Psychedelics · 1973
Medication-Assisted Psychotherapy (MAP)
Change is facilitated when a carefully prepared, supported and integrated psychedelic experience reorganises the person's relationship to themselves, to their ties, and to life and death.
Medication-Assisted Psychotherapy (MAP) is the retrospective name used in contemporary reviews to group together the form of psychedelic psychotherapy developed by the Spring Grove team and the Maryland Psychiatric Research Center, historically described as psychedelic-peak psychotherapy and applied especially systematically to the psychological and existential suffering associated with advanced cancer and the nearness of death. The treatment combined a brief but intensive psychotherapeutic preparation, a session with LSD or DPT in a carefully structured environment, and subsequent integration interviews; preparation gave priority to therapeutic trust, current conflicts, family communication, diagnosis and prognosis, philosophy of life and the willingness to face whatever might emerge, while the session encouraged inward attention through a reclining position, eyeshades, headphones, music and continuous therapeutic support. The model held that psychedelics acted as non-specific amplifiers or catalysts and that outcomes depended decisively on dose, set and setting, giving particular weight to deep emotional, psychodynamic and relational experiences and, when they occurred, to peak or mystical experiences capable of altering attitudes towards the self, other people, the illness, life and death. Subsequent integration sought to translate those experiences into everyday life, relationships and the time remaining, without assuming that a peak experience was automatic or necessary in every case. The historical evidence comes mainly from open and pre-post studies; decades later, a contemporary adaptation using psilocybin for cancer-related distress was evaluated in a randomised trial and again used an architecture of preparation, drug session and integration.
Theory of change
The person changes when preparation grounded in trust and openness allows the psychedelic experience to activate significant emotional, relational and existential material, and integration turns that experience into new attitudes and ways of living.
Core ideas
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The psychedelic session is part of a wider psychotherapy
The intervention is conceived as a process in which preparation, session and integration are mutually dependent phases; administering a substance without sufficient psychotherapeutic work belongs to a different clinical logic and does not reproduce psychedelic-peak psychotherapy. (Pahnke et al., 1970, The Experimental Use of Psychedelic (LSD) Psychotherapy).
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Set and setting are active therapeutic variables
Pharmacological properties do not by themselves explain the experience: expectations, history, readiness, the therapeutic relationship, the environment, music and the team's conduct all take part in the form the psychedelic state takes and in its possible clinical usefulness. (Pahnke, 1969, The Psychedelic Mystical Experience in the Human Encounter with Death).
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Therapeutic trust precedes experiential surrender
The programme holds that a close relationship and an atmosphere of basic trust allow vulnerability, fear and loss of control to be faced with less defensiveness; relational preparation therefore occupies a structural place and not merely an introductory one. (Grof et al., 1973, LSD-Assisted Psychotherapy in Patients with Terminal Cancer).
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The psychedelic functions as an amplifier, not as predetermined therapeutic content
LSD and DPT are conceptualised as catalysts that make diverse inner dimensions accessible, from psychodynamic material to aesthetic, cognitive or transpersonal experiences; the therapist prepares conditions and accompanies, but cannot specify in advance what content will emerge. (Grof & Halifax, 1977, The Human Encounter with Death).
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The peak experience is powerful but not obligatory
The authors attached particular value to states of unity, transcendence, meaning and intense positive affect, but recognised that even under optimal conditions such experiences do not appear automatically; the treatment must also be able to integrate psychodynamic, emotional or difficult sessions. (Pahnke, 1969, The Psychedelic Mystical Experience in the Human Encounter with Death).
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Music clinically organises the psychedelic state
Music acts as a therapeutic stimulus capable of focusing attention, releasing emotion, sustaining temporal continuity, structuring the course of the session and encouraging deepening; its selection depends on the phase and on the person's psychological state, not on a universal playlist. (Bonny & Pahnke, 1972, The Use of Music in Psychedelic (LSD) Psychotherapy).
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The end of life is worked on from the life that is still available
Although diagnosis, prognosis and death are addressed openly, the clinical focus shifts towards living the remaining time meaningfully, reconnecting with relationships and reducing isolation, rather than making death the sole object of therapy. (Grof et al., 1973, LSD-Assisted Psychotherapy in Patients with Terminal Cancer).
