By Stephen Khamsi, Ph.D.


The author describes the theoretical model of the person upon which primal therapy was initially constructed, pointing especially to its delimiting and restrictive aspects. He proposes to expand the model to make it more compatible with humanistic approaches to psychotherapy. The complementarity between primal therapy and humanistic psychology is explored, and modifications are suggested which would enhance this complementarity. The author concludes by offering a brief review of the literature that illustrates innovations in primal therapy.

All systems of psychotherapy employ conceptual models that function much like a set of blinders, enabling the practitioner to focus on important matters while disregarding the irrelevant. In any therapeutic encounter the practitioner's conceptual model of the person determines the treatment procedures employed. A therapist employing a behavioral system might treat a patient a particular way, while a psychoanalyst would think of and therefore treat the same patient in a completely different manner. A therapist's philosophy affects treatment in a way that is physical, not merely metaphysical or conceptual; a person who is being treated with aversive conditioning, for instance, is being subjected to a physical reality.

Primal therapy also has a guiding conceptual model, or paradigm. The original primal paradigm presented by Arthur Janov (1970) suggests that all persons have basic needs that must be fulfilled in order for proper psychophysiological development to occur. If basic needs are unmet, pain results. Overwhelming and sustained pain leads to physical repression and a splitting of affective from cognitive awareness. One then proceeds through life unaware of real needs and feelings and so must pursue symbolic substitutes. This process of pain and subsequent repression is called neurosis. The only way out of neurosis is to fully experience and integrate the major pains that led to primal unconsciousness and symbol-seeking behavior. This process of reexperiencing and integrating early pain is called the cure. More succinctly, people are "prisoners" of their pain until they feel it; they are then free of their "life sentences."

Janov's primal therapy, like Freud's psychoanalysis and Reich's vegetotherapy, was developed within an essentially medical framework and is aligned with the disease model of functional psychiatry. "Doctors" perform "therapy" on "patients" because they have "mental illnesses." Whereas psychiatry recognizes many functional afflictions, primal theory recognizes only one: neurosis, a disease of feeling (Janov, 1970, p. 20). Neurotic symptoms are seen as stemming from an underlying "primal pathophysiology" (Holden, 1977c). Psychoses are quantitative extensions of neurosis.

What are the clinical complements of such a model? Pain is to be felt at any expense. The patient's defenses are met with a "frontal assault" (Janov, 1977, p. 335) so that they may be stripped away. The primal model justifies the use of any technique that helps the patient (re)experience pain, such as name-calling or arriving late for sessions to heighten anxiety. Authoritarianism and "busting" may be considered necessary. In short, the therapist does something to the patient to put him or her into the "primal zone" (Holden, 1977a, 1977b).

Implicit in this model is the notion that it is best to reexperience the earliest pain one can. Some therapists come to emphasize birth and prebirth ("first line") experiences to the exclusion of childhood ("second line") pains, which are considered to be of secondary importance. Moreover, the relationship of any of these feelings to the patient's present life may be neglected. This approach is what the psychiatrist Warren Baker (1980) calls "radical primal."

Radical primal has made a core contribution to therapy. . . . 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. (p. 4)

Just as a model of this kind determines which treatment procedures are indicated, so it defines which methods are rejected. If reexperiencing pain is the prime goal of primal therapy, then a therapist will seldom if ever deviate from the orthodox strategy by showing empathy or kindness to a patient (except to increase access to primal pain) or by "allowing" a patient to express strong feelings directly to the therapist without performing a primal reduction, thereby "permitting" transference. Nor will the therapist share a personal experience with a neophyte primaler, thus initiating a primary relationship in the present. As Baker (1980) points out, "What is lacking in other therapies, i.e., feeling early body and psychological pain with a therapist capable of deep empathy, becomes the 'end-all' of primal. . . . What is of value in other therapies, i.e., intellect, words, insight and action, is often deprecated in radical primal" (p. 2). Clearly, there is a danger that a patient in orthodox primal therapy could meet the very type of maltreatment that he or she is in therapy to resolve; one must certainly be judicious in the application of such radical techniques in order to avoid compounding the pain and defensiveness of the patient.

