NURS 6640 – Psychotherapy With Individuals Assignment.

NURS 6640 – Psychotherapy With Individuals Assignment.

Introduction to individual therapy

Individual therapyWhen people think of psychotherapy, more often than not they will imagine lying on a leather couch while an intimidating psychologist takes notes on everything they say in order to dig up “repressed” childhood experiences that will provide insight into their present psychological condition. This indeed was the way of psychotherapy back in the days of Sigmund Freud. These days, psychotherapy takes on a different form and the psychoanalytic approach just described is very rarely used.  NURS 6640 – Psychotherapy With Individuals Assignment.

What is individual therapy?

Individual therapy is a psychotherapy implemented by a trained professional, usually a therapist or psychologist, to help a client work through a problem. The ways that individual therapy is implemented varies widely depending upon the psychological problem experienced by the client, the personal beliefs and practices of the therapist, and the individual needs of the client.

Below is a summary of the major forms that individual therapy can take and the mental illness or psychological problem they have been most successful in treating. Not all therapies described below will be offered by all psychologists. NURS 6640 – Psychotherapy With Individuals Assignment.

A point to keep in mind is that the more you believe you can change and that therapy can make a difference, the more positive and successful your treatment will be. This concept of self efficacy will be discussed in more detail later in the article.

What is involved in individual therapy?

The overall length of time taken for individual therapy varies widely. Usually a minimum of eight sessions are needed to make sure all aspects of the illness have been touched upon. However, your therapist may recommend more or less sessions depending on your progress. An important part of therapy is making sure that you come back for follow up sessions after one month, six months and 12 months so your psychologist can monitor your condition and make sure it is under control.

The first session will usually involve you and your psychologist “getting to know” one another. Your psychologist will ask questions about you and your past experiences, current situation, family, job and friends. Your psychologist will not push you to delve into private matters, but does need to obtain enough information about your individual needs in order to determine a course of treatment. In some cases, the problem will be quite evident to both you and your psychologist (e.g. if you are anorexic and are seeking help to fight it). NURS 6640 – Psychotherapy With Individuals Assignment.However, in some cases there may be an underlying issue you are not aware of (e.g. you may be depressed, anxious or angry without knowing why).

It is important for your psychologist to assess the problem and decide the best plan of action. The first step is to determine what the problem is. Once you and your psychologist have both developed an awareness of the situation, you can start to work together to determine why the problem is present. From here, your psychologist will implement a program to try to solve the problem.

Remember that, although your psychologist may be directing the sessions, you are the one in control. If you feel that the therapy should take a different direction, discuss this with your psychologist. He or she has selected a program to best suit your needs, but will still be very responsive to any feedback that you have. However, keep in mind that psychologists are highly trained professionals that have a lot of experience in their field. By trusting that your psychologist has your best intentions in mind, you will benefit more from the therapy. NURS 6640 – Psychotherapy With Individuals Assignment.

Therapist-client relationship

Individual therapyOne of the key ingredients of success in psychotherapy is the strength and stability of the relationship between the client and the therapist. Therefore it is very important that you are comfortable and happy with your psychologist.

Therapists that are rigid, critical and uninvolved are less effective. As you can imagine, talking to someone who you dislike and who seems to be judgemental will not do you much good. You will not want to attend sessions and you will be less likely to follow advice.

Qualities to look for in a psychologist include warmth, empathy, patience, genuineness, honesty and the ability to be upfront yet caring at the same time. These qualities help the client achieve the important goal of self efficacy. Clients that have self efficacy are clients that believe in themselves, the therapy and the psychologist. When you trust that the therapy is helping, you are are more likely to actively work on therapy goals, and are therefore more likely to experience the benefits of the treatment.

One of the most important aspects of psychotherapy is communication. Choose a psychologist you feel very comfortable talking to. Obviously when you meet a person for the first time it is very hard to tell whether or not you are going to be able to communicate effectively with them, but if you focus on the qualities listed above, you are likely to open up to them as the sessions continue. NURS 6640 – Psychotherapy With Individuals Assignment.

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Therapy goals

In every type of psychotherapy, the psychologist will help you develop specific goals for the therapy. This will include a broad overall goal as well as more focused goals that may change from session to session. Breaking the overall goal into session-by-session objectives helps to focus on specific parts of the program and make sure all aspects are properly covered. It also makes it easy to identify which specific parts you are having difficulty with and what you need to work on more. Keeping the overall goal in mind will help you get past times when you feel like giving up on the therapy. To keep focused and consistent with the therapy, remember to keep visualising yourself overcoming your difficulty.

