Pedophilia and the Metaframeworks 2010 In the first DSM published in 1952, sexual deviation was classified under “personality disorders,” specifically “sociopathic personality disturbance. ” In the DSM-IV-TR today, paraphilias are distinguished from Sexual Dysfunctions characterized by disturbance in sexual desire and the psychophysiology of the sexual response cycle. Paraphilia’s can be conceptualized as arousal patterns involving uncommon or unusual erotic appetites for a wide variety of behaviors with animate or inanimate “partners” (Gabbard). Within the context of the listed criteria [for paraphilia], it may be observed that the pathology residing in the Paraphilias is either that the partner is socially unacceptable (e. g. , corpses or animals) or that the behavior is unacceptable (e. g. , public exhibitionism) (Gabbard). As Pedophilia is classified under Paraphilias in the DSM-IV-TR, it is important to note the defining features of Paraphilias.

The DSM-IV- defines the features of a Paraphilia as recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other nonconsenting persons that occur over a period of at least six months. The DSM-IV-TR specifies for Pedophilia. The diagnosis is made if the person has acted on their pedophilic urges, or the urges or sexual fantasies cause marked distress or interpersonal difficulty (American Psychiatric Association: Diagnostic and Statistical Manual, Fourth Edition, Text Revision 2000).

The DSM IV marks nine categories for Pariphilias; Exhibitionism, Fetishism, Frotteurism, Pedophilia, Sexual Masochism, Sexual Sadism, Voyeurism, and Paraphilia Not Otherwise Specified. Although the observable behaviors are different for each of the Paraphilias, the qualitative mental experience of the paraphilia is it’s defining factor that gives name to the Paraphilias (Gabbard). This paper will focus on the Paraphilia pedophilia. Pedophilia is a diagnosis applicable to only a portion of individuals who sexually abuse children (Berlin, Fagan, Schmidt, & Wise, 2002).

Pedophiles are people, predominantly men, who demonstrate “intense” erotic interest in children. Their interest in children exceeds their interest in age-appropriate sexual (Beckstead et al. , 2004). The paraphilic focus of Pedophilia involves sexual activity with a prepubescent child (generally age 13 years or younger). The age of the individual with Pedophilia must be age 16 years, or older and at least 5 years older than the child.

For individuals in late adolescence with Pedophilia, no precise age difference is specified, and clinical judgment must be used; both the sexual maturity of the child and the age difference must be taken into account. Individuals with Pedophilia generally report an attraction to children of a particular range, and/or size. Some individuals prefer males, others females, and some are aroused by both sexes. Those attracted to females usually prefer 8-to10-year-olds, whereas those attracted to males usually prefer slightly older children.

Pedophilia involving female victims reported more often that Pedophilia involving male victims. Some individuals with pedophilia are sexually attracted only to children (Exclusive Type), whereas others are sometimes attracted to adults (Nonexclusive Type). As specified in the criteria, individuals with Pedophilia who act on their urges with children may limit their child to gentle touching and fondling of the child. Others, however, perform fellatio or cunnilingus on the child or penetrate the child’s vagina, mouth, or anus with fingers, foreign objects, or penis and use varying degrees of force to do so.

These activities are commonly explained with excuse or rationalizations that they have “educational value” for the child, that the child derives “sexual pleasure” from them, or that the child was “sexually provocative” – themes that are also common with pedophilic pornography. Because of the ego-syntonic nature of Pedophilia, meaning the pedophile believes his/her behaviors, values, feelings are acceptable to the needs and goals of their ego, many individuals with pedophilic fantasies, urges, or behaviors do not experience significant distress.

Those who do experience a sense of wrongness regarding the act may be referred to as ego-dystonic. It is important to understand that experiencing distress about having fantasies, urges, or behaviors is not necessary for a diagnosis of Pedophilia. Individuals who have a pedophilic arousal pattern and act on these fantasies and/or urges with a child qualify for the diagnosis of Pedophilia (American Psychiatric Association: Diagnostic and Statistical Manual, Fourth Edition, Text Revision 2000).

