The health insurance system and psychoanalytic psychotherapy in Japan: the association with evidence-based practice

Since 1958, the Japanese public health insurance system has covered psychoanalytic psychotherapy. Although it is called ‘standard-type psychoanalytic therapy’, it is essentially psychoanalytic psychotherapy or psychodynamic psychotherapy performed face-to-face once a week. Japan has two psychoanalytical organisations: the Japan Psychoanalytic Society (JPS) and the Japan Psychoanalytical Association (JPA), both established in 1955. Until they separated in 1980, they were one organisation that worked together to secure government approval for medical insurance coverage of psychoanalytic psychotherapy and contributed to training psychiatrists and clinical psychologists in psychoanalytic psychotherapy. Currently, less than 1% of psychiatrists and clinical psychologists in the country have undergone JPA or JPS training. Psychoanalytic psychotherapy provision nationally is difficult because psychoanalytic psychotherapists are concentrated in urban centres. Recent global trends have prompted the demand for evidence-based practice (EBP). To date, the effectiveness of psychoanalytic psychotherapy has not been demonstrated in Japan. Therefore, it is not recognised as an EBP within national measures for public mental health. However, psychoanalytic psychotherapy is essentially an ‘experience-based practice’, even though it is fundamentally different from EBP. Nevertheless, to sustain psychoanalytic psychotherapy as a viable psychotherapy in Japan, it would need to meet EBP standards.