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Caution
Primal Therapy, from Janov to Miller and Stettbacher
This lecture was given in London by Einar Jenssen

The aim of this lecture is to look at the clinical and theoretical concepts of Arthur Janov, Alice Miller and J. Konrad Stettbacher. l will concentrate on three areas. Their view on the origin of neuroses, their view of the role of the therapist and transference, and their clinical concepts for curing mental illness. l will also introduce an actual clinical example from Stettbacher's book. l will use this to illustrate the ways they work with the clinical material. l will also be giving a critical view of both their theoretical concepts and their clinical practice based on our experience. Janov's description of how he came to discover what would become Primal Therapy started when a client described a dramatic experience in an alternative theatre in London. He saw a man called Ortiz who was dressed in nappies, drinking milk from a bottle and calling for "mummy and daddy". At the end of the act he threw up and plastic bags were passed around for the audience to do the same. l won't be doing this, this evening. The client's fascination with the act inspired Janov to ask him to call out for his Mummy and Daddy. He later wrote "l heard something that was going to change the course of my professional life and the lives of my clients. What l heard was an eerie scream welling up from the depths of a young man lying on the floor during a therapy session. l can liken it only to what might hear from a person about to be murdered." Janov wanted to find the cause of this scream and in his search for an answer he ended up where Freud had started some 80 years earlier. He writes "The pains we found underlying that scream l heard so long ago were what l call Primal Pains; they derive from any source early in life - surgery, physical abuse or simple neglect. The central element of these pains comes from the lack of love. The key is that the event from which they arise contains more pain than could have been integrated at the time, making it necessary to repress a good part of it, and store it for future reference. Primal Pain arises not only from lack of love but from those epiphanic moments or scenes when the child realise he is not loved and will not be." (epiphanic means revealing)

Traumas from childhood exist in our unconscious as painful memories. These repressed memories he found to be the cause of all psychopathology. The cure of neurotic, and for Janov all mental illness lay in a dramatic reformulation of Freud's catharsis theory. According to Janov, the complete reliving of these traumas would eventually empty the pool of pain and restore mental health.

Janov certainly developed his theory very differently from Freud. He stayed with the belief that it was real childhood experiences that was the active agent in the unconscious and phantasy was only seen as a way of processing or defending against the painful memories resurfacing into consciousness. The memories were, according to his theory, reactivated by a trigger in the present that would remind us of the hurtful incident in the past. The pain that is triggered would then be defended against and repressed. This can be done in a number of ways,eg through drugs such as alcohol and nicotine, by body armour such as Reich describes, by acting out and repeating the trauma in the present . In fact Janov believes that Freud's description of defensive mechanisms , such as denial, reaction formation, projection etc. are what are used when the repressive strategies that Janov describes, fail. To sum up, Janov believes neurosis to be a disease of memory, and that the recovery of the subject's real history through the lifting of infantile amnesia. The reliving of the repressed pain will allow the client freedom from the blind control of the unconscious and thereby cure mental illness.

The role of the therapist in Janov's theory is in a sense logical from these assumptions . Transference is not important . The therapist might symbolise the parent but in Janov's language this comes in the way of the client's real experience of the past and is therefore to be discouraged. The client's should be led directly to their pain by breaking down their defences. This is done in a variety of ways. Eg. by stopping the act outs,making the client lie in a bodily defenceless position, by isolating the client or by busting. "Busting" is a term used to describe how a therapist might confront a client. "You're stupid or you're a failure," he might say The theory argues that since the pain is stored in a pool of pain and health is restored through emptying the pool anything that reminds you of the past and makes you cry is therapeutic. lt should be said that the more brutal techniques used in the early days were mostly abandoned but the theory never changed to explain this change of technique. Janov did also use the concept of dialectics to explain that if the therapist was different from the parent ie listened, was kinder, respectful etc. the contrasting behaviour put the client in touch with the old pain.

