Brief therapy, with America playing the central role, has become one of the main flows in the field of psychotherapy today. The roots of brief therapy can be found in the outstanding psychotherapy of M.Erickson, and the human communication research by G.Bateson and his group. From there, the new psychotherapy project at MRI (Mental Research Institute), headed by J.H.Weakland, formed the foundation of brief therapy. J.Haley developed a creative remedy called the strategic approach, and today, the solution-focused approach by S.de Shazer and I.Kim Berg has become very influential. The narrative model and systems approach seen in family therapy also have a close relation to it. In resolving the clinical problems of man, brief therapy takes a different point of view from the usual medical psychology, which looks for the cause and pathology of the problem. The factors regarded as important in brief therapy are pragmatism, social constructionism, the development of therapeutic language which focuses more on the solution rather than the problem itself, and the client/family's needs, thus proving that a brief, effective and efficient therapy is possible. Recently, there have been reports of practical treatment using brief therapy in the field of psychosomatic medicine. By offering a concrete way to focus on the resource and strength that pull out the solution that is characteristic of each client/family, brief therapy shows the possibility that may open the door to a new "holistic medicine" in psychosomatic medicine.

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Since solution-focused approach (SFA) has simple techniques and maintains a wide application, it will become an effective therapeutic model in the field of psychosomatic medicine. Instead of searching after problems of patients, SFA focuses on the state after solution and what has already been worked out. Benefits of SFA are 1) relatively simple enough to learn, 2) applicable widely, 3) practical, 4) applicable to family therapy and/or consultation, and 5) empowering the patient's ability to recover. Though SFA has simple techniques, these should not be used mechanically. It is necessary to use the techniques with careful attention to fit to each patient's status. In most of psychosomatic or chronic cases, patient's active participation in the therapeutic process is crucial. Since SFA has a concrete method to facilitate patient's participation in the therapeutic process, it will be a complement of the traditional medical model. For the further development, more experiences and case reports are needed. A theory that combines the way of thinking of SFA and the medical model is desired to be established.

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In psychosomatic medicine, the routine procedure begins with the identification of the patient's problems and disease and goes on to the problem talk. In the solution-focused approach, however, the effort is concentrated on the solution talk, without introducing the problems. These two approaches are thus not always coordinative. Furthermore doubts remain regarding whether or not the solution-focused approach is sufficiently effective in busy clinical practice. In our present study, we applied the solution-focused approach to two patients as part of their psychosomatic treatment and examined its clinical possibility as well as its status in psychosomatic medicine. Case 1 : A 40-year-old housewife, diagnosed as having hyperventilation syndrome. As her expectancy anxiety and depression exacerbated, she became unable to do any housework. On the basis of her plea that she was a victim of the disease, we regarded our relationship to be a "complainant" type. Accordingly, we carefully listened to her problems, established the diagnosis, praised her fortitude against adversities, and talked about the images of concrete solutions. We also asked her to determine, by the next visit, any more existing problems and/or the conditions for any "exceptionally" better state. From the second visit onward, we referred to the problems in the past tense and encouraged her to continue favorable practices in her life. After five such short sessions, her problems were solved and the treatment terminated. Case 2 : An 18-year-old girl, a high school senior, diagnosed as suffering from personality disorder and eating disorder. She refused to eat and repeatedly resorted to violence and even cut her wrists. Receptive psychotherapy was ineffective and no stable relationship between therapists and patient developed. We then regarded our relationship to be a "complainant" type and treated her consistently as such. Without mentioning her ploblematic behavior, we elicited attainable goals and the images of solutions from her with questions supposing a miracle to happen, and praised her for what achievement she had made. As the result of four such short interviews, her violent behavioral manifestations eventually subsided. We demonstrated that, even in busy clinical practice, it was possible and effective to evaluate the type of patient's relationship to the therapeutic staff, utilize the problems as resources for solution, conduct dialog designed to inspire the patient's possibility, and standardize necessary questions. The solution-focused approach thus appeared to be a valuable technique, if incorporated into psychosomatic medicine, to expediate and consolidate solutions.

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We have reported the usefulness of solution-focused approach (SFA) on the treatment of eating disorder. SFA emphasizes that therapeutic interventions must be made according to the relationship between therapist and client and admonish against the one-sided therapy and interpretation given by the therapist. These thoughts are important in the treatment of eating disorder. The relationship between therapist and client are classified into three types in SFA, 1) a visitor type, 2) a complainant type, and 3) a customer type. The relationship between therapist and client with eating disorder on the first visit is usually either a visitor type or a complainant type. It is important to lead to turn these types into a customer type. The coping questions and enough compliments were useful for the above. To set well-formed goals and find the small steps for their targets by joining hands with both therapist and client together were useful to maintain the relationship of a customer type. Otherwise, we utilize various ways for the treatment of eating disorder. For example, we utilize not only gradually increased diet practice which is usually used in cognitive-behavior therapy but also "extermination of the bug" which is mainly used in systems approach as a tool for setting small steps. To support such a unique therapy consistently, it is very important to keep the relationship of a customer type. We conclude that SFA is very useful for the treatment of eating disorder because SFA could lead a visitor type or a complainant type into a customer type in the therapist-client relationship and keep the customer type in addition to the utilization client's resource.

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The healing power of mind is defined as the potentiality of mind (i.e., feeling of reliableness, self-efficacy, etc.) which enables the healing system to be active based on the Physiological function of a human body.The concept that efficient outcomes of such power in a patient could be a therapeutic strategy led to the brief therapy focused on evoking the healing power of mind for one hundred and seventy-five patients of primary care. The factors, which are emphasized in the therapy, include : 1)feeling of reliableness, 2)feeling of hopefulness, 3)mitigation of persistence, 4)experience of success, 5)elimination of cause, and 6)extratherapeutic factors. The outcome of the brief therapy showed 20.0% of all the patients with completion of the therapy, 26.3% with the therapy currently continued, and 44.6% with incompletion of the therapy. The effectiveness of the therapy was evaluated by a questionnaire and an interview for the patients with incompletion of the therapy and those with the therapy currently continued. Both of the patients resulted in significant effectiveness to improve the clinical findings at the endpoints, compared to the outcomes at the entry-points of primary care. At least 54% of all the patients showed that the therapy was effective. Also, the half of all the patients were without medication. The author is convinced that the practice and research of the integrated treatments will greatly contribute to the further development of psychosomatic therapy, combining the common biomedical therapy with the healing power oriented therapy such as alternative medicine in the perspective of evoking the healing power of mind.

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In the chronic pain syndrome treated by psychosomatic medicine, there are varied pains in which organic factors can not he identified and the symptom is not correlative with the cause of disease. In these cases, the evaluation of pain on the part of doctor tends to be subjective and the cognitive difference in the illness between doctor and patient to be widened. Therefor, as for the treatment of chronic pain syndrome, it is important to pay affection to the communication and interaction among patient, family and doctor. From this point of view, use of brief therapy needs to he considered in order to handle these interactions. The authors report a case with chronic pain syndrome and discuss the process of 'externalizing the problem' which is one of brief therapy techniques and the application of psychotherapy in psychosomatic medicine.

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During 10 years between December 1988 and November 1998, 132 children with psychosomatic diseases (including school refusal in 41 cases, irritable colon syndrome in 17, anorexia nervosa in 21, enuresis, enkopresis and nocturia in 15 and other psychosomatic diseases in 38) were seen at the Department of Pediatrics, Nagoya National Hospital and underwent brief therapy. The results obtained after the brief therapy showed complete recovery in 74 cases (56.1%), improvement in 47 (35.6%), no change in 5 (3.8%) and drop-out in 6 (4.5%). The total number of therapeutic sessions was 578 and the mean of sessions per each case was 4.4. Our methods for the brief therapy applied to these children are described in detail in this report by giving 3 cases of representative examples.

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Fourteen chronic stable asthmatic patients in the outpatient clinic of the Kinki University School of Medicine were enrolled and the relationship between PEF and QOL was assessed by their records of asthma diary. The average age of the subjects was 56.4±13.5 yrs. All of the patients were monitoring PEF with a handy PEF meter and recorded their results in an asthma diary. Twenty-one parameters were used to assess QOL i.e., sleep, appetite, interests, work, anxiety, relation to families and friends, worries, insight, somatic or gastrointestinal symptoms, hope for the future, depressive mood, satisfaction of co-medical staff, relation with colleagues in work, libido, pain, irritation, religion, nervousness, chest symptoms (dyspnea, cough), other symptoms and activity limits. The patients checked the grade of each parameter once a week and the total score of each QOL parameter was calculated. No significant correlation was found between PEP variability and QOL scores. However, a short term correlation bet ween PEF and QOL was found in a few patients' asthma diaries. In those cases with a correlation between PEF and QOL, there were two patterns of QOL changes, i.e., PEF correlated with physical factors, and PEF correlated with psychosocial factors. Variability of PEF changed with the psychosocial factors in most cases. We concluded that PEF changes did not correlate with QOL factors in most cases. The changes in QOL factors may be helpful for detecting changes in the symptoms of asthmatic patients with a large PEF variability. Further study should be needed on the details of this QOL questionnaire because there were some problems in the items of the questionnaire.

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Since the 1960s, Grossarth Maticek and his colleagues have done several epidemiological studies in which they have proved their theory of healthy and disease prone personalities : a person of Type 1 personality tends to idealize a certain object as essential for his/her own happiness, often feels disappointed by it, and has been shown to be cancer prone ; a person of Type 2 personality tends to regard a certain object as the cause of his/her own unhappiness, often feels annoyed or irritated by it, and has been shown to be cardiovascular disease prone ; a person of Type 4 personality is ready to alter his/her way of doing or thinking towards an object whenever he/she finds it does harm or brings unhappiness to him/her in the long run, successfully avoids being repeatedly disappointed or annoyed by it, and has been shown to be resistant to various diseases. Such behavioral characteristics as in Type 1 or Type 2 personalities are called the object dependent behavioral pattern (or object dependence), which contrasts with the Type 4 personality called the autonomous and independent behavioral pattern (or autonomy). Autonomy Training (AUT) is a cognitive-behavior therapy that Grossarth-Maticek and his colleagues have developed as a device for reducing object dependency and increasing autonomy. The aim of this study is to determine if AUT is useful for Japanese. The subjects were two Japanese women suffering from dystonia : a thirty-nine-year-old working mother with blephalospasm and a fifty-year-old housewife with hemimasticatory dystonia, both of whom had not responded to medications and were referred to our clinic by an ophthalmologist and a dentist respectively. We applied AUT to the patients as a self-care manual based, outpatient therapy using a brief manual we adapted from Grossarth-Maticek's original that encourages a reader to identify and to solve his/her own problems on a trial-and-error basis and to gain a more comfortable and contented life. Changes of the patients' autonomy level were assessed through what they had reported in interviews as well as from scores of the Japanese version of the Self-Regulation Inventory (SRI), which was developed by Grossarth-Maticek to assess autonomy. The patients read the manual repeatedly and started to focus their attention mainly on their interpersonal relations. When they came to recognize their fixed and object dependent behavior patterns, especially in relations with their husbands, they started to try to change their attitudes and behaviors towards them in everyday life according to what they had learned from the manual. As a result of such changes, they reported improvement in their emotional status. Their behavior patterns were interpreted as Type 1 and Type 2 respectively, and showed improvement in the direction of increase in autonomy, confirmed by constantly improved SRI scores during their 57- and 22-week treatment periods and 41- and 74-week follow-up periods. Their behavioral changes were accompanied by improvements, although not perfect, in dystonic symptoms without receiving botulinum toxin injection therapy. In conclusion, AUT seems to be effective for Japanese in improving emotional and physical status through the development of autonomy.

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