Lower-dose psycholytic therapy - A neglected approach

Introduction

Recent decades have seen a revival of research into psychedelic drugs, but contemporary randomised controlled trials and public attention have largely focused on high-dose, mystical-experience–oriented models of treatment (the ‘‘psychedelic’’ or peak-therapy approach). By contrast, psycholytic therapy—an approach developed mainly in Europe from the 1950s to 1970s that uses repeated lower doses of substances such as LSD or psilocybin to soften defenses, evoke psychodynamic material and support psychotherapeutic work—has been relatively neglected in the modern ‘‘psychedelic renaissance’’. Earlier work, notably by Hanscarl Leuner in Germany, produced detailed phenomenology and clinical protocols for psycholysis, but much of it remained in German and was not incorporated into the recent wave of clinical research. Borgwardt and colleagues set out to reintroduce and summarise the history, methods, indications, phenomenology, safety data and efficacy evidence for psycholytic therapy. The paper aims to provide clinicians and researchers with a comprehensive overview of psycholytic practice as it developed in the mid-20th century, to compare it with the dominant psychedelic peak model, and to argue for renewed empirical investigation and possible clinical inclusion of psycholytic methods in substance-assisted psychotherapy. The authors also disclose relevant clinical experience: one author trained with Leuner and another supervises lower-dose psycholytic work in Switzerland, where a modified psycholytic model has been used in a compassionate-use context.