The German Dunkelfeld Project: A Pilot Study to Prevent Child Sexual Abuse and the Use of Child Abusive Images
Klaus M. Beier MD, PhD
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorDorit Grundmann MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorLaura F. Kuhle MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorGerold Scherner MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorAnna Konrad MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorCorresponding Author
Till Amelung MD
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Corresponding Author: Till Amelung, MD, Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Luisenstrasse 57, Berlin 10119, Germany. Tel: +4930450529304; Fax: +4930450529992; E-mail: [email protected]Search for more papers by this authorKlaus M. Beier MD, PhD
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorDorit Grundmann MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorLaura F. Kuhle MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorGerold Scherner MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorAnna Konrad MSc
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Search for more papers by this authorCorresponding Author
Till Amelung MD
Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
Corresponding Author: Till Amelung, MD, Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin, Luisenstrasse 57, Berlin 10119, Germany. Tel: +4930450529304; Fax: +4930450529992; E-mail: [email protected]Search for more papers by this authorAbstract
Introduction
Sexual interest toward prepubescents and pubescents (pedophilia and hebephilia) constitutes a major risk factor for child sexual abuse (CSA) and viewing of child abusive images, i.e., child pornography offenses (CPO). Most child sexual exploitation involving CSA and CPO are undetected and unprosecuted in the “Dunkelfeld” (German: “dark field”).
Aim
This study assesses a treatment program to enhance behavioral control and reduce associated dynamic risk factors (DRF) in self-motivated pedophiles/hebephiles in the Dunkelfeld.
Methods
Between 2005 and 2011, 319 undetected help-seeking pedophiles and hebephiles expressed interest in taking part in an anonymous and confidential 1-year-treatment program using broad cognitive behavioral methodology in the Prevention Project Dunkelfeld. Therapy was assessed using nonrandomized waiting list control design (n = 53 treated group [TG]; n = 22 untreated control group [CG]).
Main Outcome Measures
Self-reported pre-/posttreatment DRF changes were assessed and compared with CG. Offending behavior characteristics were also assessed via self-reporting.
Results
No pre-/postassessment changes occurred in the control group. Emotional deficits and offense-supportive cognitions decreased in the TG; posttherapy sexual self-regulation increased. Treatment-related changes were distributed unequally across offender groups. None of the offending behavior reported for the TG was identified as such by the legal authorities. However, five of 25 CSA offenders and 29 of 32 CPO offenders reported ongoing behaviors under therapy.
Conclusions
Therapy for pedophiles/hebephiles in the Dunkelfeld can alter child sexual offending DRF and reduce-related behaviors. Unidentified, unlawful child sexual exploitative behaviors are more prevalent in this population than in officially reported recidivism. Further research into factors predictive of problematic sexual behaviors in the Dunkelfeld is warranted. Beier KM, Grundmann D, Kuhle LF, Scherner G, Konrad A, and Amelung T. The German Dunkelfeld Project: A pilot study to prevent child sexual abuse and the use of child abusive images. J Sex Med 2015;12:529–542.
References
- 1Finkelhor D, Ormrod R, Turner H, Hamby SL. The victimization of children and youth: A comprehensive, national survey. Child Maltreat 2005; 10: 5–25.
- 2Wetzels P. Zur Epidemiologie physischer und sexueller Gewalterfahrungen in der Kindheit: Ergebnisse einer repräsentativen retrospektiven Prävalenzstudie für die BRD. KFN, 1997.
- 3Pereda N, Guilera G, Forns M, Gómez-Benito J. The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clin Psychol Rev 2009; 29: 328–338.
- 4Whitaker DJ, Le B, Karl Hanson R, Baker CK, McMahon PM, Ryan G, Klein A, Rice DD. Risk factors for the perpetration of child sexual abuse: A review and meta-analysis. Child Abuse Negl 2008; 32: 529–548.
- 5Finkelhor D. Child sexual abuse: New theory and research. New York: Free Press; 1984.
- 6Henry F, McMahon PM. What survivors of child sexual abuse told us about the people who abused them. Paper presented at the National Sexual Violence Prevention Conference, Dallas, Texas, 2000.
