Abreaction Part I: What it is and why it was abandoned in psychotherapy

by Bruce Wilson

Looking at the state of psychotherapy today, one might be forgiven for thinking that it’s always been about talking, analysis, and cognition. Psychoanalysis is focused on…well…analysis—examination, interpretation, and explanation with words upon words upon words, but it wasn’t always that way.

Before there was psychoanalysis, there was “cathartic therapy.” Freud and Breuer experimented with catharsis after being influenced by German philosopher, Jakob Bernays, who advocated Aristotelian catharsis in medical treatment. They called it  abreaction — “to react away or to react off…. the act of giving vent in speech and action to repressed experiences, and thereby disburdening one’s self of their unconscious influences.”

Even in those early years, one can see the bias towards talk therapy rather than connected feelings. In Studies on Hysteria, Freud and Breuer write, “language serves as a substitute for action; by its help, an affect can be ‘abreacted’ almost as effectively.” Eventually, psychoanalysis abandoned catharsis. The expression of feelings was never a central theme in analysis; at most, it was considered as a tool to loosen “strangulated affect” and facilitate analysis and it was usually done under hypnosis.

The “discharge” theme is also evident in the work of French psychiatrist, Pierre Janet (1859-1947), who used the colourful name of “mental liquidation” for abreaction. Janet regarded neurosis somewhat like an electrical capacitor—traumatic memories were stored as “mental energy” or “psychological tension” and abreaction was the means to release it. Several other European physicians used catharsis in the late 19th and early 20th centuries, either with or without hypnosis, and some achieved significant success. Dutch physician, Andries Hoek (1807-1885) reports the use of catharsis on a psychotic patient who was terribly tramatized by repeated childhood abuse, including rape, and by the death of her ex-fiancé, who killed himself after she broke off the engagment. Over an 11-month period of daily sessions, his patient achieved sanity. Most remarkable was that Hoek allowed his patient to take an active role in treatment and guide its course. This in itself may have been the reason why his patient got better. Having a sympathetic witness can do wonders to help someone heal, although it is not enough.

Abreaction was used by several 20th Century psychologists, especially for traumatized soldiers in the two World Wars, however, the purgation aspect increasingly came to dominate. Although the emphasis had originally been on reliving the traumatic memory, as we see in primal therapy, therapists encouraged emotional venting as a way to clear the decks for what they regarded as the real work: talk therapy. The focus shifted toward controlling emotions rather than finding resolution through their expression. Ernst Simmel, a German medical officer in WWII, regarded catharsis as an opportunity for the soldier to “master his emotions intellectually.”

After the war, emotional expression in psychotherapy became more mechanized and increasingly detached from the patient’s inner being. Psychodrama treated feelings as a sort of stage play that one could act out. (Don’t neurotics have enough acting out?) Reich had his patients access “simulated” feelings through a bizarre process he called vegetotherapy, in which:

…the analyst [asks] the patient to physically simulate the bodily effects of strong emotions. The principal technique is asking the patient to remove outer clothing, lie down on a sheet-covered bed in the doctor’s office, and breathe deeply and rhythmically. An additional technique is to palpate or tickle areas of muscular tension (“body armor”). This activity and stimulation eventually causes the patient to experience the simulated emotions, thus (theoretically) releasing emotions pent up inside both the body and the psyche…. Screaming usually occurs, and vomiting can occur in some patients.

Reich later developed this process into orgone therapy. The intent was to free up orgone energy and make it available for more useful purposes, such as orgasm. Alexander Lowen refined Reich’s therapy into Bioenergetics which again focused on body “energy” rather than integrated feeling. One sees this focus on the body in Pat Ogden’s Sensorimotor therapy, in which traumatic memories and feelings have been reduced to mere physical sensations. (I’ve viewed videos of Ogden’s approach and they are excruciating to watch. So close to feeling and yet so far!)

