Understanding Morita Therapy

Developed by Japanese psychiatrist Shoma Morita in the early 20th century, Morita is a response-orientated therapy. Meena Azzollini looks at the four steps involved in the process and evaluates the effectiveness of Morita Therapy.

 

Our emotions are an integral part of our everyday life, whether we feel happy, sad, frustrated, angry or surprised. Indeed, our emotions make the human experience rich and every emotion that we feel is important. Emotions guide the choices we make and the decisions we take. They determine how we act and behave and are even responsible for our perceptions.

 

Instinctively, you know emotions can be positive or negative. Naturally, you want to feel positive emotions because they are pleasurable and they feel good. You also want to keep negative emotions, like fear, worry, hopelessness, anger and grief at bay. But negative emotions too, have a purpose even though they bring you down and make you feel unpleasant. These unpleasant feelings give you the push you need to take action that helps you grow and develop yourself.

 

In Western culture, positive emotional states like happiness are considered the ultimate goal whereas negative emotions are seen as those feelings that impede this goal. Western psychotherapeutic treatments like Cognitive Behavioural Therapy (CBT) aim to teach people to manage or control their negative thoughts, and subsequent behaviours.

 

However, Eastern philosophies take a different approach to negative emotions. A 2017 study, which explored positive and negative emotions across cultures, showed that Easterners reported stronger positivity towards sadness than westerners indicating Easterners embraced sadness when they experience it, whereas Westerners feel they should not have to face sadness.

 

One Eastern therapy that challenges this view — that negative emotions should not be faced, or rather, they should be managed to downplay the impact they have on our lives — is Morita Therapy.

 

What exactly is Morita Therapy?

Morita Therapy believes that all emotions – even negative ones – are a natural part of the human experience. If left untampered, these emotions can guide us to live a more authentic life while appreciating reality as it is.

 

Morita therapy, influenced by the psychological principles of Zen Buddhism, emphasises the importance of experiencing feelings rather than shifting or ignoring those feelings as advocated by many Western psychotherapies.

 

Developed in 1919 by a Japanese psychiatrist, Morita Shoma, Morita therapy is a highly structured form of residential therapy which was designed in response to Shoma’s own clinical observations of inpatients confined in desolate places and treated in ways that reinforced their symptoms.

 

Morita began treating patients in his home in a rural setting, with an initial emphasis on rest. He then introduced diary writing, art, outdoor activities with observations of nature as part of his therapy and noted that the safe familial environment was conducive to healing in these patients.

Nature and gardening are an integral part of Morita Therapy shutterstock/Joshua Resnick

 

Morita therapy was initially developed to treat a Japanese syndrome known as shinkeitshitsu, which is characterised by excessive worry (anxiety) and an over focus on bodily discomfort, along with hyperactivity of mental and physical symptoms.

 

Morita argues that shinkeitshitsu, is not a biological disorder but a mental attitude. Shoma found that when patients tried to get rid of their symptoms of anxiety by talking about it, these symptoms stayed within their focus. This over focus decreased their mind-body-spirit well-being, a concept known as kokoro in Japanese, which means the mind, body and spirit are not separate but exist as one.

 

In his book, ‘Morita Therapy and the True Nature of Anxiety-Based Disorders’, Morita Shoma explains, “If a client’s emotional base is ignored, any intellectual pursuit (by the therapist) only serves to increase the distance between the experiential mastery and therapeutic resolution.”

He likens this state to a donkey tied to a post, where the donkey keeps walking around the post to free himself, only to become immobilised and attached to the post.

 

“The same applies to people with obsessive thinking who become more trapped in their own suffering when they try to escape from their fears and discomfort through various manipulative means,” says Shoma.

 

Morita advised therapists to focus on the patient’s ability to live a purposeful life, where they learn to accept their emotions so that the mind returns to balance. He warned clinicians not to become obsessed with treating their patient’s symptoms.

 

“Morita Therapy believes that all emotions – even negative ones – are a natural part of the human experience. If left untampered, these emotions can guide us to live a more authentic life while appreciating reality as it is.”

 

Ultimately, the goal of Morita’s treatment was to provide his patients with experiences that would enable them to let go of their own private struggles with their emotions and instead accept themselves, their symptoms and their reality “as it is” – known as arugamama in Japanese.

 

“This is unique to Morita theory and is distinctively different from the theory of a newer therapy called, Acceptance and Commitment Therapy or ACT,” explains Dr. Peg Levine, Medical Anthropologist, Psychologist and Director of the Classic Morita Centre in Melbourne, Australia.

 

How Morita therapy works

Morita therapy involves four stages of treatment. Each stage comprises five to seven days. The therapist will look for signs of progress before the patient can move forward to the next stage.

 

1. Isolation-rest therapy

Patients are placed in complete isolation and are asked to remain in resting or prone position except for when using the toilet and bath. The patient is not allowed to speak to anyone or undertake any activity that distracts them such as reading or listening to music. The therapist enters the room once a day to observe the patient but conversation is kept to a minimum. 

 

The role of the therapist at this point is to assure the patient that someone is nearby and to invite the person to endure and persevere in the discomfort and suffering of their anxiety-ridden emotions. The purpose of this stage is to let the mind wander as patients think about their lives, their problems and their past or their future, while they experience doubt, pain, anguish and anxiety.

