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n

Although he may havemadesignificant'progressin his pasttherapy,it is this examiner's opinion thatto maximizeMr. Wolferts' treatment'gainsit would be bestfor him to be in a program that specializesin working with sexual addiction where he can take advantageof group therapy with others who have problems with sexual acting out, psycho-educationalskills coursesspecifically designedfor thosewho act out sexually, etc. The personalitystylesanddefensivestylesof thosewho act out sexuallytendto be markedly different from the averageanxiousor depressedclient that most general therapistsareexperiencedwith.

2) Mr. Wolfertsshouldsuccessfullycompletean outpatientprogramof therapyin a recognizedsexualaddiction/abusetreatmentagency.Thisprogramshouldinclude:

a)

b)

c)

d)

e)

0

g)

Individual therapy

Group therapywith otherswho havesexualaddiction.

Involvementin variouspsych-educationalskillscourses(e.g.victim empathy,anger mimagement,assertiveness,sexualeducation,etc.)

Marital therapy (asneeded)

Family therapy (aswarranted)

Polygraphtestingto determinethenatureandextentofany otherinappropriatesexual behaviorandto helpMr. Wolfertsacceptfull responsibilityfor his actions

Sexual reorientation treatmentutilizing feedbackfrom penile plethymographyto

assisthim in 'normalizing'

or leamingto controlhis sexualarousalpattems

Treatment should be oriented toward establishingmore functional interpersonal relationships,acknowledginghis responsibilityregardinghis sexualacting out and controllinghissexualimpulses.Treatmentshouldalsobeconfrontive,highlystructured, realitybasedandshouldbeconductedby amentalhealthprofessionalwho is sufficiently trainedin theareaofsexualoffenses.

3)

Mr. Wolferts' intemetactivity shouldbe monitoredin orderto reducehis exposureto sexuallyexplicit materialandchatrooms. Thisis oftenaccomplishedthroughacouple

of different methods. Somehavefound it effectiveto not havea computerin a secluded

part of thehouse. Instead,theykeepthecomputerin thefamily room whereaccessis out

in

the open. Intemet filtering programscanalsobeplacedon thecomputer(althoughthis

is

only truly helpful in addition to monitoring), or get intemet accessfrom a provider

that filters the internet for them. Perhapsthe most effective method involves regular

checking of internet history and backup files by ft someoneelse as well as frequent (every90 to 120days)monitoringby meansof polygraphexaminations.

4)

A psychiatric consultationappearsto be warrantedto further evaluateandmonitor Mr.

Wolferts' psychological functioninganddeterminewhetherosvchotropicmedication mayhelpaileviatehisclepressivesymptomsandhis potentialrbr suicidalbehaviorit'such errrotron&lstatescontinuetbr ntorethm l2tJdaysfrom now

DSM IV DIAGNOSTIC IMPRBSSIONS:

AXIS I:

300.02

GeneralizedAnxietvDisorder

C. Y. Roby,Ph.D.'P.C.andAssociates (801)225-5451A:\Wolferts,Brien Eveluation04-ll-2003

L4

l2

 

R/O 300.3

ObsessiveCorhpulsiveDisorder

AXIS

II:

7gg.g

DiagnosisDefenedon Axis II

 

R/O 301.9

PersonalityDisorderNOS (DependentFeatures)

AXIS III:

Deferred

AXIS IV:

Problemswith primarysupportgroup Problemsrelatedto thesocialenvironment

AXIS

V:

GAF: 60 (current)

C. Y. Roby,Ph.D. Clinical Psychologist

C. Y, Roby,Ph.D.,P.C.and Associates (80f)225-5451AiWolferts, BrianEvaluetion04-ll-2003

b0