Vol.10, No.1

2020

September 2020

International Journal of Brief Therapy and Family ScienceVol. 10, No. 1, 2020

CONTENTS
Original Papers (Research and Experiment)
Development and validation of the Japanese version of Family Problem Solving Scale
Saito, A ., Okuyama, S., Sakamoto, K, and Wakashima, K. …………….…………….1-12

Short Case Reports
Brief Therapy for a Serious Sex Offender
Yokotani, K, and Tamura, K.…………….…………….…………….…………….…………….13-23
Brief Therapy for Parents Troubled by the Independence of Their Daughter with
Gender Dysphoria and Previous History of Eating Disorders
Doi, T., Mogi, H, and Kitami, M. ..…………….…………….…………….…………….…24-33

International Journal of Brief Therapy and Family Science2020 Vol. 10, No.1, 1-12
< Original Paper: Research and Experiment >Development and validation of the Japanese version of Family Problem Solving Scale
Akihiro Saito 1) Shigeki Okuyama 2)

Kazuma Sakamoto 2)

Koubun Wakashima 2)

1)

Medical Corporation Eihoukai, Kimoto Mental Clinic

2)

Graduate School of Education, Faculty of Education, Tohoku University

ABSTRACT. Family Problem Solving Scale, developed by Ahmadi et al. (2007), is an assessment scale of the problem solving abilityof married couples. The purpose of this study was to develop a Japanese version of Family Problem Solving Scale (FPSS) andexamine its reliability and validity. A questionnaire survey of 205 married men and women (91 men and 114 women) was conducted.
Exploratory Factor analysis found that FPSS was composed of two factors: “Solution orientation” and “Relationship-maintenanceorientation”. The Cronbach's alpha of Solution orientation was .92 and Relationship-maintenance orientation was .79. Moreover,
the two factors of FPSS was positively correlated with Relationship satisfaction, FACES III for marital couples and Solution
achievement. These results indicated that FPSS had good reliability and validity.
KEY WORDS: Married couple, Problem solution, Family Problem Solving Scale, Scale Development

The degree of satisfaction with the marital
Introduction

relationship is the result of positive marital

Recently, problems between couples haveactivities.

Therefore,

empirical

data

are

become diversified in Japan. These problems

significant for identifying factors that maintainbetween marital couples include domestic

good marital relationships. On the other hand,violence (DV) and divorce, as well as violence

marital couples in need of clinical support

amongothers.

usually have a low level of relationship

Therefore, the necessity for practical measures,satisfaction, and it is often difficult to identify

including couple therapy, is increasing.

factors contributing to relationship satisfaction.

datingpartners,

among

Therefore,
Previous studies on marital relationships
Most

previous

studiesonfindings

onthedegreeofrelationship satisfaction might not be useful for

maritalsupporting such couples. As a result, there is arelationships have mainly examined the degree

need for useful indices to conduct clinicalof satisfaction of positive marital relationships

interventions for such couples.

(e.g., Ito, Sagara, & Ikeda, 2007; Moroi, 1996).

According to the family systems theory, afamily as a system exhibits self-control andCorporation

tries to maintain stability (Hoffman, 1981,

Eihoukai, Kimoto Mental Clinic, Funako1293 Atsugi-city,translated by Kameguchi, 1986). In other words,

Kanagawa, 243-0034, Japanfamilies deal with problems to achieve stability

e-mail: aruitekaero@gmail.com

as a family using individual methods when

CORRESPONDENCE

TO:

Saito

Medical

faced

1

with

problematic

situations.

This

2

Saito et al.

tendency might be the same in all dyadic

the effectiveness and resources such as time

relationships, including married and unmarried

and labor. The fifth stage is the execution of thecouples. Therefore, evaluating problem-solving

selected solution and its verification, in which

behaviors used daily in married life would be

the selected solution is proactively executed,

useful for supporting all couples facing

and the results are assessed and revised if

problems. Based on the above, this study

necessary.

focused on the problem-solving abilities of

The same process is considered to be

married couples.

conducted

cooperativelyininterpersonal

systems, including married and unmarried
Problem-solutionsby

individuals

incouples. However, in the case of interpersonal

interpersonal systems

systems,

consensus

building

isrequired

Individual problem-solving behaviors have

between individuals in deciding goals andbeen formulated in problem-solving therapy,

solutions, which is different from individual

which is a type of cognitive-behavior therapy.

problem-solving.

Accordingacommunicating constructively and progressing“problem” is a situation in which a clue to thetowards the solution are required of marriedsolutionandand unmarried couples in the process of“problem-solving” is the individual process ofproblem-solving. The problem-solving process

finding out methods of managing daily-life

between a husband and the wife would go

problems effectively. Based on the above

badly if the husband is indifferent or showsdefinition, the typical process of solving

strong resistance when the wife constructively

problems

makes an effort to solve a problem. Based ontoMynors-Wallis

cannot

has

be

been

(2009),

found,

suggestedinabove,

Therefore,

thepresentforproblem-solving therapy (D’Zurilla, 1986). The

thefirst stage is the presentation of the problem,“problem-solving abilities of married couples”

which includes perceptions, attributions, andwere defined “skills for proceeding with theevaluations of the problem. The second stage isprocess of problem-solving constructively, i.e.,the clarification of the problem, which includes

presenting

the collection of information related to thedesigning the solution, making a decision,

problem, understanding the problem, andexecuting the solution, and verifying the results,

setting up concrete and achievable goals. The

through communication.”

and

in

skillsclarifying

thestudy,

problem,third stage is designing alternative solutions,which needs as many diverse ideas andFamily Problem Solving Scale

solutions as possible. The fourth stage is

The following concepts are close to thedecision making in which the solution with"problem-solving abilities of married couples:high practicability is selected after evaluating

relationship-focused coping (Kurosawa & Kato,

choices of possible solutions, and considering2013), conflict resolution strategies (e.g., Pruitt

2

The Japanese version of Family Problem Solving Scale3& Rubin, 1986), and communication patternsof the scale was examined with married couples(Christensen & Shenk, 1991), among others.

who visited consultation centers. Among them,

Relationship-focusedconflict

27 couples with low marital satisfaction wereresolution strategies assess stress between

regarded as the clinical group, and 28 couples

husbands and wives as well as specific methods

that were randomly selected were regarded asofthe general group. The results indicatedmanagement

Communication

copinginandconflict

patterns

settings.

suggestedbysignificant differences in the total FPSS score

Christensen and Shenk (1991) have also dealt

and each subscale score, with the general groupwith communication between two people.

scoring higher than the clinical group (Ahmadi

Therefore, it might be impossible to measure

et al., 2007).

problem-solving skills through communication

FPSS is useful for examining how marriedby using the above concepts.

couples

try

to

solve

problems

through

The Family Problem Solving Scale (FPSS)

cooperation when faced with problems thatsuggested by Ahmadi et al. (2007) is an index

cannot be measured using previously describedfor assessing the problem-solving abilities ofconcepts. However, a Japanese version of FPSS

married couples. This scale assesses thehasproblem-solving abilities of marital couples,development of a Japanese version of the FPSS

although the name of the scale includes theis considered to be significant for generating

word "family.” FPSS was developed based on

findings related to marital relationships.

behavior

observations

in

not

been

developed

to

date.

The

familyproblem-solving settings and the framework of

Objectives of this study

problem-solving therapy. FPSS is composed ofThis study was designed to develop the

2 factors and 30 items. The first factor isJapanese version of FPSS based on the above“Communication,” which is related to thebackground. The reliability of the scale wasexpression of individual emotions and smoothexamined by calculating α coefficients by using

conversation between husband and wife. The

the internal consistency of the scale as an index

second factor is “Problem Solving,” whichof reliability. The validity of the scale wasconsists of items related to the problem-solving

examined by assessing relationships between

processes. The sufficient adequate of this scale

the scale and satisfaction, the achievement of

was established by Ahmadi et al. (2007); theproblem-solutions,coefficient of the full scale = .91, that ofrelational efficacy, and by examining their“Communication” = .87, “Problem Solving”

correlations. It was assumed that each factor= .83, and the test-retest correlation coefficient

would be correlated with positive relationships

after 30 days =.74 for the whole scale, .71 forbetween the husband and wife because efficient“Communication,” and .79 for “Problem

problem-solving

Solving.” Moreover, the discriminant validity

facilitated by positive relationships between the3familybyfunction,

maritalcouples

and

is

4

Saito et al.

husband and wife. Therefore, it was assumed

maintain independence between husbands andthat significant positive correlations would be

wives; the envelopes were distributed in pairs

observed between the Japanese version of FPSS

to husbands and wives. The web-based

scores and the achievement of solutions toquestionnaire was also administered by (1)problems,

familygiving students the written survey request withrelationship efficacy, which would establish thethe URL of the survey website after acriterion-related validity of the scale. Moreover,university lecture and requesting students tobased on Ahmadi et al. (2007), the possibility

inform their parents about the URL and askof discriminating couples with and without

their parents to cooperate; and (2) notifying

problems using the scale was investigated topeople outside the campus of the URL andestablish the discriminant validity of the scale.

asking them to respond. The number offamilyfunction,andparticipants in the written questionnaire survey
Methods

was

129,

and

that

in

Survey period

questionnaire survey was 76.

theweb-based

The survey was conducted from November
2016 to October 2017.

Survey content(1) Face sheet: age, gender, occupation, theParticipants

length of the marriage, and the family structure

Married men and women (N=205, 91 men

were inquired.

and 114 women, mean age=43.81 years old,(2) Items related to problems in marital

SD=11.22) participated in the survey. Thererelationships: (a) the presence of current

were 82 marital couples among them.

problems in marital relationships (Yes or No),(b) the content of the problem (free description),

Procedures
Two(c) the period during which the problem has

types

of

questionnaires

werecontinued, (d) influence of the problem on

administered, which included a printed andmaritalweb-based

four-point scale ranging from "affected" to "notquestionnaire.

The

printedrelationships

assessedusing

aquestionnaires were distributed to students after

affected."a university lecture, their parents responded to(3) Satisfaction with the Marital Relationshipquestionnaires, and responses were collected

Scale: The scale developed by Moroi (1996)

throughweb-based

was used. The scale is composed of one factor,

questionnaire was distributed directly to people

and six items and evaluations are made using aoutsideexaminers

four-point scale, ranging from 1 (rarely

One questionnaire

applicable) to 4 (highly applicable). The total

thestudents.

The

the campus, andcollected the responses.

thewas put in an envelope that could bescore is regarded as the scale score.

immediately(4) The Japanese version of the Family

sealedafter

responding

to4

The Japanese version of Family Problem Solving Scale

5

Problem Solving Scale (FPSS): The scale(Wakashima & Hasegawa, 2000), which isdeveloped by Ahmadi et al. (2007) was

based on the communication theory, includingtranslated

after

cybernetics, and the systems theory. MRI brief

obtaining the original author’s approval. The

therapy assumes a “problem-attempted solution

translationthecycle." It is assumed that in this cycle, current

procedures below; firstly, two examiners, andcoping behaviors support the problems in

one translator translated the original scale. Next,

systems that have problems. Stimulating thea graduate school student that had studied incycle by “doing something different” can crack

North America conducted a back-translation.

the cycle and become a clinical intervention

After that, we asked the original author to(Hasegawa, 1987). When applying this model

check the content. Based on the original

to actual marital relationships, couples that are

author's

thefalling into a dysfunctional cycle can "doappropriateness of Japanese and ease ofsomething different," which increases theunderstanding, the examiners revised theprobability of achieving a solution to theJapanese translation and developed the final

problem. Therefore, it was inquired whether

version. The scale is composed of 30 items.

different problem-solving behaviors could be

Responses are made using a five-point scale

practiced when previous coping behaviors wereranging from 1 (not at all applicable) to 5 (veryineffective, e.g., “When problems are notapplicable). The mean value was regarded assolved, we changed the previous method andthe scale score.

improved(5) Items related to the achievements ofintervention

problem solutions: Three items were developed

perceiving a problem in a different framework,tois used in MRI brief therapy to break vicious

into
was

Japanese
conducted

comments,

examineandwhetherusedfollowing

considering

thecouple'sthesituation.”

known

as

an

“reframing,”

i.e.,

problem-solving abilities evaluated using FPSS

cycles.

are correlated with the actual achievements ofdifferent” by using reframing (Wakashima &problem solutions. It was assumed that couples

Hasegawa, 2000). In applying reframing towith higher problem-solving abilities might

actual marital relationships, couples reframe

have resolved their problems more easily todifficult to resolve problem situations by notdate. One item, “We have been solving

overestimating the problem, not regarding

problems related to marital relationships,”

specific situations as a problem, and thinking

directly inquired about the results of thethat the problem has been solved. Therefore, asolution. The Other two items were related toquestion

the intervention methods used in brief therapy

whether the significance of a problem can bebased on the Mental Research Institute (MRI)changed, e.g., “When we feel that a problem

model. MRI brief therapy is called family

cannot be solved by ourselves, we change ourtherapy using a communication approach

way of thinking and then the problem
5

Clients inevitably

Moreover,wasdeveloped,

“do

which

somethinginquired6

Saito et al.

disappears.” These questions were asked inthat respondents would respond by thinking

relation to three domains; (a) problems between

about their sibling. This scale consists of one

the husband and wife, (b) problems related tofactor and nine items. The responses to thechild-rearing, and (c) problems related toscale are made by using a five-point scaleparents-in-law. Participants responded to theseranging from 1 (Strongly disagree) to 5questions by using a five-point scale ranging(Strongly agree). The mean value was regarded

from 1 (Never applicable) to 5 (highly

as the scale score.

applicable). Moreover, a manipulation check

Ethicalwas included for couples without children,

provided in advance that participation in thewhich inquired about the degree of imagination.

study was voluntary and that the participants

The responses to this were made on a

could stop their participation at any time evenfour-point scale, and the responses ranging

after

from

4

participants were informed that their personal(imaginable) were used in the analysis. The

information would not be identified. They weremean value was regarded as the scaled score.

also told that participation was not related to(6) The Family Adaptability and Cohesion

academic

Evaluation Scale III (FACES III) for marital

institution.

3(relatively

imaginable)

toconsiderations:givingtheirevaluation

Explanations

consent.

bywereMoreover,theiraffiliatedcouples (Nagata, 1999): FACES III was used toverify the concurrent validity of FPSS. In the

Resultspresent study, we used “cohesiveness” andExploratory factor analysis of FPSS

“adaptability”

asfactors

for

ease

of

Factoranalysis(Maximumlikelihoodinterpretation, although Nagata (1999) used amethod, Promax rotation) was conducted on 29

different factor structure from the originalitems of FPSS by excluding one item showing a

FASES III after conducting exploratory factor

floor effect (6. “We have determined a special

analysis. This scale consisted of 20 items. The

place for discussion.”) (Table 1)

responses to these items were made using afive-point scalerangingfrom 1

The analysis was repeated by excluding the(Neveritems with a factor loading of less than .40 andapplicable) to 5 (Highly applicable). The mean

the items with multiple loads. Finally, avalue was regarded as the scale score.

two-factor structure consisting of 25 items was(7) Relational Efficacy Scale: Asano’s (2009)

obtained. The cumulative contribution ratio ofrelational efficacy scale was used to examine

the first factor was 32.14%, and that of thethe validity of the Solution Achievement Scale.

second factor was 39.78%. The first factor was

Asano (2009) requested participants to respondcomposed of 11 items included in theto the scale by assuming that the responses"problem-solving” factor of the original version,

were about a person closest to them. We

e.g., “When we have a problem, first we

modified the instructions in the present study soevaluate the problems and then discuss the6The Japanese version of Family Problem Solving Scale

7

Table 1: The results of factor analyzing the FPSS (Maximum likelihood method, Promax rotation)

Item

Factorcategory ofCommonality the original
version (P,
C)

F1

F2

.84
.77

-.28
-.19

.55
.48

P
C

.70

-.14

.41

P

.69
.68
.64

-.01
.08
.06

.46
.53
.45

P
C
C

.63

.12

.49

C

.61
.61
.61

-.14
.09
.04

.31
.43
.39

P
P
C

.59

.10

.41

P

.56
.56
.56
.48
-.48
.46
.43

.14
.07
.19
-.11
-.09
.24
.04

.42
.36
.46
.19
.28
.39
.21

P
P
P
P
P
C
C

18. Our quarrel becomes violent when the solution doesn’t work.*.19
9. When our opinions conflict, we quarrel and finally our relationships get worse.
-.07
28. We get nervous and start a quarrel when talking together.*.06
1. We talk in a calm tone when we have problems.
.20
21. Another problem appears while we are dealing with a problem.*.04
25. I’m disappointed when my first effort to solve a problem doesn’t go well.*.12
20. When our opinions about a problem conflict, we try to solve it before starting a.20
quarrel.
Correlation between factors
F1 ―Excluded items
5. We try to ignore our previous quarrels.
6. We have determined a special place for discussion.
15. When we have a problem, we determine the approximate time to solve theproblem.
26. When we have a problem, we don’t try to solve it rationally.
30. Usually, the problem is too big for us to solve.
Note 1) Factors in the original version: “P” = problem-solution, “C” = communication2) * = a reverse-scored item

-.85
-.72
-.69
.56
-.48
-.45

.60
.56
.43
.47
.21
.17

P
C
C
C
P
P

.42

.30

C

F1: Solution orientation(α=.92)
19. When we have a problem, we discuss the problem thoroughly.
12. When a quarrel starts, we decide the solution to the problem together.
14. When we have a problem, first we evaluate the problem and then discuss thesolution.
16. We examine the reasons when the solution doesn’t work.
3. When we have a problem, we search for a solution to the problem.
8. We plan our life cooperatively.
13. We give enough time to express his/her opinion to the partner when having a
conversation.
10. I proactively practice when I decide to solve a problem.
27. I do my best when I decide to solve the problem.
4. We have spent a certain time on communication.
2. When we have a problem, we try to increase the knowledge related to the
problem.
24. When we have a problem, we feel certain that we can solve it.
11. We usually find different solutions to a problem.
23. We usually try to choose the most appropriate solution.
29. I think we should analyze the problem when making a plan to solve the problem.
17. When we have a problem, we leave the problem unsolved.*
22. I can easily talk about my idea to my partner.
7. I can easily express my feelings to my partner.
F2: Relationship-maintenance orientation(α=.79)

0.51
C
C
P
P
P

solution,” and “I proactively practice when I

others. The first factor was composed of three

decide to solve the problem,” among others,

main elements from the perspective of content.

and 7 items included in the "communication"

Firstly, producing solutions (Item 3, 11, 12, 14,

factor of the original version, e.g., "When23), secondly, executing the solutions (Item 10,

having a conversation, we give enough time to11, 12) and thirdly, frankly expressing opinions

express his/her opinion to the partner,” among(Item 4, 7, 8, 13, 19, 22). Therefore, the first7

8

Saito et al.

Table 2: Descriptive statistics of all the scales and gender differences
Total
n
M
205 43.81
201 16.33
202 19.56

Men

SD
11.22
12.22
3.79

α
n
― 91
― 89
.94 90M
SD44.86 11.21
16.26 12.04
19.56 3.86

Women
α
―
―
.94

n
M
SD
114 42.97 11.21
112 16.39 12.42
112 19.57 3.75

αAge―Years of married life―
Relationship satisfaction.94
FPSS
Solution orientation
197 3.63.62.92 87 3.62
.66
.93 110 3.63
.58
.91
Relationship-maintenance199 3.50.69.79 87 3.48
.66
.73 112 3.51
.72
.83
orientation
FACES III
Cohesiveness195 4.06.69.92 88 4.03
.66
.91 107 4.09
.72
.93
Adaptability
195 3.72.60.80 87 3.69
.62
.81 108 3.75
.59
.79
Solution achievement
Marital problems
127 3.67.77.77 56 3.62
.86
.82 71 3.70
.70.71Child-rearing problems
112 3.71.70.77 45 3.66
.78
.77 67 3.75
.65
.77
Problems with parents in law 128 3.56
.82
.82 55 3.42
.85
.78 73 3.66
.80
.84
Relational efficacy
195 3.70.69.93 86 3.71
.74
.94 109 3.69
.65.92Note) n is lower than the other variables in the solution achievement scale, because of the manipulation check.

t――-.30 n.s.

df
―
―
200

-.11 n.s.

195-.34 n.s.

197-.56 n.s.
-.65 n.s.

193
193-.62 n.s.
-.68 n.s.
-1.63 n.s.
.16 n.s.

125
110
126
193

factor was interpreted as the tendency to try tosolve problems through cooperation between

Reliability and validity of the solution

husband and wife, which was named theachievement scale“Solution orientation.” On the other hand, theThe items related to the problem-solution

second factor was composed of four items

achievements of married couples were newly

included in the communication factor of thedeveloped. Items. Therefore, the reliability andoriginal version, such as “We talk in a calm

validity of the scale were examined. First, atone when we have problems,” “Our quarrel

principal component analysis was conducted to

becomes violent when the solution doesn’t

examine the unidimensionality of the scale. In

work,” (a reverse-scored item), among others,

all the problem types (marital, child-rearing,and three items included in the problem-solving

and parents), the values of all the three items

factor in the original version. Therefore, thewere over .70 and loaded on the first principal

second factor was interpreted as the tendency tocomponent with contribution ratios of 69.48%,

talk calmly in problem-solving settings and try

68.75%, and 73.39%, respectively. Cronbach’s

to prevent deterioration of the relationship,

α of each problem type was .77 (marital), .77

which

the

(child-rearing), and .82 (parents). Correlation“Relationship-maintenance orientation.” Thecoefficients with relational efficacy werefactor correlation between the two factors

calculated, Which indicated a significant

was .51. Cronbach’s α of each sub-scale waspositive correlation with solution achievements

calculated, which indicated that it was .92 forof each problem type ( marital; r = 81, p <.01,“Solution

was

named

orientation”“Relationship-maintenance

as

and

79.

for

child-rearing: r = 53, p < .01, parents: r = 40, p

orientation."No< .01). The above results indicated the adequate

gender differences were shown in any of thevalidity

scales (Table 2).

achievement scale developed in this study.

8andreliability

of

the

solution

The Japanese version of Family Problem Solving Scale

9

Therefore, the scale was used for further

problem indicated a higher score for eachanalysis.

sub-scale. Moreover Relationship-maintenanceorientation (d = .79) had a higher effect size

Correlation

coefficients

betweenFPSS

than Solution orientation (d = .47).

sub-scales and other scales (validity)
Significant

positivecorrelations

wereTable 3: Comparisons of a t -test between the group having a problem
and the group not having a problem

indicated between two factors of FPSS
(Solutionorientation

maintenanceandorientation)

having a problem not having a problem

Relationshipandrelationship

FPSS

n

M

SD

n

M

SD

t

Solution orientation
Relationship-maintenanceorientation

39

3.40

0.69

158

3.69

0.58

2.66

39

3.08

0.73

160

3.60

0.64

4.41

**

df

d

**

195

.47

***

197

.79

***

Note 1） p < .01 p < .001
2) d is Cohen’s d expressing the effect size

satisfaction (r =.66, p <.01; r =.54, p <.01),
cohesiveness (r =.76, p <.01; r =.50, p <.01),
adaptability (r =.61, p <.01; r=.39, p<.01),

Discussion

solution achievement (marital: r =.69, p <.01; r

Factor structure of FPSS

= .40, p <.01, child-rearing: r =.48, p <.01; r

The results of exploratory factor analysis=.21, p <.05). Solution achievement (parents)

indicated that the Japanese version of FPSS

indicated a significant positive correlation only

was composed of two factors; Solution

with solution orientation (r =.44, p <.01).

orientation

andRelationship-maintenanceorientation.

The

first

factor,“Solutionwithorientation," consisted of 9 items included inproblems and group without problems"problem-solving” of the original version and 7(validity)

items included in “communication” of theComparisons

between

the

group

original version. It is considered that theParticipants that responded to question item(2), (a), “Do you have some problem in maritalexchange

relationships at present?” affirmatively andindispensable for Japanese marital couples tohaving evaluated its effect as 3 (a little) or 4

solve problems by following the typical steps.

(rather high) were classified into the group

Wives are expected to follow their husbands inhaving a problem, and others were classified

traditional

into the group not-having a problem. A t-test

Recently, however, equality between husbands

was

an

and wives because of women’s social progress

independent variable and FPSS sub-scaleis the norm, and wives ' opinions are consideredscores as dependent variables to examine theessential at home. Given this background,discriminant validity of FPSS (Table 3). The

factors related to proper problem solving andresults indicated a significant difference in bothfrank communication might be related. The

solution orientation (t（195）=2.66, p<.01) andoriginal FPSS was developed based on arelationshiporientationquestionnaire survey conducted with marital(t(197)=4.41, p<.001). The group not-having acouples living in Teran, in Iran. In Islamic

conducted

with

the

maintenance

group

as

9

of

each

Japaneseother'smartialopinionsisrelationships.

10

Saito et al.

cultures, the roles and rights of husbands andReliability and validity of FPSS Japanese

wives are prescribed by law (Kuniya, 2012),

versionwhich makes it difficult to solve problems

Cronbach’s α coefficients of each sub-scale

through communication according to theof the Japanese version of FPSS were as

situation.

follows;

Therefore,

problem-solving

andSolutionorientation=.92

andcommunication might have been divided into

Relationship-maintenancedifferent factors in the original FPSS.

which indicated the sufficient reliability of theThehighermaintenancescale. Regarding validity, a significant positiveorientation” factor score expresses the tendency

correlation was indicated between two factors

for remaining calm when communicating andof FPSS and two factors of FACES III, i.e.,maintaining marital relationships. Many items

cohesiveness and adaptability. Cohesiveness

related to quarrels are included in this factor,

includeswhich was absent in the original version,interactions, and adaptability included items

suggesting that Japanese people might berelated to problem-solving, which confirmed

highly aware of the possibility of excited andthe sufficient concurrent validity of theconflict-ridden

includingJapanese version of FPSS. Moreover, thequarreling in problem settings. In East Asian

results of a t-test between the group (having

cultures,problems/not-having

such“Relationshiporientation=.79,

communication,asJapan,“interdependent

items

relatedtocooperative

problems)

asanconstrual of self,” i.e., the perception thatindependent variable indicated that Solutionindividuals recognize themselves as existencesorientation

embedded in relationships with others, isorientation scores in the group not-having adominant

1991).

problem were higher than the group having a

According to Takada, Omoto, and Seike (1996),

problem. The mean duration (year) of thethe interdependent construal of self is divided

problem in the group having a problem wasinto two aspects, “worry about the evaluation of

10.42 years (SD=11.15), which was rather long,others” and “harmony with or adaptation tosuggesting that the couples had been sufferingothers.” Considering the above background,from the problem for a long time. It is

Japanese couples are assumed to have aconsidered that couples in the problem groupstronger tendency to care about their partner’s

have less problem-solving abilities, which

evaluation andprolongs(Markus&

Kitayama,

adapt themselves to

the

and

problems.

Relationship-maintenanceItispossibletorelationships, compared to couples living in

discriminate couples with high problem-solving

Islamic cultures, which might have resulted inabilities from those with low problem-solving

the“Relationship-maintenanceabilities using the Japanese version of FPSS.

orientation, which is different from the original

Therefore, the scale has a sufficient degree ofversion."discriminant validity.

factor,i.e.,

10The Japanese version of Family Problem Solving Scale

11

Limitations and future perspectives
The three following issues are considered as

References

the limitations of this study and future

Ahmadi, K., Esfandiar, A., Ashrafi, S.M.N.,

perspectives; Firstly, the present study lacks theFateme, R. (2007). Construction andperspective of the family life cycle. This study

Validation of the Family Problem

was designed to develop the Japanese version

Solving Scale. Journal of Appliedof

Sciences, 7(24), 3958-3964.

FPSS

by

examiningproblem-solving

abilities common to ordinary marital couples.

Christensen, A. & Shenk, J.L.(1991).

Therefore, the characteristics of newly-marriedCommunication, conflict, andcouples or middle-aged couples were not

psychological distance in nondistressed,

examined

future,clinic, and divorcing couples. Journal ofcomponents of the problem-solving ability

Consulting and Clinical Psychology, 59,

should be examined by controlling for the years

458-463.

inthestudy.

Intheof marital life. Secondly, the methods ofD’zurilla, T.J. (1986). PROBLEM-SOLVING

maintaining relationships were not examined in

THERAPY

A

SocialCompetence

the study. There are different methods ofApproachtoClinicalIntervention.

preventing relationships from deteriorating,Springer

Publishingincluding compromising, patience, avoidance,

Japanese] (丸山晋監訳 1995 問題解決

and humor, among others. Thirdly, the types of療法

problems should be controlled in future studies.

テンス・アプローチ 金剛出版)

The participants of the current study were not

Hasegawa, K. (1987). The family paradox.

instructed to assume a specified problem.

Saiko Shobo. [in Japanese](長谷川啓三

Therefore, the types and seriousness of the1987 家族内パラドックス 彩古書房)

problems assumed by the participants might

Hoffman, L. (1981). Foundation of Family

have been different. It is suggested that future

Therapy. New York: Basic Books Inc.

studies should consider examining situational[in Japanese] (亀口憲治訳 2006 家族

factors such as the degree of conflict and the

療法の基礎理論─創始者と主要なア

possibility of manipulating the problem.

プローチ─ 朝日出版社）

Company.

[in

臨床的介入への社会的コンピ

Ito, Y., Sagara, J. & Ikeda, M. (2007). Effects
Note

of

This paper is the revision of the study
presented at the 34thmaritalrelationshipannual meeting of thecommunicationonsatisfaction-Focusedonself-disclosure. Journal of the Faculty ofJapanese Association of Family Psychology

Humanand submitted as a master's thesis to the

University, 9, 1-15. [in Japanese](伊藤Graduate School of Education, Faculty of

裕子・相良順子・池田政子 2007 夫婦

Education, Tohoku University.

のコミュニケーションが関係満足度
11

Studies,

BunkyoGakuen12

Saito et al.

Mynors-Wallis,に及ぼす影響――自己開示を中心に
文京学院大学人間学部紀要, 9, 1-15.)

L.(2005).

Problem-Solving

Treatment for Anxiety and Depression A

Kuniya, T. (2012). Family image in modern

Practical Guide.

Oxford University

Islamic society-based on the analysis of

Press. [in Japanese] (明智龍男・平井“Women’s

啓・本岡寛子監訳 2009 不安と抑うつWorld”.

TsuboiY.

&

Yamamoto. H. eds. CIAS Discussion
Paper

Seriesfor

Nagara, T. (1999). Communication behaviors

Kyoto

promoting good marital relationships.

University. [in Japanese](國谷 徹 2012

Bulletin of Aichi Shutoku Junior College.

近代イスラームにおける家族像 --連

38, 1-21. [in Japanese] (永田忠夫 1999

載記事「女性の世界 」の分析から 坪

良好な夫婦システムに影響を及ぼす

井 祐 司 ・ 山 本 博 之 編 著 . CIAS

コミュニケーション行動. 愛知淑徳

Discussion Paper Series No.23 『カラ短期大学研究紀要, 38, 1-21.)

Integrated

No.23.

