Psychotherapy Off the Wall

PSYCHOTHERAPY OFF THE WALL, continued
Unlike most exhibitionists Felicity had known, George did not give himself the justification that he only wanted to give pleasure to the ladies to whom he exposed himself. His psychotherapy and his frequent experiences in court had disabused him of that idea. Besides, the treatments he had received also included covert sensitization – a modern way of treating exhibitionists. In this method he had been induced to image the guilt and shame he felt in court when his unacceptable acts were being described in detail in public. As soon as he was feeling the guilt and shame strongly enough, he was then required to exhibit himself to a female staff member. This ‘cold’ exhibitionistic act, repeated many times, had not reduced his exhibitionistic frequency a bit. It was not that he wanted to do the act, nor did he report much pleasure or arousal in it. He felt compelled to do the act.
Believing, on the basis of the tests administered to George, that there was a negative, anxiety-mediated, arousal at the root of his compulsive actions, Felicity started George on Quirk’s stimulus conditioned autonomic response suppression (SCARS) method (described in greater detail later). Galvanic skin resistance (GSR) electrodes were attached to George’s right hand to record moment to moment changes in his palmar sweat response – as one way of measuring activity of the autonomic-emergency-stress-anxiety nervous system. Meanwhile, George was shown pictorial slides, mostly representing people in various stages of undress, usually in public or looking as though they were embarrassed by being thus unclothed. The purpose of the pictures was to evoke in George ideas related to mild embarrassment associated with being seen by others in various ways ‘exposed’ to public scrutiny – the feelings usually associated with shame. Strange and contradictory as this may seem, the idea was to desensitize or decondition (get rid of) his uncomfortable arousal or shame. [From which I would conclude that George suffered from a “character neurosis.” RR] Every time, as soon as the GSR recorded a 1,000 ohms increase (less sweat) beyond its former levels, the slide George was looking at was changed. In this method, slide change (not slide content) was used as if it were a ‘reward’ for the increase in skin resistance (less sweat, more ‘comfort’) as measured by the GSR. The idea was to train George’s physiological anxiety responses toward comfort in the situations represented by the slides – hopefully to reduce the associated uncomfortable feelings he might experience in such situations.
His wife continued to accompany George everywhere, as she had for the past many years. The treatment seemed interminable to George. It actually lasted three months, at the (maximum) frequency of three sessions a week. There were thirty-five sessions in all. There was no discussion of his exhibitionistic acts. As the treatment was reaching its planned end, Felicity was surprised when, upon inquiry, George said that his exhibitionistic acts had stopped about a month previously. Of course Felicity was a little sceptical, but he thought he would not press the issue too much as George would eventually be in court and in jail again if he was not telling the truth.
Treatment was concluded according to plan, and follow-up visits were arranged monthly. At the first follow-up visit, George reported that there had been no ‘flashing’ now for a bit more than two months. As if to confirm this, George had attended the session not wearing manacles and without an escorting correctional officer waiting for him. Felicity congratulated him, another appointment was made for a month away, and they parted.

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