#31. Healing a Lack of Primal Love

How a Lack for Primal Love can Heal

A reader writes: “I feel like I’m done with therapy but not done with my therapist. The only reason I’m still going after many years is that I am so deeply attached to him and can’t imagine life without him in it. I’ve worked through many of my issues and we talk all the time about my feelings which have not lessened in all the time we have worked together. I feel like it’s time for therapy to end. When you say antidote, what exactly do you mean? Is it possible that it can’t be resolved?”

Principle 1:  Give before you take. The goal of psychotherapy is to replace maladaptive patterns with more satisfactory ones. The first thing I think therapists need to realize, myself among them, is that our field, and the medical model in particular, have come from a place of negativity. We talk about disorders and pathology and our goal is to take them away. The movement of positive psychology has done us a favor in reminding us that attempts to take away unhealthy coping patterns without giving something positive is not going to be very successful. When it comes to attacking Entrenched Maladaptive Patterns (EMPs), we should think first of what we have to offer in trade. Only when they see something positive will our clients be able to accept the loss of something as vital as primal love.

Principle 2:  Full replacement of Primal Love is not possible. Replacement is usually the goal of the inner child, the obvious remedy for something life saving that is missing. For better or worse, full replacement is not actually possible. Therapists can’t offer 24/7 attentiveness and they cannot give the incredible degree of love that healthy parents naturally do. On the other hand, since empathy naturally leads to warm feelings, therapists generally do like their clients quite a lot. Furthermore, where therapists come the closest to being like parents is in empathy. Therapists can and do give large doses of accurate empathy. This is the essence of love, the ability and motivation to be attuned and to repair breaches when attunement fails. 

Despite the gift of empathy, there are areas where therapy can’t substitute for primal love. One is the asymmetry, the one-way quality that protects client and therapist. In most relationships, giving and receiving are in the same currency. In the therapy relationship the client pays a fee, but is not responsible for the emotional wellbeing of the therapist. In addition, in contrast to parents of young children, but similar to parents of grown children, therapists cannot take ultimate responsibility for their clients’ decision making. So, in the end, for those have been shortchanged in childhood, replacement is not the answer. The solution has to be something different.

Principle 3:  Acceptance won’t happen until all paths toward replacement have been followed. Since replacement of primal love is not really possible, then we have to think about accepting that things weren’t so good in the beginning but a fulfilling adult life is still possible. This sounds great, but no one likes to accept losses, and when it comes to life and death needs, acceptance just can’t happen without a deep conviction that replacement of what was missing is not possible or even desirable. Humans don’t accept defeat unless they absolutely have to. Even when we declare outwardly that we are accepting, deep down a degree of hope remains that somehow things will turn around. True acceptance is hard to achieve and, for critical needs, simply not possible until all efforts at replacement have been exhausted. 

Principle 4:  Work towards replacement before acceptance. The way we can convince the inner child that replacement is not the answer is by exploring every avenue by which replacement might happen. One result is realizing that full replacement is not possible. Another is becoming aware that true primal love is not what adults need or want. Having someone watching over you 24/7 isn’t really that great. It turns out that having another adult read your mind is less than satisfactory. And, within the therapeutic relationship, crossing boundaries just doesn’t work. Interestingly, while convincing the inner child that replacement can’t work, this therapeutic operation actually leads towards awareness of the good things that come with adult life. For example, the inner child discovers how much adult autonomy, the ability to choose partners, and enter voluntarily into real world relationships can be happy and positive experiences.

For a time, the therapeutic relationship may fill a genuine need for a surrogate relationship. Damaged trust and lack of skills may make outside relationships temporarily impossible. The therapeutic relationship can, and often is, a laboratory for exploring the world of relationships. This needs to be managed with care. Therapists walk a fine line between providing a substitute relationship and promising or implying fulfillment of something we can’t deliver. Among the components of a relationship that we can’t deliver are mutuality, equal emotional risk, and the physicality of a healthy adult relationship. What this means is that the therapist needs to convey, not solely in words, an ongoing and clear understanding that the therapy relationship can’t be a substitute for the kinds of relationship our clients might be seeking in the outside world. The goal of engagement with the outside world is a moving target and needs to be adjusted over time. At the beginning of the therapy, outside relationship might not be feasible, while later, it may become the main goal.

Principle 5:  Internalization is ultimately what replaces primal love. Erik Erikson used the term “basic trust” to describe the result of healthy development over the first two years of life. He meant a broad sense of confidence that things will turn out OK. Margaret Mahler wrote about how young children internalize a sense of the continued existence of a supportive mother even when she is not physically present. Over time and under good conditions, children internalize something based on the primal love they receive, which then becomes their own and portable, basic trust. They carry it with them for a lifetime and it gives them a fundamental confidence and resilience, even when they are feeling discouraged. It forms a kind of floor for hopelessness such that it can only reach a certain degree. Can this kind of internalization take place later in life?

Principle 6:  The mechanism of internalization. I don’t know what internalization really is, but I have a working hypothesis that fits with observed data. Internalization means that something is retained in implicit memory that, like the skill of drinking from a glass, doesn’t go away. What triggers the process of internalization might surprise you. It is attachment anxiety. When there is anxiety due to the perception of possible loss of connection, that is what makes us internalize the attitudes and values of the other. I think this process can take place very slowly in small increments or rapidly under more urgent conditions. That’s the answer I came up with years ago when I first identified the question as important. Not surprisingly, one of the sources was Freud’s concept of identification with the lost object. (To learn more about why I believe this, it is in my textbook, Psychotherapy: A Practical Guide. p. 207.) If correct, what this implies is that to let go of an attachment to the therapist, one needs to approach the possibility of saying good bye. We are extremely sensitive to separation, so it probably means doing this in tiny increments over whatever time it takes. On the other hand, it might happen more rapidly if conditions required that. There’s catch! If the threat of separation is too rough, then internalization stops.

Principle 7. Pendulation. Peter Levine, in his book, In An Unspoken Voice, talks about “pendulation.” What he means is that clients seeking to heal must go back and forth between a position of safety and one of voluntary willingness to encounter the things they dread. It’s a great concept and it applies nicely to internalization. When letting go is forced or not done under loving conditions, then the result is traumatization. The brain goes into emergency mode and internalization ceases. Levine makes it very clear that when clients swing towards what they dread, it needs to be done by choice and with a feeling that the time is right. Suggestion is OK, but pressure or forcing is not.

This is also why arousal regulation is such a central part of trauma therapy, where triggering the sense of danger is always close at hand. It is also why one of the four “facilitative factors” I have listed elsewhere is arousal regulation, one of several things therapists do besides directly seeking change.

Principle 8. Rapid internalization. Internalization is not always gradual. I recently communicated with a person whose beloved and very effective therapist suddenly discharged her. It was painful but somehow she knew it was time and that she would be OK. This event seemed to trigger a last chunk of internalization of her own power and choice. Perhaps she had already internalized enough of her good therapy, but it was also true that she had come far enough to know that she had not been erased from his mind or even emotionally rejected. Her sudden discharge was not traumatic.

It also probably happens that necessity can lead to acceleration of internalization. Traumatic identification with the aggressor is an example of how survivors internalize negative attitudes towards the self that were expressed in some way by the perpetrator. This undoubtedly happens under survival conditions. So it appears that somehow the brain can remain open for business, at least in compartmentalized areas, even when arousal is high. We’ll have to wait for neurophysiologists to look at this for an adequate explanation.

Principle 9. Acceptance and internalization may be the same. Accepting a painful truth seems to have many of the same characteristics as internalization of connectedness or primal love. Under traumatic conditions, it generally doesn’t happen and leaves the inner child still waiting. It doesn’t happen until all alternatives have been tried, and it doesn’t happen until there is something to take the place of what is lost. But in the end, making genuine peace with loss, where the loss is transformed into something benign, seems very similar to internalizing a positive reality such as primal love. For now, I’ll make the assumption that full acceptance and internalization are two sides of the same coin.

Putting it all together

So, putting this all together, I think clients and therapists need to work together to help the client take periodic “swings” at a better life without the constant presence of the therapist. It’s far less likely to trigger a stress response if it comes from the client. Even a hint from the therapist is likely to trigger a neglected or traumatized person into a stress response. Unfortunately, most of the time when clients suggest termination or a break from therapy, it is with a rejecting attitude towards the inner child and leads towards a kind of pseudo-separation. This leaves the inner child unchanged and in hiding. What works is when therapist and client are in tune with one another and focused on taking steps towards a healthy and positive outcome.

This kind of pendulation might start with nothing more than an idea, but should naturally move towards action to engage with the world and learn the skills of appropriate trust and healthy interaction, skills that are needed to make such moves safe and positive. Each encounter with “attachment anxiety,” if it takes place in a positive context, results in a small chunk of internalization. Once in a while, it might be a big step and a large chunk, but, within the world of therapy, the requirement for the context to be supportive and positive remains the same.

It’s worthwhile to think how long this operation takes in normal humans. Even if we have firmly internalized basic trust, the process of separating from parents and taking full ownership of our own lives is very slow. The turmoil of adolescence is testament to just how ultimately difficult separation is.


As a positive and exciting but sometimes scary pendulation takes place over time, I think there is a silent, incremental internalization of the support and caring that has been part of the therapeutic relationship. That, in the end, is the closest we can come to replacement of primal love and opens the door to true acceptance of what can never be replaced.

Jeffery Smith MD

Photo by Johann Walter Bantz on Unsplash.


As always, I would invite comments, and also, if you find these posts interesting, please tell your friends and colleagues.

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  • I’ve been reading your blog for a number of years, though I have never commented before. I feel the need to comment after reading this latest post. I have been in therapy for around 12 years with a variety of therapists. Unfortunately, like many commenters on this blog (and many complex trauma survivors in general), my experience with therapy until recently has been mixed at best. One past therapist formed an attachment with me that was really helping me heal, but ended the relationship in such a traumatic way that I came out of it worse than when I’d started. Other therapists I’ve had were fine—compassionate, empathetic—but also never managed to help me get to a point of feeling “healed.” The reason I am commenting on your blog is because my more effective therapists did many of the things that you recommend for people who lacked “primal love”—they were empathetic, they encouraged me to grieve, they helped me build a more satisfying adult life. But here’s the catch: none of this actually helped me “heal” the way you say it does. My young parts (inner child parts) never really came to a place of what you call “acceptance,” no matter how hard I worked. And I worked hard. I’ve done all kinds of things—EMDR, Internal Family Systems, yoga, meditation, bodywork, journaling, self-compassion exercises, and more. All of this did make me more functional, but I was still left with a crushing sense that I was not whole, that I would never be whole. I eventually came to a point where I didn’t think therapy had anything else to offer me, and that the risks of it far outweighed the benefits.  I decided I would just have to live with the continued pain and make the best of it.
    However, by chance, I was in a meditation group led by a therapist and I ended up clicking with her, and eventually decided to give individual therapy another shot. I’ve been working with this therapist intensively for some time now, and it has been a very different experience than any of my other therapies. One key difference, to put it bluntly, is that she has a great capacity for love and she is open about the fact that she loves me and other long-term clients (by this I want to be clear that I mean non-romantic love). My previous therapists felt that love was inappropriate in therapy, and always held themselves at a distance from me. While they were well-intentioned, I really believe that their withholding of (or inability to offer) something so critical for young parts kept me from healing. In many ways, it retraumatized the parts of me that most needed healing.

    You often say in your writing that therapists cannot offer what you call “primal love,” and that childhood needs cannot be fulfilled in adulthood. For a while, I believed that, or at least I did my best to convince my young parts of what seemed like an unfortunate but inescapable reality. I grieved endlessly and did my best to build a fulfilling adult life, even if I was often just going through the motions.

