Douglas Berger psychiatrist Tokyo and the Meguro Counseling Center follow these practice details:
The Meguro Counseling Center believes that having a set of policies and procedures transparently open to clients helps to provide a mutual understanding of how and what to expect when receiving psychotherapy. The psychotherapy practice details on this page are presented in the hopes that this will help to promote this purpose. Feel free to contact the Center if you have any questions.
The “Tokyo Meguro Counseling Center” is the name of the private consultation service run by Douglas Berger, M.D., Ph.D., a U.S. Board-Certified psychiatrist located in Tokyo and a legal permanent resident of Japan. The Meguro Counseling Center is a forum for the associated therapists to share academic and educational information on the latest treatments for psychological and psychiatric conditions, and to support each other clinically and professionally. The therapists at the Meguro Counseling Center share the policies and procedures as listed on this page, and also agree to a common Code of Ethics designed to insure the best quality of therapeutic care. Persons who entrust these therapists with their counseling needs are treated kindly and professionally, and the work at hand in the care of these persons and their issues is taken extremely seriously.
The Meguro Counseling Center is a legal Japanese personal consultation service run by Dr. Berger (“kojin jigyou”). It is not an incorporated entity, and it does not have an employment relationship with the therapists listed on this site. The network of therapists associated with the Meguro Counseling Center work independently each therapist having individual responsibility for the counseling of any clients they see, and each client seeking help at the Center needs to confirm the credentials and policies associated with their respective therapist. The Meguro Counseling Center is a community counseling and mental health consultation service, it is not a facility that provides medical care. In the case of severe depression or other psychiatric illness, the therapists at the Meguro Counseling Center can advise clients on the types of medications they may need and can organize prescriptions with a medical clinic associated with the Center similar to the function of a clinical psychologist in Tokyo.
JAPANESE MEDICAL LICENSING
Although the qualifications of the therapists associated with the Meguro Counseling Center includes U.S. Board Certified Psychiatrists, U.S. M.D., Ph.D., and Japanese Ph.D. degrees, these do not include a license to practice medicine in Japan. The Meguro Counseling Center is not a medical clinic or facility. The therapists at the Meguro Counseling Center can provide counseling and psychotherapy, and they can provide you with information and make specific recommendations to you for psychiatric medications that a physician with a Japanese medical license who is familiar with referrals from the Meguro Counseling Center can prescribe for you, but they cannot provide medical care in Japan.
There are psychiatrists in Japan who are licensed physicians, and anyone can seek help at a Japanese facility that has psychiatric services for medical care. Most international residents receive care at the Meguro Counseling Center because of the language and cultural barrier of visiting a Japanese physician who usually only dispenses medication, and because the Japanese medical system does not provide for more than a few minutes of discussion with the doctor that is usually not considered adequate by Western standards. Counseling with a therapist associated with the Meguro Counseling Center, however, should in no way be a substitute for licensed medical care when needed.
MEDICATION AND DIAGNOSES
The therapists at the Meguro Counseling Center have considerable experience in treating psychiatric conditions with psychotherapy in tandem to medication, and your therapist can provide you with information and make specific recommendations to you for psychiatric medication that can be received through our fully-integrated affiliated medical services, either directly or mailed to the convenience of your home. The Japanese National Health Insurance can be used for the medication part of our service. If you decide to go to a licensed physician to receive medications, either in Japan or elsewhere, the physician who writes the prescription (or dispenses the medication) is naturally responsible for that aspect of your care. Ordering of medication not available in Japan is also possible through this type of referral. The Center can not appropriately provide medication information or referrals on e-mail inquiry, all persons need to be interviewed in a session in order to recommend an appropriate plan of care after their needs are carefully assessed. These interviews may be conducted by phone or Skype for persons coming from overseas or located outside the Tokyo area.
The Meguro Counseling Center strongly advises that one only use medications while under the care of a licensed prescribing physician, and to consult with that physician in all instances regarding side effects, missed doses, dose changes, stopping medications, and any other aspect of medication treatment or medical care. In cases where medications are prescribed for psychiatric problems, it is the policy at the Meguro Counseling Center to recommend that clients confer with their physician on the use of low-cost generic medications whenever possible. Please refer to the psychiatric medication referral page for further details.
The Meguro Counseling Center can provide you with a letter from a U.S. qualified psychiatrist and therapists associated with a counseling center located in Japan. If a letter is required from a medically-recognized Japanese M.D., a licensed physician the Center works with can write you a Certificate of Diagnosis (“Shindansho” in Japanese). In addition, although the name of a condition (i.e., depression) may be presented to you in the context of symptoms you describe, diagnoses in psychiatry are used for the working purpose of treatment decisions, are tentative in nature, the diagnostic system used in psychiatry is still under debate, and there are no confirmatory tests or ways to prove a psychiatric diagnosis. Diagnostic terms may also be presented to you related to people you describe in order to give you ways to understand these persons. Note however, that these diagnostic terms are only tentative concepts, subject to the problem of your therapist not being able to examine the person(s) in question directly, are not official medical diagnoses, and do not mean these persons actually have these disorders.
APPOINTMENTS, FEES, AND INSURANCE
Appointments are necessary for all counseling sessions, please contact the Center for further information. Therapy hours are by appointment and include mornings and evenings Monday through Thursday, and mornings on Friday, Saturday, and national holidays.
The Meguro Counseling Center strives to maintain therapy costs as low as possible. Overhead costs are kept to a minimum, and clients are seen as infrequently as optimal care will allow (usually once or twice a month). Please inquire about the current fee structure. Although the Japanese National Health Insurance does not cover counseling services, fees can often be partially or fully reimbursed to you if you have an international insurance plan. Please inquire with your plan whether individual psychotherapy is covered. Many Westerners in Japan sign up with the U.S. based Cigna International plan or the ProtExPlan, or the New-Zealand based InterGlobal plan. The U.S. military and State Department persons are covered by the Tricare or related plans. Please confirm the plan that is right for you. Fees are due in cash at the time of service, or in advance in the case of phone/Skype sessions. A receipt template and a diagnostic code will be issued to you to fill in at no charge if you request receipts for insurance coverage. Specific fees would be requested if you wish your therapist to fill in the data.
Fees received in advance by wire, cash-post, or PayPal, are considered fees for contracted services, may be used for a maximum period of 3 months as credit for services, and are not refundable. Checks are not accepted. Credit cards are only accepted in the case of pre-payment or missed session payment, and only when transacted through PayPal.
In the case of therapy with minors (less then 20 years-old in Japan), the appointment would generally need to be made with the consent of at least one of the parents. While it is best if both parents know and are involved in the consent for therapy, any disagreement between the parents on whether their minor child should have therapy or not would be an issue that the parents would need to resolve between themselves, and the parent making the appointment would still be responsible for any session or cancellation fees. However, if the person requesting therapy is over 18 years-old and considered an adult in their home country, because these persons are also considered to have legal responsibility as an adult under Japanese law, it may be possible for the person to consent to therapy by presenting their passport and writing a note that they agree to be considered an adult as in their home country. Whether this is feasible will be determined on a case-by-case basis by the assigned therapist.
Because making an appointment means the time will be held for you, it is necessary to have a system for clients to be fair to each other and to the Center in utilizing the session hours.
- The cancellation policy for the first session would be the full fee for the session once you make the appointment either by phone or by receipt of a confirmation e-mail from a therapist at the Center.
- Cancellation for ongoing therapy is requested 72 hours in advance of your appointment. Please note that rescheduling is also regarded as a cancellation. If you were to cancel or reschedule within the specified time, the full-fee for the scheduled session would be requested, payable within one week of the missed session by bank transfer, PayPal, or cash-post (genkin kakitome) from the post office, regardless of the reason for the cancellation.
In addition, all appointments are confirmed times, there are no provisional or tentative appointments unless noted otherwise in writing. Your understanding and cooperation in this regard is greatly appreciated. As e-mails may be delayed or not go through, please be sure to confirm any e-mail cancellation by phone message if you are near the 72 hours prior to your appointment or if you do not receive a prompt reply.
