Mental Health and Psychological Needs of Japanese Clients in the U.K. Counselling and Psychotherapy Resources
Dr Yoko Totsuka, Japan Psychological Practice
Japanese nationals in the UK and their mental health needs
Since I started to work with Japanese clients in the U.K. as a Japanese psychologist and psychotherapist, I have received many inquiries not only from Japanese clients and their families, but also from English speakers including partners and friends of Japanese individuals and professionals looking for services on behalf of their Japanese clients. I wrote this article to provide some background information in hope that this will help Japanese people engage with services with support of those who are concerned about their welfare.
The number of Japanese nationals living in the UK has increased over the past few decades with the development of Japanese businesses abroad and the growing interest in education offered in the U.K. According to the Embassy of Japan, 50,531 Japanese people lived in the U.K. as of October 2003, with private company staff and their families representing 36%, students/researchers/ministers and their families 37% and residents 19%. However, the actual number of Japanese residents is said to be much higher, as the figure does not include those who did not notify the consulate or who came to the U.K. for a short period.
Psychological help for Japanese clients
Despite a large number of Japanese residents in the U.K., there is a limited resource available to cater for their mental health needs in their own language. From my experience of working with Japanese clients at the Japan Psychological Practice, which was set up to meet the specific needs of Japanese people living in the U.K., language seems to be the most common reason for clients to seek a Japanese therapist. Some of my clients spoke fluent English, but preferred a Japanese speaking therapist who they thought would be able to understand subtleties of emotions. Some felt that a Japanese therapist would have better cultural understanding. This was particularly important for some of my clients who experienced racism and were desperate for help in a safe environment.
Japanese clients I have worked with presented with a wide range of psychological problems, including depression, anxiety, phobia, somatic problems, OCD, eating disorder, domestic violence, self-harm, couple and family relationship issues, concerns about study or work, effects of childhood sexual abuse and other sexual assaults such as rape, post-traumatic stress, low self-esteem, children’s adjustment problems, parenting issues, and so on. In many cases, difficulties in adjusting to the new environment due to language and/or cultural differences seemed to feature as a contributory factor exacerbating psychological difficulties.
Clients may have different perception of psychological problems and counselling/therapy depending on their background. In Japan, as in many other societies, there is a stigma attached to psychological problems and receiving psychological help, which is often viewed as a last resort. For example, I heard about a Japanese student who was so shocked to be referred for counselling, which meant to him he was very ill, that he immediately decided to go back to Japan! These beliefs could cause delays in seeking help and subsequent recovery. However, my observation is that psychological help has become more acceptable over the years, particularly for the younger generation. If you are trying to arrange help for someone, you may wish to reassure him/her that psychological problems are common and treatable and that seeking counselling or psychotherapy is not a sign of weakness, abnormality or ‘mental illness’. It may be helpful to explain that counselling or psychotherapy can be used as a way of coping with common difficulties and stress many people experience.
Needs of specific groups of Japanese nationals
Through my experience of working with Japanese clients, I have picked up some common themes and stress factors which different groups of Japanese people seem to experience. This is my views based on my clinical experience, and is not intended to be presented as a generalised or stereotypical picture.
Approximately 50% of my clients were students who were studying on various courses including foundation, undergraduate, postgraduate and English courses. Many of them were experiencing stresses and difficulties which may be commonly experienced by overseas students, such as stresses of adjustment to a new environment and culture, isolation, and the lack of support network. In some cases, simple explanations about cultural differences helped to relieve anxiety. Some students experienced racism and prejudices, which had adverse effects on their adjustment. Concerns about study and future were also common. In addition to the language, Japanese students often find it difficult to manage different academic expectations, for example, active participation in discussions. Many students were under pressure to succeed academically, which may be a reflection of high academic expectations in Japan in general.
Any job relocation or transfer is likely to involve change in a work environment and role which can be potentially stressful. For those who are transferred abroad may experience additional stresses such as a language barrier or cultural difference. Japanese workers transferred from Japan may find it hard to manage different attitudes held by local staff towards work. One of my clients was at a breaking point when he referred himself, as he was working long hours and often on weekends because of increased workload. He told me that he had no option but to take on more work as local staff are less willing to work overtime, whereas in Japan, they all helped each other out and everyone was expected to stay until the whole section finished their job.
Spouses and children
Many families and children enjoy and gain from life abroad. However, some may experience stress that may lead to psychological difficulties. A significant number of Japanese people come to the UK as dependants. According to the Japanese Embassy’s statistics in 2003, the number of Japanese nationals except permanent residents was 40,895, of which 26% were family members. In the category of private company staff, 42% of 18,313 people were family members. The needs of children and families should not be overlooked, but their needs can be hard to pick up.
When I worked with Japanese families and couples, I often observed that each family member was affected by relocation differently. Spouses (mostly wives) may experience change of lifestyle and environment to a greater degree than their husbands who work in a Japanese environment. Wives who had to give up their own career due to their husbands’ relocation may have other issues such as loss of future prospect in their career, a sense of purpose in their lives and self-esteem. Dependants may have less support, whereas husbands have support network at the work place. Relocation may change the balance of couple relationships. For example, lack of support network such as extended families and friends may intensify conflict in couple or family relationships. Changes in the parental relationship could affect children. On the contrary, in some cases, experience of living abroad may bring partners or family members closer, resulting in improvement of their relationships.
In the small community, relationships with other Japanese people can be a source of support or stress. Wives are often encouraged to join wives’ groups of the company or a particular industry, where hierarchy of their husbands’ may determine their position. A well known anecdote tells that wives call each other at such meetings ‘Mrs X Bank’. Children may also be affected by such hierarchy ?often of their fathers’- within the small community.
Kinds of stresses children may experience may vary depending on their circumstances such as schooling. There is a range of choice of schools in the U.K. including local schools, Japanese schools and international schools. Some parents choose to send their children to local schools in hope that they will become ‘international’. However, many parents spend most of their time in the Japanese community and may not fully comprehend the level of stress their children are experiencing, and the lack of understanding could lead to unrealistic expectations. Children may find relocation experience difficult as it may mean change of environment, loss of friends and so on. Many of the children and young people I saw had experienced multiple relocations since the early age. One young person changed schools five times in eight years. Many children return to Japan from abroad every year, and problems of readjustment stress or ‘counter culture shock’ of so called ‘returnees’ are well documented.
Over 9500 Japanese people live in the UK as residents and 75% of them are women. This figure may include those who married the U.K. nationals or others with resident status, or those who obtained resident status by other means, but no statistics are available on the breakdown. From my experience, residents seemed to have different issues and needs. Their relationship with Japan may be different as the separation is likely to be much longer and may be permanent. For some internationally married couples, differences in cultural background, language, communication styles may be difficult to negotiate. Some couples, however, seem to attribute any disagreement or difficulties in their relationship to cultural difference and this often meant that they were unable to think about their difficulties as relationship issues. Some of my clients were experiencing difficulties at work, often with Japanese companies, where locally employed staff have limited opportunities, leading them to feel frustrated and undervalued. Some experienced complex dynamics and expectations as Japanese women in a Japanese environment. Many clients seemed to be experiencing common life cycle issues, which may be compounded by issues such as migration or distance from their families of origin.
Information and resources
Unfortunately, I am not aware of any therapeutic or counselling services within the National Health Service in the U.K. which provide services specifically to Japanese clients. This means that Japanese people who wish to see a Japanese therapist are likely to have to seek help on a private basis. Group With’s website is an excellent resource for those seeking Japanese speaking therapists in the U.K. and abroad. In some cases, the therapist may need to liaise with local services such as health, social and educational services in order to create a context of support for clients. For this reason, clients may benefit from working with therapists who have knowledge of local services and good command of English. Some people may have concerns about readjustment to Japanese culture. Group With’s website also provides a list of agencies in Japan where these specific needs can be addressed.
For those who do not wish to use private services, I recommend the National Health Service, where interpreters can be arranged (Group With’s website has information on the NHS written in Japanese). Many voluntary agencies also offer counselling and therapeutic service, although they may have limited resources for interpreters. Since there is no specific psychiatric service for Japanese people, they are likely to have to use the National Health Service in case of emergencies, for example, when there is a need for admission.
Dr Yoko Totsuka is a Japanese psychologist and psychotherapist (Chartered Counselling Psychologist, UKCP Registered Systemic Family Psychotherapist). Individual, couple and family therapy is offered to children, young people and adults at Japan Psychological Practice in London (Tel: 070-5002-9171, email: firstname.lastname@example.org).
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