The general therapeutic strategy in psychiatry and psychotherapy is critically dependent on the medical model previously discussed at some length. In this strategy, all emotional, psychosomatic, and interpersonal problems are viewed as manifestations of disease. Similarly, the nature of the therapeutic relationship, the general context of the interaction between the client and the helper, and the understanding of the healing process are all modeled after physical medicine.
In medicine, therapists have a long and specialized training and experience, and their understanding of what is wrong with patients by far exceeds that of the patients themselves. Patients are thus expected to assume a passive and dependent role and to do as they are told. Their contribution to therapy is limited to providing subjective data about their symptoms and feedback about the effects of therapy. The emphasis in healing is on medical interventions, such as pills, injections, radiation, or surgery; the enormous contribution to healing that comes from the inner restitutive processes of the organism is taken for granted and not specifically mentioned. The extreme is the surgical model whereby the patient is treated under general anesthesia and the help with the problem is seen as coming entirely from outside the organism.
The medical model continues to rule psychiatry despite increasing evidence that it is inappropriate and, possibly, harmful when applied as the exclusive and dominant approach to all the problems with which psychiatry deals. It has a powerful influence not only on those professionals who have an explicitly organic orientation, but also on the practitioners of dynamic psychotherapy. As in medicine, the professional is considered an expert who has a better understanding of the psyche of his patients than the patients themselves, and who will give them interpretations of their experiences. The patient contributes introspective data to the therapeutic situation, but the activity of the therapist is seen as instrumental in the therapeutic process. There are many explicit and implicit aspects of the medical model that establish and maintain the patient’s passive and dependent role. The general strategy of each form of psychotherapy is based on a concept of how the psyche functions, why and how symptoms develop, and what has to be done to change the situation. The therapist is thus seen as an active agent who possesses the necessary know-how and who influences the therapeutic process in a critical and decisive way.
Although various schools of depth psychotherapy emphasize in theory the need to penetrate behind the symptoms to the deeper underlying conditions, in everyday clinical practice, alleviation of symptoms is commonly confused with improvement, and their intensification, with a worsening of emotional disorders. The idea that the intensity of symptoms is a linear and reliable indicator of the seriousness of the pathological process has some justification in physical medicine. But even there it is appropriate only in those cases where healing takes place spontaneously, or where therapeutic intervention is directed toward the primary causes and not toward the presenting symptoms.
It would not be considered good medical practice to limit one’s activities and efforts to an alleviation of the external manifestations of a disease if the underlying process were known and could be directly influenced.8 Yet, this is precisely the strategy that dominates much of contemporary psychiatry. Evidence from modern consciousness research suggests that the routine medical and symptomatic orientation is not only a superficial compromise, as is usually recognized by more enlightened psychiatrists, but in many cases directly antitherapeutic, because it intereferes with the dynamics of a spontaneous process that has an intrinsic healing potential.
When a person suffering from emotional or psychosomatic symptoms confronts these problems during psychedelic therapy or with one of the new experiential techniques, it is characteristic that these symptoms become activated and intensified as the client approaches the biographical, perinatal, or transpersonal material underlying them. A full conscious manifestation and integration of the theme that underlies them then results in elimination or modification of the problem. The change of the external manifestations, then, represents a dynamic, not a mere symptomatic, solution.
Typically, confronting the underlying experience is considerably more difficult and painful than is the discomfort of the symptoms in everyday life, although it involves many of the same elements. However, this strategy offers the possibility of a radical and permanent solution, not merely a repression and masking of the real issues. This approach is quite different from the allopathic strategies of the medical model. It has its parallel in homeopathic medicine, where the general effort is to accentuate the existing symptoms to mobilize the intrinsic healing forces within the organism.
