Underground MDMA-, LSD- and 2-CB-assisted individual and group psychotherapy in Zurich

Underground MDMA-, LSD- and
2-CB-assisted individual and group
psychotherapy in Zurich: Outcomes,
implications and commentary
Ben Sessa and Friederike Meckel Fischer


Abstract
Underground psychedelic-assisted psychotherapy has persisted in Europe despite the banning of the substances LSD and
MDMA in the 1960s and 1980s, respectively. This article describes the work of a Zurich-based psychotherapist providing
individual and group psycholytic psychotherapy, whose practice persisted for several years before she was arrested in 2009.
The article provides commentary on the psychopharmacological, moral, ethical and legal issues of this case and discusses these issues in the context of the growing medical research of psychedelic substances as mainstream treatments for psychiatry.


Introduction
Psychedelic (hallucinogenic) substances have been used
for thousands of years by archaic and non-Western cul-
tures for psycho-spiritual healing. Following the dis-
covery of LSD in 1943, these drugs were researched
extensively by psychiatry (Hofmann, 1980). Most psy-
chedelic research ended by the 1970s amidst widespread
recreational drug use. Work with psychedelic agents
was largely absent for the next 40 years until a recent
resurgence of interest in these compounds as adjuncts
for psychotherapy (Sessa, 2005).
Despite the hiatus of clinical research since the 1960s,
throughout the world there have been some small pock-
ets of continued underground use of psychedelics for
psychotherapy. This article, which arose from several
interviews between UK psychiatrist Ben Sessa and
German psychiatrist Friederike Fischer, describes one
such project delivering individual and group psycholytic
therapy that ran for several years in Switzerland until
2009. The project came to an end when Dr Fischer and
her husband were arrested, put on trial and sentenced.
Friederike’s background history
and training
Friederike trained as a medical doctor in Germany spe-
cialising in industrial medicine and psychotherapy.
She further trained in the USA as a Holotropic
Breathwork facilitator with Dr Stanislav Grof, who
had worked extensively with LSD-assisted psychother-
apy during the 1960s and 1970s (Grof, 1980/2001).
In Switzerland between 1988 and 1993, there was a
brief period of relaxation in the Swiss legislation con-
cerning clinical use of psychedelic substances, and a
psycholytic therapy training group was set up to
instruct therapists in the use of mainly MDMA and
LSD. Psycholytic therapy involves drug-assisted psy-
chotherapy with repeated low to moderate doses – as
opposed to traditional ‘psychedelic’ psychotherapy,
which involves a single or infrequent use of a very
high dose of the drug. After Friederike had her first
personal experience with MDMA, she ‘knew immedi-
ately that it could be used therapeutically’. She and her
husband joined the training group whilst also working
in her own private psychotherapeutic practice provid-
ing non-drug psychotherapy, Holotropic Breathwork
group therapy and Family Constellation work.

Beginning individual therapy with
psychedelic drugs

When Friederike began offering individual psycholytic
psychotherapy sessions, some clients were recom-
mended by word-of-mouth, but most had already had
extensive non-drug psychotherapy with her. Only a
very small percentage of her clients (4%) went on to
drug-assisted therapy.
Those chosen to progress to psycholytic work were
those clients deemed to be ‘stuck’ or failing to progress
in traditional non-drug psychotherapy.

