The present article describes the process of primal therapy with infants, reports outcomes, and clarifies important differences in primal therapy for infants vs. adults.
The possibility of “primaling” infants occurred in when I was asked to consult on a very difficult case. An infant girl had severe and episodic bronchitis, and her condition had not been responsive to medical treatment. A psychological evaluation yielded no indication of current pathological factors in the infant or her family. On this basis we concluded that the bronchial episodes were due to undetermined allergic reactions, or to antecedent trauma.
We (the parents and I) decided to proceed with primal work, and to explore various ways to uncover the underlying traumatic material. We proceeded by massaging the infant, attempting to “simulate” the pelvic and muscular pressures of her birth (estimated from birth pictures and medical records). She had strong legs, and began to push vigorously. As the bridge of her nose reached the “pelvic orifice” (via hand simulation), she responded with generalized agitation and with wheezing. Her pushing and struggling intensified, and she had a severe bronchial episode (she did not have these in response to other forms of physical restraint, e.g. squeezing her shoulders or rib cage together). She repeated the pushing motions four times, and each time she had another episode, but with lessening intensity. Simulations were continued on subsequent days, and the bronchial episodes reliably occurred. Each day they diminished in intensity. Emotional catharses (terror, sadness, and anger) accompanied the episodes, and these also diminished on a daily basis. At the end of her final session, she let out a deep sigh, as if to say, “There, that’s finished.” Her bronchial symptoms did not reoccur (twelve-year follow up), and the primal emotions were not recapitulated (ala Emerson, 1978) as she grew up.
Primal Therapy with Infants
Since the initial case (just described), 75 infants completed primal therapy. The average number of sessions per infant was 14, with a range from 3 to 27. This work occurred within individual therapy (with one or both parents present), family therapy, and/or group therapy. The groups consisted of infants who were referred for the treatment of traumatic births and/or obvious prenatal traumas (e.g. abortion attempts, accidents, intrauterine toxicities, intrauterine addictions, near-death experiences, family crises, etc.). The success of treatment did not depend on number of sessions, but on the extent to which primal feelings were properly contained and imploded, and to the degree that deep contact was made between the parents (or therapist) and infants (see below).
Various approaches were developed to promote primal work in infants. No single approach was effective for all infants, nor were all approaches successful with a single infant. In addition, a number of techniques were applicable only to birth, while others were applicable to prenatal events. A total of seven approaches were developed, and five of them were applied in over 95% of the cases: underwater simulation, physical simulation (as described above), psychomotor restimulation, auditory restimulation, and womb-simulation. These approaches are defined and clarified elsewhere (Emerson, 1984a; 1984b).
The most frequently utilized and generally applicable technique is that of physical simulation. In general, this technique involves a gentle re-creation of the physical aspects of the trauma. The physical simulation of birth is the most straightforward, and videotapes of this work are available for professional review (Emerson, 1984c). These tapes show that birthing movements become stylized, and are spontaneously repeated in various postnatal circumstances. Repetition of these movements allows a “diagnosis” of the movements and pressures which occurred during birth. For example, one infant was a right-occiput (ROA) presentation-her birth position was on her right side, facing the left arm of her mother. As she emerged from the womb, her head rotated counterclockwise a quarter turn, and then corrected back to its original position as the right occiput and anterior portion of her head presented itself upon birth. As we placed her in this position and physically simulated the womb and the pelvic orifice with our bodies and hands, she initiated these exact movements, with associated emotional catharses.
In undertaking primal therapy with infants, a number of boundary conditions are important to consider. First, infants are not able to express themselves verbally or broadly (i.e. in art, sandplay, or play). However, they are able to express themselves nonverbally, and it is this quality which allows the therapeutic process to unfold. Studies on adult communication indicate that 75% of personal expression is nonverbal, and only 25% verbal. On this basis, it is possible to listen to and understand the communications of infants in much the same way that adults are listened to and understood. Second, infants cannot understand or follow verbal directions, so regressive methods which do not rely on verbal communication must be found. Third, in order to restimulate or simulate primal trauma, it is often necessary to create environmental and energetic conditions which are similar to those present at birth. For example, one infant had been born after a hasty rush to the hospital. He was born breech with no major complications. All birth simulations were relatively ineffective until one session for which the parents were late. Their own feelings of anxiety and frustration in rushing to the session were critical in activating the birth memories of their son. In front of their eyes he primaled terror, rage, and sadness. Psychodrama is often useful in activating the feelings which surrounded the birth.
Research has found that adult symptom patterns are associated with types of birth or prenatal experiences (Emerson, 1984b; Grof, 1978; Janov, 1973; Lake, 1981). For example, cesarian babies are more likely (as adults) to have rescue fantasies and to rely on others to “help them through.” Forcep- and induced-infants are more likely to develop symptomatic issues around intrusion and authority. Infants with prolonged containment (during second stage labor) are more likely to manifest claustrophobia.
To evaluate the effectiveness of our work, infants with similar primal experiences were grouped together, and were followed up to determine whether the domain of expected symptoms occurred. To avoid the positive effects of expectation, and to better evaluate the effects of the therapeutic treatment by itself, parents were not informed about likely outcomes of the various types of birth and prenatal experiences. Of the 75 infants who were treated, 54 were available for follow up evaluations. Of the 54, 12 had “matched controls,” i.e., infants with similar primal experiences but no therapeutic treatment (usually because the parents did not consent to treatment).
Data from the long term follow up and from the matched pairs yielded uniform findings. In general, most of the untreated infants developed the expected and pathologic symptoms, whereas the treated infants did not. However, some of the results were contradictory: six percent of the treated infants developed pathologic symptom patterns, and fifteen percent of the untreated infants did not.
A comparison of matched pairs offered some rationale for the contradictory results. Results from two breech infants and their matched controls were representative, and will be used to clarify these rationales. All breech outcomes were as expected, except that one untreated breech did not develop the anticipated symptoms. In discussions with the parents of this infant, I noticed that they possessed a unique style of parenting. They seemed to be “natural parents,” very much at ease with their child. They were not “primal-wise” nor psychologically sophisticated, yet they had the capacity to guess the likely outcomes of their child’s birth. For example, the father guessed that his son might be directionally confused (one common outcome of breech birthing). The parents were able to consider negative outcomes in a relaxed (rather than serious) manner, and often with a sense of humor. The relationship with their child seemed contactful, caring, and free of manipulation or control. In general, these qualities were obvious in the parents of untreated infants who were free of the expected symptom patterns.
We also noticed an absence of reinforcing trauma in the lives of untreated and asymptomatic children, i.e., their childhoods were free of reinforcing conditions. Conversely, many of the untreated children who developed pathologic patterns were exposed to exacerbating conditions. For example, one infant experienced severe containment during birth, and was also locked up in a closet by his brother and tied to a tree by friends. Asymptomatic conditions were most frequent for treated infants with healthy parents and an absence of reinforcing conditions.
In addition to assessing the long-term effects of primaling, short-term impacts were also evaluated. Infant primal therapy had very positive and immediate effects on presenting problems. Behavioral disorders (such as sleeping difficulties, eating problems, hyperactivity, moodiness, and irritability), emotional disorders (excessive crying, lethargy, withdrawal, anger, anxiety, and fear), and medical conditions (colic, diahrrea, bronchitis, asthma, hypothyroidism, enteritis, and eczema) were all assisted by infant primaling. While results for short-term impacts were generally positive, there were cases (12%) where neither medical nor primal interventions alleviated the referring conditions. However, referring behaviors were successfully treated in 88% of the cases. Thirty-five percent of the cases required a combination of medical and psychological treatment to impact referring behaviors, and sixty percent of referrals were successfully treated by primal therapy alone.
Life space interviews for primaled and non-primaled infants yielded supplementary data. Primaled infants were described as more trusting, contactful, energetic, present, calm, relaxed, expressive, curious, happy, secure, and independent. Pediatric ratings of psychomotor development and emotional adjustment were also higher.
Essential Primal Parameters
1. Therapist-Patient Relationship. In discussions with primal integration therapists, broad ranges of opinion on the importance of the therapist-patient relationship were encountered. Some viewed the relationship as essential, and others viewed it as unimportant or nonessential. While the importance of the relationship may be debated within the realm of adult primal therapy, the therapeutic relationship is essential in dealing with infants. This is because the infant is totally dependent upon the mother, father, and/or others (perhaps the therapist) in perceiving and processing primal feelings. This is because infants do not have the volitional capacity to perceive themselves as separate from feelings (though they do posess nonvolitional capacity-see Emerson, 1984b). As Winnicott (1960) observed, infants are impotent to discover themselves, since they have no capacity to perceive themselves as separate objects. They simply are their feelings. However, when infants see themselves mirrored in the eyes of parents (or significant others), they then have the capacity to discover themselves and their own primal feelings. As Miller (1 981, p.1 12) says, “. . . the infant is mirrored in the eyes of the mothers, and finds himself therein.” That is, when others reflect the primal expressions of infants, they are assisting infants in discovering their own feelings, and ultimately themselves. Further material on the importance of reflective responses with infants is available in Weinrib (1983), Emerson (1984b), and Neumann (1976).
In order to foster reflective functioning, the role of the primal therapist is threefold: (1) to organize the therapeutic environment in a way that assists infant primaling and to model the accurate reflection of primal feelings; (2) to identify infant feelings which are not perceived, accurately, and to work with parents toward the accurate recognition of these feelings; and (3) to alert parents to the omnipresence of primal feelings in the ordinary life-spaces of their infants. The structure of the infant psyche is a defensive, so primal feelings are accessible and actively emergent. Primal feelings have been observed to occur in response to breast-feeding, diaper changing, sudden sounds, rocking, emotional exchanges between parents, and in spontaneous ways. However, parents seldom perceive these feelings as primal in nature, or as therapeutically valuable. Instead primal feelings are relegated to categories of “unnecessary fussiness” or “terribleness.” Many times, primal catharses are seen as spoiled and irrational expressions which need to be controlled and eradicated. However, once recognized as primal material, parents are able to see these explosive behaviors as therapeutically valuable and are therefore more able to provide empathy and support to their infants.
