Psyche Unbound: Lessons for a Career in Psychedelic and Holotropic Therapies

Psyche Unbound Essays in Honor of Stanislav Grof

Written by Michael Mithoefer, M.D.

Psyche Unbound: Essays in Honor of Stanislav Grof is a festschrift in celebration of the 90th birthday of a pioneer in psychedelic-assisted therapy , breathwork, and transpersonal psychology copublished by MAPS and Synergetic Press. The new collection, edited by Richard Tarnas, Ph.D., and Sean Kelly, Ph.D., features contributions from thought leaders of the last five decades including Joseph Campbell, Huston Smith, and Michael Mithoefer, M.D., excerpted here.

Stanislav Grof’s contributions to the understanding of the psyche and the healing potential of holotropic states of consciousness are only beginning to be realized in current Western psychiatry and psychology. His work has been conveyed largely through his scientific papers, books, and lectures. I’m grateful for this opportunity to write about another avenue through which Stan taught and influenced many people who have carried his teachings into their own work: the Grof Training. For many of us, our time in Grof Training was life-changing; for some of us, it also changed the direction of our careers.

In 1990, after ten years of practicing emergency medicine, I was ready for a change. In the emergency department, the suffering I was treating so often had its roots in psychological trauma and longstanding societal forces. I was longing for a different, more collaborative approach to supporting people in their healing, and curious about possibilities for addressing the underlying causes of suffering. Casting about for a new direction, I came across a book in the library at the Medical School in Charleston, South Carolina: Beyond the Brain by Stanislav Grof. I was impressed that they had that book on their shelves at all, and not surprised that I was the first to check it out. The “cartography of the psyche” Stan described in the book was a startlingly powerful map for understanding human consciousness, including some of my own psychedelic experiences from twenty years earlier. The impact of the book on my career is evidenced by the result; I applied to Psychiatry Residency and the Grof training, and started both in 1991.

Over three years of psychiatry training I made periodic trips to California for a total of nine six-day Grof training modules. This made for an interesting contrast. The psychopharmacology taught in psychiatry training was aimed at suppressing symptoms, and Stan was demonstrating that “a symptom is something that’s halfway out,” so it may become more pronounced in the process of releasing. Most people at the Institute of Psychiatry in Charleston thought that lying on the floor with patients and doing bodywork during hours-long breathwork sessions was unethical and dangerous. Many people in the Grof training thought psychiatric drugs and psychiatry, in general, were dangerous. While I was grateful to learn from each of these very different approaches, without question I found the Grof model far more compelling in terms of understanding and bringing healing to human suffering. A few years later, my wife, Annie, also completed the Grof training. For the next ten years, we worked with patients in our outpatient psychotherapy practice and in monthly holotropic breathwork groups that we facilitated together. From the beginning, our therapy practice was oriented toward the principles we learned from Stan, that our role is to trust and support each individual’s inner healing intelligence. 

Over those ten years facilitating holotropic breathwork groups, we saw many examples of profound healing and growth, often in people who had not responded to years of therapy and medications. We also recognized that breathwork wasn’t effective for everyone. As in most areas of medicine and psychology, we need an array of different tools for different people, and there was already a body of work exploring other tools for catalyzing access to holotropic states. Stan Grof and others had published clinical research as well as case reports using psychedelics in the setting of psychotherapy, and some psychedelic plant medicines had been used for healing and exploration in other cultures for centuries. Knowing this, Annie and I felt a duty to our patients to research psychedelic treatments aimed at making them available for clinical use. 

In early 2000, we approached Rick Doblin, who had formed MAPS for this purpose in 1986. It is no coincidence that Rick had also trained with Stan and Christina Grof in one of their earlier training groups, so we shared that foundational orientation. The inspiration for the MAPS research, and the therapeutic approach we have been using in clinical trials of MDMA-assisted psychotherapy for posttraumatic stress disorder (PTSD), stems directly from the training that Rick and Annie, and I had with Stan, Christina, and the other wonderful teachers at Grof Training. This influence includes the opportunity to engage in our own deep personal work as an essential element of learning to support others in deep healing. Now, after twenty years of successful MAPS-sponsored studies, MDMA-assisted psychotherapy is likely on the verge of FDA approval for use in conjunction with psychotherapy. This will be a unique event: a drug brought to market through a non-profit and public benefit model, and used not just as a pharmacological agent but as a catalyst to access a deep healing. To use Stan’s language, it will be an FDA indication for a drug aimed at accessing “the healing potential of non-ordinary states of consciousness” guided by the “inner healing intelligence.” 

I will describe some of the seminal moments and teaching points I recall from Grof Training, which Stan conveyed with theories, stories, and by his own example. Here is some of what I learned from Stan: 

Inviting someone to do inner work and agreeing to support them in non-ordinary states of consciousness is a commitment that takes compassionate presence, energy, flexibility, a sense of humor, and stamina. The most powerful lessons for me came from spending hours watching Stan and other teachers during holotropic breathwork sessions, as they stayed with the last people in the room at the end of long, intense breathwork sessions. We saw again and again that taking extra time at the end of a session often allowed a level of healing that would not have been reached in therapy with a rigid schedule. Stan was almost always there until the end of the session, and later in the evening, often the last person awake in the hot tub at midnight ready to play another round of Higgledy-piggledy, a very complex word game I think he and Christina had invented.

Supporting someone who has the willingness and courage to do deep inner work is a great privilege that can be as nourishing as it is demanding, and as energizing as it is tiring. One of the most inspiring things I’ve heard Stan say was in Atlanta at what was billed at the time as his last public holotropic breathwork group before retiring at 70 (none of us really thought he would stay retired). We were standing around and someone asked him how it was to turn 70. His reply was something like, “Oh, it’s wonderful! The older you get, the more interesting life should become because you’ve had so many experiences to draw from.” At a time when I was already hearing friends in their late 50s or early 60s bemoaning the way things weren’t “what they used to be,” I knew which example I would try to follow. 

Curiosity, respect, and trust in the inner healing intelligence are usually more helpful than theories about pathology. This is expressed in another of the most striking things I heard Stan say during a training module (I haven’t seen this written down anywhere, so this is from my memory). One of the trainees had asked him what he would do if he thought someone is being manipulative during a session rather than genuinely in a deep process. Since Stan had many years of psychoanalytic training in the past, I’m sure he could have come up with explanations about character pathology based on psychodynamic theory, but my memory is that he said this, “In that kind of situation, I choose to believe that there is something going on that I do not understand.” The unspoken extension of that choice is that he would then continue to stay present with an attitude of curiosity, love, and trust in that individual’s own ability to discover their own path to healing. This is true to what Stan has often quoted his friend Joseph Campbell as saying: “If you’re going to have a story, have a big story, or none at all.” 

Preparation to support others in deep process includes the therapist’s own inner work. The Grof training teaches a framework for understanding the nature of consciousness and an approach to healing based on facilitating each individual’s own innate healing intelligence. Stan’s extensive knowledge about the therapeutic and cultural use of psychedelics and other technologies for shifting consciousness, combined with his “cartography of the psyche,” brings wonderful depth and color to his teaching. However, maintaining balanced presence in the face of suffering and emotional intensity requires more than a cognitive framework. Essential elements of Stan’s teaching are conveyed by his example, his modeling of compassionate, courageous, and seemingly tireless presence with people during holotropic breathwork sessions. And at every Grof training module, trainees participate in their own breathwork sessions as well as acting as sitter and facilitator for others. For me, this direct experience was the heart of the training. Although I arrived for my first training module after having had a number of years of psychotherapy, as well as past psychedelic experiences, it was quickly obvious to me how much more I had to do. Happily, it also soon became obvious what an extraordinary opportunity was presented for us all to learn through the direct experience of facing our own challenges while supported with the skill and love of facilitators who trusted our inner healing intelligence even when we were not yet able to trust it ourselves. In line with this, one of the requirements in the Grof training is that trainees can take as long as they want to complete the training modules, but are not allowed to do it in less than two years because it takes at least that long for trainees to integrate the major shifts in perspective that may come over the course of their own holotropic breathwork sessions. 

Some specific skills are important to have, such as how to offer nurturing touch or do bodywork safely and effectively to support release in the body. More important is knowing when not to use any skills other than compassionate presence. This requires that the facilitators have sufficient self-awareness and capacity to refrain from acting on their own fears in the face of intensity, or acting from a need to feel skillful or useful. Any direct work with the body should come only after time and encouragement to bring attention to the body, and to allow any movement, shaking, or other spontaneous process to unfold. This is often sufficient, without intervention by the therapists, which is needed only if the process becomes stuck. Premature or unnecessary intervention may be a distraction from an unfolding process that might have resolved without intervention, and may have led in unexpected and helpful directions. Stan has used the example of a sitter in a breathwork session who decided her “breather” needed to be comforted, so she started stroking his head and coddling him like a baby. She found out later that the breather had been having an experience as a Viking, so comforting was not what he needed! 

On the other hand, support offered skillfully at the appropriate time can be a great service. I watched Stan during a breathwork session at a training module; a woman had been in an apparently very emotionally upsetting process with lots of writhing and crying on the mat for a long time. Her sitter was next to her, very attentive but not engaging. Stan walked up and stood watching for minutes. He then slowly lay down beside her and watched for several minutes more without her being aware of his presence. His pace and manner conveyed deep caring and deep respect for her process. Finally, he said gently, “Do you really want to do this alone?” The dam broke. When she felt the loving connection and Stan’s offer of non-intrusive support her process shifted dramatically to one of welcome release. 

The experiences illustrated by these vignettes have profoundly influenced my personal life and my work. They are the underpinnings of our approach to MDMA-assisted psychotherapy in MAPS-sponsored clinical trials conducted over the past seventeen years. The overarching lessons I take from Stan, on which all the others depend, are lessons of courage, scientific honesty, and the ethical responsibility of physicians and therapists to the well-being of their patients, and of all of us to the well-being of each other. It takes these qualities to explore one’s own psyche deeply; to remain intensely curious in the face of discoveries that don’t fit with prevailing dogma about the nature of reality; to follow what patients are telling you they need, even if it means straying from rigid professional boundaries regarding touch and length of sessions as well as concepts about pathology and the nature of healing; and to recognize the fallacy in thinking there is some essential difference between therapist and patient. During our MAPS Therapist trainings we show videos of MDMA-assisted research sessions using this kind of non-pathologizing approach. Sometimes during the videos, experienced psychiatrists start crying and tell us, “This is why I went into psychiatry, this is the kind of work I’ve always wanted to do!” Stan Grof’s contributions to psychiatry and psychology, to humanity, will continue to be felt, and are a gift to all of us as we support each other in healing and growth.

Learn more about Psyche Unbound: Essays in Honor of Stanislav Grof, available January 11, 2022: