NOTES ON THE USE OF DRUC, S TO, FACILITATEGROUP PSYCHOTHERAPY

BY B E T T Y GROVER EISNEt~, Ph.D.

In the eo.ttr,se of u.sing LSD-25 (d-lys,ergie acid diethylamide*) experimentally and therapeutically for more than five years, a number .of other drugs have been used, .singly o.r in different e,c~mbinatior~s (LSD-mesealine, LSD-amp.hetamine, L,SD-dtatin, and m,esealine-amphetamine) ; the environmen.t has been manipulated (physical ,setting, music, mirror and pbo.tographs, pro,due,tion o.f art wo.rk) ; and the number of persons p.resent during drug sessi.ons** h~s. been varied, either when the dr~g-f.aeiIi~ated therapeutic process was eon=cent.rat.ed on one individtml or when it involved a group whose members were all under the drug effec,ts. This rep.o.rt concerns extracts of meaningful observation, s, frown four week-tong group therapy .semilra.rs, held in the same, settin:g with 10 .or 12 participants. The member,s we.re part of a lo,o,s,elyorganized group of individual.s, engaged in whas they call "~:e quest for meaning, the search fo.r orienta;tion, the pursuit o~f selffulfillment, and the realization of our highes.t p.oten~ti~alifie~s."Member's o,f the four therapy seminars were dra~wn fr~om this group, which uses group methods as the main ve,hiele o,f inquiry. All have become lfi:ghly e,onversant with group processes .of the .seminar type,, wherein the leader's func.tion is merely to keep. the diseus,sion on the is~sue but no.t to promote any sp.ecifie viewpoint. Me~bers of all. four groups had been to at least one "basie"f and one "eo,ntinuation" (both nontherapy-o.riented) :seminar; and subsequently had agreed to take part in the g'roulo~therapy ~seminar because .o,f a desi,re to work too,re de.ep~y on p,er,sor~al problems~. Introduc~o.ry and continuation se~ninars are tteld during the mlmmer; the rest of the year interested indivi,duals meet we.eldy in small postseminar groups for continuing di.seu.s~s~o.~s. Most of
~D-lysergic a d d diethylamide, a synthetic ergot derivative, was discovered in 1943 by H o f m a n n l and has been the subject of much study. A.ppTeeiatio~ is tendered to Sandoz Pharmaceuticals, Inc. for all.owing the experimenters to purchase the drug. ~*By " d r u g " is lneant treatment with L SD, mesc~fline, ritalin, or amphetamine, used alone or in various combi~atlons. I"Basie" or "intreduetory" semlnai~ are concerned with "issues" of life as seen in the teacMngs of Jesus ; "continuation" seminars go more deeply into what is considered important to creative living; further seminars concern themselves with progressive translation of these principles into everyday li~e:

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the participants of the four therapy seminar,s h~d been in p.r'evio~,s sihmtion.s, seminar or postseminar, with eaeh other, tIowever, none of the prior situations had involved the author; n~one of ~he individuals had attended a group therapy seminar prior to, the, sessions just reported; none of the gro,aps had met before a,,s units; nor were there member,s of any gro,up who ~a,d n e t met at least sing]y in other prior groups. A brief description of the matrix within which ~herapeutia drug sessions function optimally and an examinatio.n .oK the effectivenests o.f an informal gr(mp as an aid to i n d i ~ d u ~ l LSD therapy are important if one is to understand background faetors in dmlgfacilitated group psycho,therapy. A fairly u~iform setting evolved fro.m an .earlier study of the use of LSD as a therap.eutie tool?, ~ Drug s:essions~ held weekly, with a.n inere~a.s~e in dosage each week, to,ok place N ,a ho~spital roo~m eo,mfortably furnished with rugs, ho~s~eho,ld furniture, .and paintings. The author was present continually f~or the t~ner'apeutie sessions, usually seven to eight hours at a time,. As the drug effect wolfe ~o.ff, ,a patient wa~s taken to 'the ~r~t etinie to. work in past el.s or water eo~ors. Music was very importan.t in po,tentia~thqg .dr~g aetio,n ~ d inducing mo.od changes~ A mirro.r was used to precipitate consideration of self-images, and ph,o~.ogra~hs of family member,s and elo,se friends were found help.ful in fo.e~sing r'elatio~nship problems. There was less anxiety and optimM drug action with an aitraetive phpsieal environment a~nd someo~ne eontinu.ou.sty with the patient.

A p,hysia}a~* w~s present ~s time al,]~ow.ed, always j.oir~ng t]le patients and the N e r a p i s t for lunch. Frequently one to three additional doeto.rs might be present durin.g s.essio,ns. The patient, if he .so. desired, was al~s,o permit.ted to include a friend. LSD ses:sioa~s, used a.s an adiunet to. eonvention.M psychotherapy and p.a.tterned on thase just described, have been supervised by Dr. Marion Dakin, a.t the Southern C,alifo,rn~a Hos.p.i~t!al in Lo.s A n g d e s fo.r the las,t four year,s. A novel appeo~eh was intr'oduaed in that different individuals (patients o,r e~:-patien~.s, known :or unkno~vn to the o.riginal patient) were b,ro~ght into. the to.ore -~hile L S D treatment was in progress. There emerged from these pro~Dr. Sidney Cohen~ at that time assistant medical ehief~ Brentwocd Neu'ropsyehiatrie Hospital, Veterans Administration; at present ehief~ psychosomatic medieine, W~asworth Hospital, Veterm~s Administration, Los Angeles.

