In a recent post, I wrote about how the field of sexology is uneven in its application and rife with regional and individual biases, largely due to general sex phobia and a subsequent lack of empirical research within the field. Recently, a debate on the mailing list of one of the sexological organizations to which I belong touched again upon discrepancies within the field. The discussion in question concerned whether or not it is possible to eradicate a fetish. Most respondents were in agreement that, like a sexual orientation, eradicating a sexual fetish is not only not possible, but particularly in fetishes that cause no harm, even unethical.

One clinician, however, stated not only that eradicating a fetish is possible, but then went on to describe exactly how (he/she believes) it is done. The methodology described was so disturbing, however, that I felt it necessary to challenge the ideas presented and to present both his/her perspective as well as my response here on my blog as a cautionary tale to individuals who may have questions regarding their own sexuality so that the know what to avoid in therapy. I have eliminated any details that could reveal the identify of the other clinician.

Below is what the clinician wrote in support of fetish eradication. I am highlighting and italicizing the most objectionable aspects:

I don’t see a fetish as similar to sexual orientation – it is something that does reflect “something wrong”, and in my own experience, DOES respond to therapy! One issue is that sexual fetishes – paraphilias – typically involve sexual activity with something that does not provide the rewards that sex with another human does.  That is, talking, kissing, caressing, oral sex, intercourse, etc.  Compared to these things, really, what does masturbating while doing something like holding on to a shoe, cross dressing, etc. have to offer? In the cases I have had good results with, I have used some combination of procedures to reduce the arousal value of the fetishistic practice; and, at least as importantly, procedures to make good, open, rewarding sexual activity with a consenting adult available to the patient. This procedure  has  seen been termed “cognitive negative conditioning”.  Sometimes this been done with the patient sniffing disgusting aromas or unpleasant chemical agents, but I long ago stopped doing this, and went to the strictly cognitive negative conditioning procedures.  The reason for this was that I had a patient confess that he had indeed used all 7 of his ammonia vials this week – but he had broken them out in the parking lot just prior to coming in to see me!

The “cognitive negative conditioning procedures” involve having the patient spend….

time thinking about – and saying into the small tape recorder I give the patient -all the things that are now going wrong in his life because of his fetish; and what is likely to happen in the future for him, because of his fetish, really does reduce the arousal value of the fetish – and this is something that can’t be done in a couple of minutes, on just one day. One thing I have also found often really strongly effective as a negative involves children, if the patient has any. For example, I had one man who had a shoe fetish think about his children coming home from school in tears, saying how they were being teased about “What a freak your old man is – him and his shoe —— (expletive deleted).  In another case, we arrived at the man’s daughter saying her boyfriend was now forbidden to date her anymore:  “His parents said, ‘Come on, his Dad is some kind of a weirdo pervert!’ Oh Dad, how could you do this to me?”

Further….

While I always do the cognitive conditioning procedure with fetish patients, I sometimes also do the “stimulus satiation procedure”, which involves  changing the patients masturbation.  This is not something I usually use – it is reserved for patients who have what might be called an “extreme” fetish, and are also very well motivated. This procedure involves having the patient (at home, of course) masturbate using normal – non-fetish- stimuli/fantasy. Immediately after reaching orgasm, the man switches to his fetish, and continues to masturbate, without stopping, for a time that is unpleasant- I usually start the man with something like 10 or 15 minutes. During this time, the man will lose his erection; will not be aroused; and will likely find it painful.  Should any pleasure/arousal occur, he must immediately switch back to NORMAL stimuli. The major problem here is that it is some of the wives of the man with a fetish (I don’t think I am being sexist here; I just don’t recall ever seeing a female with what could be considered a genuine “fetish”) are so distressed by learning about his fetish that their interest/ability in sexual functioning with him are severely reduced.  I have found some success with this problem by putting off this part of the problem until we can say that his interest in the fetish is genuinely gone.

So basically if someone shows up to this therapist with questions or concerns about a fetish, the patient will be subjected to shameful thoughts and experiences regarding his own children and will be pushed into unpleasant and painful physical sensations. Wonderful. Where can we all sign up? Look, whatever this therapist is up to is not only cruel and unusual, but according to the new changes in the DSM 5, in which paraphilias (fetishes) were de-pathologized, also highly unethical.  New studies keep being published showing that fetishes are not correlated to pathology. And this person considers himself a sexologist and sex therapist. This sex phobia and negativity must be stopped, especially in clinical settings, before more unwitting people put their trust in ignorant practitioners and get hurt. There is a word for illness cause by doctors– iatrogenic. My call to the mental health field: No more iatrogenic harm to patients around issues of sexuality.

Below is my reasoned response (which went unanswered):

Do you have any empirical evidence for the efficacy of your negative conditioning and aversive techniques for fetishes? Do you have supporting documentation on what percentage of fetishes “prevent, good, open rewarding sexual activity with a consenting adult”? Many of the clients I’ve seen who have discussed their fetishes have described them in ways that enhance, rather than diminish, their sexual functioning with consenting adults. And I’m also wondering why, when working with distressed wives of the fetishist, your first option appears to eradicate the fetish rather than help the wife process her distress and understand more about the fetish, as well as take a systemic look at what else is going on in the relationship. It also appears that you are lumping all fetishes together, including those that are merely optional, preferred, as well as exclusive. Are you aware that the DSM 5 differentiates between paraphilias (which are not pathological) and paraphilic disorders?