NRNP-6645 BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY

NRNP-6645 BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY

To prepare:

  • 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.

  • Biological Basis of Psychotherapy

    Psychotherapy is rooted in biology. Many providers are now using psychotherapy to understand the genetic aspects of complex behavior in their patients. It’s like a personalized treatment that targets all the biological processes that affect how our brains react to things. Through learning and experiences, especially in how we think, feel, and manage our emotions, our sense of self and our relationships with others can change. Successful treatments not only change our brains biologically but also how we think and feel. These changes can last for a long time (Javanbakht and Alberini, 2019).

    Cultural, Religious, and Socioeconomic Factors

    Different cultures, religions, and economic situations can affect how people see psychotherapy. Some cultures don’t accept therapy because of the stigma around it. Some patients avoid therapy because they worry about being judged by their culture. People with low incomes or from minority groups might stop therapy early because of these cultural barriers. For example, compared to their numbers, Asian Americans don’t use mental health services as much as European Americans and may see therapy in a negative light. To change this, it’s important to understand and address the issues that matter to Asian Americans (Nagayama et al., 2019).

    Religion also shapes how people view therapy. Some religious groups use prayer or other religious practices alongside counseling. Many religious patients prefer therapists who share their beliefs because they want therapy that respects their religious values (Charzyńska and Heszen-Celińska, 2020).

    Economic factors can also affect access to therapy negatively. Some people can’t afford therapy, don’t have transportation to get there, or lack strong support networks. These groups often have worse outcomes with therapy. In Finland, for example, where everyone can get healthcare, access to therapy can still depend on how much money you have (Leppänen et al., 2022). People with lower incomes might be less ready to get therapy, even if they need it more. Research shows that those with lower education and income levels use mental health services less often than those who are better off (Leppänen et al., 2022).

    Legal and Ethical Considerations

    Legal and ethical issues are very important in deciding who gets therapy and how it’s done. Informed consent is key in individual, family, and group therapy. In family and group therapy, patients might be hesitant to share important information, which could affect the treatment plan. Every patient has the right to make their own decisions, which fits with the ideas of doing good and not causing harm. Therapists may approach group and family sessions differently than individual ones because of this. They might speak more generally in group sessions but be more specific in private sessions, while still being professional. Age is also a big legal and ethical concern. Younger patients might have their parents with them in therapy, which could make them hold back or not share everything. Legally, parents usually have to agree to their children getting therapy, but ethically, some therapists might let minors get therapy without their parents there, after talking it over with them. But, they still talk to the parents about what’s going on.

    Scholarly Sources

    All the sources used here are scholarly, which means they’ve been reviewed by experts and are based on evidence. They come from trusted places like The National Institute of Health and PubMed Central, which are known for having good quality research. Each article mentions previous research and who contributed to it. You can find PDFs of each article after the list of references.

    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 health59(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 neuroscience13, 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 research22(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 psychology10(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 psychology10, 1747. https://doi.org/10.3389/fpsyg.2019.01747Links to an external site.

    Pdfs

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     Reply to Comment

    • Collapse SubdiscussionTamara Smith 

      Thank you, Lashundrea, for the insightful discussion on the biological basis of psychotherapy. Your exploration of how cultural perspectives influence acceptance of therapy is important. As noted by Koc and Kafa (2019) in their peer-reviewed research, current therapy approaches might not cater to the needs of everyone in our diverse world. To truly help our clients, we must understand and respect their cultural and religious beliefs. The traditional therapy models may not be enough in today’s multicultural United States. (Koc & Kafa, 2019) We need to adapt our practices or refer clients to other professionals who can better address their needs.

      Another aspect where cultural considerations are crucial for practitioners is when clients are dealing with trauma and grief. These experiences can be challenging for anyone, but for immigrants or minority groups, there may be unique practices or beliefs that therapists need to understand. Conducting a cultural assessment helps clarify the client’s or family’s expectations of therapy. (Smid et al., 2018)

      The scholarly articles by Koc & Kafa (2019) and Smid et al. (2018) are both evidence-based and authored by experts in their respective fields. They have been published in reputable journals, adding credibility to their findings.

      ReferencesKoç, V., & Kafa, G. (2019). Cross-Cultural Research on Psychotherapy: The Need for           a Change. Journal of Cross-Cultural Psychology, 50(1), 100–115.       https://doi.org/10.1177/0022022118806577Links to an external site.

      Smid, G. E., Groen, S., de la Rie, S. M., Kooper, S., & Boelen, P. A. (2018). Toward                  Cultural Assessment of Grief and Grief-Related Psychopathology. Psychiatric services (Washington, DC)69(10), 1050–1052.   https://doi.org/10.1176/appi.ps.201700422

       Reply to Comment

    • Collapse SubdiscussionPilar Turner 

      Hello Shun, 

      I appreciate your kind words about the post, and it’s great to connect with someone from the same state! The topic of religion and its interaction with psychotherapy is indeed fascinating, especially when looking for research on the subject. It’s interesting how healthcare is increasingly relying on evidence-based and precision medicine, yet there seems to be a lack of scholarly work informing psychotherapy for nonreligious clients, as pointed out by Abbott (2021). Most research tends to focus on spiritual or religious variables.

      Parts of the research you mentioned by Charzyńska and Heszen-Celińska (2020) bring to mind the concept of separating religious beliefs from the therapeutic process. For instance, the authors discuss how some clients struggle due to spiritual conflicts or doubts related to their inability to align with a particular value system. As a healthcare provider, it’s essential to find scholarly, secular evidence to guide the care of such patients. While some individuals prefer therapists who share their religious beliefs, it’s worth considering whether a relational-cultural therapy approach might be more suitable. Could it be that the person’s self-identity within their value system is contributing to the issue? The intersection of religion, spirituality, and mental health is a complex area that requires further scientific exploration.

      Even in my own practice, I encounter challenges with this gray area during psychiatric assessments. For example, one nurse with a particular religious or cultural background might describe a patient as “hyper-religious,” while another nurse with a different background might view the patient’s prayers and faith as protective factors. This highlights the subjective nature of interpreting religious and spiritual aspects in mental health care and underscores the need for clearer guidelines and research in this area.

      References  

      Abbott, D. M. (2021). Psychotherapy with nonreligious clients: A relational-cultural  approach. Professional Psychology: Research and

      Practice52(5), 470–476.  https://doi.org/10.1037/pro0000392 

      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 health59(1), 113–134. https://doi.org/10.1007/s10943-Links to an external site.Links to an external site.

      019-00911-wLinks to an external site.

       Reply to Comment

    • Collapse SubdiscussionMichael Lessie 

      Thank you for your feedback and for highlighting the importance of considering biological factors in psychotherapy. Indeed, understanding the biological aspects of a person’s mental health is crucial for effective treatment. Each individual has unique qualities, feelings, and behaviors that shape their therapy sessions, and these are influenced by biological elements in the brain.

      It’s essential to recognize that therapy sessions for different mental illnesses vary because the underlying biological mechanisms are different. For example, depression and schizophrenia have distinct biological correlates, which require tailored approaches to therapy. Chemical imbalances in the brain, such as low levels of serotonin, can contribute to depression, as noted by Joubert (2015). Similarly, Alzheimer’s disease progressively affects brain function, leading to changes in thinking and behavior, including episodes of depression, anxiety, and aggression, as discussed by Lee (2000).

      These changes in feelings and behaviors often deviate from a person’s usual personality, indicating disruptions in the biological functioning of the brain. For instance, someone undergoing psychotherapy may be experiencing early signs of Alzheimer’s disease or have genetic predispositions that affect serotonin levels. Understanding these biological factors is essential for developing a comprehensive psychotherapy plan tailored to the individual’s needs.

      The articles you mentioned are peer-reviewed and evidence-based, providing valuable insights into how biological factors contribute to the signs and symptoms of mental illness. Incorporating this understanding into psychotherapy can enhance treatment outcomes and improve the overall well-being of patients.

      References

      Joubert, C. (2015). Are Mental Disorders Brain Disorders? Ethical Human Pyschology and Psychiatry , 17(3), 185-201. doi::10.1891/1559-4343.17.3.185

      Lee, S. D. (2000). Changes in Emotional and Behavorial Symtpoms of Alzheimer`s Disease . Americam Journal of Alzheimer`s Disease, 15(3), 176-179.

       Reply to Comment

    • Collapse SubdiscussionAlora Morgan Little 

      Great post! I agree that informed consent is essential regardless of whether it is an individual, group, or family session. Eberle et al. (2021) state that informed consent is not only a legal but also an ethical obligation and should be the first thing done before providing psychotherapy. When it comes to group and family sessions, the provider must also ensure the participants are aware of the limitations of confidentiality. Another ethical consideration would be knowing the responsibilities of a provider. Avasthi, Grover & Nischal (2022) state that the provider is responsible for maintaining professional boundaries and confidentiality, not exploiting their clients, build rapport but not a relationship, promote client autonomy, and set clear goals for sessions.

       

      References

      Avasthi, A., Grover, S., & Nischal, A. (2022). Ethical and Legal Issues in Psychotherapy. Indian journal of psychiatry, 64(Suppl 1), S47–S61.  https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21

      Eberle, K., grosse Holtforth, M., Inderbinen, M., Gaab, J., Nestoriuc, Y., & Trachsel, M. (2021, November 12). Informed consent in  psychotherapy: A survey on attitudes among psychotherapists in Switzerland – BMC medical ethics. BioMed Central. Retrieved December 3, 2022, from https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-021-00718-z#citeas

       Reply to Comment

  • Collapse SubdiscussionLauren Brudenell 

    There’s a growing understanding of how important therapy is for mental health. Many studies in the last ten years have shown that therapy works well for different mental and behavioral problems. However, despite knowing that therapy works as well as medication for these issues, fewer people are using therapy now compared to before, even though more people are seeking medication. Because therapy is effective, the American Psychological Association has said it’s a good way to treat mental health problems based on more than 50 studies. Therapy works because it builds a strong relationship between the therapist and the patient and they agree on what they want to achieve.

    Therapy is a personal treatment that deals with the whole body’s biology instead of just focusing on one chemical in the brain. It changes how the brain works by helping the person learn and experience new things, and it affects their thoughts, feelings, and how they control themselves inside. Research in neuroscience shows that behavior is influenced by genes, environment, and how the brain works. More people, especially soldiers, are being recognized as having problems like PTSD. Therapies like Cognitive Processing Therapy and Prolonged Exposure have been proven to help with PTSD by dealing with the emotions related to trauma. Prolonged Exposure helps by making the person confront their trauma, which can change how they think and feel about it.

