OUTSIDERS LOOK AT MORITA THERAPY AND NAIKAN
David K. Reynolds, Ph.D.
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A number of articles have been written about Japanese therapies by Westerners who have observed them only briefly or not at all. Such articles tell us more about the way a non-practitioner perceives these therapies than about the therapies themselves. They provide useful information about the successes and pitfalls of introducing psychotherapeutic methods across cultural lines. Again, because the bulk of the English language literature concerns itself with Morita therapy and Naikan we shall examine these two cases below.
An extreme example.
Let us begin with the most extreme example of misunderstanding. Kenneth Rexroth reviewed The Quiet Therapies in the September 25, 1980 issue of the Los Angeles Times. I have added a few comments in brackets.
"This book is mostly about Morita Therapy, developed some years back by a largely theoretical [Morita was clinically oriented] psychiatrist, Morita Shoma, and now growing in popularity in Japan and even spreading to where all the latest things spread, Southern California. It might better be known as the Patty Hearst or Chairman Mao technique, because its basis is total isolation from all interpersonal relations.
"In the most extreme form of isolation therapy, the patient is confined in a dark room with a bed, water closet, sometimes a table, all in pitch blackness. Even food is passed through a slot with a flap over it. [The rooms are cheerful and well lit, and the meals are served on trays by fellow patients. There are no slots for the passing of food.]
"After sufficient time, the patient is permitted a short period of light, given a broom, other implements and instructed to clean his room. Eventually, he is allowed to walk up and down the hallway but at first sees no one. [During the week of bedrest the therapist usually visits the patient once or twice a day. When the week is over the patient participates with others in activities around the hospital.] This is not a psychiatric technique but a police one and it was first developed in Russia to prepare witnesses for the Moscow Trials. [Morita therapy's bedrest regimen antedates the Moscow Trials and was adapted from Wier Mitchell's use of bedrest for the treatment of neurosis in Western medicine at the turn of the century.] It was then adopted by the Chinese as part of the methodology of their notorious brainwashing. [Reynolds, 1969 compared Morita therapy with Russian and Chinese brainwashing and concluded that the differences between them were quite deep and the similarities superficial.] The contemporary Morita Clinics in Japan are far from that drastic. They usually simply isolate the patient in a small hospital single bedroom, but permit no contact with others for at least a week.
"As is well known in the profession, most patients, in fact most normal people, become so starved for human contact they tend to fall in love with the first of their captors they see, just like Patty Hearst, if you believe her original testimony. [More recent work by Suedfeld, Adams, Cooper, and others indicated that sensory deprivation is not so unpleasant as some early reports described. They cite much research indicating the therapeutic value of periods of stimulus reduction in cases of obesity, alcoholism, and smoking abuse, among other problems.] The patient slowly is reintroduced to a wider range of social contact, permitted to sit in on a game of dominoes with another patient and eventually bridge. [Dominoes and bridge are rarely played in Japan and, furthermore, they are not the sort of activities that are encouraged for patients arising from bedrest.] The emerging creature is supposed to move along the course of 'therapy' in wonder at the joys of interpersonal relations. [It is rather that, joyful or not, the patient is to do what reality brings to do.] According to David K. Reynolds, this technique is eminently successful with neurotics and even psychotics. [Morita therapy works on the neurotic elements of anyone's character. It provides no cure for psychosis; the book makes no such claim.] I can imagine no worse way of handling a manic-depressive, an excited catatonic [a contradiction in terms] or just a plain, ornery, normal human being.
"There is no hint in David K. Reynolds' book that the interpersonal community may itself be sick and that the bigger it is, e.g. Russia or the United States, the sicker it is almost sure to be. [Consider Nicaragua, Guatemala, Bolivia, and some of the smaller African nations. In any case, from the Moritist perspective, the label "sick" is not meaningful when applied to neurotic individuals and makes no sense when applied to nations.] I have had some experience with Morita Therapy in Japan. [?] It certainly makes Japanese squares squarer, but in the course of time its effects wear off. [Suzuki and Suzuki, (1981) report on the basis of a large follow-up study that the maximum benefits from Morita therapy peak and maintain from about two years after introduction to the therapy or about eighteen months after termination of inpatient treatment. That is, the positive effects seem to build over time.] On psychotics, especially mild hypomanics who need only a daily dose of lithium carbonate, its effects can be absolutely disastrous."
One wonders at how the Los Angeles Times could permit such a misinformed review to be published.
Only in Japan.
In an article entitled "Four-Walls Treatment" the October 2, 1972 issue of Time devoted half a page to Morita therapy. The emphasis was on the Japanese nature of the treatment, and, of course, on isolated bedrest.
"Just as a country's artistic and social institutions usually reflect its particular outlook on life, the kind of psychotherapy that is practiced in a nation often expresses its characteristic philosophy. Morita therapy, for instance, is a uniquely Japanese creation...
"Some Westerners suggest that Morita might be appropriate for the increasing number of Americans who are attracted to contemplative philosophies like Zen Buddhism. Others believe that the method can work only with Oriental patients, whose culture fosters not active struggle against the world but passive acceptance of things as they are. In fact, say some psychiatrists, the increasing Westernization of Japan may make Morita decreasingly effective even there." (p. 50)
Many years have passed since that article was published and Morita therapy is flourishing in Japan and beginning to have an impact on Western psychotherapy, as well. One reason is that we need not polarize life into "active struggle" and "passive acceptance" as the Time article suggests. Acceptance need not be passive. It can be the necessary first step in making effort to change the world. We must look at what reality is presenting to us, accept it, and decide how and where to apply our effort to bring about change. Moritist thought advises, for example, that because feelings are uncontrollable directly by the will we should not waste our efforts trying to struggle with them. In contrast, our behavior remains within our control no matter what we are feeling, so it is in the realm of behavior that we can effectively take responsibility and bring about improvements in our lives. And what we do may indirectly affect what we feel.
So there are two characteristically Western misconceptions in the above passage. One misconception is that acceptance must inevitably be passive. The second is that a psychotherapy must choose either struggle or acceptance. The very essence of Morita therapy is the selection of areas of life within which we can efficiently struggle and other areas where we can avoid useless struggle.
A review of Morita Psychotherapy by Tom Walmsley in the December 10, 1976 issue of Durrant's begins as follows:
"Shoma Morita was a distinguished Japanese doctor who, like Freud, had a neurotic breakdown around the turn of the century. As a result of his personal experiences he developed a theory and practice of psychotherapy, counting Dr. Suzuki amongst his successfully treated patients.
"The treatment involves a period of absolute rest followed by an increasing amount of physical activity as well as other features clearly described by Reynolds. To Western eyes it seems a weird mixture of Adler and Dale Carnegie; but it draws on the complex Buddhist traditions of Japan and has some interesting parallels with psychoanalysis proper."
