You Want to Do What? Treating Paraphilic Disorders Through a Sex Positive Framework

This chapter provides concrete examples of how clinicians can conceptualize and treat the eight paraphilic disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition through such a sex positive framework. Sex positive treatment of paraphilias seeks first to educate clients on the complexity of sexuality and the variety of sexual interests, behaviors, fantasies, and identities that comprise one's sexuality, validating the client's sexuality whenever possible. Voyeurism is a paraphilia involving the desire to watch and observe others. Distress as a result of a voyeuristic desire may be the consequence of guilt and shame stemming from a values set that admonishes such fantasies. Exhibitionism is a paraphilia wherein an individual desires to be observed by others during sexual activity or becomes sexually aroused as a result of exposing their genitals to another person.