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Isolation is maintained through interpersonal avoidance
Silences, false hope and mutual protection can leave the patient alone precisely when they most need contact; including the family and opening channels of communication is part of the intervention, not a peripheral addition. (Grof & Halifax, 1977, The Human Encounter with Death).
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Re-entry can be a moment of relational repair
The gradual return to ordinary consciousness and the afterglow may increase availability for closeness, honesty and affection, creating a window in which meetings with significant others have a particular capacity to consolidate change. (Pahnke et al., 1970, The Experimental Use of Psychedelic (LSD) Psychotherapy).
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To integrate means bringing the experience into everyday life
The clinical value of a session depends on memories, emotions and insights being reconstructed, contextualised and connected to relationships, priorities and actions; the written or verbal account functions as a bridge between the extraordinary state and ordinary life. (Kurland et al., 1973, Psychedelic Drug Assisted Psychotherapy in Patients with Terminal Cancer).
Influences
- Spring Grove psychedelic-peak psychotherapy
- Psychodynamic psychotherapy
- Humanistic psychology and the therapeutic encounter
- Thanatology and clinical work with death
- Research on mystical experiences and the psychology of religion
- Set and setting in psychedelic research
- Helen Bonny's music therapy
- Transpersonal and anthropological perspectives on death and rebirth
Key references
- Pahnke, W. N., Kurland, A. A., Goodman, L. E., & Richards, W. A. (1969). LSD-Assisted Psychotherapy with Terminal Cancer Patients. Current Psychiatric Therapies, 9, 144–152.
- Pahnke, W. N. (1969). The Psychedelic Mystical Experience in the Human Encounter with Death. Harvard Theological Review, 62(1), 1–21. https://doi.org/10.1017/S0017816000027577
- Pahnke, W. N., Kurland, A. A., Unger, S., Savage, C., & Grof, S. (1970). The Experimental Use of Psychedelic (LSD) Psychotherapy. JAMA, 212(11), 1856–1863. https://doi.org/10.1001/jama.1970.03170240060010
- Bonny, H. L., & Pahnke, W. N. (1972). The Use of Music in Psychedelic (LSD) Psychotherapy. Journal of Music Therapy, 9(2), 64–87. https://doi.org/10.1093/jmt/9.2.64
- Kurland, A. A., Grof, S., Pahnke, W. N., & Goodman, L. E. (1973). Psychedelic Drug Assisted Psychotherapy in Patients with Terminal Cancer. In I. K. Goldberg, S. Malitz, & A. H. Kutscher (Eds.), Psychopharmacological Agents for the Terminally Ill and Bereaved (pp. 86–133). Columbia University Press.
- Grof, S., Goodman, L. E., Richards, W. A., & Kurland, A. A. (1973). LSD-Assisted Psychotherapy in Patients with Terminal Cancer. International Pharmacopsychiatry, 8, 129–144. https://doi.org/10.1159/000467984
- Grof, S., & Halifax, J. (1977). The Human Encounter with Death. E. P. Dutton.
- Ross, S., Bossis, A., Guss, J., Agin-Liebes, G., Malone, T., Cohen, B., Mennenga, S. E., Belser, A., Kalliontzi, K., Babb, J., Su, Z., Corby, P., & Schmidt, B. L. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of Psychopharmacology, 30(12), 1165–1180. https://doi.org/10.1177/0269881116675512
- Belser, A. B., Agin-Liebes, G., Swift, T. C., Terrana, S., Devenot, N., Friedman, H. L., Guss, J., Bossis, A., & Ross, S. (2017). Patient Experiences of Psilocybin-Assisted Psychotherapy: An Interpretative Phenomenological Analysis. Journal of Humanistic Psychology. https://doi.org/10.1177/0022167817706884
- Swift, T. C., Belser, A. B., Agin-Liebes, G., Devenot, N., Terrana, S., Friedman, H. L., Guss, J., Bossis, A., & Ross, S. (2017). Cancer at the Dinner Table: Experiences of Psilocybin-Assisted Psychotherapy for the Treatment of Cancer-Related Distress. Journal of Humanistic Psychology. https://doi.org/10.1177/0022167817715966
- Cavarra, M., Falzone, A., Ramaekers, J. G., Kuypers, K. P. C., & Mento, C. (2022). Psychedelic-Assisted Psychotherapy—A Systematic Review of Associated Psychological Interventions. Frontiers in Psychology, 13, 887255. https://doi.org/10.3389/fpsyg.2022.887255