Vol.13, No.1

2023

April

2023

International Journal of Brief Therapy and Family ScienceVol. 13, No. 1, 2023

CONTENTS

Invited Paper
Revision of the Three Steps Model
Koubun Wakashima, Saeko Kamoshida and Naoto Nihonmatsu .................... 1―5
Original Paper: Research and Experiment
Typology of Conditional Self-acceptance in Association with Positivity and Stress Response
Fumi Seki, Gen Takagi, Kohei Koiwa, Naoto Nihonmatsu and Koubun Wakashima .................... 6―14
Original Paper: Research and Experiment
The Effectiveness of a Worksheet Program Based on Solution-Focused Brief Therapy in Decreasing the Functionof School Refusal Behavior: A Longitudinal Study of Three Years in Junior High School
Mayumi Sakuraba, Gen Takagi and Koubun Wakashima .................... 15―31
Original Paper: Research and Experiment
Development of a Behavioral Scale toward People Who Fail at “Taking a Hint” and a Test of its Reliability andValidity
Kohei Koiwa, Mao Komatsu and Koubun Wakashima .................... 32―42
Original Paper: Case Report
Therapeutic Assessment with Brief Therapy: A Single Case Study of an Elementary Student’s School Refusal
Konomi Asai and Keigo Asai .................... 43―49
Book reviews
Michael F. Hoyt and Flavio Cannistrà - Brief Therapy Conversations: Exploring Efficient Intervention in Psychotherapy
Review by Keigo Asai .................... 50

International Journal of Brief Therapy and Family Science
2023 Vol.13, No.1, 1‒5Invited Paper

Revision of the Three Steps Model
Koubun Wakashima1), Saeko Kamoshida2) and Naoto Nihonmatsu3)
1)

Graduate School of Education, Tohoku University
Yamagata University Health Administration Center3)
Fukushima Medical University
2)

Abstract: The current psychotherapy concerns are extracted from the research of INOUE Enryo1),
systematic psychotherapy approximately 100 years ago. However, current psychotherapy neglects
natural recovery (spontaneous or self-healing). Hence, this study revised the Three Steps Modelpublished in 2012 as an approach for victims of the Great East Japan Earthquake based on theseidentified issues . The significant revision concerns the second step, including its concept
and procedure, and the cases wherein the third step is used are discussed.
Key Words

Introduction
During the Great East Japan Earthquake in 2011, theThree Steps Model (Table 1) was developed to help victims,
especially disaster rescuers and administrative staff(Wakashima, Noguchi, Kozuka & Yoshida, 2012). Since
then, this model has been used in clinical practice to assist
disaster victims and several other problems.

Development of Three Steps Model
Approaches to survivors include exposure therapy forpost-traumatic stress disorder and eye movement desensitization and reprocessing; however, these are only partial
approaches to trauma. The survivors also suffered othermental health concerns, including anxiety about their lives,
grief, and helplessness. Hence, the Three Steps Modelapproach (Wakashima et al., 2012) was built for such
victims, which is based on the “normalization” of Brief
therapy and follows IASC guidelines for mental healthand psychosocial support in emergency settings (IASC
Guidelines on Mental Health and Psychosocial Support indisaster rescuers’ approach involved an average of 1.83
cation, Tohoku University. 27-1 Kawauchi, Aoba Ward, Sendai City,
Miyagi Prefecture, 980-8576, Japan.
e-mail: kobun.wakashima.d3@tohoku.ac.jp

sessions per case, or a single session, to develop a sense of
security in most cases (c.f. Asai, 2019).

Inoue Enryo and Morita ShōmaStudy Group, and I read many books and articles on Morita(c.f. Nakayama, 2012)
Morita was born on January 18, 1874, and died on April
12, 1938 (Hatano, 2016). The basic theories given by
him were thus established a hundred years ago (Morita,
1922/1983). Individuals with a hypochondriac tendency
begin with a hypochondriac mood of pseudo-sensory
hypersensitivity, direct attention to the body, and increasing
sensitivity to the senses. Attention and sensitivity mutuallyintensify and exacerbate subjective symptoms, causing
fixed neurological symptoms such as headaches andpalpitations. Morita (1922/1983) named this mental process“seisin-kōgo-sayō” (Morita, 1928/1998). For example,
Gorman, Liebowitz, Flyer, and Stein (1989) suggested aneuroanatomical basis for panic disorder regarding themaintenance of panic attacks. They hypothesized that panic
repeatedly stimulate neurons in the limbic system, resulting
in a kindling phenomenon that lowers the threshold for
excitatory stimuli. The lowered stimuli threshold then
1)

The Japanese version of names is used throughout this text wherein
the surname precedes the given name. The surname is written in2

Wakashima et al.

Table 1 Three steps model (Wakashima et al., 2012, p. 74 75.).
STEP① ：Generalization based on empathy that the symptoms and reactions of patient is currently having arenatural reactions to having experienced the situation (normalize).
STEP② ：Assuming that PTSD-like reactions often recover gradually over time, we check for any differencesin the extent of the problem between the time it occurred and the present time, Support the actions
that have been taken so far (do more & compliment).
STEP③ ：The more we try to avoid grief and PTSD-like reactions, the more we lose control of them.
Therefore, we present interventions that do something different , such as observe to the problem andreactions (reframing & paradox intervention).

facilitates anticipatory anxiety (Wakashima, Misawa, Ikuta,

Sigmund Freud was born on May 6, 1856, and died on
September 23, 1939. In 1895, he co-authored “Studies inHysteria” with Josef Breuer and in 1900, he published“Dream Judgment” and in 1917, “Introduction to Psychoanalysis” as a single author. Morita was born 18 years after
Freud and died a year earlier. Psychoanalysis is thus conpractical methods, followed by Morita.
Inoue Enryo was born on March 18, 1858, and died onJune 6, 1919. He published “Psychological Abstracts” in1887, “Lectures on Monsterology” in 1896, and “Psychotherapy” in 1904. Notably, in 1904, he wrote a book titled“Psychotherapy,” even though the term had already beencoined. Morita may have been inspired by Inoue. In 1904,
Morita published “The Infection of Mental Illness” (Morita,
1904) and “Tosa ni okeru inugami ni tsuite” (Morita, 1904)

recovery, that is, clients’ self-organization, and not interfering with self-healing. In behavioral therapy, thetherapist instructs the client to perform behavior A, which
is precisely followed. However, in self-organization, thetherapist stimulates the client through behavior A andsuggests performing behavior A’, B, C, or D, dependingon what exhibits resonance. Moreover, the non-direction
observed in the person-centered approach suggests that
if the therapists’ instructions and ideas contribute to theclients’ problem-solving, then metaphorically speaking,they solve the problem mutually, and the client’s selforganization is not encouraged.
organize and improve their problem-solving skills bytransmitting unconditional positive attention and empathic
understanding, suggesting it values spontaneous healing
through visitor-centered therapy. Edward Deci is known
for intrinsic motivation research and positively evaluates

Focus on “Believing”
Yokai Studies and Psychotherapy

He states that “...physiotherapy (note: physical medicine)
should be combined with this therapy (psychotherapy) toachieve the purpose of treatment....” and “Therefore, I havecombined natural therapy and faith therapy and called it
psychotherapy” (Inoue, 1904/1988).

Another aspect of Inoue’s psychotherapy is faith therapy,
which focuses on beliefs and rituals. Several psychologicalstudies assume that faith is negative. For example, theplacebo effect (Beacher, 1955) takes place when a prescribed multivitamin drug shows improvement throughthe belief that it is an actual drug. Broadly, it refers to any
treatment that appears to be a genuine form of therapy, butdoes not include its substantive mechanism. In other words,
the concept is based on the negative assumption of being ahuman error. In recent years, such belief has been studied asa cognitive bias.

Focus on Natural Recovery(Spontaneous or Self-Healing)1964), although slightly different as a concept, implies thatteachers’ expectations improve learners’ performance;

Inoue’s Yokai studies examine the world’s mysteries
through natural science and psychology and aim to eradicate
superstitions. For example, he describes the therapeutic
effect of praying (meaning “charm”) as a psychic action

In recent years, various psychotherapies have focusedon a “Getting the client to do something by the therapist”.
However, Inoue believes in a combination of naturopathy
and faith therapy, and that current psychotherapy seems todisregard naturopathy; that is, natural recovery.
Current psychotherapy overlooks encouraging natural

Hasegawa, 2000; Wakashima et al., 2012).

Natural Recovery and Change Through “Believing”
Figure 1 demonstrates natural recovery and changes
through “believing.”

Revision of the Three Steps Model

3

Low

Third step intervention

Adaptation
Natural recovery

Standard of social living

High

1

2

3

4

5

6

7

8

9

・・・・・・・・・・

Fig. 1 Natural recovery and change through “believing”.

Figure 1．Natural recovery and change through “believing”

The horizontal axis shows time (Fig.1). The vertical axis
shows adaptation from low to high, or problems (low/high)and symptoms (low/high). The gray area at the bottom
a figurative linear change. The decreasing level of social
life at 8.5 is from natural recovery, while the top has aslower slope and will not reach the level of social life for an
extended period. For such slower-slope representing cases,
nonlinear changes the third step are necessary such as
belief and ritual intervention.

Revision of the Three Steps Model
Considering the above pioneers, the Three Steps Modelmay directly deal with natural recovery. Therefore, thisstudy proposes revising the Three Steps Model based on theabove-mentioned ideas. The primary focus of the revision
is a greater emphasis on natural change.

Linear and Nonlinear Changes
Considering the slope of the linear change and time withthe attainment of the adaptive state, when the angle of theslope is curved or at a certain degree, natural healing isvital. Only when the angle of the slope is gentle is the third
step introduced as a nonlinear change.

Second Step
There are no changes in the first step. But it’s requires
the following perspectives to understand the problem. The
second step reflects there logical levels: the symptom,
problem, and adaptation. It is essential to understand theexample, understanding the symptom level of a client withterminal cancer is counter-productive. This is because
although their condition may deteriorate, it is unusual for
it to improve. In such cases, the clients’ level of natural
recovery must be raised from level of the problem to levelof the adaptation (Fig. 2).
In the second step, the client is encouraged to speak andscore on average in recent times, with “10” being the worst
time and “0” being the last time their lives were regular or
the problem did not exist. By setting a time frame for when
the problem is at its worst, the therapist can consider thingsfrom different viewpoints rather than a single viewpoint.
As shown in Figure 2, at a single point, the focus remains
on what is lacking (what has not been done); however, atime axis helps capture the unique changes. As a result, thefocus shifts to achievement (what has been done). By using
three different levels (symptom, problem, and adaptation)

Adaptation
esira le level of adaptation

Not enough（Itʼs not done）

nough（Itʼs done）

aladaptation
Ti eFig. 2

Adaptation and Time.

Figure ． da tation and i e4Wakashima et al.

for score changes in the second step, most cases indicatedthat the problems (symptoms and adaptation) substantiallychanged (by half) than when they seemed worst in the initialinterview. The clients become aware of this shift for thewith “I know it is still hard for you.” Subsequently, they are
asked, “What did you do well (i.e., did you do somethingor stop doing something) that reduced your scores?” Thedetails are then noted, organized, and evaluated to ensure
they are helping solve the problem and clients’ are directed
to continue them.
For clients who cannot answer the question or are unsure,share that you are recovering over time. Subsequently, after
sharing the line slope, the client is asked to predict changes
over a month2). If now are the worst time, you can think
how will we make it through this time, and you can decide
what to do and what not to do to make the best of it. All
things are impermanent. After the worst time has passed,
the usual method of the 2nd step can be used.
Incidentally, Morita (1922/1983) considers the body andmind as two aspects of the same object and indicates that
rest and work are effective for both, suggesting that theworst times can be overcome.

Conclusion
The revision of the Three Steps Model is described
are crucial, while the third step is a local intervention. When
local interventions are ineffective, it is vital to reconsider
the previous steps. This model is significant because it
provides a single-session solution (3S) (Wakashima &Nihonmatsu, 2022) and prioritizes clients’ self-organization.

Acknowledgments
This model could be completed because of the contributions of Dr. Katsuhiko Sato’s (Sanraku Hospital) practicalworkshop (held at Tohoku University on July 31, 2011). We
would like to express our gratitude to Dr. Katsuhiko Sato.

References
Asai, K. (2019). The Use of the Three Steps Model after theGreat East Japan Earthquake: A Case Study in theTreatment of Flashbacks. International Journal of Brief
Therapy and Family Science, 9(1), 17―26.

Third Step

Beecher, H. K. (1955). The powerful placebo. Journal of American
Medical Association. 159(17), 1602―1606.

Here, importance is placed on natural recovery and is notinterfered with when introducing intervention tasks during
the third step. Additionally, when activating children’s
behavior who are not attending school, it is better to contact
the child who is away from home and ask them to “takethe laundry because it is going to rain” than to take on therole of washing the bath. Because, cleaning the bathtub iseasily taken for granted by people, and the negative aspects
are emphasized. In other words, interventions with a highprobability of successful performance are more suitable forclients’ behavioral activation than interventions that tend toemphasize the negative, such as those that are evaluated totake for granted or are likely not viable on an ongoing basis.
For example, if the therapist encourages the client to go forwalks during a leave of absence due to depression and lackof motivation, this task may not help create motivation andlead to negative points. When a client lacks motivation,
giving positive points for performing the minimum required
tasks is recommended. Further, intervention tasks must be
considered. However, the therapist must prepare positive
comments and points, regardless of whether the intervention
task was completed. Additionally, it is also desirable tobe able to introduce interventions such as those related toneuroception (Porges, 2003) in the third step in the future.

Gorman, J. M., Liebowitz, M. R., Fyer, A. J., & Stein, J. (1989).
A neuroanatomical hypothesis for panic disorder. The
American Journal of Psychiatry, 146(2), 148―161.
Hatano, F. (2016). The Birth of Morita Therapy: The Life
and Work of Shōma Morita. Sankeisha. 畑野文夫 2016
森田療法の誕生―森田正馬の生涯と業績. 三恵社.

Inter-Agency Standing Committee (IASC) (2007). IASC
Guidelines on Mental Health and Psychosocial Support
in Emergency Settings. Geneva: IASC.
Inoue, E. (1988). (Onnda, A. Com.). Psychotherapy. Gunsho.
(Original work written 1904) 井上円了（1988）（恩田彰
解説）. 心理療法. 群書.

Kurokawa, N. (2017). History and Findings of Psychosomatic
Therapy：The Morita Therapy. Japanese Journal of psychosomatic medicine, 57, 818―826. 黒川順夫（2017）. 森

田療法 ワークショップ：心身医学療法の温故知新. 心身医学, 57, 818―826.

Morita, S. (1904). Tosa ni okeru inugami nit suite. Psychiatria
Et Neurologia Japonica, 3, 129―130. 森田正馬（1904）. 土佐ニ於ケル犬神ニ就テ. 精神神経学雑誌, 3, 129―130.

Morita, S. (1904). Psychosis infection. Psychiatria Et Neurologia
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神神経学雑誌, 3, 26.

Morita, S. (1983). Lecture on Psychotherapy. Hakuyosha.
(Original work published 1922) 森田正馬（1983）. 精神療法講義. 白揚社.

2)

Human beings adapt, even through violence or behaviorization.
Therefore, sensitivity must be maintained that the content is appropriate
to capture the level of adaptation, differing through periods.

Morita, S. (1998). Morita therapy and the true nature ofanxiety-based disorders (shinkeishitsu) (A. Kondo,
Trans.). New York: State University of New York Press.

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Wakashima, K. & Nihonmatsu, N. (2022). A Trial of the

Nakayama, K. (2012). Inoue Enryo and Morita Shōma;Single Session Solution (3S) : A Case Study of a Family

Contribution to the Establishment of Morita Therapy.
Annual report of the Inoue Enryo Center, 3―27. 中 山 和 彦

Interview Completed in One Session. Bulletin of Psycho-（2012）．井上円了と森田正馬―森田療法成立への貢献―．
井上円了センター年報, 3―27.

Porges, S. W. (2003). Social engagement and attachment: aphylogenetic perspective. Annals of the New York Academyof Sciences, 1008(1), 31―47.
Rosenthal, R. (1964). Experimenter outcome-orientation andthe results of the psychological experiment. Psychological
Bulletin, 61(6), 405―412.
Wakashima, K., & Hasegawa, K. (2000). Brief therapy guidebook. Kongo Shuppan. 若島孔文・長谷川啓三（2000）.
よくわかる！短期療法ガイドブック. 金剛出版.

logical Support Center, Graduate School of Education,
TOHOKU UNIVERSITY, 1, 73―81.
Wakashima, K., Misawa, F., Ikuta, M., Matsuhashi, H. & Sato,K. (1999). The effect of the paradoxical Indications
in two cases of anxiety neurosis with panic attack.
Japanese Journal of Family Psychology, 13(1), 49―62.
Wakashima, K., Noguchi, S., Kozuka, T. (2012). The
Proposal of Three Step Model based on Brief. Therapy.
Interactional Mind V, 73―79. 若島孔文・野口修司・狐塚貴

博・吉田克彦（2012）. ブリーフセラピーに基づくスリー・ステップス・モデルの提案. Interactional Mind V, 73―79.

International Journal of Brief Therapy and Family Science
2023 Vol.13, No.1, 6‒14

Original Paper: Research and Experiment

Typology of Conditional Self-acceptance in Association
with Positivity and Stress Response
Fumi Seki1), Gen Takagi2), Kohei Koiwa1) 3), Naoto Nihonmatsu1) 4) and Koubun Wakashima1)
1)

The Graduate School of Education, Tohoku University
Tohoku Fukushi University
3)
JSPS Research Fellow
4)
Fukushima Medical University
2)

Abstract: Unconditional self-acceptance has been regarded as a desirable type of self-acceptancein rational therapy. However, conditional self-acceptance and its conditions, have not been
self-acceptance is related to stress response and positivity. It examines the types of conditional
self-acceptance, the relationship between conditional and unconditional self-acceptance, and thestress response and positive attitude toward life that unconditional self-acceptance fosters. The
survey results of 287 university students revealed that conditional self-acceptance was categorized
into three levels: high conditional self-acceptance, acceptance-seeking, and low conditional
self-acceptance, showing the highest to lowest stress response in the abovementioned order.
These results indicate that it is important to foster an attitude of unconditional self-acceptance tomaintain optimal mental health.
Key Words: rational therapy, conditional self-acceptance, positive attitude, stress response

Introduction
Rational therapy, founded by Ellis (1957), was developedin opposition to psychotherapy that seeks causes in past
events, focusing instead on cognitive aspects (Ito, Iwakabe,& Fukushima, 2013). Therefore, it does not consider the
goodness or badness of events but rather individuals’
irrational beliefs when they perceive events in terms of “Imust” and “I should,” which lead to inappropriate feelings
and behaviors (Takagi & Wakashima, 2019). Based on thistheoretical background, an important concept advocated by
Ellis is “unconditional self-acceptance” (1980).
What is Unconditional Self-acceptance?
Unconditional self-acceptance is defined as “accepting
oneself as one is in any situation, without making value
judgments about oneself or evaluating oneself based onsocially generalized standards” (Yoshida, Amemiya, &CORRESPONDENCE TO: Seki. Tohoku University 27-1, Kawauchi,
Aoba-ku, Sendai-shi, Miyagi 980-8576, Japan.
e-mail: fumi.seki.t7@dc.tohoku.ac.jp

Sakairi, 2019). According to Ellis (1999, translated by
Saito, 2018), when people encounter adversity, they engage
in the self-destructive tendency of evaluating themselves as
unworthy because of their own mistakes and shortcomings.
Therefore, when we encounter adversity, we need to be ina state of mind in which we accept ourselves as stable anddo not become self-destructive. In short, unconditional selfacceptance emphasizes not losing one’s value as a humanbeing at all times.
Previous research has shown that unconditional selfacceptance has a positive impact on mental health. Those
who have unconditional self-acceptance tend to have lower
depressive tendencies, stable self-esteem, and higher levelsof happiness (Chamberlain & Haaga, 2001a). Japanesestudies have also shown a relatively strong negative correlation between unconditional self-acceptance, traits ofanxiety, and depression (Yoshida, Amemiya, & Sakairi,2019). Furthermore, Chamberlain and Haaga (2001a) also
reported that unconditional self-accepting individuals wereless depressed when they imagined scenarios that evokednegative emotions.
Unconditional self-acceptance is also associated withactive attitudes that emphasize personal development,

Typology of Conditional Self-acceptance in Association with Positivity and Stress Response

beings. The theoretical discussion of unconditional selfacceptance contends that if people stop paying excessive
attention to the evaluations they receive from others, they
will not be preoccupied with self-centered concerns andwill be more interested in external matters (Ellis & Harper,
1975 translated by Kokubu & Ito, 1981). It has been shownthat unconditionally self-accepting individuals do not react
defensively to critical feedback about their performance(Chamberlain & Haaga, 2001b). Therefore, it can be said
that those with unconditional self-acceptance (1) maintaintheir mental health and (2) have a positive attitude towardlife.
Conditions for Self-acceptancePrevious research has highlighted the importance ofunconditional self-acceptance. However, conventional
research has not discussed the “conditions” of selfhuman self-acceptance into “unconditional self-acceptance”
and “conditional self-acceptance,” rejecting the latter as
the opposite of the former and as an unstable means ofself-acceptance. For example, when we set conditions
for self-acceptance, it may cause us to evaluate ourselves
as unworthy, unable to meet all conditions, and afraid of
failure or criticism (Ellis, 1973, translated by Sawada
and Hashiguchi, 1983). Thus, Ellis argues that we should
abandon evaluating our self-worth based on certain
standards and aim for unconditional self-acceptance, which
recognizes the value of being alive and accepting ourselves
as we are (Ellis & Harper, 1975 translated by Kokubu &Ito, 1981).
Conversely, several researchers view conditional selfacceptance in a positive light. For example, according
to Kuiper and Olinger (1989) and Crocker, Luhtanen,
Cooper, and Bouvrette (2003), humans are capable ofconditional self-acceptance by feeling self-worth if they
have an “attractive appearance” or “academic ability.”
These studies have shown that conditional self-acceptanceis possible, revealing a form of self-acceptance that iscontrary to unconditional self-acceptance. In addition,
the academic achievement condition for self-acceptanceis linked to the motivation to study for exams (Crocker etal, 2003). Studies show that acquiring self-worth throughachievements strengthens their awareness about improving
their current situation (Ito & Kodama, 2006). A growing
body of research suggests that conditional self-acceptance,much like unconditional self-acceptance, promotes anactive attitude of seeking human growth and progress, thus
positively impacting mental health.
Purpose of This Study
As previously discussed, unconditional self-acceptancehas been regarded as desirable. However, there is a lack of
discussion on its conditions of self-acceptance. While Ellis

7(1999, translated by Saito, 2018) denies the existence ofconditional self-acceptance, several other researchers, suchas Kuiper and Olinger (1989), Crocker et al (2003), and
Ito and Kodama (2006), view conditional self-acceptancepositively. Therefore, it is necessary to clarify how conditional self-acceptance relates to unconditional self-acceptanceand examine its effect on mental health and positivity.
Accordingly, this study proposes to examine the nature of
conditional self-acceptance. In particular, we investigate(1) the typology of conditional self-acceptance, (2) the
relationship between conditional and unconditional selfacceptance, and (3) the association of conditional selfacceptance with two theoretically assumed positive effects
of unconditional self-acceptance: stress response andpositivity toward life.
The hypotheses of this study are as follows. First, giventhat unconditional self-acceptance has been shown to be
associated with mental health because it is not self-destructive
and leads to a stable psychological state (Chamberlain &Haaga, 2001a; Yoshida, Amemiya, & Sakairi, 2019), it isexpected that those with a higher tendency toward unconditional self-acceptance will have lower stress responses
expected (Hypothesis 1). Furthermore, unconditional selfacceptance has been shown to be linked to people’s active
attitudes (Ellis & Harper, 1975 translated by Kunibun &Ito, 1981; Chamberlain & Haaga, 2001b), and conditional
self-acceptance has also been linked to active attitudes, inwhich people acquire self-worth through the achievementof conditions (Crocker et al,2003; Ito & Kodama,2006). In
light of the above, it is expected that those with a higher
tendency toward either unconditional or conditional selfacceptance will be more likely to value positivity toward
life (Hypothesis 2).

Methods
Research Participants
We conducted a web-based survey of 287 university
and graduate students (76 men, 210 women, 1 unknown).
Of these survey targets, 55 respondents with incomplete
answers were excluded from the analysis. Their mean
age was 20.67 years (max=24, min=19, SD=±1.066). We
distributed the URL of the survey page to the author’s
acquaintances and asked them to respond. In addition,acquaintances who conducted snowball sampling andresponded to the survey were also asked to distribute the
URL of the survey page to their own acquaintances.
Survey Period
The survey was conducted between early April and early
June 2020.
Ethical Considerations
The participants were given a complete explanation
before being requested to answer the questionnaire. They

8

Seki et al.

gave their informed consent prior to participation and wereassured that they could stop answering the questionnaire
midway if they found it to be too invasive. In addition,
approval was obtained from the Research Ethics Review
Committee of the Graduate School of Education, Tohoku
University (No. 19-1-042).
Questionnaire Structure(1) Face SheetThis part of the questionnaire contained items related to
students’ gender, age, faculty, major, course, and grade.
(2) Unconditional Self-acceptance
The Japanese Version of Unconditional Self-Acceptance
Questionnaire developed by Yoshida et al. (2019), withreference to the Unconditional Self-Acceptance Questionnaire developed by Chamberlain and Haaga (2001a), wasused to collect data. It consists of two subscales: “Unconwithout making conditional value judgments about oneself;“Stability” measures the tendency to maintain a stable
to oneself, even when circumstances change or when others
scores constitutes the “unconditional self-acceptance”
score.
(3) Conditional Self-acceptance
To measure conditional self-acceptance, Uchida’s (2008)
Self-Worth Scale was used. This scale is the Japaneseversion of Crocker et al.’s Contingencies of Self-WorthScale (2003) and classifies events involving self-worth
into seven categories. In this study, “conditional selfacceptance” is defined as “accepting oneself only when
the conditions for acquiring self-worth are met,” and theseven events in this scale are regarded as “conditions” thatmust be met for self-acceptance. They include: “competitiveness,” which implies doing better than others in tasks
and skills; “evaluation by others,” which constitutes being
evaluated positively by others; “physical attractiveness,”which means feeling attractive or comfortable with one’s
appearance; “support from family and friends,” which implies
being loved by family and friends; “relational harmony,”
which refers to having good relationships; “academic
competence,” which means having satisfactory academic
performance/good grades; and “being ethical,” which means
living by ethical rules. The seven subscale scores indicate“conditional self-acceptance.”(4) Positive Attitude toward Life
The Positive Attitude toward Life scale developed bytoward having goals and dreams,” “attitude toward selfimprovement,” “positive attitude,” “attitude toward valuing
time,” and “attitude toward valuing oneself.” The total

score of each subscale constituted the “positive attitude
toward life” score. Responses to all 25 items were ratedusing a 5-point scale.
(5) Stress Response
The 17 items related to general stress response of theComprehensive Stress Response Scale developed by Asai etal. (2013) were used. The total of each subscale constituted
the “stress response” score.

Results
Descriptive Statistics
Table 1 shows the mean, standard deviation, and maximum and minimum values of each variable for the entire
lated to determine the reliability of each variable; it ranged
from 0.58 0.91. All variables except “stability” showedsatisfactory values. Although it showed a low value, it wasused in this study because its reliability and validity wereTypology of Conditional Self-acceptanceCorrelation analysis was conducted to determine therelationship between variables (Table 2). Then, to classify
each individual’s conditional self-acceptance, the respondents were categorized by cluster analysis using the Wardmethod with the subscale scores as the variable. The meanvalue of each subscale was calculated and converted toa z-score, and the respondents were classified by cluster
analysis using the Ward method with z-score values. First,

and other clusters with less than 5% of the total number of
respondents were also extracted. In the two-cluster classi-

there was a bias in the number of respondents. Conversely,

was adopted because it was less biased and theoreticallyinterpretable.
In addition, to clarify the characteristics of each cluster,
the mean and standard deviation scores of the conditional
self-acceptance subscales of each cluster were obtained, anda one-way analysis of variance (ANOVA) was conductedamong the clusters (Table 3).
The first cluster exhibited a self-acceptance pattern inwhich all conditional self-acceptance z-scores were negative;
thus, we named it the “low conditional self-acceptancegroup” (Condition L group).
The second cluster, in contrast to the first, exhibiteda self-acceptance pattern with positive z-scores for all
variables, except “being ethical;” thus, we named it theTypology of Conditional Self-acceptance in Association with Positivity and Stress Response

9

Table 1 Descriptive statistics for each variable.
Variable
Unconditionality
Stability
Unconditional self-acceptanceCompetitivenessPhysical attractiveness
Relational harmony
Recognition by others
Academic competence
Being ethicalSupport from family and friends
Conditional self-acceptance Total
Positive attitude toward life
Goals and dreams
Self-improvement
Positive
Time oriented
Self-identity
Stress response
Anxiety / Tension
Moodiness / Anger
Autonomic symptoms

Mean

SD

Min

Max

3.86
3.50
3.68
5.56
4.74
4.68
4.80
4.78
4.95
5.64
5.00
3.69
3.97
3.52
3.99
3.22
3.70
1.80
2.15
1.60
1.32

1.28
1.07
0.98
1.02
1.12
1.24
1.40
0.99
1.07
0.93
0.69
0.77
0.90
1.06
0.83
1.02
0.98
0.71
0.92
0.84
0.60

1.00
1.25
1.38
1.00
1.00
1.00
1.00
1.50
1.00
1.00
2.38
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00

7.00
7.00
6.50
7.00
7.00
6.75
7.00
6.50
7.00
7.00
6.42
5.00
5.00
5.00
5.00
5.00
5.00
4.35
4.89
5.00
4.75

.77
.58
.74
.86
.81
.82
.85
.72
.60
.77
.87
.95
.85
.91
.88
.90
.79
.90
.87
.86
.73

Table 2 Correlations between variables.

1 Unconditionality
2 Stability
3 Unconditional
self-acceptance
4 Competitiveness5 Physical attractiveness6 Relational harmony
7 Evaluation by others
8 Academic competence
9 Being ethical
10 Support from family
and friends
11 Total conditional
self-acceptance1

2.38 **.86 **.80 **.20 **

3

5

6

7

8

9

.34 **.51 **.27 **.24 **.35 **.28 **.05.10.06.40 **.20 **.71 **.71 **.59 **.67 **.32 **

10

11

.02

.00
.24 **

4.05.39 **.22 **.12.49 **.08.56 **.62 **.34 **.34 **.42 **.65 ***p<.05 **p<.01“high conditional self-acceptance group” (Condition H
group).
The third cluster exhibited an intermediate pattern of
mixed positive and negative conditional self-acceptancez-scores compared with the other clusters. Specifically,
the z-scores for “evaluation by others,” “being ethical,”and “relational harmony” were positive, whereas thez-scores for “competitiveness,” “physical attractiveness,”“academic ability,” and “support from family and friends”
this group than in the other two groups. It can be inferredthat this group considers acceptance by others, such as“accepting oneself by realizing cooperation with others,” asa condition for self-acceptance. Therefore, we named thisgroup the “acceptance-seeking” group.
Relationship between Conditional and Unconditional
Self-acceptance
To examine the relationship between conditional andunconditional self-acceptance, a one-way ANOVA was
conducted with three groups of conditional self-acceptanceas the dependent variable (Table 4). The results revealed
that the differences in scores between the groups were
Tukey’s test showed that the condition L group (M=4.22)
had significantly higher unconditional self-acceptance10Seki et al.

Table 3
“Low conditional
self-acceptance”
group (n=76)“High conditional
self-acceptance”
group (n=89)

Competitiveness
M
SD
Z

5.41
1.23

6.09
0.64
0.53

5.25
0.83

Physical attractiveness
M
SD
Z

4.29
1.23

5.62
0.73
0.78

4.49
0.80

Evaluation by others
M
SD
Z

3.47
1.15

5.96
0.70
0.72

5.35
0.70
0.22

Academic Competence
M
SD
Z

4.53
1.00

5.52
0.65
0.75

4.41
0.89

Being ethical
M
SD
Z

4.70
1.18

4.78
1.10

5.38
0.74
0.40

Support from family and friends
M
SD
Z

5.41
1.09

6.13
0.60
0.53

5.48
0.81

Relationship harmony
M
SD
Z

3.77
1.26

5.57
0.81
0.72

4.95
0.75
0.22

“Acceptance-seeking”
group” (n=67)

F valueF (2,231)=15.15**
2=3<1

F (2,231)=39.217**
2=3<1

F (2,231)=166.19**
3<2<1

F (2,231)=34.01**
2=3<1

F (2,231)=9.96**
1=3<2

F (2,231)=14.80**
2=3<1

F (2,231)=67.25**
3<2<1

1=“Low conditional self-acceptance” group. 2=“High conditional self-acceptance” group. 3=“Acceptance-seeking” group*p<.05 **p<.01 ***p<.001

Table 4 Relationship between the three groups and unconditional self-acceptance, positive attitude toward life, and stress response.
“Low conditional
self-acceptance”
group (n=76)“High conditional
self-acceptance”
group (n=89)“Acceptance-seeking”
group (n=67)

Unconditional Self-Acceptance
M
SD
Z

4.22
0.94
4.22

3.16
0.77
3.16

3.51
0.88
3.51

Positive attitude toward life
M
SD
Z

3.76
0.81
3.76

3.54
0.80
3.54

3.74
0.68
3.74

Stress response
M
SD
Z

1.56
0.58
1.56

2.13
0.79
2.13

1.86
0.67
1.86

F valueF (2,231)=30.610**
1>3>2

F (2,231)=1.777

F (2,231)=13.668**
1<3<2

1=“Low conditional self-acceptance” group. 2=“High conditional self-acceptance” group. 3= “Acceptance-seeking” group*p<.05 **p<.01 ***p<.001

Typology of Conditional Self-acceptance in Association with Positivity and Stress Responsescores than did the “acceptance-seeking” (M=3.51) and the“condition” H (M=3.16) groups. The “acceptance-seeking”
group (M
acceptance scores than did the condition H group (M=3.16).
Association of Conditional Self-acceptance with Positive
Attitude toward Life and Stress Response
To examine the relationship between conditional selfacceptance and positive attitudes toward life, a one-way
ANOVA was conducted with the three groups of conditional self-acceptance as independent variables and positive
attitudes toward life as the dependent variable (Table 4).
The results revealed that the effect of conditional selfTo examine the relationship between conditional selfacceptance and stress response, a one-way ANOVA was
conducted with three groups of conditional self-acceptanceas the independent variables and stress response as thedependent variable (Table 4).
The results revealed that the difference in scores between
the groups were significant (F (2,232)=13.668, p<.001).
According to the multiple comparisons using Tukey’s test,
the condition H group (M=2.13) had significantly higher
stress reaction scores than did the acceptance-seeking(M=1.86) and the condition L (M=1.56) groups. The
acceptance-seeking group (Mhigher stress reaction scores than did the condition L group(M=1.56).

11

translated by Saito, 2018), who rejected conditional selfacceptance and stated the importance of unconditional selfacceptance.
(2) High Conditional Self-acceptance Group (Condition
H group)
The Condition H group showed positive values in all
the conditional self-acceptance scores except for “being
ethical.” It had the lowest unconditional self-acceptancescore among the three groups, suggesting that, in contrast to
the Condition L group, conditional self-acceptance tendency
is high and unconditional self-acceptance tendency islow. Therefore, from the perspective of Ellis and Harper(1975, translated by Kokubu & Ito, 1981) and Ellis (1999,
translated by Saito, 2018), who rejected “conditional
self-acceptance” as the opposite of unconditional selfacceptance, the conditional self-acceptance group can be
regarded as the group that has acquired the most undesirable
type of self-acceptance. In contrast, among the conditional
self-acceptance subscales, no significant differences were
found in the scores of “being ethical” compared to theCondition L group. Uchida (2008), who created the scale tomeasure conditional self-acceptance in this study, suggeststhat ethics and morals are not stable accompanying characteristics because they are not recognized by Japanese
university students. Therefore, while this group has a strong
attitude of conditional self-acceptance, they are close to thegroup of students who do not place much importance on
ethics as a condition for self-acceptance.

Discussion
The purpose of this study was to (1) categorize the different types of conditional self-acceptance, (2) examine
the relationship between conditional and unconditional
self-acceptance, and (3) examine the relationship between
stress response and positive attitude toward life—two
unconditional self-acceptance. The findings are described
below.
Characteristics of Each Group(1) Low Conditional Self-acceptance Group (Condition
L group)
The Condition L group had negative conditional selfacceptance scores and the highest unconditional selfacceptance scores among the three groups, suggesting that
this group is more likely to engage in unconditional rather
than conditional self-acceptance. The results of this study2018). In other words, the Condition L group is considered
to exhibit a type of self-acceptance that is similar tounconditional self-acceptance.
Therefore, it can be inferred that this group has the mostfavorable self-acceptance as pointed out by Ellis and Harper(1975, translated by Kokubu and Ito, 1981) and Ellis (1999,(3) Acceptance-seeking Group
This group differed from the others in that it showed amixed conditional self-acceptance score. Regarding therelationship with unconditional self-acceptance, unconditional self-acceptance scores were higher and lower thanthose of the “Condition L” and “Condition H” groups,
respectively, suggesting the moderate tendency for unconditional self-acceptance among the three groups. Furthermore,among the conditional self-acceptance subscales, “being
while “evaluation by others” and “relational harmony”
were positive, unlike with the Condition L group. Of these,“evaluation by others” and “relational harmony” have beenshown to be positively related to relationship orientation andcooperation (Uchida, 2008). Thus, it can be inferred that
this group places more importance on ethics and morals
than do other groups and that the main condition for selfacceptance is acceptance from others, as revealed by responses to question items such as “accepting oneself byrealizing cooperation with society and others.” However,Ellis and Harper (1975, translated by Kokubu & Ito, 1981)
stated that the belief that one must be loved and acceptedby all people is one of illogical thinking. Although thisgroup does not have an extremely conditional attitude ofself-acceptance, it can be regarded as a group that engages

12Seki et al.

in illogical thinking because it emphasizes the pursuit ofacceptance from others.
In summary, there are three types of self-acceptanceamong people: active unconditional acceptance of oneself,
acceptance achieving all the conditions imposed on oneself,
and acceptance by emphasizing ethics and morals andmaintaining cooperation with society and others.

through relationships with others but also through personal
achievement. Therefore, there are many factors that affecttheir sense of self-acceptance. It can be inferred that they
are more likely to experience anxiety about failure andcriticism.

Positive Attitude toward Life and its Relationship toStress Response
In this study, we also examined the relationship between
stress response and positive attitude toward life in theirassociation with conditional self-acceptance. The results

This study examined the relationship between the statesof conditional and unconditional self-acceptance, while
investigating how the former relates to two things that aretheoretically assumed to be positively affected by the latter:stress response and positive attitude toward life. Althoughunconditional self-acceptance has been regarded as adesirable form of self-acceptance, there has been a lack of
discussion on the conditions of self-acceptance. Thus, thisstudy examined the nature of conditional self-acceptance inrelation to unconditional self-acceptance, classifying it into
three groups: the low conditional self-acceptance group, thehigh conditional self-acceptance group, and the acceptanceseeking group. The low conditional self-acceptance groupwas shown to have a self-acceptance style like that of unconditional self-acceptance. In addition, conditional selfacceptance was not related to positive attitude toward life

toward life were found among the typologies, and only
stress reactions were found to be related. From this,Hypothesis 1 was not supported. The reason for the lackof association with positive attitudes toward life is that the
Positive Attitudes toward Life scale is not a valid scale
to measure active attitudes. Positive attitudes toward life
include not only “accepting attitudes” (accepting oneself
and life as it is) but also “active attitudes.” They are likethe passive, avoidant tendencies toward life seen in modern
adolescents, such as apathy (Ebine, 2010). Therefore, while
it is seen as a concept that indicates active human attitudes,
the complexity of the concept, which includes both receptive
and active attitudes, prevents it from functioning adequately
as a measure of active attitudes. Thus, the theoretical consideration of unconditional self-acceptance and the active
In the future, it will be necessary to consider other indicators of active attitudes to re-examine these results.
The scores for the stress response were significantly
higher among the Condition H, acceptance-seeking, andcondition L groups, in that order. Thus, it can be said
that those with a lower tendency to use conditional selfacceptance and a higher tendency to use unconditional selfacceptance are less likely to feel stress, thus supporting
Hypothesis 2. This result is consistent with the views ofEllis and Harper (1975, translated by Kokubu & Ito, 1981)and Ellis (1999, translated by Saito, 2018), who advocatedthe usefulness of unconditional self-acceptance. The results
also correspond with those of previous self-acceptancestudies, which showed that unconditional self-acceptancehas a positive impact on mental health. According to Ellis(1973, translated by Sawada and Hashiguchi, 1983; 1999,
translated by Saito, 2018), “conditional self-acceptance”
in the face of failure or criticism. Therefore, the condition
H group, which had the highest stress response, is likely
to be trapped in anxiety and depression over failure, which
in turn is likely to lead to stress response. The reasonstress response was higher in the condition H group thanin the acceptance-seeking group is that the former engages
in conditional self-acceptance that is satisfied not only

Significance and Limitations

tendency toward conditional self-acceptance had fewerstress reactions. This result suggests that having an attitudeof unconditional self-acceptance is important for maintaining mental health.
Furthermore, it is also suggested that “unconditional selfacceptance” is an important attitude in breaking the vicious
circle in brief therapy. In brief therapy, the aim is to identify
the vicious cycle of false resolution behavior and intervene
to break the cycle and create new patterns of behavior andcoping (Hasegawa, 1987). In this situation, those with ahigh tendency toward conditioned self-acceptance are likely
to set conditions for accepting themselves based on theidea that “this is how I should be.” If this is not achieved,
individuals are likely to fall into a “vicious cycle” of striving to achieve the conditions while developing illogicalthinking and regarding themselves as “unworthy.” Contrastingly, Ellis (1973 translated by Sawada and Hashiguchi,1983) stated that, although one cannot avoid evaluating
oneself at all, an attitude of unconditional self-acceptancethat rightly asserts, “I am neither good nor bad, and for theto illogical thinking. Therefore, the attitude of unconditional
self-acceptance is considered important in breaking thevicious circle of “I must be valuable.” Based on the above,
interventions that promote unconditional self-acceptance,
especially for neurotic clients that think in terms of “Ihave to be,” are considered to help breaking the vicious
circle. The results of this study suggest that the applicationof unconditional self-acceptance in brief therapy can beconsidered.

Typology of Conditional Self-acceptance in Association with Positivity and Stress Response

Finally, there are several issues that remain to beaddressed. First, we need to examine the index that measures participants’ active attitude. In this study, positive
attitude toward life was used as an indicator of active
attitude, but the complexity of the concept suggested that itwas not related to self-acceptance. Therefore, it is necessary
to use and validate an index that can measure active attitudes
such as ambition.
Second, we need to determine the scale to be used inmeasuring conditioned self-acceptance. In this study, we
created the concept of conditional self-acceptance and used
Uchida’s (2008) Japanese version of the accompanying
scale of self-worth to measure it. However, since this scale
is not a measure of self-acceptance, its validity in measuringconditional self-acceptance is questioned. Therefore, it isnecessary to create an original conditional self-acceptancescale or one derived by referring to the items of the SelfWorth Concomitant Scale.
Third, there is a need to explore other classifications,clusters, and so forth. Since this study intended to examineconditioned self-acceptance in an exploratory manner, thevalidity of the distribution of the number of people in theclusters. Conversely, since other forms of self-acceptanceare possible, at least in terms of the number of people, itis necessary to consider other possible clusters in future
research based on this study.
Fourth, the developmental aspect of self-acceptanceshould be considered. It is said that self-acceptance enables
one to have an autonomous sense of values and selfimage, while also promoting the establishment of self inadolescence (Ito, 1989). In this context, research focusing
on developmental changes in self-acceptance has been
conducted (Ito, 1991) with junior high school and highschool students. While this study focused on undergraduate
and graduate students, it is also necessary to examine theconditionality of self-acceptance from a developmental
perspective for other age groups.
Finally, we need to consider the differences between
clinical and healthy groups. This study was conductedamong general undergraduate and graduate students.
However, unconditional self-acceptance is a form of selfacceptance that rational therapists encourage in clients
who have irrational beliefs such as “I must” or “I should.”
Therefore, it is not clear whether the present results ofa healthy group will be the same as those for a clinicalgroup with psychological problems. It will be necessary
to examine the clinical group separately from the healthygroup so that the findings of this study can be applied inclinical practice.

13

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International Journal of Brief Therapy and Family Science
2023 Vol.13, No.1, 15‒31

Original Paper: Research and Experiment

The Effectiveness of a Worksheet Program Based on Solution-Focused
Brief Therapy in Decreasing the Function of School Refusal Behavior― A Longitudinal Study of Three Years in Junior High School ―Mayumi Sakuraba1), Gen Takagi2) and Koubun Wakashima3)
1)

Iwaki Junior College
Tohoku Fukushi University
3)
Tohoku University, Graduate School of Education2)

Abstract: In this study, the researchers conducted a Solution-Focused program based on the
Solution-Focused Brief Therapy for 128 junior high school students (67 males and 61 females) inof school refusal behavior scores after the implementation of the program and to examine theas well as the function of school refusal behavior in the third grade. A decrease in the function ofschool refusal behavior was found in a certain number of students after undergoing the Solutionof school refusal behavior throughout the two years exhibited a lower school refusal behavior
in third grade than others. Thus, the researchers found that the implementation of the SolutionFocused program using worksheets based on Solution-Focused Brief Therapy is effective inpreventing school refusal among junior high school students.
Key Words: Solution-Focused Brief Therapy, the function of school refusal behavior, junior highschool students

Introduction
School absenteeism has been a serious problem for
more than a quarter century; however, many students still
experience problems in relation to attending school, especially in junior high school.
Attempts have been made to prevent school refusal
behavior by improving the social skills of students byfocusing on students with a high risk for school refusal
and the effects of classroom conduct (e.g. Ishikawa, 2020;
Oguri, 2013; Satake & Koizumi, 2022). However, these
efforts focused only on students with a high risk of school
refusal or those who tended toward non-attendance atschool. Many students tend not to attend school, whichrefers to students disliking school but enduring classes
CORRESPONDENCE TO: Sakuraba. Iwaki Junior College. 37 Suganezawa, Kamata, Taira, Iwaki City, Fukushima Prefecture, 970-8023,
Japan.
e-mail: m.sakuraba@m.iwaki-jc.ac.jp

and attending school, and being repeatedly late for school.
Non-attendance should not be ignored among exceptional
students, and there is a need for research focusing on thereasons students have, for disliking school (Kameguchi,
1998).
It has been revealed that students tending toward nonattendance at school have various problems or stressors;
lems or asking for help (Kikushima, 1999; Suzuki, 2015;
Torii, 2007). Therefore, programs should be implemented toenable students to acquire and improve their coping skills
to help prevent school refusal. In this study, the researchers
aimed to build effective support for the prevention of school
refusal by cultivating the coping skills and providing solutions to students attending school.
In this study, the researchers focused on “solution
building,” which is a key concept of Solution-Focused
Brief Therapy (de Shazer, Berg, Lipchik, Nunnally, Molnar,
Gingerich, & Weiner-Davis, 1986). Solution building
consists of setting well-formed goals within their respective
frames of reference, and exploring exceptions (Smock,16

Sakuraba et al.

McCollum, & Stevenson, 2010). Despite clients not being
able to express their problems clearly, having well-formed
goals within their respective frames of reference allows
them to reach the solution voluntarily (de Shazer, 1985).
Solution building has positive effects on mental health andadaptation (Grant, Cavanagh, Kleitman, Spence, Lakota,& Yu, 2012; Smock, 2014). The researchers believe thatcultivating solution building and acquiring skills for copingwith problems or stress as well as developing solutions, canlead to the prevention of school refusal behavior.
1. The Problem with the Approach of Solution-Focused
Brief Therapy in School
Broadly, Solution-Focused Brief Therapy has beenreported to be effective in cases of hyperactivity, problem
behavior, egocentric behavior, and poor academic performance (Franklin, Kim, & Brigman, 2012). Practices toremedy such behavior are based on a Solution-Focused
approach (e.g., Kurosawa, Nishino, Tsuruta, & Mori, 2015),
especially in cases where students exhibit school refusal(Sagami, 2012). Moreover, the “WOWW” (Working On
Works) approach, an innovative program for ensuring
good quality class education, was developed by applying
the Solution-Focused Brief Therapy (Berg & Shilts, 2004).
The WOWW approach has been found to be effective in
improving students’ absence and tardiness (Kelly, Liscio,
Bluestone-Miller & Shilts, 2012), as well as the class atmosphere (Shilts, Bluestone-Miller & Kelly, 2013).
Therefore, Solution-Focused Brief Therapy is reportedly
effective in schools. However, there are some problems
that need to be addressed. First, it is difficult to conduct
a program based on the Solution-Focused Brief Therapy
without an expert. There are few reports on the SolutionFocused brief therapies for self-care. Kurosawa (2016),
discovered a Solution-Focused Approach using workseets,
but the effectiveness of the workseets themselves has
not been clarified. Thus, a professional coach is required
for the WOWW approach. There are reports of using the
WOWW approach by challenging teachers directly without
consulting an expert (Berg & Shilts, 2004). However, it isSecond, the approach of the focused solution building forproblems faced by each student was not conducted at theschools. In the WOWW approach, a coach complements
students when they do their best or meet their expectations,but each student has different needs and therefore requires
different solutions. A new program would be better forsolution building by setting goals and exploring exceptions
to solutions not only for the class but also for individual
students.
Therefore, the researchers developed a worksheet program
based on Solution-Focused Brief Therapy that could be
conducted without an expert. This program involves solutionbuilding by setting goals and exploring exceptions withrespect to students’ problems to prevent school refusal among

students.
The effectiveness of miracle questioning and exploring
exceptions with a work program based on Solution-Focused
Brief Therapy was revealed by Takagi and Wakashima(2019). Miracle questioning is an effective form of questioning in which the researchers imagine a situation inwhich a problem has been solved by setting goals (De Jong
& Berg, 2013). Moreover, exploring exceptions and scaling
questions through miracle questioning is also effective (Ito2011). Therefore, in this study, the researchers used scaling
questions, miracle questions, and explored exceptions; atthe end of the program, the researchers complimented theclients for working things out and taught them how to copewith issues in the future. the researchers developed andconducted the “Solution-Focused program” and examined
whether this program is effective for the prevention ofschool refusal among students.
2. The Function of School Refusal Behavior
To examine whether this study’s program is effective inpreventing school refusal behavior, the researchers haveto understand the common symptoms related to school
refusal behavior and the individual mechanisms promoting
it (Ishikawa, Sato, Nomura, Kiyamura, Kawano, Inoue& Sakano, 2012; Kearney & Silverman, 1996; Kearney& Albano, 2007). The researchers therefore focused onfunctional analysis. Kearney and Silverman (1996), referredto school refusal behavior as child-motivated refusal toattend school or difficulties with regards to remaining in
do not actually miss school as well as those who miss school
every day, and thus it refers to a continuum. Regarding
functional analysis, “the function of school refusal behavior” is defined as the cause of maintaining school refusal
behavior and includes four functions, namely: avoidanceof stimuli that provoke negative affectivity; escape fromaversive social and/or evaluative situations; the pursuit ofreinforcement outside of the school setting (Kearney &Silverman, 1993). When providing support to prevent
school refusal behavior, it is important to focus on thefunction of school refusal behavior and not to focus on thestrength of depression (Kearney & Albano, 2007). Focusing
on the function of school refusal behavior of students who
attend school could help prevent school refusal among
students (Tsuchiya, Hosoya, & Tojo,2010).
3. The Purpose of this StudyIn this study, the researchers developed a worksheet
program based on Solution-Focused Brief Therapy that
could be conducted without an expert and examined whether
the program is effective for reducing the function of school
refusal behavior among students from three grades in juniorhigh school. Furthermore, this study has three purposes: theLongitudinal Study of SFBT of 3 Years in Junior High schoolof school refusal behavior after undergoing the program.
The researchers examined the transition of the score of thefunction of school refusal behavior from before “SolutionFocused program 1-1” to a week after “Solution-Focusedprogram 1-2” in the first grade, and before “SolutionFocused program 2-1” to a week after “Solution-Focusedprogram 2-2” in the second grade. The second purposeof this study is to examine the relationship between thesecond grades and the function of school refusal behavior
in the third grade. The researchers predicted that students
whose function of school refusal behavior decreased after
second grade exhibited a lower function of school refusal
behavior in the third grade, than those who did not show adecrease or increase in function.

Methods
1) Date Collection and Subjects
The researchers conducted this study’s survey from
September 2018 to December 2020 with 128 students(male:67, female:61) in junior public high schools.
2) Procedure
The researchers conducted the program and questionnaire

surveys three times and the programs twice; specifically,
the “Solution-Focused programs 1” and “Solution-Focusedprograms 2.” In the second grade, the researchers conducted
the questionnaire surveys twice and the programs twice;specifically, the “Solution-Focused program 2-1” and“Solution-Focused program 2-2.” With the first graders,
the researchers conducted an extra questionnaire survey todetermine their the function of school refusal behavior in ashorter period because they had just started going to school.
The researchers conducted a questionnaire survey during
the third year. The survey was conducted by teachers as amorning activity in class. Table 1 shows the questionnaire
surveys and “Solution-Focused program.”3) Questionnaire(i) Cover Page
Participants were asked about their sex, class, and student
number. The researchers only asked about the students’attendance numbers for the first and second grades in the(ii) School Refusal Assessment Scale-Revised for Japanese
Attendance at School (SRAS-R-JA) (Tsuchiya, Hosoya, &Tojo, 2010).
The SRAS-R-JA is composed of five components:
avoidance of stimuli that provoke negative affectivity(ANA); escape from averse social and/or evaluative
situations (ESE); pursuit of attention from significant
others (PA); and pursuit of tangible reinforcement outside
the school setting (PTR). The SRAS-R-JA is a 20-item
instrument that uses a 5-point Likert scale. Participants
were asked to respond by choosing a number from one to
JA was developed for elementary school students; therefore,
the researchers used it for junior high school students withthe permission of the authors.
4) Solution-Focused Program
The researchers created a Solution-Focused program withreference to Takagi and Wakashima (2019), and arranged thelayout and sentences such that it was easy for junior highschool students to understand. The researchers presented
miracle questions and clarifying goals following Kurosawa(2016). See the Appendix for further details. As checklists,

Table 1
time

content

September to November 2018①
② Solution-Focused program 1-1↓ after about 1 week③
④ Solution-Focused program 1-2↓ after about 1 week⑤

Second grade

November to December 2019⑥
⑦ Solution-Focused program 2-1↓ after about 1 week
⑧ Solution-Focused program 2-2↓ after about 1 week⑨

Third grade

December 2020⑩

First grade

17

18

Sakuraba et al.

the researchers asked students to respond to the statement(1) Solution-Focused program 1-1“Let’s think about your problem”① Problem
The researchers asked participants to write down the
problems they faced in school, and what they were confused
about.
② Scaling questions (degree of solution to the problem
before starting the program)
The researchers asked the participants about their degree

do nothing by yourself).
③ Scaling questions (degree of ideality for life before
starting the program)Participants had to respond about the degree of ideal life“Let’s think about a small solution”④ Miracle question
The researchers asked the miracle question “How will
your life be if the problem that you wrote in ① is all gone,
just like that, by magic?
⑤ Clarifying goals
The researchers asked about the goals of living. “Pleasewrite your goals for living life as if there are no problems
as stated in ④. You should set goals such as behavioral
positive goals like ‘I will…’ and small goals that you canachieve easily.”⑥ Doing from now on
The researchers asked students about what they could door what they wanted to do from now on, based on helpful
suggestions.
The researchers informed the participants to “try to dowhat you write at ⑥” and “seek for what you want tobecome in life” for the next 1-2 weeks.
As checklists, the researchers asked students to respondto the statement, “I worked seriously and thought of small

In addition, to confirm content validity, they had torespond to “I could imagine the situation without any
problem and set small goals,” “I could solve every problem
and stay motivated,” and “I know how to solve the problem,” to check whether imagining their ideal in the miracle
question would clarify their goals.

(2) Solution-Focused program 1-2
Remembering from Program 1 to now① Scaling questions (degree of solution to the problem
after Program 1)
The researchers asked participants about the degreeof solution for the problem, similar to Solution-Focused
Program 1-1, ②.
② Scaling question (degree of ideals for life after Program
1-1)
The researchers asked participants about the degree of
their ideal for life, similar to the Solution-Focused Program
1-1, ③.
③ Coping question
The researchers asked participants who felt like they
were nearing a solution to think about why they could bein a better situation and write that down, and asked participants whose degree of problem had not changed to think
about why that happened.
“Let’s think positive images”
The researchers asked the participants to learn how todeal with feelings of disgust when they had trouble orproblems.
The researchers asked the participants to imagine aperson such as an entertainer or a close person or character
they liked and write their names. Further, the researchers
asked them to imagine and write what word the person or
character wrote about would they help you, imagine, andwrite under what situation.
The researchers asked the participants to write the firsttwo words of the dialogue on their palms and place theirpalms on their chest while thinking about positive images
three times every day (morning, afternoon, and before
sleeping at night) for a week.
As checklists, the researchers assessed the participants’attitudes through scores ranging from 1 to 5, similar to the
Solution-Focused Program 1-1.
In order to confirm content validity, participants also

I want to become in life,” “I can solve every problem withmotivation,” and “I know how to eliminate feelings of
disgust” to check whether they thought by applying the
Solution-Focused method.
(3) Solution-Focused program 2-1 (class work)“Let’s think about the ideal class”① Scaling question
The researchers asked participants about the degree ofLongitudinal Study of SFBT of 3 Years in Junior High school

19② Participants also had to provide the reason for their
responses.

ideal for life following the same method as the SolutionFocused program 1-1, ③.

③ Miracle question
The researchers asked the miracle question “How would
your class change if your classmates had a very nice day,just like that, by magic? What happens in your classroom?
Please think and respond by choosing the most positive
imaginable situation for the morning, lunchtime, andafternoon.”“Let’s think about a small solution”④ Miracle question
The researchers asked the miracle question, following thesame procedure as Solution-Focused program 1-1, ④, byasking the students to choose the most positive imaginablesituation in the morning, lunchtime, and afternoon.

④ Clarifying goals
The researchers asked for goals using the same method
as Solution-Focused program1-1, ⑤.
“Let’s think about what you can do”⑤ Seeking for exception
The researchers asked “We think that your class had time
to become, as you had described in ③, and you achieved
the goals you wrote set in ④. Please remember and write
about what you did, which would be effective for the class.
It is okay to write small things, which you have slightly
tried. Taking advantage of what, for example, you areinterested in, what you are doing, what you are good at, who
is important to you, and what is important to you.”
The researchers asked participants to “try if what you
wrote in ④ can be achieved even a little,” “seek what you
want to become in class,” and “what your classmates should
do for the class” during the next 1-2 weeks.
As checklists, the researchers asked participants to ratefrom 1 to 5, following the same method as in the Solutionparticipants also had to rate by choosing a number from 1“I
could imagine the ideal situation in class,” “I could think
about how to make efforts in class,” “I could think about
how to improve this study’s class” (to check whether they
could imagine the ideal provided in the miracle question andclarify their goals).
(4) Solution-Focused program 2-2 (personal work)“Let’s think about your problem”① Problem
The researchers asked participants to write about theirproblems, similar to the Solution-Focused program 1-1, ①.
② Scaling questions (degree of solution to the problem
before starting the programme)
The researchers asked participants about the degree ofsolution to the problem, following the same procedure as
the Solution-Focused program 1-1, ②.
③ Scaling questions (degree of ideality for life before
starting the program)
The researchers asked participants about the degree of⑤ Clarifying goals
The researchers asked for goals, following the same
method as the Solution-Focused program 1-1, ⑤.
⑥ Seeking exception
The researchers asked whether the students could achieve
the goals they wrote about in ⑤, what they did to achievethem, and the effort they had to put in.
During the next 1-2 weeks, The researchers asked participants to “try to do what you wrote about in ⑤ to see if it
can be achieved, even a little bit” and “seek what you want
to become in life.”
As checklists, The researchers asked participants to rateagree), following the same method as the Solution-Focused

Solution-Focused program 1-1.
5) Ethical Considerations
The survey was conducted as a morning activity inclass by teachers with the permission of the Board of
Education and the school principal. At the beginning of thequestionnaire, it was indicated that the survey was about
their school life and it was not a test, and it was okay to not
answer what they did not wish to answer and could stop
any time they wanted. The researchers asked for a written
student number, but the results of the survey were usedsolely for research purposes. The Research Ethics Review
Board of the Graduate School of Education, TOHOKUUNIVERSITY, approved this study (approval ID:20-1056).
6) Analysis
First, the researchers examined the checklist for eachprogram and its content validity. Next, the researchersand “High group” based on the score of SRAS-R-JA at
the time of each surevey. Then, to classify the students atof the function of school refusal behavior from the 2018 1st20

Sakuraba et al.

Sakuraba et al.

10

For Solution-Focused program 1-2, 62% of respondents
by the transition
scoreof the functionof school
refusal seek whatwant toin life,”answered
60% of respondents
examined.
Figures
2-5 showthe distributions,” I 77%
ofbecome
respondents“4=agree”

of each program. In the Solution-Focused everypor “5=strongly
agree”andfor65%“I of
could
think abproblemwith motivation,”
respondents
cluster analysis and classified the students according torogram 1-1, 78% of respondents answered

out how to make efforts in class,” and 66%

or “5=strongly“I couldifference“4=agree”
of those clusters
in the functionagree”
of schoolfor
refusalbehavior in the third grade using One-way ANOVA.

of respondents answered “4=agree” or “5=s

how to eliminate feelings of disgust.” At Solution-Focusedd imagine the situation with no problem antrongly agree” for “I could think about how

Results Moreover, 57% of respo
d set small goals.”

to improve this study’s class.” At Solution

make efforts in class,” and 66% of respondents answered

ndents answered “4=agree” or “5=strongly a-Focused program 2-2, 80% of respondents

1) Checklists of each Program and Content Validity of
Programgree” for “I can solve every problem withhow to answered
improve this“4=agree”
study’s class.”
At Solution-Focusedor “5=strongly
agree” f(1) Checklists of Solution-Focused program 1-1
motivation,”and 63%
respondents
answeor “I could imagine the situation with no p
As checklists,
the researchers
askedofstudents
to respondbased onred
the statement,
workedseriously agree”
and thought
problem andand setgoals,”
58% ofrespondents“4=agree”“I or“5=strongly
for “Iwith noroblem
setsmallsmallgoals,”
58%
of responof small solutions” by choosing a number from 1 to 5
know how to solve the problem.” For Solutdents answered“4=agree”
or of“5=strongly
every problem
with motivation,”and 63%
respondents ag
attitude regarding
each program.
who resoponded
ion-FocusedprogramStudents
1-2, 62%of respondenree” for “I can solve every problem with mand chose 4-5 were regarded as passed for the check, while to solve the problem.”ts resopondanswered1-3“4=agree”
or “5=strongly
otivation,” and 63% of respondents answere
those who
were not regarded
as passed.agree”
Figure 1 showsthe
distributionoftheresponses
tothe2)
Distributionof Score
SRAS-R-JA agree”
at each Quesfor “I tried to seek what I want to becom
d “4=agree”
or of“5=strongly
for “I k
checklist. In each program, more than 80% of students tionnaire Survey
in life,” 60% of respondents answered “4 The researchers
now how calculated
to solvethe
thetotal
problem.”
score of the SRASpassed thee check.

=agree” or “5=strongly agree” for “I can sothen divided by the number of items. Reliability analysis(2) Content validity of the program
lve
every
problemwithmotivation,”and6 performed
2) Distributionof scoreof SRAS-R-JA
each
on SRAS-R-JA,
ANA,
ESE, PA, andat
PTR
The content validity of each program was examined. wasFigures 2-5 show the distribution of each program. In in SPSS. The Cronbach’s alphas of the SRAS-R-JA was
5% of respondents answered “4=agree” orQuestionnaire Survey
the Solution-Focused program 1-1, 78% of respondents“5=strongly agree” for “I know how to eli

The researchers calculated the total score of theSDimagine the situation with no problem and set small goals.”

minate feelings of disgust.” At Solution-Foc
SRAS-R-JA in the 1stSD
Questionnaire Survey in
R-JA (mean- SD

third decimalgroupswere classified:“Low ofused program 2-1, 73% of respondents ans
2018, place).
which Three
was thendividedby the number
function of school refusal behavior group” as they scoredwered “4=agree” or “5=strongly agree” forunder 1.11,
items.
Reliability
performed“Middlefunctionanalysis
of schoolwas
refusalbehavior on“I could imagine the ideal situation in clas

SRAS-R-JA, ANA, ESE, PA, and PTR in SPSS.

Checklist of each program（attitude）

Solution-Focused program 1-1

65

Solution-Focused program 1-2

50

38

6

50

16

11

Solution-Focused program 2-1

59

48

8

Solution-Focused program 2-2

58

45

10

0%

10%

5=strongly agree

20%
4=agree30%

40%
3=neither50%
2=disagree

60%

70%

80%

90%

1=strongly disagree

Fig. 1 Checklist of each program (attitude).

3

Figure 1: Checklist of each program（attitude）

1

100%

11
“Longitudinal Study of SFBT of 3 years in Junior High school”
11

The

Longitudinal Study of SFBT of 3 Years in Junior High school

21

Solution-Focused program 1-1

The

Solution-Focused program 1-1“I could imagine the situation with no problem
and set small goals.”“I could imagine the situation with no problem
and set small goals.”“I can solve every problem with motivation.”

42

55

42
34

20

55
37

52

20
38

52

12 3

“I could
can solve
every
motivation.”
34
37
38
12 3
“I
know
howproblem
to solve withthe problem”
tocheck whether imagining their ideal in miracle
24
55
29
12 4
question, would clarify their goals.”“I could know how to solve the problem” tocheck whether imagining their ideal in miracle
24
55
29
12 4
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
question, would clarify their goals.”
5=strongly agree

4=agree

3=neither2=disagree
1=strongly disagree
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

5=strongly agree

4=agree

3=neither2=disagree

1=strongly disagree

Figure 2: Content validity of Solution-Focused Program 1-1
Fig. 2 Content validity of Solution-Focused Program 1-1.

Figure 2: Content validity of Solution-Focused Program 1-1

Solution-Focused program 1-2
Solution-Focused program 1-2“I tried to seek ‘what I want to remain in mylife.”“I tried to seek ‘what I want to remain in mylife.”“I can solve every problem with motivation.”

24

42

31

9 1

24

42

31

9 1

21

44

35

52

“I know
can solve
problemfeelings
with motivation.”
21
44
35
52
“I
howeveryto eliminate
of disgust”
to check whether they thought with the
30
40
31
42
Solution-focused method”.
“I know how to eliminate feelings of disgust”
to check whether they thought with the
30
40
31
42
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
Solution-focused method”.
5=strongly agree

4=agree

3=neither2=disagree
1=strongly disagree
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

Fig. agree
3 Content
validity 3=neitherof Solution-Focused
Program1-2. disagree
5=strongly
4=agree
2=disagree
1=strongly

Figure 3: Content validity of Solution-Focused Program 1-2

Cronbach’s alphas ofFigure
the SRAS-R-JA= 3,“ igh functionProgramof school1-2
refusal behavior
3: Contentwas
validityof Solution-Focused
ANA
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=.86,
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group”
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andwas“High=.8
functiongroup,“Middlefunctionofresearchersschool refusal
Cronbach’s
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wasofwas= refusal
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JAscoresfor allrange
uestionnaire
surveys.
Figure=.87,
and PTR was=.86.
They6 wereusedthis score
to classify
the SRAS-RJA scores for allquestionnaire
surveys.
Figureshowsallthe
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researchers
calculated
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showsof SRAS-R-JA
distribution of reliable.
SRAS-R-JA
for eachquestionnaire.
scoresthefordistribution
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FigureAsaresultoftotalingtheanswersof
110 respondents=1.7040
,
and
S
=.5
142
of
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for
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reliable. The researchers calculated the mean (55 males,
6 shows
the distributionof SRAS-R-JA
55 females),the passing
check of the scores
SolutionmeanS=1.11,
mean
S=2.30,
roundedtoprogram
1-1, and excluding those who had incomAfter totaling=1.7040
the answers
peoplemales, 58 Focusedfor, andof
S 125=.5
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of SRAS-R-JA
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19 1stpeople(17%) were in
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15 plete answers,
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.
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2018
Questionnaire
Surveymean- S =1.11, mean S =2.30, rounded topeople (12%) were in the “Low function of school refusal of school refusal behavior group,” 79 (72%) in the “Middle
classified:“ ow functionof school
refusalAfter
the answersSurveyof 125 people
the third
decimal. Threegroupswere
2018totaling
1st
Questionnaire
refusalbehavior group,” and 12 (11%) inbehavior group,”
94 (75%)in placethe “Middle
functionof function 1of schoolgroup”
theyscoredunder
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67Aftermales,
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behaviorgroup.”
school refusal behavior
behaviorand16 (13%)
intherefusal“Highclassified:group,”“ owasfunctionof school
totaling
therefusal
answersof 125peopleA one-way
ANOVA
was answers,
performed 15
withpeople“SRAS-R-JA,”
function of school
refusal behavior“Middleofgroup.”schoolrefusalbehavioro67
hadmales,incomplete
12%
behaviorfunctiongroup” astheyscoredunder
1.11,
58 females, excluding
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whA one-way ANOVA with “SRAS-R-JA,” “ANA,” “ESE,” “ANA,” “ESE,” “PA,” “PTR” as independent variables,group”
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and
were
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ow
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as independent“Groupsofnaire
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as the dependent variable was performed. As a result of analysis (Table 2), a significant difference was foundF
the analysis (Table 2), a significant difference was found between the groups (FF
FF
between the groups (FF
F
F
F
p<.001). As a result of multiple comparisons, all scores
all p<.001). As a result of multiple comparisons, all were higher in the “High school refusal behavior group”
scores were higher in the order of “High function of school followed by the “Middle function of school refusal behavior

Sakuraba et al.
Sakuraba et al.

1
1
22

Sakuraba et al.

Solution-Focused program 2-1
Solution-Focused program 2-1“I could imagine the ideal situation in class.”“I could imagine the ideal situation in class.”

34
34

55
55

21
21

42
42

“I could think how to make efforts in class.”“I could think how to make efforts in class.”

35
35

54
54

21
21

42
42

“I could think how to improve our class.”“I could think how to improve our class.”

5=strongly agree
5=strongly agree

4=agree
4=agree

23
23

53
53

28
28

11 1
11 1

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
3=neither2=disagree
1=strongly disagree
3=neither2=disagree
1=strongly disagree

FigureFig.
4: 4Content
ofSolution-Focused
Solution-Focused
Program
2-1
Contentvalidity
validity of
Program
2-1.
Figure 4: Content validity of Solution-Focused Program 2-1

Solution-Focused program 2-2
Solution-Focused program 2-2“I could imagine the situation with no problem
andtheset situation
small goals.”“I could imagine
with no problem
and set small goals.”

32
32“I can solve every problem with motivation.”“I can solve every problem with motivation.”

24
24

42
42

“I could know how to solve the problem” tocheckwhethertheir
ideal
in miracle“I couldknow imagining
how to solvetheproblem”
toclarify
theirgoals.”
checkquestion,
whether would
imagining
their
ideal
in miracle
question, would clarify their goals.”

25
25

47
47

5=strongly agree
5=strongly agree

4=agree
4=agree

59
59

16 42
16 42
38
38
37
37

81
81
31
31

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
3=neither2=disagree
1=strongly disagree
3=neither2=disagree
1=strongly disagree

Fig. 5 Content validity of Solution-Focused Program 2-2.

Figure 5: Content validity of Solution-Focused Program 2-2
Figure 5: Content validity of Solution-Focused Program 2-2
al behavior group,” 4 75% in the “Middl

2,122 =13 .43, F 2,122 =85.30, F 2,122 = 5.

group,” and “Lowfunctiongroup,”of school4 refusal
ior group,”
and=13“Low.43,functionof school
behavior
al behavior
75% behavior
in the “Middl
2,122
F 2,122=85.30,refusal
F 2,122= 5.
e function of school refusal behavior group,”group.”
group.” 7 , F 2,122 =21.81, and F 2,122 =53.57, alle function of school refusal behavior group,”
7 , F 2,122 =21.81, and F 2,122 =53.57, all
and 16 13% in the “ igh function of sc
p .001 . As a result of multiple comparisonand 16 13% in the “ igh function of sc
p .001 . As a result of multiple comparison
refusalthebehavior
group.”
s, ofallhigherin the 1orderof
As a result hooloftotaling
answersof79
people(40
A
total
123scores
people were
(64 males,
58 females,
unknown)hool refusal behavior group.”s, allscoreswerehigherin the orderofmales, 39 females)Awith
the passingof theSolution- were recruited
2019. of school refusal behavior g
one-way
AN check
A with“SRAS-R-JA,”“ igh infunction
ANexcluding
A with“SRAS-R-JA,”igh offunction
refusalg
Focused program A
1-1one-way
and 1-2 andthose
who hadAs a “result
totalingof
theschoolanswersof 117behavior
people (51“ANA,” “ESE,” “PA,” “PTR” as independenroup, “Middle function of school refusal beincomplete answers,
19 “ESE,”people (24%)
in themales, 56
females),
excludingthose
had refusal
incomplete“ANA,”“PA,” were“PTR”
as “Low
independen
roup,“Middlefunctionof whoschoolbet variables,and “ group,”
roups 51of (65%)SRAS-R-JA”
group”and “ (14%)
ow functionof schoolfunction of school
refusal behavior
in the atanswers,havior
there were
17 people
in the “Lowfunctiont variables, and “ roups of SRAS-R-JA” athavior group” and “ ow function of school“Middle function
schoolrefusal behavior
group,”
and as ofrefusalbehavior
behaviorgroup.”group,” 72 (62%) in “Middle
the of 1st
Questionnaire
Surveyin 2018
th school
refusalQuestionnaire2018 as functionthrefusalbehaviorgroup.” group,” and 28 (24%) in
9 (11%) in the the“High1stfunctionof schoolSurvey
refusal inbehaviorof school
refusal behavior
e dependent variable was performed. As a“Highrgroup.”
e dependent variable was performed. As a r function of school refusal behavior group”.
One-way ANOVA
with“ANA,”
ANOVA
performed with
“SRAS-R-JA,”
esult ofthe“SRAS-R-JA
analysis Table
2 , a“ESE,”
significant A one-way
2 2018
2nd wasQuestionnaire
Surveyesultof the analysis
Table, a significant
2018 “PA,”2nd Questionnaire
Survey variables,“PA,” “PTR” asindependent
variables,and 2“Groupsof “ANA,” 2“ESE,”“PTR” as independent
difference was found between the groups F
As a result of totaling the answers of 110
difference was found between the groups F
As a result of totaling the answers of 110 dependent variables were performed. As a result of theanalysis (Table 2), there were significant differences
between the groups (FF
FFF
all p<.001). As a result of the multiple comparison, allscores were higher in the order of the “High school refusal
behavior group,” “Middle function of school refusal behav-

naire Survey as the dependent variable. The results of
the analysis (Table 2) revealed significant differences
betweenthe groups (F
F
1
F 1
F
F
all p<.001). As a result of multiple comparisons, all scores
were higher in the order of “High school refusal behavior
group, order of Middle function of school refusal behavior

“ANA,” “ESE,” “PA,” “PTR” as independen

2nd Questionnaire Survey because the reset variables, and “ roups of SRAS-R-JA” inarchers classified it at the same interval of

the 201 2nd Questionnaire
Surveyas theandHigh201school. The researchers classified t23
Longitudinal Studyof SFBTof 3dYears 2018
in Junior
ependent variable was performed. As shown2018 1st Questionnaire Survey

15

2018 2nd Questionnaire Surv ey

192018 3rd Questionnaire Survey

he transition of the score of the SRAS-R-J

94
79

19

2019 1st Questionnaire Survey

9

72
27

0%

12

51

17

2019 2nd Questionnaire Surv ey

16

28
52

20%

“Low school refusal behavior group”

40%

60%

17
80%

100%

“Middle school refusal behavior group”“High school refusal behavior group”

6
Figure 6:Fig.istributionof score of SRAS-R-JA at each Questionnaire Survey

Table 2

grade (2018)1
Low

MiddleHigh

F value

Multiplecomparison

1stSRAS-R-JA
ANA
ESE
PA
PTR

1.05 (.04)
1.03 (.07)
1.04 (.08)
1.09 (.13)
1.05 (.12)

1.60 (.27)
1.60 (.45)
1.28 (.35)
1.62 (.52)
1.92 (.61)

2.90 (.64)
3.10 (.76)
2.68 (.70)
2.51 (1.17)
3.31 (.91)

139.43 ***85.30 ***
95.79 ***
21.81 ***
53.57 ***

L<M<H
L<M<H
L<M<H
L<M<H
L<M<H

2nd

SRAS-R-JA
ANA
ESE
PA
PTR

1.03 (.04)
1.03 (.10)
1.03 (.07)
1.05 (.11)
1.01 (.05)

1.59 (.32)
1.57 (.47)
1.30 (.38)
1.54 (.45)
1.94 (.62)

2.80 (.57)
2.90 (.88)
2.43 (.46)
2.60 (1.05)
3.27 (1.00)

108.54 ***55.45 ***
63.27 ***
34.06 ***
48.88 ***

L<M<H
L<M<H
L<M<H
L<M<H
L<M<H

3rd

SRAS-R-JA
ANA
ESE
PA
PTR

1.03 (.04)
1.00 (.00)
1.02 (.06)
1.08 (.14)
1.02 (.09)

1.55 (.35)
1.50 (.45)
1.34 (.43)
1.42 (.44)
1.94 (.68)

2.73 (.55)
2.67 (.81)
2.20 (.51)
2.56 (1.08)
3.49 (.96)

77.10 ***
42.16 ***
28.16 ***
26.83 ***
46.90 ***

L<M<H
L<M<H
L<M<H
L<M<H
L<M<H

1st

SRAS-R-JA
ANA
ESE
PA
PTR

1.05 (.05)
1.09 (.12)
1.01 (.05)
1.04 (.08)
1.07 (.14)

1.59 (.34)
1.57 (.51)
1.33 (.39)
1.51 (.40)
1.94 (.68)

2.78 (.44)
2.94 (.66)
2.36 (.62)
2.25 (.95)
3.56 (.88)

170.09 ***91.37 ***
72.64 ***
28.17 ***
83.79 ***

L<M<H
L<M<H
L<M<H
L<M<H
L<M<H

2nd

SRAS-R-JA
ANA
ESE
PA
PTR

1.03 (.04)
1.01 (.05)
1.00 (.00)
1.05 (.11)
1.05 (.12)

1.59 (.33)
1.57 (.46)
1.44 (.44)
1.47 (.43)
1.87 (.62)

2.90 (.43)
3.19 (.68)
2.42 (.62)
2.45 (1.10)
3.55 (.94)

199.79 ***131.27 ***62.01 ***
33.03 ***
89.34 ***

L<M<H
L<M<H
L<M<H
L<M<H
L<M<H

The second
grade (2019)Note) Low: “Low function of school refusal behavior group”, Middle: “Middle function of school refusal behavior
group”, High: “High function of school refusal behavior group”, SRAS-R-JA: total score, ANA: avoidance of stimuli thatprovoke negative affectivity, ESE: escape from aversive social and/or evaluative situations, PA: pursuit of attention fromp<.001

24

Sakuraba et al.

group, and order of Low function of school refusal behavior
group.”As a result of totaling the answers of 96 people (51males, 45 females) who passed the checks of SolutionFocused programs 2-1 and 2-2 and excluding those who had
incomplete answers, there were 27 people (28%) in “Lowfunction of school refusal behavior group,” 52 people (54%)
in “Middle function of school refusal behavior group,” 17people (18%) in “High function of school refusal behavior
group.”A one-way ANOVA with “SRAS-R-JA,” “ANA,” “ESE,”“PA,” “PTR” as independent variables, and “Groups
as the dependent variable was performed. As shown of
the analysis (Table 2), there were significant differences
between groups (FF
F
F
F
p<.001).
As a results of the multiple comparison, all scores werehigher in the order of “High school refusal behavior group,”“Middle function of school refusal behavior group,” and“Low function of school refusal behavior group.”
3) Transition of the Score of SRAS-R-JA
The researchers classified the transition of SRAS-RJA scores in 2018 and 2019. The researchers examined
the transition of the SRAS-R-JA scores from the 2018 1stof the SRAS-R-JA according to Wakashima, Kozuka,
Noguchi, Kobayashi, and Hasegawa (2012). Table 3 presR-JA score.

As a result of totaling the answers of 78 people (40males, 38 females) who passed the Solution-Focused
Programs 1-1 and 1-2 and excluding those who had incomplete answers, there were nine people (12%) in (1),“No function of school refusal behavior;” 12 people (15%)
in (2), “Decreased;” 47 people (60%) in (3), “Remaining
in the middle function of school refusal behavior;” threepeople (4%) in (4), “Increased;” and six people (8%) in (5),“Remaining in the high function of school refusal behavior”(Fig. 7).

in 2019 (second grade)
As a result of totaling the answers of 92 people (48males, 44 females) who passed the checks of the SolutionFocused Programs 2-1 and 2-2 and excluding those who
had incomplete answers, were:13 people (14%) in (1),“No function of school refusal behavior”; 17 people (19%)
in (2), “Decreased;” 45 people (49%) in (3), “Remaining
in the middle function of school refusal behavior;” threepeople (3%) in (4), “Increased;” and 14 people (15%) in (5),“Remaining in the high function of school refusal behavior”(Fig. 7).

researchers classified it at the same interval of 2018 andTable 3
(1) “No function of school
refusal behavior”

tionnaire Surveys Note 1.

(2) “Decreased”
Note 1, or thewere in the “Low function of school refusal behavior group” or “Middle function of school refusal behavior
Note 1.
(3) “Remaining middle
function of school refusal
behavior”

The people who were in the “Middle function of school refusal behavior group” at both the 1st and 3rd
Note 1.

(4) “Increased”
and in the “Middle function of school refusal behavior group” or “High function of school refusal behavior
Note1, or the people who were in the “Middle school refusal behavior
Note 1.

(5) “Remaining highfunction of school refusal
behavior”

tionnaire Surveys Note 1.

RAS-R-JA scores after the So ution- ocuse
ro ra
an

in the first an

ra es

e first and second grades as dependent varithe function of schoo refusa behavio

ables Table4,5 . The results revealed signifi

r in the thirsecon

the transition of the SRAS-R-JA score in thLongitudinal Study of SFBT of 3 Years in Junior High schoolra ecant differences at the 0.1% level in terms

25

3
The first grade

9

The second grade

13
0%

12

10%

47
17

20%

7

3
14

45
30%

40%

50%

60%

70%

80%

90% 100%（1）“No function of school refusal behavior”（2）“Decreased”（3）“Remaining middle function of school refusal behavior”（4）“Increased”（5）“Remaining high function of school refusal behavior”
Fig. 7

Figure 7: Classification of the transition of the SRAS-R-JA score

4) Relationship between the Transition of SRAS-R-JA
Scores after the Solution-Focused Program in the Firstand Second Grades and the Function of School Refusal
Behavior in the Third Grade
Cluster analysis using the k-means method of the transition of the score of SRAS-R-JA in the first grade andtransition of the score of SRAS-R-JA in the second grade
was performed to classify the students by the pattern ofgrades.
As a result of totaling the answers of 54 out of 115
passing the check of all programs, and excluding those who
number of participants in each cluster and the interpretabilityof the clusters were examined. CLU.1 consisted of ten participants, CLU.2 consisted of 37 participants, and CLU.3
consisted of seven participants.
A chi-squared test was performed with the three clusters
as independent variables, and the transition of the SRASR-JA score in the first and second grades as dependent
ences at the 0.1% level in terms of the ratio of the numberof participants with all transitions of scores of SRAS-R-JA.
Regarding to transition of the score of SRAS-R-JA in thefirst grade, residual analysis revealed that the proportionof participants with “1. No function of school refusal be“3. Remaining in the middle function of school refusal
in CLU.1. Regarding the transition of the score of SRAS-RJA in the second grade, the proportion of participants withat the 0.1% level in CLU.1.
In CLU.2, regarding to transition of the score of SRASR-JA in the first grade, residual analysis revealed thatthe proportion of participants with “3. Remaining in the

middle function of school refusal behavior” (75.7%) was
ticipants with “5. Remaining in the high function of schoollevel. Regarding the transition of the score of SRAS-RJA in the second grade, the proportion of participants with
“1. No function of school refusal behavior” (24.3%) and“2. Decreased function’ (24.3%) was significantly higher
at the 0.1% level. The proportion of participants with “3.
Remaining in the middle function of school refusal behavior” (0%) and “5. Remaining in thehigh function of schoollevel.
In CLU.3, regarding the transition of the score of
SRAS-R-JA in the first grade, residual analysis revealed
that the proportion of participants with “5. Remaining
in the high function of school refusal behavior” (71.4%)
was significantly higher at the 0.1% level. Regarding thetransition of the score of SRAS-R-JA in the second grade,the proportion of participants with “5. Remaining in thehigh function of school refusal behavior” was 100% and“3. Remaining in the middle function of school refusal
Therefore, CLU.1 was designated “Increased in thesecond grade” because students were remaining at the low
or middle function of school refusal behavior in the first
grade, but many students increased the function of school
refusal behavior in the second grade. CLU.2 was designated“Decreased the function of school refusal behavior throughout two years” because there are many students who were
grade, whose function of school refusal behavior became
low or decreased in the second grade. CLU.3 was designated “High function of school refusal behavior throughout
the two years” because many students remained in thegrades.

26

Sakuraba et al.

