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OF mental health care and mentally ill

Treatment of transvestic fetishism

Transvestism is not a condition that requires treatment. Nevertheless, people whose behaviour is affecting their relationships or who fi nd their behaviour unacceptable may seek treatment. Marital problems often lead to attempts at behavioural change and the initiation of therapy. Wives often have negative feelings towards their husband’s behaviour even when they know about it early in their relationship. Treatment usually focuses on the sexual elements of transvestite behaviour, and includes aversion therapy and modifi cation of sexual fantasy. Some aversion programmes have proven moderately successful. Marks et al. reported that two-thirds of participants in electrical aversion therapy improved with treatment, up to a follow-up period of two years. This compared with one-quarter of a control group who did not receive the intervention. A second approach to the treatment of transvestism involves masturbatory retraining. Here, the individual masturbates using his preferred sexual object, including female props worn either by the individual or his partner, before reverting to images of more ‘normal’ sex objects immediately before and at orgasm. Again, a number of case descriptions and uncontrolled studies have shown this method to have been used with good effect. More recently, Chiang et al. reported signifi cant changes following a cognitive behavioural programme instituted following the individual developing ‘severe moral anxiety’. The individual involved did not respond to psychodynamic therapy, but a combination of supportive and cognitive therapy proved of some value, at least in the short term.

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