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BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6635
Psychotherapy and Biological Basis
Psychotherapy comprises therapeutic exchange, empathy, transference, finding unconscious thoughts, and cognitive remodeling. Several brain areas, including the hippocampus, amygdala, temporal, and frontal lobes, are involved in learning, and psychotherapy focuses on the patient learning constructive things to eliminate destructive thoughts that impair everyday life functioning. Dialectic behavior therapy (DBT), interpersonal psychotherapy, and cognitive-behavioral therapy (CBT) alter brain function in patients suffering from social anxiety disorder, obsessive-compulsive disorder (OCD), major depressive disorder (MDD), borderline personality disorder (BPD), and posttraumatic stress disorder (PTSD).
Research reports have identified that CBT decreased para limbic and limbic hyperactivity in phobias, whereas in OCD, it decreased metabolism in the right caudate nucleus (Hamann et al., 2022; Ojeda & Hurley, 2022). Psychotherapy-treated individuals with PTSD had increased activity and connectivity in the lateral front cortex and ventromedial prefrontal cortex (Rooij et al., 2021). These modifications are associated with improvements in hyperarousal. Similarly, psychotherapy enhances the production of serotonin in the brain, which is generally low in a patient with depression and anxiety (Harbi, 2021; Wu et al., 2022). Thus, it can be inferred that symptoms of mental health disorders have a biological basis, and psychotherapy help impact the biological processes responsible for producing symptoms of mental health disorders.
Cultural, Religious, and Socio-economic Impact on Psychotherapy
Cultural and religious factors may considerably impact psychotherapy and other forms of mental health care. Some cultures continue to stigmatize mental health, making it challenging for mental health patients to receive care. Access to psychiatric care is a significant concern for many people (Della et al., 2020). Religious rituals play a crucial role in the healing process in various civilizations (Alattar et al., 2021). Despite contradictory data, individuals may be hesitant to seek official therapy owing to their beliefs, which may result in poor outcomes. Among the 14.2 million adults with mental illness in the United States, only 9.1 million (64.5%) received mental health treatment in the year 2020 (National Institute of Mental Health [NIMH], 2022). A patient’s socioeconomic situation may restrict their access to therapy. Examples of socioeconomic barriers impacting an individual’s decision to receive psychotherapy include lack of insurance coverage, extensive wait periods at community mental health centers, being unable to afford copayments, and being ineligible to receive financial aid. A research report by Foster and O’Mealey (2021) indicates that people belonging to high socioeconomic status are more likely to receive mental illness treatment.
Legal and Ethical Consideration in Group and Individual Therapy
Group and family therapy have distinct legal and ethical considerations compared to individual therapy. First, confidentiality can only sometimes be maintained in groups, even when strongly encouraged. Second, obtaining informed consent in group and family treatment is more complicated than in individual therapy (Riva & Cornish, 2018). Group facilitators and clinicians are also responsible for establishing a therapeutic bond with each participant. When conflicts arise within a group, it can be challenging to preserve. Therapists must have extensive knowledge of group dynamics and ethical dilemmas due to the nature of group therapy. Therapists should keep the preceding information in mind when developing therapeutic strategies. Providers of group therapy should remain vigilant for any issues that could compromise the safety of group members or the group as a whole and immediately address those (Riva & Cornish, 2018). Before beginning a group, it is beneficial for the therapist to speak individually with each participant. Group members must agree to maintain the confidentiality of their identities and any other information disclosed during meetings. Participants should be instructed on maintaining the secrecy of the group’s secrets when they are outside the group environment. However, in individual therapy, obtaining informed consent is relatively simple, as there is only one client. Similarly, confidentiality is only one-to-one in individual therapy and it can be maintained easily between the patient and the therapist.
Being a psychiatric nurse practitioner, I am well aware of the ethical and legal aspects of different forms of therapy sessions, and I ensure to incorporate these while working with my patients.
Alattar, N., Felton, A., & Stickley, T. (2021). Mental health and stigma in Saudi Arabia: A scoping review. Mental Health Review Journal, 26(2), 180-196. https://doi.org/10.1108/mhrj-08-2020-0055
Della, C. D., Teo, D. C. L., Agiananda, F., & Nimnuan, C. (2020). Culturally informed psychotherapy in Asian consultation‐liaison psychiatry. Asia-Pacific Psychiatry, 13(1), 12431-12439. https://doi.org/10.1111/appy.12431
Foster, S., & O’Mealey, M. (2021). Socioeconomic status and mental illness stigma: The impact of mental illness controllability attributions and personal responsibility judgments. Journal of Mental Health, 31(1), 1-8. https://doi.org/10.1080/09638237.2021.1875416
Hamann, C. S., Bankmann, J., Mora Maza, H., Kornhuber, J., Zoicas, I., & Schmitt-Böhrer, A. (2022). Social fear affects limbic system neuronal activity and gene expression. International Journal of Molecular Sciences, 23(15), 8228-8245. https://doi.org/10.3390/ijms23158228
Harbi, V. (2021). The neuroplasticity of depression: How antidepressants and cognitive behavior therapy (CBT) can reverse depression. PCOM Capstone Projects, 30(1), 1-40. https://digitalcommons.pcom.edu/capstone_projects/30/
National Institute of Mental Health. (2022). Mental illness.U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/mental-illness
Nohr, L., Lorenzo Ruiz, A., Sandoval Ferrer, J. E., & Buhlmann, U. (2021). Mental health stigma and professional help-seeking attitudes a comparison between Cuba and Germany. Public Library of Science (PLoS) ONE, 16(2), 246501-246524. https://doi.org/10.1371/journal.pone.0246501
Ojeda, W. L., & Hurley, R. A. (2022). Kisspeptin in the limbic system: new insights into its neuromodulatory roles. The Journal of Neuropsychiatry and Clinical Neurosciences, 34(3), 190-195. https://doi.org/10.1176/appi.neuropsych.20220087
Riva, M. T., & Cornish, J. A. (2018). Ethical considerations in group psychotherapy. In M. M. Leach & E. R. Welfel (Eds.), The Cambridge handbook of applied psychological ethics (pp. 218–238). Cambridge University Press. https://doi.org/10.1017/9781316417287.012
Rooij, S. J. H., Sippel, L. M., McDonald, W. M., & Holtzheimer, P. E. (2021). Defining focal brain stimulation targets for PTSD using neuroimaging. Depression and Anxiety, 38(7), 768-785. https://doi.org/10.1002/da.23159
Wu, Z., Wang, C., Dai, Y., Xiao, C., Zhang, N., & Zhong, Y. (2022). The effect of early cognitive behavior therapy for first-episode treatment-naive major depressive disorder. Journal of Affective Disorders, 308(1), 31-38. https://doi.org/10.1016/j.jad.2022.04.008
BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY
Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology?
Psychotherapy is used with individuals as well as in groups or families. The idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric-mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential.
For this Discussion, you will consider whether psychotherapy also has a biological basis and analyze the ways in which legal and ethical considerations differ in the individual, family, and group therapy settings.
- Review this week’s Learning Resources, reflecting on foundational concepts of psychotherapy, biological and social impacts on psychotherapy, and legal and ethical issues across the modalities (individual, family, and group).
- Search the Walden Library databases for scholarly, peer-reviewed articles that inform and support your academic perspective on these topics.
BY DAY 3
Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective on the value of psychotherapy treatments. Describe how legal and ethical considerations for group and family therapy differ from those for individual therapy, and explain how these differences might impact your therapeutic approaches for clients in group, individual, and family therapy. Support your rationale with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
Read a selection of your colleagues’ responses.
BY DAY 6
Respond to at least two of your colleagues on 2 different days by providing an additional scholarly resource that supports or challenges their position, along with a brief explanation of the resource.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
Week 1 Reply 1 to Dania
Hi Dania, good and interesting post. I agree with you on the fact that psychotherapy involves therapeutic exchange, empathy, transference, finding unconscious thoughts, and cognitive remodeling. Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior and overcome problems in desired ways. Psychotherapy aims to improve an individual’s well-being and mental health to resolve or control troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills (Jimenez et al., 2018). The role of psychotherapy is to facilitate the client’s work in ways which respect the client’s values, personal resources and capacity for self-determination. The aim is to empower clients and encourage them to take control of their lives. When both therapist and client agree to enter into a therapy relationship it becomes psychotherapy.
