Assessing, Treating, and Diagnosing Compulsive Attraction to Women’s Feet and Shoes

QUESTION

Sean is a 28-year-old male who has been married for 5 years and has two young children. He tells you that he is very upset and can’t seem to control his attraction to women’s feet and shoes. In meetings, he cannot concentrate if he is talking to a woman if he can see her feet. While at the company gym, he walked into the ladies’ dressing room and stole a pair of shoes. He swears that he is not a creeper and was not trying to peep at anyone. He just wanted that pair of shoes. He is in therapy because his wife found the shoes and thinks he is having an affair. Although he denied the affair, he didn’t tell her the truth. How would you assess, treat, and diagnose this client?

ANSWER

 Assessing, Treating, and Diagnosing Compulsive Attraction to Women’s Feet and Shoes

Introduction

Sean’s distressing and compulsive attraction to women’s feet and shoes is affecting various aspects of his life, including his work, relationships, and overall well-being. As a mental health professional, it is essential to conduct a thorough assessment, provide appropriate treatment, and arrive at a suitable diagnosis to address Sean’s concerns effectively.

Assessment

 Comprehensive Clinical Interview

Conducting a detailed clinical interview with Sean is the first step in understanding the extent and nature of his attraction to women’s feet and shoes. Gathering information about the onset, frequency, and intensity of his feelings, as well as any associated distress, can help identify potential underlying factors.

Psychosocial History

Exploring Sean’s personal history, family dynamics, and early life experiences can shed light on possible developmental factors contributing to his current feelings and behaviors.

 Mental Health Screening

Assessing Sean for any co-existing mental health issues, such as anxiety, depression, or obsessive-compulsive disorder, is crucial to address potential comorbidity.

Psychometric Assessments

Administering standardized questionnaires and assessments related to paraphilias, sexual behavior, and impulse control can help in understanding the specific nature of Sean’s attraction.

Functional Analysis

Conducting a functional analysis can help identify triggers, antecedents, and consequences of Sean’s behavior, providing insight into maintaining factors.

Treatment

Cognitive-Behavioral Therapy (CBT)

CBT can help Sean challenge and restructure distorted thoughts and beliefs related to his attraction. It can also address cognitive distortions that may lead to impulsivity and compulsive behavior.

 Exposure and Response Prevention (ERP)

ERP techniques can be effective in reducing the distress and urges associated with Sean’s attraction. Gradual exposure to triggers, like women’s feet and shoes, while refraining from the compulsive behavior, can help desensitize him.

Relapse Prevention

Implementing strategies for relapse prevention will be crucial to ensure long-term changes in behavior and sustain progress made in therapy.

Diagnosis

Based on the assessment, the appropriate diagnosis for Sean may include:

Paraphilic Disorder (Specifically Shoe Fetishism)

Sean’s intense and distressing attraction to women’s feet and shoes, causing impairment in functioning and leading to problematic behaviors, aligns with the criteria for paraphilic disorder.

 Impulse Control Disorder (Intermittent Explosive Disorder – IED)

Sean’s impulsive theft of shoes from the women’s dressing room at the company gym may indicate underlying impulse control difficulties.

Conclusion

To effectively address Sean’s compulsive attraction to women’s feet and shoes, a comprehensive assessment, combined with evidence-based treatment, will be essential. Engaging in therapy, exploring underlying psychological factors, and developing coping strategies can empower Sean to gain control over his feelings and behaviors. The therapist’s role will be to provide a safe and non-judgmental space for Sean to work through his concerns and support him in achieving positive behavioral change and improved overall well-being.