Week One Discussion: Biological Basis and Ethical/Legal Considerations of Psychotherapy

Week One Discussion: Biological Basis and Ethical/Legal Considerations of Psychotherapy

The question of whether psychotherapy possesses a biological foundation has been a subject of historical debate in research (Manthey et al., 2021). Recent technological advancements have introduced Telepsychiatry, offering online psychotherapy counseling services, which have become essential in mental healthcare, especially since the COVID-19 pandemic. However, this innovation has raised legal and ethical concerns (Pierce et al., 2022). As a PMHNP student, it is crucial to explore the potential biological basis of psychotherapy and understand how legal and ethical considerations differ across various therapeutic settings: individual, family, and group therapy.

Biological Basis of Psychotherapy

The concept of the biological basis of psychotherapy involves understanding the complex changes in the brain’s neurodynamic functioning in response to stressful and traumatic stimuli (Manthey et al., 2021). This idea is controversial but can be clarified by considering the biophysical aspect, which emphasizes the mind-body connection. This connection is evident in the biological cycle of circadian rhythm signaling (somatic) automatic and (biophysical/psychological) nonautomatic control (Manthey et al., 2021). According to this theory, psychotherapy operates by generating biofeedback from the brain’s innate neuronal electrical pathways in response to internal or external stressors.

Personal Leadership Philosophies

Research has shown that traumatic life experiences, such as neglect and various forms of abuse during early childhood, can lead to heritable genetic changes, triggering epigenetic responses that result in psychiatric symptoms and disorders (Wheeler, 2020). Psychotherapy has been proven effective in modifying maladaptive responses to chronic medical/psychiatric disorders, stress, and traumatic events, thereby altering the brain’s biochemical messaging network (Manthey et al., 2021). It achieves this by mediating neuronal biological reactions in the brain, particularly in areas like the prefrontal cortex, which plays a crucial role in impulse inhibition, attention, and cognitive control (Manthey et al., 2021). Psychotherapy has demonstrated its effectiveness in treating mental health problems like generalized anxiety disorder, posttraumatic stress disorder, obsessive-compulsive disorders, and major depression (Manthey et al., 2021). It does so by addressing maladaptive behavioral responses through approaches like cognitive behavioral therapy (CBT) and psychodynamic therapy (PDT) (Wheeler, 2020).

Cultural, Religious, and Socioeconomic Influences on Psychotherapy Treatments

Psychosocial factors, including culture, religion, and socioeconomic status, significantly influence individuals’ perspectives and choices regarding psychotherapy (Nichols & Davis, 2020). Cultural beliefs and norms shape how individuals prefer to receive mental healthcare, emphasizing the importance of culturally competent care. Religion also plays a significant role, as some individuals may opt for religious interventions over psychotherapy. For example, Muslims and Christians may believe in divine healing and turn to spiritual leaders and prayer rather than psychotherapy (Stuart & Ward, 2018). Additionally, socioeconomic status affects access to mental healthcare services, with lower-income individuals facing more barriers to psychotherapy (Shah et al., 2021).

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

Legal and ethical considerations differ when providing therapy in group, family, and individual settings. In individual therapy, confidentiality is paramount, and therapists must adhere to HIPAA regulations to protect the patient’s privacy (Nichols & Davis, 2020). However, in group and family therapy, confidentiality becomes more complex. Group members are collectively responsible for maintaining confidentiality, and this may be challenging due to the presence of multiple individuals (Nichols & Davis, 2020). Additionally, Telepsychiatry raises concerns about the security of shared information.

Therapists must ensure that terms and conditions of therapy, including confidentiality agreements, are clearly communicated and upheld (Kivlighan et al., 2020). Ethical concerns such as nonmaleficence and trust are critical in group, family, and individual therapy settings (Nichols & Davis, 2020). Balancing the needs of individual clients within a group or family context can be challenging but is essential for effective treatment (Kivlighan et al., 2020).

Legal and Ethical Considerations’ Impact on Therapeutic Approaches

As a PMHNP, adhering to ethical codes and legal standards is vital for providing quality psychiatric care (Wheeler, 2020). Prioritizing evidence-based treatment modalities and ensuring informed consent are essential aspects of ethical practice (Manthey et al., 2021). Providers must also be cautious not to restrict patients’ rights to refuse psychiatric care when legally permissible (Nichols & Davis, 2020). Avoiding conflicts of interest and following institutional policies and guidelines are crucial to maintaining professionalism and adhering to legal regulations (Wheeler, 2020).

Recognizing the impact of cultural, religious, and socioeconomic factors on patients’ perspectives and choices is essential for providing equitable care (Wheeler, 2020). Educating patients about the terms and conditions of their treatment, including informed consent, is crucial, as is addressing barriers to mental healthcare access (Shah et al., 2021).

Conclusion

Understanding the potential biological basis of psychotherapy is essential for providing effective mental healthcare in various settings. Cultural, religious, and socioeconomic factors significantly influence individuals’ perspectives on psychotherapy. Legal and ethical considerations differ between individual, family, and group therapy, impacting confidentiality and treatment approaches. As a PMHNP, it is crucial to navigate these complexities while ensuring ethical and legal standards are upheld, ultimately optimizing patient outcomes (Wheeler, 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.