Gosaku Naruse, PhD
International Institute for Clinical Dohsalogy
1. What is “clinical dohsa-hou” ?
A) The so called “clinical dousa-hou” is an endemic original
therapeutic or training method for clinical psychology which has rapidly developed in recent three decades (1966) and still now being widely evolve for the field of clinical psychology in Japan. Its distinctive feature is to utilize the DOHSA as the major tool not only for psychotherapeutic treatment but also in fields of psychological help in general, for instance sports, education or mental health. And verbal activity which has been the major tool for traditional psychotherapy and traditional complementary medicine in Japan is here used as only supplemental means.
B) The dohsa means a psychological process of self-striving by the owner of his body to realize a body-movement which is intended by himself. It is a psychic activity of the goal-directed striving to realize the pattern of body movement coincides with the intended pattern of motion by himself. It is the owner’s self controlling activity of his own body-movement which is schematized like as a process as follows
< Intention >—–< striving >——< body movement >.
C) In the therapeutic session of dohsa-hou, client is asked to realize a pattern of body movement as an imposed motor task by therapist. When client accepts and agrees to therapist and therapy, he strives to perform the task as his own intension. In such case, the essential of dohsa activity is a process of striving to realize the motor pattern which is given to client as the therapeutic task. Thus the role of therapist is to help his client’s process of task striving to perform the imposed pattern of dohsa. That is, the true purpose of dohsa-hou is to work upon client’s mind for therapeutic approach through the motor activity of body as a clinical tool. By his striving, client has a specific new chance for experiencing to attend and concentrate to make realaction on his own body through the co-operating work with his therapist for the same goal. Thus, the major goal of dohsa-hou is to make the patient to activate his body and mind, facilitate his sensitivity of body movement and stabilize his ability of self control for his own motor action, and also to get an experience of co-operating work with his therapist.
２. Characteristics of motor disability by cerebral palsied child
A) Clinical study of dohsa-hou made its first step in 1966 when the author found a fact that some cerebral palsied young men with heavy motor disability of arm were able to raise successfully up their arm through their own striving by hypnotic suggestion of possibility of arm movement under light trance. Since then, experimental and clinical studies were widely attempted by the author (1966, 1967, 1968a, 1968b) and his colleagues to make such a question clear what is the true nature of motor disability by cerebral palsied person. Every kind of techniques including traditional orthopedic methods and neurological training like as the so-called Bobath’s method (1976) or Bojta’s one had been examined. In spite of a general belief that cerebral palsied person is not able to move his body by himself, the autor’s studies had uncovered that was miss understanding. Widely demonstrated fact is that even if he is possible to move his body by himself because of the full physical equipments for the motion, when he strives to move his arm, the pattern of body movement as the result of striving goes far wrong from his intended pattern by his all means. Such a discrepancy inbetween intended pattern and realized one comes up from a fact that he has no suitable experience or means on how to strive for the movement of his own body according to his intention.
B) The results of study for a quarter century(1975, 1988, 1995) By the author and his collaborators suggested that as the best way for amelioration of motor disability by those person, it was necessary to stand on psychological view point and method rather than physical or physiological one, because of the fact that the basic difficulty by
those persons was psychological process of dohsa as to soft mechanism “how to move his body according to his intention”, even if their
physical or physiological conditions like as muscle-skeletal or neuro-muscular system as to a hard mechanism were well equipped and prepared for body movement.
C) Thus, a systematic technique of dohsa-hou has been developed for amelioration by helping, training, or therapy for palsied client to get master how to strive himself to perform intended pattern of movement, and it has demonstrated a very successful effect of amelioration for these person, and at present, the most part of schools and institutions for cerebral palsied over the all of this country are applying the dohsa-hou for their amelioration of motor difficulty.
3. Development of therapeutic (training) method of dohsa-hou
A) Therapeutic method of dohsa-hou had begun with muscle relaxation for the purpose to eliminate the unsuitably strong muscle
tension which disturbed the intended pattern of body movement. Relaxation training following to Jacobson’ principle of self-operations control by “progressive relaxation” were applied at first with hypnosis and afterward without hypnosis for ten years(1924, 1934). According as such unsuitable muscle tension began to release through the progression of training, many clients not so heavy became to get their body move easier or successfully corresponding to his intention.
B) Since for the other many clients who have never experienced to move his body corresponding to his intention therapeutic training by such simple relaxation showed not always so sufficient effect, it became necessary to be designed a new training method by which client had to strive more active for making a motor pattern of appointed part of body securing relaxation of the other parts of body by himself corresponding to his intended pattern. Here, client is asked to move his body as the major goal, and to put to relax as the secondary goal. That is, striving to move a part of body (for instance bending his arm at elbow) client has to relax or inhibit muscle tension of the indifferent or harmful parts (arm and especially elbow, shoulder, wrist or even hand). Through those experiencing of the task striving, feeling of body, moving-sensation of body part, striving to make a motor pattern in accordance with the intended one, confirmation of motor pattern as the result of striving so on, client usually shows rapid improvement in his motor ability.
C) It is an extremely impressive moment for therapist to see client’s unique behavior who gets the body trunk upright by himself without support by therapist at the first time in his life in which he has lived lying down on the bed or floor because of their difficulty of
getting up. Since such a moment, his looks, manners and all of behaviors are rapidly altered, and becomes look like more light heart, active and stoutly. It seems to mean that he met gravity at the first time in life and became to be able to stand his upper body upright vertically by himself on the earth corresponding with the gravity. Standing upright is not only a necessary tool for locomotion of body but also may give him living energy of human being for having active behaviour on everyday life. This is why training of self-standing upright has been taken as the most important task in dohsa-hou for cerebral palsied, .
D) On the way of study on training of stand-upright, the author and colleagues became aware of the fact that client makes up gradually the central axis of body which plays the basic role to induce the axis of his existing ego. Such a body-axis seems to integrate his all parts of body organizing as a whole and to take the role of a central basement for not only when he tries to accept and perceive the outer world but also when he strives to act upon the environment through his own body. As a matter of fact, since he became to be able to stand by himself, his ability of discrimination on the upper and lower, far and near, right and left sides so on in his environment showed remarkable advancement.
At present, the central task for motor training is the so-called “Tate”-system in which the major goal of therapy is to get client’s body-axis stand on “tate” (which means vertical) well upon the ground on earth, and to make his axis more clear, secure, soft and flexible in the every day life.
4. Major patterns of motor difficulty on each body part for “tate”- system training
Because each body part in “tate”-system motor training for cerebral palsied shows respectively some distinctive features which makes therapeutic approach difficult by its inadequate muscle tensions and in suitable movements of body, therapist has to help client suitably for client’s good management of these difficulties by his self-control for necessary muscle relaxation and purposive pattern of body movements.
These parts of body for control are shown in each part of body is expressed as psychological schema, and their characteristic difficulties for training are shown as followｓ:
1. neck : lean forward/backward, bend to right/left side, twist,
2. both part of scapula joint in back: bend forward, shrink both joints forward, lift up,
3. shoulder: lean forward, humpback, declivity/acclivity of right / left sides, lift up,
4. back : lean forward, round back, side bowing to right/left, twist,
5. waist : lean forward/backward, side bowing to right/left, twist,
6. groin : bend backward/forward, lean right/left side, twist,
7. knees : bend forward, lean backward, stretch, twist,
8. ankles: stretch, bend up, twisted in/out side,
9. feet : heel up, toe up, bend in/out side of foot up, revolve to in/out side,
10. shoulder joints: bend in/out side, stretch straight up/down/ side, twist,
11. elbows: bend in/out side, stretch straight, twist in/out side,
12: wrist : bend in/out side, stretch straight, twist in/out side,
13. hands & fingers: grip, stretch,
5。Therapeutic tasks in the “tate”-system training
A) The “tate”-system training is composed of six major tasks which include some supplementary tasks, and related tasks. The six of major task are as follows:
(1) “zai” : sitting body upright on the floor with crossed legs
(2)”hiza-tati”: standing by knees on the floor
(3)”ritui” : standing straight by legs on the floor as shown
(4)”hokou” : walking and gait,
(5)”shisei” : posture in standing posture,
(6)”taijiku” : (body axis) free and skillful manipulation of body axis and related motor patern in everyday life.
B) For the client who has been living lie down on bed or floor
since his birth, training is applied in order from (1) “zai” via (2) “hizatati”, (3) “ritui” , (4) “hokou” , (5) “shisei to (6) body axis.
C) For the client who is able to stand and/or walk, training is
applied according to his awkward or difficult pattern of motion: that is , (1) ”zai” is for client who is not stable to maintain firmly stand
straight his upper body, (2) ”hizatati” is for one who is not sure to maintain his waist straight on vertical, (3) ”ritui” is for one who is not easy to stand by legs and foot straight on the floor,（４）”hokou” is for one who is unstable to maintain body balance against the earth
proclaim shifting on both sides of leg and moving his body forward according to walking, (5) “shisei” is for one who shows characteristic distortion in front view and also side view not only on the standing posture but also on the sitting and standing by knees, and (6) “taijiku” is for one whose body axis is not stable, immature, not flexible, clumsy, or not free when he is going to make some usual daily pattern of motor behavior.
