Diagnostik und Behandlung sexueller Missbrauchstäter: Im Maßregelvollzug nach § 63 StGB und in der Präventionsambulanz

Prevention of Sexual Child Abuse: Preliminary Results From an Outpatient Therapy Program

In Germany, access to outpatient treatment services devoted to the prevention of (further) sexual offenses against minors and child sexual exploitation material (CSEM) offenses is often limited. The therapy project "Prevention of Sexual Abuse" tries to fill this gap by providing treatment to patients with a self-reported sexual interest in children and adolescents, irrespective of whether or not they are pedophilic or prosecuted by the legal justice system. Within the project, a treatment manual was developed which specifically addresses dynamic risk-factors in child sexual abusers and CSEM offenders. The treatment manual was conceived to reduce recidivism risk and to contribute to the enhancement of the patients' personal well-being. In this paper, results of the accompanying scientific research are presented: offense-supportive attitudes (N = 23), self-reported CSEM use (N = 10), emotional distress (N = 24), and participants' subjective risk perception of committing (further) sexual offenses (N = 25) reduced during the course of treatment. A reduction of offense-supportive attitudes was further observed from pre-intervention to 1-year follow-up (N = 8). Changes with regard to self-efficacy, quality of life, participants' self-perceived ability to control sexual impulses toward children and adolescents permanently, and several measures assessing different kinds of sexual recidivism did not, however, reach any level of significance. During an average observation period of 2.4 years, six patients confessed to have conducted new sexual exploitation material offenses, while no further sexual abuse cases were reported (N = 19). Due to the used research design and small sample sizes, treatment effects cannot be inferred and external validity is limited. This notwithstanding, results provide first evidence for a relationship between treatment participation and self-reported recidivism and psychological well-being.

Web-Based Health Services in Forensic Psychiatry: A Review of the Use of the Internet in the Treatment of Child Sexual Abusers and Child Sexual Exploitation Material Offenders

In recent years, web-based health services for a variety of mental disorders have been developed and evaluated. Evidence suggests that guided internet-based therapy can be as effective as conventional face-to-face therapy. In forensic psychiatric practice, few web-based treatments have been implemented up to now. However, to our knowledge, there do not yet exist guided internet-based treatments for child sexual abusers and child sexual exploitation material offenders. This review aims at examining under what conditions patients are most likely to benefit from internet-based treatments. In addition, some computer-based health services in forensic psychiatry will be summarized and their potentials and weaknesses will be discussed. Subsequently, the review focuses on the implications for the development of online treatments for child sexual abusers as well as on a variety of ethical and legal issues that practitioners may encounter during the development, evaluation and delivery of online health services. The review will conclude with proposed quality standards for the development and implementation of web-based interventions for child sexual abusers and child sexual exploitation material offenders. By virtue of the low number of psychotherapists offering therapy to this clientele as well as individual barriers to seeking treatment such as fear of stigmatization, feelings of shame, long access routes, or limited mobility due to physical handicaps, the development of mental eHealth services in this sector could close an important healthcare gap. By increasing the density of supply, more child sexual abusers and child sexual exploitation material offenders would have the chance to engage in treatment and, ultimately, more incidents of sexual assault against minors could be prevented.

Sexual interest and sexual self-control in men with self-reported sexual interest in children - A first eye tracking study

Sexual child abuse is one of the most destructive events for child development. One possible approach to avert it is the preventive treatment of individuals with a sexual interest in children. The aim of the current eye tracking study was to compare people with a self-reported sexual interest in children who participate in the outpatient preventive treatment project "PsM", pedophilic forensic inpatients, and a non-pedophilic control group. Groups were compared with respect to sexual interest and attentional control in the presence of sexual stimuli, both assessed independently of self-report. Two approaches were applied, namely the initial orientation approach for measuring sexual interest, and a sexual distractor task for measuring attentional control. Our data showed for the first time that outpatients with a self-reported sexual interest in children differed from pedophilic forensic inpatients with respect to attentional control but not with regard to sexual interest. Outpatients showed similar sexual interest in children as pedophilic forensic inpatients. They demonstrated significantly better attentional control than pedophilic forensic inpatients in the face of adult sexual stimuli, but the difference regarding child sexual stimuli did not reach significance. This might reflect a higher capacity for self-control and self-regulation in these patients. Nevertheless, child stimuli remain to be important distractors for them. Our results provide valuable additional information for the diagnosis and therapy of outpatients with a self-reported sexual interest in children. Obviously, these data are preliminary and further studies with larger groups should examine if they are replicable.