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Although psychotherapy research has traditionally focused on decrease in distress, emotion research suggests the important role of positive emotional experience in healing and growing.

This study aimed to describe the association of healthy eating literacy (HEL) with energy, nutrients, and food consumption in young women who had normal and lean weight at a Japanese university, considering their resident status.Cross-sectional data from the Ochanomizu Health Study were used in this study. Participants answered a self-administered, two-part, anonymous survey in 2018 and 2019. A total of 203 female undergraduate students with lean and normal body mass index (BMI) were included in the analysis. Single and stepwise multiple linear regression analysis was used to examine the association of HEL and resident status with healthy food consumption, such as vegetables, fish, and shellfish. The dependent variables were HEL and resident status, and the covariates were age, BMI, and the total metabolic equivalents.The median (25th and 75th percentiles) age, BMI, and total HEL score were 20 (19, 21) years, 20.2 (18.9, 21.3) kg/mThis study provides an insight into the association between HEL and dietary consumption in young women with normal and lean BMI.

This systematic case study investigated the nature of corrective emotional experiences (CEEs) that occurred over the course of psychotherapy in a single case and how those in-session CEEs were related to changes in the client's life. Client's e-mails on her experience of therapy sessions and postsession changes sent to the therapist, as well as outcome and postsession measures, were analyzed. The client was a Japanese woman who sought help for a variety of psychological symptoms including depression, anxiety, and emotional dysregulation. A long-term therapy of 67 sessions was conducted by a Japanese male psychotherapist who followed an integrative affect-focused approach. The quantitative analysis showed that the client achieved clinically significant change in depression, anxiety, self-compassion, interpersonal functioning, and self-esteem over the course of therapy. A grounded-theory analysis of client e-mails to the therapist showed that she experienced a deep connection with the therapist, gained a sense of relief through experiencing her disavowed feelings, and developed a positive sense of self in the course of her sessions. The client felt she had gained strength, had deepened her understanding of her feelings and behaviors, and that she was beginning to develop new relationships with others. The understanding of the theory of CEEs through this case, cultural issues, and the limitations and future directions of this study are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Accelerated experiential dynamic psychotherapy (AEDP; Fosha, 2000, 2021b) is an integrative, healing-oriented, mind-body, affect-focused therapy. A posttreatment outcome study demonstrated AEDP's effectiveness (Iwakabe et al., 2020) on a variety of measures of psychological functioning. This study sought to address AEDP's long-term effectiveness. As previously reported, 63 adult patients completed a 16-session AEDP treatment with qualified therapists in private practice in the United States, Canada, Israel, Japan, and Sweden. Forty patients responded to 6-month follow-up and 52 responded to 12-month follow-up. Results indicate that patients maintained their posttreatment therapeutic gains, both 6 and 12 months later. Large effect sizes (

The term hikikomori, or social withdrawal, was first coined in the late 1980s in Japan to describe adolescents and young adults who isolated themselves at home, withdrew from most social engagement, such as work or school, and had almost no relationships with others (except family members and online contacts) for longer than 6 months. Hikikomori often results from emotional injuries such as rejection, or failures that have not been addressed or even noticed. In the current case illustration, the problem of hikikomori is depicted through a client named Ken, a 40-year-old single man who, following graduation from university, became lodged in a 15-year cycle of repeatedly finding employment, quitting within the first year, and going into reclusive isolation. Ken underwent affect-oriented integrative psychotherapy for 4 years. The importance of processing emotional pain and highlighting positive emotional experiences to build a positive sense of self in working with hikikomori will also be discussed.