Area

Centerに対する問題解決療法 金剛出版)

Studies,Okamoto, Y. (2015). Transition of couple

ム』の時代Ⅲマレー・イスラム世界におけるイスラム的社会制度の設計京

relationships:

Japanesecontext

and

都大学地域研究統合情報センター)

problems. Japanese journal of family

Kurosawa, Y. & Kato, M. (2013). Development

therapy. 32(2), 12. [in Japanese](岡本吉of a relation-focused coping scale in

生 2015 カ ッ プ ル 関 係 の 推 移

marital stress settings. The Japanese（Transition of Couples）：その日本的journal of developmental psychology.

文脈と課題. 家族療法研究, 32(2), 12)24(1), 66-76. [in Japanese](黒澤泰・加Pruitt, D. G. & Rubin, J. Z. (1986). Social

藤道代 2013 夫婦間ストレス場面に

conflict: Escalation, stalemate, andおける関係焦点型コーピング尺度作

settlement. New York: Random House.

成 の 試 み . 発 達 心 理 学 研 究 , 24(1),Takada, T., Omoto. M., & Seike, M. (1996).

66−76.)

Scale for measuring independent andMarkus, H. & Kitayama, S. (1991). Culture andinterdependent view of self, revised

the Self: Implications for cognition,

edition. Memoirs of Nara University. 24,

emotion, and motivation. Psychological157-173. [in Japanese](高田利武・大本Review, 98(2), 224-253.

美千恵・清家美紀 1996 相互独立的―

Moroi, K. (1996). Perception of equality in

相互協調的自己観尺度（改訂版） 奈
良大学紀要, 24, 157-173.)

assignment of domestic work. The
Japanese journal of family psychology.

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

10(1), 15-30. [in Japanese](諸井克英

therapy guidebook. Kongo Shuppan.

1996 家庭内労働の分担における衡平[in Japanese](若島孔文・長谷川啓三

性 の 知 覚 家 族 心 理 学 研 究 , 10(1),2000 よくわかる！短期療法ガイド15-30.)

ブック

12

金剛出版.)

International Journal of Brief Therapy and Family Science2020 Vol. 10, No.1, 13-23< Short Case Report >Brief Therapy for a Serious Sex Offender
Kenji Yokotani 1) 2)

Katsuhiro Tamura 3)

1)

Tokushima University, Graduate School of Sciences and Technology for Innovation2)

PsychoBit

3)

Niigata Juvenile Detention Center

ABSTRACT. Brief Therapy (BT) has been shown to be effective in criminal population, but its effectiveness on the treatment of sex
offenders was rarely reported. This study focuses on the case of one serious sex offender to examine the potential effectiveness of BT
in the treatment. The client was a man in his 60s with multiple incapacitated rape offenses against women in their 20s. Seven inperson therapies were conducted within a prison. Therapies revealed that the client’s sex crime behaviors were motivated by his
personal goal of autonomy. Further, running was found to be an alternative behavior through which his goal could be achieved without
engaging in sex crimes. This case suggests that a solution-focused BT approach may be effective in the treatment of sex crime offenders.
It also demonstrates the importance of clarifying the offender’s personal values and transforming the values to prevent sex offence.
Adding treatment protocols to address value transformations may further increase the effectiveness of BT on sex offences.
KEY WORDS: Brief therapy, Incapacitated rape, Pseudo solution, Neutral Judgement on deficiency condition,

Introduction

RPM frames the sex offence as a coping

The prevalence of sex crimes is a societal

behavior in reaction to a situation that theconcern (Hanson et al., 2017). The recidivism

offender seeks to avoid(Marlatt & Donovan,rate is high particularly for sex crime offenders

2005). For example, if a sexual offender holds in(Hansonthe

negative feelings of anger until he is no longer

implementation of prevention programs andable to bear it, he will engage in sex crime

reductions in the number of sex crimes were

behaviors against women to relieve his negativesocial demands. Meta analysis of prevention

emotions (Marlatt & Donovan, 2005). RPM isprograms shows some degree of efficacy, but aheld to be effective: the recidivism rate for sex

proven method has yet to emerge(Schmucker &offences is lower among groups that undergo

Lösel, 2015).

RPM for a year or more compared to groups that&

Bussière,1998),

so

The Relapse Prevention Model (RPM) is thedrop out midway through(Marques et al., 2005).

most widely-known approach used today.

RPM is utilized the model of sex crime

CORRESPONDENCE

YOKOTANI, KENJI

prevention programs not only abroad, but widely

Tokushima University, Graduate School of Sciences andacross Japan as well (Asahina, 2007). RPM

Technology

has been criticized, however, for focusing only

for

TO:

Innovation,

1-1,

Minamijosanjimacho,on the negative aspects of the offenders

Tokushima-shi, Tokushima 770-0814, Japan.
e-mail: yokotanikenji@tokushima-u.ac.jp

13

14

Yokotani & Tamura(Polaschek,2003).

(Willis et al., 2014), it shares three elements with

The shortcomings of RPM are improved by

BT (Kim & Franklin, 2009). The first is that

the Good Lives Model (GLM), which has been

therapy focuses on positive aspects rather thangaining in popularity in recent years(Ward &negative aspects alone (Shazer et al., 2012).

Brown, 2004). GLM frames offenders’ sex

Second, the points for identifying processes

crime behaviors as a method for achieving theirbehind sex crime behavior (A’-1, A’-2, B’ inpersonal goals (Whitehead et al., 2007). For

Figure 1) are the same as for identifying

example, a sex offender might engage in a sex

erroneous,crime to achieve a personal goal of being(Schwartzman, 1988). Third, the points forautonomous without any restrictions imposed by

identifying processes leading to pro-social

others (Ward & Gannon, 2006). The therapist

behaviors (A-1, A-2, B in Figure 1) are the same

would acknowledge the offender’s personal goal,as for the points on which solutions are

but point out the error in the offender’s method

structured in BT (Berg & De Jong, 1996). Theseand guide him toward a lawful way to achievecommon elements are summarized in Figure 1.

his goal(Ward et al., 2012). As shown in Figure

The path leading to sex crime behavior

1, sex crime behavior (B’) and pro-social

represents a state of error, that is, a pseudo

behavior (B) are linked with the same personal

solution (A’-1, A’-2, B’ in Figure 1), so

goals under the GLM scheme (Ward & Gannon,

whenever such a behavioral chain is about to2006).

unfold, there must be an intervention to make thepseudosolutionsinBT

Although GLM is generally discussed withinclient engage in a different behavior(Berg &the framework of cognitive behavioral therapy

Miller, 1992). Since pro-social behavior is theBRIEF THERAPY FOR SEXUAL OFFENDER

15

exception for the criminal behavior chain (A-1,

According to A, he ranked around tenth in his

A-2, B in Figure 1), the intervention must serve

class academically and performed at a national

to make the client continue to engage in the samelevel in sports (short-distance track). Moved topositive behavior (Berg & Miller, 1992).

C at age 18 and enrolled in the law department

Programs

incorporating

GLM

are

of a renowned private university. At age 22,

increasingly recommended. Although a number

switched to the literature department becauseof case studies have come out mainly in the West

there were more women, and studied abroad for(Pflugradt et al., 2018; Ward & Gannon, 2006;

one year. After graduating at age 23, worked

Willis et al., 2014), research in Japan has been

until age 25 as a cook at a restaurant in his

limited to one case study(Yokotani & Tamura,

hometown B. From age 25 to 27, trained at a2018). There is also extremely little literature on

famous restaurant in Kanto district and as well

the applicability of BT for sex crime offenders.

as a restaurant abroad for a year and half.

The applicability of BT in criminal population

Suddenly began car sales at a major hometown(Franklin et al., 2011; Yokotani & Tamura,company from age 27 to 31. Married and2015a, 2015b), however, suggests that BT may

divorced during this period. Between ages 31

be an effective method of treatment for sex

and 40, changed jobs to copier sales with a major

offenders. This study examines this potential

company in his hometown B. Simultaneously

through a case of GLM-based BT conductedbegan offering cooking classes which were freewith a sex crime offender.

of charge and did not generate any revenue.

Case Summary

From ages 41 to 50, employed at a major

Client: Client was male prisoner A, in his 60s,

company in C (unclear job type). Committed

incarcerated at the time of this study in Q Prison.

fraud at age 50, but was not discovered. Between

As mental health therapist at Q Prison, heages 50 and 51, operated a restaurant in C.

commenced therapies upon being approached by

Borrowed funds from fiance's father to operate

A to talk.

the restaurant.

Family history: First-born of two brothers to

Although A committed

shoplifting at this time, he received noa father who was a municipal government

punishment(discrepancy

with

A’s

own

worker and a mother who was a homemaker instatements). At age 51, A was sentenced to 4

prefectural city B. Married from age 26 to 30;

years and 6 months in prison for incapacitated

two children. No contact with children or ex-

rape and indecent assualt. Another 1 year and 6

wife since divorce. Engaged and living withmonths of imprisonment was added for

fiance after release from previous prison, but

subsequent discovery of the fraud A had

fiance called off the engagement and separated

committed when he was 50. Incarcerated at P

after A’s recent crimes.

juvenile prison from age 51 to 56. Released on

Life history: Enrolled in public elementary,parole at age 56 and returned to his mother’s

junior and senior high schools in B prefecture.

home. Estranged from father since the sex

16

Yokotani & Tamura

crimes came to light. Employed at a major

1): A stated that he had no particular worries andhometown restaurant from age 56 to 60. Twojust wanted to talk freely. He said he wasincidents of incapacitated rape were discovered

accused of committing incapacitated rape, but heat age 60, for which A remained incarcerated atthought it was consensual. He invited an overly

Q prison after being sentenced without a stay of

proud 25-year old woman to his home andexecution.

drugged and raped her. He paid for hospital andCrime method:

Skillfully approached ataxi fees when she felt ill the next day, but when

woman in her 20s to share food and drinks.

he thought things were getting ridiculous andSpiked drinks with drugs and committed sex

refused to pay money, he was accused the next

crimes indoors against the semi-consciousday. When he was 45 years old, he opened awoman. All of A’s crimes were incapacitatedrestaurant for 50 million yen in C (prime

rape crimes since the victims were in semi-

location in Kanto district), and after it failed, heconscious states.

opened a restaurant in his hometown for 30

Therapy Process

million yen. After getting out of prison, he

Therapy

structure:

Therapies

wereplanned to build a restaurant for 10 million yen

commenced following request for therapy by A.

in D (summer resort area in Kanto district). He

30-minute personal therapies were conducted inwould make a lot of money because he coulda private room once per month. A prison officer

buy wine for about 800 yen abroad and sell it ator legal instructor was present during therapies

12,000 yen in Japan. He had connections at thefor the protection of the therapist.

Japan federation of bar associations from his law

Therapy demeanor: A willingly spoke about

student days, and he wanted to file an action

his background as a chef as well as the processagainst the prison. He also had connections at J

behind his sex crimes, but for the most part, he(major music label), and women used to flock to

did not touch on his sales work experience orhim.

other crimes of shoplifting and fraud.

A was persistent in talking about his elite

Summary of therapy process: Therapies fell

educational status, high income, and popularity

into three phases; phase 1 consisted of session#1,

with women. It was necessary to listen for abuilding rapport (following which A was

while and acknowledge him to build rapport.

transferred to R prison and underwent a half-

Following this therapy, A was transferred to R

year of an RPM-based sex crime group therapy

prison to undergo an RPM group therapy

program), phase 2 consisted of sessions #2 to #4,

program to prevent sex crime (6 months, 51

in which the process of arriving at pseudo

sessions; medium density). The program wassolutions was assessed, and phase 3 consisted ofcompulsory and A could not drop out. He

sessions #5 to #7, which focused on identifying

experienced insomnia while at R prison andand habitualizing solution behaviors.

blamed Q prison (for too little food and exercise),＃1. Building rapport April YYYY (phaseand he repeatedly said that he knew a reporter

BRIEF THERAPY FOR SEXUAL OFFENDER

17

and would sue for redress. RPM group therapy

women. If he arranged to get a woman a place

concluded that A had a habit of searching out

on stage, he could have sex with her right away.

women victims and that there was a conflict

He had also trained with the track team at a

between his own almighty self-image and how

women’s college. At the time, there were two

he was seen by others.

men among 400 members. He was having sex＃ 2

Search for solutions

AugustYYYY+1 year (phase 2): A was upset that heevery day in his room with his womenteammates.

was not informed about his own father’s death

If A meets a cheeky and snobbish woman, heuntil half a year after the fact. At that time, hewants to have his way with her. He is completely

met up with a male friend and two women he hadsatisfied if he has sex with the woman in a

met at a club and then drugged and raped thecomatose state. He suddenly changes his attitude

women. He experienced a sense of pleasure fromafterwards, and that is why he gets accused ofbeing able to do as he liked when the womenrape. When things are going well at thewere unconscious, unlike with normal sex. Next,

restaurant, he thinks up menus and does physicalat the time A was running the restaurant in his

work, so he does not need to work off his sexual

hometown B (he was in fact an employee andurges. If work is not going well, he cannot comenot owner), he drugged and raped a woman heup with ideas and his sexual urges become

had met at a coffee shop. The woman was unable

stronger, and he thinks about having his way

to go work the next day and was demoted by thewith a woman. He is a perfectionist in someshop manager. She then accused A of rape. To

aspects, and while this is not a problem whenattractive women, he gave makeup advice andthings are going well, he blames himself andwas attentive. On the other hand, he could beruns himself down when things are not goingdone with unattractive women after one go, sowell. For example, when things are going well,

he sought physical pleasure and then suddenly

he will make variations to the pasta sauce orgave them the cold shoulder, and then he ended

ingredients (minor item). If about a third of theup being accused of rape.

customers leave a certain pasta unfinished, heA seemed to commit sex crimes against

will stop serving the pasta itself (major item) as

women he did not like. Hearing details about the

opposed to trying to change it. Then he ends up

women that A did not like provided insight into

not being able to serve the lunch menu and he

the process, that is, pseudo solution, leading tofeels cornered.

the crime.
＃3

Identifying pseudo solutions October＃4
December

Identifying the sex crime process
YYYY+1year(phase2):

YYYY+1 (phase 2): A said he had always dated

Everything has to go A’s way, otherwise hemodels. That was because he had worked at a

immediately loses confidence. When he was aclub where only 50 out of 3000 people could bechef in training, he had to make the boullion, andup on stage, which was a status symbol for theif the taste was even slightly off, the entire pot

18

Yokotani & Tamura

would be dumped out right in front of him.

range. Academically, he ranked around tenth inWhen A had his own restaurant (as first chef), he

his class and served as class president. In that

did not experience much frustration thanks to asense, his father wanted perfection.

capable second chef, but that person left to start

In contrast, A’s mother was easy-going andhis own business and another person became

gentle. A cooked meals himself when he was insecond chef. Dishes handled by that person werejunior and senior high school. Even when the

returned by customers, so A had to do everythingfood had probably not turned out well, A’s

by himself. Also, when A used to run track, hemother would say that it was good. She also told

knew what the results would be within the first

him that he had a good sense for it. A was happy

few seconds. That is why he knows already if

to see his mother looking pleased. It was her

there are no results in the early stages.

smile that made him want to pursue cooking.

The therapist inquired: “Isn’t a restaurant

This gentle mother got angry just twice. The first

more like long-distance than short-distancetime was when A threw a rock at a beggar whensince you need to maintain consistency every

he was in elementary school and his motherday?” A agreed but said things just did not gostrongly reprimanded him for beating up on

right for him in his mind.

someone weak. The second time was when A

A’s perfectionist thinking was based on thewas in junior high school and A was suspectedidea that he was no good if he could not controlof taking something of a friend’s; A’s mother got

everything exactly as he had planned, and thisangry with his father because he doubted A, andlikely tied into his sex crimes. His personal goal

she said that A would never do such a thing.

was regarded as perfect control (Figure 2 C-1),

Therapist inquired: “What does your motherand we assume that he tended toward sex crimes

say when things aren’t going well?” A replied

when he was unable to achieve his goal (Figurethat his mother would say “better luck next time,”

2 C-2).

or “unless you die from it, everything else is just

＃5

January YYYY+2 years

Gentlea scrape,” or “there’s nothing wrong with 80%.”

mother (phase 3): Therapist inquired: “HaveA’s father’s perfectionist value system appeared

you ever felt like you have value even if you areto be influencing A’s negative judgment about

not perfect?” A’s father was an elite both in

his deficiency condition where he does notterms of baseball and on the job. A underwent

achieve his personal goal (Figure 1 A’-1). His

Spartan-like baseball training fit for a risingmother’s value system could be an alternative

Giant’s player. When he was in elementary

to his perfectionism. Mother’s values influenceschool, he had hard ball practice in the early

neutral judgment about his deficiency condition

mornings and after school. When he was in(Figure 1 A-1). A could reevaluate his values

junior and senior high school, he also ran sprints

from his mother’s perspective. For the next

in the early mornings and after school. This issession, Therapist advised A to think about the

why A could run 100 meters in the 10 second

kinds of things his mother had said to him.

BRIEF THERAPY FOR SEXUAL OFFENDER

19

January YYYY+2 years Digging into

Still, he realized that he liked running. He knew

mother’s values from life history (phase 3):that he would not be able to get the times he used

When A did not qualify for the B prefectural

to. But there was joy in running. His goal was tochampionships in sprints (the coach andfinish the 100 meters without injury. He wanted

everyone else thought he would), his father

to be in the finals.

＃6

stayed angry, but his mother watched and waited

The person who won the Master’s at age 80

at home for a while and said supportively,

kept careful track of his daily diet and said that

“Maybe the others just worked harder thanthe process was more important than the

you . . .” A’s father’s values still strongly

outcome, and A agreed with that thought.

influenced A even as a professional chef, and hePreviously, there had been a 60 meter race at a

had been critical of every poorly made dish bydifferent prison. Everyone had been worried

his charges. He had even gone so far as to fire

about him running, but he was fastest by atwo people within a few months.

longshot. Sometimes things do not go well with

In contrast, his mother was gentle. She told A

his cooking, but at times like that he could run tothat she could not contact him for his father’schange his mood, and his way of thinking would

funeral because that was what had beenchange. Things had been pooling up inside since

requested in his will. But A’s mother said that

he had stopped running.

she would do as she pleased from then on.
The mother’s values provided a different

A’s joy in running was related to a state ofbeing in control (Figure 2

B). His desire toperspective for A’s perfectionism. Since A will

enjoy running within the scope of his current

continue to attempt sex crimes when things doability (Figure 2 A-1) stands in contrast to his

not go perfectly so long as he holds himself to adesire to control everything about his cooking

perfectionist value system (Figure 2 A’-1), a(Figure 2

different value system needs to be re-constructed.

behavior (Figure 2 B) and is not a sex crime. A’

Therapist again instructs A to recall his mother’ss ability to run fast thus serves as an internalwords to discuss at the next session.

resource (Figure 2 A-2). In providing a space

A ’ -1). Running is a pro-social

March YYYY+2 years Habitualizing

in which A can utilize this internal resource, thethe solution (phase 3): A met with his probation

probation officer serves as an external resource

officer, who was a track and field fan and said

(Figure 2 A-2). A’s running ability combinedthat he recognized A from track. The probation

with the support of the probation officer would

officer told A that there were athletic fields near

likely encourage A to engage in running andthe probation facility (where A was scheduled tothereby prevent further sex crime behaviors.

＃7

go after release) and suggested that A could enter
the Master’s (50+) tournament. A wanted to doit. Looking back, A had been running because of
his father. He had not run since becoming a chef.

20

Yokotani & Tamura

Discussion
This study outlined a BT intervention based

BT strives to have the client constantly
construct images of achievable

solutionson the personal goals of the sex crime offender.

(Schwartzman, 1988; Shazer et al., 2012). This

Previous research has suggested that theapproach has proven effective for clients withpersonal goals of sex offenders can be split into

depression in previous studies (Kim & Franklin,

either autonomy (wanting to be in control of2009). Likewise, the approach in this study was

everything) or intimacy (wanting to be intimate

to have the offender construct a situation inwith another)(Ward & Gannon, 2006). Intimacy

which his personal goals could be achieved

has been cited as a personal goal of sex offenders

without engaging in sex crime behaviors. The

based on cases in Japan as well (Yokotani &case suggests that the simple BT model for

Tamura, 2018). This study illustrates how

constructing an image of an achievable solution

autonomy is also a personal goal held by(Berg & Miller, 1992) may provide a method of

offenders. It sheds light on how the GLM (Wardtreatment not only for depression clients, but foret al., 2012; Ward & Brown, 2004; Ward &sex

Gannon, 2006; Whitehead et al., 2007) and its

conventional BT can be applied as is to sex

model for goal achievement (Ward & Gannon,

offenders insofar as the construction of solutions.

2006) could be used in a Japanese setting. It also

On the other hand, one of the flaws inshows which aspects of sex crime treatments canconventional BT is that the path to a pseudo

be addressed through conventional BT protocols

solution and the path to a genuine solution may

and which aspects call for protocols that diverge

completely diverge in the end (Berg & De Jong,from BT.

