1. Turning Treatment Crisis to Advantage to Facilitate the Process of Morita Therapy. ○ Yosuke Mochizuki, MA. 1), Ryoichi Hoshino, PhD. 1)2), Yasuhide Iwata, MD. 1), Syu Takagai, MD. 1), Jun Inoue, MA. 2), Tomoko Watanabe, MA. 1), Norio Mori, MD. 1) 1 ） Hamamatsu University School of Medicine 2 ） Kanarekai Kojin Hospital 7th International Congress of Morita Therapy Sebel Albert Park Hotel, Melborune Thursday 4 - Saturday 6, March 2010

2. Introduction Morita therapy has been used for nearly 80 years as a therapy for anxiety-based disorders(and Shinkeishitsu). Recently, it is said that patients,who express their childish mind with psychotic anxiety and complicate the therapy, are increasing (Ushijima,2003). We also realize that it is sometimes difficult to apply the original Morita Therapy to recent patients. They often lack tolerance and over-idealise, harbor dependent personalities, and exhibit immature interpersonal skills.

3. Introduction We introduced Morita Therapy to two patients with anxiety disorders. During the sessions, they repeatedly expressed impulsive and unreasoning behaviors relevant to their immature interpersonal skill. It was the situation that we had to consider therapy interruption, if we applied the original Morita Therapy to them. However we took therapeutic tactics which turned these crises to advantage to facilitate the process of Morita Therapy, and could make our treatment more effective to them. In this presentation, we will exhibit how the therapy could be effective to them as the result of our tactics.

4. Case A 20’s male Diagnosis social phobia Chief Complaint too nervous to talk with others and to stay in front of others. History of Life and Present Illness He is the first of 3 children. He went to a school with a unified lower and upper secondary school program, but his school performance was not good. After he graduated, he went to cram-school for going to University. Three years ago, he had symptoms, such as shaky hands and excessive sweating in his classroom, and then he became unable to go to his school. Last March, his mother thought he needed to receive Morita Therapy, so he came to the University Hospital of Hamamatsu University School of medicine. He was hospitalized for receiving Morita Therapy last April. Case A

5. Isolation and Rest period Occupational Work Period Preparation for Daily Living Period Case A process of Morita Therapy He finished Isolation and Rest period in 7days. During the period, he was taken some medication such as SSRI and anti-anxiety. He had finished Light Occupational Work and Intensive Occupational Work period in 5 months. He expressed some impulsive and unreasonable behaviors during this period. Crisis points !!

8. Case A Afterward Case A fixed and stored his diary, and continued his therapy. When he told his anger at a trivial matter, we directed him to review his diary, and conveyed him emphatically not to get away from his work by his anger and impulsive behavior. We told him repeatedly that “it is the opportunity for your growth when you want to throw away everything by your anger” and led him to keep thinking his coping through Morita work. By continuing the therapy, he could engage in Morita work with his frustration.

9. Isolation and Rest period Occupational Work Period Preparation for Daily Living Period Case A process of Morita Therapy He finished Preparation for Daily Living period in 1 month. He could make concrete plan for talking with his parents about his path in life. After deciding his path in life, he left the hospital. He could fulfill a role of the leader of Morita-Group.

10. Case B 20’s female Diagnosis panic disorder Chief Complaint want to be able to work normally. History of life and present illness She is the second of 2 children. She has graduated form University for pharmacology. When she was a university student, she experienced first panic attack in a train. Three years ago, she came to our hospital, and was hospitalized for receiving Morita Therapy. She could pursue her treatment to Preparation for Daily Life period. After she left the hospital, she worked with taking medication. However her interpersonal relationships were getting worse. 6 weeks later after she left the hospital, she quit her job, and her primary doctor advised her to receive Morita Therapy again. June 2 years ago, she was rehospitalized. Case B

11. Isolation and Rest period Occupational Work Period Preparation for Daily Living Period Case B process of Morita Therapy She was not applied to Isolation and Rest period, because of her vulnerability for anxiety and impulsion. Being taken some medication, she started Intensive Occupational Work period and had finished it in 7 months. She expressed some impulsive and unreasonable behaviors during this period. Crisis points !!

14. Case B Afterward She repeatedly expressed her dissatisfaction, with crying and using violent languages to staff. Each time, we talked her that she just had a tantrum that she could not manipulate things as she wished. We explained her “It is the therapy that endure the things that you can not do so. There is no hospitalization treatment that you never get offended”. Although she failed many times in the therapy, we led her through to engage in Morita work, while her holding dissatisfaction. Gradually she acquired the skill of starting with easy things she could deal in and reduced her expressing aggression to others.

15. Isolation and Rest period Occupational Work Period Preparation for Daily Living Period Case B process of Morita Therapy She finished Preparation for Daily Living period in 1 month. She could get her job and left the hospital. She has been working at one place for about 1 year, not getting away from the work by her dissatisfaction. It is the first experience in her life. She could fulfill a role of the leader of Morita-Group.

16. Turning Treatment Crises to Advantage Our Understanding We interpreted their aggression as compensatory expression of their dissatisfaction and feeling of imperfection not to be able to solve the problems by themselves (feeling centered attitude). Behind their dissatisfaction, we assumed, there were excessive desire for life, such as “I want to do everything successfully and perfectly”. Instead of regarding patients’ acting out as treatment crises, we treated them as primary therapeutic tasks that needed to be overcome in the therapy by them (reframing our view point).

17. The therapy should lead them to think specifically about what they should have done and how they needed to modify their coping, and then we encourage them to apply their modification to actual problems. Specific Our Interventions Turning Treatment Crises to Advantage Concrete Interventions

18. The Effect of Our Therapeutic Tactics Step by Step Process They struggled all the time, with suffering the gap between their own excessive desire for life and the reality. They were repeatedly gotten to learn their mistakes and address other problems, even if attempting to get away from problems by acting out (feeling centered attitude). They came to have consciousness to have to wrestle with real problems without running away by acting out. While holding dissatisfaction, they were able to start with easy things they could deal in, and acquired realistic coping strategy. Acquiring the interpersonal skills that they did not camouflage problems by acting out, they could exert natural desire for life.

19. Conclusion Through 2 cases, we presented our therapeutic tactics for turning treatment crises to advantage. We interpreted their acting out as compensatory expression for their dissatisfaction, so in the therapy, we led them to take the initiative in solving problems by recognizing the reality. Failing repeatedly, they were able to start with easy things which they could deal in. This process led them to be able to exert their natural desire for life. And then, they could complete the therapy. By turning treatment crises to advantage, we can change these crises into opportunities for growth of patients’ acceptance ability, which is that they can hold their own dissatisfaction and anger.