Treatment Options

Treatment for paraphilias is generally multifaceted and may include group, individual, and family therapy, medication, education, and/or self-help groups (Seligman & Hardenburg, 2000; see Table 16.3). Overall, treatment is aimed at the reduction or elim­ination of the paraphiliac symptoms, relapse prevention, and increasing victim empathy (d’Amora & Hobson, 2003).

Whatever the technique, the most important goal of therapy must be to change a person’s behavior. If behavior can be changed, even if fantasies and inner emotional life are not altered, then at least the person will not be harming others or himself or herself. That is why behavioral techniques have been the most commonly used and most suc­cessful of the paraphilia treatments.

Therapy to resolve earlier childhood trauma or experiences that help maintain the paraphiliac behaviors is also helpful (H. Kaplan et al., 1994). This therapy can help increase self-esteem and social skills, which are often lacking in paraphiliacs. Positive behaviors can be encouraged by teaching paraphiliacs how to improve their social skills, allowing them to meet more men or women as potential sexual partners. To change emotions and thoughts, counseling, modeling (taking after a positive role model), or feedback can be used to change a person’s attitudes toward the sexual object. In empathy training, which is useful when there is a victim, the person is taught to increase his or her compassion by putting him — or herself in the same situation as the victim. Incarcerated sex offenders may be exposed to re­lapse prevention therapies, which focus on controlling the cycle of troubling emotions, dis­torted thinking, and fantasies that accompany their activities (Goleman, 1992). These techniques can be used in either group psychotherapy or individual counseling sessions. Group therapy has been found to be an important tool in reducing isolation, improving so­cial skills, and reducing shame and secrecy (Seligman & Hardenburg, 2000).

Yet most find their desires difficult to suppress, and for them aversion therapy is one of the most common treatment strategies (Seligman & Hardenburg, 2000). In aversion therapy, the undesirable behavior is linked with an unpleasant stimulus. For example, the person might be shown pictures of nude boys or asked to fantasize about exposing himself to a girl, while an unpleasant odor, a drug that causes nausea, or an electric shock is administered. This technique has had some success (Hawton, 1983; Little & Curran,

TABLE 16.3 Paraphilia Treatment Options

shame aversion A type of aversion therapy in which the behav­ior that one wishes to extinguish is linked with strong feelings of shame.

1978), although its effectiveness decreases over time. In shame aversion, the unpleasant stimulus is shame; for example, an exhibitionist may be asked to expose himself in front of an audience. Although removing the behavior itself may protect any victims, the person who still fantasizes about the behavior or has the same underlying attitude that led to it (such as fear of women) may not really be that much better off. The psychological underpinnings of the paraphilia also must be changed. In systematic desensitization (Wolpe, 1958), the person is taught to relax and then taken through more and more anxiety-provoking or arousing situations until eventually the person learns to relax during even the most ex­treme situations (Hawton, 1983). A number of therapies incorporate masturbation to try to reprogram a person’s fan­tasies. In orgasmic reconditioning, the paraphiliac masturbates; just as he feels orgasm is inevitable, he switches his fantasy to a more desired one, hoping thereby to increas­ingly associate orgasm and, later, erection with the desirable stimulus. Similarly, in sati­ation therapy the person masturbates to a conventional fantasy and then right away masturbates again to the undesirable fantasy (Marshall, 1979). The decreased sex drive and low responsiveness of the second attempt makes the experience less exciting than usual, and eventually the behavior may lose its desirability.

I systematic desensitization A technique by which a person learns to relax while experiencing arousal or anxiety-provoking stimuli.

orgasmic reconditioning A sex therapy technique where a person switches fantasies just at the moment of mas — turbatory orgasm in order to try to condition himself or herself to become excited by more conventional fantasies.

satiation therapy A therapy to lessen excitement to an undesired stimulus by masturbating to a desired stimulus and then immediately masturbating again, when desire is lessened, to an undesired stimulus.

ReviewQuestion Identify and discuss the treatments for the paraphilias.

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