Faculty Bibliography

Psychedelic-assisted therapy is based on the premise that psychedelic substances can act as catalysts or adjuncts to psychotherapeutic processes. Recent clinical trials involving psychedelic-assisted therapy have generally employed a similar three-part structure consisting of preparation, support during the dosing sessions, and subsequent "integration." However, the content of these sessions and the frame through which the therapists approach participants and understand the clinical process has thus far been inconsistent among studies. In designing a manualized therapy protocol for a small clinical trial of psilocybin-assisted therapy for major depressive disorder, our group sought to delineate an explicit and replicable, evidence-based model that intentionally builds upon both the neurobiological actions of the medication and the phenomenology of the drug experience. Having identified considerable concordance in proposed mechanisms of change between Acceptance and Commitment Therapy (ACT) and psilocybin therapy, we employed ACT as an overarching psychotherapeutic framework. We hypothesize that the psilocybin experience can provide direct experiential contact with ACT processes that increase psychological flexibility, and that these deeply felt experiences may in turn be reinforced during ACT-informed follow-up therapy sessions. In this paper, we describe the rationale for selecting ACT, areas of potential synergism between ACT and psilocybin-therapy, the basic structure of our treatment model, and limitations to this approach.

A growing body of evidence shows that existential and spiritual well-being in cancer patients is associated with better medical outcomes, improved quality of life, and serves as a buffer against depression, hopelessness, and desire for hastened death. Historical and recent research suggests a role for psilocybin-assisted psychotherapy in treating cancer-related anxiety and depression. A double-blind controlled trial was performed, where 29 patients with cancer-related anxiety and depression were randomly assigned to treatment with single-dose psilocybin (0.3 mg/kg) or niacin in conjunction with psychotherapy. Previously published results of this trial demonstrated that, in conjunction with psychotherapy, moderate-dose psilocybin produced rapid, robust, and enduring anxiolytic, and anti-depressant effects. Here, we illustrate unique clinical courses described by four participants using quantitative measures of acute and persisting effects of psilocybin, anxiety, depression, quality of life, and spiritual well-being, as well as qualitative interviews, written narratives, and clinician notes. Although the content of each psilocybin-assisted experience was unique to each participant, several thematic similarities and differences across the various sessions stood out. These four participants' personal narratives extended beyond the cancer diagnosis itself, frequently revolving around themes of self-compassion and love, acceptance of death, and memories of past trauma, though the specific details or narrative content differ substantially. The results presented here demonstrate the personalized nature of the subjective experiences elicited through treatment with psilocybin, particularly with respect to the spiritual and/or psychological needs of each patient.

Recent randomized controlled trials of psilocybin-assisted psychotherapy for patients with cancer suggest that this treatment results in large-magnitude reductions in anxiety and depression as well as improvements in attitudes toward disease progression and death, quality of life, and spirituality. To better understand these findings, we sought to identify psychological mechanisms of action using qualitative methods to study patient experiences in psilocybin-assisted psychotherapy. Semistructured interviews were conducted with 13 adult participants with clinically elevated anxiety associated with a cancer diagnosis who received a single dose of psilocybin under close clinical supervision. Transcribed interviews were analyzed using interpretative phenomenological analysis, which resulted in 10 themes, focused specifically on cancer, death and dying, and healing narratives. Participants spoke to the anxiety and trauma related to cancer, and perceived lack of available emotional support. Participants described the immersive and distressing effects of the psilocybin session, which led to reconciliations with death, an acknowledgment of cancer's place in life, and emotional uncoupling from cancer. Participants made spiritual or religious interpretations of their experience, and the psilocybin therapy helped facilitate a felt reconnection to life, a reclaiming of presence, and greater confidence in the face of cancer recurrence. Implications for theory and clinical treatment are discussed.

The psychological mechanisms of action involved in psilocybin-assisted psychotherapy are not yet well understood. Despite a resurgence of quantitative research regarding psilocybin, the current study is the first qualitative study of participant experiences in psilocybin-assisted psychotherapy. Semistructured interviews were carried out with 13 adult participants aged 22 to 69 years (M = 50 years) with clinically elevated anxiety associated with a cancer diagnosis. Participants received a moderate dose of psilocybin and adjunctive psychotherapy with an emphasis on the process of meaning-making. Verbatim transcribed interviews were analyzed by a five-member research team using interpretative phenomenological analysis. General themes found in all or nearly all transcripts included relational embeddedness, emotional range, the role of music as conveyor of experience, meaningful visual phenomena, wisdom lessons, revised life priorities, and a desire to repeat the psilocybin experience. Typical themes found in the majority of transcripts included the following: exalted feelings of joy, bliss, and love; embodiment; ineffability; alterations to identity; a movement from feelings of separateness to interconnectedness; experiences of transient psychological distress; the appearance of loved ones as guiding spirits; and sharing the experience with loved ones posttreatment. Variant themes found in a minority of participant transcripts include lasting changes to sense of identity, synesthesia experiences, catharsis of powerful emotion, improved relationships after treatment, surrender or letting go, forgiveness, and a continued struggle to integrate experience. The findings support the conclusion that psilocybin-assisted psychotherapy may provide an effective treatment for psychological distress in cancer patients. Implications for theory and treatment are discussed.