    However, some of my experiences with my current therapist have been really different. Unlike my previous therapists, she actually tries to meet my young parts needs. I’ve been surprised at how flexible and creative she’s been in doing this. And I’ve found that, while imperfect, these attempts have been largely successful. I no longer feel the same intense longing or the same deep despair, that I felt before. still have a long way to go, but it finally feels like I’m healing.

    I find myself feeling angry at my previous therapists, who convinced me that my needs were unfillable and unintentionally reinforced my sense that I’m undeserving of their love. I think it is true that not every therapist can work with child parts, and not every therapist is capable of deep love for clients—but frankly, such people should not be working with attachment trauma survivors.

    I guess my hope is that, as someone who teaches therapists, you will nuance your claims about how childhood needs can’t be fulfilled. I think therapists often use this reasoning against clients in ways that are really damaging. And, perhaps more importantly, this reasoning causes people like me to settle for of continued pain when that is not necessary.

    • Petlover, thank you so much for your post. It’s heartwarming to read, especially as I can so relate to everything prior to your fortuitous meeting of your new therapist. I wish you continued success on your path for healing.

  • Thank you for this helpful article. I can now readily see that it was a failure in my primal attachment that explains why I’ve had transference problems – in the past and now – with therapists.
    Internalization has occurred in regard to a much improved outlook on my abilities (or gifts, as my present therapist calls them).
    Yet anxious attachment, and the fear of abandonment, still persists. This might sound odd, but after every therapy session, it’s as if I’ve died to my therapist.. By that I mean, for no logical reason, think that the only time my therapist ever thinks about me is when I’m in her rooms having a therapy session. Now I certainly don’t wish to be in her presence 24/7, but it really bothers me to think that the only time she’s aware of me is when I’m sitting in front of her.

    Have you any thoughts on why this thinking – and its accompanying anxiety -occurs? Also, how to work towards a resolution? Thank you.

    • Feeling like one disappears in the mind of the other person during physical absence suggests that the internalized primal attachment is not there. Principles 5 and 6 in the post are the ones that say about what I know about this. JS

  • Thanks for sharing petlover. I am with a therapist who although doesn’t quite fully withhold things often talks about love and care in a round about way rather than as something that may exist between us. She is also often slow to share her feelings and experiences in the room. Whilst I appreciate that therapy should be about me and thats where the focus should say the times I have found most helpful and healing were the times she wasn’t doing these things and did share her experience. When the mask fell a little and she let her feelings on something or where she said something that explicitly showed that she cared about me. No amount of ‘I care about people I’ve worked with for a long time’ would do that. These moments however have usually been accidental as when I bring up how helpful it has been it rarely happens again for a long time until the mask slips again. My point is the more that she has let me see her care/love the more I have been able to integrate that and felt a healing. I believe that ‘Love’ …platonic love..still within certain boundaries but that is not hidden and withheld or kept secretive or locked away because they think it’s best to do so can heal. Whilst I understand I need to grieve the loss of what I perhaps didn’t get as a child growing up I don’t necessarily believe I have to go through the heartbreak of feeling that this person who I have a bared my heart and soul to and developed a strong connection with cannot never give me love.

    My worry here is that I will just be dismissed as a client who is desperately seeking my therapists love and just need to develop acceptance that that can never happen.

    I would so love to see more writing from people who have gone through this and emerged the other side with some small bit of healing. I read so many posts of people like myself who seem to spend most of time struggling and in pain. I have been with my therapist 7 years but also question whether the pain I generally feel outweighs any of the benefits.

    • Hi Chloe,
      I totally relate to everything you write. I have had numerous past therapists treat me like you describe (talking around the notions of love but refusing to say they love me, not meeting needs directly, etc.). I bet your therapist is well-intentioned, as were my past ones, but as you note, that kind of treatment isn’t healing for many complex trauma clients.
      I want to speak to your point about grieving. From my personal experience and from what I’ve read over the years, I think a lot of therapists mistake healthy grief about the past with retraumization. In my past therapy, my therapists usually withheld explicit displays of love and acts that would meet my needs. Some psychotherapy theories hold that when the therapists refuses to meet childhood needs, the client’s inner child is forced to grieve their loss and eventually heals. This was NOT my experience. The pain, despair, and longing I felt never dissipated, even when met with compassion from therapists. They told me I was grieving the past, but I now think I was being retraumatized by having my attachment figure (the therapist) do the same thing as my original caregivers (although for different reasons). Yhe result was the same: I was hurt rather than healing.
      My current therapist, on the other hand, tries to meet my young parts’ needs as much as possible. For instance, she has done things like physically hold me, send me “goodnight texts,” go on hikes with me (my young parts love the outdoors and want to share the experience of being there with my therapist), and more. All of these things have been very healing from me, and have allowed for healthy grieving of what I didn’t get as a child. It’s a bit hard to explain, but here’s how I experience it: getting a need met in the present feels really good but also reminds my young parts of times those needs were not met in the past (both by my original caregivers and by past therapists). So, for instance, when my therapist holds me, I often feel intense grief. But this feeling is very clearly about the past, NOT the present, when the need (in this case, to be held) is actually being met in a literal way. I’ve found that the grief dissipates and I feel peaceful and loved, which did NOT happen with past therapists who only offered compassion rather than actively meeting my needs.
      I don’t know what to tell you about your current therapist. My instinct is that if you have been with them for 7 years and consistently feel that many of your needs (including for explicit love) are not being met, then you may not find the healing you are looking for. Therapy in the western world is rooted in medicalized notions of pathology as well as psychoanalytic assumptions about the importance of “abstinence” (not gratifying client wishes). Also, therapy is embedded in capitalism and so many therapists frankly aren’t willing to go the extra mile for clients (it’s no coincidence that my therapist actively considers herself an anti-capitalist). Finally, I think many therapists are just afraid: of legal liability, of what their colleagues will think, of breaking taboos, of coming up against big needs and finding themselves inadequate, sometimes even of emotional intimacy. All of these fears are very human, but they keep therapists from helping trauma clients. I feel like my therapist is the exception, not the rule, and that’s why she’s been able to help me.
      I don’t know if you want my advice, Chloe, but if you do, maybe consider a direct conversation with your current therapist about these issues. But, if the therapist is unwilling to change, maybe it’s time to look for someone else and be very specific about what you are looking for. I think you probably know deep down what you need to heal; I certainly did. The hard part is finding a therapist that will work with you in a way that is able and willing to help you specifically, rather than following theories.
      Also, in terms of reading about clients who have begun healing in relational therapy after negative therapy experiences, I love this blog and follow it regularly:

  • Your welcome, wondering. Everyone deserves a therapist like mine, but she seems like the exception rather than the rule, especially for complex trauma survivors. I wish you healing as well.

    • For those who are looking for accounts about this issue, Vivian Conan’s memoir, Losing the Atmosphere tells about her experience, including being my patient. My epilogue is also relevant.

        • Actually, I agree that knowing the caring is real is very important. And clients often have this confirmed by small, unanticipated responses by the therapist. “Oh! That tells me you really do care about me “

  • HI Petlover, Thanks for your response. It didn’t show up until after I sent my last one thanking Jeffery for the book reccomendation. Honestly so much of what you wrote resonates with me and you wrote it so well it really helps me to articulate my thoughts and feelings on this. Although my therapist is no where near yours in terms of fulfilling needs there has been times when she has done minor things which have done so. Like you it felt healing rather than just warm fuzzy feelings because she had fulfilled a need. e.g she once got annoyed at something someone else did to me. In that moment I saw that she was protective of me (something that she wouldn’t usually explicitly show although will refer to feelings of that sort which often send my brain into a state of confusion as I try to figure out what she meant exactly and was she trying to say she cared etc’. Everything I read says the client will only want more more more if you fulfil their needs but it was simply not the case with me. I mean yes of course my inner child parts certainly wanted more but my adults self was able to see that I was okay with what I had and that it was still within reasonable boundaries for the therapist etc. Its so hard to explain this to someone who hasn’t gone through this. Jeffery I know some of my thoughts go against what you write and clearly you have helped many people but I just don’t see it as one size fits all which so many things I read seem to do.

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