Table 1 Key principles and practices of Morita therapy

Key principles

Natural world

Morita therapy conceptualises unpleasant thoughts and emotions as part of the natural ecology of the human experience. It draws upon the natural world, the place of humans within it, to emphasise that symptoms are not subject to the patient’s control and will naturally pass with time.

Acceptance and allowance

All emotions and thoughts are accepted as they are. Attempts to control or resist symptoms are considered to exacerbate them; therapists thus help patients to move away from symptom preoccupation and combat and towards acceptance and a focus on action. Thus, the objectives of therapy are to shift attention and perspective, rather than controlling or ‘fixing’ symptoms.

Rest

Morita therapy seeks to potentiate patients’ natural healing capacities, in contrast to resisting and exacerbating symptoms. Patients sit with their thoughts and emotions as they are, to learn how they naturally ebb and flow with time if attempts to control or remove them are not made and to build a natural desire to take action.

Action-taking with symptoms

Patients learn to undertake purposeful and necessary action, with or without their symptoms. Morita therapy thus aims to improve everyday functioning in spite of symptoms, with symptoms reducing as a by-product of moving from a mood-oriented to a purpose-oriented and action-based lifestyle.

Key practices

Positive reinterpretation technique

Therapists ‘positively reinterpret’ symptoms as desires by seeing these as two sides of the same coin. For example, in Morita therapy, social anxiety represents a desire to be accepted by others. This technique aids acceptance of symptoms as natural and inevitable.

Normalisation technique

Therapists label thoughts and emotions as ‘unpleasant’ and ‘pleasant’ but not ‘good’ or ‘bad’. They emphasise that all emotions are natural, or normal, and will ebb and flow on their own so long as attempts are not made to control or resist them.

Fumon (inattention to symptoms)

Therapists, in an effort to shift patients’ attention away from symptom preoccupation and combat, will not focus on discussion or analysis of patients’ symptoms or their causes but rather will ‘steer’ the conversation towards action-taking and the external environment.

Diaries

Patients complete daily diaries on which therapists provide comments which facilitate an acceptance of internal states and refocus attention on action and the external environment.

Four-phased model

In traditional inpatient Morita therapy, rest and action-taking are structured within four phases: (1) complete bed rest; (2) light repetitive activities; (3) more challenging activities; and (4) social reintegration. The process is understood to aid experiential acceptance of the natural ebb and flow of thoughts and emotions, to re-orientate patients in nature and to refocus attention from internal to external states.