Psycholytic therapy (historical)

1. Introduction

Version followed: Hanscarl Leuner's Göttingen model of psycholytic therapy (individual sessions inside long-term depth-psychological therapy, with inpatient "interval treatment"), as Leuner described it in German in the early 1970s and as Passie, Guss & Krähenmann (2022) reconstruct it. Ronald Sandison's Powick Hospital (UK) day-patient unit, the Swiss SÄPT group variant (1988–1993) and Betty Eisner's Los Angeles work are given as named variants. [source: Leuner, Tiefenpsychologische Aspekte der Drogenerfahrung, c. early 1970s; Passie et al. 2022]

HISTORICAL. NOT FOR USE. This tab describes a mid-20th-century hospital practice so you can recognise it, take a history from people who went through it, and respond to clients who ask about it today. It gives no doses, dosing regimens or administration details, and you should not reproduce it. The substances involved (mainly LSD, briefly psilocybin; later MDMA in Switzerland) are controlled drugs in almost every country.

What it was. Psycholytic ("mind-loosening") therapy was a European psychiatric method of the 1950s–1970s. A patient in ongoing psychoanalytic or depth-psychological psychotherapy had a series of hallucinogen sessions, given at doses described as lower than in the North American high-dose "psychedelic" approach, spaced across months of drug-free therapy. [source: Passie et al. 2022; Passie, Drug Science 2024 abstract] Sandison is credited with coining the term. Passie places this at the first European LSD symposium in Göttingen in 1960; Sandison himself recalled introducing it at a C.I.N.P. meeting in Rome around 1959. [uncertain: sources differ on date and venue] [source: Passie 1996–97; Sessa 2005]

How change was thought to happen. Leuner held that the drug was only an auxiliary tool. The real work was the depth-psychological relationship: working through material, transference and countertransference. [source: Leuner c. 1970s] He believed the drug loosened defences, so that emotionally charged, biographically meaningful images and memories, symbolic scenes, age regression and abreaction surfaced. At the same time, a "reflecting ego remnant" (an observing part of the self, Ich-Spaltung) stayed intact, so the patient could later reflect on and work through what came up. [source: Passie et al. 2022; Passie 1996–97] Leuner's theory of "transphenomenal dynamic guiding systems" held that memories and emotions were organised into complexes that shaped what emerged. Passie compares this to Grof's later COEX systems. [source: Passie 1996–97; Passie et al. 2022] Ling and Buckman argued that abreaction alone has little lasting value unless the feelings are integrated in psychotherapy. [source: Passie et al. 2022] Sandison rejected the "psychotomimetic" (model-psychosis) view and saw LSD as a loosening aid to an analysis that had stalled. [source: Sessa 2005]

Why practice stopped. The reasons were: misuse and recreational use of LSD; negative press; US federal restrictions (1962 rules making LSD an experimental drug, prohibition in 1968) and international drug control; Sandoz withdrawing supply in 1965; and, at Powick, a shift towards community psychiatry. [source: Costandi 2014; Powick Hospital (Wikipedia, citing Sandison 2001); Sessa 2005; Passie 1996–97] The EPT dissolved in the early 1970s. Leuner and Bastiaans kept special licences until they retired in the mid-1980s. Switzerland licensed five SÄPT psychiatrists from 1988 to the end of 1993. [source: Passie et al. 2022; MAPS Bulletin 1995]

Legal and regulatory status (as of the sources' dates).

• Switzerland: under Article 8 para. 5 of the Narcotics Act, the Federal Office of Public Health (FOPH) can grant an exceptional per-patient authorisation for "limited medical use" of LSD, MDMA or psilocybin. Only the treating physician can apply, with the patient's written consent, interim reports and evidence that conventional treatments are exhausted. As of 2022, no psychedelic medicinal product was approved. [source: Donauer 2022] Passie et al. (2022) say a modified psycholytic model now runs under this compassionate-use route.
• US and international: LSD was outlawed federally in 1968, and drug-control laws in the US and under the UN curtailed research. [source: Costandi 2014; Passie et al. 2022]
• Germany: the Health Ministry refused Leuner's proposed MDMA psychotherapy studies in 1985. [source: Passie 1996–97]
• Today: outside Switzerland and approved research, psycholytic sessions are not a lawful clinical service in the UK, US, Germany or most other countries. [synthesis] [uncertain: current national scheduling is not covered for each country, and rules are changing (e.g. Australia, US state programmes). Check your regulator before advising any client.]

