Showing posts with label psychotherapy. Show all posts
Showing posts with label psychotherapy. Show all posts

Monday, August 18, 2014

You’re 16. You’re a Pedophile. You Don’t Want to Hurt Anyone. What Do You Do Now?


This is a long but highly interesting article on the efforts of young men who have identified in themselves a desire for sex with children but who do not want to become perpetrators. There are very few resources around the country for these guys, which is sad because without help they are likely to become offenders.

This article comes from Medium, and I found as a selection on last week's Longreads.

You’re 16. You’re a Pedophile. You Don’t Want to Hurt Anyone. What Do You Do Now?

There’s no helpline for pedophiles who want treatment before they act. So a teen with a terrible secret had to find his own way to save himself and others like him.

By Luke Malone | Illustrations by Simon Prades

Adam was at his desk in the second-story bedroom of his family’s suburban home when he came across it. He had recently switched file-sharing programs to one that offered more content and faster browsing, and his downloading habit had increased in kind. There was now a constant stream of files whose names included acronyms such as PTHC, or pre-teen hardcore.

The boy in this video was fair-haired and looked to be about one and a half, his small, naked body tied up to restrict movement. A man’s torso entered the frame and the child began to scream. As he watched the scene unfold, Adam was transfixed, and then quickly revolted; he reached over and stopped the video. It wasn’t like anything he’d witnessed in the two years he’d been viewing child pornography. Until now everything he’d seen seemed to suggest that the kids liked it, but this toddler was clearly in pain.

He moved over to his bed, a twin with a sturdy, wooden frame, and lay down on the crumpled blue and white cloud-print sheet. Band posters clung to the surrounding walls. Directly across from the foot of the bed was a bookshelf housing an impressive collection of horror novels. Atop the shelf sat several chess and baseball trophies whose silver sheen had been dulled by dust, and he stared up at them as he tried to process what he had just seen. He felt, he told me later, a combination of anger, sadness, and confusion.

Seeing that toddler trussed up and in pain confirmed something he’d long suspected but now had to acknowledge. The man in the video was one of those guys they sometimes talked about on the news. Though Adam didn’t want to hurt anyone, he knew that, on some level, he was just like him. He was 16 years old, he was a pedophile, and he had to do something about it.


WE HAVE A FEW go-to archetypes when it comes to pedophilia: There is the playground lurker, the chat-room predator, and the monstrous (often religious) authority figure. These men are usually middle-aged, unrepentant serial abusers who are caught only after remaining undetected for years. But what about the preceding decades? When do these urges first begin to manifest?


The Diagnostic and Statistical Manual of Mental Disorders defines a pedophile as an individual who “over a period of at least six months” has “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children.” This person also has to have “acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty,” and be “at least age 16 years and at least five years older than the child or children” involved.


Anecdotal evidence suggests that most pedophiles first notice an attraction toward children when they themselves are between 11 and 16, mirroring that of any other sexual awakening. It can be a confusing time for any of us, but imagine realizing that you’re attracted to little kids. How do these young men and women negotiate that with no viable role models or support network? There is no It Gets Better for pedophiles. Are they all fated to end up as child molesters? Or is it possible for them to live a life without hurting children at all?

I spoke with experts and asked around online. I came across a site for self-described pedophiles who acknowledged their attraction and wanted help dealing with it. But the men I met were in their 50s and 60s, and I’d hoped to speak with someone younger, someone still coming to terms with what he was learning about himself. I asked them if they knew anyone like that, and a few weeks later I received an email.

“My name is Adam,” it read. “I’m 18 and non-exclusively attracted to boys and girls of all ages (particularly very young ones). I am the leader of a support group for non-offending pedophiles around my age… I would be very happy to talk with you.”


ADAM IS NOW 20 (his name, like those of other young men in this article, has been changed). He has a slightly chubby build and messy, medium-brown hair. The first time we spoke at length about his attractions, we were sitting in his old, beat-up car, in the lot of a park near the house he shares with his parents and two older brothers. It had become our regular meeting place. Outside the car, locals chatted among themselves while herding frisky Labradors and Weimaraners into the backs of jeeps; two kids roughhoused in the dirt next to us until their father asked them to stop.

Talking about his pedophilic urges, Adam refused to look me in the eye, though he often stole glances when he thought I wasn’t looking. He first noticed his attraction toward young children when he was 11. He’d developed a crush on a kindergartener at school, a boy, his desire fueled by brief, furtive glimpses of him in the halls. By the time he reached 16, his sexual interest in kids had become more defined. He found himself attracted primarily to boys between three and seven and girls aged five to eight.

When I pressed him about what he finds most attractive in a child, he shifted in the car seat from side to side, and eventually managed to say: “Small body, hairless legs, you know, things like that… like small genitalia.” But there is a strong emotional pull, a potent idea of innocence that, he explained, is far more intoxicating than anatomy. “A lot of us tend to have, I think, unrealistic views of kids,” he said. “To the point that they’re kind of angelic.” This purity, he told me, is what keeps in check his urge to act on his desires. “I see an innocence in children that would be violated,” he said.


It is why the video of the toddler, out of everything he’d seen, rattled him. There was no denying that the boy was being debased. The bound child was wailing as the man defecated on him, though his cries were soon replaced with choking splutters as his abuser began urinating in his mouth. “I wanted to reach through the computer screen and kill the person,” Adam said. “I was just so horrified at what I saw.”

I asked him what happened in the days and weeks after he’d watched the video, and he admitted he didn’t stop downloading child porn straight away. He tried his best to abstain, often going weeks, but would end up back in front of the computer. He scoured the internet looking for a way to help him break his porn “addiction” and deal with his attraction to children, and ended up at a general mental health forum. This site stated that new visitors must offer an introductory message. “I know that pedophiles don’t choose to be pedophiles,” he wrote. “I didn’t want my attraction. I don’t want my attraction. But the attraction is there, and all I can do is try to curb it.”

Instead of posting it right away, he went to bed and masturbated to child porn. “I actually felt okay about that because I reasoned that I was taking the first step toward getting help,” he said. “I guess like a drug addict enlisting in rehab and then using one last time before it starts.” He published it the following morning.

The response to his post was mixed. Some commentators were working through their own abuse history, and couldn’t stomach the idea of helping a self-confessed pedophile. But two female sexual-abuse survivors eventually came forward, convinced that he was of an age where a change could still be made. One of them, Adam believes, had suffered particularly brutal abuse, abuse that was filmed, and their conversations about the evils of child pornography would often trigger her past traumas. “She cared about me,” he said. “But she made it known that she felt I deserved whatever the law decided to do with me if I were caught for the CP [child porn].”

More than once she kept him distracted from watching porn until the early hours of the morning, when he was tired enough to go to sleep.


HIS PORNOGRAPHY habit, of course, was merely symptomatic of a larger issue. It took him a long time, he told me, to accept that his desire for young boys wasn’t simply going to evaporate just because he’d stopped downloading and watching videos, and he grew increasingly despondent trying to suppress these feelings. “I was passively suicidal for a long time. I went six months without seeking actual help aside from online,” he said.

One night, while his father was out, Adam walked into his parents’ room and handed a note to his mother as she was lying in bed. “Read this,” he said. Paula (whose name has also been changed) looked up at him and opened her mouth to speak but changed her mind when she saw the expression on his face. He slipped back out of the room and she considered the letter for a moment, turning it over in her hands. She got up and walked down the hall to Adam’s bedroom, and found him curled up in bed with his back to the door. She called out to him, but he pretended he was already asleep.

Not knowing what else to do, she walked back to her room and unfolded the note. When Adam sent me a copy of it years later, he told me he couldn’t read past the first few lines, the memory of this time still so raw for him.

