Category Archives: CBT

Therapy of Sex Offenders

Therapy of sex offenders is a difficult subject, with much misinformation around. We have data in for three types:

  1. Pedophiles
  2. Exhibitionists
  3. Rapists

In general, therapy for pedophiles and exhibitionists has fared pretty well. The best techniques are probably cognitive behavioral therapy (CBT). Persons who go through therapy are significantly less likely to re-offend than those who do not. It is a lie that sex offenders are all incurable.

The therapy of rapists has been much more difficult and until recently, it had a bad track record. However, recent advances in CBT have shown that rapists can be treated with some success. Whether that success is at a higher or lower rate than the prior two offenders is not known.

The problems with the rapist are generally at least twofold.

1. Rage, anger and hatred. Most if not all rapists have extremely high levels of rage, anger and hatred. In fact, this is what typically motivates the crime. In addition, it is typical for them to have strong to extreme levels of hatred for women. It is the rage in general and the hatred for women in particular that tends to set off the crimes.

2. Low levels of empathy. Most if not all rapists have low to nonexistent levels of empathy for their victims. Although most sex offenses are characterized by similarly low levels of empathy, the lack of empathy in rapists is quite striking. In many cases, they simply do not care how their female victim feels. In other cases, they rationalize that the victim, or really all women, want to be raped, that is, they secretly desire it or enjoy it. Some say that unless the woman is violently fighting back, that means she wants it and enjoys it.

Low empathy levels are obviously a significant driver for offending, and it is one of the hardest things to deal with in therapy. Often there does not seem to be any way to get the offender to feel empathy for his potential victims. Why this is uncertain. Perhaps some people simply do not want to feel empathy. The therapy of individuals like this is to tell that even though they don’t feel empathy for their potential victims, they should not offend anyway because to do so might get them in trouble with the law. So you appeal to the offender’s self-interest in not offending. It’s not how you will make the victim feel, it is about what will happen to your life.

There is no one type of rapist. Not all rapists are serial rapists, though serial rapists are the worst kind by far. Some rapists rape only once and without warning. When asked, some of these types say they do not even know why they raped; they just did it. Others, serial rapists and single rapists, rape at a stressful point in their lives. Rape appears to be their way of blowing off steam so to speak.

Serial rapists may have gotten into a habit of compulsively raping. In this case, it is like an addiction, and it may be difficult to break the habit.

Antecedents of rape include voyeurism, exhibitionism, transvestic fetishism, frotteurism, panty fetishes and raiding women’s places to obtain them and burglary. All of these have in common a violation of the female victim in one way or another. While many who do these things do not escalate, some do.

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Filed under CBT, Crime, Criminology, Pedophilia, Psychology, Psychopathology, Psychotherapy, Sex, Sociology

Some Cognitive-Behavioral Techniques For OCD Patients and People in General

I have OCD, but I don’t talk about it much on here because no one wants to hear about it, understandably. If you want to know what it is, check out Wikipedia. I am a “pure O” obsessional. That is, I have no compulsions. Instead, my mind just goes around in idiotic circles a lot of the time, and I worry about all sorts of stupid shit. I also spend a lot of time trying not to think about various things, or trying to stop unwanted thoughts that keep popping into my head.

Personally, I have found that cognitive techniques don’t work very well unless I am good and medicated on a good OCD drug. I take an SSRI called Lexapro, but there are many others out there. In general, you need an SSRI. SSRI’s sort of suck, but so does OCD! Pick your poison. If x dose does not work, you may need to go higher.

Non-SSRI antidepressants, Lithium and Depakote, and antipsychotics are generally useless for OCD. I don’t think anti-anxiety drugs like Ativan and the Valium type benzodiazepines work very well either.

Many if not most psychiatrists and psychologists do not understand this illness very well. I have a number of patients who I work with online, and they are always getting misdiagnosed by docs. Typically misdiagnoses are anxiety and depression, or simply no diagnosis at all.

