Acceptance. A therapeutic relationship is the key to any treatment, so it is important to manifest unconditional positive regard for a person with pedophilia. Acknowledge that attraction to children is not the same as acting on it. Do not treat the client like a ticking time bomb. Work with the client’s view of pedophilia—whether as a sexual orientation, mental disorder, addiction, or obsession. Do not enforce your values on the client. Help the client accept their condition and recognize that the attraction is not likely to change, but assure him/her that acting on the attraction is not inevitable. Avoid anything that might increase feelings of guilt or shame.
Active listening. Rather than just giving advice, listen to what the client says and reflect what you heard. Similar to attending and includes brief verbals and reflection. Respond to body language and facial expression, and communicate acceptance of the person with voice tone, as well as body language.
Advice. Use sparingly and only when requested. Identify the problem and the client’s goal. Solicit possible solutions. Provide provisional options or strategies. Phrase as recommendations rather than demands. Base on comprehensive information of background, problems, goals, resources, beliefs, etc.
Assessment. Most non-offending pedophiles who seek treatment will self identify and share their gender and age of attraction. Actuarial Risk Assessment Instruments (such as the Abel and Stable) are not designed for non-offending pedophiles, since they are based on an index offense. The Sexual Abuse Risk Assessment (SARA) is being developed by the Association for Sexual Abuse Prevention (ASAP), and may be used to help the client identify risk factors that they have the power to change if they are at risk of offending. Appraise appropriateness of behaviors but do not assume that the client has offended or will inevitably offend. Evaluate fitness for group therapy. See diagnosis.
Aversion therapy. Although it does not change a person’s sexual orientation, some therapists still teach people with pedophilia to pair a bad odor (such as ammonia) with sexual fantasies involving children. Alternatives include thoughts of being arrested or snapping a rubber band on their wrist. Not recommended.
Belief. Encourage the client to believe in him/herself by believing in the client yourself. Irrespective of whether or not you believe in a higher power, encourage the client to utilize whatever spiritual support network they are comfortable with.
Blocking. Useful in group work. Prevent inappropriate activities of group member (gossiping, lengthy storytelling, breaking confidentiality).
Brief verbals. Communicate “I’m listening” with “mm-hmm,” “hmm,” “gotcha,” “okay,” “right,” “I get it,” “I see,” “go on,” or selectively repeating one of client’s key words.
Buffering. Include comments between questions so it does not seem like an interrogation. Avoid rapid-fire succession of questions.
Challenging. Mild confrontation. Specific and concise. Disagreement with client’s misinformation or misconceptions. Identify client’s contradictions or inconsistencies (facts, timelines, etc.) Tactfully request clarification. Phrase as “I’m not understanding ….”
Change-talk. Motivational Interviewing (MI) technique. Explore the problem (is it an addiction to pictures of children). Discuss disadvantages (and advantages) of status quo. Discuss advantages (and disadvantages) of change. Encourage optimism about change. Affirm intention to change. Elaborate, summarize, and affirm change-talk. Clarify ambivalence between values and behavior. Discuss desire, ability, reasons, need, and commitment to change. Examine past experiences. Plan commitment to change. Set positive treatment goals.
Checking in. Informal assessment of the counseling process to make sure the counselor and client are on the same page and headed in the same direction.
Clarification. Requesting more specific details or challenging client’s conflicting information. Unfamiliar language, vagueness, unclear storyline, etc.
Closed-ended questions. Limit use for specific information. If you do ask questions about child sexual abuse (CSA), they should be very specific. “Did you touch her genital area?” rather than, “Did you ever abuse a child?”
Cognitive restructuring. Cognitive distortions and thinking errors are common among people with pedophilia, as they are among other populations. Have the client reframe an alternative to what a child may be thinking when the pedophile thinks the child is coming on to them.
Confrontation. More robust challenge to client’s assertions. Avoid accusations. Can be therapeutic if specific, focused, and tentative. Challenge behavior, without labeling the person. Identify discrepancies or implausibility. Encourage response and reconciliation.
Countertransference. Guard against superimposing something from your own experience onto the client, especially if you are a survivor of CSA. Strong feelings (positive or negative) toward the client must be managed. Seek supervision/consultation.
Denial. Some clients may present for therapy under pressure of allegations of child sexual abuse which they deny or deny that they are even sexually attracted to children. Therapy can sometimes be effective in spite of denial.
Develop discrepancy. MI principle in working with stages of change. Contrast current behavior with goals and values to increase desire for change.
Diagnosis. Consider the benefits and downside of a formal diagnosis of Pedophilic Disorder. DSM-5 lists three criteria for a diagnosis, which requires acting on the attraction or being distressed by it.
Directing. Keep sessions on track while respecting client’s autonomy. Includes returning, resuming, and redirecting.
Disclosure. Make it safe to discuss difficult issues. If a client wants to talk about potential boundaries they may have violated, some therapists encourage them to phrase it hypothetically or as a dream. Maintain genuine positive regard and nonjudgmental stance. Allow rather than demand.
Empathy. MI principle. Understand the client’s feelings about their experience. Not sympathy or pity. Combine carefully with limited, generic self-disclosure. “I do understand what you are going through.” Honestly identify your own feelings. Avoid judgment and blame. Also includes enhancing client’s empathy for victims of CSA and client’s potential victims.
Evaluating. Group leadership skill. Are group process and dynamics working? Includes member feedback too.
Family support. Help client evaluate the strength of their family system, considering cautiously the possibility of “coming out” to select family members.
Focusing. Summarize multiple issues raised. Hone in on the most significant topic, limiting and prioritizing the number of issues to be processed at a given time. “Which would you like to concentrate on first?”
Furthering. Request additional details to encourage the client to continue the story to a deeper level. Preferably open-ended questions.
Generalizing. Tentative interpretation of patterns. Positive and negative trends. Cite specifics that lead to your conclusion. Avoid accusations. Encourage exploration and elaboration. Relate to therapeutic goals.
Goals. Collaborate with client to develop and pursue objectives in harmony with client’s wishes, values, and belief system. Should be substantial, legal, and ethical.
Guilt. Internal feeling that one’s emotions, lack of emotions, actions, inactions, or thoughts are unacceptable. Respect client’s value system. Some people with pedophilia seek to avoid masturbating to fantasies involving children, while others find that it helps them avoid acting out with a real child.
Informed consent. Inform client of local mandatory reporting laws and under what circumstances you would feel it necessary to report. Discuss the benefits and risks of therapy. Present therapy for non-offending pedophiles as developing and discuss the success of Prevention Project Dunkelfeld. Clarify client’s role and your role. Begins with initial interview and continues throughout.
Informing. Answering a direct question. Educational information relevant to therapy. Correcting misconceptions. Consider citing sources or expertise.
Initiating. Group work. Providing structure and direction. Refocusing on goals.
Interpreting. Tentatively giving your overall impression of a pattern in the client’s thoughts, feelings, and behaviors. Generalizing. Consider the cultural context.
Life skills training. Teach social skills emphasizing adult romantic and non-romantic relationships, as well as appropriate behavior with children. Model, role play, and demonstrate.
Linking. Connecting group members, encouraging them to talk to each other in the group. Interactional. Suggest client join Virtuous Pedophiles.
Matching. Match client’s volume, tempo, tone, and sophistication of vocabulary, but don’t be afraid to use accurate sexual words (such as masturbate instead of fap). Appropriate use of “neuro-linguistic programming.”
Medication options. Even if you don’t prescribe, you should inform the client about Selective Serotonin Reuptake Inhibitors (SSRIs) that help with depression and have a side effect of lowering libido. Provide a referral to a physician if needed.
Mindfulness. Method to cope with stress and undesirable feelings. Live in the moment by using all senses. Focus on a part of the body. Meditation. Yoga.
Modeling. Group work. Demonstrate desired behavior (risk taking, openness, directness, sensitivity, honesty, respect, enthusiasm). Co-leaders set norms.
Motivational Interviewing. Express empathy. Roll with resistance. Develop discrepancy (between wishes and what is). Support self-efficacy. Avoid argumentation. Uses change talk (benefits and hope of change, desire, ability, reasons, need, and commitment to change).
Nonverbal attending. Observe client’s behavior. Use eye contact, facial expressions, nods, body language, posture, and gestures to demonstrate active listening.
Normalizing. Destigmatize the attraction without giving approval to act on it. Avoid the words should or ought, right or wrong when discussing attraction. Assure client that many people have a similar experience. Use research statistics.
Open-ended questions. More than a “yes,” “no,” or one word answer. Make sure questioning doesn’t sound like an interrogation. Broadly prompt storytelling. May be phrased as a request.
Paraphrase. Reflection that restates in your own words what the client said. If you get it wrong, the client will correct you.
Plethysmograph. Volumetric or circumferencial test used to determine arousal patterns of offenders. Invasive and generally not appropriate for youth and non-offenders.
Polygraph. Test used forensically with offenders but is not recommended for non-offending pedophiles. Some therapists use it therapeutically to verify client honesty.
Prompting. Similar to furthering to encourage the client to advance the story, but consists of brief verbals or nonverbal cues. “Go on.” “And…?” Nod, curious expression, gesture, etc.
Questioning. Preferably open-ended. May be phrased as a request. Buffer so it’s not an interrogation. One at a time. Avoid accusatory questions. Avoid “why” questions. Avoid multiple-choice. Avoid biased questions. Phrase nonjudgmentally. Avoid implicit “right” answers.
Rapport. Developing and maintaining a trustworthy, therapeutic relationship with the client so you are working together toward a solution. Comfort, trust, and safety. “What is it like for you to come to therapy?” “How was this first session for you?” Explain how the counseling process works without mystery or surprises.
Redirecting. Bringing the session back when it gets too far off track.
Reflection. Paraphrasing is restating what the client said in your own words. Includes feelings. Make it tentative. Demonstrates attentiveness. Solicit corrections.
Reframing. Proposing an alternate positive interpretation of neutral or negative circumstances. Restating something the client has said about themselves with a more positive twist.
Relapse prevention. Typical technique for offenders often dealing with the cycle of abuse that is not applicable to non-offenders.
Repeating a question. Rephrase or re-ask when client does not comprehend, it is so complex the client was unable to retrieve the answer, the client dodges because they feel judged, or they dodge because it hurts (don’t push too hard or force an answer).
Respect. Unconditional positive regard and acceptance. Treat clients with dignity so that they will become worthy of it. Develops rapport in a therapeutic relationship. Recognize that therapy is an invasion of the client’s privacy. Honor client’s right to self-determination.
Resuming/Returning. Directing the session by picking up where it was previously left, either at the beginning or in reference to a salient point.
Reverse reflection. Respectfully requesting the client to restate what you said in their own words, to make sure the client really understood you.
Role-playing. Psychodrama. Practice precise behavior patterns. Diagnostic: act out and discuss a situation. Behavioral experiment: practice alternative behaviors. Role swap: experience the impact of your behavior. Acquisition of coping strategies: practice problem solving. Some therapists use a life-size child doll.
Roll with resistance. MI principle. Don’t fight it. See it as an indication of the need to change counseling approach. May be simple reflection, double-sided reflection, amplified (exaggerated) reflection, reframing, or agreeing with a twist.
Ruler. MI technique. “On a scale of 1 to 10, how confident are you about making this change?” Always ask why their confidence was not lower so they express strength toward change.
Safety plan. Have the client identify his or her vulnerable situations, and develop a plan to protect children from being harmed and the client from false accusations.
Self-control. Have the client identify a good habit they want to develop or a bad habit they want to break and help them develop self-control in any area of life. Discuss the effects of alcohol and other inhibition-reducing drugs.
Self-disclosure. Make sure you are comfortable sharing and that it is best for the client. Be authentic. Use sparingly. Avoid countertransference or working on your own issues. Remember therapy is about the client, not the counselor.
Silence. Clients should be allowed to talk twice as much as the counselor. Become comfortable with a short pause, especially when something very sensitive has been shared. Time to think (client/counselor). Introspection. Encourage client to take responsibility. “You can start anywhere.” “Take your time.” “What do you want me to know?” “You seem (feeling word).” Not for brief therapy, initial session, or crisis.
SOLER. Sit straight facing the client (or perhaps a slight angle with female clients.) Open posture; avoid crossing your arms or legs. Let hands rest naturally on lap. Lean forward occasionally but not in female client’s space and not continuously. Eye contact. Look directly at the client without staring at them continuously. Relaxed demeanor.
Specificity. When the client is too generalized, ask for more specific clarification. “Can you give me a few examples of what’s happening there?”
Suggesting. Group work. More than advice giving. Tentative ideas for thinking or acting. Moderate member suggestions.
Summarizing. Similar to reflection on a longer block of conversation or even several sessions. Use tentative language like “typically,” “usually,” “tend to,” “sounds like,” “seems that,” “there’s a history of,” rather than definitive language like “always” or “never.”
Support groups. Virtuous Pedophiles. 12-step programs (SA, SAA). Provides goal direction and positive social values from peers.
Support self-efficacy. MI principle. Don’t force change. Allow client to change at their own pace. Encourage client to engage in change-talk.
Supporting. Allow feelings to be therapeutic first. Crisis (suicidal ideation or potential arrest). Clients can be resilient.
Terminating. Progressively address feelings and thoughts about the finite nature of therapy. Duration may be based on limited number of sessions or adequate resolution of issues. Review progress. Recommend resources. Leave door open. Groups—ongoing or number of sessions, open/closed membership.
Transference. The client superimposes something from their past experience onto the therapist. Can be useful to help them deal with their issues.
Treatment plan. Individualized rather than one size fits all. Young pedophiles are very different from adults. Exclusive attraction is not the same as a secondary attraction. Clarify roles and expectations. Prioritize collaborative goal for each session. Group therapy and/or private sessions? Will there be homework or assignments?
Validation. Assure the client that his or her thoughts and feelings are appropriate for their unique situation and perspective. Acknowledge that it is difficult to ignore a sexual orientation. “Making friends with a child can be a lot easier than developing a relationship with an adult.”
Value judgments. Counselors are not to impose their values on clients, but clients should understand that you do not approve of any sexual interaction between an adult and a child.
Vocational training. Assess need. Develop work skills. Increase self-worth. Provide positive activities.
Pray the pedophilia away.
Spirituality can certainly be helpful in maintaining control of one's actions, but there is no evidence that prayer has ever changed a person's sexual orientation.
Although aversion therapy is still used by some mental health professionals to modify arousal patterns, ASAP does not support any attempt to change a person's sexual orientation.
Ticking time bombs.
Any approach that views pedophiles as monsters waiting to abuse a child will not be as effective in helping the person to not abuse a child.