Peer Responses

Responding to Nicole Marie Galloway

Hello,

Thank you for your insightful post. Your post’s thorough examination of how biological, cultural, and socioeconomic factors influence psychotherapy is commendable; it makes a compelling point about the need for cultural adaptation in psychotherapy. Indeed, the integration of culturally adapted interventions, such as cognitive behavioral therapy (CBT), has been effective in a variety of groups (Huey et al., 2023). This aligns with my view that therapy must be tailored to individual cultural contexts to enhance effectiveness: Peer Responses.

Further, drawing on a different perspective from Hall et al.’s (2019) study, it is worth noting that culturally adapted psychotherapies improve therapeutic results, indicating that they also respect cultural identity and make therapy much more relatable and successful for clients. Notably, this article states that culturally sensitive treatment brings about better engagement in therapy, especially in areas with stigma toward mental health. Accordingly, these findings support your argument on the need for culturally competent care in psychotherapy.

References

Hall, G. C. N., Kim-Mozeleski, J. E., Zane, N. W., Sato, H., Huang, E. R., Tuan, M., & Ibaraki, A. Y. (2019). Cultural adaptations of psychotherapy: Therapists’ applications of conceptual models with Asians and Asian Americans. Asian American Journal of Psychology, 10(1), 68–78. https://doi.org/10.1037/aap0000122

Huey, S. J., Park, A. L., Galán, C., & Wang, C. X. (2023). Culturally responsive cognitive behavioral therapy for ethnically diverse populations. Annual Review of Clinical Psychology, 19(1), 51–78. https://doi.org/10.1146/annurev-clinpsy-080921-072750

Responding to Godfrey G. Joroh

Hello Godfrey,

Great work with your post. It gives a thought-provoking discussion on the biological basis of psychotherapy and ethical/legal considerations in therapy modalities. Your explanation of the role of neuroplasticity in psychotherapy, primarily through CBT, is compelling. This neurobiological evidence that psychotherapy can mold and form brain regions like the prefrontal cortex and amygdala lends a valuable dimension to how therapy works at a physiological level, as stated by Cammisuli and Castelnuovo (2023).

I will further this argument by including additional research by Manthey et al. (2021), which elaborates on how psychotherapies induce changes in brain activity related to symptom relief and long-term improvements in emotional regulation. This article supports the point that psychotherapies have long-lasting biological effects, especially in treating anxiety and depression. It further strengthens the concept of shared neural pathways between psychotherapy and psychopharmacology, as you have discussed, highlighting the enduring biological influence of therapeutic interventions.

References

Cammisuli, D. M., & Castelnuovo, G. (2023). Neuroscience-based psychotherapy: A position paper. Frontiers in Psychology, 14(14). https://doi.org/10.3389/fpsyg.2023.1101044

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/10.1080/20008198.2021.1929025

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Nicole Marie Galloway

Psychotherapy possesses a biological foundation, encompassing hormonal, neurological, and epigenetic alterations. Some findings are well-established, including the role of cortisol and alterations in specific brain regions (Fischer & Zilcha-Mano, 2022); however, areas such as BDNF levels and broader biological markers exhibit inconsistent results (Piotrkowicz et al., 2021). The perspectives on the value of psychotherapy treatments are significantly shaped by cultural, religious, and socioeconomic factors. These factors influence individual perceptions of mental health, the willingness to seek therapy, and the efficacy of therapeutic interventions (Wheeler, 2020, Chapter 1).

Psychotherapy frequently requires cultural adaptation to enhance its effectiveness. Western psychotherapies may not be universally applicable in non-Western contexts owing to variations in cultural values, beliefs, and practices. Culturally adapted interventions, including culturally adapted cognitive-behavioral therapy (CBT), have demonstrated efficacy among diverse populations (Naeem et al., 2023). The integration of religious and spiritual beliefs into psychotherapy may improve its effectiveness, particularly for individuals with significant connections to religion.

Religious and spirituality-based therapies demonstrate greater efficacy than non-religious treatments in enhancing symptoms and functioning within mental health care (Bouwhuis-Ban Keulen et al., 2023). Socioeconomic status (SES) has a substantial impact on an individual’s perception of the value and efficacy of psychotherapy treatments. Improved mental health outcomes and a more favorable view of psychotherapy typically correlate with higher socioeconomic status.

One study indicates that patients with higher socioeconomic status, defined by higher parental education, occupational prestige, and advantageous race/ethnicity, demonstrate significantly improved outcomes in coordinated specialty care for first-episode psychosis relative to those with lower socioeconomic status. The advantages of CSC were significant for high-SES patients, while the remaining 75% of patients experienced negligible benefits (Bennett & Rosenheck, 2020).

