Pedophilia
Pedophilia
Introduction
Treatment to Reduce Pedophiliac Interests
Treatment to Establish Adult Sexual Interest
Treatment to Decrease Attitudes and Beliefs Supportive of Pedophiliac Behavior
Treatment to Develop Prosocial Behavior
Treatment to Resolve Intrapsychic Conflicts
Other Treatment Modalities
Maintaining Treatment Gains and Preventing Relapse
Coordinated Efforts With Other Professionals
Conclusions
References
Pedophilia Introduction
Candice Osborn, M.A.
Alexandra M. Phipps, Ph.D.
Pedophilia is the most common paraphiliac act involving the touching of a victim against his or her will or who is unable to give consent. Conservative estimates indicate that 20% of all females and 10% of all males have been molested prior to age 18 years (Finkelhor et al. 1986). In a stratified nationwide study of females in the United States, Saunders (1992) estimated that 21 million adult females have been sexually assaulted, 60% of those prior to age 18 years. According to pedophiles’ own reports regarding children under age 14 years whom they have molested, nearly all molestations in which the child was not touched (e.g., voyeurism, exhibitionism) involved female children, whereas 62% of the molestations in which the child was touched involved male children (Abel 1989). Furthermore, contrary to data from treatment programs for child victims, child molesters report that the vast majority of their molestations do not involve incest, but rather are perpetrated against children outside of the home (Abel 1989). Child molestation is a public health problem of enormous magnitude that necessitates prompt intervention.
Until recently, mental health professionals have been ambivalent about providing treatment for pedophiles (Reddan 1998). There are at least three reasons for this ambivalence (Glaser 1998):
1. The knowledge base identifying effective treatments for pedophilia has developed slowly.
2. Clinicians who undertake treating pedophiles are often seen as supporting pedophiles rather than as trying to stop child molestation from occurring by curbing pedophiliac behaviors through treatment.
3. Clinicians often develop a sense of despair when treating perpetrators who appear to deny their problems or their need for treatment.
Because pedophiliac acts are crimes, the criminal justice system and mental health professionals have been stymied as to which system should take responsibility for dealing with pedophiles. The official American psychiatric diagnostic system (most recently, DSM-IV [American Psychiatric Association 1994]) has always defined pedophilia as a psychiatric disorder, whereas the criminal justice system has always defined pedophiliac acts as sex crimes. (See Table 69-1 for a listing of the full DSM-IV criteria for pedophilia.)
Further confusion in the field emanates from what Okami and Goldberg (1992) described as slippage in the definitions used within the field. Definitions of pedophilia in the official psychiatric diagnostic system are clear, whereas political and legal definitions of pedophilia are frequently inconsistent; thus, because the descriptions of the populations being treated are unclear, it is difficult to evaluate the effectiveness of treatments. The terms sex offenders of individuals under age 18 years, sexual deviants involving children, child molesters, ephebophiles, and pedophiles are not synonymous. Therefore, as the current treatments for pedophilia are reviewed in this chapter, the reader is urged to keep in mind that significant confusion exists in the literature as a result of inconsistent definitions of pedophilia.
All major treatment programs for pedophilia integrate components of treatment designed to do the following:
In the following review of treatment programs, the various components of the programs, which are normally integrated, have been artificially separated and individually described to clarify the details of each. In practice, these treatment components are integrated into a total treatment program. Greater emphasis has been given to those components that show the greatest treatment effectiveness and/or that have been most consistently used in the major treatment programs for pedophiles.
Appendix: Algorithm for Treatment of Pedophilia
This algorithm, or decision tree, delineates a sequence of treatment for pedophilia. It does not include all possible options available to the clinician; rather, it offers a visual diagram of how to implement or incorporate the information presented in the text.
A. Patient is acutely ill or too dangerous to treat as outpatient?
1. Yes ? Admit to inpatient treatment
2. Possibly ? Pharmacological interventions: hormonal agents (medroxyprogesterone acetate [MPA], leuprolide acetate [LPA]), selective serotonin reuptake inhibitors (SSRIs)
3. No ? Proceed with outpatient treatment
B. Outpatient treatment?
1. Deviant arousal?
Yes ? Covert sensitization, olfactory aversion, satiation, imaginal desensitization
2. Need to reduce sex drive?
Yes ? Pharmacological interventions: hormonal agents (MPA, LPA), SSRIs
3. Need to establish adult sexual interest?
Yes ? Fading, exposure, masturbatory conditioning
4. Cognitive distortions?
Yes ? Cognitive restructuring, externalizing cognitive distortions, victim empathy training
5. Deficits in prosocial behavior?
Yes ? Social, assertiveness, and sexual skills training
6. Other treatment modalities indicated?
Yes ? Psychodynamic psychotherapy, family systems therapy, sexual addiction treatment, trauma model treatment
C. How to maintain treatment gains and prevent relapse?
1. Maintenance therapy
2. Surveillance groups
3. Relapse prevention
Revision date: December 11, 2007
Last revised: by Amalia K. Gagarina, M.S., R.D.
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