Psychological understanding of this kind is characteristic of some of the humanistic experiential approaches, particularly gestalt practice. Deep respect for the intrinsic wisdom of the healing process is also essential for Jungian psychotherapy. Healing strategies of this kind have important precedents and parallels in various ancient and aboriginal cultures—in shamanic procedures, spiritual healing ceremonies, temple mysteries, and meetings of ecstatic religious groups. The testimony of Plato and Aristotle about the powerful healing effects of the Greek mysteries are important examples. All these therapeutic strategies share the belief that, if the process behind the symptom is supported, it will result in self-healing and consciousness expansion after a temporary accentuation of the discomfort. Effective eradication of psychopathological problems does not come through alleviation of the emotional and psychosomatic symptoms involved, but through their temporary intensification, full experience, and conscious integration.
As suggested in the preceding chapter, the driving force behind the symptoms seems to be, in the last analysis, the tendency of the organism to overcome its sense of separateness, or its exclusive identification with the body ego and the limitations of matter, three-dimensional space, and linear time. Although its ultimate objective is to connect with the cosmic field of consciousness and with a holonomic perception of the world, in a systematic process of self-exploration this final goal can take more limited forms: working through one’s biographical traumas and connecting with the positive and uniting aspects of one’s life history; reliving the birth trauma and tuning in to the oceanic state of fetal existence or the symbiotic fusion with the mother during nursing; or partially transcending the limitations of time and space and experiencing various aspects of reality that are inaccessible in the ordinary state of consciousness.
The major obstacle in the process of healing so understood is the resistance of the ego, which shows a tendency to defend its limited self-concept and world view, clings to the familiar and dreads the unknown, and resists the increase of emotional and physical pain. It is this determined effort of the ego to preserve the status quo that interferes with the spontaneous healing process and freezes it into a relatively stable form that we know as psychopathological symptoms.
From this point of view, any attempt to cover up or artificially alleviate the symptoms should be seen not only as a denial and avoidance of the problem, but as interference with the spontaneous restitutive tendencies of the organism.9 It should, therefore, be done only if the patient who has been informed about the nature of the problems and the alternatives, explicitly refuses to enter the process of ongoing self-exploration, or if lack of time, human resources, and adequate facilities make the uncovering process impossible. In any case, a professional using a symptomatic approach, such as tranquilizers and supportive psychotherapy, should be fully aware that it is a palliative measure and a sad compromise, rather than a method of choice reflecting a scientific understanding of the problems involved.
The obvious objections regarding the feasibility of the approach recommended here are, of course, lack of human resources and the expensive nature of depth-psychological therapy. As long as we think in terms of the Freudian norms, where a single analyst treats on average eighty patients in a lifetime, such concerns might seem appropriate. The new experiential techniques have changed this prospect drastically. Psychedelic therapy offers a substantial acceleration of the therapeutic process and makes it possible to extend indications of psychotherapy to categories of persons who were previously excluded, such as alcoholics, drug addicts, and criminal psychopaths. Since the future of psychedelic therapy is problematic in view of the administrative, political, and legal obstacles, it seems more reasonable to think in terms of the new experiential nondrug approaches. Some of them offer therapeutic possibilities that far surpass those of the verbal techniques. However, a truly realistic approach to emotional disorders would have to take much of the exclusive responsibility from the hands of professionals and utilize the enormous resources of the general population.
In the technique of holotropic therapy, developed by my wife Christina and myself, as many as twenty persons can make considerable progress in their self-exploration and healing within a session that lasts two to three hours. An additional twenty persons who function as sitters are meanwhile developing confidence in assisting other human beings in such a process. Two to three specially trained individuals are usually present to help where necessary. In many instances, sitters develop considerable benefit from helping others. Such situations not only can enhance self-confidence and provide satisfaction, but may be a source of important insights into one’s own process. Once the spell of the medical model is removed from the system, it is conceivable that the science and art of self-exploration and assistance in the emotional process of others can be included in basic education. Many techniques already in existence combine self-exploration and psychological learning with art and entertainment in a way that makes them unusually suitable for use in an educational context.
