Abstract
This narrative review paper contrasts the professional prospects of psychologists in Japan and the U.S., discussing how divergent training, licensing, and practice standards appear to influence psychologists’ profession in each country. Licensed psychologists in the U.S. practice with significant autonomy, which can be seen as a reflection of rigorous training requirements. In contrast, certified public psychologists in Japan complete a shorter-duration training regimen yet encounter more restrictive professional standards and greater financial challenges. These varying standards often create barriers to professional practice that impact psychologists on a global scale. Limited international mobility restricts opportunities for psychologists to learn abroad, exchange knowledge, and deliver culturally sensitive care to diverse populations, despite the need for such services among foreign individuals or immigrants in both countries. Furthermore, these disparities impede broader collaborative efforts to address global mental health challenges. Aligning training and licensing standards globally could enhance psychologists’ international mobility, ensure consistent quality of care, and foster global collaboration. This alignment could improve access to culturally sensitive psychological services and help bridge the mental health care gap worldwide. This review emphasizes the necessity of further cross-cultural comparisons to understand the impact of training and licensing standards on clinical practice quality and accessibility. By presenting this comparative analysis, the study aims to inspire similar efforts, promoting global licensing reciprocity and the integration of professional psychology in an increasingly interconnected world.
Keywords
Significant disparities exist in the education, training, and licensing of professional psychologists worldwide, as demonstrated by differences between Japan and the U.S. However, research exploring these differences and their effects on practice standards and career opportunities is notably lacking.
This research fills a critical gap by providing a comparative analysis of the education, training, licensing, and practice standards of psychologists in Japan and the U.S., shedding light on their implications for professional roles, job outlook, and international mobility.
This research informs practice by highlighting areas for enhancing psychologists’ international mobility and access to culturally sensitive care, and influences policy by suggesting the need for more harmonized global standards for psychology professionals.
Introduction
Gaps in Clinical Psychology Profession
With increasing global interconnectedness and psychological issues that cross state and national borders—such as migration and refugee crises—there is a growing necessity for culturally sensitive psychological services.1,2 In particular, the rapid spread of coronavirus disease 2019 (COVID-19) had a profound mental health impact on diverse populations, exacerbating suicide rates, anxiety, and depression across the world.3,4 Despite the increased demand for culturally appropriate mental health services,3,4 many countries struggled with the shortage of such services.5,6
Efforts have been made to address this shortage by increasing international mobility of mental health professionals. However, such efforts have been primarily regional, focusing on areas such as Europe, 7 United Kingdom, 8 and North America. 9 Thus, international mobility for mental health professionals remains limited. A study reviewing professional psychology across Canada, Finland, France, and the UK, indicates that psychologists are more likely to face limited international mobility than other professions, such as engineers or physicians. 10 This gap is partly due to varying licensure requirements, regulatory frameworks, and educational standards across these countries, which often create barriers for psychologists seeking to practice abroad or contribute their expertise globally. 10
In an effort to gain a deeper insight into the global gap in professional psychology, a few studies examined cross-cultural comparison in this field, including within European countries, 7 as well as between Europe and Canada, 10 Europe and the U.S., 11 and South East Asian countries and Australia. 12 While these studies provide helpful information regarding training and licensing standards in each country, there is a scarcity of research exploring broader implications. Differing regulations and educational or practice standards among psychologists across countries not only constrain international mobility but also result in divergent job outlooks on a broader scale.
This narrative paper reviews the job outlook of psychologists in Japan and the U.S., examining factors such as education, training, licensing requirements, and practice standards. This paper advocates for countries to reassess their regulatory frameworks to facilitate easier international mobility for psychologists to reduce barriers to licensure reciprocity. Such reciprocity offers numerous benefits: addressing workforce shortages by enabling deployment of skilled professionals, enhancing access to diverse services across borders, ensuring consistent quality of care through aligned standards, and fostering ongoing professional development and collaboration among global practitioners. This approach will ensure individuals receive timely, culturally appropriate care during critical periods.
