The single factor that separates pedophiles from nonpedophiles is the former’s ongoing, recurrent sexual fantasies or urges generally involving children under age 14 years. It is therefore not surprising that multiple treatments have been developed to reduce sexual interest in children. Although these treatments were initially developed to be applied on a one-to-one basis, the sheer number of pedophiliac individuals in treatment has necessitated that the treatments be provided in group formats in order to accommodate those needing treatment and to be cost-effective. Many of these treatments involve a three-step process. First, in the therapy session, the patient learns various techniques to reduce sexual interest. Second, the patient practices these techniques on audiotape outside of the session and brings in the audiotape for the group members and group therapist to hear and critique. This ensures that the patient is appropriately learning the technique. Third, the patient reports how he has implemented the technique outside of the office setting as needed whenever he feels an urge to carry out a pedophiliac act. Urges are often prompted by events occurring in the patient’s environment, stressors, or unforeseen situations that increase the pedophiliac person’s tendency to offend. To illustrate the application of various treatment components, a case study of a pedophiliac patient, Harold, is presented.
At the age of 14, Harold, now a 38-year-old married engineer, noticed his sexual interest in boys. He remembers being embarrassed that he was different. Even though he was a gifted athlete, he eventually stopped playing football and baseball because of his fear that he would have an erection in the locker room at the sight of others. He minimized his attraction to 11- to 13-year-olds and decided that if he could marry, his sexual orientation would change. Although Harold’s wife is a kind-hearted woman, the marriage has been tense as a result of his continuing attraction to boys, his worry about discovery, and the effort to be sexual with his wife.
Harold was imprisoned for 5 years and court-ordered to receive treatment while on probation, when a 14-year-old boy told a peer at school that he had let Harold “just kind of play with him.” Harold admitted fondling Andy.
Harold explained that he was feeling sorry for himself and decided to visit a nearby community center where he could enjoy the outdoors and maybe meet a young boy. When he arrived at the community center, there were not enough boys to play each position on the baseball diamond. He saw the opportunity to make himself look cooperative, helpful, and fun. He thought that he might get to know one of the boys. He identified a younger adolescent who looked lonely - like he did not fit in. He spoke to him, spent time with him, and invited him to go eat. After eating, he invited the boy to watch movies at his house. At Harold’s house Andy made himself comfortable. Harold sat close by in a friendly, casual manner. Noticing the boy’s eagerness to comply with him and his happiness at being the object of Harold’s attention, Harold began to touch his legs under the guise of massaging him so he would not get any cramps after the baseball game. Since the boy did not recoil or become upset, Harold began to massage closer and closer to his groin, watching carefully for any indication of Andy’s discomfort. Perceiving none, Harold believed he could casually touch his penis over his clothes without any rebuff. As Harold ran his hand over Andy’s pelvis and noticed no upset, Harold became more and more relaxed, interpreting that Andy would not tell on him because he probably was enjoying his touch. Harold said nothing to Andy about keeping this a secret. He did not ask if he liked what he was doing to him. Harold simply continued to casually run his hand over Andy’s penis area until Harold “could not stand it anymore.” Harold excused himself and went to the bathroom to ejaculate. He returned to the couch where Andy was lying comfortably, pretended to “finish the massage,” and checked again for any clue that Andy was upset; he found none.
Harold asked Andy if he needed a ride home. Andy agreed that he should be getting home and accepted Harold’s offer. On the way home, Harold encouraged Andy to do his homework, keep playing ball, and said he might “see him around.” The evening afterward, Harold masturbated to memories of fondling Andy. He was distracted at work by this memory. He fell asleep to the thought of massaging Andy’s legs and fondling his penis area. Harold relaxed as several weeks passed without any consequence from his behavior.
Revision date: July 4, 2011
Last revised: by Jorge P. Ribeiro, MD