Many times they are given 3-4 different drugs all at once. Psych drugs are very nasty, and you need to be on the minimum number of drugs. The trend of polypharmacy so in vogue by psychiatrists nowadays is downright sick and almost evil. Furthermore, it’s stupid and pointless. These guys are nothing more than pill-pushers anymore, and it’s the more the merrier with them.

Many psychiatrists have a poor understanding of drug interactions. I have had to warn a number of patients of drug interactions due to the drugs that their moron doctors put them on. I really don’t understand why these docs are so stupid about this stuff.

You really need to be very aggressive with psychiatrists and psychologists. If you don’t like them, just pull up your tent and move along. Be assertive to the point of demanding with them, and don’t back down. Don’t treat them like they are Gods. I’m a horrible patient, but at least I know what I’m doing. You understand your body, and you understand your illness. Don’t let some silly clinician misdiagnose you on the grounds that “they are the experts and you are not.”

Read up on your illness, and read up on your meds. One fascinating thing about OCD patients is that most of them are intelligent, often highly intelligent. The illness seems to be directly related to intelligence. One interesting finding via MRI on OCD patients is that they have more brain cells and more connections than non-patients. Upshot is as we might expect. They think too much.

Anafranil remains the gold standard for OCD drugs, but it’s pretty nasty. It’s an old, dirty drug with lots of side effects. Nevertheless, nothing helped me like Anafranil. I could not have gotten my Master’s Degree without it.

Second line are the other SSRI’s which all seem to be about as good as each other.

It seems like cognitive stuff doesn’t work until you are on the drugs. Otherwise you’re too crazy with OCD to utilize cognitive stuff.

Cognitive-behavioral therapy is the therapy of choice, and there is much material online about this. I’m not going to bother going on about it.

However, I will say that it’s a good idea to confront the thing that you fear. In my case, there were a variety of situations that I feared, all revolving around a common fear, that, honestly, is ludicrous (And that I will not discuss.). I conquered the fear at at least one level by simply throwing myself into the situations that set off the fear (or the obsessive thoughts really).

I plunged into the deep end of the pool so to speak. For a while there, the thoughts just poured into my brain like a river so I could barely even think straight. The general tendency in situations like this is to run, to get out of there.

But the truth is, “You cannot run from your fears.” If you run from them, you will never get over them. Avoidance makes OCD worse. So you just throw yourself into the feared situation, and stay there while your mind is being overrun by horrible thoughts. Don’t leave, just stay and let the thoughts “flood” into your mind. I call this technique “flooding.” After a while, you simply get sick and tired of being anxious, and the anxiety starts to go down.

Your mind realizes it can’t run away from the feared object, so it just accommodates itself to the feared situation and learns to get used to it. This is how all of us overcame all of our fears in childhood and hopefully even in adulthood. You can’t stay anxious forever. After a while, the brain says, “I give up. Fuck it. We’re gonna stay here and handle this.” In behavioral terms, this is called “extinction.” The fear is “extinguished” through prolonged exposure.

If you get good and stabilized, there are some Kundalini Yoga* techniques you can do. One is alternate nostril breathing. Hold down one nostril and breathe through the other. First breathe through the left nostril and then breathe out through the right. Inhale as slowly as possible and exhale as slowly as possible. Cycles should be on the order of 45 seconds to 1 minute if you can. This is ok for OCD, but it’s mostly an anxiety reducer that works well for anyone.

A specific one for OCD is left-nostril breathing. Hold the right nostril down and breathe in and out through the left nostril. Once again, cycles should be on the order of 45 seconds to 1 minute if you can do it.

Another thing you can do is meditation. This works well if you are already pretty stabilized and want to get better. Focus your mind on one particular spot and just stay there. Think “nothing,” “nada”, “ommmm,” or whatever you want. Try to empty out your mind as much as possible from your obsessions.

If an obsession comes, mark it as an “irrelevant thought,” and just move back to your focus. This method enables you to keep most of the irrelevant thoughts (obsessions) out of your head. This method is best described as cognitive shifting. Research has shown that in OCD there is reduced ability to engage in cognitive shifting due to reduced activity of inhibitory activity in the frontal lobe. OCD patients are like a skipping record.

Instead of thinking “nothing”, you will only be thinking of important things or things you need to think about. It’s also very peaceful and helps you to think loving thoughts.

Most obsessions are pretty much “irrelevant thoughts.” I have one woman who worries about thinking racist thoughts or thinking bad thoughts about others (She’s nice and not a racist). A man and a woman I know worry that they are child molesters (They are not.). One man worries he might be in love with a little girl (He isn’t). I have a guy who worries that he hates people or that he feels superior to people (He doesn’t really hate people or feel superior to them).

They often try to overcome their thoughts with thought compulsions. The woman tries to think good things about minorities and nice thoughts about people instead, but then OCD pops up and contradicts her with racist stuff and nasty cracks about fat people, ugly people, etc.

I told her that really, it doesn’t matter if someone is fat or ugly or geeky or Black or Hispanic, and it doesn’t matter what she thinks of minorities, geeks, fatties or uglies. Who cares? The best way is to just avoid the issue altogether. Don’t think about how the person looks and don’t think about their race. Just focus on “ommmm” and keep that stuff out.

I told the guy that it doesn’t matter whether or not he’s in love with the little girl. He can’t think about this without turning into a rat on a wheel in his mind, so the only solution is to not think of those thoughts. Thoughts that send you onto the rat wheel are automatically “irrelevant thoughts” because you will never accomplish anything on the thought rat wheel. So best not to even go towards those thoughts at all.

With the people worried they are child molesters, I tell them that there is no way to think themselves to a solution of this issue. They just go round and round endlessly: “Maybe I’m a child molester. No I’m not. Yes I am. How do I know I’m not a child molester? I’m terrified I’m a child molester.” You can’t think your way to a right answer here! Best to just avoid the question altogether.

For the guy who worries he hates people or feels superior to them, I said it doesn’t matter whether he hates people or not or whether he feels superior to them or not. But since he can’t think about this stuff without going round and round in circles forever, I said to just avoid the subjects altogether and just think, “ommmm.” He does this and finds he’s nice to most people and doesn’t feel superior to most people either. In other words, meditation allows his true feeling to come out.

You can actually meditate anywhere. I meditate in supermarkets, driving down the street (You have to be a bit careful here), at coffeeshops, and the doctor’s office, etc. If you get good at it, most people will greet you with a smile and will give off good vibes towards you. There are some dangers with meditation, but I’m not really worried about them too much.

In conjunction with meditation, I would recommend studying Zen Buddhism. I studied it for many years, and for a while, I got very, very good at it. The ultimate book ever written on Zen is An Introduction to Zen Buddhism by D.T. Suzuki.

One thing that Zen teaches you is to only think about whatever you need to think about. There’s no need to think about 1000 things at once. When you clear your mind, you will only think of necessary or important things, and extraneous or irrelevant thoughts will become infrequent.

The person living in Zen simply lives his life with a clear mind and few thoughts. He doesn’t analyze his behavior. He just lives and acts naturally. He accepts his true feelings as they come to him. Once you start endlessly analyzing all of your thoughts and feelings, you’re on the road to nowhere. Just live and act naturally and don’t analyze. If you’re sweeping the floor, think about sweeping the floor. If you’re washing the dishes, think about washing the dishes.

These techniques work not only for OCD patients, but for anyone else as well. Meditation, Zen and yoga are great for anyone. Try them out!

*There are supposedly some risks with Kundalini, but I am not worried about them. I’ve been doing Kundalini for years, and nothing bad has happened yet. Sometimes it’s a bit weird though. You can get transported back in time to “previous selves” and “previous eras.” You have to be able to handle stuff like that.

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Filed under Buddhism, CBT, Disciplines, Meditation, OCD, Psychology, Psychotherapy, Vanity, Yoga, Zen