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Biological Basis, Ethical and Legal Considerations of Psychotherapy
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The Intersection of Biology and Psychotherapy
Psychotherapy interventions aimed at altering behavior, emotions, and thought patterns
influence brain function, including neural activities and blood flow (Fumero et al., 2022)). The
study of the changes in brain activity constitutes the intersection of psychotherapy and biology.
Neuroimaging techniques, including PET and fMRI technology, aid in the non-invasive probing
of these brain activities. For instance, in a meta-analysis involving four OCD studies (n=77),
Picó-Pérez et al. (2023) reported changes in the IFG and the dmPFC brain areas following
treatment using CBT (p.5). Picó-Pérez et al. (2023) also report positive correlations between
BOLD signals with the bilateral Rolandic operculum region following CBT for social anxiety
disorder (p.6). Neuroimaging results also strengthen evidence of effective therapy strategies
against maladaptive behaviors. For instance, Fumero et al. (2022) reported higher activation of
the left middle frontal gyrus and the LIFG for CBT involving self-verbalization versus CBT
involving breathing as the responses for phobia of small animals.
Impacts of Culture, Religion and Socioeconomics
Using in-depth interviews with ten psychotherapists who had encountered at least one
refugee client, Asfaw et al. (2020) reported misconceptions about psychotherapy and a mismatch
of what to expect from therapy sessions. For instance, one respondent reported that a client could
not understand how they could open up to a stranger (therapist) who would then help them
overcome their mental challenge (Asfaw et al., 2020, p.5). Religious influences of psychotherapy
also included unrealistic expectations for therapy, such as the therapists "making the djinn
(harmful spiritual being)" disappear (Asfaw et al., 2020, p.5). Socioeconomic ability could also
lead to reduced optimism to therapeutic interventions. Potts and Henderson (2020) report that
individuals from lower socioeconomic groups may express therapeutic pessimism due to poorer
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treatment outcomes influenced by low social determinants of health. Additionally, individuals
from lower socioeconomic groups who may be familiar with a mental illness may express
pessimism about therapy after poor response to treatment by friends with mental health
challenges (Potts & Henderson, 2020, p.4).
Legal and Ethical Considerations
In family therapy, one ethical challenge is maintaining confidentiality of the information
shared in individual therapy sessions during the family therapy sessions. For instance, when
individual sessions change to family sessions, the therapist may be faced with the challenge of
maintaining confidentiality of information obtained during individual sessions which they
believe might be useful for the advancement of the family system’s interests. On the other hand,
the traditional client-therapist relationship involves fewer complexities of confidentiality, where
therapist may divulge information given in confidence if they perceive danger to themselves or
others. In group therapy, psychotherapists have a larger legal responsibility of maintaining
confidentiality among the group members compared to individual therapy.
Impacts of the Ethical and Legal Considerations
When individual therapy sessions change into family therapy sessions, the therapist must
obtain consent from the client to share the information in the family session. Otherwise,
confidentiality must be maintained, as is the case with individual clients. The consent is obtained
after the information is given, and the client and the therapist define its limits. Group
psychotherapists will emphasize the group members to maintain confidentiality within the group
and clarify the consequences of breach of confidentiality, such as removal from the group or
discontinuation from the group therapy.
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References
Asfaw, B. B., Beiersmann, C., Keck, V., Nikendei, C., Benson-Martin, J., Schütt, I., & Lohmann,
J. (2020). Experiences of psychotherapists working with refugees in Germany: a
qualitative study.GBMC Psychiatry,G20, 1-8. https://doi.org/10.1186/s12888-020-02996-0
Fumero, A., Marrero, R. J., Olivares, T., Rivero, F., Alvarez-Pérez, Y., Pitti, C., & Peñate, W.
(2022). Neuronal Activity during Exposure to Specific Phobia through fMRI: Comparing
Therapeutic Components of Cognitive Behavioral Therapy.GLife,G12(8), 1132.
https://doi.org/10.3390/life12081132
Picó-Pérez, M., Fullana, M. A., Albajes-Eizagirre, A., Vega, D., Marco-Pallarés, J., Vilar, A., ...
& Soriano-Mas, C. (2023). Neural predictors of cognitive-behavior therapy outcome in
anxiety-related disorders: a meta-analysis of task-based fMRI studies.GPsychological
Medicine,G53(8), 3387-3395. https://doi.org/10.1017/S0033291721005444
Potts, L. C., & Henderson, C. (2020). Moderation by socioeconomic status of the relationship
between familiarity with mental illness and stigma outcomes.GSSM-Population
Health,G11, 100611. 10.1016/j.ssmph.2020.100611
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Appendix
In Asfaw et al. (2020) the authors work in psychology, medicine and anthropology departments
in universities in Ethiopia (Asfaw) and Germany (the rest of the co-authors). The lead author also
co-authored another article on spirituality and mental illness. The paper was based on qualitative
research findings using academic language and targeting psychotherapists.
The authors in Fumero et al. (2020) work in clinical psychology department, health science
department and the neuroscience department of different universities in Spain including La
Laguna University and the European University of Canary Islands. The lead author also co-
authored more than 50 peer-reviewed articles on mental health. The study results were based on
an experimental design comparing responses in three conditions.
The authors in Picó-Pérez et al. (2023) are affiliated with the psychology, psychiatry and
neuroscience in Portugal, Spain and UK. The lead author (Picó-Pérez) co-authored 46 peer-
reviewed scholarly studies on emotion regulation, mental health and CBT. The findings were
based on a meta-analysis of tasks monitored using fMRI.
Potts and Henderson (2020) are affiliated with the institute of neuroscience and psychology in
London. Potts is involved in 10 scholarly studies involving mental health and behavioral
analyses. The article used academic language and the conclusions were based on empirical
analysis of secondary data.
