Let’s imagine that a thirty year old man arrives at an office, presenting obvious symptoms of an anxiety disorder and manifesting the impossibility of relating deeply to anyone. As the session progresses, the therapist asks him about his childhood, to which the patient tells him with apparent normality that he was mistreated and sexually abused by his uncle, who raised him after the death of his parents in a car accident.

The subject, then a minor, indicates that he forced himself to be strong and resist his guardian’s attacks so as not to give him the satisfaction of seeing him suffer. It is also mentioned that at the time he did not discuss it with anyone and that in fact it is the first time he has ever discussed it in public. Although the comment has arisen spontaneously and does not seem to arouse an emotion in the subject, the therapist observes that in fact this fact caused him a deep suffering that has prevented him from trusting others.

At this point, he decides to apply a type of therapy that can help the patient to externalize his pain and work on improving his symptoms and his difficulties in interacting with others: the primal therapy of Arthur Janov .

Primal therapy and Arthur Janov

Arthur Janov’s primal, primitive or scream therapy is a type of psychological therapy which starts from the basic idea that human suffering in the face of the non-satisfaction of basic needs needs needs to be expressed in a symbolic way. For Khanov, the symptom is a defense mechanism against pain.

Throughout childhood and development the human being can suffer severe traumas derived from the denial of primary needs such as those of love, acceptance, experimentation and sustenance. Likewise, in the cases in which the expression of such needs is punished in such a way that the individual cannot be loved if he expresses what he is, he will end up elaborating ways to substitute them that by blocking what he really wants will generate a high level of anguish.

Such psychological pain should be expressed . However, this pain and suffering tends to be repressed and separated from our consciousness, so that it is gradually stored in our unconscious. This repression accumulates as basic needs are denied, which means a great increase in tension for the body that can generate difficulties of a neurotic nature. For example, there may be fear of intimacy, dependence, narcissism, anxiety or insecurity.

The objective of the primal therapy would be none other than to reconnect our suffering with our body , so that we can revive the pain and re-elaborate it, expressing it. We are looking for what Janov calls a primal reaction, a re-experimentation of childhood aversive experiences on a mental, emotional and physical level.

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Classifying primal therapy

The primal therapy of Janov can be classified as one of the body therapies , a subtype of humanistic therapy whose main function is based on the use of the body as an element to analyze and through which to treat various psychic disorders and problems. Thus, in the group of so-called body therapies it is the body itself that is treated under this approach, awakening or focusing on the various sensations perceived in the body.

Despite being considered humanist, it is possible to detect in its conception a strong influence of the psychodynamic paradigm , considering that the main objective of this therapy is to reconnect our repressed and unconscious part with the body, so that it is possible to externalize the pain.We talk about pain repression and re-experimentation, as well as the fight against neurotic defense mechanisms. In fact, there have been multiple subsequent efforts to modify it and integrate the advances of different currents such as the humanist one.

Application phases

The application of the primal therapy or Janov’s scream, in its original version (later reworkings have been made to reduce the time required), requires a series of steps that we will now explore.

The therapy should be carried out in a padded and preferably soundproofed room , and the patient is asked to temporarily cease activity at different levels for the duration of the treatment.

1. Interview

Firstly, it is necessary to establish whether or not this therapy is suitable for the patient and his or her problem, not being suitable for psychotic or brain-damaged patients. It is also necessary to take into consideration whether the patient has any type of medical problem for which an adjustment of the treatment or its non-application may be required.

2. Insulation

Before starting the treatment, the subject who is going to receive it is asked to remain isolated the day before the beginning of the treatment, without sleeping and without taking any action that would allow him to discharge the anguish and tension. It is a matter of that the subject perceives and cannot avoid the anguish , without being able to repress it.

3. Individual therapy

The primary therapy starts with individual sessions, in which the subject must be placed in the position that implies a greater degree of vulnerability for him, with the extremities extended.

Once in this position, the patient must talk about what he wants while the therapist observes and elicits the defence mechanisms (movements, positions, babbling…) that the first one manifests, and tries to make them stop acting so that he can express and immerse himself in the emotional and physiological sensations that his repressed feelings cause him.

Once the emotion arises, the therapist should encourage this expression by indicating various exercises, such as breathing or through expression through shouting.

It may be necessary to establish rest periods between sessions , or for the subject to isolate himself again to further weaken his defences.

4. Group therapy

After the individual therapy, it is possible to perform several weeks of group therapy with the same functioning, without any interaction between patients within the process.

Review

The primal therapy of Janov has not received wide acceptance by the scientific community . Its focus on the repressed painful aspects has been criticized, ignoring the possible presence of other sensations that may be associated. Also the fact that the original model does not take into account the effect that the therapist himself has as a transferential element. Another element criticized is that it makes a demand on the level of time and effort that can be complex to carry out.

It is also considered that not enough studies have been carried out to demonstrate its effectiveness , as well as the fact that its effects are limited if they do not occur in a context of unconditional acceptance and therapeutic work beyond expression.

Bibliographic references:

  • Almendro, M.T.; Díaz, M. & Jiménez, G. (2012). Psychotherapies. Manual CEDE de Preparación PIR, 06.
  • Janov, A. (2009). The Primal Scream. Edhasa.