International Journal of Brief Therapy and Family Science
2012 Vol. 2, No.1, 1-15
< Original Paper: Research and Experiment t>

Critical Incident Stress of Rescue Workers after the Great East Japan Earthquake: With Examining Local Firefighters, Special Rescue Team and Rescue Divers ofJapan Coast Guard
Takaaki Usami1), Koubun Wakashima1) and Kazuki Kato 2)
1)

Graduate School of Education, Tohoku University

2)

MACROMILL,Inc

ABSTRACT. The purpose of this study was to reveal the general prevalence of PTSD symptoms among rescue workers for two time
points: just after the traumatic operation after the Great East Japan Earthquake (Time 1) and seven months or one year after theearthquake (Time 2). We also aimed to examine the effect of the casual conversation about the critical incident on PTSD symptoms
and mental condition of rescue workers. The participants were 5 rescue divers and 16 Special Rescue Team (SRT) of Japan Coast
Guard (JCG) and 52 local firefighters of disaster area. They answered the questionnaire from November 2011 to March 2012 atvoluntary basis. Traumatic stress responses were assessed for two time points (Time 1 and Time 2) with Japanese version of Impact
of Event Scale-Revised (IES-R-J, Asukai et al., 2002). The participants answered Time 1 as past reaction, and Time 2 as the current
condition. The results revealed that 28.8 % of firefighters, 6.3 % of SRT and 20% of rescue divers were categorized as high risk of
PTSD at Time 1, and 13.5 % of firefighters were categorized as high risk at Time 2 and all SRT and rescue divers of JCG werecategorized as low risk at Time 2. The results of this study presented that the conversation about the trauma had no effect on PTSD
symptoms and mental condition. However, the conversation about the critical incident would work to improve PTSD symptoms andmental condition since it seems to play a key role at the point in the past when people are sharing the experience.
KEY WORDS : critical incident stress

IES-R-J

PTSD

firefighters

special rescue team

The Great East Japan Earthquake occurred

throughout and travelled up to six kilometerson March 11, 2011 at 14:46 JST. The Easternfrom the coastline of Tohoku and Kanto region.

part of Japan, from Tohoku to Kanto region,

After the issue of tsunami warning, firefighters

was severely damaged by the 9.0 magnitude(both professional and volunteer), police

earthquake. The earthquake triggered powerful

officers, and local government officials guided

tsunamivictims to evacuate from coastal area. Some of

waves

that

reachedheights

approximately up to eight to nine metersthem injured or perished while on the duty.
Firefighters were one of the main professional

CORRESPONDENCE TO USAMI, Graduate School ofrescue workers operating after the disaster. A

Education, Tohoku University, 27-1 Kawauchi, Aoba-ku,

total of 28,600 firefighters across the country,

Sendai-city, 980-8576, Japan.

up to 6,100 at one point, have come to work for

E-mail: ijbf@nfbt.org

rescue service and security operation at disasterarea including evacuated area of nuclear plants.

1

2

USAMI, KATO and WAKASHIMAThe Japan Coast Guard (JCG) also conductedconversation about the critical incident, thethe rescue service and port reconstruction as aoperation after the Great East Japan Earthquake,part of their duty.

(3) the change of mental condition because of

It has been widely recognized the importancethe conversation. Both firefighters in Sendai

to work on the critical incident stress (CIS) of

city and rescue divers of JCG in this research

rescue workers after the accident of Air Florida

were the victims of the disaster, who resided

in 1982 (e.g., Every & Mitchell, 1997).

the area.

Following events such as Gulf War, world trade

Because we did not conduct this study withcenter bombing and September 11 attacks havelarge-sized population, we applied the analysis

highlighted the CIS on professional rescue

adopted from prior studies to compare ourworkers. In Japan, the Hanshin Earthquake inresults with those of prior studies conducted

1995 has led people to consider stress measurewith large-scale population (Hyogo Institute foras an indispensable issue among rescue

Traumatic Stress, 2000; Matsui et al., 2011).

professionals. The findings on CIS of rescue
professionals have piled up in Japan since theMethods

earthquake (Hyogo Institute for Traumatic

ProceduresStress, 2000; Tanouchi, 2005; Japan local
government

employeehealthfirefighters in Sendai city, rescue divers of

association, 2006; Ohoka et al., 2006; Matsui,second regional JCG, and SRT of third regional

Hatanaka & Maruyama, 2011). However, both

JCG, all of whom have had operation for the

researchers and practitioners have not come to

Great East Japan Earthquake at October ofany conclusions on the issue of the effect of2011. We distributed the questionnaire ofcasualfirefightersconversation

safetyabout

and

We conducted a questionnaire research onthetraumatic

experience on PTSD symptoms.

fromcompany

networkandcollected them later at October of 2011. We

In this study, we conducted a questionnaire

sent and collected them via mail for SRT at

research on professional rescue workers who

October of 2011 and rescue divers at March ofhave engaged in rescue operation for the Great

2012, respectively.

East Japan Earthquake. The participating
professionals were 66 firefighters in Sendai city,

Research participants

the nearest major city to the earthquake, all

The participants were 66 firefighters in

rescue divers of Second Regional JCG, and all

Sendai city, all of 36 SRT of third regional JCG,

Special Rescue Team (SRT) of Third Regional

and all of five rescue divers of second regional

JCG. The participants answered on the items of

JCG. All of them participated at voluntary basis.

(1) PTSD symptoms with Japanese version of

We limited the data of participants who

Impact of Event Scale-Revised (IES-R-J,

indicated that they had operation for the GreatAsukai et al., 2002), (2) the amount of casual

East Japan Earthquake. After excluding the

CRITICAL INCIDENT STRESS OF RESCUE WORKERS

3

invalid data, we applied the data of 73

to “very much” = 4. We coded the response

participants (52 firefighters: M=40.17 years,

from 0 to 1 as “little” and from 2 to 4 as “talk”

range:

SRT:

for casual conversation with each partner. As

M=29.00 years, range: 24-38 years, SD=3.03;

for family members, friends and lover, weand 5 rescue divers: M=24.60 years, range:

reduced them into one index, intimates.

23-27, SD=1.52) for following analyses. All

Participants who had at least one code of “talk”

participants were male.

among three different intimates were coded as

22-58

years,

SD=9.80;

16“talk” with intimates whereas those who had no
Measurescode of “talk” were coded as “little”.

PTSD symptoms

Changes of mental condition because of the

Impact of Event Scale-Revised (IES-R;

casual conversation about the critical incident

Weiss & Marmar, 1997) was applied to assess

We developed the items based on Kawase

the reaction of post-traumatic stress during their(1999)’s study of social sharing, which referred

rescue operation. IES-R is consisted of three

as having a conversation about the traumatic

subscales:andexperience. Participants were asked to rate how

avoidance. Japanese translated version of thismuch they have realized the changes of mental

scale (IES-R-J) has confirmed its validity andcondition since having casual conversation

reliability (Asukai et al., 2002). Higher scoreabout the critical incident. Responses were onmeans greater traumatic stress at the point ofLikert-type scale, ranging from “not at all” = 0

assessing. Asukai et al. (2002) recommended

to “very much” = 4.

hyper

arousal,intrusion,

the cutoff values of 24/25 to screen the highrisk population of PTSD. In this study, theResults

participants answered IES-R-J for two points

IES-R-J score at Time 1 by occupation of(Time 1 and Time 2). They responded Time 1

rescue professionals

as their past reaction and Time 2 as that of the

For the total 52 firefighters, the mean total

current condition.

score of IES-R-J at Time 1 was 20.10

Casual conversation about the critical incident(SD=17.37). A total of 15 participants (28.8%)

We applied five partners to have casual

had scores 25 or more points and wereconversation about the critical incident. They

classified in the high risk group; the remaining

were family members, friends, lover, colleagues

37 firefighters were categorized into the low

shared the incident (shared colleagues) andrisk group with scores less than 24 points. The

colleagues not shared the incident (non-sharedfirefighter’s mean scores of each subscale ofcolleagues). Participants were asked to rate

IES-R-J at Time 1 were 8.50 (SD=7.55) of

how much they have had casual conversation

intrusion, 6.81 (SD=6.44) of avoidance, andabout the critical incident. Responses were on

4.79 (SD=5.10) of hyper arousal. For the total

Likert-type scale, ranging from “not at all” = 0

16 SRT, the mean total score of IES-R-J at

4

USAMI, KATO and WAKASHIMATime 1 was 2.44 (SD=6.10). One of 16

0.38 (SD=1.50) of avoidance, and 0.19

participants (6.3%) was classified in the high(SD=.75) of hyper arousal. For the total fiverisk group; the remaining 15 firefighters were

rescue divers, the mean total score of IES-R-J

categorized into the low risk group. The SRT’s

at Time 2 was 3.80 (SD=1.92). All fivemean scores of each subscale of IES-R-J atparticipants were categorized into the low risk

Time 1 were 1.44 (SD=3.22) of intrusion, 0.75

group. The rescue diver’s mean scores of each

(SD=2.02) of avoidance, and 0.25 (SD=1.00) of

subscale of IES-R-J at Time 2 were 2.60

hyper arousal. For the total five rescue divers,(SD=2.30) of intrusion, 0.60 (SD=.55) of

the mean total score of IES-R-J at Time 1 wasavoidance, and 0.60 (SD=.55) of hyper arousal.

10.40 (SD=10.88). One of five participants(20.0%) was classified in the high risk group;

The PTSD symptom transition from Time 1 totheTime 2 by occupation of rescue professionals

remainingfour

rescuediverswerecategorized into the low risk group. The rescue

Next, we showed the PTSD symptom

diver’s mean scores of each subscale oftransition from Time 1 to Time 2. PTSD

IES-R-J at Time 1 were 7.80 (SD=8.04) of

symptom was categorized into three levels with

intrusion, 1.20 (SD=2.17) of avoidance, andtotal score of IES-R-J for both Time 1 and Time

1.40 (SD=2.07) of hyper arousal.

2, respectively. The three groups were less than
9 points, 10-24 points, and 25 or more points of

IES-R-J score at Time 2 by occupation of

the total score of IES-R-J. We applied therescue professionals

results of Time 1 and Time 2 in combination as

For the total 52 firefighters, the mean total

the PTSD symptom transition. The category

score of IES-R-J at Time 2 was 10.73

names are shown at Table 1. We applied the(SD=12.73). A total of 7 participants (13.5%)

name based on Matsui et al. (2011).

had scores 25 or more points and were

For the total of 52 firefighters, a total of 17classified in the high risk group; the remaining

participants (33%) had less than 9 points both

45 firefighters were categorized into the low

at Time 1 and Time 2 and were classified in therisk group with scores less than 24 points. The

Nonfirefighter’s mean scores of each subscale ofproportion with 14 participants were Resolved

IES-R-J at Time 2 were 4.35 (SD=5.48) ofgroup (28%), which showed mild stress with

intrusion, 3.96 (SD=5.82) of avoidance, and10-24 points at Time 1 but non stress with less2.42 (SD=2.91) of hyper arousal. For the total

than 9 points at Time 2. Eight participants

16 SRT, the mean total score of IES-R-J at(16%) who categorized into Recovered group

Time 2 was 1.19 (SD=4.23). All 16 participants

showed severe stress symptoms at Time 1 with

were classified in the low risk group. The

25 or more points but recovered to no

SRT’s mean scores of each subscale of IES-R-J

problematic level with 20-24 points at Time2.

at Time 2 were 0.63 (SD=2.00) of intrusion,

The two smallest populations were Prolonged

Stressgroup.

The

secondlargest5

CRITICAL INCIDENT STRESS OF RESCUE WORKERS
group and Sustained/Worsened group with six

intoparticipants (12%). Prolonged group population

Sustained/Worsened

had 25 or more points both at Time 1 and Timegroup2, which indicated that they suffered severe

Unchanged/Deteriorated group.

PTSD

period.

The exact binominal test revealed that the

Sustained/Worsened group experienced mild

population of Decreased group (n=26) was

stress symptoms at Time 1 with 10-24 points

significantly

and sustained or worsen the symptoms at Time

Unchanged/Deteriorated group (n=12). The

2.

result indicates that most of the rescue workers

symptoms

throughouttheAs for 16 SRT, 15 participants (94%) wasclassified into Non Stress group; the remaining

Decreasedgroup;

theremaining

group

and

Prolonged

reduced

into

were

greater

than

those

of

would become better even when they initiallysuffered from PTSD symptoms.

participant (6%) was categorized as Recoveredgroup.

The

Similarly, the three of the total of six rescue

occupational

differenceofrescueprofessionals on the experience of the casual

divers (60%) was classified into Non Stressconversation about the critical incidentgroup; the remaining two participants were

We analyzed the occupational difference of thecategorized as Recovered group (20%) andexperience of casual conversation about the

Resolved group (20%), respectively.

critical incident with each conversation partners.

Next, we examined whether the PTSD

The results revealed that there were no

symptoms increased or decreased from Time 1

occupational differences on the experience ofto Time 2 with all rescue professionals. We

the conversation with three different partners,

excluded the Non Stress group from thisrespectively (intimates: χ2(2) =1.32, n.s.; sharedanalysis because they have never experienced

colleagues:

the PTSD symptoms. Before the analysis, wecolleagues: χ2(2) =2.55, n.s.).

χ2(2) =1.66,

n.s.;

non-shared

reduced Resolved group and Recovered group

Table 1
The categorization and the category names of the process of PTSD symptoms
Total score of IES-R-J Time 2
0-9 points

10-24 points

25 points or more

0-9 points

Non Stress*1*1

10-24 points

Resolved

Sustained/Worsened

Sustained/Worsened

25 points or more

*1

Recovered

Prolonged

Total score of
IES-R-JTime 1
Note. *1 indicates no participants were classified into the categories.

6

USAMI, KATO and WAKASHIMA
70
60
50
40

Little

30

Talk

20
10
0

(N )

intimates

shared colleagues

no shared colleagues

Figure 1. The experience of conversation about the critical incident with three partners among all
rescue workers (N=73)

The partner difference of casual conversation

solution, which explained 74% of the variance,

about the critical incident

was preferred with both promax and principal

Furthermore,thefactor rotations of the factor loading matrix

between-partner difference with all rescue

because of its previous theoretical support, theprofessionals. The result showed that the‘leveling off’ of eigen values on the scree plot

distribution of the experience of casual

after four factors, and the insufficient number

conversation was different by three partnersof2(χ (2)=19.13,wep<.01).

examined

Following

residual

analysis revealed that rescue workers have had

primaryloadings

anddifficultyofinterpreting the fifth factor and subsequent
factors.

a conversation about the critical incident more

During several steps, a total of five itemswith intimates and shared colleagues while lesswere eliminated because they did not contributewith non-shared colleagues (Figure 1).

to a simple factor structure and failed to meet aminimum criteria of having a primary factor

The scale of changes of mental condition

loading of .35 or above, and no cross-loading(SCMC) because of casual conversation aboutof .35 or above. The items “exchanging

the critical incident

information” and “getting a good idea” did not

We conducted factor analysis with promax

load above .35 on any factor. The items

and principal factor rotations because we“understanding

assumed the factor correlations for factors

accepted”,

underlying the scale. Four factor solution was

cross-loadings on more than two factors.

supported based on the eigen values of just overone (6.79, 1.92, 1.36, and 1.16). The four factor

own“beingfeeling”,
mentally“becoming
stable”

had

The factor loading matrix for this final
solution is presented in Table 2.

7

CRITICAL INCIDENT STRESS OF RESCUE WORKERS
The items highly loading on first factor were

“being supported”, and “receiving an advice”.

“thinking the incident in an organized way”,

The third factor was named “Acceptance“thinking the incident in calm way”, “making a(M=7.23, SD=2.34, α=.86)” after the highly

sensible judgment”, “confirming own feeling”

loading items: “being agreed”, “developing theand “being objective”. We named the firstidea

factor as “Sorting out the experience (M=11.95,

sympathized”. The last factor was “Feeling

SD=3.79, α=.88)”. The second factor was

better (M=8.41, D=3.37, α=.89)”. The highly“Other’s support (M=6.89, SD=2.51, α＝.83)”

loading items were “feeling refreshed”, “being

based on the highly loading items: “receiving a

distracted”, and “not being anxious”.

about

the

incident”,

and“beingconsolation”, “being listened own feeling”,
Table 2
Factor loadings and communalities based on a factor analysis with promax and principal factor
rotations for 15 items from the Scale of Change of the Mental Condition (SCMC)because of casualconversation about the critical incident (N = 73)
1

2

3

Thinking the incident in an organized way.87

Think the incident in calm way.73

Making a sensible judgment.69

Confirming own feeling

.68

.26

Being objective

.46

.25

4

Communality
.77

.26

.59
.56
.68
.22

.42

Receiving a consolation

.90

-.28

.74

Being listened own feeling

.80

.28

.83

Being supported

.70

.23

.73

Receiving an advice.59

Being agreed

.21

.84

.83

-.31

.77

.61

.74

.73

Developing the idea about the incident.28

Being sympathized

.22

.63

Feeling refreshed

.90

.74

Being distracted

.63

.44

.30

.50

.63

Ⅲ

Ⅳ

.42

.30

.56

.47

Not being anxious
factor correlations
Ⅰ
Ⅱ
Ⅲ
Note. Factor loadings < .2 are suppressed.

Ⅱ
.42

.54

8

USAMI, KATO and WAKASHIMA

The regression analyses on IES-R-J Time 1 -psychological effects of the conversation have

IES-R-J Time 2 score difference with all rescue

no significant influence on the PTSD symptom

professionals

process (Table 3).

We conducted a stepwise multi-regression

Similarly,

weconducted

stepwiseanalysis on Time 1 - Time 2 difference of total

multi-regression analyses on IES-R-J Time 1 -score of IES-R-J. The predicator variables were

IES-R-J Time 2 score difference of three

three subscales of IES-R-J of both Time 1 andsubscales of IES-R-J, respectively (IES-R-J

Time 2, the experience of casual conversation

Time 1 - IES-R-J Time 2 intrusion, IES-R-J

with each partner (intimates, shared colleagues

Time 1 - IES-R-J Time 2 avoidance andand non-shared colleagues), and the fourIES-R-J Time 1 - IES-R-J Time 2 hyper

subscales

thearousal). the predicator variables were theexperience”, “Other’s support”, “Acceptance”

experience of the conversation with eachand “Feeling better”). The predicator variables

partner(intimates,

explained significant proportion of variance innon-shared colleagues), and the four subscales

IES-R-J Time 1 – IES-R-J Time 2 scoreof SCMC (“Sorting out the experience”,

of

SCMC

(“Sortingout

2sharedcolleagues

anddifference, R = .93, F(5) = 203.49, p<.001. The“Other’s support”, “Acceptance” and “Feelingsubscales of IES-R-J both at Time 1 and Time 2

better”).

significantly predicted the target variable,The

predicatorvariables

explained

whereas, the experience of the conversation andsignificant proportion of variance in Time 1 -SCMC had no significant effects on theTime 2 score difference for each subscale of

IES-R-J Time 1 - IES-R-J Time 2 score

IES-R-J (intrusion: R2 = .57, F(1) = 95.58,

difference. This result indicates that both thep<.001.; avoidance: R2 = .27, F(1) = 28.21,

experience ofp<.001.; hyperarousal: R2 = .75, F(1) = 212.25,

theconversation

and

the

Table 3
Summary of multiregression analysis for variables predicting the difference of IES-R-J Time 1 IES-R-J Time 2 (N = 73)
B

SE B

β

intrusion Time 1

1.15

0.09

.95

intrusion Time 2

-1.25

0.12

-.69

hyper arousal Time 1

1.20

0.14

.64

hyper arousal Time 2

-1.72

0.24

-.51

avoidance Time 1

0.37

0.08

.26

R
F

2

.93
203.49

9

CRITICAL INCIDENT STRESS OF RESCUE WORKERS
p<.001.). The results also revealed that Time 1 -SCMC (“Sorting out the experience”, “Other’s

IES-R Time 2 score differences of eachsupport”, “Acceptance” and “Feeling better”).

subscalesignificantly

Predicator variables were the experience of thepredicted by the subscale of Time 1: Time 1 -conversation with partners (intimates, shared

Time 2 score differences of intrusion wascolleagues and non-shared colleagues). As withpredicted by intrusion Time 1 (β=.76), Time 1 -the case of the analysis on the total score ofTime 2 score differences of avoidance was

SCMC, The predicator variables explained

predicted by avoidance Time 1 (β=.53), andsignificant proportion of variance in eachTime 1 - IES-R Time 2 score differences ofsubscale of SCMC with low R2 value,

hyperarousal was predicted by hyperarousal

respectively (Sorting out the experience: R2Time 1 (β=.87). These results illustrate that the= .05, F(1) = 4.71, p<.05; Other’s support: R2

process of the each symptom also has no= .07, F(1) = 6.37, p<.05; Acceptance: R2 = .08,

significant influence from the experience of theF(1) = 7.50, p<.01; Feeling better: R2 = .03, F(1)conversation and the mental condition.

= 0.63, n.s.). Once again, we just reportof

IES-R-J

weresignificant predicator variables without further
The regression analyses on changes of mental

interpretation because of the low value of R.

condition with all rescue professionals

The experience of the conversation with

Aiming to examine the effect of experience

non-sharedcolleagues

wassignificant

of casual conversation about the criticalpredicator of “Sorting out the experience”

incident on mental condition, we conducted a(β=.25)

stepwise multi-regression analysis on total

Moreover, “Acceptance” was significantly

score of SCMC. Predicator variables were thepredicted by the conversation with sharedexperience of the conversation with eachcolleagues (β=.31).

partner (intimates, shared colleagues andnon-sharedcolleagues).

The

and

“Other’s

support”(β=.29).

Given that low R2 value, we can indicate thatpredicator

the experience of the conversation about thevariables explained significant proportion ofcritical incident has no significant effect on

2variance in total score of SCMC (R = .05, F(1)mental condition.

2= 4.65, p<.05) although the value of R wasquite low. Considering the low value of R2, we

Discussions

just report significant predicator variables

We revealed the general prevalence of PTSD

without further interpretation. The experience

symptoms among rescue workers at two points:of the conversation with non-share colleagues

just after the critical incident and seven months

significantly predicted the change of mental

or one year after the Great East Japan

condition (β=.25).

Earthquake. We also obtained the results that

Next,

we

also

conducted

stepwisethe experience of casual conversation about themulti-regression analyses on four subscales ofincident was not predicted by both PTSD

10

USAMI, KATO and WAKASHIMA

symptoms and mental condition. We give some

operation at four and a half year after theconsiderations on the results at this section.

earthquake.

