Janet's bodily automatisms

1. Introduction

Version followed: Pierre Janet's own clinical work, 1886–1925. The automatism concept comes from L'automatisme psychologique (1889). The treatment comes from Les médications psychologiques (1919; English edition Psychological Healing, 1925), organised in the three-stage form reconstructed by van der Hart, Brown & van der Kolk (1989). Where a procedure in Psychological Healing is one Janet only reviewed (Charcot, Brissaud, Pitres and others) rather than one he used himself, the entry says so.

What it is. This is not a manualised therapy. It is a theory with a set of clinical procedures. Janet (1859–1947) was a French philosopher-physician who worked at Le Havre and at the Salpêtrière in Paris. He described psychological automatisms: acts, postures, sensations and memories that run in a fixed, predetermined way outside the person's voluntary synthesis. Examples are catalepsy, automatic writing, hysterical anaesthesias, paralyses, contractures, tics and somnambulistic re-enactments [source: Janet 1889 pp. 1–41; van der Hart & Horst 1989 p. 4].

How Janet thought change happens. In his account, a vehement emotion during an overwhelming event exceeds the person's capacity to integrate it. The experience is then split off as a subconscious fixed idea: a system of images, sensations, movements and feelings. It keeps acting through the body, for example as an anaesthesia, a fall that repeats a suicide attempt, or the yearly re-living of a first menstruation. Meanwhile the field of consciousness narrows and mental energy is drained [source: van der Kolk & van der Hart 1989; van der Hart & Horst 1989 pp. 5–7]. Recovery has three parts: restore psychological force and tension, transform the fixed idea into an ordinary narrated memory, and re-educate the person into completed, voluntary, adaptive action. Janet put it as "memory is an action: essentially it is the action of telling a story" (Janet 1919/1925, p. 661, quoted in van der Kolk & van der Hart 1989).

Why it is listed under body psychotherapy. Boadella (2002) calls Janet the first body psychotherapist and a precursor of Reich. His reasons: Janet studied breathing and emotion, described visceral neuroses, used massage and motor re-education, and paired psychological analysis with somatic work and later synthesis [source: Boadella 2002, article page and abstract only; full text not drawn on, [uncertain] on details].

What remains in practice today. Janet's three stages survive as phase-oriented trauma treatment: stabilisation, then processing of traumatic memory, then integration. His concept of dissociation underlies the structural-dissociation model of van der Hart and colleagues. Sensorimotor and other trauma-focused body therapies also cite him [source: van der Hart et al. 1989; van der Kolk & van der Hart 1989; contemporary lineage [uncertain]: those texts are not drawn on]. Some of his methods are historical and are labelled as such below: magnetic and metallotherapy agents, prolonged hypnotic sleep, isolation in hospital, stimulants and electrical treatment.

2. Framework

[source: van der Hart, Brown & van der Kolk 1989, citing Psychological Healing (PH) page numbers; van der Kolk & van der Hart 1989]

Overall logic: a mental economy. Janet treated exhaustion like a household budget (PH p. 663):

raise income: sleep, food, rest;
cut expenses: treat medical illness, relieve crises, reduce demands;
pay off debts: resolve the traumatic memories that keep draining energy.

Two levers ran alongside the budget. One was to channel wasted energy into useful activity. The other was to stimulate energy through graded, progressively harder tasks.

Stage 1: Stabilisation and symptom reduction

Goals: stop crises, restore sleep, eating and basic functioning, and reduce life-threatening symptoms such as suicide attempts and refusal of food. Build rapport.
Means: rest, simplifying life, hospitalisation (which Janet called "isolation"), hypnosis for relaxation and symptom relief, and education in daily functions.
Moving on: acute, uncomplicated cases could go straight to memory work once stable. Chronic or complex cases first needed a period of stimulation and re-education. These criteria are implicit in the sources, not formal.

Stage 2: Identification, exploration and modification of traumatic memories

Goals: uncover the fixed ideas, then neutralise, substitute or reframe them so that the event becomes an ordinary, past, narrated memory.
Means: hypnosis or artificial somnambulism, automatic writing, dream production, visual imagery, and suggestion by distraction. In simple cases, plain discussion or a shared diary was enough.
Moving on: the memory is "assimilated", meaning it is told as a story without crises or re-enactment. Expect layers: one fixed idea can hide another, and work may need repeating. In the Justine case, a secondary fixed idea persisted after the primary one was resolved [source: van der Hart & Horst 1989 p. 7].

Stage 3: Personality reintegration and rehabilitation

Goals: prevent relapse, and remedy residual deficits. These include poor attention, suggestibility, inability to begin or finish acts, constricted affect, hypochondria, functional somatic complaints, motor contractures, doubts and rumination.
Means: education and re-education (PH ch. XII), aesthesiogenic restoration of sensation (ch. XIII), treatment by excitation through graded action (ch. XIV), psychophysiological methods (ch. XV) and moral guidance (ch. XVI).
Ending: Janet reduced his influence step by step (PH p. 1194). Signs of progress were a calmer attitude, openness to positive influence, and shorter, milder relapses. He read a patient forgetting appointments as a sign of recovery (PH pp. 1198–9). Intervals between contacts lengthened, and severe cases kept occasional contact for years; he stayed in touch with Irène for 16 years (PH p. 1202).

Order, format and length

Not linear. Janet treated the stages as overlapping and recurring. Personality work sometimes came before memory work, and recovering a memory sometimes stabilised the patient.
Format. Individual work, in hospital (Salpêtrière) or as an outpatient. Families and acquaintances were interviewed.
Session count. None given. The cases run from weeks to many years: Nicole's course lasted 12 years, and Irène was followed for 16 [uncertain: no standard number exists].
Modern adaptation [synthesis]: weekly individual sessions of 50–60 minutes. Stage 1 runs until the client has stable sleep and eating, no recent crises, a working alliance, and can regulate arousal inside the session. Memory work runs only while the client stays within a tolerable arousal range. Stage 3 is woven through from the start.

3. Guiding principles

[source: van der Hart et al. 1989; van der Kolk & van der Hart 1989; PH vol. II pp. 709–786; Janet 1907 Lecture I; Boadella 2002 page. One-line meanings are [synthesis].]

Bodily symptoms can be automatisms with a psychological history. An unfelt limb, a fixed posture or a repeated fall may express a dissociated fixed idea. In practice, ask what event, image or unfinished act the symptom repeats.
Rule out organic disease first. Janet warned that functional paralyses, contractures, anaesthesias and pains imitate organic illness, and that this had led to needless surgery [source: Janet 1907, Lecture I]. In practice, get or confirm a medical and neurological assessment before treating any body symptom as psychological. Never assume a symptom is dissociative because you cannot find a cause.
Don't overlook a real trauma, and don't invent one. Boadella reports Janet holding both points [source: Boadella 2002 page; [uncertain] wording]. In practice, explore openly. Never suggest a trauma the client has not reported.
Take a thorough history, including collaterals. In practice, map the client's life, prior crises, losses, and the timing of each symptom's onset. Interview family where appropriate and with consent.
Stabilise before you uncover. In practice, do no memory work while the client is in crisis, exhausted, not sleeping or not eating.
Manage the energy budget. Psychological force is the amount of energy available. Psychological tension is the capacity to use it at a high, integrative level. In practice, every intervention either adds energy, saves energy or spends it; plan the session so it does not overspend.
Memory work means turning re-enactment into narrative. A fixed idea is relived, not remembered. In practice, the aim is a story the client can tell in the past tense while staying present. Catharsis alone is not the aim.
Avoid the phobia of memory. Janet named this "phobia of memory" (PH p. 661, via van der Kolk & van der Hart 1989). In practice, approach traumatic material gradually, starting with the least threatening.
Individualise eclectically. In practice, choose methods to fit the client's strengths, limits and life circumstances, not a fixed protocol.
Rapport is a tool, but dependence is a risk. Janet warned of a "somnambulistic passion" toward the therapist. In practice, use the relationship to mobilise the client, keep the client in charge of their own life, and plan to reduce your influence.
Education means a new action repeated until it becomes automatic. Janet's definition: "the production and repetition of a new action" under a competent witness who corrects it (PH p. 786). In practice, demonstrate the action, have the client do it, correct, repeat, then have the client do it alone.
Prefer active, attentive exercise over passive treatment. Janet preferred exercises done with will, effort and attention (PH p. 723). In practice, the client does the movement or breath with awareness; nothing is just done to them.
Complete the action. Janet linked neurosis to actions left inhibited or unfinished [source: Boadella 2002 page; PH ch. XIV contents]. In practice, help the client start and finish small, real acts.
Praise success, overlook failure, answer honestly. Janet advised praising successes and not dwelling on failures (PH p. 986), while giving honest feedback when asked. In practice, reinforce every completed step, don't punish lapses, and don't lie.
Diagnose before you treat. Janet warned that calling all treatment "education" "annihilates diagnosis" (PH p. 733). In practice, keep a working formulation and choose methods from it.
Moral guidance runs throughout. Janet treated guidance as essential at every stage (PH p. 1112). In practice, offer active, explicit guidance about daily life, then fade it.

4. Intervention inventory

How the inventory is organised. Entries follow Janet's stages. Each entry says whether the procedure was Janet's own, one he reviewed in PH vol. II, or a modern adaptation [synthesis]. Example language is mine and labelled (illustrative); Janet left no session scripts in the sources.

Training note for every touch, hypnosis and body procedure [synthesis]: these need specific training and supervision. Check what your licence and jurisdiction allow before you use touch, hypnosis or physical re-education. Work alongside the client's physician or physiotherapist for any motor or sensory symptom.

