I’ve been back in Tokyo a little under a year. I was first in Japan in the mid-1980s, when I stayed for four years. I’ve since retrained as a counsellor and I’m working in private practice in Tokyo, accepting referrals from an employee assistance programme, and also counselling in international schools.

It’s a different world from the one I knew in London, but not so different from the one I first encountered 24 years ago. The rich and sophisticated cultural traditions, the respect and appreciation of nature, the simplicity of the aesthetic, as well as the general honesty and politeness of the people make this a fascinating and welcoming country.

Being a counsellor, though, I’m aware that strengths have their corresponding weaknesses. Back in the 1980s I remember hearing young mothers encouraging their toddlers to have gaman: they were not to whine or complain but to ‘endure’. And gaman is still very much part of the Japanese emotional landscape. It comes from Zen Buddhism, means something like ‘enduring the seemingly unbearable’ and is a virtue closely allied to self-control, patience and dignity. After the 2011 earthquake and tsunami in Northern Japan, the spirit of gaman helped affected communities to come through the most incredible devastation and personal tragedy. However, its shadow side is that if a Japanese person talks about personal problems it can be perceived (by other Japanese people) as weak and self-indulgent. Suffering is best countered with stoicism.

This makes counselling a culturally difficult concept for the Japanese. How, I asked a Japanese psychologist, did he encourage his clients to talk about their problems? Yes, it was a very difficult area... he wasn’t sure that he would find it easy to talk to anyone himself. And then, after another long pause, he added that suicide was a particular problem in Japan.

Over the last decade, there have been more than 30,000 suicides a year in Japan, and approximately two thirds are men. In Japan suicide can be perceived as ‘honourable’ – taking, not abnegating, responsibility. The current economic hardships have given birth to a new term: inseki-jisatsu, or ‘responsibility-driven suicide’, when debtors, mostly men, take their own life so their family can claim on their life insurance. It used to be a condition that there would be no payout if someone committed suicide within one year of taking out life insurance. Suicide figures spiked after a year. When the time period was increased to two years, suicides spiked after two years. There just isn’t the same stigma around suicide as there is in the West. Perhaps this is also related to the Japanese sense of the transitory nature of life, and Buddhist concepts of re-birth?

My clients, by virtue of being English speaking, most often come from the expatriate community, or are ‘returnees’ to Japan. They have their own sets of problems. Japanese people who have lived overseas can find it hard to fit back into society; inevitably their perspective on life will be a little different… and this is particularly hard when society tends to value sameness over diversity, uniformity over difference. For a young person desperate for affirmation, this can be doubly difficult.

Also the working culture in Japan can come as a shock to expats and their partners. Working hours tend to be much longer than in the West and, on top of that, there is the culturally expected after-hours socialising. This can result in the non-working partner being left on his/her own several evenings a week, which, coupled with children settling into a new school in a different country, can place significant strain on the relationship. I think expat men married to Japanese women tend to have it a little easier as Japanese women more easily accept that husbands work and play hard, while they have the main responsibility for home and children. But modern mixed marriages pose their own problems, particularly if each person in the partnership has different cultural expectations.

In the end, despite all the differences, I think the answer is much the same as everywhere else in the world: to think, develop awareness and problem-solve. My challenge as a counsellor is going to be to find a culturally sensitive way to support clients in doing this.

Sara Hitchens has lived and worked in Spain, France, Pakistan and Japan, and has a particular interest in cross-cultural issues.