part0037

Another change is the emergence of Virtuous Pedophiles ( https://www.virped.org ) as a peer support and information site for self-identified pedophilic and hebephilic individuals who are committed to avoiding sexual offending. Although small, with less than 1,500 members according to an interview with one of its founders in 2015, several hundred members actively post. Other online forums for self-identified individuals include individuals who support or condone sexual contacts with children. Another advocacy group, B4U-ACT ( www.b4uact.org/about-us/our-mission ), has not explicitly taken an official position against adult–child sex, instead identifying its mission as one of education, advocacy, and linking individuals with mental health professionals.

A third major change is the amount of public and media attention to the plight of nonoffending pedophilic and hebephilic persons, with stories about Virtuous Pedophiles and celibate individuals with pedophilia in sources such as Salon , Vocativ, CBC, Daily Mail , and New York Magazine . The high-water mark was set by the public response to the Help Wanted story on NPR’s “This American Life” (Malone, 2014a) with an accompanying Medium piece by Malone (2014b). There is now a Help Wanted project out of Moore Center for the Prevention of Child Sexual Abuse, founded in 2012 ( http://www.jhsph.edu/research/centers-and-institutes/moore-center-for-the-prevention-of-child-sexual-abuse ; disclosure: I’m on the Moore Center’s Scientific Advisory Board.)

Prevention must be part of a comprehensive solution for the problem of sexual offending against children. In addition to treatment or legal interventions, we as a society can also try to reduce child sexual abuse by investing in primary and secondary prevention programs (see Wortley & Smallbone, 2006). Primary prevention refers to programs that are provided to (a) children in general, such as school-based education campaigns about sexual abuse (typically within a broader curriculum of sex education) and strategies to avoid risky situations or disclose sexual abuse if it occurs, and (b) adults in general, including education about how to identify suspicious behaviors or situations, intervene as a bystander, and to support children who disclose (e.g., the Darkness To Light campaign; see https://www.d2l.org ). Adult-focused interventions are usually directed toward parents, but I believe that all adults have a moral responsibility to protect children (e.g., Wurtele, Currier, Gillispie, & Franklin, 1991).

Earlier meta-analytic reviews concluded that school-based programs increase knowledge about sexual abuse and protection strategies, both on posttest and upon follow-up (Davis & Gidycz, 2000; Rispens, Aleman, & Goudena, 1997). Moreover, one study suggested that participation in school-based programs is associated with a lower occurrence of sexual abuse later in life; Gibson and Leitenberg (2000) surveyed a sample of college-aged women and found that those who had participated in school-based sexual abuse prevention programs were less likely to have been sexually abused later in life than those who did not. Although participants and nonparticipants were not randomly assigned to conditions, programs were implemented on a schoolwide basis, with no a priori reason to believe that children at some schools differed substantially in risk from children at other schools, that administrative decisions to introduce prevention programs was informed by the risk of children at particular schools, or that administrative decisions to introduce prevention programs was associated with knowledge of the risk of children at particular schools.

Unfortunately, a more recent meta-analysis by Topping and Barron (2009) highlighted methodological limitations in this area, including a common lack of control or comparison conditions, lack of evidence regarding implementation fidelity, limited evidence regarding maintenance of gains in knowledge, and limited follow-up information on disclosure or sexual abuse prevention. Topping and Barron also discussed anecdotal evidence regarding negative effects, such as anxiety, fear of strangers, and wariness about touch; however, these unintended effects were mild and transient. Primary prevention of sexual abuse through school-based interventions is challenging because of the tremendous reluctance to acknowledge the problem—from parents, administrators, and teachers—or even talk about sex with children, and because of insufficient evidence about what would make an effective intervention.

Secondary prevention programs focus on at-risk individuals, which could include persons who are likely to develop pedophilia, pedophilic individuals who have not yet had sexual contact with children, and children who are vulnerable to sexual exploitation or abuse because of their personal characteristics or circumstances. One example is the education campaigns conducted by Stop It Now!, an American nonprofit organization that uses social marketing strategies to (a) reach individuals who are at risk of committing sexual offenses against children and convince them to seek treatment and (b) encourage nonoffending adults to intervene if they suspect child sexual abuse may be occurring or might occur.