A. Assessment: psychological analysis

4.1 Detailed history with collateral interviews (Janet's own)

Purpose / when. Done at the start and revisited throughout. It locates the event behind each automatism and maps the client's energy budget [source: van der Kolk & van der Hart 1989; van der Hart et al. 1989].
Steps.
1. Take a chronological life history.
2. For each symptom, record the date of onset, what happened in the weeks before, and the situations, dates, words or sensations that set it off. Janet's Marie had crises at each menstruation; another patient's anxiety was triggered by the word "blood".
3. Ask about sleep, eating, fatigue, illnesses, losses and current demands, to fill in the budget.
4. With consent, interview family or acquaintances.
5. Get a medical and neurological workup for any motor or sensory symptom [source: Janet 1907, Lecture I; step order is [synthesis]].
Example language (illustrative). "When did your arm first stop feeling like yours? What was going on in your life in the month before that?"
Watch for. Symptoms that follow anniversaries, or that copy a posture or movement from an event. Don't push for content; record what is offered. Leading questions can implant material [synthesis].

4.2 Observing bodily automatisms and sensory gaps (Janet's method, modernised)

Purpose / when. Early assessment. It identifies which parts of body experience sit outside the client's personal awareness, such as an unfelt region, a limb that stays where it is placed, or a movement that copies the therapist.
What Janet did [source: Janet 1889 pp. 15–20; van der Hart & Horst 1989 pp. 3, 6]:
- He placed cataleptic patients' limbs, which then held the posture without tremor or fatigue for long periods.
- He showed that shaping one feature spread an emotion through the whole body. Raising Léonie's eyebrows produced a posture of terror.
- He showed that objects placed in the hand set off whole action sequences: thread led to sewing movements.
- He tested anaesthesia with strong pinching. Lucie did not react, while her split-off self, writing automatically, reported what was done.
- Historical only: do not use painful stimuli.
Modern steps [synthesis]:
1. Ask the client to scan the body and describe where sensation is vivid, dull or absent.
2. Note any belle indifférence (calm unconcern about a severe symptom). Janet named this "la belle indifférence" [source: van der Hart & Horst 1989 p. 6].
3. Note echo movements, frozen postures, or abrupt shifts in posture and voice that go with changes in state.
4. Record these as a map, and compare it with the history from 4.1.
Example language (illustrative). "Take a moment and notice your left hand. What is it like there right now? It's fine if the answer is 'nothing'."
Watch for. Sudden switching, amnesia for the session, or re-enactment. If any appear, stop the assessment and go to grounding (4.9).

4.3 Suggestion by distraction and automatic writing (Janet's own; historical, specialist only)

Purpose / when. Janet used these to reach subconscious fixed ideas in patients who could not report them, and with highly resistant patients [source: van der Hart & Horst 1989 p. 3; van der Hart et al. 1989].
What Janet did:
- He first trained Lucie under hypnosis to write without being hypnotised.
- Then, while a third person held her attention in conversation, Janet spoke quietly to her and put questions to her hand.
- The hand answered in writing and signed itself "Adrienne". This part recalled posthypnotic suggestions and a fright at age 7 [source: van der Hart & Horst 1989 pp. 3–4].
Modern status [synthesis]. Use only within specialist treatment of dissociative disorders, with training in hypnosis and dissociation. Both methods are highly suggestive and can create, harden or multiply dissociative parts and produce false content. Prefer direct, conscious dialogue.
Watch for. The emergence of new "personalities", content that escalates, or the client's increasing reliance on the method.

B. Stage 1: Stabilisation and symptom reduction

4.4 Rest and economy: reducing expenditure (Janet's own)

Purpose / when. Used when the client is exhausted, in repeated crises, or has collapsed sleep or eating [source: van der Hart et al. 1989, PH pp. 466–485, 663].
Steps.
1. With the client, list current demands and rank each by the energy it costs.
2. Agree temporary cuts to the costliest ones.
3. Protect sleep and regular meals.
4. Treat or refer intercurrent illness.
5. Simplify the daily structure. In Janet's era, hospital "isolation" from a disorganising family was a strong form of this; Janet also used admission to reorganise family arrangements.
6. Avoid sedatives where possible; Janet himself avoided bromides (PH p. 693).
Modern equivalent [synthesis]: a written week plan, temporary reduction of work or caring duties, crisis or inpatient admission only on clinical criteria, and a medication review by the prescriber. No dosing here.
Example language (illustrative). "Right now you're spending more than you have. For the next few weeks our first job is to stop the drain: which two commitments could we put on hold?"
Watch for. Rest becoming withdrawal. Janet criticised Weir Mitchell's rest cure when it was applied "in an exaggerated manner" and without moral influence (PH p. 728). Pair rest with small active tasks (4.15).

4.5 Hypnotic relaxation and symptom relief (Janet's own; requires hypnosis training)

Purpose / when. Used for insomnia, conversion symptoms, amnesia, and life-threatening states such as refusing to eat or drink. Success also strengthens rapport for later work [source: van der Hart et al. 1989, PH p. 457].
Steps (as described).
1. Induce a hypnotic state.
2. Suggest relaxation and sleep.
3. For a functional paralysis or anorexia, guide the client during hypnosis to move the limb, or to eat and drink.
4. Janet sometimes kept patients in prolonged hypnotic sleep for days or weeks without specific suggestions; one long-standing paraplegia cleared after four days. This is historical; do not replicate [source: Les médications psychologiques vol. 2, p. ~7].
Modern steps [synthesis]:
1. Explain hypnosis and get written consent.
2. Agree a signal the client can use to stop.
3. Use a brief induction with relaxation and an ego-strengthening focus.
4. Suggest small voluntary movements of the affected part, and present the regained movement as the client's own.
5. Re-orient the client fully: name, date and place.
6. Debrief afterwards.
Example language (illustrative). "As you rest, you may notice the smallest movement in your fingers, and that movement belongs to you. You can let it grow at its own pace."
Watch for. Janet found that suggestions unrelated to the trauma were accepted, while trauma-related ones met resistance; he took that as a sign that a fixed idea was active. Watch also for spontaneous abreaction or a somnambulistic crisis. If one occurs, ground and close (4.9).

4.6 Building rapport while limiting dependence (Janet's own)

Purpose / when. Runs through every stage [source: van der Hart et al. 1989; van der Kolk & van der Hart 1989].
Steps.
1. Be reliable, warm and directive in the early phase.
2. Use the client's trust to mobilise action.
3. Notice signs of "somnambulistic passion": craving for sessions, distress at gaps, and wanting the therapist to decide everything.
4. Hand decisions back to the client step by step, and space sessions as the client stabilises.
Example language (illustrative). "Last month I suggested what you might try. This time I'd like you to choose. What do you think you're ready for?"
Watch for. Too little rapport leads to drop-out. Too much produces dependence and relapse at every break.

4.7 Education in basic daily functions (Janet's own)

Purpose / when. Used in Stage 1 for clients with low energy who have lost routines of eating, sleeping, washing or social contact [source: van der Hart et al. 1989, PH p. 969].
Steps.
1. Choose one function.
2. Break it into steps.
3. Model or describe each step.
4. Have the client carry it out, in session or as homework.
5. Review it at the next session, and repeat until it is routine.
6. Then add the next function.
Example language (illustrative). "This week, let's just get breakfast back: same time each morning, sitting down, plate on the table. Nothing more."
Watch for. Fatigue. Janet varied exercises or paused them when they overtired the patient (PH p. 982ff). For eating, describe routine and regularity only; set no weight or intake targets, and involve medical care in anorexia.

4.8 Awareness exercises (Janet's own; content [uncertain])

Purpose / when. Janet prescribed awareness exercises in Stage 1 and Stage 3 to raise attention and tension [source: van der Hart et al. 1989, PH pp. 967, 972]. Their exact content was not in the sources [uncertain].
Modern form [synthesis]:
1. Have the client sit upright with feet on the floor.
2. For 1–3 minutes, the client names five things they see, then the contact points of the body with the chair, then the breath, without changing it.
3. Close by asking what the client noticed.
Example language (illustrative). "Just tell me what's here: what you see, where your feet touch the floor."
Watch for. Rising distress when attention turns to the body. If that happens, keep attention on the outside room only.

4.9 Grounding and closing after a crisis [synthesis]

Purpose / when. Janet's sources describe somnambulistic crises during memory work. They do not describe a grounding routine; this one is added.
Steps.
1. Use the client's name, and say the date and place.
2. Ask the client to press their feet into the floor and look around the room.
3. Lengthen the exhale.
4. Offer water.
5. Do not end the session until the client is oriented.
6. Agree contact arrangements until the next session.
Example language (illustrative). "Anna, it's Tuesday, you're here in my office, and that was a long time ago. Press your feet down and look at the clock with me."

C. Stage 2: Modification of traumatic memories

Before any Stage 2 work [synthesis]:

Screen for psychosis, active suicidality, current abuse or danger, and severe dissociation that has not been stabilised.
Check medical status for any intense body re-experiencing; take particular care with cardiac or respiratory illness, epilepsy and pregnancy.
Get explicit consent to memory work and agree a stop signal.

4.10 Uncovering the fixed idea (Janet's own)

Purpose / when. Used when a symptom keeps re-enacting something the client cannot narrate [source: van der Hart et al. 1989].
Routes Janet used.
- Hypnosis, sometimes after weeks or months of attempts at trance. Janet read that delay as a sign of hidden secrets. He also held that people remember best when returned to a state like the one they were in during the trauma [source: van der Kolk & van der Hart 1989].
- "Dreaming aloud" under hypnotic sleep. With Co, this brought out dreams about a friend's funeral.
- Automatic writing (4.3).
- Visual imagery.
- Plain discussion or a shared diary for simple cases.
Modern steps [synthesis]:
1. Start with the least hypnotic route: conversation and a symptom diary that the client and therapist both read.
2. Ask about the moments when the symptom starts, and what the body does just before.
3. Accept what comes, and do not interpret ahead of the client.
Example language (illustrative). "When your legs give way in the street, is there anything you notice just before: a thought, an image, a sound?" A patient of Janet's had falls in the street that re-enacted a suicide attempt in the Seine [source: van der Hart & Horst 1989 p. 7].
Watch for. Suggestion contaminating content, and premature flooding. Janet noted that a deeper layer can sit under each memory found.

4.11 Neutralisation / liquidation: graded narration (Janet's own)

Purpose / when. The core memory-work step. It turns a relived fixed idea into a narrated memory [source: van der Hart et al. 1989, PH pp. 670, 681].
Steps.
1. Rank memory fragments from least to most threatening.
2. Begin with the least threatening (PH p. 670).
3. Have the client recount the fragment in words, as fully as they can tolerate, while staying present.
4. Help them put it in order (before, during, after) and in the past tense.
5. Repeat across sessions until the story can be told without a crisis or re-enactment.
6. Then move to the next fragment.
Janet's case. Irène mimed her mother's death in delirious crises instead of remembering it. Over months, Janet worked with her to build a verbal account; he reported that "after much labor" a verbal memory was constructed (PH p. 681).
Example language (illustrative). "Let's take just the part before the hospital. Tell it to me as a story that happened then, and keep one foot on the floor here while you do."
Working / watch for.
- It is working when the story is told with less body re-enactment each time, crises stop, and the related body symptoms ease.
- Janet noted the risks: resistance can increase, and intrusions can rise. If either happens, slow down or return to Stage 1.

4.12 Substitution of images (Janet's own; hypnotic)

Purpose / when. Used when narration does not relieve the symptom. A traumatic image is replaced with a neutral or positive one, or its meaning or felt response is changed [source: van der Hart et al. 1989; van der Kolk & van der Hart 1989].
Janet's cases.
- Marie. Under hypnotic age regression, Janet suggested that her first menstruation had gone normally; her monthly crises stopped. He suggested that the old woman she saw fall had only tripped; her attacks at the word "blood" ended. He suggested that the child with impetigo she had shared a bed with was healthy and kind; her left-eye blindness lifted. Gains held at 5-month follow-up (Janet 1889).
- Cam. Hallucinated images of her dead children were replaced with flowers (Raymond & Janet 1898).
Modern steps [synthesis]:
1. Use only after the memory has been at least partly narrated.
2. Present it as imagery the client chooses, not as a claim that the event never happened.
3. The client holds the hardest image briefly, then deliberately brings in a chosen alternative image or a new ending.
4. Rehearse the change, and close by stating that the event really happened.
Example language (illustrative). "You know what happened. Now, in your imagination only, what would you want that room to look like instead?"
Watch for. Using suggestion to alter memory raises serious modern concerns about memory distortion and informed consent [synthesis]. Never imply the past was different in fact.

4.13 Reframing and forgiving the ineffective act (Janet's own)

Purpose / when. Used for obsessional, guilty clients (Janet's "psychasthenics"), and when the client stays attached to how they acted during the trauma [source: van der Hart et al. 1989; van der Kolk & van der Hart 1989].
Steps.
1. Reassure the client and restore morale.
2. Help them reinterpret their conduct as the product of overwhelm or illness rather than a moral failing.
3. Help them forgive their ineffective action.
4. With Nicole, Janet replaced her "patient myth" with a "therapeutic myth" that made the trauma easier to assimilate (Janet 1935).
Example language (illustrative). "Your body did what bodies do when there's more than they can take. It froze. That isn't the same as not caring."
Watch for. Reassurance-seeking loops. If the client needs the same reassurance repeatedly, move to response-prevention work (4.22).

4.14 Dream modification (Janet's own; hypnotic)

Purpose / when. Used for recurring traumatic dreams.
Janet's case. With Zy, Janet used hypnotic suggestion to change the content of recurring dreams about her son's death, and then to end them (Janet 1896, via van der Hart et al. 1989).
Modern form [synthesis]:
1. Have the client write the dream down.
2. They choose a changed course or ending.
3. They rehearse the new version in imagery while awake, daily.
4. Close each rehearsal with grounding. This waking version is close to current imagery-rehearsal practice; that lineage is [uncertain].

D. Stage 3: Reintegration and bodily re-education

4.15 Treatment by excitation: graded completed actions (Janet's own)

Purpose / when. Used for abulia, procrastination, social avoidance, and the inability to start or finish acts. Janet held that completed, effortful action raises psychological tension [source: van der Hart et al. 1989, PH pp. 967, 986, 1022; PH ch. XIV contents].
Steps.
1. List familiar activities the client has dropped.
2. Choose one that is small, useful and certain to be finishable.
3. Agree when it will be done.
4. The client does it to completion. A started-and-abandoned act counts as a setback for the session plan, not as a failure of the client.
5. Praise each completion and pass over failures (PH p. 986). Give an honest answer if the client asks how they did.
6. Lengthen the tasks and make them more complex step by step, including social tasks.
7. Repeat in courses: Janet found the benefit cumulative (PH p. 1022).
Example language (illustrative). "One drawer, start to finish, Thursday morning. When it's done, it's done. Tell me how you felt the moment you closed it."
Working. The client reports a lift or brightening after completing, initiates tasks on their own, and has shorter slumps.
Watch for. Exhaustion, and agitated over-activity. Janet discussed impulsive searches for excitation, such as drinking or risky acts, as false versions of this [source: PH ch. XIV §§3–4 titles; detail [uncertain]].

