Treating the Pedophile

 

What doesn't work:

During the 1950s, the psychology based on the theories of B.F. Skinner inspired a switch to behaviorist treatment of sex offenders. The classic treatment was showing pictures of children to pedophiles, then giving electric shocks in an effort to link negative emotions to the sexually arousing stimulus. Perhaps because there was no effort to understand why the men (almost all pedophiles are male) were aroused by children, the treatments failed to reduce recidivism -- repeat offenses.

What does work:

Cognitive-behavioral treatment, today's preferred technique, arose from the ashes of the preceding two treatments. Essentially, the cognitive side of treatment helps the offender acknowledge the deviant behavior, understand its harm and ideally its origin, and devise strategies to change it. Behaviorist techniques may include imagining going to prison after having sex with a child. "If you are going to try something that's been proven to work, this is the mode to try," says Joseph Plaud, a clinical psychologist who treats sex offenders and directs the Cambridge (Mass.) Center for Behavioral Studies.

Today's therapy
The "cognitive-behavioral therapy" used to treat sex offenders includes a range of treatments from "conditioning-based approaches to behavior skills training, social, empathy and assertiveness," says Plaud. "It's a package to teach pedophiles more normal ways to interact with adults, and address the underlying pattern of sexual arousal."

While electric shocks are seldom used to associate pain with unacceptable sexual fantasies, Linda Grossman, who studies treatment of sex offenders at the University of Illinois at Chicago says many cognitive-behavioral programs still use aversion therapy. "Now we think it's better to use mental images. We'll have offenders fantasizes a deviant reaction, and when they begin to feel aroused, have them fantasize the consequences of getting arrested, going to prison, and getting raped in prison."

A good deal of sex-offender treatment occurs in prison, often using group therapy. The therapist and peers try to break down the denial that offenders typically show, says Fred Berlin, who has studied treatment of sex offenders for many years at Johns Hopkins University. "The group therapy component is intended to confront the denial and rationalization. We do what we call 'therapeutic confrontation' -- set up an environment where people can speak candidly, even though they're all struggling with an unacceptable craving for sex with children."

Denial can run deep, he says. "A pedophile, will say, 'I fondled this young boy, but he was clearly aroused, he seemed to be enjoying it.' I'd tell him you can't get into the young mind and see the confusion and the subsequent pain this will cause. When offenders experience a craving, that colors their perceptions, and they can't objectively see the consequences of their behavior."

Preventing relapses
Viewing pedophilia as a strong craving, therapists have borrowed the technique of relapse prevention from the treatment of addiction to alcohol and other drugs. One goal is to identify emotions that precede a relapse, such as depressed mood, anger, intoxication, marital discord or other stress. The offender may list symptoms that others can watch for, such as spending time with children, or long periods in isolation.

 

Lifestyle changes, such as not living or working around children,
can prevent relapse. NASA.

Lifestyle changes can remove temptation, says Berlin. An offender must realize that "I don't want to work in a job where I'm in contact with children, or to live near a school."

Paul Knuckman, a clinical psychologist who counsels sex offender at a Michigan prison, says he looks for risk factors. "What are the issues associated with this offense? What's going on in the person's life at the time of the offense? What kind of stresses? Where did it happen? What made it a safe place to commit the offense? What are the victim's characteristics -- size, age, sex, availability?"

While stereotypes show pedophiles lurking in the bushes, Knuckman says the offender is often "the most functional adult in the child's arena. The child turns to the adult for attention, and the adult sexualizes the relationship, and often the child stays silent."

While treatment based on psychoanalytic introspection is out of favor, Knuckman says it's still important to help offenders understand the roots of their problems. "I focus on teaching these men that the problem is greater than this particular contact with this victim. It has to do with how they manage their lives, how they meet their needs in addition to sex needs. For many of them, sexual contact with a child is a way to feel competent, powerful, that he has some control over his life."

On the pill
For the more driven and dangerous pedophiles, chemistry or surgery may be more effective in controlling sexual impulses. Castration -- removal of the testes, which produce the male sex hormone testosterone -- when coupled with follow-up hormone monitoring, is a drastic but effective solution to sexual offenses. In European castration studies from the 1940s and 1950s, recidivism rates were in the single digits -- probably the lowest of any treatment.