I suppose that when the above reviewer read the name, Suzuki, he assumed that the reference was to Suzuki Daisetz, the well-known Zen scholar. In fact, Suzuki is a common Japanese name, rather like "Johnson" in the United States. More than one reviewer, including some eminent scholars who should know better, have made the same error, misreporting that Suzuki Daisetz was treated by Morita. For the record, it is Suzuki Tomonari who received treatment and training from Morita. He operates a Morita therapy clinic in Tokyo today.
It is understandable that a reader would try to make sense of a non-Western therapy in terms of comparisons with more familiar therapeutic approaches. Any such comparisons are likely to make the non-Western therapy seem "a weird mixture." It is rather like saying that Christianity is "a weird mixture" of Judaism and Zoroastrianism.
Not unusual are the articles and reviews that assert the irrelevance of Morita therapy for the West without even arguing the point, as if it were obviously impracticable outside of Japan. For example, in a book review in the Journal of the American Medical Association Meehan (1976) wrote:
"Readers will find this book enjoyable and, although they are unlikely to try to practice Morita therapy, they may find its basic philosophy well worth considering." (p. 206)
Pasya Thiel, a psychologist from Amsterdam, visited Morita therapy settings in Japan for a short period of time. In her review of The Quiet Therapies (Thiel, 1981) she wrote the following:
"In Japan, where a vast part of life takes place in and is determined by the group to which one belongs (mainly defined by one's job) and where there is no place for privacy, solitude or stillness, the isolating, individualizing quiet therapies would counterbalance the continuous absorption by the group. This counterbalance is, perhaps, one of the main reasons why in Japan the quiet therapies can be strong therapeutic remedies.
"However, in the West, and certainly in its big cities, the opposite is the case: more and more people lead a solitary life, social institutions are breaking down, and isolation and its subsequent problems are treated in therapies based on contact with others. From this point of view the solitude and isolation of the Japanese therapies is in our culture an alien phenomenon...
"Other aspects, particularly the atmosphere in which the therapy takes place, are alien to Western culture. The atmosphere is one of devotion, of almost religious feelings of reverence for the founder of the therapeutic school...or for the founder himself. The therapist is the wise guru, with an exalted status far above that of the patient; his assignments cannot be discussed or refused.
"With this background in mind it is clear that in the West these quiet therapies, severed from the culture and the context in which they originated, are without a basis and therefore substantially less meaningful.
"Reynolds' book may give the reader some background information and practical suggestions, and it offers the opportunity to get acquainted with some Japanese forms of therapy or what would pass as such. If, on account of this book, these forms of therapy will be adopted in Western practice remains to be seen." (English translation by G. Verhaar.)
This article is another is a spate of articles sharing the common theme that Morita therapy, Naikan, and other Buddhist- based therapies are useful only within the context of Japanese culture. There is no doubt that if one looks for a fit between a therapy and its cultural setting one can find it. Thiel seems to suggest on the one hand that a therapy must counter a cultural trend to be effective--for example, the isolation of absolute bedrest "works" because of the group orientation of the Japanese (does that mean that group therapy is the only effective method for treating "solitary" Westerners?). On the other hand, she argues that the therapy is effective only because cultural values support it--for example, the respected authority of the therapist (again, the adulation of Freud, Perls, and Skinner seems not so different from that of Morita). I submit that such comparisons are, within certain limits, merely intellectual games, scholarly pastimes useful for little more than exercising the imagination.
The above reviewer, and many others, failed to see the solidly grounded human basis of these Eastern therapies. Perhaps the failure was in faulty presentation of the therapies in English literature. We who have written on the subject may have failed to do it justice. But those who practice Morita therapy and Naikan in the West cannot help but see the depth of its experiential base and its practical applicability outside of the confines of Japan's national boundaries. As I watch my American students' growth, I cannot give much weight to the theoretical arguments for the uselessness of the method in American culture.
It shouldn't work at all.
In general, there are two sorts of criticism leveled at Morita therapy--one is that it shouldn't be effective at all; the other is that it shouldn't be effective outside of Japan. Those who argue that it shouldn't work at all usually come from a psychoanalytic approach. For example, Jacobson and Berenberg (1952) wrote one of the first English language reports on Morita therapy. It was based on their observations of the practice in the Department of Medicine at Kyushu University in 1950 and 1951. With arrogance typical of the heyday of psychoanalysis they attacked Morita's ideas for not being psychoanalytic--(1) "They don't investigate the foundations and origins of neurotic behavior," (2) "Sources of conflict material are not sought after," (3) "Dreams are given but scant attention," (4) "Transference phenomena are not referred to," (5) "Suppression is the dominant theme in therapy; conformity the goal!"
The "faults" enumerated by these military psychoanalysts would not be considered so harshly by modern psychotherapists. Competing theories about the origins of neurosis have challenged the dogma of psychoanalytic formulations. From the beginning, Morita therapists have shown interest in the personal historic causes of neurosis, but in therapy there is only the present with which to work. Recalling traumatic events from early childhood seems not so effective in turning around the lives of our suffering clients today.
Furthermore, Moritists see the unconscious in much broader terms than do the analysts. The unconscious to Morita therapists is all of the mental functioning that remains out of our immediate awareness. The unconscious regulates our heartbeats and contributes to the solution of problems as well as provoking nightmares and intuitive flashes. It is not necessarily the pool of repressed thoughts and feelings seething below the surface of our awareness as Freudians would suggest. So the attachments that develop between client and Morita therapist need not be seen as unhealthy reflections of infantile attachments to our parents, or "transference," boiling up from the primitive sexuality of the unconscious. What our clients feel for us and what we feel for our clients are simply feelings which must be handled as all feelings are handled, we must accept them as they are. And we must not allow them to distract us from our therapeutic purpose. We notice the feelings and go on about the doing of therapy. What Jacobson and Berenberg took to be ignoring of feelings generated during Morita therapy turns out to be something deeper: taking them in stride.
Their conclusion that suppression and conformity are the keywords of Morita therapy is based on a couple of misconceptions. First, they confuse suppression with acceptance. No Morita student is ever advised to ignore or suppress or deny feelings. Feelings must be recognized as they are. But they need not determine our behavior. It may look to an outsider that feelings are being suppressed when we don't permit them full expression in behavior. But, then, if we allowed feelings to rule our behavior no society could survive. Emotions cause us trouble when 1) they are allowed to dominate us or 2) when we try to ignore and deny them. Morita therapy takes the middle course of emotional acceptance without emotional domination.
The related confusion about conformity comes from failing to look deeply enough at the value of social accomplishment. In Freud's thinking there exists a sort of battle between the individual, on the one hand, trying to express and satisfy feelings and needs, and the society, on the other hand, trying to keep the feelings and needs of individuals under control. This conflict was fought out within the individual by the superego (a sort of censoring conscience) and the id (the feelings and needs) mediated by the ego (rational intellect). To these psychoanalysts it looked like Morita therapy was simply throwing its weight on the side of the superego, turning out working robots to get society's tasks accomplished. The needs of the individuals appeared to be ignored.
