Goals, Assumptions, and Methods in Therapy with Minor-Attracted Persons
April 30, 2009, 9:00 am – 4:00 pm
At this workshop, 17 mental health professionals and four minor-attracted persons met to discuss issues related to therapy with minor-attracted people. The workshop was organized by B4U-ACT with funding support from Baltimore Mental Health Systems. The following gives a summary of points presented and discussed by participants.
The attraction to children or adolescents usually becomes noticeable in adolescence or early adulthood and affects a significant minority of the population. It is likely that most people know or care about someone who is attracted to minors. MAPs face considerable stigma and condemnation from society, forcing them to remain secretive. This stigma, and a lack of information about attraction to minors, prevents professionals from providing services to MAPs. Fear, secrecy, and lack of access to inviting services can lead to a loss of hope and to harmful behavior. Thus, it is important to make services visible and available to those who seek them.
MAPs sometimes want therapy for issues unrelated to their sexual feelings and similar to those faced by other people (e.g., depression, anxiety, and addictions) and feel the need to be honest about their sexuality to receive effective help. On the other hand, some MAPs seek therapy to deal with issues that are related to their sexuality, such as stigma, stereotyping, societal hatred, the need for secrecy, and the desire to develop relationships and express feelings of love, intimacy, and sexuality without violating the law.
Both minor-attracted persons and mental health professionals bring several needs into a therapeutic relationship. Among the needs of MAPs are:
- Assurance of confidentiality regarding feelings
- Understanding of limits of confidentiality
- Respect, compassion, and acceptance by therapist
- To be seen as fully human and as individuals with as much worth as others
- Therapists who are knowledgeable about the attraction to minors and who are open to learning more
- Hope for the future
Among the needs MHPs have as they work with MAPs are:
- Clarity regarding reporting laws and liability issues
- Resources and information
- Availability of training to work confidently with MAPs
- Clinical supervision by professionals with relevant expertise
- An ability to generalize skills
- Exposure to MAPs to understand their humanity and their struggles
- An understanding that MAPs are not really different from other people
- Knowledge of ways to reach youth
The community also has several needs:
- Knowledge about attraction to minors
- Compassionate, knowledge-based services for those in the community who are attracted to minors
- Involvement of MAPs in defining and developing services
B4U-ACT suggests that therapy be based on the following principles:
- Individuality: MAPs vary in characteristics, beliefs, behavior. It is inaccurate to assume MAPs exhibit abusive behavior, violence, deception, or particularly compulsive or uncontrollable sexual feelings.
- Humanity: MAPs can and do contribute positively to society, and are entitled to respect and caring. Standard therapeutic and ethical principles apply.
- Needs: MAPs should have access to compassionate and confidential services that meet their needs and that help them feel safe.
- Confidentiality: A MAP’s sexual feelings should not be divulged to persons beyond a provider’s staff, and the client should be informed who on the staff, if anyone, will be told about his sexual feelings. The client should also be informed of the cases under which behavior would have to be reported to authorities.
The therapist and client should develop goals of therapy collaboratively. This requires that the therapeutic relationship develops as the MHP and MAP get to know each other as people and as they build trust and comfort. This developing relationship has both cognitive/verbal and affective components. In developing goals, it may be helpful to:
- Consider goals of two kinds: things that the client wants to move toward, and those that the client wants to avoid.
- Consider both immediate and long-term goals.
- Make sure goals are realistic in order to promote hope
Important goals for the minor-attracted client may include:
- Developing a positive self-concept and rejecting the “deviant” image coming from society
- Overcoming fears
- Being a contributing member of society
- Meeting basic emotional needs such as affirmation.
- Developing a sense of control over one’s destiny (empowerment)
It is helpful if the MAP does not allow labels to define him or her, and if (s)he realizes that there are people who are accepting of MAPs. MHPs can increase the number of such people by challenging the attitudes of colleagues who prejudge MAPs. MHP can be aware of biases they have learned, often disseminated through the media, based on profiles of people under the supervision of the corrections system and who are not representative of MAPs in the general population.
Effective therapy means hope for both the therapist and the client; both change in the relationship. Success may occur when
- The therapist and the client focus on small, achievable steps
- The therapist helps the client talk to people (s)he can love and with whom (s)he can be vulnerable and intimate
- The therapist helps the client identify fears and break them down in manageable pieces
It may be that the approach used should be similar to that used in promoting hope with other people. On the other hand, stigma makes it much more difficult in the case of MAPs.
To make services available to MAPs, it may be important for B4U-ACT, core service agencies, or Network of Care to develop a list of therapists who are willing to work with MAPs. Regardless of whether such a list is developed, it is important for a MAP seeking therapy to get an idea of a potential therapist’s assumptions and approaches before actually beginning therapy. On its website, B4U-ACT has published a list of questions that is useful for this purpose.
Other recommendations included:
- Providing peer-support (keeping in mind that sometimes a professional’s expertise is needed)
- Holding workshops in other locations
- Getting more people involved with planning next workshop
- Offering substantive information for MHPs, including what MAPs want or need
- Teaching MAPs how to find a therapist.
- Tackling the fears of MAPs
As a first step, participants decided to use the B4U-ACT listserv to develop a list of what MHPs need from MAPs, and what MAPs need from MHPs.