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The Treatment of Paedophiles

Two sections of Chapter 7 of

Paedophiles and Sexual Offences against Children

Dennis Howitt

Introduction to Chapter 7

(pp 189 - 192)

"If the paedophiliac interest remains at the level of fantasy and therapeutic interventions do not appear to be effective in modifying them, one treatment option that remains is to help the patients to accept their fantasies -  so long as they  continue to be fulfilling to him and do not affect others. ... A last consideration might be to recommend those whose motivation for change is minimal to move to an environment, e.g. parts of Morocco and Turkey, where legal and social constraints against non-coercive paedophiliac practices are less exrteme than in our own society."

 (Yaffe, 1981, p. 91)

 Beliefs about the value of therapy for paedophiles have changed markedly over the years. The traditional view from the classic writers on sex held paedophilia to be an intractable sexual orientation, unresponsive to treatment (e.g. Freud, 1905/1977; Krafft-Ebing, 1922). It has been suggested that this received wisdom led to the neglect of the treatment of paedophiles. During the second half of the twentieth century behavioural modification methods were developed and applied to sexual deviations. This was an era of greater optimism and new faith in the worth of therapy, justified or otherwise by facts. An important implication of these then new behaviour therapies was the de-emphasis on the past cause of the paedophilia in its treatment. Previously, psychoanalysis and related therapies assumed that the elimination of "symptoms" such as paedophilia required understanding of the individual's psychological history responsible for the problem; only by unraveling childhood experiences could a "cure" be effected. Treatment might last several years, with insight gradually unfolding about hidden childhood trauma.

Irrespective of the efficacy of such forms of treatment, they were characteristically expensive because they were carried out on a one­to-one basis with a therapist. Consequently, they were not commonly available to sex offenders. There are a few reports of significant instances of such psychotherapy with paedophiles. Freud, for example, describes the psychoanalysis of several patients who had been sexually victimized as children but apparently undertook no analyses of perpetrators themselves. This is remarkable given the vilification he ha received in the child abuse literature for putatively changing his mind about the role of sexual seduction in childhood by adults (and the consequent adult hysteria). Pressure from his colleagues pushed him towards the view that these seductions were merely fantasy (Froula, 1985: Masson, 1985). Such a denial of the sexual abuse of children has been construed as being partly responsible for the neglect of sexual abuse in clinical work during much of the twentieth century (Baartman, 1992, Bayer and Connors, 1988). Despite these claims, it is far from certain that Freud was actually convinced of the fantasy basis to seduction (Howitt, 1992); it has been claimed that Freus was sexually abused at the age of two (De Mause, 1976).
Family system therapy
has some of the characteristics of the depth psychologies. Rather than seeing the issue lying in pathological childhood experiences, sexual abuse is hold to be the outcome of pathogenic family relationships. Responsibility is thereby spread among family members and treatment of the abuser requires treatment of the family.

In the 1960s, the depth therapies were being challenged in terms of their therapeutic assumptions and effectiveness. The major characteristic of the new behavioral therapy school was its characterization of "symptoms" as learnt behaviour, not the sign of fermenting psychological conflict. Psychological techniques that promoted the unlearning or inhibition of the behaviour ere sufficient. Psychological learning theory became a major theoretical domain in clinical psychology at this time and combined academic theory with therapeutic practicalities. This was held to be a powerful combination. Purely behavioural methods dipped somewhat in popularity as thought (cognition) was increasingly incorporated into psychological theories.  The most popular of modern  therapies for paedophiles are, indeed, described as cognitive behavioral in nature. This largely means that beliefs, self-justifications, myths about child victims, attitudes and other aspects of paedophiliac thinking will be tackled during therapy alongside the more purely behavioural strategies aimed at stopping offence-related behaviour

The "fly in the ointment" of behaviour therapy for the treatment of sexual deviations relates largely to ideological homophobic issues. Many of the early behaviour therapy treatments for paedophilia emerged from attempts to make homosexuals "normal" or, at least, stop "doing their thing". While this was ideologically unproblematic when it was socially acceptable and medically tenable to regard homosexuality as a "disease", time was running run out for such points of view just as behaviour therapy was gaining popularity. The increased rejection in professional circles of pathological conceptions of homosexuality created a climate inimical to behaviourist techniques. Giving a patient painful electric shocks if he showed signs of an erection to slides of naked men was at variance with the radical ethos of homosexuality as a psychologically healthy personal choice promoted by the Gay Movement from the late 1960s.

