1. Assessment Problems (1) Psychological constructs are difficult to measure especially those involving sexual behaviour - Constraints on measurement because: (i) The legitimate right of the individual to keep much of their sexual fantasy/behaviour private (ii) ethical considerations (i.e., studying the development of sexual fantasies in children) (iii) Sexual activity occurs in private (i.e., fantasies) or semi-private (most sexual behaviour)

2. (2) Individuals present misinformation about their sexual activity if it is socially stigmatized - some have suggested that paraphiles are particularly good at lying because they live lives that necessitate hiding

3. (4) For many sexual paraphilias there are simply no sound measures for detecting their presence or absence e.g., sexual fantasies (3) Even if they want to be honest, various laws make it difficult to paraphiles to report lapses or re-lapses into parahiliac behaviour

4. Therapy Problems - There have been few well designed studies that look at the outcome of therapies for paraphiles - E.g., because of numerous design flaws, available research is equivocal with regards to whether treatments cause long-term change in pedophiles (1) Mental health professions disagree over what counts as an effective therapy

5. - Simply calling something a “therapy” doesn’t make it therapeutic - This raises a number of ethical and practical considerations related to the societal and personal costs of ineffective and/or unnecessary therapy

6. (2) Another problem involved in the treatment of paraphilias concerns the question of whether sexual orientation can be modified - Research suggest that sexual orientation (i.e., overall pattern of sexual attraction and arousal) cannot be modified - Assumption that deviant sexual behaviour is more plastic than “normal” sexual behaviour

7. - This suggests that paraphiliac sexual behaviours are no more “curable” than heterosexuality - a more attainable therapeutic goal might be to decreases the intensity of paraphiliac interests and teach skills aimed at decreasing the likelihood that the paraphile will act on his orientation - Goal of therapy is not a “cure,” but rather, the maintenance of abstinence from acting on the interest

8. (3) Recently, there has been an emphasis on treating adolescent sexual offenders because: (i) Some data suggest that many sexual offenders begin offending in early adolescence so understanding the developmental origin of such behaviours must begin at this point (ii) Intervening early decreases the harm sexual offenders do to others and to themselves (iii) Intervening early may increase the chances for successful therapeutic outcome. -Rationale: Before the behaviours have been engaged in repeatedly, they may modifiable

9. - Despite sound rationale, intervention in adolescence presents difficulties because of the adolescent’s status as a legal minor - Treatment of paraphilias involves discussion of sex, measurements involving sex (e.g., penile plethysmography), and sexual behavioural therapy (e.g., maturbatory reconditioning) - Some clinicians have faced legal and ethical charges because others have construed the treatment of adolescent sex offenders to be objectionable or indicative of child abuse

10. - The question is: Does the past behaviour of adolescents’ justify extraordinary therapy? (4) Another problem with treatment is that many paraphiles are not motivated to seek out and follow through with therapy -Many paraphiles are referred to therapy because of some legal problems or ultimatums from family or employers

11. (5) Therapy often takes place in forensic (i.e., prison, mental institution) context which complicates the therapeutic process (i)Who is the therapist’s client? The legal system paying the bills, or the sex offender? (ii) It complicates issues of therapist/client confidentiality. Does the probation officer receive periodic progress reports? (iii) It can define important limitations on therapy (i.e., ability of the paraphile to interact with others, when therapy ends)

12. (iv) it can create unwilling and unmotivated clients (v) it can involve the therapist and the client having a legal relationship that takes precedence over a therapeutic relationship (vi) the high cost of treatment failure makes therapy more difficult - because no therapy is 100% effective, the best that can be achieved is a reduction in the rate of relapse

13. (vii) Paraphiles treated in a forensic setting have high incidences of comorbid problems (e.g., Substance abuse, marital/social problems, anxiety, depression, personality disorders, anger control problems) -These comorbid problems are related in direct ways to the paraphiliac behaviour and thus, necessitate treatement above and beyond treatment of the paraphilia itself.

14. Research Problems: (i) Lawsuits charging malpractice on the part of the Clinician/researchers treating paraphiles are increasingly common despite the fact that acceptable standards were followed (ii) funding for this type of research is scarce which research impossible or effective research difficult (iii) Social taboo associated with sex research There are a number of reasons why research on paraphilias is slow to non-existant: