Category: work

Just about exactly eight years ago, I wrote a series of posts that began with this paragraph:

If you’re a psychiatrist (or psychiatric RNCS) in the US reading this, you are almost certainly aware that all of our billing codes changed on Jan 1, 2013.  If you are like most of the psychiatrists I know—at least in private practice—you are at least somewhat freaked out by this.  If so, keep reading.  If not—for example, if you’re not a psychiatrist in the US—stop reading this immediately and go do something more interesting, like… well, like just about anything other than memorizing a phone book.  (There used to be things called phone books…  never mind.)

Unlike 2013, the billing codes themselves have not changed, but as of January 1, 2021, the documentation requirements for these codes have gotten significantly less complex and onerous. Like then, this post should be of no interest to you if your are not a US psychiatrist or psychiatric nurse. But if you are—and especially if a significant portion of your practice is psychotherapy—the situation is very different from 2013 because these changes are:

• good news
• not widely publicized

My son Ben texted me the other day that his favorite blogger, Scott Alexander, had published a post reviewing Howard Shubiner’s book Unlearn Your Pain.  Despite being a psychiatry resident, Scott manages to be a prolific writer in areas of interest which appear to be TNTC.  Ben knows him through Effective Altruism, and sent me the review because it mentions ISTDP (Intensive Short-Term Dynamic Psychotherapy), the kind of therapy that I do. I had read some of Scott’s other posts with interest, always wishing I had more time to keep up.

I enjoyed the review, and sat down to email a response to Scott, since my thoughts seemed a little long to post as a comment. Scott asked me to post them as a comment anyway, at which point I discovered that his blogging platform agreed with my initial gut feeling.  So I am posting them here, and will post a link to this post in the comment section of his review.

Continue reading “A (long) Comment on Scott Alexander’s Review of “Unlearn Your Pain””

I made a few attempts to post a comment, but they didn’t stick, maybe because I included my website URL (www.natkuhn.com).  Maury Yoszef did manage to get an intelligent comment up there, thanks Maury!

Continue reading ““The Controversial Therapy That Deliberately Enrages Patients””

OK, so I went to renew my DEA number… maybe I let it go a little longer than I should have.  (Are a lot of these posts starting with “OK”?  A little anxiety there, maybe?)

In addition to wanting to know your state controlled substance number (in Massachusetts, the MCSR), they (now) need to know the expiration date of your state certificate.

The only problem: there is no expiration date printed on the MCSR certificate.  The other only problem: when you search the web and get to the Mass DPH “FAQ” page, you are told that the certificates do not actually expire, they are “recalled” every few years at the pleasure of the Mass DPH.

Continue reading “DEA number renewal needs (non-existant) MCSR expiration date SOLUTION”

I tweaked the ROS section of history to have a complete list of systems, and better prompts.

I also modified the file names so that they have the date on them.  I will leave old versions up, to reduce possible confusion.  I’ll try to remember to update the original post (at tiny.cc/cpt2013) so that it links to the blog entry for the latest update.

I’m making progress on the form for sessions/encounters and I hope to post it soon.

2013 CPT Codes for Psychiatry pdf version
2013 CPT Codes for Psychiatry .doc version for revision/remixing; more info with original post at tiny.cc/cpt2013

I just got home from the UK where I attended the three-day IEDTA meeting and a three-day ISTDP immersion course taught by Jon Frederickson and Rob Neborsky.  Both were excellent.

Over the past several years, I have been watching a spectrum of ISTDP practice and trying to understand their common elements and differences are.  Other than at conferences, most of the work I’ve been exposed to so far has been from Allan Abbass and Jon Frederickson.  The immersion was the first chance I had to see Rob Neborsky’s work in the style that he and Josette ten Have-de Labije have developed.

Trying to fit their work together with what I already understood led me to a new way of thinking about it, which I found helpful, and which I’ll describe here.  There are no new concepts here, but I think it’s simple, direct terminology that can help us understand what people are doing from a unified standpoint.

Continue reading “Affect Defenses and Relationship Defenses: a Unifying Approach to ISTDP”