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USE OF DRUGS IN GROUP PSXOHOTttERA:Pu

cedures a reeo~gnition of the group as a va]u~able faato.r in accelerating therapy and alleviating some of its too,re difficult aspeats. Two distinct and quite different advantages appeared to, accrue from the use of a number of per s.ons during a single LSD therapy ses,sion. One involved the psyehologi6al re-er~ation of early life situations. With a properly constituted group, it is possible to recapRul,ate the early family emotional setting and to oo~nfront the patient simultaneously with Oedipal and sibling pattelrn,s as well as their interactions. The other value appeared to lie in ,a eapacRy to dis churge either repressed material~ or the e~oneomitaa't a ff~ec:t, .at a nonverbal level. In ,some ease,s the material never came to eon.sciou:s knowledge o,f the pa:tient; in others, ~t seeped through gradually during a period of from three months to a year. The m~t.ter of nonverbal therapy will be described elsewhere.4 The direct and nonverbal confrontation of problem.s through ~se of drugs and the presence of additional individuals does not. take place until some time has ela.io,sed during vehieh both conventional and/or drng treatments are used and the pafdent ha:s reached a re,adiness, in time and capacity, to handle s~eh a .situation. The neeessaTy factors seemed to b e : a relation.ship o.f trust with the therapist; enough familiarity~ with drug ,ac4,io:n to allo,w 1.owermg of defensive barriers so that effective w o.rk can be don.e; capacity to tolerate interaction wRh others in a gr,oup setting, and the readiness 'to c,ome to grips with one's basic difficulties. These conditio.ns apply also to. the group situation.s described in ~hi.s study. The. c,apacity to "let one's ~self go" to the drug action is one of the most imp o.rt~ant determinants :of &rug threshold. It appears to be re~ated inversely to an individual's rigidity--hi~s need to stay in e,ontrol under any circumstances, and ~s a function os both personality structure and learning. Research t~as shown that artists repo.rted much deeper and more meaningful LSD experie~ee,s than others2 As a rule, t h e individuals without a profession experie~aced more than the professional gr:o~p, which included l~eachers and engineer,s. Rsyehiatrists, other physicians, and psyehoFlogists were the too,st refractory, * to drug experiences among t~he 194 experimental subjects. This varying ~bility to "release" unconscious material is corro~borated by perso.nal o~bservations o,f p~tients and experimental s~bjeets. Those who "fight" the drug either experience
"~'Kt comparable dosages.

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very little drug effect or are subjected to a series of unplea.sant somatic s;nnptoms, without insight, accompanied by considerable physical pain. The ir~ability to "let go" appea.~s .to, be the result o,f strong ,a~d rigid defen,ses, either against e m e r ~ n g unconscio~:s proee~sses, against the threat of in terperso~nal relatior~s, or ,both. TMs, a~p~ parently reflects fundamental defenses~ in ~ceept,anee and understanding one's self and in relating to others. The proves,s of weekly session.s with gradually increasing drug do,s~ge familiarizes p a. tier~ts with :the progressive bio,chemi,ea.l~y-il~duced relaxation of eo,ntr'ots, ~nd allows a more meaningful therape.ut~_c r'etati,on s'~ip to be esta~blished.
MATERIALS AND ~]-ETI-IODS

The four group-therapy seminars eo,nsisted of 4~2 participants who were diagnostically in the clinically normal group. T.hey had no records of hospitalization for mental illness, .although .several had had peri,ods of psyehother~apy. Ob~serva,tion a~nd retro~spective analysis gave the clinical impression that ~hi.s w~s an overly-rigid gro,up of religious individuals with above-a~er~ge intellSgence, t%orsehach examinations, given to a random hal:f of the sample, gave such a. wide scatter that no generalizations o,ther ttmn above-average intelligence could be dra~vn. There were two alcoholics in remission (AA members) in. each group, except seminar four. Here there were two persons wi.th passive-aggressive, pa,ssive character di,so.rders, one with a seh.iz~o,i.d personali~. Each seminar group contained :one olr two in.di~d~mls with such str,ong projective mechanisms a:s to sugges.t paranoid ideati:on tat times. The first, two semina,rs (nondrug) had four men and se~e,n women, while th~ two drug seminars had four men and .six women, and six men and four women, respectively. All participants were Cau~easian, exce~ot fo.r ,o,ne in the firs:t seminar who, was Mongo.liamIlassian. The age range was from 22 to, 68 years, wi.th a median of 35 years. The religi~ot~s b~ckgrouncls were ~s foilo~.s: 72 per eent Pro.te.s~tant, 19 per eer~t Jew}sh, a~d 9 per cent Catholic. All se~ninars were held for a week in the same i s d a t e d mo.untain setting. Ho,usekeeping tasks, except the coo,king, were performed by the gr,oup. The experimental study period ranged fr,om six 'to
~See u]~o ~(>ta ~n Table.

