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how to assist my doctor in therapy

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I live in Japan and in this rural area there is only one psychiatrist who can speak a little English. Up until now we just meet to get my prescription for anti-depressants refilled, but I told him last session I would like to try weekly therapy sessions. My Japanese is OK, his English is Ok, so how can we proceed? I know we will go slow and both need to be patient. Any suggestions about how I can be proactive and cooperative in the process so not all the pressure is on him?


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Guest ASchwartz

Hello PP,

I do not know the psychology and psychiatric situation in Japan at the present time but I have met Japanese psychiatrist in the past and I know, from what they said then, about 15 years ago, there is not much available to people. The reason is cultural: there is a deep sense of shame with regard to anything that is even remotely connected to depression, anxiety and mental illness. It is not that people do not suffer from these. They do. But, they would rather keep it secret and work out their problems through the family.

So, perhaps others have more updated information but, I would be surprised, interested, but surprised if things have improved very much there.

Do others have some info. for PP??


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Hi PatPaul,

As in other cultures where language and beliefs are so distinct, moving slowly and making sure he/she understands and you understand are key. I have worked, over the years, with clients from China, Vietnam, Japan and several other countries... it can be most difficult. I use a cross cultural assessment before I start so that I understand their values and the level of "assimilation" to the American culture. Some seek to be re-patterned into their culture, others are moving to become more Americanized, so learning to respect this is critical.

Good luck,


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I agree with David.

I did some counselling while I lived in Russia. I mostly counselled English speakers but some Russians as well because there therapy isn't readily available or adequate.

I especially agree about the cultural difficulties. But....this is a place where you have an advantage that your psychiatrist may not. You have experienced both cultures. Remember this as you choose your words and as you hear his responses. How do the things he says, which is based on his understanding of Japanese culture translate to you, as an american, living in Japan. Make sure the person understands you and knows where you're coming from even if you have to reword it several time to get your point across. (You may even need to feed him those cultural differences that may apply to what you're going through. But....be careful that those cultural differences and potential biases won't be a detriment to you. Ask a lot of questions before starting (which you should anyway no matter who you see)

I know for me....the situation was opposite because I was the one living in a foreign country. I was very much immersed into Russian life but despite this, I needed to be very careful when counselling my Russian clients, not to slip into my more comfortable American thinking.

If you decide to give it a try, it's a process that you will have to be patient with.

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You just triggered a another thought... I always have to check my own ethnicity at the door. I'm a 1st generation immigrant to the US and have all sorts of cultural conflicts, hourly, daily, so even here, I need to be twice as culturally competent. On the other side of this is my view that b/c I'm Hispanic, I can work with "my people" w/o having to be as watchful and careful, after all, they're from my country or speak my language-- not so! I've screwed more therapy sessions with this egocentric viewpoint than in any other place.

Ooops, sorry PP, I sort of derailed your thread a little.. mea culpa, mea culpa.

Oh, by the way, when I first read your question, I thought you lived in China and that you had an appointment with a Chinese psychiatrist... my 1st thoght was "OH Sh!+"... they are an extension of the police state and are notorious for involuntarily committing patients who may be "politically harmful" to the state by giving such diagnosis as "political maniacs", "delusions of reform" or "paranoid psychosis". My wife and I spoke with several family members of dissidents who had been committed (especially members of the Falun Gong-- look it up) for speaking out against their government. They have built and continue to build " forensic hospitals," known as Ankang, which means “peace and health or happiness” and are operated not by the Ministry of Health, but by the Ministry of Public Security.

Good luck on you session and please let us know how it goes.


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