Background to my interest in teaching children with autism

PSYCHOTHERAPY BEYOND THE FRINGE, continued

If Frances had been a man, Felicity would have known right away what to do. He was already using the phallometer to condition erotic responses in order to retrain sexual object preferences in male homosexuals, as described earlier in Englebert’s story. But there was no equivalent device available for measuring a female’s erotic responses. Felicity considered how it might be possible to construct a clitorometer to perform the equivalent conditioning procedure. His thoughts rambled around what he knew about the female sexual response, and the speed of reaction of each part — response speed is important if a response is to be conditioned or trained. A clitorometer wouldn’t help anyway because the erectile response of the clitoris, if he remembered rightly, was really quite slow — slower, he recited to himself, than the erectile response of the vulva, which, in turn, was slower than the erectile response of the nipples of the breast.

With a start, he caught himself staring at the voluptuous curves of Frances’ breasts under her tight sweater. Felicity began to blush at the thought that he may have been responding in an inappropriate way to the lady in front of him. Then the blush vanished as he realized there was a real treatment possibility associated with the fairly rapid erectile response of the breast.

Erectile tissue becomes erect as a result of dilation of the blood vessels infusing the area. The resulting increased volume of blood suffuses into the porous erectile tissue causing it to become firm and thus erect in preparation for its function — in the case of the breast to make it easy for the baby to feed. Given the relative size of the penis, it is easy to use a device to measure changes in penile volume (in an enclosed glass tube displacing air) or circumference (with a mercury strain gauge around the penis) or stiffening (with a clasp as a strain gauge). The problem with the female erectile tissues is that they are too small to accommodate any known type of device. However, erectile tissues do not only become erect, the volume of their blood contents also increases.

Felicity reasoned that even if the erectile response could not easily be measured in order to permit it to be conditioned, the blood volume might be capable of being used. As blood volume in any part of the body increases, so does the temperature of the skin in the area. If Frances taped a skin temperature thermistor in contact with the nipple of her breast, it might be possible, using simple rewards, to train any, however minor, existing erotic responses to increase in response to fantasies about sexual involvement with her husband.

Frances agreed to try the experiment on the clear understanding that there was no existing evidence that such a procedure might work. She seated herself in a room by herself, and scotch taped a thermistor (a temperature sensor attached to a skin temperature unit) in contact with the nipple of her breast. She then installed a dentist’s curved suction tube in her mouth (over her teeth). The tube led to an i/v drip bottle containing a favourite juice, with another tube leading from the bottle to a rubber hand pump operated by Felicity, with which he could administer small sips of juice as a reward. [WARNING: Beware not to drown the client!] Meanwhile, he monitored the skin temperature device from the adjoining room. Frances was asked to relax herself and to picture scenes in which she could see her husband caressing her, could hear his affectionate or sexualized remarks and could feel his caresses. For every, even momentary, increase in the recorded skin temperature she was given a small sip of her selected fruit juice as a reward. [WARNING: Beware not to drown the client!]

During the approximately fifteen sessions involved in this training, the skin temperature from the nipple rose fairly consistently — although during each session there was a good deal of variation occurring, as would be expected of erectile tissue. Frances reported that she was able to get the pictures she was trying to create more and more clearly in her mind. She was able to see and feel her husband’s arousal in her mind, and that gave her what almost seemed like an internal sense of excitement.

But she was unable to notice any increase in the erotic response of her erogenous zones when she was touched by her husband at home. She became discouraged and thought she would quit. But another thought occurred to her. She had persisted without benefit for many years in psychoanalysis. There seemed to be some slight feeling developing in this short period of treatment. Privately, Felicity considered the possibilities that she was reacting to a sense of being demeaned by the rather direct nature of the procedure, or that fear of sexual arousal was driving her from treatment as the risk of such arousal ‘breaking through’ seemed imminent. These may well have been part of her response because she decided to terminate treatment for the present and to see what developed from the first murmurings of internal excitement she had felt. Frances said she would report back in six months to a year.

However, Felicity moved his practice during that time and he never heard from Frances again.

The idea seemed sound enough to warrant some research attention. But Felicity did not receive any more clients exhibiting an equivalent presenting problem to make it possible to undertake a research study using the method. Nor has he since been asked to treat any female homosexuals for whom skin temperature training might have served as an appropriate replacement for the phallometric training element in the treatment of male gays.

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