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USE OF DRUGS IN GROUP PSYCtIOTHERAPY

eight h o u r s a d a y ; p a r t i c i p a n t s were g a N e r e d in a circle in a roo,m o.f m o d e r a t e size. The p r o c e d u r e wa.s as follows: The participants rose at 6:30 a.m. Breakfast was served at 7:30 a.m. The drugs were administered at 8,30. The first and second seminars were held with.out dru~s, whi]e in the third and fourth seminars drugs were used. The therapeutic work began at 9 and continued until 12:15 p.m. Lunch was at 12:30, and the seminar reconvened for an afternoon session of therapeutic work or art participation from 1:30 0o 4:30. There was a free period from 4:30 to 6:30 (which was dinner-time) when participants could rest, walk, s~,im at a nearby pool or in the somewhat-more-distant ocean. The two drug seminars consistently chose to work through th~ period and usuM]y spent the time in the art room painting out problems in pastels or working with clay The first two nondrug seminars had three regularlyscheduled art periods after lunch during the week. All four seminar groups finished up art work periods by associating to their own and to each other's art productions. There was no work after dinner. Music was played from 8 p.m. to 10; participation solely on a listening level was requested but not required. The music was of the more harmonic or "inte~ating" ~type, and the period proved Go be useful in integrating material from the day's work. D r u g s were g i v e n orally (see the table). I n the t h i r d s,e~nMar, mescaline a n d dexedrine w.ere ~ v e n on the .seeo.nd, third, ,and fifth days. I n the f o u r t h seminar, me.scaline and ampJh.etamine, aRe.rh a t i n g with LSD, were given on five successive days. The physician partieip,ant took the same drugs as his p a r t i c u l a r g r o u p , while the mlthor took no drugs in t'he third seminar b u t did take 22 rag. of .mes.ealine and .one 1.5 rag. dexedrine spansule on the third, fifth, and sixth days of the f o u r t h seminar (LSD days for the g r o u p ) . This added a p a r t i a l l y p a r t i c i p a t i n g role to that o.f the o,hservertherapis,t. OBs~m~A:rm~s A l t h o u g h LSD, mescaline, and the a m p h e t a m i n e s differ in m a n y ways, i n t e r e s t i n g similarities exist.* All th~ree d r u g s a.ppear t:o enhance rapp~ort and empathetie capacities, tower ego defen=sivehess, a n d f.aeilitate accessibility of uneonseio.~s ma'terial. ~, ~ T h i s was v e r y evident no.t only to the t h e r a p i s t b u t to every p a r t i c i p a n t
*The members of the fourth seminar were unable to differentiate between effectivehess of mescaline/amphetamine and the 10 to 25 gamma of L,SD~. Del~h os action seemed to correlate more with psychic state aud interaction than with the drug taken. ITowever, the last drug day was an exception when all patr took 25 or 50 gamma in an attempt to experience the integrative aspect of LSD rathear tllan just its therapeutic facilitation.

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in a d r u g s e m i n a r , a n d p a r t i c u l a r l y to tbo,se member.s of the t h i r d a n d f o t t r t h s e m i n a r s who acted ~s t h e i r own eont:rols on no n d r u g days. Vari.ous p a r t i c i p a n t s s t a t e d : Concerning the use of the drug, I can only say that I have never been able to open up so quickly or completely, I think the m/.d~ had a dual effect on me. First it loosened me up so that I could speak more easily; second it loosened the other members which allowed me to be more free to speak. . . . little or no physical effect of the d r u g . . . I am sure however the material would not have flowed forth with such incredible 'emptying-outness' if we had not had our controls weakened or knocked down by something. The feeling was that the membrane that separates the eonscious and the uneo.nseious h.ad become porous and that the unconscious was seeping through by osmosis. Rather than going down ,for information, information was coming up. In the therapy the di~g seemed to have three effects which combined to heighten the intensity and the effectiveness of what took place. In the first place, I found myself mere than usually willing to talk about myself. There was a noticeable decrease in my relucta~,ce to expose mysetf*~ and I felt quite willing to say anything that seemed appropriate. Second, I found myself much better able to eoncentraie. I was more effective in my introspection, better focused, and less troubled by attention becoming diffu~d or by irrelevancies causing me to lose my focus. When I tried to go after something, I found I was able to stay with it much more effectively than I ordinarily can. Finally, ,and most important, was my ability to go deeper into myself. My resist~ance tc probing (by myself and the therapist) was decreased and I fett as though my conscious mind could go down into deep layers of awareness--could penetrate into areas which had been deeply repressed and toward the center of my consciousness. There was less tendency to turn away from what looked distasteful and a willingness to pall out and look at whatever I found. Also, intangible resistance which usually blocks
~Mesealine and dexedrine. ~ E x p o s e in the psychologies] sense (author).

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me was redueed and I felt as tMugh I was penetrating through laye~-s whieh were ordinarily resistant and impenetrable. The effe~t,s ,on members of the fourth ~s,eminar were even too,re marked than the third. One particip,an,t spoke two months later of "the tremendous acceleration of my life (both o~bjective and subjective)." Another said: While I had a shaky time of it, it was a necessary shaking that began to lay bare at least some of the roots of my blindness and despair and trust and creativity. Drug and nondrug groups could be s,harply differentia,ted by their ability to become a cohesive whole and to come to gI~ip,s with problems. While it took three days for t~he first two n ondrug semin,ars to produce a group feeling o~f empathy sufficient to all,o,w d~scusMon of meaningful ma thins occurred in the third and four,t'h se.ininar,s within one or two hours after drug administration. The gro~ap.s in the latter seminar:s acted ~s units. This anity seemed to. be signalled, to the therapist ~t 1.e~st, by a sudden psychic quiet which appeared to pervade the enviro.naaent and the p,artie4p,a.~t:s. Problems which would o~herwise have been dealt with intellectually suddenly came alive; affect w~s discharged; and the psychic, exMt,ement and tension equilibrium, present only when there is invo.lve~ment with deep proibtems, becanae raanifest. In,dividuals seemed galvanized into participation. In the tsvo. nondrug seminars, few Fr'oblems aro,se that were disturbing enough to discharge affect or to precipitate emotio,nal el~ises. Tw.o excepdion.s were a wo,maa in the first seminar wh,o had recently bee.ome a widow and who broke down following o.ne o.f the therapy sessio.ns and had to w i t h d r a ~ from Fart~cipa.tion from ..the afternoon session, keeping one of t~be other membe~r~s with ,her for comfort. In the second seminar) the Mongoli~n-Ru:sMan, a wom,a~n who, during her 68 years, had apparently made up for her feelings of being differen,t from others by "serving" ,~nyone she c,ould, was suddenly c:on~fro.nted with this in the gro,up. She ~refused t.o recogn~ize what the members were s.aying, but she didn't a.ppear for lunch that day. One of the young co~up}es in the group sought her out and co,retorted her through the impact of the insigh,t and her sabsequent tear,s. In eontra,st, in the drug-facil~t-

