The Efficacy of Naikan Therapy on Male Offenders: Changes in Perceived Social Support and Externalized Blame

Abstract

Naikan is a contemplative self-observation practice that originated from Japanese Shin Buddhism and is utilized for rehabilitating prison inmates in many countries. Although some investigations have provided initial evidence for its efficiency in decreasing recidivism, there is still a need for further investigation of the effectiveness of Naikan on other outcomes through more controlled studies. The present study aimed to investigate the efficacy of Naikan therapy on male offenders’ perceived social support and externalized blame. Ninety-two male offenders were randomly assigned to either the experimental group or to the waiting group. All participants were evaluated by the Multidimensional Scale of Perceived Social Support and the Externalization subscale of the Test of Self-Conscious Affect before and after Naikan therapy. The results suggested that participants who received Naikan therapy showed higher levels of perceived social support and lower levels of externalized blame after Naikan therapy than before.

Keywords

Naikan therapy offenders perceived social support externalized blame rehabilitation

Introduction

Naikan, which means “inner-looking” in Japanese, is a contemplative self-observation practice that originated from Japanese Shin Buddhism. The main purpose of Naikan is to gain insights into oneself and others through a comprehensive perspective rather than a self-centered perspective. Naikan was established by Ishin Yoshimoto (1981, 1985, 1997) and was first utilized for rehabilitating prison inmates (Tanaka-Matsumi, 1979). Studies showed that Naikan was efficient in decreasing the rates of recidivism (Takeda, 1972) and reducing problems such as alcohol addiction (Suwaki, 1979), depression (Sengoku, Murata, Kawahara, Imamura, & Nakagome, 2010; Tashiro, Hosoda, & Kawahara, 2004), and anxiety disorders (Nukina, Wang, Kamei, & Kawahara, 2005).

Naikan therapy is rooted in a spiritual Japanese Buddhist practice called mishirabe, which means “self-examination.” Buddhist practitioners fasted and sometimes even stopped drinking and sleeping for a long period of time while they were doing this practice. They believed that by engaging in these behaviors, their mind would be sharpened and their thoughts and behaviors would be better reflected. Ishin Yoshimoto (1916-1988) was a devout Shin Buddhist minister. He gained the insights on how he was supported and sustained by other people, by all living creatures, and by nature through this practice (Sengoku et al., 2010). Moreover, he also realized the possibility of using this practice to help ordinary people to gain more self-understanding. Yoshimoto therefore made some modifications and eliminated the physical restrictions from mishirabe. Currently, Naikan is no longer a form of religious training. It is regarded more as a meditation practice that aims to gain self-awareness and self-understanding. Naikan was first introduced into a juvenile prison in Japan in 1954 and soon spread to other reformatories and prisons. In the 1960s, Naikan was accepted by hospitals for the self-reflection of patients with depression or drinking problems (Suwaki, 1979).

Naikan therapy is a week-long practice that requires the client to sit in a physically and socially isolated place and to contemplate his or her life daily from 6:00 a.m. to 9:00 p.m. In Naikan therapy, the client is asked to reflect on his or her relationships with important others and ponder three questions: (a) What has this particular person done for me? (b) What have I done for this person in return? and (c) What troubles have I made for this person? Usually, the practice begins with reflection on one’s mother or other main caretakers. The entire process is divided into several chronological segments. The Naikan therapists give instructions to the client and listen to the client’s answers to the three questions at 90-min intervals for only 3 to 5 minutes at a time. Unlike traditional Western psychotherapists, Naikan therapists do not follow or give any interpretations to the content of what the client says. The goal of Naikan therapists is to help the client finish what Yoshimoto called “self-illumination” (Yoshimoto, 1965).