4.16 Education and re-education: the core sequence (Janet's own definition)

Purpose / when. Used for any lost or faulty function, motor, perceptual or daily, once organic causes are excluded [source: PH pp. 741, 783–786; van der Hart et al. 1989].
Steps.
1. The therapist demonstrates a simple action.
2. The client imitates it.
3. The therapist corrects it.
4. The client repeats it until it runs automatically.
5. The client performs it alone, unsupervised (PH p. 741). Janet's definition of education is the "production and repetition of a new action" under a competent witness (PH p. 786).
Example language (illustrative). "Watch me lift my cup this way. Now you. Slower, good. Again. Five more times, and then at home on your own."
Watch for. Janet noted that failure shows up as relapse or as symptom substitution, where a new symptom replaces the old one (PH pp. 743, 745). If either appears, return to analysis (4.10).

4.17 Aesthesiogeny: restoring felt sensation (Janet's own; procedure partly [uncertain])

Purpose / when. Used for anaesthesias and loss of bodily awareness. Janet linked the return of sensation to the return of memories and of a fuller personality. In his case Marceline, total body anaesthesia while awake contrasted with full sensation and cheerfulness in somnambulism, which he saw as nearer her healthy childhood self [source: van der Hart & Horst 1989 p. 6; van der Hart et al. 1989, PH p. 788].
What is documented. PH ch. XIII covers magnetisers' "crises", metallotherapy, "complete somnambulism", and therapeutic applications. The chapter text itself is not drawn on, so Janet's exact procedure is [uncertain]. Metals, magnets and the provoked "crises" are historical and are not to be used.
Modern form, no touch [synthesis]:
1. The client sits comfortably.
2. They attend first to a region that is clearly felt, such as the hands on the thighs.
3. They move attention toward the dull region in small steps. They may add their own gentle self-touch, pressure or temperature contrast (a warm or cool cloth they hold), or small voluntary movements of that part.
4. They name any sensation, however faint.
5. Keep each round to 1–3 minutes and stop if images or emotion flood in.
6. Close by grounding, and discuss what came up.
Touch option [synthesis; consent steps not given in the sources]:
- Explain exactly where and how you would touch: for example, a light, still palm on the forearm or shoulder blade.
- Ask, and offer the no-touch version as an equal choice.
- Agree a stop word or gesture.
- Check in during and afterwards, and record the consent.
Example language (illustrative). "Stay with the warmth in your right hand. Now let your attention drift an inch up the left arm. Anything there, even 'fuzzy', counts."
Working / watch for.
- It is working when the client feels more in that region, has a sense that the part is "mine", and the dissociative indifference softens.
- As sensation returns, traumatic memories may surface (Janet's observation). Have Stage 2 resources ready, and slow down if they appear.

4.18 Re-education of functional paralysis (method Janet reviewed: Charcot's)

Purpose / when. Used for a functional limb weakness after neurological assessment [source: PH pp. 712–713].
Steps.
1. The client concentrates on a movement being made with the affected limb. In the historical method the clinician moved it passively.
2. The client describes the movement.
3. They reproduce it with the healthy limb, then attempt it with the affected one.
4. Track progress objectively. The original method used a finger indicator and a dynamometer; a modern equivalent is range of movement or a timed task, kept with physiotherapy.
Touch. Passive movement is touch: follow the consent steps in 4.17, and prefer a physiotherapist to carry it out [synthesis].
Example language (illustrative). "Watch your right wrist bend. Say what you see. Now make the same bend with your left. Now let the right try, even a millimetre."
Watch for. Effortful straining that worsens the symptom. Pain or swelling means stop and refer.

4.19 Contracture: massage, then passive movement (method Janet reviewed; Boadella reports Janet using massage)

Purpose / when. Used for a functional contracture after medical review [source: PH pp. 714–715; Boadella 2002 page].
Steps (as reported). Massage the contracted muscles first, then use passive movement, then treat the limb as for paralysis (4.18).
Modern practice [synthesis]:
- Hands-on massage is not part of most psychotherapists' scope; refer to a physiotherapist and coordinate.
- If you are licensed and trained for touch, follow the full consent steps in 4.17.
- Avoid deep pressure over recent injury, surgery, thrombosis risk, or areas the client links to abuse.
- The no-touch alternative is client self-massage and active stretching under your guidance.
Watch for. Sudden emotional release or re-enactment when the part softens. Pause and ground (4.9).

4.20 Re-education of voice: functional mutism or aphonia (method Janet reviewed)

Steps [source: PH p. 714]:
1. Breathing exercises.
2. Listening to sounds.
3. The client feels their own larynx with their fingertips while humming.
4. Repeating single syllables, then words.
Example language (illustrative). "Fingers lightly on your throat. Hum, and feel the buzz. Now 'ma'."
Watch for. Rule out laryngeal disease first. Expect emotion when the voice returns.

