Medicine:Morita therapy

Morita therapy is an ecological, purpose-centered, response-oriented therapy created through case-based research by Shoma Morita, M.D. (1874–1938). Morita developed his theory of consciousness and medically-grounded four-stage progressive therapeutic method with rigor.

The goal of Morita therapy is to have the patient accept life as it is. This does not mean that the patient cannot set and achieve goals, but be able to be satisfied with their life in the moment. Morita therapy places an emphasis on letting nature take its course. This is not to say that patients should be resigned to their mental illness but to respect the laws of nature. Feeling emotions is a law of nature according to Morita therapy. Morita therapy helps its patients understand that experiencing emotions, positive or negative, is a facet of being a human being. Morita describes his own therapy as follows:

Although I tried various therapies, including hypnosis for clients with anxiety disorders, I did not obtain results beyond the temporary relief of symptoms in clients. I also used the life-control method for many years and followed Binswanger's (1911) theory, only to find it manneristic, too theoretical, relatively impractical, and ineffective. Binswanger's methods deprived my clients of spontaneous activity. Initially, I tried to modify and extend these existing systems, but later designed my own method of treatment.

—Morita, 1928/1998, p. 35

Morita therapy was originally developed to address shinkeishitsu, an outdated term used in Japan to describe patients who have various types of anxiety. Morita therapy was designed not to completely rid the patient of shinkeishitsu but to lessen the damaging effects.

While Morita therapy has been described as cognate to Albert Ellis's rational-emotive therapy, this description does not account for the ecological foundation of the therapy. Morita therapy also has commonalities with existential and cognitive behavioral therapy.

Background

Shoma Morita, M.D. (1874–1938) was a psychiatrist, researcher, philosopher, and academic department chair at Jikei University School of Medicine in Tokyo. Morita's personal training in Zen influenced his teachings, yet Morita therapy is not a Zen practice. However, his treatment contains paradoxical methods that reflect Zen.

Morita formulated his psychotherapeutic principles in Japan as a program for the treatment of neurotic tendencies at the same time that attention in Europe was given to Sigmund Freud's discovery of the unconscious and Carl Jung's development of archetypes.

Underlying philosophy

As clients move through the four stages, their senses are activated and curiosity about the natural world increases. Herein, they engage and respond more spontaneously and creatively, while gaining a sense of their authentic self (Fujita, C., 1986. Morita Therapy: A Psychotherapeutic System for Neurosis. Tokyo: Igaku-Shoin). For Morita, it was the progressive design and ecological context that made it unique to other therapies of his time, as well as today. Therapeutic change runs deeper than thinking and behaving. One's perception of self-in-the-world shifts while moving through the therapeutic stages. A client's mind, body, and imagination have therapeutic time in a safe place in a natural environment to become revitalized; this is particularly necessary when they have survived trauma ('Classic Morita Therapy'). For instance, while pulling weeds and watching earthworms seek moist soil, they notice that their anxiety has dissipated and they soon embody such experiences. It is the therapist's role to observe, facilitate, and reinforce these experiences.

Morita therapy directs one's attention receptively to what reality brings in each moment—a focus on the present, avoiding intellectualising. Simple seeing what is (without judging), allows for active responding to what needs doing. Most therapies strive to reduce symptoms. Morita therapy, however, aims at building character to enable one to take action responsively in life regardless of symptoms, natural fears, and wishes. Character is determined by behavior, by what one does. Dogmatic patterns of collapse are replaced with the flexibility to call upon courage and empowerment. Decisions become grounded in purpose rather than influenced by the fluid flow of feelings.

In Morita therapy, character is developed by cultivating awareness, decentralizing the self, and honoring the rhythms of the natural environment and one's own diurnal rhythms. Aspects of mindfulness are contained in knowing what is controllable and what is not controllable, and seeing what is so without attachment to expectations. Knowing what one is doing, knowing what the situation is requiring, and knowing the relationship between the two are quintessential to self-validation, effective living, and personal fulfillment. Character is developed as one moves from being feeling-centered to being purpose-centered. A feeling-centered person attends to feelings to such an extent that the concern for self-protection reigns over decisions and perceptions. Given the human condition, change, pain, and pleasure are natural experiences. Indeed, emotions are a rich type of experience and a valuable source of information. Feelings are acknowledged even when what is to be done requires not acting on them. Constructive action is no longer put on hold in order to process or cope with symptoms or feelings. The individual can focus on the full scope of the present moment as the guide for determining what needs to be done.

