Saturday, May 21, 2011

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.”
I agree with Phil, but only partially. Indeed, feelings and all internal states are beyond the reach of science because science can only observe externals. In scientific psychology, those externals are human behavior. From observing people’s behavior, psychologists make inferences about what’s going on inside their minds and hearts.  Their conclusions depend on whatever school of psychology they belong to, which is often dictated by the fashion of the day.
So from the strict definition of science as empirical observation of objective phenomena “out there” in the world, primal therapy is not scientific. But that also goes for psychoanalysis, depth psychology, psychodynamic therapies, and even cognitive behavioral therapy. A therapist can never really know for sure whether it is their therapy that’s helping clients or whether it’s some other factor, like the therapist-client relationship, the client’s inner resources, the passage of time, improvement in life circumstances, simple maturity, or a combination of them all. No matter how tightly you design your studies, the determinants of human behavior are too complex to identify with 100% accuracy.
But you can make your best effort. And by doing so, you’ll get indicators as to whether your therapy is making a difference, or whether it’s something else.
In primal therapy, you can never prove that reliving old feelings are making a difference.  As Phil says, good primal therapy entails many factors – the nature of the client, the skill of the therapist, the amount of therapy the therapist has received, whether or not the therapist stays in touch with their feelings (a critical factor!), and so many more.
But all those factors can be assessed by people qualified to assess them and be included in an outcomes study. For example, take 50 clients entering primal therapy.  Document anything and everything that might affect their therapy, including physical condition, medical history, social history, nature of their problem (not necessarily DSM diagnoses but that would help when publishing papers.) I understand this is already being done at the Janov Center although not in any organized, comprehensive way with research goals in mind. If done properly, the research team could collect a large database of baseline data on incoming clients.
Then assess the therapists. How long have they been trained? How are they perceived by their senior therapists and peers in terms of skill? How do advanced clients perceive them? Are they following the rules of best practice? (Best practice guidelines are sorely lacking in primal therapy but this could change with a research program.) The point of this exercise is to gather data that is not easily quantified but is nevertheless critical for therapeutic success.
This baseline data, updated regularly, would provide a firm basis for a long-term outcome study on those 50 clients. There are a host of scales to assess health and well-being, many validated for psychotherapy. Combining these measures with physiological outcome measures would provide a wealth of data as to how people change in therapy, all of them quantifiable and subject to statistical analysis. With the many multifactorial analysis tools available, one could identify the factors that are most important for therapeutic success.
At no point would you need to prove with 100% certainty that feelings are the curative factor (to use a Janovian term). But a well-designed study would show the world that primal therapy is much more than a pseudoscientific cult, a crazy therapy  on par with rebirthing,  crystal therapy, past life therapy, or worse.
Or maybe it wouldn’t. A well-done study could show that some other factor or factors are at play. It may even show no effect at all on many people, or even a negative effect. One of the few independent outcome studies done on primal therapy showed only a 40% success rate, but the study was done 27 years ago when primal therapy was still in its infancy.
Whatever the case, scientific research would provide reliable data on which people improve in primal therapy and why. Equally important, it would identify those types of people most likely to benefit.  Despite the claims that all this is already known by those in the inner circle of primal therapy, it’s based on theory, and primal therapy has always been driven by theory. It’s never been subjected to true scientific scrutiny. It’s time this changed.
As Stephen Khamsi wrote in his excellent review of primal therapy research:
Theory can open or close our eyes. Just as Janov opened eyes when his insights were fresh, we can continue to open eyes and hearts and minds by researching and reporting human experience as it is lived – not theorized. Janov helped us see beyond the bounds of psychological theories extant. Now we must see beyond his.