Lifelong Attachment System Asian Model of Family Therapy

ABSTRACT

The concept of a lifelong attachment system is derived from the author's four decades of clinical experience. This framework aligns with the collectivist values prevalent in Asian cultures, where individuals are regarded as integral parts of a larger community. Individual well‐being is viewed as contingent upon a secure attachment system throughout the lifecycle. In order to illustrate the practical application of this concept, I will present a composite family therapy case study involving a socially withdrawn (hikikomori) adolescent. The objective of the therapy is to facilitate secure attachment systems. The therapeutic process includes establishing a therapeutic system, promoting secure communication within the system, and incorporating broader attachment networks. This composite case study discusses the culturally preferred value of human relationship from the collectivistic perspective prevalent in East Asian cities. It also introduces therapeutic approaches that effectively promote a secure family system by expanding the original attachment theory.

1. Introduction

1.1. My Cultural Journey

The concept of a lifelong attachment system sprang from my personal, cultural, and clinical experiences during my cultural journey to the West and the East, along with 40 years of clinical experience working with Japanese families and supervising therapists across various Asian regions. My journey began with a 1‐year stay in a small North Carolina town in the United States as part of the American Field Service Intercultural Program. The United States in the 1970s was truly “great” in the eyes of a naive 17‐year‐old high school student searching for personal and cultural identity. I idealized every aspect of American culture and took its values as the standard. English was the most important subject for entering Japanese universities. I was temporarily adopted for a year by an American host family with a present father and nurturing mother. A part of me longed to become an American but also feared losing my own cultural identity.

Returning to Japan, I completed my basic medical and psychiatric training. Japan's remarkable economic growth after World War II reached its limit in the 1980s, when hikikomori adolescents, who withdrew from social activities and stayed home for years, became a major social issue (Li and Wong 2015). This phenomenon is regarded as a culture‐bound syndrome typically seen in Japan and many East Asian cultures. Mental health professionals were at a loss regarding how to support these adolescents; medication did not work, and they were not motivated for individual psychotherapy. Sal Minuchin's plenary at the Japanese Association of Family Therapy's inauguration in 1984 fascinated me. I met Robin Skynner (1976), who visited Japan and offered me family therapy training in London, UK. In my early 30s, I searched for my cultural identity as a family therapist, similar to many Asian therapists trained in the West (Lee 2020). My lifetime endeavor has been to conceptualize the difference between Western (more specifically Western European and North American) and Japanese cultures and to examine the applicability of the theories and practices I was trained in (Roberts et al. 2014). Furthermore, I explored integrating these Western theories and practices of family therapy into an Asian context (Tamura and Lau 1992).

An Asian network of family therapists emerged after the turn of the century. The Asian Academy of Family Therapy was established in 2016 by Wai‐Yung Lee and her colleagues (Tamura et al. 2017). Memberships mainly consist of East Asia (Hong Kong, China, Taiwan, Korea, and Japan) and Southeast Asia (Malaysia, Singapore, and Thailand). When I was young and visited the West, I was mostly on the receiving end of knowledge. Now, as I have grown older, I am invited across various Asian regions to provide knowledge through workshops and supervision. My cross‐cultural collaboration gradually shifted from the West to the East.

1.2. Attachment in Therapy

Concepts of differentiation and attachment are the two major developmental theories that highlight the human experience of two counterbalancing life forces: togetherness and separateness (Hardy and Fisher 2018; Kerr and Bowen 1988). An attachment system in children is activated when they sense danger and seek proximity with the caregiver (Bowlby 1952). Secure attachments result from consistent, responsive, emotionally sensitive caregiving (Johnson 2019). Securely attached individuals tend to believe in the availability of significant others in times of need and report high levels of happiness, trust, and friendship in their relationships. Insecure attachments result from inattentive, under‐involved, unresponsive, or self‐preoccupied caregiving (anxious‐resistant attachment); cold, rejecting, or intrusive caregiving (anxious‐avoidant attachment); or traumatic or abusive caregiving (disorganized attachment) (Ainsworth 1979). Anxiously attached individuals may experience a strong desire for intimacy, yet also feel insecure about the responses of others, fear rejection and report jealousy, preoccupation, and emotional instability in close relationships. Individuals with avoidant attachment are less likely to believe that others will respond to their needs and tend to reject emotional closeness to protect themselves from disappointment (Smrtnik Vitulić et al. 2023).

