Paraphilias: The Psychoanalytic Theory
According to psychoanalytic theory, paraphilias are manifestations of unresolved inner conflict, which are rooted in one's childhood. It is thought that abnormal or irrational behaviors associated with each of the paraphilias are symbolic of the fear of castration. As an example, an exhibitionist may resort to flashing his penis at people, purely for his need to confirm the presence of his genitals. The shock of being flashed is the confirmation he needs to relieve the anxiety (Rathus, Nevid & Fichner-Rathus, 2005, p.594). Several theories exist about the cause of paraphilias, and there is no one correct theory. Many treatment options are available; however, it will depend on the orientation of a particular therapist as to which treatment will be applied.
Numerous treatment models are used for paraphilias, and covert aversion therapy might possibly be a good place to start. It is probably though, that a combination of therapies would be more beneficial, particularly in the case of sex offenders. Where social-skills therapies might work best for some paraphilias, social-skills training would not necessarily be an effective place to begin treating a sex offender. In this instance, drug therapy would be needed to reduce the anxieties and physical compulsion to reoffend, leaving the person more relaxed and receptive to some behavioral changes. Similarly, placing a person with frotteurism into a crowd might not be the best way to begin.
A common denominator of all paraphilias seems to be an underlying learned behavior, resulting from an incident during childhood, or a possible physical or mental abuse in adulthood. Paraphilias may also evolve due to a person's low self-esteem and continuing unwillingness to participate in social activities because they are easily intimidated. More often than not though, intimidation rests in the mind of the individual and is not due to any real harassment. Perhaps psychoanalysis is the best place to begin unearthing the primary cause, although it is not likely that psychotherapy alone can put an end to any of the paraphilias.
Not all therapists subscribe to the same theory, therefore the treatments will vary. Learning about the various theories can help an individual understand which mode of treatment they will be working with; it will also provide better insight as to possible causes of the paraphilia they are afflicted with. Like most matters, education is paramount, and being as honest as possible with the therapist will allow them to tailor the most effective treatment program.
Rathus, S.A., Nevid, J.S., and Fichner-Rathus, L. (2005). Human sexuality in a world of diversity. (6th ed.) Boston, MA: Allyn and Bacon.