The abuse inflicted on the brain from adverse experiences as discussed by Wheeler, (2020) disrupt and dysregulate the brain neural network on a cellular level.

Biological basis of psychotherapy

Traumatic events and adverse experiences as discussed by Wheeler, (2020) inflict insult on the brain resulting to disruption and dysregulation in the neural network that interferes with neurobiological genetic encoding, as well as structural changes in the brain.  The author further associated these adverse experiences as causative factors of many mental health problems and psychiatric disorders, as support by various studies on mental health disorders (Wheeler, 2020).

With advance in neuroscience, Malhotra & Sahoo, (2017) expressed in their study that psychotherapy has been identified as a therapeutic intervention for mental disorders, as it leads to structural and functional changes in the brain.  The authors also discovered in their study that using cognitive behavior therapy (CBT) for phobia treatment can decrease activity in the limbic and paralimbic areas in the brain.  For instance, the mechanism of action of CBT for phobia treatment is similar to the effect of selective serotonin reuptake inhibitors (SSRIs) when used as a treatment for phobia (Malhotra & Sahoo, 2017).   The findings identified above are suggestive of biological basis of psychotherapy.  I used the study done by Malhotra & Sahoo, (2017) because their study further explains and supports Wheeler’s notion of psychotherapy as a therapeutic intervention for mental disorders.

As a treatment intervention, psychotherapy creates awareness that enables the patient to find meaning to the feelings or symptoms of his or her mental status or mental disorder.  The patient reflects on these meanings to develop adaptive behaviors that brings wholeness and healing and achievement of emotional regulation (Wheeler, K., 2020).  In support of Wheeler’s notion, one can reflect on the study of Sousa, Pestana, and Taveares, (2019), as they discovered that broader transformations can be care effects of microchanges that occur during psychotherapy sessions.  The microchanges, according to the authors happen when a significant event has taken place during the therapy session that can impact the patient’s perception and the progress of the therapy (Sousa, Pestana, & Tavares, 2019).  Using the study by Sousa and peers, I am provided with additional information on the mechanism of action of psychotherapy.

Cultural, religious, and socioeconomic influence on our perspective on the value of psychotherapy.

Cultural competency is one of the core standards of practice for any health care personnel, including psychotherapists.  As a psychiatric mental health nurse practitioner (PMHNP), one must be cognizant of the importance of knowing one’s cultural background and how one respond when one’s cultural beliefs have been negatively challenged.  The emotional and psychological effects that patients experience when their therapists fail to acknowledge the differences in cultural beliefs interferes with the outcome of any therapy.  Even though psychotherapy has been in use worldwide, there is no model identified as ‘one-size-fit-all’ due to cultural differences.  Koc and Kafa (2019) identified this notion in the studies about the current scientific status of psychotherapy in various cultures.  The authors discussed the variations in psychotherapy models across cultural background and how the patient and his or her therapist interact based on their cultural and religious beliefs.  To present us with an example of these variations in practice, the authors discussed findings in their study relating to how the African traditional healer contacts with family members of the patient to collects information on the background of the patient.  During therapy, the patient is required to remain silent whilst the healer communicates with the “higher forces,” as verbal interactions with the patient during therapy is a hinderance to a successful outcome of the therapy.  With the Western culture and non-Western countries who have successfully adopted the psychotherapy models of the Western culture require verbal interaction between the therapist and the patient for a successful therapeutic outcome (Koc and Kafa (2019).

Religious belief of an individual can also be a determinant for participation in psychotherapy.  Koc and Kafa (2019) also discussed their findings from one of their studies about the attitude of Muslims toward psychotherapy.  The study argues that Muslims consider psychology as a secular science, so they have no confidence in it as they believe that during psychotherapy their beliefs can be analyzed and taken away from them.  For instance, Muslims in Turkey express negative attitude toward psychological services such as psychotherapy (Koc and Kafa ,(2019).  I used their study for this discussion, as Koc and Kafa systematically analyzed the studies done by others to portray the effect of how culture and religion influence patients’ participation of psychotherapy.

The socioeconomic status of a patient will also influence patient’s altitude toward psychotherapy and affect the patient’s access to adequate and effective psychotherapy.   According to Levi, Laslo-Roth, & Rosenstreich, financial constraints of an individual can affect psychotherapy, as individuals in poverty find it difficult to suppress cognitive overload created by thoughts of their economic status.  In the absence of mental clarity, these individuals are unable to accomplish decentered point of view required for behavior change for process and assimilation of thoughts, feelings, and insights experienced from therapy.  Stress is elevated in these individuals and as a result, they develop poor ability for self-regulation and cognitive flexibility resulting to inability to achieve therapeutic goals (Levi, Laslo-Roth, & Rosenstreich, 2018).   The study by Levi and peers shed light on how access to care is affected by one’s socioeconomic status.  Though therapy is available, economic inequality dictates access and outcome.

Legal and ethical aspect of group and family therapy

Psychotherapy is a psychological intervention for mental and psychological disorders.  It can be delivered in a group session with patients from different environment and background, and a family that compresses members who are most time biologically related to each other and come from the same environment.  In either settings, the therapist has a duty to provide accurate information to the members in the group.   Each member should feel safe and protected and relevant as a group member.  Irrespective of the group, the therapist has the moral obligation to provide information on risks and benefits of the group and other available options to every group member before each member is enrolled in the group.  Members should sign informed consent and given opportunity to ask questions.  Members’ confidentiality should be maintained through out the session, unless doing so endangers the life of any member of the group or the community (Blease, Lilienfeld, & Kelley,(2016).  Although other studies are available on legal and ethical issues of psychotherapy, the work by Blease, Liliefeid, and Kelley simplifies the discussion on my obligation as a therapist.

In conclusion, we should remember that providing psychotherapy can be challenging, as it takes adequate and effective practice to be skillful.   As PMHNP and a member of the patient’s treatment team, we should provide culturally competent care that is cost effective, with reduced side effects.  Patient’s safety and confidentiality always maintained whether in group sessions or not.


Blease CR, Lilienfeld SO and Kelley JM (2016) Evidence-Based Practice and  Psychological Treatments: The Imperatives of Informed Consent. Front. Psychol. 7:1170. doi: 10.3389/fpsyg.2016.01170

Koç V, Kafa G. Cross-Cultural Research on Psychotherapy: The Need for a Change. Journal of  Cross-Cultural Psychology. 2019;50(1):100-115. doi:10.1177/0022022118806577 Levi U, Laslo-Roth R, Rosenstreich E. Socioeconomic Status and

Psychotherapy: A Cognitive-Affective View. J Psychiatry Behav  Health Forecast. 2018; 1(2): 1008

Malhotra, S., & Sahoo, S. (2017). Rebuilding the brain with psychotherapy. Indian  journal of psychiatry59(4), 411–419.

Sousa, D., Pestana, A., & Tavares, A. (2019). Self-awareness, verbalization and new meanings as the  heart and soul of significant events in existential psychotherapy. Journal of Contemporary

       Psychotherapy, 49(3), 161-167. doi:

Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.

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