Balint medical interview and Balint groups are altogether called Balint method or Balint approach. Balint medical interview is the basis of a whole person approach to patients and Balint groups are a method of supervising doctors and therapists. Baint medical interview requires both doctors/therapists and patients to respect each other and establish a rapport between them. In such a relationship, doctors and therapists are encouraged to interpret patients'problems in biological, psychological, social and existential ways. It is essential to conduct a medical interview with those in palliative care or primary care and those with lifestyle-related diseases, without which comprehensive medicine will not succeed. In addition, it helps doctors and therapists not only to diagnose patients properly, but to serve as a drug (“doctor as medicine”). Balint group consists of a series of group sessions with the aim of enabling participants to use Balint method in their consultations.

The author conducted a questionnair survey with those whose attendance in Balint groups counted more than 5 times. There were 4 major categories in the questionnaire : group work (5 items), understanding patients as human beings (4 items), doctor/therapist-patient relationship (8 items), and advantages and limitations of medical approaches (3 items). The response rate was 69.9%. The survey showed that more than 60%were satisfied with and enjoyed the group sessions, and that they understood the interpersonal and emotional experiences of other participants. They also felt empowered to see their patients as human beings, to become good listeners, and to mobilise their empathy for the care of patients. In addition, Balint groups enabled them to determine problems and resourses of patients, and to feel prepared to deal with the problems. Consequently, they were enabled to practise integrated medicine, and eventually comprehensive medicine, which maintains advantages of and overcomes limitations of existing medical approaches. The group sessions also encouraged them to explore possibilities for care. However, monthly group sessions seemed inadequate for them to gain deeper understanding of supportive care. Balint method helps doctors and therapists to establish a good relationship with their patients and to become good listeners. In the process, doctors and patients become respectful for each other, try together to identify biological, psychological, social and existential factors behind major physical symptoms (or they may be psychological, social or existential), and to investigate the relationship between them. The aim of Balint method is to encourage patients to tackle their own problems. Patients may realise what has caused their illness, begin to change their lifestyle, and learn to keep their illness under control. Balint process forms the basis of narrative based medicine (NBA).

Balint method has become a part of curriculum for training and supervising medical students. It is also recommended by World Health Organisation (WHO) as a method of fostering empathy (an affective domain) and therapeutic self. Balint groups are now organised and conducted throughout the world.

Behavioral science, as well as comprehensive medicine and existential therapy, aims at supporting those people who are distressed. In this report, how behavior therapy, which is one mode of behavioral modification, can complement existential therapy is shown in a case where systematic desensitization and autogenic training are given concurrently.

Acupuncture and moxibustion therapy are part of traditional oriental medicine, which has a history of more than 2000 years, and can have effects on many diseases and symptoms.

Our department was established in 1984, and has been engaged in medical treatment and research/education in our university. We have received requests for acupuncture and moxibustion therapy from many departments, and have demonstrated the great effectiveness of acupuncture and moxibustion therapy in patients with intractable pain, paralysis or a series of unidentified complaints. Acupuncture treatment has also contributed to improvement in the physical and mental QOL of these patients, and it has objectively supported the idea of oriental medicine described in classic textbooks.

Our department has also investigated the effects of acupuncture treatment on various organs, and has initiated the scientification of traditional medicine. As a result, it was suggested that acupuncture treatment contributed to alleviation of symptoms not only by mere local reactions but also through the central nervous system. Furthermore, the responses of the body to acupuncture treatment differ between individuals with diseases and symptoms and healthy people, suggesting the possibility of acupuncture treatment being involved in the recovery of the body's homeostasis. We believe that these normalizing effects of acupuncture treatment are characteristics of traditional medicine.

Acupuncture and moxibustion therapy, which are based on holistic medicine, play a significant role as integrated medicine, and we believe that it will develop as medicine for the new era.

Background : After practicing as a psychosomatic internist(1996), the author's workplace was gradually teemed with patients at risk of ego-dystonic lifestyles. Many of them had very low self-esteem, even lacked a sense of self-worth. Attending the Kneipp therapy seminar at Bad Wörishofen in Germany(1997), the inspired author started self-training and later designed a group method : a holistic, mindfulness group aquatic aerobic exercise named ‘Suikido’(2000).

Purpose : This report is aimed at reporting how‘Suikido'has been applied to patients with stressful lifestyles and aims to depict their subjective experiences of interpersonal relationships fostered by it.

Method : Each Suikido program(60-90 min)is conducted with various walking styles(Kata)in training pools. The paired-partner system(senior/junior partners)is gradually prepared for the basic organic structure(a stage-class system)and function(self-help, mutual aid and cooperation)fostered by the pool water, ambient air and comradery.

Results : The current number of continuing participants is 75(M : 37, F : 38). Mean age is 51.9±16.7(18～83yrs), male 49.1±16.4(25～83yrs) and female 51.2±17.5(18～80yrs). Height【cm】(M : 170.0±7.6, F : 156.4±8.0), Body weight【kg】(M : 70.6±16.8, F : 51.1±9.1), Body Mass Index【kg/m²】(M : 24.4±5.3, F : 20.7±1.9). They are with fibromyalgia, panic disorder/agoraphobia(25%each), RA, depression(16%each), and other stress-induced bodily disorders(18%). The most frequently reported subjective experiences is a sense of release from the feelings of isolation/loneliness and purposelessness of life(55%). Some report the elimination of long-lasting negative evaluations of their mother-infant relationships(15%). A few members(4%)associate the Suikido and its water with the warmth and security of their mother's womb they still yearn for.

Conclusion : Suikido is a multi-level organization for profound problem solving of each participants using many, diverse, cooperating sources of knowledge and skill through creating and reconstructing human relationships by its original paired partner system. It requires only limited physical/mental strength, harnessing the group dynamics and waters own momentum. It also provides participants the medium to normalize their relationships to their surroundings. Suikido would facilitate a certain healing process for patients with damaged interpersonal relationships.

The coaching has been spread rapidly in Japan for its use in business and for the purpose of self-enlightenment since about 2002. In the medical field also, trials to utilize the coaching technique have been made and studies on smooth management of patients proceeded. The coaching originally started from the meaning of leading subjects by giving instruction and advice. Galway et al. advocated addition of factors such as looking into one's inside, autonomy, and potentialities to the coaching, with fruitful results achieved in the sports and business fields through its application. However, in Japan the coaching is applied chiefly for self-enlightenment and group coaching, and this way of application of the coaching may sometimes present forward strongly the conviction and reception or hierarchy and management. It is considered risky that the coaching associated with these characteristics tends to be propagated as a coaching business. In this study, the author would like to introduce a clinical application of the coaching in the medical field in the sense of its true meaning(using “coaching” translated into Japanese words, not in the Japanese syllabary). The origin of the word of the coaching is the “coach”, which “carries one wherever he wants to go”. From this original sense, the coaching is considered to be able to draw out the autonomic ability to make one start toward the future from the present time and place. In the clinical field, in our efforts to find what could be applied in the control of patients'adherence to the past happenings and utilized to lead them to initiate activities for the future, we have encountered logotherapy. Through introducing the paradoxical intension into the coaching technique to utilize difficulties and sufferings as the energy to face distress voluntarily and removal of one's reflection about adherence to the past(dereflection), we could successfully make the coaching as the one that is helpful for subjects to find their possible hope. On the other hand, on the basis of appreciation of the three values as advocated by Frankl-namely, the “Value of Creation”, with which one deliberates and feels the art so as to create art, with generation of hope for the life from the splendidness of Nature, “Value of Experience” to convert the experiences of having encountered difficulties and adverse circumstances to one's strong points, and “Value of Attitude” to make to one choose what attitude to take under the fate which seems to be unfortunate from any aspect-we can apply the coaching approach to help subjects to find their meaning of life and hope. We are assured of the efficacy of use of the coaching in the context of logotherapy. Thus, as we got an indication of possibility of constructing the “logotherapy-coaching” in the future, we describe our experience in this study.

Trigeminal neuralgia is a paroxysmal facial pain, characterized by an extreme, burning pain. Pain episodes are so easily triggered by daily activities that the quality of life deteriorates greatly.

The process of comprehensive medicine begins by establishing a rapport with patients. In such a relationship, one is enabled to understand patients in their bio-psycho-social and existential aspects, and assess them both pathogenically and salutogenically. By so doing, s/he tries to locate their resources as well as problems.

This is a study of a patient with trigeminal neuralgia. Based upon comprehensive medicine, we applied pharmacotherapy, nerve blocks, acupuncture, massage and medical interview to the patient. Our principal task was to bring the essence of her existence, i. e. the meaning of her life into her focus. As these complementary approaches gradually took effect and healed her physical and psychological conditions, she began to be able to control her pain. The quality of her life improved accordingly. Rather than concentrating all the effort on pain reduction, doctors and acupuncturists alike gave a top priority to the recovery of her homeostasis and quality of life.

Through logotherapy, we learned that the patient had a renowned great-grand father. It was this fact that helped her through the treatment. The awareness of her deep reverence for him stimulated the sense of incompetence she had struggled with, and motivated her to visit his grave. This became a new meaning to her. These experiences helped her to begin taking responsibility for her health.

According to “the umbrella theory”(advocated by Nagata K), an umbrella has material covering a round folding frame, and a folding stick so that it can protect one from rain. An umbrella without either material or a folding stick is useless. It is also pointed out that the structure of our medical treatment is analogous to that of an umbrella. In other words, the roles of medical treatment and patients'families are similar to material covering a round folding frame of an umbrella while patients'understanding of the meaning of life is to its folding stick. Just like an umbrella, none of them should be missing in medical treatment. The doctor-patient relationship changes as treatment progresses. Successful treatment requires not only support from doctors and therapists but also the patient's will to recover. Doctors and therapists should also engage in inspiring patients to regain their health. This case was the example of an experiential, existential approach where logotherapy was applied in combination with behavioral therapy.

In den 1930er Jahren haben - unabhängig voneinander - zwei bedeutende Psychiater gewirkt: Viktor Frankl in Österreich und Shoma Morita in Japan. Beide Psychiater haben erkannt, dass eine menschengemäße Psychologie sich eigentlich nicht nur mit der Frage befassen sollte, was der Mensch tut muss, damit er sich ,,gut fühlt“. Sowohl die Logotherapie Viktor Frankls als auch die Morita-Therapie von Shoma Moritas sagen, dass das seelische Wohlergehen und die Entfaltung des Menschen nicht zustande kommt, indem man sich nur mit sich selbst und seinem eigenen Glück beschäftigt, sondern erst, wennsich der Mensch der Welt, und vor allen Dingen anderen Menschen und Lebewesen öffnet. Und wenn er in der Lage ist, von der verkrampften und egozentrischen Suche nur nach seinem eigenen Glück für sich selbst etwas abzulassen und sich stattdessen den Sinnmöglichkeiten seiner Welt zu öffnen. Paradoxerweise zeigt sich nämlich, dass er dann nicht nur Gutes bewirkt, sondern daß es auch ihm selbst gut ergeht, weil er das Beste in sich zum Blühen bringt.

In diesem Vortrag wird eine praxisorientierte Einführung in die Logotherapie nach Viktor Frankl gegeben. Konkrete Fallbeispiele und empirische Daten belegen und werden präsentiert, die belegen, wie sehr Wohlergehen und Werthaltung miteinander zusammenhängen.