Evidence and research suggest that psychotherapy may be associated with a biological basis as well as epigenetic changes. According to an online article, it is argued that epigenetic studies may play a key role in the identification of biomarkers for psychopathology. Therefore, this may improve diagnosis and may open up opportunities regarding the mechanism of action of psychotropic drugs as well as psychotherapy. (Jimenez et. al, 2018)
Culture may influence one’s perspective of the value of psychotherapy in treatment because the culture elements of the relationship between the individual and clinician may be a factor. For example, if the clinician is unfamiliar with the client’s culture, consultation may need to take place. For example, for people of color who come to a white therapist or vice versa, racial differences often are “the elephant in the room” and must be addressed to enable the person to stay in treatment. Asking out of a genuine curiosity and admitting ignorance are collaborative and reduce the power imbalance in the relationship by allowing the patient to teach the clinician (Wheeler, 2014).
Religion may influence one’s perspective of the value of psychotherapy in treatment because religious themes may emerge in multiple ways in the therapeutic process. For example, the appearance of religious themes may be related to conflictual and regressive situations, defensive moves, and transferential feelings (Abernathy & Lancia, 1998).
Socioeconomics may influence one’s perspective of the value of psychotherapy in treatment in several ways. For example, various barriers that may interfere with the efforts of low-income individuals to access mental health service, resulting in fewer opportunities to investigate what works in therapeutic interventions. According to an online article, such barriers may include problems like transportation, childcare, perceived stigma and mistrust in the mental health care system, and cultural differences in help-seeking and idioms of distress (Kim & Cardemil, 2012).
References
Abernethy, A. D., & Lancia, J. J. (1998). Religion and the psychotherapeutic relationship.
Transferential and counter transferential dimensions. The Journal of psychotherapy practice and research, 7(4), 281–289.
Kim, S., & Cardemil, E. (2012). Effective psychotherapy with low-income clients: The
importance of attending to social class. Journal of Contemporary Psychotherapy, 42(1), 27–35.
Jiménez, J. P., Botto, A., Herrera, L., Leighton, C., Rossi, J. L., Quevedo, Y., Silva, J. R.,
Martínez, F., Assar, R., Salazar, L. A., Ortiz, M., Ríos, U., Barros, P., Jaramillo, K., & Luyten, P. (2018). Psychotherapy and Genetic Neuroscience: An Emerging Dialog. Frontiers in genetics, 9, 257.https://doi.org/10.3389/fgene.2018.00257
Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-
to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Discussion: Does Psychotherapy Have a Biological Basis?
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? For this Discussion, consider whether psychotherapy also has a biological basis.
Learning Objectives
Students will:
- Evaluate biological basis of psychotherapy treatments
- Analyze influences of culture, religion, and socioeconomics on personal perspectives of psychotherapy treatments
To prepare:
- Review this week’s Learning Resources.
- Reflect on foundational concepts of psychotherapy.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit!
By Day 3
Post an explanation of whether psychotherapy has a biological basis. Explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments. Support your rationale with evidence-based literature.
response
I think you bring a great socioeconomic factor to the discussion of treatment. You mentioned that race and differences in race between provider and patient can affect the treatment process. I found an article that supports your research in the problems that this can present. When a provider is not culturally competent, stereotyping occurs in areas such as cooperativeness and readiness for psychotherapy (Spoont, Sayer, Kehle-Forbes, Meis, & Nelson, 2016). Whether this is done unintentionally or not, there is need for correction. So how do we go about making the correct changes as providers to address cultural differences in way that we build on the therapeutic relationship and provide the best treatment? An article by Tummala-Narra, Letendre, Sarbu, Teran, & Villalba (2018) discusses models of multicultural practice that include items such as knowledge of the client’s culture and expectations of therapy, skills to intervene in a culturally-sensitive manner, and awareness on how cultural differences influence perceptions of the client.
I do not think it is possible to have this type of knowledge for every culture we will come into contact with. As you stated, it is important in these types of situations to admit ignorance. I believe that asking questions and creating that open and understanding line of communication between two cultures is key to a successful provider-patient relationship. Thank you for sharing this week!
Kelsey Rindels
References
Michele R. Spoont, P. D., Nina A. Sayer, P. D., Shannon M. Kehle-Forbes, P. D., Laura A. Meis, P. D., & David B. Nelson, P. D. (2017). A Prospective Study of Racial and Ethnic Variation in VA Psychotherapy Services for PTSD. Psychiatric Services, 68(3), 231–237. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ps.201600086
Tummala-Narra, P., Claudius, M., Letendre, P. J., Sarbu, E., Teran, V., & Villalba, W. (2018). Psychoanalytic psychologists’ conceptualizations of cultural competence in psychotherapy. Psychoanalytic Psychology, 35(1), 46–59. https://doi-org.ezp.waldenulibrary.org/10.1037/pap0000150
sample response 2
Your point about reducing the power imbalance in the therapeutic relationship really resonated with me. Clients already feel ashamed enough to have to seek help, so offering them some power can provide a firm foundation to a connected and trusting relationship. It is essential that we as practitioners are aware of our own cultural differences and our own ignorance when it comes to those of other backgrounds. If a client’s culture, religion, or situation is foreign to us, then it is comforting to understand that simply asking the client can make such a difference in the course of treatment. Significant differences in risk and prevalence of mental health difficulties have been reported between people of color and also in multicultural societies, further mediated by intersections with other factors such as gender and socio-economic status (Edge & Lemetyinen, 2019). No matter the differences we share, the common goal set by the client should be at the forefront of our focus.
I’d like to offer more insight about the biological impact of our future work as psychotherapists. Epigenetics refers to the chemical alterations in genes that may not alter DNA sequencing, but do have an impact on one’s thoughts and actions (Kumsta, 2019). Genetics play roles in modulating gene function, cellular differentiation, response to environmental triggers, and are modifiable and potentially reversible by psychotherapeutic interventions, thus carrying great potential in the future of mental health (Schiele et al., 2020). Just like medications impact the neurotransmitter releases in the brain, psychotherapy impacts the role of epigenetics in behavior modification. Given the evidence pointing to a transgenerational diffusion of epigenetic information, epigenetic alterations arising from successful psychotherapy might be transferred to future generations and thus contribute to the prevention of mental disorders (Schiele et al., 2020). It is empowering to know that we as practitioners can make a significant impact on our client’s treatment outcomes by the therapeutic modalities we utilize and the words we choose; other specialists in medicine can’t do that.
References
Edge, D., & Lemetyinen, H. (2019). Psychology across cultures: Challenges and opportunities. Psychology & Psychotherapy: Theory, Research & Practice, 92(2), 261–276. https://doi-org.ezp.waldenulibrary.org/10.1111/papt.12229
Kumsta, R. (2019). The role of epigenetics for understanding mental health difficulties and its implications for psychotherapy research. Psychology & Psychotherapy: Theory, Research & Practice, 92(2), 190–207. https://doi-org.ezp.waldenulibrary.org/10.1111/papt.12227
Schiele, M. A., Gottschalk, M. G., & Domschke, K. (2020). The applied implications of epigenetics in anxiety, affective and stress-related disorders – A review and synthesis on psychosocial stress, psychotherapy and prevention. Clinical Psychology Review, 77, 101830. doi:10.1016/j.cpr.2020.101830
sample response 3
I agree with your statement regarding psychotherapy and culture. When there is an African American patient who sees a Caucasian therapist there will be some hesitation due to the fact that the black patient may feel the white therapist cannot understand nor relate to what the black patient is experiencing. In order to understand the lives and dynamic of blacks, it is imperative that the therapist comprehend the forces and influences which affect their life and psychological makeup. One of the primary issues with blacks and barriers that are faced during therapy are the stereotype placed on the patient. Blacks have been excluded and minimized from being included in American society for the majority history, which is one reason behind the psychological implications for blacks (Seward, 2016). According to B. Jones and Thomas (2015), it was argued that, argue that there poses insoluble problems and that the white therapist’s efforts will be destructive to the black patient. The experience of racism has certainly contributed to emotional distress and psychological disease for African Americans. Black patients may have protected against early negative encounters with whites by suppression and denial which results in impairments of the patient’s capability to resolve the experience and leaves the patient more vulnerable to be traumatized by future encounters with whites. Becoming aware of the influence of culture and ethnicity within the material of each patients issues allow incorporation of the patients experience into the process of therapy and the content of clarification. One solution include a different approach that enables the clinician to enter the experience of individuals with cultures different from self. In the dynamic model of psychotherapy, the therapist undertakes the patients and perceives the world as the patient sees it. The problem is expressed from the patient’s perspective. This method permits increased empathy and the ability to communicate empathy to the patient (Casimir & Morrison, 2014; Ibrahim, 2017).
References
Casimir, G. J., & Morrison, B. J. (2014). Rethinking work with ‘multicultural populations.’
Community Mental Health Journal, 29(6), 547–559.
Ibrahim, F. A. (1985). Effective cross-cultural counseling and psychotherapy: A framework. The
Counseling Psychologist, 64, 134–145.
Jones, B. et al. (2015). Problems of black psychiatric residents in white training institutions.
American Journal of Psychiatry, 127(6), 798–803.
Seward, G. H. (2016). Psychotherapy and culture conflict in community mental health (2nd
Ed.). New York: Ronald Press.
Thomas, C. (2015). Different strokes for different folks. Psychology Today, September, 49–58.