Biological Foundation of Psychotherapy

Psychotherapy possesses a biological foundation, gaining increasing popularity among providers seeking to delve into the genetic underpinnings of complex behaviors exhibited by numerous patients. This personalized biological treatment targets all biological controls steering intricate brain reactions. The integration of novel learning and experiences across cognitive, emotional, and internal regulatory processes contributes to the comprehensive re-elaboration of the sense of self and others. Successful treatments induce both biological and psychological transformations in the brain, with the potential for these changes to endure over extensive periods (Javanbakht and Alberini, 2019).

Influence of Culture, Religion, and Socioeconomic Factors

The patient’s perspective on the efficacy of psychotherapy is significantly shaped by cultural, religious, and socioeconomic factors. Divergent cultural perceptions of health and rehabilitation affect the acceptance of therapy, with certain cultures harboring a stigma that deters individuals from seeking psychotherapy. The fear of being labeled as “crazy” in specific cultural contexts leads some patients to reject psychotherapy. Cultural barriers, particularly prevalent among low-income and minority populations, often result in premature termination of services. Notably, Asian Americans underutilize mental health treatments compared to their demographic representation, attributing negative views to psychotherapy (Nagayama et al., 2019).

Religious beliefs also exert influence on psychotherapy, with certain religious groups incorporating prayer and religious practices, either solely or in combination with counseling services. Patients of religious backgrounds tend to prefer therapists who share their beliefs, aligning therapy approaches with their core values (Charzyńska and Heszen-Celińska, 2020).

Socioeconomic factors introduce negative implications for psychotherapy, as individuals with low income, limited transportation, and weak social networks often avoid seeking services, resulting in suboptimal treatment outcomes. In contexts like Finland, where universal healthcare access is available, psychotherapy accessibility is partially contingent on one’s financial situation (Leppänen et al., 2022). Low socioeconomic status further hampers readiness to receive services, with individuals of lower education levels, despite potentially greater need, utilizing mental health services less frequently than their higher socioeconomic counterparts (Leppänen et al., 2022).

Considerations of Legal and Ethical Aspects

Legal and ethical considerations play a pivotal role in influencing an individual’s access to treatment and overall treatment outcomes. In individual, family, and group therapy settings, obtaining informed consent emerges as a common denominator. Family and group settings may witness patients hesitating to share crucial information, potentially impacting the efficacy of the treatment plan. Upholding the principles of beneficence and non-maleficence, therapists acknowledge each patient’s right to self-determination. Therapists adjust their approach in group or family sessions, often speaking in more general terms, while maintaining greater specificity and precision in private individual sessions. The age of patients raises legal and ethical concerns, particularly when minors have parents present in therapy sessions, potentially affecting the disclosure of pertinent details. While legal requirements necessitate parental consent for minors to receive services, ethical considerations may lead some therapists to obtain authorization for treating minors without the adult’s presence. Treatment decisions are, however, communicated with parents.

Reliability of Scholarly Sources

The sources referenced in this discussion adhere to scholarly standards, each being peer-reviewed and evidence-based. The articles were sourced from reputable platforms such as The National Institute of Health and PubMed Central, known for providing access to credible scholarly articles. The inclusion of tools, measures, and research findings in each article attests to its reliability. Author contributions are explicitly mentioned, and the availability of PDFs for each article is indicated following the reference section.

References

Charzyńska, E., & Heszen-Celińska, I. (2020). Spirituality and Mental Health Care in a Religiously Homogeneous Country: Definitions, Opinions, and Practices Among Polish Mental Health Professionals. Journal of religion and health, 59(1), 113–134. https://doi.org/10.1007/s10943-019-00911-wLinks to an external site.

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience, 13, 144. https://doi.org/10.3389/fnbeh.2019.00144Links to an external site.

Leppänen, H., Kampman, O., Autio, R., Karolaakso, T., Näppilä, T., Rissanen, P., & Pirkola, S. (2022). Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension. BMC health services research, 22(1), 983. https://doi.org/10.1186/s12913-022-08389-1Links to an external site.

Nagayama Hall, G. C., Kim-Mozeleski, J. E., Zane, N. W., Sato, H., Huang, E. R., Tuan, M., & Ibaraki, A. Y. (2019). Cultural Adaptations of Psychotherapy: Therapists’ Applications of Conceptual Models with Asians and Asian Americans. Asian American journal of psychology, 10(1), 68–78. https://doi.org/10.1037/aap0000122Links to an external site.

Trachsel, M., & Grosse Holtforth, M. (2019). How to Strengthen Patients’ Meaning Response by an Ethical Informed Consent in Psychotherapy. Frontiers in psychology, 10, 1747. https://doi.org/10.3389/fpsyg.2019.01747Links to an external site.

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Your comprehensive exploration of the significance of psychotherapy and its diverse applications is well-articulated. The emphasis on informed consent, the effectiveness of psychotherapy, and the considerations for group and family therapy adds depth to the discussion. Additionally, your incorporation of peer-reviewed, evidence-based articles enriches the scholarly foundation of the information provided.

The acknowledgment of psychotherapy’s effectiveness, supported by meta-analyses such as Kamenov et al. (2017), reinforces the importance of this therapeutic approach across various mental and behavioral issues. Your mention of the declining use of psychotherapy compared to psychopharmacology, despite its proven effectiveness, raises crucial questions about treatment trends and patient preferences.

The insight into the biological underpinnings of psychotherapy, as highlighted by Javanbakht & Alberini (2019), showcases its individualized yet comprehensive nature. The emphasis on the therapeutic alliance and agreement on therapy goals, as noted by the American Psychological Association (APA, 2012), underscores the collaborative nature of psychotherapy.

Your discussion of trauma-focused therapies like Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for post-traumatic stress disorder (PTSD) provides a nuanced view of how psychotherapy can be tailored to specific conditions. The integration of neuroscience research, exemplified by Stojek et al. (2018), illustrates the evolving understanding of behavioral and cognitive processes.

Addressing the role of religious beliefs and cultural considerations in psychotherapy demonstrates a thoughtful approach to the diverse backgrounds of clients. The recognition of the importance of respecting religious beliefs and cultural competence aligns with ethical practices in therapy (Carone & Barone, 2001; Sue et al., 2009).

Finally, your insights into the ethical and legal challenges in group and family therapy, and the importance of informed consent and confidentiality, provide a well-rounded perspective on the complexities therapists may encounter in these settings (Grover et al., 2022).

Your meticulous referencing of peer-reviewed articles, with clear explanations of their scholarly nature, strengthens the credibility of the information presented. This approach enhances the reliability of the discussion and aligns with the principles of evidence-based practice. Overall, your post provides a thorough exploration of various facets of psychotherapy, supported by reputable sources.

References

APA. (2012). Research Shows Psychotherapy Is Effective But Underutilized. Https://Www.apa.org. https://www.apa.org/news/press/releases/2012/08/psychotherapy-effectiveLinks to an external site.

Carone, D. A., & Barone, D. F. (2001). A social cognitive perspective on religious beliefs: their

functions and impact on coping and psychotherapy. Clinical Psychology Review, 21(7), 989–1003. https://doi.org/10.1016/s0272-7358(00)00078-7

Grover, S., Avasthi, A., & Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian

Journal of Psychiatry, 64(7), 47. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological models of

psychotherapy. Frontiers in Behavioral Neuroscience, 13. https://doi.org/10.3389/fnbeh.2019.00144Links to an external site.

Kamenov, K., Twomey, C., Cabello, M., Prina, A. M., & Ayuso-Mateos, J. L. (2017). The efficacy

of psychotherapy, pharmacotherapy and their combination on functioning and quality

of life in depression: a meta-analysis. Psychological Medicine, 47(7), 1337–1337.

https://doi.org/10.1017/s003329171600341xLinks to an external site.

Stojek, M. M., McSweeney, L. B., & Rauch, S. A. M. (2018). Neuroscience Informed Prolonged

Exposure Practice: Increasing Efficiency and Efficacy Through Mechanisms. Frontiers in Behavioral Neuroscience, 12. https://doi.org/10.3389/fnbeh.2018.00281Links to an external site.

Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The Case for Cultural Competency

in Psychotherapeutic Interventions. Annual Review of Psychology, 60(1), 525–548. https://doi.org/10.1146/annurev.psych.60.110707.163651

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Discussion Week I

In Week I’s discussion, the concept of psychotherapy, often termed as “talk therapy,” is explored as having a foundation rooted in biology. This therapeutic approach proves to be a effective instrument in addressing a spectrum of issues—psychological, behavioral, and somatic—that impact an individual’s mental well-being (Locher et al., 2019). When delving into the biological underpinnings of psychotherapy, the age-old debate of nature versus nurture surfaces. The inherent biological elements, including genetics, wield an influence on behavior and may predispose individuals to mental health challenges. Simultaneously, one’s lifestyle encompassing aspects like culture, life experiences, and education also contributes to behavioral patterns. Therefore, acknowledging the biological aspect entails recognizing the intertwined roles of genetics and environmental factors in shaping human behavior (Jimenez et al., 2018).

Personal beliefs in psychotherapy are significantly influenced by an individual’s religion, culture, and socioeconomic factors. Active participation in religious communities can offer a shared faith and a robust support system, potentially reducing levels of depression and anxiety. Many individuals turn to religion as a means of stress reduction and coping with life’s challenges (Dein, 2018). Religion, in this context, may instill hope, provide a deeper sense of purpose, enhance self-esteem, and increase overall life satisfaction. Consequently, engagement in psychotherapy may be viewed positively, as it aligns with these beneficial influences (Dein, 2018). However, cultural considerations play a pivotal role, as certain societies attach a negative stigma to mental health issues. This stigma might lead individuals to reject any form of treatment to avoid societal judgment. In some cultures, including my own, the presence of mental illness is met with discrimination, resulting in reluctance or refusal to seek treatment. Individuals may face rejection from family members, encounter difficulties securing housing or employment, and experience isolation due to the prevailing societal attitudes. Additionally, those with low socioeconomic status may encounter obstacles accessing psychotherapy due to limited resources.

The discourse also delves into the critical realm of legal and ethical considerations in mental health, particularly within the context of group or family therapy sessions. The importance of obtaining consent from each participant and ensuring awareness of limited confidentiality is underscored. It is emphasized that the therapist is not accountable for participants maintaining confidentiality. In group settings, family members may feel hesitant to express their issues, fearing judgment. Legal complexities arise concerning age, requiring parental consent for both group and individual sessions. The therapist, acting as the legal guardian, may face the ethical dilemma of sharing confidential information that poses a risk to the safety of a child, thereby breaching the trust of the patient. This ethical predicament extends to the therapist’s decision on what information to share with other group members. Balancing confidentiality and disclosure poses a significant ethical challenge for therapists engaged in psychotherapy with groups or couples (Mignone et al., 2017).

To ensure the scholarly rigor of the discussion, all cited articles are considered scholarly. They have undergone peer review and are published in academic journals, with authors recognized as scholars in the field of psychiatry.

References

Dein, S. (2018). Against the Stream: religion and mental health- the case for inclusion and spirituality into psychiatric care. BJ Psych bullentin,42(3), 127-129.

https://doi.org/10.1192/bjb.2017.13

Jimenez, J., Botto, A., Herrera, L., Leighton, C., Rossi, J., Quevedo, Y., Silva, J., Martinez, F.,

Assar, R., Salazar, L., Ortiz, M., Rios, U., Barros, P., Jaramillo, K., & Luyten, P. (2018).

Psychotherapy and Genetic Neuroscience: An emerging dialog. Frontiers in Genetic. 9, 257. https://doi.org/10.3389/fgene.2018.00257

Locher, C., Meier, S., & Gaab, J. (2019). Psychotherapy: A world of meaning. Frontiers  

         Psychology, 10, 460. https://doi.org/10.3389/fpsyg.2019.00460Links to an external site.

Mignone, T., Klostermann, K., Mahadeo, M., Papagni, E., & Jankie, J. (2017). Confidentiality

and Family Therapy: cultural considerations. ARC Journal of Psychiatry, 2 (1), 9-16.

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                                                                     Biological Basis and Ethical/Legal Considerations of Psychotherapy

Psychotherapy, indeed, has a biological basis. It is because psychotherapy is meant to treat mental illness by helping reconnect brain networks that have been negatively affected by the mental condition and, thus, helping the client improve symptoms and heal (Sweetman et al., 2019; Smith et al., 2020). The biological basis of psychotherapy is also because patients who receive psychotherapy feel better at the end of the therapy session than individuals who do not (Jimenez et al., 2018).

                                                                                             Culture, Religion, and Socioeconomics

Both socioeconomic and cultural factors indeed play a significant role in a client’s treatment success. First, in a culture where mental health is considered a curse, it might be challenging to seek therapy for fear of stigma. Culture represents essential factors that facilitate the treatment process. Cultural factors influence the nature of psychopathology and patient understanding of psychological and physical health and block every aspect of the diagnostic and treatment process, which can cause dilemmas (Kuska et al., 2016). We all have different cultures, beliefs, and taboos on how we perceive matters related to mental illnesses. In some cultures, the stigmatization which comes with an individual having a mental condition prevents one from opening up or sharing their feelings on what they are going through because they are ashamed of how people will judge them. Culture, therefore, determine the pattern of certain mental disorders. According to Howley et al. (2020), people with low socioeconomic levels are likely to have high dysfunction. They may not take personal responsibility and role in the therapy process and, thus, reduce treatment success. Clients with low socioeconomic levels are less likely to afford the cost of treatment and, thus, may not attend all the recommended therapy sessions leading to relapse of the condition.

Furthermore, religion is another factor that influences the perspective of psychotherapy treatment, either positively or negatively. Religion like Orthodox opposes psychotherapy treatment. Other Christian religions and spirituality may provide strength and support during treatment. Assisting clients in reconnecting with their faith and religion may guide them to utilize spiritual practice in addition to psychotherapy (Barnett, 2016). All mental health providers should be aware and sensitized regarding client religion, socioeconomic and culture of their patients to better understand their clients and their lives. Health providers must know how these factors impact patients’ mental health to provide effective treatment.

                                                                                                 Legal and Ethical considerations

There are several legal considerations a healthcare provider should take into account when dealing with group, family therapy, and individual therapy. Like any other treatment, psychotherapy requires a healthcare provider to consider the Health Insurance Portability and Accountability Act (HIPPA) and the confidentiality, privacy, and security of the information given during therapy. As defined by HIPPA, the confidentiality of the information given to the patients in group or family therapy must be upheld (Schiefele et al., 2018). Even though it is paramount in family and group therapy, it can be challenging to maintain confidentiality and privacy of the information discussed as opposed to individual therapy because the former involves many people. However, individual, group and family therapy requires ethical and legal principles such as confidentiality, responsibility, and informed consent. Based on responsibility, Schiefele et al. (2018) explain that therapeutic intervention in group and family therapy can be faced with the dilemma of multiple clients in the same situation; however, one individual’s best interest may not work for another person in the group. Overall, therapeutic approaches for clients in-group, family, and individual therapy can differ. However, confidentiality and informed consent of the treatment process should be preserved in both cases.

In conclusion, psychotherapy has a biological basis, and real changes occur throughout the therapeutic intervention. Religion, culture and socioeconomic factors can and do impact therapeutic outcomes. Finally, ethics and legal obligations occur during all types of therapeutic approaches. We have obligations to the individual in therapy as in the group and family treatment models.

                                                                 References

Kuška, M., Trnka, R., Tavel, P., Constantino, M. J., Angus, L., & Moertl, K. (2016). The role of

cultural beliefs and expectations in the treatment process: clients’ reflections following

individual psychotherapy. Sexual & Relationship Therapy, 31(3), 259– 270.

https://doi-org.ezp.waldenulibrary.org/10.I080/14681994.2014.1001354Links to an external site..

Barnett, J. E. (2016). Are religion and spirituality of relevance in psychotherapy? Spirituality in

Clinical Practice, 3(1), 5–9. https://doiorg.ezp.waldenulibrary.org/10.1037/scp0000093Links to an external site..

Schiefele, A.-K., Lutz, W., Rubel, J., Barkham, M., Saxon, D., Bohnke, J., Delgadillo, J., …Lambert, M. J. ( 2018). Reliability of Therapist Effects in Practice-              Based Psychotherapy Research: A Guide for the Planning of Future Studies. Administration and Policy in Mental Health and Mental Health                      Services Research, 45, 6, 598-613.

Howley, T., Leibert, T. & Lane, J. (2020). The Relationship Between Socioeconomic Status and

Counseling Outcomes. NPCC Web designer. Https://www.tpcjournal.nbcc.orgLinks to an external site..

Jimenez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., …Luyten, P. (2018). Psychotherapy and Genetic Neuroscience: An                Emerging Dialog. Frontiers in Genetics, 9, 257.

Sweetman, E., Noble, A., Edgar, C., Mackay, A., Helliwell, A., Vallings, R., … & Tate, W.

(2019). Current research provides insight into the biological basis and diagnostic potential for myalgic encephalomyelitis/chronic fatigue                          syndrome (ME/CFS). Diagnostics, 9(3), 73.

There has always been a constant debate regarding the underlying basis of many psychiatric disorders and the effects of treatment. Many mental health disorders have a biological basis and are commonly due to imbalances in the levels of neurotransmitters in the brain. Stimuli including stress have also been known to be responsible for some mental health disorders in patients. According to Holttum(2014), stress can lead to changes in the frontal lobe of individuals and affect gene expression in the patient. Treatment for mental health disorders has traditionally involved the use of medications and psychotherapy. Medications have been used to correct the imbalances of neurotransmitters in the brain. The effects of psychotherapy have not been clearly elucidated.

Advances in neuroimaging have pointed towards a biological response to psychotherapy in patients. Anxiety and depression are two of the most common mental health disorders and have been associated with abnormalities with top-down cortical control in areas of the brain which respond to emotional stimuli. According to Mucci(2021), psychotherapy corrects the neural abnormalities and strengthens the top-down cortical control of emotions. In  another study by Ioana et al(2019), they wrote that psychotherapy acts by improving  the efficacy of control processes in inhibiting emotional reactivity. Based on these findings, it is clear that psychotherapy has a biological basis in correcting the anomalies found in patients suffering from mental health conditions.

Influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments

Psychotherapy divides opinion in the general population. Some patients believe in the efficacy of psychotherapy while others believe that psychotherapy is of no benefit to the patient. A person’s perspective of psychotherapy is influenced by different factors.

A person’s culture has a big influence on a person’s perspective of psychotherapy. Individuals who come from cultures more accepting of psychotherapy will be more willing to accept that psychotherapy is effective. On the other hand, those from cultures less accepting of psychotherapy are less likely to have a favorable view of psychotherapy. It is generally recognized that psychotherapy is more accepted among Caucasians. According to Langman(1997), even though white people are wary of psychotherapy, they are more likely to engage in therapy compared to other ethnicities. It is also known that culture influences the willingness of a patient to reveal important information to their therapist. Drinane,Owen and Tao(2018) wrote that a significant number of patients lie or withhold information during therapy and this is influenced by the patient’s culture.

Religion also affects a person’s personal perspective of psychotherapy. Religious beliefs influence how people view mental illness and its treatment. According to Schwarz(2018) many religions view mental illness as a result of sin and a loss of favor from a divine entity. With these beliefs, many religions have a deep mistrust of psychotherapy. This mistrust enhances a negative perception of psychotherapy and the willingness of the individual to accept psychotherapeutic treatment. According to Nakash et al(2019), a large proportion of the population participates in an organized religion and considers their religion’s teachings when making important decisions.

Socioeconomics influence a person’s perspective on psychotherapy.Socioeconomic factors such as employment status, income levels and education levels all influence whether a person views psychotherapy favorably or unfavorably.Individuals with lower socioeconomic status are less willing to access mental health services.

Differences between legal and ethical considerations for group and family therapy and individual therapy

In psychotherapy, legal and ethical principles emphasize patient confidentiality and the need to keep patient information private. During individual therapy, the therapist provides care to one individual without the presence of others. The therapist has the ability and the means to maintain confidentiality since all information provided during sessions is between the therapist and the patient. In group and family therapy, more than one individual is involved in any therapy session. This makes it impossible to assure patients of complete confidentiality. The therapist is obligated to inform group members and family members of the risk of breach of confidentiality.According to Guo et al(2021), the very nature of group therapy reduces the chances of maintaining strict confidentiality. The therapist has a duty to inform group and family members at the start of therapy of these potential breaches of privacy due to information being shared during sessions.