Such is the model of primal therapy still being espoused by its founder ("An Interview with Arthur Janov," 1977; Janov, 1980). However, most veteran primal therapists have actually expanded and modified their approaches to include aspects of treatment and philosophy not contained in the orthodox model. Although the orthodox primal model initially led to important breakthroughs in the practice of psychotherapy, it no longer offers optimal support for primal practitioners.

The primal paradigm was formulated by Janov beginning in 1967, when his first patient underwent an intense abreaction, which he later termed a "primal." The psychologist Leslie Pam ("Primal People," 1974), a certified senior therapist at the Primal Institute, described an early model of the primal therapeutic process that was very different from the current orthodoxy.

In the early days . . . after you felt one feeling then Art [Janov] would say, "You're never going to be sick again, see?" If you felt a feeling and you came out of it and said, "Gee, I was really crazy," he would say, "Well you'll never be crazy again." . . .As though one Primal could work the cure! (p. 158)

There were three primals . . . the birth, the death and the life . . . and you had to have those three Primals. You had to do it on command. (p. 162).

This early theoretical model, in which patients were expected to be cured after experiencing three specific primals, paved the way for the estrangement of patients from their actual experiences, for responding to the myth instead of to oneself. Patients treated while the primitive three-primal model was in effect began to have those three primals. In an interview published in 1977, Vivian Janov (Arthur Janov's wife) explained how her privileged position allowed her to move beyond the myth of the three-primal model and to connect with her own genuine experience.

I began to realize . . . that some of those early patients were being too much influenced by each other and by Arthur, intellectually. And I just felt like they were getting a little mystical about it.

I guess I had more courage than they did to say to Art, "You're wrong, there is no Death Primal, and here's what's really happening. . . . I'm discovering that there's more than two or three pains down there. You know, it's like a whole big storehouse, a big ball of Pain with a lot of different labels on the ball that you have to keep hitting.

I think they were all afraid at the beginning. Everyone was so excited and exhilarated and I think they were afraid to burst Art's balloon by telling him that they were starting to feel bad again after they were supposed to be "cured." ("An Interview with Vivian Janov, 1977, pp. 184-185)

At this time primal theory was still in its formative stages. The theory was flexible; when anomalies were experienced the theory embraced them. The theoretical formulation, helping at first to focus on and organize observations and experiences, expanded as experiences broadened. Subsequent experience has shown the three-primal model to be notoriously simplistic and limiting. In my own clinical practice, for example, I have observed primals that derive from hundreds of different types of experiences.

Primal therapy has progressed from these primitive beginnings to a much more refined and systematic approach through evaluation and alteration. This process of refinement should continue. Primal therapy must remain open, as it has in the past, to evaluation, reevaluation, and modification. One of the ways that the orthodox primal model might be amended is by incorporating certain concepts from humanistic psychology. Primal therapy and humanistic psychology are compatible and complementary, each potentially extending and strengthening the other.

Humanistic psychologists tend to think of the person as a conscious agent, freely making choices and acting with intentionality; he or she is active, autonomous, creative, and self-governing, motivated by an organismic propulsion toward self-actualization. Carl Rogers (1980), for example, speaks of the "actualizing tendency" of human beings: "Individuals have within themselves vast resources for self-understanding and for altering their self-concepts, basic attitudes, and self-directed behavior" (p. 115). He also posits "an underlying flow of movement toward constructive fulfillment of . . . inherent possibilities" (p. 117). This is a picture of a person undistorted by chronic primal pain, an individual who is in touch with his or her "real self," no longer deadened or defended, ready to live now to the fullest.

While the primal model is helpful for understanding and working with someone in pain, its utility fades as the pain diminishes. This is where a humanistic model can be of assistance. A person who feels and integrates primal pain has the potential to become increasingly more conscious and free, much like the humanistic model's image. The deterministic influence of chronic, unfelt pain now becomes softer and more shadowy. The application of the humanistic model helps in understanding and working with people who have "felt through" their primal pains and have thereby heightened their ability to make use of inner potentialities.

A close look at humanistic psychotherapies suggests a reappraisal of the therapist-patient relationship offered by the orthodox primal model. For example, Rogers believes that three conditions must be present so that clients can be helped to tap their inner resources for growth: genuineness, unconditional positive regard, and empathetic understanding. I wish to make it clear that I am not implying that primal therapy should become strictly client-centered. Rather, I believe that the client-centered approach offers insights and possibilities for the receptive primal practitioner. It is important that a therapist be as therapeutically responsive as possible; this means neither attending exclusively to pain nor attending to everything except pain. We all have pain and, at the same time, we are all much more than just pain. The goal must be to respond to the whole person.

Primal theory complements humanistic psychology in that primal pain, largely unaccounted for in the humanistic paradigm, helps to explain much of the so-called existential anxiety and deficiency motivation that purportedly plague humankind. What is missing in humanistic psychology is an appreciation of the magnitude of primal pain as a reactive force in human experience and an awareness of the healing effects of reexperiencing these pains. Maslow's (1968, chap. 3) proposal, to take one noteworthy example, conspicuously lacks the notion of primal pain and its effects in determining one's status relative to deficiency- or growth-motivation. Likewise, Rogers is accepting of the person but underestimates the importance and power of facilitating primal experiences for people in pain. Humanistic psychotherapies can strengthen themselves by becoming familiar with and embracing this core principle of primal therapy.

Primal therapy already draws on several humanistic themes. For example, there is little or no emphasis on psychodiagnosis per se; experience is prized as highly as analysis; experienced reality is considered valid; and advice regarding the conduct of one's life is rarely administered. Furthermore, many examples of humanistic innovation in the theory and practice of primal therapy have been described in the literature. Vivian Janov (1973) early on questioned using the labels "therapist" and "patient" in primal therapy. Her article, "The Cure for Neurosis?" also offered a translation of the medical concept of "cure" into experiential language. Leslie Pam ("Primal People," 1974) expressed his belief that besides understanding defenses a primal therapist must be a human being with a patient. A therapist is someone who can "reflect back the truth. . . . It's sitting there and just being real" (p. 165).

Many similar contributions have come from therapists outside Janov's Primal Institute. Hannig (1980) stressed that primal therapists must be flexible in providing other avenues of self-growth. In contradistinction to Janov's insistence that a primary relationship is detrimental to the primal therapeutic process, Hannig believes that the success of any therapeutic intervention is dependent on the nature and quality of the therapist-client relationship. Humanists are intimately familiar with this idea, that of the importance of the "therapeutic alliance."

DiMele (1974) insisted that primal therapists must examine their working assumptions, guidelines, and goals; otherwise "we may be limiting the client strictly to experiences which fall within that structure. If instead, our approach is to constantly examine the structure for that which may be limiting the client, then we may be able to facilitate the client's breaching his own protective boundaries" (p. 23). Weiner (1975) noted that Janov had "seriously underestimated the strategic significance of at least one very central aspect of long term psychotherapy--the transference phenomenon" (p. 21). He further observed that "the role of pleasure . . . is conspicuously absent in Janov's theory" (p. 21). He added that "given the complexity of life-long reinforcement of neurotic character structure in our . . . neurotic culture, the expectation of a 'cure' seems a patently naive one" (p. 22).

Freundlich (1976) describes several pitfalls of primal therapy, including the glorification of pain, primaling everything, the denial of transference and countertransference, "getting into feelings," distrusting positive feelings, and the premium placed upon dramatic primals. He advocates a more open system, one that is sensitive to subtle nuances of feeling in both therapist and client. He also urged that discretion be exercised regarding which experiences are processed via primal reduction.

Expanding on the last point, Lonsbury (1978), writing in the Journal of Humanistic Psychology, stated that "the primal reduction does not fit all forms of deep feeling experience" (p. 19). Issuing an indictment of orthodox primal therapy, he explained that "those who commit themselves to the primal process are presented with a distorted approach to emotional life. . . . Patients are conditioned not to validate feeling a need for love or any other deep feeling" that does not result in a primal discharge (p. 21). Lonsbury speaks from direct experience, having undergone primal therapy with Arthur Janov. In fact, Lonsbury's is the case history presented under the name "Tom" in the appendix of Janov's (1970) Primal Scream.

More recently Roland Peters (1980), an MD who is a therapist at Janov's Primal Institute, started that "the individual can only feel each feeling when he ready for it in his life as a whole" (p. 2). Dr. Peters is interested in all facets of his patients' lives, not just in their symptoms, pain, and defenses. He moved beyond the orthodox primal model in stating further that "feeling is only a part of the whole process" of primal therapy (p. 2), implying a more holistic, developmental viewpoint.

Two processes, building up to the feeling on the one hand and making new steps on the other, are synchronous, being dialectical parts of the same process. The dialectic is that making progress in life may often allow the old feeling to come up, and then feeling the old deprivation in turn allows one to go even farther in satisfying needs. In the long term, these things happen together. The process is not complete and does not work unless each component is present. I see feeling Primal pain as an inherent part of growing, but not as the whole growth. (p. 2)

All of the preceding examples are important theoretical and clinical issues. I wish to cite one last article, written from one client's personal experience, that illustrates the beauty and the power of a more humanistic primal therapy. Psychologist Ruth Loveys (1980) described her experience of transferring from the Primal Institute in Los Angeles to the Denver Primal Center. In Denver she found the therapists not so distant from the clients as in Los Angeles. She met greater flexibility and was generally allowed to follow her own instincts. No longer was she labeled "neurotic" not drugged to counteract "mysterious pain overloads." Instead she was told that she held within herself "pockets of richness" which were as important and formative as her pain, abuse, and trauma. Because of all this, she stated, "the complete me--not just the sick side--was free to surface" (p. 9). She was thus empowered to overcome what she termed her "Primal neurosis," in which her defenses were inadvertently reinforced by the therapeutic procedure.

I am now able to allow my thoughts to flow more freely--especially, to open up to the distinct possibility of incorporating the good that is be found in other psychological theories and movements into the Primal framework. More than that, I believe that these other points of view must be merged if the Primal community is ultimately to survive. And this must be done very soon. (pp. 11-12)



Baker, W. (1980). Toward a more effective primal therapy. Denver Primal Journal, 2(2), 1-4.
DiMele, A.F. (1974). Innovations in primal-oriented therapy: The all-sound method. Primal Community,     1(1), 22-25.
Freundlich, D. (1976). Pitfalls of primal. Primal Community, 1(4), 13-18.
Hannig, P.J. (1980). Therapeutic alliance: A necessity of the future? Feeling People Newsletter, 4, 6-7.
Holden, E.M. (1977a). The dialectical unity of healing and suffering--The primal zone. Journal of Primal   Therapy, 4(1), 5-17.
Holden, E.M. (1977b). Practical applications of the primal zone principle. Journal of Primal Therapy, 4(2),   148-153.
Holden, E.M. (1977c). Primal pathophysiology. Journal of Psychosomatic Research, 21, 341-350.
An interview with Arthur Janov: Comments on the theory and practice of primal therapy. (1977). Journal   of Primal Therapy, 4(1), 82-101.
An interview with Vivian Janov (1977). Journal of Primal Therapy, 4(2), 179-191.
Janov, A. (1970). The primal scream. New York: G.P. Putnam's Sons.
Janov, A. (1977). Toward a new consciousness. Journal of Psychosomatic Research, 21, 333-339.
Janov, A. (1980). Prisoners of pain. Garden City, NY: Anchor Press/Doubleday.
Janov, V. (1973). The cure for neurosis? Journal of Primal Therapy, 1(2), 152-154.
Lonsbury, J. (1978). Inside primal therapy. Journal of Humanistic Psychology, 18(4), 19-28.
Loveys, R. (1980). From L.A. to Denver: Heading home. Some experiential differences between the   Primal Institute and the Primal Center. Denver Primal Journal, 2(2), 9-12.
Maslow, A.H. (1968). Toward a psychology of being (2nd ed.). New York: Van Nostrand Reinhold.
Peters, R.K. (1980). The integration of past and present. Primal Institute Newsletter, 2(5), 2.
Primal people: An interview with a therapist. (1974). Journal of Primal Therapy, 2(2), 155-173.
Rogers, C.R. (1980). A way of being. Boston: Houghton Mifflin
Weiner, H. (1975). Beyond Janov. Primal Community, 1(3), 21-22.

[Originally Published in The Humanistic Psychology Institute Review, Vol. 3, No. 2, Fall 1981, pp. 51-60.]

Stephen Khamsi, a primal psychotherapist since 1977, is currently in private practice in San Francisco. In addition, he teaches psychology and human sexuality at the collegiate level. Dr. Khamsi received his doctorate from the Saybook Institute in San Francisco, in part for his original research on primal therapy.

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