The insights from modern consciousness research also have far-reaching consequences for the definition of the role of the therapist. The idea that basic medical and specialized psychiatric training is an adequate preparation for dealing with psychiatric problems was frequently criticized even in traditional practice. While emotional problems do not interfere with the therapeutic abilities of a surgeon or a cardiologist, unless they become excessive, they do significantly affect the work of a psychiatrist. This is why, ideally, the psychiatrist should undergo a process of deep self-exploration.
However, several years of psychoanalytic training involving free association on the couch and supervised work with patients, barely scratch the surface of the psyche. The method of free association is a very weak tool for effective self-exploration. In addition, the narrow theoretical focus keeps the process within the biographical realm. Even years of analytic training (with the exception of Jungian analysis) will not bring the analysand in touch with the perinatal or transpersonal elements in the psyche. The use of the new experiential techniques thus requires training that involves a personal experience of the states that they facilitate. In addition, such a process is never complete; therapeutic work with others, or even everyday life, will always confront the therapist with new issues. When he or she has successfully worked through and integrated the material on the biographical and perinatal levels, the scope of transpersonal issues that can emerge is commensurate with existence itself.
For the same reason, the therapist will never become the authority interpreting for the clients what their experiences mean. Even with much of a therapist’s clinical experience, it is not always possible to predict correctly what the theme underlying a particular symptom is. The credit for this discovery belongs to Jung, who was the first to realize that the process of self-exploration is a journey into the unknown that involves constant learning. This recognition changes the doctor-patient relationship into a shared adventure of two fellow seekers.
There is, of course, seniority in this procedure; the therapist offers techniques for the activation of the unconscious, creates a supportive setting for self-exploration, teaches the basic strategies, and instills trust in the process. However, the client is ultimately the authority as far as his or her own inner experience is concerned. An experience that has been successfully completed does not require interpretation. Thus, much interpretive work is replaced by a sharing of what happened. One of the important tasks of the therapist is to insure that the experiences are completed internally and to discourage acting out, which is probably the most serious problem in this kind of work. In many instances, the difference between disciplined internalization of the process and projective acting out is a critical factor distinguishing mystical quest from serious psychopathology.
There are indications that even many of the acute psychotic conditions, for which the application of the medical model might seem most indicated and justifiable, are dramatic attempts on the part of the organism at problem solving, self-healing, and achieving a new level of integration. As I mentioned earlier, it has been reported in the literature that a certain number of acute psychotic breakdowns—even under the current circumstances that are far from ideal—result in a better adjustment that the patient had before the episode.
It is also well known that acute and dramatic psychotic states have a much better prognosis than those that develop slowly and insidiously. Observations of this kind seem to support the material from modern consciousness research suggesting that the major problem in many psychotic episodes is not the upsurge of the unconscious material, but the remaining elements of ego control that interfere with successful completion of the gestalt involved. If this is the case, the strategy of choice should not be to put a psychopathological label on the process and try to interfere with it by suppressing the symptoms, but to facilitate and expedite it in a supportive atmosphere.
Thus, the experiences of psychotic patients should be validated, not in terms of their relevance in regard to the material world, but as important steps in the process of personality transformation. Support and encouragement of this process, therefore, does not mean agreement with perceptual distortions and delusional interpretations of consensual reality. The facilitating strategy involves a systematic effort to internalize and deepen the process by diverting it from the phenomenal world to the inner realities. Attaching the inner experiences to external persons and events frequently serves as powerful resistence to the process of inner transformation.
The few alternative approaches to psychosis that have been used in the past were based on the principle of support and noninterference. My own observations from psychedelic therapy with psychotic patients and from nondrug experiential work clearly suggest that a more effective approach to psychotic episodes involves acceleration and intensification of the process by chemicals or nondrug means. This therapeutic strategy is so effective and promising that it should be tried routinely wherever possible, before the patient is admitted to a psychiatric hospital and assigned to prolonged and potentially dangerous medication with large doses of tranquilizers.
