Shugendo · Atlas

1. Introduction

Version followed: Shugendō (修験道) as presented by its head temple Kinpusen-ji (Yoshino, Nara) through Japan Tourism Agency interpretive texts, and by the Dewa Sanzan institutions (Dewa Sanzan Shrine and the Haguro Shugen temple Shōzen-in) for the public Autumn Peak retreat; scholarly framing from the Japanese Journal of Religious Studies (Nanzan Institute). This guide treats Shugendō as a religious observance (pilgrimage, mountain retreat and rite), not a therapy. The inventory covers the psychotherapist's work alongside a client who practises it.

Shugendō is Japanese mountain asceticism. Japan Tourism Agency texts describe it as mountain worship that blends older Japanese nature worship with Buddhism and Taoist elements, with Kinpusen-ji on Mt. Yoshino as its root training site (konpon dōjō). Tradition credits En no Gyōja (634–701) with founding it; he is described as a lay practitioner who never took monastic vows, and his ideal of practising the Buddhist teaching and drawing power from nature to help others is presented as its core idea [source: MLIT R1-00596; MLIT R1-00585]. Practitioners are yamabushi ("those who sleep in the mountains"); lay men (ubasoku) and lay women (ubai) take part as well as ordained clergy [source: MLIT R1-01588].

How change is understood, in the tradition's own terms: by hard training in the mountains the practitioner casts off sins and impurity and is "reborn", and may gain spiritual power (genriki, 験力) used for the community [source: MLIT R1-00596]. At Dewa Sanzan the three peaks are linked to past, present and future, and the pilgrim wears white funeral-style robes to symbolise a death and rebirth [source: The Dewa Sanzan official site]. These are religious claims, attributed to the tradition, neither endorsed nor dismissed here. For the therapist, the relevant "change" is whatever meaning the client draws from the practice, explored in their own terms [synthesis].

2. Framework

Shugendō has no therapeutic phases or session counts. Its public structure, as institutions and scholars describe it:

Mountain entry (nyūbu / mineiri). The core practice: walking mountain routes and climbing sacred peaks, symbolising leaving the ordinary world, entering sacred space and visiting the realm of the dead [source: MLIT R1-01588]. The Ōmine Okugake trail links Yoshino and Mt. Ōmine to Kumano and is described as typically walked over several days; Kinpusen-ji is the starting point for training on Mt. Sanjōgatake, with training mainly from May to September [source: MLIT R1-01588; MLIT R1-00585].
Range of austerities. Public descriptions mention practices from slow walking meditation on mountain paths to sutra chanting while suspended over a cliff edge (to confront fear), and harsh conditions including cold, heat, limited food and long treks [source: MLIT R1-01588]. Waterfall austerity (takigyō) is widely associated with Shugendō [uncertain: not verified].
Village practice (sato no gyō). Practice at home or locally, including the fire ritual (goma) at Shugendō temples, offered for peace, healing or purification [source: MLIT R1-01588].
Autumn Peak retreat (Aki no Mine-iri), Dewa Sanzan. The only official yamabushi training open to the public there; held at the end of August as a multi-day retreat in both a Shinto form and a Haguro Shugen Buddhist form (originally much longer). Overseen by Dewa Sanzan Shrine and Shōzen-in. Entry requires a contact request and selection; completion is the only public route to being recognised as a yamabushi by the Shrine. The site says participants face hunger, cold, fatigue and physical hardship and are expected to accept the possibility of death before starting [source: The Dewa Sanzan official site]. Tsuruoka City's account adds that it opens with a symbolic death and rebirth ceremony, that men and women take part, that meals are simple, and that specific training details are not made public [source: Tsuruoka / Google Arts & Culture].
Long and selective courses. A 1,000-day Ōmine course said to have been completed only twice in recorded history [source: MLIT R1-01588]; at Haguro, a winter seclusion undertaken by two specially chosen yamabushi, ending at the Shōreisai festival on 31 December [source: The Dewa Sanzan official site; Tsuruoka / Google Arts & Culture].
Tourist and introductory programmes. One- to three-day experiences (pilgrimage on the three mountains, temple lodging, vegetarian shōjin ryōri, white pilgrim dress) run by local operators such as the Haguro Tourist Association [source: MLIT R2-00652].

Who leads or authorises. Training is led by recognised guides (sendatsu) and the institutions above; the main historical lineages include the Honzan and Tōzan branches [uncertain: not verified]. Inner ritual content and initiations are restricted to the institutions and are not described here.

History in brief. Shugendō dominated Japanese mountain worship for centuries; in the Meiji separation of kami and buddhas it was effectively outlawed, but it survived and continues today [source: Tyler & Swanson 1989]. Some sacred mountains still exclude women, notably Mt. Sanjō (Ōmine), a topic of scholarly and public debate [source: MLIT R1-01588; Swanson review of Miyake 2001].

Clinical framing (therapist's work). The therapist does not stage or supervise training. Work typically clusters around: (a) before a retreat or pilgrimage (meaning, readiness, health routing); (b) during, if the client is in long-term practice (scheduling, coping); (c) after (integration of intense experiences, adverse effects, community and identity). Moving between these is driven by the client's calendar, not by treatment criteria [synthesis].

3. Guiding principles

[source for 3: CFI Supplementary Modules (APA); The Dewa Sanzan official site; otherwise synthesis]

The client's tradition is the authority on the practice. You ask how their temple or shrine teaches it; you do not teach, correct or design austerities.
Attribute, do not adjudicate. Speak of rebirth, genriki, purification or deities as "in your tradition" or "as your sendatsu teaches"; neither affirm nor debunk.
Use the client's words. Mineiri, sendatsu, shugyō, Zaō Gongen, in Japanese if they prefer; the CFI asks you to use the person's own name for their tradition.
Respect restriction. Inner training content is not published; never press a client to disclose what they were asked to keep private.
Meaning before risk, but never instead of risk. Explore significance first; still route cold, heat, food restriction, exhaustion and fall risk to the client's doctor.
No austerity prescriptions from you. You do not advise on food, cold, sleep or exertion targets.
Hardship is chosen, not imposed. Check that participation is freely chosen and that withdrawal is possible without coercion.
Hold "death and rebirth" carefully. Symbolic death language can sit alongside real suicidal thoughts; ask directly when there is doubt.
Integration is client-led. The therapist helps the client connect the experience to their life; the meaning is theirs.
Stay in role. You are not a sendatsu, priest or spiritual director; refer and collaborate instead.
Cultural humility both ways. Japanese and non-Japanese clients relate to Shugendō differently (family lineage, local identity, heritage tourism, spiritual seeking); ask, do not assume.
Even-handedness on contested issues such as women's exclusion from some peaks: explore the client's experience without taking institutional sides.

4. Intervention inventory

These are the psychotherapist's interventions alongside Shugendō practice. None of them is a Shugendō technique, and none involves teaching or supervising austerities. Unless a source is tagged, the steps are [synthesis].

4.1 Exploring the practice's meaning in the client's life

Purpose / when: At intake, or when the client mentions a pilgrimage, Autumn Peak retreat, mountain-entry training, temple affiliation or yamabushi identity. This step sets the frame for all other work.
Steps: (1) Ask what they practise, where and with whom (temple, shrine, kō confraternity, tourist programme). (2) Ask what it means to them: family or regional heritage, religious commitment, personal challenge, healing hopes, rebirth symbolism. (3) Ask how it links to the problem they came with: a resource, a stressor, or both. (4) Reflect their own terms back (mineiri, shugyō, sendatsu). (5) Agree with them how much the practice should feature in therapy.
Example language (illustrative): "You mentioned the Autumn Peak at Haguro. What does that training mean for you, in your own words?" / "Your tradition speaks of being reborn through the mountains. Is that something you're hoping for right now?"
Watch for: Hopes that training will fix a mental health crisis on its own; pressure from family or a group; the client looking for your approval or disapproval. It is working when the client talks freely in their own vocabulary and can say both what the practice gives them and what it costs.

