“A new age of psychotherapy is dawning with the ability to document differential responses to therapy and medication through positron emission tomography (PET). electroencephalography (EEG), and functional magnetic resonance imaging (fMRI),” (Wheeler, 2020). There is supporting evidence that psychotherapy has a biological basis as evidenced by a study conducted by Stojek, McSweeney, and Rauch. His study suggests prolonged exposure therapy, used for posttraumatic stress disorder, has a biological basis. Evidence from fMRI studies show that the amygdala is overactive in its response to fearful stimuli. The ventromedial prefrontal cortex downregulates the amygdala but as evidenced on an fMRI, the ventromedial prefrontal cortex is hypoactive and therefore cannot inhibit the amygdala’s overactivity.
Culture and Religion
“People from different cultures can and will see the world from different perspectives, which in turn will bring about various interpretations of the structure of the human mind and norms of behavior; definitions of abnormality will also be shaped by the standards cultures determine for normality,” (Koç & Kafa, 2018). Koç and Kafa explain that psychology has mostly been dominated by the Western world and Europe. An analysis of six premier American Psychological Association journals showed that 95% of research used in these journals were conducted on either Americans or Europeans, (Koç & Kafa, 2018). Western psychology focuses on 10 factors: individuality, reductionism, experiment-based empiricism, scientism, quantification/measurement, materialism, male dominance, objectivity, nomothethic laws, and rationality (Koç & Kafa, 2018). The researchers explain that these concepts may be in conflict with worldviews of non-Western cultures. For example, the researchers mention that while psychotherapy is widely accepted in Argentina, religious Muslim people in Turkey have negative attitudes towards psychotherapy. Many cultures will seek traditional healing methods before seeking psychiatric assistance. As practitioners, we must be cognizant of different cultural beliefs or these patients may not receive sufficient care.”According to a meta-analysis across 65 studies conducted by Smith, Rodriguez, and Bernal (2011), at the number of cultural adaptation elements increases so does the effectiveness of treatment,” (Koç & Kafa, 2018).
Psychotherapy processes are based heavily on middle-class worldview. Because psychotherapy does not reflect the worldview of a low income client, it is possible that it is not meeting the needs of this type of client. “For example, considerable research has found that individuals from low-income backgrounds are less likely to seek formal mental health services, a fact that is especially true for those low-income individuals who identify as racial and ethnic minorities,” (Kim & Cardemil, 2012). Low income individuals typically do not have access to mental health services which means there are fewer opportunities to develop therapeutic interventions for this population. Many do not have transportation or child care but other barriers include perceived stigma and mistrust of the mental health system (Kim & Cardemil, 2012).
Ethical and Legal Considerations
One of the most important legal and ethical considerations is confidentiality. In individual therapy, the practitioner can maintain confidentiality. However, in group therapy, confidentiality cannot be guaranteed because information disclosed in the group is heard by other participants (Knauss & Knauss, 2011). “Although psychologists are bound to confidentiality by professional standards, other group members are only bound to confidentiality to the extent that they uphold their promises to protect confidentiality as a condition of participating in the group,” (Knauss & Knauss, 2011).
However, unlike group therapy where all members are clients, the ethical dilemma in family therapy is determining who is the client of focus. Gottlieb, Lasser, and Simpson mention in a few examples that it is often difficult to pinpoint one issue because there may be many issues to address with each individual and that treating them altogether may be ineffective. The authors also mention that confidentiality can also become an issue especially regarding couple’s therapy because the therapist may be obligated to keep some information from one member of the couple (Gottlieb, Lasser, & Simpson, 2008). This becomes even more complicated when regarding children. “For example, parents may be given information regarding their child but not necessarily be provided personal details that the cold would prefer to remain private, (Gotllieb, Lasser, & Simpson, 2008). The same can apply to adults in which the therapist may excuse children from therapy discussions that include adult matters, such as the couple’s sexual relationship.
With individual therapy, the therapist mostly has to consider boundaries. Bardick and Willment mention that professional boundaries can be crossed more easily with access to cellular phones and social media. It is very possible that clients can access a therapist’s information on social media and contact them which puts the therapist at risk for developing a dual relationship with the client. Cellular phones have their risks and benefits. It can allow for clients to have prompt access to their therapist. “Although therapist availability may be considered a benefit, it is also a limitation, as clients may call or send text messages any time of day or night, which infringes on the counselor’s personal time, (Yonan, Bardick, and Willment, 2011)
The sources I have provided are scholarly because the sources are evidence-based and are obtained from journals specifically pertaining to psychology and psychotherapy. All can be cited in the APA format for journal articles. I have also included a reference from the APA Handbook of Ethics in Psychology.
Gottlieb, M.C., Lasser, J., Simpson, G.L. (2008) Legal and Ethical Issues in Couple Therapy. In A.S. Gurman (Eds.), Clinical Handbook of Couple Therapy (4th ed.). Guilford Press
Kim, S. & Cardemil, E. (2013) Effective psychotherapy with low-income clients: The importance of attending to social class. Journal of Contemporary Psychotherapy, 42(1), 27-35. doi:10.1007/s10879-011-9194-0
Knauss, L.K. & Knauss, J.W. (2011) Ethical issues in multiperson therapy. In S.J. Knapp, M.C. Gottlieb, M.M. Handelsman, & L.D. VandeCreek (Eds.) APA Handbooks in Psychology (Vol.2) American Psychological Association
Koç, V. & Kafa, G. (2018) Cross-cultural research on psychotherapy: The need for a change. Journal of Cross-Cultural Psychology, 50(1), 100-115. doi: 10.1177/00220221118806557
Stojek, M.M, McSweeney, L.B., & Rauch, S.A.M. (2018) Neuroscience informed prolonged exposure practice: increasing efficiency and efficacy through mechanisms. Frontiers in Behavioral Neuroscience. https://doi.org/10.3389/fnbeh.2018.00281
Wheeler, K. (Ed.). (2020) Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing
Yonan, J., Bardick, A.D., & Willment, J.H. (2011) Ethical decision making, therapeutic boundaries, and communicating using online technology and cellular phones. Canadian Journal of Counseling and Psychotherapy, 45(4), 307-326. Retrieved from https://files.eric.ed.gov/fulltext/EJ956975.pdf