The Worst Comparitive Psychotherapy Study Ever Published

by Bruce Wilson

While reading through several newspaper obituaries on Arthur Janov, one name kept coming up over and over: John C. Norcross, professor of psychology at the University of Scranton in Pennsylvania. According to Norcross, primal therapy is little more than a trendy psychotherapy that arose in the fevered sixties, and Janov was “a classic instance of being the right charismatic therapist at the right time.” And to further demonstrate his ignorance, Dr. Norcross says in the New York Times, “There is no evidence that screaming and catharsis bring long-term emotional relief.”

This comment is repeated again and again in obit after obit, merely parroting the NYT review. But the review also states:

Much of the psychotherapeutic establishment now regards the therapy as marginal. A 2006 article by Dr. Norcross and colleagues in the journal Professional Psychology: Research and Practice reported that their survey of more than 100 “leading mental health professionals” had found primal therapy to be “certainly discredited” — together with treatments including angel therapy, crystal healing, past-lives therapy, future-lives therapy and post-alien-abduction therapy.

“It’s both a discredited theory and treatment in mental health,” Dr. Norcross said. “Today, I look back at it as an unfortunate but understandable product of its time: believing that pure emotional release would prove therapeutic.”

Those are pretty strong words. After all, if you deem something to be “discredited” you should have extensive evidence to back it up, right?

Wrong.

This survey enrolled 101 so-called mental health experts to assess 59 treatments by questionnaire. “Experts” were decided by criteria such as doctorate-level education, fellows of the American Psychological Association (APA) or American Psychological Society (APS), current and former editors of scholarly journals in mental health, members of the APA Presidential Task Force on Evidence-Based Practice, and chairs or editors of the Diagnostic and Statistical Manual of Mental Disorders (DSM). In other words, no one who had ever practiced primal therapy was included. Overall, 66% of respondents were supporters of cognitive behavioral therapy (CBT) or “eclectic/integrative” therapy. In other words, these “experts” represented the dominant wing of the psychological establishment, which has always been critical of primal therapy and the notion of repressed memory.

The term “discredited” was based on the following criteria:

We operationally define discredited as those unable to consistently generate treatment outcomes (treatments)…beyond that obtained by the passage of time alone, expectancy, base rates, or credible placebo. Discredited subsumes ineffective and detrimental interventions but forms a broader and more inclusive characterization. We are interested in identifying disproven practices.

The criteria for making the discredited ratings were left to the respondents on the basis of “several types of evidence: peer-reviewed controlled research, clinical practice, and/or professional consensus.”

On a scale where 1 =not at all discredited, 2=unlikely discredited, 3=possibly discredited, 4=probably discredited, and 5=certainly discredited, “primal scream therapy” was rated as 4.51, i.e. “probably discredited” and halfway to “certainly discredited.” Primal was regarded as less credible than “standard prefrontal lobotomy for treatment of mental/behavioral disorders (4.44),” “Erhard Seminar Training for treatment of mental/behavioral disorders (4.29),” and “Psychotherapy for the treatment of penis envy (3.60).”

Therapies deemed as “unlikely discredited” included “eye movement and desensization processing (EMDR) (2.88)”, “laughter or humor therapy for treatment of depression (2.83)” (I kid you not!), “psychosocial (nonbehavioral) therapies for ADHD (2.85),” and thought-stopping procedures for ruminations/intrusive worry (2.25).” The only therapy regarded as not at all discredited, by a narrow margin, was “behavior therapy for sex offenders (1.97).”

Echoing the NYT obit, the authors concluded, “experts considered as certainly discredited 14 psychological treatments: angel therapy, use of pyramid structures, orgone therapy, crystal healing, past lives therapy, future lives therapy, treatments for post-traumatic stress disorder (PTSD) caused by alien abduction, rebirthing therapies, color therapy, primal scream, chiropractic manipulation, thought field therapy, standard prefrontal lobotomy, and aroma therapy.”

Stunning ignorance, I know. But take a deep breath.

In all the therapies listed, except the cognitively based therapies, cognitive behavioral therapists were more likely to rate them as discredited. Not only that, but most of these “experts” were not even familiar with many of the treatments. And yet they felt competent to judge them. With regard to “primal scream therapy,” 6% were not familiar with the therapy. Actually, I would say zero percent were familiar with the therapy because it is not called primal scream therapy!

Nowhere is the “evidence” mentioned that substantiates these “expert’” decisions. I assume they just cherry picked whatever papers fit their therapeutic orientation, or perhaps they just gathered around their virtual water cooler and made up that “professional consensus.” As for “primal scream therapy” they had obviously done no research to find out that primal therapy has nothing to do with screaming.

So this is the sort of misinformation about primal therapy that is circulating around the psychological community and the mainstream press. Decades ago, Art Janov decided to distance himself from the mental health establishment for this very reason. Despite his many efforts to convince his colleagues that his therapy worked, he was met with ridicule and outright defamation. Since then, primal therapy has existed on its own, quietly advancing as the decades have passed, and some respected psychologists, physicians, and neuroscientists have come to appreciate its effectiveness: Louis Cozolino, Justin Feinstein, Jaak Panksepp, Paul Thompson, and Gabor Maté, to name a few. And although the therapy still needs to be researched, it will be done without the participation of these “expert” clowns.

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Addiction: It’s Not about the Brain

by Bruce Wilson

Two items crossed my attention this week, both of them related to addiction.

The first was a WSJ article about a study looking at the adolescent brain: “Are Some Teenagers Wired for Addiction?” Using fMRI, the researchers identified a particular pattern of neural activity in teens who had a tendency to become addicted to drugs or alcohol. Specifically, these teens had lower activity in the orbitofrontal cortex (OFC), a region that mediates impulsive behavior. (More on the OFC in a future post.) The implication is that faulty OFC activity causes poor impulse control which in turn causes kids to become easily addicted. A different pattern of faulty networks was found in kids with ADHD, also related to impulse control. In other words, the brain is the problem.

Continue reading “Addiction: It’s Not about the Brain”

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Abreaction Part 2: Abreaction vs Connected Feeling – What’s the Difference?

by Bruce Wilson

In my last post, I described the history of abreaction and why it was abandoned in mainstream psychotherapy. But modern therapists who model their treatment on primal therapy often facilitate abreaction without even knowing it. They may encourage an anything-goes approach to feeling, allowing the client to go wherever they will without intervention.

The result can be an undetected slide into abreaction because it’s often easier to feel something out of context rather than face the original feeling that was triggered in the session. I asked France Janov of The Arthur Janov Primal Center to describe abreaction and how it differs from a connected feeling. She explains it as follows:

Abreaction is an emotional release that looks like a feeling, sometime sounds like a feeling, but isn’t a feeling. It is the discharge of a  feeling, disconnected from its source, making it in fact a defense or reinforcing a defense.  It can be the release of a feeling from one level of consciousness into another level of consciousness – for example, first line into third line, or first line disconnected from any other level, taking on a life of its own to the exclusion of any other levels.

Continue reading “Abreaction Part 2: Abreaction vs Connected Feeling – What’s the Difference?”

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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.”

Continue reading “Abreaction Part I: What it is and why it was abandoned in psychotherapy”

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“I’ll have a cup of enlightenment, please.” “Will that be with or without feelings, sir?”

by Bruce

If you follow Art Janov’s blog, you may have read his scathing essay on mindfulness therapy. While I agree with his basic argument—that mindfulness therapy is too often a form of mindLESSness therapy—I’d like to provide a broader perspective. In short, mindfulness is not all that bad if you use it to be mindful of feelings, rather than detach from them.

Mindfulness meditation is the current zeitgeist in psychotherapy. Not surprisingly, it fits hand-in-hand with the other dominant therapeutic modality: cognitive behavioral therapy. In fact, there is now a hybrid of the two called MBCT – mindfulness-based cognitive therapy. Both techniques are based on the same mechanism—detachment from feelings and thoughts. The “how” of mindfulness meditation can be summed up simply: sit still for 30 or 40 minutes, keep your eyes slightly open, follow your breath, and pay attention to whatever is going on in your mind and body but don’t do anything about it. Just sit there. When you catch your thoughts drifting, get back to the breath. There are variations on this theme, such as walking meditation and meditation while doing yoga or manual work. In a word, meditation is about paying attention. Be here now! Nothing more, nothing less.

Continue reading ““I’ll have a cup of enlightenment, please.” “Will that be with or without feelings, sir?””

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If you have to ask, you’ll never know.

by Bruce Wilson

I’ve often told Arthur Janov that primal therapy needs good evidence from well-designed outcome studies before the psychological community will accept it as a valid therapy. I tell him this is the only way his colleagues will come to believe that the therapy works. His response is usually something like, “they won’t believe it even if you prove it to them. With scientists, the distance from the left brain to the right cannot be crossed.”

In a way, he’s correct. To those of us who have allowed ourselves to let go and drop deeply into feelings without inhibition or control, the concept of “feeling” takes on a whole new meaning. From that point forward, the common notion of feeling held by most psychologists is revealed as a pale facsimile of the real thing. Rather, it is only the tip of the iceberg, the bare beginning of what’s needed to connect with our deepest selves and reclaim our birthright as fully feeling human beings. And as Janov repeatedly reminds us, this process must be done slowly and carefully, with a constant focus on insight and connection, otherwise we can get easily get lost in empty catharsis with few insights or bizarre ideation. Janov calls this “abreaction.”

To psychologists who haven’t gone deeply into their own feelings, this is terra incognita. Most consider deep feeling as dangerous – something to avoid lest it “retraumatize” the client. Even the most well-meaning of therapists who say their approach is “all about feelings” miss the point. The loss of control needed to descend to the level at which the trauma occurred cannot be avoided. Without it, you remain at a distance, apart from the trauma. You must go into the center of the pain to resolve it, and when done properly, the pain dissolves into feeling and the insights flow. Left brain and right brain connect to create a wholly functional, feeling being.

But in today’s trauma therapy, the client is usually led part-way into the pain whereupon the therapist intervenes with advice on how to “appraise” the feeling. The cognitive brain stays firmly in control while the feeling is observed from afar, as though on a stage. A variation of this is EMDR – eye movement desensitization therapy – where the client witnesses the trauma from afar, as though in hypnosis, and then talks about it. She remains detached from her pain because to go deeper into it risks retraumatization.

And herein lies the difficulty in encouraging the scientific community to consider primal therapy seriously: unless you’ve been there and dropped to that level yourself, the concept of primal feeling is foreign and usually confused with loud screaming, crying, venting, flailing or flopping about, or some other display of extreme emotion, but with no understanding of what is happening on the inside. More often than not, deep feeling is avoided because most if not all psychologists have some degree of past trauma they are defending against. They may have touched on it in talk therapy, cried about it even, but very few have let themselves go to the depths because after all, it is painful, and most talk therapy situations don’t allow full expression of feelings, lest it disturb their professional neighbours. Also, later trauma often connects to earlier trauma underneath, a phenomenon Janov refers to as the chain of pain. There is a general fear of losing control, despite the fact that primal therapy has mapped this territory well over its forty plus years of development.

This is why the science of primal therapy must be done by researchers who have gone through the primal process, preferably all the way through therapist training. Otherwise, there will always be the question, “just what are primal feelings?” And as Louis Armstrong said when someone asked him what jazz was, “if you have to ask, you’ll never know.”

 

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The Dalai Lama had a kind mother

by Bruce Wilson

The Dalai Lama is often held up as an example of what human beings can be: kind, loving, compassionate, even in the face of adversity. One of the reasons he is so healthy is because he had a loving mother.

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Why Past Life Therapy is Not Primal Therapy

by Bruce Wilson

On a previous post, I was asked why I neglect “past lives” in my discussions of primal therapy. The short answer is that I am not convinced that past lives or past life memories are real. If someone were to produce convincing evidence for this, I might change my tune, but the evidence would have to be extremely powerful and incontrovertible.

In scientific terms, the claim for past lives is extraordinary, and as Carl Sagan said, extraordinary claims require extraordinary evidence. I’m not saying I am certain that past lives don’t exist, only that the current evidence doesn’t support the idea. In fact, psychiatrists highly dedicated to the scientific method have produced suggestive evidence to support past life phenomena, but its relevance to psychotherapy is questionable. I explain why below. Continue reading “Why Past Life Therapy is Not Primal Therapy”

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Primal Therapy and the Limits of Science

by Bruce Wilson

A comment I hear frequently is that primal therapy can never be proven by science. As Phil states in his comment to my last post:

“…the actual practice of primal therapy can never really be scientific, in my opinion. How could it be when it is based on feelings? Adding blood pressure measurements and brain wave readings might help a little, but not much. What is critical is what the therapist says and does, and has the patient say or do. That can’t be scientific, I am afraid. It is based on feelings and intuitions on what will work or not work, based on experience and the degree to which a therapist has done his or her own feeling work.” Continue reading “Primal Therapy and the Limits of Science”

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Primal Therapy on the World Stage!

by Bruce Wilson

Today, Peter flies off to Athens, Greece, where on May 18 he will present a talk on primal therapy to an international audience of psychiatrists and psychologists. The title of his talk is:

Primal Therapy, Psychodynamic Therapies, and the Early Life Determinants of Mental Health

The conference is the:

16th International Conference of the Association of Psychology and Psychiatry for Adults and Children

At this point, it’s unclear whether Peter’s presentation will be recorded, but we look forward to hearing all about it on his return.

Good luck, Peter!

 

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