Dohsa-hou · Atlas

1. Introduction

Version followed: Naruse's clinical Dohsa-hou (rinsho dohsa-ho, 臨床動作法) with its three pillars of relaxation, tate-kei (upright posture against gravity) and communication, as set out in the Osaka University English introduction (Imura, ed., 2016) and Japanese case and research literature from the Kyushu school. Ohno's Self-Active Relaxation Therapy (SART, 2005), a simplified self-practice derivative, is described separately where noted.

Dohsa-hou ("body-movement method") is a Japanese psychotherapy that works through deliberate body movement instead of, or alongside, talk. It grew out of hypnosis research by Gosaku Naruse's team (Kyushu University) in the mid-1960s: a boy with cerebral palsy moved more freely under hypnosis, but the gain vanished afterwards, so the team looked for a non-hypnotic way for the person to release excess tension himself. They concluded that the impaired movement was partly a psychological, learned process and not explained by brain damage alone [source: Imura 2016; Kabir et al. 2018]. Kabir et al. date the start to 1966; one Japanese dissertation traces an early 1966 application (Kobayashi, Saitama rehabilitation centre, hypnotic relaxation plus movement training with seven adults with cerebral palsy) [source: Kuwashima dissertation]. The exact first site and date are [uncertain]. It began as "dohsa training" or "psychological rehabilitation" for children with cerebral palsy, then extended to severe multiple disabilities, autism, ADHD, schizophrenia, depression, eating disorders, tics, obsessive-compulsive and borderline presentations, psychosomatic disorders, older adults, athletes and healthy adults [source: Imura 2016; Fujino 2013; Kuwashima].

Core idea of change: Naruse defines dohsa (動作) not as mere body movement but as the process intention, then striving/effort, then body movement. Movement that is done to a person passively is not dohsa; the client's own intention and effort are what matter [source: Setoyama, Haramaki & Toya 2017, citing Naruse 1985; Imura 2016]. Chronic anxiety, obsessions and stress settle into the body as habitual "unwarranted" tension and awkward posture that the person often cannot feel. When the client, with a trainer's hands-on help, intends a movement, strives at it, notices the gap between habitual and new movement, releases tension by their own effort and holds an upright axis against gravity, they gain a changed way of experiencing (taiken-yoshiki, 体験様式): a sense of agency ("I am moving my own body", shudokan 主動感), reality, security and self-control, which carries over into feeling and behaviour [source: Imura 2016; Setoyama et al. 2017; Kuwashima]. Physical relaxation is secondary; the aim is an alternative mode of experiencing, so full release is not required [source: Fujino 2013].

Note on classification: although listed here under psychotherapies rooted in Eastern thought, the sources present Dohsa-hou as a secular, hypnosis-derived psychological method; none of the sources ground it in religious doctrine [source: Imura 2016; Kabir et al. 2018]. Training and professional bodies: the Japanese Association of Rehabilitation Psychology (日本リハビリテイション心理学会, founded 1976) and the Japanese Association of Clinical Dohsalogy (日本臨床動作学会, founded 1993) [source: Kuwashima; Imura 2016]. Their certification routes are not drawn on [uncertain].

2. Framework

Dohsa-hou is not a fixed-session manual. Practitioners select tasks from a repertoire to fit an assessment of the person's movement and experience, then sequence them [source: Kono lecture notice 2024; Imura 2016]. The typical arc reported across cases:

Phase 0: Assessment (mitate, 見立て). Goal: read difficulties in movement (where tension sits, posture, how the person strives, how they respond to the trainer's hands) as a window onto psychological maladjustment, and choose fitting tasks [source: Kono 2024; Imura 2016]. Typical content: observe sitting (agura), kneeling and standing posture and gait; ask about tense, sensitive or painful areas to avoid; a simple pre-test of range (e.g. seated reach to each side) [source: Imura 2016 case chapters; Kabir et al. 2018]. Common patterns noted: rounded shoulders with hiked lower back; rounded shoulders with protruding middle; twisted trunk with hiked buttocks; all with partly bent knees and ankles [source: Imura 2016].