    People’s religious beliefs can be important in therapy. These beliefs are often part of someone’s culture, and religious people might rely more on faith than on learning about how things work. Therapists need to respect their patients’ beliefs, even if they don’t agree with them, and understand how religion can affect their problems. Culture can also affect how someone sees therapy. Some people from different cultures might not agree with the usual ideas of therapy, so therapists need to understand and respect their clients’ cultural beliefs.

    Group and family therapy can be more complicated than individual therapy because the therapist has to think about how to keep everyone’s information private. It’s essential for clients to agree to be in therapy and to understand what that means. Therapists must keep their clients’ information private unless they’re required by law to report something. They must tell their clients that there are some situations where they have to report, like if someone is being hurt or is a danger to themselves or others.

    It’s important to use articles that have been checked by other experts in the field. These articles have been reviewed to make sure they’re good quality and that the information is accurate. Some of the articles I used in this discussion have been reviewed and are considered good sources of information.

    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

     

    Scholary article 3.pdfDownload Scholary article 3.pdf

    Scholarly article 1.pdfDownload Scholarly article 1.pdf

    scholarly article 2.pdf Download scholarly article 2.pdf

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    • Collapse SubdiscussionJanet John Edet 

      Hi Lauren,

      You have adequately articulated the biological basis of psychotherapy, the various factors that psychotherapists need to consider when approaching patients in psychiatric settings, and other considerations relating to individual, group, and family therapy. One of the crucial interventions or plans of care in psychiatric settings is psychotherapy. Psychotherapy targets the brain. Therapists using this approach believe that patients develop specific neural networks or patterns of thoughts due to exposure to an experience, for example, trauma. Therefore, this intervention works by endeavoring to elevate or modify maladaptive neural networks in the brain (Chiang et al., 2020). Given this, psychotherapy has a biological basis. Therefore, neuroscience should be fully integrated into psychotherapy.

      You have also discussed the influence of culture, religion, and socioeconomic status on psychotherapy. Patients differ in terms of these demographic factors, which can also influence the successful implementation of psychotherapy. Some cultures believe more in traditional healing processes than conventional ones. Therefore, assessing a patient’s perception of psychotherapy is imperative to ensure that any impending factors are addressed. Religion is another inhibiting factor. Wesselmann et al. (2015) established that Christians believe that mental illnesses result from immorality and believe in spiritual treatments. Socioeconomic status is another essential factor that psychotherapists should consider, including the inability to afford psychotherapy, lack of understanding, and inaccessibility to psychotherapeutic centers.

      Different legal and ethical approaches may exist depending on the type of therapy being explored. Psychotherapists need to be aware of factors such as confidentiality and building meaningful therapeutic relationships with clients in individual therapy. In group and family therapy, privacy may be an issue because the sessions involve more than one patient. In this case, psychotherapists need to educate participants on their responsibility. Also, confidentiality and the informed consent process must be keenly observed in these settings.

       

      References

       

      Chiang, M., Lombardi, D., Du, J., Makrum, U., Sitthichai, R., Harrington, A., Shukair, N., Zhao,

      M., & Fan, X. (2019). Methamphetamine-associated psychosis: Clinical presentation,

      biological basis, and treatment options. Human Psychopharmacology, 34(5),

      e2710. https://doi.org/10.1002/hup.2710

      Wesselmann, E. D., Day, M., Graziano, W. G., & Doherty, E. F. (2015). Religious beliefs about

      mental illness influence social support preferences. Journal of Prevention & Intervention

      in the Community, 43(3), 165–174. https://doi.org/10.1080/10852352.2014.973275

       Reply to Comment

    • Collapse SubdiscussionEddy St Surin 

      Hello Lauren,

      Your discussion is exciting and informative. I agree that psychotherapy has a biological basis. As a result of advancements in neuroscience, we now have a much deeper understanding of how the brain works. We can significantly improve mental health by using this knowledge and neuroscientific methods to psychopathologies and therapeutic interventions. The neuroscientific study can determine behavioral manifestations’ genetic, epigenetic, anatomical, circuitry, and functional roots (Javanbakht, 2019). Studies on non-human animal models have revealed many uncertainties about various diseases and supplied valuable information for testing theories in humans in both healthy states and diseases. Contrarily, although psychotherapy has a wealth of knowledge about human behavior and years of clinical practice, it still lacks empirical evaluations and techniques (Javan Bakht, 2019). Therefore, the creation of new hypotheses and, by extension, the understanding and treatment of mental states and diseases will advance dramatically with the integration of neuroscience knowledge and methodologies with psychotherapy.

      Cultural, religious, and socioeconomic factors influence psychotherapy because they influence societal behavior and decision-making. In addition to conceptualizing psychopathology, culture is known to have a part in understanding and accounting for perceived discomfort, health, and illness (Moleiro, 2018). Stigmatized groups could be exposed to more significant risk factors for mental distress, such as legal status, perceived discrimination, social exclusion, stigmatization, and victimization. For example, lesbian, gay, bisexual, and transgender (LGBT) populations have been discovered to display an enhanced risk for suicide, teasing, and other forms of victimization (Moleiro, 2018). Low life satisfaction and the emergence and persistence of psychopathological symptoms have been linked to socioeconomic disadvantages, such as poverty and environmental risk factors.

      I agree that legal and ethical guidelines dictate mental health practice. Regarding ethics, psychotherapists are expected to be conscious of their competence and limitations, that is, the degree of their knowledge, training, and supervised experience for various therapies. It is also critical that therapists are conscious of their accountability to both themselves and their patients. It is crucial to remember that any negligent activity on the part of the therapist may not only violate the ethical guidelines but also give rise to circumstances that may have legal repercussions (Avasthi et al., 2022). Therapists are required to follow HIPPA’s rules regarding data privacy and confidentiality. Getting patients’ informed permission is also morally right.

      References

      Avasthi, A., Grover, S., & Nischal, A. (2022). Ethical and Legal Issues in Psychotherapy. Indian journal of psychiatry64(Suppl 1), S47–S61. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21

      Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience13, 144. https://doi.org/10.3389/fnbeh.2019.00144

      Moleiro C. (2018). Culture and Psychopathology: New Perspectives on Research, Practice, and Clinical Training in a Globalized World. Frontiers in psychiatry9, 366. https://doi.org/10.3389/fpsyt.2018.00366

       

       

       Reply to Comment

  • Collapse SubdiscussionJudgette Green 

                                                                                 Discussion Week I

    Psychotherapy as some describe as “talk therapy” can be considered as having a biological basis. It is an effective tool in the treatment of psychological, behavioral, somatic problems and disorders that affects one’s mental status (Locher, et al, 2019). When considering the biological basis for psychotherapy the nature versus nurture argument comes into play. The role of innate biological factors such as genetic can affects one’s behavior and predispose one to mental illness. Also, a person way of life such as culture, life experience, education et al can cause one to behave the way they do. Hence, considering the biological basis then genetics and environments does play a part in human behavior (Jimenez, et al 2018).

    A person religion, culture and socioeconomics factors does affect one’s belief in psychotherapy. Persons who are actively involved in religious setting may find a common faith to believe in and may have a stronger support system thus having lesser depression and anxiety. Many people find that having a religion helps in lessen their stress level or provides a coping mechanism to deal with stress (Dein, 2018). Religion may provide a person with increase hope, better meaning of life, increase self esteem and life satisfaction as such the engagement in psychotherapy may be look upon as a positive influence (Dein, 2018). In some culture the idea of having any form of mental illness has a bad stigma attach to it.  As, such person may refuse any form of treatment to prevent this stigma. Personally, in my culture, having any form of mental illness brings discrimination and treatment is not often seek or refused. Persons may be refused housing, employment or even shun by family members for having a mental illness. A person with a low socioeconomic status may find it hard to access psychotherapy or have the resource.

    Legal and ethical issues are very important in mental health. During a group or family therapy session consent are needed from each participant and clients must be aware of the limited confidentiality. The therapist is not responsible for participates keeping the confidentiality clause. Family and group member may feel uncomfortable expressing their problem to the group in fear of judgement. A person age also has a legal issue when conducting group or even individual sessions. A parent consent is needed and as the legal guardian therapist may have to share to share confidential information that may pose a risk to the child safety thus breaking the patient thrust. The therapist may face ethical dilemma when deciding what to share with other members of the group. When do therapist keep a secret and when to break confidentiality poses an ethical problem for therapist doing psychotherapy with groups or even couple therapy (Mignone, et al, 2017).

    All articles used in this paper are considered scholarly as they were all published in academic journals, peered reviewed, and all authors are scholars in the disciple 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.

     

    Article 1-1.pdfDownload Article 1-1.pdf

    article 2.pdf Download article 2.pdf

    article 3.pdfDownload article 3.pdf

    article 4.pdfDownload article 4.pdf

     

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    • Collapse SubdiscussionLauren Brudenell 

       

      Judgette,

                 I enjoyed your informative discussion, and you provided some excellent scholarly articles. I agree with your stance that psychotherapy does have a biological basis. Major depressive disorder (MDD) is a syndrome that can be recurrent and displays symptoms of emotional, cognitive, and behavioral disorders (Sözeri-Varma & Karadag, 2012). Studies show that cognitive behavioral therapy (CBT) changes the prefrontal cortex, cingulate cortex, and amygdala (Sözeri-Varma & Karadag, 2012). CBT is a type of psychotherapy that works on the individual’s cognitions and behaviors. CBT seems to be just as effective compared to psychopharmacology’s effect, but its effects last longer (Chalah & Ayache, 2018). Although few studies are available, the biological effects in patients with depression show some evidence regarding the effects on the activity or metabolism in specific critical and subcortical areas (Chalah & Ayache, 2018). Changes in the brain about the experience have been difficult to study, but the advent of functional neuroimaging, including CT, positron emission tomography, and MRI, has made it possible (Ramy, 2017).

                 Experts in the field scholarly-peer review the articles that are provided.

      References

      Chalah, M. A., & Ayache, S. S. (2018). Disentangling the Neural Basis of Cognitive Behavioral

      Therapy in Psychiatric Disorders: A Focus on Depression. Brain Sciences8(8), 150. https://doi.org/10.3390/brainsci8080150

      Ramy, H. (2017). The Biology of Cognitive Behavior Therapy. European Psychiatry41(S1),

      S637–S637. https://doi.org/10.1016/j.eurpsy.2017.01.1047

      Sözeri-Varma, G., & Karadağ, F. (2012). The biological effects of psychotherapy in major

      depressive disorders: A review of neuroimaging studies. Psychology, 3(10), 857–863. https://doi.org/10.4236/psych.2012.310129Links to an external site.

      Article 1 response 2.pdfDownload Article 1 response 2.pdf

      response 2- article 2.pdf Download response 2- article 2.pdf

      response 2 article 3.pdf Download response 2 article 3.pdf

      Links to an external site.

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    • Collapse SubdiscussionTamara Smith 

                 Thank you, Jugette, for the thorough discussion covering the legal and ethical aspects of the therapy process. Group therapy does bring with it a set of ethical and legal concerns for the clinician and the group participants. (Smith, 2021) Group members can and do grow with the group process from hearing discussions from their peers in the group. However, groups may quickly become hostile environments for the members creating potential ethical and legal concerns for the clinician and the members. With this group, process consent from all members for confidentiality, and a clear code of ethics must be followed by all members.

      Another area with ethical and legal implications is arising with online or telehealth individual and group therapy. The benefits of telehealth therapy are established and convenient. They can be stand-alone or combined with in-person, with many younger individuals seeking online treatment and those in rural areas. (Stoll, Muller, & Trachsel, 2020) With this, informed consent is necessary as complete confidentiality cannot be guaranteed. The client’s anonymity is increased as they no longer have to appear in the practitioner’s office.

      The articles presented here are scholarly articles written by professionals in the field, peer and scientifically reviewed, and published in journals.

      References

      Smith, W. (2021). Counseling Ethics Code: 10 Common Ethical Issues & Studies. PositivePsychology.com. Counseling Ethics Code: 10 Common Ethical Issues & Studies (positivepsychology.com)Links to an external site.

      Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical Issues in Online Psychotherapy: A Narrative Review. Frontiers in psychiatry10, 993. https://doi.org/10.3389/fpsyt.2019.00993

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    • Collapse SubdiscussionAngela Brianne Njoroge 

      Hello Judgette,

      I truly enjoyed reading your discussion this week. I do agree with you that an individual’s religion, culture, and socioeconomic factors do affect one’s belief in psychotherapy. Out of these points, I believe culture plays one of the biggest parts. The article Culture and Psychopathology: New Perspectives on Research, Practice and Clinical Training in a Globalized World discusses how research widely recognizes the cultural context that defines human behavior. This includes how individuals think and feel. As well as how they relate in social interactions. Culture also defines the threshold of distress that is acceptable. Culture also plays a large part in how credible and acceptable psychotherapy treatment is in the eyes of a patient and their family. Acceptance in treatment plays a large role in how well a patient will adhere to treatment  (Moleiro, 2018).

       

      References

      Moleiro, C. (2018). Culture and Psychopathology: New Perspectives on Research, Practice, and Clinical Training in a Globalized World. Frontiers in psychiatry, 9(), 366. https://doi.org/10.3389/fpsyt.2018.00366Links to an external site.

       Reply to Comment

    • Collapse SubdiscussionJames Sahr Weima 

      Hi Judgette

      I enjoyed reading your post. I like that you kept your discussion simple and straight to the points needed. There is indeed a biological foundation for psychotherapy. 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). I came from a culture like yours where mental health issues are looked down upon, and people never seek help or cure. Working in the field now, I can see many examples of cases where help is needed, but people are afraid of the stigma that comes with it or do not take it as seriously as a physical illness. Religion also plays a vital role in influencing people’s views on psychotherapy. According to Clauss-Ehlers et al. (2019), Beliefs regarding one’s mental health and the efficacy of psychotherapy treatments may also be influenced by one’s religious affiliation. Socioeconomic status also plays a significant role in one’s ability to access proper mental health care. This might make people feel hopeless or powerless, discouraging them from getting the treatment they need (Captari et al., 2018). Proper public education about mental health, having a sound support system, and having resources available in low socioeconomic areas will help improve and encourage people to seek psychotherapy when needed. Great post.

      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.

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

       Reply to Comment

  • Collapse SubdiscussionJanet John Edet 

                                                                         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.

     

     Reply to Comment

    • Collapse SubdiscussionLashundrea Oliver 

      Janet,

      Great post. I agree with your statements concerning patient socioeconomic status and its effects on receiving or completing therapy. As you stated, persons of low economic statures tend to have barriers to completing the course of treatment due to financial challenges. It is essential to encourage this population to continue receiving services and to find resources to help alleviate challenges that this population faces daily. Psychotherapists display careful consideration for patients in this population. As stated by the peer reviewed article of Epping et al. (2017) improving mental health literacy and lowering the stigma of mental illness are critical for boosting the use of psychotherapy services by those in greatest need. Improving health literacy will help therapist better manage patients. Relevant health policy is required to eliminate barriers to and thereby enhance utilization of psychotherapy as stated by the peer reviewed article of Epping et al. (2017).

      You listed great legal and ethical considerations. Another point I would add to this discussion is the mental capacity of parents of minor patients as an ethical concern. Research suggests that parents play a crucial part in the delivery of mental health services to minor patients, and they can have a big impact on how children progress in life (Molitor and Dvorsky, 2019).  Assessing the mental status of parents during initial encounters is crucial and can be beneficial in treatment outcomes of minor patients. Recent guidelines have arisen encouraging the examination of parent psychopathology while treating younger patients, and a growing body of research has linked parents’ own mental health condition to several consequences for their kids (Molitor and Dvorsky, 2019). This is essential as parents are responsible for establishing and maintaining care for their children.

      The three articles utilized in this response are each peer-reviewed scholarly articles and written by researchers who provide substantial evidence and literature pertaining to the results of their studies.

      References

      Epping, J., Muschik, D., & Geyer, S. (2017). Social inequalities in the utilization of outpatient psychotherapy: analyses of registry data from German statutory health insurance. International journal for equity in health16(1), 147. https://doi.org/10.1186/s12939-017-0644-5Links to an external site.

      Molitor, S. J., & Dvorsky, M. R. (2019). Ethical Considerations for Assessing Parent Mental Health during Child Assessment Services. Ethics & behavior29(2), 87–100. https://doi.org/10.1080/10508422.2018.1482746Links to an external site.

      nrnp 6645 wk 1 reply 1 pdf-1.pdf Download nrnp 6645 wk 1 reply 1 pdf-1.pdf

      nrnp 6645 wk 1 reply 1 pdf 2.pdf Download nrnp 6645 wk 1 reply 1 pdf 2.pdf

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    • Collapse SubdiscussionCharles Banor 

      Hi Janet, thanks for this post.

      Communication is vital especially when it comes to psychotherapy, the client and the therapist must understand each other for effective therapy. We have different cultures globally, and in each culture, we speak different languages, although addressing culture and cultural difference as part of diversity, it is critical to consider how systemic and economic forces influence the patient presenting problem and critical interaction (Gaztambide, 2019).Like you state as a psychotherapist interpretation of nonverbal communication might create misunderstanding or misinterpretation. For example, in my African culture being quiet means respect, but in another culture, it looks rude (Gaztambide, D. J. 2019). Reconsidering culture, attachment, and inequality in the treatment

      (Lefevor et al., 2020) argue that religion and religiousness also influence psychotherapy seeking because religious individuals are less likely to seek psychotherapy when experiencing distress than nonreligious individuals. Like in any legal profession, ethical responsibility applies to psychotherapy. The Ethics Code of the American Psychological Association (APA) states that besides therapy goals for the client’s sole benefits, confidentiality issues, boundaries, and positive outcomes, each member’s entitlements and obligations must be clarified when

       

      Lefevor, G. T., Paiz, J. Y., Virk, H. E., & Smack, A. C. P. (2020). The influence of individual and congregational religiousness on seeking psychotherapy: A multilevel analysis. Practice Innovations,

      5 (4), 257-274. https://doi-Links to an external site. org.ezp.waldenulibrary.org/10.1037/pri0000113

      Gaztambide, D. J. (2019). Reconsidering culture, attachment, and inequality in the treatment

       

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    • Collapse SubdiscussionEddy St Surin 

       

      Biological Basis and Ethical/Legal Considerations of Psychotherapy

      11/29/2022

      Biological Basis and Ethical/Legal Considerations of Psychotherapy

      The biological basis of psychotherapy is not comprehensively understood. However, studies have shown that psychotherapy is a comprehensive biological treatment considering it targets all biological regulators of brain responses to mental health issues (Javanbakht & Alberini). By targeting all the biological regulators of brain responses to mental health conditions, psychotherapy contributes to the establishment of a sense of self and others. Individuals learn new experiences associated with internal, emotional, and cognitive regulation processes. A study by Scult et al. (2019) evaluated the alterations in functional connectivity related to emotional regulation therapy among major depressive and generalized anxiety participants. The study found that emotional regulation therapy contributes to changes in nodes of the salience network and default mode network to other regions in the brain. The changes were associated with the improvement of clinical symptoms among participants. These findings suggest that a successful therapy provides all-inclusive, lasting, and measurable changes in brain neurotransmissions.

      The legal and ethical considerations in psychotherapy are related to informed consent and confidentiality of patient information. Therefore, when administering individual, family, or group therapy, mental health personnel should provide the clients with information on the choice of therapy, duration of therapy, benefits, and side effects (Trachsel & Holtforth, 2019). In group and family therapy, informed consent is provided to all participants, while in individual therapy target patient is given informed consent. Unlike group therapy, family therapy constitutes individuals who know one another; usually, one individual with a problem affects others. Therefore, the affected individual should be provided with informed consent to allow others to be involved in their care.

      On the other hand, all participants in group therapy should agree to uphold the confidentiality of each other’s clinical data (Doshi et al., 2019). Consequently, those who disagree with the confidentiality rules should be excluded from group therapy. Moreover, mental health personnel should uphold the confidentiality of clients’ data in individual, group, or family therapy.

       

       

      References

      Doshi, P. V., Robak, R. W., Grffin, P. W., & Ward, A. W. (2019). Confidentiality in Counselor Experiential Training Groups: An Exploratory Study. Journal of Counseling Research and Practice5(1), 3. https://doi.org/10.56702/UCKX8598/jcrp0501.3Links to an external site.

      Javanbakht, A., & Alberini, C. M. (2019). Neurobiological models of psychotherapy. Frontiers in Behavioral Neuroscience, 13, 144. https://doi.org/10.3389%2Ffnbeh.2019.00144Links to an external site.

      Scult, M. A., Fresco, D. M., Gunning, F. M., Liston, C., Seeley, S. H., García, E., & Mennin, D. S. (2019). Changes in functional connectivity following treatment with emotion regulation therapy. Frontiers in Behavioral Neuroscience13, 10. https://doi.org/10.3389/fnbeh.2019.00010Links to an external site.

      Trachsel, M., & Holtforth, M. G. (2019). How to Strengthen Patients’ Meaning Response by an Ethical Informed Consent in Psychotherapy. Frontiers in Psychology10, 1747. https://doi.org/10.3389%2Ffpsyg.2019.01747Links to an external site.

       Reply to Comment

      • Collapse SubdiscussionTuyet Lam Gwardys 

        Hi Eddy,

        Thank you for sharing your well-detailed post.  I appreciate the study you mentioned regarding emotional regulation therapy and its impact on the brain when used on patients with major depression and generalized anxiety disorders.  I would like to share a few studies demonstrating neurobiological changes and epigenetic modifications associated with psychotherapy.

        A study by Winter et al. (2019) examined the short-term effect of metacognitive therapy (MCT) on patients with treatment-resistant obsessive-compulsive disorder (trOCD).  The results revealed improved OCD symptoms and decreased theta frequency band synchronization on EEG after MCT.  In the peer-reviewed journal article titled “Psychotherapy and Genetic Neuroscience: An emerging Dialog,” Jimenez et al. (2018) provided systemic reviews of studies that found patients with bipolar disorder have increased brain-derived neurotrophic factor methylation after psychotherapy, patients with higher methylation before treatment has a better response to psychotherapy, patients with agoraphobia have increased methylation and reduced symptoms after receiving cognitive behavioral therapy (CBT), and children who received CBT has a significant anxiety reduction.  These studies support your statement that “psychotherapy is a comprehensive biological treatment.”

         

        The scholarly journal articles I have included in this response are peer-reviewed, making them reputable sources.  The studies in these journals are quantitative research and systematic reviews, which make them reliable sources based on the hierarchy of evidence pyramid.

         

        References

         

        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 genetics9, 257. https://doi.org/10.3389/fgene.2018.00257

        Winter, L., Alam, M., Heissler, H. E., Saryyeva, A., Milakara, D., Jin, X., Heitland, I., Schwabe, K., Krauss, J. K., & Kahl, K. G. (2019). Neurobiological Mechanisms of Metacognitive Therapy – An Experimental Paradigm.  Frontiers in psychology10, 660.  https://doi.org/10.3389/fpsyg.2019.00660

        Winter et al-1.pdfDownload Winter et al-1.pdf

        Jimenez et al.pdf Download Jimenez et al.pdf

         

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  • Collapse SubdiscussionRashidat Odeyale 

    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 Psychiatry12. 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 & Culture22(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.

     

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  • Collapse SubdiscussionPilar Turner 

    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 & Practice52(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 Process59(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 Neuroscience16https://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 & Counselling48(6), 741–756. https://doi.org/10.1080/03069885.2020.1754333Links to an external site. 

     

     Reply to Comment

    • Collapse SubdiscussionLashundrea Oliver 

      Hi Pilar,

      Great post. Your post contains very informative information pertaining to the influence of culture, religion, and socioeconomic status on psychotherapy. I concur with your remark that some barriers to care can be attenuated by consistent, patient-centered education on the goals of psychotherapy. An evidence-based practice policy for psychotherapy was established by the American Psychological Association. This policy makes it clear that each patient’s individual characteristics, including developmental history, ability to function in daily activities, readiness to change or participate in psychotherapy, level of social support, and cultural influences, all have an impact on how effective any psychotherapy is (Cook et al., 2017).

      To add to your discussion a religious factor that influences psychotherapy is the way religion is viewed by providers. Research depicts that in the past the preponderance of early psychologists dismissed or marginalized clients’ spiritual activities and beliefs as manifestations of psychopathology and immaturity (Charzyńska and Heszen-Celińska, 2020). It is essential for therapist to not adopt this stance and to provide holistic care to clients and incorporate their religious beliefs into sessions when warranted. Times have since changed and spirituality has been incorporated into therapy for some clients as counselors can assist their clients in exploring and resolving their problems by utilizing client specific religious beliefs. However, several concerns about going against moral standards when assisting individuals with their spirituality remain an ethical concern per research (Charzyńska and Heszen-Celińska, 2020).

      The articles utilized in this response are scholarly. Each article is from a journal and are each study conducted by experts. The article written by (Charzyńska and Heszen-Celińska, 2020) is a qualitative study. Each article is peer reviewed.

      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 health59(1), 113–134. https://doi.org/10.1007/s10943-019-00911-wLinks to an external site.

      Cook, S. C., Schwartz, A. C., & Kaslow, N. J. (2017). Evidence-Based Psychotherapy: Advantages and Challenges. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics14(3), 537–545. https://doi.org/10.1007/s13311-017-0549-4Links to an external site.

      nrnp 6645 reply 2 pdf 1.pdf Download nrnp 6645 reply 2 pdf 1.pdf

      nrnp 6645 reply 2 pdf 2.pdf Download nrnp 6645 reply 2 pdf 2.pdf

       

       Reply to Comment

    • Collapse SubdiscussionAngela Brianne Njoroge 

      Hi Plar,

      fpsyg-10-01747.pdf Download fpsyg-10-01747.pdfI enjoyed reading your post, and your articles were very informative. You made a point

      where you discussed that the legal and ethical variables of group therapy can indeed impact

      a provider’s approach when it comes to being aware of boundaries. Professional boundaries

      as well as confidentiality in healthcare are a form of quality care that can be difficult in a

      group setting. I agree with your viewpoint on this topic. Misinterpreting these boundaries

      can lead to many legal and ethical issues.

      Clearly communicating and getting the proper consent in place can help with any ethical

      or legal issues that a provider may run into. I read an article that discussed how beneficial

      informed consent can be in any psychotherapy setting. The article states informed

      consent provides the key legal and moral legitimation for psychological interventions

      including psychotherapy. For that reason, informed consent is an essential prerequisite for

      any intervention as well as a moral duty. This consent will reflect the patient’s right to self-

      determination, well-being, and protection. By meeting moral values, informed consent has

      been named a central element of patient-centered care

      (Trachel & Holforth, 2019).

       

      Reference

      Trachel, M., & Holforth, M.G. (2019, July). How to Strengthen Patients’ Meaning Response by an Ethical Informed Consent in Psychotherapy. Frontiers in Psychology, (), . DOI: 10.3389/fpsyg.2019.01747

       Reply to Comment

  • Collapse SubdiscussionDeborah L Joseph 

    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 Neuropsychopharmacology28(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 Advances26(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 (4th ed.) Springer Publishing.

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  • Collapse SubdiscussionCharles Banor 

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

    NURS-6051N Week 11: Assignment POLICY/REGULATION FACT SHEET EXAMPLE

    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.

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    • Collapse SubdiscussionKimberly Wian 

      Hi, Charles.

      A person’s individual resource level or socioeconomic status (SES) plays a complicated role in what seems all aspects of success when it comes to psychotherapy. A low SES is often associated with of substance use, poorer physical health, and a higher prevalence of mental illness, more so than high to middle SES. Material and social deprivation has been shown to have a direct correlation to a lower access to psychiatric treatment (Finegan et al., 2018).

      As you pointed out in your post, cost is a negative determinant that makes psychotherapy services prohibitive for some, but it not only in terms of the amount of money needed to pay for the service.  It is also can have a cost to a person’s motivation to seek treatment. There are so few therapists who work on a sliding scale or that take medi-cal, that people can burn out just looking for someone to talk to and quit before they find anyone. Poor SES has been shown to predict a lower chance of connecting with a therapist (Barnett et al., 2022).

      Reference:

      Barnett, P., Oshinowo, I., Cooper, C., Taylor, C., Smith, S., & Pilling, S. (2022). The association between social class and the impact of treatment for mental health problems: a systematic review and narrative synthesis. Social psychiatry and psychiatric epidemiology, 10.1007/s00127-022-02378-9. Advance online publication. https://doi.org/10.1007/s00127-022-02378-9

      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 anxiety35(6), 560–573. https://doi.org/10.1002/da.22765Links to an external site.

       

      ref2.pdf Download ref2.pdf

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    • Collapse SubdiscussionMichael Lessie 

      Good post, I agree with you Charles, group therapy has many issues, these can be ethical and legal obstacles to overcome. Confidentiality and consent are part of the group therapy process for effective care. Therapists have a primary objective to keep any information spoke of in the group confidential. Confidentiality is protected in laws by every state and federal level that can make collaborating with others troubling (Donner, 2008).  To address this confidentiality issue, if one must speak to another colleague about a patient, one must give the only absolute information needed for the case. Group confidentiality is hard to obtain due to increase number of interactions and people involved. A therapeutic contract can be drawn up with the individuals involved before session begins. This can involve informed consent that entails any aspect of the psychotherapy is voluntary. A therapy goal could be included in this contract that allows for direction for the group. In a group setting one could setup issues that the group may not talk about, such as an affair that happened many years ago, or other issues that do not address the stated goal for therapy. Therapy should consist of three factors that reduce risk for legal and ethical trouble. These consist of positive ethics, which one strives for the best outcome while providing ethical care. Risk management which one provides therapy that has least amount of legal and ethical risks. Defensive practice, which the therapist provides positive effective care while miniating an approach that does not steer the therapist into any legal or ethical issues and or clients. Such as having a relative be a client, or an active suicidal idealization client (Ajit Avasthi, 2022). Having such goals in mind when providing psychotherapy can help reduce the risks of violating any legal or ethical issues of the clients.

                                                         References

      Ajit Avasthi, S. G. (2022, March). Ethical and Legal Issues in Psychotherapy. Indian Journal of Pyschiatry, 64(1), 47-51. doi:10.4103/indianjpsychiatry.indianjpsychiatry_50_21

      Donner, M. (2008). Balancing Confidentiality: Protecting Privacy and Protecting the Public. Professional Pyschology: Research and Practice, 39(3), 369-376. doi: 10.1037/0735-7028.39.3.369

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    • Collapse SubdiscussionJames Sahr Weima 

      Hi Charles

      I enjoyed reading your post, and I agree with all the points you made in your post. The primary intent of psychotherapy is that a person’s physical and mental well-being may be enhanced by changing their thinking and behavioral patterns (Petiprin, 2016). It can be an effective tool in treating mental disorders if used well. In your post, you stated that Captari et al. (2018) propose integrating the client’s religion and spirituality into therapy to minimize dissonance due to pertinent beliefs. I agree with this statement because religion shapes most people’s way of life and thinking. Incorporating it into therapy can be an effective tool. When providing Psychotherapy, it’s easier to deal with ethical issues. Group therapies, on the other hand, are more complex. Group therapists are responsible for ensuring their clients are aware of the potential consequences of sharing sensitive material in a public forum (Wheeler, 2013). Psychotherapy can be an effective tool depending on the patient’s case or diagnosis. Sometimes psychotherapy and medications can help a patient going through mental illness. Great post.