Table 4

CLU.1

CLU.2

CLU.3

1

2

3

4

5

Number

4

4

2

0

0

Proportion

40.00%

40.00%

20.00%

0.0%

0.00%

Number

3

6

28

0

0

Proportion

8.10%

16.20%

75.70%

0.0%

0.00%

Number

0

0

2

0

5

Proportion

0.00%

0.00%

28.60%

0.0%

71.40%

Total
10

37

7

Note
1: “No function of school refusal behavior”, 2: “Decreased”, 3: “Remaining middle function of school refusal behavior”,
4: “Increased”, 5: “Remaining high function of school refusal behavior”

Table 5

CLU.1

CLU.2

CLU.3

1

2

3

4

5

Number

0

0

7

3

0

Proportion

0.00%

0.00%

70.00%

30.00%

0.00%

Number

9

9

19

0

0

Proportion

24.30%

24.30%

51.40%

0.00%

0.00%

Number

0

0

0

0

7

Proportion

0.00%

0.00%

0.00%

0.00%

100.00%

Total
10

37

7

Note
1: “No function of school refusal behavior”, 2: “Decreased”, 3: “Remaining middle function of school refusal behavior”,
4: “Increased”, 5: “Remaining high function of school refusal behavior”

We then examined the difference in the function ofschool refusal behavior in the third grade by these threeclusters using One-way ANOVA. One-way ANOVA with
“SRAS-R-JA,” “ANA,” “ESE,” “PA,” “PTR” of 2020
three clusters as dependent variable was performed. As
a result of the analysis (Table 6), there were significant
differences between the clusters (Fp<.001, F
p<.001, F
p<.001, F
p<.01, F
p<.05).
“Decreased the function of school refusal behavior
throughout the two years” was significantly lower for“SRAS-R-JA” and “ANA” than “Increased in the second
grade” and “High function of school refusal behavior
throughout two years.” “Decreased the function of school
lower for “ESE” and “PTR” than “High function of school
refusal behavior throughout two years.” There were no

Discussionof the score of school refusal behavior after implementing

the Solution-Focused program. As checklists, the researchers
asked students to check their attitudes at the end of eachprogram. The attitudes for each program were good because
more than 80% of the students passed the check for eachprogram. On the other hand, teachers who conducted
the program said regarding the design and layout of the
program, that many of the sentences needed to be mademore friendly. Therefore, the researchers needed to make it
friendlier for junior high school students.
Next, the researchers examined content validity ofeach program. The researchers showed the proportion offor lists of content validity at each program. In SolutionFocused program 1-1, one exceeded 70% and two exceeded
60%. In the Solution-Focused program 1-2, all exceeded
60%. In Solution-Focused program 2-1, two exceeded
70%, and one exceeded 60%. In Solution-Focused program
2-2, one exceeded 80% and two exceeded 60%. Although
there the researchers re variations, all of them exceeded
approximately 60%, which revealed the content validity of
the Solution-Focused program.
Next, the researchers examined the transition of the scoreof the function of school refusal behavior by conducting theLongitudinal Study of SFBT of 3 Years in Junior High school

27

Table 6

tionnaire Survey as independent variables, and the three clusters as dependent variables.

SRAS-R-JA
ANA
ESE
PA
PTR

①

②

③

F value

Multiple comparison

1.94 (.75)
2.20 (.92)
1.82 (.73)
1.54 (.61)
2.18 (1.12)

1.42 (.42)
1.41 (.53)
1.24 (.45)
1.31 (.34)
1.71 (.78)

2.36 (.44)
2.63 (.67)
2.14 (.30)
1.94 (.80)
2.74 (1.05)

12.99 ***
14.56 ***
12.84 ***
5.55 **
4.55 *②＜①, ③②＜①, ③
②＜③
②＜③

Note
① : “Increased in the second grade”② : “Decreased the function of school refusal behavior throughout 2 years”③ : “High function of school refusal behavior throughout 2 years”*p<.05, **p<.01, ***p<.001

Fifteen percent of the students decreased the function of
preventing school refusal in the third grade. It can also be
grade. 19% of the students decreased the function of

students decreased the function of school refusal behavior.
Therefore, there was a certain number of students who
decreased the function of school refusal behavior after
undergoing the Solution-Focused program.
The second purpose of this study was to examine therelation of effects of “Solution-Focused program” in thefirst and second grade, and the function of school refusal
behavior in the third grade.
As a result of classifying the students by pattern ofgrades, the researchers obtained three types of students:
1) students remaining in the low or middle function offunction of school refusal behavior in the second grade; 2)
students decreasing the function of school refusal behavior
throughout the two years; and 3) students remaining at
a high function of school refusal behavior throughout thetwo years. As a result of examining the difference in thefunction of school refusal behavior in the third grade bythese types, students with decreased function of school
refusal behavior throughout the two years had lower scoresfor SRAS-R-JA and ANA than other students. Furthermore,
students with decreased the function of school refusal behavior throughout the two years had lower ESE and PTR
scores. Therefore, this study’s hypothesis that students
whose function of school refusal behavior decreased after
the second grades showed lower function of school refusal
behavior in the third grade, than those who did not show adecrease or increase, was largely supported.
Consequently, it was revealed that there was a relationship between the effects of the Solution-Focused programin the first and second grades and the function of school
refusal behavior in the third grade. The Solution-Focusedon the following two points:
First, the researchers presented the effectiveness ofa worksheet program based on Solution-Focused Brief
Therapy. Most of the previous approaches based on SolutionFocused Brief Therapy indicated the effects of the techniques therapists used during Solution-Focused Brief
Therapy sessions (Ginjerich, Kim, Starns, & Mcdonald,2013). A professional coach is required for the WOWW
approach. In this study, the researchers developed a worksheet program based on Solution-Focused Brief Therapy,
and the teachers distributed it to the students. As a result,some students who had decreased function of school refusal
behavior showed lower function of school refusal behavior
in the third grade than other students. Thus, the researchers
found that this study’s program based on Solution-Focused
Brief Therapy using worksheets, which is not conductedby an expert, is effective for students. This implies thata teacher who is not an expert in Solution-Focused Brief
Therapy can work with the worksheets based on SolutionFocused Brief Therapy. Therefore, the approach of the
Solution-Focused Brief Therapy can be one of ease and canbe a useful service that can provide psychological assistanceat school.
Second, the researchers found that it was effective forstudents to think about solutions to their problems andclass ideality. As the approach of Solution-Focused Brief
Therapy in school, only the WOWW approach has been
applied so far (Kelly, Liscio, Bluestone-Miller & Shilts,
2012; Shilts, Bluestone-Miller & Kelly, 2013). However,in the WOWW approach, the solution is different for each
student problem. This study’s approach was different fromprevious approaches of Solution-Focused Brief Therapy
because our program consisted of solution-building by
Solution-Focused Brief Therapy for students’ problems
and the class. In this study, the researchers found that
this approach is effective, and it can be considered a new

28

Sakuraba et al.

brief therapies.
Also, the effectiveness of miracle questioning and exploring exceptions was revealed by Takagi and Wakashima(2019). In the WOWW approach, the effectiveness of goalsetting and scaling questions was found in schools (Berg& Shilts, 2005). In this study, the researchers present theeffectiveness of miracle questions and explore exceptions
to goal setting and scaling questions for junior high school
students.

and students who cooperated in this study and Editage(www.editage.com) for English language editing.

Reference
Berg, I. K. & Shilts, L. (2004). Classroom solutions: WOWW
approach. BFTC Press.
Berg, I. K. & Shilts, L. (2005). Classroom solutions: WOWW
coaching. BFTC Press.
de Shazer, S. (1985). Keys to solution in brief therapy. NY: WW

Limitations

Norton.
de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar,First, in this study, “Solution-Focused program” were
but there were many students that were exclused fromanalysis because they were not clear about the checklistof each program or had incomplete answers. Therefore,
when examining the relationship between the transitionof SRAS-R-JA scores after the Solution-Focused programin the first and second grades, and the function of school
refusal behavior in the third, the number of subjects was 54,

A., Gingerich, W., & Weiner-Davis, M. (1986). Brief
therapy: Focused solution-development. Family Process,25, 207―222. doi:10.1111/j.1545-5300.1986.00207.x

De Jong, P., & Berg, I. K. (2013). Interviewing for solutions (4thed.). CA: Brooks ColeFranklin, C., Kim, J, S., & Brigman, K, S. (2012). SolutionFocused Brief Therapy in school settings. In C. Franklin,
T, S. Trepper, W. J. Gingerich, & E. E. McCollum (Eds.),
Solution-Focused Brief Therapy: A Handbook of EvidenceBased Practice. (pp. 231―246), NY: Oxford University

to say whether the truth in all subjects could be clarified
in this study. This was unavoidable because it was a longterm survey of three years. On the other hand, teachers
who participated in the program mentioned the design andlayout of the questionnaire and said that many sentences
had to be made child-friendly. Therefore, the researchers
need to make them more friendly and enjoyable for juniorhigh school students.
Second, there was no control group in this study, and thus
the decrease in the function of school refusal behavior after
program.” It is also conceivable that the function of school
refusal behavior naturally decreased or that it was the effectof various factors in school events and school life. Further
examination by setting an experimental group participatingin the Solution-Focused program and a control group that
did not use the program is needed.
Third, the researchers need to clarify the factors which
affect the function of school refusal behavior in detail. The
researchers should focus on three terms: personal factors,
such as solution building and resilience; school factors,
such as classroom group structure; and family factors,
such as parental involvement. In addition, in this study,
the researchers did not conduct an analysis of students’problems that were identified in the Solution-Focusedprogram. To improve the Solution-Focused program, theresearchers should classify the students’ programs andexamine the most common problems, and which of them
are related to the function of school refusal behavior.

Press.
Gingerich, W. J., Kim, J. S., & MacDonald, A. J. (2012).
Solution-Focused brief therapy outcome research. In C.
Franklin, T. S. Trepper, Wallace J. Gingerich, & Eric
E. McCollum (Eds), Solution-Focused Brief Therapy: A
Handbook of Evidence-Based Practice (pp. 95―111). New
York: Oxford University Press
Ishikawa, D. (2020). Futōkō no keikō ga mirareru jidō notekiō wo sokushin suru tame no torikumi-kobestusien・gakyūzukuri・gakōtaisei no torikumi wo sogōteki ni
okonatta jissen wo tōshite. Kyōiku jissen kenkyū, 30 ,
193―198. [in Japanese]（石川大智（2020）. 不登校の傾向がみられる児童の適応を促進するための取組―個別支
援・学級づくり・学校体制の取組を統合的に行った実践
を通して―

教育実践研究, 30, 193―198.)

Ishikawa, S., Sato, H., Nomura, H., Kiyamura, M., Kawano,J., Inoue, K., & Sakano,Y. (2012). An investigation
on mechanism of maintaining school non-attendant
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河野順子・井上和臣・坂野雄二（2012）. 不登校児童生徒

における不登校行動維持メカニズムに関する検討̶不登
校機能アセスメント尺度適用の試み̶

認知療法研究, 5,

83―93.
Ito, T. (2011). How to use Miracle Questions effectively.
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果的な用い方ブリーフサイコセラピー研究, 20(1), 15―26.)

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心理学研

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Kearney, C. A., & Silverman, W. K. (1993). Measuring the

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jsyt.2014.33.1.78
Smock, S. A., McCollum, E., & Stevenson, M. (2010). The
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小(2016). ワークシートでブリーフセラピー―学校ですぐ使

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解決志向ブリーフセラピーのコンサルテーション コミュニティ心理学研
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検討

心理臨床学研究, 37(4), 393―399.)

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中京大学心理学研究科・心理学部紀要, 7(1),19―28.)
Tsuchiya, M., Hosoya, K., & Tojo, M. (2010). Application

目白大学心理学研究, 9, 23―36.)of the School Refusal Assessment Scale-Revised

Sagami, T (2012). Solution-focused brief therapy for achild refusing to go to kindergarten and his mother:(SRAS-R) to regular elementary school children and an
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creating of desired outcomes in concurrent child-parent
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美奈子・東條光彦（2010）. 不登校アセスメント尺度改定. 登園拒否21(1), 23―32. [in Japanese]（相模健人（2012）

動療法研究, 36(2), 107―118). doi:10.24468/jjbt.36.2_107

児童とその母親に Solution-Focused Brief Therapy を用いた一事例：解決像とゴールの設定および親子同席面接

版（SRAS-R）の一般児童への適応と妥当性の検討

行

Wakashima, K., Kozuka, T., Noguchi, S., Kobayashi, T.,& Hasegawa, K. (2012) Higashi Nihon Daishinsai

30

Sakuraba et al.

“Longitudinal
Studyof SFBT of 貴博・野口修司・小林智・長谷川啓三（2012）
3 years in Junior High school” . 東日本大ni kakawarru ishinomakishisyokuinni kansuru
kenkouchosa houkoku (Report about Health Survey

震災に関わる石巻市役所職員に関する健康調査報告（1）“Government
Longitudinal
Studyof SFBT of 3東日本大震災
years in PTG
JuniorHigh school”
of Ishinomaki City
Workers(1)). Higashi
心理支援機構）Nihon Daishinsai PTG [in Japanese]（若島孔文・狐塚Appendix

Solution-Focused program 1
Appendix

Appendix

初回

初回

Solution-Focused program 1
年組

考えてみようSolution-Focused program 1
番号：

初回【はじめに】
これから、困っていることや嫌な気持ちを解決するための『解決志向プログラム』を行い
年
組
番号：
ます。
一回目では悩みに対する小さな解決について考えてもらいます。小さな解決を考えること【はじめに】
で、悩みを解決するためにできることを考えてみましょう。二回目では嫌な気持ちに対する
これから、困っていることや嫌な気持ちを解決するための『解決志向プログラム』を行い肯定的なイメージについて考えてもらいます。肯定的なイメージを考えることで、嫌な気持ます。
ちを解消するためにできることを考えてみましょう。
一回目では悩みに対する小さな解決について考えてもらいます。小さな解決を考えること
で、悩みを解決するためにできることを考えてみましょう。二回目では嫌な気持ちに対する肯定的なイメージについて考えてもらいます。肯定的なイメージを考えることで、嫌な気持
ちを解消するためにできることを考えてみましょう。

解決志向プログラム①

困っていることについて考えてみよう
解決志向プログラム①

初回④．もしも奇跡が起きて、①で書いた問題が全くなくなったら、どんな一日を過ごすでしょう

考えてみようか。今の生活と何が変わるでしょうか。思いつくことをすべて、箇条書きで書きましょう。
＊大きな変化がないと感じる④・．もしも奇跡が起きて、①で書いた問題が全くなくなったら、どんな一日を過ごすでしょう
か・。今の生活と何が変わるでしょうか。思いつくことをすべて、箇条書きで書きましょう。
＊大きな変化がないと感じる・

困っていることについて考えてみよう

は、小さな変化を えて ださい・・
・⑤．④で書いたような生活を送るために、必要な目標を箇条書きで書きましょう。
・ なお、目標を設定するときは、次のように考えてみてください。
をする という行 的な目

・

できるだけ
にでき うな小さな目⑤．④で書いたような生活を送るために、必要な目標を箇条書きで書きましょう。
・
なお、目標を設定するときは、次のように考えてみてください。
・をする という行 的な目できるだけ・①．今、学校生活の中で困っている問題（悩みや解決したいこと）を、ひとつ書きましょは、小さな変化を えて ださいにでき うな小さな目

・・
・⑥．⑤の目標を少しでも実現するために、以下のヒントを参考にしながら、“これからできそうう・・・・。小さな困りごとでもよいです。

・なこと”や“やってみたいこと”を箇条書きで書きましょう。
①．今、学校生活の中で困っている問題（悩みや解決したいこと）を、ひとつ書きましょ・ 【う・・・・。小さな困りごとでもよいです。

⑥．⑤の
目標を少し
でも実
るために、
以下のヒントを参しながら、“ったか考えましょう
これからできそう
これまで
の目
が現す
しでも
していたときを
り考に
り、何が

】

なこと”や
“やっ
いこと”を箇あなたの条書きで書みきまの中で何が
しょう。
の目
をてみた
するために、【・・②．上で書いた問題の深刻さを得点化してみましょう

0

1

2

3

4

5

6

7

8

9

10

していたときを り り、何がするために、 あなたの み の中で何がったか考えましょう

つか考えましょう・・・②．上で書いた問題の深刻さを得点化してみましょう・＊０：問題がとても大変で困っている状態、１０：自分の力で何とかやっていける状態③．上で書いたような問題がある中で、今の日常生活はどのような状態だと感じますか？得点
0
1
2
3
4
5
6
7
8
9
10
化してみましょう

れ でした。ここまでの り みを生かすために、これからの１

・

2

、 の

ことをやってみましょう。

＊０：生活がとても大変な状態、１０：とても理想的な生活を送れている状態

・⑥で書いたことを実際にやってみる

0
1
2
3
4
5
6
7
8
9
10
③．上で書いたような問題がある中で、今の日常生活はどのような状態だと感じますか？得点

れ でした。ここまでの り みを生かすために、これからの１ことをやってみましょう。

2、 の・生活の中で“これからも起き続けてほしいこと”を探す化してみましょう＊０：生活がとても大変な状態、１０：とても理想的な生活を送れている状態
0

の目 を

・

＊０：問題がとても大変で困っている状態、１０：自分の力で何とかやっていける状態

つか考えましょう】
これまで の目 が しでも

1

2

3

4

5

6

7

8

9

・⑥で書いたことを実際にやってみる

10

・生活の中で“これからも起き続けてほしいこと”を探す
2

1

1

2

Solution-Focused program 1-2
Solution-Focused program 1-2

Solution-Focused program 1-2

二回目

二回目

解決志向プログラム②

みごとや困りごとなどの問題が きると な 持 になることがあるかと思います。

二回目

二回目

年

組

な 持 になった時の番号：

解決志向プログラム②

まずは、前回からの振り返りをしましょう。

ここに書き らいまずは、前回からの振り返りをしましょう。

。

①．初回で書いた問題は、今、どのくらい深刻に感じますか？得点化してみましょう

は、でよいです。 れも書き らい

し 感じる人人＊０：問題がとても大変で困っている状態

し

0
1
2
3
4
5
6
7
8
9
10
①．初回で書いた問題は、今、どのくらい深刻に感じますか？得点化してみましょう

ここに書き
らい
は、に
な
になった
と 。 に
か

＊０：問題がとても大変で困っている状態
10：自分の力で何とかやっていける状態②．初回で書いたような問題がある中で、今の生活はどのような状態だと感じますか？
0
1
2
3
4
5
6
7
8
9
10
得点化してみましょう＊０：日常生活がとても大変な状態
10：とても理想的な生活を送れている状態②．初回で書いたような問題がある中で、今の生活はどのような状態だと感じますか？
0
1
得点化してみましょう

2

3

4

5

6

7

8

9

10

な 、書き らい
で いま
な
と

0
1
2
3
4
5
【前回よりも解決に近づいたと感じる人】

6

7

8

9

10

・
・様々なことがうまくいかない大変な時期をどのようにしてやり過ごすことができたのか、何が助けになったのかを考えてみて、思いつくことをすべて、箇条書きで書きましょう。
・

し

の人

から
て

え 、 自分の
の感じ

にして

ら

から
様

など

た

る前

は 回

か て

し

様

は 回
か て

て よ

え 、
から など
のよ な
か て
え 、
みながら など
て よ

ら

え 、

の中で、以 のことに り

3回

のよ な

だけ えてくだ い。 れも書き らい
からのよ な

え 、 や しい感じで など

これからの

前

だけ えてくだ い。 れも書き らい

え 、 自分のなどになった にの人の感じ
え 、 や しい感じで など
に
か
の
にして

な
と

書きで書きましょう。

【前回よりも解決から遠ざかったと感じる人】

をは 回 で いま人 い か て

て

は、 初の

か

・どのようにしてより良い状態になることができたのかを考えてみて、思いつくことをすべて、箇条【前回から問題の深刻さは変化していないと感じる人】【前回よりも解決に近づいたと感じる人】
・どのようにして以前の状態を維持することができたのかを考えてみて、思いつくことをすべて、箇・どのようにしてより良い状態になることができたのかを考えてみて、思いつくことをすべて、箇条
条書きで書きましょう。
書きで書きましょう。
【前回よりも解決から遠ざかったと感じる人】【前回から問題の深刻さは変化していないと感じる人】
・様々なことがうまくいかない大変な時期をどのようにしてやり過ごすことができたのか、何が助け・どのようにして以前の状態を維持することができたのかを考えてみて、思いつくことをすべて、箇になったのかを考えてみて、思いつくことをすべて、箇条書きで書きましょう。
条書きで書きましょう。

的ならいの人 でよいです。 れも書きからのよ な は 回か でて いま。
になった にに

近な人

な 、書き らいは、 初のなになった に
の人
で いま
。
と
に
か
の

10：とても理想的な生活を送れている状態＊０：日常生活がとても大変な状態

でみごとや困りごとなどの問題が きると な 持 になることがあるかと思います。
感じる人
人を 近
人 でい かな 持し になった時のにな人けるた に、以 の的なて 前 をし化しましょう。

年組
番号：前回から今日までの振り返り

前回から今日までの振り返り
10：自分の力で何とかやっていける状態

を に けるた に、以 の化しましょう。

え 、から など
みながら など

でみましょう。

の

しな ら

の

い し し
な
これからの

になの中で、以
った

の3回

た

の
の
のことにしなり ら でみましょう。

い し し

る前

しな ら

の

の

い し し
な

になった

の

しな ら

の

い し し

の

・
・・

た

の

の2

の らに

の ら

に てる

た

の

の2

2
の らに

の ら

に てる

・
・

1

・

1

2

Solution-Focused program 2-1
Longitudinal Study of SFBT of 3 Years in Junior High school

Solution-Focused program 2-1

31

初回

初回

できることを考えてみよう

Solution-Focused program 2-1

めに
初回これから

を

らいます。

で

あなた

います。

の

みや

り

とに

で

の

いて

てもらいます。

にいてても⑤．これまで③のようなクラスや④の目標が少しでも実現していた時があったと思います。そ初回の時、あなたがクラスのために、やったこと、頑張ったこと、ほんの少しでも役に立ったことできることを考えてみよう

を振り返って、箇条書きで書きましょう。
【ヒント】

めに

の
に いて
て考えてみよう

これから
らいます。
．

で

のクラスの

＊

を

の

が

0

1

で

の

が

0

1

して

2

3

ても

てもらいます。

よう

で大 な

．その
のクラスを
．
の ん を
＊

を います。
での みや り とに いて

あなた＊どんなに小さなことでも構いません。少しでもやってみたことを書いてみましょう⑤．これまで③のようなクラスや④の目標が少しでも実現していた時があったと思います。そ＊あなたが関心があること、頑張っていること、得意なこと、あなたにとって大切な人、大切の時、あなたがクラスのために、やったこと、頑張ったこと、ほんの少しでも役に立ったことな物など、の中から役立ちそうなことを活かしてみましょうを振り返って、箇条書きで書きましょう。
・
【ヒント】

、１
4

とても

5

6

な

の

・
＊どんなに小さなことでも構いません。少しでもやってみたことを書いてみましょう

7
8
9
10
て考えてみよう＊あなたが関心があること、頑張っていること、得意なこと、あなたにとって大切な人、大切・な物など、の中から役立ちそうなことを活かしてみましょう
・

を
で して
て ようい
で大 な
2

3

、１
4

とても

5

6

7

な
8

お疲れ様でした。ここまでの取り組みを生かすために、これからの１～2 週間、次のことをやってみましょう。

の

9

・

10

・

③．
が きて、クラスの
をクラ
んスと が
を
そ．
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んで

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て

・④で書いたクラスに近づくためにできそうなことを実際にやってみる

んなが
しい
を
してい と
して ましょう。
てでしょう
い 。 んなことが き ようにな でしょう 。

のクラスの

、

のクラスの

の

やすい時

・クラスの中で“これからも起き続けてほしいこと”を探す
お疲れ様でした。ここまでの取り組みを生かすために、これからの１～2 週間、次のをことをやってみましょう。

ましょう。

・クラスのためにクラスメイトがどんなことをしてくれているか探す
・④で書いたクラスに近づくためにできそうなことを実際にやってみる

＊大 な
がないと
る
、小さな
を
て
さい
③．
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してい と
して ましょう。
・ のその時、 のクラスと がでしょう 。 んなことが き ようにな でしょう 。
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・ラス
のの

、

のクラスの

、

のクラスの

の

やすい時

・クラスの中で“これからも起き続けてほしいこと”を探すをんでて ましょう。
・
の
＊大 な
がないと
る
、小さな
を
て
さい
④．③で書いたようなをために、な目標を箇条書きで書きましょう。
・ のな 、目標をす とき 、 のように
て て
い。
・

の ～をする という

・ でのる

な

にで そうな小さな④．
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な目標を箇条書きで書きましょう。

のように

て

て

い。

な

にで そうな小さな

・

2

1

・

2

1

Solution-Focused program 2-2
Solution-Focused program 2-1

Solution-Focused program 2-2
回

回

．もしも

めに
回

これから

を

てもらいます。小さな

を

います。

みに

ることで、 みをする小さなするためにで

に

ることを

いて

。 の

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てみ

ましょう。思いを います。
ることで、 みを

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て考えてみよう

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な

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の

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みに する小さなにするためにで ることを

したいこと

を、

と

いて
てみ

書きましょう。

て考えてみようなどです

ったら しいことを書こう

ってい

や

したいこと

を、

と

0

1

2

3

4

5

6

7

8

9

．てから
で書いたに
ようなまで を・な 、目標をす とき 、 のようににいると～をする というな・をで てからるまでるにで そうな小さな・ で書いたような．

書きましょう。

0＊

1で書いたような

して

2

3

があ

4

で、

5

6

7

8

9

る

のような

と

とても

な生活を れている

を

ために、

1

、１
2

3

4

5

6

7

8

9

10

まで、

んで

て

ために、

やすい時

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に

を

んで

まで、
て

さい

な目標を箇条書きで書きましょう。
て てい。

な目標を箇条書きで書きましょう。

の・ ために、やったこと、頑張ったことを振り返って、箇条書きで書きましょう。また、目標を少しでも実現す ために、あなた

の

や り

の

で役に立 そうなことがあれ 、箇条書きで書きましょう。
． の目標が少しでも実現していたときがあったと思います。その時、あなたがのために、やったこと、頑張ったことを振り返って、箇条書きで書きましょう。また、目標を少＊どんなに小さなことでも構いません。やってみて少しでもいったことを書 ましょう。
しでも実現す ために、あなたのや りので役に立 そうなことがあれ 、
＊あなた
の みと
あなたが関心があること、頑張っていること、得意なこと、あなたに箇条書きで書きましょう。
とって大切な人、大切な物などです。

ます・＊どんなに小さなことでも構いません。やってみて少しでも生活がとても大 な
0

ます
る

10

の

ましょう

すでしょう
に

な 、目標をす とき 、 のようにて てい。
・～をする というな．で のる
目標が少しにででも実そうな小さな現していたときがあったと思います。その時、あなたが

・

④．

を

きて

ことをす て書いて ましょう。

・10③． で書いたのをして ましょう④． で書いたような
があ
で、 の
のような
と
＊
がとても大 で っている
、１の で とかやっていして ましょう
0
1
2
3
4
5
6
7
8
9
10
＊
生活がとても大 な、１
とてもな生活を れているな なった 、 んなを考えてみよう
やすい時
を

までの

にい とき、
を て
まで の
・
にいると
ましょう。思いことをす て書いて ましょう。
・ な を がないとてから るまで
＊大
る
、小さな
を
て

とでもよいです。

＊
の
、 活、
、 人、
などです
③． で書いたのをして ましょう
＊もしも
がない
、少しでも
ったら しいことを書こう＊
がとても大 で っている
、１の で とかやっていがって、 をす ようにな でしょう 。
を て

＊大 な
がないと
る
、小さな
を
て
さい
．もしも
が きて、 で書いたがな なった 、 んな
・ の てからまで。
と が に って、 をす ようにな でしょう 。 きてめに
これからてもらいます。小さなましょう。

が きて、 で書いたと がにい とき、ましょう。

．

を考えてみよう

・
＊あなた

の みと

いったことを書 ましょう。

あなたが関心があること、頑張っていること、得意なこと、あなたにとって大切な人、大切な物などです。
お疲れ様でした。ここまでの取り組みを生かすために、これからの１～2 週間、次の・ことをやってみましょう。
・・

で書いた

に近づくためにできそうなことを実際にやってみる

お疲れ様でした。ここまでの取り組みを生かすために、これからの１～2 週間、次の・の中で これからも起き続けてほしいこと を探すことをやってみましょう。
・ で書いたに近づくためにできそうなことを実際にやってみる

4

5

・

4

の中で これからも起き続けてほしいこと を探す

5

International Journal of Brief Therapy and Family Science
2023 Vol.13, No.1, 32‒42

Original Paper: Research and Experiment

Development of a Behavioral Scale toward People Who Fail at“Taking a Hint” and a Test of its Reliability and Validity
Kohei Koiwa1), Mao Komatsu2) and Koubun Wakashima1)
1)
2)

Graduate School of Education, Tohoku University
Sendai City Board of Education

Abstract: This study aimed to develop a behavioral scale toward other people who fail at “taking ahint” and to test its reliability and validity. An internet survey was conducted with 419 university
students (M=20.80 years, SD=1.85). The results indicated that the scale had a six-factor structure:
Jeer / Tease, Criticize, Follow Along, Ignore, Avoid, and Gossip. Validity was examined in termsof both content and convergence. Reliability was tested in terms of internal consistency, factor
invariance, and temporal stability. The results indicated the reliability and validity of the scale.
Key Words: “Taking a hint,” Japanese culture, group norm, behavior

Introduction
The formation and maintenance of norms are essential tohuman group life (Kameda, 2015). The formation of groupnorms maintains order in the community and enables groupmembers to lead a smooth social life (Fehr & Gächter,2002). On the other hand, it also has a dangerous aspect:those who deviate from the group norm are attacked or
excluded from the group (Silver, 1994). The type of norms
emphasized in a society or group is said to depend on thecultural sphere to which the group belongs (Gelfand, Nishii,& River, 2006), and the group norms that people in Japan
have been argued to emphasize are “Taking a hint” (Sato,
2002).
“Taking a Hint” in Japan“Taking a hint” is defined as “perceiving the desired
behavior in a given situation from the social context, including the facial expressions and relationships of thepeople present, and behaving accordingly” (Koiwa, 2022).
Behind Japanese people’s emphasis on “taking a hint”
is their communication system that emphasizes social
context. According to Hall (1976), there are two aspects ofcommunication : content and social context. The weight of
the ratio varies according to culture. Hall (1976) describes
CORRESPONDENCE TO: Koiwa. Tohoku University 27-1, Kawauchi,
Aoba-ku, Sendai-shi, Miyagi, 980-8576, Japane-mail: Kohei.Koiwa.r7.@dc.tohoku.ac.jp

Japan as an example of a “high context culture” in whichsocial context is more important than content. However,some studies have criticized Hall’s (1976) theory (Cardon.,2008), as many attempts to directly model Hall’s (1976)
high/low context theory have failed. However, there havebeen many cultural psychological studies comparing
Western and Oriental people. For example, Kitayama &Ishii (2002) reported that Americans judge others’ emotions
based on verbal information, whereas Japanese place moreemphasis on auditory information. Kim & Sherman (2007)
showed that Westerners prefer to express themselves morethan Orientals, whereas Orientals place more importanceon avoiding verbalizing their own thoughts. Furthermore,
Ambady, Koo, Lee, & Rosenthal (1996) reported that
Westerners varied their mode of expression dependingon the content of the topic, whereas Orientals varied theirmode of expression depending on the relationship between
speakers. Thus, there is a wealth of evidence that indirectly
support Hall’s (1976) theory that communication in Oriental communities, especially in Japan, emphasizes social
context.
Most studies that have pointed out the importance ofsocial context have examined it as a strategy for survival
without being excluded from the group (Takahashi et al.,2009). On the other hand, it has recently been reported thatJapanese have an aspect of expecting others to behave in a
way that is sensitive to the facial expressions and emotionsof others (Hashimoto, 2019). Therefore, it is assumed
that “taking a hint” is emphasized in Japanese groups ina situation where social context-oriented communication,

Behavior toward Others who Failed in “Taking a Hint”

which was originally conducted on one’s own initiative, isnow functioning as a group norm of what one has to do.
Problems and Vicious Cycles Related to “Taking a Hint”
Nevertheless, the importance of “taking a hint” as animportant norm in Japanese groups causes two problems.
The first is the occurrence of aggressive behavior toward
those who fail in “taking a hint.” Studies of group norms
show that Japanese tend to be intolerant to deviators as
they call Yosomono (Stamkou et al., 2019; Sato, 2001). In
addition, Japanese communities try to maintain a groupby actively removing any person who disturbs its order(Setagawa, 2002). In fact, people who fail at “taking ahint” tend to be criticized or excluded in Japanese school
settings (Doi, 2008; Naito, 2009). The second problem isthat “taking a hint” has become an object of feared Many
and anxiety, or interpersonal fear (Shimizu and Kaizuka,
2002). Furthermore, because Japanese people tend toreject new group members, exclusion from a group is moredamaging in Japan than in other countries (Sato, 2002).
Therefore, Japanese adolescents are concerned about how
they are perceived by those around them and whether they
will be judged as failing at “taking a hint” (Koiwa andKomatsu, 2020).
When such social problems are viewed from the perspective of brief therapy, it is necessary to focus on the coping
behavior toward the person who failed in “taking a hint.”
In the systems theory of brief therapy and communication
theory, when problems occur in the interpersonal system,some kind of coping is done (Hasegawa, 1997). This coping
is called “first order change” or “false resolution,” and isassumed to function in a direction that causes a vicious
cycle and exacerbates the problem (Watzlawick et al, 1967;
Hasegawa, 1997). Applying the theory of brief therapy to“taking a hint,” the following situations can be envisioned.
First, in Japanese groups, the system is maintained by musystem. Therefore, group members are expected to take alltypes of measures in response to the failure. A vicious cycle
is assumed as failures and coping becomes patterned, e.g.,aggressive coping escalates and becomes problematic asbullying, or the binding force of “taking a hint” as a groupnorm becomes stronger. Therefore, based on the theory ofbrief therapy, it is important to understand how the othergroup members react toward the person who fails in “taking
a hint.”Failure in “Taking a Hint” and the Communication Label
The present study is a psychological investigation of
the behavior toward a person who fails in “taking a hint.”
Because “taking a hint” is a norm determined by the social
context, it is necessary to control the assumed social
context in order to conduct the investigation. In previous
studies, many situations have been created and examined in33

which people are judged to have failed in “taking a hint.”
First, Oishi (2009) investigated situations in which many
Japanese adolescents believed that they failed in “taking ahint.” According to the study, modern adolescents perceive
scenes in which only one person seems to be having fun
and not listening to the serious discussions of the groupmembers as a failure in “taking a hint.” Next, based on
Oishi’s (2009) findings and Bateson’s (1972) theory ofcommunicative labels, Koiwa et al. (2020) examined situations in which many adolescents judged that they failed
in “taking a hint.” According to Bateson (1972), we assign
labels to our communication: for example, “this is a playfulinteraction,” “this is a serious (non-playful) interaction,”and so on. The sender of the communication chooses a posture, gesture, facial expression, voice inflection, etc., thatthe receiver can label appropriately. According to Bateson’s(1972) theory, the receiver of the communication instantlylabels whether the communicative intent of the sender isplayful or non-playful (serious), based on the social context of the conversation and the non-verbal utterances ofthe sender. Using Bateson’s (1972) theory, Koiwa et al.
(2020) attempted to control the social context for a scene.
Specifically, they set up four scenes in which playful andnon-playful interactions occurred in a friend group, andone of the group members failed to read the implied communication labels correctly. The results showed that morethan 90% of the adolescents judged each of the words andactions as a failure in “taking a hint” and over 90% of theadolescents judged each behavior as a failure in “taking ahint.”
Behavior toward Others Who Fail in “Taking a Hint”
Previous studies have examined attacks and punishments
against people who deviate from group norms. First, Molho
et al. (2020) investigated words and actions consideredinappropriate in daily life as behavior deviating from thenorm and clarified the aspects of punishment. The results
suggest there are two forms of punishment for such aperson: direct and indirect attacks (Molho et al., 2020). In
addition, Molho, Twardawski, and Fan (2020) examined
the relationship between the severity of punishment andaggressive behavior and found that direct punishment was amore severe form of punishment.
There have also been several studies on the behaviors
toward the person who failed in “taking a hint.” First, Oishi(2009) conducted an exploratory study on the behaviors
that Japanese adolescents choose to exhibit toward a person
who failed in “taking a hint,” based on a free-description
survey of Japanese adolescents. Based on Oishi’s (2009)
study, Komatsu and Koiwa (2019), itemized behaviors
toward a person who failed in “taking a hint,” and factor
analysis revealed three factors of the behaviors: Mention,
Ignore, and Follow Along. After making modifications
to the items in Komatsu and Koiwa (2019), Koiwa et al.
(2020) conducted a factor analysis of the behaviors toward34

Koiwa et al.

a person who failed in “taking a hint” and extracted four
factors: Jeer / Tease, Criticize, Follow Along, and Ignore.
Furthermore, Koiwa and Wakashima (2021) conducted afactor analysis of the behaviors after adding items related toGossip and Avoid to the four factors of Koiwa et al. (2020);
subsequently, six factors were identified: Jeer / Tease,
Criticize, Follow Along, Ignore, Avoid, and Gossip.
Study Purpose
As previously discussed in this paper, “taking a hint” isthe social norm at the center of Japanese people’s closed
interpersonal relationships. When the problems occurring in
the Japanese group are viewed from a brief therapy perspective, it is important to measure the behavior of group members toward those who fail to “take the hint.” Consequently,
conventional studies have examined situations in whichpeople determine that they failed in “taking a hint” and the
behaviors of these people. However, the following threepoints remain unaddressed. The first is the need to createa definitive measurement tool for behaviors associatedwith failure in “taking a hint.” The items used in previous
studies varied and were revised in order to determine theappropriate number of factors. The second is the need to
examine the validity of the tool. It was not confirmed inprevious studies whether each item appropriately measured
the behavior toward the person who failed in “taking ahint,” and there was a lack of procedures for examining thevalidity of the scale. The third is the need to examine theaspects of punishment. In existing studies of group norms,
behaviors based on the perception of inappropriateness are
considered punishments for deviant individuals (Molho
et al., 2020). The severity of punishment has also been
examined (Molho et al., 2020). Research is necessary
to examine the behavior toward a person who failed in“taking a hint” and their viewpoint regarding recognition of
inappropriateness and the severity of punishment.
The purpose of this study was to develop a scale forbehaviors toward others who fail in “taking a hint.” First,
the items based on Koiwa and Wakashima’s (2021) six
factors of Jeer / Tease, Criticize, Follow Along, Ignore,
Avoid, and Gossip were created, and the factor structure
and items included in the scale were determined basedon factorial validity. Next, the reliability of the scale was
examined in terms of its internal consistency and temporalstability. In addition, the validity of the scale was examinedin terms of content and convergent validity. Then, therelationships between the perceptions of inappropriatenessand necessity of severe punishment and each behavior were
examined, as were the characteristics of each punishment.
Study Hypothesis
Because content and convergent validity were examinedand discuss the variables that are expected to be theoretishown in Table 1.
First, based on humor studies (Maki, 2008; Keltner etattacking another person verbally, while showing that thisis a playful interaction through nonverbal means, such as
facial expressions, tone of voice, and gestures. In addition,a scale exists to measure a person’s humor orientation inwhich “teasing” is classified as aggressive humor (Ueno,
1992). Therefore, it is predicted that those who have an
aggressive humor orientation often choose Jeer / Tease as away to respond to a person who fails at “taking a hint.”
Second, based on Koiwa et al. (2020), Criticize was-Table 1
Predicted Factors

Example Item
Teasing A directly on the spot.

Jeer / Tease

The act of provoking or attacking another person
verbally, while showing that this is a playful interaction
through nonverbal means, such as facial expressions,tone of voice, and gestures.
The act of directly referring to the negative feelingsor thoughts one has toward another in order to convey
them to the person.

Directly pointing out that A’s statement is not appropriate.

Criticize

Follow Along

The act of behaving so that others can understand theposition and circumstances of a person.

Casually telling other friends that A may have had theirown circumstances or reasons for behaving as they did.

Ignore

The act of actively avoiding involvement with the person
who failed in “taking a hint” in the situation.

Ignoring A’s comments on the spot.

Avoid

The act of continuing to actively avoid involvementwith the other even after the scene ends.

Even after that, trying not to talk to A by oneself.

Gossip

The act of talking maliciously or defamatory without
the person in question being present.

Talking about A behind their back.

Behavior toward Others who Failed in “Taking a Hint”

ings or thoughts one has toward another in order to convey
them to the person. It is assumed by Molho et al. (2020)
that to Criticize a person who failed in “taking a hint”
corresponds to direct aggression. Research on aggressive
behavior has identified two types of human aggression:
extrinsic aggression and relational aggression (Isobe et al.,2007). Direct aggression is assumed to be related to the
extrinsic aggression tendency (Isobe et al., 2007). (Isobe etal., 2007). Criticism is also considered to require assertion,and in particular, self-assertion ability (Harada, Yoshizawa,& Yoshida, 2007). Therefore, it is assumed that adolescentswith high self-assertion ability often choose Criticize.
Based on Sugiman (2013), we defined Follow Along as
the act of behaving so that others can understand the position
been reported that those who are highly cooperative areable to forgive their opponents (Fukumoto et al., 2019). On
the other hand, cooperativeness has three aspects: cooperative problem solving, cooperation orientation, and harmony
orientation, but cooperative problem solving indicates(Tobari et al., 2019). Therefore, it is speculated that adolescents with a high propensity for cooperative problem
solving will choose to Follow Along.

involvement with the person who failed in “taking a hint” into actively avoid involvement with the other even after
the scene ends. In normative research, deviators from thenorm are regarded as “alien others” in the group (Silver,
1994). In addition, the tendency to refuse involvement withheterogeneous others is called the heterogeneous rejection
tendency and has been examined psychologically (Kosaka,2010). Therefore, adolescents who have a tendency toreject others are thought to be more likely to Ignore or Avoid
others.
Finally, based on Eriksson et al. (2021), we defined
Gossip as the act of talking maliciously or defamatory
without the person in question being present (Eriksson
et al., 2021). Since Gossip is a kind of relational attack(indirect attack) (Archer & Coyne, 2005), it is assumed
to be related to relational aggression (Isobe et al., 2007).
Therefore, it is predicted that the relational aggression of
the sender is positively correlated with Gossip.

MethodProcedure
We recruited the participants through a crowdsourcing
service. Among the monitors owned by Crowd Works,a crowdsourcing service provider in Japan, we recruited
university, vocational school, short-term university, andgraduate students between the ages of 18 and 24.
In this study, we examined the behavior of a person who

35

failed at “taking a hint” by using the assumptions of theused a scene in which A did not listen to the conversationand the second questionnaire used a scene in which A madethe situation worse. Participants who were presented withreferred to as S1), and those who were presented with thesecond questionnaire were included in Sample 2 (hereinafterreferred to as S2).
To examine temporal stability, this survey was conducted
twice. Those who responded to the survey at Time 1(hereafter referred to as T1) were followed up one month
later at Time 2 (hereafter referred to as T2).
Subjects
In T1, 208 students in S1 and 211 students in S2 participated in the survey, totaling 419 students (201 males,
215 females, 3 gender non-responses, M=20.80 years,
SD=1.85). There were 39 students in S1 and 49 students in
S2 who participated in T2, totaling 88 students (32 males,
55 females, one gender non-response, M=20.75 years,
SD=1.46). The participants were paid an honorarium afterand S2 and that the survey was completed correctly. The
gratuities were JPY 100 for T1 and JPY 60 for T2.
Survey Period
The survey was conducted between October and December
2021, including T1 and T2.
Survey Contents
Aggressive Humor Orientation We measured respondents’ aggressive humor orientation as a convergent validity
measure of Jeer / Tease. The Aggressive Humor Orientation
Scale (Ueno, 1993) was used in the survey; the measureconsists of eight items and respondents were asked to answer
using a 5-point scale from 1 (Not applicable) to 5 (Applicable).
Aggression The aggression of the respondents wasmeasured as a convergent validity measure for Criticize
and Gossip. An aggression scale used in previous research
was used in the survey (Isobe and Hishinuma, 2007); thescale consists of two subfactors, external aggression andrelational aggression, with 19 items that participants
were asked to rate using a 5-point scale from 1 (Not at all
applicable) to 5 (Frequently applicable).
Self-assertion As a measure of convergent validity
for Criticize, we measured respondents’ self-assertiveness.
Self-assertion, a subscale of the Social Self-Control Scale(Harada et al., 2008) was used in the survey; the scaleconsists of 13 items, and respondents were asked to rate
them using a 5-point scale from 1 (Not at all applicable) to
5 (Frequently applicable).
Cooperative Problem Solving As a measure of theconvergent validity for Follow Along, we measured the

36

Koiwa et al.

respondents’ cooperativeness. Cooperative problem solving,a subscale of the Multidimensional Cooperativeness Scale(Tobari et al., 2019), was used in the survey; it consists of
six items and respondents were asked to answer using a
Tendency to Reject Heterogeneous Others We measured respondents’ tendency to reject heterogeneity as ameasure of convergent validity of Ignore and Avoid. The
tendency to reject otherness, a subscale of the Attitude
toward Otherness Scale (Kosaka, 2010) was used in thesurvey; it consists of 11 items, and respondents were asked toanswer using a 5-point scale from 1 (Not at all applicable)
to 5 (Very applicable).
About A In the survey, the person who failed at “taking
a hint” was designated as “A.” As in Koiwa et al. (2020),
participants were instructed, “A is the same gender as you.
A is a member of a group of friends with whom you areworking, and you have known them for about six months.
You talk to A when you are with your friends, but you rarely
talk to them alone.”
Failure in “Taking a Hint” We used the assumptionsof the scene method to examine the situation. Consistent
with Koiwa et al. (2020), we presented “a scene in which
A did not listen to the conversation” for S1 and “a scene inwhich A made the situation worse” in S2 (Table 2).
Behavioral Scale toward People Who Fail in “Taking
a Hint” We developed 42 items to measure behavior
toward people who fail at “taking a hint,” based on Komatsu
and Koiwa (2019), Koiwa et al.(2020). Participants wereasked to answer on a 6-point scale from 1 (Not at all) to 6
(Very much) for each item.
Aspect of Punishment In order to examine the punishment aspect of each behavior, the participants were asked
to respond to two questions regarding their perceptions of
two questions were about inappropriateness and respondents
answered using a scale ranging from 1 (I do not think it isinappropriate at all) to 6 (I think it is very inappropriate).
Next, regarding the severity of the punishment and basedon Molho et al. (2020), we asked, “Do you think that A
should be punished severely?” and respondents answeredusing a six-point scale from 1 (Totally disagree) to 6 (Verymuch agree).
Manipulation Checks Three manipulation checks

were conducted from three perspectives: 1) whether theparticipants were able to imagine A, 2) whether the participants were able to imagine a situation in which A had failed
at “taking a hint,” and 3) whether the participants judged
A’s words and actions as incapable of “taking a hint.”
Respondents answered all three questions using a six-point
scale from 1 (Not at all) to 6 (Very much).
Then, the Instructional Manipulation Check task
(hereinafter referred to as the IMC task) created by
Masuda, Sakagami, and Morii (2019) was used to selectthe defective responses. This task was created to detect
respondents who answered without properly reading the
instructions. In the task, the instruction “Do not choose any
option and proceed” is hidden in the instruction text, andthe respondent is required to click the button labeled “Next”
without answering the item.
Ethical Considerations
At the beginning of the survey, we clearly stated the
purpose of the survey, that consent was based on theindividual’s free will, that the survey would be conducted
anonymously, and that no personal information would begiven to outside parties. This study was approved by the
Research Ethics Review Committee, Graduate School of
Education, Tohoku University (Approval No: 21-1-040).

Results
Selection of Analysis Targets
Responses for seventeen respondents detected by the
IMC task were excluded from the analysis. Next, 56 respondents who answered that they “Not at all,” “Not,” or “Notso much” could imagine the person who failed in “taking
a hint” or the scene where it occurred were excluded. In
addition, we excluded the responses for 25 respondents who
answered “rather agree,” “agree,” or “very much agree” tothe item “Do you feel that A’s words and actions are capable of ‘taking a hint’?” Responses for the remaining 321
participants (S1: 165, S2: 156, 155 males, 164 females, twogender non-respondents, M=20.68, SD=1.91) were includedin the analysis.
Item Selection and Factorial Validity
To examine the factorial validity and items included inTable 2 The two scenes presented in this study.
Present to S1: The scene in which A doesn’tlisten to you

During break time, you were talking with your “group of friends,” when one friend said to you
in a serious tone, “Actually, there is something that has been bothering me lately...” and told
you about her recent problem. While all his friends were thinking of solutions to his problem
with serious expressions, only A started to share his boastful story with a cheerful tone.

Present to S2: The scene in which A made During recess, your “group of friends” was chatting and laughing. The leader of the group madea scenea joke about a past mistake. All the members of your “friend group” were laughing at the joke.
However, only one person, A, did not laugh and said, “What’s so funny?”Behavior toward Others who Failed in “Taking a Hint”

37

Examination of Content Validity
AMOS (version 20.0) (Table 3). RMSEA of less than .10
and CFI of .90 or more were set as the acceptable range ofgoodness of fit. First, a model with a six-factor structure(Model 1) using all 42 items was created. Since the CFI
was greater than .90, items were deleted from the model
based on the standardized coefficients for each of the six
factors. As a result, 17 items were deleted and a model witha six-factor structure was created using the remaining 25
items (Model 2). The results showed that RMSEA was lessthan .10, and CFI was greater than .90, which increased the
Next, to examine the validity of the six-factor structure,
it was compared with a model that assumed a five-factor
structure. First, based on Komatsu and Koiwa (2020), in
which Jeer / Tease and Criticize were assumed to be thesame factor, we tested a model in which Jeer / Tease andaddition, a correlation analysis of each factor was conducted(Table 4), and since the correlation between Gossip andby assuming they belonged to the same factor. As a result,

Who Fail in “Taking a Hint” had a six-factor structure.
Finally, considering the correlations, a model with a covariance between the error variables of Item13 and Item19

the scale, one clinical psychologist and four master’s course
graduate students majoring in clinical psychology wereitems were presented and the respondents were asked to rate
them on a four-point scale (1=not at all relevant, 2=not very
relevant, 3=somewhat relevant, 4=very relevant). The items
were selected for the survey if the ratio of the respondents
who answered that they were related (“somewhat related”
items included in the final model were adopted, and theitems included in the scale were judged to have a degree ofcontent validity.
Review of Convergent Validity
To test convergent validity, correlations with variables
that were expected to be related were examined. The results
showed that aggressive humor was positively correlatedwith Jeer / Tease (r=.45, p<.01), assertiveness and extrinsic
aggression were positively correlated with Criticize (r=.24,
p<.01; r=.23, p<.01), relational aggression was positively
correlated with Gossip (r=.39, p<.01), cooperative problem
solving was positively correlated with Follow Along (r=.20,
p<.01), and heterogeneity rejection tendency was positively
correlated with Ignore and Avoid (r=.33, p<.01; r=.40;peach of the variables assumed to be theoretically related.
Internal Consistency
For each subfactor, Cronbach’s alpha coefficients wereTable 3 Factorial Validity Examination.

Model 1Model 2Model 3Model 4Model 5 (last model)

GFI

AGFI

CFI

RMSEA

.726
.850
.731
.717
.863

.693
.815
.672
.660
.832

.860
.918
.827
.831
.923

.075
.071
.103
.101
.067

*p<.05, **p<.01

Invariance of the Factor Structure
across the assumed situations, we examined the universality

Table 4 Relationships among variables.

Jeer / Tease
Criticize
Follow Along
IgnoreAvoid
Gossip
Inapprop riate
Severity

Jeer / Tease

Criticize

Follow Along

-.

.37**
-.

.09

IgnoreAvoid

Gossip

Inapprop riate

Severity

.16**
.28**

.44**
.30**

.10
.38**

.08
.36**

.59**
-.

.30**
.66**
-.

.30**
.38**
.25**
-.

.20**
.48**
.45**
.44**
-.

-.
-.

*p<.05, **p<.01

38

Koiwa et al.

Table 5 The behavioral scale toward people who fail at “taking a hint”.
Factor name (T1/T2)
Jeer / Tease (α=.85/.87)
Teasing A directly on the spot.
(24)
その場で直接，A さんのことをからかう
Jeering A directly on the spot.
(6)
その場で直接，A さんのことをいじる
Attacking A directly on the spot with a sense of humor.
(34)
ユーモアを交えながら，その場で直接 A さんを攻撃する
Making fun of A'’s comments on the spot.
(18)
A さんの発言を，その場で茶化す
Criticize (α=.90/.90)
Directly pointing out that A'’s statement is not appropriate.
(22)
A さんの発言が適切でないと，直接指摘する
Telling A directly that their behavior is not good.
(32)
A さんに直接，よくないと伝える
Paying attention to A'’s comments directly and clearly.
(16)
A さんの発言を，直接はっきりと注意する
Directly accusing A of wrongdoing.
(37)
直接，A さんの非をとがめる
Follow Along (α=.89/.88)
Casually telling other friends that A may have had their own circumstances or reasons for behaving as they did.
(33)
A さんにも事情があったのではないかと，ほかの友人たちにさりげなく伝える
Casually telling other friends that A may not have had bad intentions.
(40)
A さんには悪意がなかったのではないかと，ほかの友人たちにさりげなく伝える
Casually telling other friends that A may have had some ideas for why they behaved as they did.
(23)
A さんにも考えがあったのではないかと，ほかの友人たちにさりげなく伝える
Making comments to other friends in defense of A.
(38)
A さんを擁護するような発言を，ほかの友人たちに対してする
Ignore (α=.88/.85)
Ignoring A'’s comments on the spot.
(7)
その場の A さんの発言を無視する
Pretending not to hear what A said at that moment.
(1)
その場の A さんの発言が聞こえないふりをする
Avoid mentioning A'’s comments as much as possible on the spot.
(19)
A さんの発言に，その場で極力ふれないようにする
Refraining from saying anything in response to A'’s comment.
(13)
A さんの発言に対して，その場で何かを言うのを控える
Avoid (α=.90/.92)
Even after that, trying not to talk to A by oneself.
(30)
その後も，A さんに自分から話しかけないようにする
Not inviting A to the next play date.
(14)
A さんのことを次の遊びに誘わないようにする
Even after that, treating A in an indifferent manner.
(20)
その後も，A さんにそっけなく接する
Even after that, trying not to react to A'’s words and actions.
(35)
その後も，A さんの言動に反応しないようにする
Even after that, consciously avoiding any relationship with A.
(22)
その後も，A さんとの関わりを意識的に避ける
Gossip (α=.92/.93)
Talking about A behind their back.
(15)
A さんの陰口を言う
Complaining about A in their absence.
(36)
A さんのいないところで，A さんに関する愚痴を話す
Talking about A'’s unfavorable characteristics in their absence.
(31)
A さんのいないところで，A さんの好ましくないところについて話す
Saying something ridiculous about A when they are not around.
(9)
A さんのいないところで，A さんを馬鹿にするようなことを言う

Standardized
factor

.866
.741
.729
.719

.914
.868
.832
.737

.884
.864
.787
.669

.831
.691
.654
.486

.853
.838
.806
.799
.721

.878
.875
.871
.826

Behavior toward Others who Failed in “Taking a Hint”

39

Table 6 Results of simultaneous multi-population analysis.

Model 0: S1
Model 0: S2Model I: Placement invariant model
Model II: Measurement invariant modelof the factor structure by conducting a multiple population
factor analysis (Table 6). First, deterministic factor analysis
was conducted for each group in S1 and S2 (Model 0), forwhich different scenes were presented. The results showedthat the degree of fit was acceptable in both groups andpresented with different scenes. In addition, the influence
indices of each factor on the observed variables were
Next, we created a placement-invariant model that assumed that the factors are measured with the same observables, even if the populations are different (Model I). We
also created a measurement-invariant model that assumed
that the factor loadings on each observation variable wereModel II was acceptable, with CFI above .90 and RMSEA
below .10, but the discrepancy between the two models was2(19)=34.64, p<.05). Therefore, we adopted an
allocation-invariant model and rejected the measurementinvariant model. This indicated that factor loadings differedacross populations, although the factors were measured withthe same observed variables even when the populations
differed.
Investigation of Temporal Stability
Correlation coefficients between the T1 and T2 scores,
which were administered after 4 weeks, were calculated.
The results showed a strong positive correlation between
Jeer / Tease and Criticize (r=.70, p<.01; r=.77, p<.01), anda moderate positive correlation between Gossip, Ignore,
Avoid, and Follow Along (r=.59, p<.01; r=.49, p<.01,
r=.68, p<.01; r=59, p<.01).
Examining Aspects of Behavior as Punishment
To examine the punishment aspect of each behavior, therelationships between the perceptions of inappropriatenessand severity of punishment were examined. For the perception of inappropriateness and behavior, a positive correlation was found with Criticize, Gossip, Ignore, and Avoid(r=.38, p<.01; r=.25, p<.01; r=.30, p<.01; r=.38, p<.01).
Teasing showed no correlation, and Follow Along showed anegative correlation (rp<.01). Next, we examined therelationship between behavior and the perceived severityof the punishment given to a person who fails to read thesituation. Positive correlations were found with Criticize,

GFI

AGFI

CFI

RMSEA

.826
.798
.804
.798

.789
.753
.764
.765

.927
.902
.908
.905

.066
.078
.052
.052

Gossip, Ignore, and Avoid (r=.36, p<.01; r=.45, p<.01;
r=.20, p<.01; r=.48, p<.01), respectively, and negative
correlations were found with Follow Along (rp<.01).

Consideration
This study focuses on the behavior toward those who failin “Taking a hint,” from the perspective of brief therapy,
in which the behavior by group members toward those who
fail causes a vicious cycle. And the purpose of this study
was to create the Behavioral Scale toward People Who Failin “Taking a Hint” and examine the reliability and validityof the scale. The validity of the scale was examined fromthe viewpoints of factor, content, and convergent validity.
First, from the results of confirmatory factor analysis, it
was confirmed that the scale had a six-factor structureof Teasing, Criticize, Follow Along, Ignore, Avoid, andGossip. Next, the results of judgments by a third party
indicated that a high percentage of all items in the factors
these results, it was determined that this scale had a degreeof content validity. Correlation analyses with other indicesindicated that aggressive humor orientation was significantly related to Jeer / Tease, assertiveness and external
aggression to Criticize, cooperative problem solving toFollow Along, heterogeneity rejection tendency to Ignore
and Avoid, and relational aggression to Gossip. Althoughsolving” and “Follow Along,” “assertiveness,” and “extrinsociations found between each of the variables assumed tobe theoretically related, suggest that the scale has a certain
degree of convergent validity.
Reliability was examined from three perspectives:internal consistency, invariance of the factor structure, andtemporal stability. The alpha coefficients of each factor
for T1 and T2 were .80 or higher, indicating satisfactoryinternal consistency. The reliability coefficients were
sufficiently high, indicating that each item of the scale
had internal consistency. The results of the simultaneous
analysis of other populations for S1 and S2, which presenteddifferent situations, showed that the model that assumed
that the factors were measured by the same observables
Therefore, the evidence indicated that this scale is effective
even when other situations judged to be failure of “taking

40

Koiwa et al.

a hint” presented. Furthermore, the reliability of the scale
was examined using a test-retest method, and a correlation
between the two surveys was shown. The results indicatedthat the scale scores were stable over time.
In summary, these results indicated that the scale has
validity (factorial, content, and convergent validity) andreliability (internal consistency, factorial invariance, andtemporal stability).
Traits of Behavior toward Someone Who Fails in “Taking
a Hint”
Next, among the six factors, we examined behaviors
that have aspects of punishment for the person who failed
in “taking a hint.” Since a previous study (Molho et al.,2020) treated the behavior toward a deviant person as
punishment based on the recognition that his or her words
and actions were “inappropriate,” the present study examined the relationship between the recognition of inappropriateness and behavior. The results indicated that thefour communicative behaviors—Criticize, Ignore, Avoid,and Gossip—were significantly related to the severity ofpunishment as well as the perception of inappropriateness.
from high to low were for Avoid, Gossip, Criticize, andIgnore. For the perception of appropriateness, the correlaCriticize, and Gossip. Notably, Avoid was more strongly
related to the severity of punishment than Criticize.
However, in terms of the perception of inappropriateness,both Avoid and Criticize were associated with the samelevel of punishment. In previous normative studies, thepunishment assumed to be severe was direct aggression(Molho et al., 2020), but the results of the present study areinconsistent with those of previous studies. We speculatethat this result was related to the closed nature of theJapanese community, in which intergroup mobility is likely
to be disadvantageous, and exclusion from the group is

to do so.
On the other hand, several issues remain to be examinedwith this scale. The first relates to the limitations of theresearch method. In this study, the assumption method wasused, consistent with Koiwa et al. (2020), to control forthe behaviors that the respondents assumed to be failure in“taking a hint”. Second, the number of subjects in the study
was limited. As most of the studies on which the present
study was based were conducted with university students(Koiwa et al., 2020; Oishi, 2009), the present study also
targeted university students who were friends in late adolescence. Third, it is necessary to examine cultural differences.
The theoretical basis of this study is a communication systemthat emphasizes social context, a characteristic of Easterncultures. In Eastern societies, there is abundant evidence
that many group members engage in social context-oriented
communication as a survival strategy (Kitayama & Ishii,
2002; Kim, 2002; Kim & Sherman, 2007; Ambady et al,1996). However, there are no studies that directly show that
Orientals expect other group members to “take a hint” andattack those who fail to do so, compared to Westerners. In
addition, the results of the present study also showed that
exclusion was used as a severe punishment, and the posJapanese communities. In order to examine whether theimportance of “taking a hint” as a norm and aggression
against deviators are phenomena unique to Japan, we hopethat the present scale will be useful to other countries andbe utilized in an international comparative study, thereby
revealing important findings in comparative cultural
psychology.

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International Journal of Brief Therapy and Family Science
2023 Vol.13, No.1, 43‒49

Original Paper: Case Report

Therapeutic Assessment with Brief Therapy:
A Single Case Study of an Elementary Student’s School Refusal
Konomi Asai1) and Keigo Asai2)
1) Department of Pediatrics, Kushiro city general hospital2) Hokkaido University of Education

Abstract: Psychological assessments, such as intelligence testing, have two aspects: gathering
information for treatment and therapeutic assessment, which directly link psychologicalassessment to patient assistance. This study examined a therapeutic assessment session using brief
therapy questioning techniques, focusing on interaction and circular causality. In one particularcase, this method was applied in the pediatrics department to a girl who was not attending school
one assessment session and one feedback session, followed by two follow-up sessions in which
the chief complaint was resolved. This study examined a particular case, and although there arelimitations to this study due to the absence of a control group and its focus on a single case, itremains important and worthwhile to examine the implementation of therapeutic intelligencetesting for children using brief therapy perspectives.
Key Words: therapeutic assessment, brief therapy, school refusal, pediatrics

Introduction
Brief therapy has a background in communication theory(Watzlawick et al., 1967) and systems theory (Bertalanffy,1969), where problems are not specifically attributed toindividuals. Instead, a therapist intervenes by identifying
interpersonal interactions as vicious cycles that occur inthe system in which the problem is maintained (De Shazer,
1985; Wakashima, 2019). Therefore, it is possible to resolve
problems such as school refusal, even in the absence of
the individual, through interventions with parents andthe school, and its effectiveness has been reported in avariety of cases (e.g., Hasegawa, 1987; Hasegawa, 2005;
Wakashima, 2010; Wakashima, 2019).
Brief therapy takes the position of not being concernedwith determining the cause of the problem and is incompatible with psychological testing, which has a backgroundof linear causality and is often viewed as separate fromtherapy when psychological testing is conducted. Hasegawa
CORRESPONDENCE TO: Konomi Asai. Department of Pediatrics,
Kushiro city general hospital, 1-12, Shunkodai, Kushiro-shi, Hokkaido
085-0822 JAPANe-mail: fullmoony_v@icloud.com(1987) divided the brief therapy interview procedure into
four steps: 1) listening to the problem, 2) determining
attempted solutions and exceptions, 3) defining specifictreatment goals to be achieved, and 4) intervention. andstated that steps 1-3 are conducted as a whole, moving backand forth during the interview.
The therapist uses multiple questioning techniques withpatients and their families to facilitate therapeutic converin an interview is important (Wakashima, 2019). For example, questions to start are asked early in the interview
to understand the problem and the patients’ vision of thesolution and to capture the direction of the interview goal
(Wakashima, 2010).
Regarding feedback from psychological tests,
Itakura (2009) discussed the possibility of new reality
construction through feedback based on the theory of social
constructivism and the narrative model perspective. In
other words, feedback from psychological testing has thepotential to constitute a new reality using the test results
as a resource, as the interaction between the tester and thepatient unfolds. By highlighting the positive aspects ofthe patient and what has already been done through thetion. It also highlights the importance of paying attention to44

Asai et al.

the “how” in communicating results; it is the aspect of therelationship, not the content.
During pediatric psychological consultations in Japan,
there is an increased need for developmental assessment
and intelligence testing is often performed as an adjunctto diagnosis. For example, a consultation where the chiefcomplaint is school refusal involves the evaluation of physical symptoms and follow-up for treatment but may also
call for intelligence and psychological testing to scrutinize
the presence of background illness (Japanese Society ofPsychosomatic Pediatrics, 2015).
Intelligence testing is not only a diagnostic aid for developmental disabilities but is also conducted to understand thechild’s abilities and characteristics and to develop treatment
and support plans. While some studies (Fujiwara, 2009;
Kataoka et al., 2012) argue that the intelligence test results
are fed back to families and schools, and that positivechanges are obtained for children, such as “the school’s
response has improved,” there are also cases where tests areused only for diagnosis and understanding of characteristics,
and are not effectively used to address the patient’s chiefcomplaints.
In addition, although regional differences in Japan exist,
demand for psychological evaluations is high relative tosupply, and medical institutions are facing prolonged waiting
periods for psychological consultation (Goto et al., 2018).
This limits the number and amount of time that can berealistically spent on psychological assessment and treatment.
This study examines the possibility of assessment sessions
that use a brief therapy perspective.
There are two paradigms of psychological assessment:
informational and therapeutic assessment (Finn & Tonsager,1997).
Information assessment is treated as gathering information for treatment and is often distinguished from subsequent psychotherapy. In other words, a therapist conducts
tests primarily for diagnosis, treatment and treatment
planning, evaluation of treatment effects, and deeper understanding (Finn, 2007), and psychotherapy is conducted
afterward. A common comment of parents of children who
have been tested for developmental counseling is that they
were only tested and not given counseling, which is likely
because assessment and subsequent treatment are often
differentiated.
In contrast, therapeutic assessment involves linking psychological assessment directly to patient assistance. Finn
(2007) described therapeutic assessment as primarily anattitude toward psychological assessment, stating that thegoal of assessment is to help create positive change in thepatient and those around the patient, and that it is not tied toany particular procedure, technique, or philosophy and canbe practiced in a variety of ways. Three examples of thispractice are presented below.

Therapeutic Assessment (Finn, 2007)
The Therapeutic Assessment Center in Austin, Texas,
has created a semi-structured collaborative assessment
approach called Therapeutic Assessment (TA). The TA2) conduct standardized testing, 3) assessment intervention
session, 4) summarizing and discussion session, 5) provide
patient’s assessment questions, that is, patient problems andquestions they wished to clarify during the examination,
were asked, and the assessment was conducted around thesequestions. During the feedback session, the therapist andthe patient discussed and confirmed the results. Feedback
is provided in writing in addition to verbal explanations.
Follow-up sessions are conducted, as required.
Therapeutic Assessment with Children (Tharinger et al.,2009)
Tharinger et al. (2009) proposed therapeutic assessmentwith children (TA-C) as a way to intervene with the wholefamily as a client for problems presented by children. The
TA-C reported a reduction in symptoms, an increase in apositive family environment and positive emotions, and adecrease in negative emotions for both parents and children
The five steps of the TA-C consist of: 1) forming theassessment questions, 2) testing the child while parents observe, 3) family interview session, 4) summation/discussion
session with the parent, and 5) feedback to the child.
Step 1 usually involves meeting with parents only.
During this step, the therapist collaboratively structures
the issues, questions, and conflicts that the parents haveabout their children, their relationship with their children,
and what they would like the assessment to address. It
also gathers background information on parental questions
and establishes a safe relationship between parents andtherapists.
In Step 2, the necessary tests are performed, scored,
and interpreted according to the manual, and aspects ofcollaboration with parents are reinforced by using one-way
mirrors and other means to allow parents to observe theirchildren during the tests.
Step 3 involves a family session to test possible interventions to help parents develop a more systemic view of theirchild’s problems in terms of case overview.
Step 4 involves sharing the test results with the parents
to develop a new understanding of the child’s issues andquestions and to support any emotional reactions generated
by the results.
In Step 5, the test results are communicated as an allegory
or metaphor appropriate to the child’s developmental age.
Collaborative WISC-IV Feedback with Parents (CFP)(Kumamoto, 2020)
In Japan, Kumamoto (2020) proposed Collaborative

Therapeutic Assessment with Brief Therapy

45

WISC-IV Feedback with Parents (CFP), which consists of
two sessions, considering that few sites can implement thestandard six steps of TA. CFP includes the essence of TA:
working with the patient and discussing the test results withthe patient. The CFP will interview the parents, develop
assessment questions, and conduct testing with the child in
Session 1. In Session 2, individual results are presented inwriting to the parents, and ideas for coping are discussed incollaboration with the parents.
In Kumamoto’s study (2020), 17 children with developmental disabilities and their parents participated in the
CFP and were tested in the first session, followed by asecond session of feedback, approximately one week later.
Three months later, a questionnaire was administered tothe parents. While there were no changes in the children’s
behavior during this period, the parents’ mental health

2nd grade of elementary school, the school closed becauseof COVID-19. Since then, she has been unwilling to attend
school for an increasing number of days, triggered by events
such as “forgetting something” or “the teacher getting
angry with the whole class.” After moving to 3rd grade, she
was unable to sit in the same classroom as her peers due topsychological issues, and her absences increased even more.
The situation did not improve, and she and her parents
visited the pediatrician at Hospital Y. The pediatrician
ordered a psychological assessment for selective mutism,separation anxiety disorder, and school refusal by thetherapist. The therapist works in the pediatric department of
Hospital Y.

behaviors toward their children. It was noted that there was
no improvement in the child’s problematic behavior andthat many parents asked for further advice and ongoingsupport sessions as a result.
Based on the above previous studies, to conduct intelligence testing as a TA, it is important to construct assessment
questions with the parents during the initial interview and tocommunicate the results in feedback sessions, emphasizing
interaction rather than a one-way explanation of resultsfrom the therapist. In addition, it may be useful to consider
assessments and interventions that view the family andschool as a system that constitutes the child’s problems,since it is often not the children themselves but their parents
who report the chief complaints.
This study reports a case in which the child’s problem

Assessment Interview
When the therapist asked about the current problems,
the parents mentioned that X was not able to sit in theclassroom and continued to attend school in a separateroom.
X said she was inclined to study with classmates, butwhen she arrived at school, she was not able to enter theclassroom. When asked about the problem in more detail, X
said that she went to school every morning with her motherand met Teacher Z at the school’s entrance, but whenever there was a class or assembly that she did not like,she froze up on the spot. X was able to calmly enter theschoolbuilding if she was told she could take a break fromher weak subjects.
X did not participate in the subjects or assemblies she
disliked. The therapist praised X’s ability to participate
in school, even partially, and confirmed her goals for thispsychological consultation. Her mother expressed hopethat X’s anxiety would go away, and she would be able

and one feedback session, followed by two follow-up sessions
in which the chief complaint was resolved and discusses
the implementation of therapeutic intelligence testing forchildren.

Session 1 (120 minutes)
Visitor: Parents, X.

wanted to go to class and play with her friends. When the
Ethical Considerations
Verbal and written consent were obtained from theparents and patients for the publication of this case. The
Ethics Review Committee of the Nursing Department ofKushiro City General Hospital approved this study.

Case Description
Case: X (3rd grade elementary school girl)
Chief complaint: She could not go to school alone because
she was afraid of being seen by others.
Visitor to a hospital: Father, Mother, X
Developmental history and current medical history:
She lived with her parents and an older brother. No specific problems were observed during early childhood. At
the beginning of elementary school, she had difficulty
separating from her mother when going to school. In thethe classroom was noisy, that she had anxiety entering thesuddenly became more anxious when entering the schoolbuilding.
An exception was that she could attend morning meetingsin her classroom with Teacher Z. When Teacher Z was notpresent, she did not enter the classroom but stayed alone ina separate room.
The following assessments were performed: WISCIV (Japanese version of the Wechsler Intelligence Scale
for Children, Fourth Edition), Picture Vocabulary TestRevised (PVT-R), Parent-interview ASD Rating Scale-Text
Revision (PARS-TR), Social Maturity Scale Third Edition,
and Japanese version of the ADHD Rating Scale-IV homeversion (ADHD-RS IV).
After the examination, the therapist repeatedly praised

46

Asai et al.

X’s ability to continue attending school in a separate room,
while relying on her teacher. The therapist also told themother that X needed to challenge her anxiety to meet her
goals and consider where she could start. In response, themother expressed her cautious attitude, saying, “I don’t
have to force X too much, do I?” The therapist asked her toobserve X’s condition from this perspective.
The Test Results
WISC-IV; FSIQ83, VCI62, PRI78, WMI118, PSI102.
PVT-R, evaluation point 4 (delayed). PARS-TR: Peak inearly childhood 16, Childhood Present 26, ADHD-RS IV;
Inattentive 6, Hyperactive-Impulsive 5. Social Maturity
Scale Third Edition, Social Life Quotient 77.
The pediatrician diagnosed her with autism spectrum
administered.
Session 2 (two weeks later)
Feedback Session (30 minutes)
Visitor: X’s parents
The therapist asked how the past two weeks had been
going. X’s mother shared Session 1 feedback with Teacher
Z. Later, X would go to the classroom with Teacher Z tosubmit a handout. Until then, Teacher Z had delivered X’s
handouts to the classroom. Teacher Z asked X to participate
in the evacuation drill, but X was able to participate. The
therapist praised X for trying new things.
Feedback on Inspection Results
The therapist informed the parents about X’s intellectuallevel, and strengths and weaknesses in her cognitive abilities.
The parents’ understanding of ASD was confirmed, and a
supplemental explanation was provided. As an assessmentof the problem it was determined that X’s verbal comprehension index and perceptual reasoning index were at amildly delayed to borderline level, suggesting that there
situations and reasoning. In addition, it is thought that thesituations, perfectionism, and other obsessive-compulsive
traits, and that anxiety and a desire not to fail due to these
traits are strong obstacles to challenging behaviors withwhich they have difficulty. The therapist informed theparents that she may be too cautious, and as a result, havefewer opportunities to try new things, which may make it
The following three concrete measures were proposed: 1)
to alleviate X’s anxiety, explain in a way that allows her tovisualize. Owing to weakness in language understanding, it
think, 2) encourage her to participate in a few of the activities
she does not want to do by devising ways to participate, and
3) incorporate vocabulary and communication training in
the time spent in separate classrooms. Both parents wereconvinced of the results and anticipated sharing the strategy
with the school; however, they still wanted to continue withfollow-ups.
The therapist and parents discussed and scheduled afollow-up session seven weeks later.
Session 3 (after seven weeks)
Follow-up Session 1 (40 minutes)
Visitor: Parents, X.
First, there was an interview with the mother for 30
minutes, and then a 10-minute interview with all particiwith X’s problem. X now spends more time in a separate
classroom next to the main classroom where she can stillhear the lesson. The classroom teacher was able to easily
move between the classroom and the adjoining classroom,and had more time to interact with X. The number ofteachers involved with X increased and X was given opportunities to engage with other children. X was resistantat first, but gradually became accustomed to the idea ofspending time together in the separate room.
The therapist praised the mother’s involvement with theschool and X’s efforts, and asked about current problems.
The mother expressed her concern that the pace of thenext step was too fast. Asking the mother for details of herconcern, she said that she was worried that since X is thetype of person who cannot say no, she would say “I can doit” even if she is forced to do so by Teacher Z’s suggestion.
She was concerned that if X pushed herself too hard, shewould not be able to return to school again.
The therapist normalized the mother’s anxiety by telling
her that not rushing is important, because she will practicethese things repeatedly. The therapist told the mother tocontinue with the challenge, after sharing her concernswith the school. The mother agreed to consult Teacher Z. A
second follow-up interview was scheduled one month later.
Four Weeks after Session 3
The appointment was postponed because X prioritizedschool events.
Session 4 (seven weeks after Session 3)
2nd Follow-up Session (30 minutes)
Visitor: Mother, X
the classroom, but in the following week, she was absent
as a reaction. After that, she took classes in the classroom
every morning.
The therapist complimented X on the challenge of exploring the right pace and the increase in what she was able
to do as a result. Once again, upon reviewing the current
problem, the mother said that X seems to have trouble communicating what she wanted to say to the teacher. Asking
for details, X had prepared a notebook so that she could
write down what she wanted to say and show it, but she had

Therapeutic Assessment with Brief Therapy

The therapist advised them to communicate this problem
with the teacher. Additionally, referring to the test results,
communication skills.
The therapist suggested that communicating requires
practice and that they should make intention cards forcommon matters, and both the mother and child agreed.
The mother said that follow-up interviews would not benecessary for a while because of X’s current good condition, and the psychological consultation was paused.

Discussion
In this study, we assessed and provided feedback on
the problems presented by the perspective of the child’sinteraction with the family and school, while administering
an intelligence test to a case of continued school refusal
because of strong symptoms of anxiety. The problem wasresolved. The following is a discussion on the implementation of TA using intelligence testing, mainly for children.
Test Results as One of the Components of a CircularCausalTA begins with a session with the patient and their family
to discuss the problem and expectations for the inspection,
followed by an inspection using standardized methods.
During TA-C (Tharinger et al., 2009), only the parents comein for the initial visit and collaborate with the therapist
to discuss issues, questions, and conflicts that the parents
have about their child, their relationship with their child,and what they would like to see during the assessment.
The therapist then gathers background information about
the parents’ questions. Time is spent on this part of the
program to build a safe relationship between the parents
and therapists (Aschieri et al., 2012). In addition, tests are
performed once or twice a week for 1 to 1.5 hours eachtime (Finn, 2007). Thus, previous therapeutic assessments
involved repeated testing as necessary to search for answers
to the assessment questions. However, in Japan, institutions
that conduct multiple psychological testing sessions arelimited. In addition, the psychological tests to be conductedin Japanese medical institutions are ordered by doctors, andthe test battery is often determined prior to the therapist’s
interview with the parent or client. Therefore, assessment
questions are usually limited to what can be measured by
the tests already available. That is, it is necessary to construct a therapeutic assessment based on a predeterminedexamination in a limited amount of time.
In general, intelligence and developmental testing gathers
information about the cognitive aspects of the individual
client for diagnosis and understanding of the condition fromwhich measures are derived, but the information obtained
from test results is a limited aspect of the client in thetesting room. Mitani (2014) proposed that developmental

47

disabilities are a product of characteristics and social barriers,
indicating the need to understand the adjustment of children
with developmental disabilities to society. In this casestudy, the results of the psychological test were considered
one of the components of the problem maintained by theinteraction between the client’s characteristics and theenvironment. This made the test a resource not only forgathering information for diagnosis and understanding thepathophysiology but also for considering direct and indirectinterventions for assessment questions.
Creating Assessment Questions Using Brief Therapy
Questioning Techniques
Tharinger et al. (2009) set up a parent-only interview
day to develop assessment questions, carefully discussing
issues that parents have about their children and their own
conflicts with them, and organizing what they would likethe assessment to address. Kumamoto (2020), however,interviewed parents, created assessment questions, andconducted the inspection in the first session. In this case,as in Kumamoto (2020), the interview, development ofassessment questions, and testing were conducted in thefirst session; however, the difference was that the motherand child were interviewed in the same room. We would
also like to emphasize that, in creating the Assessment
Questions, we used a questioning technique that focused on
aspects of the current problem and its interaction with theenvironment.
To develop the assessment questions, a brief therapy interview technique of starting questions is used (Wakashima& Hasegawa, 2018), searching for solution efforts and exceptions to problems, compliments to client resources, andwhat has already been achieved. When asked the starting
question, both parents and X hoped that X would participate
in the classroom. They wanted to explore how they could do
this. A vicious cycle was observed, in which the mother andteachers dealt with X’s anxiety and distress by removing
anxiety so as not to make X anxious, which strengthened X’stendency to avoid anxiety. However, we found exceptions,such as situations in which the prospect was clear or she
was with her mother or Teacher Z X was able to participate
in the group. In the first session, the mother and childshared the question of what to do about wanting to enter theclassroom but feeling too anxious to do so, after which theinspection could be conducted.
In many cases in Japan, when conducting assessments
centered on intelligence testing, the time allotted for thesession is the time to conduct individual testing of the childand interview the parents. To create assessment questions
in a situation where time is limited, it was considered thatthe brief therapy approach was effective in identifying thecurrent problem and then exploring the vicious cycle thatmaintains the problem and its exceptions.

48

Asai et al.

Follow-up Sessions
The sixth element of TA is a follow-up session held
1-2 months after written feedback to assess progression.
Kumamoto (2020) conducted a mailed questionnaire
survey three months after the two sessions, with no followup interviews. As a result, parents reported the following
benefits: they learned about their children’s cognitive
characteristics, were able to devise supportive measures,
became aware of ways to support their children, and theirown anxiety and feelings toward their children changed.
However, the children’s problematic behavior did not decrease, and requests for more advice and ongoing sessions
were made.
In this case study, the analysis and interpretation of thetest numerically revealed the areas in which X needed
support, which could be shared with her parents. Understanding that X had ASD was also helpful in gaining support
from others. These results are similar to those of previous
studies (Kumamoto, 2020, Fujiwara, 2009, Kataoka etal., 2012.), where the analysis and interpretation of thetest results have a certain therapeutic effect. However,prior cases did not mention follow-up sessions. Afterthe feedback session, although the problem was alreadyshowing improvement and the future direction was sharedwith the parents, they strongly desired continued followup. Therefore, the timing of the follow-up was discussed incollaboration with the parents and was set at two months.
At the first follow-up session, we kept a solution-effectiveness for other cases.
Nevertheless, this study revealed that intelligence testing
sessions, often conducted for informational purposes,
can be therapeutic for patients and their families. It wasalso suggested that focusing on the current problem andits interactions and viewing the individual test results
as an element of the system that maintains the problem,
may be effective for conducting therapeutic assessments
within a short time period. In addition, although individual
factors are not emphasized in brief therapies, the objective
presentation of these factors through standardized tests isthought to be a resource that can promote behavioral change
in clients and their families. Many cases require therapeutic
assessment and ongoing treatment. However, having a therapeutic approach to the examination sessions may help meetthe needs of clients seeking psychological support, improvethe effectiveness of treatment, and shorten the duration oftreatment.

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International Journal of Brief Therapy and Family Science
2023 Vol.1, No.13, 50

Book Reviews

Brief Therapy Conversations:
Exploring Efficient Intervention in Psychotherapy
Hoyt, Michael F. and Cannistrà, Flavio
Routledge, 2023, 194 pages, ISBN 978-1032310282
Reviewed by: Keigo Asai

The book under review provides a “brief” study ofboth the theoretical and practical aspects of brief therapy.
However, it is by no means a “brief” read. While the bookdelves into various topics, including therapeutic relationships, diagnosis, mindset, technique, logic, and history, I
found the chapter on mindset (Ch3) particularly fascinating.
In this chapter, Dr. Hoyt states that “mindset is expectation or hope,” and that the brief therapy practitioner isable to conduct one or fewer interviews because he or she
accepts the brief therapy mindset. This is blissfully obvious,
but how aware are we of this in everyday therapy? I also
felt that a greater emphasis on this kind of mindset could
lead to single session therapy (SST).
Furthermore, Ch3 examines the difficulty of departingfrom the model. While this is understandable, I also felt thatit does not necessarily apply to brief therapy, as is practiced
in Japan. In particular, in the training we conduct at the
National Foundation of Brief Therapy in Japan (NFBT),
we use both a solution-focused approach (SFA) and an
MRI approach as models, and in some cases, we also study
Minuchin’s structural family therapy. Therapists can besaid to take the stance of not sticking to one model; forexample, if the SFA model does not work for a case, they
may consider MRI, or if the MRI does not intervene withthe client, they may use the structural family therapy modeland intervene with the family.
The book also discusses the shift from what is right tothinking about what is useful. In brief therapy and SST, theimportance of pragmatics is described by Cannistrà (2020)
as well as Wakashima (2019), who views pragmatism along
the axes of “effective or counterproductive” and “right orwrong.” This is the most important feature of a brief therapy.
On the other hand, pragmatics is important, but is it all
to be denied to be faithful to a psychotherapy model? In
Japan, there is a traditional idea in training called “Shu-hari,” which has three stages of mastery: the fundamentals,
breaking with tradition, and creating one’s own techniques.
If we follow this line of thinking, then, because we havemastered fundamentals, we can take a pragmatic approachaway from the fundamentals, can we not? Because this wasa conversation between two therapists who were proficientin both brief therapy and SST, I felt that I would like to reada more detailed discussion on training for beginners.
Part 1 of the book, written in a conversational style basedon recorded conversations between Drs. Hoyt and Cannistrà,
covers various topics related to brief therapy. The friendly
and warm tone of the conversations makes the reader feelas though they are present while also providing valuable
insights. Part 2 contains the papers on SST by Dr. Hoyt andDr. Cannistrà. I had already read some of the papers presented in Part 2 before this book was published, but reading
it again in light of Part 1 seemed to have deepened my understanding of its contents.
To sum up, this book is an essential read for both beginners and experienced therapists who seek to enhancetheir understanding of brief therapy. The chapters are wellstructured and thought-provoking, and the conversational
style in Part 1 makes for an engaging and insightful reading.
Overall, this book is a valuable resource for clinicians interested in brief therapy and its practical applications.

Reference
Cannistrà, F. (2021). The vital role of the therapistʼs mindset.
In M. F. Hoyt, J. Young & P. Rycroft (Eds.), Single
session thinking and practice in global, cultural, andfamilial contexts: Expanding applications (pp.77―87).
Routledge.
Wakashima, K (2019). Tankiryoho Zissen no tameno hint 47:
Shinri ryouhou no tameno plagmatizm [Fourty seven tips
for brief therapy practice: Pragmatism for Psychotherapy].
Tomishobo