Phase 1: Relaxation tasks (弛緩課題). Goal: the client finds and releases unnoticed tension by their own effort; builds trust and shared attention with the trainer. Tasks: shoulder raise-lower, shoulder opening, trunk twist, back arching, arm raising, forward bends and local relaxation of hips, ankles, face, chest [source: Kuwashima; Imura 2016].

Phase 2: Tate-kei / axis-making tasks (タテ系・軸づくり). Goal: build an upright body axis from soles to head, coordinate tension and release across several joints, and feel grounded. Positions in order of difficulty: sitting (agura-zai), kneeling (hiza-dachi), standing (ritsui), walking (hokou), with weight-shifts in each [source: Imura 2016; Higashiyama et al.].

Phase 3 (parallel strand): Communication tasks. Goal: joint attention and understanding the other's intention, used mainly with autism, severe intellectual disability and young children [source: Imura 2016].

Phase 4: Self-practice and ending. Goal: the client (or parent) can do chosen tasks alone; review; home practice [source: Imura 2016 case 2; Kabir et al. 2018; Kono 2024].

Criterion for moving phases: most reports begin with relaxation and add axis-making tasks once sufficient relaxation has been achieved (e.g. relaxation days 1–3, kneeling added days 4–6 of a camp) [source: Kuwashima, citing Fujikawa & Hoshikawa 2010]. Within a task, move on when the client can initiate and complete the intended movement with less support and reports the bodily change themselves [source: Imura 2016; Kabir et al. 2018]. If no progress, pause the task [source: Imura 2016].

Session count and format (reported, not prescribed):

Individual outpatient: weekly 60 min for 15 weeks; twice monthly 60 min for about six months; 17, 24, 45 or 57 sessions in single cases; 15–30 min weekly at a psychiatric day centre [source: Kuwashima; Imura 2016 ch. 4.1].
Brief relaxation: about 25 min per session, three weekly sessions with students [source: Fujino 2013]; SART full programme about 24 min, seated 5-min version for groups or wheelchair users [source: Kabir et al. 2018].
Intensive camp (shinri rehabilitation camp): 4–6 days, about three sessions a day, with a trainee, parent, trainer, sub-trainer and supervisor (SV) [source: Higashiyama et al.; Imura 2016].
Group and pair formats are reported (group sessions; pair relaxation) [source: Kuwashima]. Setting: mat on the floor, comfortable room temperature, individual space [source: Setoyama et al. 2017].

3. Guiding principles

Dohsa is intention, effort, movement. Practical: never just move the client's limb for them; set up the task so they intend and try, and you support [source: Setoyama et al. 2017; Imura 2016].
Self-relaxation, not passive relaxation. Practical: your hands mark the limit and wait; the client does the releasing. Hypnosis or massage gains fade once the stimulus stops [source: Imura 2016; Kuwashima, citing Naruse 1995].
Experience over correct movement. Practical: the target is the experience of effort and change, not a perfect posture; partial release is fine [source: Imura 2016; Fujino 2013].
Wait; do not force or hurry. Practical: hold at the limit and give the client time; pushing to move them provokes counter-tension and resistance [source: Imura 2016; Setoyama et al. 2017, citing Naruse 2000].
Share the body experience in words. Practical: ask what they feel, name the stiffness and changes you feel under your hands, and agree on limits together [source: Fujino 2013; Setoyama et al. 2017].
Movement shows intention. Practical: read stiffening, pulling away, sleepiness or rushing as communication (dislike, disinterest, opposition) and adjust [source: Imura 2016].
Accept and verbalise feelings. Practical: acknowledge that the task or setting is hard before asking for more [source: Imura 2016 case 2].
Praise effort and the moment of change. Practical: brief, specific praise right when movement appears (e.g. after release) [source: Imura 2016; Higashiyama et al.; Setoyama et al. 2017].
Client chooses the stable position. Practical: let them adjust until they find the most stable posture; SART calls this one of its most important tenets [source: Kabir et al. 2018].
Adapt task and variation to the person. Practical: shorten, change position (e.g. prone instead of seated) or swap tasks to match attention, pain and condition [source: Imura 2016].
The trainer's own attitude is part of the method. Practical: a warm, accepting trainer raises engagement; know your own habitual movement patterns [source: Imura 2016; Fujino 2013; Kuwashima, citing Harada et al. 2019].
Discomfort can be expected; persistent pain is a stop sign. Practical: mild heaviness or slight pain that turns pleasant signals progress; stop if pain persists or is reported [source: Imura 2016].
Do not presume understanding. Practical: do not fit the client into theory too quickly; examine your own emotional reactions openly [source: Nomura, Kyushu University 2026].
Body first, story optional. Practical: in crisis work, start from bodily discomfort and do not question people about traumatic events [source: Tominaga 1996, via secondary summary; uncertain detail].