Fritz Perls’s Gestalt Therapy utilized emotional expression but the patient was kept firmly in the present. One of the more bizarre uses of abreaction was in Danriel Casriel’s New Identity Process, which utilized screaming as an “an emotional exercise that frees the individual from symptomatic pain and leads to the deeper feelings he has disguised.” His aim was to “re-educate” the patient’s emotions, behaviors, and attitudes. His book, “A Scream Away from Happiness” says it all.

This short history reveals clearly why abreaction was abandoned and especially why it’s regarded with such disdain today. Despite the promising beginnings of the deep feeling approach, psychoanalysis was never able to get a handle on feelings as feelings. The psychoanalyst lives in the left hemisphere and even though there may be deep intellectual understanding of how the right hemisphere processes feelings, it’s not the same as knowing it from the inside. Allan Schore comes to mind. Despite his brilliant work on early life attachment, emotional dysregulation,  and the role of the right brain, his work exudes the dry, detached intellectuality of all psychoanalysts. His therapeutic approach remains firmly embedded in psychoanalysis with the therapist in full control.

Without the understanding of how deep feelings actually work, without knowing them from the inside, one is led into a desert of ideas about feeling, some of which are quite bizarre. Abreaction, that is venting, purging, screaming, expunging, or mere expression of feelings without connection and integration is not only nontherapeutic, it is dangerous. This is undoubtedly why most psychologists reject deep feeling approaches on the grounds that they are “retraumatizing.” Dredging up feelings without a clear understanding of what’s going on is a recipe for disaster.

In my next post, I’ll discuss the difference between abreaction and primal therapy.




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13 Replies to “Abreaction Part I: What it is and why it was abandoned in psychotherapy”

  1. Hi Bruce,

    Although we can say that the abreaction method was dangerous, there was for many years a breeding ground for the creation of alternative therapies /schools around it. With the spread of economic prosperity that occurred, at least, three phenomena has changed our focus on “safer and more rational therapies”. Of democratic, human and economic factors, much of the enlightened world, closed the majority of their mental hospitals (“the cuckoo nests), which was made possible by mass production of painkillers and mass training of psychologists. Like in a tango a few step forward and some back…

    Something that once has been established, tends to maintain itself. Although we, as patients may feel differently, cognitive talk therapist, a successful, titanic (sic), pharmaceutical industry mafia and patients (who mostly shuts up) have, so far, been considered a great value for the community economy / image. This seems so incomprehensible to us as Primal People. In our internal debate, it is hard to admit that the cognitive therapy treatment has a different total value that makes a general commitment to PT still unrealistic. The fact that PT has a lower value plays of course also a role from a scientific point of view.

    Art Janov’s genius lies in the creation of conditions, at a laboratory level, for connections with the original primal pain, to live it and thus creating a reverse evolution. Art is not an entrepreneur like Steve Jobs, and therefore, so far, failed to create a platform to have an impact on political and scientific support that could add to PT’s societal value.

    During 40 years, I have tried a combination of PT, Rolfing and Homeopathy and to that added a common sense of healthy living based on values I continuously have been working on. I started with Primal Therapy and Rolfing when both were more of young enthusiasts than serious experts, and I have seen and experienced treatments in both that never should have been allowed to take place. However, the two therapies have eventually developed and have established methods with scientific ambitions, and they have great potentials for those who can find them and combine them.

    Both therapies, PT and Rolfing, are being invented / developed by two geniuses based on established eternal true principles / values. Primal Therapy on a method to reverse evolution and Rolfing on how to adjust the body / skeleton and mind to gravity. In contrast to the cognitive talk therapies, which neglect the pain, PT and Rolfing are releasing / reliving the pain and connecting our minds and bodies to what they originally, from a feeling point of view, were meant to be.

    Based on PT and Rolfing I have succeeded to demystify my epilepsy, which after I have been reliving my painful birth has very little impact on my life. They, epilepsy and pain, do no longer propel crazy neurosis, they do not give me fits. Today, I can see all these years as a positive experience which took me on a journey which increased my knowledge and understanding of the needs for a sane life. Still, I’m surprised about the fact that what I have been through and written about: No one cares! Where are all those who say that they care for science? Science is the method of deciding how things actually work, regardless of how we think they ought to work!