However, there is another way to view what is going on here. Isn't it true in your experience that the greatest satisfactions in life have come from accomplishing something you set out to do? Isn't it true that confidence comes from succeeding at some tasks you set for yourself? Society not only places limits on our expression of needs and feelings, it also provides acceptable channels for their expression and fruition. Society provides both limits but also opportunities for development. Some Morita therapists and their advanced clients are among the most non-conforming of Japanese. Morita himself was a classic example of what might be called an "enlightened eccentric." Morita therapy encourages constructive living, whether it appear conformist or not, because constructive living (in spite of loneliness and anxiety and discouragement and sorrow and the like) leads to the greatest life satisfaction. We have seen that "accomplishing the task at hand" has a broader meaning than what these two American authors take to mean "sacrificing one's own needs to get society's work done."
Japanese Moritists respond to criticism of their method.
Morita therapists have been very sensitive to the extreme criticisms leveled at their methods. Miura and Usa (1970) consider some of them. They point out that although the therapy has been criticized by psychoanalysts there are other psychoanalytically-trained therapists who see its value from neo-Freudian perspectives. Kondo Akihisa was trained by Karen Horney and practices a well-considered blend of Morita's and Horney's therapies. And Lebensohn is reported by Miura and Usa to have found common ground between Morita therapy and Sullivan's school of psychoanalysis.
When Kora (1965) published an article in the International Journal of Psychiatry on the subject of Morita therapy several of the Western-trained discussants found reasons why this method shouldn't work outside of Japan. Miura and Usa note Kora's responses to these supposed limitations. Kumasaka argued that because Westerners approach nature by challenging or opposing it, the attitude of accepting symptoms as part of one's natural state could never be adopted by Western patients. However, if Japanese patients quite readily accepted the naturalness of symptoms, Kora pointed out, there would be much less neurosis and little need for Morita therapy there, either. Kumasaka also believed that the emphasis on work in Morita therapy wouldn't be accepted by Western patients who fail to see its existential value. Such a view fails to discern that work, or "the task at hand" in Morita therapy is broadly defined nowadays to include all sorts of leisure activities, play, and, in fact, any pursuit that reality presents as needing to be done. I find no difficulty in getting across this concept to my students. Levy, another discussant, wrote that the democratic West would never accept the authoritarian role of the Morita therapist. Kora remarked that Japanese patients are not as docile these days as Levy appears to believe. Furthermore, Western patients, too, must follow their therapists' directions if they are to cooperate in the therapeutic endeavor.
Morita therapy might be useful to the West.
Koschmann (1976) is representative of reviewers who see differences between Japanese and Americans yet still admit the possibility of effectively practicing Morita therapy in the West. My comments are in brackets.
"Morita psychotherapy...helps patients see their suffering as part of their nature, the nature of existence. Western patients would find it difficult indeed to be told to 'endure' and accept their symptoms as inherent in their nature. [Japanese patients, too, find it difficult to be told this truth. If they knew it and accepted it already there would be no need for Morita therapy.] Symptoms, to the Western patient, are detachable objects to be analyzed for cause and symbolic meaning. Freudian analysis of behavior, motivation and symptoms must seem alien to many Asians, who see the unity of man's participation in nature and the universe destroyed by such dissection.
"In fact, Morita therapy suggests that such dissection only increases the individual's neurotic difficulties. Toraware means to be caught by one's obsession, or psychic state, and perhaps time and attention devoted by the patient to the anxiety or phobia only increase the toraware aspect. Instead, Morita therapy advises the patient to focus on behavior sequences, to persevere regardless of the mental interruptions of anxiety or fear, to be responsible for living a constructive, interdependent, non-self-centered life, even if beset by emotional difficulties. 'Cure,' in one sense, is acceptance.
"Westerners tend to relive their action in memory, seeking meaning through objective interpretation. Asians tend to find meaning in the unanalyzed action itself and thus seem less obsessed with 'objective investigation' concerning the participation of the self in the external world. Perhaps Asians have always known what came as such a shock to Western physicists and social scientists alike: the very act of observation alters the object being observed. Reynolds points out the subtle influence of the naturalistic orientation of the Japanese, 'the value of accepting phenomenological reality without direct resistance'. This adaptation is the opposite of concern with reality; rather than wonder why, how, or when, one should practice arugamama, or 'acceptance of the phenomenological reality'. This is the key term in Moritist thought, and indicates the ideal attitude to be attained by the patient..." (p. 327)
"But what finally emerges from Reynolds' discussion is a sense of the universality of human behavior. In the end, the psychic mechanisms he describes are recognized as decidedly human rather than uniquely Japanese, and that argues for the possible applicability of Morita therapy beyond Japan." (p. 329)
Some comments have been more sympathetic to the approaches of Eastern psychotherapies while retaining confidence in Western analysis of them.
"David Reynolds has spent much of the last ten years studying psychotherapeutic techniques and institutions from the inside--that is, taking the roles of patient and therapist as well as anthropological observer. Much of his work has been in Japan. In The Quiet Therapies he examines five Japanese techniques for the treatment of emotional suffering: Morita Psychotherapy, Naikan, Shadan, Seiza, and Zen Buddhism. The book is not meant to be an exhaustive scholarly analysis of these techniques, but rather is devoted to two related functions. First, Reynolds wants to dispel Western misconceptions of all of these techniques (for example, that they are esoteric and mystical, or that they are authoritarian and oppressive). Second, he wants to convey something about Japanese thought that might have highly useful applications in Western psychotherapy; namely the Japanese emphasis on direct experiencing and practical action as distinct from the Western (and sometimes neurotic) taste for analyzing and explaining.
"There is now a good deal of literature on Zen and other Japanese techniques of practical action aimed at improving sanity (Reynolds himself has written a much more detailed volume on Morita Psychotherapy), but this book adds some relatively unknown material to that literature. As such, it will be useful to students of Japanese philosophy, medicine, religion, and psychology. These uses are well served by two concluding chapters--one by Reynolds and one by Berkeley anthropologist, psychologist, and Japanologist, George DeVos. Both writers do an outstanding job of pointing out how the therapies discussed are sensible outcomes of Japanese traditions--religious, social- structural, familial, philosophical, and pedagogical. Reynolds does this from the vantage point of a serious pilgrim on a voyage of self-discovery; DeVos from the more analytic view of a Western-trained clinical psychologist with deep experience of Japanese culture.
The two authors point out the importance in everyday behavior of such taken-for-granted cultural beliefs as the essential perfectibility of human character; the naturalness of suffering; the educational value of struggle and hardship in themselves; the preference for action over speech; and the healing power of gratitude and atonement.
"Personally, I am convinced that Western psychotherapists can learn much from these techniques if they think carefully about where they are likely to strike chords in Western experience. Partly because of this very promise, it would perhaps have been fruitful if Reynolds had addressed himself more directly to the concerns of Western psychotherapists. I think I know why he does not--because he has learned from his subject matter the limited value of intellectual analysis as compared with intelligent practical action. His message seems to be: 'Try this--it can't really hurt you, and you may be pleasantly surprised.' But when one is talking to Western professionals, a little intellectual bait can also get good results..." (Kiefer, 1981, pp. 110-111)
The reviewer in the following passage offers precisely the sort of intellectual bait that Kiefer writes about. Lewis suggests a tie between the effectiveness of Morita therapy, for example, and the development of an "inner-control" orientation. This latter concept is, recently, a popular one among Western psychologists.
"Perhaps the most important function of (The Quiet Therapies) is in provoking us to consider two oft-ignored aspects of Japanese behavior. The first is pragmatism: the quiet therapies do not teach denial of feeling, but do teach that feeling need not interfere with productive functioning. The second is self-reliance. Patients are taught they can control their behavior; when an individual fails to be cured, it is a failure of the individual, not of the therapy. Recent advances in experimental psychology suggest that there are profound consequences of 'internal control'--of the belief that one has power to influence the outcome of a situation. The apparent success of the quiet therapies in promoting a sense of control over behavior reveals a sense in which the term 'self-reliant' may be more accurately applied to Japanese than to American psychotherapeutic techniques." (Lewis, 1981, p. 795)
Measuring Western therapies with a Moritist yardstick.
A few critics and reviewers have been able to use Morita's approach constructively as a vehicle for examining some of the assumptions and practices and limitations of Western psychotherapies. Arima (1976), for example, perceives that:
"Work is not seen as an adjunct to therapy in the way occupational therapy is considered, but it is engaged in to demonstrate to the patient the realities of life--that there is always work to do, it has to be done, and that, regardless of his or her condition, the patient can do it. The principle that underlies change in Moritist thought is that behavior--doing-- comes first, and learning and attitude change will follow." (p. 741)
But it is not only in occupational therapy that there are significant differences:
"Reynolds does well, however, in bringing out a most significant point, which is the diametrically opposite orientation of current Western therapeutic practices and Morita therapy with respect to effecting change in the patient. In the former, ever greater emphasis is placed on encounter and working through of troublesome material at the emotional or "gut" level. The orientation is decidedly inward. Morita therapy, on the other hand, emphasizes the need to maintain harmonious relationships and a low emotional tone to encourage clarity of thought and direction of attention to a rational acceptance of the self as a naturally occurring manifestation of the universe. This outward orientation and low key are particularly evidenced in the maintenance of distance through the medium of diaries, the paternalistic and impersonal tone of the lectures, and the process of manually working through one's relationships with the outside world in the quiet, protection, and peace of the hospital garden.
"Nearly 25 years ago, Solomon Asch wrote in his Social Psychology that 'No assumption has spread more widely in modern psychology than that men are ruled by their emotions and that these are irrational.' He goes on to note that this orientation has led to systematic depreciation of the possibility of intelligence and thinking in human affairs and the adoption of the position that emotion and thinking are not only different psychological operations but antithetical as well... Apparently Western clinicians would hope to resolve problems of adjustment by a frontal confrontation of the emotions. Morita therapy, consistent with Eastern thought, would seem to insist that it is better to bypass and transcend them." (pp. 741-742)
Kiefer (1976) also uses the Moritist position as a mark for measuring Western psychotherapy and underlying social concerns:
"(The study of Morita's treatment modality) also tells us a good deal about our own society, if we know anything about our own psychotherapeutic culture. First, as Reynolds points out in his fifth chapter, there are many parallels between Morita Therapy and certain Western techniques. In its emphasis on behavior rather than insight, Morita method resembles Western behaviorist methods to some extent. Certain points of Morita's theory closely resemble points made by Victor Frankl in his logotherapy, and by the phenomenological therapists. Reynolds mentions Binswanger, but one could also cite Ernest Becker, Rollo May, and William Sadler. All these treat neurosis as a distortion of basically normal mental processes and emphasize the similarity between the neurotic and the healthy personality. All of them see the neurotic as in some way endowed with superior mental qualities. All of them focus on attitudinal problems which lead the neurotic into a vicious circle of hyper-self- consciousness, loss of social effectiveness, and lowered self- esteem.
"However, basic differences between East and West are seen in clear relief through these same comparisons. The goal of most Western therapies is the removal of symptoms. In Morita Therapy one hopes the symptoms will disappear, but the therapy aims mainly at acceptance of the symptoms and the restoration of social productivity. Where Western therapies may encourage the temporary dependence of the patient on his caretakers or on a therapeutic community, this is considered a kind of necessary evil and a mere step in restoration of autonomy, if possible. The Moritists encourage patients to accept with gratitude their lifelong dependence on society, and give them every reasonable opportunity to continue their contact with the therapeutic milieu as long as they like. Fundamental attitudes about the relationship between person and society stand out here as boldly and simply as black sumi-e strokes on white paper." (p. 11)
"If Reynolds is right (and my own experience agrees with his), it means there is change in self-awareness and self- acceptance going on which will ultimately alter the fabric of Japanese society. (It is also a kind of confirmation of a growing suspicion many of us have about Western psychotherapies. The pursuit of self-awareness, instead of improving health, may only change the nature of disorder.)" (p. 12, parentheses in original.)
Plath (1977) goes so far as to speculate that Morita therapy might well have export potential:
"I am suggesting, then, that shinkeishitsu ... may not be a neurotic offshoot of Japanese primary socialization so much as an 'adjustment problem' that arises between secondary and tertiary socialization--the shift from school careers to marital and occupational careers--in the new middle class life course. Certainly this argument needs further testing...
"But if the argument should hold, then we may have an important finding relevant to the export potential for Morita therapy. If the adjustment problems of middle-class youth are much the same in all industrial societies (and I am inclined to think that they are) then the Morita approach may be worth adding to the 'clinical armamentarium' elsewhere in the world, as a specific for the troubled Hamlets of the modern era." (p. 242)
Morita therapy and Zen.
A number of reviews of Morita therapy have emphasized its connection with Zen Buddhism. Although, as indicated earlier, a few Moritists (including Morita himself) have denied any direct connection altogether there is no question in my mind that the affiliation is deep and inseparable. The illustrations that Morita used came from Zen; the concept of accepting reality as it is comes from Zen; the advice for handling symptoms is nothing other than a rephrasing of advice to Zen meditators about handling stray, intrusive thoughts and feelings. Essentially, what has happened in Morita's therapy is that the institutional religious trappings, ritual, literature, and goals of Zen Buddhism have been stripped away and the emphasis placed on proper attention to everyday pursuits rather than focusing on attention in zazen sitting. Of course, some Zen masters would say that proper attention in everyday activities is of equal importance to the attention in Zen sitting. I have yet to work with a Zen student who failed to see the immediate parallels and relevance of Morita's approach to that of Zen practice. In fact, at some Moritist hospitals in Japan zazen meditative sitting is incorporated into the hospital regime.
However, Kora (personal communication), representing the academic psychiatric establishment, points out that if a close relationship with Zen is taken seriously the chances of scientific theory building in Morita Therapy are eliminated. Zen, ultimately, is built upon non-verbal, non-conceptual understanding, and science (as it exists today) is constructed with words, concepts.
Because much less has appeared in English about Naikan there is much less in the way of critical material written by Westerners about it. As before, my comments are in brackets.
A Time article (August 1, 1983) gave Naikan a mixed review:
"To Americans, some of the treatments for these maladies may seem like anti-therapies or even brainwashing. Naikan (introspection) is a one-week program of directed meditation. It is a 30-year-old folk treatment invented by Ishin Yoshimoto, a layman with a background in Buddhism. A 'guide' first discusses the devotion of the patient's mother. [Not so, the guide merely listens to the client's report of the mother's devoted acts.] Then the process is repeated with the other important contributors to his life. The guide steers the patient away from abstract comments and complaints and focuses on his ingratitude toward the sacrifices of other persons. [The foci are three-- what was received from others, what was returned to others, and what troubles and worries were caused others.] Many patients break down crying, and some want to commit suicide out of guilt and regret. [Only one client committed suicide during the thirty- year span of Naikan practice.] The final message from the therapist is that the only escape from mental anguish is to plunge into acts of service. [The image of therapist in this article is much more directive than is true of Naikan. The primary function of the guide is to listen gratefully to the client's self-generated confessions. There is no "message" or instruction as might be found in Moritist practice.] The naikan program is used in prisons, schools, and offices. [And hospitals, clinics, and rehabilitation programs.] Some companies require everyone from the president to the newest hireling to go through it...
"A therapist in Japan is a shepherd, prodding straying lambs back toward the flock. Mental health means to live with and for others. To some American observers, it may seem that methods of both child rearing and therapy push people in Japan toward a pathologically dependent role. But, of course, the freewheeling, individualistic American, with a disposable mate and two parents stashed away in Florida may look a bit odd to the Japanese." (p. 67)
Again, we find this interesting American notion that one must be either dependent or independent, that mental health must be defined as living "with and for others" or "doing one's own thing." The reality is that no one strays too far from the flock in any culture, and that no one plods for long in the center of the flock either. Furthermore, mental health must include a component of living with and for others or loneliness and alienation destroys us. It must also include a component of individualism--and an element of individualism is present in all Japanese therapies and throughout Japanese culture, if one looks for it. It can be reasonably argued that Japanese culture permits more individualism than American culture. When one is safely protected within one's home groups there is a solid base for individualistic exploration. Japanese individualism tends to be expressed in hobbies, food preferences, clothing choices (for wear outside of the school and office), travel, selection of friends, and so forth.
Douglas (1978) makes typical media misrepresentations of Naikan:
"Another Japanese-developed therapy, which was designed to help rehabilitate criminals and "immoral" persons, also owes its inspiration to Zen, especially the practice of Zazen meditation. [Naikan was inspired by Shinshu Buddhism not Zen Buddhism. Shinshu Buddhism, with its emphasis on grace in addition to works, is much closer to Christianity than Zen. And the "immoral" persons of whom Douglas writes are all of us; for we have all taken from our worlds without noticing or appreciating or expressing our thanks.] In so-called Naikan therapy, the patients are again isolated, but this time the therapist visits the patient every hour or so to direct a detailed re-examination of his or her past life. Patients are told to think of various persons who helped them in their childhoods and are then reminded of how often they did not repay the debt they owed and how they hurt those who loved them the most. [The image here, too, is too authoritarian. The Naikansha are not directed and reminded. Rather they are invited to reflect on the three themes listed above. What emerges solely from detailed recollections from the past, without reminders from anyone, is the gradual recognition that the client has lived an unbalanced life, taking more than has been returned, hurting those who have helped.] The effect is to build up an almost intolerable burden of [valuable, existential] guilt mixed with gratitude [and awareness that we have been loved in spite of our imperfection], which often pours out in a final tearful pledge to reform. [It is natural to want to try to repay one's debts.]
"Again the emphasis is on direct attack against symptoms--to the point of 'brainwashing' [The approach is indirect and quite unlike "brainwashing" which involves involuntary treatment and forced confinement.]--rather than on developing patient insight. ["Insight" meant here was Western psychodynamic insight. If such insight, narrowly defined, is so useful why do we see so many Western patients in psychotherapy who are extremely "insightful" in this sense but still suffer from non-constructive attitudes and behaviors? Eastern therapies aim to build a character that transcends symptoms.] The extent to which either Morita or Naikan therapy might be used with more individually and rationally oriented Western patients is still unknown...But an examination of such therapies and the theories that underlie them might help Western psychologists develop a broader perspective on their work."
With these final words Mr. Douglas sets forth the possibility of Eastern therapies making some contribution to Western psychological theories despite supposed basic differences between Eastern and Western patients. But these contributions can never be made as along as the Eastern therapies are consistently misunderstood and misreported in media and scholarly reports. Until scholars and reporters are willing to make commitments of time and effort to truly study these valuable therapeutic strategies we will continue to read well-intentioned but erroneous descriptions of them. And it is my belief that they hold messages for American culture which we cannot long afford to ignore.
Even careful scholars may grossly misinterpret what they study because of their taken-for-granted Western assumptions. Kitsuse (1968) writes about Naikan in prisons:
"The method seeks nothing less than the subordination of the individual to the impositions of societal demands. What is so remarkable is not that this method achieves the ends it seeks, which are open to question, but that inmates should voluntarily submit to it, and almost without exception testify to the positive value they have received from it.
"It may well be that the value which inmates attribute to their Naikan experience is due less to an actual transformation of self, and more to the coherence of the interpretation of the past which it provides for them. The stern and uncompromising character of the interpretation must surely leave a residue of resistance and doubt. As an explanation of their immediate circumstance, however, it may have the appeal of simplicity, offering a hope that they too may yet rejoin society as serious and upright (majime na) persons." (p.7)
The effect of Naikan is much deeper than Kitsuse assumes. Humans (including prisoners) are not so uniformly foolish as to accept the imposition of societal demands in order to discover a simple and coherent explanation of their past. Naikan results in such a changed view of self that those who do it successfully become eager to accept their social responsibilities because they realize the personal implications of their attitudes and actions. The dichotomy of psychological/personal/self-seeking versus social/group-oriented/self-sacrificing breaks down completely with deep Naikan. When we harm those who help us in order to advance our status we are harming ourselves. When we serve those around us we are serving ourselves.
Two reviewers of the book, Naikan Psychotherapy, recognized the potential contribution of this therapy form to Western culture. Willard (1984) considered Naikan study to be part of the "search for ways to adapt Japanese cultural components into an evolving American cultural synthesis" and an element of "the continuing evolution of psychotherapies beyond narrow cultural and temporal bounds." A British Medical Journal (1983) review notes that "In rather bracing contrast to the current vogue for finding yourself, learning to love yourself, and everyone's right to be happy, Naikan asks the patient to think about how much he has received from the world and how little he has given in return...Let's hope it catches on."
The December, 1984 issue of Vogue carried an article by Stern covering both Naikan and Moritist topics. She chose to present to her readers Naikan insights that gratitude and guilt can be liberating from attitudes of resentment and isolation. Our identities are gifts created by those around us.
Enigmas of Western Therapy
As a university student I was puzzled when the psychology classes offered undergraduates seemed to be ignoring the psyche. The professors were concerned with the nervous system and the behavior of rats and the replies of subjects to questionnaires and the performance of college students in experimental situations, but they seemed not at all interested in the flow of consciousness that is the psychic life of all humans. Eastern therapies point to similar enigmas in the practice of Western psychotherapy. In this chapter we shall examine some of the differences between what Western psychotherapies purport to be doing and what they actually do.
Sato (1958) wrote that for all the Western therapies' talk about being "dynamic" they do a lot of static labeling. In their attempt to provide neat diagnostic categories and analytic precision Western psychotherapists underplay the flux of situational reality as it influences the flow of the mind. I am reminded of the psychiatric aides on a Veterans Administration psychiatric hospital ward who preferred not to look at a new patient's record because the record gave a "fixed" caricature of the patient and not the constantly changing being the aides would be living alongside during their eight hour shifts (Reynolds, 1976). Psychiatric records, like narrow diagnostic categories, are snapshots and not moving pictures--snapshots aren't dynamic.
Buddhist psychology emphasizes the fundamental "changingness" of human psychic existence. Such an emphasis seems to fit reality better; it provides the basis for a truly dynamic approach to psychotherapy.
This Buddhist-based processual approach to human existence acknowledges the flux of reality and the situational embeddedness of the human psyche. How "dynamic" is a Freudian therapeutic approach that holds we have a single personality which is fixed rather early in childhood and remains relatively unchanged throughout adulthood? Our experience tells us that we think and act differently in our different roles and even within a single role at different times and in varying circumstances. How can we call a Western psychotherapeutic approach "dynamic" when it ignores these fundamental dynamisms in our daily life? Only recently has Western psychology turned its attention to a true situational psychology and to a serious psychology of consciousness.
A second enigma of Western therapy has to do with the discrepancy between training and actual therapy in the real world. Our students in the West are trained to conduct therapy over a long period of time with individual patients. Phillips (1983) conducted an exhaustive study of the literature and carried out research of his own which demonstrates that across a variety of settings, client types, and therapy modalities the modal number per patient of visits to psychiatric outpatient clinics for outpatient treatment is one. In other words, people who show up for help with a psychological problem are most likely to come only once. They aren't likely to continue with subsequent treatment.
The reasons for his important and somewhat unexpected findings are still unclear. Apparently, some patients believe that a single session is sufficient to bring about a resolution of their problem. Others are undoubtedly disillusioned with their single therapy experience and resolve to avoid further treatment. Whatever the reasons, the reality is that many patients only appear for a single treatment session.
It follows that our training of therapists should prepare them to provide help in a single, initial session and to become more skillful in attracting clients back who are in need of further therapeutic support. It seems reasonable that a therapeutic approach which is simply explained, makes common sense, and provides immediate relief from some forms of neurotic suffering (even on a temporary basis) would be the therapy of choice. Even temporary relief is likely to support the clients' confidence in the therapist and bring them back for subsequent sessions when the temporary measures begin to lose their effectiveness.
Morita therapy would seem to provide just the sort of treatment mode required by this one-shot exposure to therapy. The principles are few and simple. The emphasis is on the client's practice of the principles outside the treatment setting. The straightforward commonsense approach is readily understandable to clients from a variety of cultural backgrounds and social strata along a broad range of verbal skills and intelligence levels. Built into Morita therapy is an initial level during which the client finds some immediate relief by using the attention to tasks at hand as a distraction from suffering. Those who practice Morita therapy in the West aren't surprised to hear clients marvel at the instant relief provided during the first week of trying Morita's method. Of course, using attention to work and play as an escape from unpleasant feelings is only a stopgap measure with temporary effect. The longer-term goal is acceptance of feelings as they are while doing what needs doing in order to accomplish the task at hand rather than using the task as an escape from suffering or as a step toward "cure." In the long run, the therapeutic goal is character development with the usual side benefit of some relief from symptoms.
It is puzzling that we train our Western therapists to conduct therapy in a manner which doesn't seem to fit the needs of, perhaps, the majority of clients who appear for therapy. It may be that in spite of their training our Western therapists provide help in these single encounters with these clients. But it makes sense to offer professional training more directed to the requirements of actual practice.
Research has demonstrated that the silent Freudian psychoanalyst and the reflecting non-directive Rogerian therapist still manage to communicate to their clients their preferences and interests, and so subtly influence them. Japanese therapists are overtly directive guides. The technique in Morita therapy and in Naikan is a sort of experience-based teaching. London (1964), writing of Western therapies, reminds us that every therapy contains an underlying view of the world--what is disorder, what is "cure", what it is to be human, what must be done to achieve relief, and so forth. That therapeutic perspective is taught to the patient somehow.
Why not be straightforward and open about the teaching involved in therapy? The Japanese psychotherapies provide a model of this honest openness.
Another point worth raising involves the gap that can be seen between the professional lives and the private lives of some of our Western colleagues. Comparing those Western therapists and those Japanese therapists with whom I am acquainted there is an important difference in the correspondence between what they do in therapy and how they live outside their offices. Although there are a few exceptions, Morita therapists and Naikan therapists live their respective therapeutic principles in daily life. There need be no gap between what they do in the therapy setting and outside of it. But the Western therapists (some of whom come for Moritist training) use specialized techniques and compartmentalized concepts when they conduct therapy. There is little opportunity or reason to carry over their therapy perspective outside of the office for these non-Moritists.
One disadvantage of this sort of Western compartmentalization is that there is no chance for the therapists to strengthen their understanding of their methods through daily life--they must attend special training opportunities, read specialized books, and the like. Their confidence in what they are doing professionally may not be systematically strengthened by their experiences outside the therapy settings.
Given this understanding of Western psychotherapies there is reason to believe that some Western psychotherapists will resist the incorporation of Morita therapy principles, for example, into their practice. Some of the "deficits" of Morita therapy for such therapists will be its lack of mystery, its uneconomical quality, the lack of sufficient separation between therapist and client, the absence of dramatic and appealing elements like analysis of fantasies and dreams, the assignment of credit for cure to the client, and the applicability of Morita therapy to include a less desirable, less affluent clientele. Let us examine each of these unfortunate qualities of Morita's methods in order and in detail.
For the few therapists who need to appear as though they possess arcane knowledge of the psyche, the practical, commonsense nature of Moritist principles and practice are disturbing. Morita therapy is up front in its method, explicitly acknowledging that the therapist is a teacher and guide. There is no hidden reliance on subtle head nods and selective smiling in order to guide the client along channels chosen covertly by the therapist. All therapy is education, but Morita therapists place themselves squarely within the frame of education. Most Western Moritists prefer the terms "teacher" or "guide" and "student" or "trainee" and "client" to terms like "therapist" and "patient," although in this book the term "therapist" is sometimes used to avoid confusion for the reader. The similarities and not the differences between therapist and client are emphasized in Morita therapy. We make clear the limits of what the therapist can do for the client and what the clients must do for themselves.
In most cases, Morita therapy fails to provide a long-term paying neurotic client. It works so efficiently with clients who give it a genuine try that therapists are hard-pressed to find a continuous supply of new neurotic clients with whom to work. Furthermore, those clients for whom the therapy holds no appeal quickly drop out. Fortunately, Morita's methods are beneficial to "normal" individuals, as well. It is a means of personal development and character growth. Some therapists branch out from "psychotherapy" to personal management training or courses in personal growth. Others choose to work with long term psychotics, young children, brain damaged persons, and the more difficult students.
Keep in mind, however, that the modal number of visits to the vast majority of psychiatric outpatient clinics is one. In other words, most clients show up for a psychotherapy session, whatever the form of therapy being offered, only once (Phillips, 1983). It is important to have a technique (i.e., something to teach) that will provide some benefit in a single hour. That may be all the time a therapist is given by the client. In the sense of producing clients who keep returning for therapy, no method seems economically effective in outpatient clinic settings. Morita therapy is an example of a psychotherapy which is economical for the client.
Minimal separation between therapist and client.
Western therapists have been taught, for the most part, skills that keep them socially separated from their patients. They are taught to avoid social encounters with clients outside the therapy setting. They are taught, explicitly and implicitly, to maintain distance by concealing their analyses and records from the patients themselves, by using a desk or couch for symbolic spatial separation, and so forth.
There is no question that, in the therapeutic encounter, there is some difference between the role of teacher and student. But those role differences need not carry the heavy status gap that exists in Western settings. Again, Morita therapy emphasizes that the therapist is human, like the client. They are similar in many ways, sharing moments of obsession, self doubt, shyness, rage, physical reactions to strong emotion, and so forth. The difference lies only in the therapist's knowledge of readily-learned principles and the therapist's practice in applying the principles in his or her own life and seeing how the principles apply in a variety of situations in the lives of others. Fundamentally, there is only a temporal/experiential difference between Moritist guide and client. The function of the guide is to teach the principles and applications as the client works toward catching up along the same path of self growth.
Given this attitude toward our students, Western Moritists have found it appropriate to conduct a number of sessions outside the office--walking around the neighborhood with clients who need to get their bodies moving, strolling along the aisles of supermarkets with clients who need to sharpen skills of attention while shopping, visiting clients' homes and offices to get a sense of what those settings bring that needs to be done. At times, therapy is appropriately conducted in the classroom of the office, but its application must also come in the everyday life of the client. Some traditional Western therapists would find it extremely uncomfortable to do their work outside of the safe familiarity of their offices alongside their clients.
Some of the distraction, the glamour of Western psychotherapy is absent in Morita therapy. There is no analysis of fantasy, no interpretation of dreams. Whatever the healing value of such methods, symbolic analyses have provided hours of session material for therapist and patient through the years. To the Western therapist Morita's approach may appear oversimplified because it fails to involve itself in the elaborate constructions of the mind. When the focus is on behavior much of the projections, rationalizations, and creations of fantasy are simply distractions from realistic observation and constructive action. It is not that intricate spinnings of the mind are unimportant. Rather, the fundamental task is to get behavior under rational control where it belongs. Then the spinnings will occur within the protected realm of disciplined behavior and, thus, will be less troublesome.
On the other hand, getting out of the office into other parts of the real world (supermarkets, weddings, hikes, Laundromats, offices, etc.) injects variety within the therapy hours. There seems to be a tradeoff between the fascination of mental creations, on the one hand, and the fascination of real environments, on the other. On this micro level, we can perceive the fundamental difference between psychotherapy as it has developed in East and West.
Credit where credit is due.
One of the highest satisfactions for any therapist is seeing constructive change in the life of a client. Clients and readers sometimes write thanking us for changing their lives. They are mistaken. No therapist, guide, or writer ever changed anyone's life. We only teach and write (the two are the same). Students and readers have learned and applied what they learned. The credit for changing their lives is theirs. It is possible to teach without anyone learning. It is possible to learn these lessons of life without formal teaching. Our effort applies to our behavior; theirs to theirs.
A therapist may feel satisfaction when a client improves. Feelings are, after all, natural and outside of rational control; and satisfaction is a feeling. We all like to consider ourselves important to others. But, in reality, no one rescues another, no one cures another.
Almost any student will do.
Some of the most popular Western psychotherapies seem to work only with bright, articulate patients. The therapists are assured of a well-to-do clientele who share many of the therapists' values, symbols, language. In this regard, there has been some dissatisfaction among representatives of ethnic groups and less advantaged socioeconomic strata in our society. Psychotherapy as practiced in many clinics seems not only culture-bound, but also education-level-bound and class-bound.
There are limits, too, to the sorts of people who benefit from Morita therapy. But the limits are surprisingly broad. As noted above, those who cannot understand the lessons about living for one reason or another, and those who can understand but won't put them into experiential practice, won't benefit from them. That means people who are actively psychotic and out of contact with reality, young children, people with very low intelligence, some brain damaged individuals, and some addicts, sociopaths, and the like aren't appropriate for Morita guidance.
But the principles are understandable to Blacks and Chicanos and Irish and Jews and Catholics, to uneducated migrant workers and corporate executives, to senior citizens and teen-agers. Some translation is necessary in order to communicate effectively, of course, but translating is necessary for any teaching. The material itself makes good sense to this range of people because it isn't based on being Japanese or being educated or being Buddhist or being highly verbal; it is based on being human. No one controls feelings directly by will. Everyone can take control of and responsibility for behavior. Feelings fade over time unless restimulated for every human. Self-centeredness leads to suffering for anyone. Everyone has a sense of what needs doing, yet at times we all fail to do it. Such principles fit our human experience. So do the strategies for using them in daily life, although the individual applications must differ because reality brings each of us a unique set of "tasks."
