Confessions Of A Psychotherapist Pt 03

Anxiety disorders come in all shapes and sizes, simple to complex. There are a number of diagnoses for them, but they all boil down to the common denominator of anxiety: the basic fear response without stimuli.

This is about Katy, a 20 year old female, college drop out living with her parents. The reasons for her current status will soon be apparent. She came to my office at the request of her parents.

Session 1: The Assessment

I met Katy in the waiting room which is not unusual for first contacts. She was very petite and dressed in sweat pants and a sweat shirt as if she was about to go jogging. Her brunette hair was bunched in a ponytail that had no help of a brush. She had no makeup on her face and seemed very pale in complexion. After our initial greeting I walked her back into the office.

"Well good morning, Katy, it's nice to meet you. What brings you hear today?"

Katy sunk into the arm chair with her knees up to her chin, arms crossed around her shins bouncing slightly in a childlike way. "Well, I know my parents told you what's going on, so yeah."

"They did, yes. But if you wouldn't mind, I'd love to hear from you what's going on." Another cookie cutter line I use in 80% of all my assessments.

Katy continued to rock in a self soothing way looking up at the ceiling. "I have a problem. It's really bad and I don't know what to do." She began to instantly tear up and she pulled a Kleenex from the box on the table.

I didn't respond, just waited and listened.

"I have a big problem around people, mostly men. I know you've been told about this already, but I'm basically scared all the time."

"Scared of what?"

"I'm afraid I'll do something inappropriate... like I'm afraid I'll jump on a guy." Katy nodded to herself as if she gave too much information too quickly.

"Can you explain what that means?"

Katy squeezed her arms around her legs tightly in the chair, pulling her knees deep under her chin. "I know it sounds dumb, but I'm afraid I'll lose control and reach for a man's crotch or try to do something inappropriate like that."

I tilted my head and briefly reminded myself of the active listening skills I'd learned. "Has this happened before?"

Katy snorted a laugh wiping her nose with the Kleenex, "nope." She squinted her eyes and continued to rock.

"So, what makes you think this will happen?"

"I don't know. I just one day started to worry? I guess? And my worry became a weird fear. It just gets worse and worse. I start to panic. I just think I'll not be able to stop myself."

Katy went on to explain that she had these intrusive thoughts mostly when she saw men, whether she was attracted to them or not. Those thoughts were so feared and judged by her own psyche that they had become urges. She continued to explain that she had found relief in certain activities that she felt kept the thoughts at bay.

I briefly explained the difference between thoughts, emotions and behaviors to make sure we were on the same page then dug for more information.

"So tell me about some of these things you do to make the thoughts go away."

Katy finally dropped her feet to the floor and reached for a new Kleenex. "Well they don't go away. But I just do some things to make sure the urges don't get too strong or if they get to be too much to handle, I have protection."

"Yes, tell me more about that," I said, genuinely intrigued.

"Well, I tend to look up at the ceiling when I talk to guys as you may notice. That's so I won't have to look at a guy unless I have to. Under these pants I'm wearing, I have a pair of shorts and three pairs of underwear. I've considered some sort of chastity belt and researched pricing. But the part that's making my life so difficult is that I usually run home when I'm, well, in a situation like this."

"To do what?" I was on the edge of my seat like an intern.

"Well, to make sure I don't make a fool of myself. Then, I purge the thoughts."

"Tell me about purging the thoughts."

Katy squinted her eyes and paused. She didn't want to answer, the distress was so thick.

"I usually, masturbate, to make sure the urge or whatever you call it is gone."

Katy explained that over the past two years the compulsion to masturbate was increasing. She was not sexually aroused at all, but would do this behavior for up to hours at a time to "purge" the obsessive thoughts.

The constant intrusive thoughts and time consuming compulsive behaviors had caused a massive lack in functionality in her social life as well as occupational life. Ultimately, this cycle of avoidance resulted with her moving back in with her parents.

I diagnosed Katy with obsessive compulsive disorder with a specifier of "poor insight," based on her strong conviction that the compulsions were absolutely necessary and her urges would result in loss of control.

I shared my diagnosis with Katy and we discussed treatment options. I explained exposure therapy and provided tons of data on its effectiveness supporting the treatment option. In a nutshell, I explained, exposure therapy exposes the stimuli triggering the anxious response to the patient in a controlled manner, ever increasing until the brain identifies that the body is actually not in danger. The trick is to gradually increase the trigger to reach the anxiety "sweet spot." If the anxiety is too low, it's not enough discomfort, if it's too high the patient will avoid.

Over the following three sessions, we slowly began treatment. First, I provided education on anxiety and how it affects the body and emotional state. I taught her to scale her anxiety on a 1 to 10 scale. I started with a slow diet of distressing stimuli using flash cards of male models wearing skinny jeans and we scaled the anxiety. I gave her homework to do at home using this technique.

Session 3

"Welcome back Katy, how was the homework?"

Still in the same comfortable attire, she sat a little more open with her legs crossed in the seat. Rapport was being built. She still looked up at the ceiling most of the time when talking to me.

"Well, I guess it's just easy? It doesn't cause any anxiety when I look at the pictures. I mean, it's always been in person with someone that I have problems."

"That's ok! I wanted to find the minimum so this is progress. So you know the basic idea of what we're doing here, any suggestions on how we can expose you?"

Katy shook her head, "not really."

"Do you have a close make friend or ex boyfriend or anything?"

"No. No I don't."

Katy explained that this started in high school and always impeded her ability to make relationships with men.

I was stuck here. She needed a real life stimuli. "Alright Katy. This is our third session. Let's work with what we have, okay? Can you look at my eyes?"

Katy let out an overdramatic sigh and gritted her teeth while wincing her eyes shut. She took several deep breaths.

"Katy, this is a safe place. I want you to open your eyes and look into mine. Even if it's just for a second, just do it as long as you can."

She opened her puffy eyes and stared deep into mine, her mouth quivering, struggling to maintain eye contact.

I smiled and connected her gaze, "that's it, there you go." Her teeth began to chatter and after 15 seconds she winced her eyes shut. She scaled the anxiety at an 8 and described the urge to run away. This was a perfect starting point. We continued this exposure for several sessions until eventually the anxiety was scaled at a 4 and she could stare into my eyes almost indefinitely.

Session 6

It was time to increase the stimuli. Katy had made significant progress in making eye contact and staying in the chair, fighting the urge to run away. From session 1 to 5 the amount of time she spent masturbating or purging when she got home immediately following the session was dropping in duration as well.

"Alright Katy, it's time to step it up. You've been making progress and we need to move forward. Are you ready?"

Katy nodded and smiled. This was the first time I'd seen her perfect, white teeth. She was making eye contact with me now most of the time during the sessions.

"This will be the toughest yet. It will definitely make you uncomfortable and it's supposed to, right?"

Katy nodded and winced at me.

I put my hands on my thighs drawing attention to my legs and moved my hands up toward my torso slowly. "I want you to look at my crotch."

"Oh my God!" She blurted out covering her eyes with both her hands.

"Katy, you know this is a safe place. You can do this. It's just like making eye contact, you're ready."

"I don't know if I can do that!" She blurted out.

"Yes you can, just remember to breath, diffuse the thoughts just like we learned. Give it a try."

Katy slowly moved her palms from her eyes and looked down at my crotch. She took quick shallow breaths, prompting me to remind her to breath easy. She maintained eye contact, biting her lip, struggling.

"That's it, you're doing great! Look at you, you're still in control aren't you?"

"Yes. Oh God. Yes." Her eyes still transfixed on the crotch of my slacks. I began to move my hands up toward my inner thighs. My cock was inadvertently swelling and protruding an obvious outline through my slacks which served as great stimuli for the exercise. I cupped my hand around my hard cock that was thrusting down my left pant leg. Katy started to take loud shallow breaths again.

"That's it, breathe. You've got this."

Katy scaled this at an 8 and we continued. By the next session, she was able to stare at my crotch scaling 6 in anxiety.

Session 8

This session started like the previous two. I'd rub my cock through my pants while she watched, seeing that she could maintain control much better than she imagined.

During this session, I didn't wear any underwear and about two minutes into the activity, I unzipped my fly and withdrew my hard cock through the open zipper as she watched.

"Oh my god, what are you doing? I can't, I can't-"

"Yes you can, it's just like before. They're just thoughts, Katy. Just let them be there. Don't judge them or wish them away. Just be in the moment."

I began to stroke my hard cock in front of this 20 year old girl as she stared. She started to lightly moan under her breath with her mouth gaping open.

"That's it, see? What are you thinking?"

"I think it's gorgeous," she reluctantly strained out through her gritted teeth.

"That's ok, just thoughts, remember? You haven't lost control and jumped from your chair, right?" She nodded with her eyes still transfixed. "As a matter of fact, let's prove how in control you are. Want to do that?"

She nodded her head with an almost desperate, worried look.

"Take your index finger and put it in your mouth. Get it really wet. And just rub your finger on the tip of my penis."

I was expecting protest, but Katy slowly placed her finger deep in her mouth, still staring at my cock. She withdrew her finger with a long string of saliva that followed and touched my swollen head still being stroked gently in my palm.

"Ooh, I really like that" she cooed with a hint of guilty distress. She slipped her finger all around the head of my erect cock, mixing her saliva and my pre-cum in a playful way.

I continued to give her small limited tasks for which she demonstrated perfect control to herself. She continued to rub the head of my cock and caressed my balls. I let her take over and stroke my cock as well. By the next session, she brought me to orgasm with just her hands covering her dainty little fingers with my cum.

Session 10

"Ready for your final exam?" I asked in a positive and joking manner.

Katy was wearing jean shorts with only a single pair of panties and tank top. She made eye contact nearly all the time now and gave a beautiful, energetic smile, "yep! Can't wait to find out what it is."

"You have done some great work, Katy. This might just be the last session you need. So let's get going. I need you to go ahead and stand up."

She shot up out of the chair with an energetic bounce flashing that adorable smile, just waiting to show off her new skills.

"Take off all your clothes," I told her in a firm confident voice.

Katy started to breath heavy again and bit her lower lip. Her smile slightly faded with a hint of insecurity, "are you sure? But what if I-"

"Take off your clothes, Katy."

As Katy proceeded to peel off her tank top and jean shorts, I stood up and took off all of my clothes as well. We both stood naked in front of each other. I towered over her petite, soft body and walked her backwards with my hands on her shoulders until she bumped into my desk with her buttocks. I pushed her shoulders back until she lay back on my desk with her firm little muscular legs coming off the floor and up in front of me.

I lifted her legs and feet up toward the ceiling exposing her shaved little pink pussy. She was panting in anticipation, staring into my eyes, ready for my throbbing cock to thrust deep inside of her.

I grabbed my cock by the hilt and merely rubbed her clit with the head. She grabbed hold of the desk with her hand and started thrusting her torso toward my cock, trying to force

it inside her little pussy that was starting to foam and drip onto my desk.

"Stay in control, Katy."

"No. I can't. I need it! Fuck me, Please!" She begged in a childish way.

"Yo've got this, you have control, Katy."

Katy was bouncing on my desk, grunting and whining, begging for my cock.

"Katy, the more you show me you're in control, the more I'll give you."

This almost instantly calmed her down as she took deep breaths, and closed her eyes. After almost 30 seconds, when she was calm and accepting, not fighting the urge, I rewarded her, slowly but forcefully thrusting my length balls deep into her tight, sloppy hole.

In and out, rhythmically and firmly I pounded that little 20 year old girl. Her pretty little toes in front of my face pointed up toward the ceiling. She moaned and shrieked in ecstasy, finally finding the appropriate moment to lose control. She held her breath for a moment and let out a loud cry as she soaked my balls with her cum, unleashing a massive orgasm. Moments later, completely lost in the moment, i lost control as well and drained my entire load deep inside of her beautiful little body.

As she lay panting on my desk, legs still up in the air, I asked her to scale her anxiety. She gave me that beautiful smile and said in confidence, "Its definitely a 1."