Annals of
& Integrative Health
W N NE ITIO ED
Psychotherapy sychotherapy
to contemporary MORITA THERAPY: ACBTcomparison techniques
SPRING 2011 • VOLUME 14, NUMBER 1
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BECOME A BOARD CERTIFIED PROFESSIONAL COUNSELOR Our Mission The mission of the American Board of Professionals CounselorsSM (ABPC) is to be the nation’s leading advocate for counselors. We will work with you to protect your right to practice, increase parity for your profession, and provide you with the recognition, validation, and fairness you so richly deserve. ABPC will champion counselors’ right to practice. The prestigious Board Certified Professional Counselor, BCPC® credential will set you apart as being an accomplished, competent, and dedicated mental health professional. By joining the American Psychotherapy Association® as a Board Certified Professional Counselor, BCPC®, you are joining more than an association. You become a member of a community of counselors dedicated to working together not only to better serve your clients, but also to support one another in your professional development.
• FREE subscription to our quarterly peer-reviewed journal, Annals of Psychotherapy & Integrative HealthSM • FREE online continuing education credits • Discounted rates to our annual Executive Summit • Advocacy at the state and national levels • A listing on the Find a Therapist national referral service • Networking opportunities with other mental health professionals and association members of the American College of Forensic Examiners Institute, American Association of Integrative Medicine, and American Board for Certification in Homeland Security • Discounts on professional liability, auto, life, and homeowner insurance
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F R O M T H E E D i T O R • lAuRA JOHNSON
ust as moms and dads are not supposed to have favorites among their children—even though they secretly often do—editors probably aren’t supposed to have a preference for one part of their work over another. In reality, juggling several publications and projects can feel like the ultimate in multitasking, and there is often one that receives the lion’s share of the attention. In my case, that has been Annals, although my duties have also included editing the Journal of the American Association of Integrative Medicine (JAAIM), a quarterly newsletter. And I couldn’t be happier that thanks to the merging of the two, I no longer have to play favorites. Our new journal—now named Annals of Psychotherapy & Integrative Health— will combine research, news, and commentary for mental health professionals with new content focusing on integrative health. The journal that has served members of
the American Psychotherapy Association since 1998 will now also be the official publication of the American Association of Integrative Medicine (AAIM). The journal is growing to accommodate the additional content. Publisher Dr. Robert O’Block and all the staff members here at association headquarters are excited about the new journal. And more exciting changes are on the way in 2011 as we move forward into digital distribution through major e-reader platforms and new, cutting-edge design concepts and styling. As always, I would like to express my profound appreciation for the authors whose work appears within these pages. The journal relies on the generosity of these hardworking professionals who choose to volunteer their time and effort to share their knowledge and research with their peers. Please feel free to contact me any time by e-mail at laura@americanpsychotherapy. com or by calling (800)205-9165, ext. 157.
F R O M T H E C A O • JESSiCA CAMPBEll
I
am thrilled about the launch of our new journal, Annals of Psychotherapy & Integrative Health. This premiere journal merges the publications of the American Psychotherapy Association and the American Association of Integrative Medicine. We have many professionals who are members of both associations, and it is exciting to have one journal with content for the entire spectrum of their specialties. I look forward to growing the journal into the top source for psychotherapy and integrative health news, research, and articles. With help from our members and contributors, Annals will continue to be an excellent learning tool. Along with the launch of the new journal, the associations have many other exciting things going on in 2011. We are looking forward to the 2011
(800) 592-1125
Executive Summit, which will be held on October 12-14 in beautiful Branson, Missouri. Fall is an excellent time of year to visit Branson, and I can’t wait to reconnect with members and meet many of you for the first time. The Executive Summit will feature leading speakers, interactive sessions, and great entertainment. Members will also have the opportunity to earn new professional credentials. I look forward to seeing you there! I would like to thank you all for your dedication to the associations. Without you, this new journal wouldn’t be possible. I look forward to hearing your feedback and suggestions. If you would like to contribute an article or advertise in Annals, please contact me by e-mail at jessica@aaimedicine.com or call (877) 718-3053, ext. 177.
Annals of Psychotherapy & Integrative Health
SPRING 2011 3
Psychotherapy Annals of
& Integrative Health
Become a member of the American Psychotherapy Association. We provide mental health professionals with the tools necessary to be successful and build stronger practices. Annual membership dues are $165. For more information, or to become a member, call us toll-free at (800) 592-1125 or visit www.americanpsychotherapy.com. 2011 EDITORIAL ADVISORY BOARD Debra L. Ainbinder, PhD, NCC, LPC, BCPC Janeil E. Anderson, LCPC, BCPC, DBT Edward Michael Andrews, MEd, LPC, NCC Kelley Armbruster, MSW, LISW, DAPA Diana Lynn Barnes, PsyD, LMFT Cherie J. Bauer, MPS Phyllis J. Bonds, MS, NCC, LMHC Sabrina Caballero, LCSW, DAPA Stacy L. Carter, PhD, BCPC Susanne Caviness, PhD, LMFT, LPC Peter W. Choate, MSW, DAPA, MTAPA Linda J. Cook, LCSW, CRS, DAPA, BCETS John Cooke, PhD, LCDC, FAPA Caryn Coons, MA, LPC Clifton D. Croan, MA, LPC, DAPA Catherine J. Crumpler, MA, LPC, BCPC Charette Dersch, PhD, LMFT David R. Diaz, MD Heather Irene DiDomenico, LPC, BCPC Carolyn L. Durr, MA, LPC John D. “Jodey” Edwards, EdD, DAPA, NCC, LPC-S Adnan Mohammad Farah, PhD, BCC, LPC Patricia Frank, PsyD, FAPA Natalie Hill Frazier, PhD, LPC Sabrina Friedman, EdD, CNS-BC, FNP-C Robert Raymond Gerl, PhD Rebecca Godfrey-Burt Sam Goldstein, PhD, DAPA Jacqueline R. Grendel, MA, LPC, BCPC Richard A. Griffin, EdD, PhD, ThD, DAPA Yuh-Jen Guo, PhD, LPC, NCC Lanelle Hanagriff, MA, LPC, FAPA Noah Hart, Jr., EdD, DAPA Ray L. Hawkins, PhD, LPC, AAMFT Gregory Benson Henderson, MS Douglas Henning, PhD Mark E. Hillman, PhD, DAPA Elizabeth E. Hinkle, LPC, LMFT, NBCC Ronald Hixson, PhD, LPC, DAPA, BCPC Judith Hochman, PhD Antoinette C. Hollis, PhD Irene F. Rosenberg Javors, MEd, DAPA Gregory J. Johanson, PhD Laura W. Kelley, PhD
Gary Kesling, PhD, FAAMA, FAAETS C.G. Kledaras, PhD, ACSW, LCSW Michael W. Krumper, LCSW, DAPA Ryan LaMothe, PhD Allen Lebovits, PhD Poi Kee Frederick Low, MS, BS Edward Mackey, PhD, CRNA, MS, CBT Frank Malone, PsyD, LMHC, LPC, FAPA Beth McEvoy-Rumbo, PhD Thomas C. Merriman, EdD, SBEC (Virginia) Ginger Arvan Metcalf, MS, RN Yvonne Alleen Moore, MC, BCPC William Mosier, EdD, PA-C Natalie H. Newton, PhD, DAPA Kim Nimon, PhD Donald P. Owens, Jr., PhD Thomas J. Pallardy, PsyD, BCPC, LCPC, CADC Larry H. Pastor, MD, FAPA Richard Ponton, PhD Joel G. Prather, PhD, MS, BCPC, Helen Diann Pratt, PhD Ahmed Rady, MD, BCPC, FAPA, DABMPP Daniel J. Reidenberg, PsyD, FAPA, CRS Roger E. Rickman, PhD,ThD, FAPA, CRS Arnold Robbins, MD, FAPA Arlin Roy, MSW, LCSW Maria Saxionis, LICSW, LADC-I, CCBT, CRFT Alan D. Schmetzer, MD, FAPA, MTAPA Paul Schweinler, MDiv, MA, LMHC, DAPA Bridget Hollis Staten, PhD, CRC, MS, MA Suzann Steadman, PsyD Ralph Steele, BCPC Moonhawk River Stone, MS, LMHC Mary Elise Taggart, LPC Patrick Odell Thornton, PhD Mary A.Travis, PhD, EdS, MA, BS Charles Ukaoma, PsyD, PhD, BCPC, DAPA Lawrence M.Ventline, DMin Angela von Hayek, PhD, LMFT, LPC Gene W. Walters, DSW, LCSW Melinda Lee Wood, LCSW, DAPA Rosemarie Zlotnick Cecilia Zuniga, PhD, BCPC
Annals of Psychotherapy & Integrative Health (ISSN 1535-4075) is published quarterly by the American Psychotherapy Association. Annual membership for a year in the American Psychotherapy Association is $165. The views expressed in Annals of Psychotherapy & Integrative Health are those of the authors and may not reflect the official policies of the American Psychotherapy Association.Abstracts of articles published inAnnals of Psychotherapy & Integrative Health appear in e-psyche, Cambridge Scientific Database, PsycINFO, InfoTrac, Primary Source Microfilm, Gale Group Publishing’s InfoTrac Database, Galenet, and other research products published by the Gale Group. Contact us: Publication, editorial, and advertising offices at 2750 E. Sunshine St., Springfield, MO 65804. Phone: (417) 823-0173, Fax: (417) 823-9959, E-mail: editor@americanpsychotherapy.com. Postmaster: Send address changes to American Psychotherapy Association, 2750 E. Sunshine St., Springfield, MO 65804. © Copyright 2011 by the American Psychotherapy Association. All rights reserved. No part of this work may be distributed or otherwise used without the expressed written consent of the American Psychotherapy Association.
4 SPRING 2011
Annals of Psychotherapy & Integrative Health
CONTACT PHONE: (800) 592-1125 WEB: www.americanpsychotherapy.com
FOUNDER & PUBLISHER: Robert L. O’Block, MDiv, PhD, PsyD, DMin (rloblock@aol.com) ANNALS EDITOR: Laura Johnson (laura@americanpsychotherapy.com) ADVERTISING: Laura Johnson (laura@americanpsychotherapy.com) (800) 205-9165 ext. 157 CHIEF ASSOCIATION OFFICER: Jessica Campbell (jessica@aaimedicine.com) GRAPHIC DESIGNER: Cary Bates (cary@acfei.com)
EXECUTIVE ADVISORY BOARD CHAIR: Daniel J. Reidenberg, PsyD, FAPA, MTAPA, CRS VICE CHAIR: Alan D. Schmetzer, MD, FAPA, MTAPA CHAIR EMERITUS: Michael A. Baer, PhD, FAPA, MTAPA, CRS MEMBERS EMERITUS: William Glasser, MD, MTAPA, FAPA Bill O’Hanlon, MS, FAPA, LMFT, MTAPA MEMBERS: Peter W. Choate, MSW, DAPA, MTAPA Frances A. Clark-Patterson, PhD Natalie Hill Frazier, PhD, LPC Noah Hart Jr., EdD, DAPA Ron Hixson, PhD, LPC, DAPA, BCPC Kenneth Miller, PhD, BCPC Mary Helen Morosko, MA Wayne E.Tasker, PsyD, DAPA, BCPC
CONTINUING EDUCATION The American College of Forensic Examiners International (ACFEI), sister organization to the American Psychotherapy Association, provides continuing education credits for accountants, nurses, physicians, dentists, psychologists, psychiatrists, counselors, social workers, and marriage and family therapists. ACFEI is an approved provider of continuing education by the following: Accreditation Council for Continuing Medical Education National Association of State Boards of Accountancy National Board for Certified Counselors California Board of Registered Nursing American Psychological Association California Board of Behavioral Sciences Association of Social Work Boards American Dental Association (ADA CERP) Diplomate status with the American Psychotherapy Association is recognized by the National Certification Commission. For more information on recognitions and approvals, please visit www.americanpsychotherapy.com
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Become a member of the American Association of Integrative Medicine. AAIM promotes the development of integrative medicine, which is the medicine of the 21st century. Annual membership dues are $165. For more information, or to become a member, call us toll-free at (877) 718-3053 or visit www.aaimedicine.com
CHIEF ASSOCIATION OFFICER: Jessica Campbell (jessica@aaimedicine.com) PHONE: (877) 718-3053 WEB: www.aaimedicine.com
EXECUTIVE ADVISORY BOARD CHAIR: Zhaoming Chen, MD, PhD, MS, FAAIM VICE CHAIR: Jerry M. Kantor, LicAc, CCH, RSHom (NA), MMHS
2011 EDITORIAL ADVISORY BOARD Martin Alpert, MS, DC Rolando Arafiles, MD Eleanor Barrager Maggie Bloom Brenda Brown, PhD, ND Phillip Carlyle, MD Bill Cook, MD Dean Cosgrove Debra Dallas, MS, MIFHI Lynn Demartini, DSH-P, RN, LMT Kenneth Dennis, PhD David Getoff Cindy Griffin, DSH-P, DIHom Michael Grodin, MD Christine Gustafson, MD William Hurst, PhD
Steva Komeh-Nkrumah, DrPH, RD, CNS Cuneyt Konuralp, MD, Lac Robert Kornfeld, DPM Tim Leasenby, DC Don Londorf, MD Cheyenne Luzader, MS, CCH-Ps, CT, ADS Robert McCarthy, LPC, BCPC, PhD Bill McClure, DC, JD Pamela McKimie, CHom, LAc Celestine McMahan-Woneis, PhD Mark Morningstar, DC Barbara Phibbs, OMD Jerald Ratner, MD, FAAIM Patricia Rotsztain, MS, CH, CLC Scott Saunders, MD
MEMBERS: Shashi K. Agarwal, MD, FAAIM Brian L. Karasic, DMD, MBA, CMI-IV, FAAIM Robert A. Kornfeld, DPM, DCP Matthew C. Lee, MD, FAAIM Gregory W. Nevens, EdD, FAAIM, FACFEI, DAAPM Richard C. Niemtzow, MD, PhD, MPH, CHS-V Lyni Nowak, RN, FNP-c, BCIM Gail C. Provencher, APRN, MSN, CNS, BCIM Col. Richard Petri, Jr., MC Jerald H. Ratner, MD, FAAIM Rev. Roger Rickman, FAAIM, FAPA, FABCHS, BCIM Terry A. Rondberg, DC Steven M. Rosman, PhD, MS, LAc, FAAIM Mark H. Scheutzow, MD, PhD, DHom, FAAIM William M. Sloane, JD, LLM, PhD, FACFEI, FAAIM Matt L. Spiers, DC, FAAIM Tara Sharma, MD, BCIM Catherine Ulbricht, PharmD
CONTINUING EDUCATION The American College of Forensic Examiners International (ACFEI), sister organization to the American Psychotherapy Association, provides continuing education credits for accountants, nurses, physicians, dentists, psychologists, psychiatrists, counselors, social workers, and marriage and family therapists.
The American Association of Integrative Medicine (AAIM) recognizes that a multiACFEI is an approved provider of continuing education disciplinary approach to medicine provides the maximum therapeuticbybenefit. AAIM’s advocacy the following: Annals of the American Psychotherapy Association (ISSN 1535-4075) is published quarterly by the American Psychotherapy Accreditation Council for Continuing Medical Education for broader treatment options facilitates a bond between integrative and Western medicine, and Association. Annual membership for a year in the American Psychotherapy Association is $165. The views expressed in National Association of State Boards of Accountancy Annals of the American Psychotherapy Association are those of the authors and may not reflect the official policies of the National Boardall forspecialties Certified Counselors the end result is a gathering place for healers, educators, and researchers from to American Psychotherapy Association. Abstracts of articles published in Annals of the American Psychotherapy Association California Board of Registered Nursing appear in e-psyche, Cambridge Scientific Database, PsycINFO, InfoTrac, Primary Source Microfilm, Gale Group PublishAmerican Psychological Association compare notes and combine forces, benefiting both the patient and the health care provider. ing’s InfoTrac Database, Galenet, and other research products published by the Gale Group. Contact us: Publication, editorial, and advertising offices at 2750 E. Sunshine St., Springfield, MO 65804. Phone: (417) 823-0173, Fax: (417) 823-9959, E-mail: editor@americanpsychotherapy.com.
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Diplomate status with the American Psychotherapy Association is recognized by the National Certification Commission.
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Psychotherapy Annals of
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SPRING 2011 • VOLUME 14, NUMBER 1
ON THE COVER BUILD YOUR PRACTICE WITH SOCIAL MEDIA 10 MORITA THERAPY 14 CHARLIE SHEEN WINNING? 27 PANIC ATTACKS AND SUBSTANCE ABUSE 28 MIND-BODY MEDICINE 44 NATURAL REMEDY 50 GUIDED MEDITATION 54 VIRTUAL ENVIRONMENTS 56 HELP IS ON THE WAY 76
14 FEATURES 14 the eXPeRIeNtIal theRaPY OF ShOMa MORIta:
54
DEPARTMENTS 8 MIND NeWS
A Comparison to Contemporary Cognitive Behavior Therapies
74 NeW MeMBeRS
By C. Richard Spates, PhD, Ayumu Tateno, MD, Kei Nakamura, MD, Richard W. Seim, MA, and Christina M. Sheerin, MA
78 BOOK ReVIeWS
28 PaNIC PSYChOPathOlOGY aND SUBStaNCe USe DISORDeRS
80 ShORt StORY: “Memoirizing”
By Michael J. Zvolensky, PhD, Chad Brandt, BS, and Amit Bernstein, PhD
56 POteNtIalS aND ChalleNGeS OF USING VIRtUal eNVIRONMeNtS IN PSYChOtheRaPY
By James McAdams
84 Ce teSt PaGeS
By Shulan Lu, PhD, Derek Harter, PhD, and Devin Pierce, PhD
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Annals of Psychotherapy & Integrative Health
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43
50
70 COLUMNS 10 SUCCeSS FIleS: Clients, Connections,
44
INTEGRATIVE health
44 MIND-BODY MeDICINe AAIM Chairman’s Column
By Zhaoming Chen, MD, PhD, CFP, FAAIM Chairman, American Association of Integrative Medicine
and Social Media By Laura Johnson
48 MaSSaGe theRaPY
12 ChaIR’S CORNeR: Just a Little Elbow Grease By Daniel J. Reidenberg, PsyD, FAPA, BCPC, MTAPA
By Shashi K. Agarwal, MD, FAAIM
27 CUltURe NOteS: Charlie Sheen Phenomenon By Irene Rosenberg Javors, MEd, LMHC, DAPA
70 RX PRIMeR: Adverse Effects of Antipsychotics
The Credentialed Art
50 NatURal ReMeDY
Kava (Piper methysticum G. Forst) A monograph from Natural Standard
By Ayesha Sajid, MD, David R. Diaz, MD, and Maria C. Poor, MD
54 GUIDeD MeDItatION
72 PRaCtICe MaNaGeMeNt
By Eve Eliot
From Disparities to Shortages By Ronald Hixson, PhD, LPC, LMFT, BCPC
Aging: Can it be Slowed Down?
