By Oscar Johnson

Even those fluent in the local language can feel isolated by less casual or indirect Japanese modes of communication. It’s especially true for ex-pats in rural areas where they’re less likely to find others to commiserate with. Pining for more culturally familiar relationships can compound homesickness and become what one local psychiatrist calls "adaptation disorder." Local therapists, on the other hand, say anxiety and depression are common among foreign clients.
If any of this hits close to home don’t turn to your neighborhood izakaya for answers. Besides, far from being an answer, alcohol is likely to compound such problems. Get familiar with more effective options for soothing the mind back to health. If you decide to get help your first question should be what kind of professional to seek out: a doctor of psychiatry or counseling from psychotherapist?
Only psychiatrists can make medical diagnosis and prescribe medication. The down side is that compared to other developed countries Japan has relatively few. It will be hard to find an English-speaking doctor - let alone one that’s from you’re home country - if that is what you want. The local practice also has a reputation for being more likely to dole out meds than counsel clients on the couch.
Quite the opposite is true of psychotherapy - especially in larger cities. Both English-speaking and foreign therapist are easy to find in Tokyo, for example. With this, however, comes a different challenge. Since the Japanese government only recognizes - and hence regulates - psychiatric doctors, anyone can set up a folding table on the street and offer their services as a “therapist.”
Experts recommend shopping around before choosing a therapist. Since they need not be licensed, the reputable Japan Society of Certified Clinical Psychologists has taken it upon itself to test and certify therapists. Those that opt for it will have certificates of proof. Another option is to look for a therapist with an official license or certificate from his or her (or your own) home country.
Interested but still not sure if a psychiatrist or therapist is what you need? Consider this: reoccurring problems with coworkers or neighbors may be a sign that it’s not always someone else’s fault. Sometimes a friendly ear can be a good place to start. Luckily, Tokyo English Life Line offers just such a service for free. And should you later decide to seek professional help they can also refer you to therapists with proven track records.
Learn more about the Tokyo English Life Line at www.telljp.com or call 03-3498-0231. You can reach TELL’s crises line at 03-5774-0992.