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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.




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




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



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


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




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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