4.21 Tics: immobility, then voluntary movement (method Janet reviewed: Brissaud)

Steps [source: PH pp. 717–718]:
1. The client practises holding completely still, extending the hold from seconds toward much longer periods over weeks.
2. Then they practise slow voluntary movements of the same body part without the tic, often in front of a mirror, over several months.
Example language (illustrative). "Twenty seconds of stillness, hands resting. Good. Tomorrow thirty."
Watch for. Rising tension or rebound. Coordinate with current tic treatment; the link to modern behavioural methods is [uncertain].

4.22 Stopping rumination and resisting checking (Janet's own, for psychasthenia)

Steps. Janet taught obsessional patients procedures similar to what is now called thought-stopping and response prevention [source: van der Hart et al. 1989, citing Janet 1903]. His exact procedure is [uncertain]. A modern form follows standard exposure and response prevention, with consent [synthesis].

4.23 Respiratory gymnastics (Janet recommended; Pitres's method reviewed)

Purpose / when. Used for habit coughs, yawning, sighing, hiccups and breathing tics, and to raise attention [source: PH pp. 718, 723; Boadella 2002 page on Janet's breathing studies].
Steps (Pitres, as reported).
1. Breathe deeply and slowly for about 10 minutes, once or twice a day.
2. Raise the arms on the in-breath and lower them on the out-breath. Janet preferred breathing exercises done with will, effort and attention.
Screening [synthesis]:
- Use a gentle pace, not hyperventilation.
- Check for asthma, COPD, cardiac disease, pregnancy, shoulder injury, epilepsy, and panic with dizziness.
- Stop at tingling or light-headedness.
Example language (illustrative). "Arms up as you breathe in, slowly down as you breathe out. Count it, and notice each breath."

4.24 Posture, gait and attitude training (methods Janet reviewed)

Purpose / when. Used for phobic or exhausted bodily attitudes, and agitation [source: PH pp. 715–716, 725–728].
Steps. Choose from:
- walking slowly while counting steps;
- standing upright;
- breaking a movement into its parts;
- carrying a full glass of water while walking (Atkinson);
- opening and closing the fingers slowly;
- holding a steady gaze and stillness (Turnbull);
- gait re-learning lying, then sitting, then standing, using lines on the floor and stairs (described for locomotor ataxia; that is an organic disease, so this only with medical care).
Example language (illustrative). "Walk to the window counting each step out loud, as slowly as you can."
Watch for. Self-criticism about posture. Frame it as practice, not correction of a flaw [synthesis].

4.25 Re-education of emotional expression (method Janet reviewed: Levy)

Steps [source: PH pp. 730–731]. The client learns to calm the physical expression of emotion: breathing, crying and complaining. Levy framed this as education rather than suggestion or persuasion. Janet summarised the method but did not endorse it as his own [uncertain].

4.26 Regular mental work (Janet's own case; de Fleury and Cabot reviewed)

Steps [source: PH pp. 731–732]. Set daily, fixed-hour mental work to build habit. Janet reported that making Justine do mental work seemed to help her recover. Cabot's "work cure" taught patients to work while setting worries aside.
Example language (illustrative). "Nine to nine-thirty, every day, one page of the course. Worries can wait until nine-thirty-one."

4.27 Re-education of feeding and sleep (methods Janet reviewed)

Steps [source: PH pp. 715, 723–725]. Build regular meal times, chewing and eating habits, and sleep routines. In anorexia, the historical approach was isolation plus a graduated diet. Today, refer to medical and eating-disorder services; this guide gives no intake or weight targets.

4.28 Writer's cramp and stammering (methods Janet reviewed)

Writer's cramp [source: PH pp. 719–722]: strengthen the extensor muscles, write very slowly, write with the hand turned palm-up, and do graded finger tasks such as a keyboard. Janet's sources expected 2–4 months.
Stammering: breathing and articulation discipline, rhythmic breathing with arm gestures, graduated speaking practice, singing, and recording oneself to self-correct. Refer to speech therapy today [synthesis].

4.29 Psychophysiological methods (historical; not for psychotherapists)

Janet used or experimented with stimulants, endocrine extracts, physiotherapy, hydrotherapy and electrical stimulation, and called drugs a "necessary evil" (PH p. 1030; van der Hart et al. 1989).
Today these belong to the client's physician. Coordinate, and do not prescribe.

4.30 Moral guidance and fading influence (Janet's own)

Steps [source: PH pp. 1112, 1194–1202].
1. Give explicit advice about life organisation.
2. As gains hold, reduce directives.
3. Space sessions.
4. Treat a missed appointment as possible progress and explore it.
5. Offer occasional follow-up contacts for severe cases.
Example language (illustrative). "You've been making these calls yourself for a month. Shall we try every three weeks?"

