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


  • 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”


  • 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