Psychologia. 1958. 1. 231-236.

NOTES ON TRENDS AND PROBLEMS OF PSYCHOTHERAPY IN JAPAN

T ADASHI TSUSHIMA

Kyoto Prefectural Saikyo University

INTRODUCTION

As it was so in the West, there have been various kinds of pre-scientific ideas and techniques of psychotherapy in Japan since several hundred years ago. Some of the famous books written by Japanese old scholars and wise men such as Yojokun-" The dis­ ciplines for good health" by Ekiken Kaibara (1630-1714) who had a very rich back­ ground in Chinese philosophy and literature, and Yasenkanwa-" Free talking on a night boat" by Hakuin (1685-1786), a Zen-Buddhist monk who suffered from a kind of serious neurosis are considered to have very fruitful scientific implications even from the viewpoint of the contemporary psychosomatic medicine (3). These kinds of psychothera­ peutic or mental hygienic ideas are deeply rooted in Buddhism, Yoga, Chinese philo­ sophies, Bushido-training and some Japanese religions centered around Shinto-a kind of national religion in Japan before World War n. However, we may say that considerable scientific interest in psychotherapy started after Japan had been baptisized by the western medical and psychological sciences about half a century ago. In the present-day Japan, one might find there almost any schools or orientations of psychotherapy in the West. But generally speaking, most of them have not well matured yet because of the lack of training system and agencies as well as research works in this field. It may be legitimately said that the interest in counseling and psychotherapy both in the academic and civil worlds has greatly developed after World War n under the influence of the West, especially the United States of America. In fact, the U. S. Occupation educational policy was an impetus of the deep influence of the American academic trends upon our psychological field. Also the development of psychotherapy in Japan in the last decade could not be considered separately from the improvement of democracy and awareness of individuality in this country. Before World War n, roughly speaking, psychotherapy was not seriously taken into the acade­ mic fields of psychiatry and psychology mainly because of the strong influence of the German school in psychiatry and the social situat:o:lS. Most of the psychiatrists used to be engaged in psychopathology and neurology being interested in treating the severer mental disorders and they exclusively used drugs and shocks. On the other hand, only a small number of psychologists had been interested in clinical treatment of the emotion­ ally disturbed because of the academic trends which put too much emphasis on ex­ perimental psychology on perception and sensation, and the lack of job opportunities and the concerned agencies in clinical area. Now, there are some 2100 members in the Japanese Association of Psy~hiatry and Neurology, and only about two percent of them se::m to have serious interest in psycho­ therapy. Also, there are some 1600 members in the Japanese Psychological Association, and about half of them are ei ther teaching edllca tional or clinical psychology or engaged in

23 1 TSUSHIMA clinical practice,* so more than several hundreds of the Japanese may have, more or less~ honest academic interests in psychotherapy. We have had more than one hundred translations of American and European books of various schools in psychotherapy, but most of them were published after World War ll. We have also had some Japanese original books and papers on psychotherapy before and after the War, and among them, the most extensive and representative one may be that written by Tsunero lmura, professor of psychiatry at Nihon University, formerly the head of the Department of Psychology at the National Institute of Mental Health (3). In that book, one may get a fairly good view of the picture on psycho­ therapy till 1952 when it was published. It consisted of nine chapters: Chapter I-What is psychotherapy? Chapter II-Psychotherapeutic situation, Chapter Ill-Diagnosis, Chapter IV-Support, Chapter V-Expression, Chapter VI-Insight, Chapter Vll­ Training, Chapter VIII-Flexibility of psychotherapy, Chapter IX-Theories of psycho­ therapy. In the following sections, the writer draws a brief survey of the main trends and some problems in psychotherapy in Japan.

MAIN TRENDS OF PSYCHOTHERAPY

Though there mar be many ways to present notes on this topic, the writer will try it according to the following classification. A. Psychotherapy with adults I. Individual approaches lI. Group approaches B. Psycho:herapy with children I. Individual approaches lI. Group approaches A. Psychotherapy with adults I. Individual approaches. Among the individual approaches with adults, (a) Morita therapy, (b) Nondirective approach, and (c) Psychoanalytic approach are presented in the other papers of this issue, so the writer omits the explanations about these three approaches although he gives some comments about them in later section. Several other individual psychotherapeutic approaches should be noted here. (b) Hypnotherapy; Though various kinds of hypnotherapy have been found in many old books in one way or the other, the first academic one was published in 1906 by the late T. Fukurai, a psychologist. This was written as his dissertation for the doc­ toral degree (doctor of letters, or Litt.D.). Then late U. Nakamura published a well­ rounded book on this topic in 19 I 2. The next important publication in this field was done by late K. Nakamura, a psychiatrist and psychological writer, in 1938. It is interesting that though he mentioned in his book "Education is gradual hypnosis whereas hypnosis is quick education," he changed this opinion greatly a few years later, and wrote, "The therapeu­ tic effects are rather superficial and the applicable fields of hypnosis are very limited," and he came to take a viewpoint of Morita therapy largely. The newest academic book in this field is that written by T. Takeyama Hypnosis and suggestive therapy, which was published in 1950. It may be said that hypnosis or hynotherapy is not seriously considered both in

* Forty-five prefectures (states) have more than one child guidance clinics each, about 30 universities or colleges have psychological clinics, and there are several public and private clinics for mental hygiene. Also. several universities have student counseling bureau which serve for therapeutic cOunaeIingwitb students. . PSYCHOTHERAPY IN JAPAN

medical and psychological fields at the present time in Japan, but the writer believes that we should have further explorations on it in terms of its applicability and therapeutic limitations especially in medical practices as well as in relation to secular folk religions which are prevailing here now. (d) Depthpsychological approaches: As psychoanalytic therapy is presented by K. Kake­ ta, the writer is to make a survey on the other kinds of depthpsychological approaches than that one, namely, the existential analysis etc. The existential analytic therapy: The academic interest in this approach started largely after World War n. The translations of three main books such as V.E. FlankIe's have been published in the last several years. Masashi Masaki, professor in educational psychology at Kyoto University, is one of the main figures who introduced nondirective approach and depthpsychological approaches into Japan (See Tomoda's paper in this issue). Though there seem to be some deep theoretical thoughts on psychotherapy in our -country, he may be one of the most distinguished scholars who could develop theoretical and philosophical elucidation on-the basis of psychotherapy and its relationship with human .education. But, in short, it could be said that this approach has not yet given broader influence than the psychoanalytic one has done in the fields of psychiatry and psychology in our country. Ernst Kretchmer's main books have been translated into Japanese by the several psychiatrists and psychologists such as M. Masaki, and they have given considerable influence, too. Besides these depthpsychological approaches, there have been some endeavors to find .new ways in psychotherapy in the oriental thoughts on depth of human mind. Ryo Kuroda published two volumes of books entitled, Studies on "Kan"-a sort of intuition, in 1923 and 1 9 28, in which he tried to clarify the quality of " Kan " in the light of the depth psycho­ logical thoughts both in the East and West. Tempu Nakamura, now a eighty-four years Tokyo Uni­ versity have shown their concerns on this approach in some publications (I). Yoshinori Matsuyama, Doshisha University, showed a keen interest in it in his book, entitled Ab­ normal behayiors (5). The writer also has deep interest in this approach through the direct influence of O.H. Mowrer at the University of Illinois and stimulations mainly from those books as written by the Pepinskys (8), Shaffer and Shoben (2). (f) Eclectic approach to psychotherapy: Most of the Japanese clinical psychologists TSUSHIMA seem to have eclectic approach for some reason or the other, but it seems that they have almost the same idea as follows: There is not a single approach to be able to treat in­ dependently all kinds of problems of clients in various psychotherapeutic situation at pre­ sent. They accept non-directive approach basically but recognize the necessity of diagnosis and directive techniques in some occasions when it is more effective. The writer himself: belongs to this school, because he believes that this approach is principally the most scientific one at the present time. Lastly, it should be noted here that as far as individual psychotherapy or personality counseling is concerned, the several American seminars especially the one held in 1955 for three months at Tokyo University with the three distinguished lecturers, W.P. Lloyd, F.P. Robinson and E.S. Bordin, have left broad stimulations on it. After that, E.G. Williamson and also Bordin as his second visit to Japan gave impressive lectures on the concerned topics at Tokyo University and Kyoto University. n. Group approaches to adults. The group therapeutic approach to counseling and psychotherapy has been remarkably developed since 1949 when the Institute for Educa­ tional Leaders for group dynamics was held at Kyushu University under the sponsorship of the U.S. Government Education Department. Until that time there had been little notable endeavors in this field in Japan. The Center of Group Dynamics was established at Kyushu University after that IFEL, and Jyuji Misumi at that university, who is the author of In­ troduction to social techniques (6) is one of the most active psychologists in this field in our country. H.S. Coffey, professor at the University of California and former student of K. Lewin, stayed at Kyushu University three months in 1958 and left more specified orienta­ tions and techniques in group therapy. We have had several translations of the main books in this field such as Slavson's, as well as we have had several original books and some research works in this field. But, generally speaking, it could be said that group therapy is still much younger than the individual one in Japan. Academic interests in psycho­ drama has also developed rapidly since around 1950. Daisaku Sotobayashi at Yokohama University, J. Misumi and the writer have strong interest in this method and they visited J.L. Moreno while they were in the United States. After returning to Japan, they have organized research meetings of psychodrama in each way. Kohei Matsumura, Ochanomizu College, is quite active and influential in this field. The first issue of the magazine, Psycho­ drama, was published in February 1958. But the application of psychodrama to the psychotics seems to have never been done in Japan. Here, it should be noticed that the group thera­ peutic approaches have developed quite remarkably since 1950, several years later than the democratic reform which was made at the end of Wodd War n. B. Psychotherapy with children 1. Indiyidual approaches. In the field of individual child-psychotherapy, the eclectic onc may be most prevailing, next perhaps play-therapy (See the paper by Hatase in this issue), and then psychoanalytic one. As it was described before, there are almost 70 child guidance clinics in the present day Japan, and most of the clinical psychologists engaged in these agencies are likely to use eclectic therapy more or less. Play therapy with children are adapted in several clinics and the one attached to the Department of Education, Kyoto University, is one of the most active ones in it. There are some psychoanalysis with children, and among them, the most active onc may be Seishi Shimoda who is the author of several books in this field as well as the translator of the series of A.S. Niehl. Lastly, personality counseling and psychotherapy PSYCHOTHERAPY IN JAPAN 235 with the ment'llly retarded h'lve been done to so~ne extent in sev::ral institutiom among which Omi-gakuen in Shiga Prefecture may be the most distinguished one because of the th:>roughness of therapeutic endeavour with strong and intellectu'll humanism. But in general, Japan is still in severe lack of this kind of agencies and institutions. Yasumasa Miki, professor of education at Tokyo University, is the leading figure in this field, who has organi~ed the Association of the Education for the Mentally Retarded through his persistent endeavors. lI. Group approaches. Among the group therapies with children play-group-therapy may be the most prevailing one, next transitional-group-therapy and activity-group­ therapy in Slavson's terminology (10). Among several institutions where play-group­ therapy is utilized, the Institut! for Child Development (Aiiku Kenkyusho) in Tokyo may be most active. Transitional-group-therapy is mostly adopted by Y.M.C.A. or Y.W.C.A. activities. Psychodrama seems to be applied more to children than to adults for educational, rather than psychotherapeutic purposes in the strict sense. It is also noticed here that psy­ chodrama has found wider interests among psychologists and school teachers than among psychiatrists in this country. Generally speaking, group therapy with children is also much weaker and immature compared to the individual therapy with children, as we found the same situation with adults.

SOME PROBLEMS IN PSYCHOTHERAPY The problems in psychotherapy in Japan will be discussed from both sides-theoreti­ cal and practical. First, as for Morita Therapy, the writer thinks that this approach is con­ siderably directive, though it is client-centered especially because it puts emphasis on the client's self-realization. The problem of Morita therapy may exist in its directiveness. The present social atmosphere and personality of the young generation may cause some limita­ tions in the effects of this therapy. In other words, Morita therapy seems to be deeply rooted in the authoritative social climate of about 40 years ago when it was established. But, as I mentioned before, the Japanese society has changed so much to the direction of democracy, and especially the personality of the people under the age of 20 or 25 who have received the past-war education is surprisingly democratic compared to those of their elders. Furthermore, the Japanese medical doctors seems to be rather authoritative, maybe because of their environmental conditions and training systems. The writer believes that personality change or, at least, attitude reformation of the therapists of Morita therapy school may be necessaty if they want to be more effective to the younger and coming generations. The modifications of therapeutic techniques are also required for the same reason. Here we remember Moreno's comment, "The personality of the therapist is the skill, because ...... " in psychotherapy, "it is extremely difficult, if not impossible, to separate, the skill from the personality of the therapist (7)." Second, on non-directive approach, the writer believes that the same kind of problem may exist when we try to adapt it to Japanese society. So far as the writer has observed, this therapy, works less effectively with the older and rather authoritative generations. This fact may suggest problems for the non-directive approach in Japan. Third, on learning approach to psychotherapy, the writer thinks that we Japanese psychologists both in clinical and experimental fields, should have more interest in it be­ cause personality changes are principally considered as learning process, and that all terms in various psychotherapeutic schools will be integrated into learning terminology in the TSUSHIMA long run. Fourth, on depthpsychological approach, the writer thinks that we Japanese psycho­ logists should, in general, have much stronger background of it especially on neo-freudian approach in order to have sounder and more sufficient diagnosis and psychotherapy. He also believes that we oriental psychologists should make our efforts in order to establish a newly organized depthpsychology based on our oriental thoughts in relation to Western ones for the improvement of the contemporary human sciences. Next, the most serious problem in practical aspect may be that in training system of psychotherapists in our country. As described before, clinical psychology in Japan has developed quite rapidly in the past 10 to 15 years, the training systems or curriculums for counselors and psychotherapists are still considerably immature in each department of psycho­ logy, education or psychiatry. Not a small number of the clinicians who are engaged in psychotherapy in our country have, more or less, trained themselves by experience without any severe supervision or guidance of the specialists. No university has such well matured programs for the clinical psychologists as the one in the first class universities in the United States. But, at present, about ten universities are going to establish an adequate program for training personality counselors and clinical psychologists in order to meet the strong social and academic needs.

REFERENCES

I. *Azuma, H. Neo-behavioristic approach to counseling. In Counseling Edited by K, Sawada. Tokyo: Seishin Shobo, 1957. 2. FIankle, V. E. Aw:tliche Seelsorge. 6. AuR. 1952, Japanese translation by T. Shimoyama. Tokyo: Misuzu Shobo, 1957. 3. *Imura, T. Psychotherapy. Tokyo: Sekaisha, 1952. 4. *Kaketa, K. et ai, Psycho-somatic medicine Vol. 3. Tokyo: Nihonkyobunsha, 1957. 5. *Matsuyama, Y. Abnormal b,ha"iors. Tokyo: Rironsha.1957. 6. *Misumi, J. An introduction to JOcialtcchniques. Tokyo: Hakua Shobo. 1954. 7. Moreno, J.L. Psychotherapy, present and future. In ProgreJJ in psychotherapy Edited by Frieda Fromm­ Reichmann 81: J.L. Moreno. New York: Grune 81: Stratton, 1956. 8. Pepinsky H.B. 81: Pepinsky P.N. Coumeling. New York: Ronald Press, 1954. 9. Shaffer, L.F. 81: Shoben, E.J. The psychology of adjuJlment. Boston: Houghton MifHin, 1956. 10. Slavson, S.R. Group psychotherapies, Six approaches to psychotherapy. Dryden: New York, 1954. *Written in Japanese. MS. received X 20, 58 Tadashi Tsushima (i'!!!i1I! .'it'. 1923-) Graduated from Kyoto Un;versity in 1949. 1950- Clinical psycho­ logist, Kyoto Pref. Central Child Guidance Clinic; 1951- Assist. prof., Kyoto Pref. School of Fine Arts; 1953- Lecturer to assist. prof., Kyoto Prefectural Saikyo University. 1955-1957, Fulbright scholar at the Univ. of Illinois (with Mrs. Tsushima).