2. Framework

This is a historical treatment framework, described as practised, not as a protocol to deliver. [source: Leuner c. 1970s; Passie et al. 2022]

Phase A: Assessment and selection.

• Goals: a first interview and an extended depth-psychological history; a clarifying talk about the working alliance and whether the method suits the patient. [source: Leuner c. 1970s]
• Preparatory talks covered life story, medical history and expectations, and began work on the transference. They lasted 60–90 minutes with one or two lead therapists. [source: Passie et al. 2022]
• Target group: "therapy-resistant", chronic, severely neurotic patients. [source: Passie 1996–97] At Powick, these were patients who had been in conventional psychotherapy for months or years without progress. [source: Sessa 2005]
• Criterion to proceed: indication present, no contraindication, and a working alliance established. A short trial course could test whether the patient could use the method. [source: Leuner c. 1970s]

Phase B: Substance sessions embedded in ongoing psychotherapy.

• Short course: a few sessions to support an existing analysis, or a trial. [source: Leuner c. 1970s]
• Long course (severe cases): Leuner gives roughly 8–40 sessions. Passie et al. report about 5–10 for milder cases and about 20 on average for severe cases, within 50–200 hours of accompanying psychotherapy. [source: Leuner c. 1970s; Passie et al. 2022] [uncertain: figures vary by source and period]
• Format: individual, in a quiet single room. Sessions ran 5–6 hours with a therapist present (Leuner), or the lead therapist checking in hourly with a sitter present (Passie's reconstruction). [source: Leuner c. 1970s; Passie et al. 2022]
• Spacing: usually 2–3 weeks apart, with 1–3 psychotherapy hours a week in between (Passie). Leuner describes sessions moving from weekly to every 2–4 weeks. [source: Passie et al. 2022; Leuner c. 1970s]
• Inpatient stays: 6–10 weeks with 5–8 sessions. Alternatively, "interval treatment" (Intervallbehandlung): brief one-to-two-night admissions per session while the patient kept up work and family life. [source: Passie et al. 2022; Leuner c. 1970s; Passie 1996–97]
• Powick variant: day patients, sessions usually weekly, sometimes twice weekly. Treatment was typically stopped after about 20 sessions without progress. [source: Sessa 2005]

Phase C: Working through (Durcharbeiten). A post-processing phase with few or no further sessions, focused on character analysis and working through the material. Leuner reported effects lasting up to a year. [source: Leuner c. 1970s]

Criteria for moving between phases. The sources give no formal checklist. Inferred from them: sessions continued while they produced a usable ("continuous-scenic") course and material that could be worked through. They stopped after a run without progress (Powick, about 20 sessions), or once working through could continue without them. [synthesis from Passie 1996–97; Sessa 2005; Leuner c. 1970s]

Named variants.

• Sandison, Powick Hospital (Worcestershire, UK), from late 1952. A purpose-built LSD unit opened in 1955 (Costandi) or 1958 (Wikipedia, citing Sandison 2001) [uncertain: dates differ]. It had five individual rooms. Up to five day patients came in at 9am, met as a group, went to their rooms for several hours with periodic nurse or registrar checks, and attended a wash-up group at about 4pm. Records indicate 683 patients and 13,785 sessions by 1965. Sandison left in 1964, and Arthur Spencer continued until Sandoz withdrew supply in 1965. [source: Sessa 2005; Costandi 2014; Powick Hospital (Wikipedia)]
• Leuner, Göttingen (Germany). Interval treatment and the inpatient day schedule described in section 4. Leuner ran the European Medical Society for Psycholytic Therapy (EPT). Founding date: 1964 (Passie 1996–97) or 1965 (Passie et al. 2022; Passie 2024). Dissolution: after the fifth symposium in 1971 (Passie 1996–97) or 1974 (Passie et al. 2022). [uncertain: dates differ between Passie's own publications] In 1964, 18 European centres practised the method. [source: Passie 1996–97]
• SÄPT (Swiss Medical Society for Psycholytic Therapy), 1988–1993. Group-based. On average 6.8 substance sessions (range 1–16), about every 5 months, set within an average of 70 drug-free verbal sessions roughly fortnightly. Music alternated with long silences during sessions. [source: MAPS Bulletin 1995]
• Eisner (Los Angeles, USA). LSD experiments with Sidney Cohen at a Veterans Administration hospital, then a private practice in Santa Monica. After the US ban she moved to other drugs and non-drug techniques (see section 5). The archival finding aid does not call her method "psycholytic". [source: OAC Eisner papers] [uncertain: how far her LSD work followed the European model was not established from the sources]

3. Guiding principles

These are the principles the historical sources state. The practical meaning given for today is mainly [synthesis].

