ECPY 621 – Class 3 CPT, 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  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:  with medical evaluation and management services

CPT coding cont’  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;  with medical evaluation and management services

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 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

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

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

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

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

Activity  TWISTED SISTER