BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645
BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645
Psychotherapy is a broad term that defines the use of verbal and psychological techniques as interventions for mental disorders. Psychotherapy facilitates behavior change, enhances happiness, and enables one to overcome problems. Psychotherapy is considered to have a biological basis. Mental disorders such as post-traumatic stress disorder are thought to result from abnormalities in brain adaptation and incomplete processing of traumatic events. Psychotherapeutic techniques such as trauma-focused cognitive behavioral therapy and eye movement desensitization and reprocessing therapy tend to extricate and repair these maladaptive and incomplete memories by impacting neural circuits and substituting them with positive and new coping strategies (Javanbakht & Alberini, 2019). According to Javanbakht and Alberini (2019), psychotherapy has a complex biological foundation that does not target a single neuron, receptor, modulator, or neurotransmitter but is directed into the entire biological regulations that underlie complex brain responses. Finally, psychotherapy is associated with structural changes in the brain. For instance, a systematic review by Manthey et al. (2021) demonstrated an increase in the activation of the medial prefrontal cortex and rostral anterior cingulate cortex following successful trauma-focused cognitive behavioral therapy in patients with PTSD. The subsequent sections will explore the impact of culture, religion, and socioeconomic status on psychotherapy and the variations in legal and ethical considerations in psychotherapy.
Culture, Religion, and Socioeconomic Impact on the Value of Psychotherapy
Culture, religion, and socioeconomic status impact an individual’s perspective on the value of psychotherapy. Cultural beliefs impact both health-seeking behavior and perception of psychotherapy. For instance, in some cultures, mental illness is considered a curse and is associated with considerable stigmatization (Charzyńska & Heszen-Celińska, 2020). In such communities, individuals may shun seeking appropriate psychotherapy and resolve to other complementary and alternative forms of treatment such as divine interventions. Similarly, religious beliefs influence health-seeking behavior and choice of treatment. For instance, Muslims, Christians, and Hindus who believe that God is the ultimate healer may opt for prayers rather than psychotherapy for their healing (Charzyńska & Heszen-Celińska, 2020). Finally, socioeconomic status may impact access to psychotherapy. For instance, individuals from low socioeconomic status less often seek psychotherapy probably due to cost concerns as well as a lack of understanding of the benefits and efficacy of psychotherapy.
Legal and Ethical Considerations of Psychotherapy
Ethical and legal considerations of psychotherapy vary significantly between the individual, group, and family therapy which impacts therapeutic approaches. For instance, informed consent is ordinarily by an individual and a group in individual and group therapy respectively. Similarly, privacy and confidentiality are more with the individual than group or family therapy (Avasthi et al., 2022). Likewise, documentation, competency, and responsibilities of a therapist and therapeutic contracts also differ (Avasthi et al., 2022). For instance, a therapist working with individual documents and uses skills and knowledge tailored towards the individual while a therapist working with a group must be skilled and use appropriate knowledge that upholds the interests of the group over individual interests. Similarly, working with a group is quite challenging as sharing of the information may be hindered. Legally, issues of false memories, expert opinion, and professional negligence become more difficult to handle in a court of law concerning group therapy than individual therapy (Avasthi et al., 2022). Consequently, a therapist must establish a therapeutic relationship, be competent and responsible, and identify these variations to deliver the appropriate level of care.
Conclusion
Psychotherapy has a biological basis. Psychotherapy is a complex biological process that repairs maladaptive brain alterations using multiple neurons, receptors, neurotransmitters, and modulators. Culture, religion, and socioeconomic status influence access to psychotherapy. A therapist must recognize ethical and legal considerations to deliver appropriate psychotherapy. Finally, the resources used to reference are scholarly as they are peer-reviewed journal articles from recommended sources and have been published within the last five years.
BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645 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
Charzyńska, E., & Heszen-Celińska, I. (2020). Spirituality and mental health care in a religiously homogeneous country: Definitions, opinions, and practices among Polish mental health professionals. Journal of Religion and Health, 59(1), 113–134. https://doi.org/10.1007/s10943-019-00911-w
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
Manthey, A., Sierk, A., Brakemeier, E.-L., Walter, H., & Daniels, J. K. (2021). Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD. European Journal of Psychotraumatology, 12(1), 1929025. https://doi.org/10.1080/20008198.2021.1929025
Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors,
symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology?
Psychotherapy is used with individuals as well as in groups or families. The idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric-mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential.
For this Discussion, you will consider whether psychotherapy also has a biological basis and analyze the ways in which legal and ethical considerations differ in the individual, family, and group therapy settings.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
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Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
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Psychotherapy and Biological Basis
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Discussion questions:
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Psychotherapy comprises therapeutic exchange, empathy, transference, finding unconscious thoughts, and cognitive remodeling. Several brain areas, including the hippocampus, amygdala, temporal, and frontal lobes, are involved in learning, and psychotherapy focuses on the patient learning constructive things to eliminate destructive thoughts that impair everyday life functioning. Dialectic behavior therapy (DBT), interpersonal psychotherapy, and cognitive-behavioral therapy (CBT) alter brain function in patients suffering from social anxiety disorder, obsessive-compulsive disorder (OCD), major depressive disorder (MDD), borderline personality disorder (BPD), and posttraumatic stress disorder (PTSD).
Research reports have identified that CBT decreased para limbic and limbic hyperactivity in phobias, whereas in OCD, it decreased metabolism in the right caudate nucleus (Hamann et al., 2022; Ojeda & Hurley, 2022). Psychotherapy-treated individuals with PTSD had increased activity and connectivity in the lateral front cortex and ventromedial prefrontal cortex (Rooij et al., 2021). These modifications are associated with improvements in hyperarousal. Similarly, psychotherapy enhances the production of serotonin in the brain, which is generally low in a patient with depression and anxiety (Harbi, 2021; Wu et al., 2022). Thus, it can be inferred that symptoms of mental health disorders have a biological basis, and psychotherapy help impact the biological processes responsible for producing symptoms of mental health disorders.
Cultural, Religious, and Socio-economic Impact on Psychotherapy
Cultural and religious factors may considerably impact psychotherapy and other forms of mental health care. Some cultures continue to stigmatize mental health, making it challenging for mental health patients to receive care. Access to psychiatric care is a significant concern for many people (Della et al., 2020). Religious rituals play a crucial role in the healing process in various civilizations (Alattar et al., 2021). Despite contradictory data, individuals may be hesitant to seek official therapy owing to their beliefs, which may result in poor outcomes. Among the 14.2 million adults with mental illness in the United States, only 9.1 million (64.5%) received mental health treatment in the year 2020 (National Institute of Mental Health [NIMH], 2022). A patient’s socioeconomic situation may restrict their access to therapy. Examples of socioeconomic barriers impacting an individual’s decision to receive psychotherapy include lack of insurance coverage, extensive wait periods at community mental health centers, being unable to afford copayments, and being ineligible to receive financial aid. A research report by Foster and O’Mealey (2021) indicates that people belonging to high socioeconomic status are more likely to receive mental illness treatment.
Legal and Ethical Consideration in Group and Individual Therapy
Group and family therapy have distinct legal and ethical considerations compared to individual therapy. First, confidentiality can only sometimes be maintained in groups, even when strongly encouraged. Second, obtaining informed consent in group and family treatment is more complicated than in individual therapy (Riva & Cornish, 2018). Group facilitators and clinicians are also responsible for establishing a therapeutic bond with each participant. When conflicts arise within a group, it can be challenging to preserve. Therapists must have extensive knowledge of group dynamics and ethical dilemmas due to the nature of group therapy. Therapists should keep the preceding information in mind when developing therapeutic strategies. Providers of group therapy should remain vigilant for any issues that could compromise the safety of group members or the group as a whole and immediately address those (Riva & Cornish, 2018). Before beginning a group, it is beneficial for the therapist to speak individually with each participant. Group members must agree to maintain the confidentiality of their identities and any other information disclosed during meetings. Participants should be instructed on maintaining the secrecy of the group’s secrets when they are outside the group environment. However, in individual therapy, obtaining informed consent is relatively simple, as there is only one client. Similarly, confidentiality is only one-to-one in individual therapy and it can be maintained easily between the patient and the therapist.
Being a psychiatric nurse practitioner, I am well aware of the ethical and legal aspects of different forms of therapy sessions, and I ensure to incorporate these while working with my patients.
BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645 References
Alattar, N., Felton, A., & Stickley, T. (2021). Mental health and stigma in Saudi Arabia: A scoping review. Mental Health Review Journal, 26(2), 180-196. https://doi.org/10.1108/mhrj-08-2020-0055
Della, C. D., Teo, D. C. L., Agiananda, F., & Nimnuan, C. (2020). Culturally informed psychotherapy in Asian consultation‐liaison psychiatry. Asia-Pacific Psychiatry, 13(1), 12431-12439. https://doi.org/10.1111/appy.12431
Foster, S., & O’Mealey, M. (2021). Socioeconomic status and mental illness stigma: The impact of mental illness controllability attributions and personal responsibility judgments. Journal of Mental Health, 31(1), 1-8. https://doi.org/10.1080/09638237.2021.1875416
Hamann, C. S., Bankmann, J., Mora Maza, H., Kornhuber, J., Zoicas, I., & Schmitt-Böhrer, A. (2022). Social fear affects limbic system neuronal activity and gene expression. International Journal of Molecular Sciences, 23(15), 8228-8245. https://doi.org/10.3390/ijms23158228
Harbi, V. (2021). The neuroplasticity of depression: How antidepressants and cognitive behavior therapy (CBT) can reverse depression. PCOM Capstone Projects, 30(1), 1-40. https://digitalcommons.pcom.edu/capstone_projects/30/
National Institute of Mental Health. (2022). Mental illness.U.S. Department of Health and Human Services. https://www.nimh.nih.gov/health/statistics/mental-illness
Nohr, L., Lorenzo Ruiz, A., Sandoval Ferrer, J. E., & Buhlmann, U. (2021). Mental health stigma and professional help-seeking attitudes a comparison between Cuba and Germany. Public Library of Science (PLoS) ONE, 16(2), 246501-246524. https://doi.org/10.1371/journal.pone.0246501
Ojeda, W. L., & Hurley, R. A. (2022). Kisspeptin in the limbic system: new insights into its neuromodulatory roles. The Journal of Neuropsychiatry and Clinical Neurosciences, 34(3), 190-195. https://doi.org/10.1176/appi.neuropsych.20220087
Riva, M. T., & Cornish, J. A. (2018). Ethical considerations in group psychotherapy. In M. M. Leach & E. R. Welfel (Eds.), The Cambridge handbook of applied psychological ethics (pp. 218–238). Cambridge University Press. https://doi.org/10.1017/9781316417287.012
Rooij, S. J. H., Sippel, L. M., McDonald, W. M., & Holtzheimer, P. E. (2021). Defining focal brain stimulation targets for PTSD using neuroimaging. Depression and Anxiety, 38(7), 768-785. https://doi.org/10.1002/da.23159
Wu, Z., Wang, C., Dai, Y., Xiao, C., Zhang, N., & Zhong, Y. (2022). The effect of early cognitive behavior therapy for first-episode treatment-naive major depressive disorder. Journal of Affective Disorders, 308(1), 31-38. https://doi.org/10.1016/j.jad.2022.04.008
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BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645 Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
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| Participation
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Demonstrated the following:
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| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |