Knowing and being known: Psychedelic–assisted psychotherapy and the sense of authenticity

Abstract

Participants in MDMA- and psychedelic-assisted psychotherapy often emerge from these treatments with new beliefs about themselves and the world. Studies have linked changed beliefs with mystical experiences reported by some participants during drug sessions. While there has been some debate about the epistemic value of drug-induced mystical experiences, and about the need for consent to treatments that may alter metaphysical beliefs, less attention has been given to the sense of authenticity that attends these experiences. In this paper, I consider the intersubjective context in which these changed beliefs arise. I suggest that the sense of authenticity people experience with MDMA- and psychedelic-assisted psychotherapy derives from a simultaneous feeling of knowing and being known. The medications used in these treatments reduce the defensive barriers which ordinarily prevent powerful feelings from being intersubjectively shared, allowing the subject to experience knowing and being known with the therapist and/or internalized or imagined others. In explaining this thesis, I discuss Ratcliffe's “existential feeling;” ipseity in incipient psychosis and psychedelic states; Winnicott's notions of the True Self, omnipotence, creativity, and transitional phenomena; implicit relational knowing and moments of meeting; infant-mother dyad research; predictive processing and the relaxed beliefs model of psychedelic action; the role of the “partner in thought” in knowing and feeling known. I propose that a “transitional space” model of MDMA- and psychedelic-assisted psychotherapy is well-suited for working through “not-me” or dissociated experience

Touching and being touched: where knowing and feeling meet

“…One may even argue that true empathy requires a trial stage of full imaginative absorption in the world of the other, generating a model untinged by self-representation, which may explain the occasional sense of uncanniness about intersubjective knowledge attained this way. This dream-like absorption is based on the same dynamics as absorption in play and cultural experience, and its posterior beliefs, while less constrained by prior expectation, and therefore more novel, are subject to the same illusion-disillusionment process as these transitional phenomena, wherein we agree not to ask the empathizer if he or she "created" or "found" the contents of the other's mind (Winnicott, 1971a;Fischman, 2022).…”

“…Where early psychoanalytic models attempted to find confirmation of various psychosexual developmental and energic theories in depersonalization, a less dogmatic approach recognizing the need for grounding in affected individuals may have clinical implications for a psychodynamic or relational approach to depersonalization. In this model, a psychotherapist would not only recognize the clinical importance of appropriate touch and self-touch, but also the symbolic equivalence between touching and knowing that arises in moments of meeting when two wandering minds intersect, or touch each other, in a new way ( Lyons-Ruth et al, 1998 ; Stern et al, 1998 ; Tronick et al, 1998 ; Lyons-Ruth, 1999 ; Fischman, 2022 ).…”

The Bright Side of Psychedelics: Latest Advances and Challenges in Neuropharmacology

“…However, in the last decade, psychedelic-assisted psychotherapy (PAP) has emerged as an alternative strategy, one that arose in response to the crisis of new psychiatric drugs [ 20 , 21 , 22 , 23 , 24 ]. To date, there have been promising clinical trials of PAP with LSD, psilocybin and ibogaine to combat drug, alcohol and nicotine addiction [ 25 , 26 , 27 , 28 ].…”