Pedophilic individuals may limit their activities to their own children, stepchildren, or relatives or may victimize children outside their families. Some individuals with Pedophilia threaten the child to prevent disclosure. Others, particularly those who frequently victimize children, develop complicated techniques for obtaining access to children, which may include winning the trust of a child’s mother, marrying a woman with an attractive child, trading children with other individuals with Pedophilia, or, in rare instances, taking in foster children from nonindustrialized countries or abducting children from strangers.

Except in cases in which the disorder is associated with Sexual Sadism, the person may be attentive to the child’s needs in order to gain the child’s affection, interest, and loyalty and to prevent the child from reporting the sexual activity. The disorder usually develops and shows symptoms in adolescence although some frequency of pedophilic behavior often fluctuates with psychosocial stress. The course is usually chronic, especially in those attracted to males.

The recidivism rate for individuals with Pedophilia involving a preference for males is roughly twice that for pedophiles who prefer females (American Psychiatric Association: Diagnostic and Statistical Manual, Fourth Edition, Text Revision 2000). The diagnostic criterion for Pedophilia includes recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child, or children (generally age 13 years or younger) for at least sex months. The pedophile has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

The person is at least 16 years and at least five years older than the child or children in Criterion A. This does not include an individual in late adolescence involved in an ongoing sexual relationship with a 12 or 13-year-old. The diagnostic criteria for Pedophilia include several specifications. It must be specified if the pedophile is: Sexually Attracted to Males, Sexually Attracted to Females, or Sexually Attracted to Both. It must be specified if the preference of the pedophile includes a range of attraction or is limited to incest.

Finally, the type of pedophile must be specified by the age of the individuals toward whom they are sexually attracted. The exclusive type is attracted only to children, while the nonexclusive type is attracted to age-appropriate partners in addition (American Psychiatric Association: Diagnostic and Statistical Manual, Fourth Edition, Text Revision 2000). Pedophiles diagnosed with the exclusive specifier need paraphilic imagery and/or behaviors to elicit erotic arousal. A completed sexual response cycle is “obligatorily dependent upon” the Paraphilia.

If the observed behavior appears to be consensual and age-appropriate intercourse without a sadistic component, the fantasy component must be present for the pedophile to reach orgasm. In the nonexclusive form, neither the fantasy nor the behavioral component must be present for sexual fulfillment (Gabbard). Clinicians and researchers may use typologies to gain greater understanding of correlations involved in Pedophilia. Dichotomous types, such as touching v non-touching, and/or seductive v aggressive are specifiers a clinician may use in addition to the specifiers offered in the DSM-IV-TR.

Further descriptors used by clinicians to categorize pedophiles include ego-dystonic or ego-syntonic. Ego-dystonic individuals are distressed by their paraphilic cravings, finding them to be in conflict with their personal sense of right and wrong. This is opposed to ego-dystonic individuals noted in the DSM -IV-TR. Beech and Kalmus report, “Attempting to treat individuals with ego-syntonic Paraphilias is akin to attempting to treat a substance abuser who denies having a problem (Beech & Kalmus, 2005).

Berlin et. al. , warn that such typologies and categories should be considered only suggestive of group differences, not as mutually exclusive. The current standard typologies suggested by the DSM-IV-TR were created in an effort to be descriptive without implying etiology (Alvin & Rivera, 1995). Berlin et. al. , report that researchers in a child sex offender program based in Seattle, Washington, have provided a qualitative study of the attitudes and modus operandi of men who have sexually abused children.

The men surveyed reported being attracted to a friendly, vulnerable child who would be easily persuaded, and would keep sexual abuse secret. The initial social contact with the child involved nonsexual interactions such as gifts and flattery. Sexual conversation followed. The pedophile attempts gradual progression beginning with nonsexual touch moving toward desensitization of the child for sexual touch. A sleeping child was often the victim of the touching. The offender would then use his adult authority to isolate the child and the “shared” behavior from family or peers.

