The First Science of Psychotherapy
The task of normalizing a patient’s entire system is a complex proposition because not all nervous systems are created equal. In the case of parasympaths – those low-energy types predominantly controlled by the parasympathetic nervous system due to re-shaping events in the womb and at birth – reactivity slows down. They remain passive and lethargic throughout life, permanently stuck in the energy conservation mode. That mode of operation becomes stamped in, imprinted as a life-saving device. This imprint is a memory of what the whole system did under threat in order, for example, to conserve oxygen, bind energy and slow down the metabolism to combat the deleterious effects of a mother taking drugs, drinking or a hundred other kinds of abuse. It differs from the revved-up sympath who is dominated by the sympathetic nervous system, the alerting, aggressive, fight (to get out) and battle system to save one’s life. For the patient who is a sympath, a typical session begins with higher vital signs, and tends to militate to lower levels as therapy goes on and feelings are experienced and connected. Not so with the parasympath whose body temperature often drops into the area of 96.0 degrees, steadily moving higher over months. It is the key distinguishing mark to differentiate the person with different kinds of nervous system dominance. And it is the marker for progress in Primal Therapy. Each nervous system tends to move toward normalization in our therapy; the parasympath toward higher levels, while the sympath, lower. This is what we expect to see over time in our patients. We cannot fool our biology. When we try to fool our nature, we put the patient in danger.
The parasympathetic system, as the energy conserver, is dominant in feeling. We can see this dynamic played out in sports, especially at the end of games when athletes often show emotion. It happens to many tennis players, win or lose, after long, grueling matches. Some just collapse on the court in tears. In one famous case, Roger Federer was so crushed by defeat following a hard- fought, four-hour-plus tournament in 2009 that he could barely talk during a press conference. He cried so hard and for so long that observers at the Australian Open were shocked and felt uncomfortable. With a “torrent of tears” streaming down his face, as one writer described it, the only thing the defeated champion managed to say was, “It’s killing me.” What happens is that athletes gear up for battle and maintain an intense, fighting (sympathetic) stance during the game. When it’s over, the activation dials down and they are able to feel, so emotions overwhelm them. The neurological pendulum has swung to the parasympathetic side.
The importance of the sympathetic/parasympathetic dominance is that it provides us with a biological basis for understanding personality development. At last we can leave abstraction and metaphor behind, and replace the vagaries of speculation with the precision of verifiable processes. We no longer need to talk about the "will to power" or the "will to meaning" or the "transcendent function." Instead, we can talk about the precise ways in which the brain and nervous system react to concrete events, and how those reactions become the physiological basis for the elaboration of personality. The precision of the theory and therapy leads to a precise knowledge of what is happening in sessions; we have a better fix on what may go wrong. If the theory is imprecise so will be the measures taken in therapy. It is why I call Primal Therapy the first science of psychotherapy. We don’t have to rely on patient reports to see if there is progress; there are many neurologic and biologic tools that can inform us.
For example, when the sympath is reliving first line, we see high vital signs and accelerated brain wave frequency as well as higher amplitude waves. As we descend deeper we find the limbic system at work and then, further down, the brainstem and its cohorts. So one way we see evolution at work is by which nervous system dominates. If there is crying, chances are it is limbic and not brainstem. If there are grunts and no tears, we see a nervous system at work that predates limbic evolution. We cannot deceive the brain because it tells us in its own ineffable neurologic way what we are dealing with.
What we have found is that very early events in life determine the settings of our nervous systems. What sways the two key nervous systems – both under the aegis of the hypothalamus – is the kind of biologic and neurologic reaction that is forced on us and our brains while under specific kinds of threats very early in life, during gestation and birth. There is the struggle-and-succeed syndrome, the sympath, and the struggle-and-fail syndrome, the parasympath. This latter gives up easily and smells failure. Not so the sympath who tries and tries and does not give up. And when a new patient struggles to feel even when he is not ready, we generally have a sympath on our hands. The parasympath comes in listless, down regulated, worn out, unmotivated and depressed. He sees no point in anything. This is where the therapist needs his full capacity to meet the challenge. Should he be encouraged? These are the questions we take up constantly in our staff meetings. We often bring the patient in and ask him what works. He sometimes knows and sometimes does not. With long-time patients I ask them if I made a mistake and what was it? I get good answers and I learn.
One key problem in therapy is when the doctor tries to force the patient onto a nervous system that is not his. For example, the therapist may try to get the patient to act more aggressively with his boss when his whole system, the one that helped him survive, is in the energy conservative, passive unaggressive mode. So it is like deciding that someone should be right-handed and we force him not to use his left hand. We are confounding nervous systems (run by the hypothalamus) with terrible results later, such as stuttering and cross in reading and writing. In therapy, a comparable situation is created by abreaction: forcing the wrong nervous system into action.