Corresponding Author Information: Tomoko Miwa

Session Abstract: This case discussion presents a classic case of hikikomori in a male adolescent in Japan. The first presenter will describe hikikomori, a phenomenon and syndrome once unique to Japan, but increasingly found worldwide. It is a condition whereby an individual becomes an extreme recluse. Individuals with hikikomori often experience severe interpersonal distress, resulting in significant or sometimes a complete shutting out of relationships with others. In Japan, hikikomori has become a critical social issue, currently affecting an estimated 1 million adolescents and adults. Understandably, the nature of this condition makes it difficult for the people affected to seek mental health services, making this syndrome difficult to treat. While hikikomori is viewed to be more socially acceptable than a psychological diagnosis, the utilization of mental health services to treat it remains low. For those with hikikomori, part of the issue might be the nature of social disengagement. It is suspected that a sense of shame, which is already challenging in countries such as Japan, might be the underlying force preventing individuals and their families from seeking help. The second presenter will present the case of an adolescent male with hikikomori, including a review of assessment findings from the Rorschach, MMPI, WAIS, Wartegg and Adult Attachment Projective. The third presenter will explain the shame dynamics present in the Thurston Cradock Test of Shame (TCTS) protocols of the adolescent and his parents, and will address the impact of shame on this family's struggle with hikikomori. The discussant will reflect upon the phenomenon of hikikomori in Japanese culture, this specific case, and how our understanding of family and cultural elements can guide our work with those struggling with hikikomori around the world.

Chair Information: Julie Cradock O'Leary, PhD | Private practice, Anchorage. Alaska

Discussant Information: Leighko Toyoshima Yap, PsyD | Independent practice, Oakland, California

Presentation 1 Title: Hikikomori: A growing, complicated phenomenon


Tomoko Miwa, MA | University of Denver, Denver, Colorado

Presentation 2 Title: An assessment case of an adolescent male recluse in Tokyo


Mitsugu Murakami, MA | Asian-Pacific Center for Therapeutic Assessment, Tokyo, Japan

Presentation 3 Title: Family shame dynamics in Hikikomori: Integrating TCTS protocols of an adolescent and his parents


Julie Cradock O’Leary, PhD | Private practice, Anchorage, Alaska

Tomoko MiwaTomoko Miwa

Tomoko studied psychology at San Francisco State University as an international student from Japan. She completed a master’s degree in Clinical Psychology from California School of Professional Psychology of Alliant International University, Tokyo campus. As a translator, she worked with psychologists from around the world in implementing interventions such as Therapeutic Assessment (TA). In 2011, after the Great East Japan Earthquake, she joined a humanitarian aid team of IsraAID, being a bridge between the locals and Israeli therapists providing therapy groups for children and families using art, music, dance, drama, texts (bibliotherapy). She also worked closely with midwives and nurses to introduce birth doulas into Japan.

Tomoko is currently pursuing a PsyD at Graduate School of Professional Psychology, University of Denver. Her clinical and research interests involve the intersections between perinatal and infant mental health and health disparities experienced by marginalized population.

Dr. O'LearyDr. Julie Cradock O’Leary

Julie Cradock O’Leary, Ph.D. is a Licensed Clinical Psychologist in private practice in Anchorage, Alaska. She provides therapy and psychological assessments to children, adolescents and adults. Julie utilizes a psychodynamic approach, influenced by self psychology. She is co-author of the Thurston Cradock Test of Shame (TCTS), which was published by Western Psychological Services in 2009. Julie has studied shame for over 25 years, and still enjoys discovering the intricacies of how shame is at work in individuals and systems in cultures around the world. She regularly presents on shame and the TCTS at professional conferences, as well as clinical and academic settings in the United States and abroad. She conducts research with the TCTS, and especially enjoys working with graduate students completing masters projects and dissertations, or simply seeking research experience. Julie is coauthor of two TCTS case studies recently published in Rorschachiana. She provides in-person and tele-consultation for professionals seeking to better understand shame dynamics in their clients. Additionally, Julie provides TCTS scoring and interpretation services. Julie is a member of the American Psychological Association, International Society for the Rorschach and Projective Methods, Society for Personality Assessment, and Therapeutic Assessment Institute. She is a reviewer for several journals, including the Journal of Personality Assessment and Rorschachiana.

Dr. YapDr. Leighko Toyoshima Yap

Dr. Yap is a licensed clinical psychologist who specializes in the treatment of children, and the psychological assessment of children, adolescents, and adults. She has been in private practice over 15 years, conducting psychotherapy and assessments, including psychological assessments as well as forensic evaluations. Dr. Yap has led bereavement group therapy for children and families going through loss and terminal illnesses. For many years, Dr. Yap coordinated the testing program at the Ann Martin Center, a community mental health organization where she taught assessment seminars and provided testing and clinical supervision. Dr. Yap has extensive experience in assessing and treating children and adults from diverse populations using a psychodynamic perspective. Her special interests include Collaborative/Therapeutic Assessment, bereavement work, children in divorced families, and cultural influences in psychology. Dr. Yap speaks fluent Japanese and English, and provides psychotherapy and supervision in both languages.

Mitsugu MurakamiMitsugu Murakami

Mitsugu Murakami, M.A. is a licensed clinical psychologist in Tokyo, Japan. He is the founder of Murakami Counseling Office, where he has been in private practice for 10 years. Mitsugu specializes in the psychological assessment and treatment of children, adults, and families. He is certified in adult Therapeutic Assessment, and has a leadership role in the Asian Pacific Center for Therapeutic Assessment. Mitsugu provides trainings to professional psychologists in Japan.

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