OFFENDERS 115

T: [Challenge.] So going back to your original thought, is it true that you really want to do it to make you happier if circumstances are not ideal?

C:No. It makes me unhappy.

The issue of dissatisfactions

T:Going back to thoughts about your circumstances. You’ve said there are dissatisfactions with your wife—she’s not attractive enough. She’s not as bright and exciting as you want her to be [Challenge.] What’s so bad about that?

C: It’s not that bad. I shall have to make do, and accept things as they are. I’m pretty lucky with what I’ve got. T : [Inductive question.] And what’s the worst that can happen if you never expose again?

C: I’ll feel frustrated.

T: Can you cope with that? C: Sure.

T: What evidence do you have that you can?

C: I’ve been for more than two years without doing it in the past, and nothing happened.

The cognitive changes concerning pleasure and dissatisfactions were summarised with the client at the end of the session. He said that he felt quite different. It was suggested that he keep thinking these ideas through, and that he monitor urges to expose himself.

Session eight

This session, a fortnight later, aimed to review the tenacity of the cognitive changes over this period, and their effect on urges to expose and frequency of exposure.

The client’s following quotes illustrate the content of the review:

‘It’s given me confidence. I’ve told my wife all about it—and feel a lot closer to her too. I’ve been a lot happier.’

‘I’m now accepting things I’m dissatisfied with—previously I never did this. I was always wishing I was better than I am. Now I accept how I am. I don’t really need to try and be different.’

‘I accept my wife the way she is—although she’s not perfect. I’ve appreciated her more.’

‘I don’t believe I have to do it ever again—because it doesn’t give me any permanent pleasure, only unhappiness. The worst I’ll feel is frustrated.’

Given that for this client dependency on therapy has been an important part of his presentation, the matter of future contact was discussed at length.

The client felt that there was no need for further sessions. It was agreed that he should have direct access to the therapist should he require it during a six-month period, and that he attend a follow-up session after this time.

The cognitive changes that had taken place during therapy sessions with this client had not been supplemented by keeping formal records of automatic thoughts and written accounts of efforts at changing them to functional, reality-based ones. However, evidence that at this point enduring cognitive, emotional, and behavioural change was likely to have begun was available in the form of the client’s reports of his thinking patterns and overall new attitudes, his reports of feeling much better emotionally, and the beneficial effects on urges to expose. Further evidence was provided by his rejection of the offer of future sessions, and by his realistic predictions about how he would continue to cope when future pressures and trigger situations were anticipated. It seems likely that the dysfunctional assumptions underlying the client’s original negative automatic thoughts had also been altered fundamentally, and that an extended period of maintenance of the differences achieved would serve to consolidate this.

Session nine

At six-month follow-up, the client reported a lasting effect of his changes in automatic thoughts and underlying assumptions, and on his feelings and behaviour. He had had no urges to expose or incidents of exposure over this period.

Interestingly, in the light of some comments he had made about ‘bettering himself’, he had begun adult literacy classes and elocution lessons.

He expressed no wish for further appointments.