The goals of Naikan therapy are to “deconstruct fixed, unrealistic notions of self and other” (Ozawa-de Silva, 2007) and to “increase awareness of what other people did for the client” (Tanaka-Matsumi, 1979). Such attempts meet the goals of prisons, and thus, Naikan therapy has been utilized in correctional works in prison facilities in Japan since 1954 and has since spread to other countries (Reynolds, 1980). Studies have provided initial evidence that Naikan therapy was efficient in decreasing rates of recidivism. For example, Takeda (1972) calculated rates of recidivism in five major prisons in Japan from 1958 to 1964 and found that the rates of recidivism were significantly lower among prisoners who participated in Naikan than among those who did not. Although this result might be confounded by clients’ motivation or selection criteria bias, it provided initial evidence for the improved social rehabilitation of Naikan. Yoshimoto (1997) also found that the offenders who participated in Naikan had lower recidivism rates (30.4%) than those who did not (60.1%). Yuma, Kanazawa, and Kuniyoshi (2006) compared the effectiveness of training school with probation on recidivism for Japanese juvenile delinquents since 1991. They found a preventive effect of training school, which often contains a Naikan section, for early-starting first-time offenders (n = 158) and late-starting first-time offenders (n = 5675) but not for the late-starting repeat offenders (n = 946). In addition, Y. X. Huang, Sha, Duan, Zhang, and Liu (2016) conducted a qualitative study and explored the effects of Naikan on 12 drug-addicted offenders. Based on the materials of what the offenders reported during Naikan therapy, they found that Naikan could help the offenders reconstruct their internal attachment modes.

However, these studies on Naikan’s effectiveness in offenders are limited in two regards. First, these studies cannot rule out the influences of other factors, such as therapist–client expectancies and selection criteria for clients. Thus, more controlled studies are needed to examine Naikan’s efficacy on offenders.

Second, a sole outcome of recidivism cannot provide a comprehensive understanding of how Naikan affects offenders. There is a need for further investigation of the effectiveness of Naikan on other outcomes. In fact, according to subjective reports from Naikan clients, the most commonly reported effects of Naikan were “a recognition of love and affection,” “a caring feeling toward others,” and “an improvement in human relationships” (Miki, 1972; Yokoyama, 1990). These findings corresponded with Ozawa-de Silva’s (2007) assumption that “Naikan’s efficacy lies in its mechanism of deconstructing fixed, unrealistic notions of self and other and replacing them with a new understanding of relationality. (pp. 411)” According to Dodge’s social information-processing models (Crick & Dodge, 1994), an individual’s social behavior is influenced by a sequence of processing, such as encoding social cues, interpreting social cues, and clarifying goals. Biased processing is assumed to be related to deviant social behavior (Crick & Dodge, 1996). Therefore, by reconstructing realistic notions of self and other, Naikan is intended to help offenders process social cues in an unbiased way, restore their positive interpersonal relationships, and help them build better relationships with others. Thus, it seems reasonable to assume that Naikan is efficient in helping offenders retrieve the bonds of affection and enhance their interpersonal relationships.

From this point of view, the present study focused on two particular variables that are related to the concept of interpersonal relationships and have important meaning to offenders: perceived social support and externalized blame. Perceived social support is defined as “the belief that help is available if needed” (Calvete & Connor-Smith, 2006). Many studies found that perceived social support served as a buffer between environmental stress and psychological well-being (Csibi & Csibi, 2011; Işiklar, Şar, & Çelik, 2012; Song, Bong, Lee, & Kim, 2015). In addition, an enhancement of perceived social support was considered to be correlated with a decrease in offensive behaviors (Leather, 2009). One of Naikan’s aims is to help people retrieve the bonds of affection that are covered by a self-centered perspective. Therefore, if Naikan is efficient, a positive change in perceived social support will be expected.

Externalized blame is considered a defensive reaction against painful situations (Fontaine, Luyten, De Boeck, & Corveleyn, 2001). It is highly correlated with anger and aggression and often results in conflicts in interpersonal relationships (Fontaine et al., 2001; Kuppens & Van Mechelen, 2007). According to Ozawa-de Silva (2007), one of Naikan’s goals is to deconstruct the unrealistic notions of the self and the other and to generate a realistic recognition of one’s own responsibility for what had occurred. Thus, a decrease in externalized blame is expected after Naikan.

The purpose of the present study is to evaluate the efficacy of Naikan on offenders’ perceived social support and externalized blame. The Multidimensional Scale of Perceived Social Support, Chinese Version (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988) and the Externalization subscale of the Test of Self-Conscious Affect, Version 3 (TOSCA-3; Robins, Noftle, & Tracy, 2007) were used as outcome measures before and after Naikan therapy.

