Toward a More Effective Primal Therapy

By Warren Baker M.D.

Lately we have heard concerns expressed about the directions the Denver Primal Center and myself are taking in pursuing primal therapy. This has taken on an aspect of fear, on occasion, that we are diluting primal therapy. This could not be further from our aim nor, do I believe, further from the result of the changes which, fact, have occurred here in our therapeutic approach.

A short review of our experience with other primal centers and our own development in the past two or three years will perhaps clarify what we believe have become legitimate concerns in evolving a more effective primal therapy without sacrificing the unquestioned benefits of what may be appropriately called radical primal therapy, i.e. that type of primal therapy practiced by centers which feel as discussed in detail below.

In practice, if not in expressed theory, the emphasis in radical primal therapy is almost totally on early trauma. Re- experiencing birth and pre-birth painful feelings becomes the sine qua non of therapy. Little time is allotted to the verbal, and intellectual integration of these experiences. Second line (see definition later) experiences are relegated a position of secondary importance. The relationship of an of these experiences to present life is often neglected. In effect, clients are frequently regressed to infantile states and left there unaided in their attempts to make these experiences work in their adult lives. A frequent attitude is " I shall take time out from my life until I am healed, then return to society an effective, defense-free, functioning individual."

Although the benefits of this radical but limited approach are dramatic for many, it leaves many others lost and confused. I believe this type of experience denies the value of most other aspects of a proven positive therapeutic experience, i.e. the healthy side of defenses, the value of intellectual functioning, and the need in everyone to have an organized internal ego structure; not defensive to, but facilitating to function. (There are others but space limits their mention here.)

What I now call "symbiotic therapy" often becomes the ideal. Briefly, in symbiotic therapy, the therapist is assumed to be able to enter into the earliest emotional level of the client, usually a body level, and give unlimited permission for the patient to experience with the therapist his earliest traumas. A therapist who is able and willing to give up dealing with intellectual and integrative functions during the sessions and feel exclusively from the "gut", "know all the client experiences and needs to experience, becomes the "prime" primal therapist. This is often perceived as sufficient for therapy. I call this "symbiotic therapy" because it recreates to some extent that relationship of mother to child prior to psychological birth.

This clearly has advantages and is appropriate as an integral part of therapy. In helping the client feel safe in an intimate relationship, he is able to go more deeply into crucial feelings than possibly could have been imagined previously. Unfortunately, this process frequently become an end in itself, and neither the therapist nor the client come out of this type of interaction throughout therapy. What can be a dramatically helpful part of therapy becomes a destructive regression in which pain triggers pain and the healthy part of the individual becomes even further disconnected. Too frequently clients end up seeking "ad infinitum" these intimate regressive experiences which can be most comforting and seductive, for it may be here only that the client feels fully understood and his infantile need seemingly met for the first time in his life. Unfortunately too, the therapist's own experience in his primal therapy has been in large measure of this same quality, and he may know little about effective integration, need for structure, or even the nature of the healthy personality.

What is lacking often in other therapies, i.e. feeling early body and psychological pain with a therapist capable of deep empathy, becomes the "end-all" of primal. ("You are your pain" is the expression). What is of value in other therapies, i.e., intellect, words, insight and action, is often deprecated in radical primal.

One last critical consideration: I feel all of us in the initial stages of our primal experiences isolated ourselves from the world, insisting only we had the answer. When any innovative philosophy insists it alone has the answer and is no longer open to other views, it merely repeats the mistakes of the rigidified institutions from which it so desperately flees. It frequently indulges in "group think" (see Psychology Today ,Nov. 1971). "Group think involves non-deliberate supression of critical thoughts as a result of internalization of the group's norms."

I wish to make it clear that much is gained through radical primal, if there is any question remaining of that fact in this critical analysis. Radical primal has demonstrated that re-experiencing feelings is an important capacity of the human organism for psychological and possibly body healing. Radical primal has demonstrated in a unique way the importance of intrauterine, birth and neonatal trauma. It has indicated how remarkably sensitive and sophisticated the developing embryo and infant are. Support for this new vision of the developing infant is increasing in sound scientific research. The so-called pain barrier of the theories of early infant neurophysiology and psychoanalysis, i.e. the infant has a very limited capacity to experience pain due to physiological development, is, as one researcher said at a recent symposium on "Infant Psychiatry: the New Frontier", no longer tenable. As the threatening oedipal theories of Freud are defended against by ridicule, so is the pain in us all from our intrauterine, birth and infancy defended against by this pain barrier and ridicule of primal in any form.

With some understanding of our disaffectations with the practice of radical primal, it may now be possible to see our motive for change. It now seems relevant to discuss the nature of these changes, although many of them have been implied by the previous material. I will confine myself to my own approach since others at the center may disagree as to specifics; however I believe there would be solid agreement with the spirit of these changes. I shall deal with the following topics:

1.) Post-natal Development
2.) Nature of defenses and structure of the ego
3.) The "track" and feeling and words simultaneously
4.) Present life
5.) Resisting the myths

In any child, certain post birth experiences are critical for healthy development. They must be encountered with some degree of positive fullfillment to attain healthy adulthood. Although need and pain theories of primal, i.e., pain is a result of repressed unmet need, in simplistic form, are an important contribution, they are insufficient to explain the incredible complexity of unhealthy development. Similarly, prebirth and birth trauma do not explain the complex effects of later trauma.

The psychological birth of the child, leaving the intimate symbiotic mother child relationship and becoming aware of his own person separate from the rest of his world, is crucial. The various phases illucidated by Freud, such as the oedipal, are equally real and crucial. There are many other concepts which accurately portray other pieces of truth about psychic and body development. I believe that it is vital for a therapist to have a broad range of awareness about these facts. The center also now encourages this and provides guest lecturers whenever possible.

This kind of data cannot be ignored in specific detail for adequate therapy when difficulty in these areas has been encountered in specific clients. Such problem areas do not always become obvious spontaneously to the patient as he follows his "track". Unless the therapist is knowledgeable, alert to their existence, can hear them in his client and, at times, direct the client's attention to their presence, they will be missed. These aspects of second line pain (post birth and pre-adult traumas primarily related to psychological function) must be dealt with in depth and specificity. No amount of feeling pain in general of birth and pre-birth pain can substitute for this therapy of later trauma.

The healthy child develops an ego structure which in part consists of defenses and structural map of how he perceives the world, which is close to reality and adaptable to new circumstances. Defenses in radical primal, as well as other therapies, are seen as barriers to pain and blocks to growth. A more fruitful concept, I believe, is that healthy defenses are facilitators of interactions between the person and his environment. Only when they have become rigid and directed toward blocking interaction in response to pain or conflict do we wish to interfere. They need to be encouraged when healthy and real in a process of ego enhancement. With such support the process of experiencing pain can be facilitated not restricted. The healthy defense needs differentiation from those which are self-defeating in the present. For example, intellectualization can be used as a rigid defense to block feelings and interactions as in the obsessive-compulsive personality, which clearly prevents personal growth. In contrast, this same "defense", intellectualization, when healthy and in the service of curiosity and openness can stimulate feelings and growth.

For many who come to primal, defenses are primitive and little ego structure exists. For these, an intensive devoted entirely to feeling can indeed be destructive. A place for developing structure and healthy defenses can be made as feelings are felt, hand in hand, not one then the other. At times, it may be imperative to defer any emphasis on feeling until some ego structure can be developed. There are many effective ways to build ego structure and they should be available to any competent therapist.

There are times, contrary to radical primal, when words and thought can be encouraged during intense body feeling experience. The track of the patient, however important, is not always sacrosanct. Early, and in new territory, it is vital to allow the client to discover and follow that track; but on occasion a track can become a rut. There are many ways this can occur. I wish to point out one here. Once a painful experience is discovered and felt, to some extent it may be easier to continue to re-experience this track unprofitably rather than experience new territory or this same experience in a new light. At these times, a gentle but firm jog during the feeling can be essential. There are times in intense feeling when a patient can express a new vision in words of the very process he is in, which, when he is out of the feeling, does not have nearly the impact or intregrative result. Expert doubling, as in psychodrama, can be a powerful experience for the client if applied appropriately.

I cannot emphasize enough the importance of the individual living his life as a facilitation of any primal therapy. Some of my most successful clients have never done more than once a week therapy, and continued to live using their life experiences for therapy, and their therapy for a better life. The present is an integral part of the individual, and when it is taken away by the therapist's restriction, by the client's inclination in response to his regressive desires, or excessive or too rapid therapy, it makes therapy like learning to walk with legs amputated. Of course, for some there are times when increased concentration on therapy may be appropriate, but this cannot become a way of life for truly positive benefits.