The differences in ethical considerations for individual versus group and family therapy require that different approaches should be taken in these situations. In group therapy, it is important to ensure that the patient is comfortable with sharing information with other members of the group. No member should be pressured to participate in group discussions until they are comfortable and ready to do so. In individual therapy, confidentiality is assured. The patient should be encouraged to provide all the necessary information to ensure that positive treatment outcomes are obtained.

References

Drinane, J. M., Owen, J., & Tao, K. W. (2018). Cultural Concealment and Therapy Outcomes. Journal of Counseling Psychology, 65(2), 239–246. https://doi.org/10.1037/cou0000246

Guo,T., Su,J., Hu,J., Aalberg,M., Zhu,Y., Teng,T., & Zhou,X.(2021).. Individual vs. Group Cognitive Behavior Therapy for Anxiety Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.674267

Nakash, O., Lambez, T., Cohen, M., & Nagar, M. (2019). Religiosity and barriers to mental healthcare: a qualitative study among clients seeking community mental health services. Mental Health, Religion & Culture, 22(5), 437–452. https://doi.org/10.1080/13674676.2018.1489377

Schwarz,S.(2018).Religious aspects in psychiatry and psychotherapy.International Journal of Human Rights in Healthcare, Vol 11(2), 2018. pp. 109-115.

Biological Basis of Psychotherapy  

           In Sened et al.’s (2022) review and integrative model, the biological basis of psychotherapy was explored through the lens of research on interpersonal synchrony. This work describes interpersonal synchrony as the timely coordination of two individuals behavioral, physiological and neurological functions. Interpersonal synchrony can be further simplified as the integration of brain activity between people interacting with each other; however, additional research supports that there are multiple aspects of synchrony to include movement energy, hormonal factors, physiological, and acoustic markers that take place between a patient and provider during psychotherapy (Sened et al., 2022). Sened et al. (2022) found that higher inter-brain synchrony was associated with better relationships in therapy and daily life. Conversely, this work also highlighted that deficits in the ability to achieve inter-brain synchrony are related to a variety of psychological and developmental disorders (Sened et al., 2022). Sened et al. (2022) purported that psychotherapy sessions enable regular and routine interactions that involve inter-brain synchrony, initially with the therapist, followed by general interpersonal relationships, and ultimately results in symptom reduction for positive patient outcomes. Thus, psychotherapy has a strong biological basis rooted in behavioral, physiological, and neurological functions. In essence, an effective therapeutic relationship in the context of psychotherapy requires biological puzzle pieces that match to promote inter-brain synchrony between patients and providers.  

The Influence of Culture, Religion, and Socioeconomic Status on the Perspective of One’s Value of Psychotherapy  

            Culture, religion, and socioeconomic status may influence an individual’s perspective on the value of psychotherapy treatments; however, appropriate and consistent patient-centered education on the purpose of psychotherapy can mitigate some of these barriers to care. Socioeconomic status (SES) doesn’t present as a perspective of an individual, but individuals from lower SES’s may have challenges with employment, education, access to healthcare, and financial resources that impact their value (cost) of psychotherapy. Culture and religion are two personal characteristics, and as discussed previously, the patient’s ability to understand and accept the value of psychotherapy is in the biological basis of the inter-brain synchrony that the therapist and patient can establish and maintain. According to Sunderani and Moodley (2021), a therapist’s discernment in self-disclosure versus nondisclosure in patient interactions can be viewed as one of the building blocks to forging inter-brain synchrony. Sunderani and Moodley (2021) suggested that self-disclosure of a therapist has the potential to be a transformative event that can enable the patient to feel less isolated and allow the therapist to empathize with their patients process of wholeness. Additionally, in this work, client curiosity, shared difficult traumatic experiences, and cultural similarities emerged as top themes for a therapist’s self-disclosure. Conversely, nondisclosure themes included boundary concerns, awareness of overidentification, and cultural differences. It is interesting how culture arises in both categories, especially the use of cultural similarities; not meaning the same culture, but common cultural aspects that foster inter-brain synchrony and increase the value of psychotherapy. When it comes to religion and its influence on the value of psychotherapy, Abbott (2021) believes that the scholarship for needs of nonreligious persons in psychotherapy is lacking. What’s more, this work shares that few publications related to clinical training and practice focus on providing psychotherapy to nonreligious individuals. Thus, the lack of practice guidelines, standards, and evidence-based practice as it applies to nonreligious psychotherapy is likely pervasive to a nonreligious individual’s perspective on the value of psychotherapy treatments.  

Group vs. Family vs. Individual Therapy: Legal and Ethical Considerations  

               Legal and ethical considerations for group and family therapy differ from those for individual therapy mostly due to confidentiality and patient consent. The legal and ethical variables of group therapy impact the providers approach in the context of boundaries. Professional boundaries and confidentiality in healthcare is a characteristic of quality care, but it can be challenging in a group setting. Psychotherapy group topics should be appropriate for participants and personal boundaries as far as information sharing can be reiterated at the beginning of the session. If the patient volunteer’s personal information, it is the group leader’s responsibility to ensure that the individual sharing and those receiving are not vulnerable. The legal and ethical considerations regarding family therapy can be more complex. According to Deslypere and Rober (2020), a wide range of issues concerning individual and family life may become veiled in secrecy. This work sites issues like adoption, infertility, incest, abuse, addiction, and suicide. Deslypere and Rober (2020) describe family secrets as the intentional concealment of information by one or more family members who are affected and endorsed the importance of differentiating between secrecy and privacy before sessions. In individual therapy legal and ethical considerations include the use evidence-based practice, liability of reporting abuse or potential harm to others, and maintaining patient confidentiality.  

References  

Abbott, D. M. (2021). Psychotherapy with nonreligious clients: A relational-cultural  

approach. Professional Psychology: Research & Practice, 52(5), 470–476.  

https://doi.org/10.1037/pro0000392Links to an external site. 

Deslypere, E., & Rober, P. (2020). Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study. Family Process, 59(1), 52–65.

https://doi.org/10.1111/famp.12409Links to an external site. 

Sened, H., Zilcha-Mano, S., & Shamay-Tsoory, S. (2022). Inter-brain plasticity as a biological mechanism of change in psychotherapy: A review and

integrative model. Frontiers in Human Neuroscience, 16. https://doi.org/10.3389/fnhum.2022.955238Links to an external site. 

Sunderani, S., & Moodley, R. (2020). Therapists’ perceptions of their use of self-disclosure (and nondisclosure) during cross-cultural exchanges. British

Journal of Guidance & Counselling, 48(6), 741–756. https://doi.org/10.1080/03069885.2020.1754333Links to an external site. 

Deborah Joseph

Discussion Week 1

NRNP 6645-1

Psychotherapy with Multiple Modalities

Over the past decade, there has been much attention regarding integrating neuroscience into psychotherapy (Javanbakht & Alberini, 2019).  Neuroscience is a scientific study focusing on the brain, its functions, and all the disorders that correlate with the nervous system (Javanbakht & Alberini, 2019).  Psychotherapy involves regulating the biological aspects of individualized treatment, including focusing on the brain’s maladaptive responses, which ultimately focus on a new approach to learning and adapting to new experiences involving emotions and cognition (Javanbakht & Alberini, 2019).  The foundation for the psychotherapy approach is built on years of clinical expertise and vast knowledge of human behavior (Javanbakht & Alberini, 2019).  Psychotherapy correlates with the therapy of the brain (Javanbakht & Alberini, 2019).  The desired outcome of psychotherapy is focused on a sustained optimal change in behaviors, feelings, and thoughts (Goodwin et al., 2018).  These positive outcomes produce physical changes in the brain (Javanbakht & Alberini, 2019).  Psychotherapy is imperative for psychiatric nurse practitioners to gain and maintain competence (Wheeler, 2022).

Research has shown that the brain’s activity is effective both by an individual’s genes and environment (Goodwin et al., 2018).  Culture also plays a prominent role in understanding the patient and providing the appropriate psychotherapeutic approach (Moleiro, 2018).  The factor of this culture defines how a person might think, feel, behave, and respond socially (Moleiro, 2018).  The United States is considered one of the most industrial religious countries (Koenig et al., 2020).  Patients often seek support from a church leader before they seek professional medical assistance (Koenig et al., 2020).  Most often, patients with spiritual and religious beliefs would like a mental health professional to incorporate these beliefs into treatment (Koenig et al., 2020).  These patients included racially diverse populations, women, and older adults (Koenig et al., 2020).  The advanced mental health nurse practitioner needs to remain culturally competent, sensitive, and client-focused while also being cognizant of evidence-based practice regarding client views (Koenig et al., 2020).  If there is no spiritual or religious connection between the provider and the patient, there could be apprehensiveness about the patient being transparent during therapy (Koenig et al., 2020).  There was a stigma regarding mental health in most religions in the medieval ages, and these patients were believed to be possessed by demons or involved with witchcraft (Koenig et al., 2020).  However, today there is more awareness in religions that mental health is associated with an imbalance in the brain (Koenig et al., 2020).

Socioeconomic status is a common denominator in the catalyst of a patient’s health and well-being (Jacob et al., 2022).  Studies have revealed that patients with a lower socioeconomic status drop out of therapy, and there is also limited effectiveness for these patients who receive psychotherapy (Jacob et al., 2022).  Patients with lower socioeconomic status often have a lower education level and may not understand the importance or advantages of psychotherapy (Jacob et al., 2022).  There is also a lack of financial means to obtain assistance for mental health (Jacob et al., 2022).  Research also reveals that patient populations nine years old in low-income families exhibit a reduction in dorsolateral prefrontal and ventrolateral cortex activity.  When there is a negative emotion, there is a failure to suppress the amygdala activation (Jacob et al., 2022).

