Conceptual factors in the treatment of paraphilias: a preliminary report.

The purpose of this paper is to discuss conceptual components of treating paraphilia. Detailed description of the treatment interventions will be published subsequently. The format of the psychotherapy has components similar to the programs for sexual dysfunction and homosexual dissatisfaction therapy. Intensive short-term directive conjoint therapy remains essential. The therapeutic model focuses on the paraphilia as an interpersonal relationship disorder which is manifested as an unproductive and sometimes addictive means of coping with stress, particularly engendered by discomfort with intimacy in adult erotic relationships. The basic model of psychotherapy includes specific intervention directed at potential social skill deficits, changing erotic imagery, attitude and cognitive restructuring, self-esteem difficulties, dating anxiety, sexual dysfunction, intimacy issues and addictive behavior, all of which encourage mastery, self-assertion, self-responsibility and communication skills within the context of a relationship.