One common theory about the development and maintenance of pedophiliac interest is that pedophiliac individuals recall sexual experiences with children because these memories are intensely erotic and become more so as they are paired hundreds of times with masturbation and orgasm. As a result, minor events that may have been mildly erotic become much more erotic due to these repeated pairings. Because sexual fantasies are by nature private and secretive, a pedophiliac person can easily associate images and fantasies of children with orgasm for years without others knowing. Pedophiliac interests thus become chronic and ingrained into the individual’s erotic fantasies.
A variety of satiation treatments exist, generally involving training pedophiliac patients first to masturbate to nondeviant sexual fantasies until they reach orgasm, and then, promptly following orgasm, to continue to masturbate while focusing on one of their highly erotic pedophiliac fantasies. The pedophiliac fantasies are used during the refractory or resolution phase when the patient cannot, or is not likely to, achieve erection or orgasm. This technique externalizes the pedophiliac patient’s secret fantasies of children and generates boredom and loss of sexual interest with fantasies that were previously highly arousing (Abel et al. 1984).
As with the other therapies described above, satiation sessions are audiotaped and spot-checked by the therapist to ensure compliance and accuracy of the method. More importantly, the therapist ensures that the patient is applying the satiation techniques at home as soon as she or he experiences pedophiliac fantasies or urges in order to increase his or her control over those behaviors. In situations where medical or religious factors prohibit masturbation, verbal satiation (repetitive verbalization of pedophiliac fantasies without masturbation) is substituted. For more details of this technique, readers are referred to Abel et al. (1984, 1992), Laws and Marshall (1991), Laws and Osborn (1983), Laws et al. (1978), and Marshall and Lippens (1977).
Harold was instructed to make masturbation satiation tapes. He is told to masturbate to orgasm first by fantasizing about an appropriate sexual behavior. Once he ejaculates, he is to continue to masturbate while focusing on a highly erotic fantasy that is deviant. While masturbating with the tape running, Harold verbalizes into the tape as follows:
“I am with my wife, I am looking at her beautiful hair and beautiful skin, and I am thinking about how sexy she looks to me. We are in the Jacuzzi; we dry each other off and walk over to our bed. I start to rub lotion on her and touch her gently. I massage her all over her body as she oohs and aahs with pleasure. She grabs me on the shoulders and draws me on top of her. As I enter her with my hard penis, she is biting me on the ear and wriggling with ecstasy.”
As Harold is describing this fantasy of his wife, he has been masturbating to orgasm. Then he is asked to describe an inappropriate fantasy involving a boy:
“I am looking at a young boy’s body as he eats a cheeseburger with me. He thinks I am being friendly and generous, but I am thinking about fondling him. I watch as he chews his food and laughs and smiles about watching a movie at my house. I think about how easy it will be to get him to sit on the couch next to me and let me rub his shoulders and legs. (The patient uses this same, brief scene again and again, while masturbating, until 50 minutes have passed.)
Since the client has already experienced an orgasm and ejaculation to the appropriate fantasy, it will be difficult or impossible for him to reach orgasm to the deviant fantasy, which in the past has been paired with orgasm. After making many tapes pairing the deviant fantasy to a lack of sexual response, the patient will eventually disrupt the pairing of the deviant fantasy and orgasm and be satiated to deviant fantasies.
Revision date: June 22, 2011
Last revised: by Jorge P. Ribeiro, MD