Talk therapy: East meets West.
The Morita and Naikan therapies, both developed in the first half of the 20th century in Japan, are directed at conflict resolution of anxiety and adjustment disorders as we define them in DSM-IV. Their strength lies not so much in their methodology--which in Japan requires inpatient stays and long periods of meditation--but in the concepts of learning new skills for living, coping with here and now issues, and developing action-oriented thinking and behaviors to overcome difficulties.
In short, these therapies focus on the use of readjustment strategies to treat distressing emotional issues as defined in the Eastern culture. Does this sound familiar as we define our cognitive therapies?
Today, the popular press seems to be focusing more and more on the efficacy of talk therapy. Does talk therapy have a place in medical care? Can it be codified and measured? What do outcome studies show, and who and what works best?
The answers, of course, are far from clear, but as a behaviorist/cognitive therapist who developed the learning, philosophizing, and action (LPA) technique, I can assure the doubting public that talk psychotherapy works and that its effect is, indeed, measurable.
Years ago, when I was a resident at NYU Medical Center/Bellevue Hospital Center, the residents were mainly divided into two groups: those who were committed to psychoanalytic psychotherapy and planned to continue at one of the psychoanalytic institutes in the area, and those who wanted to focus more on how we can make it better for our patients in the here and now. As you might guess, I preferred the latter group.
Over the years, I've learned to appreciate the Morita and Naikan therapies, which emphasize learning new skills based on what we expect to encounter in daily life. To me, these therapies fit in with several other Western psychotherapies that were being developed around the same time.
Group and family therapy, for example, began to develop alternatives to traditional psychotherapies. Using techniques involving education, insight, learning, relearning, and the building of hope for a better set of adjustments in one's life, Dr. Irvin D. Yalom and Dr. Salvador Minuchin made enduring changes in the way psychotherapy was delivered to groups and families. Albert Ellis, Ph.D., Dr. Frederick "Fritz" Perls, and Carl Rogers, Ph.D., all made substantial contributions to the processes of rethinking maladaptive behaviors, ideas, and perceptions, and adding new and more effective skills in living more comfortable emotional lives.
Even group awareness programs such as the Erhard Seminar Training (est), where thousands of participants had to get "it" in learning redirecting techniques, became popular. The most important development in rethinking approaches to psychotherapy, I believe, came in the cognitive-behavioral therapy as put forth by Dr. Aaron T. Beck. His codified and measured approach made it possible for an organized medical model of helping and healing to be followed.
Today, "cognitive therapy" has become an almost household term, and more and more mental health consumers ask for it. Unfortunately, far too many therapists are committed to unsubstantiated historical conflict resolution theories with little or no interest in more successful relearning/rethinking approaches.
The Morita and Naikan therapies, as developed in Japan, require a beginning term of voluntary inpatient care when regulation of the patient's daily life takes place, something we do in this country with alcohol and substance abuse rehabilitation programs. Both therapies use different formats of meditation and teaching as the cornerstone of treatment, and reeducation in negotiating life's problems with a different mindset appears to be the guiding principle in both therapies. In the United States, some Morita and Naikan treatment approaches are used, but without the inpatient care component.
These approaches are based on education, counseling, and a new way of addressing emotional problems. The therapist works as a supervisor and counselor, giving certain direction, and does not develop a therapy based on his relationship with the client. The multiple behavior therapy and cognitive-behavioral therapy models used in the United States also aim at getting the therapeutic reeducation job done with less or no emphasis in the transference aspects of the treatment.
In my learning, philosophizing, action (LPA) psychotherapeutic approach, the relearning and reeducation techniques are critical. For problems that are based in the world of action--certain types of anxiety disorders or somatoform and dissociative disorders--and for those that involve habit control issues--smoking, excess eating, and possibly trichotillomania or insomnia--the learning and philosophizing aspects of LPA move quickly into the action phase. The LPA technique is a strategy aimed at problem resolution.
When problems are rooted in perspective--decreased self-esteem, poor identity configurations, or maladaptive personality styles--that the patient either identifies or doesn't identify, more time is usually spent in the learning and philosophizing phases. After that, the action phase begins.
It's at this point that many of the cognitive-type therapies work the same way. By trying new skills, based on learning and philosophizing about the problems and finding new approaches successful, a new mindset appears, old behaviors are extinguished, and new successful styles of adaptation become part of the patient's personality.
It's good to see problem resolution in a shorter, more measurable period of time, but patient realization that problems and life's difficulties are resolving is an extremely valuable measure as well.
It's not only in Japan that this reeducation/relearning model had its origins. Behaviorism was being discussed more than 100 years ago in the West, but it was dwarfed by the psychoanalytic movement. From the time of the 1909 Clark University lectures in Worcester, Mass., Freudian influence dominated an expanding intellectualism in education, child rearing, and environmental issues in the United States. This influence slowed the behavioristic and relearning models.
The point? Whether in Japan or here, we must teach patients to learn about their problems, understand the philosophy behind them, and take action in developing new skills in thought and behavior that not only work better but are lasting.
Let me know what you think of relearning therapeutic models, and I will try to pass these along to my readers.
DR. LONDON is a psychiatrist with the New York University Medical Center and Lutheran Medical Center, New York. He can be reached at firstname.lastname@example.org.
BY ROBERT T. LONDON, M.D.
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|Author:||London, Robert T.|
|Publication:||Clinical Psychiatry News|
|Date:||Apr 1, 2006|
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