    Can you please explain why?

    Jan Johnsson

  2. Do you want my own answer to my question in my comments to your article?

    The wisdom of a dream.

    In my dreams, I resolve my problems and conflicts, or at least I work on them. After having been through Primal Therapy over four decades and having lived a lot of the pain, which was imprinted during a horrendous birth process, my dreams during the last couple of years have changed in different ways. They are still about getting stuck, not finding my way, being isolated and not understanding what is being expected of me. However, nowadays, in a dream, I can feel the reason, often all the way back to my birth. When I reach this stage, I dare to stand up and explain how I feel, and can ask for explanations about things I don’t understood, which are confusing me.

    During the spring, I had a fascinating dream. It was a realistic and positive dream, filled with music and good feelings in which epileptic cramps were understood. In the dream, I was singing like Nat “King” Cole and at the same time going through hallucinations of various kinds, both painful and pleasant. Often, my dreams have been about how I was scared of losing my job, which I was supposed to perform without understanding what was expected from me!

    Last night I had a dream of this kind, when the people, I worked for disappeared most of the time giving bad management and unable to motivate me but still expecting good result and simultaneously looking for my leadership and initiatives. It went on for a while, and I could feel the pain. Suddenly, I said stop and asked the people to explain to me what this was all about, to understand that they were responsible, and that they had better instructed me than be running away.

    All at once, I asked them if they knew what it takes to be able to feel pain? If they, for example, knew that somebody in pain is scared to death to let his pain out if she/he is worried to lose her/his job so that she/he cannot support her/himself or her/his family? Art Janov, I said, could do it because he became economically independent after his pyramidal success with his book “The Primal Scream”. Never more he had to worry about food and shelter. He could live his dream, like John Lennon and Steve Jobs, which both became economically independent of a young age. They had all the subjective wellbeing which Abraham Maslow is talking about in his Hierarchy of Needs, to realize themselves.

    In the dream, now I felt I had one answer to why so few are interested in asking for my experiences regarding Primal Therapy and Evolution in Reverse. They are too scared to lose what they have which on different levels give them food and shelter.

    First when I woke up, I felt confused. It confused me because I had no one to talk to about my dream, and because I am aware of the fact (especially in Spain) that we are living in a time of crisis when so many are constantly worried about their job, survival, family. Many are far from Maslow’s subjective well being, which is necessary to feel what is behind their anxiety, pain and/or intake of anxiolytics. Though this is, might be, the adequate moment to do it.

    When the confusion left I decided to write down my dream.

    Jan Johnsson

    1. Hi Jan,

      Thanks for your post. You make an excellent point about the economic freedom required to get well with primal therapy. You need sufficient money for individual therapy sessions, intensives and retreats, and for taking time off to heal. You need enough savings to quit a bad job and find a better one, or to go back to school to retrain for a healthier career.

      Being poor or dependent on a stressful job is an impediment to primal healing. Being unemployed and in poverty is even worse. The deprivation of the past is mirrored in the present and one can stay stuck in a combination of old and present pain. At the Denver Primal Center, Helen Roth often said, “you’re only as healthy as your environment.” The irony is that the poor and deprived are usually the most desperate for therapy.

      I hear stories from primal therapists about people who stay stuck in their pain, feeling the same old pain over and over, while making no changes in their life. If you have a painful present, the solution is not to feel the pain of the past. A key measure of progress in primal therapy (and any therapy for that matter) is developing the capacity to change your life. Sometimes that means shutting down your access to feeling and doing what it takes to get a decent job. The business world does not recognize deep feeling; you’ll find no primal rooms in corporate offices or factories. You have to suck it up and do your job.

      Arthur Janov says it’s not the job of primal therapy to tell you how to live your life, but people often need career counselling during their therapy to make positive changes. Knowing what to do after spending a lifetime hiding from your inner self doesn’t come automatically. Primal therapy is toughest for those who have the least resources, but they should never confuse their current deprivation with their past deprivation. It takes real grit to do this therapy. Resolving the past while changing the present when you can hardly pay the bills, let alone afford therapy, takes superhuman effort. Some make it; many don’t.