4. Intervention inventory

Naming: Japanese task names follow the sources (romanised as in Imura 2016 where given). Several tasks are named in the sources without a procedure being given; for those, steps below apply the general relaxation cycle and are marked [synthesis] or [uncertain]. Hands-on touch is integral to almost every task.

4.0 Before any task: screening and consent for touch

Purpose: make hands-on body work safe and agreed.
Steps: (1) Ask about tense, sensitive or painful areas and any to avoid [source: Kabir et al. 2018]. (2) Screen medical limits: the sources name dislocated hip, after-effects of stroke, muscular dystrophy (careful assessment and adapted movements), cardiac disease, seizure disorders, drowsiness from medication or illness (rest instead of tasks that day) [source: Fujino 2013; Imura 2016; Higashiyama et al.]. Further cautions I add [synthesis]: recent fracture, surgery or acute injury; osteoporosis; joint hypermobility or prostheses; spinal problems; pregnancy (avoid prone and deep twists); when in doubt, get medical clearance and involve a physiotherapist. (3) Screen touch: abused or neglected clients, and some psychiatric clients, may feel anxiety or rejection with touch; touch may be inappropriate where it is strongly rejected; consider cultural background [source: Fujino 2013]. (4) Explain what you will do, where your hands will go, that the client leads and can stop at any time; get explicit consent and re-check before each new hand position [synthesis]. (5) Agree a stop signal [synthesis].
Example language (illustrative): "This method works through small movements you make yourself. I'll put a hand on your shoulder to help you feel where it's tight. You're in charge: say 'stop' or just pause and I'll take my hands away."
Watch for: freezing, holding breath, flinching, compliance without engagement (possible trauma response) [synthesis]; pain that persists [source: Imura 2016].

4.1 Movement assessment (mitate)

Purpose: see how the person holds and moves the body, where unwarranted tension sits and how they strive, to choose tasks [source: Kono 2024; Imura 2016].
Steps: (1) Observe cross-legged sitting (agura), kneeling (hiza-dachi), standing (ritsui) and walking: chin, neck, shoulder line, back curve, waist/hips, knees, ankles, weight distribution left-right [source: Imura 2016 case chapters]. (2) Simple pre-test (SART): seated cross-legged, arms extended with hands together, reach to each side as far as comfortable; note range [source: Kabir et al. 2018]. (3) Touch key sites (neck-shoulders, hips, knees, ankles) to feel tension and how the person responds to the hand [source: Imura 2016; Kuwashima]. (4) Note the style of effort: rushing, over-tensing, passivity, avoidance, dependence on others [source: Imura 2016 ch. 4.1]. (5) Choose a first task that is achievable.
Example language (illustrative): "Just sit as you usually do. I'm only looking at how your body is holding itself, nothing is right or wrong."
Watch for: the three common awkward postures (rounded shoulders with hiked lower back; rounded shoulders with protruding middle; twisted trunk with hiked buttocks, with bent knees and ankles) [source: Imura 2016].

