New South Wales Police.
The "cognitive-behavioral therapy" used to treat sex offenders includes a range of treatments from "conditioning-based approaches to behavior skills training, social, empathy and assertiveness," says Plaud. "It's a package to teach pedophiles more normal ways to interact with adults, and address the underlying pattern of sexual arousal."
While electric shocks are seldom used to associate pain with unacceptable sexual fantasies, Linda Grossman, who studies treatment of sex offenders at the University of Illinois at Chicago says many cognitive-behavioral programs still use aversion therapy. "Now we think it's better to use mental images. We'll have offenders fantasizes a deviant reaction, and when they begin to feel aroused, have them fantasize the consequences of getting arrested, going to prison, and getting raped in prison."
A good deal of sex-offender treatment occurs in prison, often using group therapy. The therapist and peers try to break down the denial that offenders typically show, says Fred Berlin, who has studied treatment of sex offenders for many years at Johns Hopkins University. "The group therapy component is intended to confront the denial and rationalization. We do what we call 'therapeutic confrontation' -- set up an environment where people can speak candidly, even though they're all struggling with an unacceptable craving for sex with children."
Denial can run deep, he says. "A pedophile, will say, 'I fondled this young boy, but he was clearly aroused, he seemed to be enjoying it.' I'd tell him you can't get into the young mind and see the confusion and the subsequent pain this will cause. When offenders experience a craving, that colors their perceptions, and they can't objectively see the consequences of their behavior."
Lifestyle changes can remove temptation, says Berlin. An offender must realize that "I don't want to work in a job where I'm in contact with children, or to live near a school."
Paul Knuckman, a clinical psychologist who counsels sex offender at a Michigan prison, says he looks for risk factors. "What are the issues associated with this offense? What's going on in the person's life at the time of the offense? What kind of stresses? Where did it happen? What made it a safe place to commit the offense? What are the victim's characteristics -- size, age, sex, availability?"
While stereotypes show pedophiles lurking in the bushes, Knuckman says the offender is often "the most functional adult in the child's arena. The child turns to the adult for attention, and the adult sexualizes the relationship, and often the child stays silent."
Not lurking in the bushes
Priests also carry great authority, Knuckman says. "If a priest says [sex] is okay, and the parents say the priest speaks for God, no matter how scared and confused the kid is, there's authority and reassurance."
While treatment based on psychoanalytic introspection is out of favor, Knuckman says it's still important to help offenders understand the roots of their problems. "I focus on teaching these men that the problem is greater than this particular contact with this victim. It has to do with how they manage their lives, how they meet their needs in addition to sex needs. For many of them, sexual contact with a child is a way to feel competent, powerful, that he has some control over his life."
On the pill
These days, castration is more likely to be done chemically, usually by injecting a slow-release drug to neutralize testosterone. "It lowers the whole sex drive, but if you're attracted only to children, not to adults, you will have to lead a celibate life anyway, so simply lowering the sex drive makes sense," says Berlin.
Although the drugs are expensive, and may produce dangerous side effects like severe weight gain or thinning of the bones, they give real relief to many offenders, Berlin adds. "I have prescribed testosterone reducers for more than 150 people, and only a handful were [compelled by a] court order."
Eliminating the sex drive may alter one's sexual identity, but that drastic treatment must be balanced against the reality of pedophilia, Berlin says. "It's a horrible condition to have, nobody would want to have it. These folks come to appreciate that they don't have to live in society constantly looking over their shoulder. For many, finding something that helps them be in control is good news, not bad."
How do we know treatments actually work?
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©2002, University of Wisconsin, Board of Regents.