Understanding Infantilism (.org)
Chapter 3 of The Clinical Mental Health Experience of Persons with Paraphilic Infantilism and Autonepiophilia. A phenomenological research study, a doctoral dissertation Dr. Rhoda J. Lipscomb, PhD, LPC, DAACS, BCPC. It is also available in PDF.
The purpose of this phenomenological research study, using the Modified van Kaam Method by Moustakas (Moustakas, 1994), with questionnaires and semi-structured interviews, digitally recorded and transcribed, assessed using NVIVO-10 conversational analysis software is to understand, identify and describe the lived experiences of four American males who self-identify as AB/DL along with their experiences with the mental health community. Once the data was analyzed by the NVIVO-10 software, it was further analyzed by data mining to discern themes from the patterns identified through NVIVO. It is hoped that explanation of the lived-experiences of the target population sample will provide more knowledge about this particular paraphilic population, and better understand what causes people of this community to lack trust in the mental health community.
Empirical, qualitative research, particularly phenomenological investigations of lived experiences, such as those of individuals who engage in paraphilic infantilism and autonepiophilia, was utilized among the participants of this study. Given the nature of the problem statement and that there is little academic research into this area of research, a phenomenological approach was deemed most appropriate for this study.
Moustakas’ modified van Kaam method (Moustakas, 1994) of analysis of phenomenological data was used as a vehicle of exploration (Moustakas, 1994). The research design includes data collection, data analysis, presentation of findings and conclusions consistent with the seven steps of the Moustakas model. According to Moustakas (1994), an empirical phenomenological approach involves a “return to the phenomenological experience” in order to obtain comprehensive descriptions that provide the benchmark for a comprehensive, reflective structural analysis (p. 13, paraphrased). Creswell (Creswell, 2014) stated that phenomenological research is the nature of the epoch that the researcher identifies as the essence of human experiences concerning a phenomenon.
In his book Phenomenological Research Methods (Moustakas, 1994, p. 120) Moustakas describes the seven-step model for analyzing the transcribed interview of each research participant. Once each interview is transcribed in its entirety, the following steps must be taken:
1. Listing and preliminary grouping,
2. Reduction and elimination,
3. Clustering and thematizing the invariant constituents,
4. Final identification of the invariant constituents and themes by application,
5. Using the relevant, validated invariant constituents and themes constructed for each co-researcher an individual textural description of the experience,
6. Construct for each co-researcher an individual structural description,
7. Construction for each co-research participant a textural structural description of the experience (pp. 120-121) that includes the researcher co-participating in the study.
The three main approaches of research design for most research studies are quantitative, qualitative, or mixed method approach. During much of the nineteenth and twentieth centuries, psychology research used quantitative research, mainly survey and experimental research (Creswell, 2014). Qualitative research designs have become more popular in the late twentieth and into the twenty-first centuries and are composed of various types of narrative and phenomenological research. Quantitative research is applied to describe current conditions, investigate relationships, and study cause and effect phenomena (Bloomberg & Volpe, 2012). Qualitative research is suited to promote a deeper understanding of a social setting or activity as viewed from the perspective of the participants. The approach has an emphasis on exploration, discovery, and description (Bloomberg & Volpe, 2012).
There were a number of qualitative research designs from which to choose for this research study. Of the various genres, the following were considered: case study, ethnography, phenomenology, grounded theory, narrative inquiry, hermeneutics, action research, and postmodernism/post-structuralism. After reviewing the various strategies, the three best research methods for this particular subject and population of study were found to be case study, phenomenology, and postmodernism/post-structuralism. Each was then studied and considered in more detail.
According to the definitions by Bloomberg and Volpe, case studies are an intensive description and analysis of a bounded social phenomenon, be this a social unit or a system (Bloomberg & Volpe, 2012). The researcher explores the bounded system over time through in-depth data collection methods involving multiple data sources. Case studies involve a detailed description of a setting and its participants, accompanied by an analysis of the data for themes, patterns, and issues (Bloomberg & Volpe, 2012). Phenomenological research is meant to investigate the meaning of the lived experiences of people in order to identify the core essence of human experience or phenomena as described by research participants (Bloomberg & Volpe, 2012). This research involves studying a small number of subjects through extensive and prolonged engagement to develop patterns and relationships of meaning (Bloomberg & Volpe, 2012). Finally, postmodernism/post-structuralism challenges the historical assumptions of neutrality in inquiry, asserting that all research is interpretive and fundamentally political. In this approach, truth is multifaceted, and subjectivity is paramount (Bloomberg & Volpe, 2012).
