ECPY 621 – Class 3CPT, Case Conceptualization, and Treatment Planning

Overview Review last week Activity CPT coding Case Conceptualization Activity

Most Valid Diagnoses by Freq. in General Population – Common Major Depressive Disorder, Single Episode Alcohol Dependence Bipolar I Disorder Schizophrenia Major Depressive Disorder Somatization Disorder Borderline Personality Disorder

Most Valid Diagnoses by Freq. in General Population – Less Common Panic Disorder with or w/o agoraphobia Dementias – Including Alzheimer’s,

Vascular, Due to HIV Infection Antisocial Personality Disorder Obsessive-Compulsive Disorder Mental Retardation Anorexia Nervosa

Most Valid Diagnoses by Freq. in General Population – Rare Learning disorders Gender Identity Disorder Tourette’s Disorder Autistic Disorder Delusional Disorder

Hierarchy of Conservative Diagnoses Most Favorable

Major Depressive Disorder Bipolar I Disorder

Middle Ground Alcohol Dependence Panic Disorder Specific or Social Phobia

Hierarchy of Conservative Diagnoses Middle Ground – cont’

Obsessive- Compulsive Disorder Anorexia Nervosa Substance Dependence – other than alcohol Borderline Personality Disorder

Hierarchy of Conservative Diagnoses Least Favorable

Schizophrenia Antisocial Personality Disorder Dementia Due to HIV Disease Dementia of the Alzheimer’s Type

CPT coding 90804

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient:

90805

with medical evaluation and management services

CPT coding cont’ 90808

Individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient;

90809

with medical evaluation and management services

Cpt2.tifCpt1.tif

Seligman – Chapter one Determinants of Tx outcome

Therapist related Client related Therapeutic alliance Treatment Variables

Do a Client Map Diagnosis Objectives of Tx Assessments Clinician characteristics Location of Tx Interventions to be used* Emphasis of Tx*

Do a Client Map Number Timing Mediations needed Adjunct services Prognosis

Interventions – Elements of Maintaining positive therapeutic alliance Providing support Providing information/education Reducing painful feelings Decreasing specific maladaptive behaviors Modifying specific misperceptions Helping put concerns in context

Emphasis Insight vs. action Directive vs. vocative Systemic vs. client centered Group vs. individual Short vs. long term Planned vs. spontaneous With vs. without homework

Psychotherapeutic Approaches Psychoanalysis Psychodynamic Behavior Therapy Cognitive Therapy No Treatment

Other approaches – Berman Styles

Assumption based Symptom based Interpersonally based Developmentally based Diagnosis based

Case Conceptualization1. Identifying data: age, sex, race, marital/family

status, school and/or job status, living situation, etc.

2. Presenting problem: client's words and from counselor's point of view; prioritize problems

3. History of presenting problem: duration of presenting problem; precipitating events for seeking counseling, (sudden or insidious), previous problem solving and resources used

Case Conceptualization4. Previous counseling or help seeking: attitudes about

that, results

5. Medical concerns: illnesses/ problems; medications

6. Alcohol and drug use

7. Social history physical, social, emotional, spiritual; support systems

8. Family history: past and present relationship with family, problems an strengths of family

Case Conceptualization9. Mental status:• affect: appropriate, blunted, constricted• judgment: intact, impaired• oriented or disoriented• thought process: intact, flight of ideas• mood: anxious, depressed• memory: intact, impaired• speech‑ normal, loud, soft, pressured • suicidal or homicidal ideation • attitude: cooperative, angry

Case Conceptualization10. Symptomatology: frequency, duration, intensity of

symptoms:

Depression as evidenced by _________________

Anxiety as evidenced by ___________________

Stress as evidenced by _____________________

11. a) Impairment in functioning: school, social relations, family, job

b) Current functioning as compared to past year

Case Conceptualization12. Strengths, assets:

13. Counseling goals: Long and Short Term (Measurable)

14. Counseling techniques, strategies, interventions

Activity TWISTED SISTER