Primal therapy

Primal Therapy is a trauma-based psychotherapy created 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" (capitalized 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. There seems to be no documented evidence of other, completely independent psychologists replicating Dr Janov's claims. However, Dr. Janov and his associates have continued practicing the therapy and providing it at his Center in Santa Monica, 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.

Introduction
This article is about Primal Therapy as created and developed by Arthur Janov. His first book on the subject, The Primal Scream, was published in 1970 and he soon trademarked "Primal Therapy", lost a court case over it, and eventually the trademark was withdrawn by the patent office only about five years after The Primal Scream appeared. The lost legal battle over the patent was against a therapy center in Canada offering a therapy called Primal Integration. This center was using the term "Primal", which had recently been adopted by Dr Janov, with the same meaning he had given it.

Although "primal therapy", or for that matter "Primal Therapy", can now be offered by anyone, the term, Primal Therapy, is retained in this article as a convenient short hand for Arthur Janov's Primal Therapy so as to distinguish it from the primal therapy which can be and is offered around the world by people who may or may not have the necessary training and ability to provide it. This article should in no way be taken as an endorsement of any particular form of therapy.

This is not a history of Primal Therapy, though some history comes into it, of necessity, to explain some of the secrecy and confusion surrounding this subject. Although the methodology of Primal Therapy has evolved since the publication of The Primal Scream, the basic concepts have not changed: they have only been refined and elaborated. As explained in this article, in Techniques and abuses, the details of methods are not available to the public.

This is not an exhaustive account of even the main concepts that distinguish Primal Therapy from other therapies, for the reasons given above and simply because of the extensive library of books published by Arthur Janov which do just that.

Theory
Although he has used some basic terms that were in common use by professionals in psychology and medicine, Janov moved away from the accepted terminology partly because of his firm belief that mental illness is a disorder of the entire system and so is not just mental. Moreover he believed that there was just one source of mental illness (besides genetic defects) - the imprinted pain of unmet needs - and therefore just one effective treatment. He still believes that much illness that is attributed to defective genes is actually due to imprints of early traumatic pain in utero. Over the decades, since the publication of Primal Man (1975), he has addressed his books less to mental health professionals and more to the lay public. In The Biology of Love (2000), Arthur Janov reviewed all the theoretical work from his early books relating neurorology to the processing of trauma. This account updated his theory, expounded in Primal Man, drawing on (and citing) up-to-date psychological and neurological research.

Needs
There are many basic needs, which have been catalogued in Janov's books. "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."

Early in life needs are a matter of survival. "Need is a total state of the human being - and at birth we are almost nothing but need." For the helpless newborn, survival is at stake in nearly every second of existence.

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

Pain
In Primal Theory, "Primal Pain is deprivation or injury which threatens the developing child. A parent's warning is not necessarily a Primal Pain for the child. Utter humiliation is...An infant left to cry it out in the crib is in Pain...It is not hurt as such which defines Primal Pain but rather the context of the hurt or its meaning to the impressionable developing consciousness of the child."

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 has dropped much of the use of capital letters. Primal Pain may be referred to as simply pains or imprints or primal 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 parts. Based on the work of a number of neuroscientists including Paul D. MacLean, three levels of consciousness are recognised in Primal Theory with the result that 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.

The following table summarises some of the ideas and the terms Janov (J) has used as well as the conventional terms used in general and scientific papers. These terms and concepts are basic to Janov's theory and therapeutic practice.
 * 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 = early trauma imprinted in the brainstem usually involving physical injury, third line defense = intellectual defense.
 * The brainstem has also often been referred to as the reptilian brain as it is the structure which mammals have in common with reptiles.
 * The 1st line imprints occur before intellectual abilities such as the use of verbal language have developed, they are at the level of pure sensation and visceral (or gut) reaction. The brainstem is capable of processing the most primitive emotions of rage and terror and these can be experienced very early in life.

