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Primal therapy is a trauma-based psychotherapy created by Arthur Janov, Ph.D.

Arthur Janov claims that neurosis is caused by repressed pain which is the result of childhood trauma. Janov claims that repressed pain can be brought to consciousness and resolved, by re-experiencing the traumatic childhood incident and by fully expressing the resultant pain in a therapeutic setting. Janov claims that by re-experiencing traumas and expressing long-buried painful feelings, permanent resolution of neurotic symptoms will be achieved. Janov created primal therapy as the means of eliciting repressed pain and trauma. Janov claims that in primal therapy, patients would find their real needs and feelings in the process of experiencing all their Pain. The capitalized term "Pain" refers in primal theory to any general emotional distress and its purported long-lasting psychological effects.

One of the claims of primal therapy is that therapeutic progress can only be made through direct emotional experience, which allows access to the source of psychological pain in the lower brain and nervous system. According to primal theory, psychological therapies which involve only talking about the problem (referred to as "Talking Therapies") are of limited effectiveness because the cortex, or higher reasoning area of the brain, Janov claims has no ability to affect the real source of psychological pain in other areas of the brain. This is emphasized throughout the writings of Arthur Janov.

Dr. Janov and his associates have continued practicing the therapy and providing it at his Center in Santa Monica, California.

Primal therapy received public attention after ex-Beatle John Lennon sought treatment from Arthur and Vivian Janov. His experience in therapy heavily influenced his 1970 John Lennon/Plastic Ono Band solo album.

Janov's first book on the subject, The Primal Scream, was published in 1970. He soon trademarked "Primal Therapy", then lost a court case over it, and eventually the trademark was withdrawn by the patent office only about five years after The Primal Scream appeared.

Concept

Janov claims that neurosis is the result of suppressed pain which is the result of trauma, usually trauma of childhood origin. Janov claims that the only way to reverse neurosis is for the neurotic to confront his trauma in a therapeutic setting. Janov claims that by confronting his trauma, the neurotic can "re-live" the original traumatic incident and can express the emotions that occurred at that time, thereby resolving the trauma.

Janov believes that there is only one source of mental illness (besides genetic defects) - imprinted pain. And Janov believes that this unitary source of neurosis implies that there can be only one effective cure - re-experiencing.

Needs

Janov felt that much of the pain of childhood is the result of needs going unmet. Drawing from earlier psychologists, Janov described his take on the basic needs in his books. "Our first needs are solely physical ones for nourishment, safety and comfort. Later we have emotional needs for affection, understanding and respect for our feelings. Finally, intellectual needs to know and to understand emerge."

"Need is a total state of the human being - and at birth we are almost nothing but need." Janov argued that for the helpless newborn, survival is at stake in nearly every second of existence.

Janov claimed that when needs go unfilled for too long, Pain is the result (He capitalized Primal Pain in his early work, although in later works he dropped the capitalization).

Pain

In primal theory, "Primal Pain is deprivation or injury which threatens the developing child. A parent's warning is not necessarily a Primal Pain for the child. Utter humiliation is...An infant left to cry it out in the crib is in Pain...It is not hurt as such which defines Primal Pain but rather the context of the hurt or its meaning to the impressionable developing consciousness of the child."

Arthur Janov described Pain as the pain that doesn't hurt because, as soon as they go into it, it becomes simply feeling. Most of the suffering component is in the blockage or repression.

Consciousness and repression

In primal theory, Janov claimed that consciousness is not simply awareness but refers to a state of the entire organism including the brain in which there is "fluid access" between the parts. Using the triune brain work by Paul D. MacLean, and adapting it to Primal Theory, three levels of consciousness are recognized in Primal Theory

The following table summarizes some of the fundamental ideas and terms Janov (J) has used as well as conventional terms used in general and scientific papers.

• Janov described defenses as the agents of repression and consume energy while protecting the system from the catastrophic Pain of unfulfilled need. When referring to Pain or defense the word "line" is used instead of "level"; e.g. first line Pain = early trauma imprinted in the brainstem usually involving physical injury, third line defense = intellectual defense.
• The brainstem has also often been referred to as the reptilian brain as it is the structure which mammals have in common with reptiles.
• Janov claimed that 1st line imprints occur before intellectual abilities such as the use of verbal language have developed, they are at the level of pure sensation and visceral (or gut) reaction. The brainstem is capable of processing the most primitive emotions of rage and terror and these can be experienced very early in life.

Janov claims that Primal Pains are imprinted in the lower brain first then later the limbic system and still later intellectual defenses are formed by the cortex simply because this is the sequence of neurological development. Janov claims that therapy occurs in the reverse sequence: 'There is no way to go deep without first going shallow.' In primal therapy medication is prescribed for some "overloaded" patients so they don't overshoot into 1st line pains that they are not ready to feel, thereby allowing them to feel the more recent pains first.

Origins of neurosis

Primal theory claims that many or most people suffer from some degree of neurosis. This begins very early in life (especially in the "critical period" - the gestation period plus the first three years) as a result of needs not being met. There may be one or more isolated traumatic events but more often it's a case of daily neglect or abuse.

Janov claimed that neurosis may begin to develop at birth, or even before, with "first line" Pains. He also claimed it could be reversed by reliving these pains in sequence, all the way back to birth trauma. Subsequent Pain is thought to be added on top of previous pain in what is called "compounding" the Pain.

Throughout childhood more elaborate "defenses" develop as the early unmet needs keep pressing for satisfaction in symbolic and therefore inevitably unsatisfying ways.

The format of the therapy and process of healing

The overall strategy of primal therapy has hardly changed from the early days. The therapy begins with an intensive three weeks of fifteen open-ended sessions with one therapist. After this the patient can join large group meetings with other patients and therapists once or twice a week for as long as is needed. Private sessions are still available, though not every day. The length of time needed in formal therapy varies from person to person.

Connected feeling

A connected feeling, according to Janov, is a "conscious" experience which connects the present to the past and connects emotion to meaning - there may also be a connection to sensations in the case of a physically traumatic experience such as physical or sexual abuse or painful birth.

Primal

In early writings this was another capitalized concept. In keeping with modern trends lower case is used here.

As a noun or a verb, this word denotes the reliving of an early painful feeling. A complete primal has been found, according to Janov and Holden, to be marked by a "pre-primal" rise in vital signs such as pulse, core body temperature, and blood pressure leading up to the feeling experience and then a falling off of those vital signs to a more normal level than where they began. After the primal ("post-primal"), Janov claims the patient will be flooded with his own insights.

Based on Janov's own in-house studies, Janov and Holden claimed that the pre-primal rise in vital signs indicates the person's neurotic defenses are being stretched by the ascending Pain to the point of producing an "acute anxiety attack" (the conventional description), and the fall to more normal levels than pre-primal levels indicates a degree of resolution of the Pain.

Janov claims that the "primal" is different from emotional catharsis or abreaction. A primal may be referred to as a "connected feeling" but a complete connected feeling will usually take months or even years to feel, in many primals. It should be noted that "abreaction" or "catharsis" as used by other psychologists does not mean a false or unconnected feeling.

Duration

Perhaps one of the most questioned claims of Arthur Janov in his first book he said "... by the time someone has reached his eighth month he is generally well." However, years later, even decades later, many primal patients found they were still in therapy or feeling 'primal feelings.' Janov explains this by saying that the finished patient is not ecstatic or even "happy". Happiness, he says, is not a goal of primal therapy. Finished patients may still have many more hurts to feel... So they will have their moments of misery after therapy. One patient explained this anomaly this way: "At least it is real misery with some kind of end to it."'

Twenty years later Janov wrote that "The elapsed time before a patient is relatively well is longer than we originally supposed, but the specific time spent at the clinic is not. He now claims that after one year to a year and a half patients are largely on their own, with only sporadic follow up necessary." However, this duration is exceeded by many primal patients in practice.

Janov's warnings

Arthur Janov has been printing warnings for many years in all of his books, saying that people could check the credentials of any therapist claiming to be a trained primal therapist, by contacting The Primal Institute or The Primal Foundation in Los Angeles. Since 1989, Arthur Janov with his present wife, France, has had his own center separate from The Primal Institute (still directed by his ex-wife Vivian Janov). It is not a matter of public record how many therapists Arthur Janov may have trained in Paris in the 1980s when he had a clinic there or how many Janov-certified therapists are currently practicing.

Since his first book, Janov has often written about primal therapists who are not associated to his practice, whom he has referred to as "mock primal therapists" or simply "mock therapists" or "would-be practitioners."

Groups inspired by Primal therapy

Spin-off: The Center for Feeling Therapy

The following summary is based on Therapy Gone Mad by Carol Lynn Mithers, a book based on interviews of some 48 former patients of The Center for Feeling Therapy who shared diaries, notes and audiotapes with her. Marybeth Ayella has written another report in Insane Therapy, Portrait of a Psychotherapy Cult.

