Response to discussion

Discussion1

The biological basis of psychotherapy is an emerging field that links mental health treatments with neuroscience. Research in neuroimaging, neurotransmitters, and genetics reveals that psychotherapy significantly impacts brain structure, function, and biochemistry (Weingarten & Strauman, 2014). Psychotherapy influences neuroplasticity, neurotransmitter activity, and hormonal regulation, alleviating symptoms and fostering long-term changes that enhance emotional resilience and psychological well-being. These changes in understanding neuroplasticity with psychotherapy have enhanced the understanding of how psychedelics, such as ketamine, are helping to change the dynamics of psychotherapy.  In my last clinical, I was able to witness the change in how people were able to interact with their therapist after receiving ketamine therapy.  Ketamine is reported to change the brain's neuroplasticity for up to three weeks after treatment. 

Culture, religion, and socioeconomic factors are critical in shaping how individuals experience and respond to psychotherapy. Cultural values influence perceptions of mental health, the willingness to seek therapy, and the type of treatment that feels acceptable (Midlarsky et al., 2012). For instance, some cultures view mental illness through a spiritual lens, which can affect whether psychotherapy is seen as a legitimate or stigmatized approach to healing. Therapists must be culturally competent, recognizing cultural norms, communication styles, and family dynamics to provide relevant and respectful treatment. Moreover, differences in coping mechanisms, such as reliance on community support versus individual therapy, can also shape how psychotherapy is perceived and its effectiveness.

Religion is another important factor in psychotherapy, as individuals may integrate their spiritual beliefs into their understanding of mental health. Some clients may seek therapy that aligns with their spiritual practices, such as incorporating prayer or meditation, while others may view psychotherapy as conflicting with their religious values. In certain faith traditions, emotions like anger or grief may be seen as moral or spiritual issues, influencing how clients express and address these feelings in therapy. Socioeconomic factors, such as financial limitations, lack of insurance, and geographic barriers to access, further complicate the therapeutic process. Economic stressors like unemployment or housing instability can exacerbate mental health conditions; I see this daily at the inpatient mental health hospital where I work.  Most of our patients are homeless or have recently lost their jobs. 

Legal and ethical considerations in group and family therapy differ notably from those in individual therapy. Confidentiality is a critical concern in group therapy, as therapists must balance protecting each participant’s privacy while fostering open communication among members. The risk that group members may disclose private information outside the group makes it essential to establish clear confidentiality guidelines and mutual respect among members. Legally, group therapists must also consider the potential for liability if one member's behavior or disclosures affect another, requiring careful management of group dynamics. In individual therapy, confidentiality rests solely with the therapist, though specific exceptions—such as harm to self or others—can override this principle.

Family therapy involves unique legal and ethical complexities due to the multiple parties involved. Consent becomes a crucial issue, especially when working with minors or vulnerable individuals, requiring that all participants are informed and agree to the therapy. In some cases, family members are forced to attend therapy for legal reasons, which influence the therapy’s dynamics. Family therapists must remain neutral to avoid conflicts of interest, particularly in high-conflict situations like divorce or custody disputes. Legally, family therapists must be aware that their work can be subpoenaed in court, especially when sensitive issues like abuse or custody are involved. These considerations require therapists to establish clear boundaries, obtain informed consent from all parties, and ensure that the therapeutic process does not exacerbate existing conflicts or legal issues.

Discussion 2

The human relationship with clients is the medium through which the work of therapy is done in a therapeutic process. Levels of family functioning are an important consideration in determining appropriate clinical and educational intervention approaches for patients. Any number of clinicians can be involved in the treatment of a psychiatric disorder. Whenever more than one clinician is involved in treatment, there should be regular exchanges of information, it is essential to recognize treatment bias and to avoid contentious turf battles that put the patient in the middle of such conflict. For example, psychiatrists trained primarily as psycho-therapists may prescribe medications more reluctantly than those more oriented toward biologic psychiatry. Conversely, those who view medication as the preferred intervention for most psychiatric disorders may be reluctant to refer patients for psychotherapy. The orientation of the treating psychiatrist or other clinician can influence the therapeutic process during combination treatment.

     It is always important for the therapist to determine a patient’s suitability for group psychotherapy by gathering a great deal of information in a screening interview. In one- person therapy, the psychiatrist provides individual psychotherapy and medication treatment. Interpersonal psychotherapy delivered in a group format has many potential benefits in comparison with individual treatment for the most part. For example, a group format based on members’ diagnostic similarity can help alleviate patients’ concerns that they are the only one with a particular psychiatric disorder, while offering a social environment for patients who are isolated, withdrawn, or disconnected from others.

     Patients sometimes prefer having a counselor of their same race or gender, research however, does not show that racial/gender matching improves outcomes. Refugees do not easily engage in psychotherapeutic relationships. Front line physicians are however frequently consulted. Refugees prefer community-based care, as opposed to specialist or in hospital care, but are less likely to accept mental health services compared to non-migrant populations. Culture impacts patterns of coping, help seeking, adherence to treatment, emotional expression as well as relationships with clinicians. Culture and language interpreters are integral to help clinicians understand the patient’s context.

     There are a number of effective biological and psychological treatments for mental health such as antidepressant medications and Interpersonal Therapy (IPT), Cognitive Behavioral Therapy (CBT), and Behavioral Activation (BA) Therapy respectively. Studies demonstrate that the results of combined therapy are superior to either type of therapy used alone with the following outlined benefits- improved medication adherence, better monitoring of clinical status, decreased number and length of hospitalizations, decreased risk of relapse, and improved social and occupational functioning.  The term pharmacotherapy-oriented psychotherapy refers to the combined approach. The use of psychotropic drugs, in combination with psychotherapy, has become widespread. It has become the standard of care for many patients seen by psychiatrists. A major indication for using medication when conducting psychotherapy, particularly for those patients with major mental disorders such as Schizophrenia or bipolar disorder, is that psychotropics reduce anxiety, relieve distress and hostility. This improves the patient’s capacity to communicate and to participate in the psychotherapeutic process. Drugs that decrease anxiety facilitate cognitive understanding, can improve attention, concentration, memory, and learning in patients who suffer from anxiety disorders.  For a good therapeutic approach, the use of pharmacologic agents augments psychotherapy.