1996). In this study, there was partial overlap

crime

offenders

as

well.

That

is,

BRIEF THERAPY FOR SEXUAL OFFENDER

21

between the path to the offender’ s genuine

individual therapies in the case of sex offences

solution and the path to his pseudo solution (see(Hanson et al., 2017), this study demonstrated

Figure 2). This indicates that the path leading to

how a pseudo solution can be identified anda offender’s true solution (pro-social behavior)replaced with an alternative solution over ais more difficult to discover in comparison to thelimited period of seven sessions. It provides apath for depressed clients (active behavior). In

foundation for the use of a BT framework in thethe same vein, previous research has posited thattreatment of sex crime offenders and expands theconcrete changes at the behavioral level are what

potential applicability of BT beyond what has

lay the path to solution (Shazer et al., 2012). In

been suggested in previous research (Franklin et

the case presented here, however, changes at theal., 2011; Yokotani & Tamura, 2015a, 2015b).

personal value-determining level were shown to

Findings from this study will ideally contributelead to genuine solution (Figure 3). This point

to the prevention of sex crimes and reduce thespeaks to a need to address and partiallynumber of both offenders and their potential

transform the client’s value system to reachvictims (Hanson & Bussière, 1998).

genuine solution when working with sex crime
offenders (Pflugradt et al., 2018). It also

Acknowledgements

indicates that treatment of sex offenders requires

The authors thank the client of this case fora longer period of time to allow for value

permission to publish and is sincerely grateful totransformation as opposed to conventional

prison staff for their collaborative work.

behavioral transformation.
The study has several limitations to note.

References

Foremost, this was a single case from which we

Asahina, M. (2007). Approaches to sex offendercannot draw general conclusions. The success oftreatment: A post-relapse prevention model

the treatment was moreover unclear given that(special issue: A new understanding of sex

no follow-up was conducted. Even assuming

crimes) [In Japanese]. Addiction andthat the treatment was effective, the client was

Family, 24(3), 199–205.

highly intelligent and therapies with less ableBerg, I. K., & De Jong, P. (1996). Solution-individuals would not be likely to flow asbuilding conversations: Co-constructing asmoothly as they did in this case. Finally,

sense of competence with clients. Families

considering that the client’s conversational

incontent changed subsequent to his 51 sessions of

https://doi.org/10.1606/1044-3894.934

RPM, the impact of RPM should be thoroughlyBerg, I. K., & Miller, S. D. (1992). Working withassessed (Marlatt & Donovan, 2005; Marques etthe problem drinker: A solution-focusedal., 2005).

approach. W W Norton & Co.

Society,77(6),

376–391.

Despite these limitations, in contrast toFranklin, C., Trepper, T. S., McCollum, E. E., &research illustrating a need for prolonged

Gingerich, W. J. (2011). Solution-Focused

22

Yokotani & Tamura

Brief Therapy: A Handbook of EvidenceBased Practice. OUP USA.
Hanson, R. K., Babchishin, K. M., Helmus, L.

Pflugradt, D. M., Allen, B. P., & Marshall, W. L.
(2018).

A

genderedtreatment

model

strength-basedforfemalesexualM., Thornton, D., & Phenix, A. (2017).

offenders. Aggression and Violent Behavior,Communicating the results of criterion40,

referenced

Risk

https://doi.org/10.1016/j.avb.2018.02.012

categories for the Static-99r and Static-

Polaschek, D. L. L. (2003). Relapse prevention,

2002r sexual offender risk assessment tools.

offense process models, and the treatment

Psychological Assessment, 29(5), 582–597.

ofhttps://doi.org/10.1037/pas0000371

Psychology: Research and Practice, 34(4),prediction

measures:Hanson, R. K., & Bussière, M. T. (1998).

12–18.

sexualoffenders.

Professional

361–367.

Predicting relapse: A meta-analysis of

Schmucker, M., & Lösel, F. (2015). The effects

sexual offender recidivism studies. Journalof sexual offender treatment on recidivism:of Consulting and Clinical Psychology,

An international meta-analysis of sound66(2),

quality

348–362.

evaluations.

Journalof

https://doi.org/10.1037/0022-

Experimental Criminology, 11(4), 597–630.

006X.66.2.348

https://doi.org/10.1007/s11292-015-9241-

Kim, J. S., & Franklin, C. (2009). Solution-z

focused brief therapy in schools: A review

Schwartzman, J. (1988). Continuities andof the outcome literature. Children anddiscontinuities in the family treatment ofYouth Services Review, 31(4), 464–470.

substance abuse. Journal of Psychotherapy

https://doi.org/10.1016/j.childyouth.2008.

&

10.002https://doi.org/10.1300/J287v03n03_08

Marlatt, G. A., & Donovan, D. M. (2005).
RelapsePrevention,

SecondEdition:

The

3(3),

105–125.

Shazer, S. de, Dolan, Y., & Dolan, Y. (2012).
More Than Miracles: The State of the Art

Maintenance Strategies in the Treatment ofof

Addictive Behaviors. Guilford Press.

Routledge.

Marques, J. K., Wiederanders, M., Day, D. M.,

Family,Solution-Focused

Brief

Therapy.

https://doi.org/10.4324/9780203836484

Nelson, C., & van Ommeren, A. (2005).

Ward, T., & Brown, M. (2004). The good lives

Effects of a relapse prevention program onmodel and conceptual issues in offendersexual recidivism: Final results fromrehabilitation. Psychology, Crime & Law,

California’s sex offender treatment and10(3),

evaluation project (SOTEP). Sexual Abuse,

https://doi.org/10.1080/106831604100016

17(1),

62744

79–107.

https://doi.org/10.1177/107906320501700
108

Ward,

T.,

243–257.

&

Gannon,Rehabilitation,T.

etiology,A.

(2006).

and

self-

BRIEF THERAPY FOR SEXUAL OFFENDER

23

regulation: The comprehensive good lives

Prevention Science, 16(8), 1169–1176.

model of treatment for sexual offenders.

https://doi.org/10.1007/s11121-015-0571-

Aggression and Violent Behavior, 11(1),x

77–94.

Yokotani, K., & Tamura, K. (2018). A case study

https://doi.org/10.1016/j.avb.2005.06.001

of applying the good lives model to a

Ward, T., Yates, P. M., & Willis, G. M. (2012).

severe sexual offender [In Japanese].

The good lives model and the risk need
responsivity model: A critical response to
Andrews, Bonta, and Wormith (2011).
Criminal Justice and Behavior, 39(1), 94–110.
https://doi.org/10.1177/009385481142608
5Whitehead, P. R., Ward, T., & Collie, R. M.
(2007). Time for a Change: Applying theGood Lives Model of Rehabilitation to a
High-Risk Violent Offender. International
Journalof

OffenderTherapyandComparative Criminology, 51(5), 578–598.
https://doi.org/10.1177/0306624X0629623
6
Willis, G. M., Ward, T., & Levenson, J. S. (2014).
The Good Lives Model (GLM): An
evaluation of GLM operationalization innorth

Americantreatment

programs.

SexualAbuse,

26(1),

58–81.

https://doi.org/10.1177/107906321347820
2
Yokotani, K., & Tamura, K. (2015a). Solutionfocused group therapy for drug users inJapanese prison: Nonrandomized study.
International Journal of Brief Therapy andFamily Science, 5(2), 42–61.
Yokotani, K., & Tamura, K. (2015b). Effects ofpersonalized feedback interventions on
drug-related reoffending: A Pilot Study.

Addiction and Family, 34(1), 66–74.

International Journal of Brief Therapy and Family Science2020 Vol. 10, No.1, 24-33< Short Case Report >Brief Therapy for Parents Troubled by the Independence of Their Daughter with Gender
Dysphoria and Previous History of Eating Disorders
Teruyo Doi 1)

Hiroyuki Mogi 2)

1)

Nippon Medical School Chiba Hokusoh Hospital

2)

Fukaya Support Station

3)

Rissho University Psychology Clinical Center

Manabu Kitami 3)

ABSTRACT. Eating disorders are common to young women and have a high mortality. As there is a wide range of variations of thetypes of eating disorders, psychosocial treatments are provided in conjunction with pharmacotherapy. Especially family therapy is
supposed to be effective because supports from the family have significant effects on the patient’s recovery. On the other hand, thepatient has gender dysphoria with symptoms similar to disgust for one’s own femininity and also the relationship between these two
symptoms is pointed out.
In this paper, we report the concluded case where we conducted the interviews of four times in total with the parents of thedaughter (IP) with gender dysphoria and previous history of eating disorders by using brief therapy. We are going to consider thiscase from 5 points: (1) Diagnoses of a vicious circle of the family, (2) Discoveries of the family resources and exceptions, (3) Whatchanged the family system and led to problem solving, (4) Family’s acceptance of gender dysphoria, and (5) Future issues.
Key Words: Brief Therapy, Gender Dysphoria, Independence, Reframe, Paradox

Introduction

as important background factors of eating

90% of the patients of eating disorders are

disorders and the Center for Eating Disorder

young women in their teens to thirties and the

Research and Information (2019) supposes thatrate of their mortality in Japan is 7% and“the family response after the onset of

extremely high. Psychosocial treatments play asymptoms is largely involved in the prognosis

central part and pharmacotherapy plays aand the effective support from the family

peripheral part (Nakai, 2016). Many of thecontributes greatly to the patient’s recovery.

patients often feel some pain or loneliness

It was formerly reported that as the support

before the onset of symptoms and a low

using family therapy focusing on symptomatic

self-estimate is considered to be inherent inrelief of eating disorders, the focal point wasthem (Takakura, et al., 2017). Family relations

shifted from the family seeing IP with eating

are often understooddisorders as “aCORRESPONDENCE TO: DOI, TERUYO

adolescent girl” and that the changes in the

Nippon Medical School Chiba Hokusoh Hospital, 1715,

family system were promoted by defining

Kamagari, Inzai-shi, Chiba 270-1694, Japan.

another problems and intervention was madee-mail:t-doi @nms.ac.jp(Minuchin, 1978). Also in Japan, there are casestrong-willed,

rebellious,

reports by Nakamura, et al. (1988) of changes

24

BRIEF THERAPY FOR PARENTS

25

in family structures caused by strengthening

diagnosis of vicious circles of the interaction

alliance between husband and wife in the

between IP and her parents (MRI), looking forcontext of “independence” of IP (identified

exceptions, expanding them and intervening topatient). There is another report by Hatayama

make them the virtuous circles (SFA) and after(2018) that as the supports for the family of

conducting 4 interviews the problems were

eating disorders, the supports were provided forsolved and also the purpose of this paper is tothe mother suffering from her daughter withconsider the effectiveness of supports for eating

eating disorders using systems approach and it

disorder. When reporting this case, after

is known that the family therapy is effective inproviding the client (hereinafter called Cl) witheating disorders.

explanation and getting Cl’s understanding, we

On the other hand, the existence of genderobtained written consent form Cl. Besides, wedysphoria is reported as risk factors of eating

have made some changes in a part of thedisorders. Vocks et al (2008) points out that

information in consideration of privacy.

female-to-male transsexuals are apt to be highly
conscious of the restricted diet or fears ofCase Example

eating, which can become the risk factors in

Cl is the parents who worry about theireating disorders. In Japan, Hashida, et al.

daughter with eating disorders. They came to(2013) report that giving examples of hospitalthe brief therapy research institution introducedcare for eating disorder, gender identity

by other psychological services offices. The

disordershatingfamily consists of a married couple (Cl), theirfemininity are more likely to develop eating

eldest daughter and their second daughter

disorders hating femininity and the relationship(woman in her twenties). The chief complaints

between gender dysphoria and eating disorders

is that they wants to consult us how to deal withis suggested.

