In the 1950’s treatment was attempted with sex offenders, many of them pedophiles who preferred sex with boys more than having adult partners. Therapies then were more generic than nowadays, often consisting of psychoanalysis. There was no change in the sexual urges and it was felt that pedophiles couldn’t be treated. Some people mistakenly believe that now.
In the 1980’s there was growing concern what to do about the problem of child molesters, serial rapists, campus rape, risk prediction and similar issues. A variety of therapies were tried, some highly experimental. Many showed some benefit, some more than others. It was realized that these weren’t typical therapy clients and their therapy shouldn’t be routine. Sex offenders rarely refer themselves for help. They are often ashamed of their actions and feel remorseful. Others offend from anger, and feel no need to change their behaviors. Most often they are not in treatment voluntarily and they are pressured to discuss issues they would rather avoid.
We’ve learned that cognitive-behavioral therapies are effective. Specialized sex offender treatment programs typically provide a combination of individual therapy 2 to 4 times a month and weekly group therapy. Homework often is given in the form of assigned readings and writing one’s autobiography (or at least in regards to the sexual history and pattern of offenses). An essential component of treatment is the development of a relapse prevention or “community safety” plan. Plans often include a list of behaviors to be avoided, such as no unsupervised contact with minors, not going to the mall or public parks, not loitering near bars at closing time, no use of alcohol or drugs, no indulgence in deviant fantasies, and sometimes not viewing adult pornography. Some exceptions can be made as part of the treatment plan, such as having contact with their own children or using approved adult pornography to increase their interest in age appropriate sexual partners.
Much of this treatment is done on an outpatient basis, coordinated with supervision in the community by probation-parole officers. The programs are effective and the vast majority of such clients do not re-offend. Monitoring to ensure that alcohol and drugs are not being abused is routine. Visits to the home are conducted to verify compliance. Polygraph examinations are becoming more common. These are used to verify that the client is following all conditions of release to the community; that they have told the truth about their sexual and offense histories, and any other concern specific to the client.
Many clients take medications as part of treatment. Antidepressants can address real emotional issues, and they have the (in this case beneficial) side effect of lowering libido, or sex drive. Anti-anxiety drugs can address some of the underlying imbalances that contributed to the offenses. Anti-obsessional meds can reduce thoughts of sex. Anti-androgens (chemical castration) such as depo-provera, can eliminate the ability to achieve erections.
Some programs use aversive conditioning. This consists of having the client think of a deviant scenario and when they start to become aroused a noxious odor (such as ammonia or rotting meat) is puffed up their noses. They begin to associate the fantasy with an unpleasant outcome. Sometimes covert conditioning is used. This technique has the client imagine a deviant scenario and when they start to become aroused the fantasy is switched to an unpleasant one, such as remembering their arrest. There are many other types of therapies used, but less often that the ones I listed.