NAIKAN: A BUDDHIST APPROACH TO PSYCHOTHERAPY

M. Honoré France, Professor

University of Victoria, Victoria, Canada

2000

Counselling practices have long been dominated by Western counselling procedures, yet many Asian psychotherapies offer creative and sophisticated strategies that are easily adapted to a variety of theoretical approaches. Naikan is one of the most simplistic, yet elegant modalities that helpers can embrace. Naikan is a Japanese psychotherapy with philosophical roots in Buddhist spiritual practices and emphasizes reflection on past relationships. Like many Asian psychotherapies, Naikan focuses "...primarily on existential and transpersonal levels and little on the pathological" (Walsh, l989, p. 547). The essence of Naikan is revealed in the meaning from the Japanese words "nai" meaning inner and "kan" meaning observation or introspection. Personal problems and dissatisfactions are often the result of the discrepancy between the actual self and the ideal self or what is and what should be. Buddhism teaches that experience of living is far more valuable than metaphysical speculations. To philosophize to much about existence is a waste of energy, just as preoccupation with one's condition. Even to focus to much on a problem can lead to attachment. Yet Buddha taught that life should not be seen as a mystery to be figured out. No, life should be lived, simply and practically, accepting events and circumstances as they occur. To emphasize these ideas consider the wisdom in the words of the poet Chao-chou: "I have come empty-handed," said the student. "Lay it down then!" said the teacher. "But I have brought nothing with me: what can I lay down?" "Then keep on carrying it." Thus what is natural is lost as people use artificial means to deal with their anxieties and fears. If people will allow themselves to be like "water" then they can regain their naturalness and live a more constructive life. Essentially, there is no pretending for "...water reflects whatever reality brings it" (Reynolds, l989, p. 181). When people deny reality, whether it is joy or sadness, they fight against the truth of their feelings. "Shoulds" block them and prevent them from making changes to co-exit with the changing context in the environment. Like water, which always flows around objects and doesn't try to fight rocks or other obstacles, people can learn to be more flexible and move at a pace that is keeping to the circumstances of existence. The lesson is quite simple: that by just being ordinary, like water, people can live a life that is more dynamic.

Historical Background of Naikan Therapy

Naikan began as a form of spiritual training for priests of the Jodo Shinshu sect of Buddhism. Jodo Shinshu emphasized the love and self sacrifice of Buddha and how this was used to help others achieve enlightenment. Through acceptance of life the way it is and the giving joyously to others, followers were promised relief from the cycle of birth and death. The early spiritual training consisted of introspective meditation and fasting. In some circumstances these priests would go without food, water, sleep and engage in other forms of self-deprivation. The modern practice of Naikan was modified fifty years ago for lay people by Yoshimoto Ishin. "Nowadays the goal need not be a religious one of an existential confrontation with death; the aim of self-understanding is acceptable" (Reynolds, l982, p. 50). As the practice of Naikan has become more popularized it has become more of a rational and scientific method of therapy, yet it has also retain many of the spiritual constructs of Buddhism. Interestingly, it is in the prisons of Japan where Naikan has had its greatest impact. In fact, 60% of the prison facilities in Japan have used Naikan at one time or another. Prison officials reported reduced rates of recidivism among naikansha prisoners compared to those who are not following the Naikan approach (Reynolds, l982). Naikan's popularity is increasing, particularly with those working with juvenile delinquents and alcoholics, in part because Naikan can be combined with a short prison sentence and training during probationary periods.

Theoretical Basis of Naikan

In order to enhance well-being, Buddhism emphasizes self discipline or self control, particularly the power to control or modify physical aspects of the body. : "Meditation, the principal psycho- therapeutic tool of Buddhism, also can enrich traditional Western psychotherapy in several ways: 1) by offer insight into self-defeating behaviours by focusing on them and exaggerating them; 2) by severing the tight grip of thinking on behaviour by retraining attention; and 3) by producing an integrated hypothalamic response that decreases sympathetic activity" (Ramaswami & Sheikh, l989, p. 109). Through exploring early experiences and present actions clients using the Naikan approach are helped to let go of selfish attachments and guilt associated with living a self absorbed life. While the introspection is carefully guided by the therapist, clients share their recollections on: 1. what was received from significant others in terms of services, kindness, objects and other important gifts; 2) what has been returned to significant others in life; 3) what troubles, inconveniences, deceits, pettiness and the other selfish acts occurred with these people. The rationale is to focus clients on personal actions, past and present, that influenced their present situation. An important goal of Naikan therapy is to assist clients in accepting responsibility for "...their selfish and irrational behaviour" (Ramaswami & Sheikh, l989, p. 108). Responsibility extends not only to significant others in clients' lives, but also to the objects in the environment around the clients. Clients not only have to consider how they have polluted their bodies and relationships, but also how they have polluted their environment.

The Naikan Therapeutic Process

Traditional Naikan therapy consists of two parts: immersion and counselling. The immersion will take place, either in a temple or place where the client can be isolated. Clients are isolated, sleeping and taking meals alone, and required to undergo meditation training. Meditation, as the primary helping strategy, may last from 4:30 am. until 7 pm. Therapists visit clients, at intervals of one to two hours during the day, to instruct them on meditation and engage them in dialogue. In addition, therapists will also guide clients in introspection and dialogue by focusing on reoccurring life themes. For example, clients may explore desires that block constructive living, such as dishonesty, negativity, or blaming. In a sense, therapists are "fellow travelers," but with some experience in life. Despite being guides, therapists must show honour to clients and continually reinforce their ability to solve personal problems. To empower the client, the therapist will bow his or her "...head to the floor, open the folding screen, bow again, and ask clients the topic of [the] current meditation. This ritualized format symbolizes the therapist's humility as he [or she] prepares to listen to the client's confession. The client's response is similarity in ritual form. He [or she] reports the person and time period of his [or her] recollections (Reynolds, l982, p. 47)."

About 20 percent of clients' meditation is spend on significant people who have given and what they have returned to them. Sixty percent of clients' meditation is spent on the trouble or inconveniences that clients have caused significant others. Interestingly, one of the common themes during meditation are clients' relationship with their parents. Since relationships are strongly influenced by parents, this topic is often a discussed on early in therapy. One of the assumptions is that people develop a distorted self or destructive patterns in the process of growing up. While the traumas or failures of the past cannot be undone, clients' attitudes can be changed. The Naikan therapy process attempts to restructure clients' thinking and provide a moral structure for living life based on the Buddha's ideal of "giving." Clients share their idea of past events working from the past to the present. In the first week of reflection, clients share their remembrances about the themes in their relationships, while therapists listen without interpretation or comment. Besides instruction in meditation, the therapeutic process involves rephrasing, recasting, and reflecting clients' statements. Once therapists have a solid understanding of clients' issues, they will engage in interpreting and then guiding clients actions. According to Reynolds (l982) the therapist "...directs the client away from abstract or vague descriptions of past events and personal suffering. The goal is [for clients to use] concrete statements about specific personal experiences" (p. 48).

In the second phase, counselling consists of weekly or monthly visits to therapists in which clients report on their activities and the progress of their meditation. A journal is often used as a means for structuring client-therapist interactions. Homework assignments are also given to clients, which can consist of summaries of "good works" (helping others) and saying things that show appreciation to others (i.e. "saying thank you at least ten times during the day"). Reynolds (l989) describes how a client must also consider how he or she is served not only by people, but also by the energy of objects. A client can be asked to remove object from a place that they keep personal items such as a drawer: "as the items are returned to the drawer one by one, each item is thanked for some specific service it performed for the [client]...conservation of the resources in our world becomes a natural consequence of the grateful recognition of their services they perform for us" (p. 191). Since obtaining a higher state of consciousness and becoming more aware are important goals in living constructively, clients must practice daily meditation at a certain place and time. As an active strategy meditation is invaluable. The research in meditation has solidly demonstrated benefits in increasing perceptual and empathic sensitivity (Walsh, l989). Usually, clients are instructed to meditation on how someone has given to them, visualizing him or her, letting whatever feelings and thoughts develop. However, in the dialoguing with therapists, clients share how they can live life by giving back. Clients must develop strategies that do not see others as tools for satisfying personal desires, but develop relationships that are open and giving.

An Example of Using Naikan in a Western Context

To illustrate how Naikan therapy is used in a Western context, the following case of a 35 year old man trying to come to grips with a relationship breakup is discussed. "M" came to therapy with the desire to reduce stress and overcome a generally "blue" feeling. "M" reported that he felt a great deal of anger, yet even after expressing his anger, he felt "stuck." After explaining the Naikan form of therapeutic intervention, "M" was invited by the therapist to share his feelings. He talked for over an hour about his state of mind and how he thought he had been coping. The therapist listen and asked only clarifying questions. The therapist's sense of "M's" condition is personified in "M's" imagery of how he saw his life. "M" described his existence as: "Going down the road of life, minding my own business, and being attacked by colleagues who disagreed with me. The viciousness of their attacks was a real surprise and I felt myself being knocked down in the mud. The sorrow of their attacks seems to have somehow paralyzed me...I don't feel that I can get up, yet I see the uselessness of staying and wallowing in the mud."

