Primal therapy

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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.

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.


[edit] Primal Theory

[edit] 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."<ref name="Janov">Janov, A. The New Primal Scream: Primal Therapy 20 Years on (1992) ISBN 0-94210-323-8</ref>

When needs go unfilled for too long Pain is the result.

[edit] 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.

[edit] Consciousness and repression

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

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.<ref name="J&H">Janov, A. & Holden, e.M. Primal Man: The New Consciousness (1975) ISBN 0-69001-015-X</ref> Based on the work of a number of neuroscientists including Paul D. MacLean, three levels of consciousness are recognised in Primal Theory:<ref name="Janov"/>

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.

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.

[edit] 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 can not 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 succesfully treated in Primal Therapy. According to one psychotic patient's account<ref name="PrimalScream">Janov, A., The Primal Scream (1970) ISBN 0-349-11829-9</ref>,"...I know now that the needs have to be felt before their lack of fulfillment can be faced."

[edit] Origins of neurosis

Primal Theory holds that most people suffer from some degree of neurosis. This begins very early in life 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.

[edit] Primal Therapy

[edit] Techniques and abuses

Janov claims that an intellectual comprehension of the principals of Primal Therapy is not sufficient to practice it because, to really have the necessary empathy with a patient going through it, the therapist must have been through his own. Also, as long as the therapist has unresolved Pain, he is likely to symbolise and act it out on some of his patients rather than addressing the patient's therapeutic needs.<ref name="Janov"/>

Since his first book, Janov has often written about the abuses of copycat therapists, whom he refers to as "mock primal therapists" or simply "mock therapists" or "would-be practitioners". The most notorious case of abuse occurred in the seventies at The Center for Feeling Therapy, founded by defectors from The Primal Institute. It 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.<ref name="Mithers">Mithers, C.L. Therapy Gone Mad</ref>

In 1992<ref name="Janov"/>, 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 goes 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 most of the early techniques have been abandoned by the Janovs.

The dangers of inexpert attempts to provide this therapy are clear enough in the case of abusive therapists but bad results can occur 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.<ref name="Janov"/>

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,<ref name="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'."

[edit] Authentication

Another case that is notable in connection with the issue of untrained therapists attempting to practice Primal Therapy is that of Alice Miller (psychologist). 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, at 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 one would need to know where and when the therapist was trained. Arthur Janov trained many European therapists in Paris in the nineteen eighties.

[edit] 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 joins large group meetings with other patients and therapists once or twice a week for as long as is needed. 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 (in the Primal sense below) 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.

[edit] 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.

[edit] Primal

As a noun or a verb and capitalized, this word denotes the reliving of an early painful feeling. A complete Primal has been found, according to Janov<ref name="J&H"/>, 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 lower level than where they began. After the Primal ("post-primal"), the patient is often flooded with insights.

Based on detailed studies, Janov and Holden<ref name="J&H"/> 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 lower levels than pre-primal levels indicates a degree of resolution of the Pain.

A Primal should not be confused with catharsis or abreaction - 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.

[edit] Independent accounts of Primal Therapy results

In an early independent account of the results of primal therapy (published only in Sweden in English), Tomas Videgård<ref name="Videgard">Videgård, T. The Success and Failure of Primal Therapy (1984) ISBN 9122006982</ref> 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.

On balance 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.

[edit] Sidenote

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.)

[edit] References


[edit] Books

Complete list of books by Arthur Janov

[edit] External links


sr:Примална терапија sv:Primalterapi

Primal therapy

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