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a t e d seminars, the b r e a k d o w n o,f ego de fensefs a n d the co,ncomitant e m o t i o n a l u,psets o c c u r r e d in the g r o u p setting. A~s,o, a p r o c e s s occurred w i t h th,ree m e m b e r s of the: t h i r d ,s,emin a r a n d w~th e v e r y mencber of the fo.urth s e m i n a r which is ca~led a "crisis a n d b r e a k t h r o u g h , " a b r e a k i n g d:e~wn o~ decen, ses a n d rec o n s t i t u t i o n o~ ego s t r u c t u r e at a m o r e realistic a n d f l e ~ b l e level. In the third seminar, a male engineer who had had real difficulW in close interperson.al relationships although verbally insisting on his longing for a wife and children, w.as progressively confronted by the group with the dichotomy between what he said he wanted and what he actively sought. Suddenly, he shut his eyes and seemed to be in some sort of trance. Later he described his reaction as "sinking down inside" himself where he experienced l~imself as a steel ball. I-Ie observed that this ball was beginning to cheek and to crack. Allowing this to happen, as the therapist directed, a wave of anxiety overcame him, and he felt that he was going to die. As members of the group felt his anguish and gathered .around to support him, both physically and psychologically, he w~s able to consider consciously his fear of distintegration. With a terrible psychic wrench he seemed in one movement to fly apart and come together again. He gradually "came up" and felt that something very important had happened. His need to eon~ol himself was observed to have diminished, he could relate better to oCher members of the group, and was observed to have more flexibility and freedom.
@ @ @

The crisis of the other engineer in the third seminar occurred when he was discussing a series of his five abstract, brightly-coh)red paintings in the form of symbols. He suddenly became aware of the shooting star of his younger brother and how it cut a path between his golden star and the half circle of his previously-doting mother. It was as though he had been hit by a blow to his solar plexus, as the knowledge struck of how he had been cut off and in turn had cut others off. Then followed an experience for him which 'he verbalized at the time as "going psychotic" whereby all of reality ,seemed tc fragment and whirl around him in meaningless chaos. As the group quieted and focused entirely on him in silent support, the spinning splinters of the universe slowed down and began to form a constellation into a new whole, which he later exclaimed over as being "drenched in color," and seeming to glow from within. An unmarried woman teacher in her middle thirties was concerned with the lack of fulfillment of her biological role us woman. As members of the group pointed out how she undercut any man she was with and how she patronized children, even though she professed to love them, she became more tense and rigid. The group attempted in different ways to break

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through the rigidity and lack Of insight. Finally one member almost shouted at her .a recapitulation of her behavior toward the man in the group whom she felt she had loved for many years. As the impact of her ox~n destructiveness and revulsion for men hit her. the teacher was speechless with what at first seemed to be rage. Then she burst into uncontrollable sobbing as though from a!most unbearable pain. As the group felt her defenselessness and agony, the members ]eft their seats and gathered around, giving support in silence. The awareness of the group feeling of empathy suddenly cut through the pain, and she was awestricken that even though everyone knew what she had so long tried to hide, it didn't result in her rejection. I n t h e fo~rt~h seminar, w h e r e L S D w a s altemrn~ated w i t h m,eseMinea m p h e t a m i n e f o r five of the seven days, t h e r e w a s a e.onst~aat unrolling of d r a m a t i c event's and a eontinuotls floav o.f m,a t e r i a l f r o m d e e p e r levels. E v e r y m e m b e r of the g r o u p w a s v i s i b l y affected, arrd each in the g r o u p w e n t t h r o u g h a perso,nal crisis. One couple were meshed in a ve~T complicated sadomasochistic relationship with a history of a possible early molestation of the wife by her alcoholic father and the husband's tortuous relationsMp with his reliNously-fanatie mother. During the drug sessions the couple acted out their sadomasochism. One morning the husband had shouted vituperation against the world for an hour. His wife was finally goaded into a violent verbal attack 'against the group member on whom she projected her alcoholic father. Fin.ally, in a frenzy, she started toward the man. Midway she spun around and shifted her attack onto the therapist. After a few shouted impreeations, she ~arted from across the room to "drive her through the wall." lta!fway across the room the violence seemed to climax, and then the destructive wishes disintegrated as the patient reached the therapist, falling on her knees and throwing her arms around her. T h i s t r a n s c e n d e n c e of v i o l e n c e - - t h e s u d d e n s h i f t o f hate, t o t a l l y felt, into, love, w a s o b s e r v e d s e v e r a l thnes d u r i n g the fo,urth seminar. One of the participants, a surgeon, had been sublimating sexual and aggressive drives through his professional work. IIe developed a catatoniclike state, from which he was aroused to physical attack. He had been lying ht the corner while another member of the seminar "came alive" (see the following). ]finally, with goading, the group was able to get hint to join the circle, where he sat in stuporous silence, refusing to speak. Suddenly, after a very pointed interpretation by the therapist, he was out of his cha,it, past the intervening two individuals, and had the therapist by the loose folds of jacket across the chest and had lifted her off the floor. As other members of the group rose to interfere, she said, "Let him

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alone; it's all right," and they stood watching while he slowly put her back on the floor. The patient subsequently said that if there had been any fear in the therapist he would have dashed her down on the floor in an attempt to smash her to pieces. The next day this patient was free enough from previously-operating inhibitions to beat his hands on the floor as he re-lived and abreacted the guilt about masturbation instil]e.d by his restrictive, seductive, inhibited mother. One of the Inore touching epi,sodes occurred when a no,ther Ineinber o~f this s e m i n a r was "born. "~ He was a lawyer wh,o had n.ever really "becoine hiinself." On the fourth (dn~g) day of the seminar he witl~drew to a corner of the room while the group therapy was in progress. Suddenly the group realized that his breathing had changed; he was breathing heavily ~ith an increasingly .steady, deep rh~hra. As attention was called to his behavior, the group gathered around him. He reported the "coming alive" of different parts of h~s body as he was "being born." The process culmi~ate,d ~1 an experience of ecstatic freedom for him, wherein for the first time he felt that he knew who he was and the purpose and meaning of life, for him. Three years later he reported himself much more succ~sful in relationships with people, both persona] and in business, and he was seen to be much freer 'and less inhibited than he had been before the seminar. There was an enorino.us re]eas,e o.f c.reative e nergy~sii~ging, dancing~ painting, ease in rel~ating---al] th!r~o,ugh the week o.f the fo,urth grou~p. However, it Inu,st be einphasized tl~at ~his se~ninar climaxed a long prior process of working to,ward individuM creat,ivity ,and freedoin. An unexpected observation was that the experiinental do,sage unifo,rmly had greater-than-expected re,suits in spite of the sinM1 amoun'ts used. This became apperen~t the ~l~st day in the t h i r d seminar v~h:en Inesc,Mi.ne and dexedrine were u~sed. I t was a~s t h o u g h tongues had suddenly loosened, defenses become ]no,re fluid, and the g r o u p more cohes.ive. This had never before been o.bserved in a newly-for]ned g r o u p ; it is usually o.bserved o,nly a f t e r three to Mx Ino.nth.s o,f group work. In the fo~arth seininar there were several Ineinbers who had had individual LSD sessions before the: gro,up t h e r a p y seminar, and they expressed amazement that feelings., sensory s~hifts and openness, which they had experienced ~at do,sages ] 0 t~ines higher, were apparelat with the lower d~s,es, even tho~lgh
*Re,birth or b h t h e~perlences a r e v e r y c o m m o n l y seen with p a t i e n t s u n d e r t h e s e d~-ags.~, ~ There is some c o n t r o v e r s y as to w h e t h e r these a r e symbolic occurrences or have some basis in fact. F r o m repeated o b s e r v a t i o n s o f these p h e n o m e n a a n d f r o m ,~cca.sional o p p o r t u n i t i e s to check t h e f a c t s , t h e y a p p e a r to be a eombinati.on of t h e two.

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to lesser degrees. In the third seminnar o.ne young sMesman even had 'twr incide.nts of colo.red imagery with 20 mg..o.f mescoJline and 10 mg. o.f dexedrinne. Heighte.ned ,sen,sitivity, both of s,ensory and of affectual nature, occurred with all of the l~o~wdo~ses where before they had been seen in individual sessions only with much greater amo~un:ts of the drugs used. With respect to the author, LSD even in small aznounts had been found pers:o~ally so compelling that either objective actio.n mus.t be .suspended, ~r the drug a.ctio.n postponed.* A dexedrine spar~s,ule, 15 mg., is often used by the author when worMng with indivi4uals under drugs, a~nd she routinely experiences LSD-lik.e feelings, even including three-dimensional colored imagery and body sens:ations, ~hile s~pecvising high-4o,se LSD sessions. This occurs more o~te.n when several persons have taken LSD than in sessions with a single individual. It is hoped that this experiencing of drug effects, almo,s'.t, by "eontag~o.n," will be better understood with fur~th~r research. With respect to the four groulo-therapy seminars, the mlthov took no drug during the first three. During the fourth, she took 22 rag. of mescaline, with a dexedrine spansule o~ 15 rag., on the third, fifth, and sixth days--the days that the rest of the gror~p had LSD. The mescaline-dexedrine acted much ~s the dexedrine had in the past, enhancing emp.athy, sensitivity, and awareness for the author. No reactions specific to mescaline or psychedelics were feu o,ther than on the last day when the gro~up's LSD d,o,sage w~s higher; the effects on that day not only provided greater sens'itivity, awareness, and empathy for the. therapist, but were also integrative, and co]or was greatly enhanced. Discvssmlg One of the inte:resting and unexpected observation, s wa~s the effectiveness .of very small amounts of drugs. Twe.nbT mad 22 rag. ,o.f mescMine, u~sed with dexedrine ,or methedrine, is considerably less tha.n the 300 to 400 rag. which is the average effective individwal mescaline d,o,se,s In both drug seminars there was even heightened
~At one session at the Brentwood Veterans Administration I-Iospital~ the author and Dr. Cohen experimented with 25T of LSD, being joined by tyro ether researchers, mid found t h a t their LSD reactions were "postponed" spontaneously and unconsciously for five hours whe~ a critical therapeutic problem which had to be dealt with immediately arose with one of the members of the group. Both doctors suddenly experienced the initiation of the '~L.SD state'; on lea~ing the hospital five hours l a t e r - - a state which continued for the usual span of six to eight hours.