      References

      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.

      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.

       Reply to Comment

  • Collapse SubdiscussionMarci D Garcia 

     

    Week 1 Discussion

    Biological Basis

    Psychotherapy is performed in efforts that a patient may return to previous or of a more functional social status and change their environment to promote wellbeing emotionally and physically through modification of attitudes, cognitions, behaviors and feelings, (Javanbakht & Alberini, 2019.). The research group known as the National Institute of Mental Health has developed a subgroup who is researching ways to better categorize mental health diagnosis based on their neurobiological features and behaviors the patients display rather than just based on diagnostic criteria; this project group is known as the Research Domain Criteria Initiative (RDoC), (Javanbakht & Alberini, 2019.). This project has presented that psychiatric illnesses and their prognosis can have various complexities due to factors such as social environments, family upbringings, neural, psychological and genetics, (Javanbakht & Alberini, 2019.). Social environments have been linked to the mutation of epigenetics that can be passed on to offspring for as many as three consecutive generations but that they may be reversed by changing environmental factors, (Javanbakht & Alberini, 2019.). Changes in the epigenetic function such as deoxyribonucleic acid (DNA) methylation is affected. In a study completed on panic disorder diagnosed individuals, it was found that patients initially had decreased methylation which was increased with just four weeks of psychotherapy, (Javanbakht & Alberini, 2019.).

    Varying Perspectives

    Psychotherapy is viewed differently in different regions of the world. Cultures in places such as Argentina, who is heavily influenced by and trust the evolution of science, openly access therapy and confiding in others when in crisis or in efforts to improve their overall life, (). However, the Muslim culture, frown upon seeking therapy as they feel they will be challenged in their belief and way of leaving; they also lack the confidence in science that other cultures hold, (Koc & Kafa, 2019.). Religion impacts perception on psychotherapy treatments by often being integrated into the treatments, for example in Christianity, the use of divine revelation and bible references are used frequently, (Koc & Kafa, 2019.).  Due to lack of integrating cultural and religious views in minority communities with a diverse population, individuals often do not align with the therapy or find a therapeutic connection with a practitioner and ultimately cease treatment, (Koc & Kafa, 2019.).

    Considerations in Law and Ethics

    Legal and ethical considerations in psychotherapy are standard are obtaining consent and notifying the client of fees, limits to confidentiality, duration of therapy, refusal rights, cultural considerations and practitioner license status, (Barnett & Jacobson, 2019.). Ethical considerations of group and family therapy versus individual therapy are consent must be obtained by all participants and considered intellectually, emotionally, and legally; if they are not assent must take place to ensure the patient is well informed, (Barnett & Jacobson, 2019.). Legal considerations different in group or family than individual counseling are obtaining proper minor custody documentation, subpoena documentation may not be released without client permission, (Barnett & Jacobson, 2019.).  The practitioner should establish boundaries and avoid entering into multiple relationships or having sexual interactions with any of the participants, (Barnett & Jacobson, 2019.). In conducting these sessions the practitioner should remain unbiased with frequent self-assessments to ensure their own experiences are not conflicting with the issue at hand and ensure each individual has a voice during the session, (Barnett & Jacobson, 2019.).

     

    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., Vol. 3. (pp. 53–68). American Psychological Association. https://doi.org/10.1037/0000101-004Links 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.2019.00144

    Koç, V., & Kafa, G. (2019). Cross-cultural research on psychotherapy: The need for a change. Journal of Cross-Cultural Psychology, 50(1), 100-115.

     

     

    Cross-culture research.pdfDownload Cross-culture research.pdf

    Ethical and Legal.pdf Download Ethical and Legal.pdf

    Psychotherapy and Genetic Neuroscience.pdf Download Psychotherapy and Genetic Neuroscience.pdf

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  • Collapse SubdiscussionJames Sahr Weima 

    Biological Basis and Ethical/Legal Considerations of Psychotherapy

    Psychotherapy and its connection to a biological foundation

    There is a biological basis for psychotherapy, although it’s not as straightforward as some might think. The main idea behind psychotherapy is that changing how a person thinks and acts can improve their physical and mental health (Petiprin, 2016). This process, known as neuroplasticity, is the cornerstone of psychotherapy. Neuroplasticity refers to the brain’s ability to change and adapt due to learning and experiences. While this happens naturally over time, psychotherapy aims to speed up the process by introducing new ideas and techniques that can help rewire the brain and alter its function. For instance, cognitive behavioral therapy (CBT) is a type of psychotherapy that aims to improve thinking and behavior (Goldfried, 2019). Conditions like anxiety and depression may get better, and brain areas involved in emotions and behavior control, such as the prefrontal cortex and the amygdala, become more active with CBT. Research also suggests that psychotherapy can improve physical health. Studies have found that it can boost the immune system, reducing inflammation and the risk of chronic diseases (Petiprin, 2016).

    Influence of Culture, Religion, and Socioeconomics on Perspectives of Psychotherapy

    People from different cultural, religious, and socioeconomic backgrounds may view psychotherapy differently. Culture refers to the shared beliefs, practices, and values passed down from generation to generation (Captari et al., 2018). Some cultures may have negative views toward mental health issues, leading individuals to avoid seeking help. Religious beliefs can also shape attitudes towards psychotherapy, with some religions preferring spiritual solutions over medical interventions (Clauss-Ehlers et al., 2019). Socioeconomic status can also play a role in how psychotherapy is perceived. Those with limited financial resources may find it difficult to access mental health services, which can lead to feelings of hopelessness or reluctance to seek help (Captari et al., 2018).

    Differences in Legal and Ethical Considerations for Group and Family Therapy Compared to Individual Therapy

    Group and family therapy present unique legal and ethical challenges compared to individual therapy. In group settings, the exchange of personal information among multiple clients raises concerns about privacy (Wheeler, 2013). Therapists must ensure that clients understand the potential risks of sharing sensitive information in a group setting. They also need to be mindful of power dynamics within the group and take steps to address any imbalances. Family therapists must be aware of transference and countertransference issues, as well as conflicts of interest among family members. They are also responsible for meeting the individual needs of each family member (Nichols & Schwartz, 2009). This can affect the therapeutic approach used in group, individual, and family therapy sessions. In group therapy, creating a safe and trusting environment is crucial, while individual therapy focuses on maintaining client confidentiality and addressing specific concerns. Family therapists must be mindful of biases and work to address the needs of all family members throughout the treatment process (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 & Counselling50(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 Psychiatry64(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 Psychology74(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 Psychologist74(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 Psychologist74(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 America51.

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

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  • Collapse SubdiscussionYvonne Osei 

    Main Question Post

    The Biological Basis of Psychotherapy

    Using therapy to help people with different mental health issues and emotional problems is a trusted and helpful way. Therapy helps people with mental health problems to have a better life, be more independent, and handle life’s challenges better. It helps them solve their problems and deal with tough situations. People, including families, have found therapy very helpful. There are different types of therapy for different mental health issues. One example is Cognitive Behavioral Therapy, which helps with things like depression, anxiety, and eating disorders. This therapy helps people get better and go back to their normal lives.

    Many studies have shown that things like culture, money, and beliefs can affect how therapy works for people with mental health issues.

    Some studies suggest that therapy can have a bias towards biology. They say that therapy can focus on how the brain works and how chemicals in the brain affect behavior. This helps the brain deal with stress better. Therapy can also help fix connections in the brain that have been affected by bad experiences. Mental health issues like anxiety, depression, and PTSD have been treated successfully with therapy.

    Culture, religion, and how much money someone has can all affect how someone sees therapy. Studies show that differences in culture and money can make it hard for people to get the right therapy. Therapists need to understand a person’s background and beliefs to help them well. Sometimes, the therapist and the person getting therapy might have very different backgrounds. So it’s important for therapists to be open-minded and not judge people based on their background.

    Group therapy can be as helpful as one-on-one therapy. But in group therapy, people talk to each other, not just to the therapist. This can make it easier for people to share their experiences and feelings. Therapists need to make sure that group therapy sessions are private and that everyone follows the rules. They also need to think about what’s right and fair for everyone in the group.

    Before starting therapy, the therapist needs to make sure the person getting therapy understands what’s going to happen. This is called informed consent. It shows that the therapist respects the person’s rights and helps build trust.

    There can be differences in how therapy works for individuals, groups, and families. For example, it might be hard for everyone in a group to agree on a time for therapy. Some people might need extra help to feel comfortable in a group. And some might not want to share personal things with a group. Therapists need to set rules and make sure everyone feels safe and respected.

    In summary, culture, religion, and how much money someone has can all affect how therapy works for them. Some people might avoid therapy because of cultural beliefs or because they’re worried about privacy. Therapists need to make sure that everyone feels safe and respected during therapy sessions.

    I have attached some articles in a PDF. These articles are based on research and are peer-reviewed, which means other experts have checked them to make sure they’re good. They talk about bias in therapy and include studies that have been done on this topic.

    References

    Erekson, D. M., Bailey, R. J., Cattani, K., Klundt, J. S., Lynn, A. M., Jensen, D., Merrill, B. M., Schmuck, D., & Worthen, V. (2022). Psychotherapy session frequency: A naturalistic examination in a university counseling center. Journal of counseling psychology69(4), 531–540. https://doi.org/10.1037/cou0000593Links to an external site.

    David, D., Cristea, I., & Hofmann, S. G. (2018, January 29). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers. Retrieved November 29, 2022, from https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00004/full

    Gaztambide, D. J. (2019). Reconsidering culture, attachment, and inequality in the treatment of a

    Puerto Rican migrant: Toward structural competence in psychotherapy. Journal of Clinical Psychology75(11), 2022–2033. https://doi.org/10.1002/jclp.22861

    Thannhauser, R. E., Morris, Z. A., & Gamble, N. (2021). Informed consent, confidentiality, and practitioner disclosure in therapeutic work with youth: A systematic review of Practitioners’ Perspectives. Adolescent Research Reviewhttps://doi.org/10.1007/s40894-021-00173-2

    Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing

    Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological Models of Psychotherapy. Frontiers in behavioral neuroscience13, 144. https://doi.org/10.3389/fnbeh.2019.00144

     Reply to Comment

  • Collapse SubdiscussionMichael Lessie 

    Psychotherapy has its roots in biology, as the people involved in it are all composed of various biological elements like hormones such as testosterone or estrogen. Biological factors such as the biological sex and age of the patients play a significant role in psychotherapy. As individuals age, their bodies and brains change, affecting their mood and behavior.

