saori miyazaki
Source: saori miyazaki

By Saori Miyazaki, LMFT

Have you ever wondered if we could manage our mental health issues by using methods other than Western psychotherapy?

When I thought about this question thirteen years ago, I was working as a counselor at a non-profit agency where we provided HIV/AIDS prevention and treatment as well as mental health services to Asian and Pacific Islander population. Around the same time, I also started my master’s program for clinical psychology in graduate school. My hope was to become a licensed psychotherapist because I had seen how counseling and psychotherapy could be effective in treating mental illness through my job. However, I have also witnessed the concept of “seeking help by talking to a perfect stranger about a personal issue” not working well with some people; especially if they are from a culture where only a small number of people practiced Western psychotherapy.

Because of this, I was struggling with the idea on how to effectively advocate psychotherapy to the ones who have a stigma about seeing a therapist. I understood this is sometimes deeply rooted in traditional cultures. For example, when I was growing up as a child in Japan, if I were to see a mental health professional, that meant something was seriously wrong with me. To the Japanese, the words “mental health” conjured up images of mental institutions.  Consequently, if I were having some issue with my feelings, such as anxiety and depressive mood, I could not go to a mental health professional. But instead, I would have to manage it myself or seek help from close family members. Going to a stranger and paying him or her to solve my issues was not a desirable option. 

So, does that mean we Japanese never had any professionals help us maintain our mental health? This question made me want to find out how the Japanese managed their anxiety and depressive mood and other personal issues before they were introduced to the Western psychotherapy. I knew that in old days, people hid their family members with severe mental health issues from the public and locked them in a closed quarter or admitted them into a mental institution. Many were neglected by their family members due to lack of understanding and feelings of shame. But I felt there had to be some type of treatment methods for less severe cases such as anxiety.

One day in 2004, I stumbled upon a newspaper article, “A Unique Experience or a Path to Self- Discovery” by Sayaka Yakushiji which covered the rise of meditation retreats and self-reflection among young Japanese.  The article shared anecdotes of a few 30 and 40-year olds searching for an opportunity to remove themselves from their daily lives to have self-introspection. This would take place over a three-day vigorous Buddhist retreat or meditation session at temples in Japan. Almost all of them stated that the reason for participating was not to attain religious enlightenment but to simply work through their mental blocks, relationship conflicts, and even anger management issues. 

In the above mentioned newspaper article, a couple of the participants from the meditation retreat stated that they were actually hoping to acquire a drastic change and have spiritual awakening by sitting through meditation for hours, reciting and writing sutras. Instead, they ended up “finding themselves”. One man in his 30’s stated that while he did not expect to get Buddhist teachings during his three-day meditation retreat he was hoping the rigorous Buddhist training would bring about a change in his personality.  Instead, the self-reflection brought him the idea that the change needs to start within himself and the notion of “accepting” himself first emerged. “I found out that it is okay just to be me. That’s the most important thing I learned from these three days.”

One woman in this article stated that she would like to see the Buddhist temples align with the needs of people’s ordinary issues; suggesting that temples also need to function as support system for “living people”.  She did not expect to have some religious miracle treat her issues or become a serious Buddhist by joining a weekend meditation.  Rather she wanted to have a place away from everyday life where she could utilize Buddhism based philosophical guidance such as mindfulness so she could properly reflect on herself and personal issues. 

This was particularly interesting to me because these Japanese men and women chose the Buddhist temples as a space to reflect and work on their obstacles, just like some individuals here in the U.S. reach out to psychotherapists to receive mental health support.  In modern-day Japan, Buddhism is viewed by many Japanese not as a religion but more as the root of traditional customs such as funeral practices. For some Japanese, a funeral may be the only occasion that they participate anything connected to Buddhism.  Because of this phenomenon, many started to express the necessity for a structural shift within Japanese Buddhism.  In fact, it is in response of these types of demands that some temples started hosting three-day course and/or meditation workshops for the general public.

You may be surprised to know that this type of weekend retreat has not been popular in a Buddhist country such as Japan but rather in Buddhist retreat facilities here in the San Francisco Bay area. The Buddhist temples in Japan used to have much closer tie to their community members during pre-World War II period but this changed drastically after WWII. The Western lifestyle in postwar Japan along with the American Occupation, which tried to diminish anything traditionally Japanese, contributed to this shift. On top of this, the family structure started to change from the traditional larger family where we had access to elders and extended family members who could lend support to a more isolated “nuclear family” format.  This all contributed to modern-day Japanese having little psychological and physical support from their families and being too busy to take time off from their daily life to even sit quietly at some temple and be “non-productive.”  These are the reasons why I was pleasantly surprised to learn that some young Japanese are currently going back to the temples to seek mental/spiritual refuge.  

Sometimes, when we are faced with obstacles, we may feel “self-hatred” for not being able to manage it correctly and fall into a self-loathing negative pattern. We may be easily influenced by others’ opinions or attracted to a “quick solution” in order to better ourselves. But if we turn away from facing our inner self, we are still denying who we are and what we want to do with our lives.

I believe in self-reflection because individuals have the ability to improve themselves if possessing the proper mechanisms. Ultimately you are your own therapist and it is up to you to manage your problems. I am also a strong believer in counseling and psychotherapy which advocate facing our problems by “self-refection practice” because that can often lead to an answer to our struggles. In the therapy session, a good therapist can provide the client with the right tools and re-direct him/her to be insightful.

Another indigenous therapy I found is a self-reflective method which is based on Jodo Shinshu (Pure land) Buddhism called Naikan. I am going to share how I apply Naikan in my psychotherapy session to enhance the self-reflective experience in the next section.


Saori Miyazaki is a licensed marriage and family therapist in California. She is certified in Japanese Psychology and expressive arts therapy and has been implementing mindful-based psychotherapy in her private practice in San Francisco. Her work experiences include working with LGBTQ community, traumatized teens, and adults with depression and anxiety. She studied photography in college and worked as a freelance photographer before becoming a psychotherapist. She enjoys hiking, cultural events, traveling, photography, watching classic movies, having afternoon tea and chasing and being chased by her cat.

For more information see my Psychology Today page:

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