The last theoretical concept of Janov's theory that I will look at is the theory of the three lines of consciousness. This is used both as a structural model and as a diagnostic tool.The mind ,according to Janov, develops in stages in the newborn infant as the brain itself develops in concentric spheres known as neuropils. The first line functions involve the anatomic midline, gastric, respiratory, bladder and bowel functions. They are controlled by the inner portion of the brain which is practically fully functional at and before birth - the visceral level of consciousness. The second level, or emotional component of the mind, centred on the limbic system, is also functioning soon after birth. It is only some years later, however, that the cortical, thinking, symbolic brain will be fully functional. In the meantime, traumas will be handled by the lower neuropils. Thus the newborn will develop colic because he doesn't have the capacity to be mystical. He needs a more developed brain for that. When he finally achieves it, colic may transmute into mysticism. (Janov believes that all mysticism is an escape from pain.)He also believed it to be very important that the reliving of childhood memories followed the opposite path from third line to first line feelings.

l will now leave Janov and move on to Alice Miller. She had been a psychoanalyst for many years but there were many aspects of psychoanalytic practice and theory that disturbed her. Her books show a development from first wanting to change analysis in "Thou Shalt Not Be Aware" to the complete abandonment of psychoanalysis which she now describes as a theory that covers up the reality of child abuse. She was quite early on fascinated by Janov's work but after meeting many Primal therapists including Janov she was disappointed and felt dissatisfied with the quality of their work. It was after reading the book "Stone Age" by Mariella Mehr that she found in the writer's description of therapy exactly what she was looking for. She contacted the author and discovered her therapist was J. Konrad Stettbacher. In his work she found, according to her, a completely unpedagogical therapy and a complete concept of therapy. To go back to her earlier works, her first book "The Drama of the Gifted Child" is still written from a psychoanalyst's viewpoint. What is apparent in this book is her move away from the classical Freudian stance to Object Relations Theory. She is probably influenced by Winnicott and Kohut. In her following book "For Your Own Good" her language is already less psychoanalytical. Here she introduces the concepts of poisonous pedagogy to describe the child rearing practices that are so prevalent in Europe and she traces the history of these practices. She shows very movingly that pain inflicted on children, "for their own good" is not in fact helpful but it is the parent reenacting the trauma that had been inflicted on them as children. She also describes several case histories to prove her point. The most famous of these being Hitler. She shows convincingly how many of his atrocities can be explained when knowing how he was persecuted and abused as a child. It is here that Alice Miller is at her best. She is bringing the reality of child abuse to the foreground in a way that many found more powerful than Janov. She does put this in a wider context and offers an explanation for the continuation of this "inherited sin. " The child protects its parents to salvage some hope of having its needs fulfilled and in the process denies and represses its true needs or its true self. But when this child grows up to be a parent it cannot bear to see its own children get what was denied to them, This would threaten to activate the old injury and is warded off by treating the child as he or she was once treated. And so history repeats itself. But, you might point out, not all of us abuse our children as we were abused . She believes that the only way this can be avoided is when the child will have had someone in their lives who took the role of the empathic witness i.e. recognised the child's suffering and took its side against the parents.

Alice Miller is not making a clinical theory herself. She simply points out in different ways and from different angles, often by analysing famous artists, criminals and politicians, how their pathology , theories and work can be understood by knowing their childhood history of abuse and neglect. In this way she is as Janov an historical determinist. The child is a passive victim of the parents abusive behaviour, and the child's adult behaviour can be explained by understanding its traumatic history.. She does however formulate one clinical concept that is central to her theory and that is the role of the therapist. Freud had said that the psychoanalyst ought to model himself or herself on the surgeon. Clinical, observing and detached. Janov's therapist had a similar role. Janov now writes. "The therapist is simply a dealer in pain" According to Alice Miller, this was not at all what the abused child needs. The client needs an advocate that can take his or her side in the battle with the now internalised parent.

l will now move onto J. Konrad Stettbacher who has formulated a clinical theory that Alice Miller endorsed.* Whereas Janov and Miller are qualified psychotherapists, Stettbacher apparently has no professional psychotherapy training. The core of Stettbacher's theory is the "4 steps ". Stettbacher formulates the same basic trauma theory as Janov ie. it is the deprivation of basic needs that leads to repression and thereby neurosis. His structural model is also a copy of Janov's three lines of consciousness. He uses Janov's model of how therapy should be organised . That is, there is an intensive phase, with follow up in groups. He does however never mention Janov by name thereby presents Janov's theory as his own. So how do they differ you might ask? The only difference is in their concept of how traumas are resolved. Stettbacher introduced the concept of the four steps as the concept that all therapy must follow. Janov according to Alice Miller only follows the first two steps and his therapy is therefore doomed to failure. This she points out in "Banished Knowledge". But before we go further in to this it is necessary to clarify the concept of the four steps.

Briefly, step one is where you describe your bodily sensations in a specific situation or scene. What you might be seeing, hearing, sensing, smelling etc. Step two is where you articulate and express what you are feeling in this situation and how these feelings affect you and what they do to you. In Step three you have to critically examine the situation to see if what you are feeling is appropriate and also question and reexamine your parents or other perpetrators both past and present. In step four you are asked to articulate what you need and to state what you don't need or want. According to Alice Miller, Janov only follows steps one and two. Janov would claim that feeling and expressing the feeling was enough and that connections and insights follow automatically from this process. He would however, emphasise the importance of finally feeling what you need in order to be able to fulfil your present needs and not to repeat your childhood deprivation. So in this sense,step four is also part of his model. The important difference lies therefore in step three. This step has the aim of questioning the transference in the present and the parents or others in the past. It also implicitly acknowledges that the child in order to survive, protects the parents/aggressor by identifying with them. In order to keep some hope alive it is necessary for the child to believe that in some way it is their fault if they are mistreated. As Fairbairn says, "it is better to live as a sinner in a world created by God, than to live in a world created by the devil." So what is repressed is not just pain but crucially, a painful relationship. The adult's relationship to him or herself, as well as others, will also be a reflection of this. You are likely to treat yourself as well as others in the same way that you were treated by your parents. Step three is there both to question your reaction in the situation and thereby identify the transferences but also to resolve the guilt the child feels by allowing itself to be identified as the "sinner". In the dialogue of the relationship, you question why your parents treated you the way they did in order to reevaluate the responsibility you have taken for their actions. Since Janov has no explicit way of dealing with this and because the inner world in his theory consists of a pool of pain and not painful relationships, it is possible that you will remain unconscious of how you have come to identify with and protect your parents. The danger here is that the client will unconsciously go on repeating this relationship and aim to be resolving her difficulties by feeling more or deeper as a way of tolerating or mastering what is unbearable. You might be able to express your anger or protest at what you have experienced but the part of you that has identified with the parent remains unconscious. If this does not become conscious you will tend to repeat the abusive relating when you as an adult are in a position of power and have the possibilities of misusing this power. You might also remain in relationships where you are being mistreated. Many adults might say they wish to be different from their own parents and yet find themselves doing the very things that they vowed not to do and yet not understand how that has come about. What is difficult in Stettbacher's examples is how you differentiate when for example your anger is the appropriate anger of the hurt child and when you are also acting as an angry parent. l can't see that this can be untangled outside the therapeutic relationship where a sensitive use of the countertransference and the therapist's role responsiveness can help untangle the ways you have identified with your parent's and also act like them. l don't know Stettbacher's clinical work intimately enough but l can't see a way from his writings what does resolve these problems. l fear that the client and also the therapist can go one seeing themselves as victims also when they act as perpetrators. For many people it is very painful to come to see how you have hurt others, including perhaps your own children, because of your identification with the abusive parents.

l do think that Stettbacher's intention with the four steps addresses an important lack in Janov's theory, namely the fact that the internal world consists of relationships and not just a pool of pain. But as l will come to in the clinical example , l think his application of this method fails his aim of stopping the repetition of these dysfunctional relationships.

There are also other areas where l am not in agreement with Stettbacher or Janov. Janov views the therapist as a dealer in pain. He or she is a technician who should bring the painful memories to the surface so that the pool of pain can be emptied. The method might be unpleasant but it is done "for your own good." Alice Miller talks of the empathic witness, enlightened witness or child's advocate. The therapist is the witness that can see and empathise with the child's real experience. This function of the therapist is very important but we take a wider view of the therapists role. We are all raised in relationships and the damage done to us is done in relationships. The therapist might think of him or herself as an empathic witness or pain technician but the client will bring into the therapy room a whole experience of relating. Children are failed in many ways, not just through flagrant abuse. eg. A child needs a parent to respect its individuality, to allow it to be dependent when necessary and to celebrate its autonomy when that time arrives. They need parents to be receptive to their needs and sensitive to the responses they want to evoke. They need them to bear their anger and distress, admit to being wrong when they are and also to keep safe limits and boundaries. These are but a few examples of the ways a parent and l would argue a therapist needs to be available to a client. This aspect is l think neglected when both Stettbacher and Alice Miller advocate the use of self therapy through using the 4 steps. Most of us can identify with how difficult tolerating real closeness can be. To advocate a form of therapy where one can avoid this is not in my view helpful. What will never be discovered is that it is possible to expose real feelings and needs to another person without having them abused or neglected. That it is possible for someone to be in touch with your deepest distress and help you make sense of it. Human beings communicate from birth onwards and it is a crucial part of being human.