Search Strategy
Given the limited availability of peer-reviewed, empirical research, specifically examining cross-national comparison in the practice standards and prospects of psychologists, a narrative review approach was employed. This method allows for an extensive qualitative synthesis and discussion of the trends across Japan and the U.S. Primary databases searched included PubMed, PsycINFO, EBSCO Psychology & Behavioral Sciences Collection, ProQuest, and Google Scholar. The literature search included both peer-reviewed articles and gray literature written in Japanese or English, including websites of relevant professional associations to gather information on official practice standards, guidelines, and ethical principles. We also consulted additional sources, such as governmental or regulatory websites, as appropriate. Reference lists of identified articles and documents were screened for additional relevant sources that may not have been captured through the initial search. Priority was given to materials published in the past decade, ensuring the most up-to-date information.
Findings
Overview of the Mental Health Profession in Japan and the US
In Japan, certified public psychologists, certified clinical psychologists, psychiatrists, and psychiatric social workers can provide psychotherapy. In 1988, the Japanese Certification Board of Clinical Psychologists established criteria for accredited programs to train certified clinical psychologists. 13 Since then, many mental health-related certifications have been created.14,15 In 2019, the Japanese Association of Certified Public Psychologists (JACPP) founded the licensure system for certified public psychologists, which has more rigorous coursework and clinical training requirements for psychologist licensure compared to certified clinical psychologists.13,16 Certified public psychologists are nationally licensed and do not need to renew their license. In contrast, certified clinical psychologists are certified by a board and are required to renew their certificate every 5 years. These 2 professions have similar role responsibilities in clinical practice. 16 In 2020, 71% of certified public psychologists were also registered as certified clinical psychologists. 14 In 2021, the JACPP created 2 additional certificates for advanced levels of certified public psychologists, one for those with multidisciplinary skills or knowledge and a second for those with both multidisciplinary and supervisory skills and knowledge. 16 Overall, Japan’s psychology credentialing and licensing are evolving.
In the U.S., licensed psychologists, board certified psychiatrists, licensed clinical social workers (LCSW), licensed marriage and family therapists (MFT), licensed professional clinical counselors (LPCC), pastoral counselors, and psychiatric nurse practitioners are some of mental health professionals who provide psychotherapy. These professionals often have distinct training backgrounds depending on the licensure. For instance, while licensed psychologists are required to hold a doctoral degree, LCSWs, MFTs, and LPCCs typically possess master’s degrees in their respective fields.
The number of psychologists per 10 000 people in Japan and the U.S. is relatively similar, with 27 in Japan and 31in the U.S.14,17 Of note, the U.S. boasts a more diverse mental health workforce, featuring a greater number of master’s level therapists (eg, LCSWs, MFTs, LPCCs). Table 1 compares psychologist overview, including demographics, training and licensure requirements, and job prospects, between the U.S. and Japan.
Psychologist Overview of Japan and the United States.
Psychologist Practice Standards
While certified public psychologists in Japan and licensed psychologists in the U.S. share many similarities in their role responsibilities, there are some differences in the privileges that they hold. In Japan, the roles of certified public psychologists are to conduct assessment, psychotherapy/consultation, multidisciplinary collaboration (eg, liaison consultation), and education. 18 It is stipulated that if patients have a medical provider (eg, primary care physician or psychiatrist), certified public psychologists are to defer to these medical providers for diagnostic impressions and treatment recommendations with few exceptions. Japanese certified psychologists can administer assessments and provide treatment recommendations, though they are not to provide diagnostic impressions. Psychologists in Japan do not prescribe medications. 18
Licensed psychologists in the U.S. have similarly versatile roles, including conducting assessment, psychotherapy, consultation, supervision, research, and teaching. Contrary to certified public psychologists in Japan, licensed psychologists in the U.S. practice independently with a great deal of autonomy in making diagnoses and treatment recommendations as well as providing therapy. Moreover, licensed psychologists in the U.S. can petition for patients’ commitment to psychiatric hospitalization in most states. 19 In Massachusetts, for example, licensed psychologists can file for involuntary psychiatric hospitalization in the case of elevated safety concerns. 20 While most U.S. licensed psychologists are unable to prescribe medications, several states with limited access to providers have established additional training and certification for psychologists to become prescribers. 21
Overall, licensed psychologists and medical doctors appear to have more collegial relationships in the U.S. In contrast, psychologists and medical doctors appear to have implicitly hierarchical relationships in Japan, and Japanese psychologists generally have more restricted practice standards compared to those in the U.S.
