Pathways Institute for Impulse Control Orientation Booklet Designed to familiarize participants with the goals, objectives, and procedures of the Pathways Institute for Impulse Control treatment program

Pathways Institute for Impulse Control A Psychology Corporation San Francisco, California

415­267­6916

This booklet is designed to familiarize you with the Pathways Institute treatment program. It contains an overview of our program, its goals and objectives, test information, details of our meeting times and place, and other general information. Please read the booklet carefully. It is divided into the following sections:

I. Goals of the Program

II. Contractual Agreement

III. Psycho­educational Group Format

IV. Clients' Rights

V. Consent Forms

VI. Test Information

Many people feel anxious about attending the Pathways Institute group and some even report losing a little sleep the night before their first meeting. You can easily overcome much of your anxiety by reading this booklet very carefully and thinking about its contents.

Should you have any questions, please call us at 415­267­6916.

SECTION I

Goals of the Program

Goal 1. To accept responsibility for your past behavior and to commit yourself to working towards a different future.

It will be of little benefit for you to spend your time denying responsibility for your behavior. Even if you weren't guilty, it will be pointless to waste your time complaining about the world's unfairness. The fact is that the world often is an unfair place. Much of the Pathways Institute program will be beneficial to your life circumstances above and beyond any specific behaviors. So, see what you can give and get out of the program that will be to your benefit.

Goal 2. To become fully aware of the consequences of your actions and understand the impact those consequences will have on your future.

We will explain to you the possible consequences of your behavior, and what may happen to you if you continue. Please understand that we are therapists not attorneys, doctors, etc., and that you may have some questions that we cannot answer. Consult the appropriate specialist on these issues.

Goal 3. To develop a personal plan to avoid future destructive behavior.

We hope that you will take advantage of the strategies and techniques learned at Pathways Institute in order to prevent further problems in your life.

Goal 4. To discover the reason(s) underlying your behavior.

Many of you already know why you have behaved in the way you did; others may not. We will spend time discussing various reasons and motivations for compulsive/impulsive behaviors. Although we cannot guarantee that everyone will be able to discover the reason(s) for their behaviors, usually most people do uncover the reasons during the course of treatment.

Goal 5. To become aware of and understand the emotional aspects of your behavior, for example, how depression, anger, fear, and need for attention fit into the picture.

Goal 6. To recognize the importance of your basic values and beliefs and how they relate to your compulsive/impulsive behavior.

We will ask you to examine some of your very basic values, beliefs, thoughts, and feelings during the program. We do not require that you change anything, just that you be willing to do some self­examination. You may find that these beliefs have a lot to do with your behavior, and perhaps with other concerns in your life.

Our research indicates that as a group people with impulse disorders are not "emotionally disturbed". However, we have found out that many individuals with impulse disorders have disturbing emotions that often are connected or related to their behavior. We will examine some of these feelings in the program. You will learn to identify and name these feelings. You will develop skills for containing your difficult and painful feelings in order to no longer act out.

These are the basic goals of the program. Should you have questions, consult with our program. Please sign below.

______Signature Date

______(please print name here)

SECTION II

Contractual Agreement for Pathways Institute

1. I agree to participate fully in the program activities, follow instructions, complete assigned homework, attend individual sessions and contribute to the group process.

The program is designed to benefit those who participate fully. You will not be forced to do or say anything against your will. We encourage you to take full advantage of the program at Pathways Institute – but if you choose not to, please don't get in other people's way and prevent them from learning.

2. I am aware that I have the right to my opinion and perspective and the opportunity to express it clearly and freely.

You are not required to believe anything; you are free to believe what you want. If you disagree with the beliefs presented in the group, please speak up. People learn best when they have a variety of viewpoints to consider and evaluate.

3. I agree that I am responsible for my actions and learning within the group.

We do not accept excuses. If you are unclear on something, please ask us to explain it further. Make us work! If you leave the program without having learned anything, we will not accept responsibility for that. It's up to you to learn while in the program.

4. I agree to be on time and to remain in the program until completion.

Please be on time and stay for the entire meeting. If you are more than 10 minutes late you will not be allowed to enter the group and will be billed for the session. We do not allow members to attend every other week. We have found that it is not therapeutic for patients and undermines their progress and group continuity. Additionally, you must stay in the program until completion or you will not receive credit for attendance. You are required to attend 16 Psychoeducation Groups to complete this component and make up sessions will be scheduled. Any departures from the program must be discussed with the staff and a two week advance notice of discontinuation must be given.

