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Respond to this #1 Biological Basis and Ethical/Legal Considerations of Psychotherapy

Psychotherapy teaches patients to understand, accept, or manage their emotional responses. It has a biological basis since it targets the brain’s problematic adaptations and repairs them through deliberate alteration of the meaning or relevance of an event. The therapy instills new and positive ways by disengaging and repairing maladaptive brain adaptations. As a comprehensive biological treatment, psychotherapy taps into all the biological regulations underlying complex brain responses (Javanbakht & Alberini, 2019). Patients record a re-elaboration of the whole sense of self and others as well as comprehensive, lasting, measurable physical changes in the brain.

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Cognitive-behavioral therapy, for instance, restructures the brain and establishes new neural pathways. Depressed patients reinforce negative thought pathways which influence the brain’s willingness to easily process negative information and development of cognitive distortions. Studies comparing brain activity pre and post-CBT indicates changes localized to specific frontal, cingulate, and limbic areas (Rubin-Falcone et al., 2018). Amygdala activities in the limbic systems are reduced while the dorsolateral prefrontal cortex becomes relatively more active. The effects assert the biological impact of psychotherapy.

Similar effects are registered when using eye movement desensitization and reprocessing (EMDR) to manage post-traumatic stress disorder. EMDR helps the patient to focus on trauma memory while simultaneously experiencing bilateral movements through eye movements. Landin-Romero et al. (2018) explain that EMDR recall is linked to a significant decrease in blood flow in the lateral prefrontal cortex.  Further, it increases the concentration of oxygenated hemoglobin which is correlated with clinical improvement post-treatment. By instituting changes within the superior temporal sulcus and orbitofrontal cortex, EMDR outline a vital neural mechanism and the biological basis for psychotherapy as a treatment approach.

Culture, Religion, and Socioeconomic Status

Culture plays a significant role in people’s perspectives on psychotherapy treatments. Every culture has a different view on mental health.  The majority of them are characterized by stigma where they view mental health challenges as weakness and something to hide (Tanaka‐Matsumi, 2019). The stigma makes it harder to talk openly or ask for help. Equally culture influence how people describe and feel about their symptoms. It makes it hard for some people to share emotional symptoms or physical symptoms. Failure to share all information may limit the treatment approach chosen and its effectiveness. Some cultures also believe that mental illness is a curse and a punishment and can only be managed using divine interventions and not treatments like psychotherapy.

Religion also affects a patient perspective on psychotherapy treatment. Religious beliefs make it hard for many people to initiate discussions surrounding mental health. Research shows that psychiatric disorders are seen as a supernatural phenomena or demonic possession (Ayvaci, 2017). Others see psychiatric disorders as a ‘weakness in faith’ that can be resolved through willpower rather than seeking professional help from the mental health system. An example is a survey conducted among African Americans. Most of them define themselves as fairly religious and have a prevalent belief that psychiatric disorders can be overcome by heroic striving (Ayvaci, 2017). Due to such religious beliefs, some patients avoid contacting a psychiatrist and when they do, they avoid discussing their religious concerns due to the belief that psychiatrists are not sensitive or aware of their religion. It is crucial to learn about the role of religion in access to mental health care to address any noted barriers.

Lastly, a robust relationship exists between socioeconomic status (SES) and mental health. A lower SES increases the risk of getting a mental health disorder and prolongs the duration of a mental health disorder episode (Epping et al, 2017). This is because a majority of low-SES patients have a high dropout rate from therapy due to low education levels which reduce their comprehension of the importance and advantages of psychotherapy. Low SES also increases addictive behaviors which reduces the probability of the patients choosing to maintain adaptive and pro-self-behavior (Epping et al, 2017).  Financial constraints lead to depletion of cognitive resources resulting in therapy-related irrational decision making like lack of reflective self-examination, lack of agencies to achieve therapeutic goals and to endorse adaptive behaviors.

Legal and Ethical Considerations

Individual and group therapies project a difference in legal and ethical considerations. The differences are noted in the domains of responsibility and confidentiality. While individual therapy has a one-on-one approach, group therapy has multiple clients which creates an ethical dilemma in selecting the ideal intervention that suits all the group members (Stoll et al., 2020). An intervention that suits one group member may not be relevant to other group members and the counselor has to consider an intervention that balances the needs of the group members. Unlike in individual sessions, group therapy forces the therapist to exercise judgment and consider all members in the group. Patient confidentiality is also an ethical issue because of its essentiality in creating trusting relationships. It can be easily maintained in one-on-one sessions but in group therapy, it is not guaranteed. Information presented to the therapist is also divulged to other group members making it hard to ascertain confidentiality.

Impact on Therapeutic Approaches

Individual therapies are straightforward and can be handled without contravening any legal or ethical obligations. However, group and family therapy are different. The counselor should execute one-on-one discussions with each client before joining a group to evaluate their comprehension of confidentiality issues in a group setting. Further, they should inform the group members of the “third-party rule” which asserts that any information disclosed and privy to a third party cannot be termed as privileged or private information (Stoll et al., 2020). Coming up with group policies can help the group uphold an ethical code and assume ownership especially by signing a contract that promises confidentiality. Counselors should always be conversant with ethical challenges affiliated with group sessions and make these concepts clear to their clients before initiating family or group counseling sessions.

Why Sources are Scholarly

The selected sources are scholarly because they are written by scholars with advanced degrees and credentials and with affiliation to universities hospitals or similar knowledge-based organizations. The sources have a clear scope and topic full of analytical and research-based content aimed at creating new knowledge. They are peer-reviewed and project a clear structure with a formal and technical language.

References

Ayvaci, E. R. (2017). Religious barriers to mental healthcare. American Journal of Psychiatry Residents’ Journal11(07), 11-13. https://doi.org/10.1176/appi.ajp-rj.2016.110706

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), 1-8. https://doi.org/10.1186/s12939-017-0644-5

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

Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Frontiers in psychology9, 1395. https://doi.org/10.3389/fpsyg.2018.01395

Rubin-Falcone, H., Weber, J., Kishon, R., Ochsner, K., Delaparte, L., Doré, B., … & Miller, J. M. (2018). Longitudinal effects of cognitive-behavioral therapy for depression on the neural correlates of emotion regulation. Psychiatry Research: Neuroimaging271, 82-90. https://doi.org/10.1016/j.pscychresns.2017.11.002

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

Tanaka‐Matsumi, J. (2019). Culture and Psychotherapy: Searching for an Empirically‐Supported Relationship. Cross‐Cultural Psychology: Contemporary Themes and Perspectives, 482-497. https://doi.org/10.1002/9781119519348.ch23

·  12939_2017_Article_644 Social inequalities in the utilization of outpatient psychotherapy.pdf (680.488 KB)

Respond to this #2 NRNP: 6645, Week 1 Discussion Post

The brain is a mysterious and complex organ. It can repair itself after the environment has caused emotional damage. With traumatic experiences, glucocorticoids cause the hippocampus to shut down, preventing memory linkage. With high states of arousal, the hippocampus and amygdala are dissociated, impairing learning. The hippocampus shrinks from the repeated abuse causing cell death. The hippocampus can increase in size with medications and therapy, and new neurons are reproduced. Psychotherapy aims to reconstruct the neural networks by focusing on positive memories, dealing with dysfunctional memories from trauma, and giving the patient effective methods of conquering their fears. “Both optimal development and effective psychotherapy promote an expansion of the biological substrate of the human unconscious, the right brain, which is considered the dynamic core of the implicit self. (Wheeler, 2020, p. 87).” Changes in brain areas of the brain after psychotherapy have been confirmed by MRI and neuroimaging.

The PMHNP must be mindful of the patient’s cultural identity, religion, and sexual orientation when treating with therapy. The practitioner’s responsibility is to educate themselves on the patient’s beliefs, not to offend but to treat their needs effectively. Culture forms and shapes the ideas of the individual and must be respected.

An article by Darby et al. 2020, described a therapy group started in a small town on a college campus for transgender/gender diverse patients. No other such groups existed at the time, but there was a great need. The group leaders spoke with potential members by email to maintain a therapeutic, confidential environment. The emails consisted of obtaining informed consent and group expectations. Members were pre-screened before the first meeting to evaluate for a good fit. The moderators informed each member that they had to right to leave the group, but confidentiality must be maintained to protect members from being potentially outed with their sexuality. The group’s moderators attended educational seminars and meetings to educate themselves on the transgender/gender struggles and needs of the community. It is vital that the PMHNP leave their own bias out of the group and treat without prejudice but with respect for people’s dignity and rights. The therapists started the 1st meeting by introducing themselves as cisgender, meaning they identify with their given sex at birth. The members were then comfortable enough to talk about their own identities and pronouns. Another essential point was that the person at the desk was instructed not to give out the group’s name when letting members enter the meeting to promote confidentiality.

The PMHNP must embrace the potential for ethical vulnerability. The practitioner should commit to lifelong learning and education in multi-cultural backgrounds. Member’s privacy must be respected and informed consent obtained. A goal and plan for therapy must also be initiated with the group members. All group members should be informed of the potential consequences of breaching confidentiality.

 

 

References

Darby, M. E., Bolland-Hillesheim, K., Cervantes, A., & Hitter, T. L. (2020). Ethical considerations in group work with transgender/gender diverse clients. International Journal of Group Psychotherapy70(4), 579–598. https://doi.org/10.1080/00207284.2020.1787173

Grover, S., Avasthi, A., & Nischal, A. (2022). Ethical and legal issues in psychotherapy. Indian Journal of Psychiatry64(7), 47. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_50_21

McCarthy, C. J., Bauman, S., Choudhuri, D., Coker, A., Justice, C., Kraus, K. L., Luke, M., Rubel, D., & Shaw, L. (2021). Association for specialists in group work guiding principles for group work. The Journal for Specialists in Group Work47(1), 10–21. https://doi.org/10.1080/01933922.2021.1950882

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

File  00207284.2020 (1).pdf (504.019 KB)

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