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      Cupchik Centre for Assessment and Treatment

             of Atypical Theft Offenders

     website.

 

 Dr Cupchik's latest (2013) book              Dr Cupchik's first book (2002)                                                                             

                 

 

     

Dr Will Cupchik, Head,  Cupchik Centre for Assessment

and Treatment of Atypical Theft Offenders             

     

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Free Brief Screening Interview    

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Last updated on 26/2/2014

FREE BRIEF SCREENING INTERVIEW

For those persons who, after reading the information provided on this website

  • believe that they are basically honest persons who are having difficulty stopping their inappropriate and atypical shoplifting or other theft behaviors, and 
  • are genuinely interested in possibly taking part in a 20-session Skype-based live Intervention Program or an in-office Intervention Program, 

Dr. Cupchik may provide a FREE BRIEF TELEPHONE SCREENING INTERVIEW [usually lasting about 30 minutes in length].

To request this Screening Interview, fill out the questionnaire below and send it back to Dr. Cupchik:

 

 

       CUPCHIK BRIEF SCREENING INTERVIEW QUESTIONNAIRE

  This questionnaire is not to be copied or used by any other individuals or groups without the explicit writtten permission of Dr Cupchik. [Dr Will Cupchik© 2013]

If you genuinely believe you may be an 'Atypical Theft Offender' and assuming that the cost of the Program (as indicated on the Intervention Program webpage) that you would be inquiring about is affordable for you, then please fill out the questionnaire below and email to wcupchik@aol.com

 This questionnaire is intended only for persons considering taking either of the Programs referred to above and who wish to apply for the Free Brief Screening Interview to help determine whether you would be a suitable applicant to take the Program. After reviewing your information Dr Cupchik will respond to your email address and indicate whether, in his view, a Free Brief Screening Interview might be an appropriate next step. If he does, then in his email he will suggest alternate times for this to take place. 

                                      *******************

It is suggested that you copy this Questionnaire and place it into a Word document where you can then answer the questions. Then simply copy the now-completed Questionnaire and email it to Dr Cupchik. In the subject line of your email, please write the following:

[(WC) My completed FBSI Questionnaire]

                                   *********************

A note from Dr Cupchik: After reading your responses to the questionnaire below, I will reply via email and if I believe that taking the Program may be of assistance to you in (1) uncovering the reasons for your atypical theft behavior, a(2) assisting you to stop the behavior, and (3) possibly providing a detailed Psychological Report (in selected cases) for use by the court and/or your lawyer and/or therapist, then I will email you back and suggest possible times for the proposed Free Brief Screening Interview to take place. If I do not think that the Program may be suitable, then I will so advise, via email.

 

1. First name only (at this time): _______________

 

2. Age/gender: _____________ / __________

 

3. Educational Background: _____________________________________

  

4. Your work/profession: 

________________________________

  

5. Have you ever stolen from your workplace, your co-workers, clients or customers?  

6. Describe the sort(s) of theft behavior: (i.e., shoplifting, fraud, etc...) that you have engaged in.

-

7. How many times in total you have committed these kinds of acts? ________________________

 

8. From whom (relatives, friends, strangers, etc…?) and where (kind of stores, elsewhere) have you stolen? 
 

9. Over what period of time? ____________________ years

 

10. Have you ever been caught? ___________

11. Have you ever been charged? __________

 

12. Have you ever been convicted? __________ When, where and how many times, please:

-

13. Your estimate of the total amount, in dollars, of the value of the items/money stolen: ___________

 

14. Issues in your personal and/or working life that are of concern to you:

 

15. Do you take prescribed antidepressants? ____________ If so, which one? _____________ Dosage? _______________ For how long have you been taking this medication? _______________ What other prescribed medications are you taking?

 

16. Did you ever steal before being on an antidepressant? ______________

 

17. Did you steal only after you began using an antidepressant? _____________

 

18. Did/do you have a problem with alcohol? ____ ___ Street drugs (which ones)? _________________

 

19. Do you have a considerable amount of anger? _____________ If so, towards whom?

 

20. Do you tend to be depressed a good deal of the time? ______________________

 

21. Who in your personal life knows about your problem with stealing?

  

22. Does that person truly know the full extent of the problem? ____________________

 

23. What else can you relate about yourself and the goings on in your personal life, that you think may be relevant to your stealing behavior?

 

24. What (other) personal issues are of concern to you at the present time?

 

25. When did you last steal? ___________________

 

26. When did you last get caught and/or were charged? __________________

 

27. Do you currently have a charge pending before the courts? ___________ If yes, then in what jurisdiction (country, state or province)? Details of the charge, please…

 

28.  Have you ever spent any time in jail for stealing offences? _________ How many separate times, and for how much time in total? ____________

 

29. Have you been convicted of any other offences? Please describe…

 

30. Do you genuinely wish to stop your theft behavior once and for all or are you primarily or only interested in simply dealing with any current charge? ______________________ [If the latter, then working with Dr Cupchik is definitely not recommended]

 

 

31. Have you had any previous psychotherapy? ___________ Are you currently in therapy? ________ What kind, when, and what was/has been the duration of the treatment?

 

32. Please add below any other information that you care to and/or that you think Dr Cupchik should probably be aware of, when considering your request for the Free Brief Screening Interview.

 

33. Since you have been using a prescribed antidepressant, has your stealing markedly increased, lessened or stayed about the same? _______________

  

34. How would you describe the state of your primary relationship? (Strained, supportive, in trouble, etc…)

  

 35. How supportive do you think your partner would be if he/she knew the full extent of your stealing?

_________________

 

Does he/she really know the FULL extent of your theft behavior? _____________

  

36. Which Program [ (a) the Skype-based full Intensive Interventional Program, (b) the Skype-based Individualized Educational Program or the (c) in-office full Intensive Interventional Program] are you interested in inquiring about?

________________________________________________

  And what are your primary concerns in relation to considering this Program?

_________________________________________________

_________________________________________________

 

37. Where (in what country, state or province) do you live? ________________________________

 

38. Does the jurisdiction in which you live have a so-called 'three-strikes policy' for criminal behavior, including shoplifting? __________________________________

 

39. I understand that the Free Brief Screening Interview is offered only to persons who might benefit from taking the Program and for whom the funds required for the professional fee involved are not an issue.

      I have read the relevant pages on the www.whyhonestpeoplesteal.com website, am aware of the current cost of Program that I am primarily interested in and payment of the fee is not an issue for me should we agree, following our Free Brief Screening Interview, that taking the Program might well be appropriate for me and that I wish to proceed to taking the Program.

 

I agree:________             I do not agree: __________  

 

 

 
 

 

 

 

 

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Last modified: February 26, 2014