The study reports physical threats were rare, but threats to the child’s sense of psychological security were common (Berlin et al. , 2002). The treatment of Pedophilia will be effective to the extent that it is comprehensive, specific in that the clinicians should identify and address the precise problematic sexual behaviors. Pedophilia is considered a chronic behavior. It may be treatable if the clinician and client are able to implement strategies for relapse prevention. According to Berlin et. al. “The aim of treatment for pedophilia is to stop abuse of children, to prevent its recurrence, and to help the patient control his deviant behavior, impulses and preoccupations. ” Clinicians must develop individualized formulations and treatment plans for each client, even though certain generalized principles are applied to treating the disorder (Berlin et al. , 2002). “Although there are exceptions, Paraphilias usually afflict males” (Gabbard). Pedophilia is widely viewed as a male dominated illness.

Gender is an important metaframework as it is present in each of the metaframeworks; Internal Family Systems, Sequences, Culture, Organization, and Development. The gender metaframework accounts for the need of balance and harmony of the genders to facilitate interpersonal growth. The feminist approach to gender evaluates the individual’s views of power and hierarchy necessary to work on with the pedophilic client. Reframing is widely used in the feminist approach as an attempt to influence the way the client constructs meaning about him/herself, their issue, and the process of therapy (Freund, 1967) (Schwartz, 2001).

A clinician working with a Pedophile should work with the client toward a transformation of the client beliefs from neutral to curious, expert to collaborator, apolitical to openly opposing imbalance. In therapy, the pedophile may view the therapist as replaceable if not serving his perceived needs. If the Pedophile feels that it is in his interest, he will attempt to change his paraphilic behaviors; but if he cannot be convinced that change is in his interest, he will not change for the sake of others or society’s (Costa et al. , 1991).

Therapy with paraphilics should take into account the essential narcissism and sense of entitlement, but continue to work with the client validating their experiences, exploring their beliefs and actions in detail. Sequences is another metaframework essential to the therapeutic process of a pedophile as it shows patterns of action and meaning. The clinician may recognize the repeating sequences to make predictions of future actions. Through sequences and perspectivism, certain patterns are highlighted over others based on the distinctions made by the clinician.

Clinicians may realize the constraints of their clients based on the recursivness and probability of the sequence. There are four classes of sequences: (1) S1 sequences are face to face sequences of brief action or interaction, (2) S2 sequences represent aspect of routine ranging from a day to a week, (3) S3 sequences represent the ebb and flow of action/reaction ranging from several weeks to a year, and (4) S4 sequences represent transgenerational sequences of events that occur from one generation to the next.

In assessing sequences the clinician may evaluate the events, beliefs and variables in the sequence as well as the degree of commitment of the client to hypothesize the client’s commitment to change (Schwartz, 2001). The goal of treatment within the sequence metaframework is to remove the client’s constraints through altering their action and meaning of their sequences. The clinician should create a plan for the order and manner in which the sequences are addressed. It is best to first work with S1 and S2 sequences as they may be embedded in an S3 or S4 sequence.

If the meaning and action of the S1 and/or S2 sequences are changed they may resolve the higher sequence’s constraints. Therapy may shift the beliefs of the paraphilic using the internal family systems, gender, and culture metaframeworks all the while tracking back and forth to make small shifts in each sequence. Working through sequences with the client may prove useful with regard to their fantasy life as it is known “not only an integral part of his sexual behavior, but is also a stable facet of general personality and cognitive style. The therapist should explore the core sexual fantasy. In the process of describing the core fantasy the central psychological issues are likely to emerge (Costa et al. , 1991). There must be an avenue developed to replace their adrenaline releasing activity. The group process, as recommended for treatment, allows a review of sequences. It allows therapeutic confrontation of denial and self-deception. Through therapeutic confrontation, an individual can be helped to appreciate the true ramifications of his actions.

