Masturbatory Retraining

Description of strategy

Masturbatory retraining, also termed masturbatory or orgasmic reconditioning, was introduced to treat people, usually men, who sought to convert their sexual preference from homosexual to heterosexual. More recently, it has mainly been used to treat sex offenders, usually male rapists and pedophiles. It aims to condition the man's sexual arousal to stimuli considered appropriate by instructing him to masturbate to ejaculation while using fantasies, such as making love to an adult woman or man or watching slides or listening to audiotapes. He is to totally avoid deviant fantasies, such as those of children or aggressive sexual behaviors. It was expected that he would become sexually aroused to the appropriate stimuli and his interest in inappropriate stimuli would diminish. Subsequently, a procedure aimed at reducing his inappropriate interest by satiation was added. The man was instructed after ejaculating, having used the conditioning procedure, to continue to masturbate for a prolonged period, usually about an hour, while fantasizing aloud every possible variation of his deviant activities. It could be carried out by the man at his home, where he recorded his verbalizations, for the therapist to check that he was following instructions.

Research basis

Most of the empirical studies of masturbatory retraining reported its use in one or a few patients with no or inadequate controls. To assess changes in sexual preference, usually the man's penile circumference responses to appropriate and deviant stimuli prior to and following the procedure were measured. The validity of these responses as measures of sexual preference has been increasingly questioned. As they require 2 minutes to develop, the man investigated has time to modify his responses by using fantasies differing from the stimuli shown him. Nevertheless, changes in these responses following masturbatory retraining were accepted as evidence of the treatment's efficacy. Some workers pointed out that it seemed inappropriate to attempt to reduce sexual arousal to deviant fantasies by encouraging men to masturbate to nondeviant fantasies if they were already strongly sexually aroused by the nondeviant fantasies. Some pedophiles and most rapists are strongly attracted to adult women. Also, evidence was advanced questioning the conditioning rationale for masturbatory retraining. Penile volume responses to sexual stimuli have been shown to provide a much more valid assessment of sexual preference than do penile circumference responses, presumably because volume responses occur within 10 seconds, allowing [Page 368]the subject much less time to modify them. Penile volume responses to films of men who sought treatment to reduce homosexual feelings were assessed. Married men who had repeatedly experienced orgasm in the presence of cues of women, their wives, showed no evidence of increased penile volume responses to films of women or decreased penile volume responses to films of men, compared with single men with no history of heterosexual intercourse. This finding that associating orgasm with stimuli considered appropriate failed to increase sexual arousal to those stimuli indicates the need for studies using penile volume assessment to evaluate the efficacy of masturbatory retraining. Sex offenders are commonly under considerable social and often legal pressure to comply with treatment. Insistence that they masturbate for long periods while verbalizing deviant fantasies would seem likely to be experienced as demeaning by many offenders whose self-esteem is usually already low. Until there is adequate evidence that these procedures change sexual preference, their inclusion in treatment programs seems questionable on ethical grounds.

...