Tendai kaihogyo

1. Introduction

Version followed: the sennichi kaihōgyō (千日回峰行, "thousand-day mountain-circling practice") as Hieizan Enryakuji, head temple of the Tendai school, publishes it on its own site, with detail from two peer-reviewed studies in the Japanese Journal of Religious Studies: Rhodes (1987) and Ludvik (2006). The Japanese Agency for Cultural Affairs' magazine is used for the official public framing. Where these differ, the differences are noted. [source: Enryakuji 修行 page; Rhodes 1987; Ludvik 2006; Bunka-chō ぶんかる 093]

What it is. Kaihōgyō (回峰行) is a Tendai Buddhist ascetic observance on Mount Hiei (比叡山), near Kyoto. The practitioner (gyōja, 行者) walks a fixed mountain route by night and stops to worship at a very large number of sacred sites, including halls, shrines, graves, peaks, trees, stones, waterfalls and ponds. Enryakuji credits its founding to the monk Sōō (相応和尚), who in Rhodes' account lived 831–918. Enryakuji says the practice embodies the spirit of the Never Disparaging Bodhisattva (常不軽菩薩, Jōfukyō Bosatsu) of the Lotus Sutra, who honoured everyone as a future buddha. On this view, buddha-nature is found in "mountains, rivers, grasses and trees" alike. The central deity is Fudō Myōō (不動明王). In the tradition's own symbolism the practitioner's dress represents Fudō, and Rhodes reports that the walker is understood as "a symbol of a living Fudō Myōō". [source: Enryakuji 修行 page; Rhodes 1987; Ludvik 2006]

What it is not. It is not a therapy, and no psychotherapist delivers it. It is a monastic observance carried out by ordained Tendai monks within Enryakuji's institutions and lineages, supported by lay confraternities. The therapist's role is to work alongside it. Clients might include a monk or trainee, a family member, a lay supporter or devotee, or someone outside the tradition who has taken the "marathon monk" story as a personal model. [synthesis]

How change happens (as the tradition frames it). Scholars describe the walking as a form of the constantly-walking samādhi (常行三昧) of Tendai's four kinds of meditation, a connection Rhodes considers loose. Worship is meant to be continuous, not limited to the stops. The dōiri (堂入り, "entering the hall") is a seclusion in which the practitioner fasts, abstains from water and sleep, does not lie down, and recites Fudō's mantra without stopping. Ludvik describes it as the dividing point between practice for oneself (自利行, jiri-gyō) and practice for others (化他行, keta-gyō), and Rhodes says its symbolism is of death and rebirth. In the later stage the walker passes through Kyoto and blesses lay people along the streets. Ludvik notes that completers are popularly regarded as living buddhas, but she calls the path a bodhisattva practice that deliberately stops short of completion so the practitioner can go on helping beings. These are religious claims and are given here as the tradition and its scholars state them. [source: Ludvik 2006; Rhodes 1987; Enryakuji 修行 page]

Risk, as sources state it. Enryakuji's own description and the Agency for Cultural Affairs both present the observance as a harsh practice (荒行, aragyō), and the Agency calls it one that risks the practitioner's life. Rhodes writes that the dōiri fast "literally brings the practitioner to the brink of death". Practitioners carry a death cord (死出紐, shide himo) and a sword. Rhodes reports that they are pledged to take their own lives if they cannot finish. Ludvik's study does not discuss injuries. [source: Enryakuji 修行 page; Bunka-chō ぶんかる 093; Rhodes 1987; Ludvik 2006]

2. Framework

2a. The observance as Enryakuji and scholars describe it (qualitative outline)

This outline is for orientation only. It sets no schedules, distances, fasting or sleep parameters for anyone to follow.