The sequence of events that has led to any past sexual misconduct is identified. The pedophile is taught the changes necessary in their lifestyle to achieve and maintain control of the behaviors (Berlin et al. , 2002). It is only after it has seen that stopping paraphilic behavior is in his/her interest that other sequences can be addressed in (Costa et al. , 1991). It is important to note that any comorbid conditions, such as alcoholism and affective illness, also must be treated just as all levels of sequences must be addressed (Berlin et al. 2002). The developmental metaframework focuses on the human condition insofar as how the client handles, or has handled, the predictable stages of life separated by predictable transitions, such as birth, death, leaving home, ect. Societal expectations influence the development of the individual as well. Through “normal development” an individual has a sense of competence in social, relational, emotional, cognitive, and behavioral performance domains.

The constraints on “normal development” are products of extreme polarization, brought about through one’s anxiety and uncertainty Relational development enables one to carry on a relationship with continuity over an extended period of time. Relational development includes the six processes being attraction, liking, nurturing, coordinating meaning, setting rules, and metarules, as a relation fosters new demand. Group therapy can be utilized to provide emotional support, structure, and accountability to others which encourages “normal” relational development (Schwartz, 2001).

During psychosexual development, no one decides whether to be attracted to women, men, girls, or boys. Rather, individuals discover the types of persons they are sexually attracted to, ie. , their sexual orientation (Becker, Shoshani, & Shoshani, 2009). When the biology that constitutes sexual drive becomes misdirected toward children, it recurrently craves satiation. Treatment of developmental issues should address the constraints of the individual at four levels; the client’s Family Life Cycle (FLC), the individual, the biological development of the client, and the relational development of the client.

It is through the lack of support structure that the client develops constrains. At the FLC level the clinician helps transition the family, and individual, to the appropriate stage in the FLC. At the second level, regarding the individual, the clinician should work toward dampening the oscillation so the client acts age appropriately. The third level regards biological development. Here the clinician works to adjust the expectations of the individual to his/her potential. At the relational level the clinician assists the client in working with structure in their developmental process.

There will be greater distance felt in the therapeutic relationship. While helping a client work through their developmental constraints the clinician may use challenge as a tool. Hopefully, when challenged, the client’s homeostasis may shift to a morphogenic state, sending them into positive transition. One of the most frequently cited pedophilic behaviors is the individual’s experience of being a victim of sexual abuse. Childhood sexual abuse clearly stifles an individual’s development. It does not promote “normal development” as the child does not feel a sense of competence in the relational or social domain.

Early identification of the victims of sexual abuse is helpful. Children who have been sexually abused may display depression and aggressive behaviors, have an increased frequency of anxiety disorders, and have problems with age-appropriate sex roles and sexual functioning (Berlin et al. , 2002). A disproportionately high rate of childhood sexual abuse histories in nonexclusive male pedophiles was recoded in a study done by Cohen et. al. Sixty percent of nonexclusive pedophiles in the study reported experience of adult sexual advances as a child.

The proportion of pedophiles that reported a first sexual encounter at age 13 years or younger was 75%. Berlin et. al. cite inadequate attachment style rooted in a dysfunctional family to be a precondition for Pedophilia. A family without warmth would not nurture the individual, or challenge them to use their competence in any of the “normal development” domains; social, relational, emotional, cognitive, or behavioral. Therapy with a pedophile is at risk for premature termination. A paraphilic individual will not seek attachment to others, including the therapist.

Individuals with Paraphilias show a range of individual differences that may be useful in tailoring treatment to the individual (Costa et al. , 1991). Researchers have cited a range of traits and/or disorders of which the pedophile may suffer; comorbidity of Anxiety Disorder (especially interaction anxiety), a greater chance than normal to have Mental Retardation, negative affect, problems with interpersonal relations, low interpersonal warmth, self-seeking, rich fantasy life, preference of pleasure to being self-disciplined, Social Phobia, alcohol abuse, depression, drug abuse, Personality Disorder (i. . Avoidant, Antisocial, Paranoid, Narcissistic, Schizotypal, Schizoid), and/or Obsessive-Compulsive Disorder. Precipitating factors that may lead a pedophilie to offend may be an affective illness, or psychosocial stress. (Berlin et al. , 2002), (Blanchard et al. , 1999), (Hoyer, Kunst, & Schmidt, 2001), (Cohen, Frenda, Galynker, Grebchenko, & Steinfeld, 2008), . The therapist should not be deterred by the ego-syntonic pedophile, however, because there is typically sufficient general neurotic distress to motivate the man to engage in the work of therapy.

Developmentally, “The conflict most easily explored is often interpersonal relations” (Costa et al. , 1991). The therapist should work to make him/her aware of societal expectations and parameters imposed. Costa et. al. emphasizes the consequences of the client’s behaviors should be made abundantly clear to the paraphilic eg. incarceration, loss of spouse, family, ect. According to the literature researched for this topic paper, therapy works best if it consists of two aspects of treatment. Berlin et. at. ecommend treating Pedophilia with outpatient group therapy combined with antiandrogenic (sex-drive lowering) medications. A “common” treatment method is cognitive-behavioral therapy combined with group therapy, and, when appropriate, medications such as androgen-lowering agents that can act as sexual appetite suppressants (Berlin et al. , 2002). Serber notes shame aversion therapy coupled with an established appropriate alternative behavior as effective therapy for Pedophilia (Serber, 1970). Other treatment options include volitional impairment-medications (i. . Depo-Provera, Depo-Lupron, Triptorelin) that act as sexual appetite suppressants, and have proven helpful in augmenting volitional control of pedophilic attractions. A decline in testosterone is associated with a marked decrease in sexual drive, and the frequency of sexually motivated behaviors. Positively, although such medications suppress the intensity of libidinal drive, they can allow erectile function, making intercourse with an age-appropriate partner possible. Clinicians may also prescribe selective serotonin reuptake inhibitors (SSRI’s).

These drugs increase levels of serotonin lowering sexual drive. The primary goal of sex drive-lowering medications in Pedophilia is to enhance the capacity to exercise appropriate self control (Berlin et al. , 2002). In closing it is important to reiterate clinicians still know very little about how thoughts, perceptions, and behaviors acquire the capacity to act as stimuli capable of eliciting arousal for pedophiles. Even less is understood about how specific sexual arousal patterns develop, whether they are “normal” or “pathological” (Gabbard). Work Cited Alvin, P. , & Rivera, J. 1995). Sexual Pathology and Dangerousness From a Thematic Apperception Test Protocol. Professional Psychology: Research and Practice, 26(1), 72 - 77. American Psychiatric Association: Diagnostic and Statistical Manual, Fourth Edition, Text Revision (2000). (Fourth ed. ). Washington: American Psychiatric Association. Becker, M. , Shoshani, B. , & Shoshani, M. (2009). On Twisted Coalitions and Perverse - Narcissistic Configurations From Positivistic Oedipal Third to an Existential Relational Third: A Case Study. Psychoanalytic Psychology, 26(2), 134 - 157. Beckstead, L. , Blak, T. Blanchard, R. , Cantor, J. , Christensen, B. , Dickey, R. , et al. (2004). Intellegence, Memory, and Handedness in Pedophilia. Neuropsychology, 18(1), 3 - 14. Beech, A. , & Kalmus, E. (2005). Forensic Assessment of Sexual Interest: A Review Agression and Violent Behavior, 10, 193 - 217. Berlin, F. , Fagan, P. , Schmidt, C. , & Wise, T. (2002). Pedophilia. The Journal of the American Medical Association, 288(19), 2458 - 2465. Blanchard, R. , Choy, A. , Dickey, R. , Ferren, D. , Klassen, P. , Kuban, M. , et al. (1999). Pedophiles: Mental Retardation, Maternal Age, and Sexual Orientation.

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