Presentation: 24-year old male
- “Libido gone wild”
- “Rush of the chase” – Pick-ups
- Virtual chatrooms
- “Rough deep throating”
- Masturbation 1.5 hours daily
- Relationships of short duration
- Hx of anxiety in high school
- Tx: saw psychiatrist 6 years earlier for anxiety/parents’ divorce
- Feelings of shame, guilt, and anxiety over the problem
- “I’m damaged goods” – STD’s
- Not worthy of a woman
Family Hx
- Parents’ divorced 6 years earlier
- Father said to have “strong libido”
- Resents parents for not “being there the way I needed them”
- Distant relationship with sister – bulimic and alcoholic
- Close to an aunt
Developmental Hx
- No childhood sexual abuse
- Unremarkable psychosexual development
- Captain of the football team
- Top university graduate – IT major
- Left Big Eight Accounting firm
- Pursuing interest in positive psychology
Social Hx
- Big social network
- Anxious when talking to girls
- When doesn’t masturbate, feels more assertive and confident
- “Liquid courage”
- Cheated on all girlfriends
- “I like to hit on girls, make them vulnerable, and pick them apart.”
- “I don’t feel worthy of connecting with people.”
- The problem: “A layer of soothing to fill the painful void”
Parameters of the Problematic Sexual Behavior
- 1.5 hours a day masturbating to porn, etc.
- Virtual chatrooms for deep throating
- Enjoys the chase – “the hunt for prey”
- Prefers being felated
- Intercourse only in male superior or rear-entry position
- New woman = “fresh meat”
Client Goal
- To be confident and in control while working at his desk
- To develop and maintain a traditional relationship
- To eliminate the habit within a year
- To eliminate the need to use the behavior to self-soothe through masturbation
The Treatment
- Two aspects:
1. Behavioral and Emotional Change
2. Psychotherapy - Deconstruction of the negative self – “a monster”
- Increasing self-management
- Suspension of disbelief
- Finding the exception – DeShazer
- Two weeks of abstinence not previously noticed
Overcoming Shame and Building Confidence
- Identify risk factors
- Being alone
- Being at desk
- Feeling horny or anxious
- Protective Factors
- Coding urges
- Uninstalling pop-ups
- Eliminate porn on iPhone
- Eliminate WiFi (e.g. at mother’s)
- Removal of Snapchat stories
- Use of a behavioral log
Psychotherapy
- Escape from what?
- What is the fear of connection?
- Why is he unworthy?
- What is the void?
- Porn as a coping mechanism.
- The behavior as interpersonal distancing – self-protection
- Spontaneous abreaction
- “The dishonoring of the feminine” – father
- Two weeks of progress – reduced urge, “no withdrawal”
- Increased use of exercise
- Increased frequency of pot
- Discontinuation of Adderall
- “Re-introduced possibility of actualizing my positive fantasy”
Interventions
- De-coupling
- Prescribed/timed masturbation
- A day of abstinence
- Time on task
- Embrace the ambivalence
- Urge Surfing – being present and thinking through the urge
- Where is the urge in your body?
- Use of protective factors and tools
- Deep breathing – slow the urge down
- Get the neocortex online
- Once slowing down, reconnect with personal sexual guidelines.
- Bridging the Gap: Partner as object of desire