• Who leads and authorises it. The practice belongs to Enryakuji, the Tendai head temple, and is centred on Mudōji (無動寺) and its Myōōdō (明王堂) hall. Ludvik describes the transmission as oral, within lineages, and names the Imuro lineage, which was revived in the twentieth century. Rhodes says three lineages formed in the medieval period. Neither source sets out a formal selection or authorisation procedure, so the details of who may undertake it and how they are chosen are [uncertain: not verified]. According to Rhodes, the shorter form of kaihōgyō is completed by monks seeking to become sub-temple abbots, as part of a wider training requirement. [source: Rhodes 1987; Ludvik 2006]
• Stages of the long practice. The practice runs over several years in staged blocks. (1) Early years on the Hiei route, with worship at the stations. (2) A transition year that ends in the dōiri, after which the practitioner is called ajari (阿闍梨, "master"; the full title in Ludvik is tōgyōman ajari). (3) A year in which the route is extended to Sekizan Zen'in (赤山禅院) in Kyoto. (4) A final year that includes the Kyōto ōmawari (京都大廻り, "great Kyoto circuit"), during which laypeople receive blessings, and a closing period back on the mountain. Completion (満行, mangyō) brings the title dai gyōman dai-ajari (大行満大阿闍梨). Rhodes and Ludvik number the years and segments slightly differently, and Ludvik notes that individual practitioners' schedules vary. Rhodes also describes further rites after completion, including a fire ceremony (goma) at Mudōji undertaken without food, water or sleep, and a formal visit to the imperial palace. [source: Enryakuji 修行 page; Rhodes 1987; Ludvik 2006]
• Dress and symbols. The practitioner wears a cypress hat, white robes and straw sandals said to represent eight-petalled lotuses, and carries the death cord and a demon-subduing sword (降魔の剣). Enryakuji says the dress is also said to express Fudō Myōō. Rhodes reads the white robes, the ferry coin and the cord as symbols of death. [source: Enryakuji 修行 page; Rhodes 1987]
• The route record. Rhodes says practitioners copy the stations into a personal handbook (tefumi) and do not show it to outsiders. The therapist should not ask to see it. [source: Rhodes 1987]
• Lay community. The Sokushō kō (息障講, "stopping-obstacles confraternity") of Kyoto and other lay supporters guide, protect and attend the walker. Ludvik describes lay route-guides, attendants, young monks and devotees. Lay people also join the Katsuragawa summer retreat (葛川夏安居) and the fire ceremonies. Enryakuji holds public special prayer services led by practitioners who have completed the thousand-day practice, and individual lay people can attend for a fee. Photography of the walkers is restricted and generally needs their permission. [source: Ludvik 2006; Enryakuji 千日回峰行者 特別祈祷]
• Rarity. Few people complete the long practice. Rhodes puts the total since 1571 at about forty and Ludvik at 49 since 1585, so the two counts differ. [source: Rhodes 1987; Ludvik 2006]

2b. The therapist's work alongside it

None of the sources gives a session count or format for psychotherapy with people involved in this observance. The phases below are the therapist's own framework. [synthesis]

Crisis criteria override any phase. If there is suicidal intent outside the tradition's symbolic frame, medical danger, psychosis or mania, or coercion, move at once to risk management and medical referral (see 4.5 and section 5). [synthesis]

3. Guiding principles

• Attribute, don't adjudicate. Fudō Myōō, buddha-nature and the "living buddha" status are the tradition's claims, so describe them in its terms. In practice: say "in your tradition…", never "that's just symbolic" or "that's real". [source: Vieten et al. 2013, competency 1; synthesis]
• The client leads on meaning. In practice: ask what the practice means to this person before you draw on scholarly accounts, which may not match their lineage or experience. [source: CFI Supplementary Modules; Vieten et al. 2013, competencies 4 and 7]
• Don't assume competence from membership. In practice: a lay devotee, a novice and a completer stand in very different relations to the practice, so ask rather than infer. [source: Vieten et al. 2013, competency 4]
• Stay within your role. In practice: you are not a Tendai teacher or a spiritual director. Questions of doctrine, whether to continue the practice and vows go to the client's own teacher or temple authorities. [source: Vieten et al. 2013, competencies 13 and 16; APA Ethics Code 2.01]
• Health questions go to the doctor. In practice: you do not judge whether a fast or exertion is medically safe. You raise the concern, document it and support coordination with a physician the client chooses. [source: APA Ethics Code 3.09; synthesis]
• Respect secrecy and privacy. In practice: don't ask for the route handbook, restricted teachings or mantra content, and don't photograph or publicise. [source: Rhodes 1987; Ludvik 2006]
• Keep the death vow and clinical suicidality distinct, and assess both. In practice: treat the vow and its symbols as religious material, and still assess current suicidal thinking with standard methods whenever there are signs of risk. [synthesis]
• Separate experience from pathology. In practice: altered perception during extreme austerity, such as the heightened senses Rhodes reports from the dōiri, is not in itself a disorder, but it may hide one. [source: Vieten et al. 2013, competency 6; Rhodes 1987; Lindahl et al. 2017]
• Distinguish faith from OCD by motive and norm. In practice: practice that goes beyond the tradition's norms and is driven by fear or guilt suggests scrupulosity, while practice driven by values does not. [source: IOCDF For Faith Leaders]
• Avoid romanticising. In practice: the "marathon monk" image in popular media can pull clients and therapists toward admiring the ordeal itself. Keep the focus on the client's welfare and goals. [source: Rhodes 1987 and Ludvik 2006 on media attention; synthesis]
• Collaborate only with consent. In practice: contact clergy, temple staff or confraternity members only with specific written consent, and agree with the client on exactly what may be shared. [source: APA Ethics Code 3.09 and Principle E; Vieten et al. 2013, competency 16]
• Watch for dual relationships. In practice: if you are part of the same temple community or confraternity, or attend public services led by the client, assess the multiple relationship before going ahead. [source: APA Ethics Code 3.05]

4. Intervention inventory

The items below are the psychotherapist's own work alongside the observance. None of them is a Tendai practice, and none tells anyone how to carry out kaihōgyō. Unless a source is tagged, the steps are clinical synthesis built on the sources named. [source: CFI Supplementary Modules; Vieten et al. 2013; IOCDF For Faith Leaders; APA Ethics Code; Lindahl et al. 2017; synthesis]

4.1 Exploring the meaning of the practice in the client's life

• Purpose: To understand what kaihōgyō means to this particular person. It might be their own vocation, a family member's ordeal, a devotional tie to a gyōja, or an inspiring story. Use this early, and again at transitions such as entering the practice, the dōiri, completion or withdrawal.
• Steps:
  1. Ask how the client is connected to the practice. Are they the practitioner, a relative, a lay supporter or confraternity member, a devotee who receives blessings, or someone outside the tradition?
  2. Ask what the practice means to them in their own words, using their own terms (Fudō, gyō, mangyō and so on). Write down their terms and use them.
  3. Ask how the practice relates to the reason they came: whether it helps, strains or is unrelated to the problem.
  4. Explore the values it carries for them, for example the Never Disparaging Bodhisattva's reverence for all beings, which Enryakuji names as the practice's spirit, and how those values show up in the rest of their life. [source: Enryakuji 修行 page]
  5. Reflect back what you heard and check that you have it right before you formulate.
• Example language (illustrative): "You've mentioned Fudō several times. Could you tell me what Fudō means to you, in your own words, rather than how the books explain it?" / "How does your brother's practice affect how things are at home?"
• Watch for: The client may be testing whether you will dismiss or exoticise the practice. Notice whether you are drawing on popular "marathon monk" narratives instead of the client's account. It is working when the client corrects you freely and uses their own vocabulary in session.

4.2 The Cultural Formulation Interview with the spirituality, religion and moral traditions module

• Purpose: A structured cultural assessment. The APA's supplementary modules to the CFI include Module 5 on spirituality, religion and moral traditions. It explores how the tradition shapes the person's problems, stresses and coping, and how their level of involvement affects coping. [source: CFI Supplementary Modules]
• Steps:
  1. Give the core CFI first: the client's definition of the problem, cultural perceptions of cause and context, cultural factors affecting self-coping and past help-seeking, and current help-seeking. [uncertain: core CFI content summarised, not verified item by item]
  2. Give Module 5. Its areas are identity and affiliation (including family members' traditions and any additional traditions), the tradition's role in daily and family life, home and community practices and how important they are, whether the tradition, its leaders, texts or practices have helped with the problem, and whether the tradition has contributed to stress, conflict or discrimination. Paraphrase in your own words and do not read out the items. [source: CFI Supplementary Modules]
  3. Add modules as relevant. Use Module 2 (level of functioning) when walking or seclusion affects work or family. Use Module 3 (social network) for the confraternity, temple and family. Use Module 7 (coping and help-seeking) for help from spiritual leaders. Use Module 8 (patient–clinician relationship) for preferences about the therapist's background. [source: CFI Supplementary Modules]
  4. Write a formulation that keeps the tradition's own account next to the clinical account and does not let either overwrite the other.
• Example language (illustrative): "Some people find their tradition a support, some find it a source of strain, and for many it's both. Where does your practice sit for you right now?"
• Watch for: Over-reading. Austerity that the tradition sanctions is not in itself a symptom. It is working when the formulation explains the presenting problem in terms the client accepts.