4.2 The basic relaxation cycle (applies to all relaxation tasks)

Purpose: the client learns to find and release tension by their own effort.
Steps: (1) Set a clear movement target and position. (2) The client starts the movement; you support and guide its direction with your hands. (3) At the client's limit, you hold or press lightly at that part and wait for the client to release it themselves. (4) Ask them to notice the change and say what they feel. (5) Repeat two or three times per setting; if there is no progress, stop that task for now [source: Imura 2016]. SART uses three attempts per side: first to learn the goal, second with your correction of degree, direction or intensity, third to consolidate the felt sense for solo use [source: Kabir et al. 2018].
Example language (illustrative): "Go as far as feels possible... stay there... now see if that spot can let go by itself... what changed?"
Watch for: working when the client becomes passive and you are doing the moving (stop and hand control back) [source: Imura 2016]; signs it is working: sensations of lightness or warmth, calmer state, following instructions more easily, surprise at own stiffness [source: Imura 2016].

4.3 Kata-age-sage (shoulder raising and lowering)

Purpose: entry relaxation task; contrast deliberate tension with release; widely used for stress, students, disaster settings and self-help [source: Fujino 2013; Nomura 2026; Kono 2024].
Steps: (1) Client sits cross-legged on a mat (chair is a common adaptation [synthesis]). (2) Client slowly raises both shoulders, keeping the rest of the body free of tension. (3) Brief hold at the top. (4) Client lets the shoulders drop. (5) Your hands on the shoulders guide the direction and support the hold and release; give feedback on stiffness and progress while the client describes bodily feelings [source: Fujino 2013]. (6) Repeat; alternate tension and release [source: Nomura 2026].
Example language (illustrative): "Lift your shoulders slowly toward your ears... keep your neck and arms soft... hold... and let them fall. Notice the difference."
Watch for: neck, jaw or arms tensing along with the shoulders; difficulty sensing tension at first (verbal feedback helps) [source: Fujino 2013].

4.4 Kata-biraki (shoulder opening)

Purpose: release tension across the chest and front of the shoulders; listed among core relaxation tasks and used in shelter work after the 1995 Hanshin earthquake [source: Kuwashima; Imura 2016; Tominaga 1996 via summary].
Steps: one source describes a lying procedure in which the therapist supports the back and prevents rotation while the client slowly draws the shoulders back, with the therapist's hand on the shoulder supporting release [source: Fujino 2013]. Whether this is identical to kata-biraki as named by other authors is [uncertain]. Apply the basic cycle (4.2).
Example language (illustrative): "Let your shoulder move slowly backward... I'm just keeping your back steady... where does it stop? Wait there and let it soften."
Watch for: rotation of the trunk replacing the shoulder movement; breath-holding [synthesis].

4.5 Kukan-no-hineri (trunk twist)

Purpose: loosen shoulder, back and waist tension and release a bent or flexed posture before sitting tasks; also used as a communication task [source: Higashiyama et al.; Imura 2016].
Steps: performed lying on the side in published examples; SART's basic side-lying posture places the top knee forward to keep a neutral spine [source: Kabir et al. 2018]. The client rotates the upper trunk backward while the hips stay stable; you support and hold at the limit and wait for release (cycle 4.2). Exact hand placement is [uncertain]; a common-sense arrangement is one hand stabilising the pelvis and one guiding the shoulder [synthesis].
Example language (illustrative): "Keep your hips where they are and let your top shoulder turn back toward the mat... stop where it feels tight... let it settle."
Watch for: hips rolling with the shoulder; pain in the lower back (stop) [synthesis]. Used in schizophrenia work to loosen tense areas from session 3 [source: Imura 2016 ch. 4.1].

4.6 Se-sorase (back arching)

Purpose: release the rounded back; also listed as a communication task [source: Imura 2016; Kuwashima].
Steps: named in the sources without procedure [uncertain]. Use only the basic cycle (4.2) with small range. In one case a client reported pain and the trainer ended the task with a countdown and a clear "finished" [source: Imura 2016 case 2].
Watch for: pain; neck hyperextension [synthesis].

