Haruhiko Shimoyama, Ph.D., The University of Tokyo, Japan

Summary

This paper is intended as an investigation of the task of developing clinical psychology today in Japan. Clinical psychology is now beginning to develop a large profile and play a more serious role in Japanese society, but it is quite difficult to draw up a definite plan to develop it as a profession. First, we review the history of clinical psychology in Japan to describe the difficulties it is now facing. Then we make a comparison between clinical psychology in the U.K. and in Japan to focus on the characteristics of Japanese clinical psychology. It is shown that there is confusion about precisely what clinical psychology, psychotherapy and counselling are in Japan and the confusion has caused many of the problems of Japanese clinical psychology. The comparative analysis also indicates that finding a way to some form of integration is necessary to surmount the difficulties and problems. This is the task of developing clinical psychology in Japan today.

1. Clinical psychology in Japan today.

Clinical psychology has been gaining popularity rapidly due to greater demands for psychologists and counsellors. Now clinical psychology is one of the most popular courses at university and graduate school. The number of members of the Japanese Association of Clinical Psychology (JACP) was 1277 when it was founded in 1982 and now it amounts to 10869. JACP has become the biggest of the psychology-related associations. The foundation of the Japanese Certification Board for Clinical Psychologists (FJCBCP) was established in 1988. The number of clinical psychologists certificated by FJCBCP was 1936 at first and is now 7912, which, in fact, has already exceeded those of the Japanese Association of Psychology, that is 6349.

In the early 1990′s bullying in school became a serious social problem. The Ministry of Education officially decided to give clinical psychologists a trial as school counsellors to treat it and the Ministry of Finance funded the activity in 1995. It was the first time that the government officially and financially acknowledged clinical psychology as a profession. Since then clinical psychologists have been hired as helping professionals in many social fields such as victim support, HIV counselling, helping the elderly, terminal care and so on.

Japan’s growing needs for clinical psychologists (counsellors) today could be compared to the situation in the U.S.A. just after the Second World War, when the Veterans Administration and the government funded training programs for clinical psychologists. They needed clinical psychologists to treat many veterans with war neurosis. This brought about a seminal discussion about the profession of clinical psychology. Eventually the American Psychological Association (APA) set up and organized basic systems and institutions for clinical psychology, which grew as a profession until the middle of the 1950′s. This discussion generated the later development of clinical psychology（Reisman 1976）.

In the case of Japanese clinical psychology the discussion has only just been launched. Clinical psychology is only now beginning to develop its profile and play a serious role in Japanese society. However, it is rather difficult to draw up a definite plan for the development of clinical psychology as a profession in Japan since we have not thought of clinical psychology as a whole. We have not even been able to reach a consensus about a model training program although it seems to be an urgent need to set up an official training program and policies regulating the field of clinical psychology appropriate to the social demands.

We have to make the characteristics of clinical psychology in Japan clear and define the direction in which it will develop as a profession in order to draw up a plan for an official training program. I have written this paper because it is the most important task for Japanese clinical psychology today. So what I wish to do here is to consider Japanese clinical psychology from the historical and comparative point of view and to propose a direction and plan to develop a training program for clinical psychologists as professionals.

2. A brief review of the history of clinical psychology in Japan.

First of all, we have to inquire into the historical background. Literature from the Nara Era (8th century) to the end of the Edo Era (19th century) shows that people had believed psychological disorders were the result of being possessed by supernatural spirits. It indicates that there had been a local model to interpret insanity up to the Meiji period (19th century) when modern thinking and social systems were imported from the West. The local model consisted of some original combinations of religious and psychological thinking. We could find indigenous models of psychotherapy derived from these such as Morita Therapy and Naikan Therapy still being proposed after the Meiji period, though they were not as influential as those transplanted from the West.

Between the Meiji period and the Second World War some intelligence tests developed by Binet and Cattell and some ideas of psychoanalysis were introduced. However, the discipline remained in a primitive state with no clear distinction between clinical psychology, psychiatry and education for disabled people.

After the Second World War, in the 1950′s, client-centred counselling was introduced from the U.S.A. with enthusiasm. Many psychologists accepted it positively as a symbol of democracy and people who had interests in helping others rushed to learn about humanistic psychology. The boom resulted in the establishment of the Japanese Association of Clinical Psychology in 1964. 978 psychologists attended the first meeting. They started to work toward developing a nationwide certification system for professional psychologists following the APA methods mentioned above.

