Although there have been decades since Albert Hofmann discovered LSD-25 and there exist thousands of books and journals, people ask me frequently in my lectures and workshops how they should conduct safe and most productive psychedelic sessions. In this renaissance of interest in psychedelics, people often come across articles that make them curious to try psychedelics for the first time. The history of my work with psychedelics and a summary of therapeutic approaches and techniques is detailed in my book LSD Psychotherapy and in my recent encyclopedia, The Way of the Psychonaut: Encyclopedia for Inner Journeys.

I will provide below a brief summary of important information about psychedelics, mostly for those psychonauts who are about to embark on the inner journeys for the first time. To give people information about safe use of psychedelics does not mean to encourage them where and when they are illegal. Even if we think or know that the laws against them bereave patients of important medicines, they are ignorant, mendacious, or even unconstitutional (violate the freedom of religion), we have to know that ignore them can have serious consequences. Under these circumstances the decision
means to weigh reason and conscience against the power of law.
A necessary prerequisite for any work with psychedelics or other methods involving holotropic states of consciousness is good medical examination. Above all, we need to know if the person is in good cardiovascular condition. It is difficult to predict how intense emotions the psychedelic substance will elicit. High uncontrolled blood pressure, cardiac arrhythmia, history of strokes or heart attacks, or presence of an aneurysm could mean a serious risk.

While LSD is biologically a very safe substance, the use of entheogens related to amphetamine, such as MDA, MMDA, MDMA, etc. significantly increases the danger of a cardiovascular episode. The doses should stay in a reasonable range and people with cardiovascular problems should never take substances belonging to this group. There have been reports of fatalities in cases where these precautions were not respected.

Another consideration is the overall physical condition of the person who is taking a psychedelic substance. The sessions, particularly with high dosages can be emotionally and physically demanding. Current debilitating disease or exhaustion after a disease, recent operation, or injury can represent a contraindication; such situations have to be individually evaluated.

In our Maryland program of LSD therapy for terminal cancer   patients, we screened out only patients who had serious cardiovascular problems. Out of over 200 patients none died in the session or experienced any physical emergency. And yet, one of these patients died four days after the session. He had skin cancer that metastasized all through his body, but he had paralyzing fear of death and seemed to be desperately hanging onto life. In the session, he had a powerful experience of psychospiritual death and rebirth that liberated him from this fear. He died peacefully four days later. After some initial attempts, we decided not to run sessions with patients who had brain tumors. Their experiences seemed to be disjointed and confused and they had difficulties with conceptual integration of the content.

Pregnancy, particularly an advanced one, represents a relative contraindication. Women, who experience reliving of their own birth, tend to experience themselves as delivering. This involves actually strong contraction of the uterus; I have worked with women who in a session combining birth and delivery started menstruating in the middle of the cycle. Such contractions could possibly cause premature delivery.

Over the years, I have allowed many pregnant women to do holotropic breathwork, but we had the agreement that they would not continue if the process takes the form of birth/delivery. In psychedelic therapy, one cannot make such an agreement and it is wise not to work with women while they are pregnant. However, the postpartum period is an excellent time for psychedelic sessions, since pregnancy and delivery activate the perinatal memories and make them more available.

A good completion of the session often requires bodywork. There are conditions that might need limitation or modification of physical interventions – conditions after fractures or operations, vertebral disk prolapse, whiplash, osteoporosis, diaphragmatic or umbilical hernia, colostomy, etc. Blockages or pains near the genital area cannot be released by direct bodywork; however, they can be reached indirectly by working with the legs the way it has been described in my writings.

Another important consideration is the emotional condition of the person who is coming to a psychedelic session or holotropic breathwork. If this person has a history of psychiatric hospitalization, particularly a longer one, it is necessary to find out what was the nature of this disorder, what form it took, and the circumstances that led to it. This evaluation has to be done by a person who is familiar with traditional psychiatry and also with transpersonal psychology. In many instances the condition that was diagnosed as psychotic episode was a misdiagnosed spiritual emergency. In that case, we did not hesitate to accept such a person into a holotropic breathwork workshop or into psychedelic therapy and they usually did not experience any special problems.   

Ideally, the therapists or sitters should know the history of the person whom they will accompany in the session – the nature of their prenatal life and birth, if the information is available, the quality of the care they received in their infancy and childhood, main events in their lives, the traumas they remember, and seriouds conflicts they are aware of.  It is very useful to find out if there are any repetitive patterns in their lives concerning relationships to certain categories of people – authorities, peers, men or women (interpersonal COEXes). These tend to be activated and replicated in the sessions and may create problems if not anticipated.

An important function of the pre-session interviews is to establish a good working relationship and trust. If the candidate for the session does not already have information about the effect of the substance they are about to take and about the nature of the experience, we have to briefly provide it. This involves the length of the session, the need to keep the session interiorized, agreement how we will communicate, and the main categories of experiences they might encounter. Even if the intellectual information about perinatal and transpersonal experiences cannot adequately convey their power and impact, it is extremely important and useful to know about their existence and the form they take.
We have to correct the misconceptions of Western civilization and mainstream psychiatry concerning what is normal and what is “crazy.” They need to know that such experiences as reliving birth or episodes of prenatal life, ancestral, phylogenetic, and past life memories, or encounters with archetypal beings and visits to archetypal realms are perfectly normal constituents of the experiential spectrum of holotropic states of consciousness.  Experiencing them can expand our worldview and they can be important components in our process of spiritual opening and inner transformation.