The technique of case study, while initially the preferred method; was eliminated after further research into the method. Postmodernism/post-structuralism was strongly considered due to its use in areas such as queer analysis, feminist research, cultural studies, and multimodal studies, yet the belief was that it might have too much of a political undertone for this particular research population. The AB/DL community is mostly hidden from the public view with a few exceptions of sensationalistic television programs. Few of those within the community are willing to talk with researchers openly, so having a political tone was believed to carry the possibility to scare off potential study participants. The use of a qualitative study that did not employ any explicit theory was also considered, since the case could be made that no qualitative study begins from pure observation and that prior conceptual structure composed of theory and method provides the starting point for all observation (Creswell, 2014). For these reasons, both of these methods were ultimately rejected.
Eventually the phenomenological research design was chosen. It comes from the world of philosophy and psychology in which the research describes the lived experiences of individuals about a phenomenon and culminates in the essence of the experiences for several individuals who have all experienced this particular phenomenon (Creswell, 2014). It involves studying a small number of subjects to develop patterns and relationships of meaning. The focus is describing what all participants have in common in order to reduce individual experiences with a particular phenomenon to a description of the universal essence (Bloomberg & Volpe, 2012). In terms of this study, this approach allows for an exploration of more depth into the perception and real-life experiences of a few individuals regarding their feelings about their fetishes and experiences with the mental health community. This description was best suited for the topic as well as the study’s participants.
Due to the small sample size of the study participants, a qualitative social constructivism perspective was also chosen as the worldview for the study. Ultimately, a qualitative research model was chosen over a quantitative research model because qualitative research is characterized by its aim to relate understanding of an aspect of social life (Patton & Cochran, 2002). The basic premise of constructivism is that reality is socially, culturally, and historically constructed (Bloomberg & Volpe, 2012). The goal of the research is to depend on the participants’ view of the situation being studied (Creswell, 2014); in this case, their sexuality and how they engage in it.
Convenience sampling was used to select the various participants. Convenience sampling is using participants with whom the researcher has contact (Auerbach & Silverstein, 2003). Four participants were ultimately selected. Two of the participants were current patients from the researcher’s psychotherapy practice who volunteered to share their story upon hearing of the pending study. The subjects were not asked directly to participate in the study. Upon learning of the study during casual conversation at the end of a therapy session, each eagerly volunteered to participate. One of the participants was a former patient from the researcher’s private psychotherapy practice. Since he was no longer in therapy an email was sent to him asking if he would have any interest in participating and he stated he would be happy to join the study. The fourth participant was from the researcher’s social network and volunteered to be in the study upon hearing about it from his wife. His wife told him about the study as the researcher was unaware this participant had any experience with the subject being researched.
The criteria for participation was as follows: 1) participants must be between 25 and 45 years of age; 2) participants must actively be engaging in either age play or a diaper fetish; 3) participants needed to have a range of experience with mental health, ranging from some experience to little or none; 4) participants required an educational level of either currently enrolled in college or already graduated, with the minimum of a bachelor’s degree; 5) participants must be engaged in consenting fetish play; and 6) participants’ sexual behavior needed to be non-exclusive in regards to their fetish; i.e., their fetish needed to not be the only sexual behavior they engaged in. The age requirement of 25 to 45, along with the higher educational requirement, was important to analyze the effect of the Internet during the years when their fetish originated.
In an effort to discover additional participants, snowball sampling was used. Snowball sampling begins with a few individuals and asks them to suggest others from their social networks (Auerbach & Silverstein, 2003). As part of the questionnaire given to participants, each was asked if they knew anyone in the AB/DL community who might be interested in participating in the study. While two participants knew a few individuals in the AB/DL community, none of them were interested in participating so the snowball sampling did not procure any additional study participants.
The information was gathered by the combination of a self-administered questionnaire and a face to face personal interview with six semi-structured questions. The self-administered questionnaire allowed for greater confidentiality and privacy with the hope of providing a greater sense of comfort for the participants as well as gaining more honest and in-depth information. As part of the questionnaire each participant was asked if they believed there were any important questions that needed to be asked in order to better understand the phenomenon being studied.
The questionnaire was designed to request information in five areas:
Once the questionnaires were returned and analyzed, a series of six questions were finalized based on themes from the answers to the questionnaires that the researcher did not anticipate asking during the initial design. Since the participants were truly the experts about both paraphilic infantilism and autonepiophilia, this approach appeared to provide opportunities to discover unanticipated topics. This allowed the researcher the opportunity to bring up unanticipated topics, so the importance was to be flexible about the questions asked while still maintaining some structure (Auerbach & Silverstein, 2003).
The development of the questionnaire as outlined in Appendix C and the six semi-structured questions as outlined in Appendix D were influenced by much of the research literature. Speaker’s ground-breaking research was the first to look at paraphilic infantilism with a portrayal of individuals who were functional members of society rather than the highly dysfunctional ones likely to come to the attention of law enforcement or psychiatric treatment facilities (Speaker, 1986). His research strongly influenced the creation of the questionnaire. The majority of the influence for the development of the remainder of the questionnaire and the semi-structured questions came from the multiple surveys of Grey that were produced by The Survey Project (Grey, 2006-2011).
Speaker touched on the subject of AB/DL’s mental health experience while Grey asked much more direct questions about individuals experiences in his survey on “Ways to help younger AB/DL’s” ("Odds and ends part 4," 2013) as well as another survey that directly asked questions regarding whether individuals have sought mental health treatment ("Odds and ends part 3," 2013). Other surveys by Grey that were used in the development of the six semi-structured questions included looking at how views of AB/DL’s may change over time, (Grey, 2011), whether trauma had any significance in the development of paraphilic interests (Grey, 2009), and how important diapers and baby play are to individuals sexuality ("Sex and the future," 2008).
Throughout the questionnaire the terms used were those most likely used by members of these fetish communities, found on AB/DL online websites or printed in AB/DL literature and not the clinical psychological terms. The rationale for this was to promote an environment of non-judgment and empathy, and environment that could have been lost by using terms such as paraphilia. These terms have a greater social stigma and carry the pathologizing image of mentally dysfunctional or even criminal connotation (Fankhanel, 2006).
Given the nature of the study and the researcher’s relationship with the participants, numerous ethical concerns arose in the design and implementation of the study. In order to better understand the ethical issues involved in this study, the American Psychological Association “Ethical Principals of Psychologists and Code of Conduct” was consulted. Standard 8.04: Client/Patient, Student, and Subordinate Research Participants, under Standard 8: Research and Publication states, “When psychologists conduct research with clients/patients, students or subordinates as participants, psychologists take steps to protect the prospective participants from adverse consequences of declining or withdrawing from participation” (APA, 2010, p. 6). In order to protect participants’ ethical and privacy rights, several considerations were written into the consent form for participants. These included the following:
1. You may refuse to participate or withdraw once the study has started. You will not lose any benefits to which you are otherwise entitled, nor will you be penalized. If you are a current patient, withdrawing from this study will not affect your ability to continue with the mental health care you have been receiving.
2. If upon withdrawing from this study you feel your continued mental health care has been compromised in any way, you may request and will receive a list of three other local therapists who are competent and skilled in working with alternative sexual expression.
3. The information used in the research will only come from the self-administered questionnaire and the face-to-face interview. No information obtained solely from your psychotherapy sessions will ever be used.
In order to ensure confidentiality, patients’ names were not used; instead, alphanumeric codes were devised. All information received from each participant was coded with a number specific to them along with a first letter of their first name. In order to assure privacy, each participant was also allowed to slightly alter other demographic information to information of their choosing if they felt items such as age, occupation, etc. were unique enough to possibly violate their privacy. While the option was given, none of the participants chose to execute this option so there was no effect on the veracity of the data.
In addition to the above concerns about the participants, ethical concerns regarding the treatment of the data were also taken into account. Once participants agreed to the study and signed the consent forms, they were emailed or given a hard copy of the questionnaire to complete in private. Once the questionnaire was returned and all the questionnaires were analyzed, face to face interviews were conducted at the researcher’s office.
The transcripts and consent forms will be saved for at least three years. For those participants who had been previous patients in the researcher’s private psychotherapy practice, this information will be kept separate from their psychotherapy chart. The information gathered will be kept in a locked file cabinet according to HIPAA standards.
The data collected by the participants was analyzed by NVivo 10 computer software as well as mining the data for patterns and themes to the specific experiences discussed by the participants in the face to face interviews as well as their questionnaires. The results of this data analysis are discussed further in Chapter 4.
Through the use of self-administered questionnaires along with personal interviews, several men, selected through convenience sampling, discussed their experience with paraphilic infantilism and/or autonepiophilia and the effect their fetish has on their romantic relationships, daily lives, attitudes about the mental health community, and mental health issues such as depression, anxiety, and self-acceptance. The use of a phenomenological research method allowed the study to discover common themes and form hypotheses for further research. The goal of this research was not to test hypotheses, but rather to develop them. It is hoped that this research will increase the understanding of these unique fetishes within the mental health community, improve the treatment approaches used when they present for mental health counseling, and improve the fetish community’s perceptions of the mental health field and mental health professionals.
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This work is copyright Dr. Rhoda J. Lipscomb, PhD, LPC, DAACS, BCPC, posted by permission. Dr. Lipscomb can be reached at [email protected].