Having rigid rules for how therapy should progress always risks losing sight of the clients real communications and l find Stettbacher's description of his therapy very rigid indeed. There is a three week intensive period with weekly follow up in groups.(Janov uses this structure as well) In my experience this is not a usable structure for most people. Many people experience the sudden transition from intensive to less intensive therapy as a painful abandonment. This very often can't be used or dealt with and can leave the client feeling helpless and dependent at a time when he or she most needs their therapist. Also the aim of the three weeks according to Janov and l expect to Stettbacher is the breaking down of the patient's defences. In my view defences can be given up when there is a safe therapeutic alliance and the ego is strong enough to hold the disintegrating feelings. The pace of this process can only be dictated by the client and not by the timetable of the therapist's theory. l also believe that open-ended sessions induce a state of regression where the separation between past and present becomes difficult. This is because it evokes the hope of endless gratification. What is offered by the therapist is an environment which is different from the past in quality but can never promise to be different in quantity. You can acknowledge the patient's wish for you to be there at all times but to the open-endedness risks dismantling the patient's adult self.

After the three week intensive the client is followed up mostly in groups. Not everyone can use groups and in addition it must be very painful if you are in the group and find it difficult to use the method of the 4 steps. (l remember the despondency and desperation of clients in Janov's groups when they couldn't cry like the others or have birth feelings.) Stettbacher claims that most people can actively verbalise as required for the "four steps" but my experience has shown me that this is neither the case nor appropriate for most people. We would argue that a rigid adherence to a structure is surely contrary to good therapy. Therapy should help each individual find and explore their own history in their own time and in a way that has meaning for them. It is ironic if you escape the pedagogy of your upbringing only to find it equally applied in the therapeutic situation.

To give a clearer example of this process, l will give a summary of a session that Stettbacher describes in his book. For those who would like to read the original l have given the reference at the end of this paper. **

The client, a woman, describes how she always wakes at three o'clock in the morning, even if she has only been asleep a short while. She goes through steps one and two as she describes her physical sensations and feelings. Her limbs "hurt as though l had been put through a wringer." She is "furious and terrified" that she is awake. The therapist suggests the third step to try and unearth the causes for the problem and that she "think critically about the situation, those involved and yourself." The client says she didn't have coffee or overdo it in anyway. The therapist prompts her with the suggestion that negative incidents from the past can evoke states of wakefulness. She responds with a description of a drive home across the mountains in a snowstorm. She had been at her brother's wedding and because there hadn't been enough room for all the guests at the hotel, she decided to drive back. The weather was bad and because she had passengers she felt she couldn't stop the car and not drive further. She felt responsible for the passengers. "Can this event have caused the alarm function?" she asks. "That's unlikely" replies the therapist, because everything turned out alright. She then remembers that she had been born at three o'clock in the morning. The therapist asks about the birth and she said that her mother had told her recently that it was normal and had taken twelve hours. She had been a "bit blue" but she cried after a "few hard slaps on the bottom". She was born at three o'clock but not given to her mother until seven o'clock. The client couldn't be breast fed because she had such severe hiccups. She calmed down after some medication, but she was only breast fed for a week. Stettbacher writes at this point. "Here the patient requires orientation from the therapist on the birth procedure and its consequences. The length of labour twelve-hours signifies traumatisation. This is evidenced by the lack of oxygen at birth(the bluish colouring). The immediate severing of the umbilical cord caused feelings of suffocation. The blows resulted in pain and fear. The child was not brought to its mother until four hours after the birth.....This birth was a hideous experience. The sensation the child is left with is one of sheer torture."

