Primal Therapy: What's the Difference? by Nicholas Barton

At the time that Dr. Janov was writing The Primal Scream there was, in fact, a genuine need for something new in psychotherapy. The therapies extant were not doing the job, partly, I believe, because nobody was quite sure of the job they were supposed to be doing. Dr. Janov represented the frustration and gave it voice as well as action, and once he had pinpointed the inherent failing of conventional psychotherapy he spoke with the emphatic confidence and revolutionary zeal of the newly enlightened.

If one simply looks at the techniques of the therapy, it is with one or two exceptions easy to come to the conclusion that there is very little new in Primal Therapy — not, as I have indicated, that newness is a confirmation of value. People look in isolation at superficial similarities and wonder if Primal Therapy is different from other psychotherapies, but to keep one's eye on superficial similarities means that one may very likely miss the profound difference. Though I also feel that staking claims to priority is of doubtful value except to the historian, the practical features of Primal Therapy that, to the best of knowledge, had not been seen before were: the open-ended session, the initial three-week intensive period, the group format, the unfurnished, padded, soundproofed rooms. All these aspects of the Primal method stem from and serve the premise that the neurotic suffers from repressed pain, which - if he is to recover in a complete way, must be felt consciously. All techniques employed in Primal Therapy (which incidentally, tries to avoid techniques wherever possible) are geared toward allowing and thus helping a person ultimately to feel the grief, anguish, hurt and other emotional torments repressed in childhood and now finding their expression in neurosis.

This, above all, is what separates Primal Therapy from the self-identifying psychotherapies that, in a variety of ways, try to deal with the effects of repressed pain, not with the pain itself. Some come close, some take a few steps in this direction, but in the final analysis they do not open the ultimate door. Pain remains forever unacceptable and therefore inaccessible. What is more inadmissible is that it can be felt and its effects ameliorated through this natural process that has been harnessed in what we call Primal Therapy. As has been pointed out in previous articles, in the early days of psychoanalysis Freud still believed in real trauma and by use of hypnosis facilitated what he called abreaction's in his patients. At this time he was close to what is Primal Therapy, and Primal Therapy in many respects picked up the lost threads of Freudian thought.

Some of the specific elements of Freud's methods are still retained in Primal Therapy. The patient is usually made to lie down facing away from the therapist and encouraged to free associate or to say whatever comes into his mind. Listening carefully and watching closely, the therapist looks for clues to the pain (those usually appear very quickly) and by questioning, reflection, observation and confrontation follows what we have come to call "the chain of pain".

The therapist helps the patient to concentrate on his unraveling, self-revealing chain of pain, partly by preventing the patient from digression, distraction or other forms of voluntary or involuntary defense against feeling. In other words, he helps make way for the pain.

It is important to point out that the therapist does not always follow the same approach. That would be a foolhardy, rigidly mechanistic approach. He is aiming to help the patient to discover the repressed pain, and if it seems at all possible to elicit a specific painful feeling he will aim for it. He must be able to recognize that this may not be immediately attainable and that strenuous zeroing in on the pain might in fact produce the opposite result, with the patient shutting down.

While keeping alert to possible openings into specific hurt, the therapist will work to increase the patient's general degree of openness while helping to set aside defenses. He must, however, at all times be aware of what effect surrender to a particular painful feeling will have on the patient's general state of mind. For this he has to take into account all aspects of the patient's life and psychological constitution at the time. It is often that he will work to reduce access or to slow down the opening up to avoid the person becoming overwhelmed to the point that he is unable to integrate the painful feelings he is discovering.

Psychoanalysis became "the talking cure" and thus ensured that it was unlikely to cure very much. The essence of neurotic suffering is repressed feeling, not suppressed talk. Talk is only a beginning, but important for that nonetheless. The trouble is that it is often used defensively, with words scattered about like so much obscuring chaff. When Freud had helped his patients to recall the trauma with "all the feelings which belonged to the original experience," he was - apart from the fact that he was using hypnosis - essentially practicing Primal Therapy. It was a great loss, or delay, when Freud discarded the theory of real trauma in favor of drive theory because with it went the full range and depth of feeling and the associated non-verbal expressions like crying, sobbing, raging, gesturing and yes, even screaming.