On several occasions in our workshops, I have seen that individuals whose momentary emotional condition was approaching psychotic proportions were able to reach (after an hour or two of in-depth individual work using hyperventilation, music, and body work) an entirely symptom-free state or even an ecstatic condition. The experiences that mediated such dramatic changes typically involved perinatal or transpersonal themes. Although such a transmodulation should not be confused with a “cure” or a deep restructuring of personality, systematic use of this approach whenever difficult symptoms appear represents an exciting alternative to psychiatric hospitalization and the chronic use of tranquilizers. In addition, consequential use of the uncovering strategy has a potential for actually solving the problems instead of masking them and is conducive to self-actualization, personality transformation, and consciousness expansion.
The use of the approach outlined above represents a viable alternative to the traditional treatment of nonparanoid patients with acute psychotic symptoms. It involves acknowledging and validating the process as a “spiritual emergency” or a “transpersonal crisis,” instead of labeling it as “mental disease.” The patient is encouraged to go deeper into the inner experience with the assistance of the therapist. It is absolutely essential for the therapist to be familiar with the extended cartography of the psyche, to feel comfortable with its entire experiential spectrum, including the perinatal and transpersonal phenomena, and to have a deep trust in the intrinsic wisdom and healing power of the human psyche. This makes it possible to help the client to overcome the fears, blocks, and resistances that interfere with the intrinsic trajectory of the process, and support a variety of phenomena that conventional psychiatry would try to suppress at all costs.
The degree and nature of the therapist’s involvement depend on the stage of the process, on the attitude of the client, and also on the nature of the therapeutic relationship. There are two categories of patients for whom the above approach runs into considerable difficulty and might not be applicable. As a rule, patients with strong paranoid tendencies are very poor candidates; for the most part they are experiencing the early stages of BPM II. Any attempt at deep self-exploration under these circumstances is equivalent to an invitation for a ride to hell, and the therapist who makes it automatically becomes an enemy. An excessive use of projections, an unwillingness to own the inner process, a tendency to hang onto the elements of external reality, and an inability to form a trusting relationship is a combination that represents a serious obstacle for effective psychological work. Until the development of techniques that can successfully overcome this difficult set of circumstances, paranoid patients may continue to be candidates for tranquilizing therapy.
Manic patients are difficult to reach for a different set of reasons. Their condition reflects an incomplete transition from BPM III to BPM IV. A therapist attempting experiential psychotherapy with manic patients has the difficult task of convincing them that they must abandon defensive clinging to their precarious new freedom and do more serious work on the remaining elements of BPM III. For many manic patients the current treatment with Lithium salts might remain the therapy of choice, even when skilled experiential guidance is available. Paranoid and manic patients are thus poor candidates for the experiential approach, and utilizing the intrinsic healing potential of the psyche with them is an extremely tedious task. On occasion, patients from other diagnostic categories may prove unwilling or unable to confront their problems experientially; the best answer for them could be a suppressive psychopharmacological approach. Yet, others can best benefit from simple support and noninterference with the process. However, when the circumstances are favorable, active facilitation and a deepening of the process seems to be the method of choice.
Once the symptoms are mobilized and begin their transformation into a flow of emotions and physical feelings or vivid and complex experiences, it is important to encourage full experiential surrender and peripheral channelling of pent-up energies without censoring or blocking the process because of cognitive reservations. With this strategy, the symptoms will be literally transmuted into various experiential sequences and consumed in the process. It is important to know that some symptoms and syndromes are more resistant to change than others. The situation seems to be similar to the sensitivity and responsiveness to psychedelic drugs. In the spectrum of differential responses, one extreme position is occupied by obsessive-compulsive patients with their excessive rigidity and strong defenses, the other by hysterical patients who show dramatic responses to minimal interventions. A high level of resistance represents a serious obstacle in experiential therapy and requires special modifications of technique.
Whatever the nature and power of the technique used to activate the unconscious, the basic therapeutic strategy is the same: both the therapist and the client should trust the wisdom of the client’s organism more than their own intellectual judgement. If they support the natural unfolding of the process and cooperate with it intelligently—without restrictions dictated by conventional conceptual, emotional, aesthetic, or ethical concerns—the resulting experience will automatically be healing in nature.