Analysis Paper: Paraphilias G. Yvonne Christie University of the Rockies  Abstract This current paper examines the paraphilia of fetishism. The overt symtomology that defines fetishism is determined by extreme sexual arousal regarding a fantasy involving an inanimate object, such as a shoe or foot or a non-sexual part of the body. Shoe fetishism will be the primary focus of three journal articles. Identification of the various treatment approaches, client applications, types of therapy, and treatment modalities will be analyzed. The etiology will be closely detailed as the data permits. This paper will also include an overview of the treatment challenges for psychologist who address show fetishes. New methodologies and the prognosis of effective therapeutic solutions will be the conclusion of this analysis.  Analysis Paper: Paraphilias In clinical practice, diagnostic parameters or criteria are the springboard for an effective treatment plan that includes a functional analysis of the problem behaviors. Paraphilias are characterized by recurrent, intense sexually arousing fantasies, urges, or behaviors that include nonhuman objects and suffering or extreme anxiety as a result, that affects an individual's life, at home or work or socially for at least a six month duration (American Psychiatric Association (APA), 2000). The Diagnostic and Statistical Manual of Mental Disorders (DSM), (APA, 2000) is considered the guidepost and reliable resource regarding information on paraphilias. It has been conferred that paraphilias all have in common distressing and repetitive sexual fantasies, urges, or behaviors. Paraphilias, recognize their symptoms as negatively impacting their life, yet they see it as beyond their control. There are several types of paraphilias such as: exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, and voyeurism. Paraphilias are diagnosable sexual disorders. Foot and Shoe Fetish According to experts in the field of fetishism, the most common and frequent idealization is for the foot and shoe (Ellis, 1906). Fetishism disorders, more specifically shoe fetishism have several theories that attempt to explain the development of this disorder. Most experts agree that there are underlying issues related to childhood with the influence of early association and emotional shock as a primary role in the etiology. Other explanations of the causes of paraphilias typically involve the association of pleasure with varying stimuli during childhood. These associations are reinforced and the person learns to experience sexual pleasure from the stimuli when they are older. The overt symptomology that defines fetishism is determined by extreme sexual arousal regarding a fantasy involving an inanimate object, such as a shoe or foot or a non-sexual part of the body. Fetishes of this type have been described as the means unto itself and often require specific objects, styles, textures and so forth before arousal takes place or sexual gratification is culminated (Grant, 1953). These criteria must be met before any sexual arousal is possible. Fetishism is a clinical relevant variable when the fetishistic desire interferes with the individual's normal sexual functioning. (de Silva, 1993). The DSM-IV-TR requires this disorder to cause significant distress and disruption to the day-to day living of an individual (Hersen, Turner, & Beidel, 2007). Fetishism is almost exclusively found in men, and in its milder forms is rather common (Weinberg, Williams, & Calhan, 1995). Many treatment modalities involve a variety of monitoring strategies by law enforcement agencies. Treatment varies and has a mixed degree of success. However, treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior. When the underlying issues have been identified and addressed therapeutically. This disorder can have a very good prognosis. Journal Article Review Two journal articles are examined in this paper. The first one, "If the shoe fits ..." (Weinberg, et al., 1995). Explores male homosexual foot fetishism, and the foot fetish of the homosexual male. The study came out of a need to study fetishists since many of them do not let their fetishes be known to the general public. This article stated that according to their research, homosexual males developed fetishes predominately during adolescence. They discovered that heightened sexuality made these individuals more susceptible to the development of one or more fetishes during puberty (Weinberg et al., 1995). This article states that a one time event or exposure can be of such a strong magnitude to impact the development of a fetish instantly. Usually classical conditioning in regards to fetish development happens over a period of time. Once the adolescent boy experiences the sensation of sexual delight coupled with the trigger, operant conditioning comes into play and the fetish becomes well established (Weinberg et al., 1995). The study also states that many times people with fetishes come from households with suppressed sexuality. The study was conducted with 500 homosexual male participants that were mailed a questionnaire regarding the personality, learning, and the salience of the fetish. The study found that there was a positive connection in early adolescence with feet and their upbringing was very restricted regarding sex (Weinberg, et al., 1995). The treatment approaches discussed in this article involved re-conditioning the responses to a different set of stimuli and establish new classical and operant conditions without any fetishes. The results have been mixed and as such are inconclusive. The second article: Hearing before the Senate Judiciary Committee: “Prohibiting obscene animal crush videos in the wake of United States v. Stevens”, (Volkan, 2010, September 15). This article starts out with strong explanations of the sexual nature and dangers of "crush" paraphilias and crush videos and how this pertains to the shoe/foot fetish (Volkan, 2010). Volkan gives in-depth definitions of a fetish and states that a fetish is a strong recurrent sexual attraction to a non-living object. This article also states that the crush paraphilia is an extreme version of the foot fetish (Volkan, 2010). The history of paraphilias and fetishes dates back to the turn of the last century and has been associated with pleasure, usually of a sexual nature since that time. According to Volkan (2010), individuals with a paraphilia do not voluntarily seek treatment. For those that are required to attend treatment he listed the following as treatment modalities: behavior modification therapies, psychodynamic psychotherapy, cognitive behavioral treatment, pharmacological treatment, and relapse prevention. He described paraphilias as troublesome to treat, but they can be treated with limited success and frequent relapses (Volkan, 2010). Treatment Challenges One of the problems with successfully treating individuals with paraphilias is that they have a high rate of co-morbid mental disorders (Leue, 2004). Treatment plans that uses a combination of different modalities is thought to be more effective than a single modality treatment plan (Guay, 2009). Given the rather more primitive nature of the shoe fetish paraphilia and its high level of social unacceptability, it is likely that most individuals involved will not be willing to acknowledge that they engage in this activity. When a client is mandated by the courts to attend therapy, it puts them in a defensive position. A skilled therapist can be capable of breaking down the walls of defense and the establishment of meaningful dialogue. This takes time and a slow building of trust. Isolation is a big part of fetishes and being secretive and keeping to ones self is another challenge for clinicians. It has not been determined if paraphilias ever truly let someone into their inner world (Volkan, 2010). Usually they do not even make contact with the object of their fetish as a standard mode of operation. The established fetishism can be too strong for an outsider to penetrate and this can result in the client doing a basic going through the motions (Weinberg et al., 1994). Treatment of a person with a foot and/or shoe fetish is complex with several internal and external factors to consider, such as the family, the extent of the fetish, the employability of the client and what connections are reparable in a social and personal context. Learning Points An important implication supported by all of these theories of the origins of paraphilias is that humans have the capacity to develop paraphilias in a wide variety of ways (Volkan, 2010). This author learned that treatment modalities for paraphilias have not had much success and new areas need to be explored to gain a better understanding of this disorder. The lack of research and research participants available make understanding paraphilia in general a challenge. The early detection of this type of disorder has little to no empirical research. This author feels that taking a more holistic approach to assessment and treatment might open some doors that have been previously closed. During this analysis the prominent underground activities came to light and also presents as a barrier to establishing any kind of trust with those who suffer from paraphilias. Foot and shoe fetishes are complex and hard to treat. Working with this population would take a highly skilled clinician that has been trained in sexual deviations and paraphilias. The therapist would need to be a blank slate in terms of any moral or ethical judgments they might have internalized. This author has no interest or inclination to work with this population and has done more than her share of time in the trenches. This author has chosen to work with organizations concerned with proactive approaches to health and wellness. The specific area this author has chosen is green roof technologies. Working with plants and nature has an important role in our society, as does working with paraphilias. References De Silva, P. (1993). Fetishism and sexual dysfunction: Clinical presentation and management. Sexual & Marital Therapy, 8(2), 147-155. Retrieved from EBSCOhost. Ellis, H. (1906). Foot-fetichism and Shoe-fetichism. Erotic symbolism, the mechanism of detumescence, the psychic state in pregnancy (pp. 15-46). Philadelphia, PA. doi:10.1037/10946-002. Grant, V. W. (1953). A case study of fetishism. The Journal of Abnormal and Social Psychology, 48(1), 142-149. doi:10.1037/h0054877. Guay, D. R. (2009). Drug treatment of paraphilic and nonparaphilic sexual disorders. Clinical Therapeutics, 31 (1), 1-31. doi:10.1016/j.clinthera.2009.01.009 Hersen, M., Turner, S. M., & Beidel, D. C. (Eds.). (2007). Adult Psychopathology and Diagnosis (5th ed.). Hoboken, New Jersey: John Wiley and Sons, Inc.. Leue, A. (2004). Mental disorders in a forensic sample of sexual offenders. European Psychiatry, 19 (3), 123-130. doi:10.1016/j.eurpsy.2003.08.001. Volkan, K. (2010, September 15). Hearing before the Senate Judiciary Committee: “Prohibiting obscene animal crush videos in the wake of United States v. Stevens”. California State University Channel Islands, Camarillo, CA. Weinberg, M. S., Williams, C. J., & Calhan, C. (1995). “If the shoe fits ...”: Exploring male homosexual foot fetishism. The Journal of Sex Research, 32 (1), 17-. doi: 6836596. NALYSIS PAPER: PARAPHILIAS 9 Running head: ANALYSIS PAPER: PARAPHILIAS 1 ANALYSIS PAPER: PARAPHILIAS 1