Refunds may be granted under specific situations. In the rare case that your therapist is not in the office at the specified time, or has mistaken their schedule, a further session free-of-charge can be granted. Partial discounts may also be given in the case your therapist needs to cancel or change a session within 72-hours of the session; please see the specific policies your assigned therapist adheres to in their initial confirmation mail. In the rare case that your therapist does not readily reply to you, please send a mail thru the home page to confirm their status. Because each counselor is an independent therapist, however, the Meguro Counseling Center is unable to assess or refund any fees in credit you may have with your assigned therapist if they are not available or incapacitated for some reason. Please keep this small risk in mind when sending fees in advance.
It is the Center’s policy to be completely open and fair with all fee and billing policies. The policy is noted here on the web page, will be repeated verbally at the time of making a first appointment, it is noted in the e-mail for the first appointment notice, and will be noted on an Informed Consent provided at the first visit. Sessions are only scheduled at the request of and with the agreement of the client. Please be sure of your intention to have a session when you make appointments.
ADVICE AND THERAPEUTIC EFFICACY
Your therapist may occasionally provide you with suggestions or advice regarding work, family, personal relationships, or other topics. Although your therapist will try to advocate for you based on their understanding of your personal situation and psychological issues, advice should be taken with the caveat that your therapist cannot necessarily predict what might benefit someone in an actual real-life situation. Because of this, you would need to make your own personal decision in acting on any advice received from your therapist in a psychotherapy session, or from any outside agency (medical, legal, foreign residents’ advisory, etc.) that your therapist may have referred you to. Also, note that this web site and any associated web sites are for the purpose of information only. All medical, psychiatric, and mental health needs require consultation with the appropriate professional.
In addition, all non-emergency issues (i.e., other than worsening of symptoms, acute medication side effects, immediate risk for harm to self or others, etc.) should be consulted on in the face-to-face sessions, rather than in an e-mail or phone call, so that the discussion can be put in context of the entire situation, and where there is the time to evaluate all the details thoroughly.
Regarding therapeutic efficacy, although the therapists at the Meguro Counseling Center conscientiously use the most up-to-date methods in their counseling approach, there are inevitably conditions that do not improve for a variety of reasons making any guarantee of efficacy difficult. These reasons may include the nature of the condition itself, the client’s insight into the problem and/or willingness to undertake recommended treatments, the ability of the therapist and/or treatment to effect gains, or advice that does not meet the client’s expectations. While fees for unsatisfactory sessions can not be refunded, it is the client’s free choice to discontinue further meetings with their assigned therapist and/or request to see another therapist.
Unfavorable outcomes including worsening of condition or other untoward effects, psychosocial or occupational impairment, and even suicidal behaviors may be seen even when one is receiving the accepted standard of care. On rare occasion, clients may react in disagreement or unpleasant surprise in being told they likely have an illness such as depression, manic-depression, alcohol abuse, etc. The Center’s policy is that it is ultimately in the client’s best interests for gentle, but clear and transparent information sharing with clients in this regards, even if there is the risk that a client may show discomfort in receiving this information. If a client feels suicidal, homicidal, or that they might hurt themselves or others in any way, they are welcome to call us, but they must leave a written e-mail notice with their therapist to ensure that they can then take appropriate action if the assigned therapist is not available by phone.
CONDITIONAL THERAPY AND THERAPY TERMINATION
The Center/one’s therapist may need to put conditions on a client’s receiving counseling, may not be able to provide counseling, or may need to terminate ongoing counseling. These situations include danger to self or others (i.e., suicidality, intent to harm property or others, etc.), chronic inability to readily contact a client, or other disturbances to the therapy etc., that need to be determined by your therapist on a case-by-case basis. Confidentiality may need to be broken in serious cases of threat to self or others to protect those concerned.
If possible, termination of ongoing therapy should be discussed in the context of your situation during a therapy session. If you decide to terminate your therapy by e-mail or leave a message to this effect on your therapist’s answering machine, it would be appropriate practice for your therapist to call you and inquire about your status and needs for referral elsewhere. Your therapist also reserves the right to send you a follow-up e-mail if they have some specific concern about your condition and need to document they have informed you to receive a specific therapy or intervention.
EMERGENCIES AND HOSPITALIZATION
The phone number to call an ambulance in Japan is 119. For the police it is 110.
