van lessen, PhD (Cand.)
University of Utrecht
of Homosexuality 20, 1/2, 1990
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
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.
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
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;
reports a recidivism rate of 2.2% on a total of 3,186 sex offenders (Stürüp,
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,
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
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
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
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.
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
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
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.
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.
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
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.
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.
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
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 .
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.
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.
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 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.
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.
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
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.
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.
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 .
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.
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.
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
The emphasis of the counseling process has shifted from optimizing social
support towards the exploration of psychological function of pedophile
attraction and behavior.
The emphasis of the counseling process has shifted from optimizing social support towards the exploration of psychological function of pedophile attraction and behavior.
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A.X. van (1986)
V.L., C.M. Steinman, S.G. Bergerson & T.F. Holmes (1975)
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