consciousness is the
only state through which to approach
human endeavours is a contention thatRoberts (2008) has termed the single-
state fallacy. In most cultures otherthan the Western civilization such non-
ordinary states have through millennia(Rätsch, 1998) been part of integratedcultural life, as in ritual- and ceremonialsettings, or as part of healing- and
divination practices. The only knownsociety that does not include NOSCsas a part of the culture is the Western
civilization (Winkelman, 1995). NOSCshave in European culture further been
termed as pathological (Noll, 1983;Grof & Bennett, 1990). NOSCs haveeven been confused with drugged
states, and to a certain extent thereforebeen subjected to criminalization. Suchdifferences in interpretation of the
same phenomena have furthered andcontributed to the gap between western
and indigenous perspectives.
The psycholytic and the
psychedelic paradigms
The use of NOSCs as an aid intherapeutic interventions is not new.South-American traditions have beenskilled in the use of psychoactive
plants for millennia (Naranjo, 1979).In Western countries the rst uses thateventually became therapy traditions were established during the 50’s inNorth America and in Europe. Thesebecame the psycholytic tradition inEurope and the psychedelic tradition in
Canada and the US, both of which usedpsychedelics, mainly LSD, in order tofacilitate psychotherapeutic processes
and further therapeutic effectiveness
through the reprocessing and integration
of previously non-processed emotionalmaterial. The psycholytic tradition wasa theoretical and practical extension of psychoanalytically oriented therapy, in
which a low dose of LSD was given bi-
weekly (Grof, 2001). LSD served as anadjunct to therapy, making subconsciousmaterial more available for analysis. Alltherapeutic mechanisms were intensiedduring this therapy, such as emotionalabreaction, the reliving of traumaticexperiences, insight, and transferencephenomena (Grof, 2001). The inducedNOSC was easily remembered by thepatient, thus making it available forlater analysis without the substance. About 700 publications attesting to the
effectiveness of these methods were written (Passie, 2007) and psychologistsand psychiatrists within these traditions
used these methods for about 20 years.In the 60’s, however, unsupervised self-experimentations with psychedelicsby the youth movement turned intoserious problems, resulting in necessary legislative measures in an attemptto control this, which unfortunately
also hampered most therapeutic
and research-based uses of thesesubstances. The psychedelic tradition was
developed by Osmond and Hofferduring the early 50’s. One of the mostfamous research programs within thisapproach was an alcohol treatmentprogram, developed in Saskachewan,Canada (Dyck, 2006). As part of theprogram the intention was to induce afake delirium tremens by administering a single, high-dose LSD, after which the
patient was thought to reduce or stopdrinking. The results were surprising:Patients to a large extent quit or seriously reduced alcohol consumption, but thereasons they did so were different than
assumed. Many patients quit or reducedalcohol intake, due to a transforming experience often perceived to be of areligious nature. Therapy was thereafterfurthered and developed based on this
rst high-dose session. When legal issues made psychedelic
and psycholytic therapies illegal,
both these traditions merged with
other therapeutic movements, mostly expressive therapies, art therapy, andguided affective imagery techniques. To a large extent they also mergedinto transpersonal psychology and
psychiatry, in which Stanislav Grof has
been a central gure.
The shamanic paradigm
In the South-Americas, among North-American Indians, and among indigenous peoples of Africa and Asia,
healing work, divination and ritual-
religious work has been and many placesstill is part of normal cultural settings(Eliade, 1964). This draws attention tothe fact that NOSCs were and still arepresent in natural therapeutic work in
most continents. We will focus on work done by indigenous peoples practicing
in the Amazonian parts of Peru andBrazil. Shamanism is based on anessentially animistic orientation thatinuences the way disease, therapeutic work and what constitutes medicinal work in general is viewed. It is beyondthe scope of this article to present
a complete conceptual framework in this regard, but a few points will
be mentioned. From the animistic
orientation emerges the conceptionof plant spirit or plant teacher (Luna,
1984). In Amazonian culture certainplants with psychoactive properties are
regarded as plant teachers. The mostknown of these is Ayahuasca , a plant
concoct that have been in use among indigenous Amazonian cultures formillennia (Naranjo, 1979). Plant spiritsare said to present themselves to theindividual ingesting Ayahuasca through
visions (mostly closed-eye visions)
and certain songs (icaros). By therecitation of these songs the shamanenters the spirit realm (Luna, 1984).In the Amazonian culture a distinctionis made between plant body and plantspirit. If a plant is regarded as having healing properties, then this is assumedto be connected to the plant spirit,
not to the physical plant itself (plant
body) (Yensen, 1995). This marksa fundamental difference between
western and shamanic paradigms asregards what constitutes the medicinal value of plants.
