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Psychotherapy a Biological Basis

Psychotherapy a modality of treatment that may be used alone or is often used in conjunction with pharmacotherapy.  The therapist encourages the client to improve psychopathologic conditions (e.g. bipolar, anxiety, depression, schizophrenia spectrum, post-traumatic stress disorder) and functional impairment through a focus on the therapeutic relationship; the patient’s attitudes, thoughts, affect, and behavior; and social context and development.   Psychotherapists are licensed providers which include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training (Wheeler, 2018). The PMHNP must understand psychotherapy and the biological basis of psychotherapy, and explain how culture, religion, and socioeconomics might influence one’s perspective of the value of psychotherapy treatments.

Biological Basis of Psychotherapy

Studies have provided significant information regarding psychotherapy as a biological treatment that crosses major psychiatric disorders which may normalize and/or reorganize neural functioning, therefore, leading to symptom improvement (Prosser et al., 2016).  Over the last couple of decades, neuroscience research has identified the genetic, epigenetic, anatomical, circuitry, and functional bases of behavior manifestations. Research has shown that the brain changes during life via processes of neurogenesis and neuroplasticity for better or worse (Gilbert & Kirby, 2019).  The free-energy principle states the brain is constantly adapting to the conditions of the environment in which we live.  There are many models of psychotherapy and controversies for and against the evidence in favor of specific models (Prosser et al., 2016).  For example, behavioral therapies of posttraumatic stress disorder (PTSD) show how prolonged exposure therapy impacts the neural circuits related to the PTSD used in conjunction with neurobiological enhancements may improve effectiveness.

Culture, Religion and Socioeconomic Influences on Psychotherapy

Psychotherapy involves building a trusting relationship for clients to feel comfortable sharing intimate details of their life such as beliefs, attitudes, family history, and cultural values.  However, clients are not always forthcoming with such personal information.  There are many reasons why the client may conceal information from the therapist.  The client may conceal information due to fear of judgment by the therapist, the client’s perception of the therapeutic relationship, disapproval, or reactions of the therapist. As the PMHNP it is important to be culturally diverse and aware of the client’s cultural orientation. The client’s inability to open up, engage, and share vital information about themselves can significantly impact client outcomes.

Religion may play an important role in the client’s treatment.  Religion may cause a conflict of values or beliefs and maybe the reason for psychotherapy.  Research has shown that many clients also seek religion and faith-based communities for support.  Studies suggest that religion may influence psychotherapy treatment among clients with a higher religious commitment, leading to a positive association between culture and improved outcomes.  As a provider, it is important to be sensitive when addressing religious issues (Arpey et al., 2017).

Research suggests that individuals of lower socioeconomic (SES) are at a higher risk of affecting their health and care received.   Socioeconomic factors such as lack of education, resources, insurance, and assess to care may significantly impact the treatment.  There is also the social, educational, and economic disparities that exist between clients and clinicians.  Also, there is evidence of stereotyping and bias among healthcare providers, and in the health care system (Arpey et al., 2017).

In conclusion, as the PMHNP it is important to create a welcoming environment for the clients and an atmosphere of embracing vulnerable populations with various life experiences, perspectives, and cultural backgrounds.  The therapist’s culture and beliefs also influence the treatment process.  Clients who conceal more will benefit less from therapy as compared to other clients who engage, are open, and share intimate information.  Therefore, an understanding of the culture, religion, and socioeconomic factors for the individuals you are caring for is important to enhance psychotherapy treatment outcomes.   The PMHNP must be aware of their attitude and biases and how the client perceives they are being treated due to low SES and identify and reduce the barriers to care.  The therapist should also engage in reflection and professional development; as well as continuously examine their own beliefs.  The ultimate goal is patient-centered care and positively influence the psychotherapy process.