Early attempts at aversion therapy involved the pedophiliac patient’s pairing or associating mildly painful, aversive stimulation (via electrical aversion) or nausea (induced by apomorphine) with sexual fantasies and sexual thoughts of children. These forms of aversion therapy are rarely used today, because pedophiliac patients have little opportunity to apply them in real-life situations where pedophiliac urges and fantasies occur. Olfactory aversion, using spirits of ammonia, is similar to covert sensitization in that the patient is trained to pair and associate the chain of events preceding pedophiliac acts with the pungent odor of ammonia, supplied by smelling salts capsules. As with covert sensitization, the patient practices imaginal situations where the chain of events has led toward pedophiliac acts, then disrupts that chain by smelling ammonia. The therapist’s task is to help the pedophiliac patient learn how to pair the inhalation of ammonia with thoughts and urges that previously have preceded pedophiliac acts and, more importantly, to monitor the patient’s appropriate use of this technique in vivo. Pedophiliac patients carry ammonia capsules at all times so that they can immediately pair and associate the aversive odor with pedophiliac fantasies or urges in the real-life settings in which they occur. For more details regarding olfactory aversion, the reader is referred to Abel and Rouleau (1990), Laws and Osborn (1983), and Laws et al. (1978).

Harold is asked to make tapes for ammonia aversion. He will inhale ammonia to pair its noxious odor with antecedents that are likely to lead to a sexual offense. He is asked to write out these antecedents and to verbalize them on 20 tapes.

“I am feeling sorry for myself because I haven’t been able to be truly sexual in an enjoyable way for weeks. I have been trying very hard to please my wife and it is a lot of work. I decided to cheer myself up by going to a nearby community center where I can take a walk and enjoy the outdoors. When I get there, several kids are playing baseball. They were a couple of people short and I ‘reluctantly’ volunteer to help them out, stating that I used to play varsity ball in school. They are happy to have me and we have a good time. In particular, I notice a little boy who is scrawny and thin and poorly coordinated. I give him a few pointers and he seems to appreciate them.”

SWITCH
“I am breaking the capsule. I sniff the ammonia. My eyes really, really hurt. I am coughing. My throat feels terribly sore. My eyes hurt. My throat is sore, and I am coughing because I approach some boys playing baseball, hoping to get to know one of them.”

SWITCH
“I ask him casually when he and his dad play ball (knowing pretty well that he is going to say something about his dad not being available). I am right and he says that his mom and dad are divorced, his dad doesn’t spend any time with him, and his mom has a new boyfriend so he rarely plays at all. I invite him to go for a hamburger. He is enthusiastic.”

SWITCH
“I am breaking another capsule. I am sniffing the ammonia. I am coughing. My head is beginning to throb. I can barely breathe. It hurts to breathe. My head is throbbing because I invited a boy to come to a restaurant with me.”

SWITCH
“After going to eat, I invite the boy to come over to the house to watch some movies and he agrees.”

SWITCH
“I am breaking another capsule. I sniff and I am coughing and my eyes are hurting and my eyes are watering and I have a sharp pain in the back of my head and I’m getting a terrible headache. My eyes are watering and hurting because I invited a boy to my house.”

SWITCH
“Once at the house I sit close to him and offer to rub his back, arms, and legs.”

SWITCH
“I am breaking another capsule. I sniff and I am coughing. My eyes hurt. My head hurts. I feel sick. I could throw up. I feel like throwing up and my head hurts because I sit close to Andy, offering to rub his back and legs, hoping that I will be able to touch him sexually.”

SWITCH
“He relaxes, stating that he doesn’t know why he’s always so tense. As I rub his legs, I notice that as I get closer to his groin, he doesn’t say anything. I start to run my hand over his penis area and notice his penis beginning to get hard. He doesn’t say anything, keeping his eyes closed, leaning on me.”

SWITCH
“I am sniffing the ammonia. I break the capsule, I am sniffing the ammonia, my eyes are watering, my head hurts, I am coughing because I was thinking about what it would be like to touch his body.”

Switch points may vary along the chain of antecedents leading to the deviant behavior.