Therapists must cultivate the clinical competence needed to provide individual, group, and family therapy (Barnett & Jacobson, 2019).  This competency includes whether a therapist can utilize the appropriate treatment techniques and modalities specific to the patient’s treatment needs (Barnett & Jacobson, 2019).  Standard 2.06 of the APA Ethics Code emphasizes that psychologists must gather their work based on evidence-based research and knowledge (Barnett & Jacobson, 2019).   It is also vital that therapists are well-informed regarding the ethical and legal issues associated with their work (Barnett & Jacobson, 2019).  Informed consent is a moral and legal consideration when performing individual, group, and family therapy (Barnett & Jacobson, 2019).  Standard 10.1 Informed Consent to Therapy states that the clinician should maintain the following: notification of the anticipatory course of therapy, fees, arrangements, third-party involvement, a right to refuse to participate in therapy, and the licensure status of the therapist (Barnett & Jacobson, 2019).  The informed consent connection ensures a therapeutic relationship between the therapist and the client, provides for autonomy and reduces apprehension (Barnett & Jacobson, 2019).  Individual therapy gives the client one-to-one therapy, confidentiality, and the chance to build a solid therapeutic relationship with one therapist.  Group therapy is a melting pot of cultural connections that allows the individual to look at a different perspective.  Family therapy involves multiple connected people, and there is not one patient but multiple.  Confidentiality in a unique environment is contained, whereas; in a group and family, there is no guarantee of privacy (Barnett & Jacobson, 2019).  The critical thing to remember is that if there is no confidentiality, then the client may not be able to be transparent and form a therapeutic relationship with the clinician.

Psychotherapy is implemented to reduce suffering symptoms and improve the quality of a client’s life (Locher et al., 2019).  Cultural, religious, and socioeconomic factors can impact the clinician’s therapeutic approach, whether applied to individual, group, or family therapy.  The clinician’s awareness and knowledge of each client initially as an extraordinary individual with different cultures, beliefs, environments, and religious beliefs.  The outcome is ultimately building a therapeutic relationship and having a significant amount of empathy to set the foundation so the client can provide transparency about their life.  Listening to the client’s story and then applying it to it entirely enables the clinician to build a treatment plan that will have an expected outcome that improves the client’s quality of life while ensuring continuity of care.

References

Barnett, J. E., & Jacobson, C. H. (2019).  Ethical and legal issues in family and couple therapy.  In B. H. Fiese, M. Celano, K. Deater-Deckard, E. N. Jouriles, & M. A. Whisman (Eds.), APA handbook of contemporary family psychology: Family therapy and training (pp. 53–68).  American Psychological Association.  Retrieved November 30, 2022, from https://doi.org/10.1037/0000101-004Links to an external site.

Goodwin, G. M., Holmes, E. A., Andersson, E., Browning, M., Jones, A., Lass-Hennemann, J., Månsson, K. N., Moessnang, C., Salemink, E., Sanchez, A., van Zutphen, L., & Visser, R. M. (2018).  From neuroscience to evidence-based psychological treatments – The promise and the challenge, ECNP March 2016, Nice, France.  European Neuropsychopharmacology, 28(2), 317–333.  Retrieved November 28, 2022, from https://doi.org/10.1016/j.euroneuro.2017.10.036Links to an external site.

Jacob, J., Vieites, Y., Goldszmidt, R., & Andrade, E. B. (2022). Expected Socioeconomic-Status-Based Discrimination Reduces Price Sensitivity Among the Poor.  Journal of Marketing Research (JMR), 59(6), 1083–1100.  Retrieved November 29, 2022, from https://doi.org/10.1177/00222437221097100

Javanbakht A, Alberini CM. Editorial: Neurobiological Models of Psychotherapy. Front Behav Neurosci. 2019 Jun 26;13:144. Retrieved November 28, 2022, from doi: 10.3389/fnbeh.2019.00144. PMID: 31297052; PMCID: PMC6608400.

Koenig, H. G., Al-Zaben, F., & VanderWeele, T. J. (2020). Religion and psychiatry: Recent developments in research.  BJPsych Advances, 26(5), 262–272.  Retrieved November 29, 2022, from https://doi.org/10.1192/bja.2019.81Links to an external site.

Locher C, Meier S, Gaab J. Psychotherapy: A World of Meanings. Front Psychol. 2019 Mar 22;10:460. Retrieved November 30, 2022, from doi: 10.3389/fpsyg.2019.00460. PMID: 30984050; PMCID: PMC6448000.

Moleiro C. Culture and Psychopathology: New Perspectives on Research, Practice, and Clinical Training in a Globalized World. Front Psychiatry. 2018 Aug 10;9:366. Retrieved November 29, 2022, from doi: 10.3389/fpsyt.2018.00366. PMID: 30147663; PMCID: PMC6097026.

Wheeler, K. (Ed.).  (2022).  Psychotherapy for the advanced practice psychiatry nurse: A how-to guide for evidence-based practice (4^th ed.) Springer Publishing.

Biological Basis and Ethical/Legal Considerations of Psychotherapy

Biological Basis of Psychotherapy

Psychotherapy has a biological basis because it explores all the natural regulations that underlie complex brain functions and responses. The intervention deals with the brain by underlining how the brain functions, develops, and matures. Psychotherapy results in new experiences and learning that comprise emotional, cognitive, and internal regulation processes leading to long-lasting physical brain changes. Psychotherapy employs the tenets of evolutionary adaptation and hence underscores the problematical transformation of the brain and repairs the problems as informed by their development (Javanbakht and Alberini 144). Ideally, the brain is a biological tool that tracks and maps memories and experiences using its neurons. As we adapt to our immediate environment, our brain uses cortical memory to map emotional experiences that can be negative or positive. Besides, brain imaging research findings confirm that psychotherapy interventions, such as cognitive behavioral therapy (CBT), yield biological responses and alterations in the brain. CBT in treating OCD (obsessive-compulsive disorder) reduces the levels of glucose metabolism, thus improving OCD symptoms. The findings show that psychotherapy interventions are natural remedies, like pharmacological interventions, since they result in measurable and objective brain changes.

The Influence of Religion, Socioeconomics, and Culture on Psychotherapy Views

Cultural beliefs may impact a person’s perspective on the relevance of psychotherapy interventions, including care-seeking behavior. In specific cultures, those who seek psychotherapy remedies for their mental disorders are stigmatized and shamed, thus discouraging individuals from seeking psychotherapy treatment. Furthermore, some cultures link mental disorders to punishment or curse, often believing that only divine interventions can cure mental illnesses, not therapy (Reich et al. 112). Besides cultural orientations, religious beliefs may influence a person or the family of the patient to prefer prayers and divine interventions for curing mental disorders instead of embracing psychotherapy. For example, Hindus, Muslims, and Christians believe that the Almighty can miraculously heal all illnesses, including mental disorders. Captari et al. propose integrating the client’s religion and spirituality into therapy to minimize dissonance due to pertinent beliefs (1940). Lastly, socioeconomic status may influence a person’s decision to seek psychotherapy services. Most individuals from low socioeconomic backgrounds are unlikely to seek psychotherapy services due to the costs involved and inadequate knowledge of psychotherapy efficacy.

Legal and Ethical Considerations for Group, Family, and Individual Therapy

In family and group therapy, a therapist must consider norms and rules when dealing with members who might have conflicting views about the available remedies. In such scenarios, the therapist must rely on ethical standards and regulations to avoid advocating for one member only and promote cohesion (Alexander and Robbins et al. 1232-1240). The case is different for individual therapy, where the therapist deals with one client hence no conflict of interest. Moreover, the therapist must consider personal values and beliefs concerning family issues before making critical decisions when working with family and group clients.

Informed consent separates family and group therapy from individual therapy concerning legal considerations. The therapist must act as if every member is a unique client when attending to group and family clients; thus, the practitioner can share information from one member to the entire unit (Peterson and Castronova 941-942). A therapist obtains permission from only one client to use or share information in individual therapy. In contrast, the practitioner must obtain permission during conjoint family and group treatment sessions. The differences might impact my therapeutic approaches for clients in group, individual, and family therapy by considering the consequences of breaching the legal and ethical ramifications. Confidentiality and consent for data sharing are vital differences I should consider when working with a group or individual patients in psychotherapy.

Commentary of Sources: The sources I used are scholarly because they are published in academic peer-reviewed journals, including the Encyclopedia of Couple and Family Therapy, the Journal of Clinical Psychology, Frontiers in Behavioral Neuroscience, and the Journal of Racial and Ethnic Health Disparities.

References

Alexander, James F., and Michael Robbins. “Functional Family Therapy.” Encyclopedia of Couple and Family Therapy. Cham: Springer International Publishing, 2019, 1232-1240.

Captari, Laura E., et al. “Integrating Clients’ Religion and Spirituality Within Psychotherapy: A Comprehensive Meta‐Analysis.” Journal of Clinical Psychology, vol. 74, no. 11, 2018, pp. 1938-1951.

Javanbakht, Arash, and Cristina Maria Alberini. “Neurobiological Models of Psychotherapy.” Frontiers in Behavioral Neuroscience, vol. 13, no. 144, 2019, pp. 1-2.

Peterson, Colleen M., and Marj Castronova. “Ethics in Couple and Family Therapy.” Encyclopedia of Couple and Family Therapy. Cham: Springer International Publishing, 2019, 939-946.

Reich, Hanna, Luisa Bockel, and Ricarda Mewes. “Motivation for Psychotherapy and Illness Beliefs in Turkish Immigrant Inpatients in Germany: Results of a Cultural Comparison Study.” Journal of Racial and Ethnic Health Disparities, vol. 2, no. 1, 2015, pp. 112-123.

Biological Basis and Ethical/Legal Considerations of Psychotherapy

Psychotherapy and its link to a biological Base

There is a biological foundation for psychotherapy, albeit it is not as simple as some may imagine. The core tenet of psychotherapy is the hypothesis that a person’s physical and mental well-being may be enhanced by changing their thinking and behavioral patterns (Petiprin, 2016). This process, called neuroplasticity, is the foundation of psychotherapy. Neuroplasticity is the brain’s receptivity to change and adaptation due to learning and experience. This occurs on its own over time, but psychotherapy works to speed up the process by providing novel ideas and procedures that may assist in rewiring the brain and modifying its functioning. To provide just one example, cognitive behavioral therapy (CBT) is a kind of psychotherapy that alters one’s thinking and doing for the better (Goldfried, 2019). Anxiety, sadness, and other mental health issues may improve. Brain areas involved in emotion and behavior control, such as the prefrontal cortex and the amygdala, are more active due to CBT. Evidence shows that psychotherapy may also improve physiological well-being. Studies have shown that psychotherapy has beneficial effects on the immune system, including lowering inflammation and the chance of acquiring chronic illnesses (Petiprin, 2016).