The legal and ethical considerations in group and family therapy are notably distinct from those in individual therapy, largely owing to the complexities involved in managing multiple participants (Gehart, 2024, Chapter 5). Maintaining confidentiality in group and family settings presents greater challenges, necessitating explicit agreements among all participants, a process that is more straightforward in individual therapy. Informed consent encompasses complexities, including the elucidation of confidentiality limitations and the delineation of participant roles (Gehart, 2024, Chapter 5). Ethical guidelines underscore the importance of managing group dynamics and conflicts, necessitating proficiency in conflict resolution and systems theory.

The emergence of telehealth has introduced complexities, particularly concerning professional boundaries and jurisdictional matters, requiring meticulous navigation (Gehart, 2024, Chapter 5). The distinctions impact therapeutic methodologies, with individual therapy emphasizing tailored care, whereas group and family therapy necessitate the management of interactions and confidentiality among participants (Gehart, 2024, Chapter 5). Professional standards develop to respond to these complexities, ensuring ethical practices and adapting to changes such as telehealth, which affects accessibility and confidentiality (Gehart, 2024).

In conclusion, for psychotherapy to work, it’s important to understand how it works biologically while also being able to react to cultural, religious, and socioeconomic factors. These changes are necessary to get the best therapeutic results for a wide range of individuals (Gehart, 2024). There are also unique ethical and legal challenges that the field has to deal with. This is especially true in group and family therapy, where privacy and agreement issues are more complicated.

With the rise of telehealth, things get even more complicated, and therapists have to stick to strict ethical standards and professional limits (Gehart, 2024). As psychotherapy changes, it is still important to consider all of these distinct factors into account in order to provide ethical, effective care that is tailored to each client and treatment setting.

References

Bennett, D., & Rosenheck, R. (2020). Socioeconomic status and the effectiveness of treatment for first-episode psychosis. Health services research. https://doi.org/10.1111/1475-6773.13606.Links to an external site.

Bouwhuis-Ban Keulen, A. J., Koelen, J., Eurelings-Bontekoe, L., Hoekstra-Oomen, C., & Glas, G. (2023). The evaluation of religious and spirituality-based therapy compared to standard treatment in mental health care: A multi-level meta-analysis of randomized controlled trials. Psychotherapy research: journal of the society for Psychotherapy Research, 1–14. https://doi.org/10.1080/10503307.2023.2241626.Links to an external site.

Fischer, S., & Zilcha-Mano, S. (2022). Why does psychotherapy work and for whom? hormonal answers. Biomedicines, 10. https://doi.org/10.3390/biomedicines10061361.Links to an external site.

Gehart, D. R. (2024). Mastering competencies in family therapy: a practical approach to theories & clinical case documentation (4th ed.) [e-book]. Cengage Learning. https://mbsdirect.vitalsource.com/reader/books/9798214348513/epubcfi/6/2[%3Bvnd.vst.idref%3Dcover-page]!/4/2[cover-page]/6[EUENFTS421YBM9Q0V869]/2%4051:41Links to an external site.

Naeem, F., Sajid, S., Naz, S., & Phiri, P. (2023). Culturally adapted CBT- the evolution of psychotherapy adaptation frameworks and evidence. The Cognitive Behaviour Therapist, 16. https://doi.org/10.1017/S1754470X2300003X.Links to an external site.

Piotrkowicz, M., Janoska-Jazdzik, M., Koweszko, T., & Szulc, A. (2021). The influence of psychotherapy on peripheral brain-derived neurotrophic factor concentration levels and gene methlyation status: a systematic review. Journal of Clinical MEdicine, 10. https://doi.org/10.3390/jcm10194424.Links to an external site.

Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: a how-to guide for evidence-based practice (3rd ed.) [e-book]. Springer Publishing . https://mbsdirect.vitalsource.com/reader/books/9780826193896/epubcfi/6/2[%3Bvnd.vst.idref%3Dx00_Cover]!/4/2/2%4051:47Links to an external site.

Bennett, D., & Rosenheck, R. (2020) This source is published in Health Services Research, a distinguished peer-reviewed publication. The writers are likely associated with academic or research institutes, enhancing the study’s credibility. The paper analyzes the correlation between socioeconomic status and treatment efficacy, employing stringent research methodologies characteristic of academic studies.

Bouwhuis-Ban Keulen, A. J., et al. (2023) – This work, published in the Psychotherapy Research magazine, is a multi-level meta-analysis of randomized controlled trials, demonstrating a significant degree of academic research through extensive data synthesis and analysis. These strategies are conventional in scientific research focused on enhancing understanding in mental health treatment.

Fischer, S., & Zilcha-Mano, S. (2022) – This article is published in Biomedicines, a peer-reviewed publication, indicating it has been subjected to thorough professional scrutiny. The study investigates the factors behind psychotherapy efficacy, addressing scientific questions using hormonal discoveries, characteristic of academic research.

Gehart, D. R. (2024) – This textbook, published by Cengage Learning, serves as a scholarly resource for academics, particularly beneficial for students and instructors in family therapy. It offers a systematic methodology for competences and clinical documentation, demonstrating extensive research and proficiency in this field.

Naeem, F., et al. (2023) – This peer-reviewed study on culturally adapted CBT, published in The Cognitive Behaviour Therapist, contributes to scholarly conversation on psychotherapy adaptations. It encompasses the development of frameworks and evidence, essential for both practitioners and scholars.

Piotrkowicz, M., et al. (2021) – This systematic review, published in the Journal of Clinical Medicine, investigates the biochemical effects of psychotherapy, reflecting rigorous scientific effort due to its systematic approach and peer-reviewed status, therefore enhancing the medical science literature.

Wheeler, K. (2020) – This book, published by Springer Publishing, serves as a guide for evidence-based practice in psychotherapy, establishing it as a scholarly resource due to its extensive content, authoritative authorship, and application in academic contexts.

Each publication adheres to academic standards via peer review, esteemed publishing platforms, authoritative authorship, and stringent research procedures, enhancing their reputation and authority within their respective fields.

Article Explanations.pdf

Godfrey G. Joroh

Main Discussion Post:

Biological Basis of Psychotherapy and Ethical/Legal Considerations of Psychotherapy

Biological Basis of Psychotherapy

While psychotherapy is often viewed as psychological or social in nature, evidence shows that it has a biological foundation. Like psychopharmacology, psychotherapy produces therapeutic effects by causing some changes to the brain (Javanbakht & Alberini, 2019); specifically, it can produce changes in brain structure and function through mechanisms such as neuroplasticity.

For example, studies have shown that cognitive-behavioral therapy (CBT) influences brain regions associated with emotional regulation, such as the prefrontal cortex and amygdala (Beauregard, 2022). This, in turn, helps reduce anxiety and depression symptoms. This neurobiological evidence suggests that psychotherapy may share common neuronal pathways with psychopharmacology, which also affects brain activity to alleviate psychological symptoms.

Cultural, Religious, and Socioeconomic Influences on Psychotherapy

Culture, religion, and socioeconomic status can affect a person’s perception of psychotherapy and its perceived value. In this case, cultural stigma towards mental illnesses can influence how individuals view psychotherapy; in cultures where mental illnesses are perceived and accepted like medical conditions, psychotherapy might be recognized as a crucial intervention as opposed to cultures where mental illnesses are stigmatized (Tanaka-Matsumi, 2022). Besides, cultural norms around mental health treatment vary widely; some cultures favor spiritual or community-based healing over Western psychological therapies.

Religion, like culture, influences how individuals view and perceive the causes and treatments for mental health issues, and this influences whether they see psychotherapy as an appropriate or necessary intervention. For example, religions that perceive mental illnesses as spiritually related as opposed to medical-related might view psychotherapy as unnecessary and might prioritize spiritual interventions.

Lastly, socioeconomic factors influence an individual’s access to psychotherapy. Evidence shows that getting the right psychotherapist and starting the sessions can be overwhelming and costly. Getting help from recognized therapists can be expensive, and this creates a financial barrier, especially for people from low-income communities; this, in turn, can lead to disparities in mental health treatment, where those with fewer resources are less likely to receive the benefits of psychotherapy (Chan, et al., 2024).

Legal and Ethical Considerations in Therapy Modalities

Legal and ethical considerations play a critical role in determining the nature and boundaries of therapeutic practices in various settings. While the fundamental principles of ethical therapy, such as confidentiality, informed consent, and respect for client autonomy, remain the same, their application differs in individual, group, and family therapy due to the distinct dynamics and challenges posed by each modality.

In individual therapy, confidentiality is straightforward. The therapist is mandated with the central responsibility of protecting the client’s privacy, except in cases where doing so poses a risk to the individual or is required by law (e.g., reporting child abuse). However, in group therapy, confidentiality becomes more challenging due to the shared nature of the sessions. In such sessions, multiple participants are often involved, and while the therapist has the responsibility of upholding confidentiality, there is no guarantee that the other members involved would do the same; this increases the risk of breaches, especially in cases where the parties involved have differing opinions.

In family therapy, the challenge is even greater. This is because therapists must ensure that the rights and privacy of each family member are respected, especially when dealing with sensitive family issues or high-conflict situations. For example, if one family member shares a confidential issue, it is the role of the therapist to know whether it is necessary to reveal it to other family members and whether doing so will solve or escalate the issue.

Besides, when dealing with families, the therapist must decide who the client is. In this case, the client could be an individual member or the whole family. Doing this helps to determine who owns the therapeutic process and who is entitled to confidentiality.

Informed consent is another critical ethical and legal requirement in therapy. In individual therapy, informed consent is usually obtained from the client alone; it ensures that the client understands the nature of the session, the goals to be achieved, the method to use, risks, and benefits. It also involves clarifying the client’s right to withdraw from the therapy at any time. However, in group sessions, obtaining consent is more complex.

This is because, in addition to consenting to the treatment provided by the therapists, they must also consent to the group process, which might entail sharing personal information with others. In such a case, as a therapist, I would ensure that all members are aware of the potential risks of participation, such as the possibility of emotional discomfort or the unintended sharing of sensitive information.

Besides, I would remind and emphasize that I lack control over how members interact outside the group setting. In family therapy, obtaining consent might be challenging; this can be especially in situations where the therapist is working with minors or families in crisis. In such a case, the therapist must ensure that all family members understand the purpose of the therapy and the potential benefits involved.

These legal and ethical differences in group, family, and group sessions would affect my therapeutic approach. In this case, during individual therapy, I would take a client-centered approach where I would be more focused on the client’s internal experiences and personal growth. In group therapy, I would spend more time establishing ground rules for confidentiality, creating a safe and supportive group environment, and navigating group dynamics.

I would be more adaptive and respond to the group needs as a whole rather than individual needs. Lastly, in family therapy, I would strive to understand the dynamics of the family I am dealing with, such as roles, communication patterns, and power imbalances. This would enable me to address ethical dilemmas that might come up during the session.

References:

Beauregard, M. (2022, April 1). Functional neuroimaging studies of the effects of psychotherapy. Dialogues in Clinical Neuroscience, 16(1). https://doi.org/10.31887/DCNS.2014.16.1/mbeauregard

Chan, J. K., Marzuki, A. A., Vafa, S., Thanaraju, A., Yap, J., Chan, X. W., . . . Schaefer, A. (2024, April 26). A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during COVID-19: unearthing the potential role of economic concerns and financial strain. BMC Psychology, 1. https://doi.org/10.1186/s40359-024-01715-8

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological models of psychotherapy. Frontiers, 13(2019). https://doi.org/10.3389/fnbeh.2019.00144

Tanaka-Matsumi, J. (2022, August 12). Counseling across cultures: A half-century assessment. Journal of Cross-Cultural Psychology, 53(7-8). https://doi.org/10.1177/00220221221111810

Supporting Sources and Rationale:

Beauregard, M. (2022, April 1). Functional neuroimaging studies of the effects of psychotherapy. Dialogues in Clinical Neuroscience, 16(1). https://doi.org/10.31887/DCNS.2014.16.1/mbeauregardLinks to an external site.

Why it is scholarly: This article is published in Dialogues in Clinical Neuroscience, a well-regarded, peer-reviewed journal in the field of clinical neuroscience. Beauregard’s research explores the neurobiological effects of psychotherapy using functional neuroimaging techniques. It contributes to the growing body of evidence on how psychotherapy affects brain functioning. The article is peer-reviewed, providing credible and scientifically backed data, and it addresses the biological underpinnings of psychotherapy, making it highly relevant to the discussion of the biological basis of psychotherapy.

Chan, J. K., Marzuki, A. A., Vafa, S., Thanaraju, A., Yap, J., Chan, X. W., & Schaefer, A. (2024, April 26). A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during COVID-19: Unearthing the potential role of economic concerns and financial strain. BMC Psychology, 1. https://doi.org/10.1186/s40359-024-01715-8Links to an external site.

Why it is scholarly: This article is published in BMC Psychology, an open-access, peer-reviewed journal that publishes high-quality research on psychological topics. The systematic review presented by Chan et al. examines the relationship between socioeconomic factors and mental health during the COVID-19 pandemic. It focuses on emotional disorders and the role of financial strain. As a peer-reviewed publication, it is evidence-based, methodologically rigorous, and directly relevant to understanding how socioeconomic factors influence emotional well-being and, by extension, the practice of psychotherapy.

Javanbakht, A., & Alberini, C. M. (2019). Editorial: Neurobiological models of psychotherapy. Frontiers, 13(2019). https://doi.org/10.3389/fnbeh.2019.00144Links to an external site.

Why it is scholarly: This editorial is published in Frontiers in Behavioral Neuroscience, a peer-reviewed academic journal that publishes research related to the neurobiology of behavior. Javanbakht and Alberini’s editorial discusses neurobiological models of psychotherapy, focusing on the brain mechanisms involved in therapeutic processes. The editorial provides insights from leading scholars in the field of neuroscience and psychotherapy, offering evide