Pedophiles have confidentiality rights in therapy

Hi all,

I just wanted to let those of you who I haven't responded to yet know that I have not forgotten about you and I will be getting back to you very soon. Because of the complex nature of confidentiality issues surrounding this issue I don't want to get any deeper into what you can expect/demand about your confidentiality rights until I have spoken to my professors and possibly a lawyer who specializes in this sort of issue.

Because your confidentiality rights, and the limits of those rights, make such a huge difference in your ability to obtain adequate care for not only the paraphilia but also for any other mental health problems you might have, I believe that this is something that is vitally important for your group (and society).

I understand that the stigma and lack of understanding about this condition make it difficult if not impossible for you to advocate for yourselves as a group. I know that I may not personally be able to make a big difference for you until I am licensed and practicing, but I do believe that my profession will place me in the position, and give me the responsibility, to advocate for the rights of those who I serve and also for the rights of populations who I know to be discriminated against in terms of the ability to get mental health care.

BUT, I also want you to understand that there are likely many therapists out there who would like to help and advocate for your population but who feel constrained by the personal risk of attempting to help people who have been so widely and pervasively stigmatized and discriminated against. I hope that I will always feel that the need for justice outweighs my fears for my livelihood but I cannot predict the future in such a risky and unpopular cause.

What I can tell you is that I will follow up on the particulars of this situation, keep you informed of what I learn as I learn about it, be available to answer your questions to the best of my ability, and get in contact with the ACLU or other civil rights protections groups if I find that there are legal constraints that are preventing therapists from safely treating clients who happen to have this paraphilia.

I will try to respond at least somewhat to your individual questions after I speak with my professor and advisor this afternoon.
Sorry for the delay

tlkproxy wrote:
But seriously, i think you hit on the key word there: "Frustration". Judging by the replies to far, it seems to be endemic for us. I apologise for my sardonic attitude earlier, it was uncalled for. Thank you for your reply, it was good of you to give an explanation. However, it hasn't altered my perspective on psychotherapy in general.

I'm sorry for your history of abuse and i hope you won't be retraumatized if/when you attempt to engage in therapy sessions with pedophiles. Just out of curiosity, will you be engaging in this line of therapy within the correctional system, as you explained that you had experience in this area? I was unclear on that point.

Also, do you think that your example strengthens the stereotype that many - if not all - psychologists/psychotherapists head down that path of study precisely because they are prime candidates for therapy themselves?

Dear Tlkproxy,
Thank you for your apology. I understand (even more today than two days ago) why you would feel so frustrated and cynical about the ability of psychotherapy to help you with your problems. As you will see in my next post, my initial field research into the views of therapists has cured me of a great deal of my optimism and niavete about your ability to access mental health care, even if you were to believe in its potential to help you.

Thank you, also, for your empathy about my history of abuse. I imagine it is my story that makes me hope that I can help others protect children and break cycles of abuse (within and outside of families). I will not say that my history has done any good for me, but perhaps the emotional fragmentation and compartmentalization it caused will allow me to use my personal damage for some better good... if that makes sense.

Do I think my example strengthens the stereotype about psychologists/psychotherapists needing therapy themselves? I sure hope so! My experience of people in this field (professionals and students alike) is that pretty much everyone who does this, or wants to do this, has a story of mental illness and pain that at least initially drove them to want to learn more about their experience and also how to help others who have similar conditions and pain. My personal experience of my peers is that each of us choose our particular areas of specialty based upon the things that have been most problematic or helpful in our own lives-- for some of us that means a history of some sort of childhood or adult abuse, for others it is a personal battle with one disorder or another, and for still others it is an experience they went through or witnessed that affected them enough to cause a deep-seated desire to help other people live healthier and less painful lives, despite the challenges that every person will have to go through.

I believe this idea is prominent among the profession itself. My school, and many other graduate MFT programs, requires that every student have a certain number of personal therapy hours in order to graduate (at my school the number is 50). Professionals are encouraged to regularly seek personal therapy and group support throughout their careers because of the stress and secondary traumatization that so commonly occurs. We cannot effectively help our clients if we are not ensuring our own wellbeing and stability through lifestyle and therapeutic measures-- I would be very wary of seeing any therapist who did not have a therapist of their own!

I suspect this was said at least partially in jest, and I'm sorry for my lack of humor today, but I am still quite sad and angry about what I discovered yesterday... more on that in my next post on this thread.

Myopicdreams

Thanks again for replying. I’m sure I’ve come across as being terse, arrogant and obnoxious. I know I shouldn’t be taking my bitterness and resentment out on you, someone who does seem to want to do something about all this. People such as yourself are few and far between and very much appreciated.