A notorious case of therapy abuse occurred in the seventies at The Center for Feeling Therapy, founded in Los Angeles in 1971 by nine people from The Primal Institute. Joe Hart and Richard "Riggs" Corriere, together with seven other therapists - two of whom had been certified as Primal Therapists. As well as the two certified therapists, twenty five patients left The Primal Institute with Hart and Corriere. Hart and Corriere had been in the therapist training program at The Primal Institute and Corriere had contributed to a scientific study reprinted in Janov's second book.

Going Sane, the book published a few years later describing their "Feeling Therapy", was given very favorable reviews by some, notably:

"A group of very honest young therapists tell, with great candor and openness, about the new kind of therapy they are developing and the mutuality of relationship it involves." - Carl Rogers

According to Mithers, 'Later, Joe and Riggs would claim that the group had confronted Arthur Janov with their unhappiness and told him they believed patients needed to move beyond their past pain to change their present lives. Janov would deny that, comparing any attempt by Joe and Riggs to improve his ideas with interns correcting a senior surgeon's technique. Interns morover, who were really only interested in power who he'd pegged as "abreactors" - people who had emotional outbursts without truly feeling anything - and who were about to be fired anyway.'

According to Mithers description of the founding therapists' initial mind set, "...although they'd be following Janov's program, they would keep exploring ways to go beyond it. They already knew two things for sure: They would avoid the narcissism that had claimed Janov, by sharing the therapy's leadership. All decisions would be made collectively; that way, no one person's theories or ego would dominate. Even more important, all therapists would continue to get treatment from their peers. That way the therapy would grow as they did." The Center for Feeling Therapy initially followed Janov's method described in The Primal Scream by having the patient isolate him or herself for 24 hours prior to the initial three week intensive therapy. Joe and Riggs also extended primal theory using their own ideas.

Shortly thereafter, the therapists at the Center for Feeling Therapy had a "major ideological shift... Arthur Janov's theory...of childhood trauma was abandoned." This shift was caused by the realization that patients who had defected with them from Janov's institute "had been faking their primals." Indeed, one of the Center for Feeling therapists, Jerry Binder, claimed that "a lot of what had been said was a lie" for his testimonial in Janov's book. As a result, Joe and Riggs came to believe that primals as Janov described them "didn't even exist" and that Janov's cure was "a cruel hoax." Soon after, the Center for Feeling therapists replaced Janov's formulation with their own ideas emphasizing "present-life feelings." Riggs instituted groups in which there would be "no primaling or trips to the past." Soon after, the "break with Janov was triumphantly complete."

But the "biggest change was in the practice of Feeling Therapy itself... started getting wild... Every group, there was something new." Many of the original patients who'd come for Primal Therapy started drifting away: " started finding the new program a bit much. They'd come to the Center looking...to exorcise the pain of the past. They were not looking to have their lives examined...One by one, they began to drift away."

Thereafter, they developed a dream hypothesis which formed the basis of their second book, The Dream Makers. Shortly thereafter, dreams were replaced with yet another concept, called "Psychological Fitness."

The movement became more cultic over time, led mostly by Corriere, with Joe Hart still the overall leader, knowing what Corriere had wrought but lacking the assertiveness to intervene. The cult became progressively more abusive. Initially, the abuse consisted of a practice called "sluggo" in which therapists would mildly strike their patients in order to break their "defenses" and focus their attention. Over the years, the abuse developed into physical assault, sexual humiliation, and verbal assault. After nine years, the patients rebelled and the center in Los Angeles (along with its satellites in Boston, Honolulu, Munich and San Francisco) was shut down in November 1980 and the therapists were subsequently (1986-1987) banned from practicing in California as a result of lawsuits initiated about five years earlier by the patients against the therapists, accusing them of rape and other forms of mistreatment. The victims and some observers of the case were shocked and dismayed that criminal charges were not brought against the therapists, and the victims never received the apology they had hoped for from the founding therapists.

The Atlantis Commune

The Atlantis Commune was founded in Ireland in 1974 by a group of people who implemented ideas taken from The Primal Scream in their commune. The commune split up in 1988, with many of its members forming a new commune in Colombia which still exists

Reports

There have been several reports relating to primal therapy in books and peer-reviewed journals, many negative, over the decades since Janov's first book on the subject.

In response to the lack of scientific validation, Arthur Janov wrote that primal therapy is an experiential psychotherapy and that:

"Although there are scientific references and citations throughout this work, we should not lose track of the overarching truth--feelings are their own validation. We can quote and cite all day long, but the truth ultimately lies in the experience of human beings. Their feelings explain so much that statistical evidence is irrelevant."

Tomas Videgård's The Success and Failure of Primal Therapy

In an early account of the results of primal therapy (published in book form, only in Sweden in English), Tomas Videgård reported on a study of a sample of 32 patients treated at The Primal Institute. Patients entered therapy from December 1975 to May 1976.

Outcome evaluation for the patients:

• 4 Very Good
• 9 Good
• 8 Medium
• 6 Bad (including one suicide)
• 5 Unavailable for post-testing

Patients who did not "finish" the therapy were excluded. (See Duration above.) This may have biased the sample in the favor of patients who strongly believed in primal therapy. Patients in the sample had been in therapy for between 15 and 32 months.

Videgård himself went through the therapy, which may indicate a possible bias in favor of primal therapy. The evaluation was based on patients' answers to questions and some projective tests that require interpretation by the tester (Videgård himself) so there was a potential for bias. Also there was no control group to help compare placebo, natural spontaneous remission rates and the effects of maturation. There also seems to have been no controls on other variables that have been shown to help mental health such as nutrition, medication, exercise and non-primal therapy techniques. Videgård concluded that therapy at The Primal Institute was marginally better than the Tavistock clinic and markedly better than the Menninger Foundation--the two psychotherapy clinics which he used for comparison.

There is a paper by Stephen Khamsi Ph.D. about this study: The Success and Failure of Primal Therapy: A Critical Review.

Peer-reviewed journal reports

• Janov's primal scream therapy, 1975. Article in German.
• Conventional and contemporary approaches to psychotherapy. Freud meets Skinner, Janov, and others, 1977.
• Primal therapy : yesterday and today, 1978. Article in French.
• Critique on primal therapy, 1979.
• Primal therapy--a clinically confirmed procedure?, 1982. Article in German.
• An outcome study of primal therapy, 1983.
• Wilhelm Reich--Arthur Janov--a comparison of their work, 1984.
• Primal scream therapy: a new cause of Mallory-Weiss tear. 1990.

Papers by Arthur Janov in peer-reviewed journals

• Towards a new consciousness,1977.

Books by Primal patients about their therapy

• Facing the Wolf: Inside the Process of Deep Feeling Therapy by Theresa Sheppard Alexander (1997), Plume. ISBN 0452275210 ISBN 9780452275218.
• Healing Fits: The Cure of an Epileptic by Robert Reese (1988) Big Sky Press ISBN 0944-59200-7

Criticism

• Debunking Primal Therapy is a website set up by a former primal therapist trainee, and addresses such issues as peer review, falsifiability, bias, justification and other social psychological effects behind primal therapy. In the section on cohort observations of the early 2000s the author writes about his admittedly non-experimental observations:

"... in my judgment the picture is worse than what you would expect from placebo."

• Martin Gardner wrote a critical article called "Primal Therapy: A Persistent New Age Therapy." in the Skeptical Enquirer, May 1 2001. In the article Gardner discusses some of what he sees as the problems with primal therapy, and also details a protest over the publication of the book The Biology of Love (Janov, 2000).

• Alice Miller, a well-known psychologist and writer on child abuse, initially endorsed Primal Therapy, but later retracted her endorsement in a Communication to her readers, in which she criticized Primal Therapy as potentially dangerous and lacking in empirical support.

• In the section called "Primal Therapy," from the Gale Encyclopedia of Psychology, 2nd ed. Gale Group, 2001, Timothy Moore challenges and criticizes primal therapy in a number of ways, including:

"A recent survey of the opinions of 300 clinicians and researchers regarding psychotherapeutic techniques revealed that primal therapy was the technique whose soundness was most often questioned." link to article

• In the book Psychobabble (1977, ISBN 0-689-10775-7) R.D. Rosen comments on Janov's writing:

"It was that kind of talk that recalled nothing so much as L. Ron Hubbard's claims for Scientology, whose successful graduates, called 'clears,' would form a totally neurosis-free superior race." (Page 144)

• In the book Popular Psychology - An Encyclopedia (2005)(ISBN 0-313-32457-3) psychology professor Luis A. Cordon states that:

"...while undeniably an inventive and intriguing approach to psychotherapy, it lacks the underpinning of scientific validation which potential clients ought to be able to expect at this point in our history." (Page 133)

• Primal therapy is one of the therapies listed in the 1996 book "Crazy" Therapies (ISBN 0787902780)

"Two years after writing his first book, Janov's certitude about having the one cure-all was established-at least in his mind. In the first lines of his second book, Janov wrote: 'Primal Therapy purports to cure mental illness (psychophysical illness, to be exact). Moreover, it claims to be the only cure. By implication, this renders all other psychologic theories obsolete and invalid. It means that there can be only one valid approach to treating neuroses and psychosis'." (Pages 121 and 122)

• Primal therapy is cited in the book The Death of Psychotherapy: From Freud to Alien Abductions. (2000) Donald A. Eisner ISBN 0275964132. In that book Eisner writes:

"Since there is no relevant research, Primal Therapy could simply be chalked up as a placebo and the excessive demand characteristics of the extreme rituals and procedures as well as group pressures." (Pages 51-52)

• The University of Tulsa's website has a critical article called "Primal Therapy" (2006, Byrd, Ensorm and Mattachione) in its section called "Potentially Harmful Treatments". In that article the authors write:

"Overall, primal therapy is not based on scientific theory or empirical support and requires the client to spend a lot of money and a long time away from home."