4.7 Ude-age (arm raising)

Purpose: relaxation, self-control of a limb, and communication/joint attention [source: Imura 2016; Kuwashima, citing Konno 1982].
Steps: (1) Client lies on the back. (2) You take the arm and help the client lift it slowly. (3) Repeat; the client increasingly concentrates on the arm and moves it with little or no help [source: Imura 2016]. (4) Variants from case reports: start-and-stop cues; pausing to straighten the elbow; repeated raising and lowering to regain focus; prone position when sitting is hard [source: Imura 2016 cases 3 and 4.1]. (5) SART's upper-body system uses arm and shoulder abduction above the torso [source: Kabir et al. 2018].
Example language (illustrative): "Let's raise this arm together, slowly... I'll follow you... now pause... and keep going on your own."
Watch for: more eye contact, matching the trainer's pace and independent movement as signs of progress [source: Imura 2016]; noticing a change in arm direction (a reported turning point) [source: Imura 2016 ch. 4.1].

4.8 Forward bends (zenkutsu; open-leg forward bend; cross-legged forward bend)

Purpose: release back and hip tension; study of how the trainer's help shapes the client's experience [source: Setoyama et al. 2017; Kuwashima].
Steps (open-leg forward bend as researched): (1) Client sits with legs apart as far as comfortable. (2) Set: bend forward, to each side, then forward again. (3) Client goes as far as they can move by themselves. (4) Trainer's two hands on the back. (5) Three helping styles were compared: following the movement; adding encouraging words ("that's it") and checking the limit by asking; and, after the limit, inviting the client to let go of force and praising the release [source: Setoyama et al. 2017]. Use the fuller style in practice; this choice is [synthesis] from that comparison.
Example language: "Bend forward as far as you can move it yourself" is a paraphrase of the study instruction; illustrative follow-up: "That's it... is this your limit? Now let the effort go."
Watch for: pushing by the trainer, which provokes counter-resistance [source: Setoyama et al. 2017, citing Naruse 2000].

4.9 Other named local relaxation tasks

Hip/waist relaxation (koshi-yurume), ankle relaxation (ashikubi-yurume), face relaxation, chest relaxation, waist lengthening, back release in cross-legged forward bend, knee bending (hiza-mage) [source: Kuwashima; Imura 2016]. Procedures not given in the sources [uncertain]; apply cycle 4.2. Ankle relaxation was added when a client found relaxing difficult; lying ankle work was used during periods of frequent seizures because it demands little postural effort [source: Kuwashima; Higashiyama et al.].

4.10 Supine knee bending and stretching

Purpose: move the leg from the hip joint and gain the felt sense of pushing against the ground before standing work [source: Higashiyama et al.].
Steps: client on back; client bends and straightens the knee, initiating from the hip; you support and cue (e.g. a counted "one, two..." then wait for the client's own movement) [source: Higashiyama et al.].
Watch for: the client starting the movement themselves after your cue [source: Higashiyama et al.].

4.11 Tate-kei: upright sitting (agura-zai, za-i no choku-shisei)

Purpose: build a vertical axis against gravity; raise the relaxed upper body to a stable sitting posture after trunk-twist work [source: Imura 2016; Higashiyama et al.].
Steps: (1) Client sits cross-legged. (2) You prop the waist, back and head. (3) Gradually withdraw support. (4) The client usually loses posture at first, then should find stability. (5) Help the client activate their own effort and keep the axis upright [source: Imura 2016]. (6) Centring the weight in the middle makes the body easier to control [source: Higashiyama et al.]. (7) Add left-right weight shifts once stable [source: Kuwashima].
Example language (illustrative): "Let your weight sit evenly on both sides... I'm going to take a little support away... find your own straight line from your seat to the top of your head."
Watch for: chin retracting, shoulders and back straightening, waist settling, reports of more willpower, awareness and groundedness [source: Imura 2016].

4.12 Tate-kei: kneeling (hiza-dachi) and hip placement (koshi-ire)

Purpose: hold an upright axis with more joints involved; harder than sitting [source: Imura 2016].
Steps: (1) Client kneels upright with upper body straight. (2) You support torso, chest and back; gently guide the buttocks down so the waist can settle under the trunk [source: Imura 2016 case 1]. In one report the trainer placed a knee against the client's lower back and crossed the arms in front of the chest to stop collapse [source: Higashiyama et al.]. (3) Reduce support as stability grows. (4) Side-to-side weight shifts with support. (5) Knee-walking, with the trainer supporting the torso and waist when weight transfer makes the waist curve [source: Imura 2016 case 1].
Example language (illustrative): "Let your hips come forward under you... feel your weight go down through your knees... now shift a little to the left, and back to the middle."
Watch for: falling forward, waist curving, toes pointing; reddened knees during weight-shifting were praised as a sign of effort in one case [source: Imura 2016]. Check knees for pain [synthesis].

