Biological Response

 Respond to this discussion post by providing an additional scholarly resource that supports or challenges their position, along with a brief explanation of the resource. 

Biological Basis for Psychotherapy

         Our approach, comprehension, treatment modalities, research, as well as avenues in which we seek to improve upon current findings, in relation to psychotherapy, have evolved. In the words of Dr. Lara Boyd, “It is an amazing time to be a Brain Researcher studying Neuroplasticity,” (Boyd, 2017 ). By definition, a psycho is defined as a crazy or mentally unstable person; therapy is defined as a treatment intended to relieve or heal a disorder. Therefore, psychotherapy is a method used to treat or heal mentally unstable people. During my learning journey/education, I have begun to realize how complex this term is. There are several Paradigms used to explain the origin and function/process of psychotherapy. I may be considered biased due to having a science background. I can honestly say that I look for a biological basis in everything. “Some of the goals of psychotherapy include the reduction of symptoms, improvement of functioning, relapse prevention, increased empowerment, and achievement of the specific collaborative goals set with the patient,”  (Wheeler, 2020, p. 12). The Biomedical/Allopathic model explains that a patient’s problems are greatly attributed to symptoms exhibited (Wheeler, 2020 ). Symptoms this model believes should be treated with psychotropic medications which are designed to “target specific symptoms in an effort to eliminate or reduce the symptoms,” (Wheeler, 2020, p.12 ).  “Psychotherapy mediates the reintegration and connection of neural networks that have become maladaptively linked to overwhelming events,” (Wheeler, 2020, p.57). Chapter two in Wheeler provides us with detailed descriptions, explanations, and evidence-based data that goes into great detail about mental illness, different treatments, and how the brain is affected.  Therefore, it is extremely difficult to argue when discovering ways to conduct and improve psychotherapy, a biological basis is not considered. I believe Dr. Siegel said it best when he offered a contemporary explanation based on the perspective of symptoms (Wheeler, 2020).  Siegel states “mental health emerges from integration in the brain /body in relationships (Wheeler, 2020, p.19 ). The biophysiological model further explains that psychotherapists should keep in mind that mental illness is a chemical imbalance and should be treated as such (Wheeler, 2020 ). This model further explains that mental illness is an imbalance of neurotransmitters in the brain (Wheeler, 2020). This further supports the theory that psychotherapy has a biological basis. 

Culture, Religion, and Socioeconomic Influences    

        Throughout this program we have been asked to identify and address cultural biases we may have that “will” interfere with our ability to be empathetic,  productive, and successful therapists. Anyone who states they have no biases is in serious denial. Unconsciously/consciously we are taught to be biased via family, the media, social media, friends, teachers, pastors, etc. As we mature and have our own experiences, relationships, and interactions with others we begin to form our own opinions. If we are not careful we will allow what we have been taught to precede any independent thought we may have ourselves. I believe it takes someone who is not afraid to be critical of themself, asks and answers tough questions honestly, is a critical thinker, is not afraid to have family/friends disagree, and is not afraid of how they will be viewed by others as long as they are doing what they believe is right. I believe we, PMHNP Students, possess most if not all of these qualities. I do not, cannot, believe that we would have been placed on this path if we did not. “The challenge for a practitioner is twofold: learning to respect diversity and developing sensitivity to some of the issues faced by members of other cultures,” (Nichols & Davis, 2020, p.32). Nichols & Davis, 2020 suggest making connections after working hours to develop cultural sensitivity. Therapists should be aware of and prepared to address the unique subcultures within family units (Nicols & Davis, 2020). 

      Taking a client’s religious background into consideration is among the duties/guidelines of a therapist’s ethical practice (Trusty, et al., 2021).  Results from a religious study, Religious Microaggressions in Psychotherapy, report at least 39% of their participants experienced religious microaggression during psychotherapy (Trusty, et al., 2021 ). The most frequent listed was minimization and/or avoidance of religious issues (Trusty, et al., 2021).  The religious groups represented in this study were Muslims, Hindus, Buddhists, Christian, and Jewish (Trusty, et al., 2021). Muslims and Buddhists experienced the highest religious microaggression among the group (Trusty, et al., 2021).  Religious microaggressions make the working alliance weak, which results in poor outcomes. This goes back to being aware of one’s biases.  

    Socioeconomic status measures a person’s ability to obtain resources/prestige compared in relation to others and is usually measured by wealth, a marker measured on a social hierarchy, and level of education and/or occupation (Finegan, et al., 2018). It is obvious that those with limited resources are more likely to view psychotherapy as an option, not a necessity.  People who are worried about how they are going to pay their rent/mortgage, feed and clothe their family, pay their household bills, provide transportation, health care, etc., are less likely concerned about seeking psychotherapy. “Fryers, Melzer, and Jenkins demonstrated that the prevalence of anxiety and depression problems is higher in socially disadvantaged populations. Wilkinson and Pickett reported a strong correlation between inequality of income and mental illness rates across developed countries worldwide,” (Finegan, et al., 2018, p.1). Knowing this, a scary thought emerged. Those who desperately need psychotherapy will probably never have the opportunity to step foot in an office due to socioeconomic barriers. This is heartbreaking and I pray that I will be able to witness a change in my lifetime.

        Legal and Ethical Considerations

 Nichols & Davis, 2020, pose two very important questions for therapists to assist with staying within the guidelines of legal and ethical dimensions; “What would happen if the client or important others out about my actions? Can you talk to someone you respect about what you are doing (or considering)?” (Nichols & Davis, 2020, p. 34). I can imagine the level of difficulty it must take for novice therapists to stay abreast of legal and ethical guidelines. I would definitely seek mentors, current literature with guidelines ( i.e., The Ethics Code of the American Psychological Association), and other viable resources to assist me with my transition from Novice to Advanced Beginner, Competent, Proficient, and finally Expert PMHNP. I have read literature as well as asked Professionals about the time frame for this transition. The responses were generally the same; it takes 10-15 years to complete this cycle. 

         During group therapy, the therapist must establish who his/her clients are and conduct therapy sessions as such. Reiterate to everyone involved that although you would like everyone to benefit from the sessions, your ultimate goal/obligation lies within ensuring that your clients benefit from the sessions and their lives improve (Nichols & Davis, 2020, pp. 24-25 ).  During group therapy, it is easy to lose awareness of this. The therapist must exhibit control of the room, navigate the order of conversations, ensure each speaker is shown respect, and ask anyone disrupting therapy to the point of stagnation, hostility, etc., to leave the room (Nichols & Davis, p.24). You may need to address the individual separately to determine how to assist the individual with expressing his/her feelings in a healthy manner. This way they will benefit from therapy and sessions will be productive. If it is impossible to reason with this individual, you may need to ask that he/she not return or refer the group to someone with more experience. Therapists must also keep in mind the Oath taken to uphold the privacy, confidentiality, and privileged communication of the client ( Sori & Hecker, 2015, p. 451). Similar rules apply to individual therapy. There is no chance of a session being interrupted by family members. Therapists being in control of the room still applies. Sessions will be counterproductive if respect, trust, guidelines, progress, and direction are not implemented. Privacy, confidentiality, and privileged communication should be practiced with individual therapy as well.

Therapists choose different approaches to therapy for several reasons.  Family/Group therapy members offer and receive additional support. Therapeutic alliances are broadened and collectively there are shared goals that yield improvement (Sori & Hecker, 2015).  “Being in a group fosters the development of communication abilities, social skills, and results in individuals being able to accept criticism from others,” (Sori & Hecker, 2015, p. 452 ). Clients may be less reluctant to indulge in dialogue about personal feelings and experiences during individual therapy. Scheduling follow-ups, referrals, and appointments are less complex. It is possible that therapists have the ability to measure the success/progress of sessions with more ease. The challenge is remaining ethically and legally loyal to each individual. If you find this difficult you should refer the client(s) to someone else. My goal is to choose a path that will be productive/beneficial for each client. This will not always be possible, therefore my goal is to accept my limitations, welcome corrective criticism, and critique myself when possible.