ECPY 621 – Class 3

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

2. Overview • Review last week • Activity • CPT coding • Case Conceptualization • Activity

3. 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

4. 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

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

6. Hierarchy of Conservative Diagnoses • Most Favorable • Major Depressive Disorder • Bipolar I Disorder • Middle Ground • Alcohol Dependence • Panic Disorder • Specific or Social Phobia

7. Hierarchy of Conservative Diagnoses • Middle Ground – cont’ • Obsessive- Compulsive Disorder • Anorexia Nervosa • Substance Dependence – other than alcohol • Borderline Personality Disorder

8. Hierarchy of Conservative Diagnoses • Least Favorable • Schizophrenia • Antisocial Personality Disorder • Dementia Due to HIV Disease • Dementia of the Alzheimer’s Type

9. 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

10. 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 CPT coding cont’

11. Seligman – Chapter one • Determinants of Tx outcome • Therapist related • Client related • Therapeutic alliance • Treatment Variables

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

13. Do a Client Map • Number • Timing • Mediations needed • Adjunct services • Prognosis

14. 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

15. 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

16. Psychotherapeutic Approaches • Psychoanalysis • Psychodynamic • Behavior Therapy • Cognitive Therapy • No Treatment

17. Other approaches – Berman • Styles • Assumption based • Symptom based • Interpersonally based • Developmentally based • Diagnosis based

18. Case Conceptualization 1. 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

19. Case Conceptualization 4. 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

20. Case Conceptualization 9. 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

21. Case Conceptualization 10. 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

22. Case Conceptualization 12. Strengths, assets: 13. Counseling goals: Long and Short Term (Measurable) 14. Counseling techniques, strategies, interventions

23. Activity • TWISTED SISTER