Working with social withdrawal, or hikikomori, in Japan: From shame to pride.

The term hikikomori, or social withdrawal, was first coined in the late 1980s in Japan to describe adolescents and young adults who isolated themselves at home, withdrew from most social engagement, such as work or school, and had almost no relationships with others (except family members and online contacts) for longer than 6 months. Hikikomori often results from emotional injuries such as rejection, or failures that have not been addressed or even noticed. In the current case illustration, the problem of hikikomori is depicted through a client named Ken, a 40-year-old single man who, following graduation from university, became lodged in a 15-year cycle of repeatedly finding employment, quitting within the first year, and going into reclusive isolation. Ken underwent affect-oriented integrative psychotherapy for 4 years. The importance of processing emotional pain and highlighting positive emotional experiences to build a positive sense of self in working with hikikomori will also be discussed.