BACKGROUND: Clinically significant anxiety and depression are common in patients with cancer, and are associated with poor psychiatric and medical outcomes. Historical and recent research suggests a role for psilocybin to treat cancer-related anxiety and depression. METHODS: In this double-blind, placebo-controlled, crossover trial, 29 patients with cancer-related anxiety and depression were randomly assigned and received treatment with single-dose psilocybin (0.3 mg/kg) or niacin, both in conjunction with psychotherapy. The primary outcomes were anxiety and depression assessed between groups prior to the crossover at 7 weeks. RESULTS: Prior to the crossover, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life. At the 6.5-month follow-up, psilocybin was associated with enduring anxiolytic and anti-depressant effects (approximately 60-80% of participants continued with clinically significant reductions in depression or anxiety), sustained benefits in existential distress and quality of life, as well as improved attitudes towards death. The psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression. CONCLUSIONS: In conjunction with psychotherapy, single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic and anti-depressant effects in patients with cancer-related psychological distress. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00957359.

In considering a Bionian primal scene, the author first reflects on adult sexuality as it was shown and known to him in childhood through The Ernie Kovacs Show, an innovative television show from the 1950s. The pleasurable emotions evoked during that writing were complicated by the emergence of highly disturbing memories of his discovery and consumption of early psychoanalytic texts on male homosexuality. This desire to discover his fate occurred in a context of familial preoccupation with the Holocaust and a child's experience of the threat of nuclear annihilation. This imbrication led to an expansion of his limits regarding the work of the primal scene as a psychoanalytic concept.

Reply by the current author to the comments made by Stephen Hartman (see record 2010-14821-004) and Eve Kosofsky Sedgwick (see record 2010-14821-006) on the original article (see record 2010-14821-003). In my response to commentaries by Hartman and Sedgwick, I examine the positions from which each chose to speak. Hartman's rather light approach performs a particular function: the mentalization of anal erotic and homoerotic desire through the introduction of surplus meaning. I explore the relationship of this approach to the absence of rigorous theoretical critique in his essay. I question Sedgwick's decision to limit her critique to the confines of queer theory; this results in a constriction of meaning rather than the expansion she purports to offer. I challenge her notion of growth through mutual recognition with a model of change that is based in psychoanalytic theory and practice. Contrary to her assertion, I do not jettison danger or gender destabilization from the discourse on anal eroticism between men, but I question these as obligatory or constitutive to its meaning.

Anal eroticism between men has been a recurrent focus in psychoanalytic theory for over a century. Many theorists conflate anal eroticism with danger, particularly danger to masculinity and male gender identity. Defensive resistance to aggressive penetration and fear of receptivity are repeatedly invoked to understand anal erotic excitement and actions. The author reviews numerous papers on this topic from a broad spectrum of psychoanalytic theories, including drive theory, queer theory, and relational psychoanalysis and seeks to expand the discourse on anal eroticism between men. Although danger and dangerousness may be an aspect of individual anal erotic experience, it is not an essential or obligatory aspect of it; its construction as dangerous restricts the meanings that anal sexuality can carry. This imposes a defensive function on anal erotic desire or marginalized identity upon the practitioner when this is unwarranted.

On May 1, 2004, the Association of Gay and Lesbian Psychiatrists (AGLP), with co-sponsorship from St. Luke's-Roosevelt Medical Center, The Haworth Press, and the William Alanson White Institute, organized an all-day conference in New York City entitled Homosexuality and Psychoanalysis: New Directions. The proceedings of the third panel focused on Clinical Perspectives.' The first contributor is Deborah F. Glazer, PhD, who discusses the impact of homoerotic desire and same-sex object choice on the intrapsychic world and the experience of one's self, including one's sense of adequacy in one's body based, gendered self, and the ability to feel sexual desire. Jeffrey R. Guss, MD, asks, What does psychoanalysis have to say about homosexuality?' He acknowledges that gay and lesbian therapists have much to say about gay life and therapy with gay and lesbian patients. Ann D'Ercole, PhD, shifts the focus to clinical work with same sex couples. She underscores the importance in the clinical work with same sex couples of attending closely to expressions of feeling different' as such feelings can often obscure shameful feelings that can infiltrate and contaminate a relationship. Scott Masters, MD, concludes the panel with clinical material from an ongoing treatment.

Anal sex between men has been constructed in many ways throughout the last century. In this paper, I describe three realms of discourse that have offered ideas regarding the meanings and motivations of anal sex: (1) Freud's exploration of anal erotism using classical psychoanalytic language, (2) a radical sex theorist describing transcendence and community through anal sexuality, and (3) a Lacanian perspective that questions the idea of the anus as passive. Recurrent themes regarding power dynamics, identity and gender are identified and explored, and the role of anal sex as cultural signifier is examined. (journal abstract)