Vol.9, No.1

2019

September 2019ISSN 2435-1172

                                      International Journal of Brief Therapy and Family ScienceVol. 9, No. 1, 2019                                      

CONTENTS
Original Paper: Research and Experiment
The Development of the Revised Version of Solution Building Inventory Japanese version
Gen Takagi Koubun Wakashima Takahiro Kozuka, Kyung-ran Yu Kohei Sato..................... 1-7

Original Paper: Case Report
The Study of Consultation for Supporting Teachers: The Case of a Female Junior HighSchool Student who must decide her Course
Shuhei Iwamoto.................................................................................................................. 8-16

Original Paper: Case Report
The Use of the Three Steps Model after the Great East Japan Earthquake: A Case Study in the Treatment of Flashbacks
Keigo Asai ............................................................................................................................ 17-26

Original Paper: Short Case Report
A Single Session with Mother Who reframed her Daughter’s Dating Relationship
Haruka Sakai Megumi Kato Norimasa Itakura Seiya Mitani ................................ 27-30

Original Paper: Short Case Report
Diagnosis helps the patient : Counseling with a mother worried about her son’s behavior
Koubun Wakashima Naoto Nihonmatsu ...................................................................... 31-35

International Journal of Brief Therapy and Family Science2019 Vol. 9, No.1, 1-7< Original Paper: Research and Experiment>

The Development of the Revised Version of Solution Building Inventory Japanese version
Gen Takagi , Koubun Wakashima , Takahiro Kozuka , Kyung-ran Yu , Kohei Sato
1)

1)

2)

3)

1)

Tohoku University, Graduate School of Education

2)

Nagoya University, Graduate School of Education and Human Development

3)

Sakushin Gakuin University, Faculty of Human and Cultural Sciences

4)

Yamagata University, Faculty of Education, Art and Science Faculty of Education

ABSTRACT. Solution Building Inventory, developed by Smock et al.

4)2010 , was to assess how focus on solution in daily life, andwas 14-items, 5-point Likert scale. The purpose of this study was to develop the revised version of Solution Building Inventory
Japanese version

SBI-R

and to examine reliability and validity of SBI-R. A total of 800 peoples completed SBI-R, DHS, and

LOT-R. As a result, exploratory factor analysis found that SBI-R had one factor structure and was consisted 14-item. Confirmatory
factor analysis had an acceptable fit to one factor model. The Cronbach's alpha of SBI was .92 and internal consistency. Moreover,
SBI-R was positively correlated with DHS and LOT-R. These results indicated that SBI-R had good reliability and validity as ameasure of Solution Building concept.
KEY WORDS: Solution-Focused Brief Therapy, Solution Building Inventory, Reliability, Validity

Introduction
Solution-Focused Brief Therapy (SFBT) is aawareness of exceptions to their problem(s) (Dehelp model established by de Shazer et al.

Jong & Berg, 2013; de Shazer, 1991), and the(1986). The origin of SFBT is at Brief Familyclient developing hope for their future (Berg &Therapy Center (BFTC) in Milwaukee. De

Dolan, 2001).

Shazer and Berg has been developing help

Smock et al. (2010) developed Solution

methods to improve people’s lives throughBuilding Inventory (SBI) to measure the central

theoretical research (e.g., de Shazer, 1994) andconstruct of SFBT. The SBI is a 14-items

empirical research (e.g., Gingerich et al., 1988)

English instrument measure that uses a 5-point

at BFTC. In the practice, SFBT emphasizes

Likert scale (Smock et al., 2010). Although thesolution building rather than cause analysis ofliteratureproblems. Solution building consists of thepossessing three components, factor analysis

client’s clearly identifying their solution (Deyielded one factor scale (see Smock el al.

Jong & Berg, 2013), increasing the client’s(2010) for details). The SBI has been found todescribes

solutionbuildingasbe a reliable (α= .88) and valid measure on
CORRESPONDENCE TO: Takagi Tohoku University. 27-1

both clinical (Smock, 2013) and non-clinicalKawauchi, Aoba Ward, Sendai City, Miyagi Prefecture,(Smock et al., 2010) populations.

980-8576, Japan.

Takagi et al. (2015) has developed a Japanesee-mail: gen.takagi.p4@dc.tohoku.ac.jp

version Solution Building Inventory (SBI-J).

1

2

TAKAGISBI-J showed high reliability (α=.89) and

400 working peoples (200 males, 200 females)

validity: correlation with Dispositional Hopecompleted a survey containing the SBI-R, theScale (DHS) and Life Orientation Test (LOT-R).

DHS, and LOT-R. The average age of

However, the SBI-J is different from SBI in one

university students was 21.00 years olditem was dropped after the factor analysis(SD=1.72), and the average age of working

procedure. It is possible that the item contents

peoples was 40.23 years old (SD=10.96).

of SBI-J created from the procedure of back2. Questionnaires

translation may have become unnatural as1) SBI-R: Researchers revised the 14-items ofJapanesedifficult to

SBI-J (Takagi et al., 2015). The development ofunderstand. It is necessary to examine thethe SBI-R included: (i) SBI-J items revised bypossibility that unnatural Japanese of SBI-J

one university professor and one graduate

influenced the composition of the scale.

student specialized in SFBT. (ii) two university

The purpose of this study was to develop the

professors who specialized in SFBT, not

SBI-J Revised (SBI-R) and examine its factor

involved in the revised process, confirmed thatstructure, reliability, and validity. DHS and

the items of SBI-R are natural Japanese and

LOT-R scales were used to test the convergent

measure solution building. The final items ofvalidity of the SBI-R. SBI-R will be consisted

SBI-R are given in Table 1. The revised pointsof the same number of items as original

were shown in Table 2.

version of SBI.

The SBI-R is 14-items instrument using a

expression andbe

5-point Likert scale. Participants were asked for
Methods

respond by number from 1 to 5 (1 = Strongly

1. Data Collection Japanesedisagree, 5 = Strongly agree).

In November 2018, researchers conducted a2) DHS: According to Smock et al. (2010), theWeb survey targeting university students andconcept of solution building, measured by theworking peoples between 20’s and 50’s through

SBI, possess an aspect of hope. We used a

research company (Cross Marketing Inc.). 400

Japanese version of the DHS, developed byuniversity students (200 males, 200 females),Kato and Snyder (2005) to measure hope, to

SBI-R 1
SBI-R 2
SBI-R 3
SBI-R 4
SBI-R 5
SBI-R 6
SBI-R 7
SBI-R 8
SBI-R 9
SBI-R 10
SBI-R 11
SBI-R 12
SBI-R 13
SBI-R 14

Table1H14-item of Revised SBI-R,gu8%.t)j XUbPaQq,gu)a<U]`"WKUbe;tTq3 PJq,guUria4 e5K tlZoWZ !e^K`0MqUbPaQq,guZbMW[TaluYrhcVr`KdK4 f(&e;tTqUbPaQq,gu)eNTqEeSaQqbQPJq,gu4 4@u1u4 f(&eNTqu5KUbe$_SUbPaQq,gu)eNTqIf9/e-\O]`QZ
lWlu+7kZbQeu,f)edeO>P<Q`KZouQ]b4 m1f e$_SUbPa
Qq[sL,gu4 P<UWZuVd2* e$P^K`Kq,gu4 PEd(&eaQqUbtue:peLbQPJq,guUriaA eNTq9/tSp=M`QZ,g)tnpnSXqZkf#t?j W`QZ
,gu4 f(&PC *egb`lEeM`lu5KFe+tTqUbPaQq
Gt0MXRqUbPu8%.t6^Tqfe Bd'[bgDodK

TFE DEVELOPMENT OF THE REVISED VERSION OF SBI-J

3

Table2 Revised points of SBI-R
SBI-J
item 1item 2
item 3'aXF
*a2F_%T>H`VQ D`N9R9P?
*a2F_
item 5 @O?N9_P?
item 6 %TTS8_
S<A_7TS ^#bO@_CP>
item 7
O?I
item 8 %TSRS=->+CLN9IR]
item 9 %>XEI
%> 3RSO?ICPSM9N6
item 10
S)^S;_\:RP?>8_
item 11 EICPS[^.BICP>/ S8_
item 12Ua DG_IYS
PNZ 3S;_P?OZ
item 13&9
item 14 0ROUR9=ZE`R9
item 4

SBI-R
5'"aXF
5
*a A_
No revision
5
H`VQ D`N9R9%T5
*a A_
5
@O?_P?
5%TS<A_
5

S<A_7T($S!K5
5

TSRS=->+?N9I]%>+CEI%> 3RSO?_CPa6S)^S
:P?>8_C`WO/ S<A_($a@^,;N?IUa\^\@F_IYTPNZ 3S;NZ&94
0RJPU1]R9

5
5
5
5
5
5

=LN?I

test convergent validity. The DHS is a 12-items

Results

instrument using a 4-point Likert scale.

1. Fundamental statistics

3) LOT-R: Smock et al. (2010) also used the

We show fundamental statistics of SBI-R in

LOT-R to test convergent validity. We used

Table 3. We tested for any ceiling or floor

Sakamoto andeffects in 14-item SBI-R scale. No effects wereTanaka’s (2002)

Japaneseversion of LOT-R to measure goal setting andfound.

confidence in goal attainment. The Japanese

2. Exploratory factor analysis

version of the LOT-R contains 10-items using a

An exploratory factor analysis was run in

5-point Likert scale.

SPSS on the SBI-R by major factor method,
fixing the number of the factors to 1 inaccordance with the factor structure of SBI-R

Table3 Fundamental Statistics of SBI-R
item

Mean

MedianSD

SBI-R 1

3.15

3

0.93

SBI-R 2

3.09

3

0.93

SBI-R 3

3.28

3

0.96

SBI-R 4

3.10

3

0.86

SBI-R 5

3.14

3

0.97

SBI-R 6

3.28

3

0.94

SBI-R 7

3.25

3

1.00

SBI-R 8

3.19

3

0.92

SBI-R 9

3.01

3

0.94

SBI-R 10

3.09

3

0.99

SBI-R 11

3.16

3

0.97

SBI-R 12

3.16

3

SBI-R 13

3.08

3.42
SBI-R 145-point Likert scale(N =800)

Table4 Factor Analysis (by major factor method )itemfactor 1

SBI-R 130.76

SBI-R 50.76

SBI-R 120.75

SBI-R 30.73

SBI-R 40.73

SBI-R 10.72

SBI-R 20.71

SBI-R 100.70

SBI-R 90.70

SBI-R 60.69

SBI-R 11

0.68

0.95

SBI-R 7

0.63

3

0.96

SBI-R 8

0.61

4

0.95

SBI-R 140.40

4TAKAGI

SBI-R

.72

.71

.73

.73

.76

.69

.63

.61

.69

.70

.68

.40

.77

.75

SBI-R1

SBI-R2

SBI-R3

SBI-R4

SBI-R5

SBI-R6

SBI-R7

SBI-R8

SBI-R9

SBI-R10

SBI-R11

SBI-R12

SBI-R13

SBI-R14

e1

e2

e3

e4

e5

e6

e7

e8

e9

e10

e11

e12

e13

e14

Fig. 1 Confirmatory Factor Analysis with 14-item Model of SBI-R
GFI=.94, AGFI=.91, CFI=.95, RMSEA=.07, RMR=.03(Table 4). Any items with factor loading lessIn order to investigate the convergent validity

than .30 were dropped from SBI-R. As aofresult, all items were adopted as SBI-R.

composite score of the SBI-R, the DHS, and the

3. Reliability analysis

LOT-R were calculated (Table 5). A correlation

A reliability analysis was conducted on thematrix shows that the DHS (r=.419) and the

SBI-R in SPSS. The Cronbach's alpha of SBI-R

LOT-R

was α= .92.

significantly,

4. Confirmatory factor analysis

Composite scores of the DHS and the LOT-R

In order to confirm the data-driven 14-item

were also significantly correlated with one

model of SBI-R, a confirmatory factor analysis

another (r=.236).

was conducted using Amos (Fig. 1). The resultsthe(r=.418)

were

the

moderately,

correlated

Scale

with

SBI-R
***

LOT-R

.418

***

DHS
***

GFI=.94(>.90), AGFI=.91(>.90),

correlations between

the

yet

SBI-R.

Table5 Correlations of SBI-R, DHS, and LOT-R

indicated that the data-driven 14-item modelmet the criteria for a good model fit,

SBI-R,

.419

DHS
***

.236


P<.001

CFI=.92(>.90), RMSEA=.07(<.10),

6. Differences between generations and gender

RMR=.03(<.10).

In order to investigate intergenerational and5. Validity of the SBI-R

gender difference of SBI-R, two-way factorial

Table6 Two way factorial analysis of variance of SBI-R
SBI-R
generation
student
20-29
30-39
40-49
50-59

gender

n

Mean

SD

Men
Women
Men
Women
Men
Women
Men
Women
Men
Women

200
200
50
50
50
50
50
50
50
50

3.19
3.22
2.97
3.16
3.11
3.18
3.01
3.16
3.30
3.20

0.76
0.61
0.72
0.61
0.77
0.66
0.54
0.63
0.61
0.68

generation

1.49n.s.

gender1.75n.s.

generation×gender

0.75n.s.

TFE DEVELOPMENT OF THE REVISED VERSION OF SBI-J

5

analysis of variance was conducted with

sufficient validity.

generation and gender as independent variable

2. Differences between generations andand SBI-R as dependent variable (Table 6). As

genderresult, interaction was not significant (F=0.75,

Two-way factorial analysis of variancep>.10, h2=.004). Also, neither generation nor

found that generation and gender doesn’t

gender main effects were not significant

have any effect on score of SBI-R. This

(F=1.49, p>.10, h2=.002; F=1.75, p>.10,

result indicates that SBI has highh2=.002).

generality.

Discussion

3. Directions for future research

1. The reliability and validity of SBI-R

This study found that the SBI-R is a

In this study, the items of SBI-J werevalid and reliable measure of solution

corrected to natural Japanese expression.

building. Smock (2014) validated the SBI

And two university professors who familiar

withwith SFBT confirmed that the items of SBI-R

research on the SBI-R is expected to

are natural Japanese and measure solution

confirm these findings on a Japanesebuilding. Reliability and validity of SBI-R was

speaking clinical sample. In addition,

examined by Web survey targeting university

futurestudents and working peoples between 20’s andinvestigate how to increase SBI.

aclinicalresearch

sample

on

the

and

future

SBI-R

will

50’s.
High reliability of SBI-R was confirmed

AcknowledgementsbyThis sturdy received the following grant. We

Statisticalanalysis. Confirmatory

factor analysis of the SBI-R found that

appreciate this grant.

this measure has one factor scale. And all

JSPS KAKENHI Grant Number JP 18K02141

items assumed as SBI-R were adopted.
Then

SBI-R consisted of

the same

Reference

number of items as original version ofBerg, I. K. (1994). Family based service: A

SBI. In addition, the SBI-R possess asolution-focused approach. New York:high internal consistency (α= .92). ThisW. W. Norton.

finding is consistent with the original SBI

Berg, I. K., & Dolan, Y. (2001). Tales ofmeasure (Smock et al., 2010).

solution: A collection of hope-inspiring

SBI-R show high convergent validity.

stories. New York: W. W. Norton.

Smock et al. (2010) indicated that the
DHS

and

LOT-R

significantly

Optimism. In S. J. Lopez & C. R.

correlated with SBI. SBI-R was also

Snyder (Eds.), Positive psychologicalsignificantly correlated with DHS andassessment (pp. 75–89). Washington,

LOT-R.

DC:

Therefore,

areCarver, C. S., & Scheier, M. (2003).

the

SBI-R

has

AmericanPsychological

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revised Life Orientation Test. The

De Jong, P., & Berg, I. K. (2013).

Japanese Journal of Health Psychology,interviewing for solutions (4th ed.).

15, 59-63. [in Japanese] (Belmont, CA: Brooks/Cole, Cengage(2002).

therevised Life Orientation Test

Learning.

15, 59 63.)de Shazer, S. (1985). Keys to solution in
Brief Therapy. W. W. Norton, New York.

Scheier, M. F., Carver, C. S., & Bridges, M.

de Shazer, S., Berg, I. K., Lipchik, E.,

W. (1994). Distinguishing optimism

Nunnally, E., Molnar, A., Gingerich, W.,from neuroticism (and trait anxiety,&self-mastery,

Weiner-Davis,

M.

(1986).

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and

self-esteem):Atherapy: Focused solution-development.

re-evaluation of the Life Orientation

Family Process, 25, 207-222.

Test. Journal of Personality and Socialde Shazer, S. (1991). Putting difference towork. New York: W. W. Norton.
deShazer,M. (2010). The development of theoriginally magic. New York: W. W.

solution-focused inventory. Journal of

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Marital and Family Therapy, 36, 499 W.,(1994).

Smock, S. A., McCollum, E., & Stevenson,
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Weiner-Davis, M.(1988). Constructing

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Kim,

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(2008).

Examining

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effectiveness of solution-focused brief

Takagi G., Wakashima K., Sato K., Ikuta M.,

therapy: A meta-analysis. Research on

Hanada R., & Smock, S. A. (2015). The

Social Work Practice, 18(2), 107-116.

development of solution building inventory

Lipchik, E., Derks, J., Lacourt, M., &Japanese version: Validation of the SBI-J.

Nunnally, E. (2012). The Evolution ofInternational Journal of Brief Therapy andSolution Focused Brief Therapy. In C.

Family Science, 5, 19-25.

Franklin, T. S. Trepper, W. J. Gingerich

Kato, T., & Snyder, C. R. (2005). The& E. E. Mccollum (Eds.), Solution

relationship

Focused Brief Therapy: A Handbook of

subjective well-being: Reliability andEvidence Based Practice (pp. 3-19).

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Japanese

Sakamoto, S., & Tanaka, E. (2002). A
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76 227-234.)

