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 heterosexual skills and eventually establishing the ability to engage in adult heterosexual relationships. A six week, highly structured program is presented to five men in a non-residential setting. In addition to individual psychotherapy, group counceling is offered. Male pedophiles are 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 does 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.
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 rugs, have raised various ethical questions. Irreversible interventions, such as castration, seem to be effective from a criminological point of view; Stürup reports a recidivism rate of 2.2% on a total of 3,186 sex offenders (Stürup, 1968).
In an overview of treatment programs, Crawford (1981) concludes that two other approaches, psychoanalysis and individual (insight-oriented) 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 et al., 1975). All other motivations and meanings of pedophile attraction are ignored.
In later studies it is recognized that, in addition to reducing pedophile arousal, attention should be given to establishing new sexual and 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 (Barlow, 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.
Instead, the structure and function of pedophile desire is assessed in the total sexual orientation (van Naersson, 1986). As part of the assessment procedure, and 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 ot 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 phasefocuses 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 latter increases, the problems discussed change from an individual to social and communal level.
The attraction to cildren can be the source of psychological problems, because it serves no social function, is illegal and considered immoral. No one is brought up to be 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 the 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 "collegues"). Most clients are incolved 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.
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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 and analysis during the sessions were observed and reported by participants.
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Goals are defined in terms of enlarging the autonomy of the men and not, as in regualr treatment programs described earlier, in terms of regulating socially unacceptable behavior. Sexual contacts with boys 15 years old and younger 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 rpognosis 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 emotionallly unstable, tha 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 voluntary enter into a relationship of sexual contact, there is no need for the therapist to condemn or interfere.