IP continuing to vomit up what she has eaten.

ofbiological

women

Though, as mentioned above, it is often
reported that family therapy for the family(1) Structure of Interview

including IP with eating disorders is effective,

The interviews were basically conducted on

we can hardly find the reports of family therapy

a monthly basis for one hour in the brieffor IP with gender dysphoria and previous

therapy research institution. The interviews byhistory of eating disorders.

the therapist (hereinafter called Th) were

The purpose of this paper is to report the

conducted in the form of live interview where aconcluded case where with the team approachtherapist team monitored live through a videoof brief therapy to the parents whose daughter

camera, taking time-outs and obtaining advice

has gender dysphoria and previous history offrom the team. Doi acted as the main therapist

eating disorders, we provided brief therapy ofand Mogi acted as the sub-therapist. The

double description models of making atime-outs were taken in the middle of the28
26

Doi et al

session, the team had discussions and madebut toward the end of the summer vacation she

intervention at the end of the session referring

became unable to go to work and she quitted

to the opinions of the team.

the job in December, X－1year. After that, sheleft her home without telling her family. The

Course of treatment

family can contact IP, but they became worried“ ” indicates the parents’ statement, < > Th’sto hear the grandmother’s doctor say, ‘While atstatement, ≪≫ the therapist team’s statement,

home she is all right but such child may run

and ‘ ’ indicates others’ statement.

into drugs when she goes outside.”, so they

Session #1

February , X year

came to consult. The parents said, “We want IP

The parents came to interview. IP used to be

to receive counseling from a professional, too.”so good at all sports since her childhood that

Also the mother said, “I think IP has both

she was expected to compete in the Olympics

woman and man in her, so she understands both

but when she became a junior high school

feelings and becomes nervous. I think it makes

student, problem behaviors such as cutting her

her uncomfortable.” At the same time, theface with a cutter or shoplifting came to befather said, “She was selected the All Japan

recognized probably due to the stress of sport

member and the Olympics are in sight. We

club activities. However, she went on to distant

expected too much and gave priority to sports. I

high school on a sports referral. When she wasthink she tried too much not to disappoint her

a sophomore in high school and came homeparents’ expectations. I think she was actuallyfrom school, she kept on eating and vomiting

crying for help.” It is said that she told her

all morning. The father said, “We did not notice

parents that she wants to coach sports fromin her junior high school days because it isApril, X year.

hiding behind the veil, but she may have been

In a time-out, following the advice of thegreatly shocked in the world of competition as

doctor who is a member of the therapist team,

she was admitted to high school on a sports

we diagnosed that there is no medically major

referral. I think that is why eating and vomiting

problem and shared with the team the policy tobecame severe.” Her current height is 152 cm

proceed with the interviews toward searchingand she weighs 40 to 50 kg. The parents said

not symptomatic relief but redefining theabout IP, “She looks rather slim and does notproblem.

look skin and bones like a person suffering

After a time-out, we therefore told thefrom eating disorders.” Additionally, she has

parents reframing “a problem daughter who left

felt gender dysphoria since her adolescence andhome” to “a daughter who is making life forin her senior year of university she had aherself and trying to live independently”, andmastectomy. The mother said, “I accompanied

we suggested to them, <Let’s think together

her surgery.” After graduation, she got aabout what we should do to let IP ask her

position as a PE teacher in a junior high school

parents’ advice before she “causes trouble”.>.

BRIEF THERAPY FOR PARENTS

hervomiting,

25
27

Since the father said, “She comes to tell me

about

“She

may

vomit

when she has something to consult with.” andinstinctively because she cannot run fast if she

also the mother said, “I think she respects her

gains weight, but as she is taught thefather.”, we made intervention by saying to theimportance of eating (tries not to vomit too

father, <Tell IP that Th said ≪Your daughter ismuch), I think she keeps it in mind. When Th

down to earth. She thinks a lot about herself

asked, <Does that mean she herself makes

and can conduct herself.≫.

adjustments?>, the father answered, “Maybeso.”.

Session #2

March , X year

During the time-out, the team gave some

When we asked the father about the changes

opinions: ≪The parents doesn’t treat IP as aafter the last interview, he said, “No specialson. How far can they accept IP as parents?≫,change.”, but the mother said, “IP came home

≪As it is very stressful for IP to live in theto prepare for going to A Prefecture. At thattough sports world, the father’s role becomestime I told her about the counselling contents

important.≫, ≪It is very challenging for aand later LINE came which said, ‘Thank you

woman to live as a man. The parents may as

for going to counselling.’” The father said thatwell be worried more.≫, ≪It is necessary to

he told IP the counselling contents after theunderstand IP’s pain to use women’s toilet or

mother told them. The parents told that IP was

pains to circle ‘Female’ in a resume.≫ ≪Asgoing to go to A Prefecture with her same-sex

the repot of today’s interview, how about forpartner and since IP said at the time of housing

the parents telling IP “IP tries to be independent

contract, ‘You may come if you want to.’, theand it is far more challenging than ordinary

parents accompanied them. The mother said,

independence.≫ ≪It’s natural for the parents<When she wants us to accompany, she speaks

to worry about IP. I hope they will master how

like that, so I make it a point to go.> When Th

they worry.≫

said in return, <When she is in need, is she

After the time-out, we complimented thewilling to act on her own? >, the mother said,

parents that they could act in consideration of“Yes, she is.” When the father said, “She tends

IP, told the team’s opinion to them andto act as she wishes.”, Th did reframing saying,suggested to them, <Let’s think together how<She has a proper way of thinking.> and thenthe parents worry about IP.>. The mother said,

the mother said, “As she always reports after“We want to know how we support IP, so wethe event, I get upset but she may have somereally appreciate it.” Then Th told them, < IP isenergy to live.” However, the mother said

in a triple handicap, namely “the problem ofanxiously, “The toilet stinks after vomiting, so

independence, “the sex problem” and “theif she gets used to live with the partner andproblem of tough sports industry”. > and Th

vomits at home not outside, I’m afraid thereframed “a problematic daughter” to “a childpartner will become sick.” The father said

trying to confront difficult independence”. At28

Doi et al

the same time, Th told them, < It is natural thatfather said anxiously, “This is my first time toyou worry as IP is in such a tough situation. I

send my daughter out because I have left it tothink some parents worry more in such a

my wife until now (in her high school andsituation like this.> and applying joining to theuniversity days). I feel anxious.” The father

Anxious parents, reframed from “the parents

said about gender dysphoria, “I think that

who failed in raising a child” to “the parents

having a partner can’t be helped. I want her ‘towho brought up a daughter with gender

live to be herself’ for the moment. I always telldysphoria”. As the report from the parents to IP

her that I’m on her side all the time” and theof today’s counseling, we made intervention bymother said, “I wonder that various things willsaying, <Tell IP that “We were told by Th thatbegin from now. I think that she as a man can’t

our child is trying to be independent more

complain if she gets stressed because she thinkdifficult than ordinary independence.” > andit too feminine. I’m going to encourage her tosaying, < Please observe the situation at thesend SOS signals and I think I have to wait for

time.>.

her.” Then, Th said, “I’d like to ask the team
how we should create the situation where IP

Session #3

April , X year

When we asked about the change after thelast interview, the father said, “The day to go to

can consult us in case anything happens.
During the time, please think about it, too.” andtook a time-out.

A Prefecture has come, but she shows no sign

After the time-out, Th asked, “What did youof going, so I told her to take her and then she

discuss?” and the mother said in tears, “We’dwent there smoothly.” In response to this, thebetter stop being forward, thinking about mymother said, “My husband can tell her in a calm

daughter. If she is determined, it is no use being

manner while I tell her directly.” and she

forward. It can’t be helped if she fails when she

looked delighted that IP moved for a new job.

decides for herself. It may be none of our

When Th asked about the difference between

business. “To wait” may be important. I would

the previous job and the present one, thelike to wait.” and beside the mother, the father

mother answered, “I think it was tougher for

listened to what his wife said, nodding many

her to be a school teacher because she had to betimes.

a woman at school under the gaze of otherIn response to what the mother said, Th told

teachers, students and their parents. I knew itthem that the parents’ opinion and the teamwhen I heard the toilet problem here. I’m aopinion agreed, saying, <I think it is wonderful

little relieved to know that she had a room in

to wait. To tell the truth, the team couldn’t

her heart when I saw her touched by looking

provide any better idea.>. Moreover, we madeout at the scenery on the way to A Prefecture.

intervention

Even if she fails, now I think it’s all rightsuggestion. After this, please make the next

because she made decisions for herself.” Theappointment. If any serious problem does notbysaying,

<We

have

one

BRIEF THERAPY FOR PARENTS

25
29

occur by the next appointment day, will you

to be independent.’ and the mother said incancel the appointment? I would like both of

response, “I think she wants her independence

you to spend the money for the counseling fee

to be admitted. IP’s life is free and unsettlingand the transportation expense for celebratory

but there is hope. There may be no reason to bemeals. > and the parents answered, smiling,

sad as I can see some hope.” Then, the mother“All right.”.

said happily, “I have a plan to go to A
Prefecture shortly with my husband and IP says,

Session #4

June , X year

*This time, themother and IP’s elder sister came tointerview.

