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A
Model for Group Counseling with Male Pedophiles
Gertjan
van Zessen, PhD University of Utrecht, Journal
of Homosexuality 20, 1/2, 1990 Summary
Group treatment programs for pedophiles are often designed for populations of convicted men in closed institutions with limited application to other populations. Treatment is usually focused on reducing the ‘deviant” sexual arousal and/or acquiring heterosocial skills and eventually establishing the ability to engage in adult heterosexual relationships. A six-week highly
structured program is presented to five men in anon-residential setting. In
addition to individual psychotherapy, group counseling is offered. Male
pedophiles, arc trained to talk effectively about common problems surrounding
man-boy relationships. Counseling is based on the notion that the emotional,
erotic and sexual attraction to boys per se docs not need to be legitimized or
modified. The attraction, however, can be a source of psychological and social
problems that can
be handled by using a social support system. Social support for pedophile
problems can be obtained from and in interaction with other pedophiles. Gertjan
van Zessen is Clinical psychologist at Utrecht University and at the Netherlands
Institute for Social-Sexological Research. Correspondence may be addressed to
NISSO. Da Costakade 45, 3521 VS Utrecht, Thc Netherlands.
Thc author wishes to acknowledge the helpful assistance and comments of Theo
Sandfort and Alex van Naerssen during the preparation of this manuscript. Introduction
Treatment
programs for pedophiles are almost entirely designed for particular populations:
convicted men in penal or psychiatric institutions. Pedophiles and other sex
offenders are treated within the same programs, and pedophiles are almost always
treated as a homogeneous
population. A man who forced a three-year-old girl to have sexual intercourse
with [him] and another having a loving relationship with a boy of 14 receive the
same treatment. The common problem with treatment programs in institutions is
that it is
difficult to assess whether motivation to participate is internal, a real desire
to change one's behavior, or external, a desire to leave the institution as
quick as possible, Theory
and treatment
Whether medically,
psychoanalytically, or behaviorally orientated, all programs share the
presumption that a sexual attraction to children is undesirable and requires
modification. In the medical
review, pedophile behavior is the result of an excessively high sexual drive.
Medical therapies for sex offenders, including castration and
administration of hormones and drugs, have raised various ethical questions.,
Irreversible interventions, such as castration, seem to be effective from a
criminological point of view; Stürüp reports a recidivism rate of 2.2% on a
total of 3,186 sex offenders (Stürüp, 1968). In an overview of
treatment programs, Crawford (1981)concludes that two other approaches,
psychoanalysis and individual (insight-orientated) psychotherapy, not used in
conjunction with other forms of psychotherapy, are of little value in the
treatment of pedophiles. The majority of
the reported studies have roots in behavior therapy. The early behavioral
approaches were aimed at reducing the deviant sexual arousal by aversion
therapy (Quinsey et al., 1976). The attraction to children is viewed as purely
sexual (Howells,
1979). In its simplest form, the child is the stimulus that elicits sexual
excitement in the adult (Quinsey ct al., 1975). All other motivations and
meanings of pedophile attraction arc ignored. In later studies
it is recognized that, in addition to reducing pedophile arousal, attention
should be given to establishing new sexual ant! social relationships. Treatment
is aimed at conversion and at enlarging the pedophile's heterosocial and
heterosexual skills
(Crawford and Allen, 1979; Hayes et al., 1983; Travin et al., 1985; Segal and
Marshall, 1985). There is little empirical evidence, however, indicating exactly
what skills are deficient (Harlow, 1974). Treatment
is always aimed at reducing pedosexual arousal and establishing adult,
heterosexual arousal patterns (conversion). It is considered crucial for
therapeutic success to teach sufficient social skills to implement new arousal
(Herman and Prewett, 1974). Social skills training does not include enlarging
the client's autonomy but assures that the pedophile attraction remains reduced.
