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The Seven Stages of Primal Therapy

by Stephen K. Witty, Ph.D. and Stephen K. Khamsi, Ph.D.

ABSTRACT: Arguing that primal therapy needs a demonstrable empirical foundation, a phenomenological methodology was used to examine the experiences of ten Primal Therapy subjects. This procedure yielded descriptions of the experience of primaling, the global experience of Primal Therapy, and the experience of Primal Therapy over time. These descriptions were translated into theoretical statements about Primal Therapy, and a comparison generally validated Janov's pioneering assertions about Primal Therapy. Moreover, this procedure yielded a new way of understanding Primal Therapy--that during the course of Primal Therapy, a person experiences seven overlapping stages which may be summarized as Initiation, Alienation, Despair, Acceptance, Expansion, Integration, and Disengagement.

In this generation, primal therapy has been variously described by Janov (1970), Miller (1991), Stettbacher (1991), and Noble (1993). Each of these contributions has been noteworthy, and yet none has been rigorously systematic; each is prescientific, relying upon the subjective interpretation of the presenter.

Janov (1970), for example, has worked diligently to understand clinical phenomena, to formulate theoretical constructs, to organize psychological theory, and to conduct psychiatric treatment. But has he succeeded? According to Alice Miller (1990), the Swiss psychologist and author who denounced psychoanalysis after undergoing Primal Therapy, Janov has "found a crucial path" but his contribution is imprecise and incomplete (p. 148).

Miller (1990) has argued that "personal access" is critical in approaching the problems of primal psychology. Why? Because "a precise, responsible description, one that gives readers some orientation, can protect potential patients and therapists from misuse and help them avoid the dangers of a pedagogic therapist who doesn't know what he is doing" (pp. 158-159).

Miller (1990) credits Stettbacher, the Swiss primal therapist, with overcoming many of the shortcomings of Primal Therapy (Note: Alice Miller no longer recommends Stettbacher's therapy. See Communication From Alice Miller.) How did he do this? Unlike Freud, Janov, and so many others, he was not satisfied with treating, observing, and describing patients. Instead, he wished to experience in himself his new method of "gaining access" to feelings (p. 158). And although Stettbacher's (1991) "four steps" method seems to constitute only a modest scientific contribution, Miller is justified in her argument that "personal access" is critical in approaching the problems of primal psychology. Fortunately, a second generation of researchers has included personal access in their approaches to primal theory, research, and practice (e.g., Adzema, 1985; Khamsi, 1985; Videgard, 1984; and Witty, 1979).

Empirical Primal Therapy Research

All psychological theory--including primal theory--needs a firm empirical foundation. How else can we know if its theoretical formulations are valid? How else can we safely generalize from our findings? But primal theory (Janov, 1970) developed concurrently with its clinical practice, so underlying notions about the process were not conceived systematically (Witty, 1979, p. 3). Concerning primal theory, then, we must ask whether its assertions are valid representations of the lived experience of Primal Therapy (Khamsi, 1988, p. 18).

The effects of psychotherapy--including Primal Therapy--belong to the class of cause-and-effect events as studied in the natural sciences. But they also belong to "the context of meaning" as studied in the human sciences. As such, the effects of Primal Therapy require an approach that is phenomenological (Videgard, 1984, pp. 69-70).

Phenomenology focuses on the "what" rather than the "why" of phenomena. The task of phenomenology is to let the world of the describer reveal itself more completely than it does in ordinary experience (Keen, 1975, p. 41). The method essentially involves the processes of intuition, reflection, and description (Giorgi, 1971, p. 10); rather than explaining a phenomenon within a preexistent framework, a researcher describes a phenomenon as it appears--before establishing hypotheses and theories (Kruger, 1979, p. 114). The goal of phenomenological research is to produce linguistic, self-validating descriptions of subjective meaning and experience, thereby providing a reliable guidepost to the reader's own experience of a phenomenon (Spiegelberg, 1982, p. 694).

Primal theory, research, and practice--as well as related ethical considerations--need to begin with the personal access provided by phenomenological description. Why? Because empirical, phenomenological research provides the indispensable qualitative foundation necessary for valid scientific inquiry. There is a need for personal access--for systematic, phenomenological research concerning the actual lived experience of Primal Therapy (Khamsi, 1987). What is the experience of "primaling?" What is the global experience of Primal Therapy? How is the primal process experienced over time? Is there a coherent structure to the experience? Only after establishing a basic, qualitative foundation (meaning) is it appropriate to check the results via quantitative analyses, i.e., to test a theory via derivative hypotheses and outcome research (measurement).

The EPT Study

Witty's (1979) The Experience of Primal Therapy: A Phenomenological Investigation (The ERT Study) was the first systematic investigation of Primal Therapy from the viewpoint of those experiencing the process. This study generated descriptions of the experience of primaling, the global experience of Primal Therapy, and the experience of Primal Therapy over time; together, these provided a legitimate empirical foundation for Primal Therapy (p. 3). In addition, these findings about Primal Therapy were used to evaluate Janov's formulations and to suggest modifications in primal theory and practice.

In this study, Witty (1979) researched the experiences of ten subjects (S's) who had undergone Primal Therapy for at least two years. Subjects were recruited in the San Francisco Bay Area from sign-up lists at the Marin Center for Intensive Therapy and the Berkeley Center. Six subjects were male, four were female. The average age was 32.3 years (with a range from 22 to 57). Five were married, four were single, and one was divorced; occupations included a clerk, a housepainter, a housewife, a musician, a physician, two students, and three counselors. They had been involved with Primal Therapy for an average of four years (with a range of two to seven years). The average level of education was 16.1 years, or approximately 4.1 years of college (with a range of 13 to 20 years). Five subjects had previously undergone psychotherapy or counseling. These ten subjects had been treated by eight different primal therapists, with each therapist having treated no more than two of the research participants (p. 35).

Subject interviews (averaging two hours) were conducted by Witty (1979) at the subjects homes, tape-recorded, and later transcribed and analyzed (p. 37). The interviews were structured in terms of the following four questions: (1) What, in the largest sense, has been your experience of Primal Therapy? (2) What, over time, have been your specific experiences in Primal Therapy? (3) How would you describe the experience of primaling? and (4) What is your experience now, having been through Primal Therapy?

Witty and a second judge analyzed the transcriptions and extracted significant themes; they eliminated those that were purely theoretical, abstract, or repetitious. From this, 196 themes were formulated about the experience of Primal Therapy, from which seven categories emerged. These categories included both "global statements" (the experience of primaling, the global experience of Primal Therapy, and the direction of change associated with Primal Therapy) and "temporal categories" (the experience of self, the perception of others, the perception of parents or significant others, and the perception of Primal Therapy itself). A questionnaire was then assembled from these themes: subjects were asked to either endorse or reject each of the 196 statements and, for the temporal statements, to associate each theme with a point in time in their own therapy process (on a scale of 1 to 5).

In tabulating the results of the questionnaire, Witty retained approximately three-fourths of the 196 themes; these were considered expressive of the experience of Primal Therapy, having been endorsed by at least 70 percent of subjects. For those that were temporal in nature, an average score was calculated for each, and they were rank ordered (from earliest to latest) within each of the four temporal categories.

A description of the experience of Primal Therapy was thereby generated, organized around (1) the experience of primaling, (2) the global experience of Primal Therapy, and (3) the experience of Primal Therapy over time. These descriptions were then translated into theoretical statements, and were used to assess prior assertions about Primal Therapy.

The Experience of Primaling

During a primal, one makes contact with a past memory and the feeling connected with it, and has the experience of descending. A person "goes with" the feeling, lets it expand and become "big," surrenders to it, and gives in to her body-movements. In letting go, she is aware that she is really allowing feeling rather than blocking. A person often experiences oneself as lost in feeling, but at the same time there is a part of oneself "watching" as one primals. She knows she can come out of a feeling if she wants to; if the pain is too much, a person can "turn off." During feeling, one loses track of time. One feeling leads to another and, after a while, feelings seem to emerge involuntarily.

