When individuals behave in a manner that is counter to societal norms, they frequently lose self-esteem and become anxious or depressed about what they have done. The fewer people in an individual’s environment who are aware of the commission of pedophiliac acts, the more easily the perpetrator can rationalize such acts. Pedophiles molest children in secret. They develop various rationalizations and justifications for that behavior (Abel et al. 1984; Murphy 1990).

Because pedophiliac individuals do not discuss these false belief systems with others, they have minimal opportunity to correct their faulty rationalizations or cognitive distortions. Three methods have been used to confront these distortions and normalize pedophiliac persons’ cognitive beliefs regarding child molestation: cognitive restructuring, externalizing cognitive distortions, and victim empathy training.

Cognitive Restructuring

Cognitive restructuring is necessary in treatment to address pervasive denial and minimization (Nugent and Kroner 1996). The cognitive distortions of one pedophiliac individual are usually quite different from those of another, as these attitudes and belief systems develop idiosyncratically and are not checked with others. In cognitive restructuring, pedophiliac patients (generally in a group) list the reasons why they believe their acts of child molestation were justified based on their own belief system. Once these lists are developed, they are exchanged in the group so that each patient reads another patient’s list. Each participant begins to discuss why the distortions on the list before him or her are incorrect and logically unsound. The therapist sometimes role-plays being a pedophiliac person with the belief system expressed by one of the group members, and asks the group members to develop counterarguments against the role-played attitudes and beliefs.

In cognitive restructuring, special attention is given to the issue of consent, especially the inability of a child to consent to participate in adult-child sexual behavior. Common cognitive distortions (Abel et al. 1989) of pedophiles are also reviewed and critiqued by group members to normalize the pedophiliac patients’ justifications for molesting a child.

Six weeks later, Harold began cognitive restructuring. Harold wrote down the following cognitive distortions:
1. Since Andy doesn’t have a father, he needs somebody to be close to him and take care of him, especially in a physical way.
2. Andy is a young teenager and needs to learn about sex from an appropriate source like me. Otherwise, somebody might try to take advantage of him.
3. Andy never asked me to stop. He never said “I don’t like this; I don’t like what you are doing,” so he must have liked it.
4. I was a stranger to Andy. I had never seen him before and he had never seen me before. I was surprised when he acted so friendly toward me, and then I realized that he was looking for someone like me to be a father figure. Father figures talk to their sons all the time about sex.
5. Andy did not squirm, did not move my hand away, did not walk away from me; therefore he must have enjoyed it. After all, he is a teenager and teenagers usually enjoy being stimulated in a casual way.
6. All I did to him was massage his legs after a game of baseball. I was trying to be thoughtful, and people are making a big deal out of nothing. I didn’t plan on touching his penis; I was watching TV and my hand happened to run over his penis area. I didn’t really see what I was doing because I was so engrossed in what I was watching.
7. It’s not like I put my penis in his rectum and attacked him and beat him up or something. My hand happened to run over his penis and that was all. It’s not like you read about in the papers. There were no bruises, I didn’t hold him down, I didn’t tie him up, I didn’t cut him up or anything.
8. My dad used to coach baseball and used to rub my legs after practice so that I wouldn’t get cramps and my muscles would stay loose. I was thinking that there was nobody to help Andy in this way and even though my wrists were sore and arms were tired, I thought I could be nice to him and keep him from getting any cramps.

Externalization of Cognitive Distortions

A frequent problem in the examination of pedophiles’ cognitive distortions is how to identify the specific distortions used by a patient. Smith and Wolfe (1988) described a unique method of externalizing these cognitive distortions. Pedophiliac patients are asked to carry out whatever behavior they typically engage in with a child while verbalizing their beliefs during the molestation of a child mannequin dressed in a child’s clothing. Patients are generally exquisitely reactive to such mannequins and are able to carry out the procedure when prompted by a mannequin’s small body and childlike appearance. A single therapist videotapes the mannequin molestation behavior while encouraging the pedophiliac patient to verbalize his or her usual communications to the child during the molestation and his or her fantasies, thoughts, and beliefs as if he or she were able to read the child mannequin’s mind.

The second element of the treatment involves playing the videotaped scene in front of two or three adults (sometimes including members of the patient’s family and/or close friends of the patient) in the presence of the pedophiliac patient and the therapist, with the patient being given direct feedback regarding his or her beliefs about the experience that the child would be having. Such feedback is especially powerful when the adults providing the feedback recount their own normal childhood experiences and the attitudes and beliefs that they had when they themselves were children. The feedback process is generally completed on three occasions with three different feedback groups to expand the beliefs and attitudes that others have regarding the pedophiliac individual’s cognitive distortions. The advantage of videotaping the scene involving the pedophile molesting the mannequin is that once the pedophiliac patient externalizes his or her beliefs or attitudes, they can be more closely scrutinized by others because they have been captured on videotape.

A method similar to the one described above was initially reported by Serber (1970) as a means of shaming paraphiliac individuals. However, the molestation of the mannequin procedure appears to be far more effective than the shaming technique in normalizing the cognitive distortions of pedophiliac patients.

Victim Empathy Training

Another factor contributing to pedophiliac individuals’ faulty belief systems regarding child molestation is that these individuals are rarely present when their victims experience negative consequences from the pedophiliac acts perpetrated upon them. This results from the child’s being unaware of or uninformed about the nature of what has happened to him or her, the pedophile’s attributing any problems the child might experience to other causes, or the fact that the repercussions of child molestation may not impinge on the victim until weeks, months, or even years later.

Being molested has been strongly linked with multiple consequences, including a predisposition to becoming a perpetrator (Haywood et al. 1996). A majority of programs teach pedophiliac individuals the most common consequences children experience from molestation. This is accomplished by having them read vignettes written by individuals who have been sexually molested and then having them rewrite these scenes, first from the perspective of the perpetrator of the child molestation and then from the perspective of the child who has been molested. Special attention is given to the pedophiliac patient’s ability to empathize with the child and, especially, to appreciate the child’s attitudes, emotions, and beliefs at the time of the molestation as well as later. Since offenders are typically regarded as having empathy deficits that allow them to carry out their sexual abuse, many programs are emphasizing victim empathy training as crucial (Marshall et al. 1997). This victim empathy training is augmented by the viewing of videotapes in which victims describe their experiences and the consequences of their being sexually victimized as a child. Some programs require group members to engage in role-playing exercises in which specific child molestation episodes of the members are reenacted. In the role-playing exercise, the pedophiliac patient plays the role of his or her victim while another group member plays the pedophile’s role (Pithers 1991). In playing the role of the victim, the perpetrator often experiences many of the same feelings as the victim. By gaining an appreciation of these consequences, pedophiliac individuals are less able to rationalize and justify their behavior as having no impact on the child.