Focusing-oriented Psychotherapy as a Supplement to Preparation for Psychedelic Therapy

Participants need to prepare in advance for psychedelic therapy sessions. However, due to the decades-long dormancy of psychedelic experimental treatment with human subjects, a gap exists in the research concerning specific techniques for optimizing the potential psychological and psychospiritual benefits of psychedelic medicines and for reducing the risk of harmful experiences. As a result, participants may be asked to set an intention for their sessions without having a clear understanding of how to accomplish that step. Focusing-Oriented approaches to psychotherapy may support and enhance pre-session preparation for psychedelic therapy by providing facilitators with a means of teaching an embodied intention-setting technique. Psychedelic therapy involves the combination of psychotherapy and treatment with consciousness-altering substances, such as LSD and psilocybin (Grof, 1980; Strassman, 1995). Grof described two major categories for the approaches researchers took to the role the drug plays in the therapeutic process. In the first category, as used in one research modality, relatively smaller doses of the drug are administered to clients systematically to amplify the therapy and to reduce resistances. The second category places greater emphasis on the phenomenological content experienced during the period of drug action, generally involving the administration of higher doses. The need to prepare participants in advance for psychedelic therapy sessions, especially those in the second category, is widely acknowledged in the literature (Griffiths, Richards, McCann, & Jesse, 2006, 2008; Johnson, Richards, & Griffiths, 2008; Stolaroff, 2001; Strassman, 1995). However, due to the longstanding lack of support and encouragement for psychedelic experimental treatment with human subjects, a gap exists in the research concerning specific techniques for optimizing the potential psychological and psychospiritual benefits of psychedelic medicines and for reducing the risk of harmful experiences. Focusing-Oriented approaches to psychotherapy may support and enhance pre-session preparation for psychedelic therapy and warrants research. FOCUSING: BACKGROUND AND BASIC THEORY Wagner (2006) described Focusing in terms that could also refer to psychedelic therapy in most contexts when she wrote, ‘‘[Gendlin] offered these steps as a [email protected] Copyright ’ 2009 Transpersonal Institute The Journal of Transpersonal Psychology, 2009, Vol. 41, No. 2 151 practice in mindfulness to facilitate movement in those places where individuals become stuck, to enhance awareness, and to potentially open up pathways for change’’ (p. 49). A first step in assessing whether or not applying Focusing approaches is appropriate in a psychedelic therapy model is to define key terms, concepts, and processes. Focusing (Gendlin, 1981), or Focus-Oriented Therapy, refers to a form of psychotherapy that emphasizes body awareness as a means of approaching problems in ways that can promote positive change. Full concentration and acute receptivity are required for Focusing (Leijssen, 2007); therefore, this article will emphasize the use of Focusing as preparation in advance of psychedelic drug treatment sessions. Other possible applications of Focusing to psychedelic therapy will be addressed briefly in the conclusion of this article. Wagner (2006) argued that Focusing had the potential to enhance most therapeutic orientations because it used inner, indisputable experience as an indicator of change. How was Focusing different from modalities that preceded it? Beginning in the 1960s during an era of rapid change that challenged traditional methods, Eugene Gendlin (1981), along with colleagues at the University of Chicago, studied attributes of clients who had successful experiences in psychotherapy. He concluded that rewarding outcomes frequently coincided with an ability to refer to bodily experiences. Clients who were most likely to benefit from psychotherapy could be identified easily in early sessions based on what they said about how they approached problems internally. Gendlin had collaborated with Carl Rogers, the founder of clientcentered psychotherapy which emphasized the importance of empathy, unconditional positive regard, and congruence (genuineness) in the psychotherapist’s approach to the client relationship. Gendlin expanded Rogers’ approach by amplifying the emphasis on the client’s felt experience. Wagner (2006) theorized about how Focusing relied on the body to provide information that was not available through rational understanding. He wrote that the body’s reactions—the ability to localize a problem through meaningful bodily sensation and the consequent shift in physical sensations—signal identifiable changes in experience. Gendlin wove cognitive, emotional, and behavioral elements together, recognizing their common thread through the body. By entering human experience with a friendly attitude of curiosity rather than therapeutic expertise, the authority is transferred to the client. (p. 48) The primary goal of Focusing-Oriented Psychotherapy was to help clients move beyond dead ends, which was Gendlin’s (1996) term for situations in which a client could identify a problem but could not get at it. To overcome this type of psychological impasse, Wagner (2006) pointed out how Gendlin developed a process which psychotherapists or individuals could employ to augment the ability to refer inwardly and experience life from a bodily felt vantage point. 152 The Journal of Transpersonal Psychology, 2009, Vol. 41, No. 2 THE SIX STEPS OF FOCUSING Gendlin (1981) described six discrete Focusing movements that could be used as microprocesses (Leijssen, 2007) to support self-inquiry: (a) clearing a space, (b) waiting for and getting a felt sense, (c) identifying a handle, (d) resonating handle and felt sense, (e) asking, and (f) receiving. The scope of this article precludes an in-depth discussion of each movement. However, brief descriptions should be sufficient to provide the reader with a basic understanding of how Gendlin’s (1981) Focusing process helped clients perceive and touch a vague, holistic bodily sense of a problem, an ability that will be shown to have particular relevance to psychedelic therapy in later sections. Step 1: Clearing a Space The first step in Focusing begins with taking a moment to be silent and to relax. Then, the client is encouraged to direct internal attention to what is ‘‘the main thing’’ for him or her in the present moment. Gendlin (1981) explicitly cautioned against going inside, or identifying too closely with, any concerns that come up. Instead, he advised waiting until the client could take the position, ‘‘Yes, that’s there. I can feel that, there’’ (p. 44). Space clearing usually involves waiting to feel several sensed concerns and choosing the one that is foremost to work with in subsequent steps. Step 2: Felt Sense of the Problem The felt sense (Gendlin, 1996) is a meaningful bodily sensation with several fundamental characteristics which is experienced as a complex whole. A felt sense arises at the boundary between the conscious and the unconscious. It begins with a unique yet unclear quality experienced in the body as ‘‘a single datum that is internally complex’’ (p. 15). The felt sense shifts and emerges in steps. Similar to the unpredictable nature of a psychedelic experience, the unique expression of a process step cannot be determined in advance; theoretical explanation is only possible retrospectively. Step 3: Finding a Handle The third step involves identifying a descriptive word, phrase, or symbol that comes up from within the felt sense. It is a descriptor that points to the quality of the felt sense. Gendlin (1981) advised staying with the quality until a handle that matched it well surfaced. Step 4: Resonating Handle and Felt Sense The next step involves checking back and forth between the felt sense and the handle until a resonance between the two is perceived. Gendlin (1981) Focusing-Oriented Psychotherapy as a Supplement 153 recommended waiting for a signal from the body to confirm a good match. The felt sense and the handle can change during this process. What is important is to continue until the handle captures the felt sense precisely.