 

“When a client’s agony reaches a climax, it naturally and completely disappears within a short time, just like victory can be achieved during the last five minutes if a dashing attack,” writes Shoma. Patients begin to observe the transient nature of emotions that just come and go, much like nature – the changing nature of the sky and the seasons – as they suspend judgement of their emotions as positive or negative.

 

By the third day in this stage, patients are usually invigorated by the memory of overcoming their challenging emotions and the agony of the previous day disappears.

 

According to Morita, the first stage is effective for treating shinkeitshitsu symptoms of insomnia and anxiety. Usually by the fourth day, patients move into a state of boredom and want to become active. Healthy minds do not tolerate boredom according to Shoma, which is when a therapist will determine if the patient is ready to move to the next stage of the treatment.

 

2. Light occupational work

In this stage too, therapy takes place in an isolated state, although patients are allowed to go outdoors during the day and are encouraged to participate in light repetitive work such as tidying and weeding the garden, picking up fallen leaves or light raking.

 

Journaling is one of the key activities of this stage so that the therapist can better understand the patient’s emotional and physical state. However, patients are not allowed to do anything that diverts their mind or amuses them. The purpose of this stage is to allow a patient to calmly endure his or her symptoms and to inspire a desire for action, which is driven by the patient’s growing feeling of boredom.

Journaling and diary writing are also key to Morita shutterstock/WAYHOME studio

 

Patients begin to notice the activity in the natural environment such as the activity of ants or birds, or the movement of the sun across the sky, as they go about their light tasks. This distracts them from their symptoms and encourages them to explore their curiosity.

 

According to Peg Levine, “the patient observes that the more she or he partakes in purposeful activity, the more worrisome symptoms decrease.”

 

3. Intensive occupational work

The third stage comprises more labour-intensive work according to the client’s physical conditions. Activities include cleaning, gardening, meal preparations, and art projects with a focus on diary writing. Talking to others is restricted to the tasks at hand. The therapist does not respond to the patient’s attempt to engage in any emotion-based conversations. If patients write about their emotional state, or personal history or worries, the therapist directs them to record their observations of the day.

 

Morita believed this therapy helps promote self-awareness in relation to the reality of the external environment and it stimulates patients to surrender to the present situation whether their symptoms were present or not. During this stage, patients begin to experience joy that comes from achieving results through their work and efforts.

 

According to Morita, such experiences foster confidence and encourage patients to overcome difficulty and endure pain, while engaging in lively mental and physical activities. He writes: “The experiential understanding of confidence and courage, represented by the idea that much is possible in life, can be regarded as a kind of spiritual enlightenment.”

 

4. Preparation for daily living

The fourth stage prepares patients to reintegrate with the world outside of their treatment. Patients are encouraged to focus on external reality and adjust to external changes whether symptoms exist or not. Patients travel away from the treatment centre, either by walking or taking public transport and run errands such as posting letters or buying groceries.

 

According to Morita, “During purposeful outings clients experience various mental states because they are exposed to the general world after a long period of time.”

This way, patients forget their fears naturally, as they integrate their “new self” to the social world.

 

Morita Therapy today

Modern-day Morita Therapy has since been altered from its classical version. It’s often used as a treatment alongside medication and has mainly shifted from residential therapy to outpatient centres. These days, therapists place less emphasis on Zen Buddhist philosophies embedded in Morita’s treatment.

 

“Morita Therapy has been found to treat a range of anxiety disorders including post-traumatic stress disorder, depression, bipolar disorder and schizophrenia.”

 

However, the aim of the modern approach is very similar to classical Morita therapy, such as clarifying the concept of the vicious circle that maintains anxiety, and increasing awareness and acceptance of one’s emotional and physiological states, thus encouraging constructive actions.

 

As stated previously, the purpose of Morita Therapy is not to eliminate sufferings or symptoms as such attempts are considered counter-productive to healing. Thus, in Morita therapy, no interventions are implemented to reduce symptoms or modify thoughts and behavioural patterns. It differs from other contemporary therapies like Cognitive Behavioural Therapy (CBT) and Behavioural Activation (BA) where techniques such as meditation, cognitive appraisal and scheduling activities are used to intervene the experience of the symptoms.

 

How effective Is Morita Therapy?

Although Morita Therapy was initially developed to treat shinkeishitsu, it has been found to treat a range of anxiety disorders including post-traumatic stress disorder, depression, bipolar disorder, schizophrenia, eating disorders, borderline personality and other adjustment disorders. Morita Therapy is also used to treat those with chronic pain, victims of sexual assault, cancer patients and civil war victims.

 

Morita therapy may have changed over time but the purpose behind the therapy stays the same – to cultivate arugamama. “Patients learn to spread their attachments over time and re-experience a healthy imagination that balances their fears and desires over the course of the four stages, most naturally,” concludes Levine.

 

This non-intervention therapy, help patients re-establish contact with the natural environment and cultivate an acceptance of the natural ebb and flow of their emotions. Patients develop a desire for life by re-channelling their energies into purposeful action, which helps them break the vicious cycle of their symptoms and move forward in life in a meaningful and constructive way. •

 

Written by Meena Azzollini

Meena Azzollini is a health and wellness content writer from Australia. She takes a heart-centred approach to help businesses make meaningful connections with their audience through effective content marketing solutions. You can connect with her at www.meenawrites.com.