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Comparison between views
According to the above, the western
drug paradigm de-emphasizespsychological variables (set parameters)in general, and also considers social
and anthropological aspects (setting
parameters) to be less important
than pharmacological effects. This isprobably where the drug paradigmbecomes totally detached from theshamanic view and also departsfrom both the psycholytic and thepsychedelic traditions. A questionshould be asked: Could this lack of credit given to psychological and social
factors explain why the use of mind-expanding substances was consideredas “having no medical potential”? Inany case: The western drug-paradigmcontrasts a shamanic paradigm inseveral ways: First, the administrationof a psychedelic substance in a non-
drug setting, aiming at a mindfulexploration of the subconscious, will, within the drug paradigm be difcult toconceptualize. Similarly, a therapeuticor a religious setting with psychedelics
will be equally difcult to grasp withinsuch a view. Within a drug-orientedunderstanding of substances, the
very fact that something is ingestedbrings about the association of drug-
taking. To alleviate this, the conceptof non-drug setting (Halpern, 2003)becomes meaningful. The weight puton chemistry relative to psychologicaland social factors versus the emphasison rituals and setting conditions
indicate a fracture between western
and indigenous views. However,the western traditions that used
psychedelics in the 50’and 60’s, stressed
the importance of set and setting parameters and that these conditionsmodulated the pharmacological effectsextensively (Grof, 2001). This indicatesthat these two western traditions
in effect are closer to the shamanicparadigm than to the drug paradigm.During the 60’s and 70’s there werealso warnings from the scienticcommunities that psychedelics shouldnever be used outside of structured
therapeutic or religious settings (Grof,2001), warnings that continue to comefrom shamanistic communities today
(Tsamani, 2008). This may suggest thatreconciliation is possible between these
traditions. These substances are usually regulated in indigenous cultures, a
fact that adds to such reconciliation.Regulations have mostly been exertedthrough highly ritualistic settings and
religious taboos, and uses outside of
such settings have been and still are rare
and seldom culturally accepted (Luna,1984; Naranjo, 1979). This may givehope for a way to regulate psychedelics
in a healthy and wise manner that willaccept and utilize their therapeutic
potential, while unauthorized uses and
unsupervised self-experimentations arebeing warned against.
Psychedelics in therapy aiming at
emotional integration: Findings
from clinical research
Clinical research on Ayahuasca isscarce. However, Ayahuasca is, due to
its botanical and chemical complexity and its cultural heritage, probably the
most interesting psychoactive in the
entire Amazonian forest (McKenna,2004). Findings from the so-calledHoasca project (Grob et al., 1996),suggest that ritual use of Ayahuasca
may alleviate a variety of psychiatricconditions, such as depression, anxiety,drug-and alcohol-abuse, and antisocial
behavior. It was also found to have aredeeming social value. Ayahuasca hasfurther been established to be relatively
non-toxic (Gable, 2007), and safeto use by humans (McKenna, 2004;
Callaway, 1999; Grob et al., 1996). Ina study by Halpern, Sherwood, Passieet al. (2008) results indicated long-termuse of Ayahuasca to have benecialhealth effects, especially as regards
drug addiction and also as regards
general psychiatric health measured asSCL-90-R. The results were statistically signicant. No harmful effects couldbe established in this study that was
performed among participants in an
American Ayahuasca church.Clinical data in Ibogaine3 research
exist as empirical group studies
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and a vast body of anecdotal datastemming from underground therapy networks (Alper, 2008). In 1963, it was unintentionally discovered that a
single ingestion of ibogaine effectively
terminated opiate craving. Later it alsobecame obvious that this terminationof craving in some cases had long-lasting effects. Mash et al. (1998) atteststo the view that the alkaloid noribogaine
from Tabernanthe iboga is responsiblefor the anti-addictive effects, and that
this can be synthesized and given in
pill form. Others assert that the visionsinduced and the personal insights
they provide relevant for underlying
addictive behavior are necessary
prerequisites for successful therapy.Empirical results have revealed thatof 33 patients diagnosed with opiate-dependence, 76% reported no signsof withdrawal symptoms 72 hourslater (Alper et al., 1999). Similar results
have been found by Mash et al. (2001). The MAPS-funded therapy researchprogram that is running at the Iboga
Therapy House has currently treated5 persons, and results are too few topredict any outcome results.