I just want to clarify that what I said about your history of abuse was genuine, I absolutely do empathize with some cases and sincerely sympathize with the rest. More than you may realize or I’ve made clear.

Your response to my quip was unexpectedly thorough! But does reflect my own experiences as well. And your right, the jest was partial. I am concerned that such a self-contained cycle of therapy may be a case of the blind leading the blind. How can a madman teach another madman to be sane? (I just mean that abstractly of course, nothing personal to you or anyone else here). Or at the very least, if the therapist is intentionally involved in a particular field precisely because they have experiences in that area as well, isn't there a massive risk of contaminating the interactions with bias? Especially with a subject like this, which is so emotively charged.

I think this questioning is valid in an area that is of more concern to me personally, psychological research into 'pedophilia' as a concept in general. It seems to me that pedophilia has been researched, studied and conclusions drawn from an inherent standpoint, an imbibed perspective that preceded any attempts to quantify it. The verdict had already been made, and then evidence was found which supported it. It's funny how you tend to find the very thing that you're looking for.

I'd be interested to hear your thoughts. (no sarcasm this time )

myopicdreams wrote:but I am still quite sad and angry

Welcome to the club.

Also, I’m extremely curious as to what your next post will contain after a build up like that!

Dear Readers,

Yesterday morning I told you that I did not want to answer any more questions about your confidentiality rights until I made sure my understanding of things was accurate in practice. I spoke two 3 practicing therapists (one MFT, one LCSW, and one MFT-PHD--the LCSW and MFT-PhD are also professors) and what I found has very upsetting and disillusioning for me. 2 of the three were in agreement with me, that your rights are meant to be protected and that therapists who treat your population should not rush to judgement or report you without a disclosure of abuse or of clear intent to abuse. The third initially reported that you have rights but then as I inquired further it came out that he would immediately report a pedophile who had a family because he would consider there to be reasonable suspicion that the person had or would abuse their children-- just as you had told me.

In light of my interviews yesterday I cannot say I believe you have confidentiality rights in actual practice. Although 2 out of the three people I interviewed believe that the person should disclose having abused or an intent to abuse, I personally would not accept that kind of risk in your situation. I want to give you 2 possible therapy options (for the paraphilia and unrelated mental health problems), I am not very educated about either option but they seem to possibly offer you anonymity: 1) see a therapist in real life using an alias. As far as I have seen and heard about, as long as you are paying cash, no therapist asks for ID to verify that the information you give them is true. The biggest problem I see here is having a phone number to be reached at but you could say you don't have a phone and/or tell them to reach you at an anonymous email if they need to contact you. I don't think this would be a problem for many/most therapists, especially if you say you don't feel safe about it. 2) seek online therapy. I did a brief search and found that there are several online therapy sites that say they offer anonymous therapy. If you use a prepaid credit card giftcard (mastercard/visa) I believe you could anonymously access therapy online. Again, I don't know if either will work but these seemed the most promising options ATM.

I can't say that I understand what it is like to be in your shoes, but that third person gave me a small taste (he attacked me personally when he discovered I was concerned for your access to care) of what it might be like if I choose to pursue this subject and publicly advocate for your access to mental health care. I am not ready to make you any promises about how far I am willing to go, because I have a young child and long future to consider, but I want you to know that I deeply believe that you are being wronged here and that I will be taking action to help you, starting now, until it becomes more risky than I can handle.

I am now in ongoing discussion with a researcher at a major university who is just as outraged as I am about this. We are tossing around some ideas about research studies that may be able to highlight this infringement on your rights and hopefully make a difference in your access to care. I know this is far too little, and won't practically help you yet, but without research we can't even "prove" that this problem exists or matters at all.

Oh my god, I'm so sorry for being snippy before. Thank you so much for your understanding. I'm happy you feel this way, even as it's unfortunate to hear my concerns confirmed.

Blben wrote:It seems like the only way that you can get alot of therapy for pedophilia is if you actually molest a child then you are hooked up, because if you act like this is what you really are and that you are strickly attracted to children then you are classified it seems like someone that needs help. I am a pedophile and I have never acted on my desires and I don't think that I ever will but it just seems like society thinks that someday I will just cave in and act on my desires and lusts.

Blben, I want to tell you that it's a little bit complicated to get out of this understanding of pedophiles, and the laws that have built up around that understanding. Like most things in psychiatry/psychology, our understanding of pedophilia and pedophiles is based on what we have learned through research. Since non-offending pedophiles are extremely unlikely to seek therapy or volunteer to be in a research study about pedophiles, science can't even be sure that you exist.

But, I think most thoughtful scientists would hesitate before even asking you to volunteer if you are not already "out of the closet" for offending or whatnot. It is FAR too dangerous, in pretty much every way, for you to become known as having this condition and the researcher would be in a big ethical pickle if you disclosed that you were abusing children; do they break confidentiality, and potentially jeopardize their career, in order to protect those children? I wouldn't want to put myself in that situation, and I'm a little more of a risk-taker than most researchers I know

Thankfully the internet, and forums like this, might give us a way to try to understand the part of the pedophile population that never commits a crime (or gets caught). By understanding your group, and the important variables that help you successfully avoid abusing children, it is possible that we can (researchers and the public) have a greater understanding of your group as a whole. It is only with understanding that things can change, especially since our current knowledge is based only on the offenders.

Borgesius wrote:Oh my god, I'm so sorry for being snippy before. Thank you so much for your understanding. I'm happy you feel this way, even as it's unfortunate to hear my concerns confirmed.

Dear Borgesius, Thank you for the apology but I didn't think you were being that snippy I think you have probably earned the right to be as snippy as you want about this subject.

As a therapist what do you honestly think the outcome of your sessions with a paedophile will be? I'm talking the long term goal as there must be something you are aiming to achieve after a certain number of weeks/years with a patient rather than just getting to know them better.

Would you go as far as saying you could cure them? Would you just 'condition' there actions to make them 'walk away' from stressful situations? (Last I heard walking away never solved anybody's problems). Is the aim to make them no longer a threat to society or do you want them to feel good about themselves?

Sorry to bombard you with questions and I know you can only speak for yourself but 1 therapist's view is better than 0.

raleigh11 wrote:As a therapist what do you honestly think the outcome of your sessions with a paedophile will be? I'm talking the long term goal as there must be something you are aiming to achieve after a certain number of weeks/years with a patient rather than just getting to know them better.

Would you go as far as saying you could cure them? Would you just 'condition' there actions to make them 'walk away' from stressful situations? (Last I heard walking away never solved anybody's problems). Is the aim to make them no longer a threat to society or do you want them to feel good about themselves?

Sorry to bombard you with questions and I know you can only speak for yourself but 1 therapist's view is better than 0.

Dear Raleigh, This is a great question and I'm very glad you asked it! I think the answer is not as simple as it might seem but this is a complicated issue... To begin though, my overall goal with any client is to help them with whatever issues in their lives are causing them distress, help them figure out how to lead whatever life they determine is in their best interest, to support them as they navigate difficult situations, experiences, and life changes, and generally do my best to support and educate them according to their needs and unique life situation. As you might imagine, this is going to play out very differently for each client who enters my care.

I would only treat a client who agreed to make a personal promise and contract with me that they would not harm any child, or commit suicide, while under my care. I would further require that they work with me to create a plan of what they should do if they feel they are in crisis with the urge to abuse a child or commit suicide; the steps would range from calling me or another support person all the way to voluntary commitment at a psychiatric facility. I would also be committing to be a part of supporting them throughout each of these crisis plan steps. I also want to clarify that I would not expect/demand that my client disclose their pedophilia at any stage of the crisis plan (unless that was a step they desired) and would not feel it untruthful to classify an urge to harm a child as an urge to harm oneself.

The above, though, would be just the beginning of treatment. From there it would depend a great deal on who that person is in addition to being someone with this paraphilia. I would not treat anyone I could not feel sincere empathy and compassion for, nor would I treat anyone who I did not truly want to have a happy life. In terms of paraphilia, I would probably be inclined to work on acceptance of the problem, understanding that it is not their fault that they feel that attraction and the condition does not make them evil or less worthy as a human being, as well as developing a toolbox to minimize inappropriate urges and potentially dangerous situations.

I would attempt to help create or strengthen appropriate attraction to adults, though I don't know if that is possible, and help them discover whatever actions would successfully prevent that person from endangering a child. I would work hard to help them identify beliefs that are irrational, with regard to pedophilia and also whatever other issues are causing distress.

Essentially, I would view a pedophile client pretty much the same as any other client who has urges to harm themselves or others. I would be careful, support them in successfully avoiding acting on those urges, and attempt to help them create the life that they want to live.

Again... I am not yet a practicing therapist and if I were to encounter a pedophile in practicum I am certain my supervisor would immediately switch that person to a more experienced clinician. As such, you should bear in mind that my opinion may be overly idealistic and likely to evolve as I gain experience.

Hope this helps, and I am always happy to answer any questions you might have.

I wonder how many other therapists have started off idealistic like you and slid down into the negative perspective that made you "angry and sad" the other day? How long until your idealism fades as well, i wonder.