BEHAVIORAL TREATMENTS FOR MANAGEMENT OF DEVIANT SEXUAL AROUSAL. Tricia Busby, PhD Daniel Edwards, MA Maria Piccillo, PsyD. INTRODUCTIONS. Maria: “Do I Dare Go There?”; “I Went There…Now What?!?” Dan: “Getting to the Root of the Problem.”
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BEHAVIORAL TREATMENTSFOR MANAGEMENT OF DEVIANT SEXUAL AROUSAL
Tricia Busby, PhD
Daniel Edwards, MA
Maria Piccillo, PsyD
*Based on Cautela, J. & Wisocki, P. (1971b)
☺There are variations of the Covert Sensitization technique. This particular variation was developed by Marshall, 2006.
The first step is to develop at least six sequences that incorporate both aspects of an individual’s offense patterns and aspects of his deviant fantasies.
Remember, for purposes of this treatment, we define “deviant sex” as when someone does not or cannot give their consent or permission. These may be deviant fantasies an individual had in the past or ones that he is currently having.
Remember, sexual offending does not just happen. It is the endpoint of a series or chain of events. In writing these chains, an individual will want to capture the major steps in his offense patterns that led up to offending. A good technique is to model these scenarios from completed Behavior Chains, if that is an aspect of the treatment program.
An individual can work with his treatment provider to best align the two.
The deviant chain should NOT include the actual rape or molest because an individual wants to target the earlier behaviors in his offense chain. An individual should not let his thoughts progress to an actual crime. For example, contact (or “hands-on”) sexual offenses would stop right before the hands-on activity takes place. For non-contact offenses, such as exhibitionism, the scenario would terminate just before exposure.
Each chain will be broken down into six separate steps and the individual will then write these out on the front side of a pocket-sized card. The events should be written as if they are occurring in the present time. This will help to stimulate an individual’s imagination and aid him in feeling as if he is presently in the situation.
Scenario One – Offense Against John
I am sitting at home feeling irritated because my girlfriend is yelling at me again for not having a job so I decide that I will go to the county fair and go to the beer tent to feel better.
After parking my car and as I am walking to the beer tent, I notice that it is “wrist band” night and a lot of kids are around.
I am standing at the beer tent next to the Scrambler ride and I hear the carnival worker tell a young boy that he can not get on the ride without an adult.
I approach the child and offer to go on the ride with him.
We get on the ride and I sit very close to him.
I am very excited. Half-way through the ride I reach across to touch his leg.
*Each step should be a decision point where an individual has made a choice to move ahead toward offense.
The second step of the process is to list out unpleasant consequences. They may include scorn and ridicule from others, being arrested and going to jail, being physically assaulted in jail, family and friends shunning them.
As in the deviant chains, each consequence should be written in the present tense, as if it is happening in the here and now. This will help the individual actually picture the scene in his imagination.
An individual should write at least two unique unpleasant consequences on the back of each deviant chain card. These consequences will be repeatedly paired with his deviant chains.
Once an individual has written all six of their deviant chain cards and have at least two negative consequences on the back of each, the sequences should be reviewed by treatment providers and receive final approval to begin the Covert Association procedure.
The individual will begin with just three of his six cards. Each day he will read and imagine both the deviant chains and the consequences. He will read these at least three times per day. It is best if the individual can determine what three times throughout their day he is most vulnerable to engage in or be triggered by deviant thoughts or fantasies and read the cards around these times. The individual should find a quiet place where he can reliably spend about 8-10 minutes reviewing the cards each day. The individual will read these three cards, three times a day, for three weeks.
Initially, the individual will read the deviant chain sequence to the end (steps 1-6) and then flip to the reverse of the card and read the corresponding consequences. By the middle of the first week (on the third day), the individual will move the reading of the consequences up one step in his deviant chain. For example, the individual will be reading his deviant chain up to step five and then flipping over to his consequences.
During the second week, the individual will shift to flipping his consequence after reading step 3 or 4 in his deviant chain.
By the end of the third week, the individual will routinely be reading the consequences after step one.
At the beginning of the fourth week, the second set of three cards replaces the three sequences have been reading. Individuals will then repeat the entire process with the second set: three cards, three times a day, for three weeks.
Therapists should check with an individual on a weekly basis to ensure he is continuing the practice.
Rationale: Repeatedly associating appropriate fantasies with masturbatory-induced arousal should create appetitive classical conditioning procedures, thereby endowing the appropriate fantasies with positive sexual valence.
VERBAL SATIATION IS WEARING OUT THE FANTASY UNTIL YOU ARE SICK OF IT!!!
Reducing Deviant Sexual Arousal
Individual will sign a contract about the appropriate use of the images.
Still images will be assigned or chosen with the assistance of the therapist and the individual will develop consensual written fantasies that he will use with the still images. Once the fantasies have been approved and finalized, the individual will read the fantasies out loud while he is recording it so that he may use the CD to play the fantasies while he is masturbating. Individual should masturbate using the Directed Masturbation technique 3-5 a week.
Following this, the individual will then be given homework related to emotional/romantic intimacy and relationships that he will focus on for the following 7-10 days and process with his facilitators during their weekly meeting; the cycle can be repeated if needed. The goal is for the individual to only use the still images to initially develop his sexual interest in consensual age appropriate persons.
Increasing Appropriate Sexual Arousal with Directed Masturbation
Balance to potentially negative effects treatment material may have on clients
Positive correlation between self-esteem and…
Belief in ability to perform novel tasks.
Efforts at change.
Belief that change will be a benefit to the individual.
Spencer et al., 1993.