In a possible future therapeutic
context, it should be emphasized thatthe mentioned substances are meantas an adjunct to therapy, aiming atproviding the therapist with a better
clinical platform for further work withthe patient. Most therapies will then besubstance free sessions, dedicated to
integrative work, and focus on resource
implementation of more dynamicdefense styles, in addition to inducing
a greater ability to tolerate ego-dystonic
emotional material. It should also bementioned that some projects arecurrently running in several countries
using other substances than those
mentioned above (f ex MDMA andLSD) aiming at the facilitation of suchtherapeutic work.
Mechanism: Reprocessing andintegration of emotional material
The above results indicate that recent
research on drug-addiction therapy using
certain psychedelics point in the samedirection that similar therapies did inthe 50’s and 60’s. The question remains: Why do certain psychedelics often
have benecial effects on psychiatricconditions? Winkelman (1995) has
argued that these substances andplants effectuate cognitive, emotionaland, in turn, behavioral re-processing
resulting in integration; thereforehe termed them psychointegrators. Anderson (1998) assert that ibogaineeffectuate synchronization between
the hemispheres. An EEG experiment with Ayahuasca may support thesesuggestions in the case of Ayahuasca: An EEG pattern was found suggesting
hemispheric synchronization as well
as a meditative state indicative of mindful awareness of subconsciousprocesses (Hofmann et al., 2001). According to Mandell (1985), generally NOSCs that has been thoroughly worked through, including those
induced by psychedelics, will cause
better hemispheric co-ordination, thuscausing a more integrated relationshipbetween emotional and cognitive facets, which, in turn, will have advantageous
behavioral effects. All this is at presentspeculative, and research will have to
further these contentions.
Challenges: Clinical work with
psychedelics require specialized
therapeutic skills
Therapeutic work with psychedelics
and NOSCs in general brings about theneed for specialized therapeutic skills
and also presents some challenges.Difcult situations, or psychedelic
crises as they are called, are part of thetherapeutic potential of the sessions and
are generally not regarded as dangerous
or negative (Grof, 2001). They may,however, be unpleasant to the person
having them, and may therefore call foractive therapeutic assistance. Generally,according to Grof, medications areunnecessary and should be avoided.During the therapy, a problem area, aGestalt, may surface, and this Gestalt
should be allowed to nish itself, without resorting to any medications.If so handled, psychological defense
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will in most cases be restored naturally,and the experience will be easily remembered by the patient for latertherapeutic work. Depending on thesubstance being used, this will happen
within a few to 24 hours. According toGrof, tranquilizers almost always worsenthe condition, especially antipsychotic
medications, which tend to close theGestalt prematurely without restoring defenses properly. This may result ina resurgence of the emerged material when medications are removed, aphenomenon that erroneously oftenis interpreted as a sign that the patient
has gone into a permanent psychoticcondition, something that almost neverhappens (Grof, 2001). The clinicalfeatures that emerge in these situationsshould seldom be regarded as psychotic,
but may to the lay clinician, easily present themselves as such. This has ledto a need for special training programs
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in the handling of psychedelic sessions,
and such programs have previously been arranged in Switzerland (1988 to1993) and is now also under applicationin the US and in Switzerland (Doblin,2008, personal communication, 21st of March 2008, Basel, Switzerland).
