Somatic symptom disorder (somatoform disorder) is sometimes difficult to treat. One of the reasons is the issue in the therapeutic relationship. Sometimes we have a patient who expects a physician to clarify the medical cause of somatic symptoms and treat them even though the somatic symptoms cannot be explained by organic factors. It is often difficult to establish a therapeutic alliance owing to the conflict of expectations of both the patient and the physician. In that case, interpersonal psychotherapy may be useful. Interpersonal psychotherapy, which emphasizes psychoeducation and aims for the improvement of symptoms by addressing current interpersonal relationship, is applied to the clinical condition with interaction between the interpersonal relationship and symptoms. The therapeutic relationship can be regarded as a kind of interpersonal relationship and be linked to the interpersonal relationship outside of clinical sessions. Although there has been a few clinical researches of effectiveness by interpersonal psychotherapy, it may be effective if there is a strong interaction between the interpersonal relationship including the therapeutic relationship and somatic symptoms.

A vignette has been used to describe psychoeducation in instances where acceptance and commitment therapy (ACT) was used. This vignette involves psychotherapy for an individual in a medical setting. The individual in question is being treated for a psychosomatic problem in the form of irritable bowel syndrome. Like conventional cognitive-behavioral therapy (CBT), ACT emphasizes an understanding of contingency-shaped behavior and the vicious cycles of negative thoughts and feelings, but ACT differs from CBT since ACT seldom uses models of illness or models of specific symptoms. ACT focuses on having the client experience reality, and ACT uses the concepts of experiential avoidance, cognitive fusion, acceptance, and commitment to help the client to understand those experiences. Thus, ACT can probably be viewed as a form of psychotherapy that emphasizes psychoeducational components more than other forms of therapy.

Mindfulness meditation has been integrated into self-care class for patients with psychosomatic disease. The class was intended to enable them to proactively provide self-care on physical and psychological health through enhancing their awareness on their own states and to take an appropriate course of actions. Program of the class consisted of psychological education and meditation practices to enhance attention regulations. Saliva amylase and subjective evaluation on their physical and psychological states were measured before and after the program and compared. Self-report and free talk were introduced from the perspective specific to mindfulness components. Self-care class incorporating mindfulness practices might activate patients’ inner resource and enhance their awareness of “here and now” experiences, which might change the relationships with their own inner experiences and lead to appropriate management. This also suggests possibilities of improving symptoms and preventing relapse. Adaptability of patients and timing, motivation and contents of program should be further examined.

Diabetes patients have an issue that they improve their life-style by themselves willingly when they keep up their self-care behaviors (diet, exercise, self-monitoring of blood glucose, medication, insulin injection) in order to maintain good glycemic control throughout their lives. Their cognitive factor is not only to interrupt but to promote behavioral change. Therefore, it is necessary to help patients psychologically motivate self-care behavior and acquire stress coping skills on the basis of the evaluation of their illness perception and self efficacy to self-care behavior. In our educational program for diabetic and obese inpatients, a group therapist encourages them to talk about illness perception so as to adapt themselves to their daily life with diabetes and to engage themselves in self-care behavior. Patients also talk and learn each other about their coping to difficulties of living with diabetes so as to prevent a lapse and a relapse, and eventually, to maintain their self-care behavior. Furthermore, we offer an individual cognitive behavior therapy to outpatient as the individualized and optimized treatment according to the case formulation.

Fibromyalgia patients, while undergoing prolonged treatment of pain, often develop secondary symptoms such as emotional instability. This can trigger a vicious cycle by causing confusion, even provoking a temporary alteration of personality, which in turn could make their primary symptom, the pain, even worse. This study proposes a number of concrete improvements to the Psychoeducational Approach. We conducted an analysis of the information on patients and their families obtained through questionnaires, which enabled us to identify certain factors that could potentially cause pain-related secondary symptoms. For a clinical psychology program centered on psychoeducational support to work, it is crucial to understand the complex interplay of the patterns of thought, emotion, and behavior in each patient, and to create an environment that would deter the occurrence of pain-related secondary symptoms. We are strongly convinced that a psychoeducational approach with a broader understanding of the patient’s everyday life would be effective in the prevention of pain and in increasing self-management skills.

In order to predict bio-psycho-social-existential problems that patients may face after hospital admission, we developed a check sheet : Comprehensive Stress Check for Patients (CSCP). CSCP enables doctors and therapists to see how patients perceive their physical health, and psychosocial and existential problems at an early hospitalization period. We carried out a pilot survey in the Division of Geriatrics and Hypertension in Osaka University Hospital, where we are based. A total of 102 inpatients completed CSCP. As a result of factor analysis, we determined that 3 factors contributed to their subjective stress : “existential value,” “psychological environment in hospital” and “subjective physical and mental symptoms.” In our previous studies, we have noted that psychotherapists played a role in facilitating the understanding of patients in order to promote a better relationship between doctors and their patients. As this study was a continuation of our past research, we intended to create a tool that would help psychotherapists to share their expertise to understand patients with doctors. A further study will be needed to utilize CSCP in the way that will allow doctors, therapists and patients to work together towards the creation of better hospital environment.

Background : According to Dr. Kasahara, Morita-oriented counseling is the basic psychosocial treatment of choice for nervous pollakisuria. Since the case report of such effort has been scarce up to the present, a case of Morita therapy applied to treat nervous pollakisuria is reported in this study. Subject : A 26-year-old man who suffered from nervous pollakisuria. Method : The treatment process of the inpatient Morita therapy was investigated, reviewing the medical records of the doctor, the nursing records, and the diary the patient wrote during the inpatient treatment. Result : During the first month of the inpatient treatment, the patient gained the experience that he could continue to engage in what he needed to do at the time as priority without interrupting even while having an urge to urinate. As he took on a role to play in a group, he showed a strong sense of responsibility and could not rely on the other patients who did not appear to be friendly. As a result, he completed a research project alone and was exhausted at the end. Another patient once pointed out this tendency of his personality, which he accepted without becoming emotional. After this incident, whenever he faced a situation which he could not get over on his own and without the help of others, he could not consult with anybody and started to show pollakisuria as well as other physical symptoms and stayed in bed for a while. It became clear that he could not make decisions as he paid too much attention to others’ feelings. In other words, his difficulty to make decisions came from the fear of others (Taijin-kyofu), and the therapist and the patient shared the understanding that his physical symptoms and pollakisuria had a common psychodynamics of the mind of Taijin-kyofu. After returning to the hospital from his short stay at home, he started to cautiously express his opinion to others and left the hospital on the 84^th day after the end of absolute bed-resting period. He has shown a favorable progress after the discharge. Conclusion : As a treatment of nervous pollakisuria, inpatient Morita therapy was considered effective to maintain the favorable outcome by changing the patient’s attitude towards pollakisuria as well as the underlying mind of Taijin-kyofu.