Assessment Problems
(1) Psychological constructs are difficult to measure
especially those involving sexual behaviour
- Constraints on measurement because:
(i) The legitimate right of the individual to keep
much of their sexual fantasy/behaviour private
(ii) ethical considerations (i.e., studying the
development of sexual fantasies in children)
(iii) Sexual activity occurs in private (i.e., fantasies)
or semi-private (most sexual behaviour)
(2) Individuals present misinformation about their
sexual activity if it is socially stigmatized
- some have suggested that paraphiles are particularly
good at lying because they live lives that necessitate
hiding
(3) Even if they want to be honest, various laws make
it difficult to paraphiles to report lapses or re-lapses
into parahiliac behaviour
(4) For many sexual paraphilias there are simply no
sound measures for detecting their presence or absence
e.g., sexual fantasies
Therapy Problems
(1) Mental health professions disagree over what counts
as an effective therapy
- There have been few well designed studies that look
at the outcome of therapies for paraphiles
- E.g., because of numerous design flaws, available
research is equivocal with regards to whether
treatments cause long-term change in pedophiles
- Simply calling something a “therapy” doesn’t make
it therapeutic
- This raises a number of ethical and practical
considerations related to the societal and personal
costs of ineffective and/or unnecessary therapy
(2) Another problem involved in the treatment of
paraphilias concerns the question of whether sexual
orientation can be modified
- Research suggest that sexual orientation (i.e., overall
pattern of sexual attraction and arousal) cannot be
modified
- Assumption that deviant sexual behaviour is more
plastic than “normal” sexual behaviour
- This suggests that paraphiliac sexual behaviours
are no more “curable” than heterosexuality
- a more attainable therapeutic goal might be to
decreases the intensity of paraphiliac interests and
teach skills aimed at decreasing the likelihood that
the paraphile will act on his orientation
- Goal of therapy is not a “cure,” but rather, the
maintenance of abstinence from acting on the
interest
(3) Recently, there has been an emphasis on treating
adolescent sexual offenders because:
(i) Some data suggest that many sexual offenders
begin offending in early adolescence so understanding
the developmental origin of such behaviours must
begin at this point
(ii) Intervening early decreases the harm sexual
offenders do to others and to themselves
(iii) Intervening early may increase the chances for
successful therapeutic outcome.
-Rationale: Before the behaviours have been engaged
in repeatedly, they may modifiable
- Despite sound rationale, intervention in adolescence
presents difficulties because of the adolescent’s status
as a legal minor
- Treatment of paraphilias involves discussion of sex,
measurements involving sex (e.g., penile
plethysmography), and sexual behavioural therapy
(e.g., maturbatory reconditioning)
- Some clinicians have faced legal and ethical charges
because others have construed the treatment of
adolescent sex offenders to be objectionable or
indicative of child abuse
- The question is: Does the past behaviour of
adolescents’ justify extraordinary therapy?
(4) Another problem with treatment is that many
paraphiles are not motivated to seek out and follow
through with therapy
-Many paraphiles are referred to therapy because
of some legal problems or ultimatums from family
or employers
(5) Therapy often takes place in forensic (i.e.,
prison, mental institution) context which complicates
the therapeutic process
(i) Who is the therapist’s client? The legal system
paying the bills, or the sex offender?
(ii) It complicates issues of therapist/client
confidentiality. Does the probation officer receive
periodic progress reports?
(iii) It can define important limitations on therapy
(i.e., ability of the paraphile to interact with others,
when therapy ends)
(iv) it can create unwilling and unmotivated clients
(v) it can involve the therapist and the client having
a legal relationship that takes precedence over
a therapeutic relationship
(vi) the high cost of treatment failure makes therapy
more difficult
- because no therapy is 100% effective, the best that
can be achieved is a reduction in the rate of relapse
(vii) Paraphiles treated in a forensic setting have
high incidences of comorbid problems (e.g.,
Substance abuse, marital/social problems, anxiety,
depression, personality disorders, anger control
problems)
-These comorbid problems are related in direct ways
to the paraphiliac behaviour and thus, necessitate
treatement above and beyond treatment of the
paraphilia itself.
Research Problems:
There are a number of reasons why research on
paraphilias is slow to non-existant:
(i) Lawsuits charging malpractice on the part of the
Clinician/researchers treating paraphiles are
increasingly common despite the fact that acceptable
standards were followed
(ii) funding for this type of research is scarce
which research impossible or effective research
difficult
(iii) Social taboo associated with sex research