Counseling and Psychotherapy in Japan
Counseling and Psychotherapy in Japan – “Bottling Up Emotions or a Problem Shared is a Problem Halved?”
Understanding the Availability and Acceptance of Mental Health Support in Japanese Society
By Dr. Nicolas Dermota, PhD – Licensed Clinical Psychologist
As a psychotherapist practicing in Japan for many years, I am often asked by Western colleagues what mental health care looks like in Japan. Do people seek therapy here? Are the methods different? And how is mental health perceived in Japanese society? These are complex questions—and after years of practice, I can confidently say there is no simple answer.
Japan is currently experiencing a mental health awakening, yet deeply rooted traditional values still influence how individuals seek (or avoid) psychological support. Let’s take a closer look at the cultural foundations to better understand this contrast.
Cultural Roots of Mental Health in Japan
As early as 604 AD, Prince Shotoku of the Yamato clan published a Confucian-influenced document emphasizing social harmony, respect for authority, and self-restraint. This ethos promoted suppressing personal needs and avoiding burdening others with negativity—a concept that continues to shape societal behavior today.
In contrast, Western psychology, influenced by thinkers like Friedrich Nietzsche and Søren Kierkegaard, champions individuality and authenticity. In Western societies, people are encouraged to express their inner needs and seek personal growth through dialogue and introspection. The value systems couldn’t be more different.
This cultural divide becomes apparent when examining mental health statistics. While an average of 52% of people in the U.S. and Europe seek therapy, in Japan the figure is just 6%. Officially, Japan reports a 10% rate of depression, compared to 30% in the West—yet it ranks 3rd among OECD countries in suicide rates (behind only Korea and Hungary). Clearly, mental suffering exists, but Japanese individuals are far less likely to speak with a mental health professional about anxiety, depression, or emotional pain.
Instead, the societal ideal is to endure—referred to as Gaman (我慢), meaning to persevere or endure without complaint. This quality may be admirable in minor crises, but in serious emotional distress, suppression becomes dangerous. In such cases, emotional connection is crucial—whether through a partner, a close friend, or a licensed therapist. Only through human connection can we diffuse what would otherwise become an escalating emotional spiral.
The Emergence of Mental Illness Awareness in Japan
An interesting case study of Japan’s struggle with accepting mental illness is the introduction of antidepressants. In the late 1990s, major American pharmaceutical companies failed to establish drugs like Prozac in the Japanese market. The message was clear: “Japanese people don’t believe in depression.” It wasn’t until 2006, when a Japanese firm rebranded depression as a “cold of the heart” (心の風邪, Kokoro no Kaze), that mental illness slowly entered public consciousness.
Today, psychiatric medication is much more accepted. However, talk therapy—counseling and psychotherapy—still faces societal stigma. Seeking therapy is often seen as self-indulgent or a sign of weakness. Making matters worse, psychotherapy is not covered by Japanese national health insurance, so clients must pay 100% out of pocket. There is also no comprehensive law protecting the professional status of psychologists, which undermines the profession's credibility.
Although Japan has about 41,900 licensed clinical psychologists (as of 2023), few are employed full-time. Many never practice, a phenomenon dubbed “paper drivers” (those who hold a license but never use it—like unused driver’s licenses).
Nevertheless, public awareness is slowly growing. New workplace laws encourage companies to take employee mental health more seriously. Educational initiatives aim to introduce mental health awareness in schools. Even AI-based programs are being developed to help individuals open up about their feelings without shame.
Therapy Methods: West Meets East
As for psychotherapeutic approaches, early Japanese psychiatrists were influenced by Freud, Adler, and Jung, leading to a surge in Western-style clinical psychology between 1912 and 1926. Today, Western modalities dominate Japanese therapy rooms. However, Japan also developed two unique approaches: Morita therapy and Naikan therapy. Naikan therapy asks clients: 1) “What did your close ones do for you?” 2) “What did you give back to them?” 3) “What harm did you cause them?”
Notably, the question “What harm did others cause you?”—central in many Western therapies—is omitted. This reflects the cultural emphasis on empathy and accountability, rather than grievance or victimhood.
Even with increasing acceptance of Western models, traditional values like Omotenashi (おもてなし, hospitality) and Omoyari (思いやり, compassion for others) continue to discourage people from “disturbing the harmony” with personal distress. In times of crisis, rather than share, many individuals withdraw. But as we've seen, this silence can be dangerous.
Toward a New Mental Health Culture
So, how is mental health counseling in Japan evolving? Progress is happening, albeit slowly. Attitudes are shifting. Still, cultural norms like Gaman and Omoyari remain strong, often preventing individuals from reaching out. We can only hope for more public discourse, education, and normalization of help-seeking behavior.
In Austria, we say: “A problem shared is a problem halved” (“geteiltes Leid ist halbes Leid”). And this is something I see proven time and again in my work as a psychotherapist in Tokyo.
You may also be interested in: https://refugiumtokyo.com/mental-health/tipps-for-the-gaijin-life-german