Morita Therapy
Developed by Japanese psychiatrist Shoma Morita in the early part of the twentieth century, Morita Therap was influenced by the psychological principles of Zen Buddhism. His method was initially developed as a treatment for a type of anxiety neurosis called shinkeishitsu.Over time the principles of his approach have been adapted to outpatient settings and expanded to address not only emotional well-being but to improve function in many aspects of day to day life.
Two Conflicting Agendas
Morita proposed that human motivation was influenced by two opposing drives; a desire to live fully (self-actualize), and a desire to maintain security and comfort. He noted that these two drives were often in opposition. To the extent that a person pursues their most valued goals (relationships, education, parenting, career building, etc) they often experience discomfort and insecurity (anxiety, self-doubt, financial or personal risk, etc.). Morita observed that the more people attempt to avoid or suppress feelings of insecurity the more it disrupts their ability to function. Furthermore, their attention becomes increasingly fixated on erroneous efforts to escape unwanted feelings, resulting in the paradoxical effect of enhancing the frequency and intensity of the very experiences they are trying to avoid. Over time this results in increasing intolerance of unpleasant thoughts, feelings, and body sensations; an escalating mental obsession with and related enhancement of unwanted experience; and a decline in a person’s ability to take purposeful actions.
Arugamama
The goal of Morita Therapy is arugamama (acceptance of life as it is). Very often, humans experience dissatisfaction with life as it is in comparison to life as they can imagine it should be. We fall short of our own expectations, or feel frustrated with people who are not as patient, kind, or helpful as we believe they could be. Our mind has made a judgment; life is not the way that it should be. The natural result is that we strive to make life more closely match our ideal. This might seem to be a perfectly reasonable formula for improvement (notice what is wrong and make changes until it is right). There are however, some serious drawbacks to this approach. One problem is that as soon as we achieve a closer approximation to our ideas of perfection our mind is able to imagine how life could even be better. When we achieve that, the mind sets a new goal. The result is that we live in a kind of constant dissatisfaction with the present moment, comforted by the belief that once we fix what is wrong we will be satisfied. However when that “future” arrives it is just another dissatisfying present moment. In this way we live as if the present moment is a barrier to where we would rather be living. We may never really experience a deep satisfaction with the way things are in this moment, and the idealized future never arrives. Our life can become like the pursuit of an idealized mirage that grows ever more distant the more we pursue it. Another problem is that our mind is capable of imagining and wishing for things that have nothing to do with how life is. For example, people want to adopt lifestyles without experiencing the natural outcome of those lifestyles. People imagine that they can neglect and abuse their bodies and not experience negative effects to their health. People imagine that they can live fully and not experience the uncomfortable thoughts and feelings that are naturally a part of that kind of life. Morita described this as a kind of “contradictoriness of thinking”.
The Naturalness of Feeling Bad
It is a common assumption that the problem at the core of emotional distress is the presence of certain thoughts and feelings. Naturally the solution to "feeling bad" must have something to do with altering these problematic thoughts and feelings. Morita observed that even very unpleasant or irrational thoughts and feelings are quite common. He suggested that people naturally experience distressing feelings like anxiety, depression, and inadequacy. We all think irrationally on a regular basis and frequently employ so called “cognitive errors”. He suggested that unpleasant feelings or irrational thoughts were not the hallmark of abnormal psychology. Instead it was people’s attempt to suppress or avoid such experiences which lead to problematic behavior. If a person feels anxiety or has some catastrophic thoughts on the day of their wedding this would not be unusual. However, if a person does not go to their wedding in order to avoid these thoughts and feelings this is problematic. The behavior is a problem, the thoughts and feelings are natural. It is a person's response and relationship to thoughts and feelings that is at the core of the problem, not the thoughts and feelings.
The Uncontrollability of Internal Experience
Central to Morita’s theory is the observation that thoughts, feelings, and body sensations are uncontrollable through an act of will. Furthermore, that efforts employed to avoid or suppress unwanted internal experiences often have a paradoxical effect in the long run, increasing both the intensity and frequency of the unwanted experience. It is like trying to eliminate thoughts of a yellow crayon. Efforts often lead to more thoughts and associations related to yellow crayons. Even if a person is able, through some distraction technique, to avoid all "yellow crayon" thoughts, the effort required is not a sustainable solution, and short-term avoidance is typically followed by a surge of related thoughts once the suppression technique is stopped.
“Trying to control the emotional self willfully by manipulative attempts is like trying to choose a number on a thrown die or to push back the water of the Kamo River upstream. Certainly, they end up aggravating their agony and feeling unbearable pain because of their failure in manipulating the emotions.”
Shoma Morita, M.D.
Actions are Controllable
Morita notes that actions, unlike internal experience, are controllable. It is possible to act independently of or even in opposition to our thoughts and feelings. Most people can readily identify a number of examples to illustrate this concept. We wash dishes and do yard work that we don’t feel like doing. We speak in public and take tests even when filled with self-doubt. We are able to dive off of a high-dive or jump from an airplane without first eliminating feelings of anxiety.
Once we learn to accept our feelings we find that we can take action without changing our feeling state. Often, the action-taking leads to a change in feelings. For example, it is common to develop confidence after one has repeatedly done something with some success.
Self-Centered Attention and Suffering
If we observe our experience, we find that we have a flow of awareness which changes from moment to moment. When we become overly preoccupied with ourselves, our attention no longer flows freely, but becomes fixated on a self-centered focus. The more we pay attention to our symptoms (our anxiety, for example) the more we become trapped. When our attention is absorbed by what we are doing, we may not notice uncomfortable or painful feelings. However, when we try to “understand” or “fix” or “work through” feelings and issues, our self-focus is heightened and exercised. This often leads to more suffering rather than relief. How can we be released from such self-focused attention?