Method

Participants

Ninety-two male offenders willing to receive Naikan therapy voluntarily were enrolled between January and June 2015 in one prison in China. The participants were recruited through an advertisement posted on their jailhouses. All participants received an assessment before they were recruited. Those with strong suicidal tendencies, paranoia, and severe depression were excluded. Two participants did not finish the week-long Naikan therapy because they were asked to exit the study to receive the evaluations on their applications for shortened sentences. The ages of these participants ranged from 22 to 59 years, with an average age of 38 years. Fifty-one percent of the participants had received a middle school education, 30% had received a high school or vocational high school education, and 19% had received a college education. With regard to their marital status, 48% of the participants were single, 31% were married, and 20% were divorced. Twenty-seven percent were repeating offenders, and 73% were first-time offenders. Fifty-two percent committed violent crimes, 39% committed financial crimes, 6% committed drug-related crimes, and 3% committed sex crimes.

The participants were randomly assigned to either the experimental group or the waiting group. Those in the experimental group (n = 47) received Naikan therapy for 7 days in the Naikan center in the prison, while those in the waiting group (n = 45) did not receive any interventions for 7 days. Chi-square tests showed that there were no significant differences between the two groups in the distribution of each demographic variable.

Measures

Perceived social support

Perceived social support was measured by the MSPSS (Zimet et al., 1988; L. Huang, Jiang, & Reng, 1996). The scale consists of 12 items producing scores for the total perceived social support and three subscales: Perceived Family Support, Perceived Friend Support, and Perceived Other Support. Each item describes one’s perceptions of social support (e.g., “when I meet difficulties someone will be there with me”). Individuals rate each item on a scale ranging from 1 (extremely disagree) to 7 (extremely agree) according to their situation, yielding sum scores between 12 and 84. Higher scores indicate higher levels of perceived social support. The perceived social support scale (Chinese version) has good validity and reliability. The test–retest reliability of the total scale and the three subscales (Chinese version) ranged between 0.72 and 0.85 (L. Huang et al., 1996). The internal consistency of the total scale and the three subscales in the present study ranged between 0.85 and 0.91.

Externalized blame

Externalized blame was measured by the Externalization subscale of the TOSCA-3 (Robins et al., 2007; TOSCA-3-Chinese version, Gao, Qin, Qian, Liu, 2013). The TOSCA-3 is a scenario-based inventory for measuring the affective, cognitive, and behavioral responses of self-conscious emotions. The inventory consists of 16 scenarios (11 negative and five positive). Each scenario is followed by four or five possible responses. Participants are asked to imagine themselves in each situation and rate the likelihood of reacting in each of the manners on a scale ranging from 1 (not likely at all) to 5 (very likely). Scores are calculated across situations to yield indices of guilt-proneness, shame-proneness, proneness to externalized blame, proneness to detachment, and pride-proneness. For example, one negative scenario is as follows: “You attend your coworker’s housewarming party and you spill red wine on a new cream-colored carpet, but you think no one notices.” The four possible reactions are as follows: “You would wish you were anywhere but at the party” (shame-proneness), “You would stay late to help clean up the stain after the party” (guilt-proneness), “You think your coworker should have expected some accidents at such a big party” (detachment), and “You would wonder why your coworker chose to serve red wine with the new light carpet” (externalization). TOSCA-3 was chosen as the measure in the present study because it has relatively low face validity. Thus, offenders are less likely to fake. The test–retest reliability of the Externalization subscale was 0.81 (Gao et al., 2013). The internal consistency of the Externalization subscale in the present study was 0.93.

Procedures

All participants were invited to participate in the present study during the interview before Naikan therapy. They were informed that the study was unrelated to the Bureau of Prison Administration and that no individual data would be revealed to the Bureau. No incentives for participation were provided.

The week-long Naikan therapy was conducted in a separated area in the prison. A group of 10 trained Naikan therapists who worked for the rehabilitation section were in charge. To provide an isolated environment for the participants, each offender was accommodated with a 6-m² compartment that was separated by opaque Japanese folding screens. All participants shared one toilet and one bathroom. They were encouraged to focus on their own mind and ignore outside stimuli. Therefore, chatting with each other was forbidden during the week. The Naikan therapists took meals into each compartment and told each participant when it was his turn to take a shower every day.

The participants in the experimental group completed the MSPSS and the TOSCA-3 1 day before Naikan therapy and 1 day after Naikan therapy, and those in the waiting group completed the same questionnaires at the same time without participating in Naikan therapy.

Results

The Efficacy of Naikan Therapy on Perceived Social Support

Repeated-measures analysis using linear mixed models showed that there was a significant interaction effect between group and time, F(1, 87) = 12.25, p = .001, in perceived social support. The main effect of time, F(1, 87) = 6.04, p = .016, was significant. No main effect of group, F(1, 89) = 0.05, p = .824, was found. Follow-up tests indicated that the participants in the experimental group had higher levels of perceived social support after Naikan therapy (Time 2, M = 62.50, SD = 12.42) than before (Time 1, M = 56.53, SD = 12.17), F(1, 42) = 12.12, p = .001. No significant differences were found for the waiting group in perceived social support between Time 1 (M = 59.51, SD = 13.16) and Time 2 (M = 58.47, SD = 12.74), F(1, 44) = 1.00, p = .322; see Figure 1.

Figure 1.

Perceived social support of two groups.

The Efficacy of Naikan Therapy on Externalized Blame

Repeated-measures analysis using linear mixed models showed that there was a significant interaction effect between group and time, F(1, 88) = 9.41, p = .003, along with a main effect of group, F(1, 90) = 6.06, p = .016, in externalized blame. No main effect of time, F(1, 89) = 0.98, p = .326, was found. Follow-up tests indicated that the participants in the experimental group had lower levels of externalized blame after Naikan therapy (Time 2, M = 39.73, SD = 10.19) than before (Time 1, M = 44.02, SD = 11.51), F(1, 45) = 6.40, p = .015. No significant differences were found for the waiting group in externalized blame between Time 1 (M = 36.31, SD = 9.68) and Time 2 (M = 38.51, SD = 9.67), F(1, 44) = 3.17, p = .082. At Time 1, externalized blame differed significantly between the experimental group (M = 44.02, SD = 11.51) and the waiting group (M = 36.31, SD = 9.68), F(1, 90) = 12.03, p = .001; partial η² = 0.118. At Time 2, however, there were no significant differences found between the groups, F(1, 88) = 0.28, p = .597; partial η² = 0.003; see Figure 2.

Figure 2.

Externalized blame of two groups.

Discussion

Consistent with the predictions, the present study found that participants who received Naikan therapy had improved perceived social support and decreased externalized blame. The results suggested the efficacy of Naikan therapy on male offenders in the context of interpersonal relationships.

According to previous studies and subjective reports from Naikan clients, reflecting on the three questions of Naikan often produces gratitude for the support received from others and awareness of one’s debt to the world (Miki, 1972; Yokoyama, 1990). Hedstrom (1994) concluded that individuals often ignore the support received from others and tend to focus on the difficulties caused by others. This phenomenon occurs because facing one’s own debt is dreadful for many people. Naikan therapy, however, provides an opportunity for participants to examine reality and to confront this debt without denying the difficulties caused by others (Reynolds, 1980). Therefore, participants who received Naikan therapy reported higher levels of perceived social support and lower levels of externalized blame than before. Furthermore, more perceived social support and less externalized blame are correlated with less offensive behaviors (Csibi & Csibi, 2011; Kuppens & Van Mechelen, 2007). These findings are consistent with Dodge’s social information-processing models (Crick & Dodge, 1994), in which the authors hypothesized that changes in the processing of social cues would lead to changes in social behaviors. This hypothesis may partially explain why Naikan is efficient in decreasing rates of recidivism.

The present study was limited in some respects. First, no long-term outcomes and behavioral variables were examined. It is important to examine whether the effects of Naikan remain for years, especially for those who will be released, and whether Naikan leads to actual behavior changes outside the isolated Naikan center. The second limitation addresses the equivalence of the two groups on the externalized blame measure. The results showed that although participants were randomly assigned, externalized blame differed significantly between the experimental group and the waiting group at Time 1. This finding is partially due to the relatively small sample size. Another limitation refers to the lack of follow-up testing with the waiting group. Due to administration issues, we did not collect data for follow-up testing with the waiting group after they finished Naikan therapy. This lack of data weakens the rigidity of the study design. The fourth limitation is that although we randomly assigned the volunteers, the problem of selection bias might not have been completely avoided. It is possible that participants in the present study were those who were more motivated to understand themselves and to make a difference. Further research should evaluate the long-term effects and behavioral changes of Naikan therapy and replicate these findings in a larger randomized sample.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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