4.3 Role clarification, consent and the therapist's own commitments

• Purpose: To set out what therapy offers and what it does not. Vieten et al. say that drawing on clients' spiritual resources is not spiritual direction, and that psychologists should recognise the limits of their competence and consult, collaborate or refer. Use this at intake, and whenever the client asks you to rule on the practice. [source: Vieten et al. 2013, competencies 3, 13 and 16; APA Ethics Code 2.01 and 10.01]
• Steps:
  1. Explain early that you are not a Buddhist teacher and will not judge whether the client should undertake, continue or end the practice. Doctrinal questions belong to their teacher or temple.
  2. Explain what therapy will cover, its limits on confidentiality (including duties to act on imminent risk), and how coordination with doctors or clergy would work. [source: APA Ethics Code 10.01]
  3. Reflect privately on your own religious or secular commitments, for example admiration, scepticism or a personal Buddhist practice, and how they might shape your judgements. [source: Vieten et al. 2013, competency 3]
  4. Decide whether self-disclosure would serve the client. By default, keep it brief and only when it helps the client. [synthesis]
  5. Check for multiple relationships, such as membership of the same temple or confraternity, or attending services the client leads. [source: APA Ethics Code 3.05]
• Example language (illustrative): "I won't be advising you on your practice. That belongs to your teacher. What I can do is help with the sleep problems and the worry you've described, and work with your doctor if you'd like that."
• Watch for: A client who wants you to grant permission to stop or to continue. It is working when the client brings doctrinal questions to their teacher and clinical questions to you.

4.4 Accommodation in scheduling and treatment

• Purpose: To fit therapy around the demands of the observance. Walking happens at night (Rhodes says the walk starts after midnight), there are periods of seclusion, the rites are public, and the community has obligations. Use this whenever the client or a family member is in an active period of practice or support. [source: Rhodes 1987; Ludvik 2006]
• Steps:
  1. Ask about the client's calendar, including periods when contact will be impossible or unwise, such as seclusion, or when a family member's demands peak.
  2. Agree in advance on pauses, check-in points and how to re-start.
  3. Adjust homework and treatment tasks so they do not compete with religious obligations. Do not set tasks that add exertion or sleep loss. [synthesis]
  4. Offer flexible times or remote sessions for supporters whose schedules follow the walker's. [synthesis]
  5. Agree on what happens to the treatment plan if the practice ends early.
• Example language (illustrative): "Let's look at your year together. When will you be able to meet, when won't you, and how would you like to pick things up again afterwards?"
• Watch for: Accommodation sliding into avoidance of clinical problems. It is working when sessions continue predictably and gaps are planned rather than abrupt.

4.5 Health coordination: fasting, water restriction, sleep loss and exertion

• Purpose: Enryakuji, the Agency for Cultural Affairs and Rhodes all describe the dōiri as total abstention from food, water, sleep and lying down, and as dangerous to life. The walking demands extreme and sustained exertion. The therapist's job is to raise health concerns and route them to a physician, not to assess medical safety. [source: Enryakuji 修行 page; Bunka-chō ぶんかる 093; Rhodes 1987]
• Steps:
  1. Ask whether the client, or the practitioner they support, has a physician involved and whether the temple arranges medical oversight. Sources do not describe any medical oversight arrangements, so treat this as [uncertain: not verified].
  2. With consent, write to or speak with the client's doctor. Name the concerns (fasting, dehydration, sleep loss, exertion, existing conditions, medicines) and ask the doctor to advise. Do not advise on medicines yourself.
  3. Agree with the client on the warning signs that mean they will seek urgent medical care, using the doctor's guidance.
  4. For a supporting family member, focus on their own sleep, stress and caregiving load.
  5. Note the tradition's own provisions where the client or their teacher describes them. None of the sources describes medical exemptions. [uncertain: not verified]
• Example language (illustrative): "I'm not the right person to say what's safe for your body during this period, but your doctor is. Would you be willing for me to share my concerns with them?"
• Watch for: Minimising ("the practice will carry me"), refusing medical contact, or health problems that are clearly unrelated to the practice. It is working when a named physician is involved and the client knows when to seek help.

