Japanese psychoanalysis and the Ajase complex

1. Introduction

Version followed: Keigo Okonogi's elaboration of the Ajase complex (1978–2001: ideal unity → betrayal and resentment → mutual forgiveness), built on Heisaku Kosawa's 'Two kinds of guilt feelings' (written 1931–32, given to Freud in Vienna; Japanese publication 1954), used inside the mainstream Japanese format of once- or twice-weekly, usually face-to-face psychoanalytic psychotherapy (seishin bunseki-teki seishin ryōhō) with Okonogi's 'therapeutic structure theory' (chiryō kōzō-ron) as the frame. Kitayama Osamu's 'prohibition of don't look' (miruna no kinshi) and 'wounded caretaker' are added as a companion lens, and Doi Takeo's amae as background. Where Kosawa's and Okonogi's versions of the myth differ, Okonogi's is followed. [source: Mori 2016; Khishigtohtokh & Anara 2018; ja.wikipedia 'Ajase complex'; Okonogi 2003 contents] [uncertain: exact dates of Kosawa's paper differ across sources (1931, 1932, 1933)]

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; they practised ordinary psychoanalytic psychotherapy informed by it. Everything below that turns this into step-by-step practice is labelled [synthesis].

Core idea of change. Kosawa distinguished guilt felt as fear of punishment (linked to Oedipus and a paternal principle: punish and atone) from guilt that arises after being forgiven (linked to Ajase and a maternal principle: forgive and be forgiven). In the Ajase story the son who hated and attacked his mother falls ill; her devoted care, experienced as forgiveness, melts his hostility into heartfelt remorse. Okonogi read this as a developmental sequence: idealised oneness with the mother, discovery of her betrayal (that she had her own selfish wishes, including wishes against the child's existence), resentment that reaches back to one's very origin (mishōon, 'resentment before birth'), and then mutual forgiveness in which both mother and child are released. Clinically, change happens when the patient's resentment toward an idealised-then-disappointing object is lived out in the transference, survived without retaliation or abandonment by the therapist, and transformed from persecutory, punishment-type guilt into forgiveness-type remorse and mourning. [source: Mori 2016; SY-86 abstract (Niimura); ja.wikipedia 'Ajase complex'; Khishigtohtokh & Anara 2018]

2. Framework

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 [synthesis]. The sequence itself (ideal unity → betrayal → mutual forgiveness beyond resentment) is Okonogi's. [source: ja.wikipedia 'Ajase complex' summarising Okonogi]

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, length, place, fee, seating (chair or couch), and who manages medication, hospital or administrative matters (the A–T split, administrator and therapist being different people) are set explicitly and that their meaning is analysed. Duration is open-ended, typically one to several years. [source: IARPP 'Members in the Spotlight' (Agatsuma); Okonogi 2003 contents list 'practice of treatment structure theory'] [uncertain: session length, typical duration and A–T split details come from general knowledge of Japanese practice]

Phase 1 — Setting the structure and the honeymoon (ideal unity). Goals: agree the structure; build the working alliance; allow the patient's idealising, amae-type hopes of the therapist to develop and be noticed, not rushed. Typical length: first 1–3 months (about 4–15 sessions). Move on when: the structure is stable, the patient can free-associate or talk openly, and the first disappointments with the therapist or the frame appear. [synthesis]

Phase 2 — Betrayal and resentment (disillusionment). Goals: let disappointment and hidden resentment toward the therapist emerge and be named (breaks, fees, limits, the therapist's other patients, mistakes); link it to the parental story, including mishōon themes (being unwanted, born for the parent's needs, a mother who withdrew). Expect punishment-type guilt, masochism, apologising, acting out, or abrupt flight. Typical length: the bulk of the treatment, months to years. Move on when: the patient can feel and say resentment toward the therapist in the room, the relationship survives it, and remorse begins to appear alongside anger rather than only self-punishment. [synthesis built on Okonogi's sequence]

Phase 3 — Mutual forgiveness and mourning. Goals: work through remorse toward parents and the therapist; recognise the parent (and therapist) as limited, wounded, with their own needs; mourn the ideal mother; shift from self-punishment to concern and repair. Typical length: last 3–12 months, including a planned ending. Move on (end) when: the patient can hold love and resentment toward the same person, guilt is felt as regret and concern rather than dread of punishment, and the ending can be anticipated and mourned rather than fled from. [synthesis; Okonogi's work on object loss and mourning supports the emphasis — source: Okonogi 2003 contents]

3. Guiding principles

Two kinds of guilt. Listen for whether guilt is fear of punishment or remorse after being forgiven; the aim is to move from the first toward the second. [source: Kosawa via Mori 2016]
Maternal before paternal. Read problems first through the mother–child dyad (dependency, betrayal, resentment, forgiveness) and only then through rivalry and prohibition; use both. [source: Okonogi 1979 via Mori 2016; Kitayama interview, apdeba]
Resentment toward the origin. Take seriously hatred about the conditions of one's birth and early care (mishōon), not only about later events. [source: ja.wikipedia 'Ajase complex']
Betrayal is inevitable and usable. The patient will experience the therapist as betraying; this is the material of treatment, not a failure. [synthesis from Okonogi's sequence]
Forgiveness is mutual. Both sides are released: the child from hatred, the mother from her selfish wishes; in therapy the therapist also owns real failures. [source: Okonogi via Mori 2016; Mori's case of the therapist's apology]
Survive without retaliating or melting the boundary. Receive hostility without punishing, withdrawing or collapsing into indulgence. Kosawa's 'torokashi' ('melting') stance was criticised by Doi; the contemporary reading is non-retaliatory steadiness, not gratification. [source: Sakai 2025 abstract; synthesis for the contemporary reading]
Amae is to be understood, not simply gratified or refused. Notice the wish to be indulged and the conflicts inside it; Doi's later view stressed identifying with the patient to find them. [source: Sakai 2025 abstract; Doi 1971]
Structure is part of the treatment. Set the frame explicitly and analyse what the patient does with it. [source: Okonogi 2003 contents (treatment structure theory)] [uncertain: details]
Look, and stay. Do not turn away from what the patient hides (ugliness, wounds, shame); seeing it without fleeing is curative. [source: Kitayama 1985/2010 titles and interview; content from general knowledge of Kitayama, marked uncertain]
Front and back (omote/ura). Expect a public front and a private back; the consulting room is where the back can be spoken, as a secret between two. [source: Kitayama interview, apdeba]
Shame before guilt. In a culture organised around being seen by others, shame and loss of face often come before guilt; address shame first. [source: Kitayama interview, apdeba; Agatsuma in IARPP]
Preemptive apology is not remorse. Frequent apologising can be amae-seeking ('preemptive guilt'), apologising first to be forgiven; interpret it rather than accept it as remorse. [source: Mori 2016; Okano 2009 via Mori]
Mourning and transience. Ending, loss and impermanence are to be worked through, not avoided. [source: Okonogi 2003 contents; Kitayama podcast description]
Culture is a lens, not a stereotype. Okonogi and Doi presented these dynamics as universal though prominent in Japan; do not assume them for any patient on ethnic grounds. [source: Khishigtohtokh & Anara 2018 on Doi; synthesis]

4. Intervention inventory

Kosawa, Okonogi and Kitayama describe concepts, a therapeutic attitude and case vignettes, not discrete scripted techniques. The interventions below are the clinical moves their writings imply, on top of ordinary psychoanalytic psychotherapy (free association, clarification, interpretation, transference work). Each item states what is sourced and what is [synthesis]. All example language is illustrative, not the founders' words.

4.1 Setting the therapeutic structure (chiryō kōzō)

Purpose / when: First 1–3 sessions, and whenever the frame changes. Okonogi held that the explicit structure (frequency, time, place, fee, seating, cancellation rules, who handles medication or hospital decisions) shapes the transference and is itself material for analysis. [source: Okonogi 2003 contents] [uncertain: the detailed content of treatment structure theory]
Steps: (1) After 2–4 assessment sessions, propose a fixed day, time and length (commonly once weekly, 45–50 min). (2) Agree the fee and the policy on missed sessions and breaks in writing. (3) Decide chair (face-to-face, usual in Japan) or couch (see 4.15). (4) If a psychiatrist or institution manages medication, leave, or certification, name that split and who does what (A–T split). (5) Record the agreements; later, when the patient bends or tests a rule, explore it before changing it. [synthesis]
Example language (illustrative): 'We'll meet every Tuesday at 4 for 50 minutes. If something comes up about the arrangement itself — the time, the fee, the breaks — that's something we'll talk about here too, not just sort out.'
Watch for: early requests for exceptions (extra time, contact between sessions, fee reductions) — often the first amae and the first test of whether the therapist will betray. Working: the patient comes regularly and begins to react to the frame in words rather than by action.

4.2 Face-to-face free association / open dialogue

Purpose / when: The basic method throughout. Kosawa practised Freudian free association; Japanese practice largely adapts it to a sitting, once-weekly format. [source: SY-86 abstract (Kosawa used free association); IARPP (Agatsuma)]
Steps: (1) Invite the patient to say what comes to mind, including what seems trivial, embarrassing or rude toward the therapist. (2) Keep your own talk short; follow the patient's lead. (3) Note what the patient avoids saying face-to-face (shame, criticism of you). (4) Gently name hesitations. [synthesis on standard technique]
Example language (illustrative): 'You paused just then, as if something came to mind that you'd rather not say to my face.'
Watch for: polite, front-stage (omote) narration with no affect; long silences out of deference. Working: material becomes more personal, including thoughts about the therapist.

4.3 Guilt-type assessment and formulation

Purpose / when: From assessment onward, to formulate whether the patient's guilt is predominantly punishment-type (fear of retribution, self-punishment, compulsive atonement) or forgiveness-type (remorse that arises when one feels forgiven), and what blocks the second. [source: Kosawa's two types via Mori 2016]
Steps: (1) When guilt appears, ask what the patient expects to happen and from whom. (2) Note whether relief comes from being punished (self-harm, overwork, self-criticism) or from being understood. (3) Note apology patterns (see 4.9). (4) Write a working formulation: who is resented, who is idealised, what betrayal occurred, what forgiveness is missing. (5) Revisit it at reviews. [synthesis]
Example language (illustrative): 'When you feel you've done wrong, it sounds as if you're bracing for a blow. I wonder what it would be like if nobody struck back.'
Watch for: guilt that only lifts after self-punishment; complete absence of guilt (resentment kept wholly conscious and righteous). Working: the patient begins to notice the difference between dreading punishment and feeling sorry.

4.4 Ajase-sequence formulation (ideal unity, betrayal, resentment, forgiveness)

Purpose / when: Use Okonogi's three-part sequence as a map of the patient's history with the primary caregiver and of the transference. Use once enough history is known (often after 5–10 sessions). [source: Okonogi's three phases, ja.wikipedia 'Ajase complex'; Okonogi via Mori 2016]
Steps: (1) Identify the idealised oneness (what the patient longed for or once had). (2) Identify the betrayal: the moment the caregiver was revealed to have their own needs — a new sibling, a mother's illness, career, depression, an admission the child was unwanted. (3) Identify the resentment and how it is expressed or hidden. (4) Identify whether any mutual forgiveness happened. (5) Hold this privately; offer pieces when material arises, not as a lecture. [synthesis]
Example language (illustrative): 'It sounds as though for a long time she was everything, and then you found out she had a life, and wishes, that didn't include you — and that discovery felt like a betrayal you've never quite forgiven.'
Watch for: imposing the myth on a patient whose central conflict is elsewhere; using it to blame mothers. Working: the patient recognises the pattern from inside and adds their own details.