This study aimed to investigate the correlation between mindful eating and nutritional intake, food consumption, and healthful and unhealthful plant-based dietary patterns in young Japanese women. The sample comprised 215 female undergraduates who responded to a two-questionnaire anonymous survey conducted in Tokyo, Japan in 2018 and 2019 from November to December. We measured mindful eating status using the Expanded Mindful Eating Scale (EMES) and used Japanese plant-based dietary indices to determine plant-based dietary patterns. Partial correlation analyses were conducted to determine the correlation of mindful eating with energy and nutrient intake, food consumption, and plant-based dietary patterns, after adjusting for demographics and body mass index. Participants with higher sub-scores in “health of the planet” and “awareness and appreciation for food” ate higher quantities of several micronutrients and plant-based foods and were more likely to have a healthful plant-based dietary pattern. They were also less likely to have an unhealthful plant-based dietary pattern. In contrast, participants with higher scores in “non-judgmental awareness” ate less protein, whole grains, and vegetables, and were likely to have an unhealthful plant-based dietary pattern. This study is the first to show that young Japanese women with normal or lean body weight were more likely to consume healthful plant-based foods when they ate mindfully. Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Japan is often described as an intricate yet contradictory society in which the elements of the most advanced technologies and ancient cultural traditions coexist. Social cohesion rooted in uniformity and ethnic purity has long been the implicit, normative ideal in Japan, while diversity as intrinsic value is still a relatively new concept. In this monocultural milieu, intercultural couples often encounter issues associated with culturally-bound notions of gender roles and the societal pressure to conform to the implicit cultural ideal. The distress of unresolved past emotional injuries may also surface, which often results in the couple getting stuck in negative emotional cycles. This paper will discuss the case of Yoko and Frank, who were treated with an affect-focused approach in which their emotional conflicts, particularly their feelings of shame, were worked through while each partner developed their self- and other-emotion regulating capacity. The therapist also helped the couple develop new patterns of positive emotional interaction.

This study aimed to investigate the correlation between mindful eating and nutritional intake, food consumption, and healthful and unhealthful plant-based dietary patterns in young Japanese women.The sample comprised 215 female undergraduates who responded to a two-questionnaire anonymous survey conducted in Tokyo, Japan in 2018 and 2019 from November to December. We measured mindful eating status using the Expanded Mindful Eating Scale (EMES) and used Japanese plant-based dietary indices to determine plant-based dietary patterns. Partial correlation analyses were conducted to determine the correlation of mindful eating with energy and nutrient intake, food consumption, and plant-based dietary patterns, after adjusting for demographics and body mass index.Participants with higher sub-scores in "health of the planet" and "awareness and appreciation for food" ate higher quantities of several micronutrients and plant-based foods and were more likely to have a healthful plant-based dietary pattern. They were also less likely to have an unhealthful plant-based dietary pattern. In contrast, participants with higher scores in "non-judgmental awareness" ate less protein, whole grains, and vegetables, and were likely to have an unhealthful plant-based dietary pattern.This study is the first to show that young Japanese women with normal or lean body weight were more likely to consume healthful plant-based foods when they ate mindfully.Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Having a late chronotype, that is, the tendency to go to sleep and wake up at later hours, influences an individual's physical and mental health. Despite a few studies noting the association of chronotype with healthy dietary patterns, this relationship remains unclear.This study aimed to describe the association of chronotype with healthful and unhealthful plant-based diet quality in female Japanese undergraduate students.Cross-sectional.A total of 218 female university students in Tokyo, Japan.Healthful and unhealthful plant-based dietary index-Japanese version (hPDI-J and uPDI-J), calculated using the validated brief-type self-administered diet history questionnaire.A five-model stepwise multiple linear regression analysis was conducted. Independent variables were hPDI-J and uPDI-J scores, and dependent variables were various lifestyle habits related to the circadian rhythm and demographic characteristics.Mean (standard deviation) sleep duration, midpoint of sleep, sleep latency time, and social jetlag were 411 (60) min, 03:56 (00:57), 21 (27) min, and 50 (39) min, respectively. Chronotype and several variables, such as residential status, energy and alcohol intake, and nutritional knowledge, were associated with healthful and unhealthful plant-based diet quality. Individuals who had higher hPDI-J scores were more likely to have an earlier chronotype (β = -0.168, P = 0.019) and better nutritional knowledge (β = 0.164, P = 0.022) than those with lower hPDI-J scores. Individuals were more likely to have higher uPDI-J scores if they were living alone (β = -0.301, P 0.001), had a later chronotype (β = 0.181, P = 0.001), higher frequency of snacking (β = 0.164, P = 0.019), lower total energy (β = -0.445, P 0.001), and worse nutritional knowledge (β = -0.172, P = 0.001).This study provided new evidence as to the relationship between sleep and dietary habits, the interaction of which may affect women's health.

