Clinical Analysis of an Exhibitionist Patient in a Psychoanalytic Psychodrama Group

Abstract

This article examines a therapeutic experience with sexual offenders as part of compulsory treatment. More specifically, we focus on the question of exhibitionism. First, we describe our therapeutic setting: a psychoanalytic psychodrama group. Then we study the case of Fernand, an exhibitionist. The treatment revealed that Fernand was desperately seeking attention: from others, thanks to his professional skills as a repairman but also and especially, in a transgressive way, through his exhibitionism. We show how exhibitionism can condense, externalize, and project on to others, the enigmas of sex and generational differences. We then examine whether psychodrama is a tool that can be used to illuminate Fernand’s fantasies hidden behind his exhibitionist act. Finally, we wonder to what extent providing patients with the opportunity to play out their own story in a therapy, using their own body under the scrutiny of others, may help the exhibitionist to see themself in their own complexity.

Keywords:

• exhibitionism
• psychoanalytic psychodrama group
• sexual difference
• play
• group dynamic
• case study

Notes

1 “Our dark side” according to Roudinesco (2007).

2 Misdemeanor law dating from 1791.

3 In France, Article 222–23 of the New Penal Code (1994): “Sexual exhibition imposed on the sight of others in a place accessible to the public is punishable by one year of imprisonment and 15,000 euros ‘fine’”.

4 It is not our purpose to take up these questions (Smaniotto, 2020). However, it should be noted that other sexual practices such as sadomasochism, although historically classified as “perversions,” are about to be depathologized by the International Classification of Diseases 11th Revision, under the guise of partners’ consent. Indeed, the question of consent has, in our contemporary world, become the norm in sexuality, the new frontier between the normal and the pathological. Today, it is the sexual behaviors punished by the law that designate pathological sexualities. But the question remains: Are prohibited sexualities fundamentally pathological (Tousseul, 2018)?

5 Particularly in female subjects who, in Freudian theory, suffer from the lack of penis. The woman would then use exposure as a compensatory narcissistic mechanism extended to all parts of her body. This reductive hypothesis has been nuanced, and even refuted, by more recent work dealing specifically with female exhibitionism (Balsam, 2008; Holtzman & Kulish, 2012).

6 In France, the law of June 17, 1998 strengthens the healthcare-justice system. To prevent recidivism of sex offenders, it introduces, among other things, the socio-judicial follow-up measure accompanied by a judicial obligation to undergo treatment.

7 Including, according to more integrative approaches, specifically exhibitionism (Bastani, 1976; Lucas, 1990).

8 The history of this service is detailed in Réveillaud and Smaniotto (2017).

9 Great care was taken to ensure that these adult patients would not meet the children cured in this hospital, as they were received in different places and different times (daytime for the children, evening for the adults).

10 We can make the hypothesis that, contrary to what he claims, Fernand has perhaps not been only passive in this extramarital relationship.

11 In the sense of Winnicott (1963) and defined earlier in this article.

12 “Se faire bien voir” is a French expression, the double meaning of which speaks volumes with regard to the exhibitionist issue. Indeed, “bien voir” refers both to the literal sense, to perception (to be seen, perceived, visually identified) and, in a more metaphorical sense, to consideration, recognition (to be well-regarded, well considered, recognized by the other in a valued way, to make a good impression).

13 Shyness (Andrade et al., 2013) like inhibition (Hanafy et al., 2016 91), can be a paradoxical corollary of the exhibitionist inclination.

14 Fernand never specified to whom the bustier of his exhibitions belonged, nor to whom the bustier of this fantasy belongs.

15 Which is part of a very regressive logic, as evidenced by this “game.”

Additional information

Notes on contributors

Barbara Smaniotto

Barbara Smaniotto, Ph.D., is Associate Professor in Psychopathology and Clinical Psychology at Lyon 2 University, France. She is a full member of the CRPPC laboratory (Research Center in Psychopathology and Clinical Psychology), which promotes research referred to psychoanalysis. Her research interests include adult and adolescent sexual abuse. As a clinical psychologist, she works at the CRIAVS, a resource center for all persons confronted with sexual violence (professionals, family, perpetrators…), and at a victim support association. She participates in the activities of the RAPAV association, in particular the psychotherapy care for perpetrators of violence. [email protected]

Marie Réveillaud

Marie Reveillaud, M.D., is psychiatrist and psychoanalyst in La Roche sur Yon, Vendée, France. Between 1993 and 2013, she was head of Child Psychiatry in a French public hospital. In view of the high number of children who suffered sexual assaults, she developed treatments aimed at perpetrators of sexual abuse. This therapeutic device was very innovative at that time and was aimed at curing them from their issues and thus preventing the reoccurrence of those deviant behaviors. Currently, she is president and psychotherapist of an NGO called RAPAV (Thoughts and help for perpetrators of violence) created in 2011. This association offers training to professionals and psychotherapy for perpetrators of violence. [email protected]

Nathalie Dumet

Nathalie Dumet, Pr., is Professor in Psychopathology and Clinical Psychology at Lyon 2 University, France. She is a full member of the CRPPC laboratory. Her research focuses on the links between body, behavior, and psyche. As a clinical psychologist, she has a therapeutic practice with patients with behavioral disorders. [email protected]

Tamara Guenoun

Tamara Guenoun, Ph.D., is Clinical Psychologist and Associate Professor in Psychopathology and Clinical Psychology at Lyon 2 University, France. She is a full member of the CRPPC laboratory. Her research focuses on the group, including therapeutic mediation through theater. She is head of the dramatherapy specialty of the Master “Artistic Creation” at University of Paris, Institute of Psychology, France. [email protected]