Psychoanalytic perspectives on paraphilias and perversions

Since Freud's exposition of the nature of perversion in his seminal work, Three Essays on the Theory of Sexuality there has been a multitude of rich and varied explorations of human sexual fantasies and behaviours that are considered as perversions within the psychoanalytic literature. However, with more recent societal shifts towards the acceptance of sexual orientations and practices which would previously been categorized as deviant, perversion has become a pejorative term seen as stigmatizing and debasing those whose sexual preferences do not conform to the traditional norm. In this paper I argue that certain psychoanalytic concepts of perversion retain utility in how we might think about and help individuals whose sexual desires and practices cause distress to themselves and/or others, particularly in the realm of intimate relationships. Historical and contemporary theories about the nature and origins of perverse fantasies and behaviour are presented and explored, focusing on how perversion may be conceptualized as a defence against early anxieties and disturbances in the mother-infant relationship. Such ideas inform a psychoanalytic approach to the treatment of perversions, particularly in consideration of transference and countertransference dynamics. The ideas in this paper are based on my work at the Portman Clinic in London, UK.