    Different cultures view psychotherapy differently, which influences how it’s practiced and the response to treatment. For example, in Asian cultures, psychotherapy is often not considered a viable option for mental health treatment and may even be taboo. Similarly, religion can impact psychotherapy, with some religions embracing it sooner and even incorporating religious figures like pastors or priests into the therapeutic process. Socioeconomic status also plays a role, as those with lower economic means may struggle to afford psychotherapy.

    Legal considerations in psychotherapy, particularly in marriage counseling, can be complex. Statements made during therapy, especially in group settings, could potentially be used in legal proceedings such as divorce cases. For example, admissions of infidelity or criminal activity made during therapy may become relevant in court. Interestingly, research suggests that handling such admissions in a group therapy setting may be more effective than in individual therapy sessions.

    Dealing with legal and ethical issues, such as threats of harm to oneself or others, is crucial in therapy. Therapists have a duty to warn of potential criminal or suicidal thoughts. Group therapy has been shown to be effective in addressing issues like self-harm, with participants in group therapy demonstrating lower rates of repeated episodes and better overall outcomes compared to those receiving routine psychiatric care.

    In summary, psychotherapy is influenced by biological, cultural, religious, socioeconomic, legal, and ethical factors. Understanding and navigating these influences are essential for providing effective and ethical therapy. Group therapy, in particular, has shown promise in addressing various mental health issues due to its open and supportive environment.

    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

     

     Reply to Comment

  • Collapse SubdiscussionVictoria R Marisco 

               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

     

     Reply to Comment

    • Collapse SubdiscussionYvonne Osei 

      Hello Victoria,

      Thank you for your post! It was very informative, and I enjoyed reading it. You gave a detailed explanation of why psychotherapy has a biological basis. I believe that psychotherapy combined with pharmacological treatments is the best approach to treating psychiatric disorders. This is especially true when treating disorders such as depression. A considerable number of meta-analyses published in the last decade have clearly shown that both psychological and pharmacological treatments are efficacious for reducing symptoms of depression (Kamenoy et al., 2017). The reason for this is thought to be due to the biological changes that occur to the brain during both psychotherapy and pharmacological treatments. It has been hypothesized that the brain is built during development and can be rebuilt during psychotherapy. Psychotherapy can change the neural mechanisms of the brain, producing long-lasting effects (Malhotra & Sahoo, 2017).

      Thank you for sharing your knowledge.

       

      Kamenov K, Twomey C, Cabello M, Prina AM, Ayuso-Mateos JL. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychol Med. 2017 Feb;47(3):414-425. doi: 10.1017/S0033291716002774. Epub 2016 Oct 26. PMID: 27780478; PMCID: PMC5244449.

       

      Malhotra S, Sahoo S. Rebuilding the brain with psychotherapy. Indian J Psychiatry. 2017 Oct-Dec;59(4):411-419. doi: 10.4103/0019-5545.217299. PMID: 29497182; PMCID: PMC5806319.

       Reply to Comment

    • Collapse SubdiscussionRashidat Odeyale 

      Hello Victoria. Thank you for this nice post on psychopathology and the issues which are associated with mental health conditions.The cultural impact on mental health conditions and those who suffer from these conditions cannot be overstated. Larson and Anderson(2019) wrote that cultural gender norms impact the symptoms expressed by patients with mental health issues. When dealing with patients with mental health conditions, it is important to recognize how the cultural expectations of the patient based on the patient’s gender impact the symptoms exhibited by the patient. Genetic influence is important in psychopathology. Hannigan et al(2021) wrote that certain genes are linked to mental health conditions and the presence of these genes leads to early expression and worse symptoms in patients with mental illness.

      When the mental healthcare provider encounters a patient with mental illness, these considerations are important to provide the treatment that the patient needs. Taking a holistic approach ensures that the provider accounts for the influence of all these factors to ensure that the patient’s treatment is encompassing enough to meet the needs of the patient.

       

      References

      Hannigan, L. J., Askeland, R. B., Ask, H., Tesli, M., Corfield, E., Ayorech, Z., Helgeland, Ø., Magnus, P., Njølstad, P. R., Øyen, A.-S., Stoltenberg, C., Andreassen, O. A., Smith, G. D., Reichborn-Kjennerud, T., & Havdahl, A. (2021). Genetic Liability for Schizophrenia and Childhood Psychopathology in the General Population. Schizophrenia Bulletin47(4), 1179–1189. https://doi.org/10.1093/schbul/sbaa193

      Larson, S. E. M., & Anderson, M. S. C. (2019). Gender Issues When Working with Men with Depression: A Novice Counsellor’s Perspective. Canadian Journal of Counselling & Psychotherapy / Revue Canadienne de Counseling et de Psychothérapie53(3), 232–254.

       Reply to Comment

    • Collapse SubdiscussionCatherine Eden Taylor 

      Victoria,

      As Sue and Zane (2009) indicated in their reevaluation of earlier work, use of culturally appropriate techniques during psychotherapy (e.g., linear relationships and present-time orientation with Hispanic patients) is important to ensuring that patients find their psychotherapy useful and meaningful, and that they continue with treatment. A patient’s culture will affect how they value their therapy experiences.

      A patient’s culture (which is not separable from their religion) also affects how they will value psychotherapy before they have experienced it. Sue and Zane (2009) referenced an earlier article indicating that many Asian Americans have a negative attitude toward psychotherapy and do not believe it can help. Kudva et al. (2020) conducted a narrative review to explore the stigmatization of mental illnesses and people with mental illnesses throughout Asia. In some of the countries, there were widespread religious beliefs that attributed mental illnesses to supernatural forces (Kudva et al., 2020). In Buddhist thought (common in China), mental illnesses could be punishment for sins in a past life, while in countries such as Lebanon and Thailand, beliefs that spirit entities (jinns in Lebanon) could cause mental illnesses were commonly held (Kudva et al., 2020). Both of these beliefs place a low value on psychotherapy, but for somewhat different reasons. Thinking mental illness is a punishment for sin directly stigmatizes people with mental illness, suggesting they must have been bad to be sick. Avoiding this stigma will cause people to not wish to use psychotherapy. Thinking supernatural forces cause mental illness does not carry the same level of stigma, especially if the supernatural forces are not seen as arbiters of justice, but at the same time would lead to a view of psychotherapy as useless – talking to a therapist would not overcome the power of these forces. Avoiding disclosure of embarrassing information and preserving family honor by keeping secrets are also common in some Asian countries (such as China, Singapore, and India), and stigmatize both the illness and the person with the illness (Kudva et al., 2020). Being seen to visit a psychotherapist would reveal this secret, and is therefore likely to be avoided. Other cultures (such as in Japan, Singapore, the Philippines, and Nepal) see people with mental illnesses as being weak (Kudva et al., 2020). This stigma similarly will dissuade people from seeking treatment. One cultural attitude that can act to increase the value placed on psychotherapy is a prejudice against treatment with psychiatric medications (feeling they are harmful, ineffective, or addictive), which comparatively increase support for psychotherapy. This is a significant issue in Lebanon (Kudva et al., 2020).

      As Nagayama Hall et al. (2019) acknowledged in their directed content analysis study, Asian Americans dramatically underutilize mental health services as compared to other ethnic groups. Asian Americans further are especially likely to prematurely terminate mental health treatment or to attend fewer treatment sessions (Nagayama Hall et al., 2019). Cultural and religious attitudes that devalue psychotherapy are largely responsible for the initial underutilization, while treatment that is a poor cultural fit for the patient is primarily responsible for ending treatment too soon (although avoiding being seen engaging in stigmatized activities will be part of the reasons for early terminations and fewer sessions).

       

       

      References

      Kudva, K. G., El Hayek, S., Gupta, A. K., Kurokawa, S., Bangshan, L., Armas-Villavicencio, M. V. C., Oishi, K., Mishra, S., Tiensuntisook, S., & Sartorius, N. (2020). Stigma in mental illness: Perspective from eight Asian nations. Asia-Pacific Psychiatry, 12(2), e12380. https://doi.org/10.1111/appy.12380Links 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.

      Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42(1), 37–45. https://doi.org/10.1037/0003-066X.42.1.37Links to an external site.

       Reply to Comment

  • Collapse SubdiscussionAlora Morgan Little 

     

    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 neuroscience13, 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 neuroscience13, 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

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    • Collapse SubdiscussionVictoria R Marisco 

                Hello, Alora. I enjoyed reading your opinion regarding the impact culture has on psychotherapy. Approximately, one in five adults are affected by mental illness each year. However, per statistics only twenty-one percent of adults seek treatment for mental illness yearly due to the stigma surrounding mental illness (NAMI, 2022). Often times, as you have stated, an individual may not seek mental health treatment due to cultural stigma surrounding mental illness. Frequently, treatment for mental health symptoms or psychotherapy is avoided due to fear of mistreatment by society and utilize religious beliefs as treatment modalities. With negative societal views on psychotherapy, it is imperative healthcare providers break the stigma surrounding mental health treatment and advocate for accessible mental health services (Modir et. al., 2020).

      As you have stated, religion is a key influence in an individual receiving psychotherapy. With religion influencing a person’s behavior, healthcare providers must formulate psychotherapy treatment plans to prevent the avoidance of cultural beliefs based on religious preferences. It is often found in psychotherapy for spirituality to be overlooked and mental health concerns being directly addressed. It is imperative for healthcare providers to determine if an individual’s behavior is based on religious beliefs. If religious beliefs are the cause of certain behaviors, the healthcare provider can incorporate beliefs into the patient’s psychotherapy treatment plan increasing the likelihood for the individual to meet treatment goals (Barnett, 2020).

      References

       

      Barnett, J. (2020). Integrating spirituality and religion into psychotherapy practice. Society for the Advancement of Psychotherapy. Retrieved from https://societyforpsychotherapy.org/integrating-spirituality-religion-psychotherapy-practice/

      Modir, S., Alfaro, B., Casados , A., & Ruiz , S. (2020). Understanding the role of cultural stigma on seeking mental health services. CHOC. Retrieved from https://health.choc.org/understanding-the-role-of-cultural-stigma-on-seeking-mental-health-services/

      NAMI. (2022). Mental health by the numbers. NAMI. Retrieved from https://www.nami.org/mhstats

       

      How cultural stigma impacts those seeking mental health services.pdfDownload How cultural stigma impacts those seeking mental health services.pdf

      Integrating Spirituality and Religion into Psychotherapy Practice.pdf Download Integrating Spirituality and Religion into Psychotherapy Practice.pdf

      Mental Health By the Numbers.pdf Download Mental Health By the Numbers.pdf

       Reply to Comment

  • Collapse SubdiscussionCatherine Eden Taylor 

    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

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    • Collapse SubdiscussionAlora Morgan Little 

           Psychotherapy is a form of talk therapy that has been shown to be an effective treatment for mental health disorders. I, too, read about the effects of psychotherapy on patients with borderline personality disorder and then found a meta-analysis performed by Schrammen et al. (2022) reports that psychotherapy also causes changes to the prefrontal area and the fear-related limbic regions in the brain when patients with anxiety disorders.

      I also agree with you that culturally competent treatment is essential. Lee & Herschmann (2019) state that cross-cultural differences can cause a provider to enact their own cultural values onto a patient instead of considering the patient’s values during therapy when they are not culturally competent. Patients can come from many different backgrounds and cultures, so it would be essential, as a provider, to become culturally competent.

       

       

      References

      Lee, E., Johnstone, M., & Herschman, J. (2019). Negotiating therapy goals and tasks in cross-cultural psychotherapy. Journal of Social Work Practice, 33(4), 447–462. https://doi.org/10.1080/02650533.2018.1504288

      Schrammen, E., Roesmann, K., Rosenbaum, D., Redlich, R., Harenbrock, J., Dannlowski, U., & Leer, E. J. (2022, September 28). Functional neural changes associated with psychotherapy in anxiety disorders – a meta-analysis of longitudinal fmri studies. Neuroscience & Biobehavioral Reviews. Retrieved December 2, 2022, from https://www.sciencedirect.com/science/article/pii/S0149763422003840

       Reply to Comment

    • Collapse SubdiscussionTuyet Lam Gwardys 

      Hi Catherine

      Thank you for sharing your very informative discussion post.  I appreciate you breaking down the biological basis of psychotherapy to gene transcription and DNA methylation.  I agree with you that psychotherapy has biological basis. This motivated me to do more research on psychotherapy and the epigenetic mechanisms related to mental illnesses.

      In recent years, there has been increasing consensus that the learning experiences in psychotherapy may lead to epigenetic modifications across different treatment modalities.   Jimenez et al. (2018) performed systemic reviews of studies and found similar patterns in epigenetic mechanisms associated with psychotherapy.  From the studies, Jimenez et al. (2018) concluded patients with bipolar disorder have increased brain-derived neurotrophic factor methylation after psychotherapy and patients with higher methylation before treatment has a better response to psychotherapy. Furthermore, the studies provided evidence that patients with agoraphobia have increased methylation and reduced symptoms after receiving cognitive behavioral therapy (CBT), and children who received CBT has a significant anxiety reduction.  Epigenetic changes through psychotherapy could be passed on to offspring (Jimenez et al., 2018).   Jimenez et al. (2018) argue that transgenerational transmission of epigenetic modifications is possible due to 1) evidence of epigenetic modifications in humans with trauma who receive therapy and 2) children inherit one gene from their parents that is a DNA-coded environment.

      I learned that there are more than 400 types of psychotherapy.  However, most subtypes fall under major therapy categories such as behavioral, cognitive-behavioral, psychodynamic, systemic, or strategic (Jimenez et al., 2018).  In my clinical setting, the clinicians use mainly CBT for anxiety disorders in children and adolescents.  Randomized clinical trials by Zhou et al. (2019) compared the different types of psychotherapies and methods of delivering psychological treatments for anxiety disorders in children and adolescents. They found that CBT is the most appropriate choice of psychotherapy.

       

      The scholarly journal articles I have included in this response are peer-reviewed, making them reputable sources.  The studies in these journals are systematic reviews and randomized clinical trials, which make them reliable sources based on the hierarchy of evidence pyramid.

       

      References

       

      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 genetics9, 257. https://doi.org/10.3389/fgene.2018.00257

       

      Zhou, X., Zhang, Y., Furukawa, T. A., Cuijpers, P., Pu, J., Weisz, J. R., Yang, L., Hetrick, S. E., Del Giovane, C., Cohen, D., James, A. C., Yuan, S., Whittington, C., Jiang, X., Teng, T., Cipriani, A., & Xie, P. (2019).  Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis. JAMA psychiatry76(1), 41–50. https://doi.org/10.1001/jamapsychiatry.2018.3070

       

      Jimenez et al-1.pdf Download Jimenez et al-1.pdf

      Zhou et al.pdf Download Zhou et al.pdf

       

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  • Collapse SubdiscussionTammy Kay Rodgers 

    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 & Neuromedicine4(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 Neuroscience13https://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 Psychiatry9https://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 Psychotherapy74(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.

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    • Collapse SubdiscussionCharles Banor 

      Hi Tammy,

      I enjoyed reading your post. Thank you.

      DeLeon, 2003 claim that an APRN must be aware of patient’s ethnicity, religion, race, class, cultural identity, and explanation of the disease in order to properly diagnose and treat the illness because across the world, human beliefs, values, and social customs varies greatly as well as how health and healing are perceived. Mental health is still linked to spiritual roots in some parts of the world. The therapist should consider patients the unique subculture and assumptions of a family or individuals during assessments. How a diagnosis is made with clinical decisions that follow depends on social interaction that occurs in a wider social context that is the reason why what is considered a mental illness evolves under the influences of sociopolitical and other factors (Edge & Lemetyinen,2019).

       

      references

      DeLeon, P. H., Crimmins, D. B. and Wolf, A. W.2003. Afterword—The 21st century has arrived. Psychotherapy: Theory, Research, Practice, Training, 40: 164–169.

       Edge, D., & Lemetyinen, H. (2019). Psychology across cultures: Challenges and opportunities. Psychology and Psychotherapy,92 (2), 261-276. https://doi-org.ezp.waldenulibrary.org/10.1111/papt.12229

      Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.

      Chapter 2, “Basic Techniques of Family Therapy”

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  • Collapse SubdiscussionCarla Mckenzie 

    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 Communicationhttps://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 America32(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 psychology10, 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

     Reply to Comment

    • Collapse SubdiscussionTammy Kay Rodgers 

      Carla,

      I enjoyed reading your post and found the information regarding how a therapist must wait 5 years before engaging in a romantic relationship with a former client interesting. One study that I found states that 60-90% of psychotherapists will acquire romantic feelings toward a client at some point in their career (Vesentini, et al., 2022). Call me naive, but I found this number to be astonishing! I understand that most professionals would act ethically and not divulge these feelings to the client, but it brings to question if those that do divulge the information abide by their code of conduct and wait five years. Another article that I found brings up the issue of transference and countertransference of both patient and therapist. It states that therapists that are not aware of their own transference and countertransference issues can lead to inappropriate boundaries and relationships with clients essentially leading to blocks in treatment (Prasko., 2022). It is a very controversial and sensitive topic but very important when speaking about legal and ethical implications regarding the therapist/client relationship.

      Tammy

      References

      Prasko, J., Ociskova, M., Vanek, J., Burkauskas, J., Slepecky, M., Bite, I., Krone, I., Sollar, T., & Juskiene, A. (2022). Managing transference and countertransference in cognitive behavioral supervision: Theoretical framework and clinical application. Psychology Research and Behavior ManagementVolume 15, 2129–2155. https://doi.org/10.2147/prbm.s369294Links to an external site.

      Vesentini, L., Van Puyenbroeck, H., De Wachter, D., Matthys, F., & Bilsen, J. (2022). Managing romantic and sexual feelings towards clients in the psychotherapy room in flanders (belgium). Sexual Abuse, 107906322210983. https://doi.org/10.1177/10790632221098357Links to an external site.

      Managing Romantic Feelings.pdfDownload Managing Romantic Feelings.pdf

      Managing Transference.pdf Download Managing Transference.pdf

       Reply to Comment

  • Collapse SubdiscussionKimberly Wian 

    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 terapeutica163(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 psychology10(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 Process58(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 terapeutica163(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

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    • Collapse SubdiscussionTammy Kay Rodgers 

      Kimberly,

      I find studying the neuroimaging changes caused by psychotherapy very interesting! While researching changes, I found that in Borderline Personality Disorders, psychotherapy has been found to increase the gray matter in areas of the brain that are responsible for emotional regulation and high-order functioning such as, the interior frontal gyrus and the supramarginal gyrus (Mancke, et al., 2018). To support the importance of neuroimaging in psychotherapy, a recent study of a sample of combat veterans suffering with PTSD found that treatment response to psychotherapy can be predicted with a reliability of 81.4%, by performing baseline MRIs and analyzing the resting state network of the bilateral superior frontal gyrus and the presupplementary motor area (Zhutovsky, et al., 2019). The study found that after treatment of psychotherapy, non-responders had higher connectivity in the frontopolar networks of the brain in baseline scans than those that responded to treatment (Zhutovsky, et al., 2019). It was therefore determined that by utilizing baseline MRIs in those with PTSD, treatment planning should include the possibility that the first-line treatment of psychotherapy for PTSD may not be effective in these individuals (Zhutovky, et al., 2019). I find this very intriguing and hope that more research on this approach to treatment is released in the future.

      Tammy

      References

      Mancke, F., Schmitt, R., Winter, D., Niedtfeld, I., Herpertz, S. C., & Schmahl, C. (2018). Assessing the marks of change: How psychotherapy alters the brain structure in women with borderline personality disorder. Journal of Psychiatry and Neuroscience43(3), 171–181. https://doi.org/10.1503/jpn.170132Links to an external site.

      Zhutovsky, P., Thomas, R. M., Olff, M., van Rooij, S. H., Kennis, M., van Wingen, G. A., & Geuze, E. (2019). Individual prediction of psychotherapy outcome in posttraumatic stress disorder using neuroimaging data. Translational Psychiatry9(1). https://doi.org/10.1038/s41398-019-0663-7Links to an external site.

      Neuroimaging and BPD.pdfDownload Neuroimaging and BPD.pdf

      Neuroimaging and PTSD.pdf Download Neuroimaging and PTSD.pdf

       Reply to Comment

      • Collapse SubdiscussionKimberly Wian

        Hi, Tammy! Thank you for checking out my post. I loved your reply-it appealed to my inner nerd.

        The hard line between who and how the brain and mind have been studied is beginning to soften. Psychologists and neurologists are coming together and are looking to advance the science behind the belief that psychotherapy can affect neural architecture. Two ways we see the marriage of the science of the mind and brain is with what we already know in terms of how extrinsic experience can influence the brain in terms of neuroplasticity and neurogenesis. The former explains how experience can transforms the brain through learning. The latter accounts for a different type of change in the brain through experience. The areas of the brain associated with emotions and memory, i.e., hippocampus, prefrontal cortex, amygdala, and temporal lobe are highly plastic and capable of regeneration (Malhotra & Sahoo, 2017). The research using what we know about the brains ability to change through experience with help develop deeper evidence that shows psychotherapy leads to definitive and demonstrable changes in the brain.