When a person makes contact with a feeling, there is often a sense of "rightness" about it, as if one has arrived at something true and real. Having contacted a feeling, a primaler often experiences the emergence of sudden insights. The content of memories experienced during a primal session often has to do with being small and helpless, and being in the presence of one or both parents. At the end of a cycle one tends to feel lighter, as if having given up a weight. At the conclusion of a session, the person has the sense of having truly made contact with their feelings--and thereby with their real self. The insights that then emerge are experienced as solid and indisputable.

The Global Experience of Primal Therapy

A person experiences his primal process as a kind of "chipping away"--feeling old feelings in small "chunks." It is as if he is gradually giving up a heavy weight, and the more he gives up the lighter he feels. A primaler periodically experiences "plateaus" where he seems to be integrating what he has already experienced, rather than breaking new ground. The process as a whole is often experienced as an unfolding of the self.

The pattern of primal feeling is generally perceived as cyclical rather than linear. Over time, however, one seems to deal with earlier and earlier material. The person often experiences the same feeling in the context of different memories, or in the context of the same memory but as if from a different "angle." As one experiences old feelings over and over, these feelings gradually seem to emerge less often in daily life and to be generally less prominent in one's consciousness.

The Experience of Primal Therapy Over Time

During the first weeks of therapy, the person typically struggles with the issue of whether or not to commit fully to the therapy; she must decide if she is willing to take the personal risks that it entails. She often finds it difficult to contact feelings and, out of frustration, may perceive herself as a "hard nut to crack." Nevertheless, when she is able to make contact with feelings, they are perhaps deeper and more powerful than any she has ever experienced. The primaler acknowledges, as perhaps never before, the tremendous intensity of feelings and learns that she can have these feelings in the context of therapy without "going crazy." The person comes to see herself as a fully feeling person.

He now begins to perceive himself as starting a new phase of life. Feeling alone on a journey, it seems as if most other people are not capable of understanding what he is going through. He tends to feel different from other people who have not experienced the primal process, and may even think himself somehow "superior." The world seems a little crazy. People seem "unreal," as if they are playing games or masquerading. He may want to "turn on" the whole world to Primal Therapy. At the same time, he worries that the therapy may not work or that he is incapable of enduring it. The primaler sometimes wonders whether others are getting more from the therapy than he is. He is confused much of the time, but learning to allow his confusion.

During this period, the person is afraid of the outside world and withdraws from it somewhat. Often it seems that she will never get through her old feelings, as if they are a "bottomless pit." It seems as if she will never get what she needs. She wonders whether the therapy is worth the pain. She often finds herself waiting to have a "magical primal" which, in one shot, will somehow relieve here of all of her pain. Still, there are moments, often after a complete feeling, when faith about the process is renewed--that she may possibly find contentment. Primal Therapy has now begun to feel like an integral part of life. The person has come to realize that, whoever she has become, it is impossible to return to being who she was before the therapy.

The person now begins to accept that, as an adult, he is never going to get those things that he needed as a child. He realizes that he has been struggling to extract love from his parents, and from the world. Refusing any longer to beg for the love he never received, he realizes how crazy it has made him to struggle for that love. He accepts that there is no payoff for the pain that he has experienced, and that he is alone in the world.

The person now comes to see herself as truly separate from other people. At the same time, she is also becoming aware of how much she shares with everyone else in the world; she is more tolerant of others, more accepting of their feelings. She is becoming aware of something inside of herself that feels very beautiful and loving, something she is capable of sharing with others. She is also beginning to make contact with a sense of great inner power.

The primaler now begins to take a more active role in the feeling process, relying more on himself than on therapists for the direction of his therapy. He is becoming increasingly aware of the interrelationship between what is going on inside of himself and what is happening outside of him. He is gradually giving up his anger at his parents and, at the same time, feeling less attached to them. He begins to realize that he is capable of surviving on his own. The person depends less on other people and struggles less to make people understand him. Being generally more honest and straightforward with people, relationships seem easier and less complicated. He notices that he is reacting differently in familiar situations.

A primaler begins to consciously "take the bull by the horns" and to make life changes. She is beginning to live life in terms of her own needs, rather than attempting to please others. There is a developing sense of what it is to be "clear," and she more fully accept the uniqueness of her own reality. Having been through the primal process, she is now confident that her vision is deep and accurate.

Generally less anxious about "doing therapy right," he is less concerned with being a "primal person." Primal Therapy has begun to assume a generally less important place in his life. In therapy, he now tends to focus more on current rather than past feelings, although the old feelings now tend to be deeper and more terrifying than anything previously experienced. The person still feels pain in life--the pain associated with the inevitable hurtfulness of daily living. At the same time he is now capable of feeling his pain, of moving through it and beyond it. He feels generally competent, equal to life's challenges. The person now wants to explore other avenues of growth and, at the same time, seems to be attracting those things that will enhance his growth.

Theoretical Statements About Primal Therapy

The phenomenological descriptions (human science) of The EPT Study were translated into theoretical statements (natural science), resulting in the following twelve statements about Primal Therapy:

1. A primal is a psychophysiological event in which one becomes aware of an early memory and allows oneself, in the present, to fully experience that memory and the feeling associated with it.

2. During a primal, one is aware of oneself primaling and is able to discontinue primaling if the pain becomes too great.

3. During a primal, each memory and its associated feeling becomes a stimulus for the emergence of related memories and feelings.

4. Primals are often accompanied by insights that, for the person, have incontrovertible validity.

5. At the conclusion of a primal, a person experiences a subjective state of relief and well-being.

6. During the process of Primal Therapy, a person gradually reexperiences and resolves painful feelings from the past.

7. As one resolves painful feelings from the past, one gradually gains a greater sense of self.

8. During the course of Primal Therapy, a person experiences alternating periods of discovery (when new material is uncovered) and integration (when newly-uncovered material is worked through).

9. A person tends to experience earlier and earlier material as Primal Therapy progresses.

10. During the course of Primal Therapy, specific feelings are experienced repeatedly in the context of different memories, and with varying affective qualities.

11. As early feelings are experienced over and over in Primal Therapy, these feelings tend to emerge less often in consciousness, and seem to have less influence over the person's behavior.

12. A person experiences the process of Primal Therapy as occurring in seven overlapping, temporal stages.

The first eleven theoretical statements were found to parallel Janov's (Janov, 1970, 1971, 1972 & 1973; Janov and Holden, 1975) prior assertions about Primal Therapy. This is highly significant; it suggests that Janov's theory is grounded in the actual experience of clients undergoing Primal Therapy. From the rigorous perspective of the natural sciences, these assertions are hypotheses that have received provisional support and therefore merit further study.

The twelfth theoretical statement--that the person experiences the process of Primal Therapy as occurring in seven overlapping, temporal stages--is an original contribution coming out of Witty's (1979) EPT Study.

The Stages of Primal Therapy

Primal Therapy is experienced in seven dynamic, overlapping, temporal stages. This is an original concept of Primal Therapy as an orderly and cohesive process with predictable stages. Each stage seems to be a necessary precondition for each subsequent stage, and each subsequent stage emerges logically out of what has already occurred. Still, experiences that seem to characterize a particular stage may also occur at other stages. The stages are as follows:

Stage 1. Initiation: The person learns how to make contact with her real self and how to do primal work. She typically begins therapy wrestling with the issue of commitment to the therapy--as it seems risky--but ultimately accept the demands of the therapy. During this period it may be difficult to feel, and she may become very frustrated. Nevertheless, when she does contact feelings, they seem deeper and more powerful than anything previously experienced. She acknowledges the tremendous intensity of these feelings and learns that she can have these feelings in therapy without "going crazy." She now sees herself as a feeling person and as starting a new phase of life.

Stage 2. Alienation: The person feels himself separated from his network of social relationships, and from who he was before beginning the therapy. Painfully alone on this journey, he feels as if others are incapable of understanding what he is going through. He tends to feel different from--perhaps even superior to--people who have not experienced the primal process. The world seems a little crazy. People seem "unreal." He may want to "turn on" the whole world to Primal Therapy, while simultaneously worrying that his own therapy may not work or that he may be incapable of enduring it. He sometimes wonders whether others in the therapy might be getting more out of it than he is. The primaler is confused much of the time, and learns to allow this confusion. Afraid of the outside world, the person tends to withdraw.

