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Fetish, Paraphilia, Kinky Sex, Addiction: What’s the Difference? Why Does it Matter?

Fetish, Paraphilia, Kinky Sex, Addiction: What’s the Difference? Why Does it Matter?. Marty Klein, Ph.D. SASH 9/22/11. Goals of today’s talk. Discuss non-normative sexual behavior: its range, features, dynamics Discuss some of the emotional issues they may trigger in us

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Fetish, Paraphilia, Kinky Sex, Addiction: What’s the Difference? Why Does it Matter?

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  1. Fetish, Paraphilia, Kinky Sex, Addiction: What’s the Difference? Why Does it Matter? Marty Klein, Ph.D. SASH 9/22/11

  2. Goals of today’s talk • Discuss non-normative sexual behavior: its range, features, dynamics • Discuss some of the emotional issues they may trigger in us • Discuss the role of our sexual assumptions & beliefs in our diagnosis & treatment • Discuss how our assumptions, beliefs, & emotional discomfort may lead us to diagnose Sex Addiction when other diagnoses might lead to better outcomes.

  3. American culture is sex-negative.Right? It would be peculiar if therapy, as a cultural institution, did not absorb these values & vocabulary.

  4. This means that without specific professional training, our clinical values regarding sexualitywill certainly reflect society’s values—and its ignorance, shame, & anxiety.

  5. If the patient’s beliefs & assumptions are driving their problem, we need to be able to see those beliefs & assumptions. And that’s hard to do if ourbeliefs & assumptions match the patient’s.

  6. That’s why understanding ourbeliefs & assumptions about sex is the first step toward improving diagnosis & treatment.

  7. Common assumptions about sex shared by clinicians & patients • Sex = intercourse • Love should drive sexual desire • Monogamy is the gold standard of relationships • Sexual discomfort is “normal” • Male and female sexuality are very different • To improve sexual enjoyment, improve sexual “function” • Fantasy predicts behavior, or expresses desire

  8. Clinical beliefs that shape diagnosis & treatment • What is “normal” sexuality? • What is “normal” desire? What drives it? • The relationship of fantasy, desire, & arousal • Stereotypes about sexual preferences • Desires to surrender or dominate are unhealthy • The relationship between sex, love, & intimacy • The role & meaning of masturbation • S/M re-enacts trauma • The goal of sex is intimacy • Orgasm and genitality are the ultimate in sex • Monogamy is the healthiest sexual arrangement • Fantasies “mean” something • Paraphilias and fetishes are pathologies to fix

  9. What ordinary people do • Masturbation • Pre-marital sex • Pre-marital “virginity” • Extra-marital sex • Pornography • Romance novels • Internet sexuality • B/D-S/M • Non-monogamy • Role-playing; fantasies • Piercings • Anal sex • Shave/wax pubic area • Makeup sex • Costumes • Commercial sex • Adult entertainment • Sex toys • Sex games • Sex clubs • Cross-dress • Voyeurism/exhibitionism • Same-gender sex • Risk-taking • Threesomes • Fetishes, paraphilias • Friends w/benefits • Post-breakup sex • Posting sexual pictures to amateur porn sites

  10. Do we judge the activity? Or evaluate the dynamics & context of the activity?

  11. One way to evaluate patients’ sexual behavior & decision-making: Honest? Consenting? Responsible? (and, of course, how do we define these? How does patient define these?)

  12. Ways to evaluate sexual behavior & decision-making • Understand the risks? • Is there someone they can tell? • Enjoyable? • Enlivening? • Feel satisfied? • Honest w/self? • Consonant with non-sexual values? • Sober? * • Shame-free? *

  13. We don’t want to pathologize behavior we don’t adequately understand simply because it is condemned bysociety,the patient’s partner,or even the patient!(or simply because we’re uncomfortable with it)

  14. Note: healthy sexual behavior is not always: Uncomplicated Internally conflict-free Free of unwanted consequences

  15. We don’t demand that of any other activity • Sports • Home-owning • Parenting • Going to school • Shopping • TV or film watching • Attending a conference

  16. Polysemicity She doesn’t necessarily feel the way I would if I did what she does.

  17. And so we have to ask lots of questions to rule out many of the ways “normal” people use sex. Are we comfortable asking those questions? Are we comfortable hearing the answers?

  18. Freely-chosen non-normative sexual behaviors: • May involve guilt or shame • May trigger others’ condemnation • May complicate current relationship • May be quite compelling & rewarding • May involve risk • May be the primary form of sexual expression • May look different than they feel

  19. The fetish/paraphilia dynamic • Has its own integrity & logic (which we might not see) • Generally does NOT express current relationship or psychological problems • Often the most important aspect of sex • There may be no problem with it—except for difficulty with partner • Often virtually life-long • Because of American culture, may involve secrecy, guilt, and shame • Think of it as a “sexual orientation”

  20. What’s “reasonable” to want from sex changes constantly • Warmth, closeness • Wifely duty • Intercourse with one’s wife • Birth control • Female orgasm • “Functioning” • Same-gender sex • Use of sex toys, lubricant • Intimacy, communication, “nurture relationship” • Oral sex • Kissing • Monogamy • Virginity • Who initiates • “Variety” • Age, disability, menopause • Masturbation within relationship • Separate beds; separate bedtimes; child/pet in bed

  21. Some sexual issues are more difficult for us than others. They challenge our clinical beliefs or personal values. They may highlight our lack of knowledge. Information from the mass media and our personal experience may be insufficient or counter-productive. What personal issues doespatients’ non-normative sexuality raise for us?

  22. Personal issues raised bypatients’ non-normative sexuality • Being seduced/repulsed by content • Not learning about its subjective meaning for patient • Being judgmental without realizing it • Being angry that patient can enjoy what we can’t • Maybe we’re not as developed as we thought • Exaggerated fear for patient’s safety • Envy or jealousy • Discomfort with patients’ autonomy • Pathologizing their impulses--to defend against our own • Focusing on content instead of process or meaning

  23. Do we have a model of healthy sexuality? Is it mostly about the content, or the process? Is it mostly about our prejudices or social norms?

  24. Some people have heterosexual monogamous intercourse—and they are NOT emotionally healthy. Other people have other kinds of sex, on other schedules, in ways we may find discomforting—but their process, their sense of self, and their respect for their partner is intact.

  25. Are we in a position to see that?If not, why not?And if not—how do we get there?

  26. Our model of healthy sexuality • What’s the role of imagination? • When and how is it OK to objectify a partner? • What is sex for? Should it serve us, or vice versa? • How much choice do healthy people have? • What’s an orientation, vs. a compulsion? • What is healthy lust? • What is healthy masturbation? • What is healthy pornography use? • What is healthy kinky sex? • Are our criteria different for men & women? Why?

  27. Not everyone who claims to be a sex addict is a sex addict, right? How do we differentiate? Who isn’t a sex addict?

  28. Disliking the consequences of your behavior +Continuing it after promising yourself you won’t +Feeling out of control…Does NOT necessarily mean you’re out of control.Does NOT necessarily mean you’re a sex addict.

  29. “I can’t help it”—or else what? • Admit who I am • Be disloyal • Have to discuss sex life • Have unwanted conflict • Risk the relationship • Admit my anger, hurt, etc. • Leave my marriage/relationship

  30. Some people would rather have an “addiction” than • Discuss masturbation • Discuss the couple’s sex life • Discuss non-sex life (eg, chronic lateness or inability to negotiate difference of opinion) • Admit they’re unhappy • Admit they don’t want the relationship • Deal with their resentment cleanly • Admit they made a poor marital choice • Admit they’re selfish or self-destructive • Displease god • Be disloyal to their family

  31. Sexual diversity • People are sexual throughout the lifecycle • What people want from sex changes • What people are willing to pay for sex changes • Every single thing you think of as normal is pathologized somewhere • Almost every single thing you think is perverse is normal somewhere What do we do when faced with this?

  32. Let’s remember to include a role for imagination & exploration in healthy sexuality • Omitting it from recovery contributes to relapse • Patients need to become more familiar with it and trust it, rather than fearing and avoiding it. • Objectifying & sexualizing one’s partner, oneself, & the relationship is critical for long-term desire and successful monogamy • We need to trust lust and desire

  33. Marty Klein, Ph.DPalo Alto, CA Sexual Intelligence blog: www.MartyKlein.com

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