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Every therapist encounters, at least occasionally, a client seeking help with sexual issues of one ilk or another. Typically, these individuals are either overtly or covertly worried about too much sex, not enough sex, no sex, strange sex, addictive sex, cheating sex, bad sex whatever bad meansetc.
Sometimes these concerns are their primary presenting issue, but usually not. More often, sexual issues lurk in the background, hiding behind depression, anxiety, fear of rejection, shame, and similar problems. In such cases, a clients sexual concerns might only come to light while exploring the clients self-esteem, failed relationships, substance abuse, unresolved early-life trauma, mood disorders, etc.
Recognizing this, I find it useful to incorporate a few very basic sex-related questions into the initial assessment with every client. Unfortunately, many therapists and clients are uncomfortable discussing sexual issues. As fetish vs paraphilia, it is important for any initial queries to sound as neutral as possible. A few non-threatening questions I typically ask are:. Asking these simple, straightforward questions generally ensures that a clients important sexual concerns issues that might underlie and drive more obvious problems like depression and anxiety arent overlooked.
By posing queries and nonjudgmentally following up as indicated, we give clients permission to talk about their sex life and the ways in which it might be affecting them.
We let them know that its OK safe to discuss their sexual life in treatment, however much shame they may be feeling about it. At this point, some readers may be wondering exactly what I mean when I use the words kink, fetish, and paraphilia. And with good reason, because if you search the internet youll find a wide variety of definitions with quite a lot of overlap. In my work, I tend to define kinks as nontraditional sexual behaviors that people sometimes use to spice things up, but that they can take or leave depending on their partner, their mood, etc.
Fetishes are nontraditional sexual interests or behaviors kinks that are, for a particular individual, a deep and abiding and possibly even necessary element of sexual arousal and activity. Paraphilias are fetishes that have escalated in ways that have resulted in negative life consequences. A kink, a fetish, and a paraphilia can involve the same behavior, but the role that behavior plays and the effects it has can be very different depending on the person.
Consider as an analogy the difference between a casual drinker, a heavy drinker, and an alcoholic. The basic behavior, consuming alcohol, is the same, but the underpinnings, impact, and long-term effects are quite different depending on the person. Moreover, it is only when the behavior is taken to an extreme that in negative life consequences that its viewed as a disorder.
Kevin, a year-old attorney, enters therapy for severe anxiety. When asked a few basic questions about his sex life, he says that for the last several years he has been hiring a dominatrix a few times per month, paying her to physically and verbally humiliate him. He says he does not become physically aroused while this is occurring, but after the dominatrix leaves he masturbates furiously. He also says that he has recently started dating a woman he fetish vs paraphilia through another attorney, and he is afraid that if they have sex she will notice the many marks and bruises that he nearly always has on various parts of his body.
He says he wants to continue dating this woman, but he also wants to continue with the dominatrix. He is unwilling to tell his new girlfriend about his sexual arousal patterns, and this is creating a great deal of stress and anxiety. He also fetish vs paraphilia that twice in the past year he has started dating a woman he liked, only to break up with her because the stress of his compartmentalized sexual life felt overwhelming to him.
He also feels like his performance at work is suffering because of his anxiety. If BDSM was something Kevin engaged in occasionally with his partner s for a little bit of extra fun during sex, we would say hes got a kink. However, the behavior is clearly a primary element of Kevins sexual life, elevating BDSM the level of a fetish. Moreover, it is causing ificant and ongoing stress and anxiety, affecting both his social and work life. Notably, it is not the behavior itself that is pathologized. Rather, it is the way in which it affects Kevin that is pathologized.
Again, I will use alcohol as an analogy. We do not say that drinking alcohol is inherently pathological because plenty of people do it without any problems at all. In the same way, we do not say that BDSM is pathological.
If, for instance, Kevin was perfectly at ease with his dominatrix sessions and did not feel as if they were interfering with his dating and work life, and instead was coming to therapy about to his desire to change professions, his sexual fetish would be a clinical non-issue.
Sure, its the one that gets the most attention, especially with the Fifty Shades books and movies, but its hardly a lone sexual outlier. The DSM-5 specifically lists eight potential paraphilic disorders:. Once again, the APA very clearly states that a specific behavior does not become a paraphilic disorder a pathology unless and until it causes clinically ificant distress or impairment. And they could not be more right. Other somewhat outr possibilities include:. Just so you know, if theres a psychological term for it, at least a few people are into it.
So even though eyeball licking might not be your cup of tea, its a legitimate turn on for somebody. And its not the job of any therapist to pathologize this or any other non-harmful, non-offending sexual kinks and fetishes. If a specific sexual desire or behavior is not causing harm to the client or others, as therapists we should neither judge it nor try to put a stop to it no matter how weird we might think it is.
No matter how ego-dystonic, it is unlikely that any type or amount of therapy will make these interests disappear. Thus, our job as therapists is to help a struggling client explore his or her fears, shame, and misunderstandings about his or her arousal template, and to eventually reduce the negative impact that is having. For instance, we might try to help Kevin come out to the woman he is currently dating to see if she might support his fetish in a healthy and life-affirming way. And if she is not interested, we might work to help him find a woman who will.
Unfortunately, many clinicians are not trained to deal with complex sexual issues, such as kinks, fetishes, and paraphilias. Plus, some therapists are just plain not comfortable talking about nontraditional sexual topics. The best referral sources are listed below. Many of these organizations also provide trainings and certifications should you wish to learn more about a specific treatment specialty. Our experts answer candid questions about bipolar disorder formerly manic depression to enlighten, encourage, and dispel any myths. We're answering your questions and clarifying misconceptions about childhood attention deficit hyperactivity disorder.
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Here is what you can do. See how mindful fetish vs paraphilia and practicing gratitude together can heighten your sensitivity and resilience to life experiences. Your sexuality is a fundamental part of who you are. We discuss sexual dysfunctions and disorders that may affect not just your ability to enjoy sex…. Psych Central does not review the content that appears in our blog network blogs. All opinions expressed herein fetish vs paraphilia exclusively those of the author alone, and do not reflect the views of the editorial staff or management of Psych Central.
Published on PsychCentral. All rights reserved. You Want Answers? Read this next. Medically reviewed by Timothy J. All About Sexual Disorders.Fetish vs paraphilia
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