However, the movement toward the certification of clinical psychologists failed, because younger members insisted that such qualifications would side with the social authority that was oppressing weak people such as patients. They, together with young radical, strongly objected to it and tried to reorganize into an association that worked toward changing the social system. In the end, the association was dissolved in 1973. Activities such as counselling, psychotherapy and clinical psychology declined so badly that the movement toward developing professional psychology was dying by the 1970s.

During the Dark Ages, Professor Kawai assumed the leadership in reviving clinical psychology. Professor Kawai, who had learned analytical psychotherapy at the Jung Institute in Zurich and got a Jungian qualification, has led Japanese clinical psychology into its present orientation based on the individual and intrapsychic psychotherapy model. In 1982 the Japanese Association of Clinical Psychology was reestablished. Many psychotherapists and counsellors who had had been worried about putting clinical work in a social context rushed to become members. In 1988 the Japanese Foundation of Certification Board for Clinical Psychologists was established with the aim of setting up a national licensure.

As I have already mentioned, in the 1990′s, problems such as truancy, violence and bullying on the school premises had got so serious that the Ministry of Education decided to introduce a counselling system into schools and used the certificated clinical psychologists as school counsellors in 1995. Such educational problems drove the development of clinical psychology just as the war neurosis did in the U.S.A. 50 years before. Since then social needs for clinical psychologists have greatly increased in many areas in addition to school: for example, care for the victims of crimes and natural disasters, terminal care in hospitals and psychological assistance for the elderly.

A plan to privatise all the national universities has already been decided and it is going to be established in two years’ time. The Ministry of Education and Science has announced a change in the higher education system and the setting up of professional schools. The Ministry has also suggested an intention to set up a professional training school for clinical psychologists so as to meet the increasing social needs. The foundation has been asked to develop a model of training programs for a two year master course and fix the curriculum.

The higher education system is to go through drastic changes in the near future. For clinical psychology to survive that anticipated confusion in the higher education system and take steps forward, it is necessary to develop an appropriate training program as soon as possible.

However, the association has been facing many difficulties, contrary to necessity and expectation. Actually, it is difficult to gain a consensus within the field of clinical psychology and then to cooperate with academic psychology, not to mention setting up a national licensure. So why couldn’t it make progress, in spite of being in a somewhat advantageous position supported by the Ministry? This question needs to be considered and answered now.

To answer the question, we have to start by making clear the characteristics of clinical psychology in Japan. Its characteristics are very relevant to the question. A helpful method to clarify the problem is a comparative study. So we will begin by comparing clinical psychology in the U.K. and in Japan.

3. Clinical psychology, psychotherapy and counselling in the U.K.

Marzillier & Hall (1999) describe the situation of health-care professionals in the U.K. and explain the differences between clinical psychologists, psychotherapists and counsellors. They point out that the main differences occur in training and in the formal structure of their work while they may in some way overlap with and relate to each other. They go on to say that training in clinical psychology involves a specialized knowledge of psychological functioning and psychological methods, which provides particular expertise in carrying out psychological assessments such as psychometric tests, formulating problems psychologically, psychological treatment and psychological methods of research and evaluation. And they add that in basic training, clinical psychologists specialize in behavioural and cognitive therapy and after that some of them go on to train in other forms of therapy such as psychoanalysis or family therapy.

It follows from what has been said that clinical psychologists in the U.K. should be defined as psychologist-practitioners who graduate from a 3 year doctoral course of clinical psychology and do psychological assessment, treatment, research and evaluation. Compared with the academic level and the psychological orientation of clinical psychologists, psychotherapists and counsellors have different characteristics. Psychotherapists could be defined as specialists who are trained according to a specific theory of a type of psychotherapy, for example object-relation theory, and whose works depend on the theory. Counsellors could be defined as professional helpers who are trained in courses recognized by the British Association for Counselling (BAC) and do a variety of work to help less disturbed individuals.

Psychotherapy and counselling are similar to each other in that neither is connected with psychology, but they are different in terms of their training systems. Psychotherapy clings to its own theory and organizes training programs in its own institute according to the theory. On the other hand, counselling is open to a variety of theories and sets up broad generic training programs according to the BAC’s standard in academic settings such as diploma courses or master courses at university. Actually, BAC has made efforts to develop comprehensive counsellor training (Connor 1994, Johns 1998). BAC published ” Code of Ethics and Practice of Trainers” in 1985 and “Recognition of Counsellor Training Courses” in 1988. In the “Recognition”, revised in 1993, the core theoretical model that includes an eclectic or integrative model is presented (Dryden & Feltham 1994, Dryden et al 1995).