76 ChaPlaIN’S COlUMN Help is on the way By Chaplain David Fair, PhD, CHS-V, CMC (800) 592-1125
Annals of Psychotherapy & Integrative Health
SPRING 2011 7
Mind News What Your TV Habits May Say About Your Fear of Crime What’s your favorite prime-time crime show? Do you enjoy the fictional worlds of CSI or Law & Order, or do you find reallife tales like The First 48 or Dateline more engrossing? Your answers to those questions may say a lot about your fears and attitudes about crime, a new study finds. University of Nebraska-Lincoln sociologists surveyed hundreds of adults about how often they watched various kinds of crime TV. They found that how each type of program depicts crime was a factor in viewers’ opinions on everything from their fear of crime to their confidence in the justice system. Among the study’s findings: • The more frequently people watched nonfiction crime documentaries, the
Enhance Romance
by Going Out with Other Couples Romantic relationships often start out as enjoyable or even exciting, but sometimes may become routine and boring. A Wayne State University study reveals that dating couples that integrate other couples into their social lives are more likely to have happy and satisfying romantic relationships. Richard B. Slatcher, Ph.D., assistant professor of psychology in WSU’s College of Liberal Arts and Sciences and a resident of Birmingham, Michigan, specializes in social and health psychology. His recent research suggests that spending quality time with other couples may be an important way to improve long-term relationships. His study, “When Harry and Sally met Dick and Jane: Experimentally creating closeness between couples,” which recently appeared in Personal Relationships, investigated 60 dating couples in a controlled laboratory setting. The object was to better understand how friendships between couples are formed and to learn how
these friendships affected each couple’s romantic relationship. Each couple was paired with another and given a set of questions to discuss as a group. Half of the groups were given high-disclosure questions intended to spark intense discussion, while the other half were given small-talk questions that focused on everyday, unemotional activities. “In this study, we discovered that those couples who were placed in the ‘fast friends’ group felt closer to the couples they interacted with and were more likely actually to meet up with them again during the following month,” said Slatcher. “We also learned that these same couples felt that this friendship put a spark in their own relationships, and they felt much closer to their romantic partners.” Wayne State University (2011, February 14). Enhance your romance: Wayne State study shows that going out with other couples may be good for /enhance-your-romance-waynestate-study-shows
Exercise Helps Overweight Children Think Better,
Do Better in Math
more fearful they were of becoming crime victims. They also were less confident in the criminal justice system. • Frequent viewers of fictional crime dramas were not affected by the programming to believe they would become crime victims, and their support of and confidence in the criminal justice system also was unaffected by their viewing habits. • The more often people watched crime coverage on the local news, the more they believed that the local crime rate was increasing.
Regular exercise improves the ability of overweight, previously inactive children to think, plan and even do math, Georgia Health Sciences University researchers report. They hope the findings in 171 overweight 7- to 11-year-olds—all sedentary when the study started—gives educators the evidence they need to ensure that regular, vigorous physical activity is a part of every school day, said Dr. Catherine Davis, clinical health psychologist at GHSU’s Georgia Prevention Institute and corresponding author on the study in Health Psychology. “For children to reach their potential, they need to be active,” Davis said. To measure cognition, researchers used the Cognitive Assessment System and WoodcockJohnson Tests of Achievement III that measure abilities such as planning and academic skills such as math and reading. A subset of the children received functional magnetic resonance imaging highlighting increased or decreased areas of brain activity. MRIs showed those who exercised experienced increased brain activity in the prefrontal cortex— an area associated with complex thinking, decision making, and correct social behavior.
University of Nebraska-Lincoln (2011, February 7). What your TV habits may say about your fear of crime. Retrieved from http://newsroom.unl.edu/blog/?cat=3
Georgia Health Sciences University. (2011, February 10). Exercise helps overweight children think better, do better in math. Retrieved from http://news.georgiahealth.edu/archives/3263?utm_source=feedburner&utm_medium=feed&utm_campa ign=Feed%3A+mcg%2Fnews+%28GHSU+News%29
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Annals of Psychotherapy & Integrative Health
www.americanpsychotherapy.com
‘Chinks’ in the Brain Circuitry Makes Some More Vulnerable to Anxiety Why do some people fret over trivial matters while others remain calm in the face of calamity? Researchers at the University of California, Berkeley, have identified two different “chinks” in our brain circuitry that explain why some are more prone to anxiety. Their findings, published Feb. 10 in Neuron, may pave the way for more targeted treatment of chronic fear and anxiety disorders, which affect at least 25 million Americans and include panic attacks, social phobias, obsessive-compulsive behavior, and post-traumatic stress disorder. In the brain imaging study, researchers from UC Berkeley and Cambridge discovered two distinct neural pathways that play a role in whether we develop and overcome fears. The first involves an overactive amygdala, which is home to the brain’s primal fight-or-flight reflex and plays a role in developing specific phobias. The second involves activity in the ven-
tral prefrontal cortex, a neural region that helps us to overcome our fears and worries. Some participants were able to mobilize their ventral prefrontal cortex to reduce their fear responses even while negative events were still occurring, the study found. “This finding is important because it suggests some people may be able to use this ventral frontal part of the brain to regulate their fear responses—even in situations where stressful or dangerous events are ongoing,” said UC Berkeley psychologist Sonia Bishop, lead author of the paper. “If we can train those individuals who are not naturally good at this to be able to do this, we may be able to help chronically anxious individuals as well as those who live in situations where they are exposed to dangerous or stressful situations over a long time frame,” Bishop added. University of California-Berkeley (2011, February 9). Chinks in the brain circuitry make some more vulnerable to anxiety. Retrieved from http://newscenter.berkeley.edu/2011/02/09/chinksanxiety/
Schools Often React Poorly
to Student Suicides
School officials can react poorly to suicides. While well-intentioned, administrators who don’t send the right messages may make copycat suicides more likely and do not provide the help needed by those left behind. “Without the proper knowledge and resources, many school administrators may implement strategies that could actually increase the risk of suicide among students,” said Darcy Granello, professor of counselor education at Ohio State. Granello is co-author of Suicide, Self-Injury and Violence in the Schools: Assessment, Prevention and Intervention Strategies. Its segment on suicide was co-authored with her husband, Paul Granello, an associate professor of counselor education. School officials mean well in suicide response, but the best reaction is counterintuitive, said Paul. “We naturally want to have ceremonies and memorials ... but when you do this in the case of a suicide, it sends the wrong message.” Suicide should be discussed, Darcy emphasized. Schools should provide suicide risk and mental health resources to students. A research-based plan for dealing with suicides is available via the Florida Mental Health Institute: theguide.fmhi.usf.edu/ Ohio State University. (2011, February 9). Retrieved from http://researchnews.osu.edu/archive/postvention.htm
Extra Testosterone Reduces Your Empathy A new study from Utrecht and Cambridge universities has found that an administration of testosterone under the tongue negatively affects a person’s ability to “mind read,” an indication of empathy. The findings were published Feb. 10 in the journal Proceeding of the National Academy of Sciences. Professors Jack van Honk at the University of Utrecht and Simon BaronCohen at the University of Cambridge designed the study, conducted in Utrecht. They used the “Reading the Mind in the Eyes” task as the test of mind reading, which tests how well someone can infer what a person is thinking or feeling from photographs of facial expressions from around the eyes.
(800) 592-1125
Mind reading is one aspect of empathy, a skill that shows significant sex differences in favor of females. They tested 16 young women from the general population, since women on average have lower testosterone levels than men. The researchers not only found that administration of testosterone leads to a significant reduction in mind reading, but also that this effect is powerfully predicted by the 2D:4D digit ratio, a marker of prenatal testosterone. Those with the most masculinized 2D:4D ratios showed the most pronounced reduction in the ability to mind read. University of Cambridge (2011, February 10). Extra testosterone reduces your empathy. Retrieved from http:// www.admin.cam.ac.uk/news/dp/2011021001
Annals of Psychotherapy & Integrative Health
SPRING 2011 9
SucceSS fileS
Clients, Connections, and Social Media By Laura Johnson Engage or be left behind. That’s the challenge issued on the Web site socialmediafortherapists.com, and it’s a daunting one at a time when therapists face plenty of other challenges building a successful private practice.
WhaT’s your policy? Have a social media policy that
Social media’s explosive growth—with more than 500 million people on Facebook, 200 million on Twitter, and billions watching YouTube videos every day—makes it a great vehicle both for educating the public about mental health issues and for marketing your practice. Starting a blog should be the first step to establishing an online presence, said Dr. Susan Giurleo, a psychologist who also consults with health care professionals about using social media. Blogging can help establish your credibility as an expert. The focus should be on creating and sharing useful content—research findings, mental health tips, and recommendations on where readers can learn more about a specific topic. Responding to comments on your blog—even just a quick “thanks for your comment”—shows visitors to your blog that you are engaged with them and can stimulate further conversation. Like Giurleo, San Francisco psychologist Keely Kolmes provides consultation services to mental health professionals who have concerns about technology issues and how to manage their online presence. Kolmes said blogging has been “a great vehicle for me to express my thoughts on various topics and to write many blog posts about the ethics of social media … I think reading my coherent thoughts on my blog encouraged others to invite me to write articles for their publications. So it was a showcase for my thinking and writing.” Twitter, on the other hand, is useful for connection and for quickly sharing information, Kolmes said. “It has allowed me to engage the most and find others to interact with who may not have stumbled onto my blog, otherwise.” Giurleo suggests that those who are completely new to using social media start with a profile on LinkedIn, then move on to Twitter or Facebook, “where the real action is.” Mental health professionals seem to feel most comfortable with LinkedIn because they are used to socializing with colleagues there, Guirleo said. “But the real benefit for the general public is for us to be on Twitter and Facebook, since that is where they spend their time and are looking for legitimate health care information.” 10 SPRING 2011
Annals of Psychotherapy & Integrative Health
explains how you conduct yourself on the Internet and how you will respond to potential online interactions between yourself and clients. Psychologist Keely Holmes, PsyD, who has helped develop courses on social media for psychotherapists, has a comprehensive policy that she shares with her clients. As a contribution to the profession, she allows other therapists to copy or adapt to fit their own practices. You can find the policy at http:// drkkolmes.com/for-clinicians/socialmedia-policy/
Think of your online presence as a way to do community outreach, such as teaching workshops or doing presentations, Kolmes said. “But be aware that in this day and age, your professional conduct will be documented and archived forever, so think before you post!” www.americanpsychotherapy.com
Dr. Susan Giurleo is among the most high-profile success stories of therapists using social media to expand their practices. Giurleo—a licensed psychologist who is also a business consultant and marketer for health care professionals who want to diversify their income streams—graciously took the time to share her thoughts on the use of social media with Annals. Q: in what ways can the thoughtful and ethical use of social media help therapists promote their practices? a: I encourage therapists to use social media (which I consider blogging, Twitter, Facebook and LinkedIn, primarily) to educate, inform, and share evidence based-information. Social media allows therapists to demonstrate their expertise in a certain treatment area. People want to work with recognized experts. They want to be seen by someone who has a specialty and focus to their work. Social media allows therapists to stand out and differentiate themselves from others—including coaches or lay people who claim to be experts in the healing arts. Whether we like it or not, there is a great deal of competition in the area of mental health treatment. Those who use social media effectively and ethically will have an edge over those who are not present in the online space. The Pew Foundation has found that over 62% of Americans search for health care information online. ... Be present, be helpful and informative, and your practice will grow.
Do’s anD Don’Ts • Do keep your personal online activities separate from professional ones. • If you have a personal profile on Facebook, use the privacy settings to restrict who can see it—and make sure to stay abreast of Facebook’s everchanging privacy settings. • Moderate comments on your blog posts, or turn off the commenting feature. • Never post or tweet information about patients, even generically without names. The Internet has made our world much smaller and the risk of boundary violations much greater.
Q: What are the most common mistakes or missteps that you see among practitioners who are establishing a social media presence? a: Some “beginner” mistakes are not having a profile picture or bio in the social media platform. Your picture should be of you, not a brand or an object. A bio introduces people to you and is considered mandatory by those who are experienced in social media. Without a picture or bio, you aren’t being “social.” The other mistake is using social media like an advertising stream. We cannot post to Facebook or tweet about ourselves or our services over and over again. This is considered self-promotional and essentially broadcast advertising, which is not what social media is about. To engage effectively, we must share relevant information (either others’ articles, blog posts, or useful information), our own content (such as our own blog posts), and converse with others briefly using social media. One mistake we should never make is mentioning clients in social media, even if we don’t use names or identifying information. Even saying something like “Client just left the office” could be seen by that client and bring up confidentiality concerns. Q: if you had to pick only one social media platform for marketing your practice, which one would it be, and why? a: A blog. Everyone who wants to market online should start with a blog on their Web site. This becomes your online “office” and is a place to highlight your content, ideas, and expertise. Once you have a blog, you need to develop “outposts” where you share content. For me, these include Twitter and Facebook.
“Just don’t do it,” said Dr. Keely Kolmes, in a blog post titled Managing Twitter As a Mental Health Professional. “Your clients will be happier, and you will be protecting your practice.”
useful Web siTes www.socialmediafortherapists.com http://drsusangiurleo.com/getting-started-online-social-media/ www.psychotherapy.net/article/psychotherapists-guide-social-media www.webtrainingwheels.com/2010/01/social-media-for-psychologists-and-therapists/
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chAir’S corNer listen to me? Why do I feel like the kids are running the house?” Maybe they are. Maybe they are not. And maybe there is merely a generation gap that is being overlooked. Recently I was on a flight from Minneapolis to San Francisco. It is a long, 4½-hour flight, regardless of what you bring on the plane to pass the time. I brought my computer to work and listen to iTunes, the newspaper to keep up with what is happening in the world, and had hopes of sleeping for a little while to try and catch up on very little sleep for some time. On my right for this cross-country flight is Michael. Not tall, blonde, with a full head of hair and six-pack abs, Michael is in his mid50s, a well-built, strong, solid guy. He still has some precious hair left and a thick beard, both turning from dark to not dark anymore. Michael is wearing jeans and tennis shoes with a blue and white checkered, long-sleeved, collared polo shirt, telling me that he is a man who can be down to earth but also has good taste. At first, I’m not sure what he does professionally, but I assume since we were both upgraded to first class that he travels frequently and likely has a good job. Michael does not at all look like he is rolling in money (no fancy watch or jewelry, no expensive, modern glasses, and a fairly standard black carry-on, although it is a Tumi). As we begin the flight and a conversation which we both probably think will just help pass the time, I learn a lot about Michael and his family, his job, and his views on life. It is probably not uncommon for most of us that once you mention what you do, it becomes a free therapy session for the duration of the flight, but that wasn’t the case with Michael. Sure, he had many questions about psychology and diagnoses, medications, and treatments. But this wasn’t about therapy or problems for him. As a matter of fact, Michael turned out to be this normal, real person who is going about living his life the way I guess many would say it is supposed to be. He is living and not letting his life be run by something else, like texting or tweets, posts, or even video games. Michael is married for some 30 years, defying most statistics. He and his wife have two children in their 20s, both seemingly doing well. He works in finance, an understandably difficult place to be in this economy, but he is very levelheaded about his business and other people’s money. During part of our conversation about parenting—in which he says he is a strong supporter of parents needing to get licensed before they can have children—Michael tells me a great story. Not long after Michael’s son Will got his driver’s license, there was a small accident. Michael was inside one day, and Will came in the house very anxious and upset. Clearly worried about his dad’s reaction and what the consequence(s) might be, he got the words out to tell his dad that when backing out of the garage, he ever-so-slightly hit the other car in the driveway. Michael asked how bad it was,
Just a little Elbow Grease By Daniel J. Reidenberg, PsyD, FAPA, BCPC, MTAPA
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ost of us know this profile well: a dual-income family with parents working opposite shifts; two or three kids who were raised in a day care or by a combination of relatives, schools, and TV or video games; and maybe one family vacation a year (before the 2008 recession), now a “staycation.” A middle-class family with a home that is probably a little too big, and a pet or two, lots of toys and sports. Sports, sports, and more sports. They are constantly running kids to dance and hockey, baseball, practice, games, or just to watch another game. In our typical client family, life generally goes along pretty well. There are no major catastrophes outside of some expected sibling rivalry or fears of not passing the next test at school. Then something changes, and our typical family becomes our client. Maybe it is one of the children; maybe it is one of the parents. It could be that there is a parenting issue that brings in Mom, Dad, and daughter or son. As we dig into why they are in our office, we ask the routine questions: Any history of mental illness in the family? Any concerns about drug or alcohol use? Any history of head trauma or significant event that was traumatic? No, no, no are often the answers, and we continue looking. We often say, “Let me meet with the parents alone and each of the kids alone,” in hopes of finding out what is going on that isn’t being spoken. Maybe we talk to the school and see whether there have been any changes there. As we continue working to understand the family and what is really behind why they have come to our office, we don’t find the golden nugget, the smoking gun that they expected or hoped we’d find. And of course, they want a “quick fix”; doesn’t everyone these days? “Doctor, what is the problem? Why don’t they 12 SPRING 2011
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Take-away lessons: and Will said that it wasn’t too walk away. He could think his son bad, but never having been in isn’t nearly as smart as he once be1. Whether you are counseling the parents, the children, or this situation before, he wasn’t lieved he was. He could also, as he anyone else, make sure they understand the message to sure exactly what to say. So did, burst out laughing and like be the best that you can be. Help them define realistic exMichael and Will headed out any good and reasonable parent pectations based on their skills, aptitude, and intelligence. to take a look at the damage. would do, he thought to himself, Work with clients to understand that comparing themselves Calmly, Michael looked at the “Where did I go wrong in my parto others helps about as much as setting too-high expeccars and said, “Well, there are enting for him to think you can a few small scratches here, and go buy elbow grease?!” tations for themselves. Clients need to strive to be the best some black from the bumper After laughing for a few minthat they can be in everything that they do. Having goals hitting the side of the car, but utes and realizing that he was to help them achieve that will help even more. it’s not too bad.” With Will in a generational gap between relieved at both how his dad his youth and his son’s youth, 2. A little more elbow grease goes a long way. As you work handled the news and that it Michael finally said to Will, “It’s with someone, keep at it. Don’t get distracted by other cliwasn’t going to cost a small not something you buy. It’s someents’ problems, your personal problems outside of the offortune to get fixed (fearing, thing you have to apply.” A litfice, or other things. Make sure that you work just as hard as of course, that he’d be washing tle disappointed that there was your client does, and harder at other times, to keep them dishes and mowing the lawn no way to buy something that engaged in the therapeutic and healing process. However, until the day he died), Michael would give him a quick and easy when you feel like it is only you who is working (i.e., you are said, “why don’t we go up to fix, Will put some more time and the only one putting in the elbow grease), it is time to stop, the store and get some things effort—and just a little elbow step back, and reassess yourself and with your client on to buff it out and you can grease—into his task and fixed where things are and where you are headed. work on it?,” and that they up the car like it was new. did. Upon returning home, The reason this story struck me 3. Realize that there is always, always, always another posWill was really intent on dowas that I think too often, parents sibility. If we learn anything from Michael and Will, we learn ing the job and doing it right. or families come to us a) looking that what we thought and intended might not be the same He rubbed and buffed, he for a quick fix, b) not really sure as what is real for someone else. There are always multiple shined and worked away at where the problem is, c) having possibilities to human dilemmas and opportunities. the car for a good couple of spent little time thinking or talkhours. Michael knew he was ing about where things have been 4. A message I always try and share with parents is what I outside and was proud of his missed in common communicall the 3 C’s: Always try to be clear, consistent, and conson for taking responsibility, cation, and/or d) without havcrete. The more clear you can be in what you say, want, and so seriously. When Will ing considered how different the had finished what he thought world is today from when they need, don’t want, etc., the easier it will be for the child(ren) was a masterpiece of work getwere their children’s age. All of to understand you. The better you are at being consistent ting out all of the scratches, that is only to say that there really about your needs, expectations, plans, etc., the more likehe called for his dad to come might not be the “problem” that ly children are to get the same message and learn how to look at the car and deliver the they thought there is/was. There respond appropriately to it. Finally, if you can be concrete “Good job, son” speech he was may not be a diagnosable disorder about whatever you are talking to children about, you are so hoping for, and he almost or characterological problem at all. much more likely to connect with them in a way that they did. But what his dad got was Ironically, the quick fix that most can understand. ultimately so much more. parents want is the same quick fix Michael looked at the work that Will wanted! And ultimately, his son had done, and it was, in all reality, very good. He was im- as Michael pointed out to his son, sometimes it is just that you have pressed at how good the side of the car looked. But—and there’s to put in a little more time and effort, and things will work out. always the proverbial “but” in every parent’s handbook of responses: So what eventually happened to my cross-country flight partner, “It all looks really good, son. But, there are a couple of marks left Michael, and his son Will? They lived happily ever after, and both right here. They’re pretty small, and I’ll bet if you just put a little el- were better off for the chance to experience a unique moment in bow grease into it, they’ll all be gone.” Excited about the possibility time that ended up teaching them both a lifetime lesson. that he was almost done, almost saved from whatever he originally Daniel J. ReiDenbeRg, PsyD, FAPA, DAPA, MTAfeared might be the worst outcome possible, and as sincere as the PA, is the chair of the American Psychotherapy Assoday is long, Will looked at his dad and said: “Great! Where can we ciation’s Executive Advisory Board and has been a buy that?” member since 1997. He is a Fellow and Master TheraIt was at that moment that Michael realized he was learning a pist of the American Psychotherapy Association and lesson, even one greater than the one he was trying to teach his son. executive director of Suicide Awareness Voices of At that moment, Michael had a choice to make. He could get anEducation (SAVE) in Minneapolis, Minnesota. Contact gry at Will for being so naïve as to say such a thing. He could look him with your thoughts at dreidenberg@save.org. at his son with great disappointment, not say anything more, and (800) 592-1125
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The eXperienTial Therapy of
SHOMA MORITA A Comparison to Contemporary Cognitive Behavior Therapies By C. Richard Spates, PhD, Ayumu Tateno, MD, Kei Nakamura, MD, Richard W. Seim, MA, and Christina M. Sheerin, MA
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inTroDucTion
Science is a constantly evolving enterprise. While well-known ideas are outright challenged and ultimately either embraced or cast away, more obscure or culturally isolated ideas often fade into history, only to be resurfaced, reinvigorated, or completely rediscovered years later. Like all sciences, this occurs with psychotherapeutic modalities and techniques. For example, many have applauded the increased use of mindfulness and acceptance-based strategies in behavioral and cognitive-behavioral therapies, and various approaches, such as Acceptance and Commitment Therapy, Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy, Mindfulness-Based Stress Reduction, and Buddhist-inspired substance abuse treatments have arisen from both basic and applied research validating the efficacy of these techniques. Though it is a controversial distinction, some have seen these collective approaches as a “new wave,” a “third wave,” or a paradigm shift in empirically based treatments
(Hayes, 2004). However, while this may be a new movement within the cognitive-behavioral tradition, these techniques have been an integral part of Eastern therapies for years. This paper will elucidate a Japanese form of treatment know as Morita Therapy. Since its inception, Morita Therapy has developed into an established brand of psychotherapy in Asia, and some have commented on the similarities between third-wave cognitive behavior therapies and Morita’s approach (e.g., Hofmann, 2008). The point of this paper is not to highlight the proprietary nature of Morita’s work but to shed scholarly light first on the core features and processes of Morita Therapy to a degree that has been absent from the ongoing discussion. Also, by identifying original or early sources for what might have proved to be difficult-to-access works on Morita Therapy, we intend to examine how these processes align with Western therapies at a level of depth heretofore unaddressed. In a similar vein, we hope Easterners will be
able to appreciate the relevance of concepts heretofore thought uniquely Eastern and how they interlace or hold a central conceptual position in contemporary cognitive behavior therapies. It is also hoped that by doing this, we will foster a greater degree of communication, integration, and synthesis of Eastern and Western approaches and spur more informed clinical research.
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absTracT A recent trend in psychotherapies has been to utilize techniques that have an unmistakable Eastern signature, such as mindfulness and acceptance-based strategies. Although these approaches
The DevelopMenT of MoriTa Therapy
Morita Therapy was developed by Shoma Morita, a Japanese psychiatrist who lived during the Meiji Period in Japan, a period roughly beginning in 1864 and ending around 1925. During this period, Japan had adopted an “empirical science” approach to education that emphasized the importance of direct observation in analyzing events (Frühstück, 2005; Kitanishi & Mori, 1995). This approach was adopted in part from China and was further expanded through contact with the West, notably Germany and Great Britain (Low, 2005). After graduation from medical school, Morita began working with a series of patients presenting with a problem then known as neurasthenia (Beard, 1880; Charcot, 1877; Dubois, 1908; Freud, 1896/1962; Mitchell, 1900), a constellation of symptoms
have been met with widespread clinical and empirical support, an analysis of the origins of these approaches has so far been limited. This paper will redress this tendency by highlighting a Japanese form of treatment known as Morita Therapy, note the development of this approach, and outline how it is currently practiced. A further objective is to delineate how this approach aligns with contemporary cognitive behavior therapies (sometimes known as “third wave” therapies) such as Acceptance and Commitment Therapy, Dialectical Behavior Therapy, and Mindfulness-Based Cognitive Therapy in regards to case conceptualization, diagnosis, and intervention. It is hoped that this effort will open a stronger narrative regarding the core processes of these approaches and foster a greater integration and synthesis of contemporary Eastern and Western therapies.
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This article is approved by the following for continuing education credit: The American Psychotherapy Association provides this continuing education credit for Diplomates and certified members, who we recommend obtain 15 CEs per year to maintain their status. After studying this article, participants should be better able to do the following: 1. Identify the core concepts and brief history of Morita Therapy 2. Identify the four stages of classical Morita Therapy 3. Describe how Morita Therapy was changed in ecent times 4. Identify similarities between Morita Therapy and contemporary cognitive behavior therapies regarding case conceptualization and treatment processes KEY WORDS: Morita Therapy; Acceptance and Commitment Therapy; MindfulnessBased Cognitive Therapy; Dialectical Behavior Therapy; Third Wave Therapy
and Binswanger (1911), which emphasized the importance of direct experiences and the paradoxical nature of emotional control. He assimilated these ideas into his own approach, which he continued to develop and revise over time (Kitanishi, 1991; Kitanishi & Mori, 1995).
