Treatment of a transvestic fetishist with cognitive-behavioral therapy and supportive psychotherapy: case report

Transvestic fetishism is a paraphilia marked by recurrent, intense sexually arousing fantasies, sexual urges, or behavior involving cross-dressing, in a heterosexual male. There are many explanations of the pathogenesis, but none are conclusive. Different treatments have been applied, but they generally remain obscure and disappointing. Transvestic fetishists rarely seek psychotherapy, because of their dynamic balance between perversion and intrapsychic disintegration. There are few studies, either qualitative or quantitative, associated with transvestic fetishism in Taiwan. This case report describes an adolescent transvestic fetishist who underwent a brief course of psychotherapy in the outpatient department of a psychiatric center in Taipei. After consultation for one year, he still maintained his deviant sexual behavior but also developed more severe moral anxiety. He was then referred for psychotherapy. Cognitive-behavioral and psychodynamic theories associated with transvestic fetishism were reviewed and applied in both understanding and treating this client. Some temporal effectiveness was achieved with combined cognitive-behavioral and dynamic-oriented supportive psychotherapy. After 18 sessions of psychotherapy over more than 4 months, the client was able to stop his perverse behavior and have fewer sexually arousing fantasies. The prognosis of transvestic fetishism is generally supposed to be pessimistic and have a high rate of recurrence. Some propose that adolescents have a better outcome after treatment. This case report reveals the possibility of change for a transvestic fetishist. However, the long-term effects of the brief course of psychotherapy require further evaluation in the future.