Accelerated experiential dynamic psychotherapy (AEDP) is an integrative model of psychotherapy that brings together relational and experiential work, with the aim of not only alleviating suffering but also bringing about flourishing. The present study took place within a developing AEDP practice research network and examined outcomes for 62 self-referred adults treated using a 16-session format of AEDP treatment. Participants completed self-report measures before and following treatment. Measures assessed a variety of psychological problems, subjective distress, as well as aspects of positive psychological functioning. Treatment occurred in naturalistic independent practice outpatient settings in the United States, Canada, Israel, Japan, and Sweden. Large effect sizes (d > 0.80) were obtained for clinical problems and subjective distress. The majority of patients evidenced clinically reliable change according to Jacobson, Roberts, Berns, and McGlinchey's (1999) criteria. Effectiveness was further examined by dividing the sample into a clinical group with pervasive and severe problems and a subclinical group with fewer problems and mild severity. Within the clinical group, total and global scores on all measures improved significantly following treatment. Effect sizes were d > 1.00 for all scales. The subclinical group also demonstrated significant improvements, with effect sizes ranging from d = 0.46 to d = 2.07. These results provide initial empirical support for the effectiveness of AEDP as a model of therapy that can effect meaningful and significant improvements across a range of psychological symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

PurposeTo develop and validate the Expanded Mindful Eating Scale (EMES), an expanded mindful eating model created for the promotion of health and sustainability.Design/methodology/approachA cross-sectional study using self-administered questionnaire surveys on Ochanomizu Health Study (OHS) was conducted. The survey was provided to 1,388 female university students in Tokyo, Japan. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and a partial correlation analysis were used to confirm construct and criterion validity. Internal consistency of the EMES was confirmed to calculate Cronbach's alpha.FindingsThe response rate was 38.7 % (n = 537). Mean BMI was 20.21 ± 2.12, and 18.8% of them were classified as “lean” (BMI r = −0.138, −0.315, −0.339, −0.281 and 0.149, p Practical implicationsThe authors suggest the possibility that practitioners and researchers of mindful eating that includes this new concept can use authors’ novel scale as an effective measurement tool.Originality/valueThe EMES, which can multidimensionally measure the concept of the expanded model of mindful eating was first developed in this study.

Systematic case studies can benefit understanding of the process and outcome of Accelerated Experiential Dynamic Psychotherapy (AEDP; Fosha, 2000) and other affect-focused and experiential therapies by expanding the scope of investigation from the moment-to-moment emotional change on which these therapies are particularly strong to changes that occur over and across sessions. Systematic case studies are also important because the link between in-session changes and changes in the client behavior and interpersonal relationships in daily life can be explored. In the engaging AEDP case study of "Rosa" (Vigoda Gonzales, 2018), the language switching that allowed Rosa to access painful emotions had an additional relational implication in that the therapist was able to directly connect to Rosa’s child self, which was encoded in a different language than her adult self. I suspect that this prevented Rosa and the therapist from running into difficulties due to the potential mismatch in their backgrounds. Corrective emotional experience seen in this therapy confirmed the finding by my own case study research team (Nakamura & Iwakabe, 2018b) that client therapeutic gains are most clearly reflected in new relationships rather than existing attachment relationships. My commentary concludes with some questions posed to the author relating to the issue of effective training in empathic attunement and working with strong emotions in therapy.

Interest in psychotherapy integration has steadily expanded over the past decades, reaching most continents of the world and more mental health professionals than ever. Nevertheless, a country’s cultural and historical background significantly influences the nurturance or hindrance of integrative endeavors. This chapter seeks to explicate the current climate of psychotherapy integration in different continents and specific countries. With the aid of local integrative scholars, brief descriptions are presented on integrative practice, training, and research, as well as on cultural and sociopolitical issues that have shaped this movement’s impact around the world.

The goal of this special issue is to present two dramatically different models of case studies, to compare their methodological features, and to explore potential ways to integrate the two to make best use of their respective strengths. The two case study articles present an opportunity to view the breadth of psychotherapy case studies and psychotherapy practice inJapan. The commentaries provided by four eminent psychologists from both in and outsideJapan, and the subsequent responses from the two main authors, produce rich and stimulating dialogue that provides a forum for learning through case studies. This dialogue also helps to delineate the features of each case study. Reflecting on the two case study articles and the four commentaries, as the action editor of this special issue I offer my own observations, focusing on methodological issues of case studies and also on issues associated with differing cultural practices.

This issue of PCSP presents two case studies in Japan, commentaries from four prominent psychologists representing various research backgrounds, and the responses to the commentaries by the two authors. Japanese clinical psychology has historically emphasized the central role of the case study in psychotherapy and the inseparability of it from practice, research, and training. There is a plethora of case studies published in academic journals of clinical psychology and many practicing psychologists are engaged in case study activities as a part of their professional development as a result. However, this centrality of focus has not led to the examination of methodological issues associated with case studies. What constitutes a good case study or what kinds of evidence are necessary for a valid inference in case study research are both largely untouched topics. The wide variety of case studies in Japanese psychology form a continuum from one pole consisting of the traditional narrative case study to the other, consisting of a scientifically precise single case design to objectively track the change in targeted symptoms. In this issue, we present two outstanding examples of each type of case study. While different in type, each of the two case studies presented in this issue represents a model of how systematic and rigorous case studies can be conducted and documented as a form of psychotherapy research. We provide these two models (a) to encourage more case studies that meet these methodological standards, and (b) to promote the discussion on differing case study methodologies.

This study examined the experiences of Japanese clinical psychology trainees in their graduate school with the aim of identifying factors that might enhance or hinder their learning and professional development. We analyzed the interview data obtained from 17 clinical psychologists using grounded theory approach. Two major category groups were generated: Developing as a Clinician and Difficulties. The primary positive learning experiences in Developing as a Clinician were labeled “Hot Learning,” in which trainees acquired professional knowledge and skills through close interpersonal engagement with clients, peers, faculty, and supervisors. In contrast, Difficulties involved trainees’ negative experiences resulting in feelings of self-doubt and incompetence. These experiences occurred in close but sometimes conflicted interpersonal contexts, where trainees felt evaluated in a manner incommensurate with the support they received. We found that the quality of interpersonal relationships, which provided the c...

OBJECTIVE The present study constructed a preliminary process model of corrective emotional experience (CEE) in an integrative affect-focused therapy. METHOD Task analysis was used to analyse 6 in-session events taken from 6 Japanese clients who worked with an integrative affect-focused therapist. The 6 events included 3 successful CEEs and 3 partially successful CEEs for comparison. RESULTS A rational-empirical model of CEE was generated, which consisted of two parallel client change processes, intrapersonal change and interpersonal change, and the therapist interventions corresponding to each process. Therapist experiential interventions and therapist affirmation facilitated both intrapersonal and interpersonal change processes, whereas his relational interventions were associated with the interpersonal change process. The partially successful CEEs were differentiated by the absence of the component of core painful emotions or negative beliefs in intrapersonal change process, which seemed crucial for the interpersonal change process to develop. CONCLUSIONS CEE is best represented by a preliminary model that depicts two parallel yet interacting change processes. Intrapersonal change process is similar to the sequence of change described by the emotional processing model (Pascual-Leone & Greenberg, ), whereas interpersonal change process is a unique contribution of this study. Interpersonal change process was facilitated when the therapist's active stance and use of immediacy responses to make their relational process explicit allowed a shared exploration. Therapist affirmation bridged intrapersonal change to interpersonal change by promoting an adaptive sense of self in clients and forging a deeper emotional connection between the two.

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in th...

Empirically supported treatments have brought much enthusiasm for establishing a firm empirical basis for clinical practice. However controversies about what constitutes evidence in psychotherapy and what research methodologies qualify as sufficiently rigorous to produce such evidence also abound. Although most psychotherapy researchers are in agreement with the underlying rationale that psychotherapy should be based on rigorous scientific research, many are in disagreement as to what constitutes ideal scientific practice in evidence-based psychotherapy; alternative frameworks of evidence have been proposed. This paper first reviews different models of evidence, namely empirically supported treatments, empirically supported psychotherapy relationships, research informed principles of therapeutic change, and evidence-based practice in psychology, and discusses their relative strengths and limitations. Secondly, it illustrates three research topics and corresponding strategies that both supplement these evidence models and deepen an understanding of process and outcome in psychotherapy. These three areas are: mechanisms of change, systematic case studies, and researcher-practitioner collaboration.

This commentary focuses on two case comparison studies, one by Burckell and McMain (2011) on Dialectical Behavior Therapy for borderline personality disorder, and one by Watson et al. (2011) and Goldman et al. (2011) on Emotion-Focused Therapy for depression. The associated case comparison method, which evaluates and contrasts one successful case against one unsuccessful case that are both conducted in similar conditions, provides a unique opportunity for deepening our understanding of therapeutic change. Both therapies are integrative approaches that are clinically state-of-the art and empirically supported, and that have been drawing considerable attention from practitioners and researchers. In this commentary, I first discuss the case comparison method by reviewing previous such approaches, I then examine each pair of case studies with a focus on (a) findings on factors influencing success and limited success, and (b) methodological issues associated with the application of this unique method. Finally, I end my commentary with a suggestion for conducting case comparison studies.

Psychotherapy in Japan is a relatively new area of practice growing rapidly in the last 10 years, especially in the area of education as the problems associated with school-aged children such as bullying and truancy became one of the major social challenges. The majority of Japanese psychotherapists practice approaches developed in North America and Europe, and Jungian theory has been influential to Japanese psychotherapists. Psychotherapy integration in Japan often take a form of cultural integration that takes two routes: adjusting and modifying technical procedures in the western psychotherapy to suit Japanese client population and developing theoretical concepts that are more in agreement with Japanese culture and its underlying worldview. Psychotherapists in Japan emphasize the importance of a non-talking cure, or silent processes and often employ nonverbal tasks such as drawing and sandbox. They have also developed innovative theoretical constructs that emphasize the importance of healthy dependence between mother and child.

Our objective was to undertake linguistic validation and cultural adaptation of the Japanese version of the Audit of Diabetes-Dependent Quality of Life (JP-ADDQoL) and to evaluate its psychometric properties when completed by Japanese patients with diabetes.We followed the standard linguistic validation procedure and subsequently evaluated the reliability (internal consistency) and construct validity (exploratory and confirmatory factor analyses) of the translated version by surveying 239 Japanese patients with diabetes.We translated 19 items for the JP-ADDQoL. The internal consistency was excellent (Cronbach's alpha = 0.933). In the exploratory factor analysis, four factors were extracted, and most of the items in all four factors had high loadings. Forced one-factor analysis revealed all factor loadings other than those for sex life to be0.40 (sex life: 0.398). Confirmatory factor analysis indicated an acceptable fit for the JP-ADDQoL.The JP-ADDQoL showed adequate reliability and acceptable validity. Examining not only the impact of diabetes on a specific domain of life but also its importance for each patient leads to more accurate and individualized measurement of the patient's QoL.

The aim of this study was to investigate the divergence of client and trainee-therapist views of the different aspects of the alliance over the course of counseling and to relate those divergences to session-level therapeutic impacts. Forty-eight trainees and their clients completed therapies averaging 14 sessions. Results indicate that divergences in perspective did not influence the clients’ evaluations of the impact of their sessions. Only client ratings of the alliance were significantly correlated with positive session impacts. Measurements of the alliance taken at early, middle, and late phases indicated that, although both client- and therapist-rated alliance scores increased over time, convergence did not increase as therapy progressed. Implications for conceptualizing divergence as an expectable process that may not be a hindrance to positive therapy and the differences between experienced and trainee-therapists are discussed. Divergente Perspektiven zur Arbeitsbeziehung Das Ziel der Untersuchung...

This study explored the relationship between therapist interpretations and optimal in-session client processes in 20 sessions conducted by exemplary psychotherapists of three different theoretical orientations: Client-Centred Therapy (CCT), Rational-Emotive Behaviour Therapy (REBT), and Gestalt/Existential Therapy (GT). The results indicated that interpretations were used with similar frequency across therapeutic approaches, but they were neither superior nor inferior to other interventions in relation to the occurrence of optimal in-session client processes. The results support the notion that interpretation is a commonly used therapist intervention and that different therapies accentuate different aspects of interpretation. Implications for psychotherapy integration are offered and the findings are discussed with reference to theory and clinical practice.

Counselor and client 'statements from 21 sessions with eminent counselors were used to examine the relationship of counselor response modes to categories of client good moments at different alliance levels. Loglinear modeling procedures indicated that the alliance was present in all best-fitting models of the data. Exploratory examination of the models revealed that client good moments did not necessarily increase in frequency as the alliance increased. Further, different categories of interventions were associated with client good moments of provision of significant information at different alliance levels. The findings suggest that qualitatively different therapeutic processes are in operation at different alliance levels.

The relationship between client emotional expression and therapist interventions was studied in two working alliance conditions. An events-focused methodology was used to examine a total of 8 events taken from a variety of therapeutic orientations. Results indicated that, in the presence of a good client–therapist relationship, therapists showed higher levels of empathy and effectively focused on the immediately expressed feelings; in turn, their clients were engaged in exploration of feelings. In poor-relationship dyads, clients expressed negative feelings toward the therapists. Interventions rated as effective by clinical judges were characterized by accurate therapist understanding of clients' emotional expressions and working with strains in the therapeutic relationship. Ineffective interventions were associated with inaccurate assessments of clients' emotional states. Intensive analysis of these sessions led to three distinct models of in-session emotional expression events. Theoretical and practical implications of these models will be discussed.

This article explores potential benefits and problems in applying chaos theory in psychotherapy through an examination of previous attempts to integrate chaos theory into psychoanalysis and psychodynamic therapy. First a discussion provides an understanding of basic concepts in chaos theory and reviews applications in psychoanalysis. Second, problems in such applications are scrutinized. Finally, the discussion speculates on a general tendency in the literature in psychotherapy and counseling to resort to mathematical analogies, arguing that this attraction may produce an "erroneous metaphor," and gives reasons both for the attraction and its danger.

Recent developments in case study methodology reflect a rising interest that clinicians and researchers share in building a clinically useful and empirically sound knowledge base from single-case studies. The present article describes three types of single-case studies (clinical, experimental, systematic) and examines their potential contributions to psychotherapy research. It then lays out three ways in which single-case studies can be aggregated and synthesized to enhance clinical understanding: (a) a case database that allows clinicians to efficiently search for relevant cases, (b) a metasynthesis of single-case studies that integrates common themes across similar cases, and (c) an individual case comparison method in which closely matched cases are compared to identify both therapeutic and hindering processes.