Initial individual assessment with
MDMA therapy sessions
The client would start with psycho-education, the
nature of the psycholytic experience and what to
expect under the influence of the substance. Clients
were then offered an individual drug-assisted session
with MDMA. Only when the client was familiar and
comfortable with the MDMA experience, sometimes
after several individual sessions, would they be invited
to join the larger therapeutic psycholytic group.
Friederike: ‘It takes time to get to know and to be
with a substance
...
to recognise the peaks and troughs
and how to manage one’s responses and challenges’.
The initial individual sessions would also be used to
stress the importance of the rules and boundaries
employed by the group. Once a client was ready, they
were offered the opportunity to join the therapeutic
group, where other adjunctive drugs could be con-
sidered alongside MDMA, such as LSD or 2-CB.
Characteristics of clients in the
psycholytic group
Ninety-seven of Friederike’s clients were given psycho-
lytic therapy, and 60 participated in the psycholytic
groups. The gender mix was 50/50, and the age range
of clients was 18 to 70 years. There was a wide range of
different social statuses amongst the participants but
most were well educated and intellectually high achiev-
ing. The average length of stay in the group was 25
sessions dispersed over several years.
Friederike led all the group sessions herself and her
husband Konrad, whilst not a therapist, also attended
most sessions. His role was one of a passive observer,
providing an important containing element in the context
of the complex systemic dynamics that often occurred.
Structure of the group sessions
The psycholytic group met over a weekend once a month
(10 times a year) at the home of Friederike and Konrad
in Zurich. The substance-assisted therapy session took
place all day Saturday, but the group’s participants
stayed from Friday to Sunday to take part in other
non-drug aspects of the therapeutic milieu.
On Friday, participants arrived at 7 pm and had
dinner together with their hosts, sharing how they
had been since last month’s session and discussing
what they would like to achieve on the Saturday ses-
sion. Between 8pm and 10.30pm they all met for a
(non-drug) group sharing in which they related how
they had been since last month’s session and discussed
what they would like to achieve on the Saturday session
and how they would phrase their intention-question.
Each client produced a written protocol which sum-
marised the experience in the last session and which
was the ‘entry ticket’ for the new one.
On Saturday morning, Friederike prepared the
medicines according to participants’ individual needs.
Friederike set the dosages for beginners. Very experi-
enced participants would decide jointly with Friederike
what dosage to take. After a light breakfast everyone
started the session with a
Promise Ritual
, in which they
confirmed the following:
I promise to keep silence about the present people,
about the location and the holy medicine. I promise
to harm neither others nor myself during or after the
session. I promise to return from the session in a more
healed and wiser way and I carry the responsibility of
what I am doing here myself.
Then all participants held hands, wished themselves a
good journey, took the first medicine together (usually
MDMA) and immediately lay down.
Friederike and Konrad always took the same
substance as the participants. In the early stages of
the psycholytic therapy, she experimented with not
taking the drug herself but found that her guidance
and therapeutic interventions were more effective
(as described by her clients) when she took the sub-
stance together with them.
For the next 90 minutes, everyone remained still and
silent, with eyes closed lying on mattresses or sitting.
Then Friederike played the first of a number of differ-
ent pieces of music ranging from classical to New Age,
in varying tempos to ‘awaken’ the participants to the
effects of the substance, whereupon they then formed a
circle and focused their attention on beginning the psy-
chotherapeutic work.
For the next three hours, Friederike led the group
members in their individual and group work (which is
described in detail later). Then breaking at 1 pm,
participants used the bathroom and ate before
Friederike handed out to each person the second sub-
stance – usually LSD, but sometimes 2-CB.

There followed another period of silence followed by
music to bring the clients to the point where the MDMA
and the LSD or 2-CB met. At the second peak, they
would begin the intensive psychotherapeutic work
again, which could last for another five to six hours.
At around 9 pm, the session ended and the group
enjoyed a meal together, followed by a walk. No one
was allowed to leave the group alone. By midnight, all
the guests had settled to bed.
On Sunday morning, they meet for a non-drug ses-
sion to discuss and integrate the previous day’s work.
The guests then settled their invoices and went home.
The cost per guest was between 300 and 400 Swiss
Francs (£190–£250) per weekend, which included the
cost of the substances. Some clients who were strug-
gling to pay would stay behind and help with chores
by way of payment.
In the following two weeks, all the participants sent
Friederike a written report of their experience. Any of
the participants were free to contact Friederike at any
time and arrange an individual 1:1 (non-drug) session
before the next psycholytic session if desired.

