Theory

Primal theory of personality started with observations of the process of psychotherapy and has grown within the pragmatics of the therapist-client interaction. Theory construction of this sort provides a series of assumptions which are intimately tied to and guide therapeutic practice. Such assumptions usually cover the genesis, development and modification of organismic malfunctioning. However, since therapists have some goal for their clients, a theory of wellness develops alongside the theory of "neurosis.

Some primal assumptions are firmly validated and those more recently generated from the cutting edge of practice are more tenuously held. Others have not held up because new data have proved them false. What follows are general statements of our theoretical beliefs and a summary of the basic assumptions contained.

One's notion of reality is based on how he selects and processes incoming data (Spinelli, Pribram, 1967). How he selects and processes input is a function of the structure of his nervous system. (Festinger, 1967). This, in turn, determines the quality of his consciousness (Sperry, 1951). The structure of the nervous system is a result of genetic determinants evolving over millions of years, in a dialectic i with the environment - from the conception of the organism, through ontogeny and continuing for the life of the organism. An organism is structurally determined by an interaction of what it is and what environment it lives in. A paramecium in response to a highly acidic or low oxygen environment will manufacture specific proteins to accommodate and survive. These become actual physical modifications to structure and further affect how the animal will function. This is ever continuing and is a process of growth for living organisms. The higher up the phylogenetic scale the more pronounced are the effects of inadequate environments (Simeons, 1960). That is to say, the more advanced the animal the more profound are the effects of developmental deficiencies.

For most humans the in utero environment can be inadequate and stressful, providing for less than optimal development. If the womb environment is extremely depriving, the fetus can only experience life as dangerous. He has limited reactions to danger, all of them physical and a function of the primitive lower brain. As he learns to respond to stress in this way it forms the structure and possibly prototypic responses of his later life, so that any later stress will evoke these early feelings. In other words, he learns to respond to stress with severe autonomic reactions such as panic or shock. These extremely painful circumstances that can be a part of prenatal existence are not remembered consciously. As the cerebral cortex forms it becomes capable of repressing and symbolizing the pain recorded in the lower brain. What has traditionally been considered to be a fairly uneventful state in terms of the effect on one's later life - the first nine months - is actually the most significant time in a human being's development.

Deficiencies in the womb environment are exclusively physical - the need for oxygen, nutrition, fluids, growth, proper temperature, balanced hormonal, endocrine, and enzyme supply and genetic strength. In addition, Janov describes what he calls the "central reality" of the infant, which includes the need to grow and develop at its own pace, to be held and caressed, to be stimulated, to be kept comfortable, to be fed, and to be allowed to follow its own growth impulses. An infant has no way of fulfilling these needs himself; when they are not met he is left feeling helpless, frightened, unprotected, and unloved. These feelings, too, become a basis for how the adult perceives himself and the world.

As the infant matures and his needs continue to be unfulfilled the situation begins to compound in seriousness. He will pass through a number of important developmental states for which he is inadequately prepared. These are physiologically triggered events meant to correspond, by reason of evolution, with a cumulation of physical and emotional readiness for its happening. These stages happen whether or not that individual is prepared for them. If, because of severe trauma, a current hostile environment, or previous assaults on its developing mechanisms, the child is not ready for the next stage, we may find an individual whose behavior and attitudes reflect either an arrest at a certain developmental stage or an incomplete development (Pearce,1977). For example, a child should be ready at around age 10 months to leave his mother and begin to explore more independently the world around him. However, he will need to return frequently to assure himself that his mother is still there and has not left him. If his past experience has taught him to doubt that she will be there when he returns, he may opt to never "leave." This child may eventually become the overly dependent adult, unable to make decisions, passive-aggressive, asthmatic, etc. On the other hand, another child may have learned as an infant that its signals for attention and to have its needs met were ignored. Adapting himself to this limited nourishment this child formed an attitude of independence, "I can do it myself," long before the appropriate age. His personality is molded with not only independence, but a withdrawal from closeness and intimacy and an inability to form significant attachments.

In primal therapy we feel that it is not enough just to discuss these arrested or inadequate levels of development. In the therapeutic setting it is also necessary for the client to return not only to the memory, but also the feelings associated with it.

Our culture is anti-feeling. Children are expected or forced to shut off their feelings; they lose the opportunity to let their feelings out, to connect them, to place them in some kind of perspective within their lives - and, to add further injury, the child, in feeling the disapproval of his parents, begins to feel the same negative reactions to his own feelings. Hence, we see the adult not only suffering with anxiety, depression, or inappropriate behavior he cannot seem to control, but hating himself because of it. There is then further shutting down of his real self and a stronger reinforcement of neurotic and defensive behavior.

In summary, our assumptions are as follows:

1. Experiences are stored in the organism from the moment of conception on. This notion runs counter to most psychological and medical belief that the embryo, fetus and even the newborn are insensate (Ferreira, 1969). Witness the way circumcision is performed on the neonate.

2. Because the organism is dependent on the environment to have survival needs met and because, gratuitously or otherwise, they are not always met, some of his experiences are traumatic.

3. The earlier in the development of the organism a traumatic experience occurs, the more profound the effect.

4. Experiences of a hostile environment or of events which are life-threatening or traumatic are blocked from full impact or awareness and distort straight line growth. Cells modify shape or structure; body parts lose sensibility; events are forgotten or not perceived by the senses; etc.

5. Fragments of blocked experiences continue into adult life. A seemingly unconnected numbness in the left hand of an adult may later be associated with repeated slapping of the left hand while learning to write as a child.

6. Experiences stored in the organism are retrievable. That is, they can be felt again.

7. Defenses that interfere with growth are jettisoned by the client at his own pace.

8. Feeling and integrating earlier blocked experiences and expressing previously unexpressed feelings is of therapeutic benefit.

9. Our culture supports the suppression of both the expression and memory of negative feelings.

10. Education is necessary to identify feelings and the sensations which signify feelings especially those which are remnants of early trauma.

11. Feeling is the basic material and modus operandi of change.

The Setting and Format
The setting in which we do our work is somewhat unusual and will be described here. The Center has one very large group room, several smaller group rooms and a number of small individual rooms. There are no windows, and the floors and walls are padded and sound proofed. Pillows, blankets and kleenex are the only furnishings. Sessions are usually carried out in dim lighting. The facility is open 24 hours so that clients can 'feel' on their own, or with another client who will sit for them, or can meet as a group without a staff member present, at any time. Another important modification of usual psycho-therapeutic practice is that the rooms are scheduled for three hours per session. Sessions run from one to three hours.

Our full program involves a 3-week intensive during which the client, who is devoting full time to his therapy, is seen daily for a session lasting up to three hours. His therapist is on call and additional emergency sessions may be scheduled. He is seen twice by a therapist of the opposite sex from his primary therapist and may attend up to six group sessions in addition to his regular session. At groups he becomes familiar with the other therapists. After the three weeks he has the choice of individual or group sessions from the therapist(s) of his choice. We recommend an 8-12 month period to be committed to therapy.

By the time they apply, they are usually highly motivated to become involved in, if somewhat fearful of, the process. However, since they have only a dim perception of the depth and extent of their pain, it is in the first six months that the 2.%.5% who will have dropped out, leave. The bulk of these leave during the first month.

A further description of our client population.
(These data are based on an N of 250 consecutively treated clients.)

As a group, our clients when contrasted with national norms have:

1. Greater birth traumas (pre- & post-mature, breech, Caesarean section, twin, over 10 pounds at birth, especially long or short labor, birth defect or injury).

2. More trouble with the law, previous psychotherapy and hospitalizations (mental), suicide attempts, "mental illness" in the family, drug and alcohol dependency or heavy usage.

3. More siblings.

4. Fewer marriages: with an average age of 29 years, in this sample 53% have never been married (national norm 18%).

5. Greater unemployment: 42% (national norm 8%) are unemployed. This is colored by the fact that a number of people come from distant places and give up their jobs just to do the therapy.

Of the more recently treated 180 clients of the 250 on whom the data were available, 95% had multiple psychophysiological disorders. The highest incidence (range - 21%-81%) were in following systems: muscular / skeletal, gastrointestinal, respiratory, special senses & cardio-vascular.

It is our impression that our clients have had more childhood abuse (psychological, sexual and physical) than the population of patients seen in clinics by independent psychotherapy practitioners.

While we do not use clinical diagnostic categories in reference to our clients it is also our impression that our population has included persons whose primary diagnosis would fall into the psychoses, neuroses, personality disorders, psychophysiologic disorders and special symptoms as defined in the DSM II (1968).

In summary, then, we have a multiply handicapped client group who have experienced extreme problems in living and are highly motivated to change their life patterns.

Persons who are in touch with their bodies seem to move into the process and benefit more easily from primal therapy. This stems from the fact that during the therapy session we focus on the body, faces, gestures, large movements and sensations. Since we are after the recovery and expression of feeling, and feelings start in the body it is important to move to that level as soon as practicable. (General rules for guiding the therapist are to move from the present to the past; general to the specific; cognitive to physical.) We also think that physical data are more reliable of what's happening in an individual than is cognitive data. This again, leads us to consider it more efficient to work with body manifestations.

People who are in touch with their bodies may show it in several ways. One such group are they who somatize their pain. This may range from the severe asthmatic or arthritic to the person who carries tension in parts, or all, of his body. When they come to therapy they already have body manifestations of their underlying pain and are easily directed to these entrances of channels into their feelings.

A second group are in touch with their bodies in another fashion. Even though they have learned for the most part, to ignore body messages (for example: "You're tired, it's time to stop"), in favor of some more pressing internalized environmental message ("Quitters never amount to anything") they are still aware that the body is saying something. With a little help in focusing they begin to find their own "track" into their past history. Persons in this group are often easier to work with than most.

Another group who benefit are people who "can't get anything done." They seem to combine the traits of neurasthenic neurotic, asthenic and inadequate personality. They are often on welfare or Medicaid. (We have been unofficially commended by Medicaid for our record in getting patients off their rolls.)

They spend much of their early therapy dealing with feelings that stem from birth and pre-birth trauma. The positive changes that occur in this group are generally slower in coming than the group mentioned above. There is a long period of slow growth followed by a blooming in which they take a place in the world consistent with their chronological age. One reason for the slowness in movement with these people seems to be that in addition to feeling their feelings in therapy they must also learn to do things in the real world they never learned as children - coping mechanisms other persons have in their repertoire even though they may not be using them efficiently or at all.