Holotropic breathing according to S. Grof in inpatient psychotherapy

In addition to the orthodox medicine taught at universities, a range of healing modalities called alternative medicine has been established in the last two decades in the Western industrialized countries and the metropolises of the Third World. Some of them have found their way (mostly in a reduced form) into medical practice (z.B. Homeopathy, acupuncture, neural therapy, anthroposophic medicine, phytotherapy). They remain conventional insofar as a specialist continues to handle a „patient“ in a more or less mechanical-manipulative way in order to eliminate his symptoms.

Modes of healing that cannot be mechanically learned and practiced in the detachment of the psychosocial-spiritual dimension of health and illness typical of biomedical practice, due to the processes of self-awareness necessary for their practice, still meet with skepticism. Moreover, since they do not fit into the spatial, temporal, and economic corset of conventional practice and clinic operations, they are offered in the context of private „centers“, in seminar and health hotels, in evening, weekend, and annual groups.

The aim of this paper is to show, using the example of holotropic breathing according to S. Grof to discuss possibilities and limitations of introducing psychospiritually based ways of healing, their health-theoretical-philosophical context and other elements of the informal health system into conventional institutions (here: psychosomatic and psychiatric clinics). The likelihood that the biologistic conception of man dating from the 17th century will be accepted by the medical community is very small. The probability that conventional medicine based on a biologistic view of man from the 17th century as well as (psychiatric) clinics, which are closely associated with capital interests (apparatus technology, pharmaceutical companies, house technology) and authoritarian-aggressive acting experts, will promote the spread of healing methods, which, like holotropic breathing, are based on self-regulatory processes, altered states of consciousness and the associated opening for the work of a higher authority, the acceptance and promotion of emotional processes and a view of the patient as an expert; Patient“ as an expert for his healing, is undoubtedly low.

Consistent practice, as my own experience has proven, will always be accompanied by resistance, slander and expulsion. The conclusion that it is pointless to practice holotropic therapies in institutions of orthodox medicine from the beginning, I do not want to agree with, because historically all innovations that leave a prevailing paradigm are subject to this process. It itself reflects the typical phases and patterns of a birth process: one experiences in institutions then a hell that seems inescapable, followed by struggle and finally redemption when leaving them. Only those who have faced and lived through these processes in external reality will be able to support corresponding processes of change in a social context.

The nowadays widespread solipsistic practice in the private „center“ rather symbolizes the dwelling in an (illusionary) uterus, since hardly anyone can make a living with spiritual healing methods and then is supported by an „bourgeois profession“ anyway by the orthodox society. He is left only with the deceptive hope that „everything will change by itself when the system collapses“.

In terms of a scenario, I will first

• briefly outline typical settings, healing modalities and cognitive schemas (worldviews, beliefs) of New Age philosophy
• outline socio-demographic characteristics of participants in therapy methods from the informal health sector, and
• Using Stan Grof’s holotropic breathwork as an example, show the differences between conventional clinic and workshop settings and the resulting possibilities for adaptation.

The problems and conclusions presented are based on my six years of work as a clinical psychologist at a large psychiatric hospital, where I was able to gain experience in the introduction of Holotropic Breathwork during two years. At this point, I limit myself to aspects of the institutional framework; the publication of examples of concrete treatment processes is planned.

1. The Informal Culture of Health:

In contrast to the discourse about alternative medicine, which is dominated by physicians (which is usually understood to mean individual methods, as well as questions of „scientificity“, the frequency of application by physicians and patients with diseases defined by conventional medicine, cf. ANDRITZKY 1994), I have developed the concept of an informal health culture after an analysis of the components (ANDRITZKY 1997), which has also emerged in Germany in the last 20 years or so. The analysis of its dimensions of effect is a precondition for future research, which no longer locates the factors of effect in methods that are independent of the person, but in complex settings, philosophical basic attitudes, spiritual openness of the therapists and the quality of the relationship. Describable elements of informal health culture are u.a.:

1.1. A philosophical paradigm alternative to conventional medicine, referred to here as „New Age philosophy“. It consists of:

• a physical paradigm (u.a. Einstein’s theory of relativity, Max Planck’s quantum theory, Bell’s theorem), which, compared to the Newton’s mechanistic worldview (bodies, forces), features new concepts of space and time, of the relationship between energy and matter (from subatomic physics), and which, on top of this, provides traditional, religious and spiritual philosophies and practices with new rationality, as it were (cf. CAPRA 1980:13)
• a system-theoretical perspective, in which all spheres of being are interconnected and networked, similar to the shamanic cosmologies (holism, holis-mus). Health-related events and actions can here a priori no longer be separated from the influences or. It takes place in dissipative structures and self-organizing processes that only require a certain supply of energy from outside to activate their formative forces (JANTSCH 1982).
• the need for personal transformation, d.h. the becoming significant of this new world view on the way of corresponding own experiences. This personal awareness of a shamanic participation in, and responsibility for, creation, which the centers of the New Age movement (z.B. Esalen, Naropa Institute/Boulder, Californian Institute for Integral Studies/San Francisco) psycho-techniques developed during the 1970s, ultimately becomes the criterion of health. FERGUSON (1980:99ff) has aptly characterized the four phases of this transformation process as (1) entry (accidental key experience, spontaneous mystical or psychic experience), (2) exploration (conscious letting go, simultaneously fierce conflicts of old and new orientations), (3) integration („a new self in an old culture“), and (4) conspiracy (applying the new insights and skills in the service of one’s fellow man, seeing oneself as part of a network).

This paradigm shift from the mechanistic-biologistic worldview, to which conventional medicine is still committed in its everyday practice, to a spiritual-biopsychosocial worldview has far-reaching consequences for health practice: Emphasis is now placed on self-healing, self-responsibility, listening to the inner voice and introspective insight, valuing subjective interpretation of illness as opposed to submission to „expert knowledge“, the healer becomes a facilitator, metaphorical wisdom and spiritual experiences become the fulcrum of reorientation, the functioning of body zones and organs symbolically encapsulated in language (cf. DAHLKE 1996), illness as a path – symptoms as signposts (cf. DETHLEFSEN & DAHLKE 1983) become widely accepted patterns of interpretation. The realization of a lifestyle in which the individual takes responsibility for himself, his social and natural environment and experiences himself as part of a divine plan of creation becomes an expression of healing in the sense of expanding consciousness.

1.2 Unconventional methods:
There are hundreds of unconventional healing modalities based on shamanic traditions (healing with stones/crystals, firewalking, sweat lodge, vision questing, drumming, use of psychotropic healing plants such as peyote, ayahuasca, hemp, nocturnal healing rituals) or Far Eastern techniques (e.g., healing of the soul).B. Shiatsu, Yoga, Hindu and Buddhist meditation techniques, Tantra, Reiki), furthermore modern developments like Rebirthing, Bioenergetics, Watsu and other water therapies, as well as more manipulative body therapies (z.B. Re-balancing, Rolfing, Feldenkrais, Alexander technique, Esalen massage, (cf. LUKO-SCHIK & BAUER 1993). The reports in esoteric magazines (e.g.B. Esotera, Connection, Dao, Der Heiler, Bio, Natur und Heilen) it can be seen that incessantly in syncretic practice new seminar types are designed, a book is written about it, an association is founded and finally a training system with „certificate“ is developed.

