Morita Therapy, Naikan, and Trauma-Informed RecoveryFrom Arugamama to Purposeful Engagement with Life: HANA’s Clinical Understanding
1. Introduction: Morita Therapy and Acceptance-Based Recovery
Within the history of Japanese psychotherapy, Morita Therapy has developed a distinctive approach to psychological suffering. Acceptance, attention, and re-engagement with purposeful living are central to this approach. Developed by Japanese psychiatrist Shoma Morita (1874–1938), Morita Therapy was established around 1919 within the psychiatric context of early twentieth-century Japan. At the same time, its theoretical development has been understood in relation to broader Japanese perspectives on nature and Eastern philosophical traditions (Sugg et al., 2020; Nakamura et al., 2023).
Morita Therapy does not regard the elimination of uncomfortable emotions as a prerequisite for recovery. Rather, anxiety, fear, sadness, uncertainty, and other emotional experiences are understood as part of the natural human experience. What becomes important is not necessarily eliminating suffering itself, but developing a different relationship with suffering and re-engaging with the activities and realities of everyday life (Sugg et al., 2020). The therapeutic task, therefore, is not necessarily to make such emotions disappear.
HANA’s Understanding of Emotion and Feeling
HANA further develops this understanding of Morita Therapy by sometimes distinguishing between Emotion and Feeling as a clinical framework. Within psychology, Emotion and Feeling are related concepts that can nevertheless be distinguished. The American Psychological Association describes emotion as a complex response involving experiential, physiological, and behavioural elements, while feeling refers more specifically to the subjective and evaluative experience associated with an emotion (American Psychological Association, 2018a, 2018b). Drawing on this distinction, HANA sometimes understands Emotion as a natural human response involving the body and nervous system, while Feeling refers to the way a person consciously recognises, interprets, gives meaning to, and subjectively experiences that response.
For example, in response to an event, a person may experience bodily tension and a fear response. They may then recognise and interpret that experience through thoughts such as:
“I am afraid.”, “Something bad is going to happen again.”, “I am weak.” and “I need to get rid of this feeling.”
The initial natural response and the meanings or narratives subsequently constructed around that response are not necessarily the same thing. At HANA, recognising this distinction can provide one possible entry point for stepping back from the struggle to “change my feelings.” Emotion itself does not necessarily need to be forced to change. Nor does Feeling need to be judged as “right” or “wrong.”
The first step may simply be to notice:
“What is happening within me right now?”
Rather than immediately attempting to change the experience, the person can allow it to be there as it is. Then attention can gradually return to reality and everyday life through another question:
“Given what is happening now, what is needed in this situation?”
Here, HANA sees an important meeting point between Morita Therapy’s concept of arugamama and purposeful engagement with life (Kihara, n.d.-a). From this perspective, recovery does not mean eliminating uncomfortable Emotion or Feeling. Rather, it can be understood as:
continuing to participate in a meaningful life even when uncomfortable experiences are present, without allowing the struggle with those experiences to determine the whole direction of one’s life.
The shift from attempting to change experience toward learning to live with experience therefore becomes an important point of connection between HANA’s understanding of Morita Therapy and trauma-informed practice.
2. From Shoma Morita to Contemporary Practice: The Development of Morita Therapy
homa Morita developed Morita Therapy in Japan in the early twentieth century. The therapy was established around 1919 and was initially used primarily for anxiety-related difficulties, particularly conditions historically referred to as shinkeishitsu or “neurasthenia” (Sugg et al., 2020). Morita’s approach differed from therapeutic models that placed the direct removal of psychological symptoms at the centre of treatment. Morita observed that attempts to suppress, analyse, or forcibly eliminate anxiety could sometimes intensify a person’s attention to the anxiety and contribute to psychological entanglement with it. Morita Therapy therefore places considerable emphasis not simply on symptoms or emotions themselves, but on the ways resistance, excessive attention, and preoccupation may contribute to maintaining psychological distress (Sugg et al., 2020). Morita’s approach was not an invitation to deny suffering or simply resign oneself to it. Rather, it involved recognising one’s experience as it is, gradually returning attention to everyday life, and re-engaging with the activities required by the circumstances of the present moment.
Over time, Morita Therapy developed beyond its original clinical context and became the subject of international clinical and academic interest. Contemporary accounts describe Morita Therapy through concepts including arugamama, natural emotions, toraware, purposeful action, and harmony with nature (Sugg et al., 2020). Morita Therapy shares certain similarities with contemporary approaches such as Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches. However, it should not simply be equated with these approaches. Morita Therapy places particular emphasis on experiencing the natural flow of emotions while engaging with life, rather than relying primarily on intellectual understanding or cognitive restructuring (Sugg et al., 2020). The distinctive concepts ofarugamama, natural emotion, toraware, and purposeful living,together with their historical and philosophical context, contribute to the unique identity of Morita Therapy.
3. Arugamama: Allowing Experience to Be as It Is
At the centre of Morita Therapy is the concept of arugamama. Arugamama can be understood as allowing one’s present experience to exist as it is, without immediately attempting to turn it into something different. Anxiety can be anxiety. Sadness can be sadness. Uncertainty can be uncertainty. Bodily sensations can be bodily sensations. It involves allowing these experiences to exist without immediately attempting to eliminate or alter them. However, arugamama does not mean accepting defeat, resigning oneself to suffering, or giving up on change. Nor does it mean continuing to accept a harmful external situation simply because it exists. Rather, arugamama concerns the relationship a person has with what is occurring within their own experience. This resonates, in some respects, with the Zen concept of kanshō, or contemplative observation, as HANA understands it. However, HANA does not understand this simply as “observing feelings.” Rather, it involves recognising experience as it is while gradually loosening excessive preoccupation with it and returning attention to engagement with reality. The aim is not necessarily for emotions to disappear. Rather, it may involve becoming less restricted by emotions in one’s actions and thoughts, even while those emotions remain present. When changing an emotional state is no longer treated as a prerequisite for “starting to live,” a person may gradually become able to direct attention beyond their internal experience and toward other aspects of life.
Anxiety or sadness may remain, yet they do not necessarily have to determine whether meaningful activity can begin. In this sense, acceptance is not the endpoint of therapy. Acceptance creates space for re-engagement with life. What is added to that space—or whether the person wishes to expand the space further—can then become something to explore together. This is an important part of how HANA incorporates Morita Therapy into its clinical practice.
4. Natural Emotion and Toraware
Morita Therapy understands emotions as part of the natural movement of human experience. Emotions arise, change, become stronger or weaker, and sometimes return. Morita Therapy describes this natural movement through concepts such as the “law of emotions” (Sugg et al., 2020). However, when attention becomes increasingly concentrated on an unwanted internal experience and attempts to change that experience become central to everyday life, psychological toraware, or entanglement/preoccupation, may develop. Morita Therapy uses the concept of toraware to understand this process.
For example, a person may think:
“I cannot go outside until my anxiety disappears.”
“I want to talk to people once I feel confident.”
“I need to stop thinking about the past before I can move forward.”
“I need to feel ready before I begin.”
In such situations, life can gradually become organised around changing an internal experience. Morita Therapy offers another possibility. A person can recognise what is happening internally without allowing that experience to become the sole centre of attention. Attention can gradually return to the reality surrounding the person: responsibilities, relationships, activities, and what is needed in the present situation. The emotion does not have to disappear first.
5. From Mood-Led Living to Purposeful Engagement with Life
An important characteristic of Morita Therapy is the movement from mood-led living toward purposeful engagement with life. Mood-led living refers to a way of living in which behaviour is strongly determined by one’s current psychological state—whether one feels safe, motivated, confident, or ready. In such a way of living, uncomfortable emotions may gradually narrow the range of possible actions. Morita Therapy instead emphasises attending to what is needed in the present situation, rather than allowing current mood alone to determine behaviour (Sugg et al., 2020). Purpose here does not necessarily mean a grand “life purpose.” It can be small and concrete.
The question is:
“What is needed in this situation, now?”
For example:
Taking a small step toward connection despite social anxiety.
Attending to an important responsibility while experiencing profound grief.
Completing one small part of an overwhelming task.
Attending a necessary support service despite wanting to withdraw.
Taking one realistic step forward even when the future remains uncertain.
What matters is not proving that anxiety has been overcome. It is participation in life. From this perspective, purposeful action provides one way of remaining engaged with one’s life without requiring a particular emotional state to be achieved first.
6. Morita Therapy and Trauma-Informed Practice
Morita Therapy offers important possibilities for trauma-informed practice, while its application requires careful consideration. Trauma can profoundly affect a person’s experience of time, safety, memory, bodily sensations, relationships, and their sense of themselves and their lives. Furthermore, avoidance of distress following trauma should not automatically be understood as problematic behaviour. In many circumstances, avoidance represents an understandable survival strategy that developed in response to previous experiences.
For this reason, trauma-informed understandings of Morita Therapy need to clearly distinguish between:
recognising internal experience as it is and accepting a harmful external situation.
These are not the same. A person can acknowledge fear while recognising that the fear may be communicating important information. A person can acknowledge painful memories while establishing boundaries in their current life. A person can allow grief to exist while taking steps toward rebuilding their life. Therefore, purposeful engagement in trauma-informed practice does not mean:“Act anyway, regardless of your emotions.”
Rather, it involves questions such as:
“What have I experienced?”
“What is happening now?”
“What is needed in this moment to support my life, safety, values, and relationships?”
Through this understanding, acceptance does not need to become passivity, while action does not need to become pressure. Instead, Morita-informed practice can be adapted in ways that remain responsive to trauma, safety, context, and the person’s lived experience.
7. Naikan: Relationship, Reflection, and Meaning-Making
While Morita Therapy offers a direction for how a person may engage with life alongside their present experience, Naikan Therapy provides a structured approach to reflecting on relationships and past experiences. Naikan Therapy was developed and systematised by Ishin Yoshimoto (1916–1988) during the mid-twentieth century and emerged within Japanese cultural and religious contexts (Kawahara, 2002; Tsukasaki, 2019).
Traditional Naikan reflection focuses on three questions concerning a particular relationship:
What have I received from this person?
What have I given to this person?
What troubles or difficulties have I caused this person?
Through these questions, Naikan invites a person to move beyond an exclusively self-centred perspective and examine how their life has been shaped through relationships with others (Kawahara, 2002; Chilson, 2018). The process can involve awareness of gratitude, responsibility, reciprocity, and the ways in which relationships have contributed to the development of one’s life. However, when Naikan is used within trauma-informed practice, careful consideration is required regarding how these questions may affect the person. For people who have experienced interpersonal trauma, the third question—asking what difficulties they caused another person—may, in some circumstances, activate excessive self-blame, shame, or a sense of responsibility for events that were not theirs to carry. This is particularly important for people who have previously been blamed for experiences that were not their responsibility. For this reason, HANA may adapt the third Naikan question within trauma-informed clinical practice (Kihara, n.d.-b). Alongside, or in some circumstances instead of, the traditional question, “What troubles or difficulties have I caused this person?”
HANA may ask:
“What have I learned from this relationship?”
This does not replace traditional Naikan. Rather, it represents a trauma-informed clinical adaptation developed by HANA to support relational reflection while reducing the risk of drawing trauma survivors into excessive shame or self-blame.
The intention is to orient reflection toward:
awareness, meaning-making, relational understanding, and growth.
8. Integrating Morita Therapy and Naikan
Morita Therapy and Naikan can offer complementary directions for understanding psychological recovery. Morita Therapy supports a person in recognising their present internal reality while continuing to participate in life. Naikan supports reflection on relationships and past experiences from a broader perspective.
In this sense, one can support:
engagement with the present,
while the other supports:
reflection and meaning-making in relation to experience and relationships.
Together, they can be understood as a dynamic process:
Experience
→ Arugamama
→ Reflection
→ Meaning-making
→ Re-engagement with life
The person first encounters what is present without immediately attempting to solve or eliminate it. They may then reflect on that experience within broader relational and temporal contexts. Through meaning-making, new possibilities for re-engaging with life may emerge. This process may be particularly relevant to trauma recovery. Recovery is not simply about reducing symptoms. It can also involve changing one’s relationship with the past. What happened in the past does not need to be erased.
What becomes important is:
recognising what happened as part of one’s life without allowing it to determine the entirety of one’s identity or future.
9. From Japanese Psychotherapy to Culturally Responsive Practice in Aotearoa New Zealand
Cultural humility is essential when incorporating Morita Therapy or Naikan into contemporary clinical practice. Both practices emerged within specific Japanese historical, philosophical, cultural, and religious contexts. It is therefore important not to remove them from those contexts and present them simply as universal psychological techniques. At the same time, aspects of human psychological experience—including anxiety, grief, loss, relational suffering, uncertainty, and the search for meaning—may have dimensions that are shared across cultures. In Aotearoa New Zealand, Japanese therapeutic traditions may enter into dialogue with Māori worldviews, community knowledge, lived experience, mindfulness, body- and movement-based approaches, and other culturally grounded understandings of wellbeing. Such dialogue does not require different knowledge systems to be blended into a single framework. Rather, it creates space for different knowledge traditions to meet while respecting their respective origins, integrity, and distinctiveness.
In trauma-informed practice, the important question is not only:
“Does this approach work?”
It is also:
“For whom does it work?”
“Within what cultural context is it being used?”
“What adaptations may be necessary?”
“Whose worldview is being centred?”
From this perspective, cultural responsiveness is not an additional component added to therapy. It is part of ethical clinical practice itself.
10. Toward an Integrated Model of Trauma Recovery
The integration of Morita Therapy and Naikan provides a foundation for a broader understanding of trauma recovery.
Morita Therapy offers the principle of:
Arugamama.
It involves recognising present experience as it is while gradually returning attention toward life.
Naikan offers:
relational reflection.
It involves reflecting on what one has received, what one has given, what one has experienced, and what one has learned through relationships. Adding trauma-informed adaptations can help ensure that acceptance and reflection do not inadvertently reproduce shame, self-blame, or excessive personal responsibility. Together, these approaches suggest a movement from being overwhelmed by psychological experience toward creating greater space in relation to that experience. This does not require a person to become completely free from difficult emotions before beginning to live.
Rather, recovery can be understood as learning to live with what is present while gradually changing one’s relationship with the past, the present, other people, and the possibilities of the future. This understanding provides an important theoretical foundation for the development of the Mud Lotus Trauma Integration Model. Mud Lotus does not conceptualise trauma simply as a collection of symptoms that must be removed. Instead, trauma can become an experience that may be encountered, reflected upon, integrated, and understood within the wider context of a person’s life, allowing new meanings and possibilities to emerge. A lotus does not deny that it emerged from mud. Similarly, trauma integration does not require what happened to be denied.
The question becomes:
“Having recognised what happened, how can a person continue to grow with that experience?”
In this sense, recovery is not necessarily a movement from:
suffering → a life without suffering.
Rather, it may be a movement from:
being defined by one’s experience → developing a wider relationship with that experience, and expanding one’s relationship with oneself, others, and the life that may still become possible. That is the direction in which HANA’s understanding of Morita Therapy and Naikan contributes to the Mud Lotus Trauma Integration Model.
References
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American Psychological Association. (2018b). Feeling. In APA dictionary of psychology. https://dictionary.apa.org/feeling
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Kihara, A. (n.d.-b). Naikan therapy in New Zealand: A Japanese method for self-reflection and healing. HANA Counselling and Education Limited. https://www.hanacounselling.com/article/naikan-therapy-a-japanese-practice-of-self-reflection
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Nakamura, M., Niimura, H., & Kitanishi, K. (2023). A century of Morita therapy: What has and has not changed. Asia-Pacific Psychiatry, 15(1), e12511. https://doi.org/10.1111/appy.12511
Sugg, H. V. R., Richards, D. A., & Frost, J. (2020). What is Morita Therapy? The nature, origins, and cross-cultural application of a unique Japanese psychotherapy. Journal of Contemporary Psychotherapy, 50, 313–322. https://doi.org/10.1007/s10879-020-09464-6
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