The choice and dosages of substances
used for the sessions
MDMA: 80–130 mg
LSD: 50–200mg
2-CB: 15–30 mg

Combining substances
Most psycholytic sessions began with MDMA, then
LSD or 2-CB were added mid-way. Sometimes sessions
began with 2-CB or with LSD or on rare occasions
other substances such as ayahuasca or psilocybin were
used. Crucially, all the participants (including
Friederike and Konrad) at any given session always
all took the same substance at the same time; only the
doses changed between individuals.
The use of MDMA as a
psychotherapeutic agent
MDMA exerts its effects at 5-HT
2A
and 5-HT
2B
recep-
tors, creating feelings of reduced anxiety and depression
and a sense of euphoria and well-being (Brunner and
Hen, 1997; Graeff et al., 1996). Its effects at 5-HT
2A
receptors (where ‘classical’ psychedelics such as LSD
predominantly act) facilitate original and innovative
thinking (Nash et al., 1994). MDMA also exerts effects
at alpha-2 receptors, producing calmness and relax-
ation. MDMA’s actions at dopamine and
noradrenaline receptors causes increased stimulation
and motivation (Cozzi et al., 1999; Fitzgerald and
Reid, 1990; Lavelle et al., 1999). And effects at the
hypothalamus cause oxytocin release, increasing
feelings of empathy and bonding (Thompson et al.,
2007). Taken together, all these neurobiological aspects
of MDMA provide the optimal psychological condi-
tions to make it a useful drug for psychotherapy
(Greer and Tolbert, 1986; Sessa, 2011).
Psychological dynamics within group
psycholytic work
As clients progress through the course of monthly ses-
sions, they gain experience with the substance-induced
mental spaces in order to explore and challenge their
individual psychological issues. Friederike describes
three successive stages of the psycholytic therapy,
akin to a client’s personal development: ‘Primary
School’, ‘Middle School’ and ‘High School’.
The ‘Primary School’ stage
Over an average of 10 sessions, participants develop the
basic strategies required to work with MDMA and
other substances. A fundamental skill is ‘The Self
Reflecting I’; learning to be self-reflective and con-
stantly aware of one’s personal identity in order to
‘let go’ in a non-judgmental manner. Such mindfulness
is essential to cope with the psychological material
released especially with LSD and 2-CB. Becoming
‘The Empathic Observer’ provides a neutral reference
point to explore thoughts without resistance.
Friederike begins the therapeutic phase of the drug
session by asking the clients ‘Where are you?’ – which
encourages clients to visualise their problems in a
watchful manner without allowing themselves to
attach to a particular thought.
Biographical scenes of childhood emerge; with asso-
ciated reflections upon parents and memories of psycho-
logical trauma such as sexual, physical or emotional
abuse. These experiences were worked through with
trauma-specific work. Friederike guided the participants
through the re-living of the traumatising moment by stay-
ing connected to the client’s adult part, by giving safety,
by encouraging the child-self to go through and by help-
ing the client in the end to distinguish between the present
and the past. Often these experiences required live-body
work, since trauma is stored in the body too. Thus the link
between the event and the trauma was cut. Sometimes,
Friederike will initiate a symbolic role-play scenario
‘‘modified constellation work’’, with Konrad as the
role-played mother or the father. The clients are encour-
aged to engage in a verbal dialogue with one another, in
character, to play out the psychological dynamics and to
Sessa and Fischer
explore the systemic issues – all the time using the
Empathic Observer stance as a non-judgmental reference
point.
Progression through the ‘Primary School’ stage leads
to the process of ‘Correcting New Experience’, in which
they address specific personal issues and previously
unexplored relationship dynamics. Very often they
experienced the hitherto buried deep love between
their parents and themselves. They may experience dra-
matic personal revelations – within and outside the
psycholytic sessions – and may wish to make major
life changes, such as marrying (or divorcing) their part-
ner, taking new responsibilities or leaving their job.
Friederike would always reflect with them the import-
ance of ‘being with’ the issues and gaining more experi-
ence with the substances before making such drastic
life-changing decisions.
The ‘Middle School’ stage
This might last for another 10 sessions. By now, the clients
can recognise the substance
s’ mental spaces more easily
and are developing a preference for different substances
and dosages. They learn to guide their inner processes
themselves, with less intervention from Friederike. They
can go deeper into the experience and pose mental ques-
tions to themselves about biographical issues but must not
allow themselves to believe they have all the answers.
Looking more closely at systemic and dynamics
issues, the clients are able to make connections with
other aspects of their lives and lifestyles, for example
their relationships at home, employment, with their
partner and their children. There is a greater emergence
of spiritual experiences and the clients begin to under-
stand the issue of projection – that what they see on the
outside is a reflection of what they feel on the inside.
The ‘High School’ stage
This could last for up to 20 sessions. By now, the clients
have fully integrated the concepts of being still and not
attaching to emotional experiences. They fully know
the substance and can conduct psycholytic sessions on
their own. They might use lower doses and need less or
no music as they have learned how to remain still and
rise higher with less external input.
Clients begin to fully integrate their learning into
their everyday normal lives. Acquired mindfulness pro-
vides peace and tranquillity to cope with their life prob-
lems in a new way. They have changed. Their new skills
are transferable to everyday life.
Spiritual insights provide an awareness of being part
of a greater whole, something bigger than oneself.
Clients often state that underlying all experience is the
concept of
love
; binding together all other aspects of life.
This is very powerful for clients who have up till now
never enjoyed any significant experience of love. Feeling
love is a fundamental characteristic of psychedelic sub-
stances and particularly MDMA. The substance gives
the clients an opportunity to see themselves as loving
and, crucially,
lovable
individuals, which offers immense
healing potential for clients with traumatic histories.
Clinical outcomes of the psycholytic
group work
In common with many psychotherapists, Friederike did
not routinely collect quantitative psychological measures
of her clients’ progress. But of the 97 clients who under-
went psycholytic psychotherapy, the qualitative out-
comes were overwhelmingly positive. There were no
serious adverse reactions to the substances, no psychoses,
no hospitalisations and no suicides of any clients who
were actively undergoing psycholytic therapy. Almost
all of the clients describe improvements in their relation-
ships and well-being at home and work. Some stayed
with their partners, some found the strength to leave.
Some stayed in their jobs and some developed new inter-
ests, lifestyles and employment – generally away from a
more consumerist lifestyle. For example, one man left a
highly paid corporate job and trained as a counsellor and
another became a social worker.
How it all came to an end
In 2009, Friederike and Konrad were arrested when an
ex-client informed the police. The ex-client, together
with her husband had initially been successfully engaged
in non-drug and psycholytic therapy. The couple had
initially praised Friederike for their positive experiences
using MDMA and LSD. But during the course of their
therapy, the couple later separated as a result of personal
insights gained by the husband. On moving out of the
marital home, then husband briefly lodged with
Friederike and Konrad for want of a place to stay.
Subsequently, the wife blamed Friederike for her hus-
band’s decision to end the marriage and decided to
inform the police about the underground therapy. She
told the police that Friederike and Konrad had used
MDMA and LSD to ‘brainwash’ her husband and
turned him against her. She denied any positive aspects
of the sessions she had had. The police then put
Friederike and Konrad’s house under surveillance and
tapped their telephone and emails, looking for evidence
of drug dealing.
Arrested and put on trial
In October 2009, the police raided the home and found
four tablets and two capsules of MDMA, four tabs of
blotter LSD and seized written documentation and the
couple’s computers. Friederike and Konrad were
arrested and put into custody in separate prisons for
almost two weeks, during which time they were inter-
rogated. The police found no evidence to suggest the
couple were dealing drugs and they were allowed home.
The trial took place in July 2010. The prosecution
case charged that Friederike and Konrad were dealing
drugs, making a large profit and were endangering soci-