Free Association —

In many instances clues or traces to the predominant feeling of the moment appear early on in the patient's conversation, though neither he nor an untrained ear might recognize them for what they are. In any conversation in which a person is talking almost exclusively about himself and his life - as he expects and is expected to do in therapy, he will touch upon areas that are distressing to him. Inevitably, by this means, primal pain will begin to reveal itself. It may draw attention to itself quite early on in a seemingly innocent, dispassionate remark. The therapist notes this as a thread to the past and takes hold of it, either by his line of questioning or by keeping it in his mind as something to come back to if the conversation seems to be wandering into unproductive areas. The neophyte sometimes pounces over-anxiously on the first sign of pain, triumphant at having spotted his quarry. The over-eagerness can often cause the pain to run for cover. Assuming that all is well and the interventions are appropriately timed, the therapist will tug persistently on the thread until the associated feelings intensify, the symbolic manifestations dissolve and the primal feeling breaks into consciousness so that the patient can no longer hold back.

Pain is present and shows itself in more of less subtle ways — choice of words, tone of voice, facial expression, behavior, posture, attitude, opinions, sensations, subjects of conversation and so on. At the same time that it shows itself it attempts to conceal itself. Often we are presented with the emotional equivalent of an optical illusion. Viewed one way the pain is there. A slight shift in focus and it is gone. It is the job of the therapist to prevent his eye from being tricked away from the pain and to help the pain to come so sternly into focus that the reflexes that normally work to conceal it are overwhelmed. In a sense (or perhaps in all senses) he forms an alliance with the pain against the defenses.

Very important guides for the Primal therapist are the physiological concomitants of rising emotions. He is thus attentive to changes in breathing, rapid movement of the eyelids, swallowing, coughing, throat clearing, fidgeting, changes in voice tone, hand gripping, bodily discomfort, postural defensiveness, tearing and so on. Rather than taking these as warnings to back off and stimulate cognitive defenses by offering interpretations, the Primal therapist uses them as signposts. They show that he is on the right track, and they show him where to help the patient to go next. (He leads by following). His interventions are designed to help the patient into his pain. Obviously this requires a great deal of sensitive, skillful monitoring and concentration, but it is important for the therapist to be relaxed and confident in his manner while being acutely alert to all the emotional nuances. One might think this impossible, or at least unnatural, but it is achieved partly through experience and partly by the therapist's attention to his own feelings, which help the clarity of his perception.

The patient talks about his life, usually something in his present situation that is troubling him in some way. Without turning it into an interrogation or an inquisition, the therapist asks him questions designed to clear away mental obstructions to feeling that will, in turn, through full experience improve insight, perception and awareness. Often when a person talks about his feeling he finds that he does not know what to say next, how to take it any further. He thinks that he has said all that there is to say on the subject. So many times this is not so, being part of unconscious resistance or avoidance, and the therapist probes for sensitive areas, much like the doctor who, when trying precisely to locate an injury, presses upon the tender surface until the patient's sudden outcry tells him that he has found the exact spot. Unlike the conventional doctor and many psychotherapists, the Primal therapist does not withdraw or dispense palliatives. He goes on helping the patient into the pain. He encourages the patient to follow a particular tack and stresses the need to explore fully, to follow through and to surrender to any feeling that might be rising within him as a result of their talking on that particular subject. He is helping the patient to move from the generality of suffering, which is the state of being incompletely defended, into particular repressed, painful scenes, events, memories and reactions. He backs up his direct questions with expressions of plain human empathy either in speech or sometimes by touch. The less mechanical and more plainly human the therapist can be, the more effective all his communications will be. It is important to stress that although the therapist is guiding the patient toward his pain, he is not hurting the patient but helping to bring out the hurt that has already been caused.

Often there appear to be two stages in the therapy session: firstly, through conversation, removing or neutralizing whatever obstructs awareness of pain and then letting go to drop below awareness into the pain itself. (Sometimes conversation is protracted and sometimes extremely brief). We may have given the impression in the past that we do not think very highly of awareness as a therapeutic agent. What we are in fact saying is that awareness on its own cannot undo the deep binding of neurosis. But, for instance, we have always recognized that books like The Primal Scream open awareness in a way that brings readers much closer to their feelings. It adds a quality of insight. The person recognizes in the Janovian depiction of the origins of neurosis the truth of his own life and in do doing instinctively appreciates the rightness of the therapy based upon it. The recognition is not solely an intellectual one but an emotional one as well. When I am aware that something is hurting me I am closer to feeling what it is. And to feel is to know.