Naturally, a critically important element in psychonautics with psychedelics is the nature of the substance we are using and its quality, and dosage. Under current circumstances - unless a reliable source of pure chemicals is available - the best choice might be plant medicines. In some states and countries, it is allowed to grow one’s own marijuana or Psilocybe mushrooms and peyote, ayahuasca, and the parotid and skin secretions of the toad Bufo alvarius can be obtained from experienced and honest healers. Street samples of substances purchased in the black market represent a gamble and can be dangerous. One can never be sure about the nature of the substance, its dose, and quality.

Unless testing or comparing various dosages is our intention or is required by our research design, it is preferable to use higher dosages of LSD, 250-500 mcg. It might mean a somewhat more demanding management of the sessions, but it brings faster and better results and it is safer. Lower dosages tend to activate the symptoms and not bring the experience to a good resolution, because they make it easier to use defense mechanisms. Higher dosages thus usually bring cleaner resolution.

In the higher dosage range, it is important to keep the session internalized; this makes it possible to see and understand what is emerging from the unconscious and what we are dealing with. Leaving the eyes open and interacting with the environment in high dose LSD sessions is dangerous and unproductive. It confuses and mixes the inner and outer and makes self-exploration impossible. In the termination period of the session good body work is absolutely essential for the completion and integration of the experience.

I have met people who had taken LSD hundreds of time and had not discovered that the experience had anything to do with their own unconscious. It was for them like going to a strange movie, where they saw colors and patterns, everything was moving, people’s faces and the environment were strangely distorted, and they experienced intense but incomprehensible waves of emotion. Such use of LSD is dangerous and is conducive to poorly resolved experiences, prolonged reactions, and flashbacks, or worse. Safe psychonautics requires undivided attention to the unconscious material as it is emerging, full experience of emotions, and processing of the content.

The ideal situation for therapeutic sessions is a protected quiet environment which, in turn, allows for making loud vocalization and noises if necessary and the presence of a male-female duo of facilitators or sitters. We keep the experience internalized by using eyeshades and keep the verbal interaction and interventions at a minimum, unless the client initiates it or asks for it. If the person interrupts the experience and opens the eyes, we try to do what it takes to return them to introspection.

Playing music through the session can help the client to stay in the flow of the experience and move through possible impasses; it can also activate and bring to the surface deep emotions. The choice and use of music is similar as in holotropic breathwork. The general principle is to support most closely what is happening in the session, rather than trying to program the experience in a specific way. We can get the necessary clues from observing the facial expression, body language, and occasional verbal comments – sensual movements of the pelvis, clenched fists and jaws, relaxed position and blissful smile, uttering the name of the country in which the experience unfolds, etc.

We also follow the general course or trajectory of the LSD session: the intensity of the music gradually increases, reaches a climax around three hours into the experience, and then becomes more emotional, comforting, and feminine. In the final stage of the session, the music becomes timeless, flowing, meditative, and quiet. We tend to avoid pieces of music that are well known and would program the experience in a specific way, and vocal performances in languages that the client knows. If we use recordings of human voices, they should be perceived just as sounds of musical instruments and not convey any specific verbal message.

About five hours into the session, it is useful to take a break and get a brief verbal report about the client’s experience. Around an hour later might be a good time to move outside. Ideally, the psychedelic sessions would be held in a beautiful environment – in the mountains, in the forest, near a park, meadow, river, lake or ocean. In the termination period of a psychedelic session, taking a shower, a bath, or swimming in water can be an ecstatic and healing experience.

A therapeutic psychedelic session in water can facilitate regression to a prenatal state or even to the beginning of life in the primeval ocean. Depending on the place and the time of the day, we might want to take the client to a place where we can watch the sunset, the moon, or the night sky. If we do not have the luxury of any of the above, we try to find as much of the natural setting as we are able to find. Psychedelic experiences tend to connect us deeply with nature and make us realize how deeply we are connected with it and embedded in it and how much the industrial civilization has obscured it and alienated us from it.

If the session does not reach a good closure, it is essential to use bodywork to release any residual emotions or physical tensions and blockages. However, I have been able to find very few psychedelic therapists who are actually using it. The principles are the same as in holotropic breathwork. We do not use any preconceived techniques, but let ourselves be guided by the healing intelligence of the psyche and of the organism. We find the best possible ways to accentuate the existing symptoms and encourage the client to express fully whatever this brings.

Maryland psychedelic research center in Spring Grove, Catonsville near Baltimore

In our therapeutic and training programs at the Maryland Psychiatric Research Center, we organized in the late hours of psychedelic sessions family reunions. The patients would invite for these events partners, spouses, family members, or friends of their choice. We would order meals from a nearby Chinese or Japanese restaurant, which had interesting tastes, textures, and colors, and we all shared a dinner listening to quiet music. At this time, the clients were still in holotropic states of consciousness, which can remarkably enhance the quality of sensory perception. By directing this “opening of the doors of perception” - to use Aldous Huxley’s term - to objects and activities of everyday life, they learned new ways to experience nature, watch the sunset, taste food, listen to music, and interact with people.

In spite of its complicated history, psychedelic-assisted psychotherapy has shown its great potential in the treatment of phobias, depressions, psychosomatic disorders and pains. Using LSD as a catalyst, it became possible to extend the range of applicability of psychotherapy to categories of patients that previously had been difficult to reach – alcoholics, narcotic drug addicts, sexual deviants, and criminal recidivists. The current extraordinary renascence of interest in psychedelics will hopefully make it possible to use all the clinical experience that lay dormant for forty years, avoid the mistakes of the past, and have a fresh new start. I have no doubt that the new research would confirm that psychedelics are unique therapeutic agents of an entirely new kind, unparalleled in the history of psychiatry.

Stanislav Grof                                                       January 2020