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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)

1Hamamatsu University School of Medicine2Kanarekai Kojin Hospital7th International Congress of Morita TherapySebel Albert Park Hotel, MelboruneThursday 4 - Saturday 6, March 2010

IntroductionMorita 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. IntroductionWe introduced Morita Therapy to two patients with anxiety disorders. During the sessions, they repeatedly expressedimpulsive 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.Case A20s male Diagnosissocial phobiaChief Complainttoo nervous to talk with others and to stay in front of others.History of Life and Present IllnessHe 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 A4Case Aprocess 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 !!5SituationPatients BehaviorConcrete InterventionTwo months after he started the therapy

Familiar patients left and new ones hospitalized in the short timeHe was worried that familiar hospital environment might change.

He told us that he got stress out

He complained I could not eat favorite food, I could not do anything I like.

We emphasized followings.

It is better for you that you face some tough things in the therapy. If the things goes easily, you can not get opportunities you change.

If you think you have to do everything perfectly, you would give up soon. You need to think about taking advantage of your failure and overcome your problems little by little6SituationPatients BehaviorConcrete InterventionThree months later, he became a leader of Morita-Group.

His diary for the therapy was stained a little bit with something.He said angrily

My diary is soiled by staff ! I do not want to write it !!,

He tore up his diary.

We emphasized followings.

You have to fix and store your torn diary. You should not turn your eyes away from your emotional and childish behaviors ! Throwing away everything by your anger is the worst coping. You have to think the reason why the situation occur, and what you should learn by the mistake.7Case A AfterwardCase 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.Case Aprocess 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.9Case B20s female Diagnosispanic disorderChief Complaintwant 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 B10Case Bprocess 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 !!11SituationPatients BehaviorWe Concrete InterventionTwo months after she started Morita therapy.

She got frustrated with herself.

One day, she used violent language to staff .

I hate your manner of talking. Change your manner, or I never talk to you !

She refused to engage in Morita work.We explained her that

It is common social rule that if you demand changing attitude from someone, you also have to try to change yourself. It is not the goal for your therapy that you will never be frustrated. If you face bad things, you should try to modify and adjust yourself to it.12SituationPatients BehaviorConcrete InterventionShe became a leader of Morita-Group

She had dissatisfaction toward the situation that she could not communicate with other patients as she thinks.

She shouted

I can not take it anymore! Everyones eyes are painful for me !!

She kicked wall of the hospital

She scratched her arms by a ruler.We conveyed her thatIf you feel angry, you should say even one of the irony, before injuring yourself. When you have a tantrum, you just feel dissatisfaction that you can not do well. Stop blaming your dissatisfaction on others by rationalization! If someone take you for a fool, you should recognize you are a fool and make use of them as good advisers for you. It is the therapy that you think about how to take advantage of your failure to next problems.13Case BAfterward 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.Case Bprocess 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.15Turning Treatment Crises to Advantage Our UnderstandingWe 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). 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 InterventionsTurning Treatment Crises to Advantage Concrete InterventionsGuiding case A to fix and store his torn diary was intended to facilitate his growth; this is because this intervention led him to confront the fact that he did and not to get away from problems by his impulsive behaviors. Guiding case B to learn how to use irony intended that even if she had frustration or anger, she could retain her problem-solving posture with holding her these kinds of feelings.Educating them to taking advantage of their failure emphatically and repeatedly, we prompted them to exert their natural desire for life.

The Effect of Our Therapeutic TacticsStep by Step ProcessThey 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.ConclusionThrough 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.