ety at large because LSD was an intrinsically dangerous
drug. (Of note, the prosecution case never stated that
their use of MDMA was also endangering society.
Interestingly, there is no concept of MDMA-associated
neurotoxicity under Swiss law.)
In Friederike and Konrad’s defence, a number of
influential psycholytic therapists and neuroscientists
(Ede Frecska, Peter Gasser, Stanislav Grof, David
Nichols, Rick Strassman and Michael Winkelman) tes-
tified that LSD is
not
a dangerous drug and that it has
no significant physical or psychological adverse effects
when given in a controlled clinical setting. On the basis
of this evidence, the charge that the couple were endan-
gering society with their use of LSD was completely
rejected.
Friederike submitted further literature from Albert
Hofmann, Torsten Passie and others as evidence that
they had paid careful attention to Set and Setting
throughout their practice of psycholytic therapy and
that their project was non-profitable and not about
dealing or recreational/hedonistic drug use. Rather
the substances were being used with great care and
attention in the context of a therapeutic setting.
Friederike told the judge directly:
For me psychedelics like MDMA and LSD are not
drugs. They are psycho-integrative substances that
have been used for thousands of years. (It) is not like
getting drunk. The clients are in a clear state of elevated
consciousness in which they can carry out psychothera-
peutic work.
The court hearing lasted just three hours. Friederike
describes the waiting for the sentence to be passed as
‘the most frightening few hours of my life’, as she knew
there was a chance she could receive a custodial jail
sentence of up to 20 years for the alleged charges.
However, the judge understood that they were not deal-
ing and that their clients had willingly used the drugs in
the context of a clinical intervention. The sentences
were relatively lenient. Konrad was fined 10,000 Swiss
Francs (£6500) and received a 2-year probation sen-
tence. Friederike was fined 2000 Swiss Francs (£1300)
and given a 16 months suspended sentence with a fol-
lowing probation period of two years.
Other outcomes
The local media branded the couple as ‘evil’ and false
accusations were made that Friederike and Konrad
were conducting ‘sex orgies’ as part of a cult and that
they were pushing drugs upon unsuspecting or vulner-
able people for vast personal profits. Consequently, the
Zurich Health Council threatened to remove
Friederike’s professional license. She subsequently vol-
untarily gave up her qualification as a psychotherapist
rather than endure going through such a disciplinary
procedure.
Commentary
This remarkable story generates many issues worthy of
commentary. There are matters around the relative
effectiveness and safety of psycholytic therapy and the
particular manner in which it was conducted in this
instance. There are questions around the legal aspects
of these substances, the drug laws as they currently
stand and moral and ethical issues around Friederike
and Konrad engaging in this project in the first place.
What could they have done differently?
Friederike knows she strayed from the usual bound-
aries between client and therapist in allowing her ex-
client’s ex-husband to lodge briefly with her and
Konrad. However, she states that in the case of psycho-
lytic psychotherapy, it is sometimes more delicate to
find the proper distance between therapist and client.
Nevertheless, it is arguable that it is essential to do so.
Another idiosyncrasy of this project is that
Friederike could not consult widely with other clinical
colleagues for supervision. It was difficult for her to
share her thoughts, feelings and needs with anyone out-
side the project. Any clinician operating in isolation is
at risk of failing to see potential pitfalls or new angles
for therapy and is also completely ‘at the mercy’ of
one’s clients.
Friederike relied entirely upon trust to keep the pro-
ject under wraps. The ‘Promise Statement’ made at the
beginning of each drug session helped keep the project
hidden to some extent. But no matter how skilled and
containing any therapist is, it is inevitable that at some
point a dynamic may occur in which a client is over-
whelmed by issues that arise as a result of the therapy
and may wish to complain. When this occurs in trad-
itional psychotherapy, the therapist may seek support
from colleagues or from professional bodies such as
lawyers or medical insurance companies. In this
instance, Friederike had no such supports available,
which left both her and her clients vulnerable.

