Confessions of a Psychotherapist Pt. 02

Outpatient therapy is sometimes known as the referral of last resort. Generally, people go to their doctors first to explain distressing symptoms and after some routine questions and tests about a patient's behavior that are unexplained by medicine, doctors refer to mental health. This is my bread and butter as a psychotherapist.

One of my favorite examples is Dorothy. That's not her real name of course, but it will make sense in a moment. When Dorothy first came to my office, she was like most other mid-thirties, upper middle class housewives that find themselves in a therapist's office with no history of mood or anxiety disorders. Skeptical, yet concerned they're crazy. These are assumptions of course, but all I had in the brief moments of scanning her intake forms minutes before she stood nervously in my office doorway. Dorothy was beautifully over dressed for a therapy appointment. I'd make a point to tell her comfort is key. She appeared as the stereotype of a high school beauty queen turned soccer mom.

"So tell me what brings you here, Dorothy." The rote opening line in my daily work with new patients.

Dorothy smiled and stammered her words, uncomfortably shifting in the arm chair adjacent from mine. "Well... its a long strange story. It's just uncomfortable and so weird. I don't know."

I smiled and shuffled in my seat to match her behavior, the routine of building rapport. "Take all the time you need. It's safe here. Just between us, my license depends on it." We both forced a chuckle.

Silence. I let it go to the point of discomfort and continued to make eye contact for nearly a minute. It's her turn.

"Uhm. I'm having trouble with sex." I nodded and affirmed, still listening and waiting. "You see, I'm married and have been for a long time but... our sex life had stopped. I just couldn't get in the mood."

"Couldn't? Past tense?" I replied.

Dorothy smiled and shuffled, I noted that this body language meant that she's got something uncomfortable yet important to say.

She gave another chuckle as her eyes wandered the room. "Yes, so it was really nonexistent and I just couldn't ever get in the mood, like at all. It was really bad and caused a lot of problems with my husband."

"So, what I'm hearing is that for a long period of time you wanted no sex at all to the point where it stopped. But it sounds like it's not like that right now?" Reframing... right out of the motivational interviewing text book. "So what changed?"

"Well, we found something by accident. It all happened on Halloween last year. We went to costume party. I dressed as Dorothy from the Wizard of Oz and my husband was the lion. So when we got home, I was extremely... horny... and we had really passionate sex, like really passionate and this was after a year of none at all."

"Well that's not odd at all. Role play is very common and stimulates sex lives really well. As a matter of fact, it's a recommended intervention pretty often. I've assigned it as homework more than I can count." I said with confidence, thinking this will be a breeze. The smile and shuffle followed and I knew I missed the mark.

"Right! I thought it got us back on track, but it didn't... at all. The next day and week we were right back where we were. We tried to figure it out. We tried to be detectives about it and I eventually put the costume back on and... we'll then I was..."

"Horny again?" Always use their words. Therapy 101.

Dorothy smiled and nodded. "Yeah, so that was about 8 months ago. And... well, I can only have sex and only have an orgasm, even when I'm alone, if I dress up like Dorothy from the Wizard of Oz." She put her palms over her eyes in embarrassment. This was obviously causing distress. I didn't respond, just observed how she'd react to the silence. She uncovered her eyes and squinted at me as if I'd think she was insane and needed to be hospitalized.

I attempted to normalize the behavior. "Again, role play can stimulate. But it sounds like you want to find a way to have sex as yourself and not someone else?"

Dorothy let out a sigh of relief, "Yes! That's exactly it! I feel like something is really wrong with me" her voice quivered as I pushed the tissue box on the small table dividing our chairs toward her.

I formulated my plan: normalize, psycho educate, teach basic emotional scaling, analyze current behavior, replace with more adaptive behavior. "Dorothy, I think we can work together to come up with a plan. We've already identified the goal. Let's see if we can do this together."

Dorothy smiled while wiping her tears and I could see the body language expressing hope. A good sign. We spent the rest of the session walking through the thoughts, emotions and subsequent behaviors, detailing the sex down to every position and scaling the "horny-ness" she felt. I gave her a stimulus reducing exercise for homework. Go home, dress like Dorothy, get fucked and scale the emotion. Then do it again, but reduce the costume slowly. Start with taking off the shoes, then the braids, then change the dress to something similar but not the Dorothy dress, etc. The purpose as she scaled was to find the minimum point of stimulation and slowly reduce the needed role play.

***

At the following session, Dorothy was late. That either meant she failed to do the homework or it worked to the point that the distress level didn't warrant a subsequent visit.

She finally arrived. No smile, but with a sullen look on her face. She didn't speak.

"How was your week? Did you get to try the homework?" I said, having absolutely no idea where this was going.

"Yes. Yeah I tried, but no matter what. Whenever I got rid of the costume, I just couldn't even bring myself to have sex. We both talked about it and tried and I was just repulsed." She was staring at the floor, just seemingly defeated.

"You both talked about it? Dorothy, are you usually, you know, in character when you do this?" I asked, thinking my approach may be way off.

She blew her nose with a tissue and tugged her skirt down as she shuffled, "well yeah. I talk like Dorothy and he... well, acts like.. well it's not like the movie, he just acts different."

"He acts different? Like how?" I think I know where this is going.

Dorothy's tear soaked eyes connected with mine as she stared at me. Untrusting, feeling crazy. Her hands tugged again at her skirt and she rested them on her knees as she looked down shamefully to the floor. I leaned forward from my chair toward her and placed my hands on the top of her hands "I want to help you, not judge you. I know you're in distress and we can do this together."

She looked up at me and took in a deep audible breath. Tears slowly streaming. She starred in a longing way. I took a chance. "Dorothy... how horny are you now?"

She let out a slight cough, completely caught off guard with the question. "What?"

"How horny are you now? Scale it!" I demanded, raising my voice volume, causing her to jerk.

She stammered and her breathing rate increased. "I don't know. I'm not sure I'm comfortable-" I interrupted reaching my hand forward and lifting her chin to put her eyes back in contact with mine, "I said scale it!"

She let out another deep breath with an open mouth of shock at the audacity. I continued to stare demanding an answer. Her voice quivered as she started to noticeably shake "I don't.. it's.. I think... f- four... five?"

Her hand that was holding her knee was traveling up her thigh which stopped when I looked down. "Keep going, let me see your panties." She was nearly panting, clutching her skirt in a tight fist with her hand. "Do it!" I demanded and her voice reflexively let out "yes sir!" As she pulled her skirt up revealing her black silk panties.

"That's a good girl" I praised as she continued to stare into my eyes, panting with her gaping mouth. "Stand up and take all your clothes off" I said in low volume with a determined and strong voice.

Without hesitation, Dorothy rose from her chair and removed her blouse and skirt, standing in front of me with just her black panties.

"Panties too, little girl" I said in nearly a whisper which resulted in Dorothy letting out a quiet but audible moan, "yes sir."

She pulled down and stepped away from her wet black panties. Her hair was visibly wet from her pussy as she held her hands over herself, pulling slightly against her clit. I stood up and unzipped my fly, releasing my hard cock that flipped out in front of her. She began to moan even more, rubbing her soaked pussy.

"Turn around and bend over in the chair, knees on the seat." She started to get into position before I even finished my sentence. She leaned over the back rest of the chair presenting her beautiful ass in front of my throbbing cock. I gently stroked her ass and pulled her thighs apart exposing her tight little pink asshole and dripping pussy.

I thrust my cock inside of her, sloshing in and out with my hard cock as she dripped all down the patient chair. I grabbed her hair and pulled her head back as I pounded against her ass. She was starting to nearly scream. Thank goodness for the noise canceling technology in a therapist office.

Pounding and pounding against her tight ass, I could feel her pussy tighten around my cock as she came once... then twice. As I reached climax, I withdrew my soaking cock and ordered her to turn around just in time shoot my hot sticky load all over her beautiful face.

After, we finally sat back in our chairs.

"So what happened? No Dorothy outfit on, right?"

Dorothy laughed in relief, like she was normal and sane again. "I don't know? I don't understand, but that was amazing!"

"Dorothy, I think this might be really simple. I think you're a submissive."

Everything changed for Dorothy after that session. She learned about herself, researched about the dominate/submissive lifestyle and felt normal again. All too easy.