Individual therapy is defined as one person in therapy with one psychologist, counselor, therapist, or psychiatrist. On the other hand, group therapy is defined as more than one person being treated together in a formal therapeutic environment. Group therapy is a cost-effective choice for many patients without insurance (Wheeler, 2020). It provides therapists the opportunity to treat multiple patients at once which allows greater access to treatment for clients (Wheeler, 2020). With individual psychotherapy, the client is understood from an intrapsychic, interpersonal, and cognitive behavioral perspective while family therapy strives to understand the client in the context of a system (Wheeler, 2020). In terms of family therapy, clients have lived most of their lives growing up in a family and starting a new family. In group and family therapy, information is revealed to the therapist as well as to other group members. Thus, legal and ethical considerations differ from those of individual therapy. Therapists have the responsibility to inform all group participants of the need for confidentiality, potential consequences of breaching confidentiality, and that legal privilege does not apply to group discussions.
Legal and ethical considerations are very important during therapy to protect patient privacy. As a practitioner, the code of ethics requires that we adhere to the principles. Healthcare professionals including psychotherapists are legally and ethically obliged to ensure informed consent for the provided treatments comprising type and duration or potential benefits and possible risks among others. Informed consent provides the major legal and moral legitimation for physical medicine as well as psychological interventions including psychotherapy irrespective of the setting, be it inpatient or outpatient, individual, couples, or group therapy (Trachsel & Holtforth, 2019).
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). Psychotherapy and genetic neuroscience: An emerging dialog. Frontiers in Genetics, 9. https://doi.org/10.3389/fgene.2018.00257
Trachsel, M., & Grosse Holtforth, M. (2019). How to strengthen patients’ meaning response by an ethical informed consent in psychotherapy. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.01747
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.
- Explain the biological basis of psychotherapy.
Psychotherapy uses a patient-centered approach based on consistency and relationship to proffer healing to people suffering from various mental illnesses and emotional difficulties. It can help people eliminate or manage disabling symptoms, improving individuals’ functionality and general well-being and healing process. (APA,2013). Psychotherapy has a biological basis because it focuses on the brain and its functions. According to Tyron (2016), psychotherapy targets the brain’s maladaptation and repairs unfavorable brain functions by substituting positive pathways. Because the brain maps experiences using neurons, psychotherapy aims to remove the malfunctioning mappings. Linden et al. (2012) discovered that cognitive-behavioral therapy (CBT) affects substantial changes in the prefrontal cortex, a brain region associated with regulating feelings and decision-making.
- Explain how culture, religion, and socioeconomic might influence a person’s perspective on the value of psychotherapy treatments.
Culture, religion, and socioeconomic status are all significant factors that can influence a person’s opinion of the significance of psychotherapy treatments. These factors may impact people’s beliefs, attitudes, and expectations regarding mental health and psychological therapies. Culture refers to the shared beliefs, values, and practices that define a group of people, including their attitudes toward mental health and help-seeking behaviors. A person’s cultural background impacts the feelings, actions, judgment, and perception of self and others. People’s perspectives on psychotherapy are influenced by their cultural beliefs. For instance, some for example, some cultures stigmatize mental illness and may prefer only pharmacological treatments, thereby discouraging people from seeking psychotherapy treatment.
In contrast, other cultures view this as a sign of strength. 47% of Americans believe seeking therapy is a sign of weakness. Conversely, African Americans believe mental health treatment is a way to cope with stress and build resilience (Anglin et al.2008).
Religion can also impact a person’s perception of the value of psychotherapy. Religious beliefs can influence a person’s understanding of mental health issues, such as whether mental illness is a spiritual or medical problem. Some religious groups, for example, may see depression as a result of a lack of faith, whereas others may see it as a medical condition that requires treatment. Furthermore, religious beliefs may influence whether a person seeks help from a mental health professional or turns to spiritual or religious practices for coping. For instance, the Philippines is a country where almost all its citizens are Catholics, and sometimes when someone is going through depression, people comment that they need to pray more to God.
