Healing with Morita therapy

written by The WellBeing Team

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Many people in their lifetimes encounter feelings of grief, worry, hopelessness and fear. These are all quite common in the human experience. Changing them or trying to overcome them makes these feelings more rampant, intensifying their effect and adding new feelings of frustration. Our focus becomes fixated on dealing with our emotions and we lose perspective on how to take necessary action for a wholesome life.

Many Western therapeutic methods focus on trying to manage or modify these feelings, based on the assumption that emotions are what hold you back. But Morita therapy challenges this and contends that these natural responses, if untampered with, serve as a guide to live an authentic life and face life’s many situations.

Based on his own clinical observations, Morita Shoma, a Japanese psychiatrist, devised this highly structured form of residential therapy in 1919; it consists of four distinct stages. He was disillusioned by the harm caused to inpatients while being confined in dismal places and decided to take them into his country home for complete rest initially and then progressed his therapy to include art, diary writing, interaction with the environment and outdoor activities while observing that the safe familial environment fostered responsive healing.

Morita therapy was initially designed to treat those suffering from a Japanese syndrome called shinkeishitsu, characterised by excessive worry and an over-focus on bodily symptoms. In his book, Morita Therapy and the True Nature of Anxiety Based Disorders, Morita writes, “The goal of medical science is to cure illness and to enhance the quality of life. When separated from life as a whole, illness has no meaning.”

Morita was of the view that mind=body=spirit, an important fundamental of Zen and one of the many Zen principles incorporated in his treatment. He observed that the more one tries to get rid of symptoms by speaking about it, the more it stays in focus and decreases the wellbeing of the mind-body-spirit, a concept rendered as kokoro in Japanese. He thus designed his treatment to be less reliant on verbal exchange and medication.

“Morita therapy was designed to bring one to a middle path in the balance of desire and fear. Too much focus on getting rid of feelings that are judged as bad keeps those uncomfortable feelings in one’s field of vision longer,” says Dr Peg LeVine, clinical psychologist, anthropologist and director of the LeKond Institute of Morita Therapy in Victoria and co-founder of the American Institute of Morita Therapy in the USA.

“Morita takes someone from an unnatural state to a natural state, rather than from abnormal to normal state,” says Dr LeVine, who has been trained for over 20 years in the lineage of Shoma Morita and is the only clinician who practises Morita’s classical four-stage residential treatment in an English-speaking country.

”Morita therapy assists a person’s capacity to spread awareness and experience the natural world with all the senses — see, hear, taste, smell and touch. Intuition untouched by convention or trauma is part of that sensing system, too. Sometimes when people are traumatised, these senses take on a different meaning. Morita brings one back to original sense capacity and trust of intuition,” she explains.

Because this therapy returns the person to the ordinary, it has remarkable capacity to be applied across cultures and places. While neo-therapies have rendered Morita therapy too Japanese to be transferred across other cultures, today the classical treatment is not only applied in hospitals in Japan but has extended to Australia, China, Korea, Russia and developing regions of SE Asia. Professionals obtain training and first-hand residential experiences at the LeKond Institute of Morita Therapy here in Australia. The therapy has also been incorporated into post-graduate coursework in North America and Australasia.

Emotions explained

The foundation of Morita therapy is the guiding principles of emotions explained by Morita. He emphasised that his therapy is based on emotional facts, wherein one’s emotions stands alone as their own facts without the need for any interpretation, manipulation or judgement. He writes, “Ponder the old lesson … when one is angry and wishes to fight, think it over for three days before taking action. This lesson supports the fact that an intense emotion will disappear naturally over the course of three days.”

Pain and suffering will gradually subside if we allow them to follow their natural course. Emotions, when left on their own, will follow their own paths, erupt initially, climax and then lessen or altogether disappear. It has been observed that emotions intensify when the stimulus is continuous and the attention is over-focused. Emotions stay in a heightened state.

“Emotion becomes stronger when a person expresses it beyond its natural course,” Morita says, just as quarrels become more intense when past injustices are brought up. Emotions are also learnt through new experiences and fostered by repetition. “We can cultivate courage and self-confidence only through repeated experiences and successes. Through such processes, we become used to the pain that accompanies effort and we learn the pleasure of success,” explains Morita. By responding to our emotions and thoughts as they are, we are better able to respond to life’s many situations in a naturally healthy way. Morita referred to this acceptance of feelings as arugamama.

Dr LeVine adds, “While arugamama has been rendered in English as “accept things as they are”, essentially it means “respond to things as they are”. One does not have to accept what is happening or has happened, but if one does not respond according to reality, in the context in which one is living, then one suffers more.” She says, “Most often, feelings are not an either-or proposition. In my work with children, I offer a simple scheme of five experiences they might feel simultaneously: mad-sad-glad-bad-scared.

“It is the adult who pushes to rank-order these and highlight glad over mad or glad over sad, or glad over scared. Such better-worse categorising actually gets in the way of a child’s natural course. Feelings do not rank feelings — the mind does.” In her recent book, she explains, “When a person struggles to control emotion or cover up emotion by intellectual interpretations of what constitutes good or bad, s/he works against the fact that emotion has no valence.”

Four-stage therapy

Morita therapy is effective for treating a range of anxiety-based disorders, post-traumatic stress, depression and other adjustment disorders. Morita strongly recommended the screening of his patients before they started the treatment. “Those with a history of schizophrenia, intellectual disability and manic stages of bipolar disorder are most in need of risk assessment, and those with suicidal ideation and substance dependency would be ruled out due to the way in which supervision of patients is designed,” explains LeVine. The standard treatment lasts for 25 days, with each stage lasting for 5–7 days. The therapist will look for signs of progress in patients before they transition into the next stage.

Stage one consists of social isolation, silence and rest. Morita was intrigued by his contemporary Sigmund Freud’s use of the prone position in psychoanalysis and was interested in how the reclined position leads the patient’s emotions to wander freely and with less worry. The patient maintains supine position and is not allowed to read, speak to anyone, smoke, listen to music or watch television. When patients enter the first stage they are usually less engaged in the physical and natural environment. At this stage, the patient recovers from mental and physical fatigue and the therapist has the opportunity to observe the patient while resting. These observations are then used to further the therapy.

While verbal interaction with the therapist is minimal and emotional complaints are ignored by the therapist, the therapist does offer a clear, safe presence. The patient is asked to simply observe the rise and fall of emotions in this silent state. LeVine explains that the reason for such dismissal is to break any judgements of emotions as positive or negative. As a result, the patient will experience the full spectrum of emotions and observe that they mirror the dynamics of the natural environment. Patients ultimately become bored with their symptoms after four days and notice that the more they seek stimulation from the environment, the less entangled in the interpretation of emotions they are. Emotion and thoughts find their natural course without meditation or medication.

Joshua, a psychologist in his 40s from Tasmania, who experienced Morita therapy in 2009 in a small psychiatric hospital in Japan, says, “Stage one of Morita therapy was pivotal for my experience. I won’t pretend it was an easy thing. There were many things that were difficult, not the least of which was being in a different country in the midst of a different language and different social norms. You would probably think of ‘bed rest’ as lying in a comfy bed, tucked up under a doona, sleeping when you feel like it and pondering whatever is troubling you. The stark reality of lying on an inch-thick Japanese futon on the floor, staring at the wall and ceiling for days and nights, adds new dimensions to ‘uncomfortable’.

“It was also emotionally intense at times,” he adds. “But, apart from all that, there was something therapeutically pivotal that happened. Toward the end of it, my relationship to my (psychological) stuff changed of its own accord. Experiencing my own mind without the clutter and noise of the stuff that was going on in there; it was a very clear, clean and open experience.”

Having undergone the classical four stages as part of her clinical training in 1980, LeVine reassures: “The therapy is not one of endurance because it is staged and the classically trained therapist has developed the observational and clinical skills to support the client over the course of treatment. Isolation does not mean neglect.”

Stage Two consists of light repetitive work. The patient is encouraged to go outdoors and is instructed to undertake gardening activities such as weeding, planting or light raking. This stage begins with boredom and discomfort but, as soon as the patient becomes engrossed in the natural environment and participates in purposeful activity, the focus on worrisome symptoms declines. The therapist encourages the patient to partake in those elements of nature that seem to interest him. This could be the sounds of birds, or the activity of the sun or the changing length of shadows.

LeVine speaks of one patient called Raol, a first-generation Australian gay man from southern Europe: “He wrote in his diary about his personal history related to childhood sexual abuse in ways that asked me to be his witness; I wrote something simple and profound in the margins of his diary. The next morning I had an assistant teach him how to do woodcarving. He became engaged in this activity and eventually his urge to have a witness to his past experiences subsided. A turning point for him occurred when he woke to the sound of a parrot outside his window … His past became more background than foreground over time. He later said he was able to experience pure grief without his mind interfering and that he could still stay active in the garden when he felt confused.”

Stage Three is about labour-intensive work, focused diary-writing, art and communal meal preparations. The patient begins talking with others, however the conversation is restricted to the task at hand. The therapist does not respond to the patient’s attempts at emotionally based dialogues. Very often a patient with excess anxiety will form a social bond based on shared suffering. Morita therapy breaks this cycle and, instead, patients are encouraged to provide care to the environment around (fruit trees, pond life, chickens, birds and sheep). The patient will write about his observations in his diary, which the therapist will collect at the end of the day and make strategic comments in the margins. If the patient makes any personal, worrisome disclosures, he is directed to observe and record activity in his natural environment.

LeVine informs, “In this way he is prepared to form intimate relations based on wonder rather than on misery. It is incompatible to be engaged in curious activity and be anxious or depressed at the same time. The client learns this by going through the stages, not because a therapist educates or re-cognates the client. One does not need to work everything out about the past in order to participate in the present. This is an empowering perceptual change that occurs and one that assists the person to persevere, even when unmotivated.”

Stage Four involves social reintegration. The patient travels away from the centre for the first time by taking public transport or walking for communal errands such as posting letters or buying groceries. By the end of this stage, the patient returns to the social world but with an added perspective refreshed by the environment.

During the course of these stages, the patient’s over-focus on self and others spreads out to encompass nature and returns back more integrated. Morita therapy makes use of silence and the animated world of nature and this environment provides the interaction and dialogue for patient and therapist.

Those who have experienced this revelation say the therapy is too experiential to describe it in words. The only way to understand its true nature is to undergo the wondrous transformation of self with Morita therapy.


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