The Sword, the Chrysanthemum and the Consulting Room: Can Western models of psychological therapy help people who think differently? Susan Llewelyn, Oxford 2011

Paper outline Learning from history Psychological issues in Japan Relevance of Western approaches Examples from accounts of recent interventions for children affected by the Japanese tsunami Possible modifications of basic components of psychological intervention Implications for training psychologists in an increasing multi-cultural society

Learning from history Japan’s history post Meiji Restoration (grafting a modern world onto a traditional society) Post ww2 report by Ruth Benedict, importance of understanding the culture, especially the bits that don’t seem to make sense Dangers of universalism and western-centric thinking

Psychological issues in Japan Collectivist, allocentric culture Self in relationships, non-individuated Very close family structure Japan as shame based, not guilt based Key psychological concepts: - haji (shame) - wa (communication without words) - haragei (non-verbal communication of thoughts and feelings) -

Common psychological difficulties Depression Low self esteem Loneliness Bullying School refusal Social withdrawal (hikikomori) Suicide

Current psychological therapies in Japan Psychodynamic therapies as a bridge between traditional and scientific approaches Jungian and myth based approaches Counselling Morita therapy (traditional) CBT ??

Likely limitations of CBT Limited acceptability to clients Limited articulation of distress Individualistic approach Restricted capacity to engage collaboratively Insensitivity to cultural patterns of communication and coping Danger of precipitating overwhelming shame

Examples from working with tsunami survivors 2011 With acknowledgements and thanks to Miki Matsumaru and Haruhiko Shimoyama - Collective response to trauma -Reported inappropriateness of re- experiencing, for fear of distressing others -Need to accept fragility of life and collective support as a way of surviving this - Lack of fit with individual approach to therapy

“Once the modern way of life, which had been the fundamental assumption of our lives, was broken or damaged, we have come to recognize that compassion and collaboration in family and in community are really essential to live. The traditional collective way of life is probably indispensable in the fragile society like Japan.” “Now we are confronted with great hardships but we are making every efforts to cope with this overwhelming crisis. In spite of these disastrous occasions, people are trying to accept what has happened with sadness and to be calm and helping each other. I am feeling strongly that compassion and collaboration between people are indispensable for life.”

Possibly helpful Western approaches Compassionate mind training (although see Fiske 2011) Systemic approaches ACT (parallels with Morita therapy) Mindfulness and acceptance Integrative psychodynamic approaches

Possible modifications Importance of all aspects of the culture as a resource (from nature, ceremony and art to the discipline of the martial arts) Need to address and aim to reconcile contradiction between the traditional and modern Therapists may need to co-ordinate relationships between people

Challenges Need to find culturally synchronous ways of assisting integration of aspects of self Cultural needs to find a way of embracing the new, while avoiding loss of self and traditional self-confidence Clinical psychology needs to find a model which draws on both EBP and cultural knowledge

Implications for training To help all trainees grasp the cultural shell surrounding their assumptions To help trainees tolerate uncertainty

Implications for training Importance of cultural understanding and questioning one’s own assumptions Need to train in a range of models, not just CBT related approaches Value of other aspects of life: e.g., art, the ceremonial, spiritual Need to hang on to the value of EBP, but/and.... Need to understand people in context and the full implications of this for practice