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case concepTualiZaTion in MoriTa Therapy
circumstances and should not be seen as problematic. However, when an individual perseverates on these reactions, views them as intolerable, and attempts to control them, problems occur. As one contemporary Morita therapist stated, “The patient’s attempt to cure the disorder … has the opposite effect, similar to one’s awareness of becoming more mentally tenacious in remembering something the harder one tries to forget it” (Fujita, 1986). Thus, instead of allowing his or her discomfort to wane naturally, the patient inadvertently exacerbates his or her symptoms, leading to a vicious circle of anxiety, avoidance, and more anxiety (a term used most extensively by Hurry, 1915). Over time, this pattern may cause some to confuse their subjective experiences with reality (Morita, 1928/1998). Therefore, for Morita, the goal of therapy was to provide patients with a set of direct experiences that would teach them to let go of the struggle to control their private experiences and to eventually reach an acceptance of one’s self, one’s symptoms, and one’s reality “as it is” (known as arugamama in Japanese). Morita argued that an abstract understanding of this goal was insufficient; arugamama could only be attained through situations where patients could not escape or avoid their emotions (Kitanishi, 1991). He believed that, through regular contact with these situations, patients eventually learn to accept their emotions, and the mind
After conducting his initial studies on psychotherapies, TARGET AUDIENCE: Psychologists, Morita believed that the defcounselors, social workers, psychiatrists, and inition of neurasthenia was other mental health providers interested in mindfulness and acceptance-basted treatments too broad and impractical to be of any diagnostic or cliniPROGRAM LEVEL: Intermediate cal utility. Instead, he used the term shinkeishitsu to describe DISCLOSURES: The authors have nothing to disclose mood, anxiety, and psychosoPREREQUISITES: none matic concerns that arise due to a “hypochondriacal temperament” or a tendency to overly focus on the state or functioning of one’s body and to exhibit including fatigue, anxiety, and somatic issues. hyperreactivity to both mental and physical While neurasthenia had been documented symptoms. Morita argued that shinkeishitsu in German, British, French, and American was not a biological disorder but a mental medical literatures, it was not well under- attitude or a mode of living (Fujita, 1986; stood and was considered especially diffi- Ohara, 1975). cult to treat. Given the difficulty in treating Morita believed that physical and psychosuch problems, Morita initiated a telegram logical pain are normal reactions to one’s correspondence with Sigmund Freud seeking advice. Although much of the Western world had adopted Freud’s approach, Morita reported that his patients did not seem to Morita believed that physical and respond well to psychoanalysis, and he later psychological pain are normal reactions took serious issue with a number of Freud’s to one’s circumstances and should not concepts (Morita, 1928/1998). Instead, Morita began borrowing ideas from the be seen as problematic. works of Mitchell (1900), Dubois (1908),
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Around this time, a patient’s facial expression, attitude, and manner of speech become charged with vitality, as if he or she were a new person
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returns to a natural state of balance (Morita, 1928/1998). Morita advised clinicians to focus on their patients’ ability to live a “constructive” or “purposeful” life, and he warned them to not become preoccupied with treating their patient’s symptoms. These preoccupations, he said, are like “killing the ox by attempting to reshape the horns” (Morita, 1928/1998). He also urged therapists against using the patient’s discomfort as an indication of the severity of his or her disorder. The actual severity of a disorder does not always coincide with or run parallel to the sufferer’s awareness of the symptoms. Some fatal illnesses carry no subjective symptoms, while others are not a matter for alarm regardless of severe suffering. When the physicians and therapists regard only subjective symptoms as important in treating an illness, they may be concerning themselves with minor details and neglecting fundamental points (Morita, 1928/1998). (800) 592-1125
The process of MoriTa Therapy
Although it is now delivered in both outpatient settings and residential clinics (e.g., the Jikei University Center for Morita Therapy in Tokyo and Sansei Hospital in Kyoto), in its classical form, Morita Therapy was delivered primarily as an inpatient treatment. Before beginning treatment, new patients would be introduced to the theory and practice of Morita Therapy through informal meetings known as keigaikai where they could interact with past and current patients and hear lectures from clinic directors. After this orientation, the four-stage process of treatment would begin.
bed-rest period During the first seven to 10 days of treatment, patients were required to remain in bed in a single room, with time permitted only to go to the toilet, maintain bodily cleanliness, and have meals. The purpose of this stage was to help patients learn to mindfully observe their anxiety without engaging
in distracting activities. A variety of psychological and somatic reactions have been noted to occur in patients during this phase, and recent research has examined biological rhythm patterns along with autonomic and CNS reactivity during this period (Zhang, Nan, & Wang, 2007). Because the goal of this stage was to help patients fully encounter their anxiety and experience its natural rise and fall, the length of each patient’s bed rest was individually tailored (Fujita, 1986).
light Work period During this stage, which lasted one or two weeks, the patient was required to go outside to experience fresh air and silently observe others working in the garden. Morita advised patients to write about their daily experiences at the clinic but not about their symptoms. In fact, he recommended that therapists be “strategically inattentive” (known as fumon or the non-inquiry technique) to patient reports of symptoms through all stages of treatment. Morita provided brief written feedback and advice to
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“open the book to any page at random and read silently without making any special effort to understand or remember the content” tient notices that he or she is busy every day with the work that needs to be done, and this marks the point for proceeding to the next stage (Fujita, 1986).
Training period for practical living
his patients during this stage, and he encouraged them to act only according to their “desire to live fully.” The goal of this period was to promote spontaneous activity following natural impulses and curiosity and to “break down the client’s self evaluating attitudes by de-emphasizing a focus on feelings or comfort and discomfort.” Fujita (1986) suggests: Around the third and fourth day of this stage, interest in physical and mental work will accelerate gradually, much as when an infant begins to find pleasure in manifesting his or her vitality by taking some sort of action …. Around this time, a patient’s facial expression, attitude and manner of speech become charged with vitality, as if he or she were a new person compared to his or her condition before entering therapy (1986).
heavy Work period During this stage, the patient was to engage in more significant tasks, such as cleaning, gardening, assisting with cooking, shopping, or participation in maintenance of 18 SPRING 2011
the group milieu. Morita believed that this occupational therapy helped to promote awareness of oneself in relation to external reality, as opposed to a focus on the patient’s subjective experiences. Furthermore, it was thought to stimulate surrender to the present situation and promote an adaptation to nature with or without symptoms still present (Fujita, 1986). It was during this stage that the patient began to experience the joy and confidence of work achieved through his or her own efforts. For Morita: Such experiences foster a subjective attitude in the client that invigorates her or his self to endure pain, overcome difficulty, and engage in lively and spontaneous mental and physical activities. The experiential understanding of confidence and courage, represented by the idea that much is possible in life, can be regarded as a kind of spiritual enlightenment (1928/1998). The goals of this stage were usually achieved in one or two weeks in classical Morita Therapy, but the duration of this stage tends to be extended in recent practice. This stage is terminated when the pa-
Annals of Psychotherapy & Integrative Health
During this final stage, which lasted from a few weeks to one month, the patient prepared to return to his or her usual life in society. A primary goal of this stage was to help each patient to continue to focus on external reality as opposed to subjective experiences and to encourage engagement in valued actions, regardless of whether or not symptoms were still present. One way of practicing this was through reading exercises. Morita (1928/1998) instructed his patients to “open the book to any page at random and read silently without making any special effort to understand or remember the content.” This training was thought to decrease a patient’s anticipatory emotions that arise from perfectionistic values, such as focusing on symptoms of being unable to concentrate, unable to comprehend, complaints of being distracted by noises, etc. Morita reported that after a few days his patients began to read calmly despite any such distractions. Through this, “Clients are trained to adjust to changes in external circumstances,” (Morita, 1928/1998). In so doing, they are believed to be better prepared to return to a natural rhythm of life.
Modern variations This classical model of Morita Therapy has since been altered in recent years. It is now often used in conjunction with pharmacotherapies, and many therapists place less of an emphasis on the Zen Buddhist philosophy endemic to traditional Japanese culture. But, arguably, the most significant change has been the shift from Morita Therapy being used mainly in residential settings to it being predominantly used in outpatient centers. This shift largely occurred as a response www.americanpsychotherapy.com
M O R i TA T H E R A P Y
to modern limitations on insurance reimbursement, changes in health care policy in Japan, and prohibitive expense (Fujita, 1986; Nakamura, 2000). Some have also called attention to contemporary changes in Morita Therapy being brought on by the changing cultural context of contemporary Japan in response to what is recognized as a change in shinkeishitsu and evolving characteristics of contemporary patients seen by Morita therapists (Kitanishi & Azuma, 2005; Nakamura, 2000). These patients are said to resist the authoritarian style of the doctor/patient relationship commonly seen in Morita’s day and prefer the egalitarian relationship fostered in many outpatient settings. The therapeutic targets of this modern approach are very similar to those in classical or residential Morita Therapy, with the visible deletion of absolute bed rest. Goals such as clarifying the concept of vicious circle that maintains anxiety, increasing awareness and acceptance of one’s emotional and physiological states, and encouraging constructive actions are met during one or two sessions per week along with the continued use of diary feedback through verbal interviews with patients (Nakamura et al., 2009). In many ways, the outpatient implementation takes on a more didactic format than one based on direct experiences arranged by the therapeutic environment of the inpatient or residential setting. While adhering to many of the traditions laid forth by its progenitor, contemporary Morita Therapy is adapting to face modern problems, such as dealing with patient drop-out, encouraging adherence to treatment, and recognizing the need for greater client-therapist rapport (Fujita, 1986; Fujita, 1992; Kitanishi & Mori, 1995). In addition, some scholars, such as Ishiyama (Ishiyama, 1991, 1994, 2000, 2007; Ishiyama & Azuma, 2004) have reported extensively on the use of outpatient Morita Therapy
and adaptations found necessary within a cross-cultural, non-exclusively Japanese context. Moreover, efforts are being undertaken to standardize the practice of Morita Therapy. The Consensus Guideline for the Implementation of Outpatient Morita Therapy has been prepared by the Japanese Society for Morita Therapy (Nakamura et al., 2009), and the English version of this guideline was published early in 2010.
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conTeMporary cogniTive behavior Therapies
Contemporary behavioral and cognitive-behavioral therapies are best understood as an applied progression of conventional behavior therapy toward the incorporation of techniques and approaches that bear an Eastern signature. Among these contemporary approaches are Acceptance and Commitment Therapy (ACT), Dialectal Behavior Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), and certain aspects of Behavioral Activation (BA). In this section, we first provide an overview of several representative contemporary behavioral/cognitive-behavioral approaches and then compare them to Morita Therapy with the goal of contributing to the continuing discussion
surrounding their similarities and differences (see also Corrigan, 2001; Gibson, 1974; Hayes, 2008; Hofmann, 2008; Spates, 2004).
acceptance & commitment Therapy One of the more public comparisons (cf. Hayes, 2008; Hofmann, 2008) has been made between Morita Therapy and Acceptance and Commitment Therapy, otherwise known as ACT. ACT was born out of problems regarding the persistence of maladaptive behaviors due to language-based rule governance (Hayes, Barnes-Holmes, & Roche, 2001; Hayes, Strosahl, Bunting, Twohig, & Wilson, 2004). The attempt to resolve these problems led to a new approach to the study of language, titled Relational Frame Theory (RFT), and a revived philosophy of science that married pragmatism and functionalism into a view referred to as functional contextualism. Putative principles derived from RFT were then assembled into an approach to treatment known as ACT. By incorporating the notions of cognitive fusion/defusion, advances in the understanding of the paradoxical nature of thought suppression (e.g., Wegner, Schneider, Carter, & White, 1987), and techniques borrowed from other therapies (e.g., Gestalt therapy), Staff members meet at the Jikei University Center for Morita Therapy in Tokyo, Japan. The center uses both inpatient and outpatient therapy to help clients who are suffering from anxiety and other mood disorders.