Attachment theory has traditionally viewed the early years as a critical period for the development of attachment in a prototypical manner. However, recent research has shown that attachment development is more dynamic and flexible than previously assumed and that newly acquired experiences later in life can modify the original attachment prototype (Van Vlierberghe et al. 2023). Attachment‐based family therapy is utilized across various stages of the lifecycle, especially with couples, middle childhood (Van Vlierberghe et al. 2023), and adolescents (Diamond 2014; Diamond et al. 2016). Diamond et al. (2016) outlines five well‐defined therapeutic tasks for the adolescents and their families: (1) meeting with all the family members, focusing on improving the relationship between parent(s) and adolescents; (2) meeting with adolescent alone to build an alliance with the therapist, emphasizing the adolescent's strengths and interests; (3) meeting with the parents only to build an alliance with them, exploring how the current stressors might affect their parenting practices and addressing the parents' own history of attachment ruptures; (4) repairing the parent–adolescent attachment by enabling adolescents express conflict directly in a more regulated and matured manner, allowing them to receive empathy and understanding from their parents, which builds greater confidence in the relationship; and (5) consolidating the newly formed secure base. This five‐steps approach aims for establishing a therapeutic system with the adolescent and parents by offering both individual and conjoint meetings and by facilitating secure communication within the family system.

The development and resolution of problems are closely linked to the quality of the attachment system: insecure attachment systems often give rise to difficulties, whereas secure systems promote healing processes. In insecure systems, emotional expressions may be suppressed, dismissed, or overlooked; instead, emotions are subjected to criticism, denial, or rejection. Conversely, a secure attachment system fosters individuals who experience relational joy, feel loved and trusted, and possess the confidence necessary to embrace challenges, adapt to changes, and demonstrate resilience in overcoming adversity. In contrast, insecure attachment can induce fears related to inadequate connection with significant others who are supposed to provide a sense of security. Such apprehension may manifest as a range of emotional and behavioral difficulties, including depression, psychosomatic symptoms, aggressive behavior, illegal or promiscuous actions, and withdrawal from the attachment systems (Krieg and Dickie 2011; Li and Wong 2015; Santona et al. 2023).

1.3. Lifelong Attachment

While attachment theory emphasizes bonding, Bowen's differentiation theory emphasizes emotional boundaries (Miller 2023). The appropriate balance between closeness and distance attained by a well‐differentiated individual is determined by the social constructs of culture, ethnicity, gender, sexuality, and stage of lifecycle. In the culture of individualism, a human being is regarded as a separate, individual entity who has their own mind and identity (Yasui et al. 2025). People are born immature and grow to acquire individual qualities such as confidence, autonomy, self‐reliance, assertiveness, and self‐differentiation.

In the culture of collectivism, a person is not regarded as an individual entity but as a tiny part of the whole (Kim et al. 2015). Human beings are so vulnerable that they exist only in the web of relationships; nothing exists in isolation (Lee 2020). There is no such thing as an autonomous individual. Identity is formed not around an individual but around attachment systems. An individual's worth is not measured by what he or she personally achieved but by the extent to which one lives up to the expectations of others (Leong and Kalibatseva 2011). Although Bowlby (1969) described attachment as a life‐long interaction that determines the quality of family life and individual development, its application in therapy is limited to specific stages of the lifecycle (childhood, adolescence, and couple relationship in adulthood) in Western literature. The uniqueness of the family lifecycle is embedded within the larger social context (McGoldrick et al. 2015). In individualistic cultures, the basic family unit is a two‐generational nuclear family. The primary relationship in the family exists between the couple. The family lifecycle is a process of separation, individuation, and differentiation. Adolescents “leave home,” detach from their family of origin, and prepare for a new family with a partner in romantic attraction. Clear boundaries between generations are maintained to respect autonomy and individuality. In collectivist cultures, however, individuals never truly leave their family of origin. The basic family unit is an extended family spanning three or more generations. The family lifecycle is a process of integration and reconnection. Child–parent relationships remain intensely attached throughout the lifecycle. The primary relationship within the family is regarded as that between the child and the parent. Children are central to the family. Parents hold high expectations for their child's well‐being (Hsieh et al. 2017). A child gains a sense of competence by meeting parental expectations (filial piety), which can become problematic in insecure situations. Anxious parents may project unrealistic expectations and excessively interfere with their child's life, sometimes with harsh or abusive discipline. Fearful, avoidant parents avoid direct confrontation with their child, becoming overprotective and ineffectual in their parenting. As a result, the child may become the “king of the family,” wielding omnipotent tendencies that complicate school life, leading to feelings of denial, exclusion, and bullying.

The extension of attachment networks to significant figures outside the family system occurs particularly during adolescence and young adulthood (Ainsworth 1989). Young adults typically begin to differentiate themselves from the family of origin, defining their future career and sexual lives, and gradually develop new and significant relationships characterized by higher levels of mutual care and trust (Carli et al. 2024). Developmental tasks of adolescence involve not only achieving autonomy and independence from the family of origin but also creating their own attachment system with peers and later with romantic partners. Discussion of incorporating broader attachment networks is limited to adolescence in the existing literature.

Incorporating broader attachment networks such as extended family, the school system, and peer relationships is highly relevant in collectivistic cultures. Those who fail to establish secure attachments in school settings often withdraw from school. Marriage introduces two key lifecycle tasks: creating secure couple relationships and integrating into the extended family system. Failure in integration often results in in‐law conflicts, typically between mother‐in‐law and daughter‐in‐law (Park et al. 2025). The roles assumed by grandparents vary considerably and are shaped by ongoing social changes across Asia. Increasingly, parents of adolescent children are opting to establish independent households, though they frequently seek support from their own parents during periods of crisis involving their children (Raymo et al. 2015). Developmental crises such as school refusal and hikikomori are notably common among Asian adolescents. However, the participation of grandparents in these situations may intensify stress within the nuclear family, particularly when unresolved conflicts between generations remain (Lee 2020; Ma et al. 2020).

Indirect communication styles that avoid direct confrontation are commonly observed in Japanese and Korean cultures, more so than in some other East Asian regions such as Hong Kong, China, and Taiwan (Lee et al. 2013). Assertive and explicit messaging is generally not encouraged, as it can clarify personal standpoints and highlight differences. Communication effectiveness often depends on the receiver's ability to interpret underlying meanings rather than the sender's explicit articulation. In these contexts, individuals are expected to infer motivations, emotions, and attitudes through subtle cues, a practice sometimes referred to as “reading the air” (Lau et al. 2014). The “air” signifies the collective sentiment within the group or system. Those who do not accurately interpret these cues may be viewed unfavorably. In the insecure system, ambiguous non‐verbal signals, such as pauses in conversation or unclear facial expressions, might be perceived negatively, potentially increasing uncertainty within the group.

2. Case Analysis

This case serves as an example of how the life‐long attachment perspective can be applied to family therapy for a hikikomori adolescent, a phenomenon widely observed in East Asian cultures. It is not a single case study but rather a composite case study, the culmination of the author's 40 years of experience with adolescent cases in Japan and neighboring East Asian countries (Cruz et al. 2024; Johnston et al. 2023). School refusal and hikikomori clients share distinctive patterns in relationship with their family, which are reflected in gender dynamics among couples as well as hierarchical structures within the extended family system. The narrative below provides a summarized account of these cases, serving as a representative example.

Yumi, a full‐time housewife in her 40s, sought therapy for her 14‐year‐old son Kaito, who had been in a hikikomori state for 3 years following bullying by female classmates in junior high school. Kaito stayed up all night playing computer games, slept during the day, spoke minimally with his family, and had lost all connections with his friends. While encouraged to come with her family, Yumi could not bring Kaito to therapy as he refused to leave the house. She had not discussed the therapy appointment with her husband either.

In initial sessions with Yumi alone, the therapist acknowledged her struggles. Yumi had quit her job to stay home and care for Kaito, but their interactions were limited. Kaito avoided discussing his school attendance; whenever Yumi brought it up, he would lock himself in his room for days. The therapist explored the possibility of involving Kaito's father in therapy. Yumi felt it was unlikely and irrelevant since her husband, Taro, spent little time with Kaito, who actively avoided him. The couple disagreed on how to address Kaito's challenges and avoided discussing the matter. While Yumi understood the importance of her husband's involvement, she was reluctant due to underlying ambivalence. She needed his support but did not fully trust his involvement. The therapist emphasized the importance of her husband's participation as well as validating her reluctance.

Eventually, both parents attended the next session. Taro, the latecomer to therapy, was initially quiet, uncertain about what to say, and feeling guilty for his lack of involvement. Yumi became less expressive in the presence of her husband than in the individual sessions. Yumi subtly criticized his lack of involvement, leaving her to shoulder the parental responsibilities alone.

The therapist offered subsequent individual sessions for both parents. Yumi revealed conflicts with her mother‐in‐law, which she had never openly shared with her husband. Taro's parents, who lived nearby but in a separate house, were concerned about their grandson. Taro's mother frequently visited, hoping to speak with Kaito, but he refused to see her. Yumi felt implicitly criticized by her in‐laws for being an inadequate mother and viewed their visits as an invasion of privacy, whereas Taro saw their involvement as support for their grandson. She sought her husband's support but felt he consistently sided with his own mother. Yumi expressed that their disagreements extended beyond their child's issues. Taro privately shared for the first time about his wife avoiding sexual intimacy for many years, which he had never shared with his previous female therapist. Taro admitted that communication with Yumi was stressful, which led him to avoid family interactions and focus on work instead.

While the therapist acknowledged the couple's challenges, the focus remained on Kaito in the subsequent sessions with both parents. Taro advocated for pushing Kaito to return to school, but Yumi thought he was being too strict. The school counselor advised her that parents should patiently wait for Kaito to become more independent. The therapist validated both perspectives, emphasizing that differing approaches between parents could benefit a teenage child by providing both nurturing protection (protecting love) and encouraging independence (releasing love). As therapy progressed, Taro became more engaged, and both parents regularly attended sessions. They began discussing not only their son's problems but also broader marital issues, early abusive behavior by Taro, Yumi's sense of isolation, conflicts with in‐laws, and the lack of trust between the couple.

