BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645
BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY NRNP 6645
Psychotherapy and Biological Basis
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.
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.2022.04.008Links to an external site.