Counselling has improved its training system so as to become a helping profession and established its discipline in academic settings, while psychotherapy has not been concerned about building its training system in academic settings as a general discipline. In that point, counselling has a feature in common with clinical psychology. Both have certificated training courses in university. Clinical psychology has courses accredited by BPS mainly in departments of psychology. Counselling has courses recognized by BAC in departments of education or elsewhere.

4. Comparison to clarify the characteristics of clinical psychology in Japan

Thus, in the U.K., there is a rather clear distinction between clinical psychology, psychotherapy and counselling. We can represent the different relationships between them diagrammatically as Figure 1.

On the contrary there is confusion about what clinical psychology, psychotherapy and counselling exactly are in Japan. Clinical psychology in Japan is said to include psychotherapy and counselling so that we cannot distinguish between them. Such confusion is the most distinctive feature of clinical psychology in Japan.

The distinction seen in the U.K. would give us some viewpoints to analyse the confusion and distortion of clinical psychology in Japan and some clues to answer the question presented before. In British terms, the actual situation of clinical psychology in Japan would be described as follows.

Psychodynamic (especially Jungian) theory has maintained its influence so much that purely intrapsychic psychotherapy has continued to be an ideal model in the Japanese Association of Clinical Psychology (JACP). However, the intrapsychic model is actually so specialized that most members of JACP are not able to master it. In addition, many problems that clinical psychologists are now expected to deal with are concerned with interpersonal and social relationships in daily life. People want to be helped to solve some daily problems or overcome specific disorders rather than analysing their deeply unconscious conflicts in the intrapsychic world by means of psychotherapy. For example, it has been almost impossible to intervene in problems happening in school communities only with psychodynamic psychotherapy. So such kinds of psychotherapy are sometimes of no practical use. Counselling and community psychology are needed instead.

Eventually, most of the “clinical psychologists” working in the clinical fields have been forced to learn eclectic or integrative counselling skills including social consultation. This is the actual situation and an important feature of clinical psychology in Japan.

As a result, strictly speaking (or in a British sense), the title of “clinical psychology” in Japan is unclear and misleading. Actually only a few leaders are psychodynamic or analytical psychotherapists and the larger body of “clinical psychologists” are substantially counsellors. And very few are clinical psychologists as described by the British definition. We can represent these ambiguously overlapping relationships between clinical psychology, psychotherapy and counselling diagrammatically as in Figure 2. The comparison between Figure 1 and Figure2 can make the characteristics of Japanese clinical psychology clearer and help account for the task it is confronting.

Such confusion and distortion have caused a sort of paralysis in Japanese clinical psychology, which has prevented it from taking a great step forward. And one reason for the confusion has been the leading role of psychotherapy. Since psychotherapy adheres to its own theory it is inevitable that Japanese clinical psychology led by a group of psychotherapists could not equally take other theories into consideration and develop a comprehensive curriculum in academic settings.

5. An analysis of the actual situation of clinical psychology in Japan

First of all, it is difficult to decide what should be taught and trained as basic knowledge and skills common to the various theories. As far as psychotherapy is concerned, it is almost impossible to go beyond its own theory to find a common ground and a way to develop comprehensive or integrated models for training as BAC has achieved in the last 15 years. Although in Japan special techniques like dream analysis, sand play and transference analysis are often discussed, basic training for empathic communication skills is not discussed. This situation means that there are discrepancies still remain between groups based on different theories of psychotherapy in clinical psychology in Japan.

Second, it is difficult to integrate practice and research. Psychodynamic psychotherapy particularly tends to direct such exclusive attention on its own intrapsychic theory and etiology that it cannot help being against evidence-based scientific thinking. In fact, Japanese clinical psychology has not paid enough attention to psychological assessment and psychological research, both of which should be essential to clinical psychology. I think the indifference toward them shows the lack of an evidence-based attitude in Japanese clinical psychology.

For example, outcome studies such as the single-case experiment and meta analysis have not been introduced into Japanese clinical psychology, though they are already common knowledge to clinical psychologists in the U.K. and the U.S.A. Of course behaviour therapy and cognitive-behavioural therapy, which have been supported by evidence-based methods, are not popular here though they are dominant in the rest of the world. This situation means that as regards psychodynamic psychotherapy model there is a discrepancy between practice and research in Japanese clinical psychology.

Such a tendency has resulted in another serious discrepancy. Japanese clinical psychology has kept itself apart from academic psychology, which has maintained a scientific paradigm, so that the two psychologies have no connection with each other. Moreover, these days clinical psychology has begun to invade the territories academic psychology used to occupy in universities, since clinical psychology has gained much popularity and demanded more courses to accommodate students at universities. This expansion has caused conflict between the two psychologies. Supporters of academic psychology often express their objections to clinical psychology and its movement toward a national licensure.