7

International Journal of Brief Therapy and Family Science2019 Vol. 9, No.1, 8-16
<Case Report>

The Study of Consultation for Supporting Teachers:
The Case of a Female Junior High School Student who must decide her Course
Shuhei Iwamoto

1)

1)

Family Counseling Room Matsugasaki Fukuramu

ABSTRACT.

Consultation is regarded as an important activity of school counseling. In Japan, various experts should get together,

discuss, and support each other to solve the various complicated problems at school. In this study, I am going to think over theeffective consultation of teachers to solve the problems of the female junior high school student who must decide what courseshould take. In this case, although the teacher want to solve the problem, the teacher’s action for the student kept the bad relation
between the student and her mother. I shared this vicious circle with the teacher and urged him to change his action to solve theproblem. Through this case, we need to think of the system including not only the student and her family but also family and teacher.
Giving teachers the opportunity to use their specialty effects on solving problems. I discussed about the possibility to makeconsultation for teachers effective.
KEY WORDS: consultation, school counseling, multi-occupation collaboration, resource, solving effort

Introduction
In

Japan,

Culture, Sports, Science and Technology,
schoolcounselors

were2011).

stationed at some public schools in 1995

MEXT (2015b) said that various experts

andplacement

should get together and support eachexpanded from 154 to 21,764 (Japanother to solve the various complicatedMinistry of Education, Culture, Sports,

problems. As it is, experts as well as

Science and Technology, 2015a). School

teacherssocial workers, the experts of social

problems.

welfare have been stationed since 2008

Kato, T. (2008) said that cooperation isand are on the increase year by year. In

not only supporting each other but also

special education, occupational therapists

collaboration and consultation. It is thevisit school and give counseling service orcourse of interactive action of each

workshops (Japan Ministry of Education,

specialists to solve the problems. The

thenumber

of

the

good

are

neededrelationship

to

among

solve

the

specialists

CORRESPONDENCE TO:Iwamoto, Family Counselingmakes good cooperation. In addition, a

Room

16-3,

counselor should play significant role toMatsugasaki Kowakichou, Sakyoku, Kyoto-city 606-0957,

make good relationship among them. As

Japan.

for school counseling, it is obvious thate-mail: fucurum2017@gmail.com

consultation for teachers makes a large

Matsugasaki Fukuramu, Gurashiobiru

F2

8

2
9

IWAMOTO

proportion of the activity of the school

way to provide consultation. Therefore,

counselor (Shimada, H., 1999; Imura, O.,

we need to show the concrete examples

2001). According to the investigation ofand analyzed its theory.

Diltz, P., Dilani, M., Jeffry, M. L., &I am going to discuss the effective

Kimberly, M. L. 2011 , it shows that 79%

consultation through the case that I

of school counselors provide consultation

provided the consultation to a teacher

and consultation is important overseas as

and solve the problem.

well as in Japan.
There are two ways of consultation. One

Sessionis provided by the specialist and the otherI have worked at this public junior highis provided by all the members as theschool for 3 years. I worked 8 hours once

specialista week.

likeCollaborative

Process

Model (Idol, L., Whitcomb, P. P. & Nevin,A., 1995). At school, the latter tends to be

About the casechosengood

The client was a female junior highrelationship of each other and improving

school student. She was in the 9th grade.

the ability to solve the problems. In

Her family consists of five members,

Japan, consultation is identified as thefather, mother, younger sister, younger

meeting for strategy to discuss about how

brother and her. She has left her houseto solve the problem of the children

since February, X year and lived with her(Ishikuma, T., 1999). Consultation is

grandparents and her aunt on the

regarded as an activity which reflect themother’s side (Figure1).

to

aim

at

makingsituation of cooperation between teachersand school counselors (Doi, M. & Kato, T.,2011).

Cooperation

among

variousspecialists is a key to provide effective
consultation.
However, not all the school counselors
are

good

at

providingeffective

consultation from the beginning. I think

Figure 1: Client’s Family

this is because most of the school
counselors cannot come across the chance

She asked her homeroom teacher thatto see the model of effective consultation.

she wanted to receive counseling and her

Sato, M. & Kase, S. (2014) pointed out

teacher asked the author to provide herthat there is only a few studies regarding

counseling. Her teacher said, “She is not

the concrete , effective and continuous

a bad girl but often makes people around3
10

THE STUDY OF CONSULTATION FOR SUPPORTING TEACHERS

her irritated because she talks too much,even I sometimes got frustrated with her.

About the course:

She has stayed with her grandparents

I asked her whether she could talk withbecause she has not got along with her

her mother about her course because themother. She is quite selfish.”nextinterview

amongteacherandmother and her is the opportunity to talkSession#1: Early December, X year

about the choice of her course. She said,

Background:“My mothers’ opinion about the course isI asked her why she wanted to receive

different from mine. I want to enter A

counseling. She said, “I have stayed in myhigh school because I can go to the

grandparents’ house since I had quarrel

university on a recommendation in thatwith my mother. I get in touch with myschool. But my mother is opposed to mymother but whenever I meet my mother,opinionwe quarrel. So I do not want to see her.

university is high. She recommends me B

But I must meet her when the interview

high school but my teacher told me that it

among teacher and my mother and me.

is too difficult to pass the exam. My

So I want to know what I should do.”mother doesn’t know the level of each

She stayed in her grandparents’ houseschool so I don’t want her to suggest any

when she was a younger child because

opinions about my course.” Consensus

herbetween she and her mother was yet to beparents

had

to

move

another

prefecture to do their work. After they

becausethetuitionofthereached regarding her course.

came back, she had to stay in her
grandparents’ house because her parents

About the interview among them:were busy caring for her little sister andI asked her what she hopes to change.

brother. Therefore, her grandparents are

She said, “I want her not to push her

like her parents for her.

opinion on me and she may get angry
because of my grade. But I want her not

The pattern of quarrel with her mother:to yell at me. Whenever she yells at me, I

I asked her how the quarrel with her

can’t say anything, I don’t want tomother happens. She said, “My motherquarrel with her.” She wanted to maketold me something severely and I cried,

the relationship with her mother betterand couldn’t talk back. Then she told thatthen I asked her what she hopes to her

she got angry and wanted to cry because

mother. She wanted her mother just toof me. I want to talk back to her but

say, “Do your best.” She said, “If she ways

probably she will get mad at me. So I

so, I could do my best.” She wanted her

apologize and make quarrel finish.”mother to accept her effort.

4
11

IWAMOTO

I asked her to react differently frombehavior and it made her mother angry.

usual when her mother gets angry with

Then I asked the teacher to explain 3

her and see how her mother reacts her.

points to her mother. One is to tell thedifficulty to pass the exam of B highConsultation forherteacher: After

school and another is to tell complement

Session#1of the client to her mother. In addition,

After the first counseling with her, I

the other is to ask her mother toexplained her homeroom teacher about

encourage her daughter. The teacher

what she was worrying about. The

accepted these suggestions to improve theteacher said, “I understand how her

relationship of the client and her mother.

mother feels about her. I have told hermother about her bad behavior at school

Session#2: Mid- December, X year

every time she made the trouble. She

About the interview among the teacher,must grow up.” I made assessment like

mother and the client:Figure2.

I asked the client the interview among
them. She told that her grade was getting
better and her teacher praised her effort,
so her mother could not find the reason to
get angry and did not have to quarrel
with her. In addition to this, the teacher
told her mother that B high school is notsuitable her grade and her mother agree
to that and school of choice became A highschool.

A highschool

has

a

good

supplementary lessons system and she
Figure 2: The vicious circle among thethought it would help her. She wanted toteacher, mother and the client

work to help people in the future.

Her mother scolded the client and she

Some ideas when she talked to hertalked back to her mother to be acceptedmother:her effort. However, it made her motherI asked her about how she changed hereven more irritated and it made the client

attitude to her mother. She told that she

keep away from her mother. Moreover,

did not resist her mother when her

teacher told her mother only about her

mother scolded her. When I ask her tobad behavior at school. Her mothermark your feeling at one hundred perfectfocused on only her daughters’ badscore. She

said, “75points. I canTHE STUDY OF CONSULTATION FOR SUPPORTING TEACHERS

5
12

communicate with my mother well andresources that each specialist has or not.

my grades are getting better and my

In this case, the specialty of the teacher

mother accept my opinion about theis used as leadership to guide the course.

course. I am satisfied with that.”