‘Why don’t you stay at my lodging?’. I think IP
has room in her mind to say such things.”
After the time-out, accepting the team’s

Just when we thought it had come to end as

opinion, Th said to reconfirm, “We are

the appointment of interview in May wasproceeding with the counseling as we think thecanceled, an appointment was made in June.

purpose of your visit today is to report. Is that

This time, the mother and IP’s elder sister

really OK with you?” and the mother answered,instead of the father came to interview together.

“It’s OK with me to have come here to report.”

When Th asked them the reason for coming toThen, in regards to the future, we madeinterview, the mother said, “There is nointervention by letting them to choose the better

particular change, but we came to inform thesuggestion from the following two: < You makepresent situation. My husband has a plan today

the next appointment and if no problem occurs,and I came here with my elder daughter who

you cancel the appointment and you and yourwent to A Prefecture (IP’s lodgings) instead.”husband go out for a meal spending the

When we asked the elder sister how IP wasmoney.> and <You continue to “wait” and if

doing, she answered, ‘IP herself has not

something happens, first you think together

changed. She shares a room with her partner. I

with your husband. If it doesn’t work, you

don’t know whether she vomits or not, butmake a renewed appointment. > Since thewhen I was with her at night, she went out formother chose the latter, we ended the interview.

30 minutes, saying she went out to telephoneand she didn’t come home. I think she probably

Discussion

vomited.’ I checked the IP’s weight change andThis case example deals with the interviews

she answered, ‘She is firmly tightened owing toconducted with the parents whose daughter (IP)running and exercising, but I don’t think thathas gender dysphoria and a previous history of

she lost her weight.’ I asked the mother about

eating disorders, using a team approach of brief

waiting and the mother answered, ‘Whiletherapy. In the following, according to thewaiting, IP contacted us, so I think the minimal

process, we discuss (1) diagnoses of a vicious

contact would be better off.’ The elder sistercircle of the family, (2) discoveries of thesaid concerning IP’s independence, ‘She seems

family resources and exceptions, (3) what

28
30

Doi et alchanged the family system and led to problem

out information along the context of the mother,solving, (4) the family’s acceptance of gender

feeling empathy with the mother’s feeling, wedysphoria and (5) future issues.

knew that IP had strength to be independent by(1) Diagnoses of vicious circle of the family

finding the job and earning her living for

The chief complaint was to have aherself though IP had left home.

counselling session to deal with IP who

As an exception, the fact emerged that

continues to vomit what she has eaten. Th’s

“When IP is in need, IP herself sometimes asks

made a diagnosis that there are certain patterns,

for help without the parents’ having to saythat is to say, though, the efforts to solve

anything.” and “IP refuses to listen to what the

problems are made as the problem-solving

mother says, but she sometimes listen to what

behaviors, “the mother says a lot of things

the father says.”. Then when Th focused on

anxiously” to IP repeating bulimia nervosa, “IP

these exceptions and tried to expand them, thecontinues to behave selfishly (leaves home)father too far apart approached IP and thewithout consulting IP’s parents”. To prevent it,

mother too close moved away from IP. Then the“the mother further continues to nag”, but toparents realized the importance of keeping an

avoid her mother, IP continues to behave more

appropriate distance from IP and they are

selfishly. We assume that such a pattern is athought to have reached the solution ofvicious circle among the family. Behind this“waiting”.

there are regrets of the parents that their too
much expectation for IP in her childhood led to(3) What changed the family system and led

IP’s bulimia nervosa and we can see that they

to problem solving

see IP’s leaving home to be independent as partof her problematic behaviors.

In this case example, IP existed in the family
as “a problematic daughter” with genderMoreover, as another vicious circle, it was

dysphoria and eating disorders and all theconsidered that it was difficult for the parents toparents’understand IP’s gender dysphoria and false

conducted in the context. So Th’s created the

problem-solving

atpositive meanings that IP is “a child trying to“independence as ‘a daughter’” and “parents

confront difficult independence” in spite of abringing up ‘a healthy daughter” were repeated.

triple handicap (the problem of independence,

behaviorstoaim

problem-solving

behaviors

were

the sex problem and the problem of tough(2) Family resources and exceptions

sports industry), and we redefined the value ofDuring the interviews, the mother took theIP with the parents. Also the redefinition of IP’s

initiative in talking and the father took little

problem means reframing the existence of thelead to talk but he was cooperative. We thoughtparents from “the parents who failed in raising

it was a resource that the couple faced in thea child” to “the parents who brought up asame direction to support Cl. When we drew

daughter with gender dysphoria”. It is thought

BRIEF THERAPY FOR PARENTS

25
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that by Th’s continuing dialogues with thecaused by intense competition in the sports

attitudes of not seeing IP as a problem, theworld, but he didn’t tell about gender dysphoria.

parents’ feeling of remorse was relieved, theHowever, in the third interview, he told that heviciouswanted IP to live life in her own way and thatcircleoffalse

problem-solving

behaviors was broken out and the changes in
the family system took place in a short time.
These

mean that Th’s conducted

he was always on IP’s side.
By Th’s setting up the place sharing values

theof gender dysphoria, discussions concerninginterviews in the positive context of “IP’sgender dysphoria arose between the couple. It

independence” not focusing on the symptoms

is thought, as a result, the association of theof gender dysphoria and eating disorders as

couple became strong and the family system toproblems. By Th’s continuing to focus on the

support IP was reconstructed.

family’s hope and desired image of solution not
focusing on only the problems, it is presumed
that the virtuous circle was established in thefamily system.

(5) Future issues
As future issues, it is necessary to define theadaptation to eating disorders of brief therapy.
In this case example, the severity of eating(4) The family’s acceptance of genderdisorders was assessed under the instructions ofdysphoria

the doctor and the adaptation of brief therapy

Here, since there is a difference between thewas conducted after being guaranteed. Eating

father’s acceptance of gender dysphoria and thedisorders are a fatal disease and we think it ismother’s, we discuss separately.

important to discuss carefully the adaptation of

In the first interview, the mother told us in a
bland

tone

that she

had attended

brief therapy in cooperation with doctors.

IP’s

Also in this case example, it is presumed thatmastectomy and IP became naïve and painful

one of the background factors of eating

because IP had both woman and man in her.

disorders was the acceptance by the family ofThis showed that the mother could not accept

gender dysphoria. There is a report (Suzuki, et

enough IP’s gender dysphoria. In the secondal., 2001) that a poor “acceptance of femininity”

interview, we told the mother specifically how

acts on “self-esteem” and brings “a tendency tohard it was for a woman to live as a man sucheating disorders”. In the future clinical practice,as IP’s pain to use women’s toilet or pains to

we think it is necessary to deepen further

circle ‘Female’ in a resume. In the third

understanding that the degree of acceptance byinterview, the mother told that in the last

the family and the person herself of genderinterview she could realize IP’s pain of having

dysphoria relates to the symptom of eating

to work as a woman at school.

disorders.

In the first interview, the father referred tothe parents’ too much expectation and IP’s pain

Acknowledgements

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32

Doi et al

genuinely

Seiwa Shoten [in Japanese] 福田俊 監訳

appreciate the clients for giving consent to(1987). 思春期やせ症の家族―心身症

publish the case example.

の家族療法 星和書店

Insubmitting

thispaper,

we

Nakai, Y. (2016). Guideline for Eating Disorder
References

Treatment, Psychosomatic Medicine 56
Support(2), 120 -126. [in Japanese] 摂食障害治“Interesting Family” in Clinical Site!! :療 ガ イ ド ライ ン に つい て 心 身医 学

Systems Approach Making Good Use of

56(2), 120-126.

Hatakeyama,T.

(2018).

Let’sth

Aids (10 ) Growth of Child with Eating

Nakamura, H., Saitoh S., Suzuki, K.

Disorders and Mother at Family Meeting,(1988).

Experienceof

FamilyNursing Technique 64 (11), 1100-1103. [inTherapy for Parents Troubled by

Japanese] 畠山とも子 (2018). 臨床現

Their Daughter’s “Abnormal Eating

場の"気になる家族"を効果的に支援しBehavior”, Edited by Shimosaka, K,

よう!! : 援助に生かすシステムズアプ

Akitani, T, Family Therapy Case

ローチ(第 10 回)家族ミーティングにおStudy 1 Eating Disorders, Kongoh

ける摂食障害の子どもと母親の成長

Shuppan. [in Japanese] 中 村 は る

看護技術 64(11), 1100-1103

み・斎藤重司・鈴木浩二 (1988). 娘のHashida, K., Tamura, D., Satoh, Y., et al.

“食行動の異常”に悩む両親に対する(2013). Two Examples of Gender Identity

家族療法の経験 下坂幸三・秋谷たつ子

Disorder with Complication of Eating編 家族療法ケース研究１ 摂食障害

Disorder Experienced at This Department

金剛出版.

(Oral Presentation, The 71st JapaneseSocietyofPsychosomaticCenter for Eating Disorder Research andMedicine,

Information (2019) Treatment of Eating

Abstract of Oral Presentation of Tohoku

Disorder. [in Japanese] 摂食障害全国基District Regional Meeting) Psychosomatic

幹 セ ン タ ー 2019 摂 食 障 害 の 治 療

Medicine 53 (8), 790. [in Japanese] 当科

http://www.edportal.jp/pro/treatment.html

で経験した摂食障害を合併した性同一(Obtained on March 30, 2019)

性障害の 2 例(一般演題,第 71 回日本心Suzuki, M., Itoh, Y. (2001). Acceptance of

身医 学会東北地方会演題抄録) 心身

Femininity and Eating Disorder Tendency

医学 53(8), 790.

in Young Women – Self-Esteem, Body

Minuchin,S., Rosman,B. & Baker,L. (1978).

Satisfaction, Heterosexuality as Medium –Psychosomatic families; Anorexia nervosa

The Japanese Journal of AdolescentinPress.

Psychology 13, 31-46. [in Japanese] 鈴木

Translation supervised by Fukuda, S.

幹子・伊藤裕子 (2001). 女子青年にお(1987). Family of Anorexia Nervosa –ける女性性受容と摂食障害傾向―自尊Family Therapy of Psychosomatic Disease,

感情,身体満足度,異性意識を媒介としcontext.

HarvardUniv.

BRIEF THERAPY FOR PARENTSて― 青年心理学研究 13,31-46.
Takakura, O., Suzuki, C., Yamashita, M., et al.
(2017). Eating Disorders as Stress-Related
Disorders – Disease State and Therapy Psychosomatic Medicine 57 (8), 797-804
Vocks,S., Stahn,C., Loenser,K. & Legenbauer,T.
(2009).

Eatingdisturbances

in

and

body

male-to-female

image
and

female-to-male transsexuals. Archives of
Sexual Behavior 45(3), 575–585.

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