High

risk

PTSD

symptoms

appeared to 16.3% of firefighters with highIES-R-J score by the occupationlevel of exposure, who had engaged in field

We obtained the score of IES-R-J at two

operation and reported severe mental strain

points: just after experiencing of the criticalafter facing the critical incident, 12.4% of thoseincident (Time 1) and seven months to one year

who have had no field operation, 5.8 % ofafter the operation (Time 2). The response of

newly employed workers without experiencing

Time 1 was drawn as retrospective answer.

the operation on the Hanshin earthquake, andPrior studies (Hyogo Institute for Traumatic

4.1 % of those who with low level of exposure,Stress, 1999: Matsui et al., 2011) have applied

who have had engaged in field operation andthe same methodology to assess PTSD

reported no severe mental strain after facing thesymptoms. However, future studies should becritical incident. The mean score of intrusion

examined the reliability of the retrospective

subscale was higher than that of both avoidance

data on PTSD symptoms.

and hyper arousal subscales among the

Hyogo Institute for Traumatic Stress (1999)

firefighters with different operation experience.

reported the percentage of high risk population

Moreover, Hyogo Institute for Traumaticof PTSD among firefighters at two points: (1)Stress (1999) presented the process of PTSD

13 months and (2) four and a half year after thesymptoms among firefighters with high level ofHanshin Earthquake. The researchers classified

exposure. The approximately 60% of them had

the participants as high risk with the 20 points

the symptom ator higher of the total score of IES for 13

earthquake, and 43.2% at half year later, 27.2%

months later and 25points or higher of the total

at a year later, 15.9% at two years later andscore of IES-R-J for four and a half year later,

8.7% at the four and a half year later,

respectively. At 13 months later, the amount ofrespectively.

three month after the

15.9% of local firefighters who lived in the

The results of this study showed that theaffected area was categorized into high risk

13.5 % of firefighters was classified as highpopulation of PTSD. As for the firefightersrisk of PTSD at seven months after the Great

deployed from other areas at the same point inEast Japan Earthquake. No rescue divers andtime, high risk PTSD symptoms appeared at the

SRT exhibited severe PTSD symptoms at seventotal of 4.9% of them with early stage

months (SRT) or one year (rescue divers) after

deployment and 4.2% of them with latter stage

the earthquake. A prior study revealed that local

deployment. Hyogo Institute for Traumatic

firefighters who lived in the disaster area had

Stress (1999) also revealed that high risk

more risk of PTSD

population

theEarthquake (Hyogo Institute for Traumatic

firefighters who had experienced different

Stress, 2000).We can imply that firefighters and

of

PTSD

variedamong

after the Hanshin

11

CRITICAL INCIDENT STRESS OF RESCUE WORKERS
rescue divers of this study have higher risk offirefighters of this study, 33% of them were

PTSD because they lived in the affected area.

classified as the Non Stress group, 28% as

We can also point out that most Japanese

Resolved group, 16% as Recovered group, andrecognized PTSD for the first time at the

12% as Prolonged group and 12% asHanshin Earthquake. Inadequate knowledge of

Sustained/Worsened group. As for 16 SRT of

the symptom resulted in exaggerated news

this study, 94% of the participants werecoverage, which led to more people to rateclassified into Non Stress group; the remaining

them as high risk of PTSD after the Hanshin

participant was categorized as Recovered group.

Earthquake. On the contrary, the media might

Similarly, the most (60%) of the rescue divers

handle the PTSD symptom more adequatelyof this study was categorized into Non Stressafter the Great East Japan Earthquake, whichgroup; the remaining two participants were

resulted in less high risk population of PTSD.

categorized as Recovered group and Resolved

Meanwhile, we should mention that there wasgroup, respectively. We can argue that No

no high risk population of PTSD among rescue

Sustained/Worsened or Prolonged group among

divers in this study even though they were also

SRT and rescue divers resulted from the fact

local residents. We can interpret the resultthat they were still young (SRT: 29.00 years of

based on the fact that the rescue divers of thisage, range: 24-37; rescue divers: 24.60 years ofstudy were in their twenties. They wereage, range: 23-27). This argument might beyounger than local firefighters and might havesupported by the result of Matsui et al. (2011)

damaged their private properties and family

that the young firefighters generally did notless than the firefighters have done.

suffered severe PTSD symptoms and their

Next, we examined the process of PTSD
symptoms

byoccupationofprognosis was mostly favorable. While some

rescueprior findings indicated that there are some

professionals. A previous study investigated thecases of late onset of PTSD (Matsui et al.,critical incident of the firefighters within the2011),

ten years remembering back from the point ofunderstandable

research and the pattern of the process of theresulted from the critical incident would

PTSD symptoms from the time when they

develop after a short period of time. Our

experienced it to the present (Matsui et al.,research has already revealed that the current2011). Matsui et al. (2011) presented thestress symptom mostly results from the current

distribution of process of PTSD symptom

factors rather than the past ones (Wakashima,

among firefighters who had experienced critical

Kozuka, Itakura, & Usami, 2011). Therefore,

incident: Non Stress group (65.7%), Resolved

cases of late onset of PTSD would begroup (16.8%), Recovered group (2.1%), Latedeveloped by maladaptation to the workplace

onset group (6.8%), Worsened group (7.2%),

or worsened human relationship after bothand Prolonged group (1.4%). For the total of 52

personal and environmental changes because of

it

is

more

that

the

psychologically
PTSD

symptom

12

USAMI, KATO and WAKASHIMA

the critical incident.

association between casual conversation about

This study also showed the result that mostthe critical incident and IES-R-J score. Hence,of rescue workers experiencing PTSD symptom

we did not gain the support for effectiveness ofat Time 1 relieved their symptoms at Time 2.

informal debriefing on PTSD symptoms.

We can maintain that PTSD symptoms
generally tend to weaken as time goes.

Although the fact that we obtained the resultsthat there is no association between casualconversation about the critical incident andCasual conversation partners

IES-R-J score, there is a room for casual

All rescue workers have experienced casualconversation to be an influential factor for

conversation about their critical incident more

PTSD symptoms. We measured conversation

with intimates and shared colleagues while lessabout the trauma experience but we can alsowith non-shared colleagues. The results mightmeasurereflect the difference of frequency of daily

symptoms resulted from the experience. PTSD

interaction.

symptoms are relatively similar among victims

conversation

about

the

PTSD

even though each of their traumatic experiences
The association of IES-R-J score with theis unique. Therefore, it has large impact on

experience of casual conversation about thetreatment of PTSD to examine the effect of

critical incident and the mental condition

casual conversation about the PTSD symptoms.

Prior studies have not reached the conclusionon the effect of the debriefing on PTSD

The association of the experience of casual

symptoms.

conversation about the critical incident with

Some

of

them

supporttheadvantage (Chemtob, Tomas, Law, & Cremniter,

mental condition

1997), but others do not (Hytten & Hasle, 1989;

Given that low R2 value, our results also

Bisson & Deahl, 1994; Deahl, Gillham,

indicate that experience of casual conversation

Thomas, Searle & Srinivasan, 1994). In Japan,

about the critical incident has no significant

there is a report on the effectiveness of informal

effect on mental condition. Based on this result

debriefing for PTSD symptom (Hyogo Instituteas well as the result of the conversation on

for Traumatic Stress, 1999). The report

PTSD symptoms, we may argue that therevealed that people rated lower IES score at 13

informal debriefing about critical incident has

months after the earthquake than they did at

no effect on PSTD symptoms and mental

three months after the disaster. However, wecondition. We need to interpret the result in thecan point out that the research is not thelight of the fact that research was conductedevidence of effect of informal debriefing onseven months or one year after the Great East

PTSD symptoms because the decreasing PTSD

Japan Earthquake and the conversation of thesymptoms could result in less conversation

critical incident is a part of daily conversation.

about the incident. Our results showed the no

Conversation partners in this study (intimates,

13

CRITICAL INCIDENT STRESS OF RESCUE WORKERS
shared colleagues and non-shared colleagues)

their operation (Time 1) and seven months or

have ongoing relationship with the participants,

one year after the Great East Japan Earthquake.

which means they have a plenty of opportunity

We also examined the association of casualto have conversation. Seven months or one year

conversation about the critical incident withmight be enough periods to shift away fromPTSD symptoms and mental condition oftalking about the critical incident to more about

rescue professionals. The results indicated thatthe other topics on current life. Considering thatthe conversation has no significant influence on

the current symptom mostly results from theboth PTSD symptoms and their mental

current factors rather than those of the pastcondition.

(Wakashima et al., 2011), the result of thisgradually become weakened, the conversation

study might reflect that the current conversation

about the critical incident could contribute toon limitless topics rather than the past

PTSD symptoms and mental condition at aconversation on critical incident has an effectpoint in the past when people are sharing theon PTSD symptoms and the current mental

experience but not in the present where people

condition of rescue professionals.

talk more on the other topics.

However,wecannotunderscore

Given

that

PTSD

symptoms

theimportance of the conversation about theReferences

critical incident. This study indicates that mostof the rescue professionals have had the

Asukai, N., Kato, H., Kawamura, N., Kim, Y.,

experience of the conversation on the topic

Yamamoto, K., Kishimoto, J., & Nishizono,

with others. To have the experience of

M. A.(2002). Reliability and validity of theconversation

wasJapanese-language version of the Impacr ofexperiencing the conversation as a current

Event Scale-Revised(IES-R-J). Journal ofevent at a point in the past. Given that finding

Nervous and Mental Disease, 190, 175-182.

that the current symptom mostly results from

Bisson, J. I., & Deahl, M. P. (1994).

the current factors rather than the past

Psychological debriefing and prevention of(Wakashima et al., 2011). Therefore, thepost-traumatic stress. British Journal of

conversation about the critical incident could

Psychiatry, 165, 717-720.

means

that

peoplecontribute to PTSD symptoms and mental

Chemtob, C. M., Tomas, S., Law, W., &condition at a point in the past when people are

Cremniter,D.

(1997).

Postdisastersharing the experience.

psychosocial intervention: A field study ofthe impact of debriefing on psychological

Conclusions
This study clarified the general tendency andthe process of rescue workers’ PTSD symptoms
just after experiencing a critical incident during

distress. American Journal of Psychiatry,
154, 415-417.
Deahl, M., Gillham, A. B., Thomas, J., Searle,
M.

M.,

&

Srinivasan,M.

(1994).

14

USAMI, KATO and WAKASHIMA
Psychological sequelae following the Gulf

Japan local government employee safety andWar. Factors associated with subsequent

health association (2006). Shoubou Syokuin

morbidity

no

and

the

effectiveness

of

Genba

nikakawaru Stress

Taisaku

psychological debriefing. British Journal of

Follow-up Kenkyukai Houkokusyo (A report

Psychiatry, 165, 60-65.

of measure of stress on firefighters). Tokyo:

Everly, G. S. Jr., & Mitchell, J. T. (1997).

Japan local government employee safety

Critical incident stress management. A newand health association. [in Japanese] (財団era

in crisis

法人地方公務員安全衛生推進協会

intervention 2nd edition. Ellicott City, MD:(2006). 消防職員の現場に係わるストレChevron Publishing Corporation.

ス対策フォローアップ研究会報告書).

andstandard ofcare

Hyogo Institute for Traumatic Stress (1999).

Kawase, T. (1999). Kanjo wo Kataru Riyu (The

Hijouzitai Stress to Saigaikyuzyosya no

reason to talk). Bulletin of Miyazaki

Kenkozyotai

Cyosakenkyu

Municipal University Faculty of Humanities

Hokokusyo. (A report of critical incident

7(1), 135-149. [in Japanese] ( 川 瀬 隆 千

stress and health condition in rescue(1999). 感情を語る理由：人はなぜネガ

professionals). Kobe: Hyogo Institute for

ティブな感情を他者に語るのか. 宮崎公

Traumatic Stress. [in Japanese] (兵庫県精立大学人文学部紀要 7(1), 135-149).

神保健協会こころのケアセンター

Matsui, Y., Hatanaka, M. & Maruyama, S.

(1999), 非常事態ストレスと災害救援者(2011). Late-onset critical incident stress inの健康状態に関する調査研究報告書―

fire fighter in Japan. Japanese Journal of

阪神・淡路大震災が兵庫県下の消防職員

Interpersonal and Social Psychology, (11),に及ぼした影響―).

43-50. [in Japanese] (松井nikansuru

Hyogo Institute for Traumatic Stress (2000).
SaigaikyuzyosyanikansurunoShinriteki

Cyosakenkyu

Eikyo

Hokokusyo(Areport of the mental health of rescue

豊・畑中美穂・丸山 晋 (2011). 消防職員における遅発性の惨事ストレスの分析. 対人社会心理学研究 (11), 43-50).
Ohoka,

Y.,

Tsuzimaru,

S.,

Ohnishi,R.,

professionals). Kobe: Hyogo Institute for

Fukuyama, H., Yazima, J., & Maeda.,

Traumatic Stress. [in Japanese] (兵庫県精M.(2006). A report on actual conditions of

神保健協会こころのケアセンター

mental health for firefighters. Bulletin of(2000). 災害救援者の心理的影響に関す

faculty of literature, Kurume University:

る調査研究報告書―阪神・淡路大震災がSocial Walfare, 6, 85-95. [in Japanese] (大消防職員に及ぼした長期的影響―).

岡由佳・辻丸秀策・大西 良・福山裕夫・

Hytten, K., & Hasle, A. (1989). Fire fighters: A

矢島潤平・前田正治(2006). 消防隊員の

study

of

Psychiatrica

stressandcoping.

Scandinavica,

Supplementum, 50-55.

Acta

メンタルヘルスについての実態調査報80,

告. 久留米大学文学部紀要, 社会福祉学科編 6, 85-95).

CRITICAL INCIDENT STRESS OF RESCUE WORKERS
Tanouchi, K. (2005). A survey on criticalincident stress experienced by disaster
response

professionals:

Fire-fighting

personnel. Journal of Azabu Universiy,
21-32. [in Japanese] (田之内厚三 (2005).
職業的災害救助者の惨事ストレス調査 :消防職員を対象として. 麻布大学雑誌 ,21-32.)
Wakashima, K., Kozuka, T., Itakura, N., &Usami, T.

(2011).

Simultaneous andcumulative family relationship: Examining
with ICHIGEKI. International Journal of
Brief Therapy and Family Science, 1(2),104-110.
Weiss, D.S., & Marmar, C.R. (1997). The
Impact of Event Scale-Revised. In Wilson,
J.P., & Keane, T.M. (Eds.), Assessing
psychologicaltrauma

and

PTSD:

A

practitioner’s handbook (pp. 399-411). New
York: Guilford Press.

15

International Journal of Family Science
2012, Vol. 2, No.1, 16-22.

Development of the Scale on Symmetry and Complementarity in Conversation
Taku Kobayashi 1)
1)Graduate School of Education, Tohoku University________________________________________________________________________________
ABSTRACT. The purpose of this study was to develop the scale to measure the level of symmetry-complementarity (Bateson, 1936)
in dyadic conversation and to test the reliability and the validity of the scale. I developed the 25 questionnaire items and selected 13
items based on the result of item-total correlation analysis. The Cronbach’s coefficient alpha of the scale was .87, the intra-classcorrelation coeﬃcients was .58 (p<.01) and the correlation between the total scores of the SSCC and actual communication score
evaluated by the coding system (FRCCCS ; Heatherington & Friedllander, 1987) was .64 (p<.01). The results indicated that the
Scale on Symmetry and Complementarity in Conversation (SSCC) possesses high internal consistency, inter-rater reliability andcriterion-referenced validity.
KEY WORDS: conversation, symmetry, complementary, Scale on Symmetry and Complementarity in Conversation (SSCC)

findings of family structure and family function.

Introduction
In psychiatry the frame around the individual

However, these concepts are abstract and nothas been broken, and questions about why aeasy to observe. These findings may not satisfy

man does what he does are being answered in

the needs of therapeutic practice.

terms of the context of relationships he creates

Therefore, it is important to identify theand inhabits. The direct manifestation of thispractical method to achieve and understandchange that caused by the continuing emphasis

healthy family with conceptual frameworks thatupon interpersonal relations over the years andare concrete and easy to observe for clinicalthe development of ideas about systems is inpractice.

the field of family research and family therapy.

Watzlawick, Beavin, and Jackson (1967)

Couples and whole families are being brought

pointed out that communication is observable

under systematic observation (Haley, 1977).

and reflects interpersonal relationship. Rogers

Most clinicians have concerned about family
structureandfamily function

toand Escudero (2004) also argued that social

assessrelationships lie at the heart of our humanness,

problematic families. We have obtained theand in turn, communication lies at the heart ofourrelationships.

As

just

described,

to

CORRESPONDENCE TO KOBAYASHI, Graduate School

understand and help problematic interpersonalof Education, Tohoku University, 27-1 Kawauchi, Aoba-ku,

relationships (i.e. family), communication is

Sendai-city, 980-8576, Japan.

focal because interpersonal behavior are better

E-mail: t_5884@live.jp

described by transactions, observable andquantifiable behaviors (Haley, 1963).

16

KOBAYASHI
Communications has been classified into

explaining

symmetry and complementary since Bateson’s

process.

work (Bateson, 1936). These concepts were

Most

17
interpersonalofresearchers

communication

have

examinedoriginally way of differentiating behavior

symmetry and complementary with the coding

patterns within and between culture groups.

system such as Relational Communication

Subsequently, these concepts have applied toControl Coding System (RCCCS: Ericson &smaller groups such as dyadic relationship.

Rogers, 1973) and Family Communication

Symmetry refers to the communication based

Controlon similarity between persons (i.e. relationship

Heatherington & Friedllander, 1987). The

in rivals competed for performance.), anddisadvantage of these coding systems is tocomplementary refers to the communication

require enormous time and effort for researchbased on difference between persons (i.e.

and clinical assessment of symmetry andrelationship between caregiver and their child)complementary. Thus, in this study,(Wakashima & Hasegawa, 2000).

to develop the self-report questionnaire that

Coding

System(FRCCCS:

I aimedResearchers of communication who use

assess symmetry and complementarity offramework of symmetry and complementary

dyadic conversation and examined reliability

have focused on the association between socialand validity of the scale.

context

andcommunication

pattern.

Heatherington and Allen (1984) tested theMethods

association between gender and communication

Development of Questionnaire

patterns in an outpatient therapy setting.

I developed 25 Japanese written items (seeHeatherington and Friedlander (1990) tested

Appendix 1) based on coding systems (RCCCS

the association between treatment modality

and FRCCCS) and past discussions about(couples and family) and communication

conceptual imprecation of symmetry andpatterns.

andcomplementary (Bateson, 1942; Sluzki &Wildman (1991) tested the association between

Beavin, 1977). Each item asked about nature oftherapeutic approach (structural family therapy

everyday communications between dyad and is

and Milan systemic family therapy) andrated on 6-point Likert-style scale ranging from

communication patterns. According to a recent“rarely” (=1) to “always” (=6). Higher score

study in this area, to classify interpersonal

indicates symmetrical conversations are morecommunication

into

symmetryandfrequently between them. I named this scale ascomplementary isusefultothe

Scale on Symmetry and Complementarity inFriedlander,

Heatherington,

predict

following communication pattern from precede

Conversation (SSCC).

theParticipants

communication

pattern(Kozuka&

Wakashima, 2009). As described above, theseresearches

have

yield

benefits

towards

Data were drawn from 15 intimate dyads ofJapanese college students and postgraduate

18

SCALE OF SYMMETRY AND COMPLEMENTARY

Step1

Step2

Group1

Answering both

Participating(8pairs)

SSCC and QCS

10-minutes discussion

Finished

Group2

Answering

Participating

Answering(7pairs)

QCS

10-minutes discussion

SSCC

Step3

Figure1. Experimental process for each groupstudents who majored in clinical psychology

applied as their discussion theme. I recorded(mean age of the participants was 25.23,

conversation in the discussion session with

SD=3.57). I applied all data for following

video and evaluating it with FRCCCS.

analyses.

Two researchers independently evaluated one

Experimental Processof randomly selected VTR data depending on

To control order effect, participants were

FRCCCS. As for the degree of agreement ofrandomly assigned to two experimental groups

evaluated codes between two raters, kappa(Figure1).

coefficient (κ) was .84. Subsequently, only one

Each dyad participated in a 10 minutesof the two raters conducted the coding of the

discussion session. Six discussion topics wererest of VTR data. I used FRCCCS as external

cited

criterion of symmetry and complementarity

fromwebsite(http://www.ic.nanzan-u.ac.jp/~tsumura/kyouza
ikoukai/kyouzaikoukai.html:

browsedobserved in conversation.

on

September 2011). All topics are about people

Results

how get out of critical situation in mountain

First, I conducted item-total correlation

climbing. These topics are called Questions ofanalysis for the selection of question items of

Critical Situations (QCS) in this paper. The

SSCC. The result of analysis was shown atquestion that dyads have different opinion was

Table1.

Table1. The result of item-total correlation analysis
Adjusted item-total correlation coefficient
Item 1.72

Item 10.36

Item 19.46

Item 2.67

Item 11.08

Item 20.45

Item 3.58

Item 12.04

Item 21.29

Item 4.54

Item 13.53

Item 22.26

Item 5.52

Item 14.64

Item 23.00

Item 6.62

Item 15.62

Item 24.01

Item 7.52

Item 16.62

Item 25.26

Item 8.18

Item 17.34

Item 9.61

Item 18.59.

Note. Underlines indicate that these items were selected as the result of item-total correlation analysis.

KOBAYASHI
I

deleted

12

items

whose

item-total

that

19
symmetry-complementarity

ofcorrelation coefficient was lower than .50. 13

interpersonal relationships could evaluated data

items were selected as the items of SSCC based

from only one-rater of dyad.

on the result of item-total correlation analysis

show that SSCC is useful and low-cost tool to(see APPIDEX 2).

assess interpersonal relationships.

These results

Second, internal consistency for this scale

In study area of family therapy, researchers

was examined with Cronbach’s coefficient

have pointed out that the importance of seeingalpha. The alpha was .87. The result indicatesfamily as multigenerational when interveningthat SSCC has high internal consistency. Third,

the family system (Kobayashi et al., 2011).

inter-rater

reliability

for

was

Nevertheless, researches about symmetry andexaminedwithintra-classcorrelation

complementary have been conducted to limited

coeﬃcient (ICC). ICC was .58 (p<.01). The

small groups such as couple and therapist-client.

result indicates that SSCC has moderate

Behind of this issue, the disadvantage of theinter-rater reliability. Therefore, I randomly

coding systems is presumed to exist. The

selected the SSCC data from one-participant ofcoding systems such as RCCCS and FRCCCS

each dyad when I evaluate criterion-referenced

are only applicable when researchers canvalidity.

observe

this

scale

Finally, criterion-referenced validity

actualcommunication

betweenwas examined with Pearson Product-moment

participants. Therefore, researchers have not

Correlation Coefficient (r) between scores ofused these coding systems to bigger groups

SSCC and scores evaluated by coding systemsuch as multigenerational family relationship.

(FRCCCS). r was .64 (p<.01). The result
indicatesthat

criterion-referenced

SSCC

has

validity

as

scale

On the other hand, SSCC developed in thishighstudy is a self-report questionnaire. Therefore,ofresearchers can collect enormous data more

symmetry and complementarity.

easily with SSCC than those with actual

As for the descriptive statistics value, I show

observation and the existing coding systems.

them at APPIDEX3.
References
Bateson, G. (1936). Naven: A Study of theDiscussions

The purpose of this study was to develop the

Problems suggested by a Compsosite Picture

scale of symmetry and complementarity ofof the Culture of a New Guinea Tribe Drawn

conversation (SSCC). Additionally, I examinedfrom Three Points of view. Stanford: Stanford

the reliability and validity of the scale.

University Press.

The results indicate that SSCC possesses
highinternal

consistency

and

high

Bateson, G.

(1942). Morale and National

Character Watson, G.(ed)., Civilian Morale:criterion-referenced validity. Moreover, SSCC

71-91, Boston: Houghton Mifflin.

also possesses inter-rater reliability. It indicates

Ericson, P. M., & Rogers, L. E.

(1973).

20

SCALE OF SYMMETRY AND COMPLEMENTARY

New procedures for analyzing relational

Kobayashi, T., Itakura, N., Usami, T., Sato, M.,communication. Family Process, 12, 245-267.

Shimizu, A., & Wakashima, K. Predicators forFriedlander, M. L., Heatherington, L., &Marital Cohesiveness in three-generation

Wildman, J. (1991). Interperonal control infamily. International Journal of Brief Therapy

structural and Milan systematic family

and Family Science, 1(2), 117-122.

therapy. Journal of Marital and Family

Kozuka, T., & Wakashima, K. (2009). The

Therapy, 17, 395-408.

typology and change of human relations

Haley, J. (1963). Strategies of psychotherapy.

based on communication patterns: From the

New York: Grune & Stratton.

viewpointofPragmatics

ofHaley, J. (1977). Toward a Theory ofCommunication.

Japanese

JournalPathological Systems.

Counseling Science, 42(1), 1-10.

Watzlawick, P., &

Human
of
[In

Weakland, J. (eds.). The Interactional View，Japanese] (狐塚貴博・若島孔文 (2009). コ

31‐49. New York: W. W. Norton &ミュニケーション・パターンによる関係

Company.

性の類型と変化―人間コミュニケーショ

Heatherington, L. & Allen, G. J. (1984). Sex

ンの語用論の視点から― カウンセリン

and relational communication patterns in

グ研究 42(1), 1-10).

counseling.

JournalofCounseling

Sluzki, C. & Beavin, J. (1977). Symmetry andPsychology, 31, 287-294.

Complementarity： An Operational Definition

Heatherington, L. & Friedlander, M. L.

and a Typology of Dyads． Watzlawick, P., &(1987). Family Relational Communication

Weakland, J. (eds.). The Interactional View，Control Coding Manual. (Available from71‐87 ． New York: W. W. Norton &Laurie Heatherington, Psychology Department,

Company.

Bronfman Science Center, Williams College,

Tsumura, T. Tsun Tsun no taiken kara manabou.

Williamstown, MA 01267 USA).

http://www.ic.nanzan-u.ac.jp/~tsumura/kyou

Heatherington, L., & Friedlander, M. L. (1990).

zaikoukai/kyouzaikoukai.html browsed onComplementary and symmetry in family

September 2011. [In Japanese] 津 村 俊 充

therapy. Journal of Counseling Psychology,

つんつんの体験から学ぶ 2011 年 9 月閲覧.

37, 261-286.

Wakasima, K., & Hasegawa, K. (2000). Brief

Heatherington, L., & Friedlamder, M. L. (2004)

Therapy : Theory & Practice.

Tokyo:

From Dyads to Triads, and Beyond: Relational

Kongo Shuppan. [In Japanese] (若島孔文・

Control in Individual and Family Therapy.

長谷川啓三 (2000). 短期療法ガイドブッ

Rogers, L. M., & Escudero, V. (eds.).

ク 東京: 金剛出版).

–An

Watzlawick, P., Beavin, J., & Jackson,D. D.

Interactional Perspective to the Study of(1967). Pragmatics of Human Communication.

Process

New York: W. W. Norton & Company.

RELATIONAL

andRoutledge.

COMMUNICATION

Form.

193-129,

London:KOBAYASHI

21

APPIDEX1. 25 items of SSCC before item-total correlation analysis
1

あなたは、その相手と意見がなかなか合わなくとも、納得いくまで意見を主張する

2

あなたは、その相手から頼みごとをされたとしても、気乗りしなければ素直に断る

3

あなたは、その相手と違う意見を持っていたとしたら、それをその相手に伝える

4

あなたは、その相手からの頼みであれば、断らずに引き受ける

5

あなたは、その相手が出す意見には賛成する

6

あなたは、もしもその相手の言っていることや態度に納得いかないことがあっても、それを相手になかなか伝えられない7

あなたは、その相手との会話の中で自分が話したい話題から外れてしまったとしても、その話題へ戻るまで自分から軌道修正をする

8

あなたは、その相手との会話では自分が話したい話題やテーマよりも、その相手が持ち出す話題やテーマを優先する

9

あなたは、その相手と意見がかみ合わない時は、自分から譲歩して相手の意見に合わせる

10

その相手は、あなたの意見について賛成してくれる

11

その相手は、あなたからの頼みごとを、断らずに引き受けてくれる

12

その相手は、最初はあなたと違う意見を持っていたとしても、話しをしているうちにあなたの意見
に同調する

13

その相手は、あなたが話している最中であっても、割って入って自分の考えや意見を伝える

14

その相手は、あなたの意見に対して、「でも」や「だけれど」などの言葉を使って返答する

15

その相手は、あなたがその相手とは異なる意見を言ったりその相手に対して反論したりしても、すぐには意見を変えない

16

その相手は、あなたの意見や考えに対して反論する

17

その相手は、あなたとの会話の中で、自分自身よりもあなたの話したい話題やテーマを優先する

18

その相手は、あなたとの会話の中で、自分から新たな話題を提供したり、話題を変えたりはしない

19

あなたは、その相手に対して自分の考えを積極的に言うよりも、その相手の立場や意見に従っている方が気楽だ20

あなたは、その相手が自分に対して強く出てくると萎縮してしまう21

あなたは、その相手の成功談を聞くと自分も頑張らなければという気持ちになる22

あなたは、その相手とのやり取りの中で、お互いの意見や考え方が一致していると感じることがある

23

あなたは、その相手と持ちつ持たれつの関係を築いている24

あなたは、その相手と話す時、どちらかが一方的に話すよりもお互いに意見を出し合う方だ25

あなたは、その相手と議論になった際、相手からの反論があった方が熱中する

Note. Items with underline indicate that these items are reversed score items.

22

SCALE OF SYMMETRY AND COMPLEMENTARYAPPIDEX2. 13 items of SSCC after item-total correlation analysis
以下の各項目では、あなたとこれから会話を行う相手との普段のやり取りについて、お尋ねします。各項目について、あなたの考えに最も近い番号を 1 つ選び○をつけて下さい。
1

あなたは、その相手と意見がなかなか合わなくとも、納得いくまで意見を主張する

2

あなたは、その相手から頼みごとをされたとしても、気乗りしなければ素直に断る

3

あなたは、その相手と違う意見を持っていたとしたら、それをその相手に伝える

4

あなたは、その相手からの頼みであれば、断らずに引き受ける

5

あなたは、その相手が出す意見には賛成する

6

あなたは、もしもその相手の言っていることや態度に納得いかないことがあっても、それを相手になかなか伝えられない7

あなたは、その相手との会話の中で自分が話したい話題から外れてしまったとしても、その話題へ戻るまで自分から軌道修正をする

8

あなたは、その相手と意見がかみ合わない時は、自分から譲歩して相手の意見に合わせる

9

その相手は、あなたが話している最中であっても、割って入って自分の考えや意見を伝える

10

その相手は、あなたの意見に対して、「でも」や「だけれど」などの言葉を使って返答する

11

その相手は、あなたがその相手とは異なる意見を言ったりその相手に対して反論したりしても、すぐには意見を変えない

12

その相手は、あなたの意見や考えに対して反論する

13

その相手は、あなたとの会話の中で、自分から新たな話題を提供したり、話題を変えたりはしな
いNote. Items with underline indicate that these items are reversed score items.
SSCC is developed in Japanese. Regarding translation into English, please contact to theauthor. Complete questionnaire including instruction words is also available from the author.
E-mail : t_5884@live.jp

APPIDEX3. Descriptive statics values of SSCC
Mean score

44.47

Standard deviation

8.23

Maximum score

61

Minimum score25

International Journal of Brief Therapy and Family Science
2012, Vol. 2, No.1, 23-25<Case Report>

A Case of the Girl Who Reframed the Death of Her Father
Shuhei Iwamoto1)
1)

Doshisha Junior and Senior High School

KEY WORDS: wrist-cutting, grief work, reframing

The client was a ninth grade’s girl who
complained

that

she

could

not

came to the nurse’s office, she told the nurse

stopthat she cut her wrist habitually. The teacher let

wrist-cutting. In her treatment period, her father

her see to a psychiatrist and she started todied. She could find the meaning of his death

receive the treatment. Her overdosing made her

and she finally overcame various difficulties. In

grandmother to control her medicine. In

this report, I present the assessment, theJanuary when she was in the ninth grade, sheintervention and the consequence of this case.

knew that her father remained only a short time

Interview process

to live because he got cancer. After hearing the1) Character of the client

fact, she cut her wrist in the restroom at the

When the client was in the sixth grade, herstation.

parents got divorced. Her mother often left her

When she was in junior high school, sessions

and her younger brother at her grandmother’s

were held once a week. After entering highhouse because she started to work at aschool, sessions were held once a month, and anightclub. When she was in the eighth grade,

total of 12 sessions were carried out.

she cut her wrist for the first time, thinking ofher one-time boyfriend. A month later, her

Sessions before her father’s death

mother knew that the client sometimes cut her(#1:January 22, X～#4:February 12, X)

wrist, and after that the mother frequently said

Describe her solution

to her daughter “I can’t concentrate on my

In the first session, the client said, “If Mom

work because you are a worry to me! Get out ofand I calm down our nerves, I don’t need tothis house!” After a few days, when the client

take medicine and we can be a peaceful family.
That’s the solution.” She also told that she cut

CORRESPONDENCE TO: Iwamoto, Doshisha Junior andher wrist when she did not feel needed by the

Senior High School, 89, Iwakura Osagichou, Sakyoku,

people around her.

Kyoto-city 606-8558, Japan.

Interventions from counselor
The counselor suggested the client 1) not toe-mail: eto1503@yahoo.co.jp

stop cutting her wrist and 2) to search for small

23

24

IWAMOTOhappiness (positive change) in her daily life.

her father’s death. She said, “I wished that my

Positive changes

dad live long. Therefore, I should not cut my

The client reported, “I can be relaxed when

wrist anymore. It’s my dad’s happiness to keep

I’m with my favorite teacher.” (#2) In addition,myself in good health and be happy.” She

she reported, “When I go in my mom’s bed, shestarted to accept his father’s death. (#8) Her

hug me tightly.” and, “I can calm down talking

cousin was born on the day her father waswith the nurse teacher or the counselor.” (#3)

diagnosed as that he could not live long. She

In her fourth session, she reported that her

believed that there was a precious destiny

friends supported her and teachers understood

between her father and her cousin. She came toher difficulties. She told that thinking her

take care of him eagerly and talk about theparted boyfriend had no longer caused her tohope to live.

cry and wrist-cut.

Interventions from counselor

About her father

The counselor suggested the client 1) to take

The client reported that her father was inmuch time to accept her father’s death and 2) tocritical condition. She thought he was a herosearch for whatever she saw positive (positivefor her. She wanted to do something for him butchanges).

she had no ideas. She grieved, “Why my dad
will die? I wish I had cancer instead of him.”

Positive changes

Interventions from counselor to “A”

Her grandmother suggested the client to talk

The counselor suggested the client 1) toabout the relation with her mother. As a result,

think about how to make her father a “hero”

the relation with her mother became stable.

and 2) bake cookies to respond to her father’s

After that, she told that she was getting well

request.

and enjoying her part time job. At the 12th
session, she told that she had conflicts with her

Sessions after her father’s death

mother, but she could handle the problem by(#6:February 26, X～#12:August 27, X)

talking with her grandmother.

About her father
On February 22 of X, the client’s father died

Decision of what to do after graduationof cancer. She was worried about whether it

The client started to talk about her career path.

was a burden to her father that she visited him

She talked with her homeroom teacher andin the hospital. She regretted and said, “I should

school nurse and decided to change her school

die instead of him because I often cut my wrist.”

to be a beautician.

In this stage, she could not accept her father’s
death, while she felt his love. She said, “My

After changed school

dad called me ‘princess’ in E-mail.”(#6) SheIn December, X, the client moved to her new

started to think her wrist-cutting in relation toschool. In May, X+1, she told the counselor

REFLAMING OF THE DEATH OF FATHER

25

that she stopped wrist-cutting and passed theother way to be happy, she changed her career

credits. She came to be on good terms with herpath and school to become a beautician.

mother.

In this case, her father gave her the reason forliving. Yokohori (2000) stated that grief is not

Discussions

cured by someone, but the person who has lost1) Vicious circle

someone or something tries to reorganize

The client cut her wrist when her motherhis/her experiences, finds the meaning of theblamed her. The mother also blamed her whenloss and gets the power from it, with a support

she saw her daughter

from the people around him/her.

wrist-cutting. At firstsession, the counselor asked her to search for

As a conclusion, the main point of this case is

the positive change in her daily life and not tothat she restructured the meaning of her father’sstop wrist-cutting. Then she found that she wasdeath, overcame her problem and found the

supported by the people around her. That madenew career path.

her feel needed by them. I can maintain that thesense of feel needed reduced her wrist-cutting.

References
Yokobori, M. (2000). Possibility and Needs of2) Her father’s death and her change

the Grief Work Practice in the Japanese welfare

The client tried to feel her existence with

Institution.

wrist-cutting because she felt nobody needed

Woman’s Junior College, 54, 151-178. [inher. The relationship with her mother, one-time

Japanese] (横堀boyfriend, and father made her depressed. As

おけるグリーフワーク～実践の可能性と必the treatment was progressing, she started to

要 性 . 青 山 学 院 女 子 短 期 大 学 紀 要 , 54,

search for her positive change and found that151-178.)

her teachers, friends and family have supported
her. She had the chance to realize her resources
and a fact that people helped each other to live.
Wrist-cutting had been necessary for her tocalm down herself before, but after her father
died, she thought wrist-cutting made her father
sad and must not be done. She was willing to
do something for her father. Therefore, she
stopped her wrist-cutting. She had a desire to
make her father happy. To make him happy, shethought she had to become happy. “For her
father” became a good message for her. As the

Journalof

AoyamaGakuin昌子 (2000). 福祉現場にInternational Journal of Brief Therapy and Family Science
2012 Vol. 2, No.1, 26-29<Case Report>

Letter Approach to Depressed Patient with Parent-child Conflict
Yu Itoh1)
1)

Uji oubaku Hospital

KEY WORDS: parent-child conflict, letter approach, resistanceIntroduction

The client

The report is a case that a therapist applied

The client was a woman in her twenties. Her

letter as an intervention. The advantage of thisfamily: Father was consisted of mother, thetechnique is to lower the level of interaction

client, and her younger brother. She had athan that of face-to-face communication.

partner whom she hoped to marry but her

Communication with letter does not sendfamily opposed her to do with him. Her

non-verbal messages such as facial expression

diagnosis was clinical depression. Her main

and tone of voice. It gives a benefit of thatcomplaint was deteriorated relations withsender can send conflict-provoking messages tofamily and to have difficulty in recuperating at

the receiver without conflict. However, whilehome. She also tended to drive herself

the letter approach may be an easy method tocornered.

implement, it cannot be familiar for client to do.

Details Leading to Interview:

Therefore, in order to introduce the intervention
successfully,

itishighlyimportant

The client had been bullied in elementarytoand junior high school. She went on to graduate

effectively deal with client's resistance as

from a technical school and started to work.

therapist do before proposing any interventions.

Two years after beginning to work, stress fromI report the case applied letter approach. The

the job led to loss of sleep, dizziness andsessions were held with a female in her

emotional instability and a local doctor

twenties who was an in-patient with clinicaldiagnosed her with clinical depression. She

depression and who had conflict with herbegan to recuperate at home but her parents'

mother.

(specifically her mother's) understanding andcooperation for her symptom was insufficient.
Family relations also deteriorated. The doctor

CORRESPONDENCE TO: ITOH, Uji Oubaku Hospital,

determined that these conditions would have a32-1 Gokajo Sanbanwari, Uji-city,Kyoto 611-0011, Japan.

negative effect on the treatment. Hence, thee-mail: nfbtkyoto@gmail.com

doctor decided to admit her to the psychiatrichospital in which I (therapist) worked. The
26

ITOH

27

purpose of this hospitalization was to put

disqualify the subject. As a result, there had

distance between the client and her family. she

been

had a therapy with therapist once in every two

conflict-provoking topics. This vicious cycle ofweeks during her hospitalization. The total ofcommunication between parents and childeight sessions was conducted at this period (oneworked to maintain unfavorable condition atof which her parents also attended). After being

this point. On the other hand, when the client

discharged from the hospital, the session was

was careful not to speak to her parents very

conducted once a month for four months. The

much they criticized and blamed her for the fact

treatment was terminated with a total of 12

thatsessions.

Consequently, she thought, “No matter what I

no

her

conversation

sickness

was

on

not

their

improving.

say nothing works,” and began to feel a sense
Assessment: attempted solutions and viciousof powerlessness that only heightened her

circlesfeelings of depression.

At her intake session, the client talked about

The suggestion from her doctor of her

her episodes: “My parents (especially myhospitalize in order to put distance between themother) say harsh things like when it is goingclient and her parents could also work as ato get better and call me a good-for-nothing.

vicious communication circle between them.

They have also had a tendency to over-interfere

The visitations of and telephone conversations

from long ago”, “I feel like I'm causing a lot ofwithtrouble for my family because of my sickness

frequently became disputes, which made her

and it makes me cry” and “I feel like it would

emotionally instable. Even though those aroundbe better if I didn’t exist.” It was obvious thather gave the client a advice to put distancethese thoughts strengthened her feelings of

between herself and her parents, she believed

self-reproach and her pessimistic thought.

the idea that “If I never talk then things will

Moreover, the fact that her parents showed anever change.” That is, it seemed as though she

strongly negative and oppositional attitudebelieved that she must absolutely speak withtowards the partner to whom she washer parents. Therefore, as she strongly opposedconsidering getting married was another largeanystressor.

communicating with her parents and place

She had attempted to solve the problem. She
first tried to talk with her parents about theirherparents

intervention

duringthat

hospitalization

would

stop

distance from them, the conflict-provoking
situation remained unchanged.

relations and her marriage. However, whenever
she tried to talk on these conflict-provoking

Interventions and Consequences

topics, her parents criticized her saying “You

Based on the assessment, the therapist

are the reason that our family is in such a bad

introduced for the client to communicate withcondition”

her parents with letter (#2). Five conditions

and attempted to

avoid and28

LETTER APPROACH

were set to implement the letter approach foron conflict-provoking topics with written letters,

communication: 1) including words of gratitude,

not with face-to-face interaction.

2) not making the letters frequent, 3) to

Thereafter, no letters came from her parents

continue sending letters regardless of whether

for a while. After being discharged from theor not a reply is received (because there is a

hospital, the parents began to talk with theirhigh possibility that the parents may take muchdaughter about the partner and marriage. This

time to respond and cannot determine what to

was a large change for the parents-child relation

write straight away), 4) put important topics

because parents had been unwilling to talk(topics of conflict) into the letters, and 5) toabout the topics with their daughter. Throughkeep face-to-face conversation as superficial as

the written letters, her parents had room to facepossible (For example, talking about vacationthese conflict-provoking issues and it resulted

or about a pet).

in some developments on their relations.

Moreover, upon presenting the intervention,

Afterwards, the client came to live alone andto respect the efforts the client had made so far,change her job. Furthermore, her parents

the therapist explained, “You’ve been trying sosurprisingly approved her to marriage. Her

hard to talk about important things but it seems

mother still tended to over-interfere but she

like your parents are unable to understand whatcame to be able to deal with that and maintain ayou really want to say.” The aim of this remark

stable mental condition. After the twelfthof therapist was to motivate her to agree on thesession, she said “I believe I can go forward

letter approach.

from here” and so the therapy was terminated.

At the third interview, a positive change inparent-child communication was shown as the

Discussions

client reported that “I received a reply from my

We discuss the case with five terms for themother and it seems our relationship hasletter approach. First term was including words

changed greatly. We've made progress.” Hence,of gratitude: This term is important for thein fourth session or later, the therapist aimed toclient to obtain a cooperative response from themaintain the positive change.

parents.

However, before the seventh session, theThe second term was not making the lettersclient handed to her parents her a letter

frequent. At first the client was prone to try

concerning her partner and marriage and theextremely hard to write many letters but thisparents read it on the spot. Her mothercaused her to tire and made the letters hard tointeracted with the client negatively as she had

continue. Therefore, the therapists told her thatdone before. This made her relapse her

she should “continue slowly but surely over adepressive symptom. Once again, the therapist

long period of time without getting too worked

coped with this incident by letter approach.

up over it.”That is, the therapist asked the client to discuss

The third term was to continue sending

ITOH

29

letters regardless of whether or not a reply iscommunication while retaining the opportunity

received. This term was effective to give ato speak face-to-face.

positive meaning to the lack of responses

We can indicate that therapist should

paradoxically. It also worked that the client did

introduce

letterapproachwithsecuring

not feel anxiety about the lack of responses andopportunities for face-to-face communication.

prevented herself from the risk that she fell
back

into

the

same

viciouscircleofcommunication as before.

References
Hanada, R., Wakashima, K. & Ikuta, M. (2001).

The fourth one was to put important topics

Psychotherapy for client complaining of(topics of conflict) into the letters.” and thevarious

fifth was to keep face-to-face conversation asintervention by problem-interaction model.

superficial as possible. The points were to use

Psychosomatic Medicine, 5, 287-292. [inbothJapanese] (花田里欧子, 若島孔文, 生田

writtenlettersandface-to-face

problems:

diagnosis

andconversations as methods of communication

倫子.

and

まな問題を訴えるクライアントへの心

todifferentiate

communications.

the

role

In

of

these

face-to-facecommunication, the topic was limited tosuperficial

ones

level

－問題-相互作用モデルによる見立てと介入－. 心療内科, 5, 287-292.)

ofIkuta, M. (2004). Basic research and theconflict-provoking) and in letters, the topic wasapprication to clinical cases in brief therapy.

the important issues that the client truly wanted

Wakashima, K. (Ed.). Brief Therapy for

toofApplication: The Theory and Practice of

conflict-provoking). This term could work to

Psychotherapy based on Constructivism.

form a positive atmosphere between the clientTokyo: Kaneko Shobo. [in Japanese] (生田and her parents. Through letters, in which the倫子.

level of mutual interaction decreases, it was

ける基礎研究と事例への応用について.

assumed that the topics of conflict would

若島孔文 (編), 脱学習のブリーフセラ

become easier for the receiver (the parents) toピー

accept.

論と実践 (158-168). 東京:金子書房.)

communicate

(low

理療法

(2001). 不安・恐怖症状とさまざ

(high

level

Furthermore, as the client believed that she
must speak with her parents, it seemed as
though any intervention that aimed to stop
communicating at face-to-face would only
strengthen her resistance. Therefore, in thiscase, aiming to respect to her believes andvalues, the therapist introduced the treatment
that

retainthetopicsofface-to-face(2004).

ブリーフセラピーにお構成主義に基づく心理療法の理International Journal of Brief Therapy and Family Science
2012, Vol. 2, No.1, 30-32<Case Report>

The Change of Mother’s Involvement Leads to the Development of Junior HighSchool GirlAi Kamata1) 2), and Yoriko Ito1) 2)
1)

Seiwa Gakuen High School

2)

Sendai Branch, National Foundation of Brief Therapy

KEY WORDS: Black ink letter, Brief therapy, Exception

Problem behaviors

mother. This is the report of her case’s

The client was a female freshman. She

assessment and intervention.

started spending more time in the school

Characteristics of the client

nurse’s office during her club activity. Her

The client worked reluctantly, was a little

symptoms got worse, started to hyperventilate

obese and always waited until somebody had toregularly and locked herself in the bathroom fortell her what to do. Her academic performancefour hours. She also started to present the same

was also low. Besides, she frequently forgot tosymptoms at home. Furthermore, she said thatbring stuff to school and to do her homework.

she had no recollection of a minor car accident

Therefore, she had frequently received verbal

which she had on her way to school.

reprimands and advice by her homeroom

Since her schoolwork and everyday life haveteacher. the teacher sometimes needed tobeen heavily affected by these problems, we

contact her parents to encourage her to turnstarted to work on her problems. First,

them in.

considering the possibility of dissociativeHer family was a double income family. Her

disorder, we consulted her problems with thefather was a company employee who madeschoolwithfrequent business trips. Her mother worked at aadvisory teacher of her club, homeroom teacher,

hospital and she often worked until late at night.

and parents, we recommended her to visit theShedoctor. Third, we aimed to improve her

encouraged her daughter. Because of her busy

relations with her club members and herschedule, we often could not contact her whennurse.