1.3 The local-spatial allocation of therapeutic resources:
The offers for psychosocial support, therapy, counseling and crisis intervention can be found in a steadily growing mass in the context of private centers, adult education institutions (adult education centers, church educational institutions), health hotels or in vacation offers to non-European countries (health tourism). Integration into psychosomatic or psychiatric clinics can only be observed in isolated cases. As my written survey of the medical directors of 314 psychiatric and psychosomatic clinics in Germany showed (ANDRITZKY 1996), the spectrum of therapy methods has undoubtedly expanded, there is music and occupational therapy, group therapy and gymnastics, the clinics have bathing departments with massages, etc., etc., etc., a considerable part of clinical psychologists and physicians practice Catathyme Bilderleben or dance therapy. However, from the client’s perspective, in practice it is a string of methods that are applied in a rigid setting based on adaptation and subordination. Manners based on respect for clients’ autonomy and personality hardly play a role in the clinic’s daily routine.

1.4. Also the time allocation of the offers differs from the formal medical system with medical consultation hours during the day, otherwise emergency services. Typical forms of offerings are weekly evening seminars, weekend workshops, one- or two-week intensives, annual groups (usually six-week blocks), vacation offerings, events at transitions in the course of the year (New Year’s Eve, Easter, Pentecost groups, summer festival, etc.).) or in biographical passages (birth, death, mourning, partnership/ sexuality, unemployment, etc.). These stressful situations have been recognized as pathogenic by life-event research, but orthodox medicine waits idly until someone becomes somatically or psychologically manifestly ill.

1.5 Personal resources:
As at the beginning of the 19. Jh. the naturopathic movement, (cf. ROTH-SCHUH 1983) was inspired by lay people, so also today it is often members of artistic and pedagogically active professional groups who develop new healing methods and hardly established clinicians.

1.6. Further cultural elements are an own language (z.B. „release, mind, energy, chakras“), music (z.B. world music, ethno, ambient, house, space, trance, techno), the special role of the place of a center, ritual, event (z.B. in places of power, pre-Christian sanctuaries, design according to geomantic rules of Fengh-Shui), works of art (e.g. soap dispensers).B. ethnic-religious art; pictures and sculptures dealing with spiritual experiences, visions, charismatic figures or spiritual beings), nutrition (z.B. whole foods, vegetarian), codes of conduct (z.B. Talking about oneself, casual physical contact, taking off shoes, political „green orientation“).

The moments outlined here already indicate a different „non-clinical“ attitude to orthodox medicine: in the workshop setting, taking anamneses (biographical, nosological, social, family) against the background of other etiological models (z.B. „energy blockade in the subtle body“, „karmic burden“) just as little a role as diagnoses or a treatment plan. Even with somatically imposing symptoms and „illnesses“ the psychosocial-life-historical and religious-spiritual meaning content is in the foreground. The lack of labeling of participants as „patients“ is accompanied by a more personal-friendship mode of interaction in contrast to the impersonal-distant style of interaction in medical institutions.

2. Participant group of the informal health culture:

There have been as few studies on the motivations, belief patterns and socio-demographic characteristics of the participants as there have been on the health relevance of the services offered by the informal sector. In 1994-96, after explorative intensive interviews with seminar participants in a large city, we therefore conducted a broad survey of N=1135 participants of courses/seminars on aerobics, yoga, body therapies, psychohygienic and esoteric seminars (Reiki/flower essences) (ANDRITZKY 1997). Some results:

2.1. In their socio-demographic characteristics the participants are not representative for the population and for the clientele of the formal medical system: 77% are women, in terms of age the group between 30-50 years predominates, older people (main users of conventional medicine) are strongly underrepresented, the working class is hardly represented with 6% .

2.2. The health relevance of the offers mentioned can be seen from various indicators:

• high relevance of course participation as a self-help activity (between 9% and 74%, depending on the method),
• complaint-specific use of the offers (z.B. 28% of the participants of the seminars classified as „psychohygienic“ indicated partner problems, 56% depression, lack of drive, fatigue, – in each case highly significantly more than the participants of the other groups).
• For 37% of all participants, one motive for attending the seminar is to seek support for a health disorder; 28% seek support for overcoming personal difficulties,
• Significantly more participants report a subjective improvement after treatment of serious health disorders in the informal sector than those who therefore visited practitioners of the formal sector (physicians/graduate psychologists) (81% vs. 54%).
• For 71%, a general interest in the course also plays a role. This suggests that informal sector services have an attractive event value that clearly distinguishes them from the more fearful, or at least unsophisticated and cold, atmosphere of conventional medical settings (doctor’s office, hospital).

2.3. Magical-religious beliefs appear as the crucial agent to develop new forms of health-seeking behavior: Between 30% and 40% of the participants believe in the effectiveness of distant healing, rituals or believe in the existence of spirit beings, altogether. 71% believe in life after death. The belief patterns of New Age philosophy find their subjective-empirical correlate here.

3. Theory and practice of Holotropic Breathwork by Stan Grof

3.1. Characteristics of Holotropic Breathwork:
Holotropic therapy generally refers to the fact that Western man realizes only a small portion of his psychic potential and capacity for experience, the development „of agonizing symptoms that have no organic basis can be taken as an indication that man has reached a point in his inauthentic being-in-the-world where this becomes evident and thus untenable…the extent and depth of this breakdown runs more or less parallel with the development of neurotic and psychotic phenomena“ (GROF 1994:202).

Holotropic breathwork takes place after a phase of attunement, be it through a group ritual or meditation while lying down, with a partner taking on the function of sitter, accompanying the breather and providing for everything necessary during the session. After a relaxation phase, there is an invitation to intensify the breathing, to let oneself be carried by the rhythmically energizing music at the beginning, later dramatically and in the final phase more meditatively calm, evocative music and to open oneself for all arising sensations („breathe until it surprises you“).

Towards the end of the session, which lasts between two and three and a half hours, a special form of bodywork supports the resolution of unfinished experiential complexes. Subsequently, the experiences are to be represented in a picture, usually a mandala. In a debriefing (sharing) the experiences are usually communicated on the basis of the mandalas, whereby not their interpretation but only the undivided interest of the group is of importance. It is not a matter of reductionist interpretation, but rather of placing the experience in larger contexts in an amplifying manner or of mirroring it in motif complexes from religious cosmologies of other cultures.As after LSD sessions (cf. GROF 1994b:212), in the final phase of the breathing session, is the externalization of the experience in the painting or, if necessary, in the sharing. bioenergetic exercises appropriate to close a „gestalt“.

Clients experience detailed preparation for the re-actions that may occur, z.B. that an intensification of existing symptoms (somatic or psychological) in the course of or after a session is not to be understood as a sign of „aggravation“ or even of failure, but indicates that he is approaching an experience that is important to him.

The experience during the breathing sessions is occasionally accompanied by violent emotional and phy-siological reactions such as attacks of suffocation, strong sensations of heat and cold, nausea and vomiting, changes in facial color, spontaneously occurring skin eruptions, twitching and trembling, or contortions of the body. While self-regulatively, as through a „radar“ the material that is currently significant from an emotional point of view is amplified and brought to the surface (GROF 1994:25ff), it is not so much memories as in psychoanalysis that play a role, but the complete experiential return to that stage of development in which the events took place. As it turned out, besides the phases of the birth process, all physical traumas such as operations, feelings of suffocation as in whooping cough, near drowning or threatening illnesses gain a much greater role for the development of psychopathological phenomena and pain states than it was assumed so far.

Relevance and meaning of the experience are directly accessible to the breather in this self-regulative process, the healing instance is not with a therapist who interprets and questions the experience, but within himself („the healer is within“). The therapist becomes a companion (facilitator) who creates a safe framework for the experience and offers the breather – if necessary – emotional support through physical contact and/or work.