The therapist then invokes the next step. "But how could such a thing have happened? The patient now addresses his/her consternation at the mother: "But that's awful. l had no idea that my birth was so bad and is still affecting my unconscious day and night." She goes on to ask her mother why she let the staff cut the umbilical cord. She says that her father was a doctor and he surely should have explained to her the basic facts of childbirth. She then asks where the father was when she was born and gives herself the answer that he was on military service. "Are you telling me he only got leave the day after the birth? How come? Surely he could have gotten leave earlier if he had tried. Or was it because the birth was repellent to him, just as l was almost always repellent to him? Was that it? Was Dad not there because he didn't want a child in the first place? It's unbelievable. My father is a doctor, but l nearly died at birth because he refuses to be there. l just don't believe it. That blows me away."

l think when reading this passage one can see how whole stories can be made up from very little material. Stettbacher has very clear views about the causes of her wakefulness and imparts his views on birth forcefully. One can see here how he would leave himself open to accusations of "inducing false memories."

l will try to outline from my training with Janov in Paris (l983-5), how he might treat this material. When the client describes how she feels in the night, he might be much more active in trying to get her to describe exactly how she felt in the situation. He might try and put her back in the situation, by making her describe in detail how she felt, how she was lying, what she heard, smelt, thought etc. He might also make her focus on her bodily sensations, and ask her to stay with them, focus on her aching limbs etc. He might ask her what she would want to say, what she is feeling, what she needs etc. She would possibly say "Help me, l can't stand this." If this is said in a controlled voice, he might encourage her to say it louder or cry it out. It is possible that at this point she could start crying and eventually be in touch with a traumatic experience from her past. Janov would however see traumas structured in clusters. In this clients example, she would be likely to have other memories later than birth from the second or emotional level that would be important to work through before reaching the first line or birth trauma. Depending on the emotional atmosphere in the session he might decide that the client is making a first line statement but that the accessible components of the feeling are on the second line. If she seemed more emotional, engaged or closer to crying when telling about the trip over the mountains than when reporting about her feelings in the night he would have explored it in the same detailed way. What exactly was she feeling. He would ask for further details of who were the passengers .What would she have wanted to say to them. She would be encouraged to imagine herself being there and to talk directly to them. She might say : ''I feel so frightened and alone help me." This could lead to memories of other situations where she felt alone, and afraid, unable to ask for help. Janov would see it as important that these aspects are worked through before the birth trauma is explored especially in a fragile client. Janov very strongly emphasised meeting the clients where they were. If the first line feelings like her experience from the night were focused on too early the client could start abreacting. This meant for Janov that she would be discharging energy or making sounds without any real emotional content. He would however see the crying or the experiencing of the old feeling as the only way to a cure. l believe this leaves the patient in the danger of becoming addicted to "feeling" with the hope that this and only this will eventually resolve his or her suffering.

Now let us look at how Stettbacher handles the material. We can follow his use of the four steps, from describing how she feels in the night through to where she questions her birth which he believes gave rise to her feelings. The story about the wedding and the trip over the mountains is dismissed because Stettbacher believes that the origin of the feelings and sensations lie somewhere else. He searches for the original cause and here it is found at birth. You can also see in the questioning, the assumption that she has protected her parents from birth onwards and now needs to reevaluate her perceptions. The underlying belief is that she felt that she had failed, instead of feeling that her parents failed her. Stettbacher goes on to to say that the feelings of rage, humiliation, sorrow, fear etc. have to be unravelled like a tangled ball of wool. Each strand must be named, sorted and classified. Finally, in the fourth step you will according to Stettbacher, articulate in the context of the birth situation what you would have needed and your right to a better birth. eg. he quotes the client as saying "Surely, you should have come to an agreement with each other before the pregnancy. You couldn't just have a child against Dad's will. You must have noticed back then how resistant he was. You wanted to have a baby for yourself but at my expense. Afterward, when you were sick, Dad didn't come to your aid either. And, suffering as you were, you couldn't fulfil my needs. l needed you to be healthy and whole, full of enthusiasm and happiness. To this day l can remember the sadness in your face. l always felt deeply sorry for you. But l never knew what l had done wrong or how l could make it better. l needed you love to live. l needed you to be totally there for me."

Therapy in Stettbacher's view consists of a myriad of events to which the principals of the 4 steps must be applied. He claims it is a law of nature and that an untraumatised child will automatically use these steps to deal with hurts and disappointments. Alice Miller holds the same view and in her book "Banished Knowledge" uses the example of a three year old who questions his grandmother when she stops him from taking food without asking.

