It is not uncommon to read in the press or hear on the news that participants in networks linked to child pornography or cases where an adult subject has sexually abused minors have been arrested. Most of these subjects are pedophiles , people who are sexually attracted to minors.

Paedophilia is a serious problem known since ancient times that can have serious effects both on the paedophile himself and on his object of desire if he puts his fantasies into practice. Moreover, it is a problem classified as a mental disorder, and as such it is related to the intervention of psychology professionals. How do you intervene psychologically with pedophiles? Let’s start with the basics.

Brief pre-definition: what is pedophilia?

Pedophilia is a paraphilia, disorder of sexual inclination or of the choice of object in which the subject presents for at least six months a series of recurrent and persistent fantasies of a sexual type in which the object of his desire is pre-pubescent individuals, generally under thirteen years of age. These fantasies generate in the subject himself a high level of tension, discomfort or alteration of the usual functionality.

For a subject to be considered a pedophile, he must be at least sixteen years old and at least five years older than the pre-pubescent individual. It is important not to confuse pedophilia with pederasty , the former being the existence of sexual attraction towards minors while the latter indicates that actual sexual abuse has occurred. In other words, a pedophile does not have to take action: not all pedophiles are pedophiles (nor do all pedophiles have to be pedophiles, as there is sexual abuse of children for reasons other than sexual attraction).

Paedophiles are mostly middle-aged men , generally heterosexual, who tend to have links with the victims (family, neighbourhood or work) and who do not usually use violence to get close to their object of desire. However, there are also pedophiles (who statistically tend to prefer adolescents and children under three years of age), as well as pedophilia oriented towards children of the same sex.

Although it is considered a disorder, in most cases the subjects who suffer it are fully aware of their actions, enjoying freedom and willingness to carry out or not the sexual abuse. That is why most of them are criminally liable. In spite of this, there are exceptions in which other psychic alterations occur.

Types of pedophiles

There are many different types of pedophiles. Some experience deep discomfort and guilt because of the attraction they feel, while others consider it right and justify their actions and in some cases may even find themselves subjects with sadistic and psychopathic tendencies.

In some cases they have been sexually abused themselves in their childhood, while others have not. Sometimes the paedophile feels a romantic attraction towards the child in question, while in other cases it is a purely sexual interest.

When establishing a treatment, all these characteristics can greatly influence the strategies to be employed and their possible effectiveness.

Perspectives on the Treatment of Pedophilia

The treatment of pedophilia is a complex reality that throughout history has received different considerations and in which different techniques have been employed, acting both from psychology and medicine.

It must be taken into account that generally paedophiles come for consultation due to pressure from their environment or by court order , with few cases in which they do so of their own free will. This makes the treatment complex and there may be little adherence to it.

Medical treatments: pharmacology and surgery

Medical treatments for pedophilia can focus on two main groups: pharmacology and surgery. Many paedophile subjects who are afraid of sexually assaulting children or who do not want it to happen again ask for this type of intervention.

The use of pharmacology focuses on the control of sexual desire, reducing arousal, through hormonal regulation of individuals.

The two most commonly used elements historically have been cyproterone acetate, which blocks androgens and therefore reduces testosterone production, and medroxyprogesterone acetate , which decreases androgens and therefore testosterone production. Psychopharmaceuticals have also been used as tranquilizers and antipsychotics (especially haloperidol). Fluoxetine has also been used, but only causes clear improvements in subjects with compulsive characteristics.

As far as surgery is concerned, its use is controversial and risky, since it may lead to serious permanent impairment of the subject’s normal functioning, while its effectiveness is questionable, since even if the subject cannot have erections, abusive practices not involving the use of the gonads are possible. In this sense, either physical castration or removal of the nuclei of the ventromedial hypothalamus in the brain is used.

A big problem of this type of treatment is that at the bottom I do not know the basic problem, but its manifestations . In fact, even if there is no sexual desire, some subjects subjected to these interventions may continue to maintain different types of abuse.

Psychological treatments

The psychological treatment of the paedophile has to take into account, first of all, that one is in front of a patient regardless of whether or not he has committed sexual abuse. The professional who treats them must take into account that his attitude towards the individual can be decisive in time. It is a question of maintaining an attitude in which the subject is not judged and focused on obtaining his or her recovery.

It is essential that the treatment carried out is adapted to each case, since there is a great diversity of factors that can influence each person and cause the treatment to be more or less effective.

These treatments, which are carried out in the form of various programmes, must take into account not only the modification of sexual preferences but also the linking of the paedophile and the search for cognitive changes . The most commonly used paradigm in this type of case is the cognitive-behavioral one, although other approaches, such as the psychodynamic one, have also been used.

Addressing the problem

One of the first approaches to be considered is the development of positive linkages through social skills and empathy training . The use of cognitive restructuring and stress management training is recommended (since in some cases impulsive behaviours are linked to anxiety related impulses).

It is necessary to work on aspects such as the significance for the subject of the fixation by the minors, the existence of possible causal elements and their treatment if any. For example, if the victim suffered sexual abuse in childhood, work must be done to restructure the cognitions that such abuse may have provoked in the pedophile and make him see what the act may mean for his own victims.

The possible perceived ineffectiveness in maintaining relationships with adults may in some cases be one of the causes of the paedophile’s interest in minors. In this case too work can be done on the reinforcement of self-efficacy and on training in assertiveness and social skills.

In order to try to modify sexual behaviour, different alternatives and programmes have been proposed, and most of the techniques used are similar to those used in other paraphilias or to those used in cases of substance addiction. For example, contingency control is usually an element to be used, as well as assistance to support groups and group therapy in some cases.

It has been stated that a combination of pharmacological therapy together with psychological therapy is usually the most successful methodology.

Some techniques applied in the different programs

As we have seen, one of the main ways of dealing with a paraphilia from the cognitive-behavioral paradigm is the search for the development of positive attachments that allow the enhancement of sexual arousal in non-paraphiliac situations. In this sense, the analysis and modification of fantasies is usually used to carry out masturbatory reconditioning.

In the first case, the patient tries to detect and classify his sexual fantasies into normal and paraphilic , so that the subject tries to maintain the former when he practices onanism. The aim is to gradually make the subject more attracted to more habitual stimulations, such as contact with adults.

Masturbatory reconditioning consists of the subject masturbating several times in a row with non-paraphilic stimuli and indicating aloud the components of the fantasies that do include paraphilic elements. The aim is to associate the fixation by minors with the refractory period in which there is no excitation, so that little by little less activation is generated in front of the image of minors.

The paraphilic stimulus is then usually derotated. To do this, an attempt is made to alter the sequence of actions that lead the subject to become aroused by the idea of interacting sexually with a minor. Different strategies are designed in order to generate behaviours that are incompatible with each of the steps that may lead to such excitement.

Aversive techniques can also be applied such as covert aversion (in which the subject is asked or exposed to imagine situations that would stop him from acting) or olfactory (when the subject is excited by paraphilic stimuli, he is subjected to unpleasant smells so that the stimulus is associated with him instead of sexual excitement). Initially, electrical aversion was used, but nowadays it is not a common practice.

Prevention

Prevention is fundamental in order to prevent the paedophile from taking action or reoffending if he has already committed an act of paedophilia.

It is common for paedophiles to live in environments close to places with an abundance of children or to work in environments linked to childhood. This is not recommended, given that the subject is exposed to his object of desire and puts both the children and the individual himself at risk. It is not a question of isolating the subject, but of not facilitating access to minors during treatment.

Considerations

You have to keep in mind that treating a paraphilia like pedophilia is a complex and difficult challenge to achieve. In fact, part of the scientific community believes that pedophilia does not yet have a treatment that will allow it to be eliminated, based rather on modifying the behavior of pedophiles so that they do not commit any abuse. However, the treatment of symptoms alone would not address the underlying problem, thus recidivism is possible . Further research is therefore needed on this phenomenon and how to treat it effectively.

Another aspect to highlight is that there is a wide variety of cases with different characteristics: while some suffer and feel guilty for being pedophiles, others consider their acts legitimate or even hold the minor responsible for possible abuses. All these elements have to be taken into account and treated differently.

Finally, it is important to consider that, as indicated above, a pedophile does not have to be a pedophile. Not because he is attracted to minors he has committed or will commit abuse, and he has the right to be treated without being prejudged for something he has not done . However, if a psychologist or other professional does not feel qualified to work with a person with this disorder, he or she should refer the person for treatment by another professional.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Balbuena, F. (2014). Mapping paedophilia: effectiveness of treatments and future strategies. Psychology Notes, 32 (3). 245-250.
  • Salazar, M., Peralta, C., & Pastor, F.J. (2009). Treatise on Psychopharmacology (2nd Ed.). Madrid: Editorial Panamericana.
  • Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Román, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.