The meaning of the pedophile attraction for the individual is not taken into
account and no difference is made between abuse and other
interactions. Little or no attention is given to the question of whether or not
the meaning and function of pedophile attraction can be replaced by a different
meaning and function associated with heterosexual attraction. In an overview of
the literature concerning
homosexual conversion therapies, James (1978) concluded that the majority of
studies were unsuccessful in changing sexual orientation. It is likely that the
same holds for pedophile conversion therapy. Counseling
in a non-residential setting
Counseling pedophiles at the Department of Clinical Psychology at the Utrecht University differs in two crucial ways from the programs described above. Firstly, only non-residential client are seen. Most males are 25 to 50 years old, with a predominant or exclusive preference for boys between the ages of 9 and 16. These men are non-violent in their contacts with boys and show no severe psychopathology. This non-violence is one of the main differences between these non-residential clients and pedophiles in institutions, where a mixture of sexual behavior and aggression is more common. Secondly,
therapy is not aimed at conversion. Treatment is not aimed at reducing sexual
and emotional attraction to boys, nor at establishing heterosexual orientation,
nor in enlarging heterosocial skills. Conversion to a satisfying heterosexual
orientation,
however, is not considered to be entirely impossible. Although James (1978) and
Sengers (1969) claim that prognosis for conversion is poor, Masters and Johnson
( 1979)) report a few successful conversions with male homosexuals. They suggest
that (homosexual) conversion may be possible when the client is relatively
young, strongly motivated, and not exclusive1y attracted to men. As
virtually no pedophile client fulfills these conditions, no attempts at
conversion are made at the Utrecht Institute . Instead, the
structure and function of pedophile desire is assessed in the total sexual
orientation (van Naerssen, 1986). As part of the assessment procedure, an
extensive life history is taken, including a chronological account of the
psychosexual (hetero-, homo and pedosexual) development. Individual counseling
and treatment start with an analysis of this biographical material in relation
to present problems. On the whole these problems are divided into two
categories: problems concerning the erotic and sexual attraction, and problems
in the realization of these desires in interactions with others. Individual therapy
is consequently divided into two phases: identity and realization-therapy. In
the first phase, the focus is on sexual identity: on the man's sexual and erotic
desires and the cognitive framework available to structure these. The cognitions
concerning the sexual identity and the sexual self are often diffuse, associated
with feelings of guilt and insecurity and valued negatively. In this phase of
therapy, the meaning of the desires is explored and discussed. The therapist
helps to focus on the desires and to positively change the self-image. The second phase
focuses on problems concerning realization of desires and on the problems
concerning interactions and relationships with boys, and problems arising from
the forbidden nature of these relationships. The focus in realization therapy is
on the way the desires are expressed in interactions with others. The identity and
realization-phases are not mutually exclusive but represent different areas of
concern. As therapy proceeds, attention shifts from intra to inter-individual
issues. When emphasis on the later increases, the problems discussed change from
an individual to a social and communal level. Talking
in groups about man-boy relationships
The attraction to children can be the source of psychosocial problems, because it serves no social function, is illegal and considered immoral. No one is brought up to be a pedophile and there are no visible models to follow in coping with problems. The social framework for intergeneration relationships is lacking. One important Implication is that the necessary social support for pedophile issues can only be obtained in a very limited circle, mainly among other pedophiles, Social support systems are considered important in the coping process. Because the possibility of obtaining social support is scarce, it is desirable to make optimal use of the few available support systems. Social support can be found among other pedophiles in organized settings (self-help or emancipation groups, often with a strong ideological background) or in informal situations (circles or networks of "colleagues"). Must clients are involved in one or more pedophile circles. An effective way to communicate about problems is necessary. That this
communication is often reported to be unsatisfactory is partly due to the nature
of these circles, where status is mainly determined by the number of partners a
man has, as boys willing to engage in man-boy relationships are scarce.
Interactions are often characterized by jealousy and bragging about scoring. The
model for group counseling presented here is aimed at improving these
interactions. In
addition to individual psychotherapy, small groups (five to eight members) can
form to improve communication on common pedophile topics. Successful
participation in such a group increases the capacity to solve problems in the
man's own support systems. The main goal, therefore, is defined as enlarging
autonomy. Men in advanced stages of individual therapy are likely participants
in group sessions. They should be in realization-therapy and beyond
identity-therapy, since the problems discussed are, by definition, problems
concerning interactions with others. Two
male counselors, familiar with pedophile lifestyles and the problems frequently
occurring in individual therapy, suggest topics of conversation and exercises.
They structure the sessions and offer methods for the systematic analysis of
problems. Examples
of general pedophile problems are: coming out: how much self-disclosure to whom?
Interactions with boys and sexual relationships. Interactions with boy's parents
and own neighbourhood. Interactions with other pedophiles and with the police.
Growing older . Each
session deals with one or two of these themes. An inventory of prior experiences
and solutions is made, discussing the advantages and disadvantages of these
solutions and drawing conclusions.
Which subject of conversation is chosen is not as important as the way it is
discussed. Basic techniques, improving interaction (attentive listening, giving
and receiving feedback, etcetera) are stimulated. The objective is to enable men
to make optimal use or the experience available in the group, and to look at
their own problems as part of an experience they can share with others. Exercises include
role playing and short writing exercises as for example, "Consider your
last significant relationship with a boy. How would you describe yourself, as
seen through his eyes?" Effects of participation are twofold: Firstly.
participants profit from practical solutions they learn from each other,
secondly. functioning in their own social circles improves. This group
counseling mode1 was tested in 1986 in a pilot-series of 6 three-hour sessions.
Two male counselors presided over five men who were involved in individual
therapy. The sessions were highly structured. A detailed script was made
beforehand containing the abovementioned topics and exercises. Topics could be
modified according to wishes of the men. Subjects
The mean age of
this group was 40, outranged from 36 to 45. Four of the five men had little
education and were living on welfare. They considered themselves exclusively
pedophile, although all of them had had hetero and homosexual adult
relationships. They strived for affectionate and erotic relationships with
pubescent boys around the ages of 10 to 15. These four men had realization
problems. The fifth man! had recently engaged in therapy. He was well educated,
married and thought of himself as bisexual. His problem was, more than with the
other men, in the sexual-identity phase. The overall ability of this group to
function on an abstract level is categorized as low. Results
No measures to assess effectiveness of communication were taken so no pre- and posttest measures can be presented. Subjective judgment of the counselors was that the communication improved during the sessions: the men listened more attentively to each other, feedback was more frequently given and asked for and self-disclosure grew. Systematically presented schemas to analyze problems (i.e., making inventories of both negative and positive aspects, discussing benefits and disadvantages and drawing conclusions) were quickly adopted and led to an objective, rather than a subjective approach to problems. Participants preferred practical problems (e.g., interaction with parents of boys) over abstract topics (e.g., pedophilia as a social phenomenon). Nevertheless, fairly
abstract levels of analysis could be handled, for instance, when certain
techniques from rational emotive therapy were presented. Often, encouragement in
defining problems by their[ positive as well as their negative aspects (positive
relabeling) was enough to create a new and more hopeful perspective. For
instance, glowing older can be defined by a growing age-gap between man and boy,
and also by the increased skills to interact with boys. The feeling of both
participants and counselors was that the sessions were too few to efficiently
explore the relevant themes. Conclusions
and discussion
As with many
social skill programs, changes in social functioning, especially outside of
group settings, are hard to assess. Without these measures, conclusions
regarding improvements in functioning outside the group sessions cannot be made.
Although limited by the number of participants and sessions, positive changes in
interaction snd analysis during the sessions were observed and reported by
participants. Participating in a group like the one described here may form a useful addition to individual psychotherapy. Because of its limited scope, the proposed model of group counseling can not replace individual psychotherapy. This is especially true when sexual identity is the focus of treatment. For example, suppose a client enter therapy stating that he is a pedophile, afraid to engage in sexual or emotional relationships with pubescent boys. Therapy starts with an exploration of his sexual identity: what exactly are his sexual desires, how are they structured. which feelings and cognitions arc they associated with? Earlier
experiences and the function of the desires in
the total sexual orientation are assessed. This phase of therapy is emotional,
personal, and confronting, and deserves the therapist's full attention.
Furthermore, it may well be possible that the problems concern sexual
orientation in general and not only pedophile attraction. The selflabeling
"I am a pedophile" may then function as all important stabilizing
factor in the total personality structure, and prevent an effective approach of
personal problems. Participation in a group entirely focused on pedophile
realization-problems may prove counterproductive. However,
for men who arc in the therapeutic phase of dealing with realization-problems,
participation call provide a different perspective, enabling them to profit more
effectively from their own social support systems, reducing their dependency on
therapy. Participation of well adjusted pedophiles not involved in psychotherapy
is possible. This might even increase overall effectiveness, since they can
function as role models. Goals
are defined in terms of enlarging the autonomy of the men and not, as in regular
treatment programs described earlier, in terms of regulating socially
unacceptable or illegal behavior. Sexual contacts with boys 15 years old and
under are illegal in The Netherlands. The age of consent is 16. There is no law
in The Netherlands forcing therapists or counselors to report sexual acts with
minors to the authorities. A therapist cannot be considered an accessory to a
criminal act by accepting the sexual relationships of his client and choosing
not to try to reduce the pedophile attraction or behavior . Virtually
no client enters therapy requesting to be set free from his attraction to boys.
In the rare case where reduction in attraction to boys is requested, the man is
told that the prognosis for successful conversion through psychotherapy is
considered very poor. These
men strive for enduring, affectionate and erotical friendships with boys; they
have no interest in forced or violent sexual contacts. When a boy is very young
(12 years old and under) or emotionally unstable, the counselor can suggest that
the man reconsiders the relationships thoroughly, especially its sexual aspects.
A non-sexual relationship with a boy, regardless of his age, is not illegal.
However, when partners voluntarily enter into a relationship or sexual contact,
there is no need for the therapist to condemn or interfere. PostscriptThis
contribution was conceived in late 1986. Since that time considerable changes
regarding the attitude towards relationships between adults and children have
taken place within Dutch society. These changes have affected the present
problem of male pedophiles. This has led to adoptions of the model described
here. ReferencesBarlow, D.H., (1974) The treatment of sexual deviation: Towards a comprehensive behavioral approach. In K.S. Calhoun, H.E. Adams & K.M. Mitchell (Eds), Innovative Treatment Methods in Psychopathologt (121-148). New York: Wiley Crawford, D.A. & J.V. Allen (1979) A social skill training programme with sex offenders. In M.Cook & G. Wilson (Eds), Love and attraction (527-536). Oxford: Pergamon Press Crawford, D.A. (1981) Treatment approaches with pedophiles. In M. Cook & K. Howells (Eds), Adult Sexual Interest in Children (181-217). London: Academic Press. Hayes, S.C., K.G. Brownell & D.H. Barlow (1983) Heterosocial skills training and covert sesitization in sexual deviant. Behavior Research and Therapy, 21, 383-392. Herman, S.H. & M. Prewett (1974) An experimental analysis of feedback to increase sexual arouse in a case of homo- and heterosexual impotence: A preliminary report. Journal of Behavioral Therapy and Experimental Psychiatry, 5, 271-274 Howells, K. (1979) Some meanings of children for pedophiles. In M. Cook & G. Wilson (Eds), Love and attraction (519-526). Oxford: Pergamon Press. James, E.C. (1978) Treatment of Homosexuality: A reanalysis and Synthesis of Outcome Studies. Bringham Young University. Masters, W.H. & V.E. Johnson (1979) Homosexuality in Perspective. Boston: Little Brown and Company. Naerssen, A.X. van (1986) Pedofilie en hulpverlening. In M. Moors-Mommers (Ed), Handboek Seksuele Hulpverlening. Deventer: Van Loghum Slaterus. Quinsey, V.L., C.M. Steinman, S.G. Bergerson & T.F. Holmes (1975) Penile circumference, skin conductance and ranking responses of child molesters and "normals" to sexual and non-sexual visual stimuli. Behavior Therapy, 6, 213-219 Quinsey, V.L., S.G. bergerson & C.M. Steinman (1976) Changes in physiological and verbal responses of child molesters during aversion therapy. Canadian Journal of Behavioral Sciences, 8, 202-212 Segal, Z.V. & W.L. Marshall (1985) Heterosexual social skills in a population of rapists and child molesters. Journal of Consulting and Clinical Psychology, 53, 55-63 Sengers, W. (1969) Homosexualiteit als klacht. Bussum: Paul Brand Stürüp, G.K. (1968) Treatment of Sexual Offenders in Herstedvester, Danmark. Copenhagen: Munksgaard Travin, S., H. Bluestone, E. Coleman & J. Melella (1985) Pedophilia: An update on theory and practice. Psychiatric Quarterly, 57, 89-103.
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