The Change Process in Therapy
A pioneering piece of research (Marina 1982) has brought out a number of interesting points about the change process in primal integration therapy. What we are essentially talking about, it suggests, is a very fundamental cognitive-affective restructuring or personality change.
This can happen because the personality is a system such that each part depends on each other part. A change in one part of the system affects the whole of the rest of the system. For example, one woman in the research study had four main issues which all reinforced one another: Feeling suicidal, Feeling worthless; Being jealous and full of rage; and Feeling like an intruder. During therapy, a new element came in on the scene: Feeling myself more loving. This started to affect the whole balance of the other elements. After a time Feeling like an intruder was replaced by Feeling that I've got the right to be here, and other similar changes later took place in the other elements.
We do not know the details of the events which led to the incoming construct Feeling myself more loving. Since the person was in primal integration therapy, this may have been responsible. On the other hand, it may have been due to other life events, and the therapy perhaps merely made it easier for the change to work its waythrough the system. One of the things which most plagues any kind of adecent outcome study is that the client has a life outside the therapy sessions, and that most of the things which happen to the client happen there.
If we believe, as Michael Broder (1976) suggests, that the primal process consists of five phases: Commitment, Abreaction (catharsis); Insight (cognitive-affective restructuring); Counter-action (fresh behaviour in the world); and Pro-action (making real changes); then it must be the case that the later phases are just as important as the earlier ones. In other words, working through is just as significant as breaking through.
The glamorous part, and the controversial part, of our work is the 'primal', the cathartic breakthrough; but in reality the process of integration is necessary and equally exciting in its quieter way. For example, it is a great thing to get to the cathartic point of forgiving one's mother; it is another thing to start treating women decently in daily life, as a result of this.
But if we also believe in the importance of the transpersonal, we can go further, and say that the contacting and releasing of the real self is just one stage in a process which, as Wilber (1980) has pointed out, goes much further. As Adzema (1985) suggests:
A primaller also can be viewed as open to subtler energies after having reached a 'cleared out' relaxed state via primalling. . . and thereby to gain access to subtler energies still. (p.91)In other words, dealing in this very full and deep way with the psycho-logical realm enables us to go on and get in touch with the spiritual realm. But if this is the case, why have not more people working in the primal area noticed this? Adzema (1985 suggests that it is because prejudice gets in the way of it being reported, and creates a myth that nothing of this kind happens. But on the contrary:
Some long-term primallers with whom I have contact have talked of receiving love, helping, strength or bliss that seemed to becoming from a place beyond the scope of their current physical existence, to be emanating from a "higher power" of some sort. Their descriptions have many parallels to some descriptions of spiritual experience. (p.95)If this is so - and certainly this agrees with my own experience - then we can eliminate all the projections which come from unconscious material to plague spiritual life, and have for the first time a clean mysticism, not cluttered up with wombstuff, birth stuff, oral - sadistic stuff, Oedipal stuff and all the other unconscious bases for phony spirituality. As Adzema (1985) says:
. . . it becomes obvious that the 'demons', the 'monsters' and the resulting fear are not 'real' (in terms of being rooted in transpersonal or 'objective' reality). Rather, they are personal elements invading the perception of transpersonal reality...Not only this, but primal integration therapy also teaches us one of the prime lessons of all spiritual development - the ability to let go of the ego. There are times in our therapy when we have to take our courage in both hands and just go ahead, taking the risk, as it seems, of losing everything in the process. Many times the image of stepping off a cliff comes up in primal work. And of course this ability to let go, to step off into the seeming void, is crucial for spiritual commitment, as Adzema (1985) reminds us:
Likewise, an important benefit of primal is that it can teach us an attitude of surrender to process. That we can throw ourselves, time and again, into the maelstrom of catharsis and still, somehow, be upheld and even embraced, despite ourselves, gives us confidence in a beneficent universe and allows us to foster surrender in our attitudes to the pushes and pulls of process as it makes itself known to us in our daily life. (pp. 111-2)Through primal work we learn how to open up to our inner process. Through spiritual development going on from there, we can learn how to carry on with that same process, into the deepest depths of all.
This is the case of Heidi, a 40-year-old school teacher. She came to me complaining of having such severe depression that she had had to give up work. Her doctor had given her a certificate and some tablets. She was crying a great deal, and also had a lot of anger with her sexual partner, with whom she was also breaking up at the same time.
At first all I had to do was to let her cry. She needed nurturing and mothering, and I just listened to her and at times held her in my arms. What came out was that she had been taking on more and more duties at work - it seemed that she was a very good and well-liked teacher, who found it hard to say No when interesting projects came up. She had ignored her own needs and thought only of doing a good job and making people happy.
At the same time she had been having for some years a sexual relationship with a man, which had been a great strain. He had another woman, and when choices had to be made it seemed that the other woman took priority. At various times he had talked about leaving the other woman, but Heidi had now come to the conclusion that he was never going to do so, and that this was an unsatisfactory relationship for her, even though she couldn't help still being attracted to him. She had spend a lot of time trying to work out a three-way relationship. They had all wanted to be 'alternative', and she had not, as it were, wished them bad weather; she often thought they had agreed to something, but then had felt betrayed by some action of theirs. She had desperately wanted to do justice to both people, but as of now she had run out of energy for it. So she was deeply disappointed about that, too. Every time she thought about making a final break with him she would look round her house and see all the things he had helped to make - he had been of such practical help to her. A whole lot more very complex feelings, too, which came out later.
It seemed that the combination of these two strains had just become too much for her. It was made worse by the fact that both her lover and the other woman were teachers in the same school, so that she had to see him quite frequently, and her a bit less often, in the normal course of the day.