But Gay Liberation quickly disentangled Itself from the paedophile groups with which it originally marched and protested. While attitudes to homosexuality changed, there was no corresponding change towards paedophilia among professionals. Consequently, paedophiles remained appropriate clients for behavioural modification techniques during the 1970s. The ideological basis of therapy for paedophilia, by and large, remained hostile and based on its elimination. A very small number of therapists have adopted a rather different stance much more supportive of the paedophile. Such approaches illustrate by contrast some of the moral, ethical and ideological implications of conventional treatment. They are described as support therapies.

As we will see, there is a degree of uncertainty about the effectiveness of even the best researched therapies for paedophiles. There are a number of reasons for this. Many of the therapies have not been subject to specific empirical  evaluation of any sort; some have been tried with only a few clients. Often the criteria of therapeutic success have fallen well short of evidence of a decline in recidivism in offending, obviously one of the most important criteria. Research that includes a control or an alternatively treated group is in the minority of the evaluations. With a situation like this, claims of therapeutic success may sometimes be wishful thinking on the part of the clinician, the client or both.

The overall effectiveness of therapy, though, is only one matter to raise about therapy. Equally important is what sorts of paedophiles succeed best in which sorts of therapy. Little attention has been addressed to these issues. Similarly, questions such as the risk factors predicting recidivism following treatment have hardly entered the frame.

 Support Therapies

(pp 215 - 218)

One rare discussion of support therapies for the counseling of paedophiles is to be found in van Zessen (1991), who raises a number of problems with conventional treatment programmes for paedophiles. These include that they are almost exclusively designed for prisoner or psychiatric hospital populations; deal with paedophiles alongside all other sex offenders; regard paedophilia as a homogeneous issue in which the sexual rapist of a toddler is dealt with in the same way as a man having a "paedophiliac affair" with a l5-year old boy; and risk confusing a genuine desire to change sexual orientation with a  wish to get out of prison or hospital. Treatment is aimed at getting rid of paedophiliac arousal and at increasing arousal to adults, usually women, fails to distinguish between  clear abuse and consensual acts, and never explores the meaning of the paedophiliac attraction in the psychology of the man.

At the Clinical Psychology Department at the University of Utrecht, for a while non-residential clients in the 25- to 50-year old range with a preference for 9- to 16-year old boys were put through a therapy programme. Only men having non-violent contacts and no signs of severe psychopathology were eligible. The therapy was not designed to convert men from paedophilia and so did not attempt to create heterosexual arousal or to provide heterosexual courtship skills. The men, it was felt, were too old and lacking in signs of heterosexuality to make conversion a realistic possibility. Rarely had the men sought conversion.

During assessment, it became clear that the major problems for the paedophile either concerned his erotic/sexual attraction to boys or difficulties created when trying to express his sexuality in relation to other people. Identity and realization therapies formed the nucleus of individual therapy as a consequence. The focus was upon the provision of cognitive frameworks that helped to structure understanding of sexual/erotic desires.  Guilt and insecurity were characteristic of many of the men:

"In this phase of therapy, the meaning of the of the desires is explored and discussed. The therapist helps to focus on the desires and to positively change the self-image."

(van Zessen, 1991, p/ 192)

 The second phase of therapy centred on the realization of desires:

"No one is brought up to be a pedophile and there are no visible models to follow in coping with problems. The social framework for intergenerational  relationships is lacking ... Social support can be found among other pedophiles in organized settings  (self-help or emancipation groups, often with a strong ideological background) or in informal situations (circles or networks of colleagues')"

(van Zessen, 1991, p. 1992)

Having made satisfactory progress in the individual therapy, some of the men would move on to work in small groups in order to improve their ability to communicate with others about the problems created by the paedoph1le lifestyle. Matters like paedophile "coming out"; interactions with the boys, their parents and the police; and growing old as a paedophile could be discussed. Basic conversational skills, such as listening attentively and dealing with feedback, were also developed. A pilot study suggested that the listening and contributing skills of members of the group improved.

The law in the Netherlands was conducive to such therapy as there was no mandatory reporting of suspected child abuse and a therapist could not be regarded as an accessory to a crime through accepting the sexual activities of the clients. The therapy had to be modified as Dutch society became less accepting of therapeutic support for pedophilia. The newer therapy emphasized understanding the emotional functions of their paedophilia in the lives of the men.

"These men strive for enduring affectionate and erotical friendships with boys; they have no interest in forced or violent sexual contacts. When a boy is very young (12 years old and under) or emotionally unstable, the counselor can suggest that the man reconsiders the relationship thoroughly, especially its sexual aspect. A non-sexual relationship with a boy, regardless of his age. is not illegal."

(van Zessen, 1991, p. 196)

  Again, at the University of Utrecht, van Naerssen (1991) utilized a related approach, apparently supported by the Dutch police. He agreed to take referrals from the police of men, who had been involved sexually with boys or girls over 11 years of age.  There were a number of provisos, such as the man had to have requested  referral, had to be a non-violent offender and had to have no severe psychiatric symptoms such as delusions or depression. It was possible to break down this sample of clients into two broad categories - self-identified paedophiles and identity confused paedophiles .

Category 1: Self-identified paedophiles

Some saw themselves as paedophile and were very clear about this. They wished to discuss their relationships with boys and felt the lack of social support to be a problem. A sizeable group of these dealt with their relationships solely in terms of "fun and games"; attachment to the boys was difficult and long-term relationships were consequently regarded as impossible. Therapy dealt with this by explaining how relationships concentrating solely on sexual matters prevent emotional closeness. Examples of adult-child conflicts in these relationships were worked upon in order to find ways of coping with difficulties. Only a small number of these  men gained confidence in their ability to develop emotional commitment even after many treatment sessions. Mostly they continued to relate only in casual sexual encounters. Another sizable group of these self-defined paedophiles had developed emotional commitment to the children. This had its problems, since they found that the boys could not handle this  emotional aspect. The therapist explained how boys develop psychosexually and pointed out that  man-boy relationships are difficult for boys given social pressures towards heterosexuality. The therapy also included scenarios of conflicts that can arise in man-boy involvements. This type of client seemed to learn effectively in therapy since mostly they reported increased satisfaction with their relationships with underage boys, although this will seem an indesirable outcome of therapy to many people.

Category 2: Identity confused pedophiles

These did not define themselves as paedophiles with any certainty; they were confused over their sexual identity. Some wanted to undergo therapy to become "normal" in their sexual desires. They expressed great concern about their sexual feelings and worried about being found out. Sexual dysfunction was common, involving problems associated with desire, arousal and orgasm. Some were fearful of adulthood, having a sort of "Peter Pan" complex and an idealized view of childhood, and others believed that they ought to be punished for their sexual activities with boys. The therapist provided biographies in which adult-child sexual contacts were treated in a very positive way.  Some of the men were capable of defining themselves as paedophiles alter about 10 such therapy sessions, but a roughly equal number could not. Van Naerssen suggests that their histories involved very negative family attitudes towards sexuality, in which sex was separated from love and regarded as filthy but love was extremely romanticized. For these men, treatment goals concentrated on their ideas about sexuality rather then on their paedophilia as such. Mostly these men discontinued treatment.

Quite clearly this sort of therapy contrasts markedly with other sorts. The relatively liberal Dutch attitude towards paedophilia no doubt contributes to this. It should be noted that in 1950 over a third of all recorded sex crimes in Holland involved a minor; this had reduced to a little over a quarter by 1982.

References - as far as mentioned here above

Baartman, H.E.M. (1992)
The credibility of children as witnesses and the social denial of the incestuous abuse of children. In: F. Losel, D. Bender & T. Bliesner (Eds.). Psychology and Law: International Perspectives. Berlin: Walter de Gruyter, pp 345-351

Bayer, Y. & Connors, R. (1988)
The emergence of child sexual abuse from the shadow of sexism. Response, 11(4), 12-15

De Mause, L. (19176)
The History of Childhood: The Evolution of Parent-Child Relationships as a Factor in History. London: Souvenir, pp. 1-74

Freud, S. (1905 / 1977)
On Sexuality: Three Essays on the Thery of Sexuality and Other Works, compiled and edited by Angela Richards. Harmondsworth: Penguin

Froula, C. (1985)
The daughter's seduction: sexual violence and literary history. Signs: Journal of Women in Culture and Society, 11(4), 621-644

Howitt, D. (1992)
Child Abuse Errors. Hemel Hempstead: Harvester-Wheatsheaf

Kraft-Ebing, R. von (1922)
Psychopathia Sexualis. Brooklyn: Phisicians and Surgeons Press

Masson, J. (1985)
An Assault on Truth. New York: penguin

Naerssen, A. (1991)
Man-boy lovers: assessment, counseling and psychotherapy
. Journal of Homosexuality, 20(1/2), 175-187

Yaffe, M. (1981)
The assessment and treatment of paedophilia. In: Taylor, B. (Ed.), Perspectives on Paedophilia. London: Batsford.

Zessen, G. van, (1991)
A model for group counseling with male pedophiles
. Journal of Homosexuality, 20(1/2), 189-198

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