"Treatment of the Neurotic Patient, Resistant to the Usual Techniques of Psychotherapy, with Special Reference to LSD"
By G. W. Arendsen Hein
Topical Problems of Psychotherapy 4, 50-57 (1963)

Review by Adrian Pocobelli

This paper discusses different possible treatments, particularly the use of LSD, for patients who were resistant to the usual psychotherapeutic techniques. The researcher explains how patients in these situations often had a long history of treatments and felt little hope of recovering. The paper under review is a summary of the experiments and results using "psychological and pharmacological aids, which were suitable in helping these patients to stimulate introspective interest to themselves." The experiments were an attempt to stir up the repressed emotions of the patients and "break through the barriers of resistance."

The patients in the study are categorized according to 3 types. Emotional illiterates, who are characterized as unaware of the relationship between their symptoms and their emotional problems. The researcher describes these types as having "no contact with themselves," and lacking any form of introspection. These cases include psychopathic and psychosomatic patients. The second types are described as rationalising intellectuals, "who know a lot of theory, who talk easily, verbalizing a good deal of rational insight in the description of their emotional problems." Despite this, they are incapable of reconciling their insights with their feelings. Since these patients are generally not emotionally involved in the psychotherapeutic process, they have difficulty in making progress with therapeutic treatment. Character neuroses and compulsive syndromes are included in this group. The third type are the silent, tense, inhibited patients, who show "such strong resistances, conscious or unconscious, that insurmountable obstacles seem to block the way to any fruitful contact." These patients are characterized by their inability to talk, because "they are afraid to do so."

The first means of approach in aiding these patients was the use of group therapy. Accompanied by the therapist, patients would discuss each other's problems in an "emotionally more or less stable social structure, providing a background against which neurotic behaviour can clearly contrast." This method was found to work best with patients who had the least resistance as it helped to "weaken the Ego-defenses and to promote such factors as 'cross-fertilisation' and mutual identification in the therapeutic process." Under pressure from the group, some patients achieved a better understanding of themselves, and this, in turn, would create introspective activity.

For many patients, group therapy was insufficient in drawing out repressed materials such as those who suffered from traumatic experiences: " in these cases, where one feels the need to penetrate deeper into the unconscious of the patient, we have made use of chemical aids to bring repressed materials to the surface." Four different chemicals were experimented with in order to see what possible benefits might arise in regard to the treatment of these patients. The first was carbon dioxide inhalation, which the experimenter thought to be rather harsh, with little psychotherapeutic benefit since the patient would not generally remember the release of emotions that took place with the loss of consciousness. The second was called narco-analysis, which was considered useful for recalling traumatic experiences, but insufficient in penetrating the deeper levels of infantile neurosis. The third chemical used was Methedrine, which would facilitate associative processes and help patients verbalize a conflict in themselves of which they were already aware, but for the most part the drug was unable to bring repressed material into consciousness. And, fourth, Lysergic acid diethylamide, which was found to be the most advantageous and of which a much more positive tone is taken:

The introduction of lysergic acid diethylamide, LSD, as an aid in psychotherapy, has opened completely new perspectives. Whether treatment with LSD should be regarded as a therapy in itself or only as an aid in uncovering analytically oriented therapy is a question of personal evaluation. It must be pointed out that under the influence of LSD patients can experience feelings of such singular character as f.i. the transgression of Ego-boundaries and experiences of universal cosmic religious nature, which can be greatly inspiring, adding a new dimension of being to the patient's life.

An example is given of a woman who was unable to feel love for anybody other than herself, including her husband or children. After receiving LSD, she felt "waves of warmth and light," which she later described to the therapist as being "love, unselfish divine love, and that the only thing she had to do, was to open herself so that the waves could enter her, streaming through and then diverging again."

Although the researcher believes there are valid concerns in using LSD, such as disintegration of the Ego and the onset of psychosis, he states: "Our experience doesn't point in that direction." As long as the patient was given a suitable dose, i.e. 30-120 mcg, the patient's ego would remain "partially intact" as repressed material from the unconscious would be revealed to the conscious mind. This is in contrast to the use of carbon dioxide inhalation, where there was a complete disintegration of the Ego upon the loss of consciousness, and the patient would repress the material immediately upon waking up. The researcher describes the effects of LSD on the relationship between therapist and patient as "enriched with a new quality of communication-more intensive and meaningful, a more existential relationship."

According to the researcher, LSD conferred the following benefits to the psychotherapeutic process: the release of unconscious material; the reduction of resistances; the enhancement of introspective powers; the enhancement of the process of regression (in other words, an enhanced ability to relive repressed traumatic experiences); a diminishing tendency to act out; and the possibility to mobilize or intensify an analysis that has come to a standstill. Patients who do not benefit from the usual psychotherapeutic techniques are, therefore, not to be thought of as beyond help:

But I want to emphasize the point that therapeutic nihilism regarding the refractory patient is unjustified when LSD, if necessary combined with Methedrine, Ritalin, has not been tried to explore [the patient's] unknown mental resources and to set free, to liberate, the vis medicatrix naturae, the creative healing powers of the unconscious.

Looking back on the 650 or so patients he had treated, the researcher believed "the use of LSD to be a great step forward," although he is quick to point out the necessary preconditions for successful treatment, such as a good relationship with the therapist, an adequate dosage, and a number of LSD experiences by the therapist "for the same reasons as a training analysis is required for the psychoanalyst." Under the right circumstances and the proper dosage, the researcher believed LSD to be "a completely dangerless drug, with no toxic effect of any importance."

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