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1. Counseling in a Multicultural Japan


Counseling in a Multicultural Japan: A personal perspective on current issues relevant to providing open minded, person centered mental health counseling in the multicultural Japan of the 21st century (English translation of a presentation originally given at the 5th Congress of the Japanese Federation for Psychotherapy held in January 2004 in Tokyo and subsequently published.).

"For some people around the world it may come as a surprise or sound contrary to some deeply cherished beliefs to learn that Japan in the twenty first century has already been a multicultural society for quite some time. For the vast majority of the estimated two million people with the wealth of cultural backgrounds who are living, working, and contributing to the life and well being of Japanese society the truth of this fact is in all probability so obvious and known to them that it would cause them no more surprise than hearing that the sun will continue to rise to the East of every country around the world tomorrow, just as it did yesterday and today.

The aim of this brief presentation is to focus on some basic points that may be useful for mental health counselors and psychotherapists to keep in mind when providing psychological and social support though counseling for clients and patients in this multicultural society.

These points will be made by drawing on my experiences counseling with both individuals and with couples at Ikebukuro Counseling Center, and in group therapy sessions at Tokyo Counseling Service. It is my intention to highlight some of the more common stressors and problems that are people are experiencing in their everyday lives here in Japan.

Furthermore consideration to what extent people's attitudes assumptions and misconceptions about language, social attitudes, and also prejudice can effect not only the lives of people living in this multicultural society, but can also impact the quality and effectiveness of counseling services that we as mental health care professionals provide to our clients and patients.

The following points are drawn from observations and feelings that resulted through listening to and having conversations with a variety of clients and patients who with a wide range social, and in some cases cultural backgrounds.

In the content of the these clients' and patients' counseling issues there are fundamentally no significant differences when compared to anyone else's case issues, however within Japan's current social environment, in emotionally most of them describe feeling of loneliness and isolation based on depressed feeling, and all describe having had some kind of emotionally upsetting and painful experiences in working and social situations. These kind of emotionally distressing and sometimes painful experiences are quite commonly experience in all walks of life, even on occasion within our own field of mental health. That is one of the reasons why, as one health care professional in Japan who can write from the same standpoint of also having shared similar experiences, I decided to write this presentation.

Many clients report they have had the experience of often being singled out for following and being watched by security guards while shopping. Others have had the common experience of other standing passengers not sitting next to them even if the next seat is vacant on a train or bus. Some people have experienced staff in all kinds of shops, from coffee shops to furniture stores to drug stores, running away from serving them and even laughing together when they do so. Naturally, the vast majority of people have felt emotional distress and have been hurt by these kinds of discriminatory actions or reactions.

When you meet some clients in your practice or patients in your clinics or your hospital settings you may find yourself start thinking about where do they come from, which country were they born in or how long they have been living in Japan. However, when you consider the reality of modern Japan, Japanese are already living in a multicultural society. Currently the population is around 126 million people. Over recent years there has been a marked increase in the numbers of business people, craftsmen, engineers, IT professionals, lawyers and other skilled and unskilled workers originally from other countries who are now settled, living and working in all regions of Japan. This in turn has lead to an increase in relationships, marriages, and the number of Japanese speaking families in which one partner was born in another country. Nowadays, apart from in a few scarcely populated country areas, there are sure to be a lot of people who originally came from various countries who have now settled in Japan and are living in the neighborhood of your counseling centers, clinics, hospitals or welfare centers. There are some even working as counselors within these mental health care facilities. So in the current reality in this modern society we are all living in together, nationality is irrelevant when providing mental health care services to people.

The following are some reasons why it is not helpful or necessary to know the person's nationality in order to know who she (he) is. There are some members of this society who were born in Japan and have lived here all their lives and have never experienced living in other countries. There are others who speak Japanese fluently and may not have Japanese nationality.

For instance, in the case of a family where the mother is Japanese, the father is Indian and they have two children; when their children grow up and, under Japanese law, become adults at twenty years old, at that age they are currently legally required to decide their nationality for themselves. At that time one child could chose Japanese nationality while the other child could chose Indian nationality, both from the same family.

Therefore you should not consider what is the most appropriate language to use with any client or patient based on their appearance. If you find yourself deciding on which language to speak with a person based solely on appearance, then there it is worth considering that this way of thinking within yourself could indicate the existence of an unconscious complex related to race, racial stereotypes and the English language, even if on a conscious level you think or feel it is your intention to show consideration.

For instance, nobody can speak well in any language if they feel even a little depressed. Therefore when a client or patient makes a small mistake in Japanese please do not assume, "She (He) can't speak Japanese fluently" or "She (He) is not good at speaking Japanese." Even though a person might not speak Japanese fluently, as long as he or she wants to speak Japanese

please respect her or his wishes and let him or her do so. Again it is worth bearing in mind that it is quite possible for anyone to make mistakes in their mother tongue when feeling anxious, depressed or exhausted.

When people feel depressed it is natural they loose concentration and feel confused about what exactly it is they are feeling and want to say. This can also be the case with anxiety disorders. When people feel strong anxiety or experience a panic attack, they can become easily become confused about what they really want to do or what they want to say. For instance, people who experience dissociation, or a sense of separation from themselves, cannot be expected to explain clearly about their situation in any language, even if trying to do so in their mother tongue. Whether in a state of deep depression or in a high state of anxiety nobody can be expected to be able to express themselves fluently at such times no matter where they are around the world.

When you do meet a client or patient who you may feel or think does not speak Japanese it is better to check first, before proceeding on the basis of your assumptions. For instance, you can simply ask, in Japanese, "Can you speak Japanese?"

Just about anyone who is asked this question will immediately answer according to their specific situation. When someone is worried about communicating their condition or worries accurately they will answer clearly, "________ is easier for me ".

It may seem like stating the obvious but it is better not to decide anything about how to approach counseling or treating anybody simply on the basis of appearance. As mental health professionals in Japan, we should never make assumptions nor jump to any conclusions from people's appearance alone. In the multicultural society that Japan is in the twenty first century, and that we are all living in together, we cannot rely on only appearance to decide whether any new client or patient can speak Japanese or not. Appearance is irrelevant assessing a client's or patients needs. A steadily increasing and important number of people work and speak in Japanese every day of their lives and contribute their efforts to the well being of Japanese society. Among this large number of people are some who were born in other countries and already have Japanese nationality, many others have permanent residency status. They are all living and contributing their efforts to the well being of our society in this new century, just the same as you and I, and everyone else here. Considering these facts, in the current reality of our society in Japan in the twenty first century, whether of any our client or patients is Japanese can no longer be determined – and must never be determined - by assumptions based either on the color of a person's skin or on any other aspect of appearance. The simple fact is worth noting that Japanese people now ‘come in all colors, shapes and sizes' in the twenty first century. Naturally many people who speak Japanese, and who do not conform to the outdated and stereotypical image of what a Japanese person looks like, have families and children who are Japanese too. Simply put, in the current social reality that exists in Japan now, the truth is that not all Japanese are dark haired with brown eyes, some have blond hair and blue eyes too.

There is also another significantly large number of people living and working here in Japan who were born and grew up in Brazil, other American countries, Asia and Europe and other countries all over the world. They may be thought by some to conform to the now outdated stereotypical image of people who ‘look Japanese', whereas in fact some of them do not speak Japanese and may only speak in the language or languages of the country they came from, for example, in English, Portuguese or Spanish.

The over emphasis place on “appearance” is also reflected within the language we speak . For example, the words “kokujin” (literally translates as ‘black people'), “hakujin” (‘white people') in Japanese are still used by some people in daily conversation. I personally think these words are discriminatory in nature. When hearing or speaking the word “kokujin” some people here may have images solely of African Americans (and in some cases only images that are negative and prejudicial) and without considering the diversity of countries and cultures within the African continent. When speaking or thinking about "white people", some seem to be making an assumption that “white people are (United States) Americans and most American cannot speak Japanese”. Although gradually diminishing in numbers, there are still some Japanese people who still persist in believing that they have to speak English when they speak with ‘white people'. The reason why this tendency still remains in this country, even at the beginning of a new century, can be traced in the main to the influence of the Japanese educational system. This not withstanding, the reality is that there are still some people amongst us all living together here in Japan who have deep rooted prejudice in their minds.

