Overall, Morita therapists help patients to re-establish contact with nature, cultivating an allowance of their own authentic human nature with its natural ebb and flow of emotion. More specifically, therapists facilitate patients’ understanding of the vicious cycle, capacity to be with symptoms, and engagement in purposeful action (Minami
2013).
Fumon
Illustrating their non-interventional stance, therapists implement Fumon (selective non-response, or strategic inattention) in response to patients’ expression of complaints, to shift patients’ attention away from symptoms and towards purposeful action (Nakamura et al.
2010). Thus, therapists do not dwell on patients’ symptoms, nor attempt to elucidate reasons for suffering, beyond stressing the naturalness of all emotions, explaining how the vicious cycle operates for the individual, and highlighting specific desires underlying fears (Nakamura et al.
2010; Ogawa
2013). Nonetheless, in outpatient treatment therapists do initially enquire into a patient’s symptoms sufficiently to elicit how they engage in the vicious cycle; for example, therapists may respond to a patient’s description of experiencing symptoms by asking where their attention is at that time (to ascertain attentional fixation) and what they do at such times (to ascertain ‘Hakarai’) (Nakamura et al.
2010).
Rest
Traditionally, Morita Therapy begins with bed rest, taking a restorative approach to allow natural healing (Kitanishi
2005; Minami
2013; Morita
1998). Thus, therapists ask patients to ‘be with’ unpleasant thoughts and emotions without attempting to fight or control them, for anything between multiple thirty minute periods (in some outpatient settings) to approximately 1 week (inpatient settings) (LeVine
1993; Morita
1998).
By thus eliminating external stimuli and the need to confront suffering, the vicious cycle is thought to be broken: patients experience the ebb and flow of thoughts and emotions running their natural course (Fujita
1986; Kora
1995; Morita
1998). Paradoxically, rest is understood to begin the process of diminishing self-centredness with increased self-focus: patients eventually reach a state of ennui and begin to redirect their attention from introversion (self-preoccupation and fixation on symptoms) to extroversion (ecological awareness and purposeful behaviour) (LeVine
1993; Morita
1998; Ogawa
2013; Reynolds
1976). Accordingly, the patient’s spontaneous desire
to do, motivated by desire for life, is heightened, at which stage patients move onto action-taking (Kora
1995; Morita
1998).
Action-Taking
Following rest, therapists facilitate patients’ movement through three stages of action-taking: (1) light monotonous activities; (2) purposeful activities; (3) social reintegration (Morita
1998; Ogawa
2013). Over the stages, patients’ spontaneity and engagement with others, objects, and nature are increased (LeVine
1998). Patients move onto the next stage according to their readiness to undertake more demanding activities, engagement in nature and action versus engagement in the vicious cycle, and awareness of the natural ebb and flow of thoughts and emotions (Minami
2013; Morita
1998).
Stage one involves light repetitive tasks (usually using the hands) which absorb patients’ attention, engage their senses, stimulate their desire for life, and engage them in nature where possible (Minami
2013; Morita
1998). For example, patients may engage in knitting, tending to pets, and light gardening. Stage two involves purposeful and necessary tasks which are more challenging and practical (using whole body movements), cultivating patients’ capacity to undertake such activities in the presence of symptoms (‘anxious action-taking’) (Minami
2013; Morita
1998). The nature of these activities depends on what is required of patients in their environment, and may include cleaning, larger gardening projects and more strenuous exercise. Stage three involves applying Morita Therapy principles to more social tasks and larger life events, and may involve resuming or changing employment, or re-establishing interpersonal relationships (Minami
2013; Morita
1998).
In facilitating action-taking, therapists encourage patients to follow their curiosity and desires, and “ ‘jump into doing’ what is immediate and necessary” within their environment (Ogawa
2013) (p.64). In contrast to BA and CBT, whilst therapists can collaboratively identify tasks with patients which fulfil the criteria for each stage, they are not directive in activity scheduling and/or prior goal discrimination. Instead, action-taking comes about naturally and spontaneously through the inherent purposefulness of desire for life: patients are driven by self-actualising desires and tackling necessary tasks in the moment, rather than their tolerance built up through habituation and/or meeting pre-determined goals (which are avoided in Morita Therapy) (Ogawa
2007). Furthermore, the success of action-taking is not assessed in terms of its impact on symptoms: living a purposeful life in spite of symptoms
is the success (Fujita
1986). Thus, action-taking is not a means to an end, but is the end itself.
Through immersion in action and shifting of attention to the external environment, patients continue to experience how thoughts and emotions naturally ebb and flow if left alone (Fujita
1986). Indeed, it is understood that patients’ attentional fixation on their symptoms is dissipated (Morita
1998) and they move beyond conscious processing of the self: they “forget anxious thoughts and feelings and become one with action” (Ishiyama
1986) (p.379). Morita Therapy thus minimises the subjective self, inducing a ‘mindless’ state in which one is fully absorbed in the present moment (Morita
1998; Ogawa
2013). This contrasts mindfulness-based approaches, which may be seen to magnify the subjective self: increasing self-awareness in order to shift subjective experiences (potentially increasing self-focus and a fixation on emotional experience from the Morita Therapy perspective).
Diaries
During therapy, patients complete daily diary entries about their experiences of the day, on which therapists comment (Kora
1995; LeVine
1998). In their comments, as in outpatient therapy sessions, therapists recognise patients’ symptoms as natural experiences (often using natural world metaphors, such as comparing the uncontrollable nature of fluctuations in mood to those in the weather); point out attempts to fight or control inevitable emotions, and contradictions between ideal and real; reframe unpleasant thoughts and emotions as desires; and reinforce patients’ awareness of the external environment, and engagement in action and nature (Minami
2013; Nakamura et al.
2010). Therapists maintain the Fumon stance and thus, unlike in a typical BA or CBT diary, do not analyse the links between action and symptoms, nor the impact of action on mood. For example, a therapist may respond to a patient’s description of going for a walk outside and resulting improvement in mood with the following comments: “You have engaged in purposeful activity and picked up on the natural ebb and flow of emotions here. What did you notice outside?”.
Experiential Learning
The aim of Morita Therapy is not for patients to receive persuasive counselling, but to incorporate persuasive experiences, which are considered to bring a deeper level of insight than intellectual learning (LeVine
1993; Morita
1998; Ogawa
2013). Whilst approaches which emphasize specific techniques and rational understanding of emotions may be seen to intellectualize emotions, Morita Therapy thus de-intellectualizes emotions, holding that it is the very application of the intellect to emotions which perpetuates the vicious cycle through misinterpretation and over-analysis (Iwata
2019).
Through a process akin to experiential re-education, Morita Therapy patients organically discover the transient nature of emotions, and their ability to tolerate them (Fujita
1986; Morita
1998). As such, they develop intuitive, empirically-based, and embodied understandings of natural rhythms, and the futility of resisting them: “the quality of non-resistance” (Krech
2014) (p. 39). They thus move towards arugamama; a state in which patients accept and live in harmony with nature, including their authentic human nature.
Thus, although other approaches such as Mindfulness-Based Cognitive Therapy (MBCT) (Segal et al.
2002) and Acceptance and Commitment Therapy (ACT) (Hayes et al.
1999) also cultivate acceptance, by combining mindfulness with Cognitive Therapy (MBCT) or following a linear process (ACT), the nature of ‘acceptance’ differs. In Morita Therapy, acceptance has a uniquely active, spontaneous, and paradoxical quality: it
cannot be brought about through cognitively reappraising symptoms, only through direct behavioural experience and bodily engagement with nature (Fujita
1986; Morita
1998; Ogawa
2013; Watts
1961).
Morita Therapy is thus qualitatively different to established Western approaches. Whilst other approaches may appear comparable in aim (e.g. acceptance) and certain processes (e.g. action-taking), they miss the phenomenological essence of Morita Therapy: a reorientation in nature through behavioural experience alone, and with that an embodied (de-intellectualized) acceptance of thoughts and emotions as natural phenomena (Tseng
2005).