This article is a result of my participation in an internet e-group mailing list. For people who would like to join, it is called Primal-Support-Group and you can join by going to www.egroups.com/group/Primal-Support-Group.
Many times, in the span of over three thousand postings, questions about techniques of primal therapy were raised. This is a collection of my responses in interview format.
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Janov has not written much about the techniques of primal therapy except for what transpires in The Primal Scream. The three weeks intensive and the technique of isolation for the same time-period come to mind for example. Can you comment on those two techniques, that seem very specific to PT?.
Primal theory has not changed much over the years but the application you are referring to is, in my opinion, outdated. The original idea was to go forcefully againts the defenses, therefore: the idea of a three weeks intensive coupled with a period of isolation. The “official clinics” have become more flexible on the duration of isolation but the concept of a three-week intensive is still in favor.
I came to the conclusion that it is crucial to respect defenses and to look for a delicate balance between their function and the progressive access to the repressed pain. After all, defenses are natural and took millions of years to evolve. Who is to say that they should be attacked or taken away?
I must say that some of my opinions differ from Janov’s especially concerning the importance of a good life situation for the client at the beginning of the therapy. It is a therapy that can be very long, depending on the amount of the pain repressed, its nature, and the age of the client at the time of the trauma or traumata. For those reasons, the three weeks intensive is really only the beginning of the process for most people and by that time, they have already spent six thousand dollars, not counting another four thousands on average, for the people who have to leave their country, believing that the “official” clinics are the only places where they can get good therapy.
In that same line of ideas, I believe it is very important to warn clients, especially if fragile, of the dangers of uprooting themselves from their natural environment, compromising their financial security, their job, their family, friendships, etc. especially if based on the hope of a fast cure.
The ideal, in my opinion, is for most clients to go through that initial phase in their natural, daily environment unless, evidently, they need a drastic change in their life. Some people seem to have been doing better away from home, but it is not the case of the majority.
I agree with the idea of an intensive but the arbitrary period of three weeks should not be written in stone. Some people may benefit from one week only, some from two weeks , and some others from three weeks. This also applies to the isolation period. Some people should not be put in isolation at all. Think about those who have isolated themselves a whole lifetime. In the end, the therapy should be tailored on an individual basis.
Finally, what matters the most is that clients have a way to continue their therapy following the intensive. That is why I encourage strongly the creation of peer support groups before any intensive be given. This therapy cannot be systematically done alone and if you only see a therapist the cost can be prohibitive over the years. For more on that you can read my article entitled Before The Plunge, posted on John Speyrer’s Primal Psychotherapy Page.
Getting away from the techniques for a while, what would you say are the main qualities of a “good-enough” primal therapist?.
They are essentially the same as for any other “good enough” therapist, independently of orientation. First, I would say that having gone far enough in their own therapy is essential so that they can at least avoid egregious mistakes. I certainly had my share of those, some of which I still regret to this day.
Honesty, humility, compassion and non defensiveness are no less essential. Of course, a capacity to listen, listen and listen again. So is the capacity to make interventions based only on the clues given by the client, not from the therapist frame of reference.
A solid knowledge of primal theory is required of course. This is especially crucial when your client is dealing with very early pain (first line) that has no words but mainly sensations as a form of expression.
The capacity to take risks is another important quality. We want to be empathic and yet: take risks. Not exactly Roger nor Perls. Not very easy! And it is so important to be able to simply say “I am sorry.” when we make a mistake or hurt someone unfairly.
All gurus or originators of any school of therapy present with their own neurosis. They all elevate some of their neurosis to the level of a principle. Examples of this are: being tough, non-nurturing, having a weak sense of current reality, etc. Fritz Perls was a tough guy, for instance. Rogers was afraid of confrontation. Freud lived in his head…
The way I see it, primal therapy came partly from a place of “ thoughness,” not unlike the gestalt approach which glorified the “I do my thing you do your thing.” I have seen many clients fall through the cracks, with that “sink or swim mentality.” When I started therapy, in 1975, the “hard busting” (harsh confrontation of a client) was accepted more often than not.
I can see now that hard busting usually comes from a therapist’s dumping of their own pain. It may appear therapeutic, but most of the time it is twisted or unstraight anger. If you are dealing with a fragile client it may have devastating consequences. I have rarely seen good results with hard busting. On the other hand, healthy confrontation of a client’s unproductive or damaging acting out is sometimes necessary.
