29 Mar BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY
Many studies have found that psychotherapy is as effective as psychopharmacology in terms of influencing changes in behaviors, symptoms of anxiety, and changes in mental state. Changes influenced by psychopharmacology can be explained by the biological basis of treatments. But how does psychotherapy achieve these changes? Does psychotherapy share common neuronal pathways with psychopharmacology?
Psychotherapy is used with individuals as well as in groups or families. The idea of discussing confidential information with a patient in front of an audience is probably quite foreign to you. However, in group and family therapy, this is precisely what the psychiatric-mental health nurse practitioner does. In your role, learning how to provide this type of therapy within the limits of confidentiality is essential.
For this Discussion, you will consider whether psychotherapy also has a biological basis and analyze the ways in which legal and ethical considerations differ in the individual, family, and group therapy settings
Respond to this discussion post below by providing an additional scholarly resource that supports or challenges their position, along with a brief explanation of the resource.
Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective on the value of psychotherapy treatments. 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 therapy. Support your rationale with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources. (Scholarly Peer-reviewed article with the past 5 years only)
Discussion Post: BIOLOGICAL BASIS AND ETHICAL/LEGAL CONSIDERATIONS OF PSYCHOTHERAPY
Main Discussion Post-PSYCHOTHERAPY
Introduction
In real life, both Psychotherapeutic and psychopharmacologic interventions have been exploited for their advantages in psychological practice. While the latter addresses the mechanistic understanding of brain functions by framing specific questions, the former (psychotherapy) examines the richness of complex clinical and individual behavior and history (Javanbakht, & Alberini,2019). Having a holistic knowledge and understanding of the biological bases of psychological disorders, human brain-mind functions, as well as their maladaptive
responses, and identifying scientific approaches to assess how psychotherapy can help psychopathologies would significantly transform the approaches to mental health and diseases.
Increasingly, psychiatric practice and nursing conferences as well as nursing publications have over the years focused more on psychopharmacology than they have on psychotherapy. Psychopharmacology today is seen as the primary and immediate solution for various disorders (Drukarch et al., 2020). The situation keeps exacerbating with the influx of pharmaceutical companies promoting their products by paying and giving free lunch and dinner to nurses to share their latest research and products. In addition, consumer demand for a quick fix has contributed to the centrality of medication as the solution to mental health problems. However, evidence-based research (EBR) has found that not all patients are helped by medication, and the 50% compliance rates and somewhat lower efficacy rates suggest that drug therapy is not enough.
Biological Basis of Psychotherapy
Yes, psychotherapy to some extent has a biological basis and association particularly because it is a comprehensive personalized/individualized intervention that doesn’t target only one or two receptors, modulators, or neurotransmitters but encompasses all the biological regulations underlying complex brain
responses(Javanbakht, & Alberini,2019). Indeed research evidence has suggested that Emotion Regulation Therapy (ERT) changes brain resting-state functional connectivity (Scult et al., 2021). It is therefore a little wonder that its threatment outcome is reelaboration of the whole senses of self, through new learning and new experiences that encompass cognitive, emotional, and internal regulation processes. Successful therapies produce comprehensive, lasting, measurable physical changes in the brain. Psychotherapy does holistic biological work on brain deformities and malfunctioning.
It is interesting to note that the most important consideration for positive patient outcomes is the level of therapeutic relationship the healthcare giver is willing to have with his or her client, and not the model or technique employed. On this note, it is safe to say that seeing mental disorders as purely biologically inclined and threatening via chemical manipulation as the answer may assuage our own anxiety and end up keeping us in the dark about the person we (psychiatric nurses) are threatening. Our practice as psychiatric nurses and caregivers has choices of treatment modality and each choice we go for determines how we see mental illness, and what we initially say, do, or approach the illness. Our choices go a long way to improve treatment outcomes (Cameron et al., 2023).
Again EBR has found out that nurses’ or psychiatric trainees’ session-to-session state of mindfulness, instead of their general trait mindfulness, temporally led to greater client symptom reduction (Li et al., 2023). This suggests that building a patient-centered care and or relationship prior to treatment is essential and inevitable.
Socioeconomic and sociocultural factors affecting access to psychotherapies
Although monumental progress has been achieved in the development of evidence-based psychotherapies for quite a number of mental diseases there is still a greater number of socioeconomic and sociocultural issues that are militating psychotherapeutic interventions (Fonagy & Luyten, 2021). One of these barriers is the unavailability of psychotherapeutics for the vulnerable who form a greater percentage of the population. In addition, attitudinal behaviors such as people seeing psychotherapies as pro-rich and pro-highly educated are other factors that affect quality mental health. The introduction of e-mental health in the last two decades or so was expected to fill some of these gaps in access to psychotherapies. Unfortunately, the majority of our population is digitally and socioculturally disadvantaged, and minority groups remain underrepresented in studies of e-mental health and effective uptake of e-health (Leech et al., 2019).
Analyzing how legal and ethical considerations differ in Individual, Family, and Group therapy.
One fundamental thing worthy of note for psychiatric nurses and other practitioners is the recognition that the rights of patients with mental illness (PWMI) are par with the fundamental rights of every other human being and need to be clearly observed as psychiatric patients belong to a vulnerable group from evaluation, treatment, and research perspectives. In order for healthcare practitioners to achieve any precision in health intervention and outcomes, it is imperative that ethical, legal, and social issues regarding treatment be it psychopharmacology or psychotherapy are considered paramount (Raspa et al., 2020).
It is therefore important that in practice, nurses base their practice on the principles of informed consent, privacy and security of the patient, return of results, and vulnerable populations. That being said, a practitioner is legally bound to hold a patient’s health information in high confidentiality. He or she is also bound to seek to safeguard the security of such information. It is also the ethical responsibility of the practitioner to protect and respect the privacy of his or her client at all times.
Regarding informed consent, studies have suggested that the same can be solicited directly from the patient or his or her legally authorized representative or an immediate family member (Raspa et al., 2020). Studies have revealed that in all forms of therapeutic contact, the psychologist has an obligation to provide potential clients with the information required to make an informed decision to undergo treatment. It is also the ethical responsibility of practitioners to pay respect to the dignity of persons and the people they serve (Dever et al., 2023).
It is ethically and legally incumbent on the therapist to thoroughly explain the potential risks of leaving therapy prematurely and not continuing treatment with another professional. It is strongly advised that practitioners document correctly every step taken during the termination of therapy at the time. This is because that documentation may become the only evidence the therapist has to defend against a claim of negligence (Gross, 2006; King et al., 2023).
On the family and group front, psychiatric practitioners owe the families and the group (society) they serve professional and scientific responsibilities to increase scientific and professional knowledge as well as protect such knowledge from being misused (Dever et al., 2023). It is legally and ethically permitted for the psychiatric nurse to share patient health information with close family members with a patient’s informed consent. Both legal and ethical requirements in medical and psychotherapeutic are intertwined; such that when it comes to healthcare ethics, they are essential and not desirable requirements (Goldberg et al., 2023).
Again, in the context of family and or group psychotherapy, there are multiple considerations regarding who ought to be treated, by what means, when, and for how long. Regarding the presenting concern and
client, the psychiatrist would consider urgency, risk, prognosis, potential to benefit, the readiness of the individual group member, and so on (Gower, H. K., & Gaine, 2023).
What I mean is that everyone living with a mental disorder is a potentially medicolegal case unless proven otherwise (Bipeta 2019). Many times psychiatric nurses tend to be assurged by these elements which in the end affects treatment outcomes. However, we need not be fearful but exercise cautiousness in our practice while evaluating and treating patients having in mind the legal angle which ultimately boils down to the ethical aspects. It is paramount that the fear of being accused of “violation of rights” should not prevent us from providing legally sound ethical psychiatric care in the “best interest” of our patients (Bipeta 2019).
The following articles support the above argument on legal, and ethical considerations for individuals, families, and group therapy;
Dever Fitzgerald, T., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010). Ethical and legal considerations for Internet-based psychotherapy. Cognitive Behaviour Therapy, 39(3), 173–187.
Gross, B. (2006). When enough is enough. Annals of the American Psychotherapy Association, 9(2), 37–40.
King, B. C., Taylor, C. D., Garcia, J. A., Cantrell, K. A., & Park, C. N. (2023). Ethics and ecotherapy: The shared experiences of ethical issues in practice. Journal of Adventure Education and Outdoor Learning, 23(4), 452–471. https://doi.org/10.1080/14729679.2022.2029512Links to an external site.
Gower, H. K., & Gaine, G. S. (2023). Ethics of psychotherapy rationing: A review of ethical and regulatory documents in Canadian professional psychology. Canadian Psychology / Psychologie Canadienne. https://doi.org/10.1037/cap0000372.supp (Supplemental)
Conclusion
Psychotherapy assessments are key decision points, opening or closing individual opportunities and enabling
service providers to rationalize service offers in the context of limited resources (Faulkner et al., 2020).
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