Can Fetishes Even Be Changed?
I recently received a rather angry email from someone who seemed to think that fetishes are unchangeable. They said “It’s not flexible, it’s genetic”. I asked them to provide some evidence for this, and they failed to do so, which is not surprising given the many decades of research into fetishes and their treatment, which contradicts their viewpoint.
This is therefore a rather strange occurrence, but I do believe that it’s well-meaning; sexuality has historically been shamed more than any aspect of humanity, and fetishes have wrongfully received most of that shame in the 19th and early 20th century. Mostly, their opinions might just be a rebellion against the historical shame, and a move towards accepting fetishes as normal non-pathological desires – which is a very good thing. However, implying they’re unchangeable is not true. Upon further investigation, I discovered that this person was not alone, and that other members of the public have assumed this too. In this article I’ll present the research into fetishes, while trying to work out what might cause someone to not be aware of such a wealth of evidence, and even blatantly ignore it in some cases!
The treatment options are varied, and many different options have been shown to be successful, over thousands of studies and 50+ years of research. In fact, as far back as 1982, Kilmann et al (1982) conducted a review of the research up until that point, and wrote: ‘Almost all of the studies found positive treatment effects’. Laws and O’Donohue (2008), along with a team of other researchers, reviewed many hundreds of studies and made a 650+ page book out of that, as well as their guidance on the best evidence-based methods of treatment (‘Sexual Deviance: Theory, Assessment, And Treatment’). So did Langevin (1983) (‘Sexual Strands: Understanding And Treating Sexual Anomalies In Men’). So did The World Federations of Societies of Biological Psychiatry (2010) (‘Guidelines For The Biological Treatment Of Paraphilias’) In fact, many other researchers have created meta-analyses and systematic reviews of the research, and come to much the same conclusions (eg Wise, 1985; Stolorow et al, 1988; De Silva, 1993; McConaghy, 1993; Walters, 1997; Krueger & Kaplan, 2002; de Silva, 2007; Thibaut et al, 2010; etc.).
Evidence vs Shaming
However, over the recent human history, fetishes have been treated like a mental illness – quite literally. Sexuality has been kept secret and shamed by our societal standards, which have repeatedly shunned and frowned upon any non-normal (‘paraphilic’) behaviors.
It’s always best to make decisions based on evidence, but perhaps some people have ignored any evidence that gives fuel to those who wrongfully stigmatise such behaviors, and decided to claim that fetishes are unchangeable.
All the studies which show fetishes can be changed may unintentionally be implying that they should be changed, which is not true. Therefore, some people might automatically rebel against that assertion without even looking at the evidence. This is well-meaning, but not a scientifically accurate method of establishing facts.
In an extensive review of hundreds of studies, ‘The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the biological treatment of paraphilias’ (2010) recommends psychotherapy as a first-line treatment for paraphilias (paraphilia is just a fancy word for any sexual desire that isn’t common), particularly recommending CBT (cognitive behavioral therapy) where available, as the evidence for that is most reliable (Thibaut et al 2010).
If this is ineffective they then recommend drugs and physiological treatments. There are many more studies on drugs (drug companies have money, and can fund studies on drugs in ways that leave psychotherapy behind). SSRIs (Selective Serotonin Reuptake Inhibitors) have been shown to selectively reduce paraphilic desires without affecting normal sex drive (Bradford, Greenberg, Gojer, Martindale, & Goldberg, 1995; Kafka, 1994; Kafka & Prentky, 1992; Garcia & Thibaut, 2011). (The reason is beyond the scope of this article). All other drug treatments attempt to suppress sex drive as their ‘treatment’ – which is like curing an itchy nose by cutting it off! Removing your sex drive is not an adequate treatment in my opinion, it’s overkill.
The oldest and most common approach is a behavioral approach. This deals with the mental association between the fetish and pleasure.
Rachman (1966) showed a group of men pictures of boots alongside naked women, many hundreds of times, theorizing that eventually the men would associate boots with naked women and therefore become aroused just by looking at boots along. This is a process known as ‘conditioning’, and it turned out to be true – they gave the men a ‘boot fetish’ just by making their brains link boots with arousal. (then, they removed the fetish by the same method.)