Dear Mommy, I am writing this letter to you as I cannot bring myself to say what I need to say to you to your face. It would simply be too painful for me, and I don’t want you to see me cry and struggle, nor do I want you to be pained by seeing me do so… I find that I am seldom happy, and very rarely go through days when I am entirely happy… I am always overshadowed with feelings of depression, guilt and shame. I’m really sick and tired of covering these feelings up… I want you to let me see a psychologist, and for both your and my own privacy, I don’t want you to be in any way acquainted with him/her… I understand that you probably have a lot to ask me, but I need some time to get my head wrapped around things. I thank you in advance for my privacy. Love, Adam.
He didn’t explain the source of his depression and his mother decided not to ask. The next morning, she pulled him aside and told him she would find him a local therapist who took their insurance.


It was a Friday morning when Adam went to see her. As he sat with his mother in the waiting room, the reality of what was about to happen washed over him. He was overwhelmed. He was about to vocalize a secret he’d only ever previously admitted to strangers on the internet.

He was called into her office, his heart racing as he stepped toward the door. She closed it behind them, offered him a seat, and began the session with questions familiar to anyone who has been in therapy, “family history, how many siblings I have,” that kind of thing. She scribbled his answers down in a notepad, and then asked why he had come to see her. Adam had never in his life felt such dread. His body began to shake as he explained that he suffered from anxiety. She asked what was making him anxious, and he just blurted it out: “I’m a pedophile and I’m addicted to child pornography.”

She blinked at him for a moment and then asked him to repeat himself. When he did, her mood changed. “She just became extremely cold and harsh,” he said. “She even, a few times, almost got to the level of shouting.” She suggested that he was simply nervous around kids his own age — a reaction I’ve learned is common among therapists with limited experience in this area. She told him she wasn’t trained to deal with the situation, but she would ask around for information on how to help him and scheduled a second session for a couple of weeks later.

I asked Adam why he agreed to see her again, and he said he felt he had no choice: “I didn’t have anything else, you know?” He soon found himself back in the waiting room with his mother. “I walk in, she asks how I’m doing, and she seems a little bit more sympathetic,” he said. “But she told me pretty much right away, ‘I can’t do this. I have to tell your mom.’”


THERE IS CURRENTLY no mechanism for treating someone who has pedophilic urges and hasn’t acted on them. A major roadblock is the existence of mandatory reporting laws, which dictate that people in certain professions must report suspicion of child abuse and neglect to Child Protective Services. (The individuals required to make a report varies from state to state; it can include all citizens but is usually restricted to those whose work puts them in regular contact with children, such as teachers, police, and psychologists.)

Mandated reporting revolutionized the way child abuse is handled in the U.S. and has brought many incidents to light, but it can be problematic for young men like Adam who haven’t abused children. The civil and criminal liabilities facing those who fail to report someone who goes on to molest a kid, combined with the fact that it need only be based on suspicion and not probable cause, means a report could be triggered when well-intentioned individuals reach out for help. The overwhelming number of minor-attracted men I spoke with said this was too much of a deterrent. Which also makes it harder to learn more about them.

There is a lot we still don’t know about pedophilia—one researcher described our scientific understanding of it as a series of “pretty big black holes.” We don’t know, for example, how someone comes by an attraction for prepubescent children in the first place. The research we do have, and this is derived from very small sample sizes, suggests that those attracted to kids tend to be shorter, left-handed, and have a lower IQ than the broader population. Another study found that being knocked unconscious before the age of 13 might be a factor. This may sound like quackery, but it points toward biological causation. In other words, it’s likely that pedophiles are born this way.


Things are a little clearer when it comes to the numbers. Studies suggest that up to 9 percent of men have fantasized about having sex with a prepubescent child, and 3 percent of all men have gone on to sexually offend. (Not all of them would meet the diagnostic criteria for pedophilia. The latter figure includes situational offenders, men who abuse children if the opportunity arises but who otherwise have no pre-existing attraction to kids.) Michael Seto, director of the University of Ottawa’s Forensic Research Unit and associate editor of Sexual Abuse: A Journal of Research and Treatment, believes that the prevalence of male pedophiles sits closer to 1 percent of the population, which would equate to at least 1.2 million in the U.S. alone. (Female pedophiles exist, but in smaller numbers.)

The distinction between fantasies and behavior is an important one to make. Our failure to acknowledge the existence of pedophiles who choose not to act on their desires not only prevents them from coming forward to seek help but is also an obstacle when it comes to gaining support for therapeutic intervention. Seto told me there is evidence to suggest that there are a significant number of men who are sexually attracted to children and struggling, often alone, to keep their urges in check. “If you did a survey of the general public,” Seto said, “I think a large majority would assume that anyone who is sexually attracted to prepubescent children has acted on it.”


THE FIRST THING that I recall the therapist saying is ‘We’ve got a problem,’” said Adam’s mom, Paula. She knew something was up when she first entered the room. She saw her son staring at the floor, “not speaking… practically not breathing, he wasn’t moving a muscle, other than he was shaking.” And then the therapist told her why she was there.

“I was really, really shocked. I thought we were going to be talking about depression. That wasn’t even on my radar of what I thought could even come up as part of the problem,” she said. “It immediately entered my mind that perhaps somebody had abused him. How else could this have happened? How else could he have even thought to do that if he wasn’t abused?”

But while victimization is a risk factor for perpetration, it’s not a given, and the majority of abused children do not go on to offend. Paula believes her son when he says it’s not the case. “If it had already come out that he was engaged in looking at child pornography, why would he then hold back on the other component?” she said. “It would have been easier, I think, from his position to say that something had happened to him and then he is considered a victim.”

Paula hasn’t told anyone about what she learned about her son — not a friend, not a therapist of her own, not her husband. Our conversations were the first she’s had about it since finding out. “Nobody,” she said, with a melancholic laugh, when I asked who she turns to for support. “I can be certain that his dad would not have, I don’t think could have, handled it in a similar way as myself. He’s just much more emotionally reactive.”


But it doesn’t mean she hasn’t been thinking about it. I was surprised by how eager she was to talk about Adam, and so directly. In fact, discussing her son’s attraction to children seemed to come as a relief. “It is something I’m aware of when I lay down to sleep and I’m aware of it when I get up,” she said. “It’s always on my mind.”

Paula copes by being pragmatic. She helped her son find a new therapist, one better equipped to help him deal with his attractions. And when that new therapist suggested he remove all information on the two computers he used to access child porn, so as to reduce temptation and possible legal ramifications, she led the charge. “Adam told me that the only way to do that would be to actually replace the hard drives, because writing over them or just deleting information does not actually get rid of it—it’s still embedded, it’s still there,” she said, adding that they destroyed the originals. “I didn’t want him to be at any risk whatsoever, and I felt the thing to do was to immediately get rid of it.”

Her concern was hardly disproportionate to the potential repercussions. Possession of child pornography carries statutory penalties under federal and state law. These penalties can be so severe that those caught with child porn can receive longer sentences than those convicted of child abuse. Because the videos he downloaded included children under 12 years old, a first-time offender like Adam might have been fined $100,000 and sentenced up to 20 years in prison; the maximum term can be increased to 40 years for those with prior convictions.

Paula said her greatest fear is that he might one day go back to viewing child porn, but, after a little pressing, she acknowledged a larger concern. “I know that he has had thoughts, I know that he’s had urges… I know that when people have urges and thoughts that they can progress to actions, and of course I worry that could happen,” she said. “I don’t want there to be any victims. I mean, every child is very important. My son is important to me, and I would feel horrible if he was abused and I would feel horrible if he abused, so there’s no winners there.”

She and her son hadn’t spoken directly about that day at the therapist’s office, much less the underlying issue, in the intervening three years. They only recently resumed the discussion when I persuaded Adam to ask if she’d be willing to speak with me. This has forced Paula to come to terms with things she was able to avoid before. He told her he identifies as a pedophile and “it is his expectation that this is going to be a very long, lifetime struggle.” It was painful to hear, though, important. But she remains hopeful for his future.

“Best-case scenario is that this never happened and this never could happen to my son or anybody’s son, but that bubble has already popped because bad things do happen to good people and good sons and good mothers,” she said. “The next best-case scenario would be to be able to live with this burden and live a normal and happy and productive life… I want him to be happy, to not feel depressed about this, and to be able to fulfill all of his dreams that were there before and that should continue to be available to him even living with this.”


ADAM’S NEW THERAPIST put him on Zoloft and taught him to resist the urge to identify with the child molesters he encountered in the media. “A lot of it was, ‘I’m a monster’ for having viewed that stuff but also just for having these attractions,” he said. “What you hear in the media and online and how people talk, it sinks in, you know? You don’t even question it. It’s just kind of a fact.”

But his sense of social isolation wasn’t so easily remedied, and his thoughts about young children were as strong as ever. He had maintained an active presence on the mental health message boards, but said most of the members he knew were abuse survivors, depressives, or alcoholics — no one who could truly understand what he was struggling with on a daily basis.

One day he typed the words “young pedophile” into Google, and his original thread on the mental health board was the first entry to come up. But when he started to scroll down he saw similar entries on other boards, ones with headlines like “I’m a young pedophile and I need some help” and “How can I get free counseling? I’m a teenage pedophile.” Desperate for someone to relate to, he started reaching out. “I’d say, ‘I’m a pedophile. I used to have a child porn addiction. I know what you’re going through,’” he said. “‘You obviously need help, and I know someone else around our age who’s like that. I think we could be a good support for you and vice versa.’”


This is how he began communicating with other young pedophiles around the world. In turn, they introduced him to those they had managed to find. Distinct from the idea of a malevolent pedophile ring, these young men — and occasionally young women — said they didn’t want to hurt children and were trying find a way to make sure they never would. Some messaged back and forth before dropping off (“They probably got scared that it was a sting operation,” said Adam), but one by one a cluster of regulars formed. Before long Adam had inadvertently established an informal online support group for pedophiles in their teens and early 20s who want help battling their attraction toward children.

Speaking with members of the group, it’s apparent their concern about detection sits close to the surface — each citing a fear of rejection by family and friends, and the unwanted attention of law enforcement. Yet, Adam explained that many are willing to risk it rather than continue to battle their demons alone. “For a pedophile, there is almost no place to go and get information or any sort of help,” he said. “I’m sure that there are pedophiles who kill themselves who never come out as that. Who never admit to it, even in a suicide letter. I think there’s probably a lot more than people would realize.”


There are currently nine members, ranging in age from 16 to 22, eight men and one woman, though Adam said others have come and gone over the years. Some members hail from as far abroad as the Philippines, but language barriers confine most participants to the U.S. and the U.K. His group has two rules. The first is that you can’t have offended or harbor any intention to do so; those who question the concept are banished if they can’t be convinced otherwise. The second is a commitment to stopping the use of child pornography. Adam told me it’s okay if you come into the group as a user, but you must be devoted to quitting.

Adam’s mom recently found out about the group. Realizing that support is elusive to those in his situation, she accepts it. But she also harbors reservations about them operating without the oversight of professionals. “We need to understand the problem so that we can find appropriate ways to fix it. The way to help is to identify anyone that wants help,” Paula said. “We have to make connections. Just as they have things like hotlines for people to come forward and get help with problems they’re having, there has to be something available and advertised for young people that may be having these thoughts and these urges.”


ANYONE THAT'S DONE treatment with people who have sexually offended know that many of them are horrified by their behaviors,” Elizabeth Letourneau, founding director of the Moore Center for the Prevention of Child Sexual Abuse at Johns Hopkins University, told me. “A lot of these guys don’t want to be sexually abusing children.”

We first met at her office one dreary afternoon last February. Out the window, whose sill was flanked by framed photos of her two sons, you could see rain gently blanketing downtown Baltimore. The center’s core mission is “to try to change the way the nation views child sexual abuse, as something that is preventable.” From a desk piled high with books and manila folders full of journal articles, she continued: “We say we’re really concerned about sex offending and we really don’t want children to be sexually offended and we don’t want adults to be raped, but we don’t do anything to prevent it. We put most of our energy into criminal justice, which means that the offense has already happened and often many offenses have already happened.”

Letourneau is the only U.S. researcher developing science and policy in the field of primary prevention. She wants to implement a program, separate to her work at the center, that provides preventive therapy for non-offenders and offenders alike. Her focus will be on adolescents, at least initially. She believes that early intervention is more effective and that teenagers pose less of a threat to potential funders and review boards. She would also like to get parents involved, though this would present its own challenges. “The risk that you face when you have to pull in a parent and a kid is that you’re going to lose some kids who are not able to talk about this to their parent, out of fear or shame or embarrassment,” she said. “We will miss some important subgroups.”

Adam told me that, when it comes to pedophilia, there are other distinctions beyond age and gender preference — most notably, primary and exclusive attraction. A primary interest means a person is sexually focused on children but can also be aroused by those who are more age-appropriate. Exclusive attraction is when someone feels no sexual desire for anyone but prepubescent kids. Letourneau is curious if young pedophiles who show even a slight interest in their peers might respond to treatment that attempts to redirect their attention into that corner. For most people, our age of attraction increases as we mature, suggesting that it is variable. She wonders if pedophilic adolescents can be encouraged to develop acceptable sexual desires, but acknowledges that it wouldn’t be effective for those with exclusive attraction.


Historically, attempts to change sexual impulses have included arousal reconditioning, which involves, essentially, getting men to masturbate to fantasies of their preferred target and then switching to something more socially acceptable right before climax. But there is also the opposite, like satiation training, where patients masturbate to fantasies over and over again until they are drained of desire.

I suggested to Letourneau that talk of sexual reconditioning strongly echoes the tactics of gay conversion therapy, a harmful and wholly unsuccessful pseudoscience, and she was quick to distance herself. “It’s a horrible legacy of psychology and psychiatry,” she agreed. “It seems kind of archaic, actually. And, frankly, ethically challenging to do with kids. So coming up with a viable way that is respectful of the person, the child and the parent, but also effective… I don’t know what that’s going to look like. I have no idea. I don’t want it to look like arousal reconditioning, I can tell you that.”

Dr. Klaus Beier doesn’t believe in sexual reconditioning. He leads the team behind Prevention Project Dunkelfeld, a therapeutic program based in Germany that targets potential offenders. He believes that minor attraction is a fixed part of someone’s makeup, that it’s “fate and not choice.” His program is considered the global gold standard of preventive treatment, and its practitioners help adults manage their attraction to children rather than try to change it. “In my view, it’s not the inclination that’s a problem,” he said. “And I wouldn’t condemn the inclination, I’d condemn the behavior.” The program consists of weekly therapy sessions for up to 12 months. They favor cognitive behavioral therapy, but also offer libido-reducing medication, otherwise known as chemical castration, if a patient needs to reduce his sexual drive in order to benefit from treatment.


The cornerstone of the program, according to Beier, is confidentiality. Germany doesn’t have mandated reporting, and that, he said, makes it easier for men to seek treatment. The project’s aim is to bring as many undetected men forward as possible, which is more easily achieved when you remove the threat of punitive action. This includes men who have already molested a child in addition to non-offending pedophiles. In English, Dunkelfeld translates to “dark field.” Beier said most cases of child sexual abuse go unreported, and though it can be ethically challenging to suggest that sex offenders evade immediate prosecution, he and his colleagues believe that it’s better to bring them into the light for the sake of preventing further instances of abuse.