Second,cooperating

frequently

directed,ordered,andthe client became ill at school. When the her
CORRESPONDENCE TO: ITO, 2-22-2 Sakae, Miyagino,mother came to school, she behaved as if

Sendai-city 983-0011, Japan.

nothing would had be wrong with the familye-mail: sibuyori@yahoo.co.jp

and said “the daughter and I talk about
everything each other at home.” However, the30

KAMATA and ITO

31client told us that she could never withstand herrecommended that she visited his grandmothers

mother because her mother was very smart andon the weekend, but she said she could not ask

did everything.

for a favor from her mother. She also cried andcomplained that her mother would not let her

Case illustration in detailquit her club. Eventually, we suggested her torun away from home for a while. The aim ofBecause the client became ill at club activity,

this intervention was to produce exception in

we decided to watch her carefully after

her life where she could not withstand hercommunicating with advisory teacher of her

mother. After the conference, she quickly

club and homeroom teacher. The advisory

moved to the plan and left a letter to her motherteacher was often worried about her and had

and went to her grandmother’s house bytaken her home frequently. However, herovernight bus. After this incident, her mothermother usually was away from home. We had aand grandmother discussed about the client.

parent-teacher conference and her mother said

However her mother still did not let the“Even though my daughter sometimes turns herclient quit her club and the client’s fear has

homework at the last minute, there is no

increased about attending the club activities.

problem since I watch her doing them.”

She complained about her medical condition on

At this point, the advisory teacher of her clubthe day of a school event, and got permission

had not understood the relationship between her

for early dismissal. Four hours later, One of theand his club members yet because he had beenteachers checked the bathroom and found her,just appointed the job at the beginning of thisleaned on the toilet. We saw the “dissociative

school year. We collected the information about

symptom” by her saying she could not

her club and understood that their club rules

remember what had happened.

were very strict; their dress code, language, andAfter the incident, we held the conference

practice were checked and advised by clubwith her parents in accordance with “Mental

alumni. We also found that the members

Support System”, aevaluated and criticized each other very

maladjusted students. At the conference, we

severely. We reported those facts to theshare the incident and her father told us theadvisory teacher and asked those rules to besame thing has happened at home before. As anrevised.

intervention, we suggested the parents to ask

We also had a session with the client. At theher to visit the doctor.

session, we asked her the question thatFew days later, her mother reported us that she“imagine you are doing something that you canvisited her primary doctor and there was no

enjoy, what are you doing?” She answered “Iproblem. Subsequently, she had a minor car

am drawing at my grandmother’s home, who

accident but she could not remember whatlives at another prefecture.” Therefore, we

happened. Considering the fact that she lost her

support system for

32

MOTHER’S INVOLVEMENT AND DAUTHER’S IMPROVEMENT

memory of the accident, we had anotherand sayings to her daughter by turning in theconference. At the conference, her mother“Black Ink Letter” every day. The authors

insisted that the reason why the client could not

maintain that it gave the mother an opportunity

remember was an aftereffect by the accident.

to

As interventions, we presented the suggestions

Consequently, the client started next the gradethat the parents visited the doctor again andand by coming to school with no problems. She

asked their daughter to change club activity tochanged her club and started learning art andthe art club which she was interested in. We

her relationship with her friends was graduallyalso ask the mother to turn in the “black ink

improving.

letter” .

We can also argue that improvement of

reexamineherparentingmethods.

client’s symptoms results from all the staff
Improvement of the client’s symptoms andmember’s understanding and trust on herchange of parenting style of her motherstrength and adjustments of the relation withher mother.

After the client’s visit of her doctor, eventhough it was reported “there is no apparent
abnormality”, her mother started dropping her
off and picking her up by car. The mother also
started to turn in her “Black Ink Letters”. Aftera while, she reduced her symptoms and nolonger stayed at the nurse’s office. She becamea sophomore and got a group of friends andstarted studying together and attending theschool events

Discussions
The client’s mother had made an effort toparent her. The effort was to frequently
encourage and order her daughter because thedaughter worked slowly. We made a suggestion
to visit doctor for the daughter’s dissociative
symptoms for confirmation with respecting her
evaluation that her daughter’s symptom wasjust because of an aftereffect by accident. The
mother became to self-monitor her behaviors

International Journal of Brief Therapy and Family Science
2012 Vol.2, No.1, 33-35<Case Report>

Brief Therapy Sessions with Male Client of Depression
Hiroshi Okawa1), and Katsuhiko Yoshida2)
1)

Souma Follower Team2)

Seisa University

KEY WORDS: Brief Therapy, Depression, Reinstatement, Self-control

to depressive symptom, repeatedly took leaves

Introduction

from his job. At the time of the first session heThis case was performed at the NFBT

was in the middle of a two month break fromheadquarters and is a case report from thehis job and had been advised by his company's
trainee institution. To first explain the structure

physician to have a couple therapy with hisof the interviews within the trainee institution,

wife. The therapy has been finished with 15

the actual interview is recorded using a video

sessions. First through fifth sessions were done

camera while a team in the next room confirms

once a month. At fifth session, he stated that heon a monitor. Then, during the interview, theywould go to show his face at the company.

move into a different room and, during that

Given that his change, from sixth session
onwards, sessions were performed once every

time, discuss with this team in order to move

two months.
the case forward.
In this report, we introduce the case focused

Repeatedon the attempted solutions denoted by the client

PatternofAbsenceandReinstatement

and the goal was to reconsider what points may

From the client's story, the following pattern

have led to the conclusion of the case.

of absence and reinstatement was revealed.
While going to work every day his physicalCase Summary

condition gradually deteriorated. When his

The client was a male in his forties who, due

physical conditions became worsened, hewould force himself to continue to work despite

CORRESPONDENCE TO: OKAWA, Souma Follower Team,

his condition. As a consequence of the effort,

136-5-101 Nakamura azamotomachi, Souma-city 976-0042,

he was eventually forced into sick leave. At thisJapan.

point, he and those around him agreed that it

e-mail: yu_ji924@yahoo.co.jp

was best if he were to wait for his condition to
fully improve before returning to work. As a

33

34

OKAWA and YOSHIDA

result, aiming for full-recovery, his sick leave

a cold, his lower back began to hurt and once

became prolonged but the symptom has not

more his physical condition deteriorated since

fully recovered at the point of return to work.

then. He tried to cope with this situation by

Therefore, he eventually ended up returning togoing to bed early at night and just forcing

work with a less than full amount of recovery.

himself to work. His physical condition once

After the reinstatement, his physical condition

again became worsened because of this coping

became gradually worsened as he forced

and he ended up having to go to the hospital. To

himself to work in deteriorated physicalbreak this vicious cycle, the therapists asked thecondition. Based on this pattern, the following

client to go to the hospital when he could feel

three interventions were introduced.

himself catching a cold before it worsened.
Moreover, as he was concerned about thefinancial impact of his leave from work, theFirst Intervention
We told the client to reframe the client’s

therapists made a suggestion that the client

view from “go back to work when my physicalspend ten percent of his income in advance tocondition has fully recovered,” to “manage mystress relief. Based on this suggestion, the clientphysical condition while being reinstated at mydeveloped his new coping method that hejob.” This leaded to a change of his view of “Ifwould go to the hospital immediately if he were

my condition is better, then I can work.”

to catch a cold; he should get a compressor, go

Through this change of viewpoint, the client

to massage or acupuncture therapy for his backwas able to move from the dichotomic view ofpain and generally work to deal with these“working with a perfect physical condition” orphysical conditions soon after they appear.

“recovering”. He was able to work on to goal of“how can I work at my job with checking

Third Intervention

physical condition?” in the rest of the sessions.

Therapists considered that client’s wife had

Besides, the emphasis on his checking own

an effect on the client’s maintaining his

physical condition encourage him to control

behavior pattern in which he tried to work

himself rather than expect to receive thedespite his deteriorating physical condition. His

support from other people, including his

wife often became worried and attempted tocounselor and wife.

talk to him. In turn, the client, in an attempt to
not worry his wife further, pretended to be
alright and forced himself to work even in bad

Second Intervention
Based on the first intervention, therapists

condition. At this point, his wife understood his

asked about the client’s pattern after his

intention and therefore stopped talking to him

returning to work. The client revealed that heabout his condition. She did not want to

had

for

pressure him further. As a consequence, theapproximately one month. However, he caught

couple had little communication. Thus, thesettled

his

pace

of

his

life

BRIEF THERAPY WITH MALE CLIENT OF DEPRESSION
client attempted to handle his problems on his
own and even if his wife wanted to support him
she was unable to talk about his problems. The
situation was vicious cycle of for an interaction
between the couple.
Therapists intervened this vicious circle by asuggestion that wife observe her husband who
seemed to want a rest with the reframing of the
behavior of observing as “watching warmly herhusband.” Instead of talk about his condition,therapists made a suggestion to her that she
asks her husband to look after the children or toplan vacations. The aim of this intervention was
to put off the wife’s pressure from client’s
shoulder.

Discussions
From the three interventions, we can assume
that a change had occurred in the previous
pseudo-solution. We can understand the changeby two points. First, the client learned to deal
with his problems on his own because of his
wife’s new coping behavior of observing.
Second, he became able to deal with his
physical condition before it deteriorated. Given
that these changes, we can consider that he had
increased his ability to self-control and had
managed to spend his life without therapy
sessions even though he still had somedifficulty. Furthermore, he could recognize thathe successfully cope with his depressive
symptoms with support from others.

35International Journal of Brief Therapy and Family Science
2012 Vol. 2, No.1, 36-38<Case Report>

Effective Brief Therapy for Trauma Treatment
Yuji OTSUKA1)2)
1)

Asahi General Hospital Department of Psychiatry

2)

Asahi City counselor

KEY WORDS : brief therapy,

PTSD, EMDR

people were murdered or injured. When he

IntroductionThe

effectivenessMovement

exited from the building, a large number of

Desensitization and Reprocessing (EMDR) andpeople fell to the ground. He, in possession ofTrauma-Focused Cognitive Behavioral Therapy

the American Heart Association's Basic Life(TFCBT) on Post-Traumatic Stress DisorderSupport certification, helped to treat two(PTSD)

have

Nevertheless,

of

been

after

the

Eye

well

understood.

victims with light wounds and proceeded to

onset

of

perform Cardiopulmonary Resuscitation (CPR)

PTSD,

deteriorated interpersonal relations between

on

a

third

victimwho

hadentered

Identified Patient (IP) and those around him/hercardiopulmonary arrest. Upon entrusting thecan make there treatments ineffective. As avictim on whom he performed CPR over tostrategy to cope with the problem that an IP

paramedics he returned to his home but learned

who seems to be falling into a vicious cycle offrom the news on television that this victim had

deteriorating personal relations, a therapist (thelater died.

author) applied brief therapy with EMDR in

In July of the same year, during Judo practice,order to raise the effectiveness of the treatment.

he suddenly had a flashback of the scene of theCaseaccident and fell to the ground. Thereafter, he

IP was a 23 year-old, male college student. In

continued to see flashbacks which led toJune of the year X, while shopping in aanxiety and loss of sleep and he even quit goingbuilding near a station, on the road next to theto school. This continued until August of thebuilding an incident occurred in which manysame year in which he came to see a doctor at
this institution.

CORRESPONDENCE TO Otsuka, Asahi General Hospital

During the medical examination, flashbacks

Department of Psychiatry, I-1326, Asahi City, Chiba Preficture,and other re-experience symptoms, avoidance

289-2511, Japan.

symptoms such as avoiding the station at which

E-mail: otsuka@hospital.asahi.chiba.jp

the event occurred, over-stimulation symptoms
such as loss of sleep as well as impairment to36

OTSUKA37

social function were noted and he waswant to pick a fight.” Furthermore, the thought

diagnosed with PTSD.

of “No one understands me” was to be

At first pharmacotherapy was applied but his

reframed with “you yourself didn't understandsymptoms persisted and until October of the

PTSD very well until you experienced it.”year when he temporarily withdrew from

Complimenting, reframing and non-verbal

school. From April of the year+1, while he wasmessages were used to stop expressing negativereinstated in school, there was no sign that his

emotion from parents and instructors as well.

symptoms were improving and in May of the

The therapist focused on the involvements

same year he began EMDR.

without negative messages from his parents andhisprofessors and told to them that “because thesymptoms had been gradually improved. He

support of those around you is adequate, even

even went so far as to say that he would like tothough his symptoms were so severe he cango down to the station where the incident

still live a normal college life.”

