OFFENDERS 111

Session four

The aim of this first therapy session was to test the hypotheses outlined. If the hypotheses were confirmed by eliciting the same automatic thoughts again, and possibly adding to them, a number of strategies could be used. First, the dependency issue should remain of prime importance. Should some cognitive changes occur in the session, the plan for therapy and future sessions should be such that the client maintains the changes alone, and is enabled to perceive that they are not therapist-dependent. A self-help model is obviously an asset in this instance.

Second, the control issue could be questioned and challenged, and more realistic thoughts generated as alternatives.

Third, some aversive cognitions concerning re-offending might be generated by inductive questioning, and if so, suggested to the client for use as deterrents to future exhibitionism.

Fourth, if some cognitive changes are achieved, the cognitive model, including the role of thoughts and feelings in the behaviour chain, can be explained in order for the client to be as aware as possible of the potential benefits to them of maintaining cognitive changes. If they appreciate the rationale for this and agree with it, it is more likely that maintenance of the changes will be successful.

Fifth, a self-help task for use between sessions may be agreed.

These main strategies can be illustrated by extracts of dialogue which occurred during this session:

The issue of control

T: You say you know you will do it again and you haven’t got the willpower to stop.

C: Yes, I know the pattern now.

T: So is it possible to say how you’ve managed to stop since February?

C: Well, I told the wife and the doctor. I knew I needed help.

T: And you’ve carried on having urges—

C: Yes.

T: But you haven’t exposed yourself—

C: Yes, that’s right.

T: [Inductive question.] So how have you managed that? C: Well, I’ve avoided some places. I’ve been working hard… T: Anything else?

C: I’ve had less opportunities. I’ve avoided being alone. T: And when you have still had the urge?

C: I’ve controlled it. Like on the way here—I got the urge but I didn’t do it. And yesterday, I just carried on working.

T: [Challenge.] OK. It seems to me as if you are saying two things here —on the one hand you know you’ll do it again, you haven’t got the willpower. On the other hand, you say you controlled the urges, sometimes two or three times a week, for 4 months. Which one is nearer the reality?

C: Well I have controlled it—I’ve said so.

T: [Challenge.] So you have got the willpower? C: Yes, I suppose so.

T: [Challenge.] So is it really true to say you need to do it when things get dull? C: No—because I’m not doing it now.

The issue of deterrents

T: Do you say anything to yourself to try and help with the control?

C: I must tell someone.

T: And after you have told someone?

C:I feel better. This time I told my employer, who’s a friend, and then I told my wife. I tell her everything and it really helps us to communicate. If we stop talking about the problem it’s difficult to start talking about other things.

T: And what happens after that to help you with control?

C: My wife told the doctor. Then I went to him to get some help to stop me doing it. That’s why I’m here.

T: [Inductive question.] Do you ever think what would happen if you carried on doing it? C: I know I’ll get caught if I keep doing it. It starts off as just the once, but then it builds up.

T: [Inductive question.] What would happen to you after all your convictions, if you got caught again? C: I’m very worried I’d go to prison this time.

T: [Inductive question.] And if you didn’t, are there any other bad consequences?