Chapter 2
What Does It Mean “Not to Destroy”?
— Definitions and the Heritage of Japanese Clinical Practice
1. Defining “Preservational Psychotherapy” in a Single Sentence
In the first chapter, I spoke of the origins of the term “Preservational Psychotherapy” and the personal experiences that led me to it. In this chapter, I would like to pause and carefully define exactly what Preservational Psychotherapy entails.
Let us begin with the simplest possible definition:
Preservational Psychotherapy is a clinical practice that focuses less on the manipulation of symptoms or narratives, and more on protecting the “margin” (yohaku) through which a person may reclaim their own time.
This single sentence is packed with several significant concepts. Let us unravel them one by one.
2. What Does It Mean “Not to Manipulate Symptoms”?
In modern medicine, “removing symptoms” is a natural and expected goal. If one has a headache, they take an analgesic. If they cannot sleep, a sedative is prescribed. If a depressive mood persists, antidepressants are used. This is not incorrect. I myself prescribe medication in my daily practice, and it is certain that medicine can alleviate a patient’s suffering.
However, psychiatric symptoms possess a mysterious dimension.
Consider, for instance, the symptom of “anxiety.” Anxiety is undoubtedly painful. Yet, at the same time, it is a signal that something must change. Anxiety before an exam prompts preparation. Anxiety when a relationship is on the verge of collapse is an expression of vigilance toward something precious.
Or consider the state of “social withdrawal” (hikikomori). To be unable to go out into the world appears, socially, to be a “problem.” Yet, for a particular patient, retreating to their room might have been the only way to protect themselves from the outside world.
Symptoms are the result of a person’s attempt to survive, by any means necessary.
This is the fundamental perspective of Preservational Psychotherapy. “Not manipulating symptoms” does not mean doing nothing—neither medicating nor treating. Rather, it means respecting the symptom not as a “foreign object to be removed,” but as something that has “emerged from within that person’s history and context.”
Before rushing to eliminate it, one should first seek to understand what meaning that symptom has held in the person’s life—this is what is meant by “not manipulating symptoms.”
3. What Does It Mean “Not to Manipulate Narratives”?
Next, let us consider the phrase “not manipulating narratives.” Every human being possesses a “narrative” regarding their own life.
“I am this kind of person,” “My life follows this pattern,” “That event made me who I am”—these frameworks of self-understanding are what we call “narratives.” These stories are not always objectively accurate, and they often contain contradictions. Nevertheless, people live their daily lives using these narratives as a guide.
In the field of psychotherapy, there are approaches that aim to “rewrite the patient’s narrative.” For example, Narrative Therapy seeks to “re-author” a “dominant narrative” fraught with problems into a richer, alternative story. This is a meaningful endeavor in its own right.
However, “manipulating a narrative” carries inherent risks.
I am reminded of a certain patient. She held a narrative that “my life has been nothing but unhappiness.” Initially, I attempted to “correct” that story. I said things like, “But surely there were good things too,” or “If you look at it from a different perspective…” But she replied:
“Doctor, are you trying to deny my suffering?”
With those words, I realized what I had been doing. Her “narrative of unhappiness” was her means of giving meaning to her own pain. To take that story away from her was equivalent to denying the very suffering she had endured.
Rewriting a story can, at times, erase the “self that has struggled.” Preservational Psychotherapy cautions against the therapist overwriting the patient’s narrative with a “correct story.” A narrative is something that changes gradually at the person’s own pace; it is not something to be operated upon from the outside.
4. What Does It Mean to “Reclaim One’s Own Time”?
In our definition, the expression “for a person to reclaim their own time” is the part I value most. I believe that much of psychiatric distress is, in a sense, a “loss of one’s own time.”
In a state of depression, time flows agonizingly slowly. In other states, the same thoughts circle endlessly in the mind, creating a sense of being unable to move forward. In the acute phase of schizophrenia, the very perception of time may become fragmented, blurring the distinction between past, present, and future. For those with trauma, past events suddenly invade the “now”—a state known as a flashback.
All of these are states in which one has lost “one’s own time.”
◆ Time Perception and Clinical Psychiatry
The philosopher Bin Kimura (1931–2021) exquisitely described the experience of schizophrenia as a “change in the structure of time.” The continuity we usually take for granted—the flow from past through the present toward the future—is actually supported by a delicate psychological structure. In schizophrenia, this structure is shaken at its foundation. Kimura argued that treatment is deeply concerned with “reclaiming time.”
“Reclaiming one’s own time” means being able to feel the past as past, the future as future, and the present as present. It means being able to exist in this very moment. It is the ability to live one’s life not according to the ticking of a clock, but according to one’s own inherent rhythm and pace.
This is not something that is automatically achieved simply by removing symptoms with medication. Only when the pressure to “change” or “cure” is removed does a person begin to slowly reclaim their “own time.”
The role of the therapist is to avoid obstructing this “process of reclaiming one’s time”—and to protect the “margin” necessary for that process.
5. Four Clinical Principles
To make the definition more concrete, Preservational Psychotherapy rests upon four clinical principles:
- Do not rush interpretations.
- Respect defenses.
- Entrust the pace of treatment to the patient.
- Maintain the stability of the relationship and the environment.
Let us explain these in order.
Principle ①: Do Not Rush Interpretations
“Interpretation” refers to the therapist assigning meaning to the patient’s words, actions, or symptoms. “Perhaps your current feelings are related to your childhood experiences,” or “Perhaps there is sadness hidden behind your anger”—such interpretations are fundamental tools of psychotherapy.
Interpretations can be effective. Especially when a patient is in a state of not knowing why they feel the way they do, a proper interpretation can illuminate a path through the fog.
However, if an interpretation is wrong in its timing or depth, it can be harmful. Touching upon the core of a matter before the patient is ready can cause a psychological collapse. Furthermore, if a therapist’s interpretation is imposed as the “correct answer,” the patient is robbed of the power to find meaning for themselves.
Interpretation is not about giving the patient an “answer,” but about nurturing the “question” through which the patient finds the answer for themselves.
“Not rushing interpretations” also means not fearing silence. When a patient is silent, it does not mean “nothing is happening”; it may be a time when something is moving deep within them. A therapist who hurries to fill that silence with words may inadvertently interrupt that internal movement.
Principle ②: Respect Defenses
I previously mentioned “defense mechanisms”—the unconscious psychological structures people use to protect themselves.
In the tradition of psychoanalysis, defenses were often treated as “things to be removed.” Terms like “breaking through resistance” suggest that defenses were viewed as obstacles to treatment. Preservational Psychotherapy, however, views defenses through an entirely different lens.
Defenses are the wisdom a person has cultivated to avoid being hurt. They are not evidence of weakness, but evidence of survival.
For example, suppose a person who has experienced severe abuse “cannot remember” those memories. This may appear to be a “problem” at first glance. However, for that person, those memories may have been too overwhelming to face while trying to live safely in the present. The defense of “making memories inaccessible” has protected them.
To forcibly pull those memories out in the name of “treatment” is the same as tearing down a defensive wall. If the wall crumbles, the storm on the other side will come rushing in all at once.
To respect defenses is to treasure “what the person has used for protection.” Change occurs when the timing is right for the defenses to be safely relinquished—and that timing is chosen by the patient, not decided by the therapist.
Principle ③: Entrust the Pace of Treatment to the Patient
Modern medical systems demand “speed.” Limited consultation times, insurance restrictions, and the pressure for “early recovery”—patients, too, often feel the desire to “get well quickly.”
Yet, the recovery of the soul has its own inherent rhythm.
Suppose one thought they could double the speed of a plant’s growth by giving it massive amounts of fertilizer. For certain plants, excessive fertilizer would only damage the roots. Growing at a moderate, natural pace is the true strength of that plant.
The recovery of the human heart is much the same. The impatience to “heal quickly” can actually delay recovery. When a therapist demands speed—saying “try harder” or “change more”—it can disrupt the patient’s natural rhythm of healing.
As Bin Kimura argued, the temporal displacement experienced by psychiatric patients is not resolved by externally imposing a “correct pace.” Accepting the person’s unique rhythm of time is the first priority.
The therapist’s job is not to change the patient quickly, but to create a space where the patient can begin to move at their own pace.
Principle ④: Maintain the Stability of the Relationship and the Environment
“Stability of the relationship” means that the trust between the therapist and the patient maintains a consistent quality over the long term.
In psychotherapy, the therapeutic relationship itself becomes the “tool of treatment.” By feeling that “the relationship with this person is safe,” a patient can gradually open their inner self. This sense of safety cannot be nurtured in one or two visits; it is born of a steady accumulation of time.
“Stability of the environment” means that the living environment surrounding the patient maintains a degree of stability. If their housing, daily rhythm, or relationships with family and close friends are in a state of extreme instability, the “margin” necessary for psychological recovery is unlikely to emerge.
In Preservational Psychotherapy, “arranging the environment” can sometimes take precedence over psychological intervention. Creating an environment—including social and institutional levels—where the patient can feel safe enough to reclaim “their own time” is a vital part of treatment.
6. What Japanese Clinical Practice Has Nurtured
While I have outlined the principles of Preservational Psychotherapy, these ideas are not something I invented from scratch. Practices similar to this have been rooted in the soil of Japanese clinical psychiatry since long ago. This is why I originally called this approach “Japanese Psychotherapy.”
◆ Morita Therapy — The Philosophy of “Aruga Mama”
Morita Therapy is a uniquely Japanese psychotherapy founded in the 1910s by psychiatrist Shoma Morita (1874–1938). Although Morita primarily treated what he called “nervosism” (shinkeishitsu)—close to what we now call anxiety or obsessive-compulsive disorders—the core philosophy remains timeless.
The central concept of Morita Therapy is Aruga mama (accepting things as they are). Rather than fighting to “eliminate” or “overcome” anxiety and symptoms, one fosters an attitude of accepting them as they are and “doing what can be done now” despite them.
This “non-fighting” stance might seem like resignation at first. In reality, however, it is based on a deep insight: fighting anxiety often only intensifies it, creating a “vicious cycle.” The principles of Preservational Psychotherapy—”not manipulating symptoms” and “respecting defenses”—resonate deeply with Morita’s Aruga mama.
I have already mentioned Hisao Nakai, but I wish to speak of him a little more. Nakai observed the recovery process of schizophrenia over long periods and repeatedly wrote that “recovery has its own inherent rhythm.” One must not rush it. There is a way to ride the “waves” of recovery. When a storm comes, the correct answer is not to keep all sails set; rather, it is the art of survival to furl the sails and wait for the storm to pass.
I believe his practice in the consultation room was the very embodiment of what we now call “therapeutic margin.” Fearing neither long silences nor interrupting the patient’s narrative, not rushing for answers, but simply being there. This was not “doing nothing”; it was a profound clinical act of “maintaining the space through one’s presence.”
Nakai once wrote:
“A therapist, at times, may simply sit silently beside the patient. That silence can support the patient.”
These words quietly shake our fixed ideas about what “treatment” is.
7. “Ma” — A Concept of Space Unique to the Japanese Language
When discussing the Japanese clinical tradition, one cannot avoid the concept of Ma (the interval or space between).
Ma is a difficult word to translate into English. It encompasses the musical “rest,” the architectural “void,” the “silence” in conversation, and the “suspension” in Noh theater. Yet it is more than that. Ma is not an “absence” (nasu); it functions as an active carrier of meaning.
◆ Noh Theater and “Ma”
In Noh theater, there is an expression “taking the Ma.” The periods of silence placed between actions create depth and tension in the performance. While the forms (kata) are fixed, how one utilizes the Ma within those forms is said to be the difference between a master and an ordinary performer.
The architect Tadao Ando is said to have remarked that “voids give breath to a building.” A building without “margin” or empty space is suffocating. Only when there is a margin can a person expand themselves within that space.
What is Ma in psychotherapy? It is “the things the therapist does not say,” “the things the therapist does not decide,” and “the act of waiting.” It is the sharing of silence. It is keeping the answer suspended. These are the practices of Ma in psychotherapy.
Therapists often think only of “doing” (doing). What to interpret, what to convey, how to intervene. However, “not-doing” (not-doing) can also be a therapeutic act. By placing Ma, movement is born within the patient.
While this idea is rooted in a Japanese sensibility, similar insights exist within Western psychiatry as well. In the next chapter, I will introduce that lineage.