Stage 3. Despair: The person arrives at a distinct point of hopelessness and profound aloneness in the world. Attempts to avoid the loneliness, pain, and struggle are seen as futile. Often it seems that she isn't getting anywhere, that she will never get through her old feelings nor get what she needs. The primaler wonders whether the therapy is worth all the pain. She often hopes for a "magical primal" that will instantly relieve her of this unbearable pain. Still, there are moments, often after a productive therapy session, when faith is renewed that the therapy may work for her and that she may find contentment.

Stage 4. Acceptance: The primaler begins to accept the painful reality of his early life--that he did not receive nearly enough sustenance and support. He realizes that it is too late for his childhood needs to be met; and so, giving up the false hope of ever finding the love that he was lacking early in life, he resolves to stop struggling for that love in the present. He accepts that there is no payoff for his pain and that he is alone in the world. He becomes aware of himself as truly separate from, yet deeply sharing with, everyone in the world. The person is now more tolerant of others and accepting of their feelings. He now accepts that he must turn inward. Primal Therapy begins to feel like an integral part of life. He realizes that, whoever he has become, it is impossible to return to being who he was.

Stage 5. Expansion: The person turns inward and discovers a sense of great personal power, and overwhelming compassion, emanating from her center. She is becoming aware of an inner love and beauty, and she realizes that it can be shared with others. She begins to take a more active role in her therapy, and assumes a new sense of responsibility for her life; she disengages from dependence on others and moves toward self-reliance.

Stage 6. Integration: Newly-discovered feelings of personal power and compassion are now integrated into the primaler's personality, as he discovers how to live from this new identity. The person now reacts differently in familiar situations. He is more honest and straightforward than before, and relationships seem easier and less complicated. He realizes that he is capable of surviving on his own, becomes less dependent on others, and gradually feels less anger and attachment toward his parents. He begins to consciously live life in terms of his own needs, rather than in efforts to please others. The primaler actively counteracts "neurotic" habits from the past in order to gain a healthier mode of functioning in the present. He begins to accept the uniqueness of his own reality and to trust that his vision is deep and accurate.

Stage 7. Disengagement: The person feels stronger, clearer, and more whole . . . and no longer so dependent on the therapy. Having accomplished the major work of therapy, she is faced with the task of separating from formal therapy. In therapy, she begins to focus more on current feelings, although old feelings now tend to be deeper and more terrifying than ever. The primaler still feels the inevitable hurts of daily living but is capable of feeling and moving through this pain. Primal Therapy has begun to assume a less central place in her life, and she is less anxious about "doing the therapy right" or being "a primal person." The person feels able to meet life's challenges and wants to explore other avenues of growth.

Other Attempts to Define Primal Stages

Others have previously addressed the question of developmental stages in Primal Therapy. Janov (1970), for example, stated that the primal process "is almost mathematical in its lack of variation" (p. 322). Primals first deal with anger, then hurt, and then the need for love. "The Primal sequence is like life in reverse," according to Janov. "First, early in life was the need for love, then the hurt for not getting it, and finally the anger to ease the hurt" (p. 322). More recently, the Primal Institute held seminars to address the notion of stages in Primal Therapy (Stages, 1991; Stages, 1992). But both of these efforts lack scientific rigor; unfortunately, both are merely anecdotal and impressionistic in nature.

Rose (1976) proposed a series of primal "treatment stages," based on the work of the clinician Irwin Badin. They are (1) disarming the defenses, (2) anger and sadness, (3) primals relating to events of superficial importance, (4) primals relating to crucial episodes, (5) synthesis, and (6) the authentic self. This formulation, however, is also inadequate. The data include only the global impressions of a single clinician; testing was neither rigorous nor systematic, and the framework lacks logical consistency (Witty, 1979, p. 87).

Two offerings from outside the primal literature--both from "existential-analytic" therapy--were found to have significant similarities to The EPT Study's theory of stages. The first, Wheelis' (1973) "five-stage theory," defines the following stages in the process of change: (1) suffering, (2) insight, (3) will, (4) action, and (5) change (p. 102). The second, Bugental's (1965) "three-stage theory," consists of (1) awareness of existential givens, (2) confrontation with existential givens, and (3) authentic being. In both cases the person becomes aware of life's painful realities, faces these realities, and thereby discovers new resources within. These similarities in primal and existential theory should not be surprising, as Primal Therapy and the existential therapies share many common elements.

