| アブストラクト | Cognitive behavioral therapy (CBT) is often presented as a technically neutral, evidence-based psychotherapy. This article questions that assumption by examining the political, institutional, and cultural contexts that have shaped psychiatry and psychotherapies in Japan, integrating historical review, administrative data, cross-national comparison, and personal reflection. First, the postwar development of Japanese psychiatry is reviewed, focusing on gradual mental health reform following the WHO "Clark Recommendation" and the politicized professional climate of the late 1960s and 1970s. Second, the introduction and dissemination of CBT in Japan are examined using the National Database of Health Insurance Claims and Specific Health Checkups (NDB) Open Data, which reveal a decline in reimbursed CBT claims despite formal insurance coverage. This paradox is discussed in relation to Japan's regulated pay-for-service system, in contrast to the United States, where DRG/PPS and pay-for-performance models have structurally favored brief, standardized psychotherapies. Third, political and legal differences among Japan, South Korea, and Taiwan are considered to illustrate how similar cultural regions diverge markedly in governance, social change, and mental health-relevant policies. Finally, drawing on personal clinical experience, the article argues that CBT's apparent "non-political" stance is itself a political position, reflecting a broader shift toward empirically grounded but ideologically understated forms of professional practice. Psychotherapies, including CBT, are best understood as practices embedded in specific political and institutional regimes rather than as politically neutral technologies. |
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