5. Handling problems

[source: van der Hart et al. 1989 and PH page numbers as cited; items marked [synthesis] are my own guidance]

The client accepts neutral suggestions but resists anything near the trauma.
- Janet read this as a sign of an active fixed idea, not unwillingness, and turned to uncovering it [source: van der Hart et al. 1989].
- Response: name the pattern without blame. Return to stabilisation and approach the material more gradually.
Trance or recall won't come, for weeks.
- Janet took a long delay as a sign of hidden secrets [source: van der Hart et al. 1989].
- Response [synthesis]: don't force it. Switch to conversation, a shared diary or bodily tracking (4.10). Revisit safety in the relationship and in the client's current life; the client may still be in danger.
The symptom clears but another appears (symptom substitution), or the client relapses.
- Janet saw both as signs that education or memory work was incomplete (PH pp. 743, 745). Memories also come in layers: Justine's secondary fixed idea persisted after the primary one was resolved [source: van der Hart & Horst 1989 p. 7].
- Response: re-analyse (4.10) for a deeper or linked fixed idea, rather than drilling the old exercise harder.
Overwhelm: intrusions increase, or a somnambulistic crisis or re-enactment happens in session.
- Janet named increased intrusions and resistance as risks of neutralisation [source: van der Hart et al. 1989].
- Response [synthesis]:
  - stop the narration and ground (4.9);
  - in the next sessions, go back to the least threatening fragment;
  - shorten exposure to the material;
  - strengthen Stage 1 resources before continuing.
Relapse after a new life stressor.
- Irène was readmitted after her father's death. Nicole relapsed after her third delivery, 12 years into treatment [source: van der Hart et al. 1989].
- Response: plan for this in advance. Hold open-door follow-up, return briefly to Stage 1, and treat the relapse as expected rather than as failure.
Exhaustion during exercises; non-adherence to graded tasks.
- Janet varied or stopped exercises that tired the patient (PH p. 982ff), praised success and overlooked failure (PH p. 986).
- Response [synthesis]:
  - shrink the task until it is certain to be completed;
  - check the energy budget (sleep, illness, demands);
  - ask what made the task feel impossible;
  - never moralise.
Dependence, or "somnambulistic passion".
- Janet warned of an intense, near-addictive attachment to the therapist, and kept the patient in charge of their own life [source: van der Kolk & van der Hart 1989].
- Response [synthesis]:
  - name the pattern gently;
  - build the client's own decisions into every session;
  - plan breaks in advance;
  - give between-session contact clear limits.
Ruptures (not addressed in the sources) [synthesis].
- Janet's directive style can feel controlling.
- Response: invite disagreement explicitly. When a client withdraws, ask what in your last direction didn't fit. Acknowledge your part, and return choice to the client.
Suspected organic disease.
- Janet warned that functional symptoms imitate organic ones [source: Janet 1907 Lecture I].
- Response [synthesis]: new neurological signs, pain, swelling, weight change or progression mean stop and refer for medical review. Keep coordinating with the medical team throughout.
Risk of creating or shaping memories and parts.
- Janet's methods relied on hypnosis, distraction and suggestion, including suggesting that past events went differently (Marie).
- Response [synthesis]:
  - use non-leading questions;
  - avoid hypnosis-based recovery of memories that have no other basis;
  - never suggest that abuse did or did not happen;
  - document what the client offered in their own words;
  - in legal contexts, be aware that hypnotically refreshed testimony can be challenged; check local rules [uncertain].
Touch-specific difficulties (consent steps are not in the sources) [synthesis].
- Freezing, going quiet, or compliant "yes" answers can mean consent is not freely given.
- Response: stop touch, return to the no-touch version, and ask about the experience later, when the client is calm.
- Never touch areas the client links to abuse.
- Never use sexual or genital touch.
- Document consent each time.
Suicidality or self-harm (Irène made two suicide attempts) [synthesis].
- Assess risk at intake and whenever memory work intensifies, using current standard practice: ideation, intent, plan, history, protective factors.
- Make a collaborative safety plan, including lethal-means counselling (secure storage or removal).
- Increase contact or arrange admission when indicated.
- Suspend Stage 2 while risk is active.
Eating refusal or anorexia.
- Janet used isolation and graduated feeding (PH p. 715).
- Response [synthesis]: medical monitoring and eating-disorder services. Psychotherapy supports the treatment and sets no intake or weight targets.

Sources

Sources

Further reading (not drawn on unless listed above)

Janet, P. (1889). L'automatisme psychologique. Paris: Alcan.
Janet, P. (1898). Névroses et idées fixes. Paris: Alcan. Cited via the secondary sources above.
Janet, P. (1903). Les obsessions et la psychasthénie. Paris: Alcan. Cited via the secondary sources above.
Janet, P. (1907). The Major Symptoms of Hysteria. New York: Macmillan.
Janet, P. (1919). Les médications psychologiques (3 vols). Paris: Alcan. English: Psychological Healing (1925), London: Allen & Unwin.
Janet, P. (1935). Cited in van der Hart et al. 1989 for the Nicole case.
Raymond, F. & Janet, P. (1898). Névroses et idées fixes, vol. 2. Cited via the secondary sources above.

Further reading (not drawn on) [uncertain]:

PH ch. XIII (aesthesiogenic agents) and ch. XIV (excitation) in full;
the French full text of the excitation and education chapters;
Boadella's full article;
the modern texts that carry Janet's model forward.

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