Culture, Religion, And Socioeconomics and Its Influence on an Individuals Perspective on the Value of Psychotherapy Treatments

People of different cultures, religious backgrounds, and socioeconomic statuses may place different values on psychotherapy. What we mean when we talk about culture is the set of common attitudes, practices, and values taught from one generation to the next (Captari et al., 2018). Some cultures may have negative stigmas against those who struggle with mental health. Beliefs regarding one’s mental health and the efficacy of psychotherapy treatments may also be influenced by one’s religious affiliation (Clauss-Ehlers et al., 2019). Because of this, adherents of these faiths may be encouraged to go elsewhere for answers to their mental health problems rather than rely on medical professionals. A person’s socioeconomic status may influence how they value psychotherapy. People from lower socioeconomic origins may be unable to afford or have limited access to mental health care. This might make people feel hopeless or powerless, discouraging them from getting the treatment they need (Captari et al., 2018).

Describe How Legal and Ethical Considerations for Group And Family Therapy Differ From Those for Individual Therapy

Unlike individual treatment, the setting and dynamics of group and family therapy need a different set of legal and ethical issues. Multiple clients exchanging personal information raises serious privacy concerns in group therapy. Group therapists are responsible for ensuring their clients are aware of the potential consequences of sharing sensitive material in a public forum (Wheeler, 2013). In addition, therapists working with groups need to be alert to the possibility of power differences among participants and take appropriate measures to address them. A therapist working with a family must be aware of the possibility of transference and countertransference problems, as well as conflicts of interest among family members. Therapists working with families are also responsible for prioritizing each client’s unique requirements. These distinctions may affect the methods used in a group, individual, and family therapy (Nichols & Schwartz, 2009). For group therapy to be effective, the therapist must foster an atmosphere of trust and safety and keep the group’s dynamics under control. When working with a client one-on-one, the therapist his responsible for protecting the client’s confidentiality and focusing on the person’s specific concerns. Family therapists must be conscious of possible biases and take measures to meet the needs of all family members throughout treatment (Wheeler, 2013).

The following peer-reviewed, evidence-based sources support the rationale for this:

Khan, S., Shapka, J. D., & Domene, J. F. (2022). Counsellors’ experiences of online therapy. British Journal of Guidance & Counselling, 50(1), 43-65. https://doi.org/10.1080/03069885.2021.1885009

This study sheds light on how online counselors actually interact with their clients. There is information about the ethics of online counseling, the challenges of establishing a therapeutic rapport with a client through video chat, and the counselor’s personal experiences in navigating these situations.

Rothblum, E. D., & Ziegler, S. (2018). Ethical and legal considerations in family therapy. Journal of Marital and Family Therapy, 44(1), 28–37. https://doi.org/10.1111/jmft.12237

Issues including maintaining the family’s right to privacy and confidentiality and avoiding conflicts of interest are explored in this article as they relate to the ethical and legal concerns in family therapy.

Avasthi, A., Grover, S., & Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian Journal of Psychiatry, 64(Suppl 1), S47. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_50_21

Individual therapy’s legal and ethical implications are discussed in this source, focusing on such topics as informed consent, confidentiality, and the responsibility to protect. Nevertheless, these principles will not solve every problem or anticipate every circumstance in a therapist.

 References

Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy‐Heltzel, S. E., & Worthington Jr, E. L. (2018). Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta‐analysis. Journal of Clinical Psychology, 74(11), 1938-1951. https://doi.org/10.1002/jclp.22681Links to an external site.

Clauss-Ehlers, C. S., Chiriboga, D. A., Hunter, S. J., Roysircar, G., & Tummala-Narra, P. (2019). APA Multicultural Guidelines executive summary: Ecological approach to context, identity, and intersectionality. American Psychologist, 74(2), 232. https://psycnet.apa.org/doi/10.1037/amp0000382Links to an external site.

Goldfried, M. R. (2019). Obtaining consensus in psychotherapy: What holds us back?. American Psychologist, 74(4), 484. https://doi.org/10.1186/s12906-018-2325-3

Nichols, M. P., & Schwartz, R. C. (2009). The essentials of family therapy (p. 336). Pearson/Allyn and Bacon Publishers.

Petiprin, A. (2016). Psychiatric and mental health nursing. Nursing Clinics of North America, 51.

Wheeler, K. (2013). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company.

        Psychotherapy has a biological basis in many ways. The people involved in the psychotherapy are all made up of different biological components. These components include, hormones, such as testosterone or estrogen. The biological sex of the patients participating in the therapy is a major factor in the factors that would be included in therapy. Age is also a biological factor that influences psychotherapy. The biological body is different at each stage of life, the brain and body can determine mood and behavior. The brain as a child is different from one than an adult and one that is an elder.

Cultures can influence how psychotherapy is seen, performed, and the response of the treatment. Asian cultures do not see psychotherapy as a useful tool in mental health treatment. Mental health illness treatment such psychotherapy is considered a taboo, that the illness is not of concern or true illness and that the treatments are not of one of the cultures accepted form of healing (Gordon C. Nagayama Hall J. J., 2011). Religion can influence psychotherapy in that some religions may seek out psychotherapy sooner. A Pastor or Priest may act as part of the psychotherapy in some religions. Clergy involvement in marriage therapy is the highest in Christian religions (Andrew J. Weaver, 2007). Part of the therapy could involve prayer, healing oils, or other religious factors that may play a role. Socioeconomic status is influenced on what part of society can afford to pay for the billing of psychotherapy. Many lower economic people simply do not have the funds to pay for such treatment.

Legal considerations in psychotherapy can involve marriage counseling. This approach in therapy can be single or in a group. The end of the marriage could result in a divorce that has court involved. A statement made in therapy could be used in court if one made during group psychotherapy. One may make admission to infidelity or criminal activity during psychotherapy which could be used in court. During an individual therapy session these admissions of infidelity is shown to be better handled in a group therapy session than in an individual therapy session (Atkins, 2010).  This article followed groups of partners who were in committed relationships that infidelity occurred. It shown that a high percentage of successful therapy occurred during group therapy versus individual therapy.

An admission of wanting to hurt someone or to participate in self harm is a legal and ethical situation that must be handled appropriately. The therapist has an ethical and legal obligation to warn of any potential criminal or suicidal idealization (Kitchner, 1984).  Group therapy is shown to be effective in patients who have participated in self harm. The participants shown that those how were in group therapy versus routine psychiatric care were shown to be less likely to have a repeat of a self-harm episode (Allenwood, 2001). This article shows a group of individuals who were admitted in the past for self-harm, they were randomized into two groups, one with group therapy and another with routine psychiatric care. The individuals that participated in group therapy shown less chance of a repeated episodes of self-harm and better attendance at school, and a lower rate of behavioral disorder. With the knowledge this writer has learned in this discussion is that many disorders are often better treated with group therapy. These group therapies are successful due to more open type discussions, the patient feels less pressure than from siting across a therapist, other individuals may point out types of thinking or thoughts that are helpful.

References

Allenwood. (2001). Randomized Trial of Group Therapy for Repeated Deliberate Self-Harm in Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 1246-1243. doi: https://doi.org/10.1097/00004583-200111000-00003

Andrew J. Weaver, H. G. (2007). Marriage and Family Therapists and the Clergy : A Need For Clincal Collaboartion, Training, and Research. Journal of Marital and Family Therapy .

Atkins, D. C. (2010). Outcomes of couples with infidelity in a community-based sample of couple therapy. 212-216. doi: https://doi.org/10.1037/a0018789

Gordon C. Nagayama Hall, J. J. (2011). Culturally-Competent Treatments for Asian Americans: The Relevance of Mindfulness and Acceptance-Based Psychotherapies. Clinical Pyschology , 215-231.

Kitchner, K. (1984). Intuition, Critical Evaluation and Ethical Principles: The Foundation for Ethical Decisions in Counseling Psychology. Journal of Health Promotion and Prevention . doi:10.1177/0011000084123005

           Psychotherapy plays a significant biological response in neuropsychiatric treatment. With complex behaviors partaking within the framework of brain-mind functionality, a psychotherapeutic treatment approach can alter complex brain responses individually. Understanding one’s complex behaviors and maladaptive responses with the incorporation of a successful therapeutic treatment plan, the individual can have comprehensive physical variations within the brain. With complete physical variation changes within the brain, the individual’s cognitive, emotional, and internal regulation processes alter creating a whole new sense of one’s self. Psychotherapy is one treatment modality that targets all brain responses (Javanbakht & Alberini, 2019).

Researchers have determined the lack of specific cultural knowledge among ethnic-minority patients hinders compliance with psychotherapy treatment. Individuals within ethnic-minority populations are found to have ineffective psychotherapeutic plans and have an increased chance of non-attendance to psychotherapeutic sessions. Approximately, fifty-percent of ethnic-minority clients fail to participate after one session due to the inadequacies of culturally represented mental health services. Without culturally appropriate forms of psychotherapeutic treatment, individuals have found psychotherapy to be unhelpful thus resulting in non-attendance. Mental health providers must ensure psychotherapy treatments fit the client’s cultural lifestyle to prevent non-attendance and increase positive treatment outcomes (Sue & Zane, 2009).

With religion comprising an integral part of the culture, faith impacts one’s experiences, beliefs, values, and behaviors. Per studies, mental health professionals often receive minimal training in addressing spirituality within psychotherapy. If a lack of spiritual understanding is absent from the provider, clients were found to encounter developmental struggles during sessions. Religious and cultural viewpoints intergrade to create client responses emerging based on personal beliefs. Psychotherapy treatment outcomes are impacted and can be tailored based on the individual’s religious belief system (Abernethy & Lancia, 1998).

Psychotherapy clinical outcomes are greatly impacted by socioeconomics. Socioeconomic status has been linked to therapy retention. Clients of lower-socioeconomic status have been found to require additional therapy sessions due to the likelihood of extreme stressors. Socioeconomics also impacted the way an individual perceives mental health treatment and their attitude toward psychotherapy. Individuals impacted by a lower-economic status were found to lack effort, and motivation, and were passive towards mental health treatment. A reduction of effort, motivation and passiveness towards treatment was found to be impacted by a lack of social support. Forms of social support systems that were found to be lacking based on socioeconomic status were health insurance status and financial security (Hawley, et., al., 2014).

