Online Membership Application

IMHPJ is committed to supporting the highest standards of ethical and professional practice by the international community of mental health providers here in Japan. With that in mind, all applicants must review the IMHPJ Code of Ethics (2020) before completing this application. IMHPJ is a voluntary association of professionals and not a licensing body.

Membership is divided into four categories: Clinical, Associate Clinical, Affiliate and Alum. Please use the information on the Membership Qualifications page to determine the category for which you qualify.

Membership Application

Please check the box if you agree with the following:

I have read the IMHPJ Code of Ethics (2020) and the IMHPJ Constitution before completing this application and agree to abide by both in completing my application and if accepted as a member of the IMHPJ.

Please check the box if you agree with the following:

I understand that my application may take several months to process.

Confidentiality of Information: The information you provide on this form and documents you submit are used to decide on membership suitability and type, as well as for verification purposes. All communication and information regarding your application will be shared with all board members to assist in assessing and deciding on membership in this and any future applications or appeals. IMHPJ will retain your application form regardless of outcome but will delete your submitted supporting documents if membership is denied. Your information will not be shared with any third parties, other than legal professionals where required. Do you agree with these conditions?

Yes, I agree.

How did you hear about IMHPJ?

For which category are you applying?

Clinical Member

Associate Clinical Member

Affiliate Member

Alum Member

If you are applying for Alum, when was the last year you were a member?

Clinical, Associate Clinical, and Affiliate members must reside in Japan for at least eight months of the year. Do you meet this requirement?

Yes

No (Your application will NOT be approved.)

Your Preferred Pronouns

First Name

Surname

Home Address

Address Line 1

Address Line 2

City

Prefecture

Postal Code

Country

Home Phone/Mobile

Name of Practice

Work Address (Address of Practice)

Address Line 1

Address Line 2

City

Prefecture

Postal Code

Country

Work Phone/Mobile

Website URL

If you are applying for Clinical or Associate Clinical Membership, please carefully read the following requirements:

Clinical Members:
a. Master’s Degree or higher, or equivalent professional training, in a field of clinical mental health from an institution which is recognized by a regional or national accreditation body. Such training should include both theoretical courses in the specific mental health field and supervised clinical work experience. [note: part a. remains unchanged]
AND EITHER
b.1 Have completed at least 750 direct client contact hours of counselling and/or psychotherapy, with a minimum of 200 hours of supervision
OR
b.2 have completed at least 450 direct client contact hours with a minimum of 100 hours of supervision, and continue to work under supervision.

Associate Clinical Members:
a. Master’s Degree or higher, or equivalent professional training, in a field of clinical mental health from an institution which is recognized by a regional or national accreditation body. Such training should include both theoretical courses in the specific mental health field and supervised clinical work experience.
b. Have completed at least 150 direct client contact hours of counselling and/or psychotherapy, with a minimum of 50 hours supervision.
c. Are continuing to work under supervision at a level which makes it ethically reasonable to work with clients (see Ethics Code section 2.5: Professional Competence).

If you are applying for Clinical or Associate Clinical Membership, do you meet the relevant requirements outlined above?

Yes

Academic Degree, Licensure, Registration, & Experience

All Clinical and Associate Clinical Member applicants must provide evidence for:

academic degrees, with dates of completion and places of study
credentials and training experience with supervision
license or registration numbers in your home country
residency in Japan

Evidence can be provided with:

copies of degrees and credentials (scanned copies are acceptable);
official documents, copies that show your hours of clinical work with hours of supervision: or with a letter detailing how you meet the criteria above, including verifiable data
website information, including links, and a copy of license or registration
certificate of Residence [住民票], Visa card [在留カード], US Military DOD/SOFA identification card, etc.

Please upload documents below.

Academic Degree, Licensure, & Registration

What is the number of DIRECT CLIENT CONTACT HOURS OF COUNSELLING AND/OR PSYCHOTHERAPY you provided during your internship(s), and after your internship(s)?

Please tell us about your direct clinical counseling experience, and provide evidence of counseling hours both during and after your training.

*What is the number of clinical supervision hours you received during your internship(s), and after your internship(s)? (ONLY include hours that relate to the direct client contact hours of counselling and/or psychotherapy you provided)

Please tell us about your clinical supervision, and provide evidence of counseling supervision hours, and contact details of your supervisor(s).

If you are applying for Associate Clinical Membership, are you currently receiving supervision? If so, please give us more details with contact information.

Additional Education

Documents not in English MUST be translated into English. (* PLEASE NOTE: Unfortunately, file uploading is currently disabled. The membership secretary will contact you regarding your application and requesting the above-mentioned documents.)

Choose File

Do you have any history of legal convictions in Japan or any other country?

Yes

If yes, please explain.

Have you ever lost your professional license, been subject to disciplinary action by your licensing organization (including any pending or ongoing professional reviews that might limit or revoke your license to practice)?

Yes

If yes, please explain.

Are you currently accepting clients?

Yes

Would you like to be listed on our website as such if invited to become a member?

Yes

If applying to become an Affiliate Member, please tell us about yourself and your interest in IMHPJ. Please attach documents, wherever possible, to verify education, any licenses, if listed.

Please check the box if you agree with the following:

I agree to IMHPJ contacting my present and/or former supervisors (if required).

Please check the box if you agree with the following:

I agree to IMHPJ conducting a search of publicly available information to verify anything provided in this application. This could Include, but is not limited to my courses, training, license, websites, social media, and any possible complaints or disciplinary action.

NOTE: In order to be listed publicly on our website and in other directories, photocopies of all relevant academic degrees, licenses, registrations, and professional organization memberships must be included with this application, with translations if necessary.

CONSENT
Please review the IMHPJ Constitution and IMHPJ Code of Ethics.