Week One Discussion: Biological Basis and Ethical/Legal Considerations of Psychotherapy
Recognizing psychotherapy as the biological treatment alternative to psychopharmacological treatment for mental health disorders has been up for debate for many years historically according to research (Manthey et al, 2021). Current technological advancements have innovatively integrated Telepsychiatry for online psychotherapy counselling services that have evolved into mental healthcare services ever since the COVID-19 pandemic posing legal and ethical concerns in Telepsychiatry (Pierce et al, 2022). Although there are a multitude of psychotherapy approaches utilized as an alternative to psychopharmacological treatment to manage psychiatric conditions, it is important to understand as a PMHNP student if there is a biological basis for psychotherapy (Wheeler, 2020). For this discussion, I will consider whether psychotherapy has a biological basis and analyze how legal and ethical considerations vary in individual, family, and group therapy clinical settings.
Biological Basis of Psychotherapy
Conceptually understanding the paradigm of the biological basis of psychotherapy requires identifying the inherent multifactorial changes in the brain’s neurodynamic functioning impact on the psychopathological responses to stressful and traumatic stimuli (Manthey et al, 2021). Characteristically, this concept is controversial thus, it is further explained by the biophysical aspect in the theory and practice of psychotherapy dealing with the element of mind-body as a unified entity notable in the biological cycle of circadian rhythm signalling (somatic) automatic and (biophysical/psychological) nonautomatic control (Manthey et al, 2021). Reiterating the notion of this theory which denotes that the premise of psychotherapy in the essence of the biophysical mind generates biofeedback from inherent and innate neuronal electrical pathway communication systems in response to internal or external antagonistic variants of stress is key (Manthey et al, 2021).
A prime example of this theory is substantiated by heritable genetic changes from traumatizing life encounters such as neglect, and sexual, emotional, and physical abuse experienced during early childhood research has shown that potentiates an epigenetic response inducing psychiatric symptomology and disorders for victims (Wheeler, 2020). According to compounding evidence from research analysis of psychotherapy states, it is clinically effective as a modifier of the biological psychosomatic maladaptive responses to chronic medical/psychiatric disorders, stress, relapse, and remittent traumatic episodes that induce an altered state of the biochemical messaging network in the brain (Manthey et al, 2021). Essentially, psychotherapy mediates these neuronal biological reactions in the brain, thus research findings suggest that are most vulnerable to exposure to stressful and traumatizing experiences by structurally deregulating mechanisms of neural inhibition (Manthey et al, 2021). Furthermore, the biological psychodynamics of psychotherapy are scientifically known to deactivate manifestations of neuronal dysfunction by transposing messenger molecules that encompass relevant structures located in the thalamus, hypothalamus, corpus callosum, amygdala, and cerebellum (Manthey et al, 2021).
Particularly, changes in the prefrontal cortex of the brain are vital in disrupting the dopamine modulation of cognitive control hence thereby being influential in impulse inhibition, attention, cognitive reactivity, adaptability, and prospective memory (Manthey et al, 2021). Psychotherapy has been proven to enable extreme psychopathological benefits in the treatment of mental health problems such as generalized anxiety disorder, posttraumatic stress disorder, obsessive-compulsive disorders, and major depression (Manthey et al, 2021). Primarily, psychotherapy can serve the central role in modifying maladaptive behavioral responses through cognitive behavioral therapy (CBT) and (PDT) Psychodynamic Therapy (Wheeler, 2020). Ultimately the biological basis of psychotherapy is deemed instrumental in the biological approach utilized to disinhibit the cognitive distortion of negative thought processes and the innate biological instincts cultivated by incidences of stressful adversities experienced throughout the lifespan (Wheeler, 2020).
Cultural, Religious, and Socioeconomic Influence on Psychotherapy Treatments
Psychosocially factors that influence integral decision-making are instinctively sculpted by social and cultural environmental and societal norms (Nichols & Davis, 2020). Primarily, psychosocial interrelationship dynamics of an individual or group’s religious, cultural beliefs, and socioeconomics are predetermining factors that play a key role in being impressionable on their perspectives, value system, misconceptions, and overall lifestyle choices (Shah et al, 2021). Therefore, without any preconceived notion, a PMHNP must be cognoscente of how an individual’s lifestyle choices involve the complexities of social determinants associated with their cultural/religious beliefs, and socioeconomic resources may increase their susceptibility to mental healthcare disparities (Wheeler, 2020). Culturally, for example, the stigmatization affiliated with mental illness (represents having a curse or hexed in some cultures), homosexuality, HIV/AIDS, and drug addiction have been known as an underlying deterrent of societal norms (Stuart & Ward, 2018). This may influence the prominence of those who are ostracized avoiding methods of psychotherapeutic treatment to the detriment of their overall emotional, psychosocial, physiological, and psychological well-being (Shah et al, 2021). Religious influences are significantly important to understanding how individuals’ perception of psychotherapy correlates with their beliefs (Stuart & Ward, 2018). For instance, those patients whose life may be heavily reliant on the belief in divine/supernatural intervention of worship may not seek psychotherapy but conform to spiritual counsel through church leadership and prayer (Stuart & Ward, 2018).
Muslims and Christians are some typical examples of religious groups who may obey the religious principles of God being the ultimate healer of their indiscretions making psychotherapy an obsolete treatment option (Stuart & Ward, 2018). Furthermore, findings relative to the issues associated with cost-efficient barriers to access psychotherapy-related care are commonly experienced by individuals considered to be in the lower-income bracket versus those who are in a higher socioeconomic class (Shah et al, 2021). Additionally, studies have shown that the probability of the likelihood of the misconception of psychotherapy being influenced by an individual’s knowledge deficit on treatment efficacy, socioeconomic, religious, and cultural dynamics is high in some communities as unique barriers impeding optimal mental healthcare outcomes (Shah et al, 2021). Theoretically, this is evident in the principle of the nature versus nurture concept that accounts for the innate and inherent biopsychosocial and environmental conditioning that subconsciously permeates all dimensions of our lives that impact pivotal choices to resist or receive psychotherapy (Wheeler, 2020).
Legal and Ethical Considerations for Group and Family Therapy that Differs from Individual Therapy
Considerations for the legal and ethical standards of psychiatric care among groups, families, and individuals differ characteristically in the realm of evidence-based psychotherapy practices (Nichols & Davis, 2020). Each of these classifications of therapy settings illustrates methods of treatment designated to facilitate informed consent and confidentiality agreements that a provider and participants are legally and ethically bound to abide by (Kivlighan et al, 2020). Unlike group and family therapy involves where consumers have intrapersonal and interpersonal issues discussed in settings amongst multiple individuals that elicit a sense of community, thus it differs from individual therapy which focuses only involves one individual and the provider (Kivlighan et al, 2020). A provider must ensure that group, family, and individual treatment goals are met individually and collectively, which may pose challenges when multiple members are involved (Nichols & Davis, 2020). This can become a complicated process more so in family and group therapy than individual therapy. For instance, when the group/family therapy focus is diverted to the sole interest of an individual client and not moderated properly by the provider treatment is counterproductive (Kivlighan et al, 2020).
Data from a meta-analysis research study uncovered findings that empirically indicate mutual behavioral influences are more prominent among group and family membership settings than in individual therapy relative to the nature of participation and attendance patterns (Kivlighan et al, 2020). The element of mutual influence of family and group membership is obliviously irrelevant in individual therapy (Kivlighan et al, 2020). Educating members on the risks and benefits of group, family, and individual therapy is the sole responsibility of the clinician to establish a therapeutic milieu that reinforces standards of care which include nonmaleficence (no harm), confidentiality, and trust (Nichols & Davis, 2020). Ethically, confidentiality concerns present differently in group/family therapy settings versus individual therapy. Primarily, these concerns revolve around the aspect of a provider’s inability to guarantee the nondisclosure of shared information being maintained by a family or group member in group and family therapy sessions or a stranger if Telepsychiatry is used (Nichols & Davis, 2020).
Therefore, further obligating the clinician to ensure that terms, conditions, and confidentiality agreements with online and in-person consultations are adhered to and not breached to protect the best interest of the group and/or individual (Nichol & Davis, 2020). Breached treatment agreements from group membership dynamics can, directly and indirectly, impact levels of treatment outcomes, such as frequent absenteeism, subtle or overt deliberate acts of antagonizing, disrespectfulness, and dismissive behaviors according to research (Kivlighan et al, 2020). Intentionally being proactive in ensuring nonmaleficence (not harm) by prioritizing what is in the best interest of the consumer the provider must conduct individual consultations to provide an overview/reinforcement of the terms and conditions of the group, family, and individual psychotherapy (Kivlighan et al, 2020).
Legal and Ethical Considerations Impact on Therapeutic Approaches
Fundamentally, as a PMHNP adhering to the code of ethics is an integral component of facilitating clinical approaches to a group, family, and individual psychotherapy (Wheeler, 2020). Substantiating treatment modalities proven by evidence-based practice to enhance the efficacy of psychiatric treatment increases the probability of sustaining a therapeutic milieu (Manthey et al, 2021). Particularly, as a provider being committed to not being complicit in restricting patients’ rights to refuse psychiatric care if they are deemed legally responsible to do so in non-emergent and emergent circumstances is paramount (Nichols & Davis, 2020). Leading by example in avoiding any promotion of conflicts of interests is an ethical and legal obligation of a mental healthcare provider to not violate patients’ rights and be subjected to revocation of professional licensure as a PMHNP (Wheeler, 2020). Therefore, acquiring and adhering to the institutional psychotherapy policies and guidelines as a PMHNP is imperative to conduct high-quality clinical practice efforts in mental healthcare that are also legally and ethically abiding according to governing State regulations (Nichols & Davis, 2020).
Prioritizing, all standards of care that illustrate the mindfulness of the risk factors associated with social determinants of care involving a person’s religious, cultural, socioeconomic background, and knowledge base will foster moral grounding of how this may influence their perspectives, biases on psychotherapy treatment (Wheeler, 2020). It is vital to make sure patients understand that informed consent is a legally binding contract that holds them accountable for acknowledging the terms and conditions of their psychiatric treatment that also have consequences for nonadherence to those terms (Wheeler, 2020). Moreover, it is vital that as an aspiring PMHNP student I advocate, educate, and mitigate social determinants of barriers to access equitable mental healthcare for patients across the lifespan that will optimize high-quality patient outcomes (Wheeler, 2020).
Conclusion
Overall, being cognoscente of how the biological framework of psychotherapy impacts inherent and innate maladaptive responsiveness to adverse life experiences is crucial to facilitating group, family, and individualized psychiatric therapy services (Wheeler, 2020). This will all enable the PMHNP to address the perspectives and religious, cultural, and socioeconomic influences that impact a group, family, or individual’s options for psychotherapy to effectively mitigate their barriers to psychiatric care (Wheeler, 2020). Therefore, it is equally imperative for a PMHNP to establish and sustain a therapeutic milieu while considering the legal and ethical concerns associated with group/family therapy versus individual therapy dynamics (Nichols & Davis, 2020).
References
Kivlighan, D. M., Aloe, A. M., Adams, M. C., Garrison, Y. L., Obrecht, A., Ho, Y. C. S., Kim, J. Y. C., Hooley, I.W., Chan, L., & Deng, K. (2020). Does the group in group psychotherapy matter? A meta-analysis of the intraclass correlation coefficient in group treatment research. Journal of Consulting and Clinical Psychology, 88(4), 322–337. https://doi.org/10.1037/ccp0000474
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/10.1080/2008198.2021.1929025
Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2022). Pre-COVID-19 deterrents to practicing with videoconferencing telepsychology among psychologists who didn’t. Psychological Services, 19(1), 157–166. https://doi.org/10.1037/ser0000435Links to an external site.
Shah, N., Walker, I. F., Naik, Y., Rajan, S., O’Hagan, K., Black, M., Cartwright, C., Tillmann, T., Pearce Smith, N., & Stansfield, J. (2021). National or population-level interventions addressing the social determinants of mental health – an umbrella review. BMC Public Health, 21(1), 2118. https://doi.org/10.1186/s12889-021-12145-1Links to an external site.
Stuart, J., & Ward, C. (2018). The relationships between religiosity, stress, and mental health for Muslim immigrant youth. Mental Health, Religion & Culture, 21(3), 246–261. https://doi.org/10.1080/13674676.2018.1462781
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.