Psychedelic Group Therapy

This book chapter (2022) discusses the differences between individual psychedelic therapy and psychedelic therapy conducted in groups.

Abstract

“Gatherings in groups are a ubiquitous phenomenon throughout human history. This is true for everyday social tasks as well as for healing and spiritual purposes. In psychotherapy, group treatment started soon after developing psychoanalytic treatment procedures. For psychedelic therapy, however, individual treatment guided by one or sometimes even two therapists is the most common and widespread treatment model for clinical research and therapy thus far. Since the foundation of the Swiss Medical Society for Psycholytic Therapy (Schweizerische Ärztegesellschaft für psycholytische Therapie, SÄPT) in 1985 in Switzerland, we however had the opportunity to conduct psychedelic group treatment in specific settings, which the following article describes.”

Author: Peter Gasser

Summary

Gatherings in groups are a ubiquitous phenomenon throughout human history. In psychedelic therapy, individual treatment guided by one or sometimes even two therapists is the most common and widespread treatment model thus far.

1 Introduction

Group therapy is a well-investigated field of psychotherapy, and psychoanalytic group therapy has been practiced for over one hundred years. The question is whether psychedelic therapy groups can work as well, and if so, how can one provide safety for all participants?

In 2016 – 2020, we conducted psychedelic group therapy in Switzerland as part of the so-called compassionate use program. This is currently the only legal psychedelic group psychotherapy in the world.

Ancient cultures ingested mind-altering substances for healing and religious purposes. Sometimes the healer was the only person who ingested the mind-altering substance, and other times the community gathered for healing or religious rituals and all participants took the sacred substances.

Recreational group gatherings and self-administration of psychedelic drugs started at times when the substances were not banned yet, and continued in underground settings for therapeutic and healing purposes.

In Brazil, the USA and the Netherlands, religious groups have been given permission to practice rituals with peyote or ayahuasca based on religious freedom laws. In Peru, ayahuasca is legitimate as a traditional indigenous medicine.

Trope and collaborators (2019) published a systematic review of scientific publications with psychedelic group therapy.

3 Groups in Psychotherapy

Psychotherapists know that dysfunctional relationships are the root of many psychological symptoms and difficulties, and that helpful, good relationships are the first among five main factors of efficacy in psychotherapy.

Yalom (1995) sees interpersonal learning as one of the great values of group therapy, but patients often hesitate to accept a group therapy as their proposed treatment method.

When I introduce the group setting to my patients, their hesitation to join is often emotional. I have to find ways to answer their questions so that they can accept to participate in a psychedelic group treatment.

The fear of being inhibited by listening to the problems of others and the threat of being intimidated when showing their personal failures, problems and conflicts within a group often needs a longer time for providing information and addressing the fears.

Members of the ongoing psychedelic group therapy meet in between the group sessions. I see this as a part of the integration process, since meeting other participants in ordinary life can help to normalize a far-out experience in a non-ordinary state of consciousness.

The group provides the opportunity for integration of the experience, but I discourage too much contact during the acute effect of the substance for the first 5 h approximately.

4 Psychedelic Group Therapy in Switzerland

In Switzerland, we already have a tradition of conducting therapy with mind-altering drugs in group settings. The vast majority of treatments done by SPT from 1988 until 1993 were done in groups and were incorporated for a majority of patients in an ongoing individual talking psychotherapy.

There are a few restrictions to psychedelic group therapy for people who are overburdened with the group situation, such as a male patient with Asperger autism who feels highly overwhelmed when around more than one other person and a visually impaired patient who would not have enough sense of security.

In a therapeutically oriented and legally regulated setting, I have not reported about chaotic and non-manageable groups. In an illegal context, the risk for incidents is higher.

4.1 Group Therapy in the Current Program for Limited Medical Use of Scheduled Substances

After 2014, the Swiss Federal Office for Public Health gave individual permission for patients to be treated with LSD or MDMA, if they already underwent other psychotherapies.

Peter Oehen and I started treating patients in groups after being allowed to treat them in an individual setting. We reflected on setting, size, frequency and structure of the groups corresponding to our therapeutic reflections and methods.

Schmid et al. (2020) compared data from patients receiving LSD within a psychedelic group therapy with data from healthy volunteers receiving LSD in an individual setting. They demonstrated that the acute drug effects are quite comparable.

Peter Oehen and I started doing LSD and MDMA group sessions together in 2016 and asked a female co-therapist to work with us. We encouraged a quiet meditative setting and included patients using LSD and MDMA in the same group.

Oehen and I were participants in the SPT training program from 1989 to 1992 and appreciated the 3-day workshops.

For our compassionate use psychedelic group therapy in Switzerland we met on Wednesday evening at 7:30 pm. We did basic mindfulness exercises, nonverbal contact exercises with other participants or guided imagery, and then shared thoughts about the next day.

On Thursday (day 2), we met at 9:30 am and administered LSD and MDMA to the participants. Every participant has approval for one specific substance only, but it is possible to replace one substance with another over the course of the treatment.

On the day of the session with the substance, participants listened to music and regulated visible contact to the outer world by opening or closing their eyes. The therapists guided them through their processes of anxiety, psychic pain, grief, anger, etc.

During the first few hours of the drug action, participants should not interact with other people, and should remain silent. Around 4 pm, they should slowly come back to a more everyday-like state of consciousness.

Around 6 pm, patients were allowed to leave the room and be brought home, or they could stay in the room for another 2 – 3 hours and relax.

On Friday, we met for sharing in the group. Participants talked in detail about their experiences of the previous day, and gave feedback to other participants.

At the end of the sharing, all patients were given advice to treat themselves carefully over the next days, and to bring a personal report of the workshop to the next individual psychotherapy session.

5 Discussion and Conclusion

Administration of mind-altering substances in groups has a long tradition in human history. Underground group therapy is happening to some extent in many places around the world.

The program for restricted medical use of psychedelics in Switzerland allows for individual approval of treatments, giving hope and perspective to severely ill people. It allows for preliminary data and gathering experiences with problems that are poorly researched yet.

Psychedelic group therapy can be economically advantageous if the treatment requires personal guidance and surveillance by one or even two therapists for at least 6 h or at least 9 h (LSD).

The placebo-controlled randomized trial is the only way to develop “scheduled narcotics with no medical and scientific value” into prescribable medicine. However, the placebo control condition is a major problem when doing research with highly psychoactive drugs.

Psychotherapy research needs to be done with the methods and standards of psychotherapy as well as drug research to evaluate the risk and benefit of psychedelic group therapy.