• Psychiatrist Dr Anthony Clare commented on primal therapy in his book Let's Talk About Me (1981), (BBC. ISBN 0 563 17887 6):

"It does appear that the need to cling to a simple, unqualified, dogmatic theory outweighs whatever critical awareness that Janov's readers possess." (Page 121)

• In the book New Age Blues (1979, ISBN 0-525-47532-X) Michael Rossman comments on the 3 week intensive phase of primal therapy:

"The elements are all pretty traditional: isolation, deprivation, anticipation, and suggestion. You can teach people a lot of different things that way. Brainwashing and the vision-quest both use it." (Page 28)

• In a Discover magazine article, May 2007, science writer Steve Ornes wrote:

"Timothy Moore, chairman of the department of psychology at York University's Glendon College in Toronto, points out that Janov's ascertains of scientific linkage are based on uncontrolled case histories and personal observations, and as such his work has not been scientifically validated."

• Sciencetics.com has produced a podcast(number 005) that is critical of primal therapy. This podcast is now available on Itunes

• The website www.religioustolerance.org listed primal therapy in it's article "Therapeutic and Other Hoaxes" (Sept 1997, updated May 2006) in which B.A. Robinson writes:

"In opposition to primal therapy is the near-consensus among memory researchers that infants cannot retain memories of events in their life. A person's earliest memories typically are from 42 months of age or later; retained memor

1. Janov, A., The New Primal Scream page 5
2. ^ Janov, A., Prisoners of Pain page 3
3. Janov, A., Prisoners of Pain page 9
4. Janov, A., Primal Healing page 199
5. Janov, A. & Holden, e. M., Primal Man pages 1-4
6. Janov, A. & Holden, e. M., Primal Man pages 56-111
7. Janov, A., The New Primal Scream pages 54-55
8. Janov, A., The Biology of Love, 106-137
9. Janov, A., Primal Healing pages 182
10. Janov, A., The Biology of Love, page 133
11. Janov, A., Primal Healing pages 42-48
12. Janov, A., Primal Healing page 94
13. ^ Janov, A., The New Primal Scream, page 362
14. ^ Janov, A. & Holden, e. M., Primal Man pages 137-146
15. Janov, A., The Primal Scream, pages 101-102
16. Janov, A., The New Primal Scream, page 360
17. Mithers, C.L. Therapy Gone Mad, page ix
18. ^ Mithers, C.L. Therapy Gone Mad, page 60 Cite error: The named reference "Mithers60" was defined multiple times with different content (see the help page).
19. Mithers, C.L. Therapy Gone Mad, page 58
20. Mithers, C.L. Therapy Gone Mad, page 55
21. Janov, A. The Anatomy of Mental Illness, pages 198-210
22. on cover of paperback edition of Going Sane (1975) by Hart, J., Corriere, R. and Binder, J.
23. Mithers, C.L. Therapy Gone Mad, page 57
24. ^ Mithers, C.L. Therapy Gone Mad, page 70
25. Mithers, C.L. Therapy Gone Mad, page 71
26. Mithers, C.L. Therapy Gone Mad, page 72
27. Mithers, C.L. Therapy Gone Mad, pages 72-74
28. Mithers, C.L. Therapy Gone Mad, page 77
29. Mithers, C.L. Therapy Gone Mad, page 117
30. Mithers, C.L. Therapy Gone Mad, page 83
31. Mithers, C.L. Therapy Gone Mad, page 85
32. Mithers, C.L. Therapy Gone Mad, pages 199-202
33. Mithers, C.L. Therapy Gone Mad, page 102
34. Mithers, C.L. Therapy Gone Mad, page 352
35. Mithers, C.L., Therapy Gone Mad, pages 325-326
36. Mithers, C.L., Therapy Gone Mad, page 394
37. ' Screamers' cultist meets grisly end in Columbia
38. Janov, A., Primal Healing page 15
39. Videgård, T., The Success and Failure of Primal Therapy
40. Skepdic entry about "Crazy Therapies"
41. Review of "Crazy" Therapies, 1997