How Do We Know if we Are Getting
Safe Primal Therapy?

by Pat Törngren

When Primal Therapy was first described by Arthur Janov in the early 1970s it was considered revolutionary. But today, many therapists around the globe are using primal techniques in their practices, with varying degrees of success, from highly successful, to downright dangerous.

It is now known that using a few simply described techniques, it is possible for almost anyone to get some people into the reliving of childhood traumas, and sometimes even birth pain. So what is it that makes certain therapies very safe and supportive, and others dangerous to the patient undergoing the process?

The answer lies in the context in which the reliving takes place and the relationship between the therapist and the patient is probably as important as any techniques that may be used. Therapists and centers that understand that are the ones deemed to be safe, and those who don’t are the ones that are possibly dangerous to the health and safety of their clients.

In the Primal Institute Newsletter Jan/Feb/March 2004, Barry Bernfeld addresses one of the most important aspects in his article “Protecting the Primal Revolution”. He says, “The unconscious will only give up its secrets, will only reveal the pain from within when there is true safety”. This is probably the most important sentence in the whole article!

We now know that it is not desirable to try to smash a way through someone’s defenses with a sledgehammer, or prize open the unconscious with a crow bar! This was done in the early days of Primal Therapy, and it is to the credit of the Primal Institute that the danger of this is now clearly understood and such techniques are no longer practiced at the P.I., as it can take the person into breakdown rather than healing.

In some of the circles I move in, it is fashionable to put a lot of emphasis on measuring the vital signs of the patient during a primal, and therapy that does this is considered “scientifically superior” to therapy that doesn’t. I have a serious problem with that. We cannot measure the depth of healing by reducing the psyche to a set of vital signs, or reduce the human spirit to series of lines on a piece of graph paper, or blips and bleeps on a heart-rate monitor.

We owe a great debt to Dr. Janov for describing the changes in the vital signs before, during and after primals. This has led to good research being done, and a scientific basis for Primal Therapy being established. But while these phenomena are interesting and even very important for developing a scientifically credible theory of Primal Therapy, measuring vital signs is usually not helpful to the patient for his or her therapy.

The most important factor in successful therapy is long-term follow-up by one main therapist who the person works with over time. The patient needs to be is able to form a transference relationship with the therapist and be able to count on that person to be there for them well into the foreseeable future.

This does not mean that we can’t work well with several therapists or buddies, but there needs to be at least one constant and stable person who will be there over time to create true safety. (I have been in therapy with one therapist, once a week - with emergency sessions in-between when needed - for the past 9 1/2 years. This has proved ideal for me.)

On rare occasions I have had to work with a colleague of his and initially had an interesting (almost amusing) experience in this regard. A few years ago I had a birth primal over the telephone with my therapist’s locum before I had even met him! My therapist had taken a few weeks leave to go on holiday with his children, and gave me the telephone number of a colleague to call if I had an emergency.

Well, earlier that week I had to have my beloved cat “put down” and she tragically died in a great deal of pain and fear at the animal hospital, while I held her. This triggered my own birth feelings where I “died” in the birth canal, also in great pain and fear, and as a result I was in too much pain to cope on my own in the present.

So I picked up the phone and reached Peter, my therapist’s locum, whom I had never even spoken to before. I could barely introduce myself, before saying, “I am in pain right now, can you be there for me?” Peter, who had received my call on his mobile phone asked me to give him a few minutes to pull his car off the road, and was then happy to give me his full attention.

I explained to him that I didn’t need him to say anything, just to listen, and within seconds I was deep into the primal, crying like a newborn. I asked for a follow-up session, and later that week when I arrived for my first appointment, he admitted that this was something that had never happened to him before.

In fact he asked if I felt uncomfortable about having experienced something so deep with a person who was a total stranger to me. As someone who has primalled over the years with various buddies and family members (in fact sometimes anyone who I could get to listen to me) I was able to reassure him that he made a great “primal buddy”!

We did some very good work during the weeks that my therapist was away, but I have to admit that I was very happy when my own therapist returned. He has consistently provided solid containment for me over almost a 10-year period. As a result, though the depth of my primals may not be dependent on him, my level of healing is, due to the fact that I can count on him to be there for me and offer me a secure and safe space into the foreseeable future.

Another danger in addition to non-continuity of care, is forcing medication onto a patient, and I was disturbed to be told that at one Primal center, most of the patients are on medication. In fact a personal friend of mine went though such an experience, and it is quite remarkable that she lived to tell the tale.

She traveled all the way from South Africa, to a center in the USA to ‘enhance’ her therapy, after doing about 8 or 9 years of successful second-line primalling with a local clinical psychologist, who simply ‘listened and supported’. She had only a month to spend in the USA, and so was seen in therapy daily.

Within a few days she was told that she must take medication, and a number of drugs, including Prozac, were prescribed for her. My friend was very reluctant to take them as she had never needed drugs in the past, but she was told that if she didn’t take the medication, she would be thrown out of therapy. So reluctantly she complied.

Within 24 hours she had had her defenses blown apart by the drugs. She dropped straight down into birth primals (which she had never had before) and primalled the same sequence over and over (possibly as a defense) for more than 36 hours without being able to stop.

Finally heavy doses of sleep medication were prescribed, and she was able to get a little rest, or perhaps more accurately, her body was forced to take a rest. But a huge amount of damage had been done and by this time she had come apart at the seams and was feeling suicidal.

When the four weeks were over, she was taken by someone from the center and put onto the airplane back to South Africa. She was awash in primal pain and totally unable to take care of herself. She was also still suicidal and in a state of total breakdown. I believe that she did in fact actually try to commit suicide at one stage but I am not sure at what point that was.

On arrival back in South Africa she had to be admitted to a psychiatric hospital where she was diagnosed and certified as psychotic and given a number of electro shock treatments. Finally she managed to persuade the staff to allow her to use a sound-proofed, padded “isolation” room used for patients who were potentially self destructive.

There, over the weeks that followed, all on her own, she primalled her way through the pain that had been prematurely triggered, and was able to be discharged from the hospital, though the slur on her name from being certified psychotic may make it hard for her to find employment in the future. When I last saw her she was trying to raise the money to take the hospital to court and have her name cleared and herself declared “competent”.

My friend’s situation may be extreme, but it raises several important points, one of them being “pushing” people into very early first line pain and pressure to relive birth experiences, an issue which Barry Bernfeld also covered in the Primal Institute Newsletter.

Personally I have found it very helpful indeed to relive my own birth, but the reason it has been safe for me is the fact that my therapist has offered me solid containment over time, and the promise of ongoing support, way into the future. Since being with him, my birth pain has emerged spontaneously because he made it safe for my unconscious to “offer up its treasures” of its own accord.

But without that kind of support, revisiting my birth would have been potentially dangerous for me personally. It is also important that he has never pushed or even encouraged me to there, and my early primals have always begun in the here-and-now, and gone back through second-line connections, before any very early pain emerged spontaneously.

In fact my therapist only ever ‘busted’ me on one occasion, and the results were dramatic to say the least. It was near the end of a session, and he said, “I can’t help you, Pat”. This immediately threw me into my birth sequence (needing help in order not to die), which my therapist had not intended to do, and for which he later apologized.

At the time, the shock of what he had said made me go completely numb, and for the rest of my session I was barely able to speak. My therapist had no idea at the time what danger I was in, but I knew that I was in so much pain that I was nearly hallucinating. However, in spite of that I had no primal access as I had gone into shock.

It was only in the car on the way home that the feelings emerged, and I started having a birth primal on the freeway during rush hour traffic! Fortunately part of me seems to have remained in control, even though I was primalling my way through a complicated clover-leaf fly-over, with the cars bumper to bumper, while I was slumped over the steering wheel of my own car crying like a newborn baby.

I got home as soon as I could and called my therapist immediately. He picked up the phone right away, and I was able only to say, “Abraham, can you be there for me?” before I went straight into the primal again, and at a very deep level. Later he told me that after the session he had got the gut feeling that he might have triggered me in a way he hadn’t intended, and had been waiting at the phone to offer me support if I needed it.

Well, like I said, I did get home safely – probably due to the fact that my car seems to know it’s own way home since this was not the only time I have primalled while driving. But I don’t recommend it, and my therapist doesn’t either. At my next session he apologized and told me that he felt very uncomfortable with what he had done to and that he would never ever do it again. He never has.

So, while primalling early pain has helped me enormously, I believe that for most people it can be safe only when there is long-term follow-up over time, in a very stable and contained patient/therapist relationship. People who have traveled to attend a center away from the place where they live, should probably not be encouraged to get into very early pain if possible, unless some other means of long-term containment with a single supportive therapist or very competent buddy can be provided when they need to return home.

The matter is further complicated by the fact that if one’s defenses are functioning optimally, very early pain may not emerge until the individual has been in therapy for some years. By that time many people are no longer in formal therapy, and may be feeling their own pain only with friends or buddies who may not be able to provide enough support to make the process safe.

Another danger is the fact that those of us who actually “died” in the birth canal often become suicidal when reliving this trauma. This was certainly true for me since I was born “dead on arrival” (without any vital signs) after a long and complicated labor that ended in an emergency forceps delivery. I had to be resuscitated with an injection of adrenaline into my heart, a tube supplying oxygen into my lungs and physical rhythmic pressure being applied to my chest to try to start me breathing.

The ‘lesson’ that I learned from this experience was that when I was in pain, death was a wonderful way out, and brought relief from the unbearable torture that had seemed to go on forever. I think what has saved my life in the present is the fact that I didn’t ‘choose’ to die in the birth canal, but was in fact ‘killed’ by my mother. As a result my suicidal impulses have been passive death wishes rather than active urges to kill myself.

For me, reliving this very early pain has resolved a lot of important issues in my life, but what has made it constructive rather than destructive, is the fact that my therapist has been there for me all the time over the years (including 24 hour round-the-clock telephone support). The fact of his continual availability has made the process safe for me. This point was brought home to me dramatically a couple of years ago at a time when my therapist was taking a Christmas vacation.

At this time I was once again seeing Peter, his locum. For reasons that are unclear to me, I began primalling almost continuously round the clock. So I had to continue with my daily activities through the primals, which included crying in a restaurant with a friend, because I simply couldn’t hold the pain down. I also became unable to speak properly except taking baby talk, which scared and embarrassed my family and friends!

The most frightening incident happened in the supermarket on a Sunday evening. I was wheeling my packages out of the crowded center when I passed a security guard with two loaded guns in his belt. On impulse I had the overwhelming urge to lunge at him, grab a gun, point it at my right temple, and pull the trigger (I was not feeling even remotely suicidal at the time.) Fortunately I was able to stop myself, and I managed to get home, badly shaken up, but safely inside my house where there are no loaded guns.

In my mind I remained obsessed with guns, terrified of them, and scared of what I might do in the future. Fortunately a short while later, I made the connection. During my birth, death and relief from pain came to me right after experiencing a tremendously sharp pain in my right temple. This was caused by forceps, with which I was pulled out of the birth canal. As soon as I made the connection, the impulse to shoot myself in that exact same spot to get relief, disappeared, and it has never recurred. However, the whole incident was terrifying when it happened.

What is of interest to me is that my therapist was away at this time, and though his locum is a great facilitator, he doesn’t offer me the same degree of containment that my own therapist offers. My therapist does this very unobtrusively by gently helping me to get a cognitive overview of what is happening. This helps me to ‘keep my head on top of the pain’ when too much early stuff is being triggered by the circumstances in my life.

To return to the important theme of continuity, I believe that it is also very helpful to work with other primallers in small groups. But once again, I feel that these groups should be ongoing, and that people should not be encouraged to open up to very deep pain in a group that is suddenly discontinued.

When I was at the Primal Institute in 1977, we had only “big group” which was very impersonal (though sometimes helpful). So I was delighted to note that soon after I completed my time at the P.I., patients were put into small, ongoing groups. There they could use the dynamics of interacting with each other and triggering each other’s primals, while at the same time receiving support and continuity of care.

I think the whole subject of safe primalling can perhaps be summarized by that one word “care”. When it is there, no matter how deep the pain, therapy can become a safe process. If it is not there the patient will “know” it and not feel, or be, safe. So to my understanding, it is in this context of personal caring that the future success of Primal Therapy lies.