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perception o.f co~or aad some imagery, surprising ~o.r such low do,ses. These eff;e~ts were noted only in passing, and were no.t relevant to the therapeutic purpose of the seminar. However, ao.lor enhancen~ent..and imag'e~y had never been observed previously on le,s,s thre.e times the dosage used. With LSD 7~ is the smMlest am.ount having any repo.rted activity, and effects at this dosag,e are not .o,bserved in all subjects? The average LSD dose used by most investigators is from 75 to 150~,. Effects. were felt by all members o,f the fourth seminar when only 107 were used. This po~ten't~ation o.f drug dosage, observed for all memb.ers o,f the group and with all of the drug co.mbinat~ions used, has severM posM~ble causes: the gr'oup situation, the sp.ec~fic s,etting, the typ,e of individuMs p.artie~pating~ the mate.rial under di.s,eussio.u, the familiarity and orientation of the group members toward each other aad the general material, or a combination o.f faet o,rs. l-Ioweve'.r, setting ~and previous group experience do, not seem to be prime determinants; heig~htened effe,et.ive~es,s ,o~ dosage was o,bserved with the first group experiments at Brent~vo,od Ve~e.rans Administration Hospital, which were held in an ordinary o,ffiee mnong inves,tiga.t,ors who knew each other slightly; potentJ~a~on o,f do,sage with drugs used in groups has been noted unifo,rmly despite the environment and lack o.f mutual farailiarity. Pot:entiat~on has ocaurred in individual sessions when par~ti6~pants were brought in, whether known to the individual under the, drug or no~t; it has ,been observed moist strongly in situati,ons where a whole group,, well known to each other, are operating therapeutically under ,drug con~tions. It almost appears as though--up to the point of an unwieldy group~th.e ~arger t.he number of group-oriented p,artieip,ants wh.o are known to each other, the smaller the dosages required. In t,his situation, do,sages from one-~half to one-tenth the usual average amaunts ~are eff.ective, the differences depending on the..specific s.e~ting, the .emotional mater~al being dealt with, and the thresholds of the individua],s taking the drugs. A e,ommon good, such as movemerit ~oward creativity or to~ard meaningfulness .o~ life, has been observed to potentiate the dosage, as does a.ttr~aetiveness and seclusi(m of the s.etting. Finally, the deeper the emo;fio,nal level of the material dealt with, the stronger the .drug action app,ears to be,. An added observation following a nu.mber .o.f years of drug wo.rk is that familiarity with the specific drug or with ~he gener.at ca,re-

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gory of psycahede~ics in general Mso 1,ower,s thresholds. However, with very ,strongly-defended individual,s, a breakthrough of co.ntrols must occur befo~re the progressive lowering o,f thresholds is possible. Fro.m the view.po.int, o.f th.e therapist, probably the moist s:triking difference be,twee.n nondrug and drug gro,ups was the shortening of the. time. necessary for the emergence of the gr,oup, a:s .an entity, and the de.ep,ening of the therapeutic process ,as a whole. With respect t.o group, dyn,a,nfic.s~ the skill in te.ehniques, i,s remarkable for ~the pa.re~t popula:tion fro.m which the seminars were drawn; the beautiful isolated special setting als.o has a .salutary effee.t on group cohesiveness. Where the average gro.up which works t.o~ gerber once o,r twice a week does not co,alesee into. a. whole he,fore three to. six months, the se.rninars (e.omparable to nondrug gro~aps) routinely eonstellate by the end of the third day. ~o~weve.r, width the drug ~semin,ars, group cohesion to,ok place within ~o~ne,to t~wo. ho~urs after the drugs we,re inges.ted. It is the.rapeuti,cally i.mp,o.r'taat ~.o have a group of 10 people become a fee~ing unlit, a.s if it were a single individual, within an ho~ur. This iLs a rare occurrence even in groups which have ~o,rked to,be*her for s e v e r n years; in ordinary nondrug group, therapy, not. only long familiarity a M stro.ng rapport are neces:s:ary a.m.ong members., but a~so material which i s d e e p l y meaningful to. all of them. Working with skill.ed gro~up.s under .drugs, group u.nity can oe.eur in just a,s much time as i,s required four t~e drug t:o beeonle effective. I t is much more efficacious therapeut%ally t.o w.ork in a si~u,ation where defensive barriers are lowered enough s.o. tha co.mm~n~eations regi.s,ter immediately, with concomitant .affect. The enhanced empathy and lowered defensiveness make deeper feeling levels available for the partie.ipants, thus deepening the process fo.r all eonee,rned. These were undo,ubtedly fa.ctors in allowing @e lawyer t,o, be "botrn" in tile fourth ,seminar and a~so in permitting the assaultive hostility which brooke into love and freedom fo,r the mas:ochi.s~c wife and the ~filt..laden surg,eon. The use o.f drugs facilitated ease of eo.mmunic,ati.on among members of the group in two ways: heightened capacity to, verbalize about one's self, as noted by almost all participants and as reported in 'the sta.te.ments of the third seminar member,s; and a. greater flow of nonverbal feeling among the group, members. This was particularly true when emotion.M material dealt witch e a s y .devel.o~.-