Researchers theorized that if they could make people link their fetish with bad things, they would no longer be aroused, and instead they’d be repulsed. So, they exposed patients to their fetish at the same time as doing something bad – making them feel sick or smell bad things (Laws, 2001), administering pain, giving them a small shock (Wijesinghe, 1977), making them simply imagine bad things (Cautela & Wisocki, 1971;), or any number of pretty horrible things, and repeating this until the negative association formed. This worked overwhelmingly well, but it was very unethical (and in modern times, we don’t need to resort to such methods) (Gaupp et al, 1971; Langevin, 1983).
Other behavioral methods have also been used, such as ‘orgasmic reconditioning’ and ‘satiation therapy’, to similar success (Marquis, 1970; Marshall, 1979; Laws & Marshall, 1991; Hunter & Goodwin, 1992; Abel et al, 1992; Johnston et al, 1992; Laws, 1995; Marshall et al 1999).
The problem with the behavioral approach, aside from ethical implications in some of the early, extreme examples, is that it treats the association between the fetish and pleasure, and not the root cause (as noted by Langevin, 1983). This is only useful when the root cause of fetishes remain a mystery, as behavioral solutions do treat the symptoms well, but it would be much better to change the root cause itself.
Aside from our associations which do shape our sexual desire, the reason why fetishes form is due to a complex interconnected combination of our fears, feelings, and unmet needs – particularly ones formed during childhood (Stoller, 1979; La Torre, 1980; Langevin, 1983; Stoller, 1986; Morin, 1995; Rosen, 1996; Sawyer, 1996; Kaplan, 1997; Lowenstein, 2002; Siegel, 2011; Baumeister, 1988 & 2014).
Essentially, most fetishes incite some emotion within us. Being tied up (bondage) makes you feel totally powerless and vulnerable – turning these emotions into sexual pleasure. Cuckolding is about inadequacy – it makes you feel inadequate, inferior, and excluded. These emotions get turned into pleasure by people who have these fetishes, so that they don’t feel these emotions, but instead feel arousal. (See: ‘The Psychology Behind The Cuckold Fantasy‘)
The reason why has been explained in numerous ways – as a method of protection (Siegel, 2011), as an escape from self-awareness (Baumeister 1988 & 2014), as a fantasy of revenge over the emotions that hurt us (Stoller 1979 & 1986), or as a way to affirm ourselves (Morin, 1995). The explanation differs depending on whether we are a victim of these emotions (such as with masochism and ‘submissive’ fetishes) (Kernberg, 1988) or whether we are acting these emotions onto someone else (such as with sadism and ‘dominant’ fetishes) (Stoller, 1979).
Essentially, by experiencing these emotions in a safe environment, and recreating hurtful experiences either as the victim or the victor, we’re able to overcome them in some way. The exact reason why is untestable, but it doesn’t quite matter which explanation to listen to – they all explain the same thing. They also all point towards the same treatment, regardless of the explanation – that by acknowledging and dealing with these emotions inside of us, and meeting the unmet needs, the fetish stops being arousing, as there is no longer as much pain to turn into pleasure.
Psychodynamic or ‘insight-oriented’ therapy has therefore been used to successfully treat fetishes along these lines. (Bemporad, Dunton, & Spady, 1976; Stoller, 1979; Goldberg & Wise, 1985; Sawyer, 1996; Tan & Zhong, 2001; Fink, 2003; Wiederman, 2003).
Cognitive, Social, Humanistic
When someone engages in a sexual desire that is distressing, harmful to themselves or others, impairs their life, or causes shame, there’s probably other reasons beyond being aroused. It’s not normal to sacrifice those things for the sake of sexual fulfilment, and most people wouldn’t do that. Sometimes cognitive distortions can be involved, sometimes it can attempt to make up for unfulfilled social deficiencies, and sometimes it can be a faulty attempt to meet other needs. (La Torre, 1980; De Silva, 2007; Laws & O’Donohue, 2008; Thibaut et al, 2010; Baumeister, 2014). Therefore, these other forms of psychotherapy are useful in addressing unique additional factors.
No Treatment At All
Both Langevin (1983) and Siegel (2011) describe fetishes spontaneously changing without treatment, over the natural course of life. Walters (1997) notes a lack of research on this ‘spontaneous remission’, writing: ‘The lack of research on spontaneous remission in the paraphilias may reflect an untested assumption on the part of some investigators that people do not get over paraphilic behavior without some type of formal intervention. This is an assumption, however, that requires empirical testing; for if it can be demonstrated that a certain portion of the paraphilias improve without professional assistance then the argument that paraphilias are essentially chronic, progressive conditions will need to be revised.’ There is a lack of empirical research about fetishes changing without intervention- and perhaps it may not happen – but with an intervention, it isn’t even a question.
Thibaut et al (2010) write about paraphilias co-occurring with psychotic illnesses, saying ‘In some cases, the paraphilia is secondary to the psychotic illness and subsides when the psychosis is successfully treated, whilst in other cases, the paraphilia is independent of the psychosis and may need treatment in its own right (Smith and Taylor 1999; Baker and White 2002)’. Again, it isn’t even a question among psychologists. Only the people in my email inbox!
Self-help is also effective, and can provide results similar to therapist-led psychotherapy (Marrs, 1995; Sbraga, Pickett, & West, 2005; Laws & O’Donohue, 2008). That is the purpose of this website: if you have a cuckold fetish and want to change, you’re in the right place. (Behavioral, psychodynamic, cognitive, social, and humanistic approaches are covered on my website, because a combined approach is recommended by nearly all reviews of the research).
Criticisms Of Research
The research is by no means flawless. Ideally, the best forms of studies are randomized, controlled, double-blind trials. This is a method of testing which is most reliable, for it eliminates bias. However, as Langevin (1983) noted, it is very hard to do this with fetishes, and perhaps even unethical. Much of the research has lacked controls, randomization, or double-blind features, which makes it hard to be certain of it. Although they do exist, they are not the majority.
Furthermore, hardly anyone actually seeks treatment for their fetish. There’s such a lot of shame and secrecy around it that these people stay hidden. Most of the research is actually done on sex offenders, who offend in some fetishistic way (exhibitionism, pedophilia, rape motivated by sadistic fantasies, voyeurism, etc) because that’s when researchers can actually get hold of these people.
Kilmann et al (1982) noted that the problems with the research involved the lack of an adequate follow-up period and the reliance on verbal reports – problems noted by Langevin (1983) in his extensive book on treating fetishes. Of course, if a treatment approach is successful, the effects need to still be present 5-10 years after the treatment occurs – otherwise, it might just be temporary. Studies with only a 1-year follow-up period are therefore not certain. Of course, it’s a lot harder (and more costly, and more time consuming) to create a 5-10 year follow-up period, so it’s much rarer.
One study was done over 25 years, on 7,275 people, and found good evidence for long-term success (89.9% success rate at 5 years, 87.8% success rate at 25 years, of those still participating at that time), but only focused on CBT, and again only studied sex offenders, with no control group for ethical reasons, all of whom were male (Maletzky & Steinhauser, 2002). Given the large time frame, many participants were not available for follow-up – and perhaps this could affect the data. Also, treatment methods evolved so much in that time frame that there was no consistent, standardised method – all participants received something slightly different, which makes it difficult to evaluate one specific method.
Similarly, verbal reports are not 100% reliable – if someone says the treatment worked, how can you be sure they’re telling the truth? It would be unlikely, but possible, for them to lie, so phallometric data (where a device is attached to the penis to measure any slight hint of an erection in response to their previous fetish) is more reliable. But, again, more difficult, rarer, more expensive, and potentially degrading. The 25-year study above did use these erection-measuring devices, as well as polygraph tests, but only some participants were available to do so – and again, this might affect the data.
Still, this is no reason to completely discard those studies which don’t have those aspects and decide that fetishes can’t be changed. That would be silly. Rather, it is best to use these objections to weigh the research fairly.
It is also valid to question at what point ‘evidence’ becomes ‘proof’, and whether the research on fetishes has crossed that point. This is a subjective evaluation beyond the scope of this article – but a valid argument to make. It would certainly fair to say that we have enough mediocre studies, but need more high-quality studies. It is not valid, however, to say that fetishes cannot be changed, or that the evidence doesn’t say they can.