      Sad to say, sometimes the most appropriate thing to do in this unfeeling world is to suck it up and make the money required to find freedom.

  3. This is a good summary here. Psychodrama and
    bonding therapy (new identity process) seem to
    be therapies which some feel can be combined with
    primal in a positive way. At least for me, I don’t see the value with that as they are really different
    and not helpful with the primal process.
    They are both very directive. The primal
    techniques stand on their own, I think, and
    there is no benefit combining them with a lot of
    other things.
    In reading some of the gestalt therapy writings,
    gestalt seems in some ways a precursor to primal,
    but different in basic ways.

  4. I watched people at funerals and gathered that various forms of comfort, including financial and work assistance, as well as help with planning and empathetic support, seemed to let people feel their traumatic loss and begin their unique grieving process.

    I am poor, and I cannot affort PT, or the time, or the change of location. Additionally I have to try to help myself, years after a crude form of primal therapy performed in Michigan.

    So, I abandoned the linear staged approach, and added a sense of a virtual therapist in my mind. This I have called “dreaming while I am awake”. I use, even abreaction, even self talk therapeutic approaches and lots of imagination. They do not harm me because I don’t emphasize any of them and I only seek a sense of comfort, a communication between how I feel and what helps me feel comfortable. This is similar to what people experience at funerals when they have suffered a loss.

    What I have found is, yes, some abreactive experiences, but since I change the approaches and try to avoid patterns, I tend to weaken my gates and slowly build a situation of felt comfort that allows real feelings to emerge and be felt. This happens almost as if they were an explosion or egress of feeling which emerge with their own set of insights.

    Once I was remembering my sister who when she was very young would cry and say “I feel so lonely.” I tried in my imagination to comfort her, I talked out loud to my children for whom I may not have been very present in a feeling attentive way. I talked to my mother and those I wished had cared more for me. I felt alone like my sister, and suddenly I blurted out “I got nobody.” and I sobbed deeply and had many insights concerning how I too had felt “lonely” and I realized that my love of talking to myself was self comfort to fight this terrible feeling. This need dropped and I would find myself wanting to speak ill of another driver under my breath and I would suddenly realize I felt no need to do that. I am not so sure that having a therapist is always the best way to go, since I have found them as much a problem as a help very often times, and regarding buddies, I found the innattentive breathing of a friend to be very annoying as he “sat” for me. Virtual therapy in the imagination has often been far better for me than the attentive caring therapy I received so long ago. Also, since I don’t strive to find “pained need” I find that what comes up tends to be more genuine and helpful.

    Abreaction may easily be the direct result of having a therapist, paying too much money, and seeking “pain”. I had a rabbit once who I tried to take for walks. He didn’t like to go where I wanted and if I tugged a bit to encourage him he would put out his paws and stare defiantly at me. I came to look at this approach as an attempt to “drag the rabbit”, to push what is unwanted or the “negative”, and in the case of PT it seems to be the same when it ignores contexts and tries to “tug” people into expressing their “pain”. My approach supplies the contexts I need and the opportunity to “plug and play” anyone into my waking dream that seems to be helpful. Seeking comfort sets you up for allowing discomfort to rise, and when it does it is natural and not an “act”. I have watched even Art’s patients in therapy and said to myself. “When my voice is strained like that I know I am not feeling and I try another tact.”

    Too often, therapies try to “drag the rabbit”. You catch more flies with honey than with vinegar. Simple comfort may not produce primals, but I am here to tell you that if you change the forms of comfort from understanding, to empathizing, to provided relief through creative imagination, the symbols hiding the pained need, like cancer cells using chemotherapy, tend to crumble if you use enough forms of comfort and use them over a long enough period of time. I find that the draw back to my approach is getting myself to do it often enough, but I do not experience it as “unsafe”. My approach may not handle first line material well, but I am not convinced anything really does when you are poor and have no real sense of security in life…

    Your thoughts?