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mental levels of the partieip,ants. This effeet seems heightened by the addition of other participants who ~re familiar wi@ the process, as has been noted during indivi4ual s~ssions. This potentiation may possibly be psychogenic in that the gro,up si.~.ati.on usu~ally involves some form of re-ereatio,n of early l~.fe situ~atio.ns. Fread's emp,hasis on the. Oedil~al situation seems to. have o~b,seured, as Adler e.orreetly no.ted, the great impo.rtanee of sibling relatio,nships. Many times older sister:s and brothers sup,ersede parent~al fig~ures; often N e sibling situation ree~pit.ulates the Oedip~ls complex and serves to ,set it i:n more deeply; .o,ee,asionally the 0edipal relatio.n,s~hip and the sibling rel,ati.onship pull the ehild in %o.posi~ce~dentifieation direet.ion.s and initiate iden~tity eonfliets. W i N a proper e.ans'titu,ted gro~up, i.t seems po.s,sible to re.capitulate the early family emotional setting' and to eonfront the p.a,tient simultaneously with 0edip,al and sibling pa.tterns, a:s well as with their interactions. While this can produce s:tr elinie.al reae~ions, these can be centre.lied. Besides, group, pressures tend to s.oeialize the emerging thoughts and acti.o~s. The "right to. rejeet o.r withdraw" of the patient or group members is abrogated by t.he therapist whenever it is felt to be o,nly r'esistanee. The patient mu'st come to terms with the individaa.1 .he warLts to, eliminm.e. As this is accomplished, penetrating insights often ensue and problems frown early childhood are resolved. The ree,on,stitutio.n o.f early .emotional environments may iner'ea:se 'the a.ffeetive dis,charge and apparently potenti~ates the drug effeet. Aetually, it ma5~ we~l be t M t under these eonditio~n.s, t~e d r u g d,osage ~s,ed %r individual treatment e.an be decreased. The p.roce~ss of moving on h.eTond early emo~tio~al blo,eks i.s particularly apparent at certain points in treatment. When the individual is able to reveal himself to an.o,ther, ~he therap.ist~ .mno N e r person is admitted into. his univer.se and ~t re-erea.t:es tlae tkm.e when the child differentiates himself from mother, tt~.en adrnit,s m o , ~ r to his universe. W h e n a s,eeo~r~d member .of the group, is ,allawed--is related t o - - t h e 0edipa.1 ,situation o~ten is re-erea:ted. Finally as moce than two individuals are all.o,wed in simulta,ne.o~s relationship, the sibling relatio,r~s are recapitulated. In essence, there is almo~st a step-wise b,uildi,ng of the ehildho:od familial pa

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An analo~gy from geoinetry presents its,elf to represent thes.e critical points of opening-up-to-relationship far fihe individual. One dot is a total~ity, a universe in and o,f its,elf, as is a e~lid:, psychically; with two do.ts, a new figure e,oines i)nto, being--.the line, which might symbolize tile Inothex-child r.el,ationship; three dot:s, o,r the. c.onjunc.tion of three lines~ be,c.orae.s a ~riangle and represents the locking together of mother, father, and c~hild (',the triangle b.eing the too,st stable geometric foe/m) ; the f,o,ur do,t,s o,r the conjuncti,on of four lines Inake:s a reef,angle (o~ften a square) which might we,l] represent the in~tr'oduc.tion and inc;orpo.ration of a sibling (which avpears to be, next to the shift froin one dot to the line, the most dif~ault therapeutic transition); and la.stly, the eontimfing process of adding do.ts--or more side,s--t,o the polygon, until eventually ther are so many sideLs th,at the square has become a circle. The .see.o~ndvalue of a group used in conjune,tio.n with d r u g s - the facilitation of the discharge of repres:sed m a t e r i a l or at lea,st its concomitant affect, nonverbally--is not u nders:t.o.o,d, nor is the manner clear by which the process is Inediated. The phenomenon of "emotional e o n t a # o n " is familiar to all who have been c,anght up in the joy or sorrow o.f others. Symp~athetie listene~rs elicit more ma~terial; a loving mother can heal pain withcmL ~spea]dng a word. This i,s empathy at the individual level. The same phenoinenon holds tr~ae for gro.ups: gangs are kno,wn to be more labile. than individuals; a mob can be turned to violence very quickly, as with lynchings, l~eligions experiences in primitive group ri't~ls, in e,ei'tain emotionally-oriented denomination,s like the "Holy Rollers," and in the Indian peyote cult, o.ffer examples of nonverlbal emo:tional eatharsis in a group set.ring. One might sp,eculate about the lifting of inhibitions i~n the ton'text of the larger unity of the group, and the interaction o,f the who,le being greater than the sum of the parts. Fm:ther, there app.ea,rs to. be so.me alleviation of guilt; certainly the lifting of falsely-imposed guilt is observed ~lmost universally with the therapeutia use of psychedelic drugs. Perhaps the effeetivenes~s o~f emotion,al catharsis through the group is due to So,he eo~nbinat~on o~ lifting of guilt, the greater access to dee,per levels of affeat, a~d the enhanced empathy and "security" of a grou~., embarked on a mut.lml pro,ces.s which e.reates a larger universe within which the individuals are able to find greater integration.

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GI%OU1~ P S Y C I - I O T ! ~ l g I ~ A I ~ Z