4.13 Tate-kei: standing (ritsui) and stepping down (fumi-shime)

Purpose: stand on one's own soles with an upright axis; "standing by pressing down through the feet" is one of the two example tasks given for clinical use [source: Kono 2024; Imura 2016].
Steps: (1) Guide the knees forward so weight moves onto the soles; place the feet; block the waist from curving [source: Imura 2016 case 1]. (2) Standing knee-bend: bend hip, knee and ankle together, then straighten them together [source: Higashiyama et al.]. (3) Tiptoe work: release the ankles and lower the heels; alternate making and releasing ankle tension to improve control [source: Higashiyama et al.]. (4) Left-right weight shifts with the waist supported [source: Imura 2016]. (5) A second trainer may be needed for stiff ankles or hyperextended knees [source: Imura 2016 case 2].
Example language (illustrative): "Soften your knees a little and let your weight land on the whole sole... press down into the floor... feel the floor pushing back up through you."
Watch for: hyperextended knees, weight on heels or toes, held breath; stability time lengthening and spontaneous standing in daily life as progress markers [source: Imura 2016].

4.14 Tate-kei: walking (hokou)

Purpose: carry the axis into movement [source: Imura 2016].
Steps: transfer weight completely onto the stepping foot before moving the next; flex the hip and lift the knee; trainer support reduced from both hands to one hand to none [source: Higashiyama et al.; Imura 2016 case 1].
Watch for: gliding or lateral-shift gait; falls (keep space clear and stay close) [source: Imura 2016; synthesis].

4.15 Communication tasks

Purpose: develop joint attention and the felt understanding of another person's intention, mainly with autism, severe intellectual disability and young children [source: Imura 2016].
Steps and variants: ude-age paced together (4.7); trunk twist and back arching done with attention to the partner; simultaneous jumping; palms touching then moving together in one direction; seesaw on the floor; handshake. Responding correctly to a handshake or seesaw is taken as a sign the trainee grasped the trainer's intention [source: Imura 2016]. In one case with a non-verbal child, finger games (imitating a raised finger, a "fox" hand) were used to re-engage attention, then the task resumed [source: Imura 2016 case 3].
Example language (illustrative): "Touch! ... Now let's push this way together."
Watch for: eye contact lengthening, imitation, matching pace, calmer behaviour [source: Imura 2016].

4.16 Self-Active Relaxation Therapy (SART) programme (Ohno 2005)

Purpose: a simplified Dohsa-hou repertoire clients learn to do themselves; the key difference is the client's active role and understanding of the movements for later independent use [source: Kabir et al. 2018].
Steps: (1) Intake on tense, sensitive or painful areas. (2) Seated pre-assessment of reach. (3) Basic side-lying posture, top knee forward, neutral spine. (4) System 1, upper body: shoulder abduction above the torso. System 2, lower body: hip abduction below the torso. System 3, whole body: multi-section stretch in which the trainer helps deepen the stretch. Movements include arm raises and horizontal shoulder abduction with trunk rotation. (5) Each movement on both sides, 2–3 times per side, using the three-attempt structure (4.2). (6) Post-assessment: the client labels the body state and compares with before. About 24 minutes; a 5-minute seated version (by verbal instruction or DVD) for groups and wheelchair users [source: Kabir et al. 2018].
Therapist role: verbal cues, support the position the client negotiates, monitor the neutral spine, encourage smooth movement, invite going beyond the starting range where feasible [source: Kabir et al. 2018].
Watch for: whether the client can describe and reproduce the movement alone [source: Kabir et al. 2018].

4.17 Self-practice and home practice

Purpose: generalise self-regulation outside sessions.
Steps: teach one or two tasks the client can do alone (e.g. shoulder raise-lower, standing with pressing down) [source: Kono 2024]; for children, coach parents in home practice of chosen tasks (e.g. arm raising, trunk twist) [source: Imura 2016 case 2]; SART is designed for autonomous use [source: Kabir et al. 2018]. Agree when to use it (e.g. on noticing tension) and review at the next session [synthesis].
Example language (illustrative): "When you notice your shoulders creeping up, try the lift-hold-drop three times, and tell me next week what you noticed."
Watch for: few studies have tracked home practice [source: Kabir et al. 2018]; ask concretely [synthesis].

4.18 Intensive camp format (psychological rehabilitation camp)

Purpose: concentrated training for children and adults with disabilities and their families.
Steps: 4–6 days; about three Dohsa sessions a day; a team of trainee, parent, trainer, sub-trainer and supervisor; tasks reviewed on the last day with parent guidance for home [source: Higashiyama et al.; Imura 2016]. Social and play activities run alongside [source: Imura 2016 case 2].
Watch for: fatigue and sleepiness in later sessions; illness or medication sedation (rest instead) [source: Imura 2016; Higashiyama et al.].

4.19 Group and pair relaxation; crisis and disaster use

Purpose: brief stress relief for groups (students, school classes, older adults, disaster survivors).
Steps: group or pair formats are reported (pair relaxation: participants help each other) [source: Kuwashima]. After the 1995 Hanshin-Awaji earthquake, "relax dohsa-hou" was offered in four evacuation shelters from March to July 1995 to 147 people in groups of 5–10; helpers did not ask about disaster experiences and aimed at a comfortable bodily experience, starting from complaints such as stiff shoulders (85%) and insomnia (43%), using shoulder opening and trunk twist [source: Tominaga 1996, via secondary summary; original not drawn on]. Workshops teach self-administered versions for disaster and emergency support [source: Kono 2024]. Use with elderly survivors in Iwate is reported [source: Kabir et al. 2018].
Example language (illustrative): "We won't talk about what happened unless you want to. Let's just see if those shoulders can get a bit lighter."
Watch for: tearfulness or emerging distress (see 5); people who decline touch (offer the solo version) [synthesis].

5. Handling problems

Opposition, avoidance, running away, "truancy". Common during hard or painful tasks and with children with autism; early sessions may be unproductive. Responses from the sources: acknowledge that the situation is hard and verbalise the feeling; wait nearby until the person is calm and tolerates touch before starting; spend time inviting, then switch to another task (e.g. walking); add playful elements; consider a different approach [source: Imura 2016 cases 2–3; Higashiyama et al.]. Add [synthesis]: offer a choice of two tasks so the client keeps control; with adults, explore the resistance verbally as you would any other.
Client cannot relax or cannot feel tension. Expected at first in some clients; give verbal feedback on what you feel under your hands [source: Fujino 2013]; add an easier local task such as ankle relaxation [source: Kuwashima, citing Uehara & Yamanaka 2012]; stop the task if there is no progress and return later [source: Imura 2016]. Do not push harder: forcing provokes counter-tension [source: Setoyama et al. 2017, citing Naruse 2000]. The difficult spot is itself the work; the client's own effort to release it is what counts [source: Kuwashima].
Passivity and dependence. If you find yourself doing the moving, or the client waits for your hands, reduce support, give start-stop cues and ask the client to initiate [source: Imura 2016]. In one schizophrenia case a parent sitting close and holding the client's neck was judged a sign of too little distance; work toward the client's own management [source: Imura 2016 ch. 4.1].
Pain. Heaviness or slight pain that turns pleasant indicates progress; persistent or reported pain means stop the task; one trainer closed a painful task with a short countdown and a clear ending [source: Imura 2016]. Add [synthesis]: never hold a client at a painful limit; reduce range; refer for medical review if pain persists after sessions.
Physical conditions and symptoms. Spasms interfering with seated work: change position (prone ude-age) [source: Imura 2016 ch. 4.1]. Seizures: wait, check response by voice before resuming; use lying tasks during seizure-prone periods [source: Higashiyama et al.]. Drowsiness from medication or illness: postpone tasks and let the person rest [source: Higashiyama et al.]. Stiff joints: add a second trainer [source: Imura 2016]. Hip dislocation, stroke effects, muscular dystrophy: careful assessment and adapted movements [source: Fujino 2013]. Medication changes during therapy can confound apparent effects; coordinate with the prescriber [source: Imura 2016 ch. 4.1; synthesis].
Touch is unwelcome or triggering. Clients with abuse or neglect histories, and some psychiatric clients, may react to touch with anxiety or rejection; touch may be inappropriate for those who strongly reject it [source: Fujino 2013]. [synthesis]: start with tasks the client does alone with verbal guidance only (e.g. solo shoulder raise-lower, SART seated version), let the client place your hand, keep contact to shoulders and back, use a chaperone or same-gender trainer if requested, and document consent.
Relaxation feels invasive or destabilising. The authors note that people with ego or self-pathology might experience relaxation as invasive (not observed in their non-clinical sample) [source: Fujino 2013]. [synthesis]: in psychosis, dissociation or severe trauma, keep tasks short and grounding (tate-kei standing and pressing down, eyes open, talking), avoid long passive supine work, stop if depersonalisation, flashbacks or panic emerge, re-orient to the room, and only continue with the treating team's agreement. Relaxation-induced anxiety is reported for other relaxation methods; assume it can occur here [synthesis; not reported in opened Dohsa sources].
Emotion surfaces during body work. Unpleasant feelings (anxiety, frustration) can arise when tension or movement blocks are met, and the sources treat this as therapeutically meaningful [source: Setoyama et al. 2017]. [synthesis]: pause the movement, keep a light, still hand only if welcome, name what you see, let the client choose whether to talk, then return to a simple grounding task. In disaster settings do not probe for trauma details [source: Tominaga 1996 via summary].
Gains fade between sessions. Early improvements were hard to keep alone in one case [source: Imura 2016 ch. 4.1]; hypnotic or massage-based release fades because the person has not learned self-release [source: Kuwashima, citing Naruse 1995]. Respond with home practice of one or two tasks and review [source: Kabir et al. 2018; Kono 2024].
Relapse after ending. In one tic series, two of seven relapsed after treatment ended; a second course of clinical Dohsa-hou was followed by no further relapse [source: Kuwashima, citing Yoshikawa 2000].
Rupture with the trainer. Trust between trainee and trainer raises motivation, and a warm trainer raises task engagement [source: Kuwashima]. [synthesis]: if the client becomes guarded after a hands-on moment, stop touch, ask what happened, own any misjudgement, renegotiate consent and offer hands-off tasks before resuming.
Fatigue and attention drift. Expect sleepiness late in intensive formats; shorten, vary or use play to re-engage [source: Imura 2016].
Limited applicability. The method "cannot be universally applied"; effectiveness is modest for autism and it is best combined with other methods; it is a supplement, not a cure, in cerebral palsy [source: Imura 2016]. [synthesis]: use Dohsa-hou as one component within a broader treatment plan for psychiatric disorders, keep standard care (medication, psychosocial treatment) in place, and do not use it to replace medical care.
Scope of practice and training. Hands-on body work requires training and supervision; Japanese practice uses supervised trainer/supervisor structures [source: Higashiyama et al.]. [synthesis]: check that physical contact is within your licence and insurance, obtain supervised training through the professional associations, and keep written records of consent to touch.

Sources

Sources:

Books and papers cited via the above (not drawn on):

Naruse, G. (1973). 心理リハビリテイション (Psychological rehabilitation).
Naruse, G. (1985; 1988; 1995; 2000). Works on dohsa training and dohsa therapy, including Jiko-Control-hou (1988), as cited by Kabir et al. 2018 and Kuwashima; exact titles of the other years not verified.
Ohno, H. (2005). Self-Active Relaxation Therapy (SART).
Tsuru, M. (1982; 1995; 2007). Dohsa-hou with schizophrenia.

Further reading (not drawn on) [uncertain]: Naruse's primary books; the full Tominaga (1996) paper; certification rules of the Japanese Association of Rehabilitation Psychology and Japanese Association of Clinical Dohsalogy; procedures for se-sorase, fumi-shime details, koshi-yurume and face/chest relaxation.

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