3.2. Basic assumptions: the perinatal matrices. Based on the contents of consciousness and modes of experience observable under the influence of psychedelic substances such as LSD and psilocybin, GROF (1994) discovered a „cartography of the Psche“ which, beyond the biographical aspects described in psychoanalysis, includes a perinatal and transpersonal dimension. These levels of experience, as they also occur in shamanic methods of trance induction (drumming, montone dancing, fasting, isolation) or near-death experiences, are related to the phases of the birth process described by GROF (1994: 30ff) as the four perinatal matrices (I-IV). They include (strongly abbreviated) the following constellations of experience (positive or. negative expressions):

• the amniotic universe (I): undisturbed intrauterine existence, experience of unity, „paradise“ vs. images of polluted waters, deserts, wastelands, baleful astral influences.
• cosmic engulfment/ hopelessness (II): Onset of biological birth; disturbances of intrauterine harmony by chemical signals, uterine contractions: Sensations of being crushed, hell, visions of the end of the world, shortness of breath
• the struggle before death and rebirth (III): Movement of the fetus through the birth canal: Motifs of titanic battles, wars, blood sacrifices, natural disasters, torture
• death and rebirth (IV): biological birth: increase of fear, pain, pressure, followed by sudden relief and relaxation; abandonment of all previous reference points in life, end of a struggle for survival, visions of blinding light,
• Redemption, liberation, end of wars, revolutions, supernaturally beautiful landscapes, revelations of divine beings from different cultures. In the books of the dead of various cultures and epochs these motifs can be found elaborated (GROF 1994a).

Sensations, emotions, memories and experiences can emerge in constellations (systems of condensed experience, COEX), which contain contents from perinatal, transpersonal and biographical levels (e.g., death and rebirth).B. biographical events, mythological motifs, identification with an animal, a race, a feeling in which the breather experiences, as it were, all the analogous sensations of humanity, or the encounter with an archetype).

Holotropic Breathwork also includes unconditional and loving acceptance of all arising sensations and experiences, in the case of pain also their systematic amplification up to the unbearable. This becomes the gateway to „let them go“, to get rid of their energy either in a purely energetic-cathartic way or to recognize in a flash etiological and final meaning connections in the rise of images and events. While in breathwork with the appearance of „symptoms“ thus the process of healing begins this is in psychiatric thinking, where the patient (which in the sense of resistance and defense is often also its own goal) is to be returned to the initial state, exactly the opposite.

3.3. contraindications:
Heart problems, epileptic seizures and increased intraocular pressure are important contraindications. Likewise, borderline psychotic episodes and previous psychiatric hospitalizations increase the risk of complications, which, however, can be absorbed in the inpatient setting if the team has the appropriate capacity for empathy and can be effective as an impulse for growth. In conversations that I had in the course of the training modules with S. Grof, he expressed his conviction that holotropic breathing would not be very successful in paranoid reactions, because the facilitator would then be experienced as a real person even more threatening, likewise a pronounced tendency to external cause attribution is an indication that someone does not want to engage in inner experiential processes. More important than the diagnosis, however, seemed to be the structure, reaction modes and overall personality of the prehospitalized client: What constructive ego parts does the patient have available, is he in a supportive social network, what role does the blockade of emotional expression play in the therapy process. It seems to me that also in the conventional psychiatric hospitals a quite considerable part of patients (I would estimate it at least to 50%) show the characteristics of a spiritual crisis, in which an awareness of the symptoms remains as an inner experience and the causes are not exclusively attributed to events of the outer world (cf. GROF & GROF 1991:69ff).

The indication for holotropic breath work thus results from the synopsis of these conditional moments of institution and client personality, and of course the contact to the therapist, which is not rather based on sympathy as in the informal field, but on the basis of the usual internal ward assignment system.

Essential for the indication question appears in a clinic also the empathic competence of the nursing staff of a team. If, as is the norm at least in psychiatry, it reacts to strong emotions with fear, interprets the patient’s reactions as „aggravation“ and then prompts the doctor to medicate, holotropic work seems hardly feasible in the longer term. Ideally, the team should have appropriate self-experience. Since this is not the case, initially the silent presence during breathing sessions can promote cooperation and an initial empathy with the processes, especially in the reference care system, where a nurse is assigned to specific patients.