Orgasmic Reconditioning

Description of the Strategy

Imagery during masturbation and during interpersonal sexual activity is of paramount importance in treating the sexual offender. Fantasy sustains urge; thus, gaining access to such fantasies can be crucial in understanding sexual desires and reactions. However, clients' fantasies remain very much a private reserve of information, inaccessible to the treatment provider unless and until full trust is established. Therefore, the techniques described here must be approached cautiously only after building full rapport with the client. This is of special importance in working with the sexual offender, who, most often, does not enter treatment on an entirely voluntary basis.

Orgasmic reconditioning (OR), also called masturbatory reconditioning, has been described as a series of techniques for treating sexual offenders, the vast majority of whom are males. (In keeping with the standard nomenclature in this literature, clients will be referred to in the male gender only.) These methods can be applied, with some imagination, to female offenders and to other disorders, such as the sexual desire, arousal, and orgasmic disorders. However, in this description, its applications to sexual offenders will be emphasized inasmuch as it is within this population that these techniques have been developed and best studied.

Because OR employs a client's own sexual fantasies to reduce or eliminate deviant arousal and behaviors, it is usually introduced into treatment when sufficient trust has been established to discuss masturbation fantasies. It forms but one set of treatment methods generally employed among a number of techniques (described elsewhere in this volume), such as assisted covert sensitization, aversive conditioning, and relapse prevention, in an overall treatment program for the sexual offender.

Three types of orgasmic reconditioning techniques have thus far been employed for sexual offenders: directed masturbation, masturbatory satiation, and masturbatory fantasy change. In directed masturbation, the client is simply asked to masturbate to nondeviant fantasies or depictions, such as photographs, as often as daily and to avoid masturbation to any deviant fantasies. This assignment may continue for a period of 2 to 4 months or more. As with all OR techniques, these masturbation sessions are considered private and are usually carried out in the client's home when he is alone. (Compliance may be checked with homework audiotapes, as described below.) Theoretically, the link between appropriate fantasies, such as sexual activity with an adult female, and the pleasure of self-stimulation and, eventually, orgasm, should eventually strengthen nondeviant arousal. Moreover, abstinence from masturbation to deviant fantasies should weaken interests in those directions.

However, most sexual offenders are already aroused to normal stimuli in addition to possessing deviant attractions. Therefore, increasing arousal to nondeviant stimuli is a goal reserved for those offenders who lack sufficient normal arousal. For the majority of offenders, it is of more crucial concern to reduce deviant arousal. Therefore, masturbatory satiation has assumed a place of even greater importance than directed masturbation in the repertoire of treatment techniques for the sexual offender.

In masturbatory satiation, the client is asked to masturbate to fantasies or pictures of sexual activity with an appropriate stimulus (such as a same-aged female) until he reaches climax. At that point, he is directed to continue to try to masturbate for anywhere from 15 to 60 minutes to his deviant fantasies (such as images of sexual activity with a young girl or boy, or rape scenes). Although 60 minutes has been recommended by some authors, a 30-minute period may be easier for the client to accept and hence may encourage greater compliance. Again, audiotapes may help ensure some measure of compliance. The client is usually asked to perform this technique each time he masturbates, but not less than three times each week.

...