Her mother did not agree with her

From this experience, we got hypothesis

daughter’s opinion about her course, but

that

the

the teacher accepted the client’s opinion

explanation from not the client but otherand show her mother it was appropriate

person. So I finished the counseling to her

for her and suggest her mother not to put

making sure to use help from others

her daughter into a corner. It madewhen she was about to quarrel with hersignificant progress in the relationshipmother.

between the client and her mother.

hermotherunderstandMoreover, the teacher praised the client

The later state:in front of her mother and it shows the

In the end of January, X+1 year, themodel of the way to treat the examinee.

client went to talk with nurse teacher,but her condition was good and stable. In

2. Description of the communication

the mid- February, X+1 year, she passed

pattern including a teacher:the entrance exam of A high school. I

On the other hand, the specialty ofasked the nurse teacher to ask her toschool counselors is that they can makecome to the follow- up interview, but she

assessment from the objective viewpoint.

said, “I am busy going shopping with myIn this case, the teacher regarded thismother, and our relationship is quite

problem as the relationship between the

good.”

client and her mother but I made ahypothesis that to solve this problem. We

Discussion

needed to add the relationship between

1. Regard the specialty of the teacher as a

the teacher and the family (Figure3). The

resource:

teacher told her bad behavior to her

In

this

case,

I

providenot

only

mother to make the client improve hercounseling

to

the

clientbut

alsobehavior and solve the problem. However,consultation to the teacher. As Kato, T.

actually it caused the quarrel between(2008) said, cooperation is a process forthe client and her mother. The teacher

solving problems that always require

did not notice that his behavior made thetwo-way interaction in order to make use

problem more complicated.

of both specialties. Specialties means
resources

in

Brief

Therapy.

The

important point is whether we can use

6
13

IWAMOTOteacher changed the relationship between
the client and her mother. It means theway of coping changed from leading tosupporting. It also means the role of the
Figure 3:

Assessment

includingtheteacher

relationshiphas

settled:Second-thechanged

and

Order

been

Change(Watzlawick, P. et al., 1974).
We need to make sure how the teacher

In this way, school counselors maketry to solve the problem. We have to thinkassessment

about the possibility of keeping bad

relationship and should intervene in thecommunication pattern because of theirpoint

wrong effort to solve the problem. In thisconsultation for teachers, we should showcase, if we draw the vicious circle except

the various point of view to solve thethe teacher, the possibility to solve theproblem such as relationship between the

problem depends on only the client’s

student and his or her parents, oreffort, but it was difficult way to solve theteachers and family and so on.

thatthroughiseasyseeingtovariouschange.

Inproblem. To change their relationshipwas quite difficult and it may be

3. Prospect:exhausted her. In fact, the client was

In this study, I discussed the possibility

often defeated by her mother and found

to expand the way of solving the problem

no ways to change the relationship. I

through

tried to advise her to change her behavior

teachers as well as the family. According

to her mother but it has already done andto Caplan, G. (1970), consultation has

fallen through and continued to keep thefoursame pattern of communication: theconsultation, 2. Consultee-centered caseFirst- Order Change (Watzlawick, P.,

consultation,

Weakland, J. H., & Fisch, R., 1974). I

management

thought it was difficult to change her

Consultee-centeredmother through changing the client’s

consultation. This case is classified as 1.

behavior. Therefore, I relied on the

We need to accumulate such kinds ofteacher to solve the problem. If I include

cases more. It indicates the models ofa teacher into vicious circle, there will beeffective consultation.

a possibility that something will change.

According to the survey to elementary

The teacher has a good motivation toschool teachers, school counselors shouldsolve the problem and easy to work inmake a good relationship with teachers

practice. In this case, consultation to theand students every time, everywheretheforms.

assessment

1.
3.

including

Client-centeredcaseManagement-oriented
consultation,

4.

management

14
7

THE STUDY OF CONSULTATION FOR SUPPORTING TEACHERS

becauseit

makes good consultationand Mutual Recognition of School(Cholewa, B., Scott, G. E., Thomas, A. &Counselors and Teachers. Journal of

Cook, J., 2016). Yoshikawa, S. (1999) who

School Mental Health, 14(1), 37-49. [inpropose the Systems Consultation told

Japanese]2011that top priority of the consultation
depends on the relationship with the, 14(1), 37-49.

members concerned. In this case, I do notdiscuss how to make good relationship

Idol, L., Whitcomb, P. P. & Nevin, A.

with the teacher but we should also

(1995) The collaborative consultation

accumulate the study for how to makemodel.

good relationship. I would help teachers

Psychological Consultation, 6, 347-361.

and school counselors that are lack of

Imura, O. (2001) Rinshō shinri-gaku

first hand experiences and make themkenkyū no dōkō to kadai (Trends andprovide good consultation.

issues of clinical psychology research)

Journalof

Educational&

The Annual Report of Educational

Appendix

Psychology in Japan, 40, 123-132. [inI took care of paying attention to private

Japanese]

2001

information.
40, 123-132.
Ishikuma, T. (1999) Gakkō shinri-gaku:

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chīmu ni yoru shinri kyōiku-teki enjo

York: Basic Books.

sābisu(School

psychology:

Psychoeducational

aid

Cook, J. (2016) Teachers' Perceptions

teacher,counselorandguardian's team) Tokyo: Seishinshobo.

Cholewa, B., Scott, G. E., Thomas, A. &Experiences

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with

School Counselors: A Qualitative Study.

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Professional School Counseling, 20(1),77-88.
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SchoolCounselor

Japan Ministry of Education, Culture,
Sports, Science and Technology (1995)

Consultation Engagement. Journal of

Sukūrukaunserākatsuyōchōsa

School Counseling, 9(13), 1-25.

kenkyū itaku jigyō (Commissioned

Doi, M. & Kato, T. (2011) The Correlation

projects of study on utilization of school

between Frequency of Consultation

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Culture,Sports,Scienceandhttp://www.jaot.or.jp/wp-content/upload

Technology [in Japanese]

s/2010/08/tokubetsushien-report.pdf#se

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Japan Ministry of Education, Culture,
Sports, Science and Technology (2008)

B9%E5%88%A5%E6%94%AF%E6%8F%B4%27Sukūrusōsharuwākākatsuyōjigyō

Japan Ministry of Education, Culture,jisshi(Implementation

Sports, Science and Technology (2015a)

guidelines for utilization project ofShotō chūtō kyōiku bunka-kai chīmu

school social worker) Japan Ministry ofgakkō sagyō bukai kiso shiryō (Primary

Education, Culture, Sports, Scienceand secondary education subcommittee

and Technology [in Japanese]“Team School” working group basic

yōryōdata) Japan Ministry of Education,

2008

Culture, Sports, Science and Technology
Japan Ministry of Education, Culture,[in Japanese]

2015aSports, Science and Technology (2011)

Tokubetsu

shien

kyōiku

e

no

2016

11

30

sagyōryōhōshi sankaku moderu-an ni

http://www.mext.go.jp/b_menu/shingi/chkansuru hōkoku Monbukagakushō gaukyo/chukyo3/052/siryo/__icsFiles/afieldshimesushien

file/2015/05/07/1357412_04_1.pdf#searc

tokubetsu shien kyōiku sōgō suishin

h=%27%E3%82%B9%E3%82%AF%E3%

jigyō ni sotte (Report of trial model for

83%BC%E3%83%AB%E3%82%AB%E3

occupational therapist participation in%82%A6%E3%83%B3%E3%82%BB%E3

special support education: According to%83%A9%E3%83%BC+%E8%A8%AD%

development and disability support /E7%BD%AE%E6%95%B0%27

special support educational synthesis

Japan Ministry of Education, Culture,promotion

hattatsu

project

shōgai-tōbyMinistryofSports, Science and Technology (2015b)

Education, Culture, Sports, Science

Chīmu to shite no gakkō no arikata to

and Technology) Japan Ministry of

kongo no kaizen hōsaku ni tsuite

Education, Culture, Sports, Science(tōshin) (About the way of being of theand Technology [in Japanese]school

as

a

team

and

future’s

improvement plan (Report)) Japan

2011

Ministry of Education, Culture, Sports,
Science and Technology [in Japanese]
2016
30

11

2015b

9
16

THE STUDY OF CONSULTATION FOR SUPPORTING TEACHERS

2016

11

the studies in clinical phychology at9http://www.mext.go.jp/b_menu/shingi/cschool: Focusing on active approach)hukyo/chukyo0/toushin/__icsFiles/afiel

The Annual Report of Educational

dfile/2016/02/05/1365657_00.pdf

Psychology in Japan, 38, 120-129. [inKato, T. (2008) Issues of the collaboration

Japanese]

1999

between the school-specialized agencies
in the school counseling. Journal of

JoetsuClinical

Psychology

andCounseling, 7(1), 73-78. [in Japanese]
2008

38, 120-129.
Watzlawick, P., Weakland, J. H., & Fisch,R.

, 7(1),(1974)

Change: Principles ofproblemformation

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W. W. Norton. [in Japanese]

73-78.

andproblem

1992

Sato, M. & Kase, S. (2014) Trends andissues of school consultation research

Yoshikawa,S.

(1999)

Shisutemuzu

in recent years in Japan: Focusing on

konsarutēshon no gakkō rinshō de nopractical study on the regular schoolsriyō (The way of using Systems

and regular classes. Bulletin of Tokyo

Consultations at school) Yoshikawa, S.

Gakugeiof(Eds.) Shisutemu-ron kara mita gakkō

educational sciences, 65(2), 165-173. [inrinshō (Clinical Pedagogy from System

Japanese]

Theory)University.

Division

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217-234.

