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Mental health and counseling in Japan: a path toward societal transformation.

Article Excerpt
The collectivist Japanese culture has been influenced by Westernization and internationalization. Today's Japanese mental health problems reflect the confUsion among Japanese individuals who live in an unstable period between enduring interdependent cultural values and emerging Western values of independence. This article underscores the importance of mental health counselors working congruently within Japanese society by incorporating the social justice perspective. A conceptual framework for optimal societal adaptation is presented. The proposed model consists of action-oriented outreach and advocacy designed to create societal transformation to foster psychological well-being and reduce existing stigma about psychosocial problems and treatment. Mental health issues in the changing climate of contemporary Japan are illustrated. Emphasis is placed on culturally specific trends and resources in order to prevent conflicts and to maintain harmony among individuals within the changing societal systems.

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A recognition of the need for counseling has become much more apparent among the Japanese public since the economic crash of 1992. A bubble economy that made Japan the world's second largest economy in the late 1980s ended in great financial disruption and the worst Japanese recession in history (Kinugawa, 2002). This drastic period brought about many personal and social problems that increased the need and demand for mental health treatment. As the Japanese perception of counseling services changed, the number of mental health professionals increased. Western practitioners have been invited as guest speakers and trainers at universities and professional conferences as seen at the 2004 World Congress of Behavioral and Cognitive Therapies held in Kobe, Japan. Many Japanese graduate schools use non-translated American textbooks and periodicals to deliver the latest theory, practice, and research.

A major challenge remains for Japanese professionals to identify and implement culturally relevant and effective services. In Japan, the modification of traditional Western counseling approaches, however, seems to be minimally effective as the individualistic/independent and Eastern collectivistic/interdependent cultures collide. According to Markus and Kitayama (1991), Japanese people, and other Asians, hold an interdependent construal of the self, which is clearly different from an independent construal of self as seen in many Western cultures. An interdependent-self construal has a strong orientation to relational and other environmental contexts, both of which are important factors for defining the self in Japan. The Western independent self, on the other hand, is relatively firm and separated from social context and uses a perceived relationship with others to compare and evaluate the self.

Because the interdependent self consists of a strong orientation to the social environment and relational factors, mental health counselors of Asian clients must take into account and carefully explore the surrounding context in which clients' problems are perceived and presented. In the context of multicultural counseling, Yeh and Hwang (2000) asserted the importance of the contextual examinations as follows:

Specifically, a client's self and particular concerns, such as relationships with friends, family, and partners; personal and professional decision making and choice gender role; and racial identity. These concerns should not be addressed solely as intrapsychic phenomena contingent on deficient internal attributes and processes. Rather, an interdependent perspective proposes that the counselor address the client's concerns by examining the surrounding context that shapes the client's experience, interactions, and sense of self. (p. 425)

By using a case illustration, these scholars delineated the ethnic identity formation of a Chinese American and suggested interpersonally oriented goals to assist the client in integrating the two different cultural orientations. Although their overall counseling implications are valuable, the counseling that they describe still rests within the concept of individual counseling as opposed to interventions involving a client's social context.

Conventional mental health counselor-client activities and service modes (i.e., individual, couple, family, and group) for minorities in the United States recently have been criticized by scholars (e.g., Ivey & Collins, 2003; Prilleltensky, 1997; Ridley, Baker, & Hill, 2001: Vera & Speight, 2003). They argue that effective intervention must go beyond the scope of traditional counseling practices: multicultural counselors must work within the community, institutional, political, and related social systems and address social injustices that exist in the United States. In the Japanese context, a social justice perspective is vital for generating a healthy social environment for all Japanese individuals.

In this article, the author first addresses the need for professionals to work with and within society by illustrating major mental health problems in contemporary Japan. In the second part of the article, the author presents a conceptual framework for optimal adaptation to recent societal changes by incorporating a social justice perspective into the notion of the interdependent Japanese culture. This framework emphasizes broad, system-wide intervention to create a social transformation that could, in turn, provide a sufficient social context in which the interdependent self of the Japanese culture might thrive.

MENTAL HEALTH PROBLEMS TODAY: FOCUSING ON SOCIETAL CHANGE

Westernization in Japan began with the U.S. occupation after World War II. Economic and political restructuring led to stability and eventually a democratic process....