Insurance Coverage
Reimbursement by insurance for psychological services has been much less common in Japan compared to the U.S., though the reimbursement system has been changing. 22 Recently, there have been advancements in the inclusion of psychological services within the Japanese healthcare system. According to JACPP, 23 specific psychological services have started to be included in the national health insurance reimbursement schedule in 2024. These services involve tasks such as psychological assessments and interventions under the supervision of medical providers, which could gradually improve the accessibility and affordability of mental health care in Japan. Given Japan’s universal healthcare insurance system, expanding insurance coverage for psychological services holds significant potential to enhance mental health service accessibility nationwide.
In the U.S, various payment sources are accepted by health service psychologists, private insurance, Medicare, Medicaid, Tricare, and VA insurance. Notably, 81% of psychologists accept self-pay, with 16% of psychologists exclusively accepting self-pay as their payment source. 24 A convoluted insurance reimbursement scheme in the U.S. can constrain the affordability and accessibility of mental health services for certain populations. Overall, insurance reimbursement schemes appear to negatively affect mental health service accessibility in both countries, but in different ways.
Job Prospects
The job outlook for psychologists varies significantly between the U.S. and Japan. In 2023, certified public psychologists in Japan were employed across various sectors: 40% in medical/public health, 34% in education, 30% in welfare, 14% in other fields (eg, private practice), 8% in industry, and 5% in correctional facilities. These percentages reflect overlapping employment areas, indicating that some psychologists worked in multiple sectors. 25 Among licensed psychologists in the U.S. in 2021, 59% worked in private practice, 23% in hospitals or organized human service settings, and 14% in educational settings, with the remainder employed in government, business, or other areas. 24 Notably, private practice was much less common among Japanese psychologists, with only a small portion working in this field, in contrast to more than half of U.S. psychologists.
In 2023, the employment status of certified public psychologists in Japan was as follows: 96% were employed, with 33% working full-time and 36% part-time in the field of psychology; the rest worked in fields other than psychology. Among those employed outside of psychology, 25% reported that they chose their jobs because the desired work conditions (eg, work location and hours) could not be met in the field of psychology. 25 Of part-time workers, 54% did not find a full-time job that they had desired. 14 In the U.S. in 2020, 93% were employed, (66% full-time; 27% part-time), 1% was unemployed, and 6% were not in the labor force. 24 Overall, among employed psychologists, 59% of those in Japan had full-time jobs, compared to 73% of their counterparts in the U.S. This disparity may suggest that psychologists in Japan face greater difficulties in securing job stability than those in the U.S.
Salary and Compensation
Psychologist’s salary varies greatly depending on numerous factors such as employment status, employment setting, geographic location, experience, and sex/gender. Reportedly, in 2020, more than 60% of full-time psychologists in Japan earned less than 300 000 yen per month (≈ $2759: conversion based on 1 USD = 108.57 yen as of December 2020) and earned less than 3 600 000 yen (≈ $33 158) per year, 14 whereas the national median annual salary for professions in Japan was 4 370 000 yen (≈ $40 251). 26 There were no data regarding psychologists’ salaries based on sex. 14 Notably, men with a master’s degree in Japan earned an average monthly salary of 400 500 yen, while women with a master’s degree earned an average monthly salary of 290 100 yen. 27
In contrast, the median and mean annual salaries for licensed psychologists in the U.S. in 2015 were $85 000 and $100 362, respectively. 28 Their median annual salary is higher than the median household income in the U.S. ($56 516) in the same year.28,29 Median salaries for male psychologists ($91 000) were higher than female psychologists ($80 000). White psychologists ($88 000) made higher median salaries than non-White psychologists ($71 000). 28 Approximately 57% of licensed psychologists had salaries ranging between $60 000 and $120 000.