Nevertheless, the plug could have been pulled at any
time by any one of the clients in the years before it
ended. The fact it lasted as long as it did clearly dem-
onstrates a very high level of understanding of shared
goals between therapist and clients – perhaps more so
than one would normally see with traditional therapy.
In retrospect, Friederike could have been more judi-
cious in selecting clients going forward for psycholytic
therapy, in order to avoid those not prepared to bear
the responsibility of their own actions. However, in
reality she
was
judicious – recruiting only 4% of her
available pool of clients she held in non-drug therapy.
So there is no evidence she had a cavalier approach to
using substance-assisted therapy.
Moral and ethical issues
Some drugs are legal, widely advertised and socially
sanctioned despite being more toxic than many others
whose use is restricted (Nutt et al., 2010). This fact and
the negative press reports against Friederike and
Konrad reflect the general public’s critical feelings
about illegal drugs. Many people erroneously believed
Friederike made great profits from her work, even
though the price charged for the entire weekend’s
therapy is below what some psychotherapists charge
for a single two-hour session of traditional
psychotherapy.
Friederike knew these substances offered her clients
a therapeutic option not available through traditional
psychotherapy. The substances could be used safely
with appropriate set and setting controls, which she
followed fastidiously. She was conservative in her
selection of clients and careful to ensure they were ade-
quately followed-up outside the sessions.
Having exercised all these controls, Friederike
nevertheless provided this therapy in spite of the
illegality. Does this make her a foolish law-breaker?
Or a brave clinician prepared to carry considerable per-
sonal risk (for which she subsequently paid the price) in
order to provide a viable clinical intervention for her
clients?
How widespread is underground
therapy?
It is estimated there are dozens of other underground
psycholytic psychotherapy groups operating through-
out Switzerland using MDMA, LSD and other
agents. And it is conceivable that the practice
is also going on in the UK. Many people today use
psychedelic drugs as part of a healing and wholesome
community cohesive experience, rather than sim-
ply an act of hedonism; much more so than when
they take other drugs such as alcohol and cocaine.
In 2009, in Berlin, two deaths occurred in the context
of an underground psycholytic therapy group session.
Clients were accidentally given lethal doses of the drug
methylone. This
tragedy highlights the particular risks associated with
a lack of quality controls involved with underground
therapy.
The future for psychedelic research
After 60 years of widespread recreational LSD use by
hundreds of millions of people, there have still been no
recorded deaths or any clinically significant morbidity
issues with the drug. Although LSD is an immensely
powerful substance, it has been repeatedly demon-
strated that it can be used perfectly safely in a clinical
setting with due care and attention (Gasser, 2014).
Similarly with MDMA, after 25 years of heavy recre-
ational ecstasy use throughout the world, the morbidity
and mortality rate remains very low and when taken in
a controlled clinical setting, there is no substantial
evidence for irreversible neurotoxicity (Sessa, 2007).
Decades of anecdotal examples of the positive use of
psychedelics as agents for healing are now being
backed-up with contemporary clinical trials (Krebs
2013). In the face of continued unremitting mental dis-
orders – especially the anxiety-based disorders – we are
seeing increasing numbers of clinicians looking for
viable alternative treatment options. All of the contem-
porary clinical psychedelic studies, though well
designed, have nevertheless had to endure considerable
ethical and legal barriers – far above those expected by
conventional psychopharmacology trials (Sessa and
Nutt, 2015).
Psychedelic research studies completed in recent
years include a DMT human dose-response study
(Strassman, 1995), ketamine psychotherapy to treat
heroin dependence (Kruitsky et al., 2007), the use of
psilocybin-assisted psychotherapy to treat obsessive
compulsive disorder (Moreno et al., 2006) and the use
of MDMA to treat PTSD (Mithoefer et al., 2011). And
worldwide, there are many more projects underway.

The current renaissance in psychedelic research
is flourishing. It is looking increasingly likely that
within the next 10 to 15 years, clinicians wishing
to use psychedelic-drug assisted psychotherapy will
be able to carry out this form of treatment using regu-
lated, legal and appropriately monitored structures
(Sessa, 2012).