Pedophilia

Treatments

Cognitive Behavior Therapy and Pharmacotherapy       

Treatment Summary: Treatment for pedophilia usually focuses on decreasing inappropriate sexual urges and increasing one’s ability to resist those urges when they occur. The primary treatments for pedophilia include Cognitive Behavior Therapy, pharmacotherapy (drugs that suppress sexual appetite), or a combination of the two. Cognitive Behavior Therapy (CBT) attempts to influence cognitive processes before a sexually deviant behavior occurs. Relapse prevention and aversion conditioning are two common approaches used in CBT. Relapse prevention involves helping the offender recognize high-risk situations in which he is likely to feel or act on inappropriate sexual urges and avoid those situations. Aversion conditioning consists of pairing a deviant sexual urge with something unpleasant such as a foul odor so that the offender associates the deviant behavior with something bad. This is followed by the pairing of appropriate sexual stimuli and something pleasant to reinforce the desired association (Marshall, 2006). Two well-developed models for therapy are the Risk/Needs Responsivity Model and the Good Lives Model. The Risk/Needs Responsivity Model evaluates the subject in terms of the risk he poses to others, and treatment is personalized to best facilitate change. The Good Lives Model is a strength-based initiative that focuses on promoting goods while reducing risk. The approach builds on personal strengths and respect for the individual to help offenders to self-actualize thus reducing their desire to harm others (Ward, Mann, & Gannon, 2007). Pharmacotherapy focuses on reducing the sex drive by lowering testosterone levels which decreases the frequency and intensity of deviant sexual urges. These drugs include medroxyprogesterone acetate (MPA), cyproterone acetate (CPA), luteinizing hormone-releasing hormone (LHRH), and leuprolide acetate (LA). Many researchers agree that the best result is achieved when CBT and pharmacotherapy are used concurrently (Schober et al., 2005). Hormone therapy modifies the sex drive while CBT influences cognitive processes resulting in a new, healthier belief system and decreased deviant sexual desire. 

• Reference: Marshall, W. L. (2006). Olfactory Aversion and Directed Masturbation in the Modification of Deviant Preferences: A Case Study of a Child Molester. Clinical Case Studies, 5(1), 3-14. doi:10.1177/1534650103259754 Schober, J. M., Kuhn, P. J., Kovacs, P. G., Earle, J. H., Byrne, P. M., & Fries, R. A. (2005). Leuprolide Acetate Suppresses Pedophilic Urges and Arousability. Archives of Sexual Behavior, 34(6), 691-705. doi:10.1007/s10508-005-7929-2 Ward, T., Mann, R. E., & Gannon, T. A. (2007). The good lives model of offender rehabilitation: Clinical implications. Aggression and Violent Behavior, 12(1), 87-107. doi:10.1016/j.avb.2006.034 

• Submitter: Fran Hoffman 

Antiandrogenic therapy, or chemical castration 

Treatment Summary: The intracellular androgen receptors regulate testosterone. Testosterone regulates sexuality and aggression and maintains male sexual characteristics. Although it has not been proven that pedophiles have abnormally high testosterone concentrations, antiandrogenic therapy is thought to reduce a pedophiles sexual urges. Antiandrogen drug therapy basically suppresses androgen action at the levels of the receptor, so testosterone production is greatly reduced. Antiandrogen drugs include Cyproterone Acetate (CPA) and Medroxyprogesterone Acetate (MPA). Hypoandronism eventually stumps male sexuality, sexual fantasist, and desire. This mode of therapy has proven to be highly effective. 

• Reference: Rasler, A., & Eliezer Witztum, A. (2000). Pharmacotherapy of paraphilias in the next millennium. Behavioral Sciences & the Law, 18(1), 43-56. Retrieved from Academic Search Complete database. 

• Submitter: Ashley Dawn Sheppard 

Cognitive Behavior Therapy 

Treatment Summary: The best treatment for pedophilia is on-going cognitive behavior therapy, although one type of treatment does not necessarily help all offenders; there are different levels of pedophiles and what works for one pedophile may not be helpful for another. Cognitive behavior therapy is a process that includes assessments with a few different models which may all apply to many pedophiles or only one may apply to a pedophile. The models include the risk/needs model, which pertains to the higher the risk the more intensive treatment is needed. The next model is the good lives model which includes developing life skills such as social skills, positive attitudes, and raising self-esteem to attain a happy life. The last model is combining treatment models, emphasizing all models to help develop a well rounded individual who is in control of their life and will not re-offend. Success of the models includes many information building techniques, starting with a life history so the therapist may better understand the client in identifying mental, emotional, and behavioral issues of the past and present. 

• Reference: Marshall, W., Marshall, L., & Serran, G (2006). Strategies in the Treatment of Paraphilias: A Critical Review. Annual Review of Sex Research, 17162. 

• Submitter: Cheryl L. Caldwell 

Cognitive behavioral therapy and Medication 

Treatment Summary: Cognitive behavioral therapy focuses on getting the individual to see there is a problem and help change their thought process dealing with the behavior. They can go through empathy training and classes to help control their urges. Anti-androgen drugs are the only way to control the urges an individual has. These drugs lower the male hormones causing a decrease in sexual desires, activities, and fantasies. Some researchers believe that cognitive behavioral therapy is too “one size fits all” approach. There should be flexibility in the therapy approach and the therapist should be able to adjust according to the individual. Incorporating therapy and medication is the best approach. 

• Reference: Marshall, W. L., Marshall, L. E., & Serran, G. A. (2006). Strategies in the Treatment of Paraphilias: A Critical Review. Annual Review of Sex Research, 17162-182. Retrieved from EBSCOhost. Pedophilia. (Cover story). (2004). Harvard Mental Health Letter, 20(7), 1-4. 

• Submitter: Victoria Rutter-Reese 

Eye movement desensitization and reprocessing trauma treatment in combination with cognitive behavioral therapy-relapse prevention 

Treatment Summary: Eye movement desensitization and reprocessing (EMDR) trauma treatment in combination with cognitive behavioral therapy-relapse prevention (CBT-RP) treatment was used within a sample of 10 adult male sexual offenders who were themselves abused as children. This treatment was compared to a control treatment group of 22 sexual offenders, also abused as children, undergoing CBT-RP only. Results indicate that sexually deviant arousal, as measured by penile plethysmography (PPG), was significantly decreased in both a post-treatment test and a 6 to 12 month follow-up examination in 9 of the 10 EMDR trauma treatment and CBT-RP combined therapy group. In the CBT-RP-only group, post-treatment PPG response increased slightly, but did not significantly differ from pretreatment response. 

This study suggests that EMDR trauma treatment in combination with CBT-RP is a potentially effective treatment for sexually abused sexual offenders. EMDR trauma treatment is a technique previously used to treat post-traumatic stress disorder and involves elements of exposure therapy with bilateral eye movement, finger tapping, or various other methods of repetitive movement that seem to function as a means of cognitive load reduction. While the technique is fairly new, much attention from clinicians and researchers alike has ultimately propelled EMDR to controversial standing. While the previous study elucidates potential effectiveness, there are still many that question the necessity of the eye movement and its advantage over exposure therapy alone. 

• Reference: Ricci, R., Clayton, C. A., & Shapiro, F. (2006). Some effects of EMDR on previously abused child molesters: Theoretical reviews and preliminary findings. The Journal of Forensic Psychiatry and Psychology, 17(4), 538-562. & Herbert, J. D., Lilienfeld, S. O., Lohr, J. M., Montgomery, R. W., O’D onohue, W. T., Rosen, G., & Tolin, D. T. (2000). Science and pseudoscience in the development of eye movement desensitization and reprocessing: Implications for clinical psychology. Clinical Psychology Review, 20(8), 945-971. 

• Submitted by: Leandra Lomosad 

Psychoeducation and Repeated Exposure 

Summary of Treatment: Treatments for pedophilia should primarily focus on psychoeducation to educate about how inappropriate sexual urges should be avoided and how they are able to do so. The primary treatments for pedophilia included psychoeducation, repeated exposure, or a combination of the two. Psychoeducation attempts to help normalize their feelings and give them comfort to discuss it before the inappropriate sexual thoughts turn into inappropriate sexual actions (Bruce et al., 2018).  It is also critical that the client does not misinterpret their pedophilic thoughts as them doing something dangerous (Bruce et al., 2018). This may lead them to actually acting on their urges. Being unable to interpret or understand their thoughts is what may cause them to believe they truly are a pedophile. When introducing psychoeducation, the goal is to discuss the patients thoughts and make them more realistic as opposed to their over exaggerated misconceptions of sexual thoughts (Bruce et al., 2018). In addition, the patient should be informed that when they are compelled to act on their urges, although it may be something small at first, it will increase the likelihood of re-occurring compulsions. Acting on these urges leaves the patient in a continuous cycle of experiencing the inappropriate thoughts and then acting on them (Bruce et al., 2018). The actions do tend to become more dangerous as the disorder persists. Repeated exposure is also beneficial to these patients is modeling the appropriate behavior so that the patient can see how they should respond to their compulsions (Bruce et al., 2018). When you start off with exposing these patients to small things such as images or audio it encourages the patients to practice controlling their emotions (Bruce et al., 2018). This would be monitored and would also demonstrate modeling of appropriate behavior from the counselor for the patient. They are encouraged not to participate in positive or neutralizing thoughts denying that they are not a pedophile or reassuring to themselves that they did not commit certain acts that they did (Bruce et al., 2018). 

• Reference: Bruce, S., L., Ching, T. H., & Williams, M. T. (2018). Pedophillia-themed obsessive-compulsive disorder: Assessment, differential diagnosis, and treatment with exposure and response prevention. Archives of Sexual Behavior, 47(2), 389-402. https://doi-org.tamuct.idm.oclc.org/10.1007/s10508-017-1031-4 

• Submitted by: Catherine Atkinson