Most sexual behaviors are the result of an extensive chain of events that end with the consummation of a sexual act. Similarly, pedophiliac sexual acts are the eventual consequences of a chain of events: experiencing increased stress, emotional distress, or loneliness; engaging in pedophiliac fantasies; going to where a child may be; identifying/singling out a child; grooming the child; isolating the child; creating an atmosphere of closeness and trust with the child; and finally molesting the child. Following the actual pedophiliac sexual act, the perpetrator may talk to the child or threaten the child to keep the sexual abuse a secret. In reality, the pedophiliac individual rarely experiences immediate negative consequences as a result of the abuse. Aversive consequences may not occur until weeks, months, or even years later.
In covert sensitization, pedophiliac patients are taught to identify the chain of events leading to their pedophiliac acts and to pair these events with potential negative consequences of such acts (e.g., humiliation from the public exposure of their pedophiliac behavior, loss of contact with family members or loss of occupation as a result of arrest and incarceration, physical assault while incarcerated). The patient practices imagining the chain of events leading to pedophiliac acts and inserts these imagined negative consequences into the chain so that there are frequent aversive consequences directly associated with any element of the chain of events leading toward pedophiliac acts.
The therapist’s responsibility is to train pedophiliac patients in the application of covert sensitization and, more importantly, to monitor patients’ ongoing use of such covert scenes in the real world, when they are having increased urges or fantasies or find themselves in environments or stressful situations that aggravate their pedophiliac interests. Details of covert sensitization have been discussed by Abel et al. (1984, 1992).
Because the purpose of covert sensitization is to link negative consequences to molestation for the pedophiliac individual, Harold was instructed to tape-record 20 covert sensitization scenes. After writing out the chain of antecedents that had led to his touching Andy and their possible negative consequences, Harold verbalized these on audiotape so his therapist and group members could hear them. He was instructed to insert the word “switch” between the antecedent and the consequence.
“I am feeling sorry for myself because I haven’t been able to be truly sexual in an enjoyable way for weeks. I have been trying very hard to please my wife and it is a lot of work. I decided to cheer myself up by going to a nearby community center where I can take a walk and enjoy the outdoors. When I get there, several kids are playing baseball. They were a couple of people short and I ‘reluctantly’ volunteer to help them out, stating that I used to play varsity ball in school.”
“I am at work, I am surrounded by my fellow engineers, and we are talking about an important project that I am heading up. My boss walks in with his face ashen, behind him are two police officers. They ask me my name, which I confirm. They tell me I am under arrest for molesting a 14-year-old boy named Andy. Of course I start to protest, saying I don’t know what they’re talking about, that surely this is a mistake. They escort me out of the boardroom in handcuffs in front of everyone. I hear gasps and murmurs and “What is going on?” following behind me as I walk down the hall. The police tell my workmates I am a child molester, and they are shocked. We ride the elevator down with several of my well-known clients looking puzzled and confused. We walk out into the bright sunlight where a squad car is waiting. I am being taken away by the police because I volunteered to help kids out, thinking that I could become sexual with one of them.”
“As I am at the baseball diamond, I notice a particular boy who looks scrawny and looks like he doesn’t fit in. I notice him because I think that he would be easy to get to know so that I can sexually fondle him.”
“I am at work and I hear loud steps outside of my office and I hear voices asking for me and my boss knocks on the door and there are two officers with him. They are asking me my name and telling me to come with them. I feel very scared and I feel like I could throw up. I realize they have found out about what I did to Andy.”
“As I talk to this boy, Andy, I realize that he is enjoying the attention that he is getting from me and is eager to please me. I think about how easy it would be to invite him to go to eat with me so that maybe later, I will be able to fondle his penis.”
“I am being taken to jail. I will be going there for 10 years. My lawyer says there is nothing he can do for me, and I wonder how I could have been so stupid as to molest Andy and think I could get away with it. I think about all the things I had planned to do in the following years and how a big chunk of my life is going to be taken away. I feel like crying and crying and crying. I feel like disappearing forever.”
Revision date: June 18, 2011
Last revised: by Jorge P. Ribeiro, MD