An important legal and ethical consideration providers must abide by is client informed consent. Informed consent is the process of sharing client healthcare information. In the past, psychotherapy was shielded from informed consent due to the infrequent uncensored use of therapeutic communications available to others. However, that is no longer the case. Psychotherapy healthcare information is now shared easily through electronic health records and with others involved in the psychotherapeutic treatment process. Group and family therapy sessions risk sensitive client information being shared. Clients have the right to openly discuss information with whomever they choose, but healthcare providers must ensure informed consent is obtained to protect patient privacy. Importantly, informed consent allows the expansion of client treatment options with the incorporation of others into the client’s treatment plan impacting client outcomes (Beahrs & Gutheil, 2001). As a healthcare provider, I would ensure the client is educated thoroughly on the incorporation of others into their treatment plan. Also, I would ensure documentation is gathered from the client detailing who they would specifically like to be directly involved with.

Overall, it is vital as a healthcare provider all cultural components, legal, and ethical considerations are respected. Client-provider rapport is a critical element to a positive client outcome. In order for rapport to occur, the provider must respect a client’s way of life and tailor psychotherapy sessions based on the client’s beliefs. Most importantly, counseling outcomes are directly based on the client’s response to psychotherapy treatment.

References

Abernethy, A. D., & Lancia, J. J. (1998). Religion and the psychotherapeutic relationship. Transferential and countertransferential dimensions. The Journal of psychotherapy practice and research. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330516/

Beahrs, J. O., & Gutheil, T. G. (2001). Informed Consent in Psychotherapy. American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.1.4

Hawley, L. D., Leibert, T. W., & Lane, J. A. (2014). The relationship between socioeconomic status and counseling outcomes. The Professional Counselor. Retrieved from https://tpcjournal.nbcc.org/the-relationship-between-socioeconomic-status-and-counseling-outcomes/

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological models of psychotherapy. Frontiers in behavioral neuroscience. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608400/#:~:text=Psychotherapy%20is%20an%20individualized%20yet,regulations%20underlying%20complex%20brain%20responses.

Sue, S., & Zane, N. (2009). The Role of Culture and Cultural Techniques in Psychotherapy: A Critique and Reformulation. Pathways2Promise . Retrieved from https://www.pathways2promise.org/wp-content/uploads/2017/01/The-Role-of-Culture-and-Cultural-Techniques-in-Psychotherapy-1.pdfLinks to an external site.

Informed Consent in Psychotherapy-1.pdfDownload Informed Consent in Psychotherapy-1.pdf

Religion and the Psychotherapeutic Relationship.pdfDownload Religion and the Psychotherapeutic Relationship.pdf

Neurobiological Models of Psychotherapy.pdf Download Neurobiological Models of Psychotherapy.pdf

The Relationship Between Socioeconomic Status and Counseling Outcomes.pdfDownload The Relationship Between Socioeconomic Status and Counseling Outcomes.pdf

The Role of Culture and Cultural Techniques in Psychotherapy.pdf Download The Role of Culture and Cultural Techniques in Psychotherapy.pdf

Over time, epigenetic changes can happen, and sometimes these changes are maladaptive, and psychotherapy causes learning and new experiences, which then help and regulate the maladaptive processes (Javanbakht & Alberini, 2019). In addition, events such as trauma can cause neurodevelopmental genes to undergo epigenetic modifications, which can cause, for example, poor emotional responses, and psychotherapy can modify the response that the epigenetic modifications caused (Jimenez et al., 2018).

Socioeconomic status, culture, and religion can influence a person’s perspective on the value of psychotherapy in a few ways. A person’s socioeconomic status can influence their views on psychotherapy. For example, a disadvantaged person may not value psychotherapy because they may feel it is too expensive to afford or may not completely understand the purpose or advantages of the therapy and think they are just paying someone to talk to. In some cultures, mental health disorders are still very stigmatized. Ran et al. (2021) state that some cultures believe that a person with a mental illness is strange, dangerous, or they are being punished for something. So that stigma causes a negative perspective on the value of not only psychotherapy but mental health treatment altogether which causes people not to seek care. In addition, religion can affect a person’s perspective on the value of psychotherapy because some religious groups believe that therapy should be done through the church and only through the revelation of scripture. So they reject or do not value any mainstream treatments such as psychotherapy.

Legal and ethical considerations differ between the group, family, and individual therapy. Regarding group therapy, patients should be given autonomy and not have to provide any information they do not choose to. The provider should also explain the limitations of confidentiality during a group session and get consent from everyone in the session. The same goes for family therapy; however, if a child is involved, the laws are different in every state. For example, in some states, the parent can only receive certain parts of a minor’s chart; in other states, the minor has very few rights so, the parents can access all the patient’s information. The provider must know the laws and patient rights so that they can provide legal and ethical care. When it comes to individual therapy sessions maintaining boundaries is essential. Regardless if it is a child or an adult, the provider must explain the importance of maintaining professional boundaries. The provider should also explain that if the patient has family or friends that are also being seen, they can not receive information on them unless the other patient gives the provider written approval to release information.

Explaining Supported Sources

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience, 13, 144. https://doi.org/10.3389/fnbeh.2019.00144

• This research article was published by the Frontiers in behavioral neuroscience and underwent a collaborative peer review; the article is a literature review that discusses psychotherapy as a biological treatment and evidence found on the topic.

Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., Martínez, F., Assar, R., Salazar, L. A., Ortiz, M., Ríos, U., Barros, P., Jaramillo, K., & Luyten, P. (2018, July 17). Psychotherapy and genetic neuroscience: An emerging dialog. Frontiers. Retrieved November 29, 2022, from https://www.frontiersin.org/articles/10.3389/fgene.2018.00257/full

• This is a systemic review of emerging evidence that psychotherapy can affect epigenetics; the review has been peer-reviewed and published in Frontiers.

Ran, M.-S., Hall, B. J., Su, T. T., Prawira, B., Breth-Petersen, M., Li, X.-H., & Zhang, T.-M. (2021, January 7). Stigma of mental illness and cultural factors in Pacific Rim Region: A systematic review – BMC psychiatry. BioMed Central. Retrieved November 29, 2022, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02991-5#citeas

• This systemic review followed the PRISMA reporting guidelines and used CASP. The systemic review was peer-reviewed and published by BMC Psychiatry.

References

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience, 13, 144. https://doi.org/10.3389/fnbeh.2019.00144

Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., Martínez, F., Assar, R., Salazar, L. A., Ortiz, M., Ríos, U., Barros, P.,  Jaramillo, K., & Luyten, P. (2018, July 17). Psychotherapy and genetic neuroscience: An emerging dialog. Frontiers. Retrieved November 29, 2022, from https://www.frontiersin.org/articles/10.3389/fgene.2018.00257/full

Ran, M.-S., Hall, B. J., Su, T. T., Prawira, B., Breth-Petersen, M., Li, X.-H., & Zhang, T.-M. (2021, January 7). Stigma of mental illness and cultural factors in Pacific Rim Region: A systematic review – BMC psychiatry. BioMed Central. Retrieved November 29, 2022, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02991-5#citeasLinks to an external site.

Psychotherapy and Genetic Neuroscience_ An Emerging Dialog.pdf Download Psychotherapy and Genetic Neuroscience_ An Emerging Dialog.pdf

Neurobiological Models of Psychotherapy.pdfDownload Neurobiological Models of Psychotherapy.pdf

Stigma of mental illness and cultural factors.pdf Download Stigma of mental illness and cultural factors.pdf

Psychotherapy has been shown to have a biological basis. It has been known for more than a decade that psychotherapy has different levels of effectiveness against certain disorders for patients with different alleles for a particular gene involved in serotonin neurotransmission (Jimenez et al., 2018). This is a biological linkage to psychotherapy. Neural models have been constructed to show how brain activity changes in response to psychotherapy (Jimenez et al., 2018). Current research focuses on identifying the epigenetic mechanisms by which psychotherapy affects the expression of genes related to psychiatric disorders (Kumsta, 2019). For example, one recent study found a correlation between positive response to psychotherapy for borderline personality disorder and decreased methylation of a gene (known as FKBP5) that codes for a stress response protein (Quevedo et al., 2022). DNA methylation decreases gene transcription, and psychotherapy has been connected to increased methylation of some genes and increased methylation of others (Quevedo et al., 2022).

Lower socioeconomic status is associated with increased likelihood of psychiatric conditions, and has been connected in some studies with less access to psychiatric treatment and with lower likelihood of successful outcomes from treatment (Finegan et al., 2018). In particular, having lower income, being unemployed, and living in a low-income neighborhood are frequently statistically significantly correlated to poorer treatment outcomes (Finegan et al., 2018). A perspective on the value of psychotherapy is not fixed by its overall statistical likelihood of success, however, but by the individual’s overall knowledge, both formal and informal, competing needs, and hierarchy of values. Socioeconomic status impacts each of these in ways that are not necessarily generalizable. Socioeconomic status is likely to affect how much someone reads about psychotherapy and how many psychotherapists they know or talk to, but the depth of knowledge does not translate to the value they place on psychotherapy, especially as that value is partially based on a comparison to psychopharmacologic therapy. As needs for therapy may be highest among low socioeconomic status populations where access to therapy may be lowest, it is unclear whether socioeconomic status significantly influences the numbers of psychotherapy patients someone knows, and knowledge of others’ treatment outcomes both lacks comparison points and is based on small samples. Competing values and needs revolve around what is foregone by seeking psychotherapy and what is sought to be gained by seeking psychotherapy. Not only are these difficult to identify and measure in many respects, there is a selection bias introduced in that only those persons who sufficiently value psychotherapy enough to seek out psychotherapy would be interviewed about their values and needs. Even with all of these limitations, there is reason to believe that some aspects of socioeconomic status (primarily economic aspects) are correlated with the value a person places on psychotherapy. However, cultural and religious beliefs are likely to have far greater impacts on how someone values psychotherapy.

Culturally competent treatment is important for getting patients to both initiate and complete psychotherapy treatment (Gainsbury, 2017). The greater the degree of differences between the patient’s culture (including their religion) and the therapist’s expected culture (including their religion), the less likely the patient is to feel that their culture will be valued and respected, and the less they are likely to value psychotherapy. Beyond the patient’s need to feel valued and respected by the therapist, there are differing cultural and religious beliefs about psychotherapy that may greatly affect how patients value it. Psychiatric illnesses may be stigmatizing in a cultural or religious group such that seeking psychotherapy would itself be stigmatizing if discovered by others (Bloch et al., 2018). Psychotherapy may be seen broadly as a secular institution opposing a religious life, or particular therapeutic practices may be seen as contrary to religious ideals of how one should deal with distress (Bloch et al., 2018). For religious or other cultural reasons, psychiatric illnesses may be seen as personal weaknesses or failings that should be dealt with by methods other than medicine or therapy, thus leading to a low value placed on psychotherapy (Ayvaci, 2016). Or, religious or other cultural beliefs could give primacy to psychopharmacological approaches, thus devaluing psychotherapy (Bloch et al., 2018). The fact that psychotherapy requires discussion of personal wants and needs with someone who is a stranger may also be considered improper in a culture, either because it is prioritizing individual needs or because it is sharing private matters outside a family unit or other in-group – and this problem is even more significant for group therapy. If differences in language are present, they may also devalue psychotherapy to a patient, as treatments offered may seem inappropriate for the facts as understood by the patient. For example, the same word may be translated to English either as “sadness” or as “depression” (Bloch et al., 2018), which can lead to inappropriate treatment plans.

In individual therapy, the therapist’s duties are toward the patient, and confidentiality may only be trumped under the circumstances where disclosures are mandated or authorized by state law, such as a duty in most states to warn of a threat made by the patient to harm another person (Merideth, 2007; NCSL, 2022). In both family and group therapy, there are multiple patients, and the therapist has duties toward all of them. The American Group Psychotherapy Association (2002) has set forth ethical guidelines for practitioners of group therapy. Informed consent is common to all ethical codes for psychotherapy (and is incorporated into legal requirements), but the nature of what information must be given and consented to is different for group and family therapy as compared to individual therapy, as the therapist must disclose that other patients in the therapy will learn everything shared by a patient, and are not bound by the therapist’s duty of confidentiality. Even though the other patients must agree to keep what they learn confidential (and obtaining consent to this is an ethical requirement for the group or family therapy practitioner), they might still use or disseminate that information in a way that harms the patient. Family therapy poses a greater danger of misuse of information to harm the other person within the context of a family relationship, while group therapy poses a greater danger of disclosure of information outside the group of patients. Protection of confidentiality by the therapist extends to identifying information about the group, not just information about a specific patient (AGPA, 2002). The group or family therapist must also understand the legal rules in their state for privilege in group or family therapy communications and explain these rules to their patients in order to have informed consent (AGPA, 2002). In addition to not discriminating against patients due to gender, religion, ethnicity, sexual orientation or other characteristics, the group or family therapy practitioner must take efforts to ensure that other patients do not discriminate against a group member (AGPA, 2002). The American Association for Marriage and Family Therapy (2015) has created similar guidelines for family therapy.

The increased duty of protection of patients that comes with family or group therapy must be taken into account in making recommendations for commencing group or family therapy. As a therapist, I will need to answer to myself the question whether this patient should be in this type of therapy with these other patients before making a specific recommendation for group or family therapy. This will include satisfying myself that other patients should be able to trust a particular patient before I suggest that patient join a group. This will require some development of a therapeutic relationship and sufficient opportunity to examine and talk to the patient. It is likely in many cases that a recommendation for group or family therapy would not be made until well after the patient’s initial visit, whereas individual psychotherapy could begin at the first visit.

Of the 11 sources used in this discussion, two (AAMFT, 2015; AGPA, 2002) are ethical guidelines promulgated by professional organizations concerned with psychotherapy. These guidelines are the product of the work of teams of professionals regarding matters within their field, and because they concern ethics rather than matters subject to the scientific method, are considered scholarly for the purpose of discussion of ethical issues. One source (NCSL, 2022) is the product of a group with expertise in legal research. Legal scholarship is generally not peer-reviewed, but the publications of a body which provides expert policymaking advice to governments should be considered scholarly. The other eight sources are publications within peer-reviewed journals. Of these, three (Ayvaci, 2016; Gainsbury, 2017; Kumsta, 2019) are review articles, one (Bloch et al., 2018) is an interdisciplinary examination comparing historical texts to modern practices, two (Finegan et al., 2018; Jimenez et al., 2018) are systematic reviews, one (Merideth, 2007) is expert ethical and legal advice for practitioners, and one (Quevedo et al., 2022) is an original research study.

References

American Association for Marriage and Family Therapy [AAMFT] (2015). Code of ethics. AAMFT. https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

American Group Psychotherapy Association [AGPA] (2002, February). AGPA and ICGBP guidelines for ethics. AGPA. https://agpa.org/home/practice-resources/ethics-in-group-therapy

Ayvaci, E. R. (2016). Religious barriers to mental healthcare. The American Journal of Psychiatry Residents’ Journal, 11(7), 11-13. https://doi.org/10.1176/appi.ajp-rj.2016.110706

Bloch, A. M., Gabbay, E., Knowlton, S. F., & Fins, J. J. (2018). Psychiatry, cultural competency, and the care of ultra-Orthodox Jews: Achieving secular and theocentric convergence through introspection. Journal of Religion & Health, 57(5), 1702-1716. https://doi.org/10.1007/s10943-018-0678-z

Finegan, M., Firth, N., Wojnarowski, C., & Delgadillo, J. (2018). Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta-analysis. Depression and Anxiety, 35(6), 560-573. https://doi.org/10.1002/da.22765

Gainsbury, S. M. (2017). Cultural competence in the treatment of addictions: Theory, practice and evidence. Clinical Psychology & Psychotherapy, 24(4), 987-1001. https://doi.org/10.1002/cpp.2062

Jimenez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R., Martinez, F., Assar, R., Salazar, L. A., Ortiz, M., Rios, U., Barros, P., Jaramillo, K., & Luyten, P. (2018). Psychotherapy and genetic neuroscience: An emerging dialog. Frontiers in Genetics, 9, 257. https://doi.org/10.3389/fgene.2018.00257

Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. Psychology and Psychotherapy: Theory, Research and Practice, 92(2), 190-207. https://doi.org/10.1111/papt.12227

Merideth, P. (2007). The five C’s of confidentiality and how to DEAL with them. Psychiatry 2007, 4(2), 28-29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922345/

National Conference of State Legislatures [NCSL] (2022, March 16). Mental health professionals’ duty to warn. NCSL. https://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx

Quevedo, Y., Booij, L., Herrera, L., Hernandez, C., & Jimenez, J. P. (2022). Potential epigenetic mechanisms in psychotherapy: A pilot study on DNA methylation and mentalization change in borderline personality disorder. Frontiers in Human Neuroscience, 16, 955005. https://doi.org/10.3389/fnhum.2022.955005

BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY

Biological Basis of Psychotherapy

There are many studies that support the biological basis of psychotherapy and the effectiveness of the treatment in the mental health of those that suffer with issues. As we have learned, the functioning of neurotransmitters, synapses, and various areas of the brain are responsible for memory, attention, impulse control, emotions, and many other aspects that make up a person’s behavior and characteristics (Javanbakht & Alberini, 2019). Psychotherapy does not target one singular area of the brain, but reaches into the brain’s complex regulatory processes as a whole and teaches new experiences and learning processes that reforms the brain (Javanbakht & Alberini, 2019). An example of this is a psychotherapeutic approach called Eye-Movement Desensitization Reprocessing (EMDR). EMDR has been found to have efficacy in treating trauma and Post Traumatic Stress Disorder (PTSD) (Haour, et al., 2019). EMDR uses bilateral stimulation to alter the memory pathway in the brain by re-encoding memories, which ultimately leads to desensitization to the traumatic experience giving the therapy a biological basis (Haour, et al., 2019).

Cultural, Religious, and Socioeconomics

Culture, religion, and socioeconomic status can play a large role in the development of psychopathology and can deter some that are impacted from seeking treatment. Cultures that feel stigmatized such as, the LGBTQ communities, migrants, and those of low socioeconomic status have been studied to have an increased incidence of depression and suicide, and certain religious practices and beliefs can be stigmatized and viewed as mental illness when witnessed by some (Moleiro, 2018). In regard to seeking treatment, those in lower socioeconomic status may not have proper access to healthcare needs, and those of higher socioeconomic status may not seek treatment for a conceptualized fear of being labeled or shunned in their society.

Legal and Ethical Considerations for Group and Family Therapy

Legality and ethics is always a key consideration when delivering care to a patient. When providing care to a group of patients or a family, the provider must take into consideration the boundaries of the group as a whole and to be able to navigate these boundaries without violating them through training, education, and competence (Whittingham, et al., 2021). The provider must be competent in cultural diversity as members of various backgrounds and ethnicity could be attending the group and the provider should obtain informed consent from all parties involved. Group participants must also agree to abide by HIPAA laws as they may hear personal information about other members, and these rules and guidelines must be clearly established prior to the facilitation of the group.

A way that group therapy differs from individual therapy is that it may provide insight to the provider when seeing how individuals interact or behave differently while in a group setting as opposed to individual sessions. It may also empower the individual to share more regarding their feelings after witnessing that others have experienced the same. I would encourage my patient in individual session to join group therapy sessions as it may help them process their feelings and allow for progression in treatment.

References

Haour, F., Dobbelaere, E., & de Beaurepaire, C. (2019). Scientific evaluation of emdr psychotherapy for the treatment of psychological trauma summary: Scientific evaluation of emdr psychotherapy. Journal of Neurology & Neuromedicine, 4(2), 5–14. https://doi.org/10.29245/2572.942x/2019/2.1234Links to an external site.

This article is published and licensed, and includes 96 supporting references.

Javanbakht, A., & Alberini, C. (2019). Editorial: Neurobiological models of psychotherapy. Frontiers in Behavioral Neuroscience, 13. https://doi.org/10.3389/fnbeh.2019.00144Links to an external site.

This article was found in the PubMed database and published by the National Library of Medicine and the article has received copyright and licensing privileges.

Moleiro, C. (2018). Culture and psychopathology: New perspectives on research, practice, and clinical training in a globalized world. Frontiers in Psychiatry, 9. https://doi.org/10.3389/fpsyt.2018.00366Links to an external site.

This article has been peer reviewed, licensed, and published.

Whittingham, M., Lefforge, N. L., & Marmarosh, C. (2021). Group psychotherapy as a specialty: An inconvenient truth. American Journal of Psychotherapy, 74(2), 60–66. https://doi.org/10.1176/appi.psychotherapy.20200037Links to an external site.

This article was issued in the American Journal of Psychotherapy and published by the American Psychiatric Association.

Week 1: Assignment 2-Discussion Biological Basis and Legal & Ethical Considerations of Psychotherapy

Carla McKenzie BSN, RN

College of Nursing-PMHNP, Walden University

NRNP 6645: Psychotherapy Multiple Modalities

Dr. Lavon Williams

11/30/2022

Psychotherapy has been proven effective and is shown to alter the brains state. Wheeler states that psychotherapy aids in the reconstruction of neural networks which leads to the strengthening and improvement of brain healing (Wheeler, 2020). According to Bambling, a biological basis for psychotherapy includes expression of gene alterations that can be viewed using positron emission tomography scans (Bambling, 2013). Psychotherapy is known to have the same positive effects on the brain as medication management. Fuchs (2004) states, the goal of psychotherapy is to remodel the subcortical-limbic systems neural pathways (Wheeler, 2020). Culture has a large impact on the way a person views themselves and the world around them. Croucher, et.al., states that religion is a crucial aspect of the human condition (Croucher, et.al., 2017). Culture and religion are major factors that influence the way a person views illness, disease, and mental illness. Many Eastern cultures do not view mental illness the way that it is viewed in Western culture. There are some cultures that relate what we consider to be mental illness as spiritual enlightenment. Those cultures in particular tend to not seek treatment for mental illness and are both reluctant and pessimistic about therapy modalities and the use of medication. Christians place their belief and foundation for healing in Jesus and can at times reject traditional medicine as it is viewed as not having total faith in God for healing. Socioeconomics play a role in the value of psychotherapy in that many clients rely on health insurance coverage. Many clients struggle to make co-pays and out of pocket medical costs. Financial challenges can deter a person from seeking psychotherapy. Legal and ethical considerations for group and family therapy differ from that of individual therapy in that group and family therapy requires clarification at the start of treatment as to which of the participating individuals are clients and outline the type of relationship that the practitioner will have with each member (Nichols & Davis, 2020). Written waivers are required in marital or family therapy for the practitioner to be able to disclose information from one family member to another (Nichols & Davis, 2020). Ethical considerations for individual therapy include mandates by The American Counseling Association (ACA, 2014) that state practitioners must wait 5 years after the last clinical contact to have romantic or sexual relations with a former client, this includes the clients family members and are not allowed to maintain relationships with present clients through social media (Nichols & Davis, 2020).

References

Bambling, M. (2013). Neurobiology of behavior change Links to an external site.Links to an external site.[Video/DVD] https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/neurobiology-of-behavior-changeLinks to an external site.

Croucher, S. M., Zeng, C., Rahmani, D., & Sommier, M. (2017). Religion, culture, and Communication. Oxford Research Encyclopedia of Communication. https://doi.org/10.1093/acrefore/9780190228613.013.166Links to an external site.

Jain, S., & Roberts, L. W. (2009). Ethics in psychotherapy: a focus on professional boundaries and confidentiality practices. The Psychiatric clinics of North America, 32(2), 299–314. https://doi.org/10.1016/j.psc.2009.03.005Links to an external site.

Locher, C., Meier, S., & Gaab, J. (2019). Psychotherapy: A World of Meanings. Frontiers in psychology, 10, 460. https://doi.org/10.3389/fpsyg.2019.00460

Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
Chapter 2, “Basic Techniques of Family Therapy”

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
Chapter 1, “The Nurse Psychotherapist and a Framework for Practice”
Chapter 2, “The Neurophysiology of Trauma and Psychotherapy”

Ethics in Psychotherapy_ A Focus on Professional Boundaries and Confidentiality Practices – ScienceDirect.pdfDownload Ethics in Psychotherapy_ A Focus on Professional Boundaries and Confidentiality Practices – ScienceDirect.pdf

Religion, Culture, and Communication _ Oxford Research Encyclopedia of Communication.pdf Download Religion, Culture, and Communication _ Oxford Research Encyclopedia of Communication.pdf

Psychotherapy_ A World of Meanings.pdf Download Psychotherapy_ A World of Meanings.pdf

Legal and Ethical Considerations for Individual, Group, and Family Therapy

Therapy is defined by Oxford Languages as a treatment intended to lessen or remedy a disorder, for example a course of antibiotics for a urinary tract infection. It is further defined but separated from biological conditions as the treatment of mental disorders by psychological means.

For the sake of this discussion the use the latter definition for therapy shall encompass an individual, family, or group setting, which includes a single person or a group of individuals undergoing therapy concurrently with at least one therapist. With each setting the common legal and ethical consideration should differ with respect to the sociodemographic population it serves (Watson, 2019). Respective therapy settings are built on the notion that the system focuses on the therapeutic relationship of the members. In a group setting versus individual setting, the members have shared implied confidentiality responsibility and informed consent for the members involved. An individual therapy requires only the discretion of the therapist and client for confidentiality and consent when delivering care. In all settings, the therapist should consider the sociodemographic diversity in group, such as age, gender, race, or religious beliefs, when caring for patients to ensure the therapeutic alliance and efficacy of the selected therapeutic modality.

Biological Basis of Psychotherapy

Psychotherapy is a psychological treatment that has historically been thought of as separate from medical community. Research is now looking at the biological impacts with regard to the response by the brain and body in terms of psychotherapy. Not only neurotransmitters and receptor response to medication but also at any physiologic response such as changes in heartrate, basal cerebral blood flow, and chemical responses like increases in oxytocin or reduction of glucose in a psychotherapeutic setting. Mental health is understood through the lens of nature versus nurture and the effects of each on the functioning of the brain and behavior. Psychotherapy looks for a cause through different therapeutic models which, generally attempts to change the psychological functioning of the brain. Possibly due to a lack of published research with regard to evidence surrounding the biological implication of psychotherapy it is difficult to ascertain the metric that is used to measure psychotherapy’s biological efficacy when measured against pharmacological therapies in treating illnesses such as depression or anxiety. The latter half of the twentieth century has seen growing interest in tools to measure the biological impacts of psychotherapy, but due to its largely physically noninvasive nature psychotherapy tools of investigation are imaging (Marano et al., 2012). Without more neuroimaging and published research, it will be difficult to create the evidence-based intersection between neurobiology and psychotherapy, let alone compile enough physiologic research data.

Culture, Religion, and Socioeconomics

Developing effective therapeutic alliance with the patient is essential for a safe and trusting environment for providing care. Healthcare providers should consider culture, religion, and socioeconomic factors when trying to engage with a patient. Culture determines perception of how psychotherapy is viewed and received. There are many cultural differences that a competent therapist needs to take into consideration. For example, quick tangible results for an Asian American patient are comparable to Asian culture gift giving rituals. It is also important to receive immediate benefits so as not to erode the patient/therapist relationship (Nagayama et al., 2019).  Cultures differences are many and can impact the way a patient relates with the therapist. Socioeconomic factors such as employment status, gender, age, marital status, income levels, and education levels also determine how a patient views mental health and differing abilities to explain and understand in the confines a psychotherapeutic setting.

Reference:

Marano, G., Traversi, G., Nannarelli, C., Pitrelli, S., Mazza, S., & Mazza, M. (2012). Functional neuroimaging: points of intersection between biology and psychotherapy. La Clinica terapeutica, 163(6), e443–e456.

Nagayama Hall, G. C., Kim-Mozeleski, J. E., Zane, N. W., Sato, H., Huang, E. R., Tuan, M., & Ibaraki, A. Y. (2019). Cultural Adaptations of Psychotherapy: Therapists’ Applications of Conceptual Models with Asians and Asian Americans. Asian American journal of psychology, 10(1), 68–78. https://doi.org/10.1037/aap0000122Links to an external site.

Watson, M. F. (2019). Social Justice and Race in the United States: Key Issues and Challenges for Couple and Family Therapy. Family Process, 58(1), 23–33. https://doi.org/10.1111/FAMP.12427

Marano, G., Traversi, G., Nannarelli, C., Pitrelli, S., Mazza, S., & Mazza, M. (2012). Functional neuroimaging: points of intersection between biology and psychotherapy. La Clinica terapeutica, 163(6), e443–e456.

Functional_neuroimaging-with-cover-page-v2.pdf Download Functional_neuroimaging-with-cover-page-v2.pdfContentServer.asp.pdf Download ContentServer.asp.pdf

nihms969817.pdf Download nihms969817.pdf

ContentServer-1.asp.pdf Download ContentServer-1.asp.pdf

When defining psychotherapy the American Psychological Association states psychotherapy is a collaborative treatment that is built between a

therapist or other qualified provider and an individual. This communication is intended to assist people to find relief from emotional distress, as in

becoming less anxious, fearful or depressed. During these meetings individuals may be seeking solutions for problems in their lives, assisting in

modifications of ways of thinking and acting that are preventing the individual from being productive in their life(American Psychological Association,

2017).

Research is showing more and more evidence that psychotherapy does in fact have a biological basis. This is a biological basis because psychotherapy is

brain therapy. This particular type of therapy is assisting in re-elaborating many senses such as the sense of self through fresh experiences while

encompassing emotional, cognitive, and internal regulation processing. Psychotherapy is individualized to that one person’s needs and produces lasting

physical changes in our brain (Jayanbakht & Alberini, 2019).

I believe culture, religion, and socioeconomics have major influences on an individual’s perspective on psychotherapy treatments and their value.

For example, Asian Americans have been found to have few treatment sessions and a higher right of terminating psychotherapy sessions.   Some

cultures may have different beliefs in treatments, and socioeconomics poses as a potential challenge if psychotherapy is not financially available.

Cultural competency may also influence individuals’ belief in what they believe to be tangible benefits of psychotherapy (Nagayama Hall et al., 2019).

As a PMHNP there will be legal and ethical matters to consider when providing therapy for a family compared to an individual. HIPPA can

become both a legal and ethical concern when providing family therapy. Although family therapy can be beneficial as it provides a mean of emotional

support it is important for the provider to understand what can and can’t be shared at that time. The articles I selected for this discussion were utilized as credible and resourceful resources as they were peer-reviewed articles.

References

American Psychological Association. (2017). Clinical Practice Guideline. https://www.apa.org/ptsd-guideline/patients-and-families/psychotherapy.pdfLinks to an external site.

Javanbakht, A., Alberini, C. M., eds. (2019). Neurobiological Models of Psychotherapy: How Psychotherapy Changes the Brain. Lausanne: Frontiers Media. doi: 10.3389/978-2-88963-036-3

Nagayama Hall, G.C., Kim-Mozeleski, J.E., & Zane, J. (2019, March). Cultural Adaptations of Psychotherapy: Therapists’ Applications of Conceptual Models with Asians and Asian Americans. Asian American