4.6 The death vow and death symbolism: respectful enquiry and suicide risk assessment

• Purpose: Rhodes reports that practitioners carry a sword and a death cord and are "pledged to kill themselves if they are unable to finish their practice". White robes and a ferry coin symbolise death, and the dōiri carries death-and-rebirth symbolism. Clinicians must neither treat this religious frame as psychopathology nor overlook real suicidal risk, including in practitioners who stop, are injured or feel they have failed. [source: Rhodes 1987; Enryakuji 修行 page]
• Steps:
  1. Ask respectfully what the cord, the sword and the vow mean to the client within their lineage. Teachers and practitioners may understand these as symbolic, literal or both, and none of the sources describes how this is understood today. [uncertain: not verified]
  2. Separately, and in plain terms, ask about current thoughts of death or suicide, hopelessness, plans or intent, and any recent crisis such as injury, enforced stopping or shame. Follow your service's current standard risk-assessment and safety-planning procedures.
  3. If risk is present, make a collaborative safety plan, involve crisis services as your standards require, and with consent involve trusted community members or the client's teacher.
  4. Document both the religious meaning and the clinical assessment.
• Example language (illustrative): "I'd like to understand what the cord you carried means in your tradition. And separately, because I ask everyone this when things are hard: have you been having thoughts of ending your life?"
• Watch for: Failure, injury or withdrawal reframed as a death obligation; shame-driven hopelessness; agitation; the client cutting themselves off from the community. It is working when the client can talk about the vow's meaning and their own safety as two different conversations.

4.7 Altered and challenging experiences: telling spiritual experience apart from illness

• Purpose: Prolonged sleep loss, fasting, exertion and continuous mantra recitation can bring unusual perceptions. Rhodes reports that during the dōiri the senses become acute, and one practitioner described hearing incense ash fall. Lindahl et al. (2017) documented challenging meditation-related experiences across cognitive, perceptual, affective, somatic, conative, sense-of-self and social domains. Some lasted months or longer, and some experiences valued during retreat later disrupted daily life. Use this when a client describes unusual experiences during or after intensive practice. [source: Rhodes 1987; Lindahl et al. 2017 via Brown University summary]
• Steps:
  1. Listen in the client's own frame first, and ask how their teacher and tradition understand such experiences.
  2. Map the experiences against the domains Lindahl et al. describe and ask about impact on functioning, sleep, work and relationships.
  3. Screen for psychosis, mania, depression and dissociation, and for medical causes. Sleep loss and fasting call for medical review via the client's doctor. Vieten et al. list telling spiritual experience apart from psychopathology as a core competency. [source: Vieten et al. 2013, competency 6]
  4. If symptoms persist or impair functioning, refer for psychiatric assessment without dismissing the spiritual meaning. DSM-5-TR includes a "religious or spiritual problem" category among other conditions that may be a focus of clinical attention (Z65.8).
  5. Use grounding and normalising: regular sleep, food and social contact after periods of practice, as agreed with the doctor. Lindahl et al. found that talking with someone familiar with these experiences helped. [source: Lindahl et al. 2017 via Brown University summary; synthesis]
  6. With consent, coordinate with the client's teacher about what is expected within the tradition.
• Example language (illustrative): "Some people find their perceptions change a lot in intense practice periods, and for some those changes carry on afterwards. How has it been for you since you came out of the hall?"
• Watch for: Disorganised thinking, grandiosity beyond the tradition's frame, not sleeping at all after the practice has ended, depersonalisation that does not fade. Trauma-sensitive adaptations of contemplative practice (for example Treleaven 2018) and the systematic review by Farias et al. 2020 are relevant background [uncertain: not verified]. It is working when the experiences are integrated or fading and functioning is recovering.