Taro: My wife is too indulgent with Kaito. She responds to all his requests and even brings meals to his room. Even if he can't go to school, at the very least, he should develop healthy daily habits. He should get up in the morning and eat his meals together with the family.

Yumi: My husband is too strict. When Kaito is playing games, he gets irritated and scolds him, so Kaito is afraid of him. I think he should try to empathize Kaito's feelings a bit more and not push him out of the nest so forcefully. It might be better to wait patiently for Kaito to grow on his own. The school counselor also recommended this approach.

Therapist: Both of you are thinking very carefully about Kaito. The mother's gentleness and the father's strictness may seem like opposite approaches, but both kinds of love are necessary for a child to grow. The “protective love” from the mother and the “releasing love” from the father‐‐having both allows an adolescent to develop autonomy and adapt to society.

Yumi: My husband always escapes into his work. I quit my job to focus on Kaito and am basically handling everything on my own, so I wish he would help more. But honestly, I can't trust him. Although it's no longer the case, when our child was small, he often came home late at night drunk and forced me to have sex. Those memories are traumatic for me. Even if I consult him about problems with my mother‐in‐law, he either doesn't listen or sides with her, telling me to just endure it. While I want him to be involved with Kaito, at the same time, I'm afraid he'll get involved in the wrong way and make things worse.

Taro: I think I'm doing my best for the family, but she doesn't understand the tough work I'm dealing with now at all. Whenever we discuss it, she always brings up past events and blames me. My wife has refused sex with me for years. Whenever we try to talk as a couple, it always turns into a fight about these things, and we never reach a conclusion?it just ends in stalemate. Honestly, I'm scared to talk to my wife about these issues, which might be why I avoid them.

Therapist: The two of you are skillfully and calmly sharing some very difficult topics with each other. Certainly, it would be hard to have such conversations alone at home. But both of you are committed to coming to therapy, and in front of me, you can face each other sincerely. Although challenging, this work is required to establish a secure family environment for your son.

As the therapy progressed, Taro began spending more time talking with Kaito, who initially refused to respond but eventually challenged his father in a rebellious manner. Although Yumi initially intervened, fearing serious fights, the therapist advised her to trust the process and observe calmly without interfering. Yumi was afraid of how Kaito would react and was unable to tell him that both parents were attending therapy. The parents could discuss this matter and, eventually, the mother allowed the father to invite Kaito to join them for a session. Kaito agreed to participate if it was online. He observed his parents having conversations with the therapist via Zoom. While Kaito could see his parents in the therapy room, he kept his own camera off so that he could not be seen. At the following session, Kaito was able to come to the therapy room together with his parents for the first time. While quiet and initially reluctant to address his own challenges, Kaito actively shared his views on his father's alcoholism and his mother's depression during therapy sessions with his parents. With increased participation, Kaito gradually expanded his activities within and outside the family.

Kaito used to shut himself in his room and refuse to meet his high school teacher when she visited the home. However, after participating in therapy, Kaito was able to meet with the teacher during home visits, and eventually, he was able to go to school for a short time to meet with the teacher in the late afternoon when other students had gone home. The therapist then invited the high school teacher to a therapy session, where Kaito, his parents, the teacher, and the therapist discussed what each person could do to support Kaito going forward while listening to Kaito's wishes. The teacher was unsure how much to encourage Kaito to return to school. Kaito shared his anxiety in the session about how his classmates might perceive him. The parents requested that the teacher encourage Kaito to attend only within a manageable range. From the following week, Kaito was able to attend not only after school but also started participating in classes.

The therapist made intentional efforts to involve the under‐engaged father by being mindful of their gender dynamics. The therapist acknowledged Taro's fears about being criticized for not spending enough time with his family and acknowledged his worry that the therapist might have already aligned with his wife before he joined the sessions. The therapist also encouraged him to discuss his sexual experiences, which he found challenging to share with female therapists.

3. Discussion

This story illustrates how a family can fall into crisis when a child loses social connections in a collectivistic society. The mother was emotionally close to her child and became overly anxious about sending them to school. On the other hand, the father distanced himself from the family system and avoided actively engaging with or influencing the child. As a result, both parents lost confidence in their parenting and were unable to provide proper guidance or discipline, and the child missed opportunities to develop social skills, making it harder to connect to the outside world. Moreover, a distance developed in the marital relationship, intimacy was lacking, and only anxious and conflict‐ridden communication was repeatedly exchanged. Such a family is a typical example of an insecure family system, in which emotional and physical problems are more likely to develop, along with behavioral issues such as social withdrawal, internet addiction, or suicidal tendencies. To support these families, it is important for all members to objectively reflect on their emotions and relationships and to reconsider their respective roles and interactions. These issues are carefully addressed one by one in the secure context, aiming to rebuild the family's sense of security and foster the child's ability to engage with society with confidence and security.

