The document discusses several key considerations in psychotherapy across cultures and populations. It notes that psychotherapy has a biological basis as evidenced by neuroimaging studies showing changes in brain regions involved in fear responses during PTSD treatment. However, it also acknowledges that Western psychotherapy models may conflict with non-Western worldviews. For example, religious Muslims in Turkey view psychotherapy negatively. Low-income individuals also face barriers like lack of access and perceived stigma. Additionally, the document outlines some ethical issues in different therapy settings, such as maintaining confidentiality in group therapy and determining the client focus in family therapy.

1. [From 10$/Pg] Six Premier American Psychological
[From 10$/Pg] Six Premier American Psychological Biological Basis“A new age of
psychotherapy is dawning with the ability to document differential responses to therapy
and medication through positron emission tomography (PET). electroencephalography
(EEG), and functional magnetic resonance imaging (fMRI),” (Wheeler, 2020). There is
supporting evidence that psychotherapy has a biological basis as evidenced by a study
conducted by Stojek, McSweeney, and Rauch. His study suggests prolonged exposure
therapy, used for posttraumatic stress disorder, has a biological basis. Evidence from fMRI
studies show that the amygdala is overactive in its response to fearful stimuli. The
ventromedial prefrontal cortex downregulates the amygdala but as evidenced on an fMRI,
the ventromedial prefrontal cortex is hypoactive and therefore cannot inhibit the
amygdala’s overactivity. Culture and Religion“People from different cultures can and will
see the world from different perspectives, which in turn will bring about various
interpretations of the structure of the human mind and norms of behavior; definitions of
abnormality will also be shaped by the standards cultures determine for normality,” (Koç &
Kafa, 2018). Koç and Kafa explain that psychology has mostly been dominated by the
Western world and Europe. An analysis of six premier American Psychological Association
journals showed that 95% of research used in these journals were conducted on either
Americans or Europeans, (Koç & Kafa, 2018). Western psychology focuses on 10 factors:
individuality, reductionism, experiment-based empiricism, scientism,
quantification/measurement, materialism, male dominance, objectivity, nomothethic laws,
and rationality (Koç & Kafa, 2018). The researchers explain that these concepts may be in
conflict with worldviews of non-Western cultures. For example, the researchers mention
that while psychotherapy is widely accepted in Argentina, religious Muslim people in
Turkey have negative attitudes towards psychotherapy. Many cultures will seek traditional
healing methods before seeking psychiatric assistance. As practitioners, we must be
cognizant of different cultural beliefs or these patients may not receive sufficient
care.”According to a meta-analysis across 65 studies conducted by Smith, Rodriguez, and
Bernal (2011), at the number of cultural adaptation elements increases so does the
effectiveness of treatment,” (Koç & Kafa, 2018).SocioeconomicsPsychotherapy processes
are based heavily on middle-class worldview. Because psychotherapy does not reflect the
worldview of a low income client, it is possible that it is not meeting the needs of this type of
client. “For example, considerable research has found that individuals from low-income
backgrounds are less likely to seek formal mental health services, a fact that is especially

2. true for those low-income individuals who identify as racial and ethnic minorities,” (Kim &
Cardemil, 2012). Low income individuals typically do not have access to mental health
services which means there are fewer opportunities to develop therapeutic interventions
for this population. Many do not have transportation or child care but other barriers include
perceived stigma and mistrust of the mental health system (Kim & Cardemil, 2012). Ethical
and Legal ConsiderationsOne of the most important legal and ethical considerations is
confidentiality. In individual therapy, the practitioner can maintain confidentiality.
However, in group therapy, confidentiality cannot be guaranteed because information
disclosed in the group is heard by other participants (Knauss & Knauss, 2011). “Although
psychologists are bound to confidentiality by professional standards, other group members
are only bound to confidentiality to the extent that they uphold their promises to protect
confidentiality as a condition of participating in the group,” (Knauss & Knauss,
2011).However, unlike group therapy where all members are clients, the ethical dilemma in
family therapy is determining who is the client of focus. Gottlieb, Lasser, and Simpson
mention in a few examples that it is often difficult to pinpoint one issue because there may
be many issues to address with each individual and that treating them altogether may be
ineffective. The authors also mention that confidentiality can also become an issue
especially regarding couple’s therapy because the therapist may be obligated to keep some
information from one member of the couple (Gottlieb, Lasser, & Simpson, 2008). This
becomes even more complicated when regarding children. “For example, parents may be
given information regarding their child but not necessarily be provided personal details
that the cold would prefer to remain private, (Gotllieb, Lasser, & Simpson, 2008). The same
can apply to adults in which the therapist may excuse children from therapy discussions
that include adult matters, such as the couple’s sexual relationship. With individual therapy,
the therapist mostly has to consider boundaries. Bardick and Willment mention that
professional boundaries can be crossed more easily with access to cellular phones and
social media. It is very possible that clients can access a therapist’s information on social
media and contact them which puts the therapist at risk for developing a dual relationship
with the client. Cellular phones have their risks and benefits. It can allow for clients to have
prompt access to their therapist. “Although therapist availability may be considered a
benefit, it is also a limitation, as clients may call or send text messages any time of day or
night, which infringes on the counselor’s personal time, (Yonan, Bardick, and Willment,
2011)The sources I have provided are scholarly because the sources are evidence-based
and are obtained from journals specifically pertaining to psychology and psychotherapy. All
can be cited in the APA format for journal articles. I have also included a reference from the
APA Handbook of Ethics in Psychology. ReferencesGottlieb, M.C., Lasser, J., Simpson, G.L.
(2008) Legal and Ethical Issues in Couple Therapy. In A.S. Gurman (Eds.), Clinical Handbook
of Couple Therapy (4th ed.). Guilford PressKim, S. & Cardemil, E. (2013) Effective
psychotherapy with low-income clients: The importance of attending to social class. Journal
of Contemporary Psychotherapy, 42(1), 27-35. doi:10.1007/s10879-011-9194-0Knauss,
L.K. & Knauss, J.W. (2011) Ethical issues in multiperson therapy. In S.J. Knapp, M.C. Gottlieb,
M.M. Handelsman, & L.D. VandeCreek (Eds.) APA Handbooks in Psychology (Vol.2)
American Psychological AssociationKoç, V. & Kafa, G. (2018) Cross-cultural research on

3. psychotherapy: The need for a change. Journal of Cross-Cultural Psychology, 50(1), 100-
115. doi: 10.1177/00220221118806557Stojek, M.M, McSweeney, L.B., & Rauch, S.A.M.
(2018) Neuroscience informed prolonged exposure practice: increasing efficiency and
efficacy through mechanisms. Frontiers in Behavioral Neuroscience.
https://doi.org/10.3389/fnbeh.2018.00281Wheeler, K. (Ed.). (2020) Psychotherapy for the
advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.).
Springer PublishingYonan, J., Bardick, A.D., & Willment, J.H. (2011) Ethical decision making,
therapeutic boundaries, and communicating using online technology and cellular phones.
Canadian Journal of Counseling and Psychotherapy, 45(4), 307-326. Retrieved from
https://files.eric.ed.gov/fulltext/EJ956975.pdf