The psychoanalytic perspective of Paraphilias is that paraphilias are psychological defense, usually against unresolved castration anxiety. I would treat the patient in two stages. The first stage that I would use is psychotherapy. In this stage the goal would be to assist the patient with identifying the underline issue and why he engages in paraphilia thoughts and activities. The goal would
also be to assist the patient with understanding the links between unresolved issues in his childhood with his thoughts and or actions in his adult life.
The second stage of the process would be cognitive behavioral therapy. The goal for this stage would be to teach the patient on how to re program his thoughts an order for the patient to stop the habit of linking one action to a fear of castration. The goal is to condition the patient to think in a different way about his fear of castration an order to stop the abnormal thinking process.
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