The Map of Primal Therapy

The EPT Study has established that there is an orderly, cohesive, even predictable structure to the experience of Primal Therapy. Because of this, the theory of stages can be used as a "map" of the primal process. In general, this map of Primal Therapy may facilitate more effective and stage-appropriate interventions.

One would be ill-advised, however, to rigidly apply this theory of stages. While it has been established that Primal Therapy has a structure, it has also been established that there is tremendous individual variation among primal clients (e.g., Walsh, 1984, pp. 117-119). In addition, strict stage theories are known to gloss over differences, inconsistencies, irregularities, and other real but complicating features (Flavell, 1982).

With this proviso in mind, we can appropriately entertain the idea that clinicians can utilize this map in several ways. First, therapists can educate potential clients as to the complexities and the difficulties of the primal process. Since a complete Primal Therapy would seem to involve moving through all seven stages, perhaps the person should be prepared to stay with the process to its completion or not to start at all.

Second, therapists can use the map to identify where their clients are in the primal process. Therapists can monitor clients' progression through the stages, and assess whether and how clients become "stuck"--and presumably "unstuck"--in one or more particular stage(s).

Finally, the map can be used to inform therapists and clients of the specific tasks of each therapy stage. This information can be used to formulate strategies that encourage and promote therapeutic movement, and to assist clients in traversing the characteristic difficulties associated with each stage. For example, some of the known challenges in Initiation lie in learning how to do primal work, making a commitment to the process, and surrendering to feeling. Later in therapy, for another example, the therapist would be aware of the kind of issues the person is likely to encounter upon entering Integration, such as countering neurotic habits and making changes in one's lifestyle.


The EPT Study has systematically elicited empirical, phenomenological data from subjects about their Primal Therapy experiences. Going directly to people undergoing Primal Therapy, rich descriptions of primal experiences were produced through systematic encounter and reflection. These original descriptions have stood the test of time, and they stand as the purest expressions of the Primal Therapy experience.

The phenomenological descriptions in The EPT Study have helped to strengthen the empirical foundation for primal theory. The descriptions were also used to check Janov's pioneering assertions about the primal process, which were largely validated.

Finally, the descriptive research of The EPT Study resulted in an original contribution--that Primal Therapy is experienced in seven overlapping stages. Primal Therapy begins with Initiation, in which a person learns to make contact with his or her real self, leading to Alienation both from the unreal self and from the network of social relationships in which that unreal self functioned. As this sense of alienation intensifies, the person arrives at a point of Despair in which they experience profound aloneness in the world. No longer avoiding their aloneness and pain, the struggle to alter one's situation is finally seen as futile, and one moves to Acceptance of the reality of one's early life: that they did not receive enough sustenance and support. One turns inward and undergoes an Expansion in which one discovers a sense of personal power--and feelings of overwhelming compassion--emanating from one's center. As a consequence of this discovery, the person begins to experience an Integration in which they incorporate into their personality newly-discovered feelings of personal power and compassion, and discovers how to live in the world with new feelings and a new identity. Completion of these tasks leads to Disengagement in which, having accomplished the major work of therapy, one is faced with the task of separating from the formal process of therapy.


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STEPHEN K. WITTY, Ph.D., is a clinical and consulting psychologist in Colorado Springs, Colorado, and a candidate in Jungian analysis with the Inter-regional Society of Jungian Analysts. He is interested in the phenomenology of intensive psychotherapy and the interface between primal and Jungian work.

STEPHEN K. KHAMSI, Ph.D., is a licensed psychotherapist in San Francisco, California, and has practiced primal therapy since 1977. Stephen received his doctorate in psychology from the Saybrook Institute in San Francisco, in part for his original research on the phenomenology of birth feelings in primal therapy. In addition to teaching psychology and human sexuality at the collegiate level, Stephen is interested in the ethics and professionalism of primal therapy, and in primal therapy as an international movement.

This article was originally published in Primal Renaissance: The Journal of Primal Psychology, Vol. 1, No. 2, Autumn 1995, pp. 22-33.

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