Introduction
In my consultation room, there is a single chair.
Every day, a variety of people sit in that chair. Those who cannot sleep; those who feel they want to disappear; those who do not even understand the source of their own suffering. Those who have become unable to go to work; those who cannot quit medications they have taken for many years; those who repeat the same story, year after year.
I sit opposite them and listen to their stories.
For over thirty years, I have done exactly that.
When I first began this work, my goal was to “cure.”
I believed that the job of a psychiatrist was to remove symptoms, correct cognitions, and lead the patient to a better state. I thought that with sufficient reason and knowledge, I could unravel the knots of human psychological suffering.
However, as I accumulated clinical experience, that conviction began to crumble.
The harder I tried to “change” them, the more my patients stiffened. The more I hurried to “make them better,” the more the relationship fractured. The more I tried to “hand over the correct answer,” the further the patient withdrew.
Striking the same wall time and again, I slowly changed my direction.
From “curing” to “not destroying.” From “changing” to “protecting.” From “handing over answers” to “remaining in ‘not knowing’ together.”
This book is a record of that transition.
I have named this approach “Preservational Psychotherapy” (Onzon-teki Seishin Ryoho).
The word “preservation” carries the meaning of actively and continuously protecting something. The heart of Preservational Psychotherapy lies in not rushing to change what the patient already possesses—their own unique sense of time, their distance from the world, and the wisdom they have cultivated to survive. Instead, it is about treasuring those things as they are and protecting the “margin” (yohaku) through which the person can begin to move at their own pace.
I have written this book primarily for the “educated general reader” who may have no direct connection to the medical field.
It is for those who wish to understand psychiatric care; for those who stand beside someone in psychological pain; and for those who wish to think a little more deeply about the meanings of words like “treatment,” “recovery,” and “care.”
Whenever specialized terminology appears, I will explain it with care. I do not assume any prior knowledge of psychiatry. I have written this for readers who harbor a sincere interest in the human heart.
In Chapter 1, I describe the personal path that led me to this way of thinking, including unexpected connections to history and philosophy.
In Chapter 2, I carefully unravel the definition of “Preservational Psychotherapy.” The wisdom nurtured by Japanese clinical practice—Morita Therapy, Hisao Nakai, and the Japanese concept of Ma (space/interval)—is woven into this definition.
In Chapter 3, we turn our gaze toward the traditions of Western psychiatry and philosophy. You will see how various thoughts—Winnicott, Bion, Levinas, and Gilligan—all point in a single direction.
In Chapter 4, we step outside the consultation room. The social pressure to “heal quickly,” the limits of our systems, and the context of the city—these are issues of psychiatric care, but they are equally the issues of society itself.
In Chapter 5, I reflect on the whole and speak quietly of what this way of thinking ultimately indicates.
This book is not a finished theoretical treatise.
The concept of “Preservational Psychotherapy” is still in the middle of being nurtured within my clinical practice. There are many things I do not understand. There are many questions for which I have no answer.
Yet, I have written of that “not knowing” exactly as it is.
This is because “remaining in a state of not knowing” is the very core of this philosophy.
There is no need to rush. There is no need to change. There is no need to have the answers. Simply being here is already the beginning.
To you who have opened this book, I offer my heartfelt gratitude.
(March 2026, at Shinagawa Psychosomatic Clinic — Tadashi Kon)