In the U.S.A., APA set up a scientist-practitioner model as a training model at Boulder conference in 1947 as a first step in the process of establishing clinical psychology as a profession. Although the scientist-practitioner model has been revised in some ways, it has continued to be the base on which clinical psychology has developed (Hayes et al. 1999). The scientist-practitioner model has provided the framework to integrate research and practice, science and clinical work, and academic psychology and clinical psychology. This integration has become a powerful engine to boost clinical psychology. It has allowed clinical psychology to be evaluated not only in practice but also academically and then to be socially recognized as a profession.

On the contrary, there has been a serious split at the basic level in Japanese clinical psychology as described above. As long as psychotherapy is an ideal model, Japanese clinical psychology cannot branch out of sectionalism and the split, which has been causing paralysis. In this situation it is no wonder that Japanese clinical psychology could not take a step toward a profession required going beyond the divisions of psychotherapy.

6. Topics we have to discuss now so as to develop Japanese clinical psychology

Here is the key to an understanding of the difficulties of clinical psychology in Japan. The comparative analysis shows that some integration is necessary to surmount the difficulties. So we can say that this is actually the “developmental task” of clinical psychology in Japan today.

Integration is also needed to establish a national licensure for clinical psychologists. Many psychiatrists want to have absolute authority and do not want to cooperate with other professionals. They declare that they would object strongly to legitimatising the qualifications of clinical psychologists as long as clinical psychologists do not accept the condition that they must work only under the control of psychiatrists. In fact, this is a major obstacle, and the activities of clinical psychologists are greatly limited in medical settings. In this tough situation, unless clinical psychology is integrated with academic psychology and supported by psychology as a whole, it will be almost impossible to establish a national licensure. We shall now look carefully into ways to approach some integration in developing an educational system for professional psychologists. To meet the social demand for clinical psychology, we have to set up an education system to train up clinical psychologists able to help people in trouble effectively.

The FJCBCP had held a nation-wide examination for the certification of clinical psychologists. The applicants had been limited to those people who had a Master’s Degree in psychology or a psychology-related field. The examination consists of a paper and an interview. The questions are on general psychology, psychological assessment, psychotherapy (counselling), community psychology and ethics. The system changes drastically in 2002. The FJCBCP limits the number of applicants for the examination to graduates with a Master’s degree in clinical psychology accredited by the foundation only. The FJCBCP decides the curriculum and staff of the Master’s course in clinical psychology and is the judge of whether it should be worthy of being accredited.

Under these conditions we have to develop a through training system for professional psychologists. It is important to decide what it is essential for the certificated clinical psychologist candidates to learn during the 2 year Master’s course in graduate schools. The main topics we have to discuss here are as follows.

1) What should the foundation of the training program be?

Theories abound, such as Behaviourism, Cognitive-behavioural theory, Humanistic theory, Psychoanalysis, Analytic psychology, System theory, Community psychology and Solution-focused approach, in the first place. We have to fix a common ground among different theories, which can provide clinical psychology with a base for integration.

2) What kind of training model should be taken and developed?

There are various training models such as a core-theoretical counselling model, an eclectic counselling model, an integrative counselling model, a psychologist-practitioner model or a scientist-practitioner model. We have to set up a training model to integrate the knowledge and skills of clinical psychology. If there is a common feature of training processes among different models it may suggest a way towards some integration.

3) How should we construct the curriculum and locate it in an academic setting in the higher education system?

In order to fix the curriculum in an academic setting, it is necessary for clinical psychology to collaborate with academic psychology. We have to find a way to integrate training programs with research psychology. We also have to discuss whether the scientist-practitioner model is appropriate for clinical psychology in Japan.

7. Conclusion

In 2000, FJCBCP set up a working group to develop a training program and establish an education system for clinical psychologists in response to a request from the Ministry of Education and Science. The foundation appointed me as the person in charge of the group. I visited U.K. to discuss the topics listed above with counsellors and clinical psychologists working as trainers and to get some perspective for designing a training program.

As a result of my discussions, I found, first, that the psychologist-practitioner model of BPS can provide us with much information, but it not relevant to Japanese clinical psychology today. The psychologist-practitioner model has cognitive-behavioural theory at its centre and integrates other theories around it. We have to learn and introduce much more assessment and research methods developed according to cognitive-behavioural theory into Japanese clinical psychology. However, we could not focus on cognitive-behavioural theory, since we do not have the tradition of concentrating on it. In the traditional and social context, an integrative counselling model might be more relevant to our situation. It is because the majority of clinical psychologists here have mainly been counsellors, as mentioned above, and the professionals that society needs have been school counsellors for at least the past 5 years (Shimoyama 2000).

