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Forty-five men arrested for exhibitionism were treated by mandatory group therapy over a three-year period. Individuals with mental retardation, organic
brain syndrome, or psychosis were excluded. Without legal pressure, denial of the significance of the symptom and inability to tolerate the anxieties of therapy made some leave treatment after a month or so. The progress of the others is seen in the following phases.
Denial: The shame, guilt, and remorse of self-exhibiting is denied and is re-enforced by the conviction that the act will not be repeated. At the same time, the act is considered a form of manliness. For the first six months of group participation, the patient remains isolated, though constant repetitious confrontations by more advanced group members, rather than contributions by group leaders, gradually weakens this isolation. The patient then involves himself voluntarily, instead of under duress. Acceptance: On realizing that his exhibitionism is immature and destructive, the patient recognizes emotional links with the other members, but he does so with difficulty. Anger: Anger is the emotion most dreaded by the exhibitionist because of fear of retaliation and of being overwhelmed by his infantile rage. Yet he equates rage and destruction with true masculinity. The most frequent objects of his rage are the important females in his life. He vents his anger in the group situation, however, on abstracts such as the law, social attitudes, etc. Disappointment: The patient's mastery of his fear of anger gives him a masculine identity, but he is disappointed because the old exhibitionistic urges still persist. He is then shown the fact that his impulses are now conscious—a sign of progress—and that they are easier to control. Upward movement: Exhibitionists are usually underachievers, but many make progress in their jobs during this phase of group therapy. Separation: For these patients, who may be jailed at the first recurrence of thei