Hikikomori (social withdrawal), a phenomenon characterized by avoidance of social participation, has already been discussed from various perspectives such as personality and pathology. In our clinical practice (ca. 370 cases in Japan) we found two types of psychic functioning in Hikikomori.

One concerns withdrawn patients who suffer from psychic conflict. They are considered treatable with psychodynamic therapy. The other consists of patients who avoid psychic conflict. They are considered difficult to treat with psychodynamic therapy, and are closer to borderline and psychotic cases. Psychodynamic therapy is difficult for the latter patients because their isolation fostered by videogames and Internet use does not help them to use their affective representations.

In conclusion, elements that influence the effectiveness of psychodynamic therapy include whether the patient expresses conflict, whether the family relationship is taken into consideration in psychodynamic therapy, whether the patient expresses his/her emotions, and whether the patient is absorbed in the world of images of videogames and the Internet.