4.2 Cultural Formulation Interview with the spirituality, religion and moral traditions module

Purpose / when: A structured assessment of how the tradition shapes the problem and coping. Use it at assessment, before a major retreat, or when religious material is central.
Steps: Run the core CFI, then Supplementary Module 5 (Spirituality, Religion, and Moral Traditions), which covers four areas: spiritual, religious and moral identity (affiliations, community, family traditions, other traditions practised); the role of the tradition in daily, family and home life and in activities outside the home, such as ceremonies; its relationship to the problem (whether it has helped them cope, whether they have consulted a leader, and whether texts, rituals or pilgrimage have helped); and stresses and conflicts (distress tied to practice or identity, discrimination, conflicts over spiritual or moral matters) [source: CFI Supplementary Modules]. Put "Shugendō" or the client's own name (for example "Haguro Shugen") where the module has a placeholder, and explore each tradition separately if the client holds more than one, since many also practise Shinto and Buddhism [source: CFI Supplementary Modules]. Add Module 7 (Coping and Help-Seeking) to cover private spiritual practice and help from religious or community sources and from healers [source: CFI Supplementary Modules]. Do not read the items word for word from this guide; use the published instrument.
Example language (illustrative): "Some people find their mountain practice helps with difficulties like this, and others find it adds pressure. How has it been for you?" / "Have you talked about this with your sendatsu or anyone at the temple?"
Watch for: Conflicts between the client's religious and family expectations; discrimination they report (for example as a woman barred from a peak, or as a non-Japanese practitioner); the tradition being both a coping resource and a source of stress. It is working when your formulation includes the practice as the client sees it.

4.3 Readiness review before a retreat or intensive pilgrimage

Purpose / when: The client plans the Autumn Peak, a multi-day Okugake walk or another intensive training. Institutions describe hunger, cold, fatigue, hardship, and accepting the possibility of death, and they do not publish the inner content in advance [source: The Dewa Sanzan official site; Tsuruoka / Google Arts & Culture].
Steps: (1) Review current mental state: mood, recent psychosis or mania, dissociation, active trauma symptoms, eating-disorder history, suicidal thoughts. (2) Ask what the client knows about the conditions and what they have been told to expect. (3) Discuss how the retreat context (uncertainty, fear-confronting practices, reduced food and sleep, group pressure) could interact with their vulnerabilities. (4) Agree a plan: who they can tell at the retreat if they struggle, how to withdraw, and contact afterwards. (5) Route all physical-health questions to their doctor (4.4). (6) Respect their decision; your role is informed choice, not permission.
Example language (illustrative): "Since the details aren't published beforehand, let's think about what you'd do if something felt overwhelming. Who there could you tell?" / "How would you feel about leaving early if you needed to? Is that allowed in your group?"
Watch for: Recent psychosis, bipolar disorder, active PTSD or eating-disorder history, which call for more caution and close liaison with the doctor; any sense that leaving is forbidden or shameful. It is working when the client has a realistic picture and a concrete plan for getting help.

4.4 Routing health issues to the client's doctor

Purpose / when: Any practice involving cold, heat, limited food, long treks, steep or exposed terrain, or reduced sleep. Public sources describe freezing cold, stifling heat, fasting and long treks, and official sites warn against visiting the higher peaks outside their seasons because of snow and extreme weather [source: MLIT R1-01588; The Dewa Sanzan official site].
Steps: (1) Name the qualitative risks the sources describe: cold, heat, exhaustion, limited food, falls on cliffs and rock. (2) Encourage a medical review before training, especially for heart, lung, diabetes or other metabolic conditions, pregnancy, eating disorders, low weight, or older age. (3) Do not advise on medicines, food, fluid, cold or exertion; leave those to the doctor. (4) With consent, share relevant mental health information with the doctor, for example eating-disorder risk. (5) Ask whether the organiser has a way to excuse or adapt participation for health reasons [uncertain: not verified].
Example language (illustrative): "Some of this sounds physically demanding: cold, little food, long walks. It would be good to talk it through with your doctor before you go. Would that be OK?"
Watch for: The client minimising risk because hardship is "the point"; restrictive eating that continues after the retreat; injuries or exhaustion described as spiritual tests. No source presents Shugendō as a treatment for physical disease; healing prayers such as goma are religious offerings, with no clinical evidence of physical benefit [source: MLIT R1-01588; synthesis].

4.5 Accommodation in scheduling and treatment

Purpose / when: The client trains seasonally (Kinpusen-ji training mainly May to September; the Autumn Peak at the end of August) or holds temple duties [source: MLIT R1-00585; The Dewa Sanzan official site].
Steps: (1) Map the client's religious calendar at the start of treatment. (2) Plan breaks, telehealth or extra sessions around retreats rather than treating absence as non-adherence. (3) Time exposure work or medication-related reviews (by the prescriber) so they do not clash with a retreat. (4) Agree contact before and after each retreat.
Example language (illustrative): "Let's put your training dates in our plan now, so we can work around them."
Watch for: Therapy and practice turning into competing loyalties; the client hiding absences out of embarrassment. It is working when the plan treats the practice as part of the client's life.

4.6 Post-retreat integration

Purpose / when: After a retreat, pilgrimage or long period of practice, especially when the client reports a strong experience of "death and rebirth", gratitude, fear, visions or a changed sense of self. Tsuruoka's account notes participants often return with new appreciation of everyday things such as food [source: Tsuruoka / Google Arts & Culture].
Steps: (1) Invite an open account and do not interpret. (2) Ask what the experience means within their tradition, and whether they have discussed it with their sendatsu. (3) Explore what they want to carry into daily life: relationships, work, values. (4) Check sleep, appetite, mood and functioning since returning. (5) If difficulties persist, move to 4.7.
Example language (illustrative): "You said it felt like being reborn. What is different for you now?" / "How have sleep and eating been since you came down from the mountain?"
Watch for: Re-entry difficulty: feeling flat, alienated or irritable at home; continuing restriction of food or sleep. It is working when the client links the experience to concrete choices and day-to-day functioning is steady or better.

4.7 Challenging experiences and differential assessment

Purpose / when: The client reports distressing or unusual experiences linked to practice: fear or terror, changes in arousal, perceptual changes such as light experiences, energy-like bodily sensations, changes in sense of self, or delusion-like ideas. Research on meditation-related challenges documents these categories in practitioners of other Buddhist traditions [source: Cheetah House VCE; Lindahl et al. 2017]. Evidence specific to Shugendō mountain austerities is not established [uncertain: not verified].
Steps: (1) Normalise that intense practice can bring difficult experiences, without dismissing their religious meaning. (2) Assess safety, sleep, mood, psychotic features, mania and dissociation. Check physical causes such as dehydration, low food intake, hypothermia or heat illness, and injury, through the doctor. (3) Distinguish an experience the client can hold within their tradition's framework, with intact functioning and insight, from an emerging disorder: persistent loss of functioning, fixed false beliefs, manic symptoms, severe dissociation or suicidal thinking. (4) Where it fits and the client agrees, record it as a religious or spiritual problem using the DSM-5-TR code for that category (Z65.8). (5) Ground: stop or reduce intensive practice for now, regular meals and sleep, social contact, and orienting to the present. (6) With consent, consult the client's teacher about how the tradition handles such experiences. (7) Specialist resources include Cheetah House's consultations and clinician trainings [source: Cheetah House VCE]; the systematic review by Farias et al. 2020 and trauma-sensitive mindfulness (Treleaven 2018) are further references [uncertain: not verified].
Example language (illustrative): "Experiences like this can happen with intense practice, and they can mean different things. Let's understand what's happening for you and keep you safe while we do."
Watch for: Missing a psychosis or mania because it is framed as spiritual, or pathologising a valued religious experience. Signs of progress are better sleep, less fear, and the client making sense of the experience with their community.

4.8 Holding symbolic death language with suicide-risk enquiry

Purpose / when: Shugendō uses death imagery: white funeral-style robes, a symbolic death at the start of the Autumn Peak, the descent at Haguro likened to dying and passing through hell, and the expectation that one accepts the possibility of death [source: The Dewa Sanzan official site; Tsuruoka / Google Arts & Culture].
Steps: (1) Treat the symbolism respectfully as the tradition's language. (2) If the client is depressed, hopeless or has a history of self-harm, ask directly about suicidal thoughts and plans, using current standard risk assessment. (3) Separate the wish for symbolic renewal from any wish to die. (4) If risk is present, follow your safety-planning procedures, involve supports, and reconsider the timing of any dangerous training with the client and their doctor.
Example language (illustrative): "Your tradition talks about dying and being reborn. Sometimes people who are struggling also have thoughts of actually not wanting to live. Has anything like that been on your mind?"
Watch for: Risk-taking on cliffs or in bad weather that seems self-destructive; giving away belongings before a retreat. Clear future plans and renewal framed as growth are reassuring signs.

4.9 Scrupulosity, purification and moral injury

Purpose / when: The tradition aims to cast off sins and impurity through training [source: MLIT R1-00596]. Watch for this when a client describes compulsive purification, fear of having trained "wrongly", repeated confession-like rituals, or intense guilt about past failings.
Steps: (1) Separate devout practice from OCD-like patterns: intrusive doubts, rituals the client cannot stop, distress out of proportion, and practice the client's own tradition would not require. (2) If OCD is present, offer ERP adapted to respect the faith, with consultation with a religious authority the client chooses so that exposures do not violate core commitments; IOCDF-affiliated clinicians describe collaborative work that includes clergy [source: IOCDF provider profile; synthesis]. (3) For moral injury (for example guilt over abandoning training, harm to others, or transgression in the community), explore values, responsibility and repair, including ritual means of repair the client's tradition offers, without acting as confessor.
Example language (illustrative): "It sounds like the doubt keeps coming back however many times you purify. Would your sendatsu see it as necessary to repeat it this many times?"
Watch for: Exposures that feel like an attack on the faith; reassurance-seeking from you. It is working when rituals become fewer, distress falls and the client remains comfortable with their faith.

4.10 Grief, ancestors, ritual and community

Purpose / when: The Dewa Sanzan site describes mountains in older belief as resting places for ancestors' souls, and yamabushi as guides for souls and ritual specialists. Gassan is linked to the afterlife [source: The Dewa Sanzan official site; Tsuruoka / Google Arts & Culture]. Bereaved clients may undertake pilgrimage or seek rites for the dead.
Steps: (1) Ask whether the practice relates to a loss. (2) Explore what the rite or pilgrimage offers: continuing bonds, completing obligations, community support. (3) Support the client in using their temple, shrine or confraternity community. (4) Watch for prolonged grief and offer grief-focused work alongside.
Example language (illustrative): "Did walking the three mountains have anything to do with your father's death?"
Watch for: Ritual used to avoid grief; isolation if the client has left a community. It is working when the client feels connected to the person who died and to living supports.

4.11 Collaboration with sendatsu, priests and temple or shrine staff

Purpose / when: The client wishes it, for example to plan safe participation, interpret a difficult experience, or adapt ERP.
Steps: (1) Obtain explicit written consent that states what may be shared. (2) Clarify roles: they guide the practice, you handle the mental health care. (3) Ask how the institution handles illness, withdrawal and distress during training. (4) Share only what the client agrees; never ask for restricted ritual content. (5) Record agreed points and review them with the client.
Example language (illustrative): "Would it help if I spoke with your sendatsu about how to step back from training while you recover? What would you be comfortable with me sharing?"
Watch for: The client feeling outnumbered; confidentiality slips in a small community. It is working when the client experiences a joined-up team.

4.12 Consent, group dynamics and the teacher relationship

Purpose / when: Shugendō training is hierarchical and demanding, and the Autumn Peak requires accepting hardship and the possibility of death [source: The Dewa Sanzan official site]. Any client in intensive group training, or in a small independent group outside the established institutions, may benefit from this.
Steps: (1) Ask how decisions are made, whether participants can refuse a practice or leave, and how injury or distress is handled. (2) Note signs of coercive control as general guidance: isolation from family, control of money or information, punishment for doubt, secrecy beyond normal ritual discretion, and dangerous tasks demanded without the right to refuse [synthesis]. (3) Support the client's own judgement and their right to step back. None of the sources cited reports an independent investigation of misconduct by Shugendō teachers; do not assume misconduct. If a client reports abuse, follow your safeguarding and reporting duties.
Example language (illustrative): "In your group, what happens if someone says they can't do a particular practice?"
Watch for: Fear of leaving; injuries treated as failures of faith. The ability to say no without penalty is a healthy sign.

4.13 Gender, exclusion and identity

Purpose / when: Women take part widely, and the Haguro Autumn Peak admits women, but some sacred mountains still exclude them, notably Mt. Sanjō (Ōmine) [source: MLIT R1-01588; Tsuruoka / Google Arts & Culture; Swanson review of Miyake 2001]. Female, transgender or non-binary clients may feel hurt, conflicted or excluded.
Steps: Explore the experience and its meaning, validate the feelings without attacking the tradition, and support the client's chosen path, whether that is acceptance, advocacy or practice at another site.
Example language (illustrative): "How was it for you to learn that part of the route is closed to women?"
Watch for: Internalised shame; conflict with family members who practise. It is working when the client holds their own position with less distress.

4.14 Trauma-sensitive considerations

Purpose / when: Public descriptions include fear-confronting practices, such as chanting while suspended over a cliff, and harsh physical conditions [source: MLIT R1-01588]. For trauma survivors, these may trigger re-experiencing, panic or dissociation.
Steps: (1) Identify likely triggers: heights, being held or restrained, darkness, cold, hunger, group commands. (2) Practise grounding and stabilisation skills before the retreat. (3) Help the client find out from the organiser whether they can opt out of particular elements, and rehearse saying so. (4) Plan follow-up.
Example language (illustrative): "If a moment on the mountain brings back the old fear, what helps you come back to the present?"
Watch for: Treating re-traumatisation as "facing fear". It is working when the client keeps a sense of choice and returns without a flare of symptoms.

4.15 Role boundaries, self-disclosure and competence

Purpose / when: Throughout. The psychotherapist is not a sendatsu, priest or spiritual director.
Steps: (1) Avoid dual relationships, for example training in the same group or guiding the client on a pilgrimage. (2) Disclose your own religious commitments only when it serves the client, briefly. (3) Build competence in the spiritual and religious domain through training and consultation; published competency sets exist (Vieten et al. 2013) [uncertain: not verified]. (4) Follow your professional ethics code on competence, multiple relationships and respect for religious diversity [synthesis].
Example language (illustrative): "I'm not a teacher in your tradition, so on questions of practice your sendatsu is the right person. What I can help with is how this is affecting you."
Watch for: The client treating you as a spiritual authority; your own fascination with the tradition steering the sessions.

5. Handling problems

All guidance in this section is [synthesis] unless tagged.

The client wants you to approve or forbid a retreat. Return the decision to them. Lay out the factors (mental state, medical advice, the plan for getting help) and record that the choice was informed. If there is acute risk (psychosis, mania, suicidality, severe eating disorder), say clearly that you are concerned and involve the doctor. Do not prescribe or ban religious practice.
The client is unwell but insists on training. Explore what missing it would mean (shame, losing their place, family duty). With consent, ask the institution whether a deferral or a lighter way of taking part is possible. Keep a safety plan in place.
Overwhelm during or after training (panic, dissociation, perceptual changes, insomnia). Use the grounding and reduced-practice steps in 4.7. Check physical causes through the doctor. Treat it urgently if there are psychotic or manic features or risk. Tell the client that difficult experiences after intense practice are documented in research and are not a personal failing [source: Cheetah House VCE].
The client won't disclose what happened at the retreat because the content is not made public [source: Tsuruoka / Google Arts & Culture]. Respect this. Work with the client's emotional experience and its effects instead of the ritual content: "You don't need to tell me what was done, only how it's affecting you."
"Non-adherence" caused by the religious calendar. Re-plan around it (4.5). Do not interpret it as resistance.
Rupture over the therapist's perceived scepticism (for example about genriki, deities or rebirth). Acknowledge it, name your stance (you respect the tradition and focus on wellbeing), and invite feedback. If you hold a different faith, say so only if it helps, and keep it brief.
Hardship becomes self-punishment. Food restriction, overexertion or exposure continues outside sanctioned training. Assess for an eating disorder, depression or self-harm. Ask whether their teacher would endorse the behaviour. Involve the doctor.
Injury, illness or failure to complete training. Explore shame and moral injury and the tradition's own ways of returning to practice. Look for depression after a perceived failure.
Family conflict (a family lineage expects practice that the client rejects, or a family opposes a convert's practice). Use CFI Module 5's stresses-and-conflicts questions [source: CFI Supplementary Modules]. Consider family sessions.
A small, independent or online group claiming Shugendō authority with dangerous or secret demands. Assess using 4.12. Encourage the client to check the group's standing with established institutions such as Kinpusen-ji or Dewa Sanzan Shrine. Follow safeguarding duties if abuse is disclosed.
Minors. If a young person is taking part in harsh training, follow safeguarding procedures and check that parental consent and the young person's own assent are genuine and that exposure to cold, hunger and danger is proportionate. Consult your safeguarding lead.
Leaving the practice. Clients who withdraw may grieve their community and identity. Support grief and identity rebuilding, and avoid either celebrating or discouraging the departure.
Therapist out of depth. Consult a colleague with competence in Japanese religion and culture, or a psychiatrist for differential diagnosis, and refer if needed.

Sources

Books and articles cited:

Miyake Hitoshi (2001). Shugendō: Essays on the Structure of Japanese Folk Religion, ed. H. Byron Earhart. Ann Arbor: Center for Japanese Studies, University of Michigan (details as given in Swanson's review).
Lindahl et al. (2017). The Varieties of Contemplative Experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLOS ONE, 12(5), e0176239 (details as given by Cheetah House).
Farias et al. (2020), systematic review of adverse events in meditation, Acta Psychiatrica Scandinavica.
Treleaven, D. (2018). Trauma-Sensitive Mindfulness [uncertain: not verified].
Vieten, C., et al. (2013). Spiritual and religious competencies for psychologists [uncertain: not verified].
ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem')

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