Primal Pains are imprinted in the lower brain first then later the limbic system and still later intellectual defenses are formed by the cortex simply because this is the sequence of neurological development. Janov claims that therapy occurs in the reverse sequence: 'There is no way to go deep without first going shallow.' In Primal Therapy medication is prescribed for some "overloaded" patients so they don't overshoot into 1st line pains that they are not ready to feel, thereby allowing them to feel the more recent pains first. These drugs are not seen as the cure, just a temporary aid in special cases.

Origins of neurosis
Primal Theory holds that many 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.

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.

Techniques and abuses
Since his first book, Janov has often written about the abuses of therapists, whom he has referred to as "mock primal therapists" or simply "mock therapists" or "would-be practitioners".

The Center for Feeling Therapy
The following summary is based on Therapy Gone Mad by Carol Lynn Mithers, a book based on interviews of some 48 former patients of The Center for Feeling Therapy who shared diaries, notes and audiotapes with her. Marybeth Ayella has written another report in Insane Therapy, Portrait of a Psychotherapy Cult.

A notorious case of therapy abuse occurred in the seventies at The Center for Feeling Therapy, founded in Los Angeles in 1971 by nine people from The Primal Institute. Joe Hart and Richard "Riggs" Corriere, together with seven other therapists - two of whom had been certified as Primal Therapists. As well as the two certified therapists, twenty five patients left The Primal Institute with Hart and Corriere. Hart and Corriere had been in the therapist training program at The Primal Institute and Corriere had contributed to a scientific study reprinted in Janov's second book.

According to Mithers, 'Later, Joe and Riggs would claim that the group had confronted Arthur Janov with their unhappiness and told him they believed patients needed to move beyond their past pain to change their present lives. Janov would deny that, comparing any attempt by Joe and Riggs to improve his theory with interns correcting a senior surgeon's technique. Interns morover, who were really only interested in power who he'd pegged as "abreactors" - people who had emotional outbursts without truly feeling anything - and who were about to be fired anyway.'

Going Sane, the book published a few years later describing their "Feeling Therapy", was given very favorable reviews by some, notably:
 * "A group of very honest young therapists tell, with great candor and openness, about the new kind of therapy they are developing and the mutuality of relationship it involves." - Carl Rogers

The Center for Feeling Therapy followed Janov's method, described in The Primal Scream of having the patient stay alone for 24 hours prior to the initial three weeks intensive. But what was a recommendation in Janov's instructions: "preferably in a hotel room near the office" became an order "Twenty four hours before your therapy begins check into a motel near the Center". This was not the only element of Janov's treatment that was taken to an extreme - the isolation was prolonged inappropriately. Isolation is not prolonged more than a couple of days in many cases in Primal Therapy since many patients are depressed and actually isolate themselves as a defense - also it had not been used at The Primal Institute for treating psychotics or people with brittle defenses.

Unlike The Primal Institute, The Center for Feeling Therapy was organized as a commune. According to Mithers description of the founding therapists' initial mind set, "...although they'd be following Janov's program, they would keep exploring ways to go beyond it. They already knew two things for sure: They would avoid the narcissism that had claimed Janov, by sharing the therapy's leadership. All decisions would be made collectively; that way, no one person's theories or ego would dominate. Even more important, all therapists would continue to get treatment from their peers. That way the therapy would grow as they did."

An abusive cult developed in the commune, mostly led by Corriere, with Joe Hart still the overall leader, knowing what Corriere had wrought but lacking the assertiveness to intervene. Finally the patients rebelled and the center in Los Angeles (along with its satellites in Boston, Honolulu, Munich and San Francisco) was shut down in November 1980 and the therapists were subsequently (1986-1987) banned from practicing in California as a result of lawsuits initiated about five years earlier by the patients against the therapists, accusing them of rape and other forms of mistreatment. The victims and some observers of the case were dismayed that criminal charges were not brought against the therapists and the victims never received an apology, they had hoped for, from the founding therapists.

In an interview with Swedish journalist Hedda Waldenstrom in 1977, just "about a month short of ten years" after Danny's scream, asked if there had been any important changes in Primal Therapy since The Primal Scream was published, Arthur Janov and Michael Holden replied "Art: The technique has changed radically as well as the theory and research. And the staff has changed radically. There's hardly anything the same. Michael: Except the premise. Art: The premise is exactly the same. That is, you relive Pain and you get well." Asked what effect the splits had on the work at the Institute, Janov explained that "... the staff is much more together, much more concise...". The defectors "forced us to redefine what was wrong. Why people were going astray."

Techniques
There is evidence that this revision of the methodology of Primal Therapy was well under way when Janov's second book was published in 1971 (complete with Corriere's contribution). It seems that a trend toward a less pressured approach without reliance on physical methods that had been borrowed from Reichian therapy was already underway. This can be inferred from the account of a patient describing the difference between the Orgone therapy (Reichian), that she had previously had and the therapy she was getting at The Primal Institute:
 * 'Perhaps the most important thing is that I feel my own pain when and if I am ready for it. I now believe there is no significance in reenacting an incident if I am not already in the feeling of it. It only becomes playacting, and in this way any patient can avoid really feeling his pain forever. When I saw the orgone therapist only once a week I soon learned how to fool him, and myself. In Primal Therapy I am more on my own, feeling my own pain when and if I am ready. My contact with a therapist is close, so there is less opportunity for games. I want to progress for my own welfare, not because it pleases a therapist.'

Arthur Janov became even more secretive than he had been initially about the techniques of Primal Therapy. In 1992, Janov gave two reasons 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 practitioners. 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 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
A case that is notable in connection with the issue of Primal Therapy versus primal therapy is that of Alice Miller. This story shows how a well known psychologist and writer on child abuse was taken in and got some early results that inspired her to promote the primal therapy in her early books only to be disappointed later and retract her endorsements in a web page entitled Communication to My Readers as well as printing retractions in her later books. She came to not recommend primal therapy in general.

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 1980s when he had a clinic there or how many Janov-certified therapists are currently practicing. The directors of The Primal Institute (founded by Arthur and Vivian Janov in 1969) were trained by Arthur Janov and have had well over twenty years of experience. The credentials of therapists claiming to have been trained there (before or after Arthur Janov left) can be checked by contacting The Primal Institute.

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.

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 and Holden, 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.

Janov claims that the "primal" is different from emotional catharsis or abreaction. 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. It should be noted that "abreaction" or "catharsis" as used by other psychologists does not mean a false or unconnected feeling.

Duration
Perhaps one of the least understood and most questioned claims of Arthur Janov in his first book is that '... by the time someone has reached his eighth month he is generally well. What does this mean?...Let me make clear that the finished patient is not ecstatic or even "happy". Happiness is not a goal of Primal Therapy. Finished patients may still have many more hurts to feel... So they will have their moments of misery after therapy, but as one patient put it, "At least it is real misery with some kind of end to it."'

Twenty years later Janov wrote that "The elapsed time before a patient is relatively well is longer than we originally supposed, but the specific time spent at the clinic is not. After one year to a year and a half patients are largely on their own, with only sporadic follow up necessary."

Types of patients treated
Arthur Janov noted in 2006 that there is not really any common type of Primal Therapy patient, "although all of them sense a deep unhappiness, a lack of fulfillment, and feel they're not getting what they need out of life." He listed some broad categories of cases treated: "psychosomatic cases - asthma, colitis, migraines, high blood pressure, and epilepsy; as well as behaviour disorders - those who are unable to sustain adult relationships, who divorce often, who cannot concentrate (ADD), and who are seriously depressed."

There are accounts of their therapy by patients in all of Arthur Janov's books. The names are usually changed to protect the privacy of the patient. An account by an epileptic patient of his treatment can be found in the book Healing Fits. A brief note about his therapy by an ADD patient is on his website.

Failures
In 2006, Arthur Janov listed some limitations of Primal Therapy:
 * 'Does Primal Therapy have its failures? Yes, but not nearly as many as what I saw when I practiced Freudian analysis. We have a hard time with those who took many LSD or Ecstasy trips or those psychopaths who incorporated the therapy into their tendency to scam and fake. There are those who are very defensive and shut-off, who take a long time to open up, but if they stay with it, they are often successful. Because we are not an in-patient facility, we take very few psychotic patients. They need more care and supervision than we can offer.'

Reports
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. 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. (See Duration above.) Patients in the sample had been in therapy for between 15 and 32 months.

Videgård himself went through the therapy. The evaluation was based on patients' answers to questions and some projective tests that require interpretation by the tester (Videgård himself) so there was a potential for bias. 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.

There is a paper by Stephen Khamsi Ph.D. about this study: The Success and Failure of Primal Therapy: A Critical Review.

Peer reviewed journal reports

 * 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.
 * Primal scream therapy: a new cause of Mallory-Weiss tear. 1990.
 * Whatever Happened To Primal Therapy? Discover Magazine, May 2007

Papers by Arthur Janov in peer-reviewed journals

 * Towards a new consciousness,1977.

Books by Primal patients about their therapy

 * Facing the Wolf: Inside the Process of Deep Feeling Therapy by Theresa Sheppard Alexander (1997), Plume. ISBN 0452275210 ISBN 9780452275218.
 * Healing Fits: The Cure of an Epileptic by Robert Reese (1988) Big Sky Press ISBN 0944-59200-7

Criticism

 * Debunking Primal Therapy is a website set up by a former Primal Therapy participant, and addresses such issues as peer review, falsifiability, bias, justification and other social psychological effects behind primal therapy.
 * Online compendium of brief Primal Criticisms
 * An early 1975 criticism of Janov within the Primal framework: Beyond Janov, by Herman Weiner, Ph.D.
 * Critical review of the 1996 Janov's book Why You Get Sick and How You Get Well: The Healing Power of Feelings
 * Primal Therapy is one of the therapies listed in the 1996 book "Crazy Therapies" (ISBN 0787902780)
 * Two years after writing his first book, Janov's certitude about having the one cure-all was established-at least in his mind. In the first lines of his second book, Janov wrote: "Primal Therapy purports to cure mental illness (psychophysical illness, to be exact). Moreover, it claims to be the only cure. By implication, this renders all other psychologic theories obsolete and invalid. It means that there can be only one valid approach to treating neuroses and psychosis". (Pages 121 and 122)


 * Primal Therapy is cited in the 2002 paper Fringe Psychotherapies: The Public at Risk
 * Rebirthing, Primal Scream Therapy, and Dianetics (Scientology) all assert that people can and should recall times in their lives when their brains and cognitive processes were too immature to lay down memories of the sort posited by these theorists (page 11)

Answers to criticism

 * A rebuttal to the "DebunkingPrimalTherapy" site, specifically its charges of cultism, by a former primal patient.

Sidenote re John Lennon
The musician John Lennon, and his wife, Yoko Ono, both went through Primal Therapy in 1970, and shortly afterward Lennon produced his raw, emotional album, John Lennon/Plastic Ono Band. (Ono recorded a parallel album, Yoko Ono/Plastic Ono Band from her experiences; both albums were released on the same day on the Apple record label.) Lennon's album featured a number of songs which were directly inspired by his experience in therapy, including "Remember", "I Found Out", "Isolation", "God", "Mother", "My Mummy's Dead", and "Working Class Hero". Lennon ended his therapy sessions before completing a full course of therapy.

(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
 * Ayella, Marybeth F.Insane Therapy, Portrait of a Psychotherapy cult ISBN 1-56639-601-8
 * Janov, A. The Primal Scream (1970) ISBN 0-349-11829-9
 * Janov, A. The Anatomy of Mental Illness (1971) ISBN 0-425-02494-6
 * Janov, A. & Holden, e. M. Primal Man (1975) ISBN 0-690-01015-X
 * Prisoners of Pain (1980) ISBN 0-385-15791-6
 * The Biology of Love (2000) ISBN 1-57392-829-1
 * Janov, A. The New Primal Scream (1992) ISBN 0-942103-23-8
 * Janov, A., Primal Healing (2006) ISBN 1-56414-916-1
 * Mithers, C.L. Therapy Gone Mad (1994) ISBN 0-201570-71-8
 * Reese, R., Healing Fits: The Cure of an Epileptic (1988) Big Sky Press ISBN 0944-59200-7
 * Videgård, T. The Success and Failure of Primal Therapy (1984) ISBN 91-22-00698-2