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    Psychotherapy Practice Details




    ABOUT DR. BERGER

    Dr. Berger graduated from the University of Connecticut and received his M.D. from New York Medical College. He then completed a 4-year residency in psychiatry at New York Medical College. He is Board-Certified in Psychiatry from the American Board of Psychiatry and Neurology. Now based in Tokyo, Dr. Berger had served on the Faculty of the Albert Einstein College of Medicine Department of Psychiatry in New York as an Assistant Professor of Psychiatry. Dr. Berger has also a Ph.D. in Medical Science received while at the Tokyo University Department of Psychosomatic Medicine. Please see the About Dr. Berger Page for more details.

    JAPANESE MEDICAL LICENSING

    Although Dr. Berger is a Board-Certified physician in psychiatry in the United States, he is not a licensed physician in Japan. Dr. Berger can do counseling and psychotherapy, but he 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. In the case of severe depression or other psychiatric illness, Dr. Berger may refer clients for medication, similar to the function of a clinical psychologist in Tokyo.

    Most international residents see Dr. Berger 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 Dr. Berger, however, should in no way be a substitute for licensed medical care when needed.

    Because there is no comprehensive regulatory system for psychotherapists in Japan, it is important for those seeking therapy to confirm the credentials of their prospective therapists on their own:

  • Dr. Berger's American Board Certification in Psychiatry (Certificate No. 34086) can be verified through the web site of the American Board of Medical Specialties (You first have to register to use this service, then enter name as: Douglas Berger in the search). Click here to see a cached version of Dr. Berger's Board Certification search results.

  • Dr. Berger's Ph.D. in Medical Science from the University of Tokyo School of Medicine (Registration No.11965), received while at the Department of Psychosomatic Medicine at Tokyo University, is displayed along with Dr. Berger's other certificates, diplomas, and Board-Certifications in the therapy office.

    MEDICATION

    Dr. Berger can provide you with information and make recommendations to you about psychiatric medications. 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. Dr. Berger works closely with a number of Japanese and Western medical doctors that have a medical license in Japan who he can refer you to for medication he recommends if required. Ordering of medication not available in Japan is possible through this type of referral.

    Dr. Berger 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 Dr. Berger's policy to recommend that clients confer with their physician on the use of low-cost generic medications whenever possible.

    APPOINTMENTS, FEES, AND INSURANCE

    Appointments are necessary for all counseling sessions, please contact Dr. Berger for further information. Therapy hours are by appointment and include mornings and evenings Monday through Thursday, and mornings on Friday, Saturday, and national holidays.

    Fees are due in cash at the time of service, 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 ProtExPlan or the New-Zealand based InterGlobal plan; please confirm the plan that is right for you.

    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.

    CANCELLATION POLICY

    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 Dr. Berger 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. 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. 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. In addition, session appointments are mutually understood to imply a need for care, i.e. it would not be an appropriate use of the session appointments for the purpose of contemplating a need for care with a plan to cancel the session before the 72-hr deadline if no need is then considered.

    It is Dr. Berger'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

    Dr. Berger may occasionally provide you with suggestions or advice regarding work, family, personal relationships, or other topics. Although Dr. Berger will try to advocate for you based on his understanding of your personal situation and psychological issues, advice should be taken with the caveat that Dr. Berger 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 Dr. Berger in a psychotherapy session.

    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 Dr. Berger conscientiously uses the most up-to-date methods in his counseling approach, there are inevitably conditions that do not improve for a variety of reasons. These reasons may include the nature of the condition itself, the client's insight into the problem and/or willingness to undertake recommended treatments, or the ability of the therapist and/or treatment to effect gains. On rare occasion, clients will react in disagreement or unpleasant surprise in being told they likely have an illness such as depression, manic-depression, alcohol abuse, etc. Dr. Berger'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.

    CONDITIONAL THERAPY AND THERAPY TERMINATION

    Dr. Berger 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 serious disturbances to the therapy. Confidentiality may need to be broken in serious cases of threat to self or others to protect those concerned.

    If you decide to terminate your therapy by e-mail or leave a message to this effect on Dr. Berger's answering machine, it would be appropriate practice for Dr. Berger to call you and inquire about your status and needs for referral elsewhere. If possible, termination of ongoing therapy should be discussed in the context of your situation during a therapy session.


    EMERGENCIES AND HOSPITALIZATION

    If you think you have a medical or psychiatric emergency and you cannot contact Dr. Berger, you should either contact your general medical physician, or you can visit a hospital emergency room near your place of residence. 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) located near Hiroo station. The British Embassy also has a helpful list of hospitals in Tokyo and Yokohama.

    The number to call an ambulance in Japan is 119. 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. A large private psychiatric hospital is the Hasegawa Byoin in Chofu (Tel: 0422-31-8600). SOS International may be helpful for non-Japanese that may require repatriation.

    In the case that you or a significant other requires psychiatric hospitalization, Dr. Berger can provide you with the names of some Japanese hospitals for your reference. However, as Dr. Berger does not work directly with the physicians in these institutions, nor have any specific ability to effect hospital admission, he 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. 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.

    While Dr. Berger 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.

    CONFIDENTIALITY

    Confidentiality is defined as the maintenance of privacy between one's therapist and a client about the fact that they are consulting with the therapist, as well as the details of the consultation. Assignment to therapy with one of Dr. Berger's associates indicates that the client consents to the fact that the assigned therapist may need to discuss any and all of their clinical information with Dr. Berger.

    Dr. Berger and his associates form the Meguro Counseling Center. This is an associated network of therapists who work independently but share clinical support functions that include educational meetings, professional literature, mutual consultation on specific clients’issues, and other related activities in the service of providing the best care possible. The therapists at the Center will also cover for inquiries, emergencies, and correspondence for each other if one is away, and will confidentially share client lists, phone numbers, and clinical information in this regards. In the service of good clinical practice, Dr. Berger may have an associate therapist from the Meguro Counseling Center follow-up with the client in cases of therapy termination by the client.

    Confidentiality is strictly maintained with the following caveats:

  • 1.) Written requests by a client for Dr. Berger 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, Dr. Berger 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. 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.) Dr. Berger does not 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 Dr. Berger 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 Dr. Berger will try to do his best to maintain appropriate privacy lines between these persons for information given in confidence, he 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 Dr. Berger regarding their relationships or clinical concerns related to persons who are not part of the therapy sessions, Dr. Berger can only provide provisional discussion on persons he does not directly evaluate. For persons who have come to sessions, Dr. Berger requires 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 Dr. Berger and Dr. Berger cannot contact the client, or failure to submit agreed upon fees (contacts in this case are limited to Dr. Berger inquiring about the client's safety and requests for unpaid fees to Dr. Berger and/or the Meguro Counseling Center).
  • 10.) Requests for information about a client by a court of law (Dr. Berger 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 Dr. Berger, and as such are not subject to request for destruction, disclosure, or transfer to the client or other party. Written therapy summaries can be given to clients upon request as necessary and appropriate.
  • 12.) It is assumed that Dr. Berger can freely contact any e-mail addresses or call any phone numbers you provide to him and use his name as "Dr. Douglas Berger", "therapist", "counselor", or "psychiatrist from the Meguro Counseling Center". In most cases he will call himself, "Doug Berger", or "Doug", and he may use discretion in using other unrelated names in cases where persons other than a client may answer the phone to protect client confidentiality. Dr. Berger will conscientiously endeavor to honor clients' requests not to use specific contacts, not to use his real identity for specific telephone numbers, not to call on specific days/times etc., however, he can not absolutely guarantee that he will be able to honor complex requests in this regards (all requests must be received in writing by e-mail).
  • 13.) Dr. Berger retains the right to maintain any and all information including contact information received from clients, and he can not absolutely guarantee he would not call a specific phone number and/or introduce himself in a specific way once a client has provided contacts to him 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 Dr. Berger 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 Dr. Berger with a contact or phone number. Please note, however, Dr. Berger 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 Dr. Berger, and that Dr. Berger may initiate termination of ongoing therapy in these instances.
  • 14.) Once a client has contacted Dr. Berger, he has the responsibility to attempt to contact the client and inquire about their condition and safety as soon as possible. Because of this, Dr. Berger may use any and all information in an e-mail or phone contact for the purpose of inquiring about a Client's status or purport of their contact, including phone numbers displayed with or without a voice message, and reply with his real name and/or affiliation.
  • 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 with Dr. Berger. 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 Dr. Berger who will evaluate the appropriate action for each situation.

    Please also refer to the Meguro Counseling Center Code of Ethics page for further details.

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