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they lead to clinically significant distress or impairment
(e.g., are obligatory, result in sexual dysfunction, require
participation of nonconsenting individuals, lead to legal
complications, interfere with social relationships." In
other words, fantasies or behaviors which are consensual
and which do not cause you undue distress are not
paraphilias and are not pathological. Over the last several
editions of the DSM, this section has become more liberal.
Nevertheless, it is not the last word on the subject.
If your therapist suggests that your sexual expression
is pathological, make sure he understands this section of
the DSM. Many therapists seem to ignore it or have not
read it.
You are seeking a therapist because parts of your
life are not working. The process of fixing that problem
may involve examining your entire life ­ the areas that
you believe are working as well as those that are not. Of
course, we would all like simply to remove the troubled
areas without upsetting the rest of our lives; unfortunately,
that is not always possible.
You're not looking for someone to "cure" you
of being gay or a fetishist or polyamorous or an S/M
practitioner; those things are not, in and of themselves,
illnesses. (The claims of certain fundamentalist Christian
groups notwithstanding, the chances of anyone being able
to "cure" you are extremely slim to nonexistent anyway.)
However, if your sexual desires are making it difficult for
you to manage the rest of your life, or are making you
unhappy, or are driving you toward doing things you find
ethically unacceptable, the therapist can and should help
you find more comfortable and acceptable ways to live
with your sexuality.