After

seven

sessions

of

EMDR,

occurred. However, upon seeing the report on

In response to the IP’s negative expressions

or the dates surrounding the incident, or whensuch as, “I'm always fine so why I do suddenly

he saw large numbers of people and police

get worse?” , reframing was once again applied

officers that made him remember the traumaticwith phrases: “There's no such thing as PTSD

event, he had flashbacks and showed symptoms

in which the symptoms are present at every

as he had done at the onset of his PTSD. When

moment,” “It's going to take some time before

he displayed the symptoms, his friends,

those around you can adjust to your PTSD.”

university professors, and parents talked to him

When his parents and professors communicatednegative topics such as, “Don't take anymore

with him too negatively, the therapist visited

medicine!”, “Can't you consider this news andthem. Only complimenting and reframing wereyour experience separately?”, and “Can't you

used without dealing with thedo anything yourself without relying on

communication but there was a certain message

doctors?” IP became confused during thesefrom the treatment that physician visited toconversations. Therefore, in order to maintain ameet them. The aim of the intervention was tomore favorable environment for his treatment,

non-verbally encourage them to realize thatbrief therapy was introduced for his treatment

something very serious had occurred. After thewith EMDR. He was treated mainly withvisit, the exchange of strong negative emotions

complimenting and reframing in order to stop

was successfully restrained.

negative

communicating negatively and motivate toreceive treatment. The compliments were “It'sConclusion

amazing that you can continue a treatment like

PTSD has the following characteristics: The

EMDR that brings on so much stress,” “It's notcause is something far away from everyday life.

easy to be told such unpleasant things and not

The Symptom can be prolonged. In general

38

BRIEF THERAPY FOR TRAUMA

only the name is known without knowledge of

to visit IP’s parents and professors. However,

the

in

this intervention is seen to work as non-verbal

misunderstanding. There is a risk to leadmessage that something very serious had

conflict

occurred.

symptoms

andbecauseofitresults

thedeterioratinginterpersonal relations between the people such

In Japan's medical treatment policy, physicians,

as victim and family, lovers, friends, school

nurses and psychiatric social worker(PSW)sstaffs,companies,

making up a multi-occupational team has

assailants, police officers, firefighters, lawyers,provided outreach service to victims of mental

public prosecutors, and judges.

disorders. In the future, there is the possibility

The effectiveness of EMDR and TFCBT on

that clinical psychologists are to become

PTSD has been proven but cases in which

nationallydeterioration of personal relations with thosemulti-occupationalaround the patient can lead to these treatments'

professionals. This means that the therapist also

ineffective. There is also no evidence to support

would be required to work outside therapy

the idea that brief therapy and/or interpersonalroom. Therefore, as with the case presented intherapy are less effective than these otherthis report, I can argue that the outreach therapy

established treatments.

service is important.

workplaces,

insurance

certified

and
team

to
of

join

this

healthcare

Brief therapy has a powerful effect on avoiding
the risk of personal relations falling into a

References

vicious

their

Bisson J, Andrew M. (2007). Psychologicalcommunication. The personality and life

treatment of post-traumatic stress disorderbackground of PTSD patients is varied but,

(PTSD). Cochrane Database of Systematicthere are some similarities between the cases in

Reviews, 3.

the

cycle

patient’s

andimprovinginterpersonal

relationship.

Sharpless, B. A. & Barber, J. P. (2011). A

Therefore, brief therapy can better the patient's

Clinician's Guide to PTSD Treatments for

symptoms by treating their

Returninginterpersonal

Veterans.

Professional

relationship.

Psychology: Research and Practice, 42 (1),In this case, while EMDR was effective with IP,

8-15.

deteriorated

interpersonal

relationshadnegative effect on his symptoms. Therefore,
introducing brief therapy with EMDR was
effectivefor

improvinghistreatment

environment and symptoms.
An advantage of brief therapy is that therapist
can change the patient without direct contact
with him/her. The therapist was not necessary

International Journal of Brief Therapy and Family Science
2012, Vol. 2, No.1, 39-41<Case Report>

The Problem Resolution with “Almighty Key” for a Depressive Client
Fumie Sato1)
1)

Sendai Branch, National Foundation of Brief Therapy

KEY WORDS: Depression, Brief therapy, Exception

The Characteristics of the client

himself who used to be; He wanted to work in

The client was unmarried 35-year-old man.

ways that he had worked before he got the

Although he had worked as a field overseer

disease; He wanted to have more conversations

before the onset of depression, He waswith his colleagues at working places.

technical personnel at the point of the first

The intervention at first session

session. His personality was serious-minded

After the therapist (the author) listened theand well-organized and he had been taciturnclient’s narratives seriously, accepted his

since he was little. He had very few friends. His

emotion, and empathized with him, thefamily structure consisted of his mother and his

therapist let him search the positive sides of his

younger brother. His mother lived alone andlife which is the “almighty key to solve theshe lived off her pension and the money sent byclients' problems”.

the client.
He had an onset of depression since five years

The second session

ago and had sometimes taken leaves of absence

Therapist (TH): Have you experienced any

from his job. At the point of first session, hechanges in your life?

had returned to work, however, he could not do

Client (CL): I'm surrounded by good people.

his work well and felt alienated in his working

TH: Last time you told that you wereplace. He had also used to have his suicidal

cold-shouldered, weren't you?

ideation. He still went to hospital and took
antidepressants

at

that

point.

His

CL: I'm inconsistent, am not I? However, I've

main

noticed that they show consideration forcomplaints were that he did not want to be likeme.
TH: I think it is a good to realize that and you
aren't inconsistent.

CORRESPONDENCE TO: SATO, Sendai Branch, National
Foundation of Brief Therapy, 2-18-13 Cyomeigaoka, Sendai

Besides, the client told that he could sleep

city, Miyagi, 981-3212, Japan

without taking sleeping pills despite the fact

e-mail: ijbf@nfbt.org

that he took them at the point of the firstsession.

39

40

SATO
a little bit more?

The intervention at second session

CL: It is still impossible for me.

The therapist suggested to the client that he

TH: However, last time you told that you weretakes a leisurely bath on Saturday night andin a fair way to return to the field. Do

consults with his doctor as to whether or not he

you have any reasons?

may sleep without taking sleeping pills and

CL: Once, when I got depression, I was told

suggested to him that he continue to search theby a colleague in front of the otherpositive sides of his life.

colleagues that I don't want to work withsuch a guy, which made me depressed.

The third session

As I had to work with him, I got

TH: Have you experienced something good?

depression.

CL: People around me care about myself. They
speak to me, and I got praise from the

TH: Why haven't you gotten depression thistime?

assistant section manager. Now, I have

CL: It is due to my so-what attitude thinking

come to be able to think positive.

“I won't lose to such a guy”, because theCurrently, my main assignment is chores

person is less skillful than me at the job.

using the computer.
TH: Do you think you can do the fieldoverseer?

TH: Great. You have been able to turn defiant,haven't you?
CL: Yes.

Cl: I think I can do, though I can't understandsome part of the job.

The intervention at the fourth session
The therapist conveyed the message that

The intervention at third session

turning defiant is one of the almighty key toAfter giving the client positive feedback that

overcome the difficulties.

he can recognize his current situation positively
and he behaved to be praised by others, theThe fifth interview

therapist asked him to do more of searching the

CL: I have experienced many good things. I

positive sides of his life.

have gotten insured, I have lost myweight 1kg, and then, I have come to

The fourth interview

think that though the content of my job

CL: I have experienced so many good things.

is ordinary this work will give the basis

Until now, I had been depressed because

for other’s work. Above all, I have comethe people around me seem to be busy.

to think I am happy.

However, I no longer experience such

Adding to these remarks, the client had comefeelings.

to be able to care about the other colleagues,

TH: That's great. Then, can you afford to work

such as he worried about their depressive mood.

THE PROBLEM RESOLUTION WITH “ALMIGHTY KEY”
Furthermore, he no longer felt alienated, he hadcome to speak to others spontaneously, thinkpositive, and work as well as he worked before
he got depression. He also has come to talk that
his job is interesting. Given those facts, thetherapist supposed that the original chiefcomplaint had been solved. Besides, his
insomnia symptom has also resolved. Therefore,
the treatment had terminated at this session.

41

International Journal of Brief Therapy and Family Science
2012 Vol. 2, No.1, 42-45<Case Report>

Intervention toward Anxiety and Complaint on School Life
Junko Takahashi1)
1)

Sendai Branch, National Foundation of Brief Therapy

KEY WORDS: Brief Therapy, School teacher, Junior high school

Support and Intervention

Characteristics of the client
The client was a second-year junior highOn the other hand, that she had a different

school girl who was transferred from anotherside at home was observed through herschool within the same city in April. She started

mother’s statement. According to the mother’scomplaining that she did not feel a part of thestatement, she at home was talkative andschool and did not want to attend school not

somehow droll, interested in singing andlong after the transfer. She did not feel

dancing and was hoping to become an idol.

comfortable with her classmates because of her

Additionally it became apparent that she wasreticence and shyness. She found break time

suffering from her inability to express her true

particularly difficult as she felt she was alone.

self in the school. She was also concerned thatfalling behind academically due

Although she continued to go to school, sheto herstarted spending time at sickbay or leaving

absenteeism and leaving school early, which inschool early.

other words showed her willingness to succeed
academically.

Her parents were concerned that she might

The client’s classroom teacher attempted theend up not going to school altogether andoccasional consultations over the phone orfollowing interventions.

face-to-face occurred. According to the parents,

Interview with A during break

it took her a long time to make close friends at

The lunch break was set as a time for thethe previous school and it took her until July toclient to talk with the teacher as she mainly felt

get used to the class.

anxious during break, although she was given a
choice whether she wanted to come or not. She
was told she was welcomed to come to the staff
1-27-154,

room whenever she felt uncomfortable in her

Minami-nakayama, Izumi ward, Sendai city 981-0911, Japan.

class room. The number of visits to the staff

e-mail: ijbf@nfbt.org

room reduced as she started making friends.

CORRESPONDENCE

TO:

TAKAHASHI,

Supporting parents

42

TAKAHASHI

43

The teacher provided encouragement to the

She started communicating with her teamparents that the client would soon make goodmembers with eagerness and became lively likefriends with her gentle nature and charm anda different person.

also suggested that they continue to observe thesituation until July. Since it took her a long time
to familiarize herself with the previous school

ConsequencesThe

client’s

facialexpression

becamein the past, her shyness was accepted positively,

brighter as she made a friend who she could let

as part of her personality.

her hair down with. She became anxious when
the friend was off school or left early, therefore,

A sense of belonging through extra-curricular

she visited the staff room and spent time withactivities

the classroom teacher.

The client expressed her wish to join the

One day when she was spending break withtable tennis club just before the summer holiday.

the friend’s absence, she told that the school

After the trial, she was pleased that senior

without the friend was too lonely to tolerate.

students gave her the compliment that she was

The teacher replied that the friend had told thenatural with the sport. She made good friends

same and acknowledged their bond. Since thenthrough the activity and the club provided theshe stopped taking absences.

place where she could feel she belonged andsomething she could enthuse about.

Discussions
The client initially took herself as a failure
for her lack of ability to adapt in a new

Self-affirmation and a sense of role
To the question by the teacher what made her

environment. In addition, she seemed to have

happy on the particular day on the one of her

been suffering from the gap between her true

visits to the staff room, the client replied bybright and energetic personality and the fact

expressing her happiness in her ability tothat she could not behave so. The class teacher

supervise as a team leader at cooking class andtried the approach of not rushing to find ain her sense of being dependable. As it

solutioncoincided

understanding that being oneself takes time.

with

the

time

of

conductingorgivingup

easilywhile

questionnaires to decide group leaders of her

Provision of the place where she could

homeroom class, the teacher told her that

express her feeling (staff room) and the tablesomeone in the class recommended her as atennis club as a new environment worked

Life Group leader as well as mentioning her

positively and it can be deduced that thesepotential of being a natural leader. She washelped her regain her true self. Being given the

excited to hear this and showed her keenness tonewbecome one. Her parents were informed on this

responsibility can be fulfilled within her limit)

and she was appointed as the Life Group leader.

enhanced her self-affirmation and it played an

role

of

team

leader

(of

which

44

ANXIETY AND COMPLAINT ON SCHOOL LIFE

important role to solve this issue. As cited inher bond with new friend and the team leaderrole in this case, to feel needed can strengthen
oneself.