After mastering the skill of meditation and practicing it for some time, the therapist focused on significant relationships, positive and negative, in his life. Of the many people he felt were significant in his life, he chose to "work" on a relationship involving a colleague who he felt had treated him in a unfair way. Rather than focus on the negative aspects of his relationship with the person, he was asked to focus on what he had learned in the encounter with that person. While finding it difficult to explore the positive parts, he did list of number of things he had learned about himself and how the experience had changed his life. After considerable time exploring this experience (two sessions consisting of one-hour each), he was surprised at what he had learned. Of these, what predominated was the "little kindnesses" of acquaintances and how much "closer" he had been drawn to his family. The method used to explore these themes followed the follow format: instruction from the therapist on the topic to focus on; meditation for one hour on the topic; dialoguing the messages in the meditation in a journal; and sharing of the messages with the therapist. Generally, the therapist focused on actions and meaning. In every case "M" was asked to make sense of what was given and what he did to repay to others. While the emphasis was on the positive, "M" feelings were honoured. However, rather than staying with those feelings, the therapist refocused him towards the positive. Over the next two sessions, "M" explored a number of other relationships from the past, including the relationship with his parents, siblings and ex-spouse. In each case, he was asked to meditate on how these people had influenced and given "something" to his. This was followed by an exploration of how he had given back to others. After tying all these themes together, "M" was asked to write out how, when, where and with who he would return the "gifts" that he had been given. In addition, to the dialoguing, meditation and journaling, "M" was asked to consider how he treated pets (cats), plants and objects in his daily life. A clear theme was his pleasure at "taking care" of his pets and house plants. In fact, he learned that he was happier in "nurturing" than in controlling in his relationships with.

The basic Naikan approach was followed by the therapist in counselling "M," with the philosophy and basic strategies remaining constant. However, in adapting the approach to "M's" cultural milieu, the therapist structured the intervention by teaching meditation skills and encouraging him to focussed on the meaning in his actions. The therapist did not engage in interpreting his actions, but encouraging him to arrive at his own meanings. Finally, the therapist focussed on moving "M" towards active and positive strategies for living in harmony with himself and his environment. Specific living strategies that gave back were discussed and clarified so "M" had a clearer idea of what he could do. The two follow- up sessions evaluated how well the strategies were working for him. It was not surprising that a motto he developed and promised to repeat everyday consisted of this thought: "the best way to receive is to give."

Conclusion

The "spiritual" aspects of Buddhism are reflected in the human condition, moreover Naikan reinforces a positive method for living life in a practical manner. As "M" discovered, there are some things that occur in life that cannot be changed or explained. What "M" learned to do was "let go" of his anger and hopelessness about regaining what he had before. However, it was not just a "letting go," but a development of a more constructive way of living in the world. "M" learned that he had been given a great deal in life, in fact he said many times he had been fortunate, but he also discovered that he had given very little back. In fact, he discovered that in "giving" he had a great sense of satisfaction and an outlet for his sadness about the breakup of his marriage. In the process, he learned how to use meditation and "good works" to gain more control over his anxieties and fears. The most difficult strategy was learning how to "let go" of his anger and disappointments, but he realized that survival depended on being more flexible (just like water). While much can be made of how different Naikan is to many Western forms of therapy, in fact, the differences are not as great as first seen. Take for example, Behavioralism, a very Western approach, and one can see many similarities. Both emphasize self-control and both avow the intention of helping to modify bodily process to enhance well-being. Both have the same objective of teaching clients new bahaviours and reducing the gap between the real self and the ideal self. However, they differ in that behaviorism stresses the value of counter-conditioning in undoing neurotic behaviour, while Naikan stresses insight. Naikan, views insight and training as the best means for developing a constructive life style. My experience with "M" and other clients who opt for the Naikan approach reinforces my belief that Naikan is easily adapted into a Western cultural mode. I continue to believe that meditation is one of the best coping strategies to empower clients and provide them with the ability to be more positive. Naikan has a simplicity about it that I can only describe as eloquent and expressive. It is easily adapted to Western culture and the Gestalt therapeutic approach that I normally practice. Naikan respects the dignity of all things. In fact, the Buddhist ideal may not be all that different from Christianity ideal or any other spiritual approach that seeks harmony. I have found that the premises of Naikan which emphasizes the connectedness of all things, the impermanent of existence, the acceptance of suffering, and the giving to others has a seductive quality about it that is empowering.

References

Reynolds, D. (l989). On being natural: Two Japanese approaches to healing, In A. Sheikh & S. Sheikh's Eastern and western approaches to healing: Ancient wisdom & modern knowledge, NY: John Wiley.

Reynolds, D. (l982). Quiet therapies, Honolulu, HA: University of Hawaii Press.

Ramaswami, S. & Sheikh, A. (l989). Buddhist psychology: Implications for healing, In A. Sheikh & S. Sheikh's Eastern and western approaches to healing: Ancient wisdom & modern knowledge, NY: John Wiley.

Walsh, R. (l989). Asian psychotherapies, In R. Corsini & D. Wedding's Current Psychotherapies (4th Edition). Itasca, NY: F. E. Peacock.