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Help the client stop thinking in rigid, black-or-white terms, and foster emotional engagement as opposed to emotional avoidance.
mit to acting in accordance with these values in spite of negative thoughts and feelings (Hayes et al., 1999). To accomplish these goals, ACT utilizes metaphors, experiential exercises, and various other techniques culled from numerous psychotherapeutic disciplines. These are all designed to help individuals distance themselves from the literality of their thoughts, become more aware that their thoughts do not constitute their identity, to undermine reason-giving, live more in the present moment, and commit to patterns of valued action (Strosahl et al., 2004).
Dialectal behavior Therapy
ACT became a systematized treatment package amenable to scientific inquiry. ACT starts from the contention that psychological pain is not pathological and that all healthy individuals will regularly experience emotional pain and distressful thoughts (Hayes, Strosahl, & Wilson, 1999). However, ACT goes further to differentiate this pain from suffering (Eifert & Forsyth, 2005). While pain results from the mere existence of these thoughts and emotions, psychological suffering is due to an insidious four-step process: (1) The individual becomes excessively attached or “fused� to the literal content of thoughts, causing him to view these experiences as highly meaningful while turning attention away from the present moment. (2) He or she 20 SPRING 2011
Dialectical behavior therapy (DBT) developed out of clinical work with patients with borderline personality disorder. Through this work, it was suggested that traditional cognitive-behavioral interventions, which focused exclusively on symptom change, tended to make clients feel invalidated, while humanistic treatments, which focused almost exclusively on validation, rarely addressed timely change (Sanderson, 2002). Rather than choosing one or the other perspective, views these private events as pernicious and Linehan (1993a) reported she eventually unacceptable and develops an unwillingness found that a balance between these two stratto experience them. (3) Out of this unwill- egies led to the most favorable treatment outingness, the individual begins the vain ef- comes. This dialectical stance was also found fort to control these private events, known to be a way to understand the dichotomous as experiential avoidance (Hayes, Wilson, patterns of thinking and behaving seen in Gifford, Follette, & Strosahl, 1996). (4) individuals with Axis II behavior problems, The individual then mistakenly assumes and, coupled with principles from Zen phihis thoughts and emotions are the causes of losophy and behavioral theory, eventually distress, which allows him to justify these developed into a comprehensive and multiunworkable coping strategies and render- modal treatment package (Sanderson, 2002). ing the symptoms less responsive to real According to DBT, psychological suffering contingencies in the environment (Strosahl, occurs when individuals over-regulate and Hayes, Wilson, & Gifford, 2004). avoid their private experiences in attempts Based on this conceptualization, the goals to please others. This is believed to lead to of ACT are to help the individual accept an invalidation of those experiences and a these unwanted private experiences, iden- tendency to oversimplify the ease with which tify a set of valued life directions, and com- one should be able to solve one’s problems
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The main goals, then, of MBCT are to (McMain, Korman, & Dimeff, 2001). The individual is said to use vain attempts to cultivate “a detached, decentered relationregulate emotions, resulting in feelings of ship to depression-related thoughts and feeldesperation, impulsivity, and a low threshold ings” (Teasdale et al., 2000) and provide the for distress, which leads to further hypersen- patient with skills necessary to prevent the sitivity and often harmful coping strategies escalation of such thoughts in the future. (Linehan, 1993a). To reach this end, the patient is taught to To counteract this cycle, the primary goals not alter the content of his thoughts but, of DBT are to teach more effective coping rather, to examine the way these thoughts skills, help the client stop thinking in rigid, are experienced and to develop a meta-cogblack-or-white terms, and foster emotional nitive awareness of the thoughts through engagement as opposed to emotional avoid- meditation and other mindfulness exercises ance. Numerous therapeutic techniques are (Fennell, 2004). utilized in the context of group and individual psychotherapy to meet this end, includ- analysis of shareD core ing teaching mindfulness skills, distress-tol- feaTures erance skills, interpersonal effectiveness skills, It is acknowledged that each of the aforeetc. (Linehan, 1993b; Linehan, Cochran, & mentioned treatments has unique characKehrer, 2001). teristics both in conceptualization and approaches to intervention. Such differences Mindfulness-based cognitive include Morita Therapy’s classical use of absolute bed rest and work therapy as the Therapy Work in Mindfulness-Based Cognitive principal vehicle for achieving therapeutic Therapy (MBCT) began through the study aims, DBT’s emphasis on teaching coping of factors of why some people are more skills, ACT’s focus on undermining mallikely to relapse than others after a major adaptive language processes, and MBCT’s depressive episode. It was ultimately found attention to the prevention of relapse. In that those who are able to distance them- addition, each treatment has made an idenselves or be mindful of their thoughts were tifiable empirical contribution to treatment less likely to relapse (Teasdale et al., 2002; process and outcome literature. However, it Teasdale et al., 2000). Thus, through a union can be seen that the treatments are united of Beck’s cognitive therapy (Beck, Rush, by several core concepts, leading to strikShaw, & Emery, 1979) and components of the Mindfulness-Based Stress Reduction program of Kabat-Zinn (1990), this empirically Each of us has the supported relapse prevention program was developed (Teasdale et al., 2000). desire to live life fully The core of MBCT case conceptualization and actualize our is the differential activation hypothesis—the notion that negative, self-devaluative, hopeunique potential. less thinking patterns become associated
The Normality of Suffering. Morita Therapy and many of the contemporary behavior therapies are aligned in the notion that much psychological suffering is a consequence of our reactions to normal psychological processes that are common to us all. Morita discussed this in terms of sei no yokubo, or the self-actualizing tendency (Reynolds, 1976). Each of us has the desire to live life fully and actualize our unique potential. However, in striving to be the best we can be, we inevitably encounter pitfalls, setbacks, and pain. None of these, in this view, should be considered pathological or deviant. Contemporary cognitive behavior therapies largely concur with this notion. For example, the DBT standpoint is that pain and distress are normal, unavoidable facts of life (Linehan, 1993a). Likewise, ACT rejects the notions of happiness being a normal state of humans, and similarly rejects the idea that psychological pain is a “mental disease” to be isolated and extracted from the individual’s thinking. Instead, it offers the assumption of a destructive normality; the notion that otherwise adaptive psychological processes sometimes tend to inadvertently lead to suffering (Hayes, et al. 1999). Maladaptive Focus of Attention on One’s
with one’s depressed mood states. Once this relation is established, even minor feelings of low mood can elicit a downward spiral of maladaptive thinking patterns (Segal, Williams, & Teasdale, 2002).
Symptoms. Morita Therapy and contemporary therapies also agree that psychological problems are not due to symptoms per se but to hyper-attention on these symptoms and the confusion of thoughts with reality
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ing commonalities in case conceptualization and treatment process. Further, a more complete understanding of these similarities may foster a greater appreciation and potential integration of these treatments toward
the end of better patient care. But beyond this, such an exercise may lead to higher quality strategic research that evaluates pertinent core components shared across these interventions and eventually to “constructive research designs” that lead to the most powerful empirically supported therapies for patients (Borkovec & Castonguay, 1998). In this section, we provide a comparison of these shared core features.
case conceptualization
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(known in Morita Therapy by the Zen term akuchi). Morita believed that neurotic symptoms (shinkeishitsu) begin through a process known as seishin kogo sayo, or “psychic interaction” (Morita, 1928/1998). This is the observation that psychological problems arise when one does not permit the mind to flow naturally from one idea to another but, instead, becomes fixed or obsessed on bothersome thoughts or sensations (Fujita, 1986; Reynolds, 1976). Central to MBCT is the idea that problems occur when the client adopts the notion that “my thoughts are who I am” (Fennell, 2004), thus identifying the self according to the content of the thoughts and not merely his or her relationship to those thoughts (Segal, Williams, & Teasdale, 2002). This tendency leads the individual to become overly attentive to even minor psychological symptoms, triggering a downward spiral towards symptom relapse. ACT presents a similar conceptualization that problems occur when individuals identify themselves as the content of their thoughts (self-as-content), rather than simply the context for them (self-as-context). The individual is said to then focus on, or become fused to, to the literal meaning of these thoughts (cognitive fusion), diverting attention away from the present moment. In discussing the development of emotional dysregulation, DBT presents a similar notion, in that after experiencing a stressful event, the individual has difficulty reorienting his attention and returning to an emotional baseline (Sanderson, 2002). The Vain Attempt to Control Private Events. Focusing on these thoughts and sensations often leads to the erroneous conclusion that these events are negative and must be controlled. The attempt to manipulate one’s private events and bring them in line with one’s desires was called shiso no mujun by Morita (1928/1998). He suggested that disorders are based in the faulty belief that one ought not to have private sensations and cannot live life normally until they are eliminated. The “vicious circle” formed between these ideas 22 SPRING 2011
on the one hand, and attempts to control symptoms (toraware) on the other, becomes an early focus of therapeutic intervention in Morita Therapy. Similar concepts can be found in contemporary behavior therapies. DBT argues that the inability to accept pain as a part of life leads to frustrating attempts to over-regulate and invalidate one’s experiences (McMain et al., 2001). ACT believes that an unwillingness to have private events and futile attempts to avoid them are at the heart of suffering. And MBCT argues that the tendency to see minor dysphoric moods and depressive thoughts as catastrophes is the catalyst of further distress (Segal et al., 2002). The Perpetuation of Symptoms. Morita Therapy and most of the contemporary cognitive behavior therapies agree that a vicious circle leads to the escalation of psychological symptoms. After over-attending to his or her thoughts and sensations, viewing them as negative, and engaging in a fruitless attempt to control them, the individual is said to recoil from life and focus even more on such events, thus perpetuating suffering.