So a central difference between Miller/Stettbacher and Janov, is that Janov claims the curative process is automatic as soon as the defences come down and the underlying need and pain is felt. Connections between feelings in the present to events in the past would then naturally follow. But we also see that Janov would be very different in how he deals with the first two steps apart from not using step three or the questioning. l will come back to Stettbacher's example but first l will look at how l might interpret this clinical vignette and why. There are obviously many things we do not know about the client and her history, so it is open to various interpretations. But before going further I need to introduce the concept of unconscious communication.

It was Freud who first discovered that unconscious material is not communicated directly but rather through the processes of displacement and encoding. eg. The client's unconscious perceptions of the therapist might be revealed in stories about a colleague at work despising them. The British School of Psychoanalysis has been known to take this view to an extreme with what is called the " you mean me approach". The colleague story would be interpreted as the him representing the therapist, and the client believing that the therapist despises him. l am aware that this is oversimplifying the analytic view but l am using it to illustrate the mechanism of unconscious communication. To quote Paula Heimann, the therapist has in his/her mind the question, " who is speaking to whom and why right now?" This means that communication is not just taken at face value but expected to contain unconscious communication about the therapy, the therapist and the therapeutic situation. Stettbacher and Janov reject this view. Miller claims that stories of abuse are revealed directly when the therapist is of the right orientation and adequately empathic. l would consider this to be a simplification. In my experience, the client's material might well include unconscious communication about the therapist, therapy etc.

This session can be looked at in many different ways and conclusions can only be drawn after a lot of work with the material presented in the sessions. l would have several questions in mind. Why is the client telling the story about her night's sufferings now? Could it have anything to do with the last session? Is it a reproach to the therapist that he isn't making her "better"? Has he failed her in some way? Perhaps by being away and this may be her way of telling that she is suffering and needs his presence? That she feels left alone with her suffering? l would ask for more details of the night and what she thought and felt in those long hours. When she moves onto the second phase with the trip over the mountains l would still have these and other questions in mind. Is her description of her trip, her way of telling how she experiences the therapeutic process? She could be telling how overwhelming she finds it and how she feels she has to do it without help, on her own. She might need the therapist to see that he has not been enough in touch with her suffering, that she feels abandoned with overwhelming feelings. l know that Stettbacher has clients in groups and so the other passengers might refer to the other members of the group whom she sees as unhelpful and her responsibility. Perhaps she was the responsible one in her family and would need now to ask Stettbacher for help and dare not? l think that these are crucial considerations to hold in mind.

Even if you don't follow the unconscious communication, the story she is telling cannot just be dismissed as having no importance. eg. she mentions she has just been to her brother's wedding. What did this mean to her? Did she feel abandoned by her brother? She mentions that there wasn't room for her at the hotel. How did this make her feel? We can easily imagine that she might have felt left out or indeed pushed out. She might be telling that she is feeling left by the therapist and she fears he has someone more important than her to go to. If these are her feelings, then they tell us crucial information about her past relationships. There are also all sorts of questions that could have been asked about the drive itself. How she felt , and perhaps what she would have needed to ask from them and what that would have meant to her. There is certainly plenty of unexplored material here. But you might ask, what is the relevance of all this if the real cause of all the misery is her birth?

First it is important to note that the past only has relevance as a part of the present. It doesn't exist as a separate entity but is a part of the fabric of our present experience. Therefore the therapist or perhaps someone else like a partner become the real symbols of the parents. In this way the whole drama of the past becomes alive in the present. It is here that we meet a personal history in a three dimensional way. It is in relation to a boss, lover or therapist that feelings of dependency, fear of being demanding, rage at not being cared for, humiliation at showing fear or need are now reenacted and reexperienced. It can be a great relief to be angry at a parent or pillow. The parents are not there and cannot retaliate. It is much harder to express rage at the therapist and risk losing your therapist's concern or inviting his or her retaliation. This was the real dilemma of a child, and is now experienced in the present. But it is only by bringing the drama out where it belongs that the real feelings of the past emerge. The therapist needs to have what Bion calls "negative capability", i.e. to tolerate being seen as bad or failing the patient.