In individualistic cultures, individuals are encouraged to cultivate self‐reliance, assume personal responsibility, and take ownership of their emotions. The use of “I‐messages” is promoted to articulate personal emotional needs while minimizing projection and dependency, which tend to be viewed negatively. Conversely, collectivist cultures emphasize overcoming difficulties through mutual support. Within these groups, emotional experiences are shared among members of the attachment system; another person's pain and joy are collectively experienced. Projection and dependency are generally regarded as natural and unavoidable. In secure attachment systems, both positive and negative emotions are appropriately expressed and acknowledged. However, within insecure systems, even positive emotions are likely to be misunderstood, ignored, rejected, criticized, or denied (Table 1).

TABLE 1.

Family therapy of individualism and collectivism.

	Individualism	Collectivism
Concept of self	Individual identity	A part of the wholeness
Family unit	Nuclear family	Extended family
Primary relationship	Couple	Parent/child
Family Life cycle	Process of Differentiation	Process of Integration
Key issues in family life cycle	Leaving home Generational boundary	Home coming Filial piety
Communication style	Explicit, assertiveness	Implicit, sensitivity
Mode of psychotherapy	Individual Therapy	Family Therapy
Goal of therapy	Gaining personal quality through individuation	Creating secure system

3.1. Lifelong Attachment‐Based Family Therapy: An Asian Model

The author proposes a newly devised model of family therapy, which is based on the lifelong attachment system hypothesis, which is highly relevant to Asian families. This concept contrasts with the Western model of attachment‐based family therapy, which focuses on specific periods of developmental stages (childhood and adolescence) and specific relationships (such as the partnership dyad).

An attachment system refers to a group of people who are connected for survival, sharing living space and significant time in daily life, and relating to each other to achieve a collective task. Parent–child attachment is lifelong, not limited to childhood and adolescence, and is a reciprocal process—children receive attachment from parents, and parents likewise gain attachment from their children (An et al. 2023). While parents are key attachment figures for children, children also offer parents confidence and well‐being by showing unconditional trust and achieving academic success. As children become adults, they often provide comfort and security to their aging parents and fulfill filial duties, reflecting important Confucian values. Practical family life has shifted from the traditional three‐generation extended family household to a two‐generation nuclear family system during the process of modernization in Asia. However, even within nuclear families, relationships with grandparents and adult siblings remain indispensable parts of the family attachment system. When each family member is healthy and functional, the role of these bonds lies dormant, but when the child faces a crisis and needs support—for example, difficulty at school, school refusal, or social withdrawal—their bonding becomes salient, which can promote mutual support and/or conflict. In the composite case, Yumi and Taro failed to properly address the long‐standing conflict between Yumi and her mother‐in‐law, which resulted in emotional distance between the couple. This issue needed to be safely shared in the therapeutic context before exploring the parental coalition for their child's problem.

The roles assumed by each parent often differ significantly. In this example, the mother left her job to care for her son, while the father maintained a more peripheral involvement in childcare. Typically, mothers are associated with providing emotional and nurturing support, whereas fathers are seen as offering instrumental assistance, particularly regarding socialization. This dynamic can result in distinct family relationships, including enmeshed mother–child bonds, disengaged father–child interactions, and emotionally distant partnerships between spouses. The Lifelong Attachment is not limited to the mother–child relationship but extends to the father–child bond as well. Fathers may experience a conflict of loyalty between their family of origin and their nuclear family.

Social agencies and peer support groups play a significant role in the attachment systems—for example, classmates and teachers, colleagues in the workplace, and “mom friends” for young parents raising children. People inevitably belong to multiple attachment systems throughout their lives. Secure and insecure emotions are automatically transmitted within and across these attachment systems: for instance, a parent's anxiety is transmitted to the child, a husband's anxiety is transmitted to his wife, and the anxiety within the family system can influence the attachment in the school or workplace systems. Attachment security is not solely determined by the individual's recollections of past experiences; rather, it is sustained and continually renewed by the ongoing quality of emotional bonding. Therapists and clients form another crucial attachment system for those in need, with the therapist becoming a temporary attachment figure. The main objective of the therapy is to establish a sense of security within the therapeutic system, which then enhances security in family and related attachment systems. To achieve this, there are three principal therapeutic factors that facilitate secure attachment within these systems: (1) establishing a therapeutic system, (2) promoting secure communication, and (3) incorporating broader attachment networks.

3.2. Establishing Therapeutic System

Mental health conditions have historically faced significant stigma, and psychotherapy has not been widely embraced in many Asian societies (Kageyama et al. 2017). Although this stigma has gradually faded, some of the family members still frequently exhibit hesitation to participate in therapy. When family therapy was introduced in Japan during the 1980s, practitioners identified traditional gender roles—particularly the dynamic of enmeshed mothers and absent fathers—as a major challenge to conducting conjoint family sessions. Although societal perspectives on gender have evolved over the past 40 years, it remains common for families, especially those exhibiting anxious or avoidant tendencies, to be reluctant to engage collectively in therapy. Family therapy has demonstrated significant effectiveness for Asian families when a secure therapeutic alliance is established. In cases involving insecure family systems, intervention often begins by supporting the most motivated family member to encourage the participation of others. Young people who experience hikikomori avoid contact with anyone outside their families, making them unlikely to seek treatment directly. As in the composite case, it is the mother who recognizes the problem and actively seeks help, while the father tends not to get involved. This pattern is explained by traditional gender roles: mothers are seen as responsible for childcare and household duties, while fathers tend to focus on work and responsibilities outside the home. However, my clinical experience suggests that insecure relationships within the family are the main reason for fathers' absence. Collectivist family therapy deliberately encourages reluctant family members to join, aiming to transform anxious communication into interactions that foster secure attachment.

In the composite case description, Yumi initiated therapy independently and was initially hesitant to invite her husband, Taro, to join the sessions. Although both parents rationally acknowledge the importance of collaboration for their child's well‐being, those within insecure family systems frequently encounter challenges engaging in joint therapeutic efforts.

Yumi initially experienced feelings of inadequacy in her role as primary caregiver, sensing implicit blame from her partner and extended family members. The marital relationship was characterized by emotional distance, as both partners found it challenging to openly share their feelings. Key concerns included achieving work–life balance, equitable division of household responsibilities, approaches to child‐rearing, interactions with in‐laws, and sexual intimacy within the marriage. In some cases, couples in less secure relationships may sustain emotional distance as a means of conflict avoidance. The therapist worked collaboratively with Yumi to foster a sense of security and empowerment, preparing her to eventually involve her hesitant partner in therapy.

The formation of a therapeutic system is achieved when the therapist establishes a secure alliance with all participating family members, including those who join the process later. For instance, Father Taro, who entered therapy at a later stage, may experience apprehension regarding potential bias from a therapist who has already developed rapport with Yumi. It is important for the therapist to recognize the traditional gender role, such as the expectation for the father to serve as the leader or authority figure, which may contribute to reluctance in engaging in an egalitarian therapeutic dialog. Maintaining therapeutic neutrality is essential to ensuring that each family member feels equally supported throughout the process.

The adolescent child, reluctantly brought to therapy, hesitated to share his emotions openly. Therapists should respect such silence, allowing the child to listen to his parents' conversations without pressure to speak. Facing one's own anxieties is difficult for anyone, and people often project them onto significant others. Parents may project their anxieties onto their children, and children, in turn, project theirs onto their parents. For adolescents who have come to therapy at the urging of their parents, confronting their own issues head‐on can be overwhelming. It is often easier to begin therapy by addressing the parents' issues as projected by the adolescent, which can provide a more accessible way to introduce them to the therapeutic process. Reframing problematic adolescents by highlighting their positive qualities and relational competencies can be beneficial (Andolfi 2024).

3.3. Promoting Secure Communication

The therapist establishes a secure therapeutic context by facilitating safe and open communication. All members of the system are encouraged to express both positive and negative emotions in a manner that supports mutual understanding, acceptance, and empathy. Effective methods for fostering secure communication include (1) addressing diverse family issues, (2) integrating individual and conjoint family sessions, (3) carefully regulating emotional expression, (4) strategically employing non‐verbal communication, (5) utilizing online communication platforms, and (6) exploration of the self of the therapist.

While therapy began as child‐focused, other family issues surfaced over time, such as sexuality, abusive behavior, and in‐law conflicts. Individual‐oriented child therapists often focus heavily on the child's issues while ignoring broader family dynamics. System‐oriented therapists view these additional issues as opportunities to gain deeper insights into family dynamics. Each session starts with the child's issues before gradually inviting exploration of other matters. By providing a safe therapeutic environment, parents can share unspeakable concerns without projecting their anxieties onto the child. Adolescents' symptoms often serve as therapeutic guides to explore family issues (Andolfi 2024).

Combining individual sessions with family conjoint sessions can be effective for fearfully avoidant families. Individual sessions allow clients to safely express their emotions without the presence of family members, avoiding confrontation, conflict, and criticism (Berg and Jaya 1993). Latecomers may benefit from building trust with the therapist individually before joining family sessions. Traditional men who believe they hold a dominant position want to save their face and find it difficult to show their vulnerabilities to their family members. Clients in a subordinate position may find it difficult to share real feelings in front of the dominant person being afraid of negative consequences (e.g., wife against her husband, child against parents). Adolescents and other vulnerable family members often prefer individual sessions. Therapists encourage clients to share their private stories with others in subsequent meetings. At the end of each session, therapists discuss who should attend the next session, whether jointly or individually. When sharing information in a joint session that has not yet been disclosed within the family, it is important to respect the individual's privacy while also ensuring the safety of sharing (Daneshpour 2025).

Communication within insecure systems is frequently ineffective, often manifesting as intense conflict or mutual withdrawal. The therapist methodically manages expressed emotions, which can present as either overt confrontation (excessive expression) or avoidance (insufficient expression). In both cases, the therapist directs the communication process by permitting only one individual to share their emotions with the therapist while other members observe the exchange without intervening. Each participant is given an opportunity to express themselves, after which the therapist encourages reflection on the experience of sharing genuine emotions within the family context. Ultimately, the therapist acknowledges the value of this structured communication approach, particularly as it addresses patterns of unsuccessful communication.

Non‐verbal communication is often used to accommodate cultural preferences for indirect interaction and to avoid direct confrontation. It can convey implicit, analog emotional messages, while verbal communication conveys explicit, digital, and rational messages. Non‐verbal cues may include tone and speed of voice, emotional expressions such as crying or anger, facial expressions, head posture, body movements, and eye contact. Silence can also serve various functions, being interpreted as anxiety in insecure contexts or as calmness in secure ones. Therapists are mindful of these subtle non‐verbal cues among family members. They are encouraged to use non‐verbal messages like facial expressions, eye contact, and brief interjections such as “Right,” “I see,” or “Exactly” to demonstrate validation and empathy toward clients.

Online communication has grown in popularity since the COVID‐19 pandemic (Smith et al. 2023; Lebow 2020). Video conferencing platforms such as Zoom, Microsoft Teams, and Google Meet enable therapists to facilitate secure communication, particularly with families exhibiting avoidant behaviors. Individuals who may be reluctant to participate in face‐to‐face sessions, including hikikomori adolescents, can engage in therapy through online sessions without visually exposing themselves. Hybrid meetings that integrate both in‐person and virtual components offer practical solutions for families dealing with high levels of conflict or abuse by allowing communication without direct physical contact. Additionally, messaging applications like WeChat, LINE, and WhatsApp serve as valuable tools for facilitating communication. These platforms are especially beneficial for individuals who find verbal expression challenging, such as members of the younger generation who are accustomed to digital communication. Many families now establish group chat rooms for text‐based interactions, and therapists may be invited to join these chat groups to implement text‐based therapeutic interventions.

3.4. Broader Attachment Network

Individuals participate in multiple layers of attachment systems. The parent–child and couple relationships within a nuclear family typically constitute the primary attachment system. Secondary attachment systems may include environments where individuals spend significant portions of their daily lives, such as school classrooms, workplaces, and neighborhood communities. Tertiary attachment systems encompass broader social support networks, including educational, medical, social work, social welfare, and psychotherapy agencies. These various attachment systems exert reciprocal influences on one another. Security established within one system can impact perceptions of security in others; for instance, the nature of the relationship between parent and grandparent is often transmitted to the next generation. Similarly, a child's sense of security at home can affect their sense of security at school. Concern for a child's well‐being expressed by educators may extend to other support agencies, such as school counselors, healthcare providers, or local child protection services. Collectively, all primary, secondary, and tertiary attachment systems comprise a broader attachment framework. The therapist can organize a network meeting with relevant agencies from various disciplines to ensure secure communication and prevent isolation.

The seriousness of a child's challenges, such as school refusal, suicide, or physical abuse (bullying), can create significant concern among involved systems and may result in these groups projecting their anxieties toward each other. For instance, schoolteachers might attribute the issues to parenting practices, while parents may point to school‐related factors, such as guidance or disciplinary approaches. School counselors may identify a lack of empathy from teachers as a contributing factor, whereas teachers might critique counselors for their approach to counseling processes. Child protection agencies and medical or psychological professionals may express concerns about family or school dynamics, while families and schools may note perceived inadequacies or delays in social support services. Such reciprocal criticism among stakeholders can contribute to isolation and an increased sense of insecurity when addressing crisis situations.

A therapist can facilitate a support network meeting, providing an opportunity for parents and relevant agencies to discuss their concerns collaboratively rather than assigning blame. Although such meetings may not yield immediate solutions, they can foster a sense of connection and trust through the sharing of common difficulties. Ongoing meetings can expand this supportive network and help sustain long‐term assistance while minimizing burnout and feelings of inadequacy. Collaborative and trusting relationships can alleviate anxiety within families and school systems, potentially reducing the child's distress both at home and at school.

Therapists may involve members of the extended family system in the therapeutic process. In collective cultures, parents and children maintain emotional connections throughout their lifecycles, regardless of whether they live together. A genogram spanning at least three generations can be used to help therapists and clients visualize transgenerational attachment patterns. Grandparents may serve as consultants by offering emotional and practical support to the nuclear family of their adult child. Siblings, positioned as third parties, can provide additional perspectives on the parent‐child relationship. Multiple family group meetings have proven effective for families whose children exhibit school refusal. These families often experience feelings of isolation due to the social stigma associated with their child's challenges. Such meetings help reduce this sense of isolation and provide peer‐to‐peer support by enabling participants to safely share their common difficulties.

