Japanese psychoanalysis and the Ajase complex

Domain I · Psychodynamic & depth psychology · Keigo Okonogi, Heisaku Kosawa · 1931 · Japan

What it is

This is a theory and a clinical sensibility, not a manualised therapy. There is no treatment manual, no session protocol and no fidelity scale. Its authors describe a way of understanding guilt, resentment and dependency in the mother–child relationship and how these appear in the transference;…

Format

• No phase model is laid down by Kosawa or Okonogi. The phases below map Okonogi's three-part Ajase sequence onto the course of a psychoanalytic psychotherapy; the mapping is. The sequence itself (ideal unity → betrayal → mutual forgiveness beyond resentment) is Okonogi's.
• Format. In Japan, psychoanalysis at several sessions a week has long been rare; most work is once-weekly (sometimes twice), 45–50 minutes, usually sitting face-to-face, called psychoanalytic psychotherapy rather than psychoanalysis. Okonogi's therapeutic structure theory requires that frequency,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• intellectualisation; patient feeling categorised. Working: the patient uses the image to talk about feelings, not about theory.
• the couch experienced as abandonment (the therapist turning away); dissociation. Working: freer association without loss of contact.
• pathologising ordinary dependency; therapist enactment (always rescheduling for this patient). Working: the patient can ask directly and tolerate a 'no'.
• the patient flipping into self-blame to protect the idealised therapist; enactments (quitting). Working: the patient can say 'I was angry with you' and stay.
• polite, front-stage (omote) narration with no affect; long silences out of deference. Working: material becomes more personal, including thoughts about the therapist.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.