Nowadays the reality is that the social fabric of Japanese society has completely changed. There are children of the second and third generation who were born in Japan.

At universities all around the world Masters' and Doctoral degree courses in both in Asian Studies courses and also in Japanese Language and Japanese Literature courses and other Japanese language training program has over the last twenty to thirty years seen significant growth in both popularity and numbers. So the number of people who can speak Japanese fluently before they come here have also increased.

As in any other multicultural society, it is vitally important use a person centered approach "Person centered” when meeting any new client or patient for the first time. In Japan today there are an increasing number of business people and other professionals from various countries around the world living and working in both Japanese and multinational companies. Some of the complete intensive Japanese language training programs before relocating here and are fluent before coming to Japan. Others may study in preparation before moving to Japan and then continue their studies with ‘in house' company Japanese language personal tutors. So the fact is that many of them are bilingual and conducting business in Japanese, conducting research in Japanese within large Japanese companies, and doing other jobs in Japanese everyday. On the other hand there may also be some other clients or patients we meet with who have only recently come here, and just the same as all of us, are working and contributing to our common social well being, even though they have just come to Japan and so are not yet able to speak Japanese fluently. So in practice it makes no sense to try to use a ‘one approach fits all' way of speaking and listening to all clients and patients. It is much more appropriate to be keep an open mind, flexible in our methods of communication and tailor our approach to people in a positive and responsive way to each and every person we counsel or treat.

Keeping this point in mind, ideally it would be better to have intake application forms at counseling and medical centers not only in Japanese but also in a variety of languages, for example in Korean, Chinese, Tagalog, Spanish, Portuguese, Arabic, Hindi and English, Even though this in practice might be difficult. Whenever possible staff first meeting patients in a hospital or clients at a clinic or counseling center should speak naturallyin Japanese. Only when necessary, and again in accordance with the wishes of the client or patient, would it be appropriate to us a different language. Regardless of whether someone inquires in person at the reception in a clinic or by telephone, if a client or patient talks to you in Japanese first, it is only reasonable to expect that you answer in Japanese. People have enough common sense that if they at anytime somebody thinks Japanese is too difficult for to communicate in they will soon say, for example, "Can you speak English?” or "Can you understand Chinese?” and so on. On every occasion whether communicating in Japanese or in another language please reply in accordance to the wishes of each client or patient, whenever humanly possible. However, one way of responding which should be avoided at all times and in all situations is to attempt to speak in a kind of English created only from your ‘old memories', even if you think to do so from the best of intentions. Especially if you think you are not good at speaking foreign languages do not try to speak in English from memory of high school or college English. A lot of the vocabulary and grammar taught in the past could well be old fashioned and communicate with people in modern English in this century.

In particular vocabulary and technical terms in the fields of psychology and psychiatry change in the flowing current s of scientific research and developments. For example, Bipolar Disorder was previously referred to as Manic Depressive Disorder.

As psychotherapists we recognize that when in conversations with or when explaining to clients and patients, it is better to use language that they use in their daily lives in way that is easy to understand. Naturally this is always the case regardless of whether we speak in Japanese, English or any other language.

In conclusion, in our roles as psychotherapists - whether a nurse, a psychiatric social worker, a psychiatrist, a psychologist or a school counselor - we have no need to focus on diagnosis when working together in psychotherapy with a client or patient. It is however vitally important to listen carefully to what he or she is saying and to listen with compassion and empathy for her or his emotional condition and pain.

Naturally it is important to understand and respect her or his culture and value that have raised her or him up , however ..

There is no need either to take into account the current or former nationality of any person who we work with in psychotherapy. Neither is it reasonable to vary our approach to psychotherapy with any person on the basis, of her or his appearance or on the basis of any other language she or he may be able to speak.

In general we need to keep in mind the danger of the tendency to think about or see any client or patient in stereotypical notions or images that we may have unintentionally absorbed during the process of studying and training in psychology and mental illness. Therefore it is important, to just listen with respect and care to a client's or a patient's words, listening without pre judging what or how she or he thinks or feels. In Japan, as in every other multicultural country around the world every person is unique and naturally has her or his unique story. In psychotherapy it is important that the client or patient feels that her or his life story is respected and heard in her or his own unique terms.

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