Your therapist will also help you to:

  • Identify coping strategies: These may be coping strategies that have helped you in the past. Your psychologist will teach you to adapt these strategies to your current situation. If your coping strategies have been unsuccessful in the past, your therapist will guide you in the development of new ones.
  • Rearrange life priorities: Sometimes people have psychological problems because they have an irrational expectation of themselves and others. This increases the pressure on everyone and can lead to stress, anxiety and depression. By rearranging your expectations and priorities you may be able to avoid unnecessary stress. NURS 6640 – Psychotherapy With Individuals Assignment.
  • Focus on meaningful pursuits.
  • Identify personal strengths: Sometimes during times of psychological crisis it is easy to focus on your weaknesses and what you do not have, instead of your strengths and the wonderful things you do have. Psychologists will draw your attention to positive aspects about yourself, and help you rediscover and bring them out again. This will help you to believe in yourself.

Children and individual therapy

Play therapyPsychotherapy for children is quite different to psychotherapy for adults. Children do not understand the role of psychologists and can be threatened by being alone with them. Quite commonly, children will want their parents to be present before they trust psychologists enough to talk with them alone. It may help to give the psychologist a non-threatening name like “the talking doctor” so that children can better understand their role.

Psychologists commonly adopt play therapy when they are working with children. This allows them to develop a fun and comfortable relationship with the child, and can also give the psychologist an idea of how the child is coping.

Adolescents and individual therapy

Adolescence is a time when children learn to embrace independence and make decisions for themselves. However, with this new responsibility and freedom, many adolescents struggle psychologically. Peer pressure and sexuality can be very confusing and upsetting. Techniques used for adolescents are similar to those used for adults. Teenagers are more likely to be defiant towards the therapy. Therefore, more time and patience need to be adopted by both the psychologist and parents for for the psychologist to “get through” to the adolescent and for the therapy to be effective. NURS 6640 – Psychotherapy With Individuals Assignment.

Therapeutic techniques

There are some common techniques used in individual psychotherapy:

Play therapy

Play therapy allows children to express their reality through imaginative play, and gives them the ability to approach and retreat from the intensity of their situation as they please. NURS 6640 – Psychotherapy With Individuals Assignment.It also allows them to re-enter childhood during a period when they are faced with very adult demands  Play can indicate how children are coping with their condition and how much they understand about what is happening. For some children, the expression during play can be an indicator of how they are coping with their situation. Very constricted play often represents an overwhelmed child. More imaginative and lively play can be an indicator of emotional restoration.

Exercise therapy

Regular exercise is a cost-effective treatment for moderate depression. Studies have shown that people who exercise regularly report:

  • Less self reported pain
  • Less stress and anxiety
  • Improved body image

Relaxation/meditation therapy

Relaxation or meditation therapists guide you through a series of visualisation exercises that help you better understand the goals and possibilities of the treatment. There may also be some muscle relaxation through massage or yoga-type activities. Some psychological conditions that can benefit from relaxation therapy include:

  • Clinical health (including any physiological condition that a client may be suffering from, whether it be a migraine or cancer)
  • Anxiety. NURS 6640 – Psychotherapy With Individuals Assignment.
  • Post-traumatic stress disorder (PTSD)

Milieu therapy

Milieu therapy is a highly structured type of therapy based on support by the psychiatrist. The psychologist will try and interpret symptoms as a meaningful aspect of your personality or experience. The psychologist will give you constant feedback about your progress throughout the sessions. Milieu therapy is used to treat:

  • PTSD

Laughter therapy

Humour in psychotherapy has positive consequences on mental health. Laughter provides relief and can decrease stress. Laughter also has positive physiological effects on the body. Laughing with people increases interpersonal skills. Your psychologist will encourage you to laugh as much as you like throughout the sessions. NURS 6640 – Psychotherapy With Individuals Assignment.

A technique commonly used in group therapy is the formation of a circle, with each person lying face up on another person’s stomach. Once one person laughs, the trembling of the stomach causes the next person to laugh, then the next, until the whole group is cracking up together about nothing in particular!

Laughter therapy is used to treat:

  • Depression
  • Clinical health

Behavioural therapy

Behavioural therapists treat problem behaviours directly. Behaviour is changed through several classical conditioning, aversive and exposure exercises. Behaviour therapy can be used to treat:

  • Eating disorders
  • Phobias

Cognitive therapy

Cognitive therapists believe that one’s thoughts guide their emotions and psychology. By making changes to irrational thoughts and vicious self-blame cycles, many psychological disorders can be treated, including:

  • Eating disorders
  • Depression
  • PTSD

Cognitive behavioural therapy

Cognitive behavioural therapy is, as the name suggests, a mixture of cognitive and behavioural therapy. It is a very efficacious and wide spread treatment, mainly used for:

  • Eating disorders

Manual based therapy

Manual based treatments have evolved through years of studies and research and have been refined to treatments that can be very successful. This is why manual based treatments tend to be more empirically supported. Manual based treatments are highly specific for the disorder they are treating, and are usually more successful in patients who do not display comorbid conditions. Manual based treatments are used for:

  • Eating disorders

Individualised therapy

An individualised psychotherapy program has been developed by the psychologist specifically for you. This will usually involve a blend of many psychotherapies in order to address the many psychological aspects that tend to accompany a psychological disorder. NURS 6640 – Psychotherapy With Individuals Assignment.

Biopsychosocial therapy

Biopsychosocial therapy is the therapy most commonly used to treat people who are suffering from clinical health problems and the psychological distress that comes with it. Biopsychosocial therapy focuses not only on the physical aspects of your condition, but also psychological factors (e.g. depression and anxiety) and your social situation (e.g. family and work). The biopsychosocial model is used as an alternative to biomedical models (based on the idea that biology is directed linked to symptoms). Many clinical conditions can be treated this way, such as:

  • Migraine
  • Arthritis
  • Substance abuse
  • Cancer
  • AIDS

Follow up

An important aspect of any psychotherapy is the follow up. It is easy to feel abandoned after therapy sessions have finished; you will be used to having an hour or so a week in which you can talk to a very supportive and empathetic objective person, and you may feel its abrupt end. It is therefore a good idea to “wean” yourself off psychotherapy. Perhaps have an extra session two weeks after the program has been completed, and another after a month. This will let you to discuss any concerns you have with your psychologist and it will also allow them to monitor your progress after the program.

Psychological changes do not happen over night. Very often, the psychological treatment is only the first step. NURS 6640 – Psychotherapy With Individuals Assignment.The hard part starts once you have left therapy; you have to implement the changes yourself and work hard at all the skills and advice that you were given in therapy. It is quite natural to be intimidated by this, so follow up sessions can be a very comforting solution. Follow up sessions remind you that you are not completely alone. You can go back to your psychologist and receive more help. They will make sure you do not slip back into your old negative thinking or acting patterns.

Effectiveness

Psychotherapy is a highly effective treatment for a wide range of psychological conditions.

The effectiveness of the therapy depends on what you are willing to put into it in terms of time, effort and faith. Trying your best to take on board everything you have learnt from your psychologist will enable you to make changes to your life. There is only a certain amount the therapist can help you with. After that, your wellbeing comes down to your own determination and willingness.

References

  1. Myers DG. Chapter 17: Therapy. In: Brune C. Psychology 7th Edition. New York: Worth Publishers; 2003. 659-85.
  2. Grepmair. Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: A randomized, double-blind, controlled study. Psychotherapy and psychosomatics. 2007; 76(6): 332-8.
  3. Vatne S, Hoem E. Acknowledging communication: A milieu-therapeutic approach in mental health care. Journal of Advanced Nursing. 2007; 61(6): 690-8.
  4. Maccormack T, Simonian J, Lim J, Remond L, Roets D, Dunn S, Butow P. “Someone who cares”: A qualitative investigation of cancer patients’ experiences of psychotherapy. Psycho-oncology. 2001; (10): 52-65.
  5. Nordhus. Brief dynamic psychotherapy with older adults. Journal of Clinical Psychology. 1999; 55(8): 935-47. NURS 6640 – Psychotherapy With Individuals Assignment.
  6. Neron S, Lacroix D, Chaput Y. Group vs individual cognitive behaviour therapy in panic disorder: An open clinical trial with a six month follow-up. Canadian Journal of Behavioural Science. 1995; 27(4): 379.
  7. Delaney K. Top 10 milieu interventions for inpatient child/adolescent treatment. Journal of Child and Adult Psychiatric Nursing. 2007; 19(4): 203-14.
  8. McKay JR, Alterman AI, Cacciola JS, Rutherford MJ, O’Brien CP, Koppenhaver J. Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: Initial results. Journal of Consulting and Clinical Psychiatry. 1997; 65(5): 778-88.
  9. Ghaderi. Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa. Behaviour Research and Therapy. 2006; 44(2): 273-88.
  10. LeMay K, Wilson KG. Treatment of existential distress in life threatening illness: A review of manualized interventions. Clinical Psychology Review. 2008; 28(3): 472-93.
  11. Brown MR, Sourkes B. Psychotherapy in pediatric palliative care. Child and Adolescent Psychiatric Clinics of North America. 2006; 15(3): 585-96,viii.
  12. Tkachuk. Exercise therapy for patients with psychiatric disorders: Research and clinical implications. Professional Psychology, Research and Practice. 1999; 30(3): 275-82.
  13. McCreaddie M, Wiggins S. The purpose and function of humour in health, health care and nursing: A narrative review. Journal of Advanced Nursing. 2007; 61(6): 584-95.
  14. Compas BE, Keefe FJ, Williams DA, Haaga DAF, Leitenburg H. Sampling of empirically supported psychological treatments from health psychology. Journal of Consulting and Clinical Psychology. 1998; 66(1): 89-112.
  15. Bortolotti B, Menchetti M, Bellini F, Montaguti M, Berardi D. Psychological interventions for major depression in primary care: A meta-analytic review of randomized controlled trials. General Hospital Psychiatry. 2008; (30): 293-302.

1. The definition of counseling/therapy refers to psychotherapy. MHPs & QMHPs are not typically
trained to do psychotherapy, yet they can bill for the service?
Answer: All providers must only deliver services within their scope of practice, training, and
experience.
2. Recently I heard of an event rate one could bill. Our agency is beginning to do a multi-family
group which is difficult to bill. Is there another option than the traditional group rate process
under individual/family/group therapy?
Answer: The event rate is used in 132 services only for medication administration and case
management-LOCUS. There is no event rate for therapy/counseling.
3. Can two Rule 132 services be provided on the same day? For example, individual
therapy/counseling and then group therapy/counseling?
Answer: Yes, two services may be provided in the same day. The services provided must be on
the treatment plan and provided at different and not overlapping times.
4. The focus of our work is child/adolescent. It is common for us to also work with parents, in how
to manage/influence the child’s behavior. We often help them learn to manage ADHD or ODD
symptoms, and assist them in developing behavior charts and then monitor follow-through to
help deal with behaviors. Do we bill this as family therapy or community support?
Answer: The client is the focus of services provided to the parents, i.e., how to
manage/influence the child’s behavior. Both family therapy and community support may be
provided to parents. Billing depends on the intervention with them. Community support focuses
on skill building and the development of natural supports while therapy focuses on therapeutic
interventions. Be prepared to defend the service that is billed.
5. How can we provide and bill for art therapy under Rule 132?
Answer: This may be a viable service for some clients. However, as a Medicaid reimbursable
service, the documentation needs to reflect that there is an assessed need; the service must be
on the treatment plan and case notes should reflect therapeutic intervention, not the quality of
the art work. Activities such as skill building and assisting clients in the development of
interpersonal skills to live, learn and participate in their community is most compatible with the
service definitions of Community Support and Psychosocial Rehabilitation.
6. Since MISA and DBT outpatient groups are “specialized” groups, can they be billed as
Therapy/Counseling groups?
Answer: MISA and DBT groups can be billed as Therapy/Counseling Groups if they meet Rule
132 requirements for therapy/counseling and the service is provided for the treatment of the
mental illness. NURS 6640 – Psychotherapy With Individuals Assignment.
7. We do DBT, which seems to fit into more than one category. I had it in PSR because of the skills
training, CBT aspects, and frequent need for Community Support, supporting the skills and
prevention of symptoms, often during off-hours. Medicare considers it Group Therapy.
Somewhere in the trainings, it was split out as an outpatient specialty group. Can I put it into
PSR Services? On the notes, can we call it PSR/Group Therapy to please both MRO and
Medicare?
Answer: Under Rule 132 parts of DBT could be billed as Therapy/Counseling, Community
Support, and/or PSR services. When billing both MRO and Medicare for a given intervention, we
recommend you indicate the payor next to each service title, e.g., PSR (MRO)/Group Therapy
(Medicare). Additionally, care must be taken to not bill multiple payers for the same service.
8. Is skills training, e.g., DBT, allowed as Individual Therapy/Counseling and/or Group
Therapy/Counseling, and what are some examples of appropriate outcomes?
Answer: DBT is allowed as individual or group therapy/counseling and should be billed as
therapy/counseling. Skills training that meets rule 132 requirements for PSR service can be billed
as PSR Service.

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9. Is therapy/counseling counted as part of PSR service?
Answer: No, therapy/counseling should be billed as therapy/counseling (see Reimbursement
Guide). It is not part of the PSR schedule.
10. 1) If group therapy is scheduled and only one member shows up and the clinician meets with
him/her – is this still billed as group therapy or as individual therapy? 2) If individual therapy is a
service on the treatment plan and one clinician’s name is down as the person responsible, does
this mean that they are the only clinician at the agency who can provide individual therapy for
the client?
Answer: Group therapy is defined as therapy for 2 or more individuals together. Therapy for
only one person is not group therapy. The staff person indicated as responsible is not necessarily
the staff person who delivers the service. Yes, other qualified staff can deliver any service.
11. I was told that with some of our past audits, we were supposed to produce a group sign in sheet
for our Mental Health Intensive Outpatient Services (MHIOS) program for the auditors to review.
When I read the Guidelines, instructions and checklist that the auditors use, only PSR and CSG
require a roster for review. Adult and adolescent MHIOS do not require this. They only require a
schedule. Do we need to keep sign in sheets/rosters for MHIOS?
Answer: Because mental health intensive outpatient services have required ratios, there must
be a group list including clients and staff so reviewers can verify that the ratio was maintained.
12. If an agency is providing Multifamily Therapy, which would be provided in a group setting with
family members of multiple consumers, would this be categorized as Therapy/Counseling group,
or as Family Therapy. I am assuming that based on the rate structure our definition of
Therapy/Counseling Family, is based on serving only one family, or the family of one consumer
at the session, and the rate structure for Therapy/Counseling Group is to support a service in
which the family of more than one consumer is participating. Please advise if this is a correct
interpretation.
Answer: This would be group therapy because you don’t have the ability to deal with the single
family dynamics that you would in a family therapy session with only one family.
13. In our agency there is a need for formal face-to-face group psychotherapy sessions for
family/foster family members on behalf of some of our child/adolescent clients who function in a
particularly stressful environment. In the Service Definition and Reimbursement Guide it states
that “Services to the family on behalf of the client should be reported and billed using the code
for family therapy and counseling.” Can we do so, or do we need to bill group psychotherapy if
the service is to members of more than one family at the same time?
Answer: This should be billed as group therapy/counseling. It will be important that the benefit
to each client be documented in their specific record. Also, remember that the documentation in
each client record may not include the names of other clients. NURS 6640 – Psychotherapy With Individuals Assignment.
14. Someone has a diagnosis of anxiety. You are working on not only the cause but are using
techniques to alleviate the problem such as thought stopping or relaxation techniques. Is this all
billed under therapy or does it have to be broken down to individual skills training? This would be
a problem since this is on site.
Answer: What you describe sounds like therapy/counseling. However, your agency must make
the clinical judgment about the most appropriate service to bill for each session. Please refer to
the rule, the Guidelines, Instructions and Checklist and the Service Definition and
Reimbursement Guide for assistance in making those decisions.
15. Neither the rule nor the interpretive guidelines say anything about incidental telephone calls
between sessions not being therapy/counseling. The Guide includes this language, but doesn’t
really say what incidental telephone calls are. How should billing for these calls be submitted?
Answer: How you bill depends upon what you are doing during the call. When working with a
client on difficult coping issues that come up between scheduled sessions, such as just finding
out they have a terminal illness, a fight with family/friend, a severe depressive episode, etc.,
what you are really doing is therapy/counseling by phone, and the Rule allows that. If you are
doing therapy/counseling by phone, you should bill for it. If during the call, you are working on
helping the client build the skills to deal with these sorts of issues, then it would be CSIndividual.
16. If different therapists see siblings and the parent requests a family therapy session – can each
therapist bill for the time focusing on their specific client in the family session?
Answer: No. Only one therapist may bill for one family therapy session.
17. A local nursing home does not offer DBT and would like their client to receive those services at
our agency. The nursing home does provide individual and group therapy. Can we provide DBT?
If we were allowed to provide DBT, would it look like double billing?
Answer: While this consumer is likely not part of the DMH target population, there is nothing in
policy that forbids your providing services to her/him. We do, however, urge you to assess
medical necessity for DBT yourself. The same requirements apply to this consumer as to any
other. There must be a mental health assessment, a diagnosis, a treatment plan containing the
need for therapy to address a goal, updates, etc. It is not double billing unless two providers bill
for the same service at the same time.
18. Cinema, books and music containing topics related to recovery and their application to everyday
life are sometimes used as a therapeutic group tool to help consumers. Is the time spent with
these groups billable if no facilitation occurs? For example, during approximately 15 minutes
within a one-hour period, the group may listen to music, read a book excerpt, or watch a movie
scene, and follow that with a discussion.
Answer: No. When staff provides a specific service to a specific person(s) per a treatment plan,
that service is billable. When staff is observing clients watching movies, reading books, etc., that
is not billable.
19. Can staff provide Therapy/Counseling to clients on-site at a Residential facility, or do they need
to use CS-Residential no matter what type of service they are providing?
Answer: Community Support services provided in supervised residential, crisis residential or
CILA should be billed as CS-Residential. Any other service provided to clients in residential sites
should be billed as the service provided, (Therapy/Counseling in this instance), not as
Community Support. NURS 6640 – Psychotherapy With Individuals Assignment.
20. The Guidelines, Instructions and Checklist states that Therapy/Counseling is not a separately
billable service for clients receiving CS-Team services. Is this correct? If non CS-Team staff does
therapy with a client, what code should they bill to?
Answer: Thank you for pointing out this error. It will be corrected. If a client receiving CS-Team
receives Therapy/Counseling, Therapy/Counseling should be documented and billed.
21. Is it necessary to document the interactions among group members in a Group
Therapy/Counseling note?
Answer: Yes. As for all services, the note must describe the intervention provided and the
client’s response to it in relation to his/her goals/objectives. For confidentiality, no other client’s
name may be listed in the note.
22. We just launched our first set of Multi-Family Group Therapy sessions two weeks ago. We have 8
families involved. The weekly session starts out with the full 8 families together, then we break
into smaller groups, then back to the full group for additional work. Should this be billed and
coded as group therapy/counseling?
Answer: This should be billed as group therapy/counseling. In fact, during the smaller break out
groups, the time must still be billed as one group. (9/1/11)
23. I have several questions on how to document and bill for group therapy services: (1) Is the ratio
2:1 at a minimum? (2) Is there a cap on frequency/duration? (3) What is documentation
requirement for group therapy? (4) If there are 5 members in a group with 2 facilitators, how do
we bill and document?
Answer: The specific requirements for the provision of Therapy/Counseling can be found in 59
Ill. Adm. Code 132 (Rule 132) at 132.150(d). Specific documentation requirements can be found
at 132.100(i). The rule is available online at http://www.dhs.state.il.us/page.aspx?item=56754.
Specific to your questions above: (1) While there is no ratio specified, yes, the minimum is 2
consumers to 1 staff. You cannot have a group without at least 2 consumers. (2) There is no cap
on frequency or duration, but all services provided must be medically necessary. NURS 6640 – Psychotherapy With Individuals Assignment.Additionally,
please note DMH utilization management criteria found at
http://www.dhs.state.il.us/page.aspx?item=52733. (3) See 132.100(i) as noted above. (4) You
may only bill for one staff person providing group therapy/counseling regardless of how many
staff you have in the group. (12/1/11)
24. Is there a maximum number of clients allowed to participate in a therapy/counseling group that
we can bill for?
Answer: No, but it must be reasonable for the staff to actually be able to provide medically
necessary therapy/counseling to the group. (12/1/11)
25. We would like to run a parent support group/psycho-ed group to our clients’ parents. Therefore,
if we run an 8 week group for 2 hours/week and there are 6 participants in this group (1 parent
per client), would we bill 2 hours for each client’s parent participation in group therapy? If that is
correct, then that clinician/facilitator would earn a total of 12 billable direct hours.
Answer: First, you must always bill as services to a particular enrolled client. The services must
be provided relative to the client’s needs, not the parent’s. Second, the services must be
medically necessary and specified on the ITP as directed by the MHA. Finally, if that is the case,
then yes, there would be 12 hours of therapy/counseling at the group rate billed by the clinician.
Additionally, whenever a client reaches 10 hours of therapy/counseling (individual, group and/or
family) in a fiscal year, she/he may not receive more without a medical necessity review and
authorization by DMH. (12/1/11)
26. We are confused about the difference between therapy/counseling and community support. If
they overlap, as we understand the definitions, during a session, do we bill separating for
different parts of the session? Also, how do we bill when providing play therapy for children?
Answer: Please refer to Rule 132 for definitions of each service. When services overlap in a
session, bill the entire session as the predominant service type. Play therapy would be billed as
therapy/counseling. (9/1/13)
27. We’ve had some recent discussions on Cognitive Enhancement Therapy and would like to know if
it is covered under Rule 132 as a service. What Rule 132 service would it be considered and how
would it be authorized and billed?
Answer: CET is billable as Therapy/Counseling. To be less specific, evidence based therapy
models may be billed as Therapy/Counseling under Rule 132. It is important to note that the
required documentation of the provision of therapy/counseling MUST include a description of the
intervention, client’s or family’s/guardian’s response to the intervention, and progress toward
goals/objectives in the ITP. A note stating that CET was provided is not sufficient documentation
of the service. (9/1/14)

Question 1

  1. You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve seen him.NURS 6640 – Psychotherapy With Individuals Assignment. It’s hard to talk about this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ which therapeutic principle?
A. Encouraging catharsis
B. Encouraging abreaction to repressed feelings
C. Identifying conflict-resolution techniques
D. All of the above

Question 2

  1. When the patient comes into the office, she says, “I just saw a friend of mine out in the waiting room. What’s wrong with him?” The PMHNP says, “He’ll be fine. He has mild depression.” Which of the following statement is correct related to confidentiality rights?
A. The PMHNP was not protecting patient confidentially rights.
B. The PMHNP was not using identifying information in the patient situation above.
C. Because the patient signed a consent form, the PMHNP was legally allowed to share information.
D. The PMHNP’s response was ethical and legal because she was trying to answer the question.

 

Question 3

  1. The PMHNP is working with a school-aged child who has been diagnosed with depression. The child has attended several sessions with the PMNHP, but recently presents with avoidant behavior by showing increased distress and being late to sessions. What approach does the PMHNP need to employ with the child to continue making therapeutic progress?
A. Remaining quiet until the child is ready to talk
B. Using communication techniques that are expressive
C. Inviting the child’s parents to speak on behalf of the child
D. All of the above

NURS 6640 – Psychotherapy With Individuals Assignment.

Question 4

  1. A 24-year-old female patient presents for her initial appointment with the PMHNP. Which action will the PMHNP take to establish therapeutic alliance?
A. Validating the patient’s affect
B. Asking the patient questions about her main concerns
C. Establishing a therapy process
D. All of the above

 

STUDY GUIDE

This quiz (NURS 6640: Psychotherapy With Individuals Exam Questions and Answers) will cover the following topics, which relate to psychotherapy with individuals in the Wheeler textbook and the Fisher textbook excerpts:

 Topics

  • The Nurse Psychotherapist and a Framework for Practice
  • Confidentiality Limits in Psychotherapy: Ethics Checklists for Mental Health Professionals
  • Assessment and Diagnosis
  • The Initial Contact and Maintaining the Frame
  • Cognitive Behavioral Therapy
  • Supportive and Psychodynamic Psychotherapy
  • Stabilization for Trauma and Dissociation
  • Motivational Interviewing
  • Psychotherapeutic Approaches for Addictions and Related Disorders

 

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company. NURS 6640: Psychotherapy With Individuals Exam Questions and Answers

  • Chapter 1, “The Nurse Psychotherapist and a Framework for Practice”
  • Chapter 3, “Assessment and Diagnosis”
  • Chapter 4, “The Initial Contact and Maintaining the Frame”
  • Chapter 5, “Supportive and Psychodynamic Psychotherapy”
  • Chapter 7, “Motivational Interviewing” (pp.299-312)
  • Chapter 8, “Cognitive Behavioral Therapy”
  • Chapter 13, “Stabilization for Trauma and Dissociation”
  • Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders”

NURS 6640 – Psychotherapy With Individuals Assignment.

Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001

 

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002. NURS 6640: Psychotherapy With Individuals Exam Questions and Answers. NURS 6640 – Psychotherapy With Individuals Assignment.

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