Overall, the median salary for psychologists in Japan is below the median household income in Japan. In contrast, psychologists in the U.S. typically earn higher salaries than the national average.
Demographics
Differences in psychologist demographic characteristics between Japan and the U.S. are evident. Of certified psychologists in Japan, 73.0% identified as female, 26.2% as males, and the gender of 0.8% was unknown. 14 Of licensed psychologists in the U.S., 59.2% identified as female, 40.6% as male, 0.2% as other, and 0.1% as transgender. Most U.S. psychologists (87.8%) identified as White/Caucasian. 30 There are no available data on the racial/ethnic background, sexual orientation, and disability status of psychologists in Japan.
As noted above, the psychology profession in Japan is predominantly women. This trend may be attributed to traditional gender roles that still prevail in the country, where women are often expected to pursue careers in nurturing and caregiving fields. The lower financial and professional value placed on psychology as a profession compared to other fields might also contribute to this trend. Men in Japan might be more inclined to pursue careers with higher status and income potential due to social expectations and pressures for them to be primary financial providers. Consequently, men may be less likely to pursue careers in psychology. Furthermore, given that Japan is a homogenous country, reporting on racial/ethnic background is uncommon across various fields, including psychology. This limited sensitivity to diversity and cultural differences may be an area that Japan needs to address to enhance its inclusivity and promote equitable access to the psychology profession.
Required Education and Training for Licensure
In Japan
One potential reason for differences in role responsibilities and job outlook between the U.S. and Japan may be the varying levels of rigor in required training and licensure in each country. In Japan, certification for public psychologist is granted by the JACPP. A master’s degree is typically required, and individuals with a bachelor’s degree can be eligible to become a certified public psychologist if they complete a 2-year accredited training program. 31 However, the limited availability of accredited programs makes this option less accessible to individuals. 32
The educational curriculum required to become a certified public psychologist in Japan is designed to ensure that students gain a general knowledge base in psychology and profession-wide competencies (eg, research, ethical and legal standards, assessment, intervention, supervision, interpersonal skills). The undergraduate curriculum covers 25 courses in psychology (eg, general psychology, developmental psychology, clinical psychology, social psychology, cognitive psychology), as well as research methodologies, statistics, assessment, and ethical and legal standards, along with 80 supervised clinical hours. The master’s curriculum includes 10 advanced courses related to various fields such as welfare, education, healthcare, and forensic psychology, with specialization courses, along with 450 supervised clinical hours. 31 All supervised clinical hours are earned through practicum (ie, externship). Typically, students do not need to compete for practicum opportunities, as practicum positions are secured by the program. 31 The JACPP standards for the educational curriculum lack a strong emphasis on individual and cultural diversity. While this is understandable given Japan’s predominantly homogeneous population, with foreign nationals comprising only 2.5%, 33 it results in fewer opportunities for developing cultural competency. For more details, see the JACPP standards. 31
As of September 2023, there were 178 programs that met required curriculum for certified public psychologists. 34 Upon completion, individuals must pass a national licensing exam. Certified public psychologists with advanced certificates must have 5 to 10 years of clinical experience and engage in additional training (ie, continuing education credits) to renew their certificates. 16
In the U.S
Being a licensed psychologist in the U.S. is competitive and time-consuming given its educational requirements, supervised clinical experience, national and state licensing exams. State licensing boards grant licensure for individuals who have met the state-specific requirements, including a doctorate degree in psychology (ie, clinical, counseling, school) from a regionally accredited or government-chartered institution.35,36 Similar to Japan, the educational curriculum for APA-accredited doctoral programs in psychology is designed to ensure that students gain a general knowledge base in psychology and profession-wide competencies, with a focus on individual and cultural diversity. For more details, see the APA standards. 37 As of July 2024, there are 422 APA-accredited programs in the U.S. 35
Additionally, in the U.S. individuals must accrue required supervised clinical hours during practicum (ie, externship), predoctoral internship (which typically occurs during the final year of doctoral study as a full-time status), and postdoctoral residency (which occurs after earning a Ph.D./Psy.D. degree). Practicum training during graduate study prepares students for securing an internship, where they generally accrue 2000 h, followed by another 2000 h during postdoctoral residency. Supervised hour requirements range from 1500 to 6000 h depending on jurisdiction. 36 Upon meeting these requirements, individuals must pass a standardized, national licensing exam, as well as a state-specific examination on the state laws, regulations, and ethics, for licensure. Psychologists must then engage in continuing education activities to renew their licensure, with renewal periods varying by state. 38
Cross-cultural comparison
In Japan, it typically takes about 6 years to become a certified public psychologist, including undergraduate and graduate education. In contrast, the path in the U.S. generally spans 5 to 8 years after obtaining a bachelor’s degree, due to the longer duration of doctoral programs (4-6 years) and additional post-doctoral supervised experience (1-2 years). In Japan, students usually receive practicum opportunities without significant competition and are not required to complete an internship or clinical qualification exam. Conversely, in the U.S., gaining entry into doctoral programs is highly competitive, and the internship and fellowship process mirrors the medical school matching system, adding to the competitiveness.