“The answer lies in practicing and mastering an attitude of being in touch with the outside world. This is called a reality-oriented attitude, which means, in short, liberation from self-centeredness.”
Takahisa Kora, M.D.
The successful student of Morita therapy learns to be aware of and accept the moment to moment fluctuations of thoughts and feelings without unnecessary struggle or resistance. He/she learns to ground behavior in reality and takes constructive actions that meet the needs of the situation. Cure is not defined by the alleviation of discomfort or the attainment of some ideal feeling state (which is impossible) but by purpose directed actions which helps one to live a full and meaningful existence rather than to be ruled by thoughts and feelings.
The methods used by Morita therapists vary. In the traditional inpatient approach there is a period of isolated bed rest before the patient is exposed to counseling, instruction and occupational therapy. Increasingly, Morita principles are being applied in outpatient settings. In the U.S., inpatient Morita therapy is generally unavailable, and most practitioners favor a counseling or educational approach, the emphasis of which is on developing healthy living skills, learning to work with our attention, and taking steps to accomplish tasks and goals. For this reason, Morita therapy is sometimes referred to as the psychology of action.
“In general, the stronger we desire something, the more we want to succeed, and the greater our anxiety about failure. Our worries and fears are reminders of the strength of our positive desires....Our anxieties are indispensable in spite of the discomfort that accompanies them. To try to do away with them would be foolish. Morita therapy is not really a psychotherapeutic method for getting rid of “symptoms”. It is more an educational method for outgrowing our self-imposed limitations. Through Moritist methods we learn to accept the naturalness of ourselves.”
David Reynolds, Ph.D.
Naikan
Naikan is a Japanese word which means “inside looking” or “introspection”. It is a structured method of self-reflection that helps us to look at ourselves, our relationships, and our actions from a new perspective. Reflecting on our lives through the lens of Naikan often transforms long held but inaccurate beliefs about our lives. In turn this perspective will often give rise to feelings of gratitude, indebtedness, and responsibility.
The following description appears in the book Naikan: Gratitude, Grace, and the Japanese Art of Self-Reflection written by Gregg Krech.
Naikan was developed in Japan in the 1940’s by Ishin Yashimoto, a devout Buddhist of the Pure Land (Judo Shinshu) sect. His strong religious spirit led him to practice mishirabe, an arduous and difficult method of meditation and self-reflection. Wishing to make such introspection available to others, he developed Naikan as a method that could be more widely practiced.
Naikan broadens our view of reality. It’s as if, standing on top of a mountain, we shift from a zoom lens to a wide-angle lens. Now we can appreciate the broader panorama - our former perspective still included, but accompanied by much that had been hidden. And that which was hidden makes the view extraordinary.
Naikan’s profound impact resulted in its use in other areas of Japanese society.Today, there are about 40 Naikan centers in Japan, and Naikan is used in mental health counseling, addiction treatment, rehabilitation of prisoners, schools, and business.
Naikan is simple to learn. It is based on three basic questions:
What have I received?
What have I given?
What troubles and difficulties have I caused?
Used creatively these questions can shed light on the hidden aspects of our relationship to all things; on the fundamental nature of how we view our life. Ultimately Naikan is a dedication to the truth. Not the self-serving construction of what we think about ourselves, but a search for the actual events of our lives as they might be experienced by those around us. This truth, though sometimes daunting, is also liberating.
Acceptance and Commitment Therapy
A number of Mindfulness-Based Cognitive Behavioral Therapy approaches have emerged over the past 2 decades. Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavioral Therapy (DBT), and Acceptance and Commitment Therapy (ACT) are prominent examples. One feature these approaches have in common is considerable research supporting their effectiveness with a wide array of human problems; depression, anxiety, addiction, chronic pain, to name just a few .
It has been noted that these approaches share many basic assumptions and concepts with Morita Therapy. Anyone familiar with the basic assumptions of Acceptance and Commitment Therapy has to be impressed by the incredible parallels to Morita.
We believe that anyone interested in Morita Therapy would be well served by understanding ACT and vice versa. ACT is arguably the most empirically based therapy, emerging from Relational Frame Theory, a study of language and its relationship to human suffering. ACT has not only amassed considerable evidence of its clinical effectiveness, but also support for its basic assumptions about the mechanisms by which it works. The ACT community has also developed helpful tools for assessment and clinical intervention that Morita Therapists can benefit from.
Morita Therapy in turn offers ACT practitioners 80 years of intervention experience. When I have asked expert practitioners of Morita Therapy how their practice differs from ACT, most have responded that Morita interventions are often grounded in purposeful activities within naturalistic settings, rather than simulated or conceptual interventions within clinical settings. This is a generalization. I have also heard ACT therapists talk about the importance of working with their clients in “real-life” settings while engaging in purpose centered activity. However, ACT evolves out of a clinical tradition that is largely verbal. Western practice is predominantly occurring in offices and clinics. By contrast, Morita Therapy evolved out of the experiential learning tradition (zen) which gave rise to flower arranging, tea ceremonies, and archery as vehicles for transformation. Traditionally Morita Therapy occurred in a home setting and emphasized occupational methods like sweeping the floor and chopping wood to teach core principles.
We believe there is a lot of potential for ACT Therapists and Morita Therapists to learn from one another. We also believe that combining approaches common to Morita Therapists with interventions used by ACT therapists is of great benefit. In our own experience we have found a comfortable and effective integration of the two approaches.