I see a male client-let's call him "James"--who is shy, polite, and has a dark secret: he can only achieve sexual gratification by masturbating in public. Since his early teens he has sought sex in covert, furtive ways that typically violate the rights of others: exposing himself in his car while cruising, or eventually masturbating in plain view in crowded buildings. When he describes his sexual behavior he sounds confused and distressed. He wants so badly to have a normal sex life with a steady partner, but he worries he will never be aroused without the thrill of being in public. In working with him, it became clear that we would have to identify how his arousal template was formed to know how modify it.

What's an Arousal Template?

According to Patrick Carnes, Ph.D., author of Facing the Shadow: Starting Sexual and Relationship Recovery, an arousal template consists of "the total constellation of thoughts, images, behaviors, sounds, smells, sights, fantasies, and objects that arouse us sexually." This constellation encompasses vast categories of stimuli that come from our early experiences with family, friends, religious affiliations, media, and teachers. Much of what is arousing to us registers subconsciously-a person's pheromones, the tenor of her voice, the feel of his skin, the way she carries herself. One is often aware of being attracted to a "type": blond and busty, slim and intellectual, or intense and outspoken.

Formerly, arousal templates were thought to be fixed-once a Leg Man always a Leg Man--but in fact they can be expanded. This is quite evident in people addicted to Internet porn. Because of the easy access and variety of porn available, many are becoming aroused by increasingly graphic and in some cases, criminal sexual content. This concept of escalation explains how heterosexual men might be found watching transsexual orgy porn or bestiality. In many cases these men did not start off being attracted to ponies but as their neuropathways became desensitized to standard male-on-female porn they sought out more and more intense stimuli to achieve the same effect.

What went wrong?

James grew up with a single mother and a rotating cast of Mom's deadbeat boyfriends. He was physically abused and neglected and rarely got time alone with Mom. He craved attention from Mom and yet she was wrapped up in her love life and unavailable to parent him. James learned that he was powerless and invisible to the person he needed most. The message he got was that love and attention were not given freely and could not be asked for; they had to be stolen. This brutal dynamic set up an arousal template based on exhibitionism. During puberty he began experimenting with peeping and over the next 20 years his behaviors escalated. Sex was about the shock on a woman's face when she noticed his genitals-in this moment he felt truly seen and deeply aroused. His most ardent desire--to be noticed, acknowledged, loved--became twisted and cemented into a compulsive need to be seen masturbating by non-consenting others.

What can be done?

When James was finally caught by a co-worker, he hit his rock bottom. His shattered illusion brought him into treatment and his willingness was the first step in changing his destructive patterns. Through intensive individual and group therapy James examined his arousal template in relation to his family of origin issues, which set him up to rage against women for not meeting his needs. He began to understand that he "acted out" his anger at women by frightening them and over time learned how to express his upset and other feelings directly. Learning to soothe himself in healthy ways allowed him to get in touch with a broader range of erotic experiences. Now that sex was about pleasure, and not demanding to be seen, he learned what he really liked and how to ask for it with a partner.

Depending on the severity and rigidity of a person's sexual behavior, he/she may need inpatient treatment or an intensive outpatient program. Others may benefit from weekly individual therapy and 12-step meetings, like SAA. Whatever the case, it is important the individual connect with others who have had similar experiences and can help lift the shame and provide support. For more information on help for problematic sexual behaviors, click on the links below.

Sante Center for Healing

Center for Healthy Sex

Sex Addicts Anonymous (SAA)

Sex and Love Addicts Anonymous (SLAA)

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