~     Introduction to Chapter 7     ~

(pp 189 - 192)

"If the paedophiliac interest remains at the level of fantasy and therapeutic interventions do not appear to be effective in modifying them, one treatment option that remains is to help the patients to accept their fantasies -  so long as they  continue to be fulfilling to him and do not affect others. ... A last consideration might be to recommend those whose motivation for change is minimal to move to an environment, e.g. parts of Morocco and Turkey, where legal and social constraints against non-coercive paedophiliac practices are less extreme than in our own society."

 (Yaffe, 1981, p. 91)

 Beliefs about the value of therapy for paedophiles have changed markedly over the years. The traditional view from the classic writers on sex held paedophilia to be an intractable sexual orientation, unresponsive to treatment (e.g. Freud, 1905/1977; Krafft-Ebing, 1922). It has been suggested that this received wisdom led to the neglect of the treatment of paedophiles. During the second half of the twentieth century behavioural modification methods were developed and applied to sexual deviations. This was an era of greater optimism and new faith in the worth of therapy, justified or otherwise by facts. An important implication of these then new behaviour therapies was the de-emphasis on the past cause of the paedophilia in its treatment. Previously, psychoanalysis and related therapies assumed that the elimination of "symptoms" such as paedophilia required understanding of the individual's psychological history responsible for the problem; only by unraveling childhood experiences could a "cure" be effected. Treatment might last several years, with insight gradually unfolding about hidden childhood trauma.

Irrespective of the efficacy of such forms of treatment, they were characteristically expensive because they were carried out on a one­to-one basis with a therapist. Consequently, they were not commonly available to sex offenders. There are a few reports of significant instances of such psychotherapy with paedophiles. Freud, for example, describes the psychoanalysis of several patients who had been sexually victimized as children but apparently undertook no analyses of perpetrators themselves. 

This is remarkable given the vilification he ha received in the child abuse literature for putatively changing his mind about the role of sexual seduction in childhood by adults (and the consequent adult hysteria). Pressure from his colleagues pushed him towards the view that these seductions were merely fantasy (Froula, 1985: Masson, 1985). Such a denial of the sexual abuse of children has been construed as being partly responsible for the neglect of sexual abuse in clinical work during much of the twentieth century (Baartman, 1992, Bayer and Connors, 1988). Despite these claims, it is far from certain that Freud was actually convinced of the fantasy basis to seduction (Howitt, 1992); it has been claimed that Freus was sexually abused at the age of two (De Mause, 1976).

Family system therapy has some of the characteristics of the depth psychologies. Rather than seeing the issue lying in pathological childhood experiences, sexual abuse is hold to be the outcome of pathogenic family relationships. Responsibility is thereby spread among family members and treatment of the abuser requires treatment of the family.

In the 1960s, the depth therapies were being challenged in terms of their therapeutic assumptions and effectiveness. The major characteristic of the new behavioral therapy school was its characterization of "symptoms" as learnt behaviour, not the sign of fermenting psychological conflict. Psychological techniques that promoted the unlearning or inhibition of the behaviour ere sufficient. Psychological learning theory became a major theoretical domain in clinical psychology at this time and combined academic theory with therapeutic practicalities. 

This was held to be a powerful combination. Purely behavioural methods dipped somewhat in popularity as thought (cognition) was increasingly incorporated into psychological theories.  The most popular of modern  therapies for paedophiles are, indeed, described as cognitive behavioral in nature. This largely means that beliefs, self-justifications, myths about child victims, attitudes and other aspects of paedophiliac thinking will be tackled during therapy alongside the more purely behavioural strategies aimed at stopping offence-related behaviour

The "fly in the ointment" of behaviour therapy for the treatment of sexual deviations relates largely to ideological homophobic issues. Many of the early behaviour therapy treatments for paedophilia emerged from attempts to make homosexuals "normal" or, at least, stop "doing their thing". While this was ideologically unproblematic when it was socially acceptable and medically tenable to regard homosexuality as a "disease", time was running run out for such points of view just as behaviour therapy was gaining popularity. 

The increased rejection in professional circles of pathological conceptions of homosexuality created a climate inimical to behaviourist techniques. Giving a patient painful electric shocks if he showed signs of an erection to slides of naked men was at variance with the radical ethos of homosexuality as a psychologically healthy personal choice promoted by the Gay Movement from the late 1960s.

But Gay Liberation quickly disentangled itself from the paedophile groups with which it originally marched and protested. While attitudes to homosexuality changed, there was no corresponding change towards paedophilia among professionals. Consequently, paedophiles remained appropriate clients for behavioural modification techniques during the 1970s. The ideological basis of therapy for paedophilia, by and large, remained hostile and based on its elimination. A very small number of therapists have adopted a rather different stance much more supportive of the paedophile. Such approaches illustrate by contrast some of the moral, ethical and ideological implications of conventional treatment. They are described as support therapies.

As we will see, there is a degree of uncertainty about the effectiveness of even the best researched therapies for paedophiles. There are a number of reasons for this. Many of the therapies have not been subject to specific empirical  evaluation of any sort; some have been tried with only a few clients. Often the criteria of therapeutic success have fallen well short of evidence of a decline in recidivism in offending, obviously one of the most important criteria. Research that includes a control or an alternatively treated group is in the minority of the evaluations. With a situation like this, claims of therapeutic success may sometimes be wishful thinking on the part of the clinician, the client or both.

The overall effectiveness of therapy, though, is only one matter to raise about therapy. Equally important is what sorts of paedophiles succeed best in which sorts of therapy. Little attention has been addressed to these issues. Similarly, questions such as the risk factors predicting recidivism following treatment have hardly entered the frame.