INVITED CASE TRANSCRIPT

BEHAVIORAL ANALYSIS OF A FETISH: FIRST INTERVIEW

JOSEPH R. CAUTELA
Boston College

Summary - This transcript illustrates how behavioral analysis and therapy are constant
coexisting processes. The patient is shaped into cooperatmg with likely treatment procedures.
Some therapeutic suggestions are made. e.S. pointing out the aversive consequences of
engaging in the overt and covert maladaptive behaviors.

Th: Tell me your problem, then we will see Th: Well. you never know. If you keep
if I can help you. fantasizing about boys, the urge might
Pt: I have a foot fetish. become too great. Also, don’t you
Th: Will you elaborate on what you mean think that it could harm a boy
by “foot fetish”? psychologically if you did?’
Pt: I get aroused thinking of boys’ feet. Pt: I never really thought much about it,
Th: What age are the boys? but I guess you’re right.
Pt: Twelve to fourteen years. Th: Is there any other reason you want to
Th: What do you think about that gets you get rid of the problem?
aroused? Pt: I think it’s a sin. I have a strong
Pt: I imagine that I am wrestling with a Catholic upbringing.
boy and his feet rub against my penis Th: If you think of it as a sin, then why do
and face. you do it?
Th: Do you have this fantasy when you Pt: Well, the habit is so strong now it is
masturbate? out of control.
Pt: Yes. Th: When did you start fantasizing about
Th: How often do you masturbate? young boys in a sexual way’?
Pt: Two or three times a day. Pt: Oh, when I was around 13 or 13.
Th: Why do you want to get rid of the foot Th: Didn’t you think it was a sin then?
fetish? Pt: No.
Pt: I want to lead a normal life and get Th: Why not?
married. Pt: Well. I was told masturbation was
Th: That is a good reason, but is it the only wrong, but when I first had the fetish I
reason?’ used to wrestle as much as I could with
Pt: Well, I am afraid I might actually try boys my own age and went off that
to do it with a boy, but I’m so afraid of way.
getting caught, I will probably never Th: Didn’t anybody notice it?
do it. Pt: No.
Requests for reprints should be addressed to: Joseph R. Cautela, Department of Psychology. Boston College, Chestnut
Hill, MA 02167. U.S.A.
1. Reinforcing the previous statement.
2. Informing client of the negative consequences of inappropriate fantasizing about boys.

161
167 JOSEPH R C.AUl-ELA

Th: Why not? Th Let’s talk about females. Do you ever

Pt: I always wore light jockey shorts. get aroused by thinking about females
Th: It’s difficult to believe no one noticed. in a sexual way?
You didn’t think that you were Pt: I rarely think of a female in a sexual
masturbating while wrestling and try- wav.
ing to go off while wrestling?” Th Whv not?
Pt: No. Pt: I was told it was wrong and the few
Th: Why not? times I tried it, nothing happened.
Pt: Well. I always thought masturbation Th Have you ever been aroused thinking
was doing it with your hand. of a female or watching a female’?
Th: Was sex ever discussed in your family? Pt: No. I even tried watching X-rated
Pt: God no! My mother told me not to movies, but I end up looking at the
date until after college. She was afraid man’s feet.
I would get aroused. Th: Does looking at men’s feet get you
Th: What is your relationship with your aroused?
mother like? Pt: No, not directly, but it makes me think
Pt: She interferes with my life all the time. of boys’ feet.
She still tries to tell me what to do. Th: What else is apt to lead to sexual
Th: Do vou live with her‘? fantasy about boys or masturbation?
Pt: No. ‘I bought my own house and live Pt: When I’m lonely, anxious or bored.
alone. Th: W’hat about seeing boys’ feet’?
Th: Do you have many friends’? Pt: Oh. yes, especially boys’ feet at the
Pt: No. I am very lonely. I have no beach or watching TV.
friends. Th: What about magazines or advertise-
Th: Where do you work’? ments in the newspapers’?
Pt: Pt: Yes. definitely.
Th: Don’t you have any friends there? Th: If you fantasize, does it usually lead to
Pt: No, in fact, they tease me a lot. masturbation?
Th: About what’.’ Pt: Yes. if I am in a place vvhere I have a
Pt: Oh. everything, especially about sex. chance to do it.
They always ask me if I’m getting Th: Where arc these places’?
much lately. Pt: At home, alone. in a bathroom if no
Th: How do you respond? one else is around.
Pt: I get flushed and upset but I don’t say Th: Is that all’?
anything. Pt: No. sometimes at the beach.
Th: When they tease you about sex why Th: How do you manage that’?
don’t you smile or smirk and say. “I’m Pt: I lie down at the beach on my stomach
doing alright”.’ while I am looking at a boy’s feet near
Pt: That‘s a good idea. me.
Th: Maybe we can desensitize you against Th: How can you do that’?
being teased so it won’t bother you.’ Pt: I pump up and down rubbing my penis
Pt: That would be great! against the blanket on the sand.

3. Pointing OUTthe possibility he was noticed and Indicating that. it’ masturbation war l<rong. then tlchb~ratrl~ wre~ling
to have an orysm is masturbation and thrrrforr ewng.
-l. Suggesttng a therapeutic strategy.
5. Shapins for later USC of desrnsltization.
 ANALYSIS OF A FETISH 163

Th: Aren’t you afraid of getting caught?’ Th: Why didn’t you go along with it?
Pt: I’m very careful. Pt: I didn’t want to make a girl pregnant.
Th: It sounds risky to me.’ Th: How old were you?
Pt: Yes. I suppose it’s not worth the risk. Pt: I was a sophomore in high school.
Th: You‘re right. It’s very important for Th: You were a sophomore in high school
you to know that every time you and you believed that kissing would
fantasize and masturbate about wres- make a girl pregnant? That seems hard
tling with boys you make the fetish to believe in this day and age.“’
worse. It’s just like doing it in reality. Pt: Well, I avoided anything about sex
You strengthen the habit.’ because my mother and teachers said
Pt: I guess you’re right, but it’s out of it was wrong.
control. Th: What about your father? What was his
Th: Well, I’ll help you to get control over relationship with your mother’?
the habit.’ Pt: He never said much. My mother ran
Pt: Can you? the show.
Th Well, we have a good chance if you Th: Didn’t you do things with your father?
cooperate. I can teach you relaxation. Pt: Hardly ever. He was too busy work-
teach you the self-control triad to get ing.
rid of your negative thinking and have Th: Do you have any brothers or sisters?
you imagine something terrible or Pt: I have two brothers. One is single and
disgusting happening if you start in- the other one is married.
appropriate sexual fantasy.“’ Th: Do you see much of them’?
Pt: Is that all? Pt: I see the older one once in a while, but
Th: No. There are other coping mechan- he doesn’t seem to want me around.
isms we can use. Also, we have to try Th: What makes you think that’?
to get you aroused toward females.” Pt: They don’t talk to me much when I’m
Pt: But isn’t that a sin? there, and they never invite me. I have
Th: Well. what is more sinful; having a to invite myself.
foot fetish that can ruin your life, or Th: How often do you see your mother?
learning to be aroused to females’?” Pt: As little as possible. About once a
Pt: Well. if you put it that way. month, but she always tries to boss my
Th: I’m’just saying that, in my experience life.
in treating fetishes, it is necessary to Th: But, I see by the form you completed
build up heterosexual relationships that you’re 31 years old. I guess I’ll
and arousal. It’s up to you if you want have to teach you how to be properly
to change. That’s my approach. I3 assertive to your mother and to people
Pt: OK. That makes sense. in general.”
Th: Didn’t you ever date a female? Pt: I could use it.
Pt: Once in high school. We were in a car. Th: Have you tried to get therapy before’?
She wanted to kiss and be passionate. Pt: No, but I went to shrines in the

6. Sensitizing the client about the possibility of bcin g caught (negative conxqurnce).
7. Again focusing on a negative consequence.
S. Reinforcing the connection between inappropriate fantasy and masturbation and making his problem worse.
9-11. Giving the client the expectancy that, if hc cooperates with the procedures mentioned. he could get better.
12. Not allowing 3 loophole for lack of cooperation.
13. Shaping motivation to cooperate in developing heteroswual skills.
1-I. Indicating the possible need for sex information.
15. Shaping for cooperation in assertiveness training.
164 JOSEPH R CAUTELA

country. Canada and France to Th: DO YOU think you might have sinus
achieve a cure. headaches?
Th: I think there is no way to get a miracle Pt: The neurologist didn’t think the
cure. I’m afraid it’s going to take hard headaches were due to my sinus,
work. 16 Th: Maybe you ought to see an eye. ear,
Pt: I am beginning to realize that as we nose and throat specialist.
talk. Pt: That’s a good idea.
Th: Do you still want to get rid of your foot Th: After you check it out, perhaps we can
fetish? help you reduce or eliminate your
Pt: I’d do anything. I don’t want to be headaches. i’
lonely. I want to be loved and have a Pt: You think you can do that?
normal relationship with a girl. Th: Well, with your cooperation, it’s worth
Th: How else did you try to get rid of your a try. I am not too clear why you can’t
problem? play sports.
Pt: Well, as a teenager in Sth or 9th grade. Pt: I have a piece of bone missing on the
someone said I had small feet. I tried right side of mv head. I \vas told that a
to make my feet larger by the power of strong blow there could kill me.
my mind. I thought I had special Th: Why don’t you have your physician
power and could get bigger feet by send me your medical reports’?
force of my mind. Pt: I will.
Th: Do you still believe that? Th: Have you clnted at all since high
Pt: No, but I was short and didn’t play school?
sports and felt inferior. so I was Pt: I see a girl now, but we are just
desperate. friends. She has had no szsual esperi-
Th: Why didn’t you play sports? ence and I don’t find her attractive
Pt: When I was 5 years old. I was in an physically or scsually.
automobile accident and got a head Th: How often do you see ner?
injury. Pt: About once every t\vo weeks. It’s
Th: How severe? better than staying home.
Pt: Well, I had an abnormal EEG, which I Th: When did you stop wrestling with
still have occasionally. boy/s?
Th: Do you have headaches? Pt: When I was a sophomore.
Pt: Yes, constantly. Th: You didn’t masturbate after that’?
Th: Have you been to a neurologist re- Pt: No. I didn’t masturbate until I was in
cently? the service.
Pt: Yes. He said he can’t find anything Th: When were you in the service’?
specific now. Pt: After high school.
Th: Do you take medication for your Th: What happened to start you to
headaches? masturbate’?
Pt: Yes, once in a while I take aspirin. Pt: I had this friend in the service. 1 used
Th: Do you have any other medical prob- to play with his feet lvhile he was
lems‘? sleeping and go off. One night I was
Pt: Yes. 1 have clogged sinus, constipation caught.
and insomnia. Th: Didn’t your friend know what was

16. Preparing the client for difficulties in therapeutic cooperation and progress
17. Shaping for cooperation in modifying headache behavior
 XNALYS!S OF A FETISH 165

going on? that. Do you have any arousal from

Pt: No. He was a heavy sleeper. lookino at men’s feet?‘”
Th: It’s hard to believe he didn’t know Pt: No, n:t now.
what was going on.18 Th: It seems clear that your sexual educa-
Pt: After I was caught he didn’t talk to me tion was inadequate to say the least.
anymore. Pt: There is still a lot I don’t know,
Th: I’m not surprised at that. What hap- especially about the difference be-
pened when they found out?” tween males and females.
Pt: They didn’t have enough evidence, so Th: Well, if you are going to stay in
they dropped the case. The fellow who therapy with me, I will give you
saw us got confused with his testi- reading material and discuss anything
mony. you want. Also, it would be a good
Th: What made you start to masturbate? idea for you to see a female co-
Pt: Well, they asked me to see a psychia- therapist to discuss social skills and
trist. He suggested that, if I mastur- make vou feel comfortable with a
bated, I would be less apt to get into female.“’
trouble. So I started the habit. Pt: Do you really think you can help me? I
Th: I thought you were only aroused by have had the habit such a long time it’s
watching boys. hard to imagine changing.
Pt: Yes, that’s true, but I knew this fellow Th: Well, if you really want to change and
since we were boys and we used to you cooperate it will be hard work but
wrestle a lot. Also, when we slept over I think you can learn to develop a
at each other’s houses, I used to play normal heterosexual relationship, if
with his feet when we slept together on that’s what you want.”
double beds. Pt: That’s what I really want.
Th: It’s amazing how you got away with Th: Ok, let’s do it.

18. 19. Pointing out denial of aversive consequences.

20. Suggesting danger of continuing to play with feet.
21. Shaping for cooperation in obtaining information about sex and learning social skills.
22. This statement indicates, for treatment to be successful, it will have to be a joint effort between client and therapist.