The First Three Weeks by Nicholas Barton

An initial three-week period of intensive therapy was already in operation by the time The Primal Scream was published in 1970, and it has remained a feature of Primal Therapy ever since. In fact, it is one of the aspects of the Primal method that sets it apart from other forms of therapy. Although it has been informally reviewed from time to time, it has never come into serious question. The reason three weeks was chosen was to take into account the needs of both therapist and patient. The patient would get an extended introduction to the therapy, which would help to make decisive inroads into his neurotic defenses while it allowed therapists one week of a month. It was clear that the concentration required for daily attention to one person in open-ended sessions for weeks at a time would be wearing and that both parties would need a break from such close contact.

The Primal Scream gives the impression that defenses are under constant and vigorous assault in the three weeks, with the steady use of isolation, sleep deprivation and deep breathing techniques, and, in the pioneering days of the therapy the approach was more along those lines. However, modifications in technique have inevitably occurred over the years, and the interventions are less forceful and the therapist's manner less dogmatic than is suggested by chapter eight of The Primal Scream. It became evident that a strenuous impatience with defenses often strengthened resistance, exposed some patients to too much pain at once, interrupted natural sequences in opening up or persuaded patients to rely too heavily and too passively upon active interventions by therapists that sometimes showed itself in a ritualized approach to therapy.

There were those who got the impression that blasting their way through defenses was a way to cut corners and shorten the difficult process of feeling repressed pain. It began to look as if some people viewed so-called Primal techniques as a sort of behavioral LSD. This also tended to promote the abreactive or performance style of primal. It further contributed to the belief that meaningful change would only take place within the walls of the therapy room. Although firm defense-countering interventions are still made when appropriate, the approach is generally more one of encouraging people to let go rather than demanding that they do so, remembering that pain, by its very nature, is always straining to become conscious. The helping hand doesn't have to be a pushy one.

The patient spends enough time and energy defending against his pain that he doesn't want to have to defend against an overly intrusive therapist either by passive resistance or by jumping obediently to his commands. He also needs to realize that there is plenty to do in responsibly confronting the defenses inherent in the conduct of his daily life. In the end, people will let down their guard with someone they can trust and on whom they can depend to remain on their side while telling them the truth.

As with many other features of the Primal method, the three-week format is not rigidly adhered to for everyone. There are occasionally people who benefit from stretching out their sessions over a longer period. This is not usually discovered until the intensive period has begun. Alterations are at the discretion of the therapist, who will normally discuss them in advance at staff meeting. The three weeks are obviously useful for establishing a rapport between therapist and patient. They also make it harder for defenses, once disrupted, to reform as they do in cases where a patient has to wait a week or more for his next session. (As I've indicated, with some people you may want this to happen because daily confrontation with the painful truth is too much for them.)

The therapist can get to know his patient more easily and more thoroughly and earlier on in the process than if he were to drop in for 45 minutes once a week. It's important to consider that therapist and patient are going to be spending a lot of time working closely together over the following months. It's as well to give plenty of time to getting the communication off to a good start. This special period of concentrated individual attention inevitably provokes transference, which is neither deliberately promoted nor actively discouraged. It is used for what it is: the displacing of reactions, feelings and needs from the past into the present. The transferred feelings are turned back into themselves.

"By the time he (the patient) begins, he already knows what to expect," writes Arthur Janov in The Primal Scream. This may be true to some extent, but we have to remember that his expectations have also been fueled by his neurotic hope, inaccurate press reports, rumor, gossip, fear, out-of-date or incomplete literature and possibly by reports from friends who have already had the therapy. So the three weeks involves education to counter myths and unreal expectations surrounding the therapy and to allay fears and doubts. It is also a time to iron out inappropriate habits and approaches to the therapy. This is when the patient is helped to get to know himself and to recognize defenses so that he can gradually become his own therapist. And of course, primarily, it is a time to begin self-discovery and recovery through feeling buried grief, bound reactions and unattended needs.