That brings me back to the question of dumping. Too often people in primal therapy, under the guise of “expressing their feelings” have learned to dump their toxic material on other people. It can be very self-centered, in the sense of “anything goes” in order to get to your feeling. I have seen it many times and I have done it myself. It can be very damaging to a relationship. This is a good example of when a therapist should intervene and confront the offender in an appropriate way.
You mentioned Carl Rogers, the originator of client-centered therapy. Do you consider primal therapy client-centered?
I find it troubling to read that there are so-called primal therapists out there who are not client-centered. In my experience, good primal therapy, including my own is always client-centered. In other words, the interventions, which should be minimal, are always dictated by what the client just said or what their body is trying to say.
The number one intervention in primal therapy is : Listening, listening and listening again. The second one is: Probing or asking simple questions like: “ What do you mean?”, “What happened?”, etc. Those simple questions come from being interested in your client’s story. Of course, if you are more interested in your theory than in your client as a whole person, you will not be able to do this.
A session always starts from a position of “not knowing.” We never assume anything. We listen, we observe and we let the story unravel. One of the major flaws of a non-seasoned primal therapist is trying to focus the client too soon, trying to be clever at determining what the main feeling is as soon as possible. That is a mistake. .
There will be many chances to hear “the feeling”. Let the story unfold, make few interventions, let the train follow its tracks. The conductor is the client, the track is the unconscious. They have no choice but going where they are going, if you do not derail them, if you do not pick the track for them. Let them be!.
You mentioned probing questions. It has been reported that some primal clients feel easily distracted even by occasional questions. Like it stops them in their tracks and they have to think before they can answer. Someone said: “It brings me back in my head” or “It takes me right out of the feeling.” How do you handle that?
If a client tells me: “Don’t make any intervention,” or “Don’t ask any question.” as a client-centered primal therapist, I don’t make any intervention, I don’t ask any question. I just listen.
Also, I would like to clarify the following: as a rule, we do not ask questions when a client is close to a feeling, is in a feeling, or is coming out of a feeling. There are rare exceptions. For example: ten minutes have gone by and the client seems lost, or in a daze. Out of natural curiosity and concern it makes sense to ask: “What is going on?”
The reason why we don’t ask questions when someone is approaching (descending towards) or coming out of a feeling is that we don’t know where they are in terms of thoughts, images, sensations or associations. They may have been crying talking to “mommy,” but now they are thinking about what happened today with their boss, for instance.
Last but not least, probing questions are asked mostly in the conversational (third line) part of the session or in the post-session. At the beginning of a session, the purpose of such questions is to establish context for the feeling. A rich context usually leads to a deeper and more connected feeling. In the post-session, the purpose is to help the client integrate everything that happened in the session, elicit insights and point towards how all this material can possibly contribute to a better quality of life.
Before we go on, would you tell us what you mean by first line, second line and third line of consciousness?
Those terms were coined by Arthur Janov, based on Paul McLean's biological concept of a triune brain. According to McLean, the development of a human being recapitulates the evolution of the species over millions of years, from reptiles to mammals and, eventually, to Homo Sapiens. McLean thus gave credibility to the existence of three distinct levels of consciousness.
First line pain is pain associated to a very early event (before, during or soon after birth) with severely traumatic consequences, because of its life and death meaning. Anoxia (lack of oxygen) at birth is a good example of it. The trauma , with all its physical components, is imprinted in the primitive brain of the baby and the body remembers it for life, even if it cannot be remembered intellectually with words.
The imprinted suffering is associated with abnormal vital signs such as high or low body temperature and blood pressure, fast, slow or irregular heartbeat, shallow breathing, fragile digestive system, etc. Later, it will show up emotionally (panic attacks, for example) and also in the way we think (e.g., paranoia, suicidal thougts..) and behave (especially behaviors taken to the extreme). First line pain always involves sensations and will often show up in nightmares.
Second line pain is emotional pain due to traumatic events that occurred later in chilhood. Those pains are not forgotten either, although they can be repressed just like first line pain. They leave a trace in the more evolved emotional brain (limbic system) of the child and can be remembered as specific emotions associated with the painful events. Loosing a parent, being sent to boarding school, being molested, are all examples of such pain. Besides anger as a possible first reaction, the language of tears is mostly associated with that level of consciousness. The language of words is also accessible by that time.
Third line pain is pain that is processed later, when the adult brain (neo-cortex) is fully developped and can make sense of it or alleviate it by taking actions that involve abstract reasoning and planning. The third line level of consciousness provides us with the ability to differenciate our internal states from the reality out there.
Is there much touch going on between therapists and primal clients in a typical session?
I would not say “much.” Touch is not used as a systematic technique, for instance. It is a very complex subject and I may write a whole article about it. For the time being, let me talk about three different situations:.
There is the spontaneous, friendly touch. Hugging is an exemple of it. We could call that third line touch.
Then, there is the reassuring touch that will bring an overload down. Art Janov used to say that touch, in that context, is worth 50 mgs of Thorazine. By and large we could consider it a second line type of intervention. This is a what a parent would do to calm down a child “in shock” and then, let them have their feeling. The sense transmitted here is: “It’s OK, I am here, it’s safe.” It usually takes the person straight to second line crying.
This same kind of touch can be applied on the way back from a deep first line feeling. The client will often crawl to you like a baby in need of comforting. Getting the touch that one never got after a difficult birth is a good example, acting in a dialectic fashion and often taking the client to baby crying. In other words, they are on the way up from a deep (sometimes overloading feeling) and the right kind of touch helps them integrate the pain and the needs on the three levels.
There are very specific kinds of touch, the purpose of which is to address a first line sensation. For example: the client’s head seems to be looking for some resistance. In this case, the therapist might offer a pillow’s resistance, gently at first, then might increase the pressure, depending on the client’s reaction. It can be a mistake if the client seems to be forcing the move. Then it seems unnatural and you release the pressure. It it was right, the client will experience a new part of the birth sequence, feel relief and have integrated insights on the three lines.
I personally need pressure on my sternum at times, or on the third or fourth cervical vertebra, because my neck got stuck at birth. At any rate, touch is not used loosely and is usually in response to a very specific clue given by the client. This is when the knowledge of the three lines of consciousness is very important, if one is going to give the right kind of therapeutic touch.
Do most clients have access to first line material right at the beginning of the therapy? .
Some people do have access to first line (at or around birth) pain very early in therapy and some do not, depending on how defended they are. And of course, some people have less early pain than others. We find all kinds of combinations. When I first started therapy, I was essentially what we call a second liner. I cried for years and years and that felt sufficient.
My first line pain started manifesting itself around 12 years ago. In other words, I was fairly repressed, which is a positive when you are overloaded on all levels. It started with my neck arching, while crying deeply. We call those first signs of very early trauma “first line intrusions.” It’s like someone who would have their first tears and be surprised they can cry.
Over the years, the sensations became more and more specific, to the point of choking, not breathing and my heart feeling like it was going to seize. My colleague and therapist kept saying: “Stay with the body.” Because at that point, it is easy to be in a mélange (on the three lines at the same time). .
What helped me the most, was to follow my breathing exactly, without any control coming from my head. Sometimes, it wanted to slow down and stop. At times, it lead to hyperventilation. The body knows where to go. Follow the leads. Some times it helps to exagerate the sensation, especially in new terrritory. It’s like giving that sensation a chance to express itself a little more. The same way you would encourage someone to stay with the tears, on the second line.
And of course, it is natural not to have access to any word or any crying while in a pure first line sequence. You cannot cry while you are lacking oxygen for instance. You cannot cry, even less talk, while you are stuck in the birth canal. If you are in a sensation and are talking or crying at the same time, it may be that there is a rapid succession between first, second and third levels of consciousness which is perfectly okay , or it may be that you are in that mélange (on the three levels at the same time). If that goes on for too long, it offers little resolution and eventually needs to be addressed.
What about deep breathing? Is this a technique applied very often?.
In my experience deep breathing is rarely used as a specific technique of primal therapy. The reason is that we follow the client wherever they need to go (client-centeredness). Either they need to go with words, with the emotions (anger or tears) or with the body. This is not to say that attention is not paid to breathing patterns. On the contrary.
The decision to go with the body is not something arbitrarily decided by the therapist. It is not decided by the client either. The clues always come from the body itself. For example, if you start coughing , choking , or gagging and it appears that you do not let it happen all the way, we might say: “Stay with the coughing,” “Stay with the choking,” etc. That simple move could help the client to stay with the sensation and experience the next part of the traumatic sequence, for instance: suffocation, turning blue, etc.
The same principle applies to breathing. In my case, very often, the breathing wants to slow down. My energy goes down as well and I don't feel or have the strength to keep on talking. If I were to keep on talking while my body is giving all the clues that I am exhausted, my therapist might say “Go with the body” or make a sound like “Shhh. . ." or say “Follow your breathing.”
What happens then is this; my breathing slows down more and more, naturally, because it is a memory, a part of my traumatic sequence. Eventually, I stop breathing for some time and then, I go into salamander motions (convulsions) in a desperate attempt to move forward (to get out).
The point is that my therapist did not use a breathing technique. She just followed me where I needed to go and my body gave her all the clues. I did not need to breathe heavily for thirty seconds as might have been decided by some self-centered therapist: I needed to let my body stop breathing because that’s where it needed to go.
That brings me back to the analogy of the train: The train will follow the tracks if we do not derail it or switch the rails.
We listen to the breathing patterns the same way we listen to the words, when words impose themselves, the same way we encourage the tears when someone is trying to avoid a painful emotional subject, the same way we listen to and give a chance to any body manifestation. If your body is struggling with a tic, let’s say : raising the eyebrows or the righthand shoulder or both at the same time, we won’t say: “Stop it.” We’ll say: “Let it happen.” If the sensation is timid, we might even say: “Exagerate it.” in order to give the buddying sensation a better chance to express itself.
Remember: things of the body were the first ones to be repressed. Always comes a time in therapy, when the body will say: “Hey. . . pay attention! I am here”. We do not decide what will be there and when. We do not make exceptions for breathing patterns.
P-S-G: I have had fantastic results with Stan Grof's holotropic breathwork and believe that it is a perfect complement to primal therapy. What is your opinion of holotropic breathwork?
R. B.: I do not have anything against holotropic breathwork, if you feel it helps you. On the other hand, I have to say I don’t see the need for such a technique in client-centered primal therapy. Any technique used in primal therapy should emerge from the clues given by the client, not from one systematically applied technique. We try to be as close to nature as possible.
P-S-G: Can you tell us something about the use of medication in primal therapy?.
We use medication the same way it is used in the psychotherapy environment at large. It is a decision that is never made by the therapist. If we think that medication would be of some help, we refer the client to a psychiatrist. It certainly would be the case if a client suffered from psychotic episodes, major depression, or constant panic attacks, for instance.
Unless there is an immediate crisis that requires immediate medical attention we try to push away the medication option as much as possible. It comes after having exhausted all natural means. First, we have to make sure that the client is getting good therapy and that everything is being done that has to be done in order to insure a good quality of life. We will consider a referral for medication evaluation if one is wallowing in first line pain constantly (in spite of good care), suffering too much, unable to function or, at times, unable to feel at all because of global repression, usually due to first line overload.
One of the ways to deal with overload is not to add to it, but diminish it by taking away as many struggles as possible in the present. Most people who come to a primal clinic are not rich. They come to therapy with the hope of being cured “à la Primal Scream” and are often uprooted from their country, family and friends. .
Again, in my opinion, the three weeks in some clinics are too expensive and not necessarily a good formula for everybody, especially for the people who have little money.
Moreover, the three weeks of intensive therapy, especially for the people with the most pain, are only the tip of the iceberg. The problem is even more compounded for the people with poor access to their feelings. It puts them in a position of “trying too hard” to do the therapy and sometimes leads to abreaction (release of tension, without connection and healing taking place).
All of this contributes to the overload for many people, in my opinion. Let us face it: if you are offered unrealistic hope, spend the little money you have left and find out you are only at the beginning of a long process, this is overloading in itself.
The best way to deal with overload is to be on the client’s side, in terms of their quality of life, and not to add to their every day life struggles.
One last question. One of our members has stated: “Contrary to Janov’s beliefs, I believe that “transference” is alive and well, and the relationship with your therapist is part of your healing process.” What do you think?
I agree very much! In my opinion, that was and still is one of Janov’s most serious mistakes. As far as I know, he has not changed his view, at least in writing. It goes against his own theory that a positive dialectic is necessary for good therapy. A “good enough” therapist is one who can give us to a certain extent the quality of nurturing that was lacking in our parents.
I believe that mistake contributed to the false idea that you can feel pain on your own for ages and still hope to get well. There is a very good book written on the subject, by Theresa Sheppard Alexander, a former therapist at the P. I. The title is: Facing The Wolf: inside the process of deep feeling therapy. I strongly recommend it.