Primal therapy

Primal Therapy is a trauma-based psychotherapy developed and popularized by Arthur Janov, Ph.D.

Janov claimed that in Primal Therapy patients would find their real needs and feelings in the process of experiencing all their "Pain" (technical term of Primal Theory - see below).

One of the fundamental principles of Primal Therapy remains that therapeutic progress can only be made through direct emotional experience, which allows access to the source of psychological pain in the lower brain and nervous system. According to Primal Theory, psychological therapies which involve only talking about the problem (referred to as "Talking Therapies") are of limited effectiveness because the cortex, or higher reasoning area of the brain, has no ability to affect the real source of psychological pain in other areas of the brain. This is emphasised throughout the writings of Arthur Janov.

The absence of peer-reviewed outcome studies to substantiate these claims led to the therapy falling out of favor in academic and psychotherapeutic circles. However, Dr. Janov and his associates have continued developing the therapy and providing it at his Center[1] in Venice, California.

Primal Therapy received public attention after ex-Beatle John Lennon sought treatment from Arthur and Vivian Janov. His experience in therapy heavily influenced his 1970 John Lennon/Plastic Ono Band solo album.

Primal Theory

Needs

There are many basic needs, which have been catalogued in Janov's books, including some that were not previously widely recognized as needs, such as our need to be touched and held. "Our first needs are solely physical ones for nourishment, safety and comfort. Later we have emotional needs for affection, understanding and respect for our feelings. Finally intellectual needs to know and to understand emerge." When needs go unfilled for too long, Pain is the result.

Pain

In Primal Theory, "Pain" (capitalized to distinguish it from ordinary physical, emotional or mental suffering) is unprocessed input of a highly painful, and therefore generally important, nature being stored by the nervous system for processing during a situation more conducive to learning. An event that creates Pain is by definition "traumatic" (automatically repressed as too threatening). Situations more conducive to learning may be removal from the immediate danger of the situation and/or adequate neural maturity (in the case of childhood trauma). For the mentally ill, the situation more conducive to learning has not yet arrived.

Arthur Janov has often written that his patients refer to Pain as the pain that doesn't hurt because, as soon as they go into it, it becomes simply feeling. Most of the suffering component is in the blockage or repression.

In later books, Janov drops much of the use of capital letters. Primal Pain may be referred to as simply pains or imprints.

Consciousness and repression

In Primal Theory consciousness is not simply awareness but refers to a state of the entire organism including the brain in which there is "fluid access" between the constituents. Based on the work of a number of neuroscientists including Paul D. MacLean, three levels of consciousness are recognised in Primal Theory:

In Primal Theory, the concept of repression is more complex than in earlier theories of psychological repression as it can occur on the physical, emotional or intellectual levels of consciousness.

Level/Line	Technical name	Functions mediated	Incorporates
First	somatosensory	sensation and visceral responses	survival mind
Second	affective	emotional responses	feeling mind
Third	cognitive	cognition and intellectual faculties	thinking mind

Defenses are the agents of repression and consume energy while protecting the system from the catastrophic Pain of unfulfilled need. When referring to Pain or defense the word "line" is used instead of "level"; e.g. first line Pain = body trauma, third line defense = intellectual defense.

Mental illness

In Primal Theory, mental illness is one illness with many different forms of expression. The mental illness of the psychopath, the neurotic and the psychotic in all cases has, at its root, pain that was too threatening to be felt - the pain of unfulfilled need. This Pain, as it is termed, is automatically repressed by the central nervous system but at the cost of disordering the interconnections of the mind, impairing consciousness so that the individual cannot access the original trauma. This allows survival but at a much reduced level of functioning and high levels of stress. Repression is never completely effective. Events in later life are always capable of reactivating the imprinted Pain resulting in symptoms such as anxiety, compulsions, outbursts of disproportionate emotion, depression, etcetera.

The main determinate of whether a person becomes a psychotic or a psychopath rather than a neurotic is the "charge" or "valance" of the Pain. When Pain is extreme these extreme forms of illness can result. It is claimed that psychotics have been successfully treated in Primal Therapy. According to one psychotic patient's account,"...I know now that the needs have to be felt before their lack of fulfillment can be faced."

Origins of neurosis

Primal Theory holds that most people suffer from some degree of neurosis. This begins very early in life (especially in the "critical period" - the gestation period plus the first three years) as a result of needs not being met. There may be one or more isolated traumatic events but more often it's a case of daily neglect or abuse that culminates, usually around the age of six, in a feeling that is conceptualized as not being loved or wanted. (This usually occurs around the age of six because it is at that time in the child's development that the nervous system is almost completely myelinated, at which point it becomes neurologically possible to conceptualize the Pain.) A six year old is still not emotionally or intellectually capable of accepting such an awful concept - not being loved by one's parents - it would be competely overwhelming. So the protective gating mechanisms of the central nervous system automatically repress the Pain.

