Post an Explanation of Whether Psychotherapy has a Biological Basis 

Research supports many neurobiological differences in the brain of individuals with mental health conditions. Changes occur in chemistry, flow of neurotransmission and structure (Goodkind et al., 2015). Mental health conditions often result from less-than-ideal circumstances, such as in depression, or occurrences that vastly differ from our expectations, such as in the development of anxiety and trauma disorders. Experiences may occur consistently or as a single event. Neurobiological changes have also been linked to disorders that are primarily genetically associated, such as in schizophrenia. Whether or not an individual suffers a mental health condition due to situational/circumstantial reasons or genetic disposition, evidence suggests grey matter loss in at least three brain structures- the left and right anterior insula ad the dorsal anterior cingulate. The grey matter loss is similar in patients with varying psychiatric conditions (Goldkind et al., 2015).

Considering the presence of biological differences in brain structure among psychiatric patients, some of which are the result of experience driven psychiatric conditions, psychotherapy, a therapeutic experience, demonstrates its ability to alter brain structure. Psychotherapy involves a therapeutic exchange, validation, empathy, transference, uncovering unconscious thoughts and cognitive restructure and the opportunity for new learning. When we learn, new neurons and pathways are created, in areas of the brain such as the hippocampus, amygdala, and the frontal and temporal lobes (Malhotra & Sahoo, 2017). Magnetic Resonance Imaging showed decreased metabolism in the in the right caudate nucleus in obsessive compulsive disorder (OCD) and limbic and paralimbic hyperactivity in phobias with cognitive behavioral therapy (CBT) (Malhotra & Sahoo, 2017). In patients with post-traumatic stress disorder, psychotherapy increased lateral frontopolar cortex activity and connectivity with the ventromedial prefrontal cortex, which is associated with improvements in hyperarousal (Fonzo, et al., 2017). Just as our experiences and certain genetically associated mental health conditions have been shown to affect brain neurobiology, we can see evidence of biological changes as a result of certain forms of psychotherapy.

Explain how Culture, Religion, and Socioeconomics Might Influence One’s Perspective on the Value of Psychotherapy Treatments

Culture and religion may significantly impact access to psychotherapy and other mental health treatment. Mental health is not widely understood and accepted in all culture, therefore accessibility may not prevalent. For example, mental health is the most neglected health aspect among the Pakistani population. Many patients do not have access to psychiatric services. The incidence of schizophrenia in Pakistan has increased significantly in recent years (Nawaz, Gul, Amin, Huma, & Al Mughairbi, 2020). Studies of Asia revealed mental health problems are the result of somatic and organic factors requiring physical treatment. Mental health causes in China are believed to be the result of  an imbalance of cosmic forces, with the preferred treatment being to restore balance between interpersonal relationships, diet, exercise, and cognitions. Similar findings were identified in Nigeria (Chaudhry, Mani, Ming, & Khan, 2016).

In some cultures, religion may be associated with decreased levels of depression and anxiety. Religion is rooted in trying to understand the meaning of life. Religion provides purpose, meaning, structure and a community with which to connect. These factors can have a large positive impact on mental health, with research suggesting reduced suicide rates, alcoholism, and drug use. It is further identified that 25 % of individuals who practice religion, seek out clergy as their first line treatment for mental health (Ayvaci, 2017). Many cultures rely on religious practices for healing. Although research suggests positive outcomes, results may not be as effective and depending on beliefs, individuals may be reluctant to seek formal treatment.

Socioeconomics may restrict patients’ abilities to access care due to a lack of insurance and long wait lists through community mental health centers. Gaps may exist where some patients may have insurance, but are unable to afford copays, or although they cannot afford services, do not qualify for aid for a variety of reasons. Additionally, mental health care may not be available in rural areas without long commutes, etc. These factors lead to underserved populations for mental health care.

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 Therapies 

Legal and ethical considerations differ for group and family therapy than for individual therapy. First, informed consent is not as straight forward in group and family therapy as in individual treatment. The provider/clinician can only project the course of treatment and not fully anticipate what will transpire due to interactions of multiple individuals (Riva & Cornish, 2018). Second, confidentiality may be limited in group settings as confidentiality is strongly encouraged but may not be guaranteed. Additionally, a group facilitators/clinicians must maintain therapeutic alliance with all group members and not just one individual. This dynamic may be difficult to manage when tension evolves between group participants.

Regarding legal implications, many states have a third-party rule. This rule states that any information disclosed in the presence of a third individual is not considered privileged or private information. Each group participant should understand that, if called to testify against another group participant, an individual can be legally compelled to disclose information (Bond, 2015).

The unique characteristics of group therapy require specific skills in group techniques and ethics. Therapeutic approaches of group leaders need to consider the information presented above. Group leaders need to be skilled in establishing group norms and rules and the identified risks to confidentiality group treatment may present. Throughout therapy, group providers need to be vigilant in monitoring for issues among group participants which may threaten confidentiality of group members and thus cohesiveness of the group. It can be helpful for the group clinician to have a discussion with participants before joining the group. The facilitator should discuss group policies and norms when participants meet for the first time. Ideally, group members should agree to maintain the privacy regarding other group member’s names, circumstances, identifying details, and other information discussed during meetings. Group participants should also be educated on how to interact to maintain confidentiality, should they happen to encounter each other outside of group.

Explain Why Each of Your Supporting Sources is Considered Scholarly

A total of eight resources were utilized to support this discussion post. The supporting research used to back my thoughts are scholarly resources, except for two books. Most sources are from 2016 later, with two being published in 2015. Each publication is from an accredited source, written by authors with relevant credentials, and are based on either random controlled trials, systematic reviews, or meta analyses, which hold the highest reliability in statistical research. Please see attached for PDF versions of all articles referenced.

References

Ayvaci, E.R. (2017). Religious barriers to mental healthcare. The American Journal of Psychiatry, 11(7), 11-13. https://doi.org/10.1176/appajp-rj.2016.110706

Bond. T. (2015). Standards and Ethics for Counseling in Action (4th ed.). Sage Publications.

Choudhry, F.R., Mani, V., Ming, L.C., & Khan, T.M. (2016). Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatric Disease and Treatment, 12, 2807-2818. https://doi.org/10.2147/NDT.S111543 

Fonzo, G.A., Goodkind, M. S., Oathes, D.J., Zaiko, Y.V., Harvey, M., Peng, K.K., Weiss, E., Thompson, A.L. Zack, S.E., Mills-Finnerty, C.E., Rosenberg, B.M., Edelstein, R., Wright, R.N., Kole, C.A., Lindley, S.E., Arnow, B.A., Jo, B., Gross, J.J., Rothbaum, B.O., & Etkin, A. (2017). Selective effects of psychotherapy on frontopolar cortical function in PTSD. American Journal of Psychiatry, 174, 1175-1184. https://doi.org/10.1176/appi.ajp.2017.16091073

Goodkind, M., Eickhoff, S.B., Oathes, D.J., Jiang, Y., Change, A., Jones-Hagata, L.B., Ortega, B.N., Zaiko, Y.V., Roach, E.L., Korgaonkar, M.S., Grieve, S. M., Galatzer-Levy, D.I., Fox, P.T., & Etkin, A. (2015).  Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry, 72(4):305–315. https://doi.org/10.1001/jamapsychiatry.2014.2206

Malhotra, S. & Sahoo, S. (2017). Rebuilding the brain with psychotherapy. Indian Journal of Psychiatry, 59(4), 411-419. https://doi.org/10.4103/0019-5545.217299

Nawaz, R., Gul, S., Amin, R., Huma, T., & Al Mughairbi, F. (2020). Overview of schizophrenia research and treatment in Pakistan. Heliyon, 6(11), e05545. https://doi.org/10.1016/j.heliyon.2020.e05545

Riva, M. T., & Cornish, J. A. E. (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