5. If I am unable to attend a session, I agree to phone, stating the reason.

If you are unable to attend an individual session you are required to give us a TWO WEEKS advance notice. If you do not give us a two week advance notice you will be billed for the missed session.

6. I agree not to attend any sessions while under the influence of alcohol or other mood altering substances.

7. I agree to refrain from physical contact or violence while attending sessions. I also agree to refrain from outside contact with other group members.

During the course of treatment we ask you to refrain from outside contact and building any kind of relationship with other group members. This promotes safety and equality among all group members.

8. I agree to respect the confidentiality of our group sessions.

As members of this group you are asked to keep the confidence and anonymity of all other group members. Please do not discuss the content of another persons sharing or any identifying information about other group members to anyone outside of the group. If you are in individual therapy you may discuss your group experience with your licensed individual therapist as that is a confidential relationship.

9. I agree to make payment in advance for the month. I also agree to making my checks out in advance.

10. I agree to be thoughtful about what I share and how I share it.

Try to avoid detailed gratuitous discussions of your behaviors. Try to avoid culling intrigue about your behaviors. We need to understand the difference between thinking about behavior and avoiding thinking by discussing provocative information about it in order to divert you from your goal to stop the behavior. Try to observe when shares are triggering you in the group and bring it to the attention of group to discuss as soon as you notice being triggered. Additionally, please be respectful of others while giving any feedback.

11. I agree to complete all data forms and tests prior to starting psycho­educational group meetings and at follow up.

These tests/forms are essential to our program; we ask for your cooperation in completing them as instructed.

12. I understand that the length of the group is structured around the number of attendees.

If a group has 3 or fewer members, the group will meet for 60 minutes. If a group has 4­6 members, the group will meet for 75 minutes. For groups that are 7 members or larger the group will meet for 90 minutes. If the membership of the group changes, the group meeting times will be adjusted accordingly.

These are the basics of the contractual agreement. Should you have questions, please consult us. Please sign below.

______Signature Date

SECTION III

Psychoeducational Group Format

The psychoeducational group covers sixteen topic areas and each session lasts 60­90 minutes. The format of the session includes structured activities, interactive discussion and various media to stimulate work. Each group will have about four to ten members and a group leader. Members are required to keep all information confidential.

The material covered in each session is presented below:

Module 1: Stages of Change Module 2: Communication Skills Module 3: Impulse Disorders Module 4: Information Regarding Specific Impulse Disorder Module 5: Cognitive Distortions & Thinking Errors Module 6: Emotional Regulation & Anger Module 7: Behavioral Regulation Module 8: Responsibility & Accountability Module 9: Secrets & Shame Module 10: Psychodynamics Module 11: Issue Relevant to Specific Impulse Disorder Module 12: Healthy Lifestyle Module 13: Impact on Others Module 14: Intimacy & Relationship Module 15: Relapse Prevention I Module 16: Relapse Prevention II

Weekly homework assignments will be assigned. Assignments are intended to allow participants the chance to reflect on the week’s topics, prepare for the next session, reinforce work, and maintain a sense of ongoing connection and support with Pathways Institute. Please note specific modules may take longer than one week.

SECTION IV

Clients' Rights

1. You have the right to a confidential relationship with Pathways Institute and with your counselor or psychologist. All information disclosed within the program is confidential and may not be revealed to anyone outside of the program without your written permission except where disclosure is required by law.

2. Under certain legally defined situations, we are required to reveal information disclosed during the course of your treatment to other agencies or persons without your written consent. We are not, however, required to inform you of our actions but would take every step to contact you if these occur. These situations are as follows: a. If you reveal information to us or we have reasonable suspicion of child abuse, child neglect, elder or dependent adult physical abuse, we are required by law to report this to the appropriate authority. b. If you make a serious threat of physical violence to a reasonably identifiable victim, we are required by law to warn the intended victim and to notify the appropriate law enforcement agencies. c. If you are in therapy or being tested by order of a court of law, the results of the treatment or tests ordered must be revealed to the court. d. If a court of law issues a legitimate subpoena, we are required by law to provide the information specifically described in the subpoena. e. We are also permitted by law to breach confidentiality if we have reason to believe that because of an emotional problem you are likely to harm yourself or others or others' property unless protective measures are taken.

3. You have a right to review and/or receive a copy of your records at any time, except in limited legal or emergency circumstances. If we determine that there is substantial risk of significant adverse or detrimental consequences to you in seeing or receiving a copy of the mental health records, we may decline to permit inspection subject to conditions outlined in Section 123115(b)(1­4), Health and Safety Code.

4. If you ask for it, any part of your records on file with us can be released to any agency or person you specify. We will inform you at the time of your request whether or not we think releasing that information to that agency or person might be harmful to you in any way.

5. Your file is updated (a brief summary of the session is recorded) after each session. Your records are kept for seven years after you terminate treatment and then appropriately discarded (e.g. shredded).

6. You have the right to ask questions about any of the procedures used in the course of therapy. If you ask, we will explain our customary approach and methods to you. We will also explain alternative approaches to the treatment which we may not be qualified to provide.

7. Dr. Smithstein is a licensed clinical psychologist. Ms. Corsale is a licensed MFT therapist. Pathways Institute treatment providers will draw on a variety of psychological approaches including behavioral, DBT, cognitive­behavioral, psychodynamic, attachment theory, and psychoanalytic theory.

8. You have the right to choose not to be in this program. If you choose this we will provide you with names of other qualified professionals whose services you might prefer.

9. You have the right to terminate this program at any time without financial, legal or moral obligations other than those you have already incurred. You may, however, be in violation of your probation. Please check with your attorney or probation officer.

The Treatment Process

Participating in this program can result in a number of benefits to you, including a better understanding of your personal goals and values, resolution of the specific concerns that led you to seek help, and improved interpersonal relationships. Working towards these benefits, however, requires effort on your part and can bring on strong feelings of anger, depression, fear, etc. Attempting to resolve issues between partners, family members, and other individuals can also lead to discomfort and may result in changes that were not originally intended. There is no guarantee that the program will yield positive or intended results. In fact, for a minority of individuals it will not be helpful. You may discontinue your participation at any time but with appropriate advance notice (see Section II, #5).

Fees

1. Intake and Program Enrollment $______To be paid in full at the time of intake.

2. Sixteen module Psycho­education course $65/per session To be paid in $260 installments at the beginning of each month.

Fees Continued 3. On­ going Recovery Group (after graduating from the Psycho­education course).

Fee: $65.00 per 60­90 minute group session, paid in advance for each month, unless other arrangements have been made.

4. Individual Psychotherapy Sessions

Fee arrangements will be made on a case by case basis. Sliding scale is available, please ask for an application.

5. Cancellation Notice

We require a TWO WEEK advance cancellation notice for individual sessions. If you do not give us a two week advance notice you will be billed for the missed session. (see Section II, #5) There is no cancellation policy for group sessions such as 2­week or 48 hours. Missed group sessions will not be refunded.

6. Insurance

Insurance coverage may be available for some individuals with coexisting psychological conditions.

7. Professional correspondence/reports with attorneys, courts, diversion programs, probation or parole matters

I If you need professional correspondence and/or reports, please alert your intake therapist regarding this matter during the intake. Advanced notice is required; without this advance notice this service may not be available.

Emergency Procedures If you need to contact your therapist between sessions, please leave a message on our voicemail at (415) 267­6916 and your call will be returned (including weekends). If an emergency situation arises, you may call the 24 hour crisis line in San Francisco at (415) 781­0500 or the police at 911.

I have read and understand the foregoing.

______Signature Date

SECTION IV

Consent Forms

Consent to Disclose Confidential Information

As mentioned previously, all information (be it in written or verbal form) pertaining to your participation at Pathways Institute is kept strictly confidential. This is done in order to protect your privacy and we endorse this concept wholeheartedly. Note that in order to maximize your treatment, Pathways Institute treatment providers and supervisors will share information with each other about your treatment. Additionally, some of our treatment providers receive on­going supervision from our experts; information about you and your treatment will be shared during supervision in order to ensure the highest quality treatment.

In certain circumstances, we have clients who are legally required to attend treatment. However, without your written permission we cannot inform the court that you attended and completed the Pathways Institute group. If this pertains to you, a consent to disclose information form appears on the next page. By signing the form, you authorize us to report to the court your attendance and successful completion of the Pathways Institute group. The only information that we will disclose is your attendance and completion of the Pathways Institute group unless specified by other arrangement. We do not divulge your test scores, personal information, or any other statements made by you during treatment. Thus, everything else is kept confidential. If you'd like for us to tell the court of your attendance, please sign the form entitled "Consent to Disclose Confidential Information."

Consent to Participate in Research The second consent form pertains to our use of your test scores and treatment information for research purposes. Pathways Institute maintains an active research program, the purposes of which are to: a) better understand impulsive and compulsive behavior, b) evaluate the success of our program, and c) share our research with the scientific community through publishing articles in professional journals. You are not required to allow us to use your information–in no way will your decision on this matter affect your completion of the Pathways Institute program. However, we urge you to allow us use of this information. We assure you that your scores will be kept confidential; in no way will your name ever be associated with your information publicly. Should you be willing to allow us use of your information (and virtually every Pathways Institute participant has allowed us to do so), please read and sign the form entitled "Research Consent Form." If you have questions, please contact us.

Pathways Institute for Impulse Control RELEASE OF INFORMATION CONSENT FORM

I, ______(Date of Birth: ______), hereby authorize the Pathways Institute for Impulse Control to disclose records obtained in the course of my diagnosis and treatment:

NAME OF ORGANIZATION TO WHICH DISCLOSURE IS MADE PATIENTS INITIAL DATE

______

______

______

______

The disclosure of records authorized hereby is required for the following purpose:

______

______and such disclosure shall be limited to the following specific types of information:

______

______

This consent is subject to revocation by the undersigned at any time except to the extent that action has been taken in reliance hereon, and if not earlier revoked, it shall terminate on ______(date) without express revocation.

Dated:______

______PATIENT

______PARENT , GUARDIAN OR AUTHORIZED REPRESENTATIVE OF PATIENT

Copy given to patient ___Yes ___No Pathways Institute for Impulse Control A Psychology Corporation San Francisco, CA 94123 415­267­6916

Pathways Institute for Impulse Control CONSENT TO BE A RESEARCH SUBJECT

A. PURPOSE AND BACKGROUND

The Pathways Institute for Impulse Control is studying various impulse disorders and treatment. The studies aim to explore the contributors, social and psychological dimensions of impulse disorders and treatment effects. Because I am a client at the Pathways Institute for Impulse Control I am being asked to participate in this study.

B. PROCEDURES If I agree to be in the study, any testing materials, answers to questionnaires, and other materials from the program may be used as information.

C. RISKS/DISCOMFORTS

1. Discomfort: Some of the questions may make me uncomfortable or upset. I am free to decline to answer any questions I don’t wish to, or stop participation in the study at any time.

2. Confidentiality: Participation in research may involve a loss of privacy. My answers to study questions will be kept as confidential as possible. My name will be disconnected from my responses and assigned a code number to protect my identity, and only Dr. Smithstein and Ms. Corsale will have the name­number link. All coded information will be kept in a locked file inside a locked office. Supervisors and clinic administrators will not have access to these files. No individual identities will be used in any reports or publications resulting from the study.

D. BENEFITS

While we can not guarantee benefits from participating in this study we believe that individuals will benefit in a number of ways. The study will give the participants the opportunity to reflect on their impulsive behaviors and the impact it has had on their life in a confidential supportive environment. Participants will have the knowledge that their contribution is aiding in the ongoing understanding and treatment of other people suffering from compulsive behaviors. The study results are intended to generate ideas for treating behavioral problems while addressing community concerns.

E. REIMBURSEMENT

There will be no reimbursement for participating in the study.

F. ALTERNATIVES I am free to choose not to participate in this study. If I choose not to participate in this study, it will not affect my status in the Pathways Institute program.

G. COSTS

There will be no costs to me as a result of taking part in this study.

H. QUESTIONS

I have talked to Pathways Institute staff about the study, and have had my questions answered. If I have further questions about the study I am to call Dr. Smithstein or Ms. Corsale at (415) 267­6916.

I. CONSENT

I have been given a copy of this consent form to keep.

PARTICIPATION IN RESEARCH IS VOLUNTARY. I am free to decline to be in this study, or to withdraw from it at any point. My decision as to whether or not to participate in this study will have no influence on my status at the Pathways Institute for Impulse Control.

______Signature of participant (research subject) Date

______Name of research staff administering consent SECTION V

Orientation and Test Information

During your intake and assessment, in addition to an interview you may be given tests so that we can conduct the most comprehensive assessment possible. You will be asked to complete some tests in advance of your first appointment and other tests at our offices. At the time of your assessment interview you will be given instructions on how to complete each test.

At the conclusion of your intake, you will be presented with an assessment and treatment recommendations.

Copyright © All rights reserved. No part of this booklet may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without permission in writing from the Pathways Institute for Impulse Control.