Another innovative example of secondary prevention is the aforementioned Dunkelfeld Project, which recruits pedophilic and hebephilic individuals to participate in treatment designed to help them refrain from engaging in sexual behavior involving children (see Figure 9.1 ). The project is unique, benefiting from foundation and government support and no mandatory reporting requirement that would inhibit undetected individuals who have committed sexual offenses against children from coming forward (see Mandatory Reporting section below). The Dunkelfeld Project involved a 1-year cognitive behavioral program and sex-drive reducing medication for some treatment clients.

Beier et al. (2009) reported on the first data from the Berlin site: 286 individuals completed the telephone screening, representing 60% of those who contacted the Project. Of the screened respondents, 58% reported a sexual preference for prepubescent children and 28% for pubescent children. Schaefer et al. (2010) found that more than half of the Project participants had committed sexual offenses against children, with an average of 3.2 victims each. Neutze, Seto, Schaefer, Mundt, and Beier (2011) analyzed clinical assessment data from 155 Project participants. Here, 70% reported pedophilic sexual interests, almost half directed toward boys, and the other 30% reported hebephilic sexual interests. Most (90%) were significantly distressed by their sexual attraction to children, and all were seen as having some impairment in their functioning (e.g., interpersonal relationships). Of the 155 cases, 137 responded to questions about lifetime sexual offense history: 69% admitted to prior sexual offenses against children (mostly contact but also exhibitionism and sexual interactions involving talk or sharing of pornography) and 67% admitted to prior child pornography offenses. All the participants reported on the past 6 months: 26% reported no sexual offenses; 41% reported child pornography offending only; and 33% reported sexual offenses against children. The Dunkelfeld Project has since received government funding to expand across Germany, and Beier et al. (2016) recently announced a pilot project in Berlin for juveniles concerned about their sexual interest in children.

The Dunkelfeld Project addresses two gaps in the current responses to sexual offending against children. First, it tries to reach men who have committed sexual offenses involving children but have not been investigated by police or child welfare agencies, which may not be possible under current legislation in countries such as Canada and the United States because of mandatory reporting requirements. Men who were facing legal proceedings because of sexual offending were excluded from the program. Second, similar to Stop It Now!, the Berlin project tries to reach pedophilic and hebephilic individuals who are motivated to abstain from sexual offenses against children. Some of these men would likely be able to do this on their own, given they been successful so far without formal assistance, but others might fail at a future date. The Berlin program has run several treatment groups and is currently collecting self-reported outcome data. Unfortunately, plans to conduct a randomized clinical trial of the Dunkelfeld program did not come to fruition because of practical obstacles.

The croga.org site is also a secondary prevention effort, directed toward online child pornography offenders with education and self-help content. This website has been updated and is now operated by the Lucy Faithfull Foundation in the United Kingdom (they also run Stop It Now! UK: http://get-help.stopitnow.org.uk ; see also A. Brown et al., 2014). While I was editing this book in October 2017, the Dunkelfeld Project announced a new website for individuals concerned about their sexual interest in children, adapting the Dunkelfeld treatment program for anonymous online education and self-help ( https://troubled-desire.com ). In both cases, the developers recognized that online options are more scalable than in-person treatment and would reach individuals who might otherwise not seek help. My hope is that these online options can be evaluated, given data from self-quizzes and the option to capture online metrics, such as number of visits and engagement.

I have already mentioned that one of the distinctive features of the Dunkelfeld Project is that clinicians are not legally obliged to report suspected child abuse. Many other countries have mandatory reporting laws, designed to encourage the identification of abused children and subsequent action to protect them. These laws vary in coverage and obligation, but the common theme is that a designated group of individuals (e.g., child-serving professionals) are required to report suspected child abuse, including physical abuse, sexual abuse, emotional abuse, and neglect. In Canada, the obligation covers all members of the public but especially professionals who work with children, including health care professionals, teachers, social workers, and child and youth service providers. The legal obligation to report supersedes the professional obligation and tradition of confidentiality, where it is usually understood that what is revealed in assessment or treatment is not shared with others without express consent.

The goal of mandatory reporting—to protect children—is laudable, but there can be confusion about the scope of the mandatory reporting obligation, both among designated reporters and among the public, and this confusion can have unintended consequences. Many individuals concerned about their sexual interest in children may be reluctant to seek help because they worry that the clinician might be obliged to report them to authorities, breaching confidentiality. For example, the clinician may believe the obligation is triggered because the client lives or works with children or because the client discloses sexual behavior involving children. It is unknown what the net results are: Is the potential benefit of protecting children by mandatory reporting greater than the potential benefit of providing treatment and support to individuals to prevent sexual abuse of children?

It is also unclear what mandatory reporting policies are best. In their analysis of data from 44 states in the United States, Steen and Duran (2014) found that whether reporting system structures were centralized or decentralized had an impact on aspects of entry into the child protection system (maltreatment referral rate, percentage of referrals screened in for investigation, the screened-in report rate, the substantiated report rate) but that reporting policies did not. On the other hand, Mathews, Lee, and Norman (2016) looked at trends over a 7-year period following the introduction of a mandatory child sexual abuse reporting law in western Australia and found an increase in the number of reports and a doubling of the number of substantiated reports, suggesting more sexually abused children were being identified. Krase and Delong-Hamilton (2015) found no difference in the rate of reporting or in reporting outcomes between states that designate certain professionals have the obligation to report and states with a universal obligation that includes all members of the public.

My view is that individuals who self-identify as having sexual interests in children and self-refer for services should not trigger mandatory reporting unless they admit to sexual offenses against identifiable children or admit that they are concerned about their risk to sexually offend against children in their orbit. Consistent with the motivation–facilitation model, the simple fact that they are sexually interested in children is not in and of itself a sufficient factor without antisociality (which is expected to be lower for those who self-refer) and opportunity. For the treatment provider, meaningful treatment can occur without talking in detail about previously undetected sexual offending. A good example involves individuals who self-refer because they are concerned about their child pornography use. As noted in Chapters 3 and 7 , child pornography offenders without any evidence of contact sexual offending are very unlikely to commit contact offenses in the future, but they could potentially benefit from support and counseling.

The core rationale of situational crime prevention is that potential perpetrators are influenced by the perceived benefits and risks of crime. Cornish and Clarke (2003) identified crime prevention techniques that influence these perceptions, by increasing the effort involved, increasing the potential risks, reducing the potential rewards, reducing situational provocations or triggers, and removing justifications or excuses. For example, school-based sexual abuse prevention programs can increase the effort involved and increase the potential risks of sexual offending by teaching children what constitutes acceptable and unacceptable touching and how to disclose their discomfort to trusted adults. As another example, shifting public attitudes so that adults who are suspicious that a sexual offense might have occurred are more willing to talk to the children they are concerned about could increase disclosure and early intervention.

Leclerc, Smallbone, and Wortley (2015) looked at the reports of 87 men convicted of sexual offenses against a minor under the age of 16 regarding their first, second, and most recent offense (if applicable). The authors were interested in the impact of a potential guardian (another adult) on sexual offending. The presence of a guardian did not prevent sexual offenses, which was not a surprise because the questions were asked about offenses, rather than failed attempts or situations where the person was tempted to offend but did not act. However, even for offenses, the presence of a potential guardian reduced the duration of offending and reduced the likelihood that penetration occurred, suggesting that prevention efforts to reduce unmonitored access to children by identified offenders or at-risk individuals can have a positive impact. In another study, McKillop, Brown, Wortley, and Smallbone, (2015) also showed an effect of guardian presence on duration and intrusiveness of offending; guardians were present two thirds of the time. Sexual offenses were most likely in the afternoon and evening, reflecting opportunities outside of school. Older child victims were more likely to be offended against by an unrelated perpetrator and to be offended against later in the day.

The Thorn Foundation ( https://www.wearethorn.org ) is a nonprofit organization in the United States, cofounded by celebrities Ashton Kutcher and Demi Moore, with a special emphasis on technological solutions to online sexual offending (disclosure: I am Thorn’s pro bono scientific advisor). I consider some of this work to be secondary prevention because it is directed at individuals who are already involved with or curious about online child pornography. This is done by directing messages to individuals who search for child pornography online, disrupting their illusion of anonymity and encouraging them to seek confidential help. Some of Thorn’s work is also relevant to situational crime prevention, because of projects they are involved with that make it more difficult to share known child pornography images, through a cloud-based photo hash sharing platform (PhotoDNA) that enables online technology companies to scan for known child pornography images against a database maintained by the National Center for Missing and Exploited Children. It is important to note that the hash checking can be done automatically, quickly and efficiently flagging potentially illegal content for human action. I am particularly keen on the scalability of online technologies such as PhotoDNA for blocking and flagging attempts to share known child pornography images online. Algorithms could also be developed to flag sexual communications between adult and minor users for analysis by human agents, to confirm whether the communications violate terms of service.

I suspect that stigma is a major prevention obstacle because individuals with pedophilia or hebephilia are among the most reviled members of communities, making it even more difficult to self-identify or to seek help (Jahnke & Hoyer, 2013). Many people assume that most, if not all, individuals with pedophilia or hebephilia have sexually offended against children. Jahnke, Imhoff, and Hoyer (2015) conducted two studies examining the stigmatization of pedophilic individuals. In the first study, 854 adults were approached in two German cities to participate in a brief street survey about stereotypes, emotions (fear, anger, pity) and social distance for people who abused alcohol and then for persons with a “dominant sexual interest in children,” specifying in both conditions that the person had not violated any laws. Participants demonstrated greater stigma for persons with pedophilia; for example, 84% expressed anger toward persons with pedophilia versus 41% for those who abused alcohol, and 14% thought persons with pedophilia were better off dead versus 3% for those who abused alcohol. People who abused alcohol were seen as having more control, although both groups were seen as dangerous to children. Study 2 replicated these results using an Amazon Mechanical Turk sample of 201 participants, this time comparing opinions about those with a dominant sexual interest in children to sexually sadistic persons and antisocial persons, countering the idea that the stigma associated with pedophilia might be more generally associated with sexuality or suspected criminality.

The stigma facing individuals with pedophilia or hebephilia has big implications for the potential scope and uptake of prevention and early intervention programs such as the Dunkelfeld Project and Stop It Now! Stigma is related to stress and can increase distress and psychopathology, to the point of meeting the criteria from the Diagnostic and Statistical Manual of Mental Disorders (fifth ed.; American Psychiatric Association, 2013) for pedophilic disorder (rather than simply being ascertained to have pedophilia). At the same time, stigma may prevent many individuals from seeking help, thereby unintentionally increasing the likelihood that some individuals will act on their sexual interests and commit sexual offenses.

What can be done about stigma, given it affects the climate in which public policies are enacted and it can shape the availability and quality of services to help those seeking assistance? Jahnke, Philipp, and Hoyer (2015) looked at the results of a brief, 10-min online video intervention comparing 137 psychotherapists-in-training randomly assigned to the intervention and a comparison video about violence-free parenting. The intervention had a significant impact on the trainees’ ratings of perceived controllability, dangerousness, anger, pity, and social distance, suggesting education could be helpful.

Reflecting social norms, minority stress, and stigma, 12 of the 15 respondents in Houtepen, Sijtsema, and Bogaerts (2016) reported struggling with their sexual attraction to children in some way, referring to the very negative public climate. Only one participant reported having positive feelings, noting that he recognized it was wrong but adding that he “had always liked going against the rules.” Thirteen sought help from others including friends or like-minded peers, with six seeking a mental health professional. Unfortunately, three of the six thought this professional contact was not helpful because of a lack of clinical knowledge about pedophilia; the other three thought it helped them disclose and accept their sexual feelings. One other thought it would not be helpful so did not try, and two decided against it because they worried about stigma.

Three participants sought peer support, which they said they found helpful because the peers understood them, did not judge them, and served as role models for disclosing to people they were close to and for refraining from acting. This suggests that peer support sites, such as Virtuous Pedophiles, could be a useful part of the response to pedophilia and to sexual offending against children. Contrast this with 11 respondents who confided in a nonpedophilic person. Some of the participants acknowledged they did this on purpose to have a more effective guardian to help them refrain from offending; one can therefore imagine the other person was a partner, family member, or close friend, although Houtepen et al. (2016) did not say. Two participants had never disclosed their sexual attraction to children to anyone, one believed he would be rejected, and the other was unrepentant, saying he had multiple “romantic” relationships with children in the past and so he would not want to disclose to put himself at risk.

Stigma was mentioned in Chapter 3 as one of the big reasons that little is known about unidentified persons with pedophilia who are not known to the clinical or criminal justice systems. Thus, researchers do not know what factors help or hinder persons with pedophilia from acting on their sexual interests in children. Even if one has little or no sympathy for the affected individual, remember that this attitude can put children at risk because the stress of being a sexual minority can exacerbate factors known to be associated with risk of sexual offending, including emotional dysregulation and social–interpersonal problems (recall the dynamic risk factors on the Stable-2000/2007). Researchers do not know if this is true for paraphilic individuals as well, but evidence strongly suggests the importance of sexual minority stress among nonheterosexually oriented persons (whether they identify as bisexual, gay, lesbian) (Hatzenbuehler, 2009). If we can agree that children could be protected from sexual exploitation and abuse, then we have a strong reason to deal with our anger, fear, and prejudices regarding pedophilia and hebephilia.

There are some glimmers of hope that stigma can shift, with predominantly positive reactions to media stories, such as Luke Malone’s (2014a, 2014b) “Help Wanted” story ( This American Life and Medium ). To illustrate, Theaker (2015) conducted a content analysis of Facebook comments to posts about the Luke Malone piece on the This American Life Facebook page, examining a set of 711 comments for four posts to the page in 2014 (April 11, 13, 21, and August 11). She determined that the majority of comments (58%) were mostly positive, 23% were mostly negative, 14% were mixed, and 5% of comments could not be categorized.

One can also look at the results of a B4U-ACT (2011b) Spring 2011 survey regarding 193 respondents’ (98% male) interest in seeking professional help and perceived stigma. Of the 159 respondents who answered a question about wanting mental health care related to their attraction to boys or girls but who did not receive it, 40% said yes. Concerns included stigma, professional demeanor, or knowledge (e.g., 88% disagreed with a statement that mental health professionals have a good understanding of attraction to minors; 54% did not think they would be treated with respect; 62% did not think they would be treated nonjudgmentally), and incompatibility between personal goals (e.g., becoming more comfortable with sexual attraction) and professional/social goals (focused on not acting, protection of children). Referring to confusion about the impact of mandatory reporting obligations, 51% did not think they would be treated with confidentiality. In discussing what informed the above, the majority of respondents said they were influenced by social attitudes, statements or articles they had read by mental health professionals, and their own or like-minded peers’ experiences with mental health care. This highlights the collective responsibility in how mental health professionals and researchers write and talk about pedophilia and hebephilia.

B4U-ACT conducted another survey in summer 2011, with 209 respondents asked about their interactions with mental health professionals. In this sample, 58% said they had wanted to see a professional but did not do so. Of the 120 respondents who responded about their goals, the most common goal (73%) was to “figure out how to live in society with this attraction,” followed by dealing with society’s negative responses (68%), understanding the cause of the attraction (52%), and dealing with sexual frustration (51%). Only 32% wanted to learn how to control their sexual feelings; 27% wanted help to extinguish or reduce the attraction to boys or girls; and 23% wanted to develop or increase an attraction to adults. This is an interesting finding because it may point to either confidence among these respondents in their ability to manage their sexual attraction or this not being an important goal for respondents (no questions in the survey asked about behavior or intention or wish to act). It is also points out that what a potential client might want may not match what professionals or the public think should be the goals of therapy. It is notable, but not surprising, that professionals were more concerned about potential risk to children than the respondents and were less concerned than the respondents about self-concept, dealing with stigma, and figuring out how to live with their attraction to children.

The most common reasons given for not seeing a mental health professional were fear of a negative reaction by the professional (78%) and fear of being reported to police (78%) or to family, employer, or others (68%). Other common reasons were uncertainty about how to find someone (54%) and concern the professional would not be knowledgeable (43%). About half of the respondents reported negative consequences of not getting help, the most common reasons being depression (19%), low self-esteem (12%), suicidal thoughts/attempts (10%), and loneliness/social withdrawal (10%). One quarter of respondents participated in treatment voluntarily (which could include pressure from family or others), and 10% participated involuntarily (presumably because of legal action, although that was not specified). The opportunity for education and outreach here, both to the public and to professionals, is clear and could have a high impact.

The range of options for pedophilic individuals who are not involved with the criminal justice system is much narrower than for those identified because of sexual offenses and depends on their volition. The client and persons close to him (spouse, family members, close friends) should be educated about pedophilia and the potential risk to children. This kind of clear and open communication is likely to be challenging, given the strong, negative reactions that persons with pedophilia face in society (Jahnke & Hoyer, 2013; Jenkins, 1998), but the support and monitoring that can be provided by these persons could be very helpful in preventing future sexual offenses against children (recall the Circles of Support and Accountability model). An important prevention component would teach bystanders to intervene and target situational factors that increase the risk of sexual offending (situational crime prevention): effective parental supervision, guardianship of responsible adults, and school-based education for children, especially vulnerable children.