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Mad City

Crazy world got you down? Daneeta Loretta Saft talks to some people who can help.



"Psychotherapy is best described as a helping profession. Therapists are trained to examine their client' coping, communication and life skills. Once problem areas are pinpointed and confronted, change can take place, and the therapist supports the clients with their new challenges. It is not easy. It is often painful. It is work, and it requires a commitment." Lisa Mowrey

On any given day in Tokyo, it seems half of the people around me are going crazy. Stressful work environments, unhealthy lifestyles, culture shock, and homesickness all associated with living in a foreign environment add to whatever psycho-baggage we've brought with us. Things can get pretty heavy here, and when people crack, friends and family may not always recognize the call for help or be able to help even if they do. I recently interviewed a psychiatrist, a psychotherapist and two patients* about their experiences here in Tokyo.

Counselors and psychiatrists
The major difference between psychiatrists and counselors is the training. Both may have PhDs, both are trained in talk psychotherapy, but a psychiatrist also has an M.D. How important of a distinction is this? Dr Doug Berger, who has been practicing psychiatry in Japan for some years, explains. "Conditions such as manic depression and schizophrenia are caused by chemical imbalances. A psychiatrist is trained to recognize these imbalances and qualified to prescribe medication to treat them." Counselors, on the other hand, are trained mostly in talk therapy. They may recognize an imbalance and suggest that their patients visit a psychiatrist, but they cannot diagnose such conditions and prescribe medication.

That's not to say that someone without a PhD can't effectively shrink your head. "I had never been to a mental health practitioner in Canada," says Ruth, a 37-year-old investment consultant. "When a friend of mine suggested that I see one here to help me deal with the stress of my job, I balked at the fact that she only had a master's degree in counseling psychotherapy." Ruth changed her tune when she found that she could work with her therapist to deal with not only her stress, but some older issues as well.

What to expect
Every therapist is different. Some specialize in certain disorders, most have their own opinions about schools of psychology (Freudian, Jungian, Gestalt), some are more aggressive than others, and some you may take a pass on - nothing wrong with that. Many psychotherapists believe it is important for the patients to come to realizations about their behavior on their own so they generally won't say "Well, I think you're an alcoholic with suicidal tendencies."

Talk therapy is basically you talking and them listening and asking questions. Psychotherapists may also incorporate alternative methods of therapy like guided meditation and hypnosis, give you homework and suggest that you attend support group meetings in conjunction with your therapy.

Trust is the key. "If the therapist can't build a bond with the client, then therapy just isn't going to take place," says Lisa Mowrey, a practicing psychotherapist. "It may take weeks or months to develop that trust. Some people just may not be ready to lay it all on the line. They'll tell you little things first, then, after months of therapy, they'll suddenly tell you a big secret that they've been holding on to." Others will be ready to work fast as soon as they enter therapy. They've gone as far as they can go on their own, and they know they need help.

Also important is the knowledge that it usually isn't easy to dig into your own personal nightmares: "At first I didn't like my therapist," says Mike, a 28-year-old English teacher. "Then I realized that it wasn't him that I didn't like, it was having to deal with all of these things that happened in my past. I was directing all of my anger at him. It hasn't been easy, but it's been worth it."

So what kinds of things are we dealing with here? "Most of the psychological problems seen in the foreign community in Japan seem to be part of difficulties people had well before they came to Japan," says Berger. Berger doesn't belittle the fact that living in a foreign environment is stressful, however: "One's stress, perception of stress, and ability to cope with stress are important factors that predict one's adaptation to a foreign culture." When the ability to cope with stress breaks down for whatever reason, it may be time to seek out help.

Cost
Psychotherapy is not cheap anywhere. In Tokyo, most counselors start at JY10,000 per hour (one hour every week... well, you do the math). Tokyo English Life Line (TELL) offers free help in a crisis, and the TELL Community Counseling Service and Ikebukuro Counseling Center both offer a sliding scale fee system for people who can't afford full fare.

There are many English-speaking, licensed therapists in Tokyo. Both patients said that they hesitated going to see a therapist because it had such a stigma in their home countries - seeing a therapist means you're crazy. "It doesn't seem to be the same here in Tokyo. I'm much more open to the idea of seeing a therapist here than in England. Maybe it's because we have to be pretty open-minded to live in a different culture anyway. Or maybe it's simply because no one back home will find out. But after a year of therapy, I really don't care who knows. I'm just glad that I've started to heal."

Lisa Mowrey practiced psychotherapy in Tokyo for nearly four years. She has recently rotated back to the US. Dr Berger practices in Tokyo and can be reached at 03-3716-6624. Contact TELL Community Counseling Service at 03-3968-4084 and Ikebukuro Counseling Center at 03-3980-8718. See the Looking Good section and At Your Service listings in Tokyo Classified for other practitioners in the Tokyo area.

*Patient names have been changed.

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