        Reference:

        Malhotra, S., & Sahoo, S. (2017). Rebuilding the brain with psychotherapy. Indian journal of psychiatry59(4), 411–419. https://doi.org/10.4103/0019-5545.217299

         Reply to Comment

    • Collapse SubdiscussionYvonne Osei 

       

      Hello Kimberly,

      Thank you so much for the insightful information provided. This is just to add little information on the impact of differences on therapeutic approaches in group and family therapy.

      Therapists should be aware of the ethical and legal consequences of breaching the clients’ confidentiality rights. Therefore, they should be careful about what they are supposed to reveal to their clients regarding information about personal health. Therapists must determine the kind of information that the client wants disseminated to the family members before going on with the family therapy (Cottone et al., 2021). The therapists’ role is to educate the group on observing the client’s confidentiality from other group members right from the beginning of the treatment.   According to Thannhauser et al., (2021) well-implemented informed consent procedures demonstrate psychotherapists’ respect for clients’ right to self-determination and can initiate meaningful contributions to treatment through enhancing mutual trust, building rapport, and facilitating a sense of ownership.  Participation is encouraged in group therapies, making it difficult for therapists to regulate how much information about the client is dispersed to other people.  An advantage of the group therapy is to ensure that  proper time management between the therapist and the client.

      Thank you for sharing your knowledge

      References

      Cottone, R. R., Tarvydas, V., & Hartley, M. T. (2016). Ethics and decision making in counseling

      and psychotherapy. Springer Publishing Company.

      Thannhauser, R. E., Morris, Z. A., & Gamble, N. (2021). Informed consent, confidentiality, and

      practitioner disclosure in therapeutic work with youth: A systematic review of Practitioners’ Perspectives. Adolescent Research Review. https://doi.org/10.1007/s40894-021-00173-2

       Reply to Comment

  • Collapse SubdiscussionAngela Brianne Njoroge 

    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 Guidelinehttps://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

     Reply to Comment

    • Collapse SubdiscussionJudgette Green 

      Hello Angela,

      I enjoyed reading your post. Psychotherapy is a form of treatment that is used for mental illness along with psychopharmacology (Avasthi et al, 2022). It is believed by many to have a biological basis. As psychotherapy becomes more popular legal and ethical issues will arise. The rules that govern individual therapy may be different from group and family therapy. During individual therapy the therapist has only one client and is able to maintain a higher level of confidentially versus group therapy. In group therapy the therapist is held to the laws of confidentiality, however the participants are not held to the same level, and faces no legal consequences if information is shared. When providing group and family therapy all the participants are seen as equals and the therapist cannot take sides example during couple’s therapy. The therapist needs to remain nonjudgmental and not favoring a particular side. For minors consent need to be gained from parents or guardian and assent for the minor child. For all clients participating in psychotherapy should provide inform consent and should be aware of their roles and that of the therapist. During the time of Covid-19 many providers shifted to online group and individual therapy which presented its own challenges. Confidentially been one of the issues that online therapy presented. Inform consent should also include the risk and benefits of tele psych (Weinberg, 2020).

       

       

      References

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

      Indian Journal of Psychiatry, 64(1), 47-61.

      https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21Links to an external site.

      Weinberg, H. (2020). Online group psychotherapy: Challenges and possibilities during Covid-

      19- A practice review. Group Dynamics: Theory, Research, and Practice, 24(3), 201-

      211. https://doi.org/10.1037/gdn0000140Links to an external site.

      2020-69287-004.pdf Download 2020-69287-004.pdf

      Response 2 article.pdf Download Response 2 article.pdf

       Reply to Comment

      Collapse SubdiscussionTuyet Lam Gwardys

      Psychotherapy is a Biological Treatment

      There is growing evidence that psychotherapy, such as cognitive behavioral therapy (CBT), physically alters the brain similar to the effects of psychotropic medications (Jimenez et al., 2018).  Psychotherapy is defined as a talk therapy to improve psychological, emotional, or behavioral challenges (Locher et al., 2019).  According to Weldon and Kay (2015), neurobiological changes can be seen through the process of attachment, empathy, and learning during psychotherapy.  During talk therapy, the emotional engagement or attachment between the psychotherapist and the client alters the oxytocin levels and activates the mu-opioid receptor (Weldon & Kay, 2015).  Similarly, when the clinician demonstrates empathy to the clients, the experience alters the clients’ oxytocin and arginine vasopressin.  Lastly, as the clients continue to learn about themselves and their environment through psychotherapy techniques, the learning experience alters the clients’ brain by replacing bad memories with new ones (Weldon & Kay, 2015).  The physical modifications in the brain through psychotherapy allow the psychotherapists to predict treatment outcomes and develop the appropriate treatment plan for the client.

      Culture, Religion, and Socioeconomics

      Culture, religion, and socioeconomic may influence how the clients communicate their symptoms, how they value psychotherapy, their understanding of the illness, the type of treatment they are willing to try, and their compliance with treatment (Moleiro, 2018).  Culture is a set of beliefs, values, language, and behavior that characterize a particular group of people that can influence the client’s social responses to mental health illness (Heyes, 2020).  Cultural beliefs shape psychotherapy models and patient care; therefore, it is essential to recognize the client’s historical roots and cultural perspectives.  Cultural competence helps psychotherapists work effectively to meet the client’s needs and improve treatment outcomes.

      Religion and spirituality are a big part of many people’s lives, and it help them define their attitudes, values, lifestyle choices, and decision-making.  Religion is described as shared beliefs, rituals, and practices. Spirituality is defined as a connection to God and nature (Victor & Treschuk, 2020).  Several studies demonstrate a correlation between religion and spirituality (R/S) and mental health issues (Vieten & Lukoff, 2022).  These studies provide evidence that there are negative impacts on the treatment outcomes when R/S are not addressed in psychotherapy.  Furthermore, a meta-analysis by Captari et al. (2018) provides evidence that R/S-accommodated psychotherapies achieved more significant patient symptom improvements than those in non-R/S psychotherapies.  Unfortunately, some clinicians do not routinely inquire about religion and spirituality in their initial evaluation or address it in the treatment planning, which can have a negative impact on the treatment outcome.

      Clients with low socioeconomic status have higher prevalence rates of mental issues than those with higher socioeconomic status and are less likely to participate in psychotherapy (Niemeyer & Knaevelsrud, 2022).  Socioeconomic status is determined by income, occupation, and education.  Leppanen et al. (2022) examine the use of rehabilitative psychotherapy in Finland in correlation to socioeconomic status.  The study provides evidence that individuals with lower education and occupation status use psychotherapy less frequently than those of higher socioeconomic status (Leppanen et al., 2022).

      Legal and Ethical Considerations

      The legal and ethical considerations for multi-person therapies are more complex than individual therapy because of the need for collateral contracts and the increased challenges to maintaining boundaries and confidentiality.  In the United States, by law the clinicians must obtain informed consent for treatment and provide confidentiality and access to records.  In couple, family, and group therapies, collateral contracts can create legal and ethical problems for the clinician, such as problems associated with boundaries in multiple relationships, confidentiality, multicultural awareness, duty to warn, and child custody issues (Barnett & Jacobson, 2019).  Due to the complexity of the situation and the multiple people involved, I will follow the Standard 10.02 in the Code of Conduct by identifying the client(s) and clarifying the relationship and role of each member (ANA, 2010).  In addition, I will follow the Standard 10.03 in the Code of Conduct, which encourages clinicians to outline confidentiality laws and the roles and responsibilities of all participants (ANA, 2010).  There may be problems in multi-person therapy that are not addressed in the Ethics Code; thus, the APA (2010) encourages clinicians to focus on the principle of beneficence to promote the client’s welfare and preserve autonomy to the best of their ability.  Each state has its law for issues relevant to multi-person therapy; therefore, I need to review the licensure law in the state where I obtain my license (Barnett & Jacobson, 2019).

      Research

      1. (Jimenez et al., 2018) is considered scholarly because it is a peer-reviewed journal article that provides systematic reviews on psychotherapy associated with epigenetics changes.
      2. (Charzyńska & Heszen-Celińska, 2020) is considered scholarly because it provides qualitative research on spirituality and therapy.
      3. (Leppänen et al., 2022) is considered scholarly because it provides qualitative research on socioeconomic factors and psychotherapy.

      References

      American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. American Psychological Association. Retrieved November 29, 2022, from https://www.apa.org/ethics/code

      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. https://doi.org/10.1037/0000101-004

      Captari, L. E., Hook, J. N., Hoyt, W., Davis, D. E., McElroy-Heltzel, S. E., & Worthington, E. L., Jr (2018).  Integrating clients’ religion and spirituality within psychotherapy: A comprehensive meta-analysis.  Journal of clinical psychology74(11), 1938–1951.  https://doi.org/10.1002/jclp.22681

      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 health59(1), 113–134.  https://doi.org/10.1007/s10943-019-00911-w

      Heyes C. (2020).  Culture.  Current biology: CB30(20), R1246–R1250.  https://doi.org/10.1016/j.cub.2020.08.086

      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 genetics9, 257. https://doi.org/10.3389/fgene.2018.00257

      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 research22(1), 983.  https://doi.org/10.1186/s12913-022-08389-1

      Locher, C., Meier, S., & Gaab, J. (2019). Psychotherapy: A World of Meanings.  Frontiers in psychology10, 460.  https://doi.org/10.3389/fpsyg.2019.00460

      Moleiro C. (2018).  Culture and Psychopathology: New Perspectives on Research, Practice, and Clinical Training in a Globalized World.  Frontiers in psychiatry9, 366.  https://doi.org/10.3389/fpsyt.2018.00366

      Niemeyer, H., & Knaevelsrud, C. (2022). Socioeconomic status and access to psychotherapy.  Journal of clinical psychology, 10.1002/jclp.23449.  Advance online publication.  https://doi.org/10.1002/jclp.23449

      Paul Victor, C. G., & Treschuk, J. V. (2020). Critical Literature Review on the Definition Clarity of the Concept of Faith, Religion, and Spirituality.  Journal of holistic nursing: official journal of the American Holistic Nurses’ Association38(1), 107–113.  https://doi.org/10.1177/0898010119895368

      Vieten, C., & Lukoff, D. (2022). Spiritual and religious competencies in psychology.  The American psychologist77(1), 26–38.  https://doi.org/10.1037/amp0000821

      Welton, R., & Kay, J. (2015).  The Neurobiology of Psychotherapy.  Psychiatric Times.  Retrieved November 29, 2022, from https://www.psychiatrictimes.com/view/neurobiology-psychotherapy