3.5. Self of the Therapist

A therapist's most vital skill in creating a secure environment is maintaining a sense of safety that is resilient enough to counteract the anxiety clients bring. This stable presence allows clients to gradually develop secure attachment styles over time. While clients in emotional crisis and experiencing anxiety may ask for quick relief, it is the therapist's responsibility to foster an atmosphere where clients can tolerate discomfort, enabling long‐term growth and resolution of underlying issues. As a therapist becomes part of a clients' attachment system, core emotions begin to flow in the system; the clients' deep anxieties surface, while the therapist acknowledges and validates the expressed pains. Clients with insecure attachments are often highly sensitive to the emotional state of their therapist. They may fear rejection and emotionally withdraw from therapy at first, then gradually test the therapist's response by revealing a small part of their negative emotions, sometimes projecting these onto other family members or to the therapist. The prevailing emotional tone in the therapeutic process depends on the therapist's ability to remain composed and resilient in the face of emotional distress. The therapist must thoroughly process their own full range of own emotions to empathize with clients' anxieties while maintaining emotionally calm. Therapists encounter various forms of anxieties in clinical practice; doubts about clinical competence, difficulty managing intense emotional exchanging between the clients, negative projection directed at the therapist, and fears of poor outcomes by addressing forbidden emotional territory. Some of these anxieties may arise from the therapist's own private experiences, such as traumatic events in childhood and adolescence, unresolved attachment scars in the family of origin, unresolved grief or guilt from the past, or ongoing conflicts in the present. A therapist who has not adequately processed these insecure emotions may unconsciously project them onto clients, feel difficult to emotionally connect with the clients who have similar experiences, and struggle to maintain a neutral position in the therapeutic system.

Professional training should emphasize developing emotional awareness so that therapists can embody an authentic sense of security. Trainees are encouraged to share their full spectrum of emotions—positive and negative—from past, present, and future experiences in a supportive setting (Aponte and Kissil 2015). Within this environment, the therapist's insecure emotions are recognized, accepted, and validated by supervisors and peers in the training group. The aim of the training is not to reframe negative experiences or force optimism but rather to objectively relate to one's subjective feelings from a meta‐perspective and to create sufficient secure space in the mind of the therapist to comfortably absorb clients' insecure emotions.

Therapists are encouraged to recognize how their own gender and sociocultural backgrounds may impact the development of a secure therapeutic system with client families. For example, in typical Asian families with enmeshed mothers and disengaged fathers, the formation of a secure therapeutic system depends on successfully engaging the under‐involved fathers. Therapists should carefully consider how their own experiences with male family members—such as grandfathers, fathers, brothers, male partners, sons, and grandsons—both past and present, might influence the creation of a secure therapeutic alliance, either positively or negatively. In my situation, I must pay close attention to how multilayers of my own identities—including being male, heterosexual, cisgender, part of the senior generation, middle class, a professional, and Japanese ethnicity—may shape expectations and interactions with clients of different genders, sexual orientations, generations, and sociocultural identities.

4. Conclusion

The main limitation of this manuscript is its reliance on anecdotal evidence drawn from personal, cultural, and clinical experiences, rather than rigorous empirical research. Consequently, its applicability across diverse cultural contexts may be constrained. However, these anecdotes provide valuable insights into real‐world applications and contextual understanding that may not be captured through empirical studies alone. The yin‐and‐yang concept, originating from Taoist Chinese philosophy, describes complementary yet interconnected forces that create self‐sustaining cycles. Psychotherapy is both a humanistic science—generalizable across varied contexts—and an artistic practice that remains unique to each individual and resists universal generalization. The family system can be understood as both an individual's unique experience and as an objective entity that may be categorized as functional or dysfunctional. Individuals often seek separation from negative influences and value personal autonomy, while also desiring secure connections with loved ones for mutual support. Notably, a sense of security is often appreciated through contrasts with insecure experiences. These examples illustrate how Taoism encourages the integration of complementary concepts. While it is acknowledged that Asia and the West possess distinct cultural frameworks necessitating different models of psychotherapy, fundamental human processes such as attachment and differentiation transcend these cultural distinctions.

Human beings demonstrate both vulnerability and resilience, often achieving a sense of security by navigating uncertain experiences. The Asian approach to attachment‐based therapy integrates universal psychological processes with culturally specific considerations. Although individualism and collectivism are frequently viewed as contrasting paradigms, they can be regarded as complementary aspects of human behavior. In the context where individuality is emphasized, functional separation is preferred as a solution to dysfunctional connection, whereas in contexts where collectivity is emphasized, functional connection is favored as a solution to dysfunctional separation. The Asian model of attachment‐based therapy provides not just a solution for Asian families but also serves as a universal framework for healing that transcends cultural boundaries.

Supporting information

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