Problems faced by psychologists in Japan

Psychology is the science of human behavior and mental processes. The discipline encompasses a variety of fields such as developmental psychology, the study of age-related changes in behavior and mental processes, cognitive psychology, the study of vision, hearing, and other forms of cognitive function; and social psychology, which focuses on the social aspects of human behavior and generates theories of social behavior. Indeed, there are many subfields of psychology; however, most do not directly benefit the general population.

In contrast, clinical psychology has an impact on a wide range of people. Clinical psychologists who work as specialists at hospitals provide assessment and counseling services to individuals with psychological problems. The addition of counselors to schools in recent years has increased public awareness of clinical psychologists; in fact, a number of individuals studying to become psychologists were inspired by their experiences with school counselors. Moreover, clinical psychologists with an expertise in psychological trauma provide support following criminal acts or large-scale disasters.

Although psychologists are crucially involved in several aspects of society, many are not currently supported by the national government of Japan, resulting in an unsecure employment situation. For example, school counselors, who provide support to countless children, receive a high hourly wage; however, they are considered to be part-time employees and, as a result, many face an uncertain future.

Movement to implement a national qualification for psychology

The absence of national qualification for psychologists working in hospitals is problematic for patients and psychologists. Work at hospitals is assessed by the healthcare fees incurred; however, the services provided by the psychological staff are not covered by health insurance. Thus, although the patients and hospital need the services of psychologists, hospital managers have little incentive to hire them. As a result, few psychologists are employed by medical institutions. Moreover, a patient who wishes to receive psychological counseling at a medical institution must pay high fees due to the lack of coverage by public health insurance.

Psychologists and speech-language-hearing therapists held a similar position in Japan until a national qualification for speech-language-hearing therapists was established in 1997. Since then, the number of speech-language-hearing therapy training programs and graduates has increased along with a steady rise in employment opportunities. Moreover, in contrast to psychology, speech-language-hearing therapy has expanded beyond medical institutions and education into nursing care.

What is a national qualification for psychologists?

The current situation has not been passively accepted by psychology-related groups; however, several attempts to introduce a national qualification have been abandoned at the last minute in the face of a variety of conflicting interests in and outside the field of psychology. However, the situation changed early this year. Negotiation was conducted by related officials and a bill for the accreditation of psychologists was drafted on June 16, 2014. The bill is scheduled for deliberation during an extraordinary session of the Diet to be held this autumn. Article 2 of the drafted bill offers the following definition of an accredited psychologist.

Enactment of this bill is expected to enable psychologists to provide support from a more secure position in the healthcare and educational arenas and to increase awareness of psychology professionals among the general population. I hope this bill will receive continued support.

The field of neuropsychology

Our laboratory conducts research in neuropsychology, the area of psychology that has a neuroscience perspective. Although neuroscience is based on the physical and biological aspects of the brain and nervous system, the focus of neuropsychology is on the individuals who suffer from brain injuries or disorders and their families and, as such, the clinical psychology perspective is essential.

For example, neuropsychologists working in the field of rehabilitation assess, train, and consult with individuals who have acquired brain damage resulting from traffic accidents, stroke, or other medical conditions. In addition to facilitating functional recovery of the damaged brain, the neuropsychologist helps the patient understand his or her condition. Neuropsychologists specializing in neurology often work with patients suffering from dementia. In this role, supporting the families and helping them understand the patient’s condition is as important as evaluating the patients themselves.

We are currently conducting neuropsychological assessments in patients undergoing awake craniotomies for the resection of brain tumors with the cooperation of the Department of Neurosurgery at Tokyo Metropolitan Komagome Hospital. The patient is awake during this procedure allowing brain functions such as language and movement to be monitored. Awake craniotomy is thought to be the best method for preserving brain function during extirpative surgery. In addition to monitoring the patient, the neuropsychologist performs the vital role of providing emotional support to help the patient comfortably endure the lengthy procedure.

Thus, the contribution of neuropsychologists is not limited to the conventional role of rehabilitation but, rather, extends to involvement during medical interventions.

The brain as a common language

The brain gives rise to our mental processes; thus, brain damage may disturb a wide range of daily activities. For example, damage to the frontal lobe, which lies behind the forehead, interferes with concentration and the ability to follow a logical sequence. Damage to the parietal lobe, located behind the frontal lobe, affects the ability to read and write and impairs one’s sense of direction.

Furthermore, we often find that, despite never having suffered obvious brain damage, individuals who have had life-long problems concentrating or difficulties with reading and writing, no matter how hard they have studied, have frontal or parietal lobe deficits. Moreover, neurological examinations often reveal a decline in brain function in elderly individuals who have difficulty following a logical sequence or who have lost their sense of direction.

Thus, brain damage, developmental disorders, dementia, schizophrenia, and other brain disorders can be linked to human behavior and perception when considered through the brain. Moreover, neuropsychology plays an important role in translating our knowledge of the brain and mind into effective treatment protocols and helping patients and their families understand and cope with the brain disorders affecting them.

Conclusion

Despite the fact that neuropsychology plays a vital role in explaining the link between the brain and human behavior, no national qualification exists for clinical psychologists in Japan, and neuropsychologists do not receive sufficient recognition. In the United States, psychologists receive a PhD following a course of study, and they are able to obtain certification (state license) and the higher position of clinical neuropsychologist through continuing education and research activities. Moreover, American clinical neuropsychologists can start their own practice. These goals are not possible for Japanese neuropsychologists at present; thus, I hope the government will establish a national qualification of Accredited Psychologist and that neuropsychologists in Japan will gain increased recognition.