Kongoushuppan. [in Japanese]
1999,

65(2),

165-173.
Shimada, H. (1999) Kyōiku bamen ni

okeru rinshō shinrigakutekikenkyū nodōkō to kadai: Kōdō-teki apurōchi wochūshin ni (The trend and problem of

217-234.

Tokyo:

International Journal of Brief Therapy and Family Science2019 Vol. 9, No.1, 17-26<Case Report>

The Use of the Three Steps Model after the Great East Japan Earthquake: A Case Study in the Treatment of Flashbacks
Keigo Asai

1)

1)

Hokkaido University of Education

ABSTRACT.

After the Great East Japan Earthquake, many citizens experienced severe psychological reactions. This paper

describes a three steps model characterized by solution-focused brief therapy sessions. In one particular case, this method was
successfully utilized over the course of only two sessions by a therapist who was able to treat and resolve the flashback episodes ofan adult female client who saw full recovery and complete normalization of her traumatic symptoms within two years, and all
without the use of traditional trauma-oriented treatments. This study examines that particular case, and although there are limitations
to this study due to the absence of a control group and its focus on a single case, it remains important and worthwhile to examine theremarkable effectiveness of this three steps model for clients with post-traumatic stress disorder.
KEY WORDS: Great East Japan Earthquake, Flashback, Solution-focused brief therapy, Three steps model, Post-traumatic stressdisorderIntroduction
At 14:46 on March 11, 2011, a massive

missing (Japan National Police Agency,

undersea earthquake measuring 9.0 on2019), and about 51,778 people are still

the Richter scale caused a tsunami thatliving as internally-displaced persons asdevastated the shoreline of eastern Japanof 2019, eight years after the earthquake

from the Kanto region to the Tohoku, and(Japan Reconstruction Agency, 2019).

theFukushima

The survivors experienced both physicalPrefectures in particular. The tsunami

and mental suffering. Post-traumatic

damagedPower

stress disorder (PTSD) is a common

Company’s (TEPCO) Fukushima Daiichi

psychological problem following natural

Nuclear Power Plant (NPP), creating adisasters

catastrophic

tsunamis

Iwate,

Miyagi,Tokyo

andElectric

radiation

hazard

in

such

as

earthquakes(American

andPsychiatricFukushima Prefecture. In total, 15,897

Association, 2013; Weathers, Keane, &people died, 2,533 people were declared

Foa, 2009), and the Great East Japan
Earthquake left many survivors with

Hokkaido

PTSD symptoms. The proportion of the

University of Education, Graduate School of Education,

adult population who suffered PTSD

1-15-55, Shiroyama, Kushiro-shi, Hokkaido 085-8580 JAPANsymptoms was as high as 21.6% in 2011e-mail: asai.keigo@k.hokkyodai.ac.jp

and 18.3% in 2012 (Yabe, et al., 2014).

CORRESPONDENCE

TO:

Keigo

Asai

17

18

ASAI

One of the primary PTSD symptoms isthat are feared or avoided (Foa et al.,the flashback, or the reexperiencing of a2008). In studies of earthquake survivors

traumatic event, and the Diagnostic andin

Statistical Manual of Mental Disorders

employed self-exposure instructions on

haspersistent

PTSD were statistically more effective

reliving/reexperiencing phenomena as athan control groups after treatment

diagnostic criterion for PTSD (American(Başoğlu,Psychiatric Association, 2013). Osuch etBaşoğlu et al., 2005). Regardless of theal, (2001) noted that flashbacks areearthquake

unlike normal memories in that patientsfound significant pre- to posttreatment

report that “I feel like I am back there”

changes on standardized measures of(i.e., when and where the traumatic event

PTSD severity (Cahill et al., 2009).

occurred) and experience a loss of control.

EMDR, developed by Shapiro (2001), is

The flashback is an autonomic responsea multistage treatment for PTSD thatthat is physiologically much more similar

involves the particularly unique process

to a panic attack.

of desensitization and reprocessing. The

Psychotherapy is a treatment of PTSD,

core intervention requires the client toincluding the flashback, that has beenrecall trauma-related memories while

found to be effective. Exposure therapy

also attending to some form of external(ET) and eye movement desensitization

oscillatory

and reprocessing (EMDR) have also been

facilitated by the therapist moving afound to be effective in the treatment offinger from side to side across the client’s

PTSD symptoms (Watts et al., 2013; Defield of vision. The client’s experience

Bont et al., 2016).

have shown rapid changes in a client’s

In fact, ET and EMDR have been highly

emotions,

recommended for the treatment of PTSD,

memories and the reduction of subjectivewith much evidence in support of its

distress with each bilateral stimulation

effectiveness (Department of Veterans(Shapiro, 2001; Shapiro & Laliotis, 2011).

Affairs and Department of Defense, 2017).

Some clients reported feeling as if theirET includes imaginal exposure to thebrain was cloudy (Broad & Wheeler,

traumatic memory and in vivo exposure2006). For tsunami survivors in Srito reminders of the trauma or triggers for

Lanka, case studies illustrated thattrauma-related fear and avoidance are

EMDR is an effective treatment for PTSD

characterized by a series of proceduresin general, with specific utility fordesigned to help individuals confront

disaster-related PTSD (Jayatunge, 2008).

thoughts using safe or low-risk stimuli

Additionally,

listedsuch

Turkey, interventionŞalcioğlu,groups that

Livanou.,

survivors,many

stimulation

insights,

2007;
studies

typically

sensations,systematic

reviews

andofTHE USE OF THE THREE STEPS MODEL AFTERTHE GREAT EAST JAPAN EARTHQUAKE

19

EMDR have shown statistical and clinicalcommunication

significance in reducing PTSD symptoms,

avoiding the risk of failing personalanxiety, depression, and other forms of

relations (Otsuka, 2012).

distress experienced by survivors of

As a form of SFBT, the three steps model

natural disasters (Natha & Daiches,is an effective method in the treatment of2014).

PTSD (Wakashima et al., 2012). In thisBased on the evidence, ET and EMDR

model, PTSD symptoms have been shown

are effective forms of psychotherapy forto undergo spontaneous improvement in

the treatment of PTSD, though there aremany cases. The therapist gives the

drawbacks.

frequentclient advice on how to concretely cope in

exposure to frightening memories andthis method, which is composed of thethus can impose unnecessary burdens onfollowing three steps:

the

ET

involves

client. Porges (2017)indicated

that

ET

and is successfulinhas evenmightincrease

Step 1: Normalize

sensitivity to the stimuli associated with

Therapists normalize the symptoms anda traumatic event. As for EMDR, its

reactions

implementation

additional

Normalizing comments show empathy fortraining and cannot be carried out unlessthe client and assure them that thea therapist is qualified to employ thissymptoms and reactions in clients of arather rarified treatment. This becomes adisaster are a natural human reaction.

requiresinclientsofadisaster.

problem in the event of a large-scaledisaster, as the number of qualified

Step 2: Do More of What’s Working &therapists available to provide such aCompliment

treatment is limited and will quickly

Therapists endorse clients that act andbecome strained.

cope independently. Therapists makeFurthermore, while the effectiveness ofsureET and EMDR on PTSD has been proven,

improvements from the client’s previous

there are cases in which the deterioration

psychologically imperiled states. Theyof personal relations with those aroundshow clients that PTSD-like reactions

the client can lead to these treatments

reduce gradually over time in many

becoming ineffective. On the other hand,cases.

to

point

out

differencesandthough, there is also no evidence tosupport the idea that solution-focused

Step 3: Reframing & Paradox

brief therapy (SFBT) is less effective than

Therapists give clients some suggestions

thesetreatments.

for intervention. They show that when

SFBT has a powerful effect on improving

PTSD-like and grief reactions are avoided,

otherestablished

20

ASAI

the more uncontrollable client tend to

EMDR.

become. Therapists thus suggest thatclients do something different, such as

Case description

courageously confront the problem.

The client is a 43-year old female living

The

three

steps

model

need

not

in the Tohoku area with her husband.

necessarily employ Step 3. If clients with

She is an office worker. On March 11,

disaster stress problems realize their2011, she was subject to a natural

response is a natural reaction and theirdisaster,symptoms are slowly alleviating, they

Earthquake. In 2013 she began attending

have the option to wait and see if thesecounselingproblems resolve themselves without

therapeutic care of the author. The

confronting them directly. When clientsclient’s employer gave her a stress test

experience a slow natural recovery and a(K-6; Kessler et al., 2002), and her results

disturbed daily life, therapists might beexceeded the cut-off point by over 13

more willing to employ Step 3. This

points. The counseling sessions weremodel primarily addresses traumaticconfined to a two-week period.

the

Great

East

sessions

Japan

under

the

memories, including grief or PTSD-like
symptoms. People are generally proactive

Session 1

in accessing their memories. However,

The therapist asked the client, “Whatpeople with traumatic memories can

are

your

goals

becametogether?”The

confusedbecausetraumaticfromclientourworking
answered,memory can often feel as if they are being“Compared with what I was before theinvaded. Step 3 thus makes the create

earthquake, the efficiency of my work has

meaning for an intervention and pay

declined, and I have become less active,

attention to their problem.

so I expect that this situation will only

Also, the three steps model is not only

get slightly better.” It was revealed thatused independently, but can also be

her problem with being less active arose

implemented in combination with otherwith the earthquake.

psychotherapy techniques such as EMDR

She came to think of going out on social

and TFT (Wakashima & Usami, 2013).

occasions as troublesome and avoided

The case report in this study examines

drinking with coworkers because of a

the application of the three steps model toprevious incident where she had said

the clinical case of an adult woman who

harsh things to a junior coworker. She

suffered from flashbacks. In this case, thetherefore tries not to drink alcohol. She

flashback episodes are resolved before

used to play music in a band before theattempting

earthquake, but since the earthquake she

theimplementationofTHE USE OF THE THREE STEPS MODEL AFTERTHE GREAT EAST JAPAN EARTHQUAKE

21

has distanced herself and no longer sees

her parents were swept away by thethem socially. The problems with her

tsunami although she did not actually see

workplaceit happen, and so on), and she uses a lot

efficiency,

though,arerelatively recent and began occurringof energy to deal with them.

only several months prior to her first

Regarding her medical history, shecounseling

visitedsession. The

troublesheapsychiatrist

where

she

experiences is not remarkable in its

underwent PTSD prevention in the earlyseverity, but it takes a noticeably longer

days after the earthquake, but she hastime

not been there since, deciding that shetodocuments.

lookthrough

Also,

she

unfamiliar

found

herself

often cried at home after drinking

unable to read books unrelated to work.

prescribed medicine with alcohol.

On weekdays she feels occupied because

The therapist listened to her story usingof work, but on her days off she feels athe three steps model. The therapist

state of emptiness. She finds herself

normalized that the reactions she had togoing to the office on Monday mornings

the trauma were normal reactions, evenand hurriedly finishing a job that shein their perceived abnormality (Step 1:

brought home with the intention ofNormalize). The therapist gave the client

finishing it over the weekend only to findcompliments about how she was doing

herself not able to finish it. She does not

her best even in this time of difficulty

miss her deadlines, however, and is thus

(Step 2: Do More of What’s Working &able to avoid problems at work. In

Compliment). The therapist determined

addition to these problems, she lost her

to not use Step 3, but instead opted forparentsJapan

EMDR, which has a strong record of

Earthquake. On the other problems, sheaddressing flashback memories, because

recounted the episodes of her increased

it was the flashbacks that were severely

weight, enthusiasm for drinking alcohol,

impacting her daily life. The therapist

taking out her frustrations on younger

explained the merits and drawbacks ofcoworkers, and so on.

EMDR and recommended doing EMDR at

Her

to

the

Great

post-earthquake

Eastflashbacks

occurred on a daily basis, and she feels

the next session. The client replied that
she wanted to try it.

invaded by these past experiences andimages (her parents were swept away by

Session 2 (Two weeks after the first

the tsunami, she saw the faces of corpses,

session)she recalled the smell when she went toSince

the afflicted area, saw her destroyed

explained that her condition had gotten

home, she was haunted by the fact that

better and she

the

last

session,theclientwas improving

her

22

ASAI

efficiency at work. She was also able to

Step 2 of the three steps model had beenread three books in two weeks. Her

employed.

coworkers said she was smiling more.

centered on utilizing the knowledge that

Regarding her flashbacks, they were not

the nature of PTSD symptoms is that

occurring as often and had almost become

theyinvisible, as if they were a “haze.” She(Wakashima et al., 2012).

said the following: “When I heard what

In addition to the three steps model, it

EMDR is, I realized that I am in a serious

was assumed that informing the client ofsituation. Because everyone has had thethe EMDR technique, and the possibility

same disaster experience, I didn’t want toofspeak much about how much trouble I

normalization effect. The effectiveness of

was having with my situation.”

the ET and EMDR for PTSD has been

Therefore, the therapist did not employ

demonstrated, but for a deterioration of

EMDR, and instead complemented her

the interpersonal relationship of a client,current state and told her she would bethese therapies have no effect.

willing to talk again whenever the client

On the other hand, SFBT can handle

needed.

both the PTSD symptoms of an individual
and

The

model

naturally

utilizing

theisalleviate

it

on

a

with

her,

problemsofmethodtime.

exertedainterpersonal

Follow-up session (Two weeks after the

relationships because it avoids the risk of

second session)poisoning personal relationships and has

The therapist noted that the client’s

astate had been calm since the last session.

communication (Otsuka, 2012). Therefore,

The therapist therefore determined tosome documented cases made use of aterminate the sessions based on the

combination

relatively calm state of the client at both(Grandison, 2007).

the follow-up and second session.

As client interest in psychotherapy

powerful

effect

of

on

EMDR

improving

and

SFBT

grows, it is expected that the number ofDiscussion

clients who feel the need for a specific

The purpose of this study is to examine

treatment regimen will also increase.

the effect of applying the three steps

Therapists are needed to ensure themodel to a client suffering from flashback

client’s

episodes. As a result of the model’s

psychotherapy

techniques

implementation, the flashback symptoms

introduce

psychotherapy

were reduced. Furthermore, a salutary

desired by the client. Psychotherapy for

effect appeared as if EMDR had beeneffective PTSD treatment can have two

utilized. In this case, only Step 1 andeffects on clients: a psychotherapeuticadequatetheunderstanding
and

of
to

methodTHE USE OF THE THREE STEPS MODEL AFTERTHE GREAT EAST JAPAN EARTHQUAKE
effectandareframing

effect.

23

The

However, this study was a report based

psychotherapeutic effect refers to theon a single case. Also, the client had

effects of the psychotherapy methods

flashback symptoms, but she was notthemselves. The reframing effect, on the

diagnosed

other hand, is used to convey to the client

there is much complexity in the variousthat they were in a terrible situation

manifestations of PTSD. Therefore, it iswhen the psychotherapy was conducted.

not possible that the results of this

Therefore, for the effective treatment ofresearch immediately can be adapted to

PTSD symptoms, when therapists use

all PTSD symptoms.

with

PTSD.

Furthermore,

not only the three steps model but also
ET or EMDR as a method, it is necessary

Conclusion

to be able to deliver a meta-message that

Despiteconveys the idea that “you [the client] arepossible in this case to alleviate thein a very difficult situation.”

symptoms of the flashbacks from which

In the case of large-scale disasters suchthe client had suffered in a relatively

as the Great East Japan Earthquake,short period of two sessions. For the

these

on

client with symptoms of PTSD, the idea

unhealthy, negative phenomena, such asthat not only carrying out the therapy but

PTSD. However, in many cases, thealso emphasizing to the client that thesymptoms of PTSD or disaster-related“therapy will be carried out” brings

stress have been proven to reduce withreframing and normalizing effects to athe passage of time Yabe, et al., 2014;

difficult situation. It is necessary for the

Wakashima et al., in press). In recent

therapist to be aware of these effects toyears, rather than the negative aspect, amost effectively carry out the moreconcept focusing on the positive aspect oftraditional forms of psychotherapeuticindividuals such as Posttraumatic growthtreatment.

effects(Tedeschi,

and

are

focusedCalhoun,

only

1996)

these

limitations,

it

was

and

Posttraumatic success (Bannink, 2008)

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Posttraumatic growth or Posttraumatic

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main-cat2/sub-cat2-1/20190227_hinans

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Plant Accident: Results of a mental

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Fukushima

HealthManagement

SurveyFy2011andYabe H, Suzuki Y, Mashiko H, Nakayama

inFy2012.

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Acknowledgements

Survey (2014). Psychological distressSpecial thanks to Ms. Konomi Asai, Ms.

after the Great East Japan Earthquake

Pufu Asai, and Mr. Tatsuya Matsumura.

and Fukushima Daiichi Nuclear PowerInternational Journal of Brief Therapy and Family Science2019 Vol. 9, No.1, 27-30<Short Case Report>

A Single Session with Mother Who reframed her Daughter’s Dating Relationship
Haruka Sakai , Megumi Kato , Norimasa Itakura , Seiya Mitani
1)

1)

2)

3)

)

School Counselor of Gifu Prefecture

Employment and Livelihood Support Center for Persons with Disabilities of Gifu Prefecture , Funabuse

2)

Gifu University

3)

Tohoku Fukushi University

4)

ABSTRACT.

In this case, IP had been absent a high school for a few days, after she troubled with her boyfriend. Then, her mothercame to see school counselor (SC). The mother said, “I hope my daughter to break up her boyfriend”. However, if mother told IP to
do so, she argued that her mother did not understand her at all, and did not listen to her mother. SC formulated a bad circle as
described above. Then, SC emphasized that IP is kind and great, and her mother appreciate them. SC told the mother how excellent
she was and intervened “please send a message to her that you really understand your daughter’s feeling.” After the session, themother changed how to approach her daughter. Then her reaction was also changed, and they peacefully talked to each other. Afterall, IP started smoothly to go to school again. The mother regarded that the relationship between her and her boyfriend wascomplementary communication which means that her boyfriend is in one-up position to control her and her position is one-down.
After the session, however, the relationship established in the mother changed into meta-complementary communication whichmeans that the position of IP and her boyfriend seems to be one-up and one-down, respectively. After all, mother could give themthe choice to break up or not. And she changed interacting with her daughter, IP started to go to school again.
KEY WORDS: Normalization, Utilization, Meta-complemental communication

Introduction

how mother reframed the relationship ofIn this case, IP had been absent a highIP and her boyfriend through the session.

school for a few days, after she troubled
with her boyfriend. Then, her mother

Case Summarycame to see school counselor (SC). IP and

IP and her boyfriend were third year

her mother were regarded as “problem”

high school students They were in theby the school, because their relationshipsame club, and started dating at the firstwas codependence. This case finished in a

grade. Teachers of their high school often

singlethisguide them because they were always

relationship. In this report, we’ll discuss

together even in public. Furthermore, hersessionfor

utilizing

boyfriend had gotten along with another
CORRESPONDENCE TO:Sakai,girl student, which made IP get angry

e-mail: hachico8514@yahoo.co.jp and break a toilet. Therefore, IP was a

27

28

SAKAI et al

troublemaker for school. Her mother was

decided not to go to school, she spent time

also

she

calmly at home and said “I want to do mycriticized the school staff to protect IP

best for study and club.” Her motheranytime.

thought that her daughter was a great

When IP was absent school, teacher

girl. In addition, when IP was fine, sherecommended IP and her mother to havesometimes said “I wonder why I love him.”a counseling. On the day, IP did not comeHer mother heard that her boyfriend wasto school, so only her mother came to the

not cared for at his home. Thus, thesession.

mother thought that IP sympathized withatroublemaker,

becausehim, and she might not help going around

Case Processwith him.

Clarification of problem
First, SC asked mother what distressed

Utilization and intervention

her. The mother said, “I hope my

SC said, using the mother’s words, “it isdaughter to break up her boyfriend”.

normal that you want to break up them.

Mother thought that he said to IP,

But, your daughter seems to understand“someone spoke ill of you,” because heyour thought. On the other hand, shewants to monopolize IP. Therefore, IP

may be painful because of her kindness

didn’t know what and whom to believe,andand she could not go to school. Then, SC

Nevertheless, you really understand her

asked a starting question, “what do youkindness, I thought.” SC emphasized thatwant to talk about to feel glad to be here?”

IP is kind and great, and her mother

Mother answered, “I want to break up myappreciate them. The mother agreed anddaughter and her boyfriend. For thatsaid

purpose, I can do anything!” However, if

commiserate with her boyfriend.” SC told

mother told IP to do so, she argued thatthe mother how excellent she was andher mother did not understand her at all,intervened “please send a message to her

and did not listen to her mother. SC

thatformulated a bad circle as describeddaughter’s feeling.” Mother said, “Surely.

above. The more her mother required her

If possible, I want to break up them as

to break up with him, thus, the more shesoon as possible, but it cannot be decided

move away her mother.

without her decision.”

can

“my

you

not

break

daughterreally

up

is

with

kind,

understand

him.

and

your

After the Session

Exception
Mother told stories that seemed to be

The next day after the session, IP and“exceptions”. For

her mother came to school, and talked

example, whenIP

A SINGLE SESSION WITH MOTHER WHO REFRAMEDHER DAUGHTER’S DATING RELATIONSHIP

29

with her class teacher. The mother said,

not have broken up with her boyfriend“I had always circular conversations withbecause of her kindness. Additionally, SC

my husband. After the session with you, I

intervened the mother to tell IP that you

changed how to approach my daughter.

understand your daughter. Utilization isThen her reaction was also changed, anda basic principle for solving problem

we peacefully talked to each other.” After

proposed by Milton Erickson (Watzlawick,all, IP started smoothly to go to school

Weakland, & Fish, 1974). He often

again.

utilized not only present problem andsymptom,

but

also

obstinate

belief,Discussions

delusion and behavior (William, H. O.,

In this report, we want to discuss two1987). In this case, SC highlighted thepoints below. First, how did SC process

words that IP is kind and great” said by

her resistance, and led intervention.

mother and the view that the mother

Second,appreciate IP. Therefore, it is consideredhowmotherreframed

relationship of IP and her boyfriend.

that the mother’s resistance could beprocessed and intervention was accepted.

Processing resistance
As

one

of

processing

Reframed relationshipresistance,

normalization is considered useful. This

Mother thought that IP’s boyfriend

mother wanted to break up them as soon

wanted to control and monopolize her.

as possible. This feeling was a sign to

But the mother thought that the reason

care for IP, but telling IP to break up

why they did not break up is not only his

made her feel that her mother does notpossessive feeling but also IP’s kindness

know anything. After all, telling IP toandbreak up was considered false solution.

expanded the context so that the motherThen,understanding

became convinced that IP is kind, so shemother’s feeling, and normalized hercannot help going around with him. That

mind. This provided relationship withis,mother and SC, and processed resistance.

relationshipbetweenher

Moreover, this mother’s way of thinking

boyfriendwascomplementary

had been considered codependent on IP

communication which means that her

and troublesome by teachers of the school.

boyfriend is in one-up position to control

However,this

her and her position is one-down. After

codependence, and complimented thethe session, however, the relationshipmotherestablished in the mother changed intoSC

expressed

SC
on

dared
that

to

the

utilizemotherhad

comprehended her feeling that she could

sympathy

theformotherhim.

regardedmeta-complementary

Then,

SC

that

the

and

her

communication

30

SAKAI et al

which means that the position of IP andschool. The frame of IP’s kindness could

her boyfriend seems to be one-up andbe a treatment double bind, because

one-down, respectively. In other words,

whatever she does with the frame, hermeta-complementary communication ismother would think her behavior as her

intentionallykindness.

communicatingcomplementarily to control the otherperson. Mother changed her thought ofReferences

the relationship of IP and her boyfriend

Watzlawick, P., Weakland, J. H., & Fish,from complementary communication to

R. (1974) Change: Principles of problem

meta-complementary

formation and problem resolution. W.

communication.

After all, mother could give them thechoice to break up or not.

W. Norton & Company, Inc.
O’Hanlon,W.

H.

(1987)In this case, although mother andunderlying

daughter’s codependency is regarded as

Erickson’s therapy and hypnosis. W. W.

problem,

Norton & Company, Inc.

SC

dared

to

utilizetherelationship, which enables IP to attend

principles

Taproots:ofMiltonInternational Journal of Brief Therapy and Family Science2019 Vol. 9, No.1, 31-35< Short Case Report >Diagnosis helps the patient: Counseling with a mother worried about her son’s behavior
Koubun Wakashima  Naoto Nihonmatsu
1)

1)

1)

Graduate School of Education, Tohoku University

ABSTRACT.  Diagnosis helps the patient. In this paper, we show that diagnosis have the potential to protect abilities, efforts, andpersonalities. In one particular case introduced in this study, a mother who was anxious about the son of a high school student who
visited a psychiatry who was hiding in the parents talks. In the case, the diagnosis is used successfully as a amulet. The purpose ofthis study is to examine how the diagnosis works for the case. It is important to focus on the use of the function of the word
diagnosis based on pragmatism.
KEY WORDS: The function of diagnosis, PragmatismIntroduction
Diagnosis (the name of an illness or avisited a mental clinic secretly from his parents.

disability) sometimes helps the patient. Thisfunction of getting diagnosed has been called

Session 1“gain from illness.” Diseases and disabilities

IP recognized that he might have ADHD and

can protect a person’s abilities, efforts, andvisited a mental clinic without telling his

personality,

paper

parents. The clinic staff called his home andintroduces such a case study and discusses how

said that the staff forgot to give IP a document.

a specialist can manage this process.

IP’s mother got to know that IP visited theamongothers.

Thismental clinic because of this phone call. IP was
Case description

diagnosed as having ADHD tendencies at the

The client (CL) was a mother in her 40s. She

clinic. Concerta 10mg, Sulpiride 100mg, andvisited the author’s counseling room, after

Etizolam 0.25mg were prescribed, and IP wasbeing introduced by an acquaintance. Her

instructed to take the medicine once a day. His

family consisted of the client, her husband, andfather got to know about the prescribed

the Identified Person (IP, a senior high school

medicines and said, “Nonsense! The diagnosis

student). Her chief complaint was that she

is wrong.” The next day, IP took the day off

wants to consult a specialist about IP whofrom school for the first time. Now, IP has

CORRESPONDENCE

Koubunmeals with his family but does not talk during

Faculty of Education, Tohoku University, 27-1,

the meal. After eating, he immediately goes

Kawauchi,back to his room. The CL is also worried aboutTO:

Aoba-ku,

Wakashima
Sendai-shi,

Miyagi,the situation.

980-8576, JAPANCL stated that “IP might have experienced

e-mail: Koubunwakashima@gmail.com

31

32

Wakashima & Nihonmatsu

setbacks for the first time after entering senior

position as parents worrying about your child.

high school and found that he was poor at

You should avoid doubting whether thestudies compared to other students,”“I think

diagnosis is correct or not, which would lead toit is not good for him to use the diagnosis as an

doubting IP. Finally, the TH advised that IP

excuse for his current state and pretend thatmust have made a great effort to enter higheverything is ok if he is taking medicine.” Theschool by compensating for his disabilities if hetherapist (TH) asked her, “What do you expect

had ADHD tendencies.” CL said, “I want to tellof the counseling provided here?” CL said, “IIP that he has so far made a great effort.”

don’t know how to deal with IP. None oftreating him too carefully, leaving him alone, orSession 2
IP’s parents (CL and IP’s father) came

meddling with him too much might beineffective.”to counselling. TH asked them about IP’s

After listening to her, TH explained two things

conditions since the first session. CL

that CL and IP’s father could do. Firstly, theyanswered that IP was taking medicine,

should stop arguing about the hospital and thestarteddiagnosis. Also, IP and his parents had aconversation, and smile, and became

conflict over the medicine, which increases IP’s

calmer than the time of the first session.

worries. The CL should tell IP at least to inform

IP’s father said, “When talking with IP

her when he goes to the hospital, and that there

before the first session, we told him to get

was no need to talk about the content of his

aconsultation or his medicine. Secondly, theworried about him. Then, IP objected,

diagnosis might protect IP from being hurt. IP

asking why we (parents) try to control

might blame himself for his lack of ability andhim despite his decision and action.” TH

not try if he is discouraged by his poor

said, “IP may be refusing to visit otheracademic results. Therefore, his diagnosis

hospitals or clinics because he is afraid ofmight have become a charm that protects him

being diagnosed as not having ADHD. In

and parents should not deny the diagnosis. The

that case, the cause of his current

diagnosis protected IP's self-esteem. Moreover,condition might be regarded as his lack of

the parents should watch over him.

ability or effort. More problems such as

toparticipate

second opinion becauseinwefamilywere

Moreover, CL recognized that the prescribedschool refusal might be caused if IP getsmedicines caused high physical dependence.

more depressed by such a diagnosis. For

She said, “We are anxious about him taking thethe time being, it is important to support

medicine because we are his parents. I want to

him so that he wouldn’t get more

ask the doctor about the process by which hedepressed.”made the diagnosis. Is it ok?” TH said, “WhenOne of the problems currently faced by

you meet the doctor, you should keep yourIP included difficulty in getting up in the

33

DIAGNOSIS HELPS THE PATIENT

morning. Every morning CL gently wakes

concentrate on studying without being

up IP and his father asks him, “Are you

distracted by comics or TV when I takeok?”. IP’s father asked TH, “How should I

the medicine prescribed by the clinic.” THdeal with IP? Worrying too much might

asked, “Don’t you need medicine when

not be good, I think…” TH suggested,

you are able to concentrate on studying?”

“How

about

in

an

IP

mannerandmedicine.” The goal of this session, whichmaking him think that he is not in such a

was shared by TH and IP, was to become

bad condition?”able to concentrate on studying without

excessively

treating

supportivehim

answered,

“I

might

not

need

IP’s father said, “I want to bring IP totaking medicine. Moreover, TH explained

this counseling room.” TH said, “It isthat Concerta leads to high physicalimportant to add meaning to the reason

dependence and that the effect of thefor inviting IP to the counselling room.

medicine

You should take the position of worrying

therefore, the amount of medicine needs

about your son. It might be better thatto be increased. IP answered smiling, “I

you bring IP here after you receive

am surprised to hear about this problem.”

explanations from the clinic doctor.” After

IP’s daily routine was “going to school

one month, CL gave a phone call and saidb y b i c y c l e e a r ly i n t h e m o r ni n g ,that CL and IP would come to see TH. IP

conducting morning athletic club training

was to come to the next counselingactivities, taking classes, doing clubwithout knowing that the parents had

activities, coming back home, having

already referred to the counseling room.

dinner, taking a bath, studying, anddecreases

with

time,

and

going to bed. IP went to a cram school

Session 3

twice a week on weekdays. TH said,

First, TH spoke only CL without IP’s

“Aren’t you too busy? When you get tired,

presence. The reason for doing this is as

you cannot concentrate on things. You

follows. IP might wonder why TH knew

should take a rest so that you will be in

specific details because IP did not know

your best condition next year.” TH gavethat his parents had already visited theIP two tasks. Firstly, IP should makecounseling room. Even if TH mentioned

time when he doesn’t have to study. TH

this, IP would think that it was told bytold IP that it is important even for

the CL before, during the current session.

working adults to divide working andLater, TH had a session with only IP.

spare time. Secondly, IP was told that heTH asked IP, “Do you have any

should study before taking a bath on the

problems now?” IP answered, “I cannot

days when he doesn’t have to go to his

concentrate on studying” and said, “I cancram school. TH explained that the

34

Wakashima & Nihonmatsu

parasympathetic

nervoussystemis

explained that IP was in the middle ofactivated by taking a bath, which relaxes

exam week and didn’t want to be absent

the brain.

from school. IP said about the status of

Next, TH interviewed CL. CL said, “I

his medication that “I don’t need to go tohave never noticed my son having any

the clinic anymore” after the third session.

problems. I know about ADHD because of

It seems that now IP doesn’t go to the

my work, but it was a surprise for me

clinic or take any medicine.

that my son is taking Concerta.” TH

CL said that IP still stayed up till late,asked, “What do you usually talk withshe was not sure whether IP was able to

IP?” She answered, “For now, I tell him toconcentrate on his studies or not, and she

take care of himself before everything.”

was anxious because IP did not express

TH asked CL about her own life. CL

his intention clearly to CL. Although IP

said, “I cannot sleep until IP goes to bed,

does not talk about studies and his futureworrying about him. I usually watch TV

courses with CL, he often talks about hiswhen IP is up, and I can relax.” CL’s

hobbiessleeping time decreased after she got tocelebrities and pop idols. TH said, “That’sknow that IP visited the clinic. TH said,rare for high school boys. You and your“You must be tired because you are notson seem to have good relationships.” CLsleeping enough.” CL answered, “I’m notsaid, “I will try to interact with him more

feeling well but that is not because of myoften.”

including

topicssuch

asson, but because I caught a cold,.” TH
said, “I think IP was courageous to visit a

Session 5 (three months after the fourth

mental clinic all by himself.” CL said,session)shedding tears, “I was shocked when I got

Only CL came to consult TH. TH asked

to know he went to the clinic without

her about IP’s visit to the clinic after IP

telling me. However, it is an independent

came to the counseling room. CL said,

step because he made a decision by“Now he doesn’t go to the clinic or takehimself.”

any medicine.” TH asked her about IP’s

Finally, the tasks given by TH to IP

current condition. CL said IP retired fromwere shared between CL and IP in the

club activities because he became ajoint session.

third-year student, but he doesn’t seem tostudy

Session 4

so

hard.

However,

no

major

problems were observed. Furthermore, it

Only CL came to consult because IP

was confirmed that IP’s father was

said, “I don’t need to go because mysupportively involved with IP. Therefore,

problems

the counseling was completed.

have

been

solved.”CL

DIAGNOSIS HELPS THE PATIENT

35

Discussion
The purpose of this study was to showcase was solved.

that for IP who had a psychiatric visit
behind their parents, the diagnosis may

Conclusion

be linked to protecting his personality

The case ended with a brief period ofand ability. In this case, Although CL infour Cl sessions and one IP session. The

this case seems to be concerned about theword diagnosis (illness or disability) may

diagnosis of IP and the effects of drugs, it

have an aspect that helps oneself. The

does not know how to relate to IP. As afunction of such a diagnosis can protect

result, IP has stopped going to hospitalability, effort, and personality. Therefore,

and taking medication, and can now

communication that suspects a diagnosis

spend without major problems. Theortherapist's vision and assessment was tocommunication

ensureperson's personality. The function of

that

Cl's

worrying

about

psychiatric visits to IP did not hurt thepersonality

andability

of

IP.

a

hospitalmay
thatfunctionasthreatens

thepragmatic based diagnosis is important.

The

intervention on CL was also aimed at

References

making IP deny himself the diagnosis by

Wakashima, K., & Hasegawa, K. (2000).

more

Brief Therapy: Theory & Practicesupportive" based on this assumption. On(2th ed.). Tokyo: Kongo Syuppan. [ inthe other hand, in the session with IP, hisJapanese]theparadox

"I

worry

about

current state can be explained by linking
the importance of sleeping time and time
management,thesuperiorityofparasympathetic nerves, etc. so that hecan act to concentrate on study even if
you quit medicine. It functions as anintervention that does not hurt.
Diagnosis can be utilized as a frame toprotect abilities, efforts, and personalities.
In this example, the “Bind the narrative”(Wakashima & Hasegawa, 2000) byadding meaning to the meaning, such asthat the diagnosis functions as a "amulet",and there is room for improvement of thelife rhythm rather than IP. Thus, thisInternational Journal of Brief Therapy and Family Science( I J B F ) Contribution rule1.

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