The Meguro Counseling Center recommends keeping a list of hospitals that are near your place of employment and residence that can provide you with medical and/or psychiatric care in the case of an emergency. If you think that you or a significant other may have an emergency and you are not accustomed to speaking Japanese easily, we recommend that you prepare a card in Roman letters that describes your name, address, phone number, and a few short phrases in Japanese that state your needs for emergency help. If you take psychiatric medications, you should also prepare a list of all your medication names and doses in Japanese. The Meguro Counseling Center can help you prepare this information in a session.
The Meguro Counseling Center itself does not have an emergency outreach function. If you or a significant other has an urgent medical or psychiatric situation and you cannot readily contact your therapist, you should either contact your medical physician, visit a hospital emergency room, or call an ambulance or the police as soon as possible. Most all university hospitals have emergency rooms and psychiatric wards. One hospital with emergency services is the Tokyo Metropolitan Hiroo General Hospital (Tel: 03-3444-1181) in Minato ward located walking distance from the Hiroo subway station or a short Taxi ride from either the Ebisu or Meguro JR Yamanote line train stations. The U.S. Embassy also has a helpful list of hospitals in Tokyo.
The problem is that most of these hospitals will likely tell you to find a psychiatric hospital and will not easily allow you inside the emergency room unless you are quite adamant you will hurt yourself and/or note to them that the Medical Doctor Law No.19 (“Ishihou Ju-Kyu Jou”) stipulates that doctors can not refuse to see patients. You may do better by calling the Tokyo Metropolitan Health and Information Center called “Himawari” which also has an English line at: 03-5285-8181 to find a hospital that will accept you for psychiatric reasons, although it can take some time to effect acceptance from a hospital. A private ambulance company, Zen Nichi Kyu (Tel: 0120-340-560), may be helpful in involuntary admission cases in Japan where the family has already made arrangements with a specific hospital. SOS International may be helpful for non-Japanese that require escorted repatriation to their home country.
For clients being seen at the center, in the case that you or a significant other requires psychiatric hospitalization, your therapist can provide you with the names of some Japanese hospitals for your reference. However, as the therapists at the Meguro Counseling Center do not work directly with the physicians in these institutions, nor have any specific ability to effect hospital admission, they can not guarantee which hospital will actually accept a specific patient, the adequacy of the care provided, the ability of the staff to speak English, nor take responsibility for the care received from these medical facilities.
Obtaining admission to a psychiatric unit in Japan is usually not as easy to effect as it is in many Western countries. Japanese psychiatric hospitals and wards tend to be full, and these facilities usually require that the person has a significant and disabling psychiatric illness with active symptomatology. Fluency in Japanese, as well as participation in the Japanese National Health Insurance, are key factors in the likelihood of being accepted for psychiatric hospitalization. Without the National Health Insurance or good Japanese language skills, a Japanese hospital is likely to coordinate with one’s embassy for prompt discharge and repatriation even if one is accepted for admission.
While your therapist will conscientiously help you with advice in these cases, the procedure for in-patient hospital admission is something that in the end is up to the patient and/or significant others to effect via contacting hospitals, taxi, police, ambulance, etc. You may also want to contact your embassy for advice and assistance. If there is ongoing risk of need for admission to a psychiatric ward and the person in question does not have good command of Japanese, then it is prudent to consider repatriation to one’s home country before an emergency arises.
For first-time inquiries, as it is impossible for the Center to understand your exact needs over the phone or e-mail, you would need to make a personal decision on what kind of hospital, doctor, or medical treatment you think you need if you have an emergency or require hospital admission. You may use the information and links on this page to guide you, and you can reference the medical information provided on the various Tokyo embassy web sites (U.S., Austrailian, Canadian, etc.).
If you are trying to effect admission to a hospital for someone who does not wish to go to a hospital, even if that person is clearly in a bad state of mind, drinks heavily, may feel significantly suicidal etc., it is practically impossible to get them admitted against their will. Neither the police nor an ambulance are likely to forcibly bring a person who does not wish to be admitted unless there has been a clear event of danger to onseself or other with noticible and significant consequences of physical injury and/or damage to objects. Unfortunately, many of these persons will fall thru the cracks in the system.
Confidentiality is defined as the maintenance of privacy between the Center/one’s therapist and a client about the fact that they are consulting with the Center/one’s therapist, as well as the details of the consultation. Engaging in therapy with the Center indicates that the client consents to the fact that the assigned therapist may need to discuss any and all of their clinical information with the Center Director. The therapists at the Center will also cover for inquiries, emergencies, and correspondence for each other, and will confidentially share client lists, phone numbers, and clinical information in this regards. In the service of good clinical practice, one’s therapist may have an associate therapist from the Meguro Counseling Center follow-up with client inquiries and in cases of therapy termination (only associates at the Center will be given client information for the purpose of follow-up).
Confidentiality is strictly maintained with the following caveats:
- 1.) Written requests by a client for their therapist to contact specified persons.
- 2.) Verbal or written requests by a client for receipts to be used for insurance and/or other purposes.
- 3.) Verbal or written acceptance of a referral to another health-care practitioner indicates consent to share all clinical information with that practitioner without time limitation.
- 4.) Cases of threat to self or others to protect those concerned. In these cases, the Center/one’s therapist reserves the right to decline accepting a client for counseling or to terminate ongoing therapy, and may need to contact any persons at risk for injury and/or the local authorities as appropriate. Any contacts received that are of a derogatory and/or possibly threatening nature may also be reported to the police, the person’s place of employment, and/or significant others. In addition, information may be shared with other English speaking therapists in Japan in cases where a client exhibits a physically dangerous or harassing nature with their therapist in order to protect the English speaking mental health community.
- 5.) Neither the Center nor any of the therapists use encrypted e-mail and will reply to e-mails received as if they were private correspondences. Because of this, there is always the small risk of a privacy leak from the internet and/or one’s e-mail inbox (cell phone/computer etc.), or mail being viewed during maintenance by an internet service provider etc., if a client chooses to use these methods of communication. The same would apply for letters sent or received through the postal service.
- 6.) Privacy leaks incurred when entering or leaving the counseling office or building premises, or a chance encounter and greeting with one’s therapist outside the office which may be seen by others.
- 7.) What is private and what is shared can become very unclear when family and/or significant others are involved in some capacity in the therapy (i.e., joint sessions, phone discussions with multiple members, etc.). While The Center/one’s therapist will try to their best to maintain appropriate privacy lines between these persons for information given in confidence, the Center/one’s therapist cannot absolutely guarantee the confidentiality of specific items, facts, or discussions, nor be held responsible for the confidentiality of specific information when a complex interaction of related persons is involved.
- 8.) While clients may consult with their therapist regarding their relationships or clinical concerns related to persons who are not part of the therapy sessions, their therapist can only provide provisional discussion on persons they do not directly evaluate. For persons who have come to sessions, the therapist would require at least their verbal consent in order to discuss their clinical details with a third party, even if that party has also previously been part of the sessions.
- 9.) Missed sessions without contacting one’s therapist and the therapist cannot contact the client, or failure to submit agreed upon fees (contacts in this case are limited to the Center/one’s therapist inquiring about the client’s safety and/or requests for unpaid fees to one’s therapist and/or the Meguro Counseling Center). In the case of unpaid fees, one’s therapist may contact a client’s family, significant other, the client and/or family or significant other’s place of work, etc., and ask these persons or organizations to follow-up with the client on the status of the delayed payment.
- 10.) Requests for information about a client by a court of law (the Center/one’s therapist will still try to maintain confidentiality as much as possible in these instances).
- 11.) All documents related to a client’s therapy, e.g., therapy notes, materials received from clients or third parties, etc. are maintained confidential with the above caveats as applicable. Both therapy notes and materials received from clients or third parties are the personal notes and sole property of the applicable therapist, and as such are not subject to request for destruction, disclosure, or transfer to the client or other party. Please note that, as the service is not medical care, therapy notes are not the same as “medical records” that patients who receive care at medical clinics may have the right to obtain copies of. Written therapy summaries can be given to clients upon request as necessary and appropriate, and with applicable fees. In addition, the Center can not guarantee to have access to electronic or paper documents/records more than 5 years-old as they may be in storage or unavailable for other reasons.
- 12.) It is assumed that one’s therapist can freely contact any e-mail addresses or call any phone numbers you provide and use their name as e.g., “Dr. Doug Berger”, “therapist”, “counselor”, or “psychiatrist from the Meguro Counseling Center”. In most cases your therapist will call themselves by their name as, “Doug Berger”, or “Doug”, and they may also use discretion in using other unrelated names in cases where persons other than a client may answer the phone to protect client confidentiality. If you are not reachable, do not have an answering machine or do not reply, an SMS may be sent to your mobile phone number that asks you to reply and may include an e-mail address from the Center. Depending on our office needs and/or situation in contacting a particular client, we may legally make calls from our main number as noted on the Home Page, from a mobile phone, or from in internet-based phone service i.e., Skype, and these calls may or may not display caller ID at our discretion. Calls may be made between the hours of 8:00am and 10:45pm Japan time. It is impossible to predict a client’s specific situation when returning calls and the Center can not take responsibility for difficulties encountered in your receipt of a call. Your therapist will conscientiously endeavor to honor clients’ requests not to use specific contacts, not to use their real identity for specific telephone numbers, not to call on specific days/times etc., however, the Center can not absolutely guarantee that your therapist will be able to honor complex requests in this regards (all requests must be received in writing by e-mail).
- 13.) The therapists at the Meguro Counseling Center retain the right to maintain any and all information including contact information received from clients, and they can not absolutely guarantee they would not call a specific phone number and/or introduce themselves in a specific way once a client has provided contacts if there is an urgent need to contact a client and other means of communication are not successful in timely fashion, and this would need to be determined by your therapist on a case-by-case basis. There is also a small risk of human or machine error in the organization and management of contacts that a client requests not to use that any therapist or counseling center may have, so that it is important for clients to consider these items before providing a contact or phone number. Please note, however, that the Center does not accept clients that do not provide a phone number, are not readily contactable by phone, or do not return messages in a timely manner that would need to be determined by your therapist, and that your therapist may initiate termination of ongoing therapy in these instances.
- 14.) Once a client has contacted the Center, the Center has the responsibility to attempt to contact the client and inquire about their condition and safety as soon as possible. If persons are not available or do not reply within a reasonable amount of time (the duration of which would need to be determined by the Center on a case to case basis), the Center may use any and all information in an e-mail or phone contact, or information available on the internet or other public databases etc., including phone numbers displayed with or without a voice message, and reply with the Center’s name and/or affiliation, or use electronic means to contact any and all phone numbers, e-mails or SMS messages received. This policy also extends to unknown contacts so that any contact may be replied to using any publicly available information and replied to as noted in #12 above. If you do not wish to receive a return call to a number you call from, you should either not display your phone number (dial 184 in Japan before dialing our number), use a phone that return calls can be received on, or leave a message to the effect that you do not wish a return call to that number.
- 15.) Written or verbal inquiries from a third party about persons who have not approved a release of information to the third party will either not be responded to, or consist of the reply: “I can not reply to inquiries about specific individuals who may or may not be in my practice”, irrespective if whether the person in question has ever been a client at the Center. Copies or reports of such inquiries may be forwarded to the person in question, a legal authority, or any other related individual if deemed necessary, with or without notice to the sender or individual in question, under the discretion of the Center who will evaluate the appropriate action for each situation.
- 16.) In the case of therapy with minors, because parents have legal and logistic guardianship over the minor, there may be cases where the parents need to know specific details of what has been told to the therapist by the child. Examples of these situations include: danger to self or others (desire to hurt oneself or others), drug or alcohol use, incidents of rape or molestation, promiscuity, pregnancy and abortion plans, etc.
- 17.) Clients acknowledge that any information about themselves in a public format could be seen by their therapist by serendipity, or in the case of a clinical or administrative need to do a search; and the therapists at the Center reserve the right to make the decision on the appropriateness of disclosing to the client that a search has been done on a case-by-case basis.
※ Please also refer to the Meguro Counseling Center Code of Ethics page for further details.
To contact the Meguro Counseling Center please click here
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