6. Procedure in training session
A) Decision of major task and supplementary tasks in therapeutic session,
B) Relaxation by “omakase” : to get client entrust therapist with his whole body and mind through sufficient relaxation,
C) Making postural pattern of body: to make most suitable posture for training corresponding to major task by therapist’s hands/body for help,
D) Putting client’s heart and soul into his body: to get client stand independently on his body with his own striving and
responsibility trusting to his body and unconscious activity,
E) Making body axis: to get client stand straight up, stamp down, make a firm step on the earth,
F) Making joint on axis: to get client make one or some flexible points on the body axis,
G) Making flexible axis of body: to get client manipulate freely and well balanced body axis on the earth integrating his all parts of body and his mind into a whole activity.
7. Essentials of therapeutic experiences by palsied client in motor training of dohsa-hou
A) Therapeutic purpose of dohsa-hou for therapist is to help his client to get valuable experiences in therapeutic sessions for the sake of modification of manner of experience in his everyday life not only on the motor actions, but also a lot and various kinds of feeling in dohsa-process, getting client to attend on to his own body and movement, to recognize to his parts of body again, to grasp his body map more clear, to feel of himself striving for dohsa activity, etc.
B) The manner of striving to realize or perform a motor pattern given by therapist as a therapeutic task has to be altered by client himself through taking a new and necessary manner of striving and at the same time giving up the old and harmful manner. Because of such a harmful striving is generally done without awareness, it may be necessary for therapist to get his client be aware of his own striving. Although such a striving may be experienced by client with awareness in the first half of therapeutic process, therapist has to help his client to be able to strive successfully to realize the task without awareness in the later half.
C) For realization of intended pattern of motor task client has to carry out suitable management and control in every moment of dohsa process integrating two kinds of activity into a whole: one is his own striving to bring the pattern of body movement as like the feed forward information, and the other is recognition of real body movement as the effect of his own striving like as the feed back one.
D) It is the beginning and also the most important condition in the dohsa therapy that client has to leave his body and mind to his
therapist entrusting his treatment with like as hypnotic rapport. Under such a condition of rapport client is able properly to accept even
something subtle signs for communication from his therapist, and also he is possible to leave his body to himself at the same time leaving his non-conscious activity and mind to himself. Therefore it is very much important job for therapist to help his client to make such a therapeutic relationship like as hypnotic rapport.
-Jacobson, E.(1938). Progressive Relaxation. Chicago:The University Press
-Jacobson, E.(1964). Anxiety and Tension Control. Philadelphia: J.B. Lipincot
-Naruse, G. (1966). Nohsei-mahi shya no shinrigakuteki rehabilitation. -I: shikan-koudou ni tuite. (Psychological rehabilitation of cerebral palsy. -I: on relaxation behaviour). Archives of Educational
– psychology, Faculty of Education, Kyushu University, 11, 2, 33-46.
-Naruse, G.(1967). Nohsei-mahi shya no shinrigakuteki rehabilitation
– II: Tan’i dousa ni tuite. (Psychological rehabilitation for cerebral palsy II: On unit pattern at joint motion). Archives of Educational psychology, Faculty of Educatuon, Kyushyu University, 12, 2, 43-64.
Naruse ,G.(1973). Shinri Rehabilitation. (Psychological Rehabiritation). Tokyo: Seisin
-Naruse, G.(1975). Psychological treatment of motor difficulty for cerebral palsied children. The Journal of Rehabilitation Psychology, III. 1-10.
-Naruse, G.(1976). A comparative syudy of the psychologica treatment to Bobath’s method. The Journal of Rehabilitation Psychology, IV. 1-7.
-Naruse, G.(1976). Examination and treatment of standing posture ofcerebral palsied children. The Journal of Rehabilitation Psychology, IV. 8-14.
-Naruse,G.(Ed.),(1984). Shougaiji no tameno dohsahou. (Dohsa-hou for Disabled Children). Tokyo: Tokyo Shyoseki.
-Naruse, G.(1985). Dohsa-Kunren no Riron. (Theoretical Study of Dohsa -Training). Tokyo: Seisin Shobou.
-Naruse, G.(1992). Recent development of Dousa-hou in Japan. The Journal of Rehabilitation Psychology, XVII, XVII, XIX, 1-6.
-Naruse, G.(1995). Rinshou Dohsagaku kiso. (Theoretical Basis of the Clinical Dohsalogy). Tokyo: Gakuenshya.