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Chlorpromazine
Used in Terminating Psychedelic Sessions
by Stan Grof
Excerpt from LSD Psychotherapy
Adequate handling of critical situations is one of the crucial problem LSD psychotherapy. A session in which the process gets out of control is not only fruitless, but harmful; it creates frustration and disappointment in both therapist and patient, undermines their mutual trust, and can shatter their feelings of personal security. For the therapist adequate experience and training, including his or her own LSD sessions, is therefore of paramount importance. At the time of my LSD research in Czechoslovakia, the training for future LSD therapists more-or-less followed the psychoanalytic model. It required a minimum of five personal LSD sessions under the guidance of an experienced therapist, and thirty therapeutic sessions with psychiatric patients conducted under supervision. LSD training sessions were also found very useful for those psychiatric nurses who functioned as female co-therapists or came into contact with patients under the influence of LSD.

The use of tranquillizers is an issue of considerable practical significance and deserves a special notice. In general, an experienced therapeutic dyad can handle all, or almost all, situations that occur in LSD sessions by psychological means alone. I have personally conducted more than three thousand sessions over the years, and only three were terminated by tranquillizers. All three occurred in the early years of my LSD research when my experience with drugs was very limited. Thorazine and other major tranquillizers are not specific neutralizers of the LSD effect. Used in high dosages, they have a general inhibiting effect that overrides and masks the psychedelic action of LSD. Detailed retrospective analysis of this situation usually shows that the patient experiences the action of both drugs simultaneously, and that the combined effect is rather unpleasant.

The use of tranquillizers in the course of psychedelic sessions is potential very noxious. The most dramatically negative LSD experiences have a strong tendency toward positive resolution; if they are well resolved they are extremely beneficial for the subject in the long run. If tranquillizers are administered in the middle of a difficult psychedelic state they tend to prevent its natural resolution and positive integration. They "freeze" the subject in a negative psychological frame and thus contribute to the incidence of prolonged reactions, negative aftereffects, and "flashbacks." The routine administration of tranquillizers in the middle of negative psychedelic experiences is therefore a harmful practice that should be discontinued. This is even more true of their use in the context of LSD psychotherapy, which follows in general the strategy of an uncovering technique. Unpleasant experiences are caused by the emergence of highly-charged emotionally traumatic unconscious material. Since this material is the source of the patient's difficulties in everyday life, negative episodes in LSD sessions, if properly approached and handled, represent great opportunities for therapeutic change.

In LSD psychotherapy, there is a continuity in the content of consecutive sessions. If we terminate an unpleasant experience by administering tranquillizers, the unresolved material will continue to surface in future session til the patient reaches the point where he or she is capable of confronting and resolving it. Therefore, the therapist should first exhaust all possibilities of a psychological intervention before considering tranquillizers. If a specific vicious interaction has developed between the sitter and the client, and the siuation appears to be irresolvable, another therapist should be called to take over the session; provisions for such situations should always be made in advance.

If all psychological approaches fail and tranquillizers have to be used, it is much better to start with Librium (30-60 milligrams) or Valium (10-30 milligrams), which seem to alleviate painful emotions without interfering with the course of the session. As soon as possible, the patient should resume a reclining position with eyeshades and headphones, to continue the introspective approach to the experience.