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How to Find Counseling: Making the Most of University-Affiliated Centers and External Psychological Clinics

おひさま 子ども・ファミリークリニック

Have you ever experienced this?

My doctor said, 'You should get counseling.'
I went home and looked for a clinic in the neighborhood.

It said 'Psychologists available,' but when I asked, they said, 'We only offer 15 minutes once a month.'
Another clinic said, 'The psychologist has retired and is no longer here.'
Looking at the hospital's booking site, psychological counseling has a wait time of several months.
The place I finally got through to on the phone said, 'It's 10,000 yen per session.'

'Wait, is it this hard?'
'Where am I supposed to go?'
'To begin with, how do you choose a good counselor?'
'Are graduate student counselors actually qualified?'

I feel like giving up before I even start counseling.

This is a reality that almost every parent trying to find counseling for their child encounters.

In my child psychiatry clinic, every time I meet a child who needs counseling, I explain this to their family.

'In Japan, there are very few places where children can receive continuous counseling. Therefore, you need to combine multiple options. Let's think together about places that are realistically available today.'

Today, I will talk about realistic information on where to receive counseling and how to choose it.

Related Articles

These are other articles that will deepen your understanding when read along with this topic.

*This article provides general information based on the clinical experience of a child psychiatrist and does not make definitive statements about individual cases. For the diagnosis, treatment, and support of your child, please consult with professionals such as your family doctor, school counselor, or special needs coordinator.

The content of this article is a reconstruction of what the author, a child psychiatrist, actually tells parents and patients in daily consultations, with all personal information completely removed.

1. Options for places where you can receive counseling

1) Medical institutions (Child psychiatry clinics/hospitals)

Pros: Covered by insurance, smooth coordination with doctors
Cons: Psychologists are often not full-time, frequency is limited (about once a month)

Counseling at medical institutions is 'great if available,' but in reality, slots are limited. Clinics with full-time psychologists are a minority nationwide. Even if they exist, there are often no slots for new patients.

2) University-Affiliated Psychological Counseling Centers

Pros: Low cost (approx. 1,000–2,000 yen for 30 minutes), quality is managed
Cons: The counselor often changes every 1–2 years, depends on the region

Counseling centers operated by graduate school clinical psychology departments.
Graduate students (master's and doctoral students) provide counseling under the supervision of professors.

People often think, "Is it okay to rely on a graduate student?" but,

  • Master's and doctoral students majoring in psychology

  • Professors provide regular supervision (guidance)

  • Multiple experts review cases in case conferences

  • The quality is surprisingly high

The cost is 1,000–2,000 yen per 30-minute session, which is exceptionally cheap among non-medical counseling options.
It is one of the most realistic options for ongoing visits.

However, the fact that the counselor changes upon completion of their program (every 1–2 years) is a drawback.
If you want to build a long-term relationship, this needs to be considered.

3) Private Psychological Centers (Private practices by Clinical Psychologists/Certified Public Psychologists)

Pros: The counselor remains the same for a long time, and you may encounter highly specialized psychologists
Cons: High cost (market rate is 5,000–15,000 yen per 50-minute session)

Clinical psychologists and certified public psychologists working in private practice.
Quality varies greatly depending on the facility and the individual.
High price does not equal high quality, so it is important to check their reputation before using their services.

4) School Counselors (SC)

Pros: Free, completed within the school, smooth coordination with the school
Cons: Only available 1–2 days a week, deep psychotherapy is difficult, quality varies greatly by person

School counselors dispatched to public schools.
They are excellent as an initial point of contact.
However, they cannot provide deep, continuous psychotherapy.

5) Municipal Educational Counseling Centers

Pros: Free, community-based support
Cons: Long waiting times, limited frequency

Counseling agencies operated by municipal boards of education.
Being able to use them for free is the biggest advantage.
However, the frequency is limited, such as once or twice a month.

6) Health Centers / Child and Family Support Centers

Pros: Free, includes support for general daily life
Cons: Mental health professionals may not be on-site at all times

Municipal health centers and child and family support centers.
You can receive developmental consultations and parenting advice.

7) Prefectural "Mental Care Centers" and "Mental Health and Welfare Centers"

Pros: High level of expertise, specialized treatments such as trauma therapy
Cons: Often requires a referral letter from a medical institution, long waiting lists

These specialized institutions handle cases such as severe trauma, attachment disorders, and post-abuse support.
In many cases, you cannot use these services without a referral from your primary care physician.

2. Key points for deciding "where to choose"

The balance between "cost" and "continuity"

For children's counseling, it is not uncommon for it to continue for 1 to 2 years.
Rather than going to an expensive facility once or twice, attending a more affordable facility consistently is more effective.

  • University-affiliated psychological counseling rooms: 2 times/month × 12 months = 24,000–48,000 yen/year

  • Private psychological centers: 2 times/month × 12 months = 120,000–360,000 yen/year

Please choose by considering your family's financial situation and the necessary duration of treatment.

"Distance from home/school"

Counseling will not continue if it is a hassle to get there.

  • Within 30 minutes from home

  • A place you can stop by on the way home from school

  • A time slot that is easy for parents to provide transportation

Choosing a facility that meets these criteria is the secret to continuity.
Even if the quality is good, if it takes an hour one way, many people drop out within six months.

"Compatibility with the child"

With counselors, there is personal compatibility.

  • Male counselor vs. female counselor

  • Younger counselors vs. older counselors

  • Play therapy (through play) vs. verbal counseling (through talking)

  • Cognitive behavioral therapy vs. psychodynamic therapy

It is important to choose a format and person that matches the child's age, characteristics, and preferences.

In particular, for girls who have a fear of men (due to past trauma, a violent father, etc.), it is essential to choose a female counselor. For children in upper elementary school and above,
verbal counseling is often more suitable than play therapy.

“For siblings, use different counselors”

If siblings are assigned to the same counselor, it can sometimes become difficult to speak honestly.

  • “The psychologist knows about my older brother, so it’s hard to speak ill of him.”

  • “I might be compared to my younger sister.”

Ideally, each sibling should have their own dedicated psychologist.

Now that we have covered the options and criteria for judgment, I will discuss how to combine these resources and draw lines between them and medical care—next, I will talk about specific ways to use them in the consultation room.

Sources and Reference Information

3. What I do in the consultation room

Having read this far, many of you may feel, “I understand that there are about seven options for counseling and that I should choose based on the balance between cost and continuity. But if I am already visiting a medical institution, what is the ‘correct way to combine’ it with external counseling?”
“I don’t know how to draw the line between what to consult with medical professionals and what to consult with psychologists,” “How should I use a referral letter to connect quickly?” “I feel like my current counselor isn’t a good fit, but is it okay to change?” “I am considering developmental support and SST, but where should I start?”—faced with counseling options, parents often stop, not knowing how to combine them.

In the consultation room, before starting counseling, I first begin by sharing the “division of roles between medical care and psychologists” with the parents.
The procedure for using a referral letter effectively to connect to counseling, having the “courage to change” when it is not effective, the guideline of assessing progress over six months to a year, considering developmental support and SST as options for external institutions, and the fact that “there are limits to counseling within a clinic”—I tell parents this honestly from the start. After visualizing the division of roles between medical care and external institutions, we choose a counseling venue based on the family’s financial situation and ease of access.

I hope you will read this as a “foundation” when your family discusses “where should we ask for our child’s counseling?” or when you ask your primary doctor or homeroom teacher “where should we consult?”

3-1. Share the "Division of Roles Between Medical Care and Psychologists" with Guardians

Before starting counseling, I tell guardians the following:

"My role is diagnosis, medication management, and family support. The psychologist's role is to listen carefully to your child's feelings and help them organize their thoughts and interpersonal relationships. It is confusing if both roles are filled by the same person. Please separate the roles and utilize both."

Doctors have limited time (10 to 15 minutes for follow-ups).
Psychologists have more time (e.g., 50 minutes).
Utilizing each of their strengths is most effective for your child.

3-2. Make Good Use of a "Referral Letter"

When using external counseling or mental health institutions, having a doctor's referral letter helps:

  • The receiving side can understand the child's condition

  • The handover is smooth

  • It is easier to coordinate with medical care in an emergency

When I refer a patient to an external counselor, I always write a referral letter.
I also ensure that the doctor and psychologist exchange information regularly.

3-3. "The Courage to Change When It's Not Working"

Counseling is not something that you must continue once you have started.

  • The personality of the counselor is not a good fit

  • The child seems distressed even while attending

  • There is no change even after half a year

In these cases, please have the courage to change.
Consider moving to a different psychologist or institution while consulting with your doctor.
"Enduring and continuing is not necessarily in the child's best interest.

3-4. "Evaluate Over 6 Months to 1 Year"

Once you start with a new psychologist or institution, continue for 6 months to 1 year to see if there are any changes.

  • Has the child become accustomed to the facility?

  • Has a relationship been established with the psychologist?

  • Are there any changes in behavior at home?

  • Are there any changes in school life?

If there is even a slight improvement in these areas, it is worth continuing.
If there is no change at all and the individual still seems to be struggling, consider making a change.

3-5. "Consider External Options for Developmental Support and SST"

When social skills training (SST), parent training, or developmental support is necessary and cannot be provided by a medical institution, utilize external developmental support centers or university psychological centers.

  • Private developmental support facilities (child development support, after-school day services)

  • University psychological centers (those that conduct SST)

  • Municipal developmental support centers

For these as well, either the doctor will provide a referral letter, or the family can apply directly.

3-6. Communicating the "Limitations of Counseling at a Clinic"

Including the clinic I operate, there is a reality where it is structurally difficult for many psychiatric and child psychiatric clinics to provide long-term, continuous counseling.

  • Under the framework of insurance-covered medical care, the revenue from psychological counseling is low

  • Hiring full-time psychologists is difficult from a management perspective

  • The number of patients that can be seen in a day is limited

Due to these circumstances, clinics often take on the role of "diagnosis and medication management," while external institutions handle "counseling."

I convey this honestly to the family and ask them, "Please do not try to complete all counseling here; let us support you as a team with external partners."

4. "Finding a Counselor" You Can Do at Home

"Points to Confirm During the Initial Phone Call"

Things to confirm when calling a counseling institution for the first time:

  1. Target age range(Do they cater to children and adolescents?)

  2. Frequency and Fees(How many times a month, cost per session)

  3. Approach(Cognitive Behavioral Therapy, Play Therapy, Family Therapy, etc.)

  4. Continuity of the Assigned Counselor(Possibility of rotation)

  5. Coordination with Physicians(Will they coordinate if you provide a referral letter?)

  6. Impression of Phone Support(This is also important)

The last point, "Impression of Phone Support," is surprisingly important.
If the person who answers the phone is cold, slow to respond, or gives vague explanations—such institutions often provide low-quality counseling as well.

"Things to Check During the Initial Interview"

During the initial interview,

  • The counselor's demeanor (whether the child feels at ease, whether they feel tense)

  • Clarity of explanations

  • How they listen to the child

  • How they coordinate with the family

Please observe these.
If you feel it is not a good fit during the first session, there is no need to continue.

"The Idea of Combining Multiple Institutions"

Do not try to cover everything with a single institution.

Example:

  • Attending Physician (Child Psychiatry Clinic): Diagnosis, medication management, family consultation — once a month

  • University Psychological Counseling Center: Counseling — twice a month

  • Municipal Developmental Support Center: Developmental support group — once a week

  • School Counselor: Consultation at school — biweekly

Create a team to support your child by combining these resources.
Even if one institution is not perfect, there are parts that can be supplemented by combining them.

Do not make "continuing itself" the goal

Counseling is not intended to be continued indefinitely.
The goal is for "your child to be able to deal with their feelings in their own way."

  • Some children graduate after one year of counseling

  • Some children attend continuously for many years

  • Some children graduate once and return during adolescence

Your child only needs to attend for as long as necessary.
Please do not feel pressured that you "must keep going forever."

5. Conclusion: Cultivating the Right Counseling Together

Counseling is a two-person relationship between the child and the psychologist, and the family and the doctor form a team that supports it.

If you try to find the perfect counselor, you will often find no one.
Instead, find a place where the chemistry with your child is decent and it is easy to continue, and build the relationship from there.

And change it as needed.
Do not feel guilty about changing.
Combining appropriate support according to your child's condition and stage—this is the realistic way to use counseling.

In my clinic, I tell parents who are struggling to find counseling:

"Please do not try to find the 'perfect counselor' on the first try. It is okay to have the mindset of trying a few places, finding one where you can continue, and then cultivating it together with your child."

I tell them this.

And I also say,

"The very experience of your child having an 'adult they can talk to' other than their family through counseling is a great asset. Everything that follows will come along slowly."

I also tell them this.

Counseling is also a means for a child to have a "trusted adult other than family."
This becomes a strength that supports the child's life throughout adolescence and adulthood.
The experience of having a long-term relationship with an adult who has a different perspective than the family.
That supports the path to becoming an independent adult.

To families struggling to find counseling—let's work together to create support that suits your child, without rushing and while looking for combinations.
We child psychiatrists are also one of your companions on this journey.

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