Among the most common problems facing young women in this age range and those in their twenties I would definitely include eating disorders, depression, anxiety and obsessive compulsive behavior. Many who come for counseling often give as their reason for doing so as experiencing problems in forming “ningen kankei” which is often directly translated as “human relationships” and covers both personal relationships inside and outside the family and also in more general social environments such as at college or within a company.

…. Also how is it treated there?

As in any country treatment varies considerably depending on the psychiatrist providing that treatment. Perhaps I should first explain that some psychiatrists here may still regard mental health care and other psychological support services to be solely within their ‘domain’ and simply don’t see or understand the need for counseling from other health care providers as an integral part of the treatment of anorexia or any other kinds of psychological disorders. They tend to take a completely pharmacological approach to treatment, in some cases sometimes seeing the client for several minutes only, prescribing medication and offering very little in the way of counseling or other forms of psychological support. However I think it’s fair to say that among the majority of psychiatrists here there are many very gifted and skilled doctors who place a stronger emphasis on a teamwork approach to psychiatric care and counseling and who would favor combining their own psychiatric and diagnostic skills with individual and family counseling at independent counseling centers, university student counseling centers or by referring to other medical specialists.

What’s the difference between a psychologist and a psychiatrist here?

Basically a psychologist is a trained counseling and group therapy mental health care provider providing psychological and social support services. A psychiatrist is a medical doctor who is also a trained mental health care provider but who, as a medical doctor, is licensed in Japan (‘kokkashikaku’) by the Ministry of Health and Welfare to diagnose, prescribe medication and provide treatment. Some people find it easier to have counseling with a registered mental health counselor (clinical psychologist or psychotherapist) rather than a psychiatrist. But of course counselors, psychotherapists and psychiatrists are concerned with the same fundamental aim: to help the client find a solution to their problem whether it is mainly a social, emotional or mental problem.

It is worth mentioning that the situation at present in Japan is that only medical doctors are legally nationally qualified and licensed (kokkashikaku) by the Ministry of Health and Welfare to diagnose, provide treatment and/or prescribe medication. C.P.s here are board certified by the Japan Society of Certified Clinical Psychologists to provide counseling services in the form of client centered psychological and support services. It is neither ethical nor legal for anyone other than a medical doctor licensed by the Japanese Ministry of Health and Welfare, regardless of whether they may be qualified or licensed to do so in states or countries abroad, to be offering diagnosis (“shindan”) or treatment (“iryou”) as part of their counseling services in Japan.

Are people in Japan still reluctant to seek counseling in your experience?

Yes, compared to the situation in some other countries some people here may still be reluctant to seek counseling, although overall I would say that overall counseling has gained greater social acceptance, especially over recent years.

One reason for this is that there is still quite considerable prejudice against people facing emotional and psychological issues in some quarters of Japanese society and some people here consider mental illness within the family could be seen as being cause for a sense of “social shame” known as “haji”. For this reason, in some cases, people receiving counseling may try to conceal the fact from their families and in other cases it can be difficult to convince parents of the need for psychiatric treatment for their children.

However recently social attitudes are beginning to change a lot and younger people in particular are becoming more positive in their attitude towards counseling and so it is gaining a greater degree of social acceptance. Also it appears to be the case that men here have a better understanding and are more willing to accept the benefits of counseling services, particular with regards to stress management and family counseling, than was the case several years ago.

If you are not already qualified and certified to offer counseling services here as a Clinical Psychologist by the Foundation of the Japanese Certification Board for Clinical Psychologists (Nihonrinshoushinrininteikyoukai) then please take steps to do so. Over 95% of university graduates from masters courses in psychology in 1999 went on to gain further experience and study for the JSCCP exam to become JSCCP board certified CP’s. You can find out more about how to qualify here as a clinical psychologist in the “Counseling and counselors” section above.

If you have a BA in Psychology or other relevant first degree that’s a good first step but if you are seriously considering becoming a counselor/psychotherapist in Japan you will have to go on to graduate with a master’s degree. Since April 1996 only MA and Ph.D. level candidates are now eligible to apply for qualification as a clinical psychologist.

Sounds obvious but……

Do keyword searches using Japanese search engines and directories in Japanese. For example, entering “Japan clinical psychology” in Japanese will produce 100 times more useful results than searching for “Japan clinical psychology” in English.

May sound even more obvious but…..

Whether you are Japanese or not it may not create the impression you want to if you write saying you are looking for a job as a “bilingual counselor”. Japan like any other country has good mental health who want to assist ALL people regardless of the clients’ nationality and the language they speak. Being able to speak English or other languages can be a useful skill at times but is perhaps best not regarded as a way to avoid (re)adjustment into Japanese society.

In a country where until relatively recently there were not as many opportunities to gain experience through official ‘internship programs’ as in other countries even qualified therapists often find career opportunities initially through volunteering at counseling centers and community organizations.

If you are not Japanese and do not yet have the JSCCP or PSW (Psychiatric Social Worker) qualifications and are seriously considering working here as a useful and effective mental health counselor or JFP (Japanese Federation for Psychotherapy) psychotherapist within the mental health professional community here in Japan you should:

1. learn to speak and understand Japanese.

2. gain a good working knowledge of Japanese society, culture and values.

3. not consider working with Japanese or clients of any other nationality in English unless you understand Japanese too.

4. be prepared to be patient. It takes longer to become established and respected here. If you simply are looking for a relatively more relaxing and financially rewarding way to experience a year or two living and experiencing life in Japan and have more vacation time to enjoy it you could probably achieve this in less demanding occupations.

5. be prepared to study at least to masters level in order to become fully qualified to work as a mental health care professional in Japan.

6. make contact with and establish an effective working relationship within a Japanese hospital/clinic which has psychiatrists on staff who are nationally licensed in Japan to provide treatment and diagnosis, or find a position within an established counseling center which also has the resources, connections and an effective working relationship with a Japanese hospital/clinic with psychiatrists on staff who can support your clients in situations where they are in need of immediate recommendation to an established medical institution for medical support or hospitalization.

7. Finally I would also clearly advise against thinking about seeing clients in you own apartment and giving out your personal phone number. There are many social, cultural, professional and ethical reasons for not doing so in Japan. At the least you could find yourself feeling unsupported, vulnerable and socially isolated. It could also lead to unforeseen problems for both your clients and for yourself to do so.