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. Retrieved from EBSCOhost.Pessimism about pedophilia. (2010). Harvard Mental Health Letter, 27(1), 1-3. Retrieved from EBSCOhost.
  • Submitter: Victoria Rutter-Reese
Virtual Advisor