She became extremely sensitive to any suggestion that she might go back to work. Her self-esteem had sunk to a very low ebb. The school policy was to give generous sick leave to senior teachers, so in a way this was an ideal opportunity to do some deep work on herself. We started off with two-hour sessions once a week, and after two months moved to one-hour sessions twice a week, and after another month to one hour once a week; this latter lasted for a month. The rationale for this was that at first there was a great deal of distress, and the two-hour sessions were very good for dealing with this, giving time for the client to come up from the very deep levels she was getting into. Later there was less distress, and so we could proceed in a more considered and chosen fashion, deciding what needed to be done and doing it as expeditiously as possible. Later again it was more a question of just tidying up the remaining loose ends and working through any new problems quite quickly.
After the first few meetings, the energy seemed to settle mainly around her father. He had died before she was born, at the end of World War II, but her mother had not known this for sure until she was two years old. During that time her mother had been distressed, anxious and impatient, and seemed to have passed on to her in some way the feeling: "Is he or isn't he?" (This was very similar to the feeling she had about her lover - is he or isn't he with me?) Her grandfather had stepped in and allowed the two of them to stay with him until Heidi's mother remarried, when Heidi was six years old. This grandfather was sensitive, intelligent, worldly-wise but in some ways innocent, and very devoted to the two of them. He taught her many things and spoiled her, telling her she was wonderful and very clever.
But her father, though absent, had been more important for her. She had idealised him as a child, and thought of him as a hero. She had to live up to his expectations and do him credit. She did do well at school, and passed all her examinations with flying colours, first at school and then at the university. In her present job she had always had the feeling of doing well, and had been given special projects and extra responsibility.
It was then we discovered one of the points we mentioned in the earlier part of this article - it is the things we like which stop us developing, much more than the things we dislike. As we went deeper and deeper into Heidi's memories about her father, we found that she had taken on board as an absolute injunction that she must live up to his expectations. Even when she fought against this, and did things she knew he would not have approved of, she had to do them perfectly, so as to be able to face him. It would be too much to do something of her own and then find that she had to face his disappointment. So her job had become a challenge to him - a challenge which she could never meet, because he could always raise the standard in a way which left her powerless.
It was clear at this point that her father had turned into an internal persecutor. She had turned him into an implacable and impossible figure, very close to what Freud called the superego, Perls called the top dog, Jung called the father complex, and so on.
As she became more and more aware of this, so her emotions started to become deeper and more engaged, I encouraged her to stay with these feelings and really experience them, rather in the manner which Mahrer (1986) calls 'carrying forward the potentials for experiencing'. The emotions became more and more primal in their intensity. Suddenly when she was talking directly to her father on the other cushion, a wave of primal rage came over her, and she said "I don't have to please you any more!" I encouraged her to repeat this phrase with more and more intensity, until she went into a powerful catharsis, and then collapsed. I covered her up and watched over her until she recovered enough to leave.
In the following session a great weight seemed to have fallen off her shoulders. She came in smiling, and said "I didn't really believe in all that therapy stuff, but now you've convinced me." She was able to talk about visiting her parents abroad for a holiday, and getting a new job, and having a friend over to visit, and going on a psychosynthesis weekend.
She found it much easier now to express her anger towards her ex-lover, whom she had definitely parted with now. Although she was still attracted to him, and found the whole issue a painful one, the degree of pain was now much more bearable. Getting clear in one area made it much easier to get clear in the other.
It is important not to lay too much stress on this one incident, of course. There were at least four other factors which had made this breakthrough possible: the previous course of the therapy, which prepared the way for this act and made it seem natural; a change in medication which meant that she was less drowsy, more alert than before; some autogenic training (involving full relaxation), which made her better able to be present in the here and now; and a stay with a friend who had looked after her with a lot of care. Heidi began to talk about going back to work, but still genuinely could not face the twin threat of the work and the lover. So the therapy turned more on to the problems around him, which turned out to be very complex. But in the end, Heidi was able to breathe more easily and take back nearly all of her illusions and projections on to him.
This case was very suitable for an article like this, even though it does not bring out the full holonomic process, because it was quite short and concentrated, so that the main lines are not lost in a mass of detail. We have the initial presenting problem, quite a complex mixture of work and private life; we have the gradual focussing upon one issue, always going by the client's energy and directions; we have the resolution of that issue in a cathartic experience; we have the working out of the complex relationship with her lover; and we have the progressive working out of the practical matters which then emerged.
A number of factors helped to make this case a success.
First Heidi had a good friend called Victoria, who spent a lot of time with her, simply listening to her and comforting her and telling her she was OK. We find that the support network of a person can be quite crucial in allowing the client to get the most out of their therapy. In fact, Swartley often said that the 'second-chance family' which is often found in intensive primal integration groups could be a highly significant element in the process of therapy. The fact that Victoria could provide just such a second-chance family, allowing Heidi to regress almost to a baby stage and then grow up, was in my opinion of inestimable benefit.
Second, the fact that Heidi had very good employers, who were willing to support her for three months while she worked out her problems, and who were then prepared to lose her without any criticism, was also of great value. She did not take this for granted, but appreciated it very much as a gift.
Third, the fact that the man she had been with did not pester her or burden her or make life difficult was very helpful. There were certainly occasions when he did suggest coming round or going out with her again, but not in a way which put great pressure on her.
Fourth, her mother and stepfather held open house and were very supportive when she wanted to take a holiday with them. The fact that they lived in another country probably helped to make the holiday she took even more refreshing and different for her.
It is very important to recognize these factors and the part they played. Therapists sometimes write as if therapy sessions were the whole of life, or at least most of it, and of course this is never so. The everyday life of the client can be immensely influential in helping or hindering the kind of work which a client needs to do in therapy. And it is everyday life which lasts when therapy is over.
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