Ultimately, the successful student of Morita therapy learns to accept the internal fluctuations of thoughts and feelings and ground his or her behavior in reality and the purpose of the moment. Cure is not defined by the alleviation of discomfort or the attainment of some ideal feeling state (which the philosophy of this approach opposes), but by taking constructive action in one's life which helps one to live a full and meaningful existence and not be ruled by one's emotional state.

Morita's four stages

Morita offered a four-stage process of therapy involving:

• Absolute bed rest
• Occupational therapy (light)
• Occupational therapy (heavy)
• Complex activities

The first stage, seclusion-and-rest, lasts from four to seven days. It is a period of learning to separate oneself from the minute-by-minute barrage of the constant assault on one’s senses and thought processes by a loud and intrusive world. The patient learns to turn off the television, close the door temporarily to demanding work, well-meaning friends, and even family. The patient is ordered to stay on absolute bed rest, even to take meals, only rising to use the restroom. When the patient expresses boredom and wishes to rise and be productive, then they may move to the second stage.

During the second stage, patients are introduced to "light and monotonous work that is conducted in silence." The second stage takes three to seven days. Mental activity is slowly starting to come back. Patients may wash their face in the morning and evening, and read aloud from the Kojiki. One of the keystones of this stage of self-treatment is journal writing. In this phase, patients are also required to go outside, that is, both outside of themselves and out of the house, the goal being to begin a re-connection with nature. No strenuous physical work is allowed, such as climbing stairs and sweeping.

In the third stage, patients were allowed to engage in moderate physical work, but not social interaction. Like the second stage, this stage lasts from three to seven days. For people with physical injuries, it is the phase where they move from passive treatment given to them by others (i.e. chiropractic, massage and pain medicine) to learning to begin healing themselves through a stretch- and strength-oriented physical therapy program. Morita therapy incorporates moving from being treated to learning self-treatment in both the physical and psychological realms. Depending upon the depth and nature of injury (of spirit, mind or body), this third stage can become a part of daily life for some patients. The patient is encouraged to spend time in creating art – writing, painting, wood carving, or whatever puts them into contact with the creative aspects of their humanity. Some patients will participate in work that they might consider beneath them, such as scrubbing toilets. The purpose of this stage is to instill confidence, empowerment, and patience through work.

The fourth stage is the stage where patients can be reintroduced into society. It can last from one to two weeks. The patients apply what they have learned in the first three stages and use it to help them with the challenge of reintegration into the non-treatment world. This is the phase in which the patient learns to integrate a new lifestyle of meditation, physical activity, clearer thinking, more ordered living, and a renewed relationship with the natural world. Instead, they will integrate their "new self" into the imposed set of changes brought about by their trauma, pain and limitations. As re-integration into the world outside of treatment brings with it some unanticipated challenges, the patient returns to the materials they studied and perhaps even the counsel of their teacher to find coping skills that will allow them to progress further and further on the journey of recovery. The patient should feel joy, hope, and acceptance at the end of this stage.

Methods (Western)

Shoma Morita's groundbreaking work was first published in Japan in 1928. Pure Morita therapy had its greatest applications to a Japanese culture almost one hundred years ago. Morita Therapy Methods (MTM) brought Morita's original thinking to the west, and has sought to adapt it to modern western minds and culture.

The original Morita treatment process has the patient spend their first week of treatment isolated in a room without any outside stimulation—no books, no television, no therapy other than being alone with their own thoughts. It is unlikely that a modern day psychiatrist or psychology would prescribe a whole week of bed rest, and thus Morita therapy has been modified to MTM. However, MTM stays true to the underlying principles of Morita therapy.