Overall, Japan’s certification process appears to be more accessible in terms of the academic degree and clinical training required. The lower costs and shorter time frame for obtaining a master’s degree may make the process more appealing to potential candidates. In contrast, the U.S. requires a doctoral degree and a more extensive period of training. This may result in a more comprehensive training experience, while this route may be more costly and time-consuming, making less accessible to potential candidates.
To summarize, shorter training requirements in Japan may enable more individuals to obtain a psychology license. In contrast, longer or more intensive training in the U.S. offers benefits such as more specialized expertise, more learning opportunities for complex clinical cases, and greater responsibilities and privileges as mental health clinicians.
Implication
This review highlights the differences in the prospects of psychologists between Japan and the U.S., focusing on education, training, licensing, and practice standards to better understand global gaps within the field. In the U.S., the work of licensed psychologists is highly valued, and they practice with significant autonomy. In contrast, certified public psychologists in Japan operate under more restrictive professional standards, facing greater financial and job-related challenges. These differences likely stem from varying levels of rigor in training, licensing, and practice standards in each country.
Furthermore, variations in training, licensing, and practice standards between Japan and the U.S. may hinder psychologists’ cross-cultural mobility. Japan is currently undergoing a transition in psychology credentialing and licensing. National efforts have been made toward globalization in various fields, including psychology. 39 A survey showed that nearly one-third of certified public psychologists acknowledged the importance of global perspectives in their practice. 14 Nevertheless, limited international mobility of Japanese psychologists remains.
This limitation, combined with language barriers, poses a significant challenge to providing culturally appropriate treatment. The number of foreign nationals and international students in Japan is growing. Despite significant needs, these individuals have limited access to culturally and linguistically appropriate psychological services due to various reasons, including language barriers and insufficient training opportunities focusing on cultural sensitivity for psychologists in Japan. 40 Even if Japanese psychology professionals want to study in the U.S., it is difficult to receive education there while enrolled in a graduate program in Japan due to the lack of credit transferability. Additionally, because qualifications are not recognized across borders, they cannot engage in clinical practice or receive clinical supervision as part of their continuing education after obtaining their qualifications. As such, it is uncommon to see Japanese certified public psychologists or certified licensed psychologists for clinical training in U.S. healthcare systems.
Additionally, Japanese psychologists who want to relocate to the U.S. for more comprehensive learning or due to personal reasons may face restrictions when seeking licensure in certain states or provinces in the U.S., as they need to meet U.S. licensing requirements, which may include obtaining a doctoral degree. Limited international mobility for Japanese psychologists could hinder opportunities to practice abroad, exchange trainings and clinical knowledge, or participate in international clinical trials.