These speculations may also be per'tinen~t, in the c:o.n,sideration of how and why groups appear to potentiate drugs so that much smaller do.sages are needed for memb.ers skilled in group procedures than for indixddual.s who experience the drug reaction by themselves. Another factor which appears to be inher,en4, in skilled, empathetic groups is the ability of the group, to help, indivicluN members thro.ugh emo4ional cri.ses with less pain and more rapid integrati,o.n. The psychological support can be .strongly felt with drug groups; the support available through the gathering of the group around an indi~ddual and touching him in a crisis, is so. apparent that it almost seems a palpable entity. Th'e lo,we.ri~.g .of barriers is experienced remarkably among group mew_ber~s~ even by participant observers. At times it. seems as though the group were. not. only a psychic entity with no barrier~s be~w.een individuNs; when ta~e.re is elo.se eontae.t in e,onjunetfon with physical suppor% i.t o,ften feels as though even p,hysieM boundaries are in abeyance. Group members o,ft.en report not knowirLg w~at is part o,f their o~-n body and w.hat belongs to that .o.f other individuals in ghe group. While it ~s difficult t,o sort out how much of the t,her'apeutie improvement reported as a result of the seminars was due to the skill of the participant.s, the settfng, and the seriousness of the members in their pur,suit of "self-fulfihnent," it is po~s.s~bte to. make some statements with respect to the effect of the drugs, .sine,e ,all .o,f the ocher faeto,rs were present in both .drug and nondr~g gro,ups. It seemed that rappo,rt, depth of feeling and psychic activity, ,and the amount of ehang,e .o,bserved in individuN:s (both at the seminars and su,bsequently) were greater for drug semirmr:s than for nondrug, and greater for the fourth seminar where drug4s were used five consecutive days o.ut of seven, in eontro~st to the third seminar where the?- were used three days of week. Since. the effee~.s and the changes were greater with drugs thorn witho.ut drugs, aald in the fo,urth seminar than in the third semin,ar, it appears as though the use .o.f LSD, mescaline, and the amphetamines .did indeed facilit~ate the group therapy process wheal r~s,ed with member,s skilled in gr.oap dynan~ies. At an evaluative meeting of fourth seminar member:s, severn months a.fter the seminar was over, "the desirability .of having similar seminars in the future" was diseu~ssed, along with "the r~s.e

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of LSD or other aids at such seminars." "A.s to the first question it was the sense of the gro.up.., that the eontimtanee o,f snell s,eminars woutd be o.f substantial benefit. As to..the second ques,tfi, o~a, the future use of LSD .and related materials at s~a:ch seminars, we felt generally ~hat sueLh ~s'e was o.f consider~b.te help. in our seminar, .eo,ntributing materially to the depth and sigalifieanee of the "material." An examination is made o,f four gro~up therapy s,e~ingr~s, o,f comparable e(~mpositio.n and fro.m the same parent population, held in the s,a.me :setting for the duration of one week, two og which used drugs in a~a attempt t.o facilitate the gr.o.up t~herap,eutie process and two of which .did not. TJhe evoh]fion of a matrix for therapeutic drag sessions was .disc~s:sed, a~d the background wa's given for the use o,f additional individuals 'to speed up the handling o~f problems a~rising from early family rela.fionsh~ps. From the eomparis.on of the nondrug and the drug group,s, and of the two..druid groups themselves, it seems, app,aren~ that the use .of LSD, mescaline, and amphetamine did in f,a,et lower defensive barriers, enhance empathy, facilitate verbal and nonverbal eomm ~ . ieatio.n anaong group members, and make available deep,er level,s, of feeling. More "chang,e" o,f the type assoe~at~ed wi*h hnprove.merit .appeared to occur in the seminar where .drugs were used the sec,ond, third, and fifth .days o.f the week than in the. n.ondrug seminars; an even greater amour~t of "c]aange" was associated width the fourth s~eminar where drugs were used five consecutive days out of the seven. T~helre was e OhMs:tent observation of po,tentiati,o.n o~f the drug do,sage, probably primarily beeause o.f the gro.np s~tua,tion. The b.aekground a~]d fa'miliarity of the members of the group with the pr.o,ees~s and with each other, and the partieulars of the sett'mg no doubt also added to the enhanced ,action of the, drugs. Much lower do,ses of LSD and mesealine-a.mphetamine,when used wi*h a group., seemed to. ~ e l d results equivalent to the signi.fieantly higher dose,s necessary for individual drug session,s. Speea]lations were made concerning the means by which drugs faeil.itate the group processes and by w'hi'ell skilled gro,up, members po.tentiate drug dosages, and note was made that the setting i'tself is a}so an imp,ortant fae,to.r.

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ACKNOWLEDGMENTS The aut,hor is deeply indebted to Dr. Herman C. B. Denber for his critical and cre:ative editing and his ge~erous help with tkis and with other work. Measureless thanks are also due to Dr. Marion J. Dakin for her untiring support, witho,ut which many of these projects could not have come to fruition. 1334 Westwood Boulevard Lo~s Angele,s 24 California
REFERENCES 1. ttofmann, A.: Discovery of d-lysergic acid diethyla~lmide-LSD. Sandoz Excerpta (Sandoz Pharmaceuticals, Haaover, N. J.), V I I : l , 1943. 2. Cohen, S., and Eisner, B. G. : Use of LSD in a psychotherapeutic setting. A.M.A. Arch. Neurol. and Psychiat., 81: 615~619, 1959. 3. Eisner, B. G., and Cohen, S.: Psyc,hotherapy with lysergic aeid diethylaxaid2. J.N.I~[.D., 127: 528-539, 19~8. 4. Eisner, B. G.: Unpublished obse~zations. 5. Janiger, 0. : Personal commnnication and unpublished data from experiments and follow-up questionnaire material 6. Denber, H. C. B. : Personal communication. 7. Osmond, H., and I{nbburd, A. : Personal communication. 8. Denber, I-I. C. B., and l~inkel, M. (editors) : Psyclmdynaznic and therapeutic aspects of mescaline and ]ysergie a~cid diethylamide. J. N. M. D., 125: 42:3-451, 1957. 9. Griener, T. ; Burc~h, N. R., and E~delberg, R. : Psychopathology and psychophysiol(~gy of minimal LSD-25 dosage. A.M.A. &rch. Neurol. and Psychiat., 79: 208-210,
1958.