Neurosis may begin to develop at birth, or even before, with first line Pains, which then make the infant very irritable and difficult to care for. This can bring another round of trauma if the parents' patience is stretched beyond the limit ("compounding" the Pain).

Throughout childhood more elaborate defenses develop as the early unmet needs keep pressing for satisfaction in symbolic and therefore inevitably unsatisfying ways.

Primal Therapy

Techniques and abuses

Since his first book, Janov has often written about the abuses of copycat therapists, whom he has referred to as "mock primal therapists" or simply "mock therapists" or "would-be practitioners". A notorious case of therapy abuse occurred in the seventies at The Center for Feeling Therapy, founded by two defectors (trainees) from The Primal Institute together with seven other therapists representing a whole range of theories (Client-Centered Therapy, Gestalt Therapy, Encounter Therapy and Bioenergetic Therapy). With this conglomeration of theoretical underpinnings, "Feeling Therapy" was given very favourable reviews by some (notably Carl Rogers). The center was organized as a commune, in which an abusive cult developed. It was eventually shut down and the therapists banned from practicing in California as a result of lawsuits brought by the patients against the therapists, accusing them of rape and other forms of mistreatment. The victims and some observers of the case were further horrified that criminal charges were not brought against the therapists.

In 1992, Janov gave two reasons, in Chapter 17 of an update of his first book, why he had written so little about techniques of Primal Therapy:

• Earlier descriptions of technique had been abused by the untrained, harming their patients.
• It takes years of training to be able to apply the complex methodology.

He went on to point out some of the mistakes that were being made by the would-be practioners. From those comments and further reading of this book and his others, a general picture of the techniques and process of Primal Therapy can be formed. Specific examples are sometimes given but only the sketchiest of tips on how to recognise when to employ a specific technique. There was a little written about the techniques of Primal Therapy in the early books but many of the early techniques have been abandoned by the Janovs, particularly physical ones such as deep breathing.

The dangers of inexpert attempts to provide this therapy are clear enough in the case of abusive therapists but bad results can occur, according to Janov, when warm, well meaning therapists, lacking the empathy and technical knowledge necessary, resort to a mechanical application of isolated techniques and inevitably do the wrong thing quite often, in some cases even causing patients to become psychotic.

What is curative, according to Janov, is feeling in context - this involves connecting to memory and to the present - not any particular form of expression of the feeling which the patient may choose. According to Arthur Janov,

"Primal Therapy is not just making people scream. It was the title of a book. It was never 'Primal Scream Therapy'. Those who read the book knew that the scream is what some people do when they hurt. Others simply sob or cry. It was the hurt we were after, not mechanical exercises such as pounding walls and yelling, 'mama'."

Authentication

Another case that is notable in connection with the issue of untrained therapists attempting to practice Primal Therapy is that of Alice Miller. This story, if the sources have it right, shows how an intelligent woman was taken in and got some dramatic results that inspired her to promote the therapist and the therapy only to be disappointed later and retract her endorsements in a web page entitled Communication to My Readers. If a renowned psychologist and author can fall prey in a time of need, the danger is very real.

Arthur Janov had been printing warnings for many years in all of his books, saying that people could check the credentials of a therapist, claiming to be a trained Primal Therapist, by contacting the Primal Institute or the Primal Foundation in Los Angeles. Since 1989, Arthur Janov with his present wife, France, has had his own center separate from the Primal Institute (still directed by his ex-wife Vivian Janov). So it might help to know where and when the therapist was trained. It is not a matter of public record how many therapists Arthur Janov may have trained in Paris in the nineteen eighties when he had a clinic there or how many Janov-certified therapists are currently practicing. The only way to check, at present, on a specific therapist is by email to Arthur Janov at his website. Janov's center is the only place currently providing training in his methods.

The directors of Vivian Janov's Primal Institute were all trained by Arthur Janov and have had well over two decades of experience.

The format of the therapy and process of healing

The overall strategy of Primal Therapy has hardly changed from the early days. The therapy begins with an intensive three weeks of fifteen open ended sessions with one therapist. After this the patient can join large group meetings with other patients and therapists once or twice a week for as long as is needed. Private sessions are still available, though not every day. There is flexibility within this format to allow the therapy to be adapted to the individual's needs. The length of time needed in formal therapy varies from person to person.

The therapy is aimed at helping patients to "primal" (see below) and to reach a point where they can leave therapy and get on with life, feeling ("primalling") as and when necessary without the aid of a therapist.

The most complete information on the process of healing in Primal Therapy comes from Arthur Janov's books, which are quite long and detailed and give many case histories and brief reports from patients. The more recent books usually contain something new of significance as research is ongoing.

Connected feeling

A connected feeling, in Primal Theory, is a "conscious" experience which connects the present to the past and connects emotion to meaning. There may also be a connection to sensations in the case of a physically traumatic experience such as physical or sexual abuse or painful birth.

Primal

In early writings this was another capitalised concept. In keeping with modern trends lower case is used here.

As a noun or a verb, this word denotes the reliving of an early painful feeling. A complete primal has been found, according to Janov, to be marked by a "pre-primal" rise in vital signs such as pulse, core body temperature, and blood pressure leading up to the feeling experience and then a falling off of those vital signs to a more normal level than where they began. After the primal ("post-primal"), the patient is often flooded with insights.

Based on detailed studies, Janov and Holden claimed that the pre-primal rise in vital signs indicates the person's neurotic defenses are being stretched by the ascending Pain to the point of producing an "acute anxiety attack" (the conventional description), and the fall to more normal levels than pre-primal levels indicates a degree of resolution of the Pain.

A primal should not be confused with emotional catharsis or abreaction[2] - throughout his writing Janov makes this distinction. A primal may be referred to as a "connected feeling" but a complete connected feeling will usually take months or even years to feel, in many primals.

Reports on Primal Therapy

There have been several reports relating to Primal Therapy in books and peer-reviewed journals over the decades since Janov's first book on the subject. Much of the research cited in Janov's books in recent years is neurological research which he sees as supporting his theory.

However, it should not be forgotten that Primal Therapy is, first and foremost, an experiential psychotherapy. In Arthur Janov's words (remembering his technical use of the word feeling - see "connected feeling"):

"Although there are scientific references and citations throughout this work, we should not lose track of the overarching truth - feelings are their own validation. We can quote and cite all day long, but the truth ultimately lies in the experience of human beings. Their feelings explain so much that statistical evidence is irrelevant."

Tomas Videgård´s The Success and Failure of Primal Therapy

In an early account of the results of primal therapy (published in book form, only in Sweden in English), Tomas Videgård reported on a study of a sample of 32 patients treated at The Primal Institute (Janov). Patients entered therapy from December 1975 to May 1976.

Outcome evaluation for the patients:

• 4 Very Good
• 9 Good
• 8 Medium
• 6 Bad (including one suicide)
• 5 Unavailable for post-testing

Patients who did not "finish" the therapy were excluded. Patients in the sample had been in therapy for between 15 and 32 months. Janov now claims that the formal therapy can take significantly longer than this and has never put a time limit on the therapy process overall as it depends on how much Pain the individual has to resolve.

Videgård himself went through the therapy. It should also be noted that the evaluation was based on patients' answers to questions and some projective tests that require interpretation by the tester. Videgård concluded that therapy at the Primal Institute was marginally better than the Tavistock clinic and markedly better than the Menninger Foundation - the two psychotherapy clinics which he used for comparison.

Reports on Primal Therapy in peer-reviewed journals

• Janov's primal scream therapy, 1975. Article in German.
• Conventional and contemporary approaches to psychotherapy. Freud meets Skinner, Janov, and others, 1977.
• Primal therapy : yesterday and today, 1978. Article in French.
• Critique on primal therapy, 1979.
• Primal therapy--a clinically confirmed procedure?, 1982. Article in German.
• An outcome study of primal therapy, 1983.
• Wilhelm Reich--Arthur Janov--a comparison of their work, 1984.
• The derailment of behavior therapy: a tale of conceptual misdirection., 1989.
• Primal scream therapy: a new cause of Mallory-Weiss tear. 1990.[3]

Papers by Arthur Janov in peer-reviewed journals

• Towards a new consciousness,1977.

Books by Primal patients about their therapy

The following publications are not presented as authorities on Primal Therapy. These are accounts by patients of Primal Therapy as they experienced it. If these people are authorities on anything, they are authorities on themselves, with the help of Primal Therapy.

Healing Fits: The Cure of an Epileptic by Robert Reese (1988) Big Sky Press ISBN 0944-59200-7

Sidenote re John Lennon

The musician John Lennon went through Primal therapy in 1970, and shortly afterward produced his raw, emotional album, "John Lennon/Plastic Ono Band". The album featured a number of songs which were directly inspired by his experience in therapy, including "Remember," "Isolation," "I Found Out", "God," "Mother," "My Mummy's Dead," and "Working Class Hero." (For more on this subject, see the webpage, "John Lennon - Primal therapy,"which includes excerpts of interviews of John Lennon, Arthur Janov and Vivian Janov, along with an account of one of John's therapy sessions written by Pauline Lennon.)

Books

Complete list of books by Arthur Janov

External links

• Dr. Arthur Janov's Primal Center home page
• The Primal Institute directed by Vivian Janov