The Ups & Downs of the Penile Plethysmograph

Transcription

1 What Exactly is a PPG The Ups & Downs of the Penile Plethysmograph Ezio Leite, LPC, LMFT, LSOTP Sean Braun, LPC, LSOTP PSY 301 W. Rosedale St. Fort Worth, TX Setting Up The Client Reasons To Use The PPG Headset & Microphone Extra small gauge Respiration Belt Galvanic Skin Responders Initial Assessment Determine treatment needs Assess risk Confronting denial Helps to open up communication between you and your penis Reasons To Use The PPG The single best predictor of sexual offense recidivism for Child Molesters are measures of deviant sexual arousal as measured by phallometric assessment (PPG). Reasons To Use The PPG All sexual offending is, by definition, socially deviant, but not all sexual offenders have deviant sexual arousal or preferences Hanson and Bussiere (1998) n=28,972 1

2 Times To Use The PPG Pre-Trial Initial phase of treatment Treatment progress Assess behavioral work End of treatment Problems with Self-Reported Arousal Cal - 68 y/o man who reported no erection in over a year. Inability to ejaculate. Arrested for Burg of Hab (stepdaughter and stepgranddaughter) Problems with Cal s Self-Reported Arousal Female Adult (Appropriate) Female Adult - Relational (Appropriate) Female Infant Internet Chat - Female Child Male Infant So What Can The PPG Tell You Gender Preference Age Preference Preference in regards to Consensual Sex Sex Sex PPG is NOT intended for What to Look for in Results The sole reason for a diagnosis Determining guilt/innocence of a sexual crime Use as the ONLY diagnostic tool Significant arousal response Area under the curve Control measures 2

3 Reasons for Flat Response Pattern Anxiety Impression Management Weak stimuli Failure to attend to stimuli Manipulation of penis or gauge Alcohol, Drugs, Medication Erectile Dysfunction Pre-test Setup Making clients comfortable Rapport Dispel myths Information about detection of countermeasures Importance of client giving honest and accurate representation Importance of client paying attention to what he is seeing and hearing Even SHOWING them the lab before the day of the PPG oftentimes reduces their anxiety Reasons for Behavioral Work in the PPG Lab Behavioral Interventions DECREASE CLIENT S RISK TO THE COMMUNITY Help client to be able to actually SEE changes he is making sense of accomplishment Teach client what works to control his arousal Preparing the Client How did I develop my deviant arousal? Help client understand the BENEFITS Reinforce that most of the work will be done by client outside of the lab Conditioning/Lab work may continue for 3-4 months Different behavioral exercises work for different clients Behavioral Interventions Aversive Conditioning Covert Sensitization A B C B C B C B C D 3

4 Behavioral Interventions Aversive Conditioning Covert Sensitization A B C B C B C B C D Behavioral Interventions Aversive Conditioning Covert Sensitization A B C B C B C B C D Assisted Covert Sensitization Minimal Arousal Conditioning Other Increasing Appropriate Arousal Charting my work outside the lab Collaboration with Physician SSRI s Depo-Provera Assess for ED Blood pressure medication Diabetes What Goes On Inside The Lab? Clinician is able to observe current arousal to the stimuli presented Clinician can give client real-time feedback (verbal or lights) of his arousal as it is being observed/measured Case Study 1 Deviant Responder (JL) Case Study 1 Deviant Responder (JL) 30 y/o W/M Federal Probation Possession of Child Pornography Children ages 3-17 Including S&M involving children Female Adult (Appropriate) Female Adult -Relational (Appropriate) 4

5 Case Study 1 Deviant Responder (JL) 3 months of lab work Helped client develop insight into the words and phrases that were very arousing to him: I m gonna cut you Initially used weak covert scenes, though he said they were strong Olfactory conditioning with ammonia Had client view his PPG trace to monitor his own arousal as he listened to stimuli Case Study 1 Deviant Responder (JL) At the end of the 2 nd month, client said that since beginning to see some changes with the work he is doing outside of lab, he is committed to make more significant changes With a new found commitment, his lab sessions showed significant improvements between lab sessions Case Study 1 Deviant Responder (JL) PPG Retest Case Study 2 Pan Responder (CP) Female Adult (Appropriate) Female Adult -Relational (Appropriate) 63 y/o W/M Parole Sexually abused 4 y/o girl I thought she was 10 y/o Case Study 2 Pan Responder Female Adult (Appropriate) Female Adult -Relational (Appropriate) Exposing to a Female Adult (Age of Victim) Violence with a Child Case Study 2 Pan Responder (CP) Was not aware of his sexual response/arousal Had him say STOP during lab when he thought that he was beginning to show minimal arousal Covert sensitization work outside of lab 5

6 Case Study 2 Pan Responder (CP) Female Adult (Appropriate) Female Adult -Relational (Appropriate) Exposing to a Female Adult (Age of Victim) Violence with a Child d y/o Federal Probation Traveled out of state to meet a 13 y/o girl Sexually abused the girl he met but our work here is not yet done Female Adult (Appropriate) Female Adult -Relational (Appropriate) Internet Pornography Female Internet Chat Female Infant Healthy fantasy script Hands-off arousal Spoke fantasy out loud during lab to ensure that he was using a healthy fantasy Other appropriate visual and audio stimuli Keeping Track of Improvements Female Adult -unclothed (Appropriate) Female Adult visual-clothed (Appropriate) Female Adult -Relational (Appropriate) Keep good notes of what client is saying he is doing when able to quickly decrease his arousal See what is NOT working Internet Pornography 6

7 Remember Clients were able to modify their arousal; HOWEVER, they must continually work toward keeping their deviant arousal in check Just because you are at your ideal weight does not mean that you are done. You must maintain healthy habits for the rest of your life! Thank you Ezio Leite, LPC, LMFT, LSOTP Sean Braun, LPC, LSOTP PSY 301 W. Rosedale St. Fort Worth, TX