Pine Grove, Professional Enhancement Programme and Gentle Path Sex Addiction Clinic, 20-23rd October

Pine Grove Professional Enhancement Programme(PEP) in Hattiesburg Mississippi provides a suite of specialist services concerned with professionals who have been disruptive or who have violated professional boundaries. The services consist of Evaluation, Treatment and Monitoring elements.

Program Director Philip Hemphill invited me to sit in on patient groups and staff meetings over the course of a few days and in that time I experienced a real flavour of how things work there. The programme is values based and this approach informs the staff and patients experience in a consistent way. Values are referred to frequently by patients and staff alike and they serve to set a clear ethical tone for the whole programme. I also got to sit in on a staff meeting and saw and heard how staff live the values of the programme.

 The values are:

• Open, honest, direct communication
• Respect for self and others
• Responsibility for one’s choices
• Accountability for one's choices and willingness to hold others accountable
• Inclusion of all members
  

Treatment is typically a six week course with participants living in designated accommodation nearby. As with other courses in the US the costs are paid by the participant from their own resources; Pine Grove is part of Forrest General which is a public health facility and as such puts profits back into the community by re-investing in its programmes.

The programme attrats mostly physicians, from a range of specialties and with a range of presenting problems, which can include sexual boundary violations with patients, addictions and psychiatric problems. There can be quite high levels of psychological disturbance and functioning can be severely impaired.

Group work includes treatment planning, community meetings and psychotherapy sessions. Patients attend the YMCA each day and every week they participate in a 'ropes' programme, which is an outdoor team challenge. I was allowed to be there for a session; it involved climbing an outdoor wall and getting round low slung wires between trees without touching the ground. How the group works together to solve the problem, how people felt, what they said and what they did are all then processed, both with the course leaders and again back in the centre at the groups. Each patient is also in individual therapy with one of the two principal psychologists.

Treatment plans are set by patients and staff working together. Each day every patient is scored against their agreed points for development, such as 'boundaries' 'awareness of others' 'ability to receive feedback' etc Challenge and accountability are central themes, with patients and staff sharing in giving feedback at every opportunity.  There is a psychiatrist on staff and medication is prescribed if appropriate. Patients keep their own treatment plans and are fully involved in developing them.

At the heart of the programme is a strong focus on accountability, in line with the core values. In practice this means that the staff keep focused on challenging patients to be accountable for their actions and thier effects on other people. This neccessarily involves a high degree of awareness and understanding of the ways in which people can minimise, deny and rationalise their behaviours.

All participants are assessed and all have reports on their progress and their risk and safety levels. They may take polygraph tests also.  These reports go to the referring agent, which is usually the regulatory board or the employer.

I was lucky also to be invited over to the Gentle Path Sex Addiction clinic, Patrick Carnes facility, also part of Pine Grove/Forrest General. This is a residential centre, Pine Grove having purchased a set of duplex former hotel properties.  Referrals come from across the US and beyond and the length of stay is typically 45 days. Again group work is a key feature, the 12 step model is central, as is attachment and boundary theory; Clinical Director Deborah Schiller describes sex addiction as a matter of profound boundary impairment. The disease model of addiction is also referred to and there are regular lectures on a range of topics, including nutrition, recovery, brain development and boundaries.  I sat in on a session where patients drew out a diagram of thier family history and it was striking how much addication was in the family, with sometimes three generations on both sides of the family having alcoholism, drug or other addications.  I was also privileged to have sight of the draft of Carnes next book, part of a whole cycle he is part way through.