Case Illustration: The Case of Mr. B
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