Bill Gatingway (fiction) - Psychiatric Disorder..Paraphilias..Exhibiting Disorders..Voyeurism...Frotteurism

Bill Gatingway (fiction)

Psychiatric Disorder
Paraphilias
Exhibiting Disorders
Voyeurism
&
Frotteurism

Analysis by
Felicia McCaw, Student Ph.D.
Saginaw Valley University Student Zone
Free to Live and Release Trouble Agency
Fall 2012


WORKING DRAFT EDITED 8-28-2014




Ms. Felicia McCaw
Saginaw Valley State University
Social Work and Sexual Violence
Instructor – Dr. Edward C. Jones
SW 314
Fall 2012





Biopsycosocial Assessment
of Bill Gatingway


Identifying Information

Bill is a 27 year old single black male of unknown religious background. He has never been married and resides in Ottaburg, Michigan and is a student at Vasact Community College fulltime.

Presenting Problem

Bill has contacted my agency for the uncontrolled compulsion he is suffering. He has expressed his anxiety and nature of being distraught about his inability to control his obsession to voyeur and acts of Frotteurism. Further he has established by written consent to undergo therapeutic sessions of discussions to repeat regression methodology to control obsessive behavioral patterns of reflective mental disorder psychological problems.

Bill has expressed that he feels compelled to watch women undress by either peeping in their window, using a mirror on his shoe, hiding in dressing rooms and doing acts of unwanted physical contact on strangers (women) that consist of groping and pressing himself against them in grocery lines, at the movies in lines for entry, in the elevator or in any close confined space.


Biopsycosocial Assessment
of Bill Gatingway
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Family Background

Bill stated that his parents are still alive and of mixed descent. His father is of mix culture of Black and Mexican and his mother is of mix culture of Black and Norwegian. Both are college educated and one works for the City of Ottaburg as an Assessor and his mother works at Ivancorp as a manager of the City Works Department. Both are 56 years of age and had him when they finished college and were married before his birth. Both parents have a good relationship with their son because he is an only child. Because Bill comes from a cultural heritage of three races he has mingled with all three races and has established his comfort with his heritage and acceptance of who and where he comes from. He established that he believes in God but does not attend church but his parents does and are of the Baptist faith.
Bill related that both his parents raised him in a strict authoritarian fashion and made him accountable for any misdeeds. His family’s income put them in the upper middle class and allowed them to socialize regularly with co-workers and neighbors.
Developmental History

Bill recounted that he was a normal child with normal tendencies and that nothing out of the ordinary from birth to infancy had occurred but indicated he started watching the neighbor next door sunbathing in the nude when he was nine

Biopsycosocial Assessment
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Developmental History (continued)

years old. He further stated that he found some adult magazines that his father had “stashed in the garage” and felt compelled to look at them every day when he was 10 years old and throughout adulthood. He stated that he started masturbating at the age of 11 after watching his father in the garage one day and began to emulate his behavior. Bill stated no one has ever relayed that anyone in the family of having suffered any disorder of any kind whether mentally or physically. He recounted that he had his tonsils removed after inflammation and drainage that required immediate removal but no other physical ailments.
Adult Adjustment Patterns
Bill stated he had no trouble adjusting to school from elementary to high school but since the age of 11 years he began to watch girls avidly. He further stated that he used excuses to get close and touch them and participated in recreational play and social activities that allowed close proximity. He stated that he never served in the military or achieved or did anything outstanding. He further asserted that his first sexual interaction with a female was at the age of 14 years and she was three years older than him. The relationship lasted 1½ years and his next relationship begun when he was 16 years old and continued for three years. During both relationships he was unfaithful and had sex continually with other


Biopsycosocial Assessment
of Bill Gatingway
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females and by the time he was 20 years old, he stated he began to really act compulsively as a voyeur and started to touch any female in any fashion he wanted and that is why he is here now to get help.
Assessment of Current Situation

Bill’s reflective state of mind and behavior reflects a clear indication of mental suffering and uncertainty of how to proceed to help himself. As per my analysis of him, he has clear indications of identity problems and lack of appropriate roles to follow, and a somewhat detrimental state of general adjustment in living, social attitudes are restrictive, constrictive and fraught with psychological problems. The psychological problems relate to his being a voyeur with the negative connotations of frotteurism. He is unemployed now but enrolled as a full-time student, single and involved with a female five years younger than him and who is unaware of his inner struggle with his sexual disorders. His interpersonal relationships are fair but distant and his values are fair and exhibited by him is the goal to change his life and eradicate his sexual disorder. Further relayed by him is that he wishes to establish a life as his parents and emulate them.







Biopsycosocial Assessment
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Research
Subject of Discussion I

Uncontrollable Acts of Frotteurism (Toucherism)

Frotteurism
(Classified under Axis I as
a Sexual Disorder)

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) text revision (DSM-IV-TR; American Pyschiatric Associaiton [APA], 2000)
Frotteurism involves touching and rubbing against a nonconsenting
person. The behavior usually occurs in crowded places from
which the individual can more easily escape arrest (e.g., on busy
sidewalks or in public transportation vehicles). He rubs his genitals
against the victim’s thighs and buttocks or fondles her genitalia or
breasts with his hands. While doing this he usually fantasizes an
exclusive caring relationship with the victim. However, he recognizes
that to avoid possible prosecution, he must escape detection after
touching his victim. Usually the paraphilia begins by adolescence.
Most acts of frottage occur when the person is between the ages of
15 -25 years, after which there is a gradual decline in frequency.

Over a period of at least 6 months, recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors involving touching
and rubbing against a nonconsenting person.

The fantasies, sexual urges, or behaviors cause clinically significant
distress or impairment in social, occupational, or other important
areas of functioning. (Page 527)




Biopsycosocial Assessment
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Bill’s behavior corresponds to the symptoms listed for Frotteurism because during the Interview I he stated that he acts without knowledge and presses himself against strangers (females) in closed areas. Further that this behavior resulted in full arousal by rubbing his pelvic area and penis on the victimized person. Also, he would relate that he would also fondle areas of the female and this reflects his sexual disorder. His disorder has caused unwanted fantasies, driving of sexual urges that compels sexual gratification of behaviors and which in turn causes significant clinical distress or impairment of ability to mix in socially because of his unconscious inability to conform to norms and impairs his ability to function correctly in occupational areas and other areas that require proper and correct functioning. Also, related was that this behavior had been ongoing over a six month period and this is the usual standard for establishing that a mental disorder exists and if it has been on a continual basis than this automatically establishes that the client is suffering mentally and in throes of distress because of his actions. As per the DSM-IV manual his behavior exhibits that he fits the diagnosis for Frotteurism (Toucherism).
As a working hypothesis people who suffer from frotteurism (or frotteurs) have no established psychological foundation to establish a basis of support for this
behavioral pattern. One hypothesis suggest that repetitive acts and repeated



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success and pleasure from the acts causes continual acts of touching and pressing
the pelvis and penis to an unwilling female and because he receives self gratification and pleasure this behavior is reinforced and maintains a continuance of the acts. People who have been established as frotteurs or suffering from frotteurism either come forward on their own or have been ordered by a court order to mental health for psychiatric evaluation and assistance.

Subject of Discussion II

Uncontrollable Acts of Voyeurism
(Classified under Axis I as
a Sexual Disorder)

Voyeurism

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (1994) text revision (DSM-IV-TR; American Pyschiatric Associaiton [APA], 2000)
The paraphiliac focus of Voyeurism involves the act of observing unsuspecting individuals, usually strangers, who are naked in the process of disrobing, or engaging in sexual activity. The act of looking (“peeping”) is for the purpose of achieving sexual excitement, and generally no sexual activity with the observed person is sought. Orgasm, usually produced by masturbation, may occur during the voyeuristic activity or later in response to the memory of what the person has witnessed. Of these individuals have the fantasy of having a sexual experience with the observed person, but in reality this rarely occurs. In its severe form, peeping constitutes the exclusive form of sexual activity. The onset of voyeuristic behavior is usually before age 15 years. The course tends to be chronic.

Biopsycosocial Assessment
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Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The additional problematic behavior that exist and is exhibited by Bill Gatingway is known as Voyeurism as cited by the Diagnostic and Statistical Manual, 4th Edition 302.82 Voyeurism.

His behavior corresponds to the symptoms listed for Voyeurism because during Interview II he stated that he suffers from uncontrolled compulsions to watch, stare, listen and observe in all capacities of voyeurism. He relayed that he gets overwhelming pleasure and sexual gratification from looking at the nakedness of females and is an avid collector of pornography (adult magazines) and has to be in private because he experiences orgasmic triologies. Because he is involved in all forms of voyeurisms he finds it hard to function properly in society for lapsing into fantasies of extreme that appear in truth of reality which cause him to approach his subject of interest with familiarity and refer to his fantasies and try to interlock her with interaction and invoke a memory in her.

He recalled he had started watching females at the age of 11 years of age and was compelled, intrigued and fascinated at the differences in his body and hers. His voyeuristic behavior exhibited renders him functionally deficit to function properly in society unless assistance is relayed to help either reduce episodes of voyeurism
or try reversal therapy (as cited by Dr. John Eaton, Website-Reverse Therapy, as support to use reverse therapy or reversal therapy in therapeutic sessions to work with problematic issues to learn to control and subsequently reduce the need to act out a psychological habit with the ulterior goal in mind of eradication.). Since Bill start of voyeurism initiated pleasure and the act of accomplishment that resulted in unparalleled success of not getting caught this perpetuated his continuance of this behavior.



Biopsycosocial Assessment
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As reflected voyeurism is a psychological and mental disorder that has effective states on mental status and mindsets that conclusively cause affective inability to function normally in society. Further as it relates to his experience as a voyeur and a participator of frotteurism it conclusively relates and support the theory that both paraphilias can conjunctively exists and reflectively cause internal damage mentally as both exists on a co-parallel basis. (As cited in the Diagnostic and Statistical Manual, 4th Edition indication that the possibility of having more than one paraphilias is possible and plausible – see page 523.)

Because both paraphilias exists on a co-parallel basis this causes additional distress and disable the ability to intermingle on interpersonal levels.

Intervention

Bill Gatingway is a person who suffers from two sexual disorders with one bordering and including toucherism that fall under the category of paraphilias – frotteurism and voyeurism. Both disorders cause psychological and mental disturbances because of hidden perceptions of compulsion to act on impulse in any closed confined spaces or any place where apprehension cannot be done.

The mode of treatment cannot be established if non-compliance is exhibited by the frotteur or voyeur and in order for any treatment to be effective to alter and modify existing psychological behavioral patterns it must be continued. Once the acknowledgement of a need to change is done and the need for alteration will establish that behavior therapy can be utilized to alter these states of behavior to change and learn to control the impulse to touch non-consenting women.

As cited from the website Encyclopedia of mental disorders, the process in establishing treatment starts with medroxyprogesterone (a female hormone) which will be prescribed to decrease sexual desire and start as a basis to reestablish control. Behavior Therapy will be used in repetitive measures of negative reinforcement to try to halt and prevent and curtail impulses to touch. Further based on my recommendation utilizing of video-enhance scenarios reflecting acts of voyeur and frotteurism will be shown to client as well as documentation of


Biopsycosocial Assessment
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responses to images as well as to questions asked will be kept and compared to each session given. Five hundred images of suggestive imagery of both acts of
paraphilias (voyeur and frotteurism) will be utilized to begin the process of behavioral alteration and documented notes per image of response will be maintained as comparison to each interaction with client. As another step in my working with client regression methodology will also be used to help control obsessive behavioral patterns and by its significance will be used in each studied measure.

Review of taped session with client and interaction regarding behavior with client will be done and psychotherapeutic treatment will be utilized to attempt to uncover the underlying cause of behavior. This treatment will consist of strengthening
social skills, providing problem-solving pointers to reflect an issue and then have clients try to come up with a remedy using observatory skills to provide an image and project strategies to schedule strategies to confront disorders and enable change. Interactive exchanges with the client will be done to ascertain the difficulty it may involve to initialize changes to alter behavior. Having the client to reflect on his observatory skills will allow a measure of his cognitive abilities to understand the need to change his behavioral pattern by permissive alteration.

By obtaining the client’s permission to submit to the testing session and being in a natural observation area to make client comfortable it will allow a clear relationship between client and psychologist and enable rapport and ease. Developing rapport with the client is of the upmost importance because it will allow the relaxation stage and enable the acceptance and change phase to develop.

The goal and purpose is to develop discipline and focus to enable self-control and change and get client on the road to normalcy and acceptance of who they are, were and who they can become. By admitting there is a problem and facing it head on this will allow the acceptance that it can be done and achievement is not far away.





REFERENCES
Guterman, J. T., Martin, C.V. & Rudes, J. (2011). A Solution-focused Approach to Frotteurism. Journal of Systemic Therapies, 30(1), 59-72.
Diagnostic and Statistical Manual of Mental Disorders. (1994). DSM-IV. Published by the American Psychiatric Association. Washington, D.C.: U.S.
Langstrom, N. (2009). The DSM Diagnostic Criteria For Eshibitionism, Voyeurism and Frotteurism. Arch Sexual Behavior, 39, 317-324.
All About Counseling.com. Behavioral Therapy. Basics of Expanding Horizons Through
Behavioral Therapy. Retrieved September 23, 2012, from
http://www.allaboutcounseling.com/library/behavioral-therapy/
All Psych Online. The Virtual Psychology Classroom. Voyeurism in Paraphilias and Sexual Disorders. Retrieved September 22, 2012, from
http://allpsych.com/disorders/paraphilias/voyeurism.html
Forensic Psychiatry.ca. Frotteurism. Retrieved September 22, 2012, from
http://www.forensicpsychiatry.ca/paraphilia/frotteurism.htm
Encyclopedia of Mental Disorders. Frotteurism. Retrieved September 22, 2012,
from http://www.minddisorders.com/Flu-Inv/Frotteurism.html
Encyclopedia of Mental Disorders. Voyeurism. Retrieved September 20, 2012,
from http://www.minddisorders.com/Py-Z/Voyeurism.html
Encyclopedia of Mental Disorders. Voyeurism. Retrieved September 20, 2012,
from http://www.minddisorders.com/Py-Z/Voyeurism.html
Wikipedia. Voyeurism. Retrieved from September 20, 2012, from
http://en.wikipedia.org/wiki/Voyeurism
Wikipedia. Frotteurism. Retrieved from September 20, 2012, from
http://en.wikipedia.org/wiki/Frotteurism
Mind Disorders. Frotteurism. Retrieved September 20, 2012, from


REFERENCES
Page 2
http://www.minddisorders.com/Flu-Inv/Frotteurism.html
Mental Help, Sexual Disorder Symptoms – Frotteurism – Sexual Disorders (Paraphilias) Resources. Retrieved September 20, 2012, from
http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=542&cn=98
Fuchs, Marek. Gender-of-interviewer effects in a video-enhanced web survey: Results from randomized field experiment. PsycArticles, Social Psychology 40.1.
http://0-search.proquest.com.library.svsu.edu/psycarticles/docview/614507078/13956210F...
Reverse Therapy. Dr. John Eaton. Retrieved October 11, 2012, from
http://www.reverse-therapy.com/