Downplaying Diagnosis Another commonality between Morita Therapy and contemporary therapies is the downplaying of syndromal classifications and a greater emphasis on functional diagnoses (Hayes, et al. 1996; Reynolds, 1976; Morita, 1928/1998) and their indications for treatment. As a physician, Morita advocated the use of thorough assessment and accurate diagnoses, but he argued that these diagnoses should not be construed as a way of pathologizing the patient or his or her problems: “I think that assessment and diagnosis requires a scrutiny of the client’s environmental living conditions, characteristics and the origin of her or his symptoms. However, no policy for treatment or prognosis can be established on the basis of diagnoses from symptoms alone” (Morita, 1928/1998). Like many contemporary therapies, which argue that pathologizing problems is a hallmark of an invalidating environment (Linehan,
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1993a) and all individuals’ problems differ only in degree, not in kind (Hayes et al., 1999; Sanderson, 2002), Morita believed that the diagnostic emphasis should convey how much the patient is like other humans (Reynolds, 1976), and the patient’s distress should not be seen as an intractable disease. Through his mentor, Shuzo Kure (a student of Emil Kraepelin), Morita was only a generation removed from Kraepelin’s teachings, yet he rejected many of the structural notions found in that diagnostic system.
Treatment The Goal is Valued Living, Not Symptom Amelioration. Due to the conceptualizations of problems, each above referenced approach focuses not on a specific set of techniques, but on the processes of therapeutic change. For example, underlying all of these treatments is the common overarching goal to help the client live a valued life. After receiving Morita Therapy, “the patient may still have fears, unhappiness, or other symptoms. If, however, his behavior has changed, if he is capable of carrying out his living regardless of his symptoms, he is qualified for discharge,” (Reynolds, 1976). Similarly, contemporary behavior therapies will seek not to “alter the content of (one’s) cognitions… (but) the nature of the patient’s relationship to them” (Segal, Williams, & Teasdale, 2000); not the pain they are experiencing, but the suffering that is compounded by their hyper reactions to symptoms (Hayes, Strosahl, & Wilson, 1999); and to resolve, not the patient’s view of the presenting problem, but the behavior that is interfering with the individual’s life (Linehan, 1993a). Separating Thoughts from Reality. One’s thoughts, perceptions, and desires sometimes correspond with one’s reality, but often they do not. Becoming entangled in one’s thoughts—perhaps even fearing them—is a path to psychological suffering. Thus, Morita Therapy and the contemporary behavior therapies all advocate www.americanpsychotherapy.com
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Many argue that true happiness comes not from psychological insight but from effective engagement in life.
a distinction between private events and roundings (mushoju-shin), confronting one’s the context in which they occur. For ex- emotions, and directly experiencing the rise ample, in Morita Therapy, “clients are dis- and fall of these emotions as natural (Morita, couraged from becoming attached to and 1928/1998). A salient parallel can be seen preoccupied with their thoughts, from de- in ACT, which emphasizes the importance pending on their subjective ideals, or from of accepting one’s private events (underminbehaving to satisfy their emotions and in- ing the dominance of emotional control fatuations” (Morita, 1928/1998). Likewise, and avoidance) and fostering willingness through cognitive defusion/meta-cognitive to make contact with the present moment awareness exercises, cognitive content ver- (Strosahl, Hayes, Wilson, & Gifford, 2004). sus context distinctions, and de-centering Such parallels are also prominent in both techniques, contemporary cognitive be- DBT and MBCT, which place great emhavior therapies seek to help clients begin phasis on the development of mindfulness viewing their “thoughts as transient mental and acceptance. events, rather than aspects of the self or reValued Action. Many argue that true hapflections of objective truth” (Segal, Williams, piness comes not from psychological in& Teasdale, 2002). sight but from effective engagement in life. Contact with the Present Moment. Simple Morita realized this fact early in his career recognition of the distinction between one’s and made it one of the key principles of his private events and one’s reality is not suffi- therapy. By shifting his patients’ attention cient. In each of these therapies, individuals away from their “symptoms” and toward must learn to accept themselves, their symp- meaningful or constructive activities, Morita toms, and their reality “as it is” (a concept was able to help them experience greater Morita termed arugamama). This is achieved self-worth and joy in the simple tasks of by becoming open and attentive to one’s sur- everyday life. (800) 592-1125
Therapy is not based on those principles that encourage momentary happiness or superficial pleasure; rather therapy is conducted on the basis of the principles that highlight practice. In this way, clients will experientially understand that to make an effort is to move towards true contentment; true happiness is achieved by making an effort. This presents a more accurate view of life (Morita, 1998). Not only is this found in ACT (i.e., values clarification exercises and commitment to action strategies that are aligned with personal values), DBT (i.e., emphasis on opposite action, decreasing mood-dependent behaviors, and simultaneous reinforcement of socially effective behaviors), and MBCT (i.e., use of mastery activities), but this is also intrinsic to many other contemporary therapies, such as Functional Analytic Psychotherapy (Kohlenberg & Tsai, 1991), Behavioral Activation (Addis & Martell, 2004), Integrative Behavioral Couples Therapy (Jacobson, Christensen,
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Prince, Cordova, & Eldridge, 2000), and Buddhist-inspired CBTs (e.g., Darnall, 2007; Witkeiwitz & Marlatt, 2007).
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conclusion
We believe a better understanding of these core processes could encourage more constructive research and foster a greater appreciation and potential integration of these treatments rather than the promotion of mere therapy “branding” alone.
In this paper, we have attempted to provide an overview of Morita Therapy and selected contemporary cognitive behavior therapies to supply a richer sense of the parallels respected therapy in the East, its attempts between them. As Tanaka-Matsumi (2004) to empirically validate its techniques and has indicated: Like contemporary therapies, export them to the West have so far been Morita Therapy “attempted to free patients underwhelming. This paper is an attempt from preoccupying fears and anxieties by to redress these deficits and make the proencouraging acceptance of them without cess of this therapy more explicit so it can avoidance.” come under better scientific investigation However, it was not the purpose of this and scrutiny. In addition, we hope that this paper to laud the works of Morita or argue discussion permits Eastern therapists to peer for the novelty or originality of his work or into contemporary developments within the the work of any contemporary therapy. In Western tradition and appreciate the disfact, Morita clearly acknowledged that many tance this field has come from its original of his ideas were borrowed from his Western focus on animal learning and conditioning. contemporaries, such as Mitchell (1900), It is readily acknowledged that both Morita Dubois (1908), Binswager (1911), Beard Therapy and contemporary cognitive be(1880), Freud (1896/1962), and Kraepelin. havior therapies have their own identifiable Rather, Morita’s real significance was that strengths, but we hope that we have made a he was able to synthesize these pre-existing point that these treatments, though develideas and package them in a way that made oped separately, are united in many features, them accessible to his culture while con- processes, conceptualizations, and techniques. ducting a functional account of the effects. Furthermore, we believe a better understandPerhaps, modern progenitors of new thera- ing of these core processes could encourage pies should also be commended for attempt- more constructive research and foster a greating similar strategies. Therefore, it would er appreciation and potential integration of prove impossible to argue persuasively that these treatments rather than the promotion any therapy is wholly original, as all scien- of mere therapy “branding” alone. tific thought is inspired and influenced by In our opening, we addressed the prointellectual predecessors. More than this, cess of the scientific evolution of ideas. It the repackaging of existing therapies in new is propitious, therefore, that we end on a or creative ways did not begin in the late similar theme concerning the pivotal ther20th century. Even Mitchell was accused of apy that has been the subject of this review. borrowing his technique of isolation and According to Morita, “My study is not combed rest therapy from his predecessors (see plete, of course, and my interpretations may Mitchell, 1900). be mistaken. However, I hope that other inWe hope that our portrayal accomplishes vestigators will understand my intentions, its mission of permitting a primarily Western discuss them, and exchange opinions.” And audience of contemporary behavior thera- “I hope that further research in this field pists to peer into an Eastern counterpart that will be developed more vigorously by those has much in common with its basic func- who are stimulated by this book” (Morita, tional approach, therapeutic processes, goals, 1928/1998). We could collectively hope for and selected techniques for accomplishing nothing better pertaining to these and other them. Although Morita Therapy is a well- emerging evidence-based therapies. 24 SPRING 2011
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references
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ABOUT THE AUTHORS This work is an outcome of a collaboration between psychotherapy researchers in the United States and Japan. c. RichaRD sPates, PhD, RichaRD w. seiM, MA, and Spates
chRistina M. sheeRin, MA, are in the Depart-
ment of Psychology at Western Michigan University in Kalamazoo, Michigan. Their work focuses on contemporary evidence-based treatments for anxiety and mood disorders. ayuMu tateno, MD, and kei nakaMuRa, MD, are at the Jikei University CenNakamura ter for Morita Therapy in Tokyo, Japan, where they utilize inpatient and outpatient Morita Therapy to help clients suffering from anxiety, mood, and psychosomatic concerns. Spates spent a sabbatical experience studying at the Morita Therapy Center. Tateno spent a sabbatical year at Western Michigan University studying contemporary behavior therapies.
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