• The drug is an auxiliary; psychotherapy is the treatment. [source: Leuner c. 1970s] Today: any account in which the substance itself "does the therapy" departs from even this historical model.
• Embed sessions in long-term depth-psychological therapy. [source: Passie et al. 2022; Leuner c. 1970s] Today: the history to take is of the whole treatment, not just the drug days.
• Keep an observing ego. A usable session preserves a "reflecting ego remnant". [source: Passie et al. 2022; Passie 1996–97] Today: ask former patients whether they felt present or overwhelmed. Overwhelm was the course Leuner judged non-therapeutic.
• Abreaction must be integrated. [source: Ling & Buckman via Passie et al. 2022] Today: catharsis without working through was considered of little value even then.
• Select for ego strength, real suffering (Leidensdruck) and own motivation. [source: Leuner c. 1970s; Passie et al. 2022] Today: patients who lacked these were considered poor candidates and at higher risk.
• Work through transference and countertransference. [source: Leuner c. 1970s] Expect erotic and paranoid transference. [source: Passie et al. 2022] Today: boundary failures during sessions were a recognised risk, so ask about them.
• Therapist training includes self-experience. The EPT recommended at least five supervised self-experiences. Leuner also required psychoanalytic training, clinical experience and pharmacological knowledge. [source: Passie et al. 2022; Leuner c. 1970s] Today: this is historical training practice and does not authorise anyone to take or give controlled drugs.
• Don't stop abreaction or intellectualise in session. Sitters offered quiet presence and containment. [source: Passie et al. 2022]
• Touch is limited and consented. Only non-invasive touch such as hand-holding, after informed consent. Leuner kept touch between shoulder and hand. [source: Passie et al. 2022] Today: a former patient reporting other touch is describing a deviation from the model.
• Warm, trusting atmosphere. Passie credits Leuner's empathy and "playful authority". [source: Passie 1996–97]
• Recovered memories are meaningful but not necessarily accurate. [source: Passie et al. 2022] Today: treat memories recovered in such sessions as clinical material, not verified history.
• Clinician's role today: history, harm reduction, integration and referral, never facilitation. [synthesis]

4. Intervention inventory

The inventory has two parts.

• 4A, historical procedures (A1–A13): what was done, described so you can recognise it. NOT FOR USE. No doses, substance choice or administration details are given, by design.
• 4B, what a clinician does today (B1–B6): the clinical procedures for working with this history. These are [synthesis] unless a source is tagged.

4A. Historical procedures (not for use)

A1. Indication and contraindication screening (Leuner)

• Purpose / when: to decide whether a patient was suitable, at the start of Phase A. [source: Leuner c. 1970s; Passie et al. 2022]
• Steps (as described):
  • Indications listed by Leuner:
    • neuroses (anxiety, depressive, obsessive-compulsive) and character neuroses;
    • "psychopathy" and borderline states;
    • sexual complaints;
    • psychosomatic and conversion symptoms.
    • His core groups were anxiety neuroses, depressive states and character neuroses.
  • Absolute contraindications: organic brain disease; pregnancy; recent liver damage; endogenous depression or mania; schizophrenia; intellectual disability. Passie et al. also list serious liver or kidney disease and endogenous psychoses. Most 1960s authors excluded patients with a first-degree relative who had psychosis.
  • Relative contraindications: low motivation; histrionic personality prone to acting out; personality disorder without suffering; markedly infantile personality.
  • Favourable signs: ego strength, stable work history, real suffering, own motivation.
• Example language: none in sources.
• Watch for (today's reading):
  • Leuner's indication list included homosexuality, and his stated age range began in childhood (from about 5 years). [source: Leuner c. 1970s] By current standards, treating sexual orientation as a disorder is a conversion practice. Children could not meaningfully consent. Treat any client account of either as possible harm (see B2 and section 5). [synthesis]
  • Passie et al. call the 1969 EPT indication list outdated in terminology. [source: Passie et al. 2022]

A2. Preparatory interviews and working alliance

• Purpose / when: to build the alliance, gather history and expectations, and start transference work before the first session. [source: Passie et al. 2022; Leuner c. 1970s]
• Steps (as described):
  • A first interview and an extended depth-psychological history.
  • A clarifying talk about the working alliance and whether the method suits the patient.
  • 60–90-minute preparatory sessions with one or two lead therapists.
  • In Leuner's unit, an individual pre-session talk the evening before.
• Example language: not given in sources. Illustrative only, to show the stance: "Whatever comes up, images, old memories, strong feelings, we will look at together afterwards. Nothing has to be solved on the day." (illustrative)
• Watch for: the sources do not detail a structured informed-consent process for the 1950s–60s. [uncertain] Powick's later compensation claims (section 5) make consent a key history question today.

A3. Morning pre-session meeting

• Purpose / when: orientation on the session day. [source: Leuner c. 1970s; Passie et al. 2022; Sessa 2005]
• Steps (as described):
  • Göttingen: breakfast, then a preparatory talk (Passie) or a morning group talk (Leuner).
  • Powick: up to five day patients met together before going to their individual rooms.
• Example language: none in sources.
• Watch for: none specified.

A4. The individual substance session (setting)

• Purpose / when: the core drug session, held in the morning. [source: Passie et al. 2022; Leuner c. 1970s; Sessa 2005; Costandi 2014]
• Steps (as described, no pharmacology):
  • A simply decorated, soundproofed or secluded single room. Softly lit (Leuner).
  • The patient lay or sat on a bed, wore eye patches and listened to soft music.
  • Powick rooms had a chair or sofa, a record player and a blackboard for drawing.
  • Session length about 5–6 hours. Leuner describes the therapist as present throughout, with exceptions. Passie's schedule has a sitter present and the lead therapist checking in hourly.
  • At Powick, patients were not watched constantly. Nurses or registrars checked periodically, and many patients preferred to be alone.
  • Sessions were audio-recorded.
• Example language: none in sources.
• Watch for (historical course markers) [source: Passie et al. 2022]:
  • Hours 1–3: daydream-like twilight, little talk, biographical images.
  • Hours 3–4: stronger transference, more talkative.
  • Hours 5–8: urge to describe, deeper insight.
  • Age regression and bodily arousal could occur.

A5. Sitter and lead-therapist conduct during the session

• Purpose / when: to keep the patient safe and contained so material could emerge. [source: Passie et al. 2022]
• Steps (as described):
  • The sitter kept an informal, safe atmosphere, mostly through quiet presence, adapted to the patient.
  • The therapist did not stop abreaction and avoided cognitive discussion during the session.
  • Therapists were prepared for erotic or paranoid transference.
  • Touch: only non-invasive (e.g. hand-holding), after informed consent. Leuner limited it to shoulder-to-hand.
• Example language (illustrative): "I'm here. You don't need to explain anything right now." (illustrative)
• Watch for: boundary drift. Intense transference combined with physical vulnerability was a recognised risk. [synthesis from Passie et al. 2022]

A6. Recognising the course type

• Purpose / when: to judge in real time and afterwards whether a session was therapeutically usable. [source: Passie 1996–97; Passie et al. 2022]
• Steps (as described): Leuner distinguished three reaction courses.
  • "Continuous-scenic": coherent, flowing scenes with an observing ego kept. The only course he considered usable for therapy.
  • "Stagnating-fragmentary": distressing and of little use.
  • A third course type is not detailed in the sources. [uncertain]
• Example language: none in sources.
• Watch for: fragmentary, stuck sessions. These were the historical marker of a poorly suited patient or session.

A7. Psychodrama elements

• Purpose / when: used in some individual cases. [source: Passie et al. 2022]
• Steps: not detailed in the sources. [uncertain]
• Example language: none in sources.
• Watch for: not described.

A8. Same-day post-session group ("wash-up")

• Purpose / when: to process the day while defences were still loosened. [source: Passie et al. 2022; Sessa 2005; Leuner c. 1970s]
• Steps (as described):
  • Göttingen: lunch, then psychodynamic group therapy in the afternoon (a late-afternoon group discussion, per Leuner).
  • Powick: a wash-up group at about 4pm before patients went home. Costandi describes daily group sessions.
  • Group work during intoxication was abandoned, because therapists could not follow the interactions. [source: Passie et al. 2022]
• Example language: none in sources.
• Watch for: aggressive or depressive after-effects, which Leuner says were handled through group aftercare. [source: Leuner c. 1970s]

A9. Art and creative work

• Purpose / when: non-verbal expression after the session. [source: Passie et al. 2022; Leuner c. 1970s; Sessa 2005]
• Steps (as described): an art room with drawing, painting, writing and clay after the session, or rest followed by creative work. At Powick, a blackboard in the session room.
• Example language: none in sources.
• Watch for: not specified.

A10. Evening routine

• Purpose / when: end of the inpatient session day. [source: Passie et al. 2022]
• Steps (as described): dinner, with a light sleep aid offered (medical decision; no details given here).
• Example language: none in sources.
• Watch for: not specified.

A11. Recordings, transcripts and integration sessions

• Purpose / when: working through in the days after a session. [source: Leuner c. 1970s; Passie et al. 2022]
• Steps (as described):
  • A one-to-one talk the day after the session to consolidate findings.
  • The patient listened to the session recording at home and made a transcript, reviewed with the therapist the following week.
  • Dream-work methods were applied to the session material.
• Example language (illustrative): "Let's take the scene you transcribed and treat it like a dream. What stands out to you now?" (illustrative)
• Watch for: the authors caution that recovered memories may be emotionally meaningful without being historically accurate. [source: Passie et al. 2022]

A12. Interval psychotherapy and "interval treatment"

• Purpose / when: to keep the patient's ordinary life intact while continuing sessions. [source: Leuner c. 1970s; Passie 1996–97; Passie et al. 2022]
• Steps (as described):
  • Outpatient depth-psychological therapy, 1–3 hours a week.
  • A brief admission of one or two days and nights for each substance session, initially weekly, later every 2–4 weeks.
  • The patient kept up work and family life between admissions.
• Example language: none in sources.
• Watch for: not specified.

A13. SÄPT group-session variant (Switzerland 1988–1993)

• Purpose / when: a licensed psycholytic group format. [source: MAPS Bulletin 1995; Vice 2015]
• Steps (as described):
  • Patients had long courses of drug-free verbal therapy, on average about 70 sessions roughly fortnightly.
  • Substance sessions took place in groups, roughly every 5 months after about 10 verbal sessions.
  • Patients interacted with therapists and each other.
  • Selected music alternated with long silences.
• Example language: none in sources.
• Watch for: about one-third of former patients reported anxiety, panic or horror during sessions. Only one reported lasting disadvantage. [source: MAPS Bulletin 1995]

4B. What a clinician does today with this knowledge

B1. Taking a history of past psycholytic or LSD therapy

• Purpose / when: when an older client mentions "LSD treatment" or "drug-assisted analysis" in a 1950s–1970s hospital, or a stay at Powick, Göttingen or another of the 18 European centres. Also for a client treated in Switzerland in 1988–1993 or since 2014. [source for scale and sites: Powick Hospital (Wikipedia); Passie 1996–97; MAPS Bulletin 1995] [steps: synthesis]
• Steps:
  1. Establish the basics: where, when, inpatient or day patient, how many sessions, and what the stated reason for treatment was.
  2. Consent: ask what the client was told and whether they felt free to refuse or stop.
  3. The client's experience: how the sessions felt, what came up, and whether they felt accompanied or left alone. At Powick, patients were often alone with periodic checks.
  4. Conduct: whether touch or any conduct crossed boundaries. The published model limited touch to consented hand-to-shoulder contact.
  5. Diagnosis: what diagnosis or "indication" they were given. Note pathologised sexual orientation, and treatment as a child.
  6. Aftermath: after-effects, with onset and course; what later care they had; whether they took part in the 2002 Powick settlement or similar claims.
  7. Meaning today: what the client makes of the experience now.
• Example language (illustrative): "Some hospitals used LSD alongside psychotherapy back then. Can you tell me what you remember of how it was explained to you, and what the sessions were like?" (illustrative)
• Watch for:
  • shame or fear of being seen as a "drug user";
  • minimisation;
  • memories recovered under the drug being treated as settled fact. Sources caution these may be meaningful without being accurate. [source: Passie et al. 2022]
  • It is working when the client can give a coherent account at a pace they control. [synthesis]

B2. Supporting clients harmed by historical drug therapy

• Purpose / when: a client describes lasting distress, a sense of having been experimented on, coercion, or treatment aimed at sexual orientation. [synthesis] [context: in 2002 the NHS settled out of court with 43 former Powick LSD patients for £195,000 in total (Dyer, BMJ 2002, cited in Powick Hospital (Wikipedia); Costandi 2014). The specific allegations are not given in the sources. [uncertain]]
• Steps [synthesis]:
  1. Validate the experience without arguing about the historical model's intent.
  2. Assess current symptoms with standard tools: trauma, depression, anxiety, any perceptual after-effects. Refer to psychiatry or neurology where symptoms are perceptual or neurological.
  3. Map what was harmful: lack of consent, being left alone, boundary violations, pathologising of identity.
  4. Offer trauma-focused treatment by current evidence-based standards, with stabilisation first.
  5. Records: help the client request their records if they wish (via the relevant health-records route).
  6. Legal advice: signpost independent legal advice for any claim. Do not advise on merit.
  7. Conversion practices: where treatment targeted sexual orientation, name it as a now-rejected practice and use affirmative approaches.
• Example language (illustrative): "What was done to you was considered treatment then. That doesn't make it right for you, and your reactions to it make sense." (illustrative)
• Watch for:
  • re-traumatisation from detailed recall: pace it;
  • anger at the profession, which may show up in the rupture with you.
  • It is working when symptoms fall and the client's account shifts from self-blame. [synthesis]

