What Are The Clinical Concerns For Those Who Participate In Fetishistic Or Paraphilic Exploration?

Fetishistic Exploration Gone Wrong

As clinicians, we are always looking for the concept of impairment. If the clients’ fetish, Kink, or paraphilia is interfering in their relationships, work, or creating financial, legal, or health concerns, then as clinicians, we need to address that. Otherwise, most consensual sexual exploration is healthy and part of the healthy spectrum of human sexuality. However, there are a number of areas where, as a clinician, I have seen impairment. Remember that a fetish will add to connection and sexuality whereas, a paraphilia may prevent connection, especially if the fetish is required in order to have any sexual satisfaction.

The Co Dependent Fetish?

One of the more common issues I find in my clinical practice is the co-dependent. I have seen a number of clients who choose to stay in toxic relationships because their partner supports their fetish and they are afraid that they will be unable to find another companion who will not judge them. Additionally, I have seen partners who “take one for the team” and participate in fetishistic or Kinky behaviors under a certain amount of distress due to their own insecurities. I have also seen sexual fetishes and paraphilias used as a tool by abusers to hold their partners hostage. Again, this particular issue has nothing to do with the activity and more to do with the co-dependent behavior, which needs to be addressed with self-esteem work, cognitive behavioral therapy (CBT), and other known interventions. As a therapist, it is important to not fixate on the fetish and instead focus on the issues that are truly keeping a client trapped in this abusive dynamic, otherwise you patient may keep themselves in a dangerous situation.  

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Rear View Of Couple’s Hand Tied With Metal Chain At Outdoors

Fetishistic Compulsions

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In my clinical experience, I have also seen impairment where a client has developed compulsive behaviors surrounding their fetish or Kink. There is a term called “sub frenzy” where a new submissive is so excited to be involved in the lifestyle that the submissive’s behaviors begin to impair other parts of their lives. This resembles addictive behaviors; however, I hesitate to call it an addiction, as there is controversy about the concept of sexual addiction within the sexual health community. Many in the clinical sexology community hold the belief that normal healthy behaviors cannot be a product of addiction; whereas, others in this community believe that any behavior can be susceptible to the addictive process. In any case, this fundamental belief should not prevent the mental health provider from recognizing that any behavior that causes impairment, that a client continues to participate in, can be considered dangerous. As a provider, if the client begins to have compulsive and impairing behavior, I encourage the clinician to examine the root of the compulsion and coach them in intervention-based tools.

Fetishistic DANGER!

Sexuality is a large and enjoyable part of the human experience, but if misevaluated, this can lead to patient harm. Sexual safety and health education need to be priorities for healthcare providers. The Internet is riddled with misinformation on the proper use of protection and the true risk of sexually transmitted disease contraction. I have seen a number of clients from both extremes regarding the probability of safety. They either do not understand the probable risk or have developed a phobia of any sexual interaction due to the information they have gathered on the Internet. Additionally, I have few clients who do not know how to properly use a male condom, let alone a female condom. It is essential that when discussing sexual health practice with your patients to have an honest conversation of probable risk vs. safety measures with demonstrations. As a provider, you are ethically obligated to have knowledge of these topics so that you have a stronger role in patient education and support.


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