4.5 Interpreting mishōon (resentment about one's origins)

Purpose / when: When the patient expresses grievance about being born at all, being unwanted, being a replacement child, conceived to save a marriage, or raised to meet a parent's needs. In Okonogi's reading, Ajase's grudge is against the mother who wanted him for her own sake and then wished him dead. [source: ja.wikipedia 'Ajase complex' (mishōon; Kosawa's version: queen has the hermit killed, then tries to abort the cursed child)]
Steps: (1) Let the grievance be fully stated without correcting it. (2) Name the resentment directly as resentment, not just sadness. (3) Link it to the patient's stance in current relationships (e.g., feeling used, refusing to need anyone). (4) Later, link it to the transference (the therapist who sees you for money, has other patients). (5) Only after it has been fully held, explore what the parent's own situation might have been. [synthesis]
Example language (illustrative): 'Underneath the sadness there seems to be real anger — at being brought into a life arranged around her needs, not yours.'
Watch for: premature reframing ('she did her best') that shuts down resentment; overwhelming rage or suicidal ideation linked to 'I should never have been born' (use standard risk assessment). Working: resentment becomes speakable without collapse into self-hatred.

4.6 Transference interpretation of betrayal

Purpose / when: In the middle phase, whenever the patient reacts to breaks, lateness, fees, the therapist's limits or mistakes, or signs of the therapist's other attachments. This is where Okonogi's 'betrayal by the mother' is relived. [source: Okonogi's sequence; transference use is synthesis]
Steps: (1) Notice indirect signs: missed sessions after a break, sudden politeness, complaints about others who 'only care about money'. (2) Bring it into the room: name the possible feeling toward you. (3) Link to the original betrayal only after the here-and-now feeling has been acknowledged. (4) Do not defend yourself or over-apologise. (5) Return to it repeatedly; each round is working through. [synthesis]
Example language (illustrative): 'You've told me about three people this week who let you down. I wonder if I'm the fourth — I was away for two weeks, and you came back very polite with me.'
Watch for: 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.

4.7 Non-retaliatory holding of hostility (the contemporary reading of 'torokashi')

Purpose / when: When hostility, contempt or attacks on the therapy appear. In the Ajase story, the mother's devoted care in response to the son's attack is what turns hatred into remorse. [source: Khishigtohtokh & Anara 2018; Mori 2016]
Historical note: Kosawa's own technique, 'torokashi' ('melting'), aimed to melt the patient's aggression through the analyst's accepting, almost parental devotion; he sometimes combined free association with Buddhist prayer. Doi criticised this stance, and Kosawa's successors removed the religious elements. No documented serious harm was found, but gratifying, devotional or religious practices are outside the contemporary frame and should not be reproduced. [source: Sakai 2025 abstract; SY-86 abstract (Niimura)] [uncertain: the detailed content of 'torokashi']
Steps (contemporary, [synthesis]): (1) Receive the attack without counter-attack, sarcasm or withdrawal. (2) Keep the frame unchanged (no extra sessions or fee cuts as appeasement). (3) Name the hostility and its function. (4) Show by continuity — next session, same time — that you and the relationship survived. (5) Watch for the remorse that may follow and receive it as in 4.8.
Example language (illustrative): 'You're furious with me today, and you're also watching to see whether I'll punish you or disappear. I'm still here, and I'll be here next Tuesday.'
Watch for: your own urge to retaliate or to placate; masochistic tolerance of abuse (set limits on threats or violence). Working: hostility is followed, sometimes sessions later, by spontaneous concern or regret.

4.8 Receiving forgiveness-type remorse (sange)

Purpose / when: When, after resentment has been survived, the patient shows regret, concern for the parent or therapist, or wishes to repair. Kosawa valued this 'heartfelt remorse' that follows being forgiven over guilt as fear of punishment. [source: Khishigtohtokh & Anara 2018; Mori 2016; ja.wikipedia 'Ajase complex' (sange, confession/repentance)]
Steps: (1) Do not rush to absolve ('it's fine, don't worry') — that cuts the remorse short. (2) Do not amplify it into self-punishment either. (3) Name it as concern, distinct from earlier dread. (4) Link it to the capacity to love and hate the same person. (5) Explore what repair, if any, is realistic in the patient's actual relationships. [synthesis]
Example language (illustrative): 'This feels different from the guilt you came in with. That was fear of being punished; this sounds more like being sorry — because you can see what it was like for her too.'
Watch for: remorse that turns into compulsive apology or caretaking; remorse used to restore the idealised oneness and avoid further anger. Working: guilt is lighter, more specific, and leads to concern and action rather than self-attack.

4.9 Interpreting preemptive apology and amae-seeking guilt

Purpose / when: When the patient apologises constantly, often before anything has happened, or uses guilt language to elicit reassurance. Mori named this 'preemptive guilt': admitting fault first in the expectation of being forgiven, reflecting amae; Okano linked excessive guilt language to dependence-seeking. [source: Mori 2016; Okano 2009 via Mori]
Steps: (1) Notice the pattern over several sessions before commenting. (2) Describe it neutrally. (3) Explore what the apology is meant to secure (forgiveness, closeness, avoiding anger). (4) Explore what happens if it is not answered with reassurance. (5) Distinguish it, in the patient's own experience, from real regret. [synthesis]
Example language (illustrative): 'You've said sorry four times today, and nothing has gone wrong between us. I wonder if saying sorry first is a way of making sure I'll stay kind.'
Watch for: the patient experiencing the observation as a rebuke (and apologising for apologising) — address that shame gently. Working: fewer reflexive apologies, more direct requests.

4.10 Understanding and interpreting amae

Purpose / when: Throughout, when the patient hopes to be indulged, presumes on the therapist's goodwill, or sulks (suneru) when this fails. Doi's early approach left the patient in the state of wanting to be indulged without being indulged, to restore a sense of self; his later approach had the therapist identify with the patient to find the conflicts and emotions contained in amae. [source: Sakai 2025 abstract; Doi 1971]
Steps: (1) Notice indirect requests for indulgence (asking you to decide, presuming special treatment). (2) Neither simply gratify nor coldly refuse. (3) Name the wish warmly. (4) Explore the feelings inside it (longing, fear of rejection, resentment when unmet). (5) Link it to the Ajase sequence: unmet amae is often where betrayal is felt. [synthesis]
Example language (illustrative): 'Part of you hoped I'd just know what you needed without your having to ask — and when I didn't, you went quiet and a bit hurt.'
Watch for: pathologising ordinary dependency; therapist enactment (always rescheduling for this patient). Working: the patient can ask directly and tolerate a 'no'.

4.11 Owning the therapist's real failures (the mother's side of mutual forgiveness)

Purpose / when: When the therapist has made an actual mistake (double-booking, lateness, a wrong date, a misattunement). Okonogi's forgiveness is mutual; in Mori's case, the therapist's spontaneous apology for a possibly mistaken appointment date shifted the relationship, after which the client began to notice the therapist and speak about guilt toward her parents. [source: Mori 2016]
Steps: (1) Acknowledge the error briefly and specifically. (2) Do not over-apologise or explain at length (that turns the session toward your needs). (3) Invite the patient's reaction, including anger. (4) Explore what it was like to be apologised to. (5) Later, link to the parent who never acknowledged their part. [synthesis built on Mori's case]
Example language (illustrative): 'I got the date wrong last week, and you came for nothing. I'm sorry. I'd like to hear what that was like for you — including whatever was annoying about it.'
Watch for: the patient rushing to reassure you (role reversal, caretaking the wounded caretaker — see 4.13). Working: the patient can be angry and then let it go, and later speaks more freely about parental failures.

4.12 Working with the prohibition of don't look

Purpose / when: When the patient hides a part of themselves (an 'ugly', wounded or shameful side) and fears that being seen will end the relationship; or when the patient idealises a caretaker and cannot bear to see their flaws. Kitayama derived the pattern from Japanese myths and folk tales (Izanagi and Izanami; the crane wife): a prohibition against looking, the partner looks, discovers the hidden wounded or ugly nature, recoils in disillusionment, and the woman leaves in shame, so the relationship ends without working through. [source: Kitayama 1985 (IRP 12:173), 2010 (book) — titles only; podcast description (Izanagi–Izanami)] [uncertain: the pattern's details are from general knowledge of Kitayama's work]
Steps: (1) Notice prohibitions on looking in the patient's account (topics never discussed, a parent's illness or exhaustion everyone ignored). (2) Notice the same in the room (subjects the patient warns you off, signs of shame). (3) Name the fear that if you see, you will recoil or the patient will have to leave. (4) Look — explore it — and stay: show by continued interest that the relationship survives. (5) Help the patient do the same toward the disillusioning parent: see their wounds without fleeing. [synthesis]
Example language (illustrative): 'I think you've been sure that if I saw this part of you, I'd be put off and things between us would end. We're looking at it now, and I'm still here.'
Watch for: the patient abruptly ending therapy after a revealing session (the crane-wife exit) — anticipate it and name it; therapist's own recoil. Working: shameful material is followed by return, not flight.

4.13 Interpreting guilt toward the wounded caretaker

Purpose / when: When the patient feels a heavy, indebted guilt (e.g., sumanai, 'it never ends') toward a self-sacrificing parent whose devotion visibly wore them out, and therefore cannot express anger or separate. Kitayama wrote on 'the wounded caretaker and guilt'. [source: Kitayama 1991 (IRP 18:229), title only] [uncertain: content described from general knowledge]
Steps: (1) Identify the caretaker's sacrifice and the patient's sense of having caused the wound. (2) Name the double feeling: gratitude and resentment at being owed. (3) Explore how this blocks anger and autonomy. (4) Watch for it with you: the patient worrying you are tired, protecting you. (5) Work toward seeing the caretaker as a person with limits rather than a victim the patient injured. [synthesis]
Example language (illustrative): 'It's as if her exhaustion is a debt you can never repay — so being angry with her, or with me, feels unforgivable.'
Watch for: the patient caring for the therapist; the therapist becoming a martyr (over-working for this patient). Working: anger and gratitude can coexist; separation steps no longer feel like wounding.

4.14 Working with front and back (omote/ura) and shame

Purpose / when: When the patient presents a socially correct front and keeps the real feelings 'backstage'. Kitayama describes a double standard of public front and private back, a culture organised around being watched by others, and the consulting room as the place where shameful topics are spoken, as a conscious secret between two people rather than something repressed. [source: Kitayama interview, apdeba; Agatsuma in IARPP (patients sensitive to how others see them)]
Steps: (1) Treat polite, formal speech as the front, not as resistance to be broken. (2) Acknowledge explicitly that this room is a place for the back. (3) Ask about what is 'not said outside'. (4) Treat disclosed secrets as shared between the two of you; be explicit about confidentiality and its limits. (5) Address shame (being seen) before guilt (having done wrong). [synthesis]
Example language (illustrative): 'Outside, it sounds like you have to keep everything in order. In here, the parts you'd never show anyone are exactly what we can look at.'
Watch for: the therapist becoming a judging audience; disclosures followed by missed sessions (shame hangover). Working: the patient's language becomes less formal and more emotionally direct.

4.15 Deciding between chair and couch

Purpose / when: At the setting stage, and if the frequency increases. Face-to-face once-weekly work is the norm in Japan; the couch removes the mutual gaze, which may hinder some patients but help others escape the shame of being watched. Kitayama agreed in interview that it can be useful to be freed from the culture, especially a culture of shame. [source: apdeba interview (editors' note and Kitayama's reply); IARPP (Agatsuma)]
Steps: (1) Default to face-to-face for once-weekly work. (2) Consider the couch if the patient is crippled by being looked at, or if frequency is two or more per week and the patient can tolerate regression. (3) Discuss the meaning of the change with the patient beforehand. (4) Observe what changes after the switch. [synthesis]
Example language (illustrative): 'You've said that my face is the hardest thing — you're always checking whether I approve. We could try the couch, so you can talk without watching me. What comes to mind about that?'
Watch for: the couch experienced as abandonment (the therapist turning away); dissociation. Working: freer association without loss of contact.

4.16 Mourning, transience and the planned ending

Purpose / when: In the final phase and around any loss. Okonogi wrote on object loss and mourning; Kitayama treats transience as a source of vitality and links it to mourning and resilience. The aim is an ending that is mourned and mutually forgiven, rather than the abrupt departure of the folk tales. [source: Okonogi 2003 contents; Kitayama podcast description] [synthesis for ending procedure]
Steps: (1) Set an ending date well in advance (often 2–6 months for long treatments). (2) Expect a revival of the betrayal theme: the ending as the therapist's abandonment. (3) Interpret it and allow resentment. (4) Review what changed, including the patient's grievances about what therapy did not give. (5) Allow sadness and gratitude together; keep the final session ordinary. [synthesis]
Example language (illustrative): 'In a sense I'm leaving you too, just as you feared. You may be angry about that, and also sad — both belong to this ending.'
Watch for: sudden early termination to avoid the goodbye; idealised flight into health. Working: the patient can say goodbye with mixed feelings and without having to leave first.

4.17 Using the myth narratively (optional)

Purpose / when: With patients who are psychologically curious or culturally familiar with the stories, a brief reference to Ajase or to the 'don't look' tales can give shape to experience. Kosawa and Kitayama used myths as interpretive frames for theory; whether to share them with patients is not specified in sources found. [source: SY-86 abstract; Kitayama interview, apdeba] [synthesis]
Steps: (1) Use only after the patient has described the pattern in their own terms. (2) Offer briefly, as a picture not a diagnosis. (3) Return immediately to the patient's experience. [synthesis]
Example language (illustrative): 'There's an old story of a son who hated his mother for what she'd wished on him, and then was nursed by her when he fell ill. Something in what you're describing reminds me of it.'
Watch for: intellectualisation; patient feeling categorised. Working: the patient uses the image to talk about feelings, not about theory.

5. Handling problems

Sources do not give problem-management protocols; nearly all guidance here is [synthesis] grounded in the concepts above, with source tags where a concept applies.

Stuck in idealisation (Phase 1 never ends). The patient is grateful, compliant, never critical. Response: look for small disappointments (breaks, fee, your misunderstandings) and name them; interpret preemptive apology (4.9) and amae (4.10); ask what it would mean to be disappointed in you. [synthesis; concepts from Okonogi's sequence, Mori 2016]
Resentment without movement (stuck in Phase 2). Grievance is righteous and endless; the therapist feels worn out. Response: keep surviving without retaliating (4.7); check whether you are subtly pushing toward forgiveness (which re-enacts the parent's demand); explore what the grievance protects (the hope of an ideal mother, the fear of mourning); move from 'what she did' to 'what it would mean to let go of the claim'. [synthesis]
Punishment-type guilt and self-harm. Guilt is discharged through self-harm, overwork, or provoking punishment. Response: name the punishment logic (4.3); do not participate by scolding; for self-harm or suicidal ideation follow standard risk assessment and safety planning, involve the psychiatrist or team where an A–T split exists. [synthesis; risk management is standard practice]
Resistance as politeness and silence. Long silences, formal speech, deference. Response: treat as shame and front-stage behaviour (4.14) rather than opposition; name it gently; consider whether face-to-face gaze is intensifying shame (4.15). [source: Kitayama interview; Agatsuma in IARPP] [synthesis for responses]
Abrupt flight after disclosure (crane-wife exit). Patient cancels or quits after showing something shameful. Response: anticipate it the session it happens ('you may want to stay away after today'); if the patient misses, send a brief, non-pressuring contact keeping the slot open; on return, interpret the fear that being seen ends the relationship (4.12). [synthesis; pattern from Kitayama, uncertain]
Ruptures from the therapist's mistakes. Response: own the error briefly (4.11), invite anger, avoid over-explaining; then explore the parallel with parents who never acknowledged their part. [source: Mori 2016] [synthesis]
Ruptures from the frame (breaks, fees, cancellation charges). Response: hold the frame; interpret the reaction as betrayal transference (4.6); adjust the frame only for real-world reasons, and then analyse the change. [source: Okonogi's structure theory, details uncertain] [synthesis]
Non-adherence (missed sessions, lateness, unpaid fees). Response: treat as communication first; explore before enforcing; enforce the agreed policy consistently, because inconsistency becomes indulgence and later betrayal. [synthesis]
Overwhelm and regression. Intense dependency, crises between sessions, demands for more contact. Response: once-weekly work can under-hold severe regression; consider increasing frequency, clarifying the A–T split (psychiatrist handles crises and medication), and limiting between-session contact to agreed channels. Do not 'melt' boundaries in the name of maternal acceptance; Kosawa's devotional stance was criticised by Doi. [source: Sakai 2025 abstract] [synthesis]
Therapist countertransference: rescuer or retaliator. The Ajase dynamic pulls the therapist either to become the idealised devoted mother or to become punitive. Response: monitor in supervision; ask whether you are extending sessions, reducing fees, or becoming cold; return to the frame. [synthesis]
Mother-blaming. The formulation drifts into blaming mothers, or the patient's actual father, siblings or trauma are ignored. Response: remember Okonogi's forgiveness is mutual and includes seeing the mother's own position; also use paternal/Oedipal formulations where they fit (Kitayama uses both). [source: Kitayama interview; Okonogi via Mori 2016] [synthesis]
Forced or premature forgiveness. Patient (often with abuse histories) feels forgiveness is expected. Response: forgiveness is an outcome, never a task; explicitly say that the patient does not have to forgive anyone; with abuse or ongoing danger, prioritise safety and validation of harm. [synthesis — sources do not address this]
Cultural mismatch. Non-Japanese patients, or Japanese patients who reject the 'Japanese' framing. Response: use the dynamics (betrayal, resentment, two kinds of guilt) without cultural labels; Doi and Okonogi saw them as universal though prominent in Japan. [source: Khishigtohtokh & Anara 2018 on Doi] [synthesis]
Concerns about the theory's textual basis. Patients or colleagues may note that the Buddhist sutras do not support the mother-centred story (in the sutras the grudge is against the father, and the hermit's murder by the queen is absent). Response: treat the Ajase complex as a clinical model, not scripture; this does not affect its use in session. [source: ja.wikipedia 'Ajase complex' (Okonogi's own source critique; Kosawa's version traced to Chikazumi Jōkan)]
Religious elements. Kosawa sometimes combined free association with Buddhist prayer; successors removed this. Do not introduce religious practice into therapy; if the patient brings their own religion, explore its meaning as with any material. [source: SY-86 abstract] [synthesis for guidance]

Sources

Sources:

Books and papers cited (not drawn on; bibliographic details partly from general knowledge [uncertain]):

Kosawa, H. (1954). Zaiaku ishiki no nishu: Ajase konpurekkusu [Two kinds of guilt feelings: the Ajase complex]. Seishin Bunseki Kenkyū 1(4). (German original given to Freud c. 1932.)
Okonogi, K. (1978). The Ajase complex of the Japanese. Japan Echo 5.
Okonogi, K. (1979). Nihonjin no Ajase konpurekkusu [The Ajase complex of the Japanese] (book edition 1982). Tokyo: Chūkōron-sha.
Okonogi, K. & Kitayama, O. (Eds.) (2001). Ajase konpurekkusu. Tokyo: Sōgensha.
Okonogi, K. (2003). Seishin bunseki no susume. Osaka: Sōgensha.
Iwasaki, T. et al. (Eds.) (1990). Chiryō kōzō-ron [Theory of therapeutic structure]. Tokyo: Iwasaki Gakujutsu Shuppansha.
Doi, T. (1971). Amae no kōzō. Tokyo: Kōbundō (English: The Anatomy of Dependence, 1973).
Kitayama, O. (1985). Pre-Oedipal 'taboo' in Japanese folk tragedies. Int. Rev. Psycho-Anal. 12:173–186.
Kitayama, O. (1991). The wounded caretaker and guilt. Int. Rev. Psycho-Anal. 18:229–240.
Kitayama, O. (2010). Prohibition of Don't Look: Living through Psychoanalysis and Culture in Japan. Tokyo: Iwasaki Gakujutsu Shuppansha.
Okano, K. (2009); Kitayama, O. & Basak, J. (2025). Psychoanalytic Explorations into the Primal Relationship in Japan and India. Routledge.

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