Delphi recommendations for diagnosis and treatment of sexual interest in children in non-mandated community settings

We gathered insights from an international panel of experts to derive guidelines for best practice treatment of people with a sexual interest in children via a Delphi survey. This iterative method fosters consensus-building by a structured series of questionnaires combined with controlled feedback.

Visit The Journal of Sex Research to read the full publication.

The results of this process are presented below, where you will find those strategies and interventions that achieved consensus and that experts reached consensus on.

The following recommendations were generated from a diverse group of experts as part of a Delphi survey for clients with sexual interest in children who self-refer to treatment. The recommendations are for clients seeking treatment in non-mandated settings and are not intended for application to clients in forensic settings who are mandated to treatment.

It is also important to highlight that these are the recommendations that our experts generated/agreed on and do not necessarily represent the personal views of the research team or funders. Other recommendations that experts were divided on are presented and discussed in the peer-reviewed article.

 

Download the full document with recommendations

  • General Therapeutic Stance
    • The therapist should not automatically assume that the client is a danger to children just because the client reports a sexual attraction to children.

     

    • The therapist should create a safe, supportive, and non-shaming therapeutic environment, where the client can talk about their sexual attraction to children without fear of judgement.

     

    • The therapist should not treat the client differently than any other psychotherapy client.

     

    • The therapist should borrow concepts and treatment strategies that are used with other sexual minority populations (e.g., knowledge of sexual minority stress, challenging self-stigma and harmful myths).

     

    • The therapist should be upfront about any limits of privacy and confidentiality (depending on the laws of the country or region) and discuss with the client what type of information the therapist needs to disclose to third parties.

     

    • The therapist should be aware that having a sexual attraction to children in and of itself never needs to be reported.

     

    • The therapist should provide trauma-informed treatment.

     

    • The therapist should give the client an even greater sense of security and confidentiality than what is expected for other therapeutic clients. For instance, the clinical practice should be set up in a way that clients do not expect that others can infer the purpose of their visit by seeing them enter the building.

     

    • The therapist should focus on protective factors and strengths rather than risk factors and deficits.

     

    • The therapist should focus on the client’s courage in disclosing their sexual interest to the treatment provider after their disclosure.

     

    • The therapist should not assume that clients need help managing their sexual urges.
  • Assessment
    • During the initial assessment, the therapist should assess co-morbid mental health problems, such as mood disorders or substance disorders. This could include unstructured clinical interviewing and/or the use of standardized measures like BDI, SCL, MINI, etc.

     

    • During the initial assessment, the therapist should assess pre-existing medical conditions.

     

    • During the initial assessment, the therapist should screen for self-harm and suicidality (e.g., suicide ideation and previous suicide attempts).

     

    • During the initial assessment, the therapist should assess whether the reported sexual attraction may be due to other mental health problems, for example pedophilia-themed obsessive-compulsive disorder or neurological disorders rather than a genuine sexual attraction to children.

     

    • During the initial assessment, the therapist should explore the client’s own understanding of and feelings towards their sexual attraction.

     

    • During the initial assessment, the therapist should explore expectations with regards to treatment.

     

    • During the initial assessment, the therapist should assess treatment motivation.

     

    • During the initial assessment, the therapist should explore the sources of the client’s distress.

     

    • During the initial assessment, the therapist should conduct assessments related to the client’s self-concept and internalized negative societal attitudes about people who are sexually attracted to children.

     

    • During the initial assessment, the therapist should gather information about the client’s support system, including information about whether people in the client’s social network know about the sexual attraction to children.

     

    • During the initial assessment, the therapist should ask about the client’s knowledge of community resources and forums that are available and their use of such sources.
  • Harm Reduction
    • To reduce the risk of sexual offending, I would recommend the following approaches: focusing on the clients’ needs based on the Good Lives Model. This involves identifying the clients’ values and goals as well as means to achieve them through an offense-free lifestyle.

     

    • To reduce the risk of sexual offending, I would recommend the following approaches: exploring the client’s pro-social values and increasing the clients’ commitment to them. For instance, wanting to keep children safe can be an important reason to abstain from sexual acts with children.

     

    • To reduce the risk of sexual offending, I would recommend the following approaches: explaining the legal consequences of acting on sexual attraction with children or using child sexual exploitation materials.

     

    • The risk of sexual offending, I would recommend the following approaches: when discussing why sex with children is bad, it is helpful to approach the immorality of adult child sex with nuance and to avoid oversimplifying statements of harm (e.g., “Children will always be harmed by sexual contact with adults”).
  • Well-being, Self-Acceptance, and Stigma
    • To increase self-worth and well-being, I would recommend the following approaches: employing the same therapeutic arsenal that therapists use for other patient groups, i.e., ACT, CBT, DBT, brief solution-focused therapy, motivational interviewing, relaxation techniques, etc.

     

    • To increase self-worth and well-being, I would recommend the following approaches: increasing self-acceptance of sexual attraction to children.

     

    • To increase self-worth and well-being, I would recommend the following approaches: working with the client to reduce the fear of committing sexual offences against children in the case that the fear is unwarranted or due to the internalization of stigma.

     

    • To increase self-worth and well-being, I would recommend the following approaches: addressing if and how public stigma and/or the client’s feelings of attraction affect their well-being.

     

    • To increase self-worth and well-being, I would recommend the following approaches: assessing the client’s fears of detection and rejection, and to discuss whether they are realistic.

     

    • To increase self-worth and well-being, I would recommend the following approaches: finding adaptive ways of coping with stigma (e.g., social support) as opposed to nonadaptive ways of coping with stigma (e.g., substance abuse, social isolation).

     

    • To increase self-worth and well-being, I would recommend the following approaches: addressing goals, plans, and desires for the client’s future that they feel have been interrupted by dealing with their sexual attraction.
  • Alternative Sources of Sexual Gratification
    • In regard to discussions about sexual gratification, include discussion of legal ways to achieve sexual gratification, which does not involve children under the age of consent. Alternative ways to achieve sexual gratification can include the use of masturbation to sexual fantasies of children or the use of non-pornographic pictures of children (e.g., from a fashion magazine).

     

    • In regard to discussions about sexual gratification, changing or re-directing the sexual attraction to children is more likely to be helpful for people who are non-exclusively attracted to children.
  • Social Functioning and Disclosure
    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: for clients who experience grief at the prospect of never having a romantic partner treatment could focus on coming to terms with this or compensating for this loss in other areas of their life.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: working on grief at the prospect of never having a romantic partner is more important for clients who are exclusively sexually attracted to children.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: working on responses to utilize when others ask about the client’s romantic status.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: suggesting additional resources such as online support groups for people who are sexually attracted to children and do not offend.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: discussing that the client’s interpersonal problems or social fears (if applicable) might be a natural reaction to stigma.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: for clients who wish to disclose to their support network, focusing on strategies for coming out and coping with possible negative responses.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: not making non-exclusive patients feel that their attraction to adults is the only “legitimate” side of their attraction.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: helping clients find intimate conversations and understanding form other sources (e.g., friendships with adults), if romantic relationships with adults are unattainable.

     

    • To increase social functioning and/or work with disclosure, I would recommend the following approaches: establishing intimate relationships with adults should not be the only goal with non-exclusive clients.
  • Psychoeducation
    • Therapists should educate clients about the difference between having a sexual attraction to children and acting on it in ways that are illegal and/or harmful. This includes the information that persons attracted to children can choose not to act on those thoughts and feelings just as adults choose not to act on every adult to whom they feel attracted.

     

    • Therapists should educate clients that sexual attraction to children is unlikely to disappear and cannot be “cured” or wished away.

     

    • Therapists should educate clients that sexual attraction to children develops in a similar way to and has similar characteristics as other sexual interests (e.g., typically including romantic as well as sexual feelings).