Further l would consider the possibility that the client after having had little response to her first reports tells Stettbacher that she was born at 3 o'clock in the morning as a way of capturing his attention . I am not suggesting that she is doing this consciously but just as we have unconscious communication from the client, we can have unconscious communication from the therapist. Stettbacher does in the information he sends out to applicants start his description of therapy with the sentence " All aberrations stem from birth". This is a very suggestive statement to make. Let us now look at the next step. In step 3 the client goes on to address her criticisms of the parents. l do think reevaluation of the situation and the feelings involved is important but fail to see any therapeutic benefit from the sequence of questions asked. We believe, that for the questions to have meaning they need first to be addressed in the transference, either extra or intra therapeutic, that is in the present. It is relevant to question why she can't ask for help, and to ask what it would mean if she could have her fear seen and accepted rather than having to keep it hidden. In this situation a real dialogue becomes possible. If it emerges that the story over the mountains is an analogy of her feelings about her therapy and therapist, then the therapist can acknowledge that perhaps he has been too unaware of her need for help. That maybe being seen in groups is difficult for her and that she feels pushed aside as her wedding story might indicate. Why is this real dialogue important? l believe it is because it opens up for a new and different use of the therapist than what she felt was possible with her parents. Repair becomes a possibility. If she is not heard at once, it doesn't mean it is impossible to get through to the therapist/parent but that although his understanding and intuition isn't perfect, he or she can learn from her and she can again be understood. The question Stettbacher's client asks her parents could also easily be contradicted. Maybe it was impossible for the father to get leave from the military before she was born. Who knows if he tried. In Stettbacher's terms, we could be accused of protecting the parent, but this isn't our aim. What we want to point out is that her questions go nowhere. He has failed her, full stop. If however, there is the possibility that she is also communicating to her therapist that she again does not feel understood or helped, by keeping the feelings with the father, all she has achieved is a split between a bad father in the past and a protected idealised father/therapist in the present. So paradoxically, she does end up still protecting the parent.

To clarify I am not saying that all communications about parental abuse are an unconscious perception of the therapist but if you neglect this possibility , you risk losing a very important part of a client's communication. For her to stay with a therapist who does not hear her real pleas , who can't bear her fear and anger, is to repeat the child's dilemma. Again she would be accepting to have to hide her real feelings in order not to be rejected. More optimistically, l would hope that for the first time she can experience that somebody can stay with her in her deepest despair.

In Stettbacher/Miller's concept of therapy there seems very little room for repair through the therapeutic relationship. It is tempting, at the end of this sequence to say that for Psychoanalysis, it is transference within the therapy that is significant and that for Janov/Miller and Stettbacher it is transference outside of the therapy that matters. Although the client does need to use the therapist as an advocate or empathic witness it is but one of the functions of a therapist. He or she will certainly at times be the bad parent, the good parent, the ideal parent, the understanding parent, or the abusive parent to name but a few. The therapist needs to be able to understand and unravel,together with the client, what happens in their relationship and in the client's relationship with others. Only then can the client's real feelings and his/her real story emerge. This brings us almost to the end of our lecture .I am aware that we have only touched a few of the areas we could discuss in relation to primal therapy. l do however feel the need to mention one more point before l end, and that is the notion of "cure". Janov and Stettbacher indicate that all illness, both physical and mental, can be cured with the help of their therapies. l think they are entering in to a very difficult area here. The notion of the perfect human being is a mythical construction. Janov writes there is a new man walking the land , "Primal Man." Not only is this not true but it lends itself to quite a fascist view of human nature that undermines the real achievements of therapy.

Therapy can enable you to stop the repetition of dysfunctional relationships based on your painful experiences in the past. It can help you find more of what you need in the present. But we are still human beings in an uncertain world, full of complexities and unanswered questions. Therapy can help in transforming this from an overwhelming experience to something more hopeful and creative. To end with a quote from Jacques Lacan. Much of what he writes is difficult to relate to but l think he is close to what l would be aiming at when he writes, "The patient either speaks about himself, or to the therapist. When he speaks about himself to the therapist, the therapy is finished." Thank you for listening.

*Since this lecture was written Alice Miller has changed her view of Stettbacher's therapeutic approach. She does no longer, in any way, support or endorse his clinical practice. A short summary of her views can by found on the internet in "Alice Miller - A Communication to my Readers."

**The example we used can be found on pages 61-67 of Making Sense of Suffering" by J. Konrad Stettbacher in the Chapter "The Therapy, subheading "The First Signs of Change" This is the American Edition by Dutton published in l991



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