Shamanic traditions have developed
their own ways of handling psychedeliccrises, and often rely on many years of extensive personal experience with theuse of psychedelics as well as many yearsof training in the handling of such crises.In these traditions the psychedelic crisis
is regarded as a process of awakening
and also as a healing process. To serveas a helper in such a crisis is an ancient
way of relating and is not very different
from the relation-based therapies inthe west. Emphasis is put on serving
as a quiet center and to be mindfully present. Without previous experience with psychedelics it is regarded as
impossible to meet a psychedeliccrisis, an attitude that is shared with
the psycholytic western paradigm. It isfurthermore important to pay attentionto the role of the sitter during the
crisis, and priorities should be madeto be supportive, to make a supportive
and calm space for the emergence andto try to follow the experience. Aboveall, one should never try to take over
the experience by talking or leading in aspecic direction.
As mentioned, psychedeliccrises are usually not dangerous,
and will in most cases solve withinreasonable time, depending on thesubstance taken and the type of
problem encountered (Grof, 2001). Inshamanistic traditions these crises have
been known for millennia and they aretraditionally regarded as very safe, an
observation that goes along well with
experiences from western traditions,in which specialists have made similarexperiences through clinical work withpatients. In a study using clinical datafrom forty-four professionals that hadutilized psychedelics in therapy with
psychiatric patients, in only 1.8 casesout of a thousand was a prolonged
reaction reported (dened as morethan 48 hours) (Cohen, 1960). Ingroups without psychiatric problems,the prevalence was much lower 0.8 outof thousand treated
In these rare cases, professional and
responsible therapeutic after-work
will, almost always resolve the problem(Grof, 2001).
Conclusion
There is reason to suggest that NOSCs
may be suited for working withemotional material that is difcult toaccess in the ordinary waking state. Thisis especially the case when the emotionalconict has been therapy resistantfor some time and over several trials with other therapies. There is furtherreason to believe that the use of certain
psychedelics is safe if properly used in
clinical settings, supervised by specially
trained therapists Clinical psychology
and psychiatry are furthermore in needfor more effective methods for reaching and working with subconscious
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material. They are also in need for morecost-effective methods. This shouldargue for the need to investigate the
clinical potential of psychedelics.
Footnotes
1Psychedelic (Greek) = mind-manifesting 2 Ayahuasca means Vine of the Dead. Ayahuascais usually made from two plant constituents:Psychotria viridis and Banisteriopsis caapi,
which contain dimethyltryptamine (DMT) and aseries of beta-carbolines respectively.3Ibogaine, an indole alkaloid from the plant
Tabernanthe iboga. The alkaloid is used ritually in Western Africa, especially in the Bwiti-cult.
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Hoffmann, E., Keppel Hesselink, J. M. &
Marianne Kaspersen
ble uteksaminert psykolog i Bergenhøsten 1995. Hun har også i overkantat tre år fra medisinstudiet vedsamme universitet. I Trondheimhar hun arbeidet med forskning,undervisning og ulike former forklinisk virksomhet. I en periode på 3år arbeidet hun ved NTNU, seksjonfor Biologisk psykologi. Hun harogså hatt undervisningsoppdrag
ved andre universitet og er nå i ferdmed å fullføre spesialisering innenklinisk voksenpsykologi. Hun har videreutdanning innen barnefaglig
sakkyndighetsarbeid og tar oppdrag
som rettsoppnevnt sakkyndig. Hunhar tre vitenskapelig publikasjoner i
internasjonale tidskrift og ere stårfor tur. I disse dager leverer hun sittdoktorgradsarbeid: ”Diagnostikk og prediksjon av PTSD: Muligheter og utfordringer”.
Halvard Hårklau
er utdannet ved NTNU med hovedfag i biokjemi. Han har undervist bådefor NTNU og andre oppdragsgiverei en årrekke. I en periode var hanogså involvert i et forskningsprosjektinnen protein-kjemi, og har i denforbindelse hatt to utenlandsopphold
ved University of California - Davis iUSA. Han har tre publikasjoner innenproteinkjemi.
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Foto: sxc.hu