At a very simplistic level the outcome of working with KS has been successful in that to date he still has not reoffended and as of June 2018 this is still the case. He reports that he does not think of carrying out voyeuristic acts, has not had any near misses, and has completely changed the focus of his pornography use and masturbatory fantasies. Although the pornography, by its nature, still does have a strong voyeuristic element (his preference is for pornography that depicts women masturbating) it does not involve explicit narratives or presentations of voyeuristic strategies and behaviour nor any form or urolagnia. He is employed, engages in social groups, but still lives a relatively solitary, isolated life, although he acknowledges that in part this is because he works shifts, which impacts on when he is available to socialise, and that his contemporaries have all got busy lives too. He has not had any form of romantic interaction, not even a date, and has not engaged in any form of sexual contact with a woman. This does still cause him a degree of concern, but interestingly now he interprets this as being as a result of his “cowardice” of approaching women rather than because he explicitly expects to be rejected. He is not good at generating his own possibilities for finding opportunities to be around people, nor strategies to engage with people. He has not attempted to educate himself in sexual behaviour. So to some extent the work has been successful, but some of the underlying areas that might further reduce his risk are still extant. From the perspective of risk this is a matter for concern, but perhaps no more than when working with people who are sexually attracted to children. We do not claim that we are changing that sexual attraction, rather giving people the understanding for why acting on that attraction is illegal and damaging, and strategies to avoid and manage risky situations and thoughts, we support them in preventing the attraction from becoming action. We also need to consider the possibility that much of KS’ change may be a result of maturation and perhaps his sexual interests have simply changed over time.
Having reached this point KS’ concerns have changed and he is reflecting more on having not lived the life that he wished he had. He feels that he has not achieved his full potential and in comparison with his peers he has fallen short. This is both within the spheres of success at work and success within relationships. He has a strategy to deal with what he sees as his shortfalls in work, less so in his relationships, and he sees that as a continuing odyssey that will demand he exposes himself to more social risk and makes the effort to learn more about intimacy and sex.
This is the first, detailed case study of a voyeur and it offers the opportunity to examine, in some depth, how his offending developed and how we might understand the psychology underpinning it. KS has experienced a number of issues that could have led to a number of different interpretations. For example, the fact that from an early age he was exposed to his mother using the toilet might be understood within a psychodynamic framework as being importantly causal. It may have played a part in determining the kinds of coping behaviour KS resorted to when he was triggered to find ways to cope with fear of intimacy but that makes it no more important than, for example, KS’ food preferences and certainly less important that the cognition that led him to find the idea of women going to the toilet as curious. This perhaps is the crux of KS’ voyeurism, a curiosity that became a part of his pornographic interests, which then was an obvious strategy to gain some level of sexual satisfaction once the typical routes of satisfaction through sexual contact with consenting partners was no longer a “safe” choice. Rather than find a way to challenge Daria’s accusations, either intellectually or through further education and experience, he resorted to secret methods, which he could rationalise as challenging (so not entirely aberrant and shameful) and that prevented the chance of further threats to his self-esteem. The effort to do this was more immediately satisfying than the effort and risk of addressing his real concerns. For KS the danger is that if his sexual interests change again or he ceases to care about the consequences of further offending he may again resort to voyeurism.
What does this tell us more generally about voyeurism? As stated at the start of this case study we always have to be cautious about case studies as they cannot extract the specifics of the person. KS is a particular kind of voyeur and reached that point of his behaviour through a particular route, which, hopefully, the formulation provides a helpful map to describe that journey. However, there may be some useful pointers to consider for the assessment of voyeurs.
Firstly is to consider the possibility that rather than voyeurism being the result of some kind of sexual aberration that is due to inherent deviancy, it is a coping mechanism. As such we are provoked to examine what it copes for. Is it to provide access to viewing a particular kind of behaviour, that could indicate a developmental or trauma issue? The reasons for seeking opportunities to see people undressing may be different to seeking opportunities to see people defecating, and it is important to unpick these different kinds of voyeurism and determine if they are underpinned by the same psychology or not. Even if the same psychology is at play we would want to know why in one person it is expressed as viewing someone undressing through a window versus viewing someone using a toilet. The hypothesis for KS’ interest in urolagnia is that he was seeking knowledge about women, about their behaviour, what makes them different to men and to each other, to give him some form of sexual knowledge and to experience a sense of power-through-secrecy. KS couldn’t get this information through direct contact with women and was not prepared to find other ways to learn. Similarly with his upskirting , it was a strategy to have a false sense of intimacy, both intellectual and sexual, without the costs of achieving these goals through other means.
If we can identify that coping is a plausible explanation, the next stage is to investigate why voyeurism has been favoured as a coping mechanism and are there other ways that the person could cope. One method could be to entirely rely on pornography as that would keep him from causing harm and upset in the community. This has its own risks, as clinical experience has shown that some people broaden their pornographic palette to start to include more and more extreme kinds of behaviour, which can result in online offending. It also would not tackle the underlying risk issues nor take into consideration an individual’s quality of life. To solely rely on pornography, when other prosocial options are available does seem like an impoverished life. In KS’ case, he could educate himself, he could practise social skills, he could develop relationships, he could have sex, but these are longer term, potentially risky courses of action. He is stymied by perceiving these routes as risky and, in his own words, being “lazy”. He appears to be more interested in finding ways to force change in a top-down manner, rather than bottom-up. This may always leave him vulnerable. Interestingly these are skills that most of us take for granted and many of us have no sense of how we developed these skills. Yet, they are involved in very complex processes, managing the interaction between people, the gradual escalation of intimacy and self-disclosure, and then engaging in behaviour that may be anxiety provoking as we expose ourselves sexually. Perhaps our rudimentary ideas about sexual education need to take into account this complexity and in doing so we may inadvertently provide vulnerable individuals with the knowledge and skills they need to prevent them developing antisocial coping mechanisms.
It would be useful to explore the aspects of a voyeur’s self-esteem in a variety of areas, particularly linked to relationships and sex and microscopically analyse that individual’s past romantic and sexual experiences. Have they felt sexually demeaned or threatened, do they have concerns about their sexual abilities (whether from experience or hypothetically), their sexual knowledge, their sexual behaviour? Given the ubiquity of pornography, presenting an artificial sense of sex and what people know, do, how effective it is, it is not surprising that vulnerable people will develop a sense of sexual behaviour that may feel far beyond their reach and if it is unobtainable through socially acceptable routes they may find other ways to have some semblance of a sexual life. It is possible that other paraphilia are similar coping mechanisms. The challenge is to find ways to support an individual’s self-esteem in ways that are linked to social and sexual contact and this may be difficult with an individual whose self-esteem in those areas is so very fragile.
From the perspective of how KS was treated, having identified a variety of underlying issues these were approached in a variety of ways including CBT, psycho-educational approaches, and learning-theory-driven methods. Many of the previous case studies of voyeurs suggest that there is one underlying problem and one way to tackle it, which is insulting to individuals and to human psychology. Very few of our behaviours have a single, simple cause and theories of behaviour that don’t reflect the interaction between experiences, biology, biases, society, the individual’s immediate context, and cognition are unlikely to give us the information that we need to support people in changing. It is also important to try not to dismiss particular approaches if one does not believe in them. It would have been possible to ignore KS’ early exposure to his mother using the toilet, as KS did, as that might imply a psychodynamic interpretation of his behaviour and had the consequence of interfering with KS’ relationship with his mother, which has been and continues to be very positive and supportive. Indeed, KS’ mother is one of his strongest sources of social contact. Different approaches suggest different areas of focus, different kinds of information to gather, and by trying to be comprehensive in understanding the people we work with we hope to serve them more effectively and more ethically.
Most importantly, the message from this exercise is that it is clear that we know very little of voyeurs and voyeurism. As it may primarily take place without anyone knowing, we might not have a sense of how common it is and may be of the view that what we don’t know doesn’t hurt us. However, even if only thinking about the quality of life of voyeurs, the possibility that it may escalate, we need to know more, we need to take it seriously, and we need to find ways to help and understand these individuals.