B3. Appraising historical claims (with clients, colleagues or media)

• Purpose / when: a client or colleague cites old success rates as proof that "psycholytic therapy works". [synthesis]
• Steps:
  1. Name the figures accurately:
     • Sandison's 1954 report: of the patients treated, 14 recovered, 1 greatly improved, 6 moderately improved, 2 not improved. [source: Costandi 2014]
     • Mascher's 1967 review: about two-thirds of difficult chronic cases improved. [source: Passie et al. 2022]
     • Leuner's literature review: 1,600 cases, with 61–70% success in his core groups. [source: Leuner c. 1970s]
     • Göttingen follow-ups: above 66%. [source: Passie et al. 2022]
     • Swiss 1988–1993: 85–91% self-reported improvement. [source: MAPS Bulletin 1995]
  2. Name the design limits: naturalistic studies with no control groups, self-report and likely publication bias. Even Gasser and Passie say the figures are not proof of efficacy. [source: Passie et al. 2022; MAPS Bulletin 1995; Vice 2015; Costandi 2014]
  3. Separate the historical model from current trials, which use different formats. [synthesis]
• Example language (illustrative): "Those early numbers come from clinics reporting on their own patients, without comparison groups. They're interesting history, not proof." (illustrative)
• Watch for: romanticising or demonising the history; aim for neutral accuracy. [synthesis]

B4. Responding to a client who wants "psycholytic" or low-dose substance therapy now

• Purpose / when: a client asks you to provide, sit for, or recommend psycholytic sessions. [synthesis]
• Steps:
  1. Be clear that you cannot provide or facilitate sessions with controlled substances outside a licensed framework.
  2. Explain the lawful routes in general terms:
     • in Switzerland, a treating physician may apply to the FOPH for a per-patient limited-medical-use authorisation where conventional treatments are exhausted [source: Donauer 2022];
     • elsewhere, approved clinical trials. [synthesis]
  3. Explore the request: what the client hopes for, and their treatment history.
  4. Offer evidence-based alternatives and, where appropriate, depth-psychological therapy without substances.
  5. Document the conversation.
• Example language (illustrative): "I can't arrange or take part in sessions with these substances, but I can help you think through what you're hoping for and what lawful options exist." (illustrative)
• Watch for: the client planning use anyway. Move to B5. [synthesis]

B5. Harm-reduction assessment for clients using substances outside clinics

• Purpose / when: a client tells you they will attend, or have attended, an underground or overseas "psycholytic" or retreat session. [synthesis, per Domain VII harm-reduction rule]
• Steps [synthesis unless tagged]:
  1. Stay non-judgemental and keep the alliance.
  2. Screen for the conditions historical programmes treated as exclusions:
     • psychotic illness or bipolar disorder, including family history of psychosis;
     • organic brain disease;
     • pregnancy;
     • serious liver or kidney disease;
     • personality structure prone to acting out;
     • borderline structure, which Leuner flagged for psychotic complications. [source: Leuner c. 1970s; Passie et al. 2022] Add current suicidality, cardiovascular disease and current psychiatric medication. [synthesis]
  3. Educate in general terms: risks of interactions with prescribed medicines, of unknown substance content and of unsupervised settings. Advise discussing medicines with a prescriber. Give no dosing or sourcing information.
  4. Safety plan: a sober support person, crisis contacts, and a plan for prolonged distress or psychotic symptoms (emergency services).
  5. Ask about the facilitator's conduct: touch policy, a two-person team, medical cover. Unconsented touch was outside even the historical model. [source: Passie et al. 2022]
  6. Refer to medical care where risks are present.
• Example language (illustrative): "I'm not going to help you get or use it, but I do want you safe. Can we go through some risks and a plan for if things go badly?" (illustrative)
• Watch for:
  • high-risk indicators: psychosis history, active suicidality, pregnancy;
  • the client hiding plans.
  • It is working when the client shares plans openly and has a written safety plan.

