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अमूर्त

Psychoanalytic Formulations in Psychedelic Therapy for Treatment Resistant Depression (TRD)

Carolina Maggio, Friederike Meckel Fischer, Nadav L Modlin, James Rucker

Recent studies have shown promising data regarding the safety and efficacy of psychedelic therapy for Treatment Resistant Depression (TRD), providing initial evidence of rapid and sustained response in this population. Despite lack of rigorous data pertaining to the role of the therapist, historically and in modern trials, the therapeutic alliance is considered a central component in the treatment model, and conceived as inextricable from the drug’s subjective effects in achieving therapeutic outcomes. In modern psychedelic research, transpersonal and third-wave cognitive-behavioural psychology have played a primary role in guiding the conceptualisation of the treatment and the chosen interventions of the therapist. However, the intense emotional episodes that may emerge during the psychedelic experience also alludes to the presence of inter subjective dynamics, such as the existence of transference and countertransference in the therapeutic relationship, which psychoanalytic theory may offer insights on and whose scope and significance have not yet been the subject of study.

The current paper explores the role of the therapeutic relationship as a dynamic process within the context of Object Relations (ORT) and Attachment Theory (AT). It postulates that TRD may derive from early years attachment injury, and that the role of the psychedelic therapist has a reparative function due to the reported regressive nature of the psychedelic experience, and its most acute effects relate to a mystical-type experience. The paper also explores the nature of ‘non-duality’, through a psychoanalytic lens and as seen in the occurrence of ego dissolution in the psychedelic state, as well as in affect. Considering the mysterious nature of the psychedelic experience, this paper conceptualises psychedelic therapy as a fluid and highly interpersonal process; an inter subjective developmental encounter within the therapeutic relationship and between patients and the psychedelic experience. Reporting the experience of two patients undergoing psychedelic therapy with psilocybin for TRD and in combination with therapists’ supervision notes, anonymised case studies are presented with the consent of the participants.