Primal therapy is a trauma-based psychotherapy created by Arthur Janov, who argues that neurosis is caused by the repressed pain of childhood trauma. Janov argues that repressed pain can be sequentially brought to conscious awareness and resolved through re-experiencing specific incidents and fully expressing the resulting pain during therapy. In therapy, the patient recalls and reenacts a particularly disturbing past experience usually occurring early in life and expresses normally repressed anger or frustration especially through spontaneous and unrestrained screams, hysteria, or violence. Primal therapy was developed as a means of eliciting the repressed pain; the term Pain is capitalized in discussions of primal therapy when referring to any repressed emotional distress and its purported long-lasting psychological effects. Janov criticizes the talking therapies as they deal primarily with the cerebral cortex and higher-reasoning areas and do not access the source of Pain within the more basic parts of the central nervous system. Primal therapy is used to re-experience childhood pain—i.e., felt rather than conceptual memories—in an attempt to resolve the pain through complete processing and integration, becoming real. An intended objective of the therapy is to lessen or eliminate the hold early trauma exerts on adult behaviour. Primal therapy became very influential during a brief period in the early 1970s, after the publication of Janov's first book, The Primal Scream. It inspired hundreds of spin-off clinics worldwide and served as an inspiration for many popular cultural icons. Singer-songwriter John Lennon, actor James Earl Jones, and pianist Roger Williams were prominent advocates of primal therapy. Primal therapy has since declined in popularity, partly because Janov had not demonstrated in research the outcomes necessary to convince research-oriented psychotherapists of its effectiveness. Proponents of the methodology continue to advocate and practice the therapy or variations of it.
Janov states that neurosis is the result of suppressed pain, which is the result of trauma, usually trauma of childhood origin. According to Janov, the only way to reverse neurosis is for the neurotic to recall their trauma in a therapeutic setting. Janov contends that the neurotic can thereby re-experience their feelings in response to the original traumatic incidents but can now express the emotions that at that time were repressed, thereby resolving the trauma.
Janov believes that there is only one source of mental illness (besides genetic defects): imprinted pain. He argues that this unitary source of neurosis implies that there can be only one effective cure: re-experiencing.
Janov believes that much of the pain of childhood is the result of needs going unmet. Drawing from earlier psychologists, he 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."
Janov asserts that when needs go unfulfilled for too long, pain is the result. (Janov capitalizes Primal Pain in his early work, although in later works, he dropped the capitalization.)
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."
Janov describes "Pain" as the pain that does not hurt because, as soon as the person goes into it, it becomes simply feeling. Most of the suffering is in the blockage or repression, not the Pain itself.
In primal theory, 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.
|Level/Line (J)||Technical name||Functions mediated||Brain structures involved||Incorporates (J)|
|Third||cognitive||cognition and intellectual faculties||neocortex||thinking mind|
|Second||affective||emotional responses||limbic system||feeling mind|
|First||somatosensory||sensation and visceral responses||brainstem||survival mind|
According to Janov, 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. The therapy therefore 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 do not overshoot into first-line pains that they are not ready to feel, thereby allowing them to feel the more recent pains first.
Primal theory contends that many or most people suffer from some degree of neurosis. This neurosis begins very early in life (especially in the "critical period"—birth 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 is a case of daily neglect or abuse.
Neurosis therefore may begin to develop at birth, or even before, with first-line Pains. 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 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 joins 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.
A connected feeling, according to Janov, is a "conscious" experience that 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.
As a noun or a verb, the word primal 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 concluded 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 distinguishes the primal from emotional catharsis or abreaction, an abreaction being (according to Janov) a "pseudo-primal". 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. Psychiatrist Anthony Storr claimed that primal therapy techniques have much in common with abreaction.
In The Primal Scream (published in January 1970), Janov wrote, "By the time someone has reached his eighth month he is generally well...Many patients finish before the eight months; some remain in therapy for ten or eleven months. It all depends on how sick they were to begin with."
In an interview with the Pittsburgh Press in April 1971, Janov estimated an average of 11 months of therapy after the three-week intensive.
A therapist working for Janov stated in 1973: "The need for therapy really never ends. Nobody is ever able to flush all the pain from his body." According to this source, there were patients who stayed in therapy for as long as two years.
The only independent account on primal therapy studied 32 patients who entered therapy at The Primal Institute in 1975 and 1976. The study concluded, "The main result is that about 40% of the primal patients achieve a satisfactory result within 15 to 25 months."
In The New Primal Scream (published in 1991), Janov wrote that after a year to a year and a half, patients are able to continue therapy on their own, with only sporadic follow-up necessary.
Commenting on the "modest" claims John Lennon made about his own 1970 primal therapy experience, Janov said, "The therapy takes at least thirteen-fourteen-fifteen months....I worked with him from March through July—five months. That was when he was forced to leave."
According to Stanislav Grof, many patients stayed in primal therapy for years with no substantial progress. According to Grof, the clinical state of some patients actually worsened.
In The Primal Scream (Chapter 8), Janov wrote: "Primal therapy is much more economical than conventional insight therapy—not only in financial terms but also in the time involved. The total financial outlay is about one-fifth the cost of a psychoanalysis."
In 1971, the three-week intensive (two to four daily hours) had a cost of $1,650 USD. In 1973, the cost—payable in advance—was $6,000 USD for six months of therapy. In 1978, a year of primal therapy had a cost of $6,600 USD.
Arthur Janov printed warnings for many years in all of his books, stating that people should 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 . Unaffiliated groups espousing primal therapy have included the Atlantis commune established in Ireland in 1974.
Since his first book, Janov has often written about primal therapists who are not associated with his practice, whom he has referred to as "mock primal therapists" or simply "mock therapists" or "would-be practitioners".
Over the decades since Janov's first book on the subject, there have been several reports and critiques relating to primal therapy in books and peer-reviewed journals.
Arthur Janov wrote that primal therapy is an experiential psychotherapy and that:
Janov initiated from the outset small-scale research using questionnaires and measures of EEG, body temperature, blood pressure and pulse from his patients. A 1971 Pittsburgh Press article cited a University of California at Irvine study on primal therapy patients that showed a slowing of brain waves. Janov claimed that primal therapy reduced, in some patients, the frequency and the amplitude of Alpha waves, core body temperature (as much as three degrees) and blood pressure (as much as 30 percent). Two Brain Research Institute (UCLA) scientists confirmed that there were brain-wave changes in primal patients.
In 1993, Janov stated: "It is a therapy that has been investigated for over fifteen years by independent scientists, and the findings are consistent. Primal Therapy is able to reduce or eliminate a host of physical and psychic ailments in a relatively short period of time with lasting results." Janov lists research evidence at his webpage. In 2010, Janov said of primal therapy, "It is one of the most heavily researched private psychotherapies extant in the world."
Authors Prochaska and Norcross called the research by Janov "largely uncontrolled, non comparative and short term."
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 who entered therapy at The Primal Institute in 1975 and 1976.
The outcome evaluation for the patients was 4 Very Good, 9 Good, 8 Medium, 6 Bad (including one suicide), 5 Unavailable for post-testing (left therapy prematurely). Patients who did not finish the therapy were excluded. (See Duration above.) Patients in the sample had been in therapy for between 15 and 32 months.
Videgård himself went through the therapy. The evaluation was based on patients' answers to questions and some projective tests that require interpretation by the tester (Videgård himself). There was no control group.
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 he used for comparison. Videgård wrote, "The outcome is about half as good as Janov claims the results of PT to be," calculating a 40 percent success rate, compared with a 98-100 percent success rate claimed by Janov.
Primal therapy has not achieved broad acceptance in mainstream psychology. It has been frequently criticized as lacking outcome studies to substantiate its effectiveness. It is regarded as one of the least creditable forms of psychotherapy and has been classified in a 2006 APA Delphi poll as "discredited".
Primal therapy has sometimes been dismissed as shallow, glib, simplistic, or trendy. It has also been criticized for not paying sufficient attention to transference. Some researchers have suggested that primal therapy's contention that adults can recall infantile experiences is empirically refuted. Primal therapy has also been rejected as dogmatic or overly reductionist.
In the book Let's Talk About Me, Anthony Clare criticizes primal therapy in several ways. He claims that Janov sees confirming evidence everywhere: "Everything is taken as evidence of [the truth of Janov's Pain Theory]." He claims that Janov has "no evidence" that childhood traumas cause adult neurosis, except for the "frenzied memories" of his patients.
In a 1982 paper published in the journal Zeitschrift für Psychosomatische Medizin und Psychoanalyse, Ehebald and Werthmann report that, following a review of the scientific literature, they found "no on-going reports of primal therapy's therapeutic results, no statistical studies and no follow-up studies." Concluding that primal therapy is not a valid therapeutic technique, they stated that most psychotherapists in the Federal Republic of Germany believe it to be questionable in theory and dangerous in practice.
Alice Miller initially endorsed primal therapy. Later, however, she wrote a communication to her readers in which she expressed some reservations about it. In that communication, she stated that primal therapy could be dangerous when conducted by therapists who are not properly trained. She also stated that there was "too much faith" in cathartic discharge, claiming that the relief was sometimes temporary. She also voiced criticisms about the structure of the initial three-week intensive phase, claiming that it could provide opportunities for unscrupulous therapists. She warned of the dangers of developing an "addictive dependency" to pain.
In 1996, authors Starker and Pankratz published in Psychological Reports a study of 300 randomly sampled psychologists. Participants were asked for their views about the soundness of methods of mental health treatment. Primal therapy was identified as one of the approaches "most in question as to soundness."
The 1996 book Crazy Therapies discusses Janov's claim to have discovered the one cure for neurosis: "Evidence that expressing angry, violent behaviour does not drain it away but increases the chances of its recurrence has been presented in the scientific psychology literature for years." (p. 128)
In the 1998 book Insane Therapy, sociologist Marybeth F. Ayella says that "what Frank (1974:424–25) describes as healing cults more closely resembles what I think occurs in Primal Therapy than does Janov's description."
Primal therapy is cited in the book The Death of Psychotherapy: From Freud to Alien Abductions. The author, Donald A. Eisner, claims that primal therapy, like all other schools of psychotherapy, has no scientific evidence of effectiveness beyond placebo.
In the Gale Encyclopedia of Psychology, Timothy Moore wrote: "Truth be known, primal therapy cannot be defended on scientifically established principles. This is not surprising considering its questionable theoretical rationale."
Martin Gardner wrote a critical article called "Primal Therapy: A Persistent New Age Therapy" in the Skeptical Inquirer. Gardner discussed some of what he sees as the problems with primal therapy, and also details a protest over the publication of Janov's 2002 book The Biology of Love.
The National Council Against Health Fraud (NCAHF) Newsletter listed primal therapy, among other treatments, in the article "Dubious Mental Health".
Primal therapy lacks protocol. In a usual setting between psychologist and client, a “believed cause” of certain painful thoughts and feelings from the past are generally addressed as a means to find amends to the root of the problem. Professionals that practice this therapy do not address such causes which calls its legitimacy into question.
A 2015 article in the peer-reviewed APA journal Psychology of Consciousness suggested that primal therapy, as well as some other therapies, may have produced false memories, specifically those within the period of infantile amnesia in early infancy, and in memories for birth.
In 1967, Janov had his pivotal session with Danny Wilson (pseudonym), a patient who recalled emotionally a Theatre of the Absurd function where Raphael Montañez Ortíz shouted "Mama!", inviting the audience to do the same. Janov encouraged Danny Wilson insistently to do the same. The patient finally fell to the floor in pain for half an hour. Janov taped the session and reheard it repeatedly. He did not understand its meaning until years later.
In 1968, The Primal Institute was founded by Arthur Janov and his first wife, Vivian.
On January 1, 1970, Arthur Janov published his first book, The Primal Scream. In March, Arthur and Vivian started treating John Lennon and Yoko Ono. In 1970, Janov registered the name Primal as a trademark at the U.S. Patent Office and had his attorneys sue therapists using the word Primal to describe their work. The International Primal Association and the Primal Feeling Center challenged Janov's trademark. In 1978, the U.S. Department of Commerce cancelled the registration. "Primal Therapy" is now listed among genericized trademarks that became "free to anyone to use in describing products or services."
In 1971, two trainee primal therapists (another source claims they were "therapists" at the Primal Institute), Joseph Hart and Richard Corriere, abandoned Arthur Janov and started the Center for Feeling Therapy. Hart claimed: "When we left Janov, forty percent of the patients came with us....we found that most had been faking their primals."
In 1973 a "birth simulator" was in use at the Primal Institute. The simulator was a 10-foot-long adjustable pressure vinyl tube. The patient was covered with a slick substance to simulate birth. Reports were made of bruises from obstetricians' fingers appearing on the skin of patients reliving their births.
In 1977, Arthur Janov filed a $US7.1 million suit against Psychology Today, because the magazine called primal therapy "Jabberwocky".
In 1982, Arthur Janov and his second wife, Dr. France D. Janov (married 1980), started to offer primal therapy in Paris through an organization called the European Primal Institute (EPI). According to the UNADFI and Science et Vie, patients had to sign a contract "disengaging the Institute of all responsibility" until the Parisian operation closed down without previous warning in August 1985. According to these sources, some patients were "abandoned" (abandonnés), caught by the sudden closing of the EPI with their therapy unfinished. Janov wrote them a letter saying, "I can not live anymore in the midst of pain and misery; after 35 years seeing patients, it is time for me to live my own life."
In June 1989, two fires caused an estimated $US475,000 ($821,000 in 2009 dollars) damage at The Primal Institute in West Los Angeles. Authorities ruled the fire as arson.
In 1989, Arthur Janov established the Janov Primal Center in Venice (later relocated to Santa Monica) with his second wife, France.
The musician John Lennon and his wife, Yoko Ono, went through primal therapy in 1970. A copy of the just-released The Primal Scream arrived in the mail at Lennon's home, Tittenhurst Park (sources differ about who sent the book). Lennon was impressed, and he requested primal therapy to be started at Tittenhurst. Arthur Janov and his first wife, Vivian Janov, went to Tittenhurst in March 1970 to start the therapy, which continued in April in Los Angeles. Arthur Janov went to Tittenhurst after giving instructions in advance about the isolation period and giving instructions to Lennon to be separated from Ono. Lennon and Ono had three weeks of intensive treatment in England before Janov returned to Los Angeles, where they had four months of therapy.
According to some sources, Lennon ended primal therapy after four months. Arthur Janov later said, "They cut the therapy off just as it started, really....We were just getting going....We had opened him up, and we didn't have time to put him back together again." (INS records released under FOIA confirm Janov´s claim). Another source states that Lennon and Ono broke off treatment after continuous disputes between Ono and Janov. Lennon asked Janov for a primal therapist to be sent to Mexico, but Janov refused. The web page "John Lennon – Primal therapy" includes excerpts of interviews with John Lennon, Arthur Janov, and Vivian Janov, along with an account of one of Lennon's therapy sessions written by Pauline Lennon.
Lennon refused to be filmed in therapy by Arthur Janov, saying, "Who are you kidding Mr. Janov?" Lennon commented after therapy, "I still think that Janov's therapy is great, you know, but I do not want to make it a big Maharishi thing" and "I just know myself better, that's all. I can handle myself better. That Janov thing, the primal scream and so on, it does affect you, because you recognize yourself in there...It was very good for me. I am still 'primal' and it still works." and "I no longer have any need for drugs, the Maharishi or the Beatles. I am myself and I know why."
Shortly after therapy, Lennon produced his album John Lennon/Plastic Ono Band. (Ono recorded a parallel album, Yoko Ono/Plastic Ono Band, from her experiences; both albums were released on the same day on the Apple record label.) Lennon's album featured a number of songs that were directly affected by his experience in therapy, including "Remember", "I Found Out", "Isolation", "God", "Mother", "My Mummy's Dead", "Well Well Well," and "Working Class Hero".