Second, I realized that a distinction between clinical psychology and counselling might not always be a good thing. A distinction might prevent them from collaborating with each other. It is true that there has been confusion between counselling, psychotherapy and clinical psychology in Japan, but it also means that we have an opportunity to convert this confusion into an integrative whole because we have not been divided completely. I wish to clear up this confusion by integrating. At this point, the scientist-practitioner model of APA could give us a suggestion.

The recent scientist-practitioner model is very comprehensive and integrated because it includes integration between clinical psychology, psychotherapy and counselling as well as between academic psychology (research) and clinical psychology (clinical work). It regards counselling as a basic skill to establish a rapport, and learning counselling is a task completed at the first stage of the Master’s course (Mathews & Walker 1997). These days, communication skills to establish helping relationships, which are provided by counselling, are generally considered as a common ground of the helping professions including clinical psychology (Corey & Corey 1998). In the Master’s course, textbooks on the integrative counselling model such as Egan (1986) and Carkhuff (1987) are often used.

In addition, trainees who go on to doctoral courses are to be taught and trained in a variety of theories of psychotherapy. Robertson (1995) indicated that psychotherapy education and training have rendered toward an integrative orientation. And finally clinical psychology in the U.S.A. today is inclined to complete its speciality by integrating assessment, intervention and research with the framework of the cognitive-behavioural theory and a biopsychosocial integration model (Plante 1999). Thus, it is so comprehensive that it takes 7 years at least for a trainee to become eligible to take an examination for licensing.

We have to develop a training program just for a two year Master’s course. A two year course is too short to teach everything. Therefore, we have to decide what basic skills, knowledge and attitudes need to be taught first. At this point, basic training in Master’s courses in clinical psychology in the U.S.A. is relevant and suggestive to our situation.

However, if we stick at Master’s course level training or counselling training, clinical psychologists in Japan could not take professional roles with responsibility of managing mental health care programs. So we should classify clinical psychologists into two types: Master’s level clinical psychologists and doctoral level clinical psychologists. In the doctoral course, we have to add more professional and comprehensive education and training to bridge the discrepancy between practice and research, clinical psychology and academic psychology.

To develop doctoral level education and training, the psychologist-practitioner model of BPS and the scientist-practitioner model of APA could be suggestive, but it is not ideal to combine practice and research in Japan because Japanese clinical psychology has not included scientific research before. So, it would be better to introduce qualitative research methods at first to offer a bridge between practice and research.

We therefore conclude that we should develop a two stage integrative training model appropriate for the characteristics of Japanese clinical psychology and construct a curriculum as soon as possible.

References

1. Carkhuff, R.R. 1987 The art of helping. Human Resource Development Press.
2. Clegg,J. 1998 Critical issues in clinical practice. SAGE Publications.
3. Conner, M. 1994 Training the counsellor: An integrative model. Routlege
4. Corey,M.S & Corey,G. 1998 Becoming a helper 3rd ed. Brooks/Cole Publishing. Company.
5. Dryden, W. & Feltham, C. 1994 Developing counsellor training. SAGE Publications.
6. Dryden, W. & Horton,I. & Mearns,D.1995 Issues in professional counsellor training:Counsellor trainer & supervisor. Cassell.
7. Egan, G. 1975 The skilled helper. Monterey,Books/Cole.
8. Hayes,S,C. Barlow,D,H. and Nelson-Gray,R,O. 1999 The scientist practitioner: research and
   acountability in the age of managed care. Allyn and Bacon.
9. Hollanders,H. 1999 Eclecticism and integration in counselling:Implications for training. British Journal of Guidance & Counselling, 27(4), 483-500.
10. Johns,H. 1998 Balancing Act: Studies in counselling training. Routledge.
11. Marzillier & Hall,J. 1999 What is clinical psychology? 3rd ed. Oxford University Press.
12. Matthews,J.R. & Walker,C.E. 1997 Basic skills and professional issues in clinical psychology. Allyn & Bacon.
13. Plante,T.G. 1999 Contemporary clinical psychology, John Wiley & Sons.
14. Reisman,J. M. 1976　A history of clinical psychology. Irvington Publishers.
15. Robertson, M.H. 1995 Psychotherapy education and training: An integrative perspective. International University Press.
16. Shimoyama,H. 2000 On the education and training system of clinical psychology: Comparison with U.K and U.S.A. In Bulletin of Foundation of the Japanese Certification Board for Clinical Psychologists. 12(1) 19-32.