The shinkeishitsu concept has also been broadened to consider not just anxiety, but life situations in which modern westerners may find themselves, involving stress, pain (physical, psychological, or both) and the aftermath of trauma (physical, psychological or both). In addition, MTM can help patients deal with shyness. While no cure-all, and requiring personal commitment and action, MTM is an amalgamation of Eastern treatment methods applied to the Western mind, and claims to help patients find, and use, a well of inner strength deep within themselves that enables them to make powerful changes in their life, though further research to clarify its effectiveness in Western settings is still [2011] required.

As with Morita therapy proper, MTM is roughly divided into four basic areas of treatment.

While Neo-Morita models are on the rise in English-speaking countries, consumers are advised to ask two critical questions: What is Morita therapy according to Morita? Have the research-practitioners trained extensively in Morita therapy as intended by Morita before reformulating Morita's ecological-determined therapy?

Research

A Cochrane review conducted in 2015 assessed the effectiveness of Morita therapy for anxiety disorder in adults. The review states there is very low evidence available and it is not possible to draw a conclusion based on the included studies.

See also

• David K. Reynolds
• Naikan
• Quiet sitting

Further reading

• Morita, Shoma (1998) (Kondo, Akihisa, trans., LeVine, Peg, ed.) Morita Therapy and the True Nature of Anxiety-Based Disorders. State University of New York Press.
• Chang, SC. (1974). Morita Therapy. American Journal of Psychotherapy, 28: 208-221.
• Chang, SC. (2010). Psychotherapy and culture. Morita therapy: An illustration. World Cultural Psychiatry Research Review. December, 135-145.
• Deng Yuntian, Out of the quagmire of obsessive compulsive disorder 走出強迫症的泥潭. A detailed book about Morita Therapy.
• Fujita, Chihiro. (1986). Morita Therapy: A Psychotherapeutic System for Neurosis. Tokyo: Igaku-Shoin.
• Ikeda, K. (1971). Morita's theory of neurosis and its application in Japanese psychotherapy. In J.G. Howell (Ed.), Modern Perspectives in World Psychiatry (519-530). New York: Brunner/Mazel.
• Ishiyama, Ishu. (1988). Current status of Morita therapy research: An overview of research methods, instruments, and results. International Bulletin of Morita Therapy. (1:2), November, 58-83.
• Ives, Christopher. (1992a). The teacher-student relationship in Japanese culture and Morita therapy. International Bulletin of Morita therapy. (5:1 & 2), 10-17.
• Kitanishi, Kenji. (2005). The philosophical background of Morita therapy: Its application to therapy. In Asian Culture and Psychotherapy: Implications for East and West. University of Hawai'i Press, p169-185).
• Kondo, Akihisa. (1953). Morita therapy: A Japanese therapy for neurosis. The American Journal of Psychoanalysis, (13:1), 31-37.
• Kondo, A. (1975). Morita therapy: It's Sociohistorical Context. In Arieti, Silvano and Chrzanowski, Gerard (1975). New Directions in Psychiatry: A Worldview.
• Kondo. A. (1983). Illusion and Human Suffering: A brief comparison of Horney's ideas with Buddhistic Understanding of mind. In Katz, Nathan (Ed), Buddhist and Western Psychology. Boulder: Prajna Press.
• Kora, Takehisa. (1965). Morita Therapy. International Journal of Psychiatry. (1:4), 611-640.
• LeVine, Peg (2017). Classic Morita Therapy: Consciousness, Zen, Justice, Trauma. London: Routledge Press.
• LeVine, P. (2016). Classic Morita therapy: Advancing consciousness in psychotherapy. Psychotherapy and Counselling Journal of Australia.
• LeVine, Peg (1991). Morita psychotherapy: a theoretical overview for Australian consideration. Australian Psychologist, 26 (2), 103-107.
• LeVine, P. (1994). Impressions of Karen Horney's final lectures. Australian Psychologist. (29:1), 153-157.
• Ogawa, Brian (2007). A River to Live By: The 12 Life Principles of Morita Therapy, Xlibris/Random House.
• Ogawa, B. (2013). Desire For Life: The Practitioner's Introduction to Morita Therapy for the Treatment of Anxiety Disorders. XLibris Publ., Indiana