Parents are sensitized to primal pain and the primal process through the use of films (Emerson, 1984ac) and educational material. The films provide a modeling of typical primal responses and a range of empathic responses. Educational materials cover the various stages of birth and prenatal life-birth has four specific stages (Goof, 1975) and the prenatal period has three (Emerson, 1984b). Each stage has fundamentally unique traumas and concomitant primal feelings. When these are known, parents are more able to perceive the bases for primal trauma, to understand primal pain, and to empathize with it.
2. Implosive Containment. In my early work with infants, I noticed a strong tendency for infants to “lose it.” That is, they would intensely cathart, but in a way that seemed disconnected-almost as if they were “on another planet.” Little contact with infants was possible. Furthermore, the catharses would continue unabated, gradually evolving into temper tantrums and/or exhaustion. Some therapists saw the tantrums and/or the exhaustion as evidence of sufficient catharsis and therapeutic progress. However, regardless of the number of subsequent sessions, these catharses continued unabated, as though they were having little impact on underlying pain. Results supported the latter notion. Some immediate changes were evident, but long-term follow up showed that the presenting problems and anticipated symptom patterns were frequent at later ages. This observation supports the notion that strong catharsis alone does little to eliminate the existence of primal pain.
This conclusion challenges a basic tenet of primal therapy with adults, i.e., that the more intense and the deeper (below layers of defense) the level of catharsis, the greater the healing potential (Janov, 1973). The obverse is true with infants. That is, the more defensive the infant (while still exhibiting some defenselessness), and the more contained the catharses (while still qualifying as catharses), the more likely the process will be healing for the infant. The promotion of healthy defensiveness and the containment of primal feelings has the consequent impact of improving contact between parents (or therapist) and infants. This process is called implosive containment.
Implosion is defined by Webster as “a bursting inward-contrasted with explosion.” The goal of implosive containment is to support the infant in maintaining a certain distance from primal material, and to control the level of catharsis, The theoretical foundations for this process have been outlined elsewhere (Emerson, 1984b, 1986). These might be summarized as follows. Containing primal feelings keeps the energetic expression of primal pain within the boundaries of the infant’s sensorium (ala Mahler, 1968), which in turn promotes a healthy sense of self in relation to the pain. The converse of this situation (out-of-sensorium) calls for a healthy defen- siveness, or what might be called a healthy distancing from the pain. This occurs when infants “lose it,” and the pain is boundless in its expression and lacking in contact. When this situation develops, the encounter with primal pain is being mediated by the higherself system (ala Assagioli, 1965) of the infant. This mediation fosters an undiscriminated merging and primary identification with primal experi- ence. Primary identification involves the preverbal and undifferentiated incorpora- tion of primal feelings as one’s own, at the deepest levels of the psyche. This has the sum effect of forming attachments to primal pain, and complicating the separation and individuation process. It is essential to realize that the immature ego system of infants is incapable of dealing with primal pain that is not incorporated (i.e., in sensorium). When this is allowed to occur, the Self is the primary structure of the infant psyche which mediates primal traumata, with the consequent problems discussed above. The most desirable feature and basic outcome of implosive containment is that it keeps the infant’s primal feelings contactful, both to him/herself and to others. When infants are available for contact, then the process of mirroring becomes possible. A high degree of contact and the presence of mirroring are the two ingredients which most optimally foster the healing of primal pain.
3. Schematic Repatterning. Infants (from O-2) learn byperforming repetitive actions on objects (Piaget, 1954,1955), and these actions become internalized as subliminal action patterns and as thoughts. For example, an infant who throws a ball over and over again will gradually come to think about throwing a ball. Furthermore, when the infant thinks about throwing the ball, all the electro-myographical and muscular processes involved in throwing the ball are subliminally activated. These internal responses are eventually associated with language and values as the child grows (e.g. I like throwing the ball, Throwing the ball is boy-stuff, It’s hard for me, etc.). These subliminal and intraorganismic patterns are called schemas.
Since birth is an action event for the infant, and since it involves repetitive actions under stress, it is an ideal psychomotoric system for the development of schemas. Repetitive actions which are performed to get from the womb to the world become foundation movements for schemas. Emerson (1984a) has delineated the various schemas which evolve out of birth movements. He found that schemas are characterological, that they persist into adulthood, and that they express as well as perpetuate unintegrated primal trauma. For these reasons, it is extremely important to diagnose the dysfunctional birth schemas of infants, and to initiate the discovery and repatterning of more functional movements. The specific techniques in accomplishing schematic repatterning have been covered elsewhere (Emerson, 1984b, 1984c).
Primal therapy with infants, as described in this paper, has been an evolving and challenging process, both theoretically and therapeutically. In my experience, it calls upon and challenges the deepest and the best of what it means to be human. So far, the work appears to be fruitful for infants, and deeply gratifying for parents and therapists. Any commentary, additional perspectives, and/or feedback on the presented material would be appreciated.