Psychoanalytic Psychotherapy for Hikikomori Young Adults and Adolescents

Abstract

A hikikomori is a child, an adolescent or a young adult who voluntarily retreats into his own home for long periods, not showing evident signs of psychological distress or overt mental disorder. This phenomenon was first described in Japan, but several research studies show that it is spreading in many countries around the world. The author hypothesizes that the decision to become a hikikomori is made by the person in an attempt to find a solution to difficulties in relationships with himself and with others. The choice of reclusion rapidly becomes a trap: in this condition the individual is imprisoned in complex functions of the mind which curb and restrict independence and personal autonomy. This is owing to the fact that, with the withdrawal, a pathological personality organization, formed during the years of early infancy, gradually takes control of the internal world, pushing towards anti‐developmental mental states and behaviours. The paper continues with some reflections on individual treatment with psychoanalytic psychotherapy of adolescents and young adults in a state of acute social withdrawal. The reference model used is John Steiner's notion of ‘psychic retreat’. A description of a four‐year treatment completes the paper, allowing for further clinical reflections.

Understanding the experiences of hikikomori through the lens of the CHIME framework: connectedness, hope and optimism, identity, meaning in life, and empowerment; systematic review

“…The case studies were of eleven hikikomori, nine males and two females, who had been in social withdrawal for 2–20 years, were aged 13–40, and whose behaviors were reflective of those reported in the above quantitative studies, namely, confining themselves at home, spending the majority of their time in their room, and not engaging in any social relationships or avoiding face-to-face contact with others (Table 2 ) [ 44 – 49 ] and having social anxieties [ 50 ]. One hikikomori felt exhausted from effort in maintaining relationships, was unable to relate well with others, feared entering adult society, and had no confidence in coping with society [ 51 ].…”

“…One of the hikikomori would leave home once a month for appointments at an outpatient clinic [ 44 ]. While another reported of mistrusting their parents and inability in approaching the opposite gender when interested [ 50 ]. A reversed sleep/wake cycle of being awake in the evening and sleeping during the day was reported [ 44 , 47 ].…”

“…More studies are needed to further explore gender distribution ratios and if there are behavioural differences between male and female hikikomori. Hikikomori are not confined to any specific race or nationality, and American, Brazilian, Chinese, French, Italian, Japanese, Korean, Oman, Spanish, Taiwanese, and Ukrainian hikikomori have been featured in cross-sectional studies or case reports (Table 2 ) [ 3 , 38 , 39 , 41 , 43 , 45 , 47 , 49 , 50 , 59 – 63 ]. No studies were found on the culture or religion of hikikomori; however, hikikomori were reported to have high levels of computer or Internet use, ranging from 5.09 ± 4.97 to 5.20 ± 3.40 h per day [ 3 , 35 ].…”

“…Intervention, case studies and qualitative studies were found using specific elements within the CHIME Framework, such as rebuilding a positive self-identity, social roles or life, and empowerment through the interventions, namely, Free Space Wood [ 56 ], psychotherapy [ 50 , 73 ], social worker engagement [ 54 , 74 ], play therapy [ 75 ], and C-BED [ 18 ].…”

“…Of studies exploring the use of psychotherapy to help hikikomori rebuild their lives, showed that a long duration was needed until recovery was achieved, and that it was difficult to convince hikikomori to stay in the therapy program. In the case studies, a duration of two to four years was reported before recovery was achieved [ 50 , 73 ]. In Lee et al’s [ 3 ] study, 41 hikikomori received a mean number of 2.8 sessions of psychotherapy with home visits.…”