ecpy 621 – class 3 cpt, case conceptualization, and treatment planning
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ECPY 621 – Class 3CPT, Case Conceptualization, and Treatment Planning
Overview Review last week CPT coding Case Conceptualization Activity
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
Goals Measurable Short Term Goals
What is the behavior? Who will measure? What is the goal? Where is the behavior now? When will we measure? How will we measure?
Activity TWISTED SISTER