Approach of Douglas Berger Psychiatrist Tokyo


The Tokyo Meguro Counseling Center cares for persons with a wide variety of psycho-social problems. The Center is also experienced in Alcohol Treatment in Japan, and is happy to help persons with alcohol or substance abuse issues in Tokyo or greater Japan via phone or Skype counseling. Douglas Berger, the  psychiatrist of Tokyo, takes a measured approach to psychiatry.  You can find  information about that here and at the Meguro Counseling Center.

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Cognitive Behavioral Therapy (CBT): CBT is helpful to delineate maladaptive and negative thinking patterns that often torment and distress people. CBT is particularly useful as an adjunctive and rehabilitation treatment for depression and other problems including low self esteem, anxiety, and other issues. Lists of thought distortions, records of dysfunctional thoughts and their rational reappraisal, life planning strategies that can overcome one’s usual negative pattern of behavior etc. are often given in a work-book fashion that can be an effective method toward self-improvement. This is an example of Psychopharmacology-Integrated CBT (Cognitive-Behavioral Therapy), where a medication-illness paradigm is integrated with a psychology-psychotherapy paradigm in order to boost treatment effects from both angles.

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Depression & Anxiety: Sometimes an illness like severe depression or anxiety may require medication in order to allow the talk therapy to jump-start. The therapists at the Meguro Counseling Center have considerable experience in using psychiatric medications and keep up to date with the many medications used in Western countries that are not yet available in Japan. Your therapist can provide you with information and recommendations regarding psychiatric medication, and the Meguro Counseling Center works together with a number of physicians licensed in Japan who can provide a prescription as appropriate.

Some of the more common problems that the therapists at the Tokyo Meguro Counseling Center have experience treating includes self-confidence problems, relationship/family problems, depression and manic depression, anxiety/panic, eating disorders, obsessive-compulsive disorder, phobias, substance and alcohol abuse, history of traumatic experiences (PTSD)/child abuse, feelings of unreality, sleep disturbances, psychosomatic (mind/body) disorders, women’s issues, gay and lesbian issues, and child and adolescent disturbances. The Tokyo Meguro Counseling Center has considerable experience in the treatment of depression. Corporate training and conflict resolution is also available, please inquire for details. In addition, Phone or Skype counseling is often provided for persons living in the Kansai area (Kobe, Osaka, and Kyoto). See the Tokyo Meguro Counseling Center’s web site for more details.

Charts & Graphs. The Meguro Counseling Center often uses charts and graphs in order to conceptualize clinical issues in visual form. These are some examples of the many files used with clients at the Center (the graphs require individual discussion in order to make sense in context of each unique situation):

  • Core Issues and Defenses; a flow chart of the core psychological issues people have and the adaptive and maladaptive defenses people use.
  • Mood Effects On Psychology; a diagram of how abnormal mood can lead to feelings and behaviors that are not optimal.
  • Self Esteem Needs In Relationships; an illustration of how the mechanics of intimate relationships can lead to crashes in self esteem.
  • Obedience and Defiance Cycle; how a cycle between obedience and defiance can lead to resentment, guilt and fear, and secondary depression, anxiety, conflict, and decreased self-assertion.

Douglas Berger psychiatrist Tokyo - Meguro Counseling Center logoThe Tokyo Meguro Counseling Center strives to create a friendly and compassionate atmosphere in its counseling style. An eclectic counseling approach using a balance of the different major types of therapy (cognitive/behavioral (CBT), psychodynamic, supportive, group psychotherapy and others) is employed to fit with what each individual requires in order to achieve the goals set in the sessions.

Psychodynamic Psychotherapy: Also called insight-oriented psychotherapy. A central theme in therapy is that everyone has certain core issues like feeling inadequate or unloved that one sometimes makes maladaptive defenses against (ie. trying too hard to get noticed by others or getting into unhealthy romantic relations) that can lead to trouble for the individual. Understanding and re-working these defenses and how they lead to trouble, as well as minimizing the effects of one’s core issues is a very useful tool in therapy. A detailed description of this approach can be found here: Core Issue-Defense Paradigm, and this page illustrates some clinical case examples. This is a related paper on how defenses can be used in psychotherapy to help one understand and work-through maladaptive behavioral styles.

Contact Douglas Berger psychiatrist Tokyo, Japan

What are “irreversible passage points”? If you wait the passage is irreversible: waiting too long for marriage or family making, waiting to study something and then getting old, a family dies with your plans still hanging, etc. Look closely at the train you are on and the stops!

The dose-response issue keeps popping up. This time it's depot injections. "I don't have symptoms so I often skip my injection days" is common. This defeats the purpose of getting depot injections to begin with.

Learn to use as needed extra doses, half doses, every other day doses, rotation schedules to avoid tolerance, and other flexibilities you'll never learn in medical school!

Antipsychotics can cause weight gain and diabetes. Psychosis can cause frightening delusions, family breakup, maybe suicide. We need to decide which side of the coin can be treated vs the risk of treating vs not treating.

Getting a handle on the cause vs trigger of depression is important. When did it start, what are the stresses, how does it relate to medications, drinking, relationships, etc. Never rush to a decision. Us: https://t.co/VOm63HtESZ, https://t.co/uaoP3ZdWvx

Tolerance to meds is common, esp ADHD & sleepers. Starting a rotation of 2-3 types on a cycle of some days or weeks usually works like a charm. No need to give up!

Psychiatry has few objective measures. One is looking at the chronology of events vs. onset of symptoms. If the symptoms started before a discrete event there is little logic to conclude that the event is causative. Us: https://t.co/VOm63Hc41r, https://t.co/uaoP3ZvxU7

Some people have so much anxiety that makes them go to the toilet, some “fight” back at their anxiety, and some need to give up and take meds. Us: https://t.co/VOm63HtESZ, https://t.co/uaoP3ZdWvx

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What about paranoia? We can give meds but what about reasoning? An “agency coming after me” is common. We try to remind people that if an agency was after them they would have been gotten already because agencies don’t like to waste time. Us: https://t.co/W6SS4mUflN

What to do when your company wants you to get a specific psychiatric intervention to return back to work, although you don’t have a problem to work? Get a Dr letter and a legal consultation. Us: https://t.co/W6SS4mCEuf, https://t.co/urVpIy8ewg

Many of our consultees in Japan have similar troubles, lack of exercise, don’t seek intimacy, don’t seek career development, don’t work on their language skills. Various causes, various interventions. Us: https://t.co/W6SS4mUflN, https://t.co/urVpIxQD7G

Infidelity, knotty problem. The truth, we as humans cannot be expected to be robots, but we need to keep the value on deep relationships over lust. How? Live humbly and safely. Us: https://t.co/W6SS4mUflN, https://t.co/urVpIxQD7G

No matter how many times you tell them, some patients just never take the dose or dosing schedule recommended. This can lead to significant morbidity and mortality.

Welcome challengers to your belief system who put you up against the ropes. They will force you to learn how to justify your argument, or force you to change it. Either way will help you grow. Us: https://t.co/W6SS4mUflN, https://t.co/urVpIxQD7G

Look at your position in life, family, work, lifestyle. What do you need to focus on? Realize your life positions will change, family will grow, jobs have an end. Move thru the phases with forethought. Us: https://t.co/W6SS4mUflN, https://t.co/urVpIxQD7G

What are the signs of ability to thrive? Family, Love, Friends, and work. Work requires persistence, flexibility, and strategic progress. Us: https://t.co/W6SS4mCEuf, https://t.co/urVpIy8ewg

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