Our routine psychosomatic techniques include interview counseling approaches combined with simplified versions of psychoanalysis, as well as behavioral modification techniques. Our somatopsychically oriented approaches include "body learning" such as self-examination of bodily functions (e. g. blood pressure, etc), biofeedback, bioenergetic therapy, Morita therapy, fasting therapy, art therapy and Yoga training. Psychopharmaceuticals are also routinely used with problems at all levels, whenever necessary. On route to actualizing the integration of these varied approaches we feel we are discovering some important clinical principles. One is the primary importance of restoring an optimal level of interoceptive awareness to the patient so that he, or rather his body, can learn prohomeostatic selfcontrol. Secondly, the natural state of consciousness (so-called ASC) induced by somatopsychic approaches generally serves as a desirable preparatory condition for orthodox psychosomatic approaches. For instance, fasting therapy, a unique Japanese somatopsychic therapy, provides us with a unique medium for psychotherapeutic approaches by facilitating a kind of ASC. Bioenergetic therapy, scream therapy, Gestalt therapy, etc. can, for example, be very useful in promoting insightive processes (as in psychoanalysis) by actively stimulating abreaction through somatopsychic techniques.Another important principle is the general clinical effectiveness of patients' learning to become aware of their 'observing' selves and learning to positively accept existential anxiety. For example, positive acceptance of existential aspects can be a basic goal in the management of patients in clinically extreme situations. As these various levels of anxiety exist simultaneously in many patients, it becomes a difficult problem to make a correct diagnosis and to select suitable therapeutic techniques. We are now focusing on this kind of training in our department.

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The eminent effects of Morita's Therapy for neurotics are widely known; however, the reports on psychosomatic patients are very few. This fact suggests the Morita's therapist is of the opinion that his approach is not always effective for psychosomatic disorders especially with pathological organic distortion. For example, follow-up studies conducted by Takagi and Maruyama, which included a small number of psychosomatic patients, reveal that the ""orthodox Morita's Therapy"" beginning with the absolute bed rest was not so effective. The author has applied Morita's therapeutic approach to severe cases of psychosomatic disorders and obtained the following results.1. To psychosomatic patients without pathological organic change, Morita's Therapy is applicable. To those with pathological organic change, it is better to administer internal treatment first and then apply Morita's approach. 2. Prescription of minor tranquilizer or antidepressants is necessary for certain types of patients. 3. To the patients with severe psychosomatic conditions, it is desirable to introduce them gradually into Morita's therapy by using autogenic training, hypno-therapy, psychodrama, art therapy, recreational therapy, and so on. 4. It is helpful to distinguish at least three character types amongst psychosomatic patients : Morita Shinkeishitsu, Melancholic type (Tellenbach) and hysteria type. The first two types are easy to introduce into Morita's Therapy. 5. When two or more therapeutic methods are used jointly, a firm theoretical formulation need to be established.

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An attempt was made to analyze the problems of clinical indications and limitations of fasting therapy on the basis of data provided through our own fasting therapy method. The subjects consisted of 380 cases with various neuroses and psychosomatic diseases in whom the efficacy rate of fasting therapy was found to be 87% according to a questionnaire inquiry. During the course of fasting, some of these patients received such serial clinical examinations as EEG, the L-DOPA test and the dexamethasone suppression test. Power spectrum analysis of EEG demonstrated that while a slowing of the α-wave component became progressively apparent during fasting, upon resumption of diet a more regular pattern of power distribution was gained. Basal growth hormone levels were significantly higher at the intermediate period of fasting, whereas the response to L-DOPA administration was highest after the recovery phase of fasting. Although the dexamethasone suppression rate exhibited no significant change during fasting, suppressed serum 11-OHCS levels after dexamethasone administration did not vary widely when results after fasting were compared with those before fasting. These results indicated that total fasting acts as a kind of metabolic stress on the human body and brings brain function into a newer equilibrium. Moreover, fasting itself involves psychological factors such as regression, enhanced suggestibility, suppressed hunger and social deprivation, each of which may play a role in corrective therapy. On the basis of the therapeutic mechanism of fasting therapy, it seems to be particularly suitable for conditioned emotional response, reinforced conversion reaction, and habituated abnormal eating behavior. According to out experience, excellent therapeutic efficacy was usually obtained among the following psychosomatic diseases which fall within the above-mentioned conditions : irritable colon including polysurgery cases, NCA, borderline hypertension, obesity, mild diabetes, hyperventilation syndrome, etc. Some severe cases of neurotic depression and bronchial asthma, as well as immature personality, were also well controlled by fasting so long as its motivation was established in advance. Statistical analysis demonstrated generally less effect in the case of longer morbidity, low intelligence, hypochondriacal character, miserable environment and un-co-operative behavior with regard to fasting. Abnormal ECG findings and hemorrhagic diathesis were occasionally experienced during fasting, so as a consequence fasting was considered to be contraindicated for patients with ischemic heart disease and active peptic ulcer. However, the limitations of fasting therapy are likely to be overcome if the therapy becomes more integrated via combination with other therapeutic approaches.

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The Sandplay Technique is carried out by having the patients do the sandplay. It was created by M. Lowenfeld, as a method of psychological treatment for children. D. Kalffe, started using it for adults by combining it with the analytical psychology of C. G. Jung. Kawai received training and supervison from her and started introducing the Sandplay Technique in Japan. The author learned it from Kawai and found that the sandplay technique was effective as a psychotherapeutic approach to psychosomatic diseases. Main characteristics can be summarized as follows. 1. You can not proceed it without the patient trust in the therapist. Not everybody can get better, just because he does the sandplay. 2. By touching the sand, the patient regresses into infancy. This can provide him with favorable treatment condition. 3. In case of neurosis, as emotional expression is facilitated readily and abundantly, this approach can be a good indication. 4. Even for the psychosomatic patients with alexithymic tendencies, good therapeutic result can be expected as it appeals to the patient's emotion directly with the use of the sand and no words. 5. It can cover a variety of patients ranging from children to old people. By now, we have found it useful for neuroses, peptic and duodenal ulcers and the irritable colon syndrome. 6. As the indispensable factor, it requires the trust between therapist and patient which is, needless to say, basic for every psychotherapy. Also, good results can be expected when it is combined with other approaches, such as A. T. and T. A. 7. If the patient gets to unconscious contents and can not integrate his mind and body, as might happen in schizophrenia or compulsive neurosis, caution must be taken by the therapist. 8. The most important point is that the therapist selects a right kind of objects for treatment.

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In this paper, the author outlines major topics in relation to the indications and limitations of hypnotherapy as the space does not permit him to present thorough and systematic discussions. 1. Treatment of carsickness by a single session. A single session of hypnosis was conducted to 1120 junior high school students suffering from carsickness. As the result, 89% of them showed improvement. A follow-up study 3 years later found complete cure in 45% of the subjects. 2. Application of hypnosis to endoscopic examination. Patients suffering from stomach disorders sometimes have difficulty in taking endoscopic examination due to their overwhelming anxiety. Hypnosis can make it much easier for the doctor to conduct the examination. 3. Hypnotherapy for patients with hemiplegia. The patients with serious motor disorder in the upper and lower extremities due to the sequelae of cerebral vascular disorders (eg. cerebral thrombosis or hemorrhage) showed improvement after hypnotherapy to such an extent that they had no longer serious problems in daily life. 4. Application of hypnosis to psychoanalysis. Hypnosis was applied to the course of psychoanalysis in order to break through resistance or facilitate treatment by using a post-hypnotic amnesic technique. 5. Application of hypnosis in behavior therapy.The image technique can be applied in the systematic desensitization procedure.6. Treatment of chronic stomach ulcers by prolonged hypnosis. Prolonged hypnosis was applied to the patients with chronic and intractable stomach ulcers who repeated aggravation and improvement over the past several years. Their symptoms disappeared within a short period of time with no recurrence. 7. Development of creativity. An image technique was applied to an artist who had been at a deadlock. As the result, he found a new idea to bring his ability to full play.The cases 1 through 5 show that hypnosis can provide other therapeutic approaches with an excellent therapeutic setting. Cases 6 and 7 indicate that hypnosis can be a direct approach to man's self-control. The limitations of hypnosis have different meanings depending on who uses hypnosis and how it is used. More discussions are needed because often it is not the limitations of hypnosis but rather the limitations of the hypnotist that need to be considered.

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The indication and limitation of transactional analysis(TA) was discussed from the point of view that the patient's basic communication pattern was projected into the doctor-patient relationship. The authors applied TA to the patients with post-operative abdominal disturbance, anorexia nervosa and bronchial asthma, and the following points were made clear. 1. TA can be a useful tool to establish rapport with the patient. To do this, the doctor needs to grasp his own communication pattern, the patient's transactional pattern and a pattern which is created in the doctor-patient relationship. 2. TA helps the therapist to observe what is taking place in the process of treatment, particularly to facilitate the patient's understanding of the mind-body relationship on the basis of this observation. 3. TA can be helpful for the patient to express his emotions in a manner which is appropriate for his interpersonal relations. This requires a certain amount of time for the patient to be quite well acquainted with TA. 4. TA can be used as a means of education and guidance for the patients with considerable ego strength. 5. Aggravation can be prevented by teaching the patient to review the course of his own illness using the TA language. 6. TA should not be used for the patients having"basic fault" in terms of his personality development.

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The author used behavior therapy for the treatment of 112 cases with psychosomatic diseases, and discussed the application and limitation of behavior therapy in psychosomatic medicine. The results were summarized as follows : 1. Behavior therapy could be used for the treatment of all types of psychosomatic diseases. 2. The ages of the application ranged from 5 to 70,and no significant difference was found between male and female patients. 3. The duration of the treatment ranged from one month to 12 months, and the average duration of the treatment was 3.4 months. 4. 87.5% of the subjects (89 out of 112 cases) revealed successful outcomes. 5. With regard to the ineffectiveness of behavior therapy, the following causes were pointed out. a. Impossibility of learning b. Insufficient motivation c. Reluctance of patient to accept the directives of the therapist d. Pervasive anxiety 6. In the follow-up study conducted 6 months to 10 years after treatment, the treatment was found to be effective in 82.6% of the patients. There was no symptom substitution amongst the patients, but five cases relapsed and in three cases, their conditions aggravated. 7. The author firmly believes that the application of behavior therapy will be enlarged more and more in accordance with the development of biofeedback techniques and the approaches to the broad spectrum of perception, recognition, emotion, and so on.

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Autonomic functions such as related to the circulation system is influenced by respiration, and respiration is also influenced by emotion. It is suggested that respiratory control is accompanid by the simultaneous control of autonomic function and emotion. An attempt was made to identify the characteristic resiratory patterns of psychosomatic patients, and then, applied some respiratory therapy using a biofeedback technique to the patients with neurosis and hypertension. As the result, an abnormal respiratory pattern was found, in patients with neurosis and hypertension and among the three sub-groups of neuroses, depressive, anxiety and hysteric, the respiration patterns were different. Next, in order to control the respiratory pattern, we gave a respiratory training to the patients (abdominal breathing) by feedback with visual analogue information. This effect was noticed clearly, especially in cases of anxiety state. Along with improvement in respiratory pattern, subjective complaints decreased in the patients with anxiety neurosis and hyperventilation syndrome. No noticeable effect was obtained, however, in depressive and hysterical patients. These subjects who showed abnormal egogram patterns were also unresponsive to the respiratory training. In moderate hypertensive patients, the blood pressure lowering effect of the respiratory training was confirmed; this was especially marked when deep breathing was practiced at rest. The question has been raised, however, as to whether this effect continues for a long period of time after the training. Finally, a review was made on clinical application of biofeedback training in relation to Blanchard and Hirai reports. Further work needs to be done to clarify its application and limitation as the biofeedback technique has only a short history of clinical application.

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