B6. Integration support after a session

• Purpose / when: after a client has had a session (in a licensed programme, abroad, or illicitly) and brings the material into therapy. [synthesis]
• Steps:
  1. Stabilise first: sleep, functioning, risk.
  2. Invite a written account of the experience. This adapts the historical transcript practice to lawful talking therapy. [source for the historical practice: Leuner c. 1970s]
  3. Work with images symbolically, as you would with a dream, and link them to life-story themes and the transference. [historical basis: Passie et al. 2022; application: synthesis]
  4. Hold recovered "memories" as material, not verified fact. [source: Passie et al. 2022]
  5. Integrate the material into ongoing goals, rather than seeking further sessions as the main treatment.
• Example language (illustrative): "If this image were a dream, what might it be saying about where you are now?" (illustrative)
• Watch for:
  • persisting distress or perceptual changes: refer for medical assessment;
  • grandiosity or a push for repeated use.
  • It is working when insights translate into changes in relationships and daily life. [synthesis]

5. Handling problems

5A. Problems the historical sources describe, and how they were handled (historical, not for use)

• Anxious or aversive reactions during a session.
  • Leuner: met first psychotherapeutically. If that failed, a physician could give a medication to reduce the drug effect (a medical decision; not described here). [source: Leuner c. 1970s]
  • SÄPT: about one-third of patients reported anxiety, panic or horror in sessions. [source: MAPS Bulletin 1995]
• Unproductive ("stagnating-fragmentary") sessions. Leuner judged these distressing and of little use. The sources answer mainly through selection (ego strength, motivation) rather than a specific in-session technique. [source: Passie 1996–97; Passie et al. 2022] [uncertain: no in-session remedy found]
• Aggressive or depressive after-effects. Handled through group aftercare. [source: Leuner c. 1970s]
• Prolonged psychotic reactions and suicide.
  • Leuner cites a UK series with psychotic complications lasting over 48 hours in under 1% of patients, about two-thirds of whom fully recovered, and a very small treatment-linked suicide rate. He flags borderline structure as a particular risk. [source: Leuner c. 1970s]
  • Passie et al. state that surveys of over 9,000 patients and a Swiss retrospective study found major complications no more frequent than in conventional psychotherapy. [source: Passie et al. 2022]
  • The SÄPT follow-up found no suicides, hospitalisations or psychoses lasting over 48 hours during treatment. One patient reported persistent depression beginning three months after the last session. [source: MAPS Bulletin 1995]
  • These are practitioners' own figures. [uncertain]
• Erotic and paranoid transference. Therapists were to expect it and work with it analytically. Touch was limited to consented hand-to-shoulder contact. [source: Passie et al. 2022]
• Acting out. Histrionic patients prone to acting out were a relative contraindication. [source: Leuner c. 1970s; Passie et al. 2022]
• Non-response. At Powick, treatment was typically stopped after about 20 sessions without progress. [source: Sessa 2005]
• Group sessions under the drug. Abandoned, because interactions could not be followed. Groups moved to after the session. [source: Passie et al. 2022] (The SÄPT later reintroduced group substance sessions. [source: MAPS Bulletin 1995])
• Dependence. Leuner reported at most psychological dependence in his own cases and contrasted this with uncontrolled illicit use. [source: Leuner c. 1970s]
• Drift into improvised techniques: the Eisner case.
  • After the US ban, Betty Eisner used other drugs, carbogen inhalation, hot mineral baths, massage and "blasting" (patients yelling into a muffled washcloth).
  • In 1976 a patient died after mineral-bath treatment and blasting. A wrongful-death investigation and an APA ethics investigation followed. California revoked her licence in 1978, and her attempts to restore it in the early 1980s failed. [source: OAC Eisner papers]
  • Lesson: unstructured, escalating cathartic techniques outside any published frame carry serious risk. [synthesis]
• Harmful aims and populations. Leuner's indication list included homosexuality and an age range starting in childhood. [source: Leuner c. 1970s] These are now recognised as unethical (conversion practice; inability of children to consent). [synthesis]

5B. Problems a clinician meets today [synthesis unless tagged]

• Stuck client: endlessly retelling the historical treatment.
  • Shift from narrative to meaning and present impact ("What does it still decide for you today?" (illustrative)).
  • Use a trauma-focused approach with paced exposure only after stabilisation and consent.
• Overwhelm when recalling sessions or integrating new ones.
  • Slow down and ground: orientation to the room, breathing at the client's own pace.
  • Agree stop signals.
  • Return to stabilisation before more detail.
• Doubt about recovered memories. Hold them as meaningful material without confirming or disconfirming them as history. [source: Passie et al. 2022 on accuracy] Avoid suggestive questioning.
• Resistance or rupture: the client feels judged for their interest in, or use of, psychedelics, or feels you are "selling" them.
  • Name it and restate your role: safety, understanding, lawful options.
  • Repair openly: "I may have sounded like I was lecturing. That's not what I want." (illustrative)
• Pressure to facilitate. The client asks you to sit for, supply or recommend underground sessions.
  • Decline clearly and explain that it is outside lawful practice.
  • Continue B4 and B5.
  • Document.
  • Consult your professional body's guidance. [uncertain: guidance varies by jurisdiction]
• Non-adherence to the safety plan. The client goes ahead without the agreed precautions.
  • Review without shaming and update the plan.
  • Increase contact around the planned date.
  • Make sure crisis numbers are current.
• Persistent distress, perceptual changes or psychotic symptoms after use.
  • Urgent medical or psychiatric assessment.
  • Standard suicide-risk assessment where indicated, including safety planning and lethal-means counselling (safe storage and removal).
  • Do not interpret psychotic symptoms as "integration material".
• Disclosure of boundary violations by a current or past practitioner (sexual touch, touch without consent, exploitation during altered states).
  • Believe and support the client.
  • Explain reporting options: the practitioner's regulator, and police where a crime is involved.
  • Follow safeguarding duties for any risk to others, and mandatory reporting where your jurisdiction requires it.
  • Even the historical model limited touch to consented hand-to-shoulder contact. [source: Passie et al. 2022]
• A colleague offering "psycholytic" sessions without a licence.
  • Raise concerns per your professional code.
  • Seek consultation.
  • Report to the relevant regulator where client safety is at risk.
• A client from a pathologised group, e.g. one treated for homosexuality, or treated as a child.
  • Use affirmative, trauma-informed care.
  • Acknowledge institutional harm.
  • Signpost survivor and advocacy support if wanted.
• Client seeking Swiss limited-medical-use treatment.
  • Explain that only a Swiss treating physician can apply, per patient, and that conventional treatment must have been exhausted. [source: Donauer 2022]
  • Coordinate care and integration if they proceed lawfully.

Sources

Sources:

• Lower-dose psycholytic therapy – A neglected approach (Passie, Guss & Krähenmann, Frontiers in Psychiatry 2022), PDF
• Lower-dose psycholytic therapy – citation record (Frontiers)
• Leuner, H.: Tiefenpsychologische Aspekte der Drogenerfahrung (German, c. early 1970s; MAPS bibliography scan)
• Passie, T.: Hanscarl Leuner: Pioneer of Hallucinogen Research and Psycholytic Therapy (MAPS Newsletter 7(1), 1996–97)
• Passie, T.: A history of the European Medical Society for Psycholytic Therapy (EPT) 1964–1974 (Drug Science, 2024; abstract only)
• Sessa, B.: Meeting with Ronnie Sandison (MAPS, 2005)
• Powick Hospital (Wikipedia)
• Costandi, M.: Looking Back: A brief history of psychedelic psychiatry (The Psychologist, BPS, 2014)
• Psycholytic Therapy With MDMA and LSD in Switzerland (MAPS Bulletin 5(3), 1995)
• Switzerland briefly legalized LSD therapy and then couldn't let it go (Vice, 2015)
• Guide to the Betty Grover Eisner papers (Online Archive of California)
• Donauer, D.: Legal framework for the use of psychedelics in Switzerland (MLL News, 2022)

Further reading (not drawn on): books and papers cited:

• Sandison, R.A., Spencer, A.M. & Whitelaw, J.D.A. (1954). The therapeutic value of lysergic acid diethylamide in mental illness. Journal of Mental Science (located via PubMed).
• Sandison, R. (2001). A Century of Psychiatry, Psychotherapy and Group Analysis. Jessica Kingsley (cited via Wikipedia).
• Leuner, H. (1962). Monograph on the experimental LSD psychosis (cited via Passie et al. 2022).
• Mascher, E. (1967). Outcome review of psycholytic therapy (cited via Passie et al. 2022).
• Dyer, C. (2002). NHS settles claim of patients treated with LSD. BMJ (cited via Wikipedia).
• Eisner, B. (2002). Remembrances of LSD Therapy Past (memoir).