Morita therapy

Morita therapy is an ecological and 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 as much rigor as his contemporaries, Sigmund Freud, Alfred Adler, Anna Freud, Carl Jung, Jacques Lacan, Melanie Klein, and Wilfred Bion.

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.

A brief introduction

To an outside reader, Morita therapy may seem straightforward and simple. However, this is not a ‘just do it’ therapy or an early form of Mindfulness therapy. Morita therapy offers a philosophical orientation and experiential method that moves clients to 'follow Nature' and act according to the 'laws of emotion' that he described; in this way one can live according to her or his own essential nature’. 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. In principle, my method of therapy requires residential care….My treatment involves four stages: (1) isolation-rest therapy, (2) light occupational therapy, (3) heavy occupational therapy, and (4) complicated activity therapy in preparation for actual life" (Morita, 1928/1998, p. 35).

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 Buddhism 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 Dr. 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 therapy was developed to deal with what Dr. Morita defined as Shinkeishitsu - "anxiety-based disorders" involving a high degree of perfectionism.

Morita offered a four-stage process of therapy involving:

• Seclusion and rest that is monitored for client safety
• Occupational therapy (light)
• Occupational therapy (heavy)
• Complex activities.

Morita therapy may be seen as a form of re-socialisation, involving a social influence process.

Morita Therapy Methods (Western)

Shoma Morita's groundbreaking work was first published in Japan in 1928, so that 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.

Thus, for example, 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. Modern-day benefits providers are unlikely to see the ancient wisdom of paying for people who are attempting to learn to better face the challenges of life to spend a week alone sitting in a hospital bed; and the practice has been modified, the MTM approach seeking nonetheless to remain consistent with the underlying principles.

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). 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.

The four areas of treatment

Phase one is the seclusion and rest phase; according to Morita (1998), it is the place where his therapy begins. It is a period of learning to separate ourselves from the minute-by-minute barrage of the constant assault on our senses and thought processes by a loud and intrusive world. We learn to turn off the television, close the door temporarily to demanding work, well-meaning friends, and yes, even family. The body returns to natural diurnal rhythms.

Phase two introduces us to "light and monotonous work that is conducted in silence". One of the keystones of this stage of self-treatment is journal writing. Our thoughts and feelings come to us in indistinguishable waves and flood our minds. Writing in our personal journals helps us learn to separate our thoughts from our feelings and define their different effects on our lives. In this phase we also go outside… outside of ourselves and out of the house and begin a reconnection with nature. We leave the solitude of Phase one and go out of doors. We breathe the fresh air and feel the sun on our faces. We walk. We walk and breathe. We walk, breathe and reconnect with the world of nature that has been shut out of our lives by pain and stagnation for weeks, months, even years. We move from darkness to light in both figurative and literal ways.

Phase three is one of more strenuous work. Dr. Morita had his patients engage in hard physical work outdoors. This is what we call the "chopping wood" phase. For people with physical injuries, it is the phase where you move from passive treatment given to you by others (i.e. chiropractic, massage and pain medicine) to learning to begin healing yourself though a stretch and strength oriented physical therapy program. MTM incorporates moving from being treated to learning self-treatment in both the physical and psychological realms. It is hard, it hurts, and it will be a challenge to persevere in the beginning, but if you are ever going to move from being the treated victim to being the recovering survivor this step must occur.

Depending upon the depth and nature of injury (of spirit, mind or body), Phase three can be short or long. For some it becomes a part of daily life, forever. Some pain resolves, some pain needs to be managed. The beneficial aspect of this phase of treatment is that it also encourages the engagement of what we now understand is the right side of the brain. The recovering survivor is encouraged to spend time in creating art—writing, painting, wood carving—whatever puts them into contact with the creative aspects of their humanity.

Phase four is when Morita would send patients outside the hospital setting. They would apply what they had learned in the first three phases and use it to help them with the challenge of reintegration into the non-treatment world. This is the phase where 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. They are not returning to their former lifestyle. 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 survivor 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.

See also

• David K. Reynolds and his Constructive Living
• Naikan
• Quiet sitting
• Classic Morita Therapy

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 (1991). Morita psychotherapy: a theoretical overview for Australian consideration. Australian Psychologist, 26 (2), 103-107.

LeVine, P. (1993). Morita therapy and its divergence from existential psychotherapy: A proposal for adopting a Morita-based philosophy for use in psychotherapy. International Bulletin of Morita Therapy, Autumn, 56-78.

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