So it is clear that there are aspects of Morita therapy that make it unattractive to some Western therapists. It lacks mystery, it may be financially unprofitable, it blurs the difference between therapist and client, it sidesteps some appealing elements found in Western analytic therapy, it gives credit to the client for cure, and it allows an overly broad spectrum of clientele.
The enigmas of Western psychotherapy are without number. Ah, the mysterious, inscrutable, West.
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Reply to Criticism of Morita Therapy and CL in the 1990's
I welcome this opportunity to clear up some misunderstandings about both Constructive Living (CL) and Morita Therapy (MT).
Let's take a look at the author's qualifications to write an article about MT and CL. I haven't seen other articles by the author on MT and haven't heard of any period of his extended study of the Japanese language or of MT in Japan. The author seems to have received most of his understanding of the subject from the writings and perhaps the direct teaching of Ishiyama. Certainly, the only MT references in the draft of the article given to me were in English by Ishiyama. Similarly, the author's credentials for writing about CL are suspect. There is no reference to any of my more than a dozen books and numerous articles on CL and MT published by both academic and popular presses. There are no quotes from interviews with CL instructors or with me.
In sum, the author appears to have received most if not all of his information about CL and MT from Ishiyama. I am rather surprised that his article is published in an academic journal without a thorough, even review of the literature.
Before considering the material about CL let us look at some of the related material in the article.
The author is misinformed about Naikan: 1) In only a few centers are to be found court-remanded juvenile delinquents and even in these they make up a small proportion of the Naikansha. 2) Naikan has three themes, not two: what was received from others, what was given to others, and the troubles caused others. 3) One might expect that if Naikan (or MT, for that matter) were culture-bound Westerners wouldn't try it or benefit from it. But they do try it and among those who do many benefit from it (Reynolds, 1992).
There is a fair amount of misinformation about MT in the article. There is no single Morita lineage through Kora. For example the prominent therapists Usa and T.Suzuki are not in such a lineage. There is no extended formal training in Morita therapy in Japanese medical universities (averaging 10 minutes devoted to the subject in the curricula) except at Jikei and Hamamatsu Universities and no graduate training on the subject in Japanese psychology departments to my knowledge. In fact, psychologists in Japanese Moritist settings tend to be relatively low-status assistants and psychological test 7 濠administrators compared to genuine medical Morita therapists.
I recently received one of the first Kora Prize awards at the National MT meetings in Kochi, Japan. If that qualifies me as a "respected Morita therapist" then I can think of at least three such therapists who regularly use MT with clients who have no shinkeishitsu diagnosis. In my recent Special Lecture at the Kochi meetings I pointed out the limitations of labelling diagnoses and limiting concepts like "personality" and "character" adopted thoughtlessly from Western psychology. I expressed my doubts that a "fumon" therapy can be adapted to a talking counselling format.
Now let us consider the complaints about CL one by one: 1. The author claims that CL is based on an iemoto system. In the past I have jokingly refered to a CL iemoto system. What exists is a formal course of training which leads to certification in CL, not MT. In Japan there is no formal certification program or any universal accepted system for being recognized as a Morita therapist. I have personally trained about 90% of those certified in CL because I wanted to be personally sure of their quality. The remaining 10% have been trained and certified by two of my senior student colleagues. Thus we maintain quality control. If that be an iemoto system, then it is found throughout the West as well as Japan. It might be noted here that certification courses in CL have been and will again be offered in respectable settings in Japan as well as in the West.
2. Morita used Zen sayings in his teaching. I see no reason not to use Zen (or Sufi or Hassidic or Christian) tales or problems (koans) to teach CL lessons. CL keeps inviting the student to check what is being taught with the student's own experience of reality.
I find much more of a religious flavor to modern Western psychological counselling concepts: ego, character, unconscious feelings, superego, motivation, to name a few. The patient is expected to believe, for example, that special training allows a therapist to discern feelings and elements of character or ego of which the patient is unaware and "get them out." Such thinking smacks of exorcism in modern garb.
3. The author of the article offers generalities but no specifics for most of his critical remarks. I would like a list of the names of CL instructors who call themselves Morita therapists (if such a list can be produced). I would be pleased to ask them to desist. I have no authority to control what anyone says, however. The fact of the matter is that I have only one vote at the annual International Association for CL meetings just as every other attending member. Anyone who has attended one of our meetings (Mr. Ives has not) could confirm that CL instructors are an opinionated and varied lot, unwilling to conform to my will.
4. The author mistakenly asserts that CL certification training takes place in a period "often less than a week." Actually, certification training in CL involves an intensive 10-day period in which trainees and instructors live together full time. I know of no Morita setting in Japan except for the lay organization Hakkenkai retreats where live-in training is regularly offered. Western counselling psychology offers no such regular live-in training in MT to my knowledge. And the result of counselling training in the West is an office-based practice that would shun outside the office contact with patients although Morita actually lived alongside them.
Approximately half those who complete the ten-day training are certified in CL. Those who do not exhibit an ability to communicate the theory and exhibit CL principles in their daily lives are not certified (Reynolds, 1992).
I am not at all impressed by the peer-supervision offered in Western psychology. Supervision is a custom, only as good as the supervisors. Sociologists recognize that the primary purpose of any professional organization is to protect its identity and priveleges. Supervision in psychology offers a sanctioned rite of passage rather like that of an advanced degree. Frankly, I prefer that my CL instructors not be subjected to such outmoded methods and concepts as those offered in much of current Western clinical and counselling psychology.
5. Morita claimed that everyone has some shinkeishitsu qualities and that these qualities are magnified when we become physically ill. It is a simple logical step to the conclusion that everyone could benefit to some degree when exposed to Morita's ideas about living. He wrote, furthermore, that the psychological functioning of shinkeishitsu people is the same as that of normal people; no new psychological mechanisms need be postulated. Why not allow others then to benefit from Moritist's thought?
In sum, what we have reflected in Ives' article is a sort of second-hand attempt to discredit a method that has already helped thousands of suffering people because it doesn't meet some self-serving standards of counselling professionalism. Our mail list is nearly 8,000 strong with many letters of thanks among them. CL books have sold over 100,000 copies. Millions of newspaper and magazine readers hve encountered MT and CL ideas thanks to our efforts.
Counselling psychologists and other mental health professionals would do well to cooperate with us in our well-thought-out efforts to help suffering people. Many have already chosen to do so. Of the one hundred certified CL instructors more than forty have advanced degrees in mental health fields (physicians, psychologists, social workers, nurses).
MT provides a new and radical perspective for rethinking the whole theory and practice of Western psychotherapy. There is no need to try to make it conform to Freudian psychodynamic thought.
For some time to come psychologists will continue to be second-class citizens in the medical sphere of MT in Japan. For whatever reasons some psychologists choose to take a more critical stance toward CL. History will demonstrate which course is proper.
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