8. Difference from “Supportive Psychotherapy”
I would like to clear up a common misunderstanding here. “Preservational Psychotherapy” and “Supportive Psychotherapy” are not the same thing.
Supportive Psychotherapy is a form of treatment that aims to alleviate a patient’s psychological distress, help them adapt to reality, and improve their self-esteem. It involves listening, empathizing, encouraging, and advising as necessary. It is a vital form of treatment and serves as the foundation for much outpatient psychiatric care.
What, then, is the difference?
Supportive Psychotherapy has a clear goal held by the therapist: “to put the patient in a better state.” The therapist is the active “supporter,” and the patient is the “one being supported.”
Preservational Psychotherapy calls this very structure into question. Who decided the goal of “making them better”? Does “supporting” sometimes rob the patient of their autonomy? Does “encouraging” send a message to the patient that “you must not be weak”?
Preservational Psychotherapy seeks to remain constantly aware of the potential “violence of good intentions” on the part of the therapist.
The danger of supporting is the possibility that “the ‘I’ who is trying to help you” shifts, before one realizes it, into “the ‘I’ who is trying to manage you.” Preservational Psychotherapy exists not to change the patient, but to allow the patient to continue being themselves. The difference is subtle, but fundamental.
9. It Is Also Different from “Doing Nothing”
Let us clear up one more misunderstanding. “Not destroying,” “not rushing,” and “protecting the margin”—these are entirely different from “doing nothing.”
Consider the act of growing a plant. If one says “I’ll leave it to nature” and provides no water, the plant will wither. However, if one gives it massive amounts of fertilizer every day in an attempt to “grow it faster,” the roots will rot.
A skilled gardener observes what the plant needs at this very moment, finely adjusting the amount of water, the exposure to light, and the quality of the soil. “Watching over” is a highly active skill.
The “not destroying” of Preservational Psychotherapy is the same. The therapist continues to observe the patient’s state with meticulous attention. How is today’s condition different from last week’s? What words did they react to? What kind of silence flowed between us? Is the dosage of medicine appropriate? Has there been any change in their living environment? While continuously sensing these elements, the therapist provides the minimum necessary intervention at the necessary time.
Preservational Psychotherapy is not “passive abandonment”; it is “active non-intervention.”
Perceiving this difference is at the very heart of practicing Preservational Psychotherapy.
10. Summary of This Chapter—and Toward the Next
In this chapter, I have discussed the definition of Preservational Psychotherapy and the Japanese clinical tradition that supports it.
Not rushing to remove symptoms. Not trying to rewrite narratives from the outside. Respecting the person’s unique rhythm of time. Protecting the stability of relationships and environments. Morita’s Aruga mama, Nakai’s “sitting beside,” and the Japanese concept of Ma—all of these resonate deeply with the philosophy of Preservational Psychotherapy.
But why is “not destroying” and “waiting” ethically correct? What kind of philosophical and ideological foundations do these ideas have?
In the next chapter, we will delve into the traditions of Western psychiatry and philosophy—Winnicott, Bion, and the world of ethics—to explore the ideological foundations of Preservational Psychotherapy.
Column ②: Psychoanalysis vs. Cognitive Behavioral Therapy—The Difference Between Two Great Powers
In the world of psychotherapy, there are many schools of thought, but the two most influential in the modern era are “Psychoanalytic Therapy” and “Cognitive Behavioral Therapy” (CBT).
Psychoanalytic Therapy follows the tradition started by Freud. It aims for deep psychological change through the exploration of the unconscious, the analysis of childhood experiences, the interpretation of dreams and slips of the tongue, and the analysis of the patient’s feelings toward the therapist (transference). It is said to take time but can bring about profound transformation.
Cognitive Behavioral Therapy (CBT), developed in the latter half of the 20th century by Aaron Beck and others, is a therapy based on scientific evidence and is currently the mainstay of psychotherapy. By identifying distorted thought patterns and changing them into more realistic ways of thinking, it seeks to improve emotions and behaviors. It tends to produce results in a relatively short period.
Preservational Psychotherapy does not “deny” these two. Both are vital tools. However, for certain patients—especially those whose psychological structure is in a fragile state—the “attempt to change” found in these approaches can sometimes backfire. Preservational Psychotherapy provides an alternative stance for such situations.
(End of Chapter 2)
