1. The Paraphilias An Experiential Approach to “Dangerous” Desires
Class 7

2. Paraphilias
Recurrent, intense sexually arousing fantasies, sexual urges, or sexual behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one’s partner, or (3) children or other nonconsenting persons that occur over a period of at least 6 months

3. Types of Treatment Cognitive Behavioral Therapy The Experiential Model
Experiential Psychotherapy is to allow the individual to fulfill – rather than constrain – his or her sexual and other potentials

4. Goals of Treatment
Treatment interventions for counseling couples engaging in variant forms of sexual behavior include strategies aimed at assisting couples to create mutually satisfying and healthy sexual relationships.
Treatment interventions for individuals engaging in more problematic atypical behaviors may include behavioral, cognitive, and biological approaches

5. The methods, goals, and outcomes are focused on reducing recidivism rather than on the kinds of personal development valued by psychotherapists.
Within the literature, the entire enterprise of trying to diagnose, classify, and control sexual behavior among consenting adults seen is morally rather than scientifically based and is thus ethically dubious.

6. Definition By definition, paraphilia’s are unusual sexual interests.
The DSM 5 listed the paraphilias as follows:
Voyeurism
Exhibitionism
Frotteurism
Pedophilia
Fetishism
Sexual sadism
Sexual Masochism
Transvestic Fetishism

7. The paraphilias tend to be divided in terms of coercive or illegal (i
The paraphilias tend to be divided in terms of coercive or illegal (i.e., voyeurism, exhibitionism, frotteurism, pedophilia) versus the non-coercive paraphilias (i.e., fetishism, consensual sexual sadism and masochism, transvestism)
The only consistent element across the literature is the notion that the large majority of paraphiliacs are male.

8. Of Interest
The average sex therapist may have been trained in psychodynamic, behavior, and biological theories of psychopathology but generally is unlikely to be seeing patients who present for treatment of atypical sexuality.
Much of the literature on sexual deviance is focused on pedophilia, rape, and exhibitionism.

9. Two new paraphilia categories were proposed in 2009: “coercive paraphilic disorder” and “Pedohebephilia.”
They were not added to the DSM 5

10. The paraphilias qualify for treatment only when they involve distress and dysfunction - and a patient. In the sex therapy literature, there is little discussion in recent years of how to treat the non-coercive paraphilias, presumably at least partially because individuals with unusual sexual proclivities do not present for treatment of them.

11. Experiential Model of Treatment
Experiential psychotherapy is unique, brings about fundamental change relatively quickly, and may seem intimidating to those unfamiliar with this approach. It does not aim to treat symptoms, problems, or conditions but instead uses the presenting problem as an opportunity for qualitative change.

12. The goals are for the client to integrate whatever is deepest within, thereby becoming a qualitatively new person, and for the client to be free of any painful feelings that were present at the outset.
In other words, the goal of experiential psychotherapy is to allow the individual to fulfill-rather than contain-his or her sexual and other potentials.

13. The Development of Atypical Sexual Behavior
Psychodynamic Perspective: from a psychodynamic perspective, various forms of sexual expression originate as a defense mechanism serves to protect the ego from repressed, distressed, or painful thoughts or memories.

14. From a behavioral perspective, atypical sexual behavior develops when a person sexual responses become conditioned to stimuli that depart from normative sexual practices.
From a cognitive viewpoint, people’s belief systems are based on faulty assumptions, misperceptions, or self-serving interpretations and are the basis for variant forms of sexual behavior.

15. Developmental conditions such as the occurrence of childhood sexual abuse, viewing pornography at an early age, or family psychopathology may influence the development of such atypical sexual behaviors such as the paraphilia-related disorders.
The biological perspective theorizes that there may be neurophysiological differences between those who developed paraphilia’s and paraphilia-related behaviors regarding sexual inhibitions and sexual risk-taking behaviors.

16. Abel’s Four-Stage Model
Stage 1: A child is exposed to sexual stimulation either by actual physical contact (directly) or by observing or hearing (indirectly).
Stage 2: A child rehearses what was experienced with imagined consequences (positive or negative)

17. Stage 3: A child experiments or tries out a behavior and directly experiences positive or negative consequences of the behavior.
Stage 4: Depending on the prior behavioral consequences, the behavior may be repeated or varied into different manifestations leading to greater reinforcement.
(Adapted from Wincze, 2000, p. 452)

18. Exhibitionism
Exhibitionism involves recurrent intense sexual arousal by the exposure of ones genitals (usually male) to an unwilling observer (most of the time, and adult woman or female child)
Most exhibitionists one to ”shock or embarrass the observer.”
Exhibitionists are usually male and initiate behavior prior to the age of 18.

19. Fetishism
Fetishism involves recurrent intent sexual arousal by the exclusive use of quote in animate object.”
Often the person masturbates fuck touching, smelling, or rubbing the fetish object.
Popular fetish objects include women’s lingerie; for garments; gloves; shoes; and other materials.

20. Frotteurism
Frotteurism refers to recurrent and intense sexual arousal that involves touching hand rubbing against a nonconsenting person.
These behaviors typically occur in the crowded public places such as subways, elevators, buses, or sidewalks.
Most men who engage in frotteurism are between the ages of 15 and 25, after which the frequency of behavior decreases.

21. Pedophilia
Pedophilia involves ”obtaining sexual gratification by watching, touching, and engaging in simple or complex sexual acts with pre-pubescent children, Usually those 13 years old or younger.
It is the most serious and destructive manifestation of atypical sexual behaviors and typically falls within the legal description of a felony.

22. Sexual Masochism
Sexual masochism involves intense sexual arousal by the act or thought of being humiliated, beaten, Bound, or otherwise made to suffer.
Although many people have masochistic fantasies such as being raped or bound by others during sexual intercourse or while while masturbating, the diagnosis is only given to those experienced significant distress due to impairment by these fantasies are acts.

23. A hazardous and sometimes fatal form of masochism known as ”hypoxyphilia” involves decreasing oxygen to the brain in order to enhance erotic pleasure an orgasm.
Perform individually or with another person, such acts lead to between 250 and 50 in United States

24. Sexual Sadism
Sexual sadism involves real acts of inflicting psychological or physical suffering on others in order to gain sexual excitement.
The majority of sadists engage in sexual behaviors with consenting partners who are also masochists, thus deriving mutual sexual gratification.

25. Transvestic Fetishism
Transvestic fetishism or transvestism pertains to cross-dressing (most often by males) in the clothes of a woman in order to attain sexual arousal.
Transvestites are heterosexual males although some may engage in homosexual experiences. Many are married.

26. Voyeurism
Voyeurism (Peeping) involves gaining sexual arousal by observing others, usually nonconsenting strangers, while they’re undressing, unclothed, or engaged in sexual intercourse.
Sexual observation has become part of the norm for many adolescents as well as adults in our culture as they do to sexually explicit behavior and content offered via the Internet and or television.

27. Other atypical sexual behaviors
Cybersex – involves an emotional dependency on Internet and Internet-related sexually oriented sites.
Compulsive Masturbation – defined in one text as one or more times a day, every day. In such cases a couple’s relationship will be affected, particularly if one partner discovers the practice and disapproves or shames the other partner.

28. Prolonged Promiscuity – refers to a consistent pattern of engaging in sexual activities as a way of attaining “sexual conquests.”
Pornography Dependence – a persistent repetitive pattern of dependence on visual pornographic materials such as magazines, videos, and Internet pornography

29. Telephone Sex Dependence – involves a persistent, repetitive reliance on phone sex for sexual arousal.
Sexual Desire Incompatibility – refers to a difference between partners in their level of sexual desire. One partner typically places excessive demands on the other, causing that person to feel smothered by the other and unable to meet consistent demands for sex.

30. More Atypical Sexual Behaviors
Paraphilia NOS Categories
Erotic Focus
ZOOPHILIA/BEASTIALITY
Animals
Formicophilia
Small Creatures
Klismaphilia
Enemas
Mysophilia
Filth
Urophilia
Urine

31. Soiling/damaging clothing or body
Coprophilia
Feces
Vampirism
Blood
Saliromania
Soiling/damaging clothing or body
Vomerophilia
Vomiting