- 7 National Sex Offender Public Website. Facts and Statistics. 2012. Available at: http://www.nsopw.gov/de/Education/FactsStatistics (accessed December 10, 2012).
- 8Hanson RK, Bussière MT. Predicting relapse: A meta-analysis of sexual offender recidivism studies. J Consult Clin Psychol 1998; 66: 348–362.
- 9Mann RE, Hanson RK, Thornton D. Assessing risk for sexual recidivism: Some proposals on the nature of psychologically meaningful risk factors. Sex Abuse 2010; 22: 191–217.
- 10Blanchard R, Klassen P, Dickey R, Kuban ME, Blak T. Sensitivity and specificity of the phallometric test for pedophilia in nonadmitting sex offenders. Psychol Assess 2001; 13: 118–126.
- 11Blanchard R, Kuban ME, Blak T, Cantor JM, Klassen P, Dickey R. Phallometric comparison of pedophilic interest in nonadmitting sexual offenders against stepdaughters, biological daughters, other biologically related girls, and unrelated girls. Sex Abuse 2006; 18: 1–14.
- 12Hanson RK, Morton-Bourgon KE. The characteristics of persistent sexual offenders: A meta-analysis of recidivism studies. J Consult Clin Psychol 2005; 73: 1154–1163.
- 13Seto MC, Cantor JM, Blanchard R. Child pornography offenses are a valid diagnostic indicator of pedophilia. J Abnorm Psychol 2006; 115: 610–615.
- 14 American Psychiatric Association, American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association; 2013.
10.1176/appi.books.9780890425596 Google Scholar
- 15 World Health Organisation. International statistical classification of diseases and related health problems 10th revision. Geneva: World Health Organisation; 2007.
- 16Andrews D, Bonta J. The psychology of criminal conduct. Newark, NJ: Lexises/Matthew Bender; 2006.
- 17Fago DP. Comorbid psychopathology in child, adolescent and adult sexual offenders. In: JS Wodarski, MC Hilarski, eds. Comprehensive mental health practice with sex offenders and their families. New York: Haworth Pr Inc; 2006: 193–219.
- 18Mann RE, Barnett GD. Victim empathy intervention with sexual offenders: Rehabilitation, punishment, or correctional quackery? Sex Abuse 2013; 25: 282–301.
- 19McGrath RJ, Georgia FC, Burchard BL, Zeoli S, Ellerby L. Current practices and emerging trends in sexual abuser management—The safer society 2009 north American survey. Brandon, VT: Safer Society Press; 2010.
- 20Marshall WL, Marshall LE, Serran GA. Strategies in the treatment of paraphilias: A critical review. Annu Rev Sex Res 2006; 17: 162–182.
- 21Davis RA. A cognitive-behavioral model of pathological Internet use. Comput Hum Behav 2001; 17: 187–195.
- 22Hall GCN, Hirschman R. Sexual aggression against children: A conceptual perspective of etiology. Crim Justice Behav 1992; 19: 8–23.
- 23Marshall WL, Barbaree HE. An integrated theory of the etiology of sexual offending. In: WL Marshall, DR Laws, HE Barbaree, eds. Handbook of sexual assault. New York: Springer; 1990: 257–275.
10.1007/978-1-4899-0915-2_15 Google Scholar
- 24Ward T, Beech A. An integrated theory of sexual offending. Aggress Violent Behav 2005; 11: 44–63.
- 25Quayle E, Taylor M. Model of problematic internet use in people with a sexual interest in children. Cyberpsychol Behav 2003; 6: 93–106.
- 26Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child 1994; 4: 31–53.
- 27Ward T, Siegert R. Toward a comprehensive theory of child sexual abuse: A theory knitting perspective. Psychol Crime Law 2002; 8: 319–351.
- 28Hanson RK, Harris AJR. Where should we intervene? Dynamic predictors of sexual offense recidivism. Crim Justice Behav 2000; 27: 6–35.
- 29Hanson RK, Harris AJR, Scott T, Helmus L. Assessing the risk of sexual offenders on community supervision: The Dynamic Supervision Project. Ottawa, Canada: Public Safety Canada; 2007.
- 30Duff S, Willis A. At the precipice: Assessing a non-offending client's potential to sexually offend. J Sex Aggress 2006; 12: 43–51.
10.1080/13552600600568887 Google Scholar
- 31Beier KM, Ahlers CJ, Goecker D, Neutze J, Mundt IA, Hupp E, Schaefer GA. Can pedophiles be reached for primary prevention of child sexual abuse? First results of the Berlin Prevention Project Dunkelfeld (PPD). J Forensic Psychiatry Psychol 2009; 20: 851–867.
- 32 Berlin Institute of Sexology and Sexual Medicine. Das Berliner Dissexualitätsprogramm. Unpublished manuscript, Berlin, 2005.
- 33Beier KM, Loewit K. Syndyastic sexual therapy—Concept and foundations. Sexuologie 2011; 18: 85–94.
- 34Pithers WD. Relapse prevention with sexual aggressors: A method for maintaining therapeutic gain and enhancing external supervision. In: WL Marshall, DR Laws, HE Barbaree, eds. Handbook of sexual assault: Issues, theories, and treatment of the offender. New York: Plenum Press; 1990: 343–361.
10.1007/978-1-4899-0915-2_20 Google Scholar
- 35Ward T, Gannon TA. Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders. Aggress Violent Behav 2006; 11: 77–94.
- 36Ward T, Hudson SM. A self-regulation model of relapse prevention. In: DR Laws, SM Hudson, T Ward, eds. Remaking relapse prevention with sex offenders: A sourcebook. Thousand Oaks, CA: Sage; 2000: 79–101.
10.4135/9781452224954.n5 Google Scholar
- 37Ward T, Hudson SM, Keenan TA. Self-regulation model of the sexual offense process. Sex Abuse 1998; 10: 141–157.
10.1177/107906329801000206 Google Scholar
- 38Amelung T, Kuhle LF, Konrad A, Pauls A, Beier KM. Androgen deprivation therapy of self-identifying, help-seeking pedophiles in the Dunkelfeld. Int J Law Psychiatry 2012; 35: 176–184.
- 39 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Washington, DC: American Psychiatric Association; 2000.
10.1176/appi.books.9780890423349 Google Scholar
- 40Bumby K. Assessing the cognitive distortions of child molesters and rapists: Development and validation of the MOLEST and RAPE scales. Sex Abuse 1996; 8: 37–54.
10.1177/107906329600800105 Google Scholar
- 41Marshall WL, Marshall LE, Sachdev S, Kruger R-L. Distorted attitudes and perceptions, and their relationship with self-esteem and coping in child molesters. Sex Abuse 2003; 15: 171–181.
- 42Rambow J, Elsner K, Feelgood S, Hoyer J. Einstellungen zum Kindesmissbrauch—Untersuchungen mit der Bumby Child Molest Scale bei Missbrauchs- und Gewalttätern. Z Sexualforsch 2008; 21: 1–15.
- 43Schaefer GA, Feelgood S. Empathy for children scale. In: TD Fisher, CD Davis, WL Yarber, SL Davis, eds. The handbook of sexuality related measures. London: Routledge; 2011: 7–12.
- 44Fernandez YM, Marshall WL, Lightbody S, O'Sullivan C. The child molester empathy measure: Description and examination of its reliability and validity. Sex Abuse 1999; 11: 17–31.
- 45Neutze J, Seto MC, Schaefer GA, Mundt IA, Beier KM. Predictors of child pornography offenses and child sexual abuse in a community sample of pedophiles and hebephiles. Sex Abuse 2010; 23: 1–31.
- 46Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press; 1965.
10.1111/j.1559-1816.2002.tb02765.x Google Scholar
- 47Schmitt DP, Allik J. Simultaneous administration of the Rosenberg Self-Esteem Scale in 53 nations: Exploring the universal and culture-specific features of global self-esteem. J Pers Soc Psychol 2005; 89: 623–642.
- 48von Collani G, Herzberg PY. Zur internen Struktur des globalen Selbstwertgefühls nach Rosenberg. Z Differentielle Diagn Psychol 2003; 24: 9–22.
10.1024//0170-1789.24.1.9 Google Scholar
- 49Russell D, Peplau LA, Cutrona CE. The revised UCLA loneliness scale: Concurrent and discriminant validity evidence. J Pers Soc Psychol 1980; 39: 472–480.
- 50Lamm H, Stephan E. Zur Messung von Einsamkeit: Entwicklung einer deutschen Fassung des Fragebogens von Russell und Peplau. Psychol Prax 1986; 30: 132–134.
- 51Check JVP. The hostility toward women scale. Winnipeg, Manitoba, Canada: University of Manitoba; 1984.
- 52Allan M, Grace RC, Rutherford B, Hudson SM. Psychometric assessment of dynamic risk factors for child molesters. Sex Abuse 2007; 19: 347–367.
- 53Endler NS, Parker JDA. Coping inventory for stressful situations. Toronto: Multi-Health Systems; 1999.
- 54Kaelin W. Deutsche 24-Item Kurzform des “Coping Inventory for Stressful Situations” von N. S. Endler & J. D. A. Parker. Basierend auf der Übersetzung von N. Semmer, F. Tschan, & V. Schade. Bern, 1995.
- 55Wilson RJ. Emotional congruence in sexual offenders against children. Sex Abuse 1999; 11: 33–47.
- 56Schwarzer R. Social-cognitive factors in changing health-related behaviors. Curr Dir Psychol Sci 2001; 10: 47–51.
- 57Cortoni F, Marshall WL. Sex as a coping strategy and its relationship to juvenile sexual history and intimacy in sexual offenders. Sex Abuse 2001; 13: 27–43.
10.1177/107906320101300104 Google Scholar
- 58Paulhus DL. Measurement and control of response bias. In: JP Robinson, PR Shaver, LS Wrightsman, eds. Measures of personality and social psychological attitudes. San Diego, CA: Academic Press; 1991: 17–59.
10.1016/B978-0-12-590241-0.50006-X Google Scholar
- 59Musch J, Brockhaus R, Bröder A. Ein Inventar zur Erfassung von zwei Faktoren sozialer Erwünschtheit. Diagnostica 2002; 48: 121–129.
- 60Swift JK, Greenberg RP. A treatment by disorder meta-analysis of dropout from psychotherapy. J Psychother Integr 2014; 24: 193–207.
10.1037/a0037512 Google Scholar
- 61Swift JK, Greenberg RP. Premature discontinuation in adult psychotherapy: A meta-analysis. J Consult Clin Psychol 2012; 80: 547–559.
- 62Seto MC. Pedophilia. Annu Rev Clin Psychol 2009; 5: 391–407.
- 63Beggs SM, Grace RC. Treatment gain for sexual offenders against children predicts reduced recidivism: A comparative validity study. J Consult Clin Psychol 2011; 79: 182–192.
- 64Wischka B. Das Behandlungsprogramm für Sexualstraftäter. Recht Psychiatr 2013; 31: 138–145.
- 65Edwards R, Whittaker MK, Beckett R, Bishopp D, Bates A. Adolescents who have sexually harmed: An evaluation of a specialist treatment programme. J Sex Aggress 2012; 18: 91–111.
- 66O'Reilly G, Carr A, Murphy P, Cotter A. A controlled evaluation of a prison-based sexual offender intervention program. Sex Abuse 2010; 22: 95–111.
- 67Barnett GD, Wakeling HC, Mandeville-Norden R, Rakestrow J. How useful are psychometric scores in predicting recidivism for treated sex offenders? Int J Offender Ther Comp Criminol 2012; 56: 420–446.
- 68 Institute of Sexology and Sexual Medicine, Charité—Universitätsmedizin Berlin. The Berlin dissexuality therapy program. Weimar: Gutenberg Druckerei GmbH; 2013.
