02/10/2017

Treatment of Psychospiritual Crises | Stanislav Grof MD. PhD.

Treatment of Psychospiritual Crises

Psychotherapeutic strategy for individuals undergoing spiritual crises is based on the realization that these states are not manifestations of an unknown pathological process, but results of a spontaneous movement in the psyche that engages deep dynamics of the unconscious and has healing and transformative potential. Understanding and appropriate treatment of spiritual crises requires a vastly extended cartography of the psyche that includes the perinatal and transpersonal region. This new model has been described at some length elsewhere (Grof 1975, 2001, 2007 a). The nature and degree of the therapeutic assistance that is necessary depends on the intensity of the psychospiritual process involved. In mild forms of spiritual crisis, the individual is usually able to function in everyday life and cope with the holotropic experiences as they emerge into consciousness. All that he or she needs is an opportunity to discuss the process with a transpersonally oriented therapist, who provides constructive supportive feedback, helps the client to integrate the experiences into everyday life, and suggests literature that contains useful information.

If the process is more active, it might require regular sessions of experiential therapy during which we use faster breathing, music, and bodywork to facilitate emergence of the unconscious material and full expression of emotions and blocked physical energies. The general strategy of this approach is identical with that used in holotropic breathwork sessions (Grof 2001, 2007 b). Allowing full expression of the emerging unconscious material in the sessions specifically designated and scheduled for this purpose reduces the possibility that it will surface and interfere with the client’s life in the interim periods. When the experiences are very intense, all we have to do during the work with the clients is to encourage them to close their eyes, surrender to the process, observe what is happening, and find expression for the emerging emotions and physical feelings.

If we encounter psychological resistance, we might occasionally use releasing bodywork like in the termination periods of breathwork sessions. Holotropic breathwork as such is indicated only if the natural unfolding of the process reaches an impasse. Therapeutic work with this category of clients has to be conducted in a residential facility where supervision is available twenty-four hours a day. These intense experiential sessions can be complemented with Fritz Perls’ Gestalt practice (Perls 1973), Dora Kalff’s Jungian sandplay (Kalff 180 2004), Francine Shapiro’s Eye Movement Desensitization and Reprocessing (EMDR) (Shapiro 2001), or bodywork with a psychologically experienced practitioner. A variety of auxiliary techniques can also prove extremely useful under these circumstances. Among them are writing of a log, painting of mandalas, expressive dancing, and jogging, swimming, or other sport activities. If the client is able to concentrate on reading, transpersonally oriented books, particularly those focusing on the problem of psychospiritual crises or on some specific aspect of the client’s inner experiences, can be extremely helpful.

People whose experiences are so intense and dramatic that they cannot be handled on an out-patient basis represent a serious problem. There exist practically no facilities offering supervision twenty-four hours a day without the use of routine suppressive psychopharmacological intervention. Several experimental facilities of this kind that existed in the past in California, such as John Perry’s Diabasis in San Francisco and Chrysalis in San Diego, or Barbara Findeisen’s Pocket Ranch in Geyserville, were short-lived. The main reason for it was the fact that the insurance companies refused to pay for alternative therapy that was not officially approved. Solving the problem of such alternative centers is a necessary prerequisite for effective therapy of intense spiritual crises in the future.

In some places, helpers have tried to overcome this shortcoming by creating teams of trained assistants who took shifts in the client’s home for the time of the duration of the episode. Management of intense acute forms of spiritual crises requires some extraordinary measures, whether it is conducted in a special facility or in a private home. Extended episodes of this kind can last days or weeks and can be associated with a lot of physical activity, intense emotions, loss of appetite, and insomnia. There is a danger of dehydration, vitamin and mineral deficiency, and physical exhaustion. Insufficient supply of food can lead to hypoglycemia that is known to weaken psychological defenses and bring additional material from the unconscious. This can lead to a vicious circle that perpetuates the acute condition. Tea with honey, bananas, or another form of food containing glucose can be of great help in grounding the process.

A person in intense psychospiritual crisis is usually so deeply
involved in his or her experience that they forget about food, drink, and elementary hygiene. It is thus up to the helpers to take care of the client’s basic needs. Since the care for people undergoing the most acute forms of spiritual crises is unusually demanding, the helpers have to take shifts of reasonable duration to protect their own mental and physical health. To guarantee comprehensive and integrated care under these circumstances, it is necessary to keep a log and carefully record the client’s intake of food, liquids, and vitamins. Sleep deprivation has similar effects as fasting; it tends to weaken the defenses and facilitate the influx of unconscious material into consciousness. This can also lead to a vicious circle that needs to be interrupted. It might, therefore, be necessary to occasionally administer a minor tranquilizer or a hypnotic. In this context, tranquilizing medication is not considered therapy, as it is the case in traditional psychiatric facilities. It is given solely for the purpose of securing the client’s sleep. The administration of minor tranquilizers or hypnotics interrupts the vicious circle and gives the client the necessary rest and the energy to continue the following day with the uncovering process.

In later stages of spiritual crises, when the intensity of the process subsides, the person no longer requires constant supervision. He or she gradually returns to everyday activities and resumes the responsibility concerning basic care. The overall duration of the stay in a protected environment depends on the rate of stabilization and integration of the process. If necessary, we might schedule occasional experiential sessions and recommend the use of selected complementary and auxiliary techniques described earlier. Regular discussions about the experiences and
insights from the time of the episode can be of great help in integrating the episode.

The treatment of alcoholism and drug addiction presents some specific problems and has to be discussed separately from therapy of other psychospiritual crises. It is particularly the element of physiological addiction and the progressive nature of the disorder that requires special measures. Before dealing with the psychological problems underlying addiction, it is imperative to break the chemical cycle that perpetuates the use of substances. The individual has to go through a period of withdrawal and detoxification in a special residential facility.

Once this is accomplished, the focus can turn to the psychospiritual roots of the problem. As we have seen, alcoholism and drug addiction represent a misguided search for transcendence. For this reason, to be successful, the therapeutic program has to include as an integral part strong emphasis on the spiritual dimension of the problem. Historically, most successful in combating addiction have been the programs of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), fellowships offering a comprehensive approach based on the Twelve Step philosophy outlined by Bill Wilson.

Following the program step by step, the alcoholic or addict
recognizes and admits that they have lost control over their lives and have become powerless. They are encouraged to surrender and let a higher power of their own definition take over. A painful review of their personal history produces an inventory of their wrongdoings. This provides the basis for making amends to all the people whom they have hurt by their addiction. Those who have reached sobriety and are in recovery are then asked to carry the message to other addicts and to help them to overcome their habit.

The Twelve Step Programs are invaluable in providing support and guidance for alcoholics and addicts from the beginning of treatment throughout the years of sobriety and recovery. Since the focus of this collection of essays is the healing potential of holotropic states, we will now explore whether and in what way these states can be useful in the treatment of addiction. This question is closely related to the Eleventh Step that emphasizes the need “to improve through prayer and meditation our conscious contact with God as we understand God.” Since holotropic states can facilitate mystical experiences, they clearly fit into this category.

Over the years, I have had extensive experience with the use of holotropic states in the treatment of alcoholics and addicts and also in the work with recovering people who used them to improve the quality of their sobriety. I participated in a team at the Maryland Psychiatric Research Center in Baltimore that conducted large, controlled studies of psychedelic therapy in alcoholics and hard drug addicts (Grof 1980). I have also had the opportunity to witness the effect of serial holotropic breathwork sessions on many recovering people in the context of our training. I will first share my own observations and experiences from this work and then discuss the problems involved in the larger context of the Twelve Step movement.

In my experience, it is highly unlikely that either holotropic
breathwork or psychedelic therapy can help alcoholics and addicts at the time when they are actively using. Even deep and meaningful experiences do not seem to have the power to break the chemical cycle involved. Therapeutic work with holotropic states should be introduced only after alcoholics and addicts have undergone detoxification, overcome the withdrawal symptoms, and reached sobriety. Only then can they benefit from holotropic experiences and do some deep work on the psychological problems underlying their addiction. At this point, holotropic states can be extremely useful in helping them to confront traumatic memories, process difficult emotions associated with them, and obtain valuable insights into the psychological roots of their abuse.

Holotropic experiences can also mediate the process of psychospiritual death and rebirth that is known as “hitting bottom” and represents a critical turning point in the life of many alcoholics and addicts. The experience of ego death happens here in a protected situation where it does not involve the physical, psychological, interpersonal, and social risks it would have if it happened spontaneously in the client’s natural surroundings. And finally, holotropic states can mediate experiential access to profound spiritual experiences, the true object of the alcoholic’s or addict’s craving, and make it thus less likely that they will seek unfortunate surrogates in alcohol or narcotics.

The programs of psychedelic therapy for alcoholics and addicts conducted at the Maryland Psychiatric Research Center were very successful, in spite of the fact that the protocol limited the number of psychedelic sessions to a maximum of three. At a six-month follow-up, over one half of chronic alcoholics and one-third of hard-core narcotic drug addicts participating in these programs were still sober and were considered “essentially rehabilitated” by an independent evaluation team (Pahnke et al. 1970, Savage and McCabe 1971, Grof 1980). Recovering people in our training and workshops, almost without exception, see holotropic breathwork as a way of improving the quality of their sobriety and facilitating their psychospiritual growth.

In spite of the evidence of its beneficial effects, the use of
holotropic states in recovering people meets strong opposition among some conservative members of the Twelve Step movement. These people assert that alcoholics and addicts seeking any form of a “high” are experiencing a “relapse.” They pass this judgment not only when the holotropic state involves the use of psychedelic substances, but extend it also to experiential forms of psychotherapy and even to meditation, an approach explicitly mentioned in the description of the Eleventh Step. It is likely that this extremist attitude has its roots in the history of Alcoholics Anonymous. Shortly before the second international AA convention Bill Wilson, the co-founder of AA, discovered after twenty years of sobriety the psychedelic LSD. He took it for the first time in 1956 and continued experimenting with it with a coterie of friends and acquaintances, including clergymen and psychiatrists. He was quite enthusiastic about it and believed that this substance had the ability to remove barriers, which keep us from directly experiencing God.

The AA board was shocked by his suggestion that LSD sessions should be introduced into AA program. This caused a major turmoil in the movement and was eventually rejected.
We are confronted here with two conflicting perspectives on the relationship between holotropic states and addiction. One of them sees any effort to depart from the ordinary state of consciousness as unacceptable for an addicted person and considers it a relapse. The contrary view is based on the idea that seeking a spiritual experience is a legitimate and natural tendency of every human being and that striving for transcendence is the most powerful motivating force in the psyche (Weil 1972). Addiction then is a misguided and distorted form of this effort and the most effective remedy for it is facilitating access to a genuine spiritual experience.

The future will decide which of these two approaches will be adopted by professionals and by the recovering community.

In my opinion, the most promising development in the treatment of alcoholism and drug abuse would be a marriage of the Twelve Step Program, the most effective strategy for treating alcoholism and addiction, with transpersonal psychology that can provide a solid theoretical background for spiritually grounded therapy. Responsible use of holotropic therapy would be a very logical integral part of such a comprehensive treatment.

My wife and I organized in the 1980s two meetings of the
International Transpersonal Association (ITA) in Eugene, Oregon, and Atlanta, Georgia, that demonstrated the feasibility and usefulness of bringing together the Twelve Step Programs and transpersonal psychology. The empirical and theoretical justification for such merging was discussed in several publications (Grof 1987, Grof 1993, Sparks 1993).

The concept of “spiritual emergency” is new and will undoubtedly be complemented and refined in the future. However, we have repeatedly seen that even in its present form, as defined by Christina and myself, it has been of great help to many individuals in crises of transformation. We have observed that when these conditions are treated with respect and receive appropriate support, they can result in remarkable healing, deep positive transformation, and a higher level of functioning in everyday life. This has often happened in spite of the fact that, in the present situation, the conditions for treating people in psychospiritual crises are far from ideal.

In the future, the success of this endeavor could increase
considerably, if people capable of assisting individuals in spiritual emergencies could have at their disposal a network of twenty-four-hour centers for those whose experiences are so intense that they cannot be treated on an out-patient basis. At present, the absence of such facilities and lack of support from the insurance companies for unconventional approaches to treatment represent the most serious obstacles in effective
application of the new therapeutic strategies.

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