In the U.S. and Canada, consistent standards for licensing, training, and education facilitate psychologists’ ability to meet requirements across jurisdictions. The U.S. has made considerable efforts to make psychology credentialing and licensing more reciprocal across states. However, unlike Japan, which embraces a national licensing system, some barriers to mobility still exist within the U.S. 9 Variations in training requirements and the need to provide extensive documentation for practicing in multiple states can be challenging and discouraging. Maintaining licensure in multiple states is also often cost-prohibitive due to high licensing fees.
The impact of restricted mobility extends beyond just the U.S. and Japan. Varying professional and licensing standards across countries can leave numerous foreign individuals or immigrants in the U.S. unable to access psychologists familiar with their culture and language, despite needing such services. By globally aligning training, licensing, and practice standards, as is the case with medical doctors, psychologists would enjoy increased mobility. This could enhance access to care and bridge the mental health care gap worldwide.
Developing global standards for psychologists’ licensure and training is a crucial step toward enhancing international mobility and ensuring high-quality mental health care globally. Standardized requirements would facilitate cross-border practice, enabling psychologists to exchange knowledge and adopt best practices from different regions. This would also ensure that mental health professionals are equipped to provide culturally sensitive care, improving mental health outcomes for diverse populations.
International collaboration is key to achieving these standards. Engaging with global psychology associations, conducting comprehensive research to identify best practices, and advocating for policy changes to recognize foreign qualifications are essential steps. Additionally, educational institutions can develop programs aligned with these standards, and create exchange opportunities to facilitate cross-border training. Increasing public awareness about the benefits of global standards can further support their adoption and implementation. Moreover, enhancing the standards and training for cultural competency in Japan is crucial, given the growing number of foreign nationals and international students. While overcoming language barriers is challenging, such trainings may reduce psychologists’ reluctance toward treating non-Japanese clients and facilitate the use of technology for language interpretation. Through these efforts, we can work toward a more integrated and effective global psychology profession, ensuring accessible and high-quality mental health care for all.
Limitations
This study has several limitations. First, the scarcity of detailed empirical studies on cross-national comparisons in professional psychology limits the ability to draw broad conclusions. The reliance on secondary sources such as reviews in peer-reviewed articles, gray literature, and official websites may introduce biases and gaps inherent in these materials. Additionally, inconsistencies in data availability, including demographic details and salary information, make it difficult to draw comprehensive comparisons. Second, cross-national comparisons between Japan and the U.S. are inherently challenging. For example, healthcare systems and insurance reimbursement schemes are remarkably different in these countries as noted above. Cultural stigma toward mental illness may restrict the use of mental health services in Japan, despite the potential demand for such services. Additionally, government investments for education and communication are crucial for reducing cultural stigma, enhancing mental health awareness, and improving access to mental health care. Third, the evolving nature of credentialing and licensing standards in both countries means that findings may quickly become less applicable.
Conclusion
Professionals accustomed to a single educational and clinical framework might overlook the potential benefits of alternative approaches. By comparing outcomes to Western standards, contemporary scientists might perceive any differences as deficiencies. However, alternative frameworks can provide valuable insights. 41 Embracing diverse educational and clinical practices can promote global knowledge exchange and improve culturally sensitive mental health care, ultimately benefiting the psychology profession worldwide.
Despite existing limitations and challenges, further investigation on the impact of training, licensing, and professional standards on clinical practice quality and mental health care accessibility, while considering broader factors, is essential to advance the field worldwide. By modeling an approach for reviewing data from 2 countries, we hope to inspire others to undertake similar comparative studies. This collaborative approach can foster global expansion and growth of the field, a vital objective in our increasingly interconnected world.
Footnotes
Author Contribution Statements
• Tamaki Hosoda-Urban: conception and design, drafting and revising the article.
• Makiko Watanabe: conception and design, drafting and revising the article.
• Ellen H. O’Donnell: conception, revising the article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The current study has been funded by the Japan Society for the Promotion of Science (JSPS) [grant number: 23K16283].
Ethics Approval and Informed Consent
Our study did not require an ethical board approval because our research is a literature review study.
This study is a review of existing literature and does not involve the collection of primary data from human participants. Therefore, ethical approval and informed consent are not applicable.