“Telling the police would not be the first step we would choose,” said Dunkelfeld’s research coordinator, Gerold Scherner. “If we know about this, we will talk about it frankly and openly: What happened? What can you do? How safe is the child?”

In the United States, researchers can apply for a Certificate of Confidentiality. These federal certificates, if granted, protect the privacy of research study participants and can offer temporary exemptions from mandatory reporting laws. But there has been only one certificate granted in the area of pedophilia research. Between 1977 and 1985, Dr. Gene Abel interviewed 561 unidentified sex offenders in order to better understand this under-researched population. No one has been given one since.

It’s a hard ask, but Letourneau is considering applying for a certificate when she launches her new program. She doesn’t know if she’ll have much luck. “I’d like to be able to include youth who have offended but who are undetected, and the reason for that is that if they’re undetected they’re gonna stay undetected,” she said. “Do you want them to get help or not? For my money, you really want to be working with the kids who have already started offending, because those are the ones most likely to offend again.”


IT'S NOT THAT I don’t want to see a therapist,” said Mike, a 21-year-old on the West Coast. “It’s just that I don’t feel that I can see a therapist.”

I had been speaking with Mike online for two months before he agreed to let me fly out and meet in person. We met in the parking lot of a local supermarket and wound up talking in front of a Starbucks. He is pale and slight, and has a long face dominated by high cheekbones, wide brown eyes and dark, curly hair. Unlike Adam, he is outwardly confident and unguarded; he talks fast, casually jumping from one topic to the next, and has no reservations about discussing his attraction to children. He explained that he maintains a clear distinction between those he feels sexually attracted to and those with whom he feels a close paternal bond. He told me he only feels an erotic pull to girls aged seven to 12, and that for two-to-six-year-olds it’s more of a protective, almost brotherly instinct. He said this is what makes him such a good preschool teacher.

He is currently studying child development, and substitute teaches part-time for a pre-kindergarten program. He plans to continue working with kids up to six when he graduates from college, and said his connection to children helps him relate to them better. “I’ve had people say, ‘If you don’t go into teaching you’re doing the world a disservice. Like, you’re brilliant, why would you not?’” he said. “I never felt like I shouldn’t be here, this is dangerous… Long-term maybe this is a bad idea, but in the moment, right now where I’m at, I’m fine.”

Mike first noticed his sexual interest in children at 13, when he developed a crush on a girl he used to babysit. She was around three at the time and would strip naked and run around the house. “I was aware of it but it was like, well, it will go away,” he said. “I’m 13, so I’m transitioning from girls without boobs to girls with boobs.” He said he never acted on it, but that doesn’t mean he wasn’t tempted, admitting that he would find himself overcome with curiosity when he changed her diaper. “I’d want to touch her and that’s kind of as far as anything went,” he said.


When he started his teaching placement, he created a strict set of rules: staying away from the bathroom area where possible and avoiding any physical contact with the children. He said he would tense up when the more playful kids approached him for a hug. This wasn’t so much to keep the children safe, he told me, as to ensure people wouldn’t become wary of him. Which was something his dad warned him about when he first started. “He’s like, ‘People are going to be suspicious of you simply because you’re a guy. Don’t do anything stupid,’” he said. “And, honestly, I wonder if that had anything to do with it, because that kind of freaked me out.”

Adam asked Mike to be the first one to join the group in mid-2011, and they’ve communicated almost daily since. He said he’s not worried that Mike will abuse the children in his care, but he does wonder why he would leave himself open to temptation. “As much as I support Mike, and I’m definitely very close with him, his becoming a teacher is never something I’ve supported,” he said. “And not because I think he’d slip up, because I honestly believe very firmly that he wouldn’t, but I think he’s going to torture himself a lot in that position. I think that’s not going to make him very happy.”

Like Adam, Mike grew increasingly depressed while grappling with his desires. He never made active plans to commit suicide, but told me that he thought about it and knew what to do if the time came. “If I had a sawn-off shotgun, that would be it,” he said. “I don’t want to take pills because I could come back from that.” Ultimately, he felt he couldn’t kill himself and leave his family with no context for what he had done, and instead hoped that God would take care of matters for him. “But at the same time, I was still… It would be nice if I got hit by a car or I got really sick,” he said.

More than anyone else I spoke with, Mike seems like he could benefit from having a professional to talk to, and not just because of his proximity to children. I was taken by his urgent need to disclose information others might have a hard time expressing. Late one afternoon we were sitting in his car in the parking lot of a different shopping mall. After hours of conversation, I suggested that we wrap for the day and he flat-out refused, telling me in an uncharacteristically abrupt tone that he had to get it out. We continued speaking until the encroaching shadows finally met and turned to darkness, stopping only when the center’s cleaning staff began arriving for their night’s work.


IN PLACE of therapy, Mike leans on Adam and the group. They talk via email, text, telephone, and Skype, but their primary tool of communication is Gchat, where they can speak in groups or have multiple conversations at the same time. If arguments break out among members they look to Adam, their default leader, for advice.

In the beginning they were all pretty fragile, wrestling with this dark secret and what it meant for their futures. But once they’d exhausted talk of their attraction to children and the unique set of issues that come with it, they turned to far more routine topics: chatting about computer games or The Walking Dead, or sharing random YouTube clips.

Adam told me that sometimes they’d tease each other about peer-aged crushes, offering relationship advice and egging each other on to ask people out. “I talked to Mike a fair bit about dating. Partly about the guy I dated for a little while and partly about this girl in his class who he wanted to ask out. He’d find every excuse in the world not to do so, and I’d be supportive by trying to push him to take the leap,” he said. “We did talk about everyday things that most everyone else in the world has to deal with.”


James, 22, is another member of the group, and the only registered sex offender. In May 2011 he was convicted of indecent liberty with a minor and sent to prison. Adam was reluctant to break the group’s most fundamental rule by letting him join, but eventually became convinced of his commitment not to reoffend. Since then, they’ve grown close. “We talk about the obvious subject of being a pedophile, you can’t get around that,” James said, adding that it’s lost some of its urgency over the years. “We just think about it as if we’re both fans of this sports team. We sit there and talk about it in that same direction, but we can immediately turn around and talk about something else. To other people it’s a huge deal, but to us it’s just life. Life as it is. We’ve been living with it our whole lives.”

When I asked Adam to show me examples of their chats, he said they no longer keep records for security reasons. But, after some digging, he eventually found a handful of logs from the early days. The conversations in the documents he sent me veered from mundane to earnest, among them a discussion of whether shotacon or lolicon — manga and anime depictions of intergenerational sex — are morally acceptable alternatives to child porn. On several occasions it seemed like they were testing the waters with each other, admitting suspect behavior and then waiting for the other one to respond.
1:46 PM Mike: so you’re right
i do have a problem
i’ve started googling pictures of girls in their underwear and such on a regular basis
so fucking awful

1:47 PM Adam: …you need to stop this before it’s too late
if I can, so can you

Mike: yeah
ive even seen some CP show up in the results

Adam: :o

Mike: that was really disturbing
it wasn’t serious

Adam: did you look at it?

Mike: no
admittedly I kinda wanted to though
1:48 PM Adam: you need to stop
Adam’s group of young pedophiles isn’t the only such self-help resource on the internet. There is B4U-ACT, a Maryland-based outfit with around 100 subscribers, which offers peer support services to pedophiles and guidelines for accessing mental health providers who might be willing to help. However, the moderators of B4U-ACT claim that because they’re not a research organization they can’t say whether all instances of adult-child sex are intrinsically harmful. “But we do support and would advocate for minor-attracted people to live law-abiding lives,” said Matthew Hutton, