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Sexual Infantilism in Adults: Causes and Treatment - Section 4

Section 4 of Thomas John Speaker's Masters thesis "Sexual Infantilism in Adults: Causes and Treatment"

"Refuse to put yourself down, no matter what anyone thinks of your tastes. If you are not able to do this, think about consulting a psychotherapist -- not about your sexual preference, but about your anxiety associated with disclosing it." The Forum Advisor commenting on a diaper fetish, (Forum Advisor, p. 70).

A new model of fetish etiology arose with the research of the social learning theorists and the behaviorists. Rather than being a reaction to the frustration of sexual desires as in the Freudian model, fetishes were now viewed as the result of processes "whereby culturally inappropriate stimuli and responses acquire unusually strong sexual reinforcing properties", (Bandura, 1969, p. 512). An object becomes paired with a pleasurable sexual response often enough to begin to elicit the response by itself. This model was demonstrated in the laboratory by 1966 (Rachman, 1966) and, since replication in 1968 (Rachman and Hodgson, 1968), has been generally accepted by most therapists.

The behavioral model of fetishism generated a new type of treatment, behavioral therapies based on the assumption that fetishes are by nature pathological. Research was geared toward producing more effective therapies: the ethical and political questions created by these therapies were, for the most part ignored.

During the sixties and into the seventies, aversive therapy was used to treat a variety of deviant sexual behaviors including fetishes. 'Success' in aversive therapy consisted of extinguishing the target behavior, deviant arousal. The aversive approach was found not to be a 'cure' since the target behavior often either reappeared (relapse) or was found to be unextinguishable (Sansweet, 1975: Barlow, 1974, p. 127). Personality 'side-effects' were observed and ethical questions regarding the 'punishment' aspects of the treatment were raised by some of aversion's pioneers. In 1969, Simon Rachman said, "...we feel that aversion therapy should only be advised if there are no alternative methods of treating the patient" (Rachman and Teasdale, 1969, p. 316).

Rachman's reservations were essentially ignored. Research, rather than seeking non-aversive treatment alternatives, was primarily directed at developing more efficient methods of aversion (Faustman, 1976). Aversive techniques became components of 'combined treatments'. Experimentation involved types of aversion (chemical, electrical or imaginary), added to other behavioral therapies such as control of masturbatory fantasies, sexual retraining, gender identification, counter-conditioning, and anxiety reduction (Bandura, 1969: Marshall, 1973. 1973; Evans, 1968: Brownell, Hayes and Barlow, 1977). The results of such experimentation demonstrated two things: (l) aversion could be made more efficient by combining it with other types of behavior therapy. and (2) the wide variety of results across the spectrum of sexual deviations suggests that individualization of combination therapies will improve effectiveness (Barlow, 1974, p. 127).

Barlow summarized these experiments and proposed a clinical model in which the treatment of sexual deviations involves (l) accurate psychometry of behavioral excesses and/or deficits in four aspects of sexual behavior (deviant arousal, heterosexual arousal, heterosocial skills, and gender-role identity), and (2) "construction of specific treatment packages" based individually on these measurements (Ibid, p. 123). Barlow states,

Sexual deviation encompasses a number of behavioral excesses and deficits. The most notable behavior is sexual arousal-to non-normal or deviant persons, objects or activities. In fact, deviant sexual arousal has come to define sexual deviations in the textbooks of psychopathology and even in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM II). In the clinic, this emphasis on deviant arousal is misleading. It is very seldom that a client who complains of deviant arousal does not present associated behavioral deficits or excesses. Yet, ... treatment is often aimed exclusively at eliminating deviant arousal and success is defined as its absence (Ibid, p. l2l).

Barlow feels that "there are at least three associated problems that may accompany deviant sexual arousal". These are deficiencies in heterosexual arousal, deficiencies in heterosocial skills, and/or gender-role deviations. (He excludes from the model "temporary emotional reactions such as 'anxiety' or 'depression' which result from life circumstances of the client and not from deviant arousal per se, and personality disorders which are patterns of interpersonal behavior not directly connected with deviant sexual arousal"). Sexual deviation, according to the Barlow model, involves deviant arousal which may or may not be accompanied by "an absence or minimal levels of heterosexual arousal", (deficiency in heterosexual arousal), an inability to "act on" heterosexual arousal due to a lack of "heterosocial skills necessary for meeting, dating and relating to persons of the opposite sex" (deficiencies in heterosocial skills), and/or "some degree of gender-role deviation in which opposite sex role behaviors are present and some preference for the opposite sex role is verbalized" (gender-role deviation) (Ibid., pp. 121-122).

Under the Barlow model, treatment of sexual deviations involves "accurate assessment of 'numerous excesses and deficits ... which would require intervention'". followed by the application of "efficient and effective treatment procedures for the various components of sexual deviation" (Ibid.).

While this model has some definite advances in therapeutic technique (such as the construction of specific action plans for each case), there are a number of obvious blind-spots. Most obvious is a therapist bias toward heterosexuality. As homosexuality is now considered to be an acceptable sexual preference by many (e.g., its removal from DSM II), it is hoped that the Barlow model would be adjusted to reflect the choice of homosexuality as an option available to clients.

Another problem with the model is the incongruence between assessment and treatment of the sexual arousal, social skills and gender-role components on the one hand, and the deviant arousal component on the other.

Notable is the failure of the Barlow model to allow for possible functional or beneficial aspects of sexual deviations like fetishes. While other components of the model are analyzed for "excesses and deficits" and thus are evaluated on a continuum for which some level of behavior is 'appropriate', deviant arousal seems to be automatically labeled as psychopathologic. This conflicts with a basic component of the model:

Deviant arousal

Figure 1: Barlow Model of Sexual Deviation (Barlow, 1974, p.122).

The notion of applying one treatment, such as aversion therapy or psychotherapy, to every type of disorder is a traditional one in clinical psychology and psychiatry which is now giving way to specific treatments for specific problems (Bergen and Strupp, 1972). In sexual deviation, no client is the same. Each has some combination of the excesses or deficits noted above. A recurring theme in this chapter is the need for individualized assessment of each client and the construction of specific treatment packages based on an analysis of behavioral excesses and deficits found in sexual deviation (Ibid., p. l23).

By automatically considering deviant arousal as pathologic, therapists are blinded to the 'normal' and 'functional' aspects of that deviation and automatically 'treat' the client with the one treatment method held to be 'successful' (aversion therapy).

Psychological theory since Freud has held that some degree of sexual deviation occurs in most people (hence, is 'normal'): In a 1905 essay on sexuality; Freud wrote, "No healthy person, it appears, can fail to make some addition that might be called perverse to the normal sexual aim". He added that this precluded anyone from using the word 'perversion' as a term of reproach: in the Freudian view, we are all 'perverts' (Goleman and Bush, 1977, p. 104). Current views incorporating Freud's observations see fetishes on a normal-abnormal continuum: "Many people have mild fetishes -- they find such things as silk underwear arousing -- and that is well within the range of normal behavior; only when the fetish becomes extreme is it abnormal" (Hyde, 1979, p. 351). Thus, the question of whether treatment is necessary is dependent upon whether use of the fetish is by preference or by compulsion. If the use of a fetish is necessary for arousal or replaces human partners, it is likely that the client will request treatment to put the fetish back into perspective. (Figure 2).

Strenght of Preferent for Fetish Object

Figure 2: The Continuum from Normal to Abnormal Behavior in the Case of Fetishes (Ibid.).

Hyde's continuum can also be applied to the question of whether a fetish is functional or dysfunctional: some types of fetishism clearly assist the individual to live more effectively (functional) while other types are harmful to the individual or those around him/her (dysfunctional). This notion is best analyzed on an individual basis. Some case illustrations should help.

Within the last few months, I've found myself wetting my diaper before I realize that I am wetting. This excites me, as does the fact that I am wearing baby apparel instead of adult apparel. I am sexually aroused whenever conscious of my diapers and rub myself through them constantly. Walking causes me to get excited as I am massaged by the dry or wet diaper and I use this as a form of masturbation. I would like to add that along with the physical stimulation from the diapers and plastic panties, I am also turned-on by the psychological aspect, i.e., wearing and wetting diapers as an adult when they are associated with babies. (I do like to think of myself as a big baby). (Case Study: K).

Benefits he obtains from regression are primarily emotional:

I always feel a tremendous release when in diapers, like I am loved and cared for. (Case Study: F).

They also include developing orgasmic capacity:

"... there is some evidence that people who spend more time in sexual reverie may have a better time in bed. This is certainly true for inorgasmic women: very often they have little or no sex- fantasy life. In their training program for such women, sex therapists Joseph LoPiccolo and Julia Heiman urge them to develop their fantasies to the fullest ..." (Goleman and Bush, 1977, p. 104).

Fetishes can also help in developing intimacy between partners:

Kaplan feels that people should not be ashamed of their sexual tastes or fantasies, no matter how exotic they may seem. 'I always encourage couples to share their masturbatory and sexual fantasies with each other', she says. There is little danger in scaring off the partner, she adds. 'It increases the intimacy and openness between a couple. If you really love someone, their unusual fantasy doesn't frighten you, but it may make you feel more protective. If you know that something excites the other person, you're not turned-off by it. You say, "Good, let's use it to give you pleasure". I've never seen disclosure like that do any harm, at least not in therapy' (Ibid.).

At the other end of the continuum, fetishes can be dysfunctional:

...unusual fantasies are pathological only in the extreme, when the preoccupation with the unusual desire is exclusive ... (or) when it is harmful to the person or others ... (Ibid.).

Examples of fetish dysfunctions would be when an object takes the place of a human partner (to use the diaper fetish cited, if she was uninterested in sex with a partner because her turn-on was exclusively the diaper), or if the use of the object is harmful to the person or others (her use of diapers encourages a lasting regression (self-harm) or she purposely exhibits herself in diapers in public causing embarrassment to her lovers (harm to others)).

Blindness to the functional-dysfunctional continuum eliminates the incentive for therapists to precisely assess the client's situation and absolves the therapist from any responsibility for the political aspects of altering personality in the client. If fetishes are inherently psychopathologic, the therapist is doing the client a favor by 'curing' him. The ethical issues involved are enormous:

... while society is developing an increasing tolerance of deviant sexual behavior between consenting adults and new behavioral surveys report a growing degree of deviance which challenges the traditional assumptions of normalcy, those practicing such deviations can still be subjected, as psychopaths, to indeterminate incarceration and 'rehabilitative' therapy (Kittrie, 1971, p. 364).

In other types of sexual deviations, such as homosexuality, behavioral therapists have been encouraged by their peers and their subjects not to alter sexual preferences, even in clients who request it (Goodall, 1975). One has to wonder how many people will needlessly suffer aversion simply because this examination of the functional-dysfunctional aspects of fetishes is not being done. Assessment of how the 'deviant arousal' serves the client (fulfills needs} will further safeguard the client's rights and, simultaneously,require the therapist to be as certain as possible that they have obtained a complete ecological picture of the behavior before beginning therapy.

An additional problem with Barlow's model is a firm reliance on aversion as the treatment of choice for deviant arousal. Other components merit a variety of approaches (e.g., the heterosexual arousal component: Barlow lists four 'promising' techniques -- systematic desensitization, exposure to explicit heterosexual themes, masturbatory conditioning and fading). Deviant arousal is treated solely with aversion. Rachman's suggestion to explore all alternatives before advising a client to undergo aversion is again ignored. Under the Barlow model, none of the alternatives is explored first.

These problems can be remedied and Barlow's treatment of deviant arousal will be more congruous to the rest of the components by adding another treatment to therapy: the PLISSIT model.

PLISSIT was developed by Jack Annon, and the program involves four levels of approach to the problem of deviant sexual arousal: Permission, Limited Information, Specific Suggestions, and Intensive Therapy (acronym: PLISSIT). The method is sequential; the therapist advances to the deeper level of intensity only when earlier, less-intense methods have failed.

Annon explains:

PERMISSION: The largest number of sexual problems can be effectively treated by the helping professional giving well-placed, accurate permission to the client. Permission, used in this model, implies a kind of professional reassurance, letting clients know they are normal -- okay -- not deviant or perverted. Many people are not bothered by the specific behavior they are engaged in but are concerned that it is seen by most other people as wrong or aberrant (Sinclair. 1978. pp. 331-332).

This intervention would be used when the major problem seems to be guilt or a lack of self-esteem: when the fetish is not at the 'necessity' or 'substitute' stage. An example would be the opening quote from the Forum Adviser.

LIMITED INFORMATION: Limited information, usually expanded on permission, provides the client with specific factual information directly relevant to the particular sexual concern (Ibid.).

Intervention here involves correcting misinformation and myths on such topics as averages (size, frequencies), masturbation, menstruation and aging processes. If the client in the first example felt he needed to know about others practicing similar fetishes, perhaps he could be shown The Fetish Times so that he could see he is 'not the only one'. More information is needed when permission is not enough to reduce guilt or anxiety.

SPECIFIC SUGGESTIONS: An even smaller number of clients need intervention at the next level. The therapist offers his suggestions only after (s)he has taken a sexual problem history. The sexual problem history includes (1) description of the current problem, (2) onset and course of the problem, (3) client's concept of the cause and maintenance of the problem, (4) past treatment and outcomes, and (5) current expectancies and goals of treatment .... This history is important to maximize the likelihood that the specific suggestions will be effective in alleviating the sexual distress (Ibid.).

Types of 'dysfunctional' fetishes would enter the PLISSIT model here. The necessity for modification of behavior becomes apparent: the sexual problem history explores the functional-dysfunctional aspects of the fetish, etiology and past treatments, and current understanding and expectations. This 'reality check' is absolutely necessary to develop treatment plans tailored to the client, which will carry a greater chance for success. At this level, the client's resources are also assessed. The sexual problem history allows a therapist to evaluate the availability of therapeutic alternatives before Intensive Therapy is required.

INTENSIVE THERAPY: The final level ... is required by a very small number of persons with sexual complaints. Their dysfunction is sufficiently involved and complicated that intervention using permission, limited information and specific suggestions is not sufficient to alleviate the dysfunction (Ibid.).

Only at this point does aversion become the therapy of choice. Aversion to eliminate the fetish, the deviant arousal, is necessitated when the dysfunction is severe enough to resist less intensive methods, or when the deviant arousal is highly negatively-sanctioned and modification is mandatory (e.g., child molesting).

The addition of the PLISSIT model of treatment and a more sensitive evaluation procedure in cases of deviant sexual arousal (accurate assessment of how deviant arousal fits into a particular lifestyle) should increase the efficiency of the Barlow model. Such treatment and assessment modification would make the model more sensitive to variations of perception and behavior in each client, thus increasing the chance for a more perfect individualized treatment plan and, concurrently, a higher rate of success. Sensitization of assessment procedures could bring about a greater therapeutic economy by allowing therapists to treat deviant arousal with a variety of techniques instead of only aversion. Treatments could be matched more accurately with client needs, perhaps eliminating the use of aversion techniques when only counseling was required.

Finally, presenting a client with alternative treatment strategies increases the chance that clients are able to give 'informed consent' to therapy, thus restricting the chance that the client will be the victim of unethical therapist practices.

It seems clear that the vast majority of infantilists, at least those represented in this survey, have little need for therapy. They have managed to adapt their lives to fit around their preferences and are quite happy being who they are. On the other hand, for those persons who choose to alter their sexual preferences to fit better into their lives, it seems more appropriate to create the 'best' therapy possible, a marriage of client-centered therapy and efficient behavioral techniques which allows the client to take control of his/her life without sacrificing 'freedom and dignity'.

Examined: 9 April 1980| HTML conversion: 4 June 2010

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