Socioeconomic status can also influence an individual’s perception of psychotherapy. Individuals from lower socioeconomic backgrounds may face financial barriers to obtaining mental health services and may perceive therapy as an unnecessary expense. Furthermore, people from lower socioeconomic backgrounds may face more stigma associated with mental health issues, influencing their willingness to seek help.
Cultural, religious, and socioeconomic factors have been shown in studies to influence people’s attitudes toward psychotherapy. Pescosolido and colleagues (2008) discovered, for example, that cultural beliefs and attitudes toward mental health were significant predictors of whether individuals sought help from a mental health professional. Blevins and colleagues (2018) discovered that religious beliefs and practices were associated with attitudes toward psychotherapy among people suffering from depression.
- Describe how legal and ethical considerations for group and family therapy differ from those for individual therapy and explain how these differences might impact therapeutic approaches for clients in group, individual, and family therapy.
Because of the unique dynamics of multiple clients in therapy sessions, legal and ethical considerations in group and family therapy differ from those in individual therapy. Because of the presence of various clients, confidentiality is a critical ethical consideration in therapy, and it is incredibly complex in group and family therapy. Group and family therapists must protect individual clients’ privacy while maintaining the group or family dynamic’s integrity. For instance, group members may know critical information about a group member that may affect the member’s opinion. The American Counseling Association (ACA) Code of Ethics requires group and family therapists to obtain written consent from all clients before therapy and establish clear guidelines for maintaining confidentiality within the group or family (ACA, 2014).
Informed consent is another critical ethical consideration in therapy, and it is even more complicated in group and family therapy. In addition to obtaining informed consent from individual clients, therapists must also obtain informed consent from the group or family since the group requires participants to interact with one another. It is an important ethical issue because it ensures that participants make informed decisions to participate in the therapy.
American Counseling Association. (2014). ACA Code of Ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. Retrieved from https://www.apa.org/ethics/code/ethical-principles-2017.pdf
Anglin, D. M., Alberti, P. M., Link, B. G., & Phelan, J. C. (2008). Racial Differences in Beliefs About the Effectiveness and Necessity of Mental Health Treatment. American Journal of Community Psychology, 42(1-2), 17-24. https://doi.org/10.1007/s10464-008-9189-5
Blevins, C. E., Weatherspoon, A., DeFife, J. A., McAdams, D. P., & Gubi, A. (2018). Religiousness, spirituality, and depression: A study of mental health treatment-seeking adults. Journal of Affective Disorders, 232, 109-116.
Ethical Challenges in Group and Personal Therapy | Psychology Paper Examples. (2022, January 14). PsychologyWriting.com. https://psychologywriting.com/ethical-challenges-in-group-and-personal-therapy/
Linden, D. E. J., Habes, I., Johnston, S. J., Linden, S., Tatineni, R., Subramanian, L., … & Goebel, R. (2012). Real-time self-regulation of emotion networks in patients with depression. PloS one, 7(6), e38115.
M, N. (2021, April 21). Biological Basis of Psychotherapy Treatments – Best Nursing Writing Services. Best Nursing Writing Services. https://www.bestnursingwritingservices.com/biological-basis-of-psychotherapy-treatments/
Pescosolido, B. A., Gardner, C. B., & Lubell, K. M. (1998). How people get into mental health services: Stories of choice, coercion, and “muddling through” from “first-timers.” Social Science & Medicine, 46(2), 275-286.
Tyron W. (2016). Psychotherapy Integration via Theoretical Unification. International Journal of Integrative Psychotherapy, 7(1),1-26.
Robinson, B., Ph.D. (2021, February 4). 47% Of Americans Believe Seeking Therapy Is A Sign Of Weakness. Forbes. https://www.forbes.com/sites/bryanrobinson/2021/02/04/47-of-americans-believe-seeking-therapy-is-a-sign-of-weakness/?sh=124a800d4413
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