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

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

3. 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

4. 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

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

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

7. Do a Client Map  Number  Timing  Mediations needed  Adjunct services  Prognosis

8. 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

9. 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

10. Psychotherapeutic Approaches  Psychoanalysis  Psychodynamic  Behavior Therapy  Cognitive Therapy  No Treatment

11. Other approaches – Berman  Styles Assumption based Symptom based Interpersonally based Developmentally based Diagnosis based

12. 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

13. 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

14. 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

15. 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

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

17. 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?

18. Activity  TWISTED SISTER