    Rev 😉 David Mitchel Stow

    1. Good points, Mitch. You have to do what it takes to get relief in the present. You cannot feel your old stuff while the slings and arrows of present day misfortune are hitting you from all sides. Sometimes comfort is the right medicine. Many people in primal have discovered this. I sure have.
      — Bruce

  5. There is a video link you might want to add here. Toward the end of the video there is a new treatment for PTSD which really needs addressing. I would like it discussed in the contexts of primal therapy. Comfort isn’t just palliative when you change the forms of it as I suggested. Comfort begs the question “why the need?”. Different forms of comfort within a short time span can actually bring up primal pain. It only becomes merely palliative when you “stay in one comfort zone”. Various attempts at comfort slowly reveal what needs comforting and this opens primal pain. I have experienced this myself. My approach is random, but the insights seem to come, along with the deep feelings and insight bearing tears, in the staages Art recommends. I stimulate even the first line although gently and rotate this approach with other attempts to “feel better” and I find that what needs to come up does. Deeper things are there but they don’t arise and blow me away. Focusing heavily on things that can bring up first line or pre verbal pain though in any exclusive way is indeed prone to rebound effects and is in my opinion potentially dangerous especially to fragile individuals.

  6. Why is abreaction dangerous? Is it because the therapist allows the patient to relive the emotional upset so thoroughly that they become lost in it? A person correctly trained knows that the patient only needs to see and acknowledge the emotional content of a past traumatic event in order to remove the emotional charge built up within the memory.

    I have been using this technique for years and never has a patient gotten lost in a memory to the extent that he begins to act it out. The real ‘trick’ if you will, is as Breuer noted in the cases he and Freud published in Studies of Hysteria (1895) is to take the memory bite by bite, layer by layer. As the memory is uncovered a layer at a time, the emotions are seen and dealt with. As each successive layer is uncovered, the emotional content bleeds off in such a way that once the entire memory is in mental view of the patient, they have dealt with the emotional content of it and have come to the point of laughter over it. And as we all know, laughter is 99% of the time the healthiest sign possible.

    1. Andy, abreaction in primal terms means feeling without understanding or connection. It is a form of venting, which is non-therapeutic. Another form of abreaction is disjointed feeling. You start into your session on a particular topic and then you veer off into a feeling that is unrelated to your topic. It’s a defense.

      It sounds like you are doing something more like primal. i.e. connected feeling with context. If I remember correctly, Breuer and Freud were doing abreaction with hypnosis which is not therapeutic. And it’s too easy for the patient to get stuck or off-track into something unrelated. I believe that is why the old pioneers give up on abreaction. They much preferred to do therapy with their heads rather with their feelings. That is an indicator of how unfeeling and defended they were. You have to have done deep feeling work in order to do it with clients.

  7. The exact term I use is Guided Cartartic Abreaction Therapy. It is a modified vesrsion of what Freud and Breuer published. The patient goes thru the memory while awake, guided and kept on track by the Therapist. Done correctly it is a very safe and effective technique.

    As I said above, after years of use I can say I have never had a patient go off on a tangent or get stuck in a memory. I have never seen a patient end in anything but a good condition after a session. There are rules and guidelines to prevent it.

    1. It sounds similar to primal therapy. Another important factor is not to allow the patient wallow in their pain. It can happen, especially when very painful material comes up. It may not resolve in a single session or even many sessions so there needs to be process to bring them back into the present. I saw many people get lost in their pain in the early days of PT; they tended to get worse rather than better. These days, they have procedures in place to prevent that.

  8. By the way, my posts are in defense of correct technique, not a particular style of therapy per se. And to clarify, I have had patients attempt to go off track but I do not allow it. They must stay on track and fully work each incident addressed or a less than stellar result will happen.

    1. That’s good. Digging up old feelings can be risky and it’s not as easy as many people claim. You can’t just lay down and let your body guide you; you have to have a good therapist to prevent you from getting overloaded or off-track, especially as heavier material comes up.

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