Psychedelics and Psychotherapy

Psychedelics have shown great promise in modern clinical trials for treating various psychiatric conditions. As a transdiagnostic treatment that exerts its effects through subjective experiences that leave enduring effects, it is akin to psychotherapy. To date, there has been insufficient discussion of how psychedelic therapy is similar to and different from conventional psychotherapy. In this article, we review the shared features of effective conventional psychotherapies and situate therapeutic psychedelic effects within those. We then discuss how psychedelic drug effects might amplify conventional psychotherapeutic processes—particularly via effects on meaning and relationship—as well as features that make psychedelic treatment unique. Taking into account shared features of conventional psychotherapies and unique psychedelic drug effects, we create a framework for understanding why psychedelics are likely to be effective with very diverse types of psychotherapies. We also review the formal psychotherapies that have been adjunctively included in modern psychedelic trials and extend the understanding of psychedelics as psychotherapy towards implications for clinical ethics and trial design. We aim to provide some common conceptual vocabulary that can be used to frame therapeutic psychedelic effects beyond the confines of any one specific modality.

”Open” and ”closed” therapies

As a longitudinal process, psychotherapy is geared to facilitate a positive change in the patients. Starting from the classical psychoanalytical tradition, a fundamental aim in many types of psychotherapy is to increase the clients’ contact with their problematic emotions and parts of the self, and increase their self-reflexive abilities. As the interaction in psychotherapy aims towards a change, it is evident that it is not only the patient’s inner experience that changes during the process of psychotherapy, but also the relationship between the participants develops over time. In this paper, we propose a way to describe the global dynamics of the therapist-patient interaction, by making a distinction between what we call open and closed therapies. This perspective emerged from our work with a set of data coming from five dyads of psychodynamic psychotherapy. We consider how much variety there is in the interactional moves of the participants, that is, in the possible relations between two turns at talk. We call therapies with sequential variation as “open therapies” and those with rather stable sequential patterns as “closed therapies”. We propose that the variety on sequential relations links to the phasic organization that is common to all psychotherapeutic processes (in that they have beginning, middle and end) and to the change in the internal world of the patient.

Doświadczenie tanatyczne i przezwyciężenie trwogi tanatycznej w powieściach Olgi Tokarczuk Ostatnie historie i Anna In w grobowcach świata

The author of the paper examines two novels by Olga Tokarczuk – Final Stories and Anna In in the Tombs of the World in terms of self-psychotherapeutic functions of these texts in the process of overcoming the thanatic fear in the contemporary civilisation, characterised by the lack of effective rites of passage. It analyses the link between artistic devices and specific self-psychotherapeutic processes (desensitization, mythodrama) which they serve.

Imagination and Self Disorders in Schizophrenia: A Review

Anomalies of imagination are frequent and handicapping in schizophrenia spectrum disorders (SSDs) but neglected in psychopathology due to the lack of a conceptual framework to model disorders of imagination. Recently, the link between minimal self disorders and pathology of imagination has been emphasized. The aim of the present article is to discuss this initiative by stressing their paradigm drawing on the recent imaginary turn in phenomenological research. Although this field of research is currently very active in philosophy, there are very few translational approaches in psychopathology or cognitive sciences. In this paper, we examine how contemporary research concerning fantasy and imagination can lead to the elaboration of an epistemological and phenomenological framework for schizophrenia research. We first examine the psychopathological literature on anomalous fantasy and imagination in SSDs. Then we propose an exhaustive overview of the imaginary turn of philosophical phenomenology. Further, we examine the theoretical and practical implications of such a recasting of phenomenological research. We show how fantasy and imagination are involved in the embodiment process, and how identity and imagination are interlinked. Finally, we propose an overview of the possible implications for the understanding of psychotherapeutic processes and recovery strategies.

Working up to the wire…

This is a reflection on the power of endings and time boundaries, exploring the way that time can act as a catalyst in psychotherapeutic processes. The article describes the ending processes with five clients. These occurred simultaneously due to the author’s relocation. Some responses illuminate hitherto hidden and intractable internal structures, and in others the intensity of the limit acts an impetus for the client to grasp something new. Drawing on Power’s comprehensive book: Forced Endings in Psychotherapy and Psychoanalysis (2016), the author reflects on the power and energy springing from the setting of the time boundary and the different dynamics created in client and therapist. There is acknowledgement of the pressure that this can create in the therapist and also there are reflections about what ultimately may be achieved.

Psychotherapist Interventions Coding System (PICS)

The aim of the present study is to reformulate a descriptive typology previously developed with grounded theory as a result of the qualitative analysis of a good outcome case study. We developed a transtheoretical and easily usable coding system. We describe the developing process of this new coding system, which is focused on the use of language by the psychotherapist. Four researchers were discussing every stage and basing decisions on consensus. As a result, we have developed the Psychotherapist Interventions Coding System (PICS). The resultant coding system is described within 4 group of macro categories: (1) Discursive contract; (2) Facilitators of the therapeutic relationship (3) Facilitators of the client’s speech; and (4) Liberation of constraining speeches. The PICS aims to contribute to developing knowledge on research and how therapist interventions contribute within psychotherapeutic processes, acknowledge the kind of interventions therapists are using in the sessions and assist teaching on novel therapists in training programs.

Process-symptom-bridges in psychotherapy: an idiographic network approach

Aim: Real-time monitoring of psychotherapeutic processes was recently described as a promising, new way of track-ing periods of change in ongoing treatments. This approach generates complex, multivariate datasets that have to be presented in an intuitive way for clinicians to aid their clinical decision-making. Using network modeling and new approaches in centrality analyses, we examine “bridge nodes” between symptom stress and aspects of the psychotherapeutic process between therapy session (intersession processes, ISP). Method: We recorded intersession processes as well as depressive and anxiety symptoms using daily questionnaires in ten cases. Regularized, thresholded intraindividual dynamic networks were estimated. We applied bridge centrality analysis to identify individual bridges between psychotherapeutic processes and symptoms in the resulting models. Casewise interpretations of bridge centrality values are offered. Results: Bridge centrality analysis revealed individual bridge nodes between intersession processes and symptom severity. Strength and direction of bridges varied substantially across individuals. Conclusion: Given current methodological challenges, idiographic network studies are feasible and offer important insights for psychotherapy process research. In this case, we demonstrated how patients deal with periods of increased symptom stress. In this case we have described how patients deal with their therapy under increased symptom load. Bridges between psychotherapeutic processes and symptom stress are a promising target for monitoring systems based on ISP. Future studies should examine the clinical utility of network-based monitoring and feedback in ongoing therapies. In the near future, process feedback systems based on idiographic models could serve clinicians to improve treatments. Keywords: depression, anxiety, intersession processes, ecological momentary assessment, network analysis