Q&A: What Works in Sex-Offender Treatment

TIME speaks with Dr. Renee Sorrentino of Massachusetts' Institute for Sexual Wellness about sex-offender treatment and her work with pedophiles

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At least 300,000 cases of child sex abuse are reported in the U.S. each year — and the real number of children who are molested is likely far higher. But while laws get tougher all the time, very little is known about how to treat sex offenders in order to prevent these crimes.

Dr. Renee Sorrentino is medical director of the Institute for Sexual Wellness in Massachusetts and a clinical instructor in psychiatry at Harvard Medical School. TIME spoke with her about the research on sex-offender treatment and her work over the past 10 years with these difficult patients.

What do you think causes pedophilia?
There’s a theory that basically something is wrong neuroanatomically. There are some [ideas] that there’s something genetically determined. And there are some [theories] about imprinting, which is the idea that when you [reach] the age of sexual interest or awakening, if there’s a mismatch where you [see] something and masturbate to it, it can imprint to that, like with foot-fetish guys.

Were most offenders themselves sexually abused as children?
The majority of sex offenders do not have a history of child sexual abuse.

What percent of sex offenders are women?
It’s very small. I have maybe 10% women. They tend to be emotionally dysregulated, and if you treat the main problem, then the sexual problem tends to go away in those women.

Are all pedophiles compulsive about the behavior?
Pedophilia is just sexual orientation — it’s no different than saying someone is interested in adult women. It doesn’t say anything about the appetite, just says something about the object of interest.

A pedophile can commit a crime and not be compulsive. Or they can be very much preoccupied by the fantasy but might not even engage in it.

We’re trying to change the brain so there is less focus on [deviant] sexual behavior, not to affect the machinery.

Why did you decide to work with a group that is so stigmatized?
I’m a forensic psychiatrist and most of us specialize. I was interested in doing some part of psychiatry that was more evidence-based. I liked that there’s science to it.

We have three very effective treatments in psychiatry: electroconvulsive therapy for depression, clozapine for schizophrenia and the third is Lupron, which is a hormonal agent [used to treat sex offenders].

I was struck by how effective this medication was and how it had such a profound effect on individual lives. They’re able to live life without being preoccupied, they don’t have the craving anymore. They’re still interested in kids but don’t have to spend time thinking about it [or acting on it].

Is that the drug used for what’s known as “chemical castration?”
We’re not actually trying to cause sexual dysfunction. The idea is to change brain chemistry, not the physiology of reproduction and not to have impairment in getting an erection or performance, but to intervene in higher levels in the brain.

So the idea is to stop the deviant sexual behavior but not preclude consensual sex?
That’s the name of the game when you use Lupron … the idea is to give enough to [stop] the bad behavior and [deviant] thoughts but retain sexual function. That would be the best treatment for anyone with [some] normal sexual interests.

But aren’t pedophiles only attracted to children?
Most pedophiles have some interest in adults. We try to help them therapeutically with making relationships with adults. The hope is that Lupron will diminish sexual thoughts with kids but allow them to function, but it doesn’t always work like that.

What about offenders who are exclusively attracted to children?
In individuals that have no normal sexual interests or are at high risk of recidivism, we may forgo that, and they’re going to have sexual dysfunction.

Why would you even risk letting them have some sexual function?
This is what’s hard for people to understand. When you talk about treating sex offenders, you want to address risk factors. Pedophilia is a risk factor, but so is lack of intimacy or support. People who are not involved in relationships are also higher risk. Working on bolstering those things decreases recidivism.

It’s the same thing that happens with community notification. Some studies show that it can increase risk of recidivism. How it does that is because individuals unable to live anywhere become homeless or unemployed, which are two individual risk factors for recidivism.

(MORE: Understanding Psychopathic and Sadistic Minds)

What is the actual recidivism rate for sex offenders overall?
About 13%. If you show the data about criminal nonsexual offenders and compare, the rates for sex offenders are low, but people don’t tolerate any recidivism.

If Lupron works so well, why isn’t it used more often?
Most offenders don’t have the opportunity for pharmacological intervention for several reasons. Very few psychiatrists do this, so the opportunity doesn’t arise. And second, it’s a huge cost. Just the medication itself is $800 a month, never mind the monitoring. But if you look at cost of civil commitment annually, it’s certainly a cost saver.

Do you have people who take it without being mandated?
People are surprised when I tell them I have several patients who called me asking to be put on Lupron without any court [order]. Unfortunately, I often have to turn them down, which is a terrible thing. We have pedophiles who want treatment but can’t afford it.

Once guys learn about it from other patients, they’re very interested. What a majority of these guys are struggling with is how to live life with a sexual attraction that’s against the law. If you can tell them about something that can actually help, they’re pretty interested.

So, what does the evidence suggest should be done instead, in terms of talk therapy?
We have a model where the focus is on “Let’s help you live a healthy life.” You might have problems with relationships: let’s focus on other risk factors for [reoffending], like intimacy deficits or substance abuse. Don’t just focus on denial. You focus on them, not just on the sex disorder and the problem. The data is now showing that it is superior to the old relapse-prevention model, but only a minority of programs have incorporated that.

MORE: Registries Don’t Keep Sex Offenders From Restricted Areas

7 comments
ShellyStow
ShellyStow

For some reasons, comments are disappearing from this comment board.

It should be noted that:

Not all who have pedophilia have committed child abuse or molestation. Pedophilia is a condition, not an act. It is a medical, not a legal, term.

Many who have sexually abused a child are not pedophiles. Relatively few are.

ShellyStow
ShellyStow

I wonder why my comment was removed? Can anyone enlighten me? I did not violate any of the rules or procedures.

Baldur
Baldur

I appreciate the author's interest in going beyond the myths and discovering the truth about pedophilia, but she is still far too influenced by the bigotry and prejudice so common in western societies when it comes to this subject.


As a general rule, if a trait is severely harmful it limits itself to a vanishingly small fraction of the population - yet studies reveal that 20 to 30 percent of men find prepubescent girls AT LEAST as attractive as women, and over 90 percent of men have SOME sexual attraction to women. The percentages among women are unknown, but it is quite possible that the numbers are at least as high. Behavior that is considered suspicious and evil in men is considered healthy and good in women, which means that female pedophiles are less likely to attract attention.


Rind et al (1998) demonstrated a lack of psychological harm in consensual adult-child sex, a finding that was repeated with another study in 2005.  Susan Clancy's "The Trauma Myth" has demonstrated that such relationships are not perceived as traumatic by children at the time they happen - only afterwards, after people have told them they have been victimized.


There is every reason to believe that pedophilia is a healthy and normal part of humanity, present to various degrees in most of us, is probably related to nurturing behavior and may be linked to neoteny, self-domestication, and the rise of human intelligence.

Baldur
Baldur

Correction:  I meant to say that over 90 percent of men have SOME sexual attraction to PREPUBESCENT GIRLS.  Of course, it is also true that a similar percentage have some sexual attraction to women, as such attractions are not mutually exclusive - but the point is that most men (and women) have SOME degree of sexual attraction to children, even though it is significantly weaker than the attraction to adults for a majority.

ShellyStow
ShellyStow

Expanding on the points made by fl9826024, I do not feel that this article differentiates adequately between a "sex offender" and a "pedophile" or between a "pedophile" and a "sexual child abuser."

Pedophilia is rare, as stated by the other poster. The media and the general public use the term pedophile synonymously with sex offender. Pedophilia does not indicate an act. There are a significant number of pedophiles, officially diagnosed and not, who have never touched a child inappropriately and never will. 

And conversely, not all who sexually molest children are pedophiles; in fact, the greater percentage are not.

And finally, most instances of child sexual abuse in general are committed by family members or others close to the child, and, once exposed, these cases, especially the incest situations, have a much lower rate of repeat offense than the 13% stated in the article.

VirginiaHall
VirginiaHall

The writer alludes to, but does not explicitly state - that creating an underclass of people who can not find work, can not find a place to live, and are precluded from reintegrating into the community at all -- makes NO ONE safer.  Laws which continue to PUNISH ex offenders after they have "served their time" are counterproductive both in terms of public safety and from a treatment standpoint.

fl9826024
fl9826024

A salient factor not mentioned in this article is that the words "sex offender" consists of a broad scope of sex activity.  True pedophilia is very rare.  Many other offenders are hebophilias.  For instance, anyone who found Zach Efron or Miley Cyrus sexually arousing would fall into that category.   Many people on the sex offender registry are young adults who had sexual contact with their HS sweetheart who may be just three years younger.  Although the law states that that is child molestation, social science would state otherwise.  Accidentally downloading  underage  model pics such as Dorothy Stratten would constitute child porn and label you a pedophile.   The terminology is in severe need of redefining before we can have a dialogue.