Why Has This Knowledge Not Found Some Members Of The Public?
Upon seeing psychologists resort to trying to remove the sex drive from their patients with drugs, and even the idea of treating it like a biological (not psychological) issue – which is incorrect – could be why a few people have assumed that fetishes cannot be changed, or have some sort of biological cause. Fortunately, no research review recommends drug therapy on its own, and some discourage drug therapy for anything other than court-mandated cases, and psychological treatments are more widely encouraged.
In the behavioral research, seeing people treating the symptoms and not the cause is certainly discouraging, and the [incorrect] implication is that the root cause can’t be changed, or is unknown. Perhaps, again, this might be why a few people have contradictory opinions.
The insight-oriented approach seems to imply that something is ‘wrong’ with people with fetishes – when really, everyone has unique fears, deep-rooted emotions, and unmet needs, and only in some cases does it drive sexual desires to be outside the realms of societal acceptance. The knowledge that fetishes are normal might make some people rebel against this approach, thinking it’s old-fashioned or kink-shaming, when really, this is a misconception. (See: ‘What’s Wrong With Having A Fetish?’)
More likely, this information is simply just not part of the public knowledge. Most people with a fetish may automatically try to work out for themselves why they have their fetish, creating their own stories and justifications – which is fine. However, it creates misleading and untested information to be spread by how many people ‘believe’ it might be true, rather than an evidence-based approach.
And sometimes, the voices that are the loudest are not the best informed. Google, for example, ranks search results by how many other places on the internet link to that page. If a particular page is widely shared and linked to in relevant places, it ranks higher, and gets seen by more people – no matter the scientific validity (that’s also why you should share this article and post a link to it in somewhere relevant!). Anyone claiming that fetishes are unchangeable might enthusiastically share any web page repeating that, regardless of its reliability. Then, that page gets seen, shared, and the arguments get spread without question. Whereas the majority of people who have more accurate viewpoints are less likely to talk about it, care about it, or even bother to argue – so those viewpoints don’t get shared and heard. (So, please share this page to correct the balance, and help make sure public knowledge is well-informed!)
Abel G.G., Osborn C., Anthony D., et al. (1992) Currents treatments of paraphiliacs. In: Bancroft J, Davis CM, Ruppel Jr HJ. (1992) Annual review of sex research: An integrative and interdisciplinary review. Vol. III. The Society for the Scientific Study of Sex. Printed by Stoyles Graphic Services, Lake Mills, Iowa; 255–90.
Abel G.G., Osborn C.A., Anthony D., et al. (1992) Current treatments of paraphiliacs. Annual Review of Sex Research;3:255–90.
Baumeister, R. F. (1988). Masochism as escape from self. Journal of Sex Research, 25(1), 28-59.
Baumeister, R. F. (2014). Masochism and the self. Psychology Press.
Bradford, J. M. W., Greenberg, D. M., Gojer, J. J., Martindale, J. J., & Goldberg, M. (1995, May). Sertraline in the treatment of pedophilia: An open labeled study. Paper presented at the annual meeting of the American Psychiatric Association, Miami, FL. Cited in: Laws & O’Donahue (Eds.) (2008) Sexual deviance: Theory, assessment, and treatment. Guildford Press.
Breslow, N., (1989). Sources of confusion in the study and treatment of sadomasochism. Journal of Social Behavior and Personality, 4, 263–274.
Cautela J.R., Wisocki P.A., (1971) Covert sensitization for treatment of sexual deviations. Psychological Record; 21: 37–48.
DeSilva, P. (1993). Fetishism and sexual dysfunction: Clinical presentation and management. Sexual and Marital Therapy, 8(2), 147–155.
De Silva, P. (2007). Paraphilias. Psychiatry, 6(3), 130–134.
Dozier, C. L., Iwata, B. A., & Worsdell, A. S. (2011). Assessment and treatment of foot—shoe fetish displayed by a man with autism. Journal of applied behavior analysis, 44(1), 133-137
Feldman, M. P. (1966). Aversion therapy for sexual deviations: A critical review. Psychological Bulletin, 65(2), 65-79.
Freund, K. (1976). Diagnosis and treatment of forensically significant erotic preferences. Canadian Journal of Criminology and Corrections, 18, 181–189.
Garcia, F.D. & Thibaut, F., (2011). Current concepts in the pharmacotherapy of paraphilias. Drugs, 71(6), pp.771-790.
Gaupp, L.A., Stern, R.M. and Ratliff, R.G., (1971) The use of aversion-relief procedures in the treatment of a case of voyeurism. Behavior Therapy. 2(4), pp.585-588.
Goldberg, R. L., & Wise, T. N. (1985). Psychodynamic treatment for telephone scatalogia. American Journal of Psychoanalysis, 45, 291–297.
Hunter J.A, & Goodwin D.W. (1992) The utility of satiation therapy in the treatment of juvenile sex offenders: variations and efficacy. Annals of Sex Research 5: 71–80.
Johnston P, Hudson S.M., & Marshall W.L. (1992) The effects of masturbatory reconditioning with nonfamilial child molesters. Behaviour Research and Therapy;30:559–61.
Junginger, J. (1997). Fetishism: Assessment and treatment. In D. R. Laws & W. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 92–110). New York: Guilford Press.
Kafka, M.P., (1994). Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Annals of Clinical Psychiatry, 6(3), pp.189-195.
Kafka, M. P., & Prentky, R. A. (1992). Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. Journal of Clinical Psychiatry, 55, 351–358.
Kaplan, L. J. (1997). Clinical manifestations of the perverse strategy. Psychoanalysis & Psychotherapy. 14(1), 79-89.
Kilmann, P. R., Sabalis, R. F., Gearing, M. L., Bukstel, L. H., & Scovern, A. W. (1982). The treatment of sexual paraphilias: A review of the outcome research. Journal of Sex Research, 18(3), 193-252
Krueger, R. B., & Kaplan, M. S. (2002). Behavioral and Psychopharmacological Treatment of the Paraphilic and Hypersexual Disorders. Journal of Psychiatric Practice, 8(1), 21–32.
La Torre, R. (1980). Devaluation of the human love object: Heterosexual rejection as a possible antecedent of fetishism. Journal of Abnormal Psychology, 89, 295–298.
Lalumiere, M. L., & Quinsey, V. L. (1998). Pavlovian conditioning of sexual interests in human males. Archives of Sexual Behavior, 27, 241–252.
Langevin, R. (1983) Sexual strands: Understanding And Treating Sexual Anomalies In Men, Hillsdale, NJ: Erlbaum
Laws, D.R. (1995) Verbal satiation: Notes on procedure, with speculations on its mechanism of effect. Sex Abuse;7:155–66.
Laws, D.R. (2001) Olfactory aversion: Notes on procedure, with speculations on its mechanism of effect. Sexual Abuse: A Journal of Research and Treatment;13:275–87.
Laws, D.R., Marshall W.L. (1991) Masturbatory reconditioning with sexual deviates: An evaluative review. Advances in Behaviour Research and Therapy; 13:13–25.
Laws, D. R., & O’Donohue, W. T. (Eds.). (2008). Sexual Deviance: Theory, Assessment, and Treatment. Guilford Press.
Lennon B. (1994) An integrated treatment program for paraphiliacs, including a 12-step approach. Sexual Addiction & Compulsivity; 1:227–41.
Lowenstein, L. F. (1997). Fetishes: General and specific. Psychotherapy in Private Practice, 16(4), 53–65.
Lowenstein, L. F. (2002). Fetishes and their associated behavior. Sexuality and Disability, 20(2), 135-147.
Maletzky, B.M. and Steinhauser, C., (2002) A 25-year follow-up of cognitive/behavioral therapy with 7,275 sexual offenders. Behavior Modification, 26(2), pp.123-147.
Marquis, J. N. (1970). Orgasmic reconditioning: Changing sexual object choice through controlling masturbation fantasies.Journal of Behavior Therapy and Experimental Psychiatry, 1, 263–271.
Marrs, R. (1995). A meta-analysis of bibliotherapy studies. American Journal of Community Psychology, 23, 843–870.
Marshall, W. L. (1974). Case report: A combined treatment approach to the reduction of multiple fetish-related behaviors. Journal of Consulting and Clinical Psychology, 42(4), 613–616.
Marshall, W. L. (1979) Satiation therapy: a procedure for reducing deviant sexual arousal. Journal of Applied Behavioral Analysis; 12: 10–22.
Marshall W, Anderson D, Fernandez Y, eds. (1999) Cognitive behavioral treatment of sexual offenders. New York: John Wiley & Sons.
Mason, F. L. (1997). Fetishism: Psychopathology and theory. In D. R. Laws & W. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (pp. 75–91). New York: Guilford Press.
McConaghy, N., (1993). Sexual behavior: Problems and management. New York: Plenum Press.
Nagler, S. H., (1957). Fetishism: A review and a case study. The Psychiatric Quarterly, 31(1-4), 713-741
Morin, J., (1995). The Erotic Mind: Unlocking the Inner Sources of Passion and Fulfilment. HarperCollins.
Penix, T., (2008) Paraphilia Not Otherwise Specified: Assessment And Treatment. In: Laws & O’Donohue (eds) (2008) Sexual deviance: Theory, assessment, and treatment. New York: Guilford Press.
Pfaus, J. G., Erickson, K. A., & Talianakis, S. (2013). Somatosensory conditioning of sexual arousal and copulatory behavior in the male rat: A model of fetish development. Physiology & behavior, 122, 1-7.
Rachman, S. (1966). Sexual fetishism: An experimental analogue. The Psychological Record, 16(3), 293-296
Rachman, S., & Hodgson, R. (1968). Experimentally induced “sexual fetishism”: Replication and development. Psychological Record, 18, 25–27.
Rosen, I. E. (1996). Sexual deviation. Oxford University Press.
Sawyer, D. (1996). An attempt to repair: The meanings of a fetish in the case of Mr. A. Issues in Psychoanalytic Psychology, 18, 21-35
Sbraga, T. P., Pickett, L., & West, A. (2005, October). Cognitive-behavioral bibliotherapy for sex offenders: Minimalist intervention, maximum impact. Paper presented at the annual meeting of the Association for the Treatment of Sexual Abusers, Salt Lake City, UT. Cited in Penix (2008)
Stoller, R. J. (1979). Sexual excitement: Dynamics of erotic life. London: Maresfield Library.
Stoller, R. J. (1986). Perversion: The erotic form of hatred. Karnac Books
Stolorow, R., Atwood, G., & Brandchaft, B. (1988). Masochism and its treatment. Bulletin of the Menninger Clinic, 52, 504–509
Siegel, S. (2011) Your Brain On Sex. Sourcebooks Casablanca.
Tan, Y., & Zhong, Y. (2001). Chinese style psychoanalysis—Assessment and treatment of paraphilias: Exhibitionism, frotteurism, voyeurism, and fetishism. International Journal of Psychotherapy, 6(3), 297–314
Thibaut, F., Barra, F.D.L., Gordon, H., Cosyns, P., Bradford, J.M. and WFSBP Task Force on Sexual Disorders, (2010). The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias. The World Journal of Biological Psychiatry, 11(4), pp.604-655.
Walters, G. D. (1997). The paraphilias: A dialectically informed review of etiology, development, and process. Sexual Addiction & Compulsivity, 4(3), 221–243.
Wijesinghe, B. (1977). Massed aversion treatment of sexual deviance. Journal of Behavior Therapy and Experimental Psychiatry, 8(2), 135-137.
Wiederman, M. W. (1998). The state of theory in sex therapy.Journal of Sex Research, 35(1), 88–99.
Wiederman, M. W. (2003). Paraphilia and fetishism. The Family Journal, 11(3), 315-321.
Wilson, G. D. (1987). An ethological approach to sexual deviation. In G. Wilson (Ed.), Variant sexuality: Research and theory. London: Croom Helm.
Wise, T. N. (1985). Fetishism: Etiology and treatment. A review from multiple perspectives. Comprehensive Psychiatry, 26(3), 249–57.
Note: Strictly speaking, the term ‘fetish’ refers to an attraction to an object whereas ‘paraphilia’ refers to situations. However, in common language the term fetish is used as any attraction to anything specific, outside of normal sex, so that’s how I’ve used the term ‘fetish’.