Therapy with substanceTherapy with Substance: Psycholytic psychotherapy in the twenty first century by Dr Friederike Meckel Fischer, Muswell Hill Press, 2015.

In the field where psychedelics and psychotherapy overlap, there are two main schools: the school of psychedelic therapy, most popular in the United States, which aims to give people a complete mystical experience in a very limited number of high-dose sessions, in order to help them overcome problems or reach a certain state that will help transform the person’s life for the better. The therapist generally remains silent throughout the psychedelic sessions and lets happen whatever happens. Psycholytic therapy, on the other hand, generally involves lower doses and a higher number of sessions with a psychedelic substance, and aims to bring to the surface the causes of the problems in someone’s life. By going into these, and by talking about them during the experience, insight comes and the problems dissolve. This latter approach was mainly popular in Europe and is practiced to this day in unofficial settings.

Dr Meckel Fischer is a medical doctor who went on to study many alternative modalities of healing, most notably Holotropic Breathwork under Stanislav Grof and Psycholytic Therapy with the Swiss medical society for psycholytic therapy (SAEPT) under the guidance of Samuel Widmer. She practiced psycholytic therapy (which at that point had become illegal) for some time, until one of her clients reported her to the police. She was put on trial in Switzerland and convicted. This made it possible for her to describe her experience without fearing to be convicted again. The resulting book is both a fascinating personal account of the way she learned from psycholytic therapy herself and the insights she gathered through her many years of experience in treating people.

The first three chapters deal with Dr Meckel Fischer’s personal path to healing and understanding through different types of therapy after a deep crisis in one of her relationships. She started with regular cognitive therapy, but quickly moved on to depth-psychology, and then to transpersonal psychotherapy with the help of holotropic breathwork under the guidance of Grof. At some point Grof pointed her in the direction of therapy with substance and she dove into this path, externally claiming to do it strictly for professional reasons, while at the same time discovering that it really helped her on a personal level as well.

The author then goes on to give a brief description of what psychotherapy entails in her opinion. She emphasises that there has to be a motivation for change, but that this change can only be initiated by allowing the unconscious material to come to the surface. Effective therapy and lasting change can only happen if the root cause is addressed, which means that the unconscious and pre-conscious causes, that lie in the transpersonal and perinatal domains emphasised by Grof, are allowed to be integrated into consciousness. Meckel Fischer thinks traditional psychotherapy does not work on this level and is therefore rarely effective in treating deeper issues.

She subsequently describes the different substances used in psycholytic therapy, showing how all of them have both unique and general properties. She acknowledges that people both can and have to learn how to work with these substances, and that initial sessions can lack direction and purpose. With time and experience, the sessions become more focused and people learn how to access their unconscious more intentionally. Meckel Fischer is of the opinion that any guide in a psycholytic therapy session should use the substance themselves along with the patient, as this helps them to sense what is going on within the participant: “A mountain guide cannot lead a walker through territory that they have not explored personally”. Her arguments for this point of view are convincing, although they may be considered controversial from a western medical perspective.

Meckel Fischer identifies several tools that help the guide perform psycholytic therapy. These tools are somewhat specific to her, as they resonate with her professional experience and background, but they can be somewhat generalised. Among them are the therapist, the substance, family constellation work, live-body-work, the group and music. All these aspects influence the experience and some can be utilised to initiate or deepen a process within a participant. These tools are used throughout the session. The series of sessions moves a person through different stages: from beginner to graduate, from starting out on the path of self-discovery to knowing the way and being able to continue on their own.

She furthermore shows the different stations along the path to integrating deep unconscious material, from the core therapeutic issue, through psychosomatics, epigenetic and perinatal experiences towards spiritual experiences. Meckel Fischer gives many examples and shows how many of the stories of the people she guided fit the stages and stations she enumerates. It seems to be a universal process that is similar to the hero’s journey, popularised by Joseph Campbell.

The author ends with a discussion of the dangers and side effects of using psychoactive substances in psycholytic therapy. One of the most important dangers is of course the illegality, although she believes that under certain circumstances this can help participants to take responsibility for the process they are entering. She also briefly relates the process of psycholytic therapy to shamanism, healing and spirituality, but doesn’t really go into depths with regards to these ideas. In the concluding remarks, she hints at what lies beyond psycholytic therapy: something that isn’t therapy anymore, but that heals our worldview and makes us more integral with our environment and holistic in our outlook.

At times the impression arises that the author too readily claims that her personal experiences with certain substances are universal; this is especially tangible in the explanation of the effects of the different substances. In other cases, she acknowledges that her experience is hers alone, but the general tone of the former examples makes one think that she feels otherwise. Meckel Fischer mentions one way in which to conceptualise and practice psycholytic therapy, and does not envision the possibility that other ways are possible. However, the wisdom the book embodies generally sounds genuine. There are nuggets of wisdom that make one realise a deeper truth, like: “the intention expressed on the evening before the session signals the first stage of the process of integration”. Others run contrary to the idea that one session should be enough: “The ability to be ‘on a substance’, and learn to observe the inner self under its effects in a composed, centred and disciplined way, increases with practice”.

Overall, the book offers a great look into a very promising way of using psychedelics that can be integrated into our society quite easily, as it has built-in mechanisms for minimising risks and maximising positive outcomes, as well as the idea of medical/psychological supervision. It is a timely book, which can help to institutionalise the craft of psycholytic therapy into something that can be learned, practiced and taught to others through experience. Meckel Fischer also makes a great case for experienced practitioners to help newcomers. Moreover, disorders are viewed in a more integrative and holistic manner, showing that no-one is completely sane and no-one is completely mad, but that all can benefit from deep therapeutic work on the self. It is a book for everybody who’s interested in doing serious therapeutic work with psychedelics, either by themselves or, when legal constraints are removed, in the form of individual or group therapy.

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