Cole had moved from a large institution for mentally retarded people to a small group home (within the community) in a rural setting. This was a major change for Cole. Since the age of five, he had spent 21 years in an institution, a portion of which was in a facility aptly called a back ward. Cole was high-functioning and motivated to succeed in his new residence. However, the staff discovered that Cole engaged in bizarre sexual practices, and, as a consequence, they referred him for behavioral counselling. The behavior of concern was coprophilia combined with coprophagia. The staff had completed a frequency count of the behavior, and it was clear that it was occurring at least three times per week. In the initial interview, Cole was informed that the behavior was causing concern in the group home. He was given two treatment options: (1) He could work towards obtaining pleasure from more acceptable sexual practices; or (2) he could engage in the behavior in a more hygienic manner. This nonjudgmental approach, and the oppor? tunity to select an option, surprised Cole. In fact, he quickly stated that he hated the behavior and was disgusted by it. Cole seemed unable to explain why he engaged in the behavior, except to state that it good. When asked what it felt like when he masturbated without using feces, Cole answered by saying that there was blood on his penis. This response immediately precipitated a referral to a urologist for assessment. However, the evaluation indi? cated that Cole had no urological complications. After several sessions, Cole disclosed that if he wanted to mastur? bate, he had to do it quickly to avoid being caught by the institutional staff. Thus, he would would grab his penis very hard and would rub it very quickly, which would provoke bleeding. Cole would then abstain from masturbation for several days, as the presence of blood would scare him. Also, Cole felt that he could not report it to the ward doctor, as he would have to admit that he had engaged in masturbation.