4.8 Scrupulosity: screening and ERP adapted with religious consultation

• Purpose: The observance involves exact routes, worship at every station, vows, purity of conduct, and strong pass/fail stakes. A client who is prone to scrupulosity may turn these into compulsions. The IOCDF describes scrupulosity as OCD with religious or moral obsessions. It may show up as fixing on minor details while neglecting central parts of the faith, or as avoiding religious practice. Shame often delays help-seeking for years. Use this when practice-related checking, reassurance-seeking or guilt is out of proportion. [source: IOCDF For Faith Leaders; IOCDF blog (McKee)]
• Steps:
  1. Compare the behaviour with the tradition's norms, ideally with input from the client's teacher. OCD-driven practice tends to go beyond the norm. [source: IOCDF For Faith Leaders]
  2. Assess the motive. Values-based practice goes with meaning, peace and gratitude. OCD-driven practice goes with fear, obligation, guilt and shame. [source: IOCDF For Faith Leaders]
  3. Formulate using exposure and response prevention (ERP), with the client's consent and, where they wish, with a religious authority consulted, so that exposures never require breaking genuine religious obligations.
  4. Build a graded plan aimed at excess compulsions, such as repeated checking of the route record, extra recitations to undo "mistakes", or seeking reassurance from clergy. Do not target the observance itself.
  5. Ask faith leaders, with consent, to reduce reassurance gradually and to respond with questions such as "What do you think?". The IOCDF gives tapering examples such as for confession. [source: IOCDF For Faith Leaders]
  6. Help the client reconnect with the tradition's values once compulsions ease. [source: IOCDF For Faith Leaders]
• Example language (illustrative): "Let's ask your teacher what the tradition actually requires here. Then we can work on the extra checking that goes beyond that, which seems to be driven by fear."
• Watch for: The therapist designing exposures that violate religious commitments, and clergy who keep reassuring. It is working when distress and time spent on rituals fall and the practice feels less fear-driven.

4.9 Moral injury, shame and withdrawal from the practice

• Purpose: The practice is public and its stakes are framed as life-and-death, so not finishing, being injured, or being judged unsuitable may bring profound shame or a sense of having betrayed a vow, the teacher or the community. Use this after a stop, a failure, or a conflict with the community's expectations. [synthesis, informed by Rhodes 1987 on the vow]
• Steps:
  1. Explore what the client believes the tradition says about not finishing, and what they believe about themselves.
  2. Separate the voices: the teacher's, the community's, the tradition's texts, and the client's own self-condemnation.
  3. With consent, invite the client to bring the doctrinal question to their teacher, for example how the tradition understands an unfinished practice. Do not offer theology yourself.
  4. Use compassion-focused or acceptance-based work on shame, in the client's own language. [synthesis]
  5. Reassess suicide risk (see 4.6).
• Example language (illustrative): "You've said you feel you broke your word. Whose judgement weighs on you most, your teacher's, the community's, or your own?"
• Watch for: Withdrawal from all community contact, rumination and hopelessness. It is working when the client can hold the event without global self-condemnation and has re-established some community or spiritual connection they value.

4.10 Grief, ritual and community support

• Purpose: Families and lay supporters face long periods of worry, separation, and possibly the practitioner's decline, while the community's rites (the Kyoto blessing walk, fire ceremonies, the Sokushō kō) can be sources of support. Use this with relatives and supporters, and after bereavement or when someone leaves monastic life. [source: Ludvik 2006; Enryakuji 千日回峰行者 特別祈祷; synthesis]
• Steps:
  1. Map supports: the confraternity, temple contacts, family and secular friends (CFI Module 3).
  2. Name anticipatory grief and fear openly for families.
  3. Encourage participation in community rites if the client finds them meaningful, and respect withdrawal if they don't.
  4. For a person leaving monastic life, work on the loss of identity, community and role, and on rebuilding practical life. [synthesis]
• Example language (illustrative): "While your son is on the mountain, who checks in on you?"
• Watch for: Isolation, and supporters neglecting their own health. It is working when the client has supports that work and grief is moving rather than frozen.

4.11 Collaboration with clergy and temple authorities

• Purpose: To coordinate care with the client's teacher, temple priests or lineage authorities, who hold the religious authority over the practice, when the client wishes. Vieten et al. list consultation and collaboration with clergy as part of competence. The APA code requires cooperation with other professionals where appropriate and training, consultation or referral where religion is essential to effective services. [source: Vieten et al. 2013, competency 16; APA Ethics Code 2.01 and 3.09]
• Steps:
  1. Get specific written consent: who, for what purpose, and what may and may not be shared.
  2. Agree a narrow question, for example what the tradition expects of a monk who stops for health reasons, or how to reduce reassurance-giving.
  3. Respect the community's own authority and confidentiality, and do not ask for restricted teachings or the route record.
  4. Feed the outcome back to the client and let them decide how to use it.
• Example language (illustrative): "Would it help if I spoke with your teacher about the sleep plan your doctor suggested? You can decide exactly what I say."
• Watch for: Pressure on the client to share more than they want; triangulation between therapist and teacher. It is working when the client experiences the collaboration as support, not surveillance.

4.12 Clients outside the tradition who model themselves on the "marathon monks"

• Purpose: Rhodes and Ludvik note that broadcasts and books have spread wide public interest in the practice. Some clients may take it up as a template for self-designed ordeals of extreme walking, fasting or going without sleep. Use this when a client describes personal austerities justified by the kaihōgyō story. [source: Rhodes 1987; Ludvik 2006; synthesis]
• Steps:
  1. Explore what draws them: discipline, meaning, atonement, identity, or control.
  2. Point out, without judgement, that the observance as the sources describe it takes place within an ordained monastic setting, lineage and community. A self-designed imitation has none of these.
  3. Screen for eating disorders, exercise compulsion, self-harm, mania and suicidality, and route health questions to a doctor.
  4. If the interest is spiritual, suggest learning from Tendai institutions directly. Enryakuji, for example, holds public prayer services that lay people can attend. [source: Enryakuji 千日回峰行者 特別祈祷]
• Example language (illustrative): "What is it about the monks' practice that speaks to you? I'm curious what you hope it will do for you."
• Watch for: Restriction or exertion that is escalating, secrecy, and "proving" oneself. It is working when the underlying need is named and pursued safely.

4.13 After completion: public role and integration

• Purpose: Completers receive the title dai-ajari, lead public prayers and give blessings, and attract devotion and media attention. The shift from practice for oneself to practice for others carries public expectations. Use this if a completer or someone close to them seeks therapy. [source: Ludvik 2006; Rhodes 1987; Enryakuji 千日回峰行者 特別祈祷; synthesis]
• Steps:
  1. Respect the role. Explore how the client manages public reverence alongside ordinary needs.
  2. Ask about physical after-effects and route them to a doctor.
  3. Attend to the boundaries of power in relationships with devotees. [synthesis]
• Example language (illustrative): "Many people look to you now. Where do you get to be simply yourself?"
• Watch for: Isolation inside the role, and exhaustion. It is working when the client has private relationships and supports.

5. Handling problems

The sources on kaihōgyō do not address psychotherapy, so everything in this section is [synthesis] unless a source tag says otherwise.

• The client wants you to approve or forbid the practice. Restate your role (4.3). Separate the clinical question ("What does your doctor say about your health?") from the religious one ("What does your teacher say about continuing?"). Offer to support a conversation with either. [source: Vieten et al. 2013, competencies 13 and 16]
• The client refuses medical contact. Explore the reasons, for example fear of being stopped, or a belief that medicine contradicts the practice. Do not argue doctrine. Offer a narrower step, such as the doctor knowing only the timing of the practice. Document the concern and the client's decision. If danger is imminent, follow your jurisdiction's duty-of-care procedures. Do not give medical or medication advice yourself.
• Signs of acute medical or psychiatric danger during or after a seclusion or walking period (confusion, collapse, severe dehydration signs reported by the client or family, psychosis, mania). Treat these as an emergency and use emergency medical services. Contact the teacher or temple only as consented, or as emergency law allows.
• The death vow comes up in a crisis. Assess suicide risk directly and follow current standard risk-assessment and safety-planning practice, while showing respect for the vow's religious meaning (4.6). If the client wishes, involve the teacher. Clarify with them how the tradition actually understands an unfinished practice, rather than assuming either a literal or a symbolic reading. [uncertain: present-day teaching on the vow not verified]
• Overwhelm after intense practice (sensory hypersensitivity, insomnia, fear, loss of sense of self). Use grounding: regular sleep, food (as the doctor advises), social contact, and less input. Screen for psychiatric illness (4.7). Lindahl et al. found that talking with someone who knows these experiences helped, so consider connecting the client with the teacher or with a peer who has been through it. [source: Lindahl et al. 2017 via Brown University summary]
• Stuck in shame after stopping. Use 4.9. Ask whether the tradition has its own ways of reintegration or reframing, and invite the client to ask their teacher. Do not supply theology.
• Scrupulosity that looks like devotion. Clergy and family may admire extra recitation or checking. Use the IOCDF distinction between norm and motive, and plan a gradual reduction in reassurance with consenting faith leaders (4.8). [source: IOCDF For Faith Leaders]
• Non-adherence to therapy tasks. First check whether tasks clash with practice obligations or add fatigue. Simplify them and fit them to the calendar (4.4).
• Rupture over the therapist's stance. Signs include the client feeling exoticised ("the marathon monk"), pathologised, or recruited into your own views. Name it, apologise for what you got wrong, ask what felt off, and go back to the client's own terms. Review your own reactions, and seek consultation if your religious or secular commitments are influencing you. [source: Vieten et al. 2013, competency 3]
• Power and coercion concerns. Documented misconduct connected with kaihōgyō: none found in the sources consulted. If a client describes pressure to continue despite medical danger, punishment for stopping, isolation from family, or exploitation by anyone in a position of authority, assess for coercive control. Support the client's own choices, consider safeguarding and legal duties, and do not make the teacher your default collaborator in that case. Help people leaving religious life with loss, identity and any religious trauma they report.
• Children and young people. None of the sources describes minors undertaking kaihōgyō. They describe ordained monks as practitioners, with young monks (kozō) among those who attend the walker (Ludvik). If a minor is involved in severe austerity of any kind, follow local safeguarding procedures. [source: Ludvik 2006; synthesis]
• The client is a public figure in the tradition. Protect confidentiality carefully, for example over appointment visibility and records. Avoid attending services the client leads unless you have assessed the multiple relationship. [source: APA Ethics Code 3.05]
• The therapist's own fascination or disapproval. Use supervision. Admiring or condemning the ordeal can both pull you off the client's agenda. [source: Vieten et al. 2013, competency 3]
• Language and translation. Ask for and use the client's Japanese terms, and check your understanding of them. Prefer interpreters who are familiar with Buddhist vocabulary, and have the client confirm key meanings. [source: CFI Supplementary Modules (cultural identity); synthesis]

Sources

Web sources:

• 修行｜延暦寺について (Training, Hieizan Enryakuji official site)
• 千日回峰行者 特別祈祷 (Special prayer by thousand-day practitioners, Hieizan Enryakuji)
• 文化財のトビラ 093: 伝教大師1200年大遠忌記念 特別展『最澄と天台宗のすべて』 (大澤信, 文化庁「ぶんかる」, 2022)
• Rhodes, R. F. (1987). The Kaihōgyō Practice of Mt. Hiei. Japanese Journal of Religious Studies, 14(2–3).
• Ludvik, C. (2006). In the Service of the Kaihōgyō Practitioners of Mt. Hiei: The Stopping-Obstacles Confraternity (Sokushō kō) of Kyoto. Japanese Journal of Religious Studies, 33(1), 115–142.
• American Psychiatric Association (2013). Supplementary Modules to the Core Cultural Formulation Interview (CFI).
• Vieten, C., Scammell, S., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2013). Spiritual and religious competencies for psychologists. Psychology of Religion and Spirituality, 5(3), 129–144.
• American Psychological Association. Ethical Principles of Psychologists and Code of Conduct (2002, amended 2010 and 2016).
• IOCDF. For Faith Leaders.
• IOCDF Blog. Discussing faith and OCD (McKee).
• Brown University (2017). Study documents range of challenging meditation experiences (summary of Lindahl et al. 2017, PLOS ONE, doi:10.1371/journal.pone.0176239).

Further references, all [uncertain: not verified]: Farias et al. (2020), systematic review in Acta Psychiatrica Scandinavica; Treleaven (2018), Trauma-Sensitive Mindfulness; Cheetah House resources; the DSM-5-TR text on "religious or spiritual problem"; Kodera (1979), cited by Rhodes for the four historical phases.

ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem')