If you have ever typed “therapy Tokyo” into a search box, you will have met three Japanese words in the results, and you will probably have seen all three translated as something like “mental health clinic”. That is where the confusion starts. The words describe three different kinds of help, staffed by different professions, paid for in different ways. People who have lived here for years still mix them up. It is worth ten minutes to get them straight, because the one you choose decides what happens when you walk through the door.
精神科 (seishinka): psychiatry
精神科 is a medical department. The person you see is a doctor. The work is diagnosis and, where it is needed, medication, and the visits are run the way medical visits are run in Japan: a questionnaire, a short consultation, a prescription if one is called for, and a follow-up appointment a few weeks later.
Because it is medicine, it is covered by Japanese health insurance in the ordinary way. You pay the standard patient share. If you are in ongoing outpatient treatment, there is a scheme called 自立支援医療 (jiritsu shien iryō) that reduces that share further. The clinic can tell you what to take to your ward office.
A psychiatrist is also the person who writes the certificate an employer may ask for if you need time away from work. If that is what you need, this is where to go.
心療内科 (shinryō naika): psychosomatic internal medicine
This one has no tidy English equivalent, which is why it causes the most trouble. 心療内科 is also a medical department, also staffed by doctors, also covered by insurance. Its focus, on paper, is physical symptoms with a psychological component: the stomach that will not settle before meetings, the sleep that has gone, the headaches nobody can find a cause for.
In practice the line between 心療内科 and 精神科 is blurred. Many clinics put 心療内科 on the sign because it carries less stigma, and then see much the same range of difficulties as a psychiatric clinic would. If you book at one, expect something close to a psychiatric consultation: brief, medical, insured, and likely to involve medication if the doctor thinks it will help.
カウンセリング (kaunseringu) and 心理療法 (shinri ryōhō): counselling and psychotherapy
The third word is the one we do. Counselling and psychotherapy are talking therapy, provided by psychologists and psychotherapists rather than doctors. A session is longer, usually fifty to ninety minutes. There is no questionnaire to fill in before you are seen and no prescription at the end. The work is a conversation that continues over weeks or months, about what has brought you and what you would like to be different.
This is the part that surprises people who come from countries where talking therapy sits inside the health system. In Japan it generally does not. Counselling and psychotherapy are, in most settings, paid for privately, even when they take place inside a clinic. That is not a quirk of any particular practice. It is how the system is drawn, and knowing it before you start looking means a private fee does not feel like a mistake you have made.
Which one do you need?
The practical rule is simple. If you need medication, or a certificate, or you are in acute distress and need to be seen quickly, you need a doctor, which means 精神科 or 心療内科. If you want to understand something and work on it over time, you want a counsellor or a psychotherapist.
A great many people need both, and in Japan they are usually in two different buildings. A psychiatrist locally for medication, a therapist online for the talking. The two do not compete. They do different jobs, and a good therapist will say so plainly when a doctor should be part of the picture.
One more thing worth knowing. Consultations in Japan tend to be short and led by the practitioner’s questions, in whichever of the three settings you choose. Say what you want in the first few minutes. A symptom you do not mention is a symptom nobody asks about.
What BeyondBleu is, and is not
BeyondBleu is the third kind. We are a psychotherapy practice: individual therapy, couples therapy, family therapy, and psychological assessment, delivered online in English and Japanese to people in Japan and to people who have left. We do not prescribe medication and we do not issue diagnoses for official purposes. If you need either, we will say so and help you find a doctor.
Sessions are private pay and are not covered by Japanese National Health Insurance. No referral is needed, and no letter from a doctor. What it costs, how long a session is, and what happens if you need to cancel are all written down on our fees page, because those are the four questions anyone should be able to answer before you book, and most practices worth attending will.
If you are reading this because the search results have left you stuck, the English-language therapy in Tokyo page describes how the practice works and who is on the team, and online booking shows the available times.
If you need help now
If life is in immediate danger, call 119 for an ambulance or 110 for the police. For distress that is urgent but not an emergency, the Yorisoi Hotline is free on 0120-279-338; press 2 for languages other than Japanese. BeyondBleu is an appointment-based practice and cannot respond to urgent messages outside session times.
Tumee Hugginson, MA, is the Clinical Director of BeyondBleu, a psychotherapy practice founded in Tokyo and working online across Japan and beyond.