As in any theoretical approach, however much it attempts to be open, myths about the "right way" arise. Out of our long destructive experience to look for cures exclusively outside ourselves to solve our problems rather than responding to each situation appropriately, we greedily search for the unfailing guideline. These are few and they are never unfailing. In closing, I wish to mention:

1. The myth that there is a right way to do primal. There is none. The most difficult therapy of all, perhaps, is primal because it demands openness. This goes against most of our training and lifetime experience. There are no crutches.
2. The "that's not primal" myth. Any technique or approach may be primal facilitating. The only test is whether it works. If something is not working, "primal" or not, forget it.

3. The "first line" myth. How often do we take any new primal experience, usually first line (body pain), however feelingly arrived at and beneficial on first discovery, and make it the answer for all future pain thus avoiding the pain of a new trauma experienced later, often second line. The rut experience again. Every level must have its own time and place.

4. The "only my feeling" myth. The statement "I know this is only my feeling" is a discount of oneself. All feelings and experiences have some truth in the present as well as the past. When we give no credence to the validity of our expression in the present we leave ourselves open to missing the truth in the present. How often have I heard a therapist say to a client, "That is your feeling," when what the client was saying was true in the present as well.

5. The "I am my pain" myth. I am a lot more than that!

6. The "all of my pain is real" myth. Certainly much pain is real and the accuracy of our relived experience is far beyond what I could have possibly imagined before primal. However, as mentioned earlier, pain can trigger pain, particularly when insufficient integration of each experience has occurred and present life is minimal. Pain induced pain is unrelated to real events of the past. (See Kindling, Psychology Today, Aug. 1980). This can be dangerous!

7. The "all growth comes from inside" or "I won't need after primal" myth. As in any living organism, think of the plant, growth comes from optimal interaction of outside with inside. I will always need from outside. As the composer Aaron Copeland said at eighty. "There is nothing like approval to soothe the aching body of old age." If I can abandon my search for the unsatisfied need of infancy, perhaps I can partake of that which is given in abundance in the present.

8. "It will all happen big someday" myth. Core growth often happens slowly and even unnoticed at first. The big bang of primal therapy is a rarity, if it occurs at all. Sometimes it takes a conscious check to see where I was a year ago to make the change obvious.

9. The "I need an all safe therapist" myth. To have a therapist with whom you can feel reasonably comfortable most of the time is important. But when this occurs unfailingly, I believe something may be wrong. I need to be able to work through some feelings of discomfort with my therapist, and when I see clients searching for the perfect, all safe therapist, I wonder, "how will he ever get to that feeling without dealing with it with someone with whom he does not feel completely safe." When it is too easy to change therapists, the client may use this to avoid crucial areas.

10. "The client knows best" myth. This has been the cornerstone of much of primal philosophy, at least in words. Unfortunately, it is true only to a degree. In terms of underlying "body wisdom" it has merit, but there are times when even the body, let alone the intellect, can become self- defeating. Here the attuned therapist must be directive or at least suggestive - a bust as we say. It is the most difficult, delicate part of the therapeutic relationship, but essential. It need not, however, come from a place in the therapist which puts the client one down as occurs so frequently in the medical mode.

11. The "I am cured" myth. Like the words "I am clear" of the dianetics persuasion, "I am cured and free of my reservoir of unfelt pain" are absurdities. We live as dynamic organisms, never static. We will have pain, always, but hopefully here we can come to use our freely energized capacities to live it and not be the frozen dead bodies in response to pain that we all were to some degree before therapy.

12. "This is the right therapy for me" myth. Unfortunately, the sense of the rightness of a particular therapy is often an act out of pain rather than toward health. What makes the therapy work is often in spite of, not because of, that feeling.

In summary, radical primal has made a core contribution to therapy; the value of re-experiencing early trauma as body and psychological painful feelings. It is not, however, sufficient in itself for optimal growth to occur. The human being is far more complex and remarkable. It deserves and requires having all aspects, i.e., all feelings, intellect, words, structure, action,'present life, humor, defenses, even soul, utilized as well in any effective therapy. This is our idea of effective primal therapy. We feel second to no one in our endeavor to achieve this kind of therapy here.

I believe it would be a good idea to have a forum of some kind where these issues could be discussed further for those interested. Let us know if you are.


Dr. Baker was in private practice specializing in family and adolescent therapy when he became interested in Primal Therapy in 1972. Initially, he cautiously tried some of the techniques with a few selected patients. In 1974 he was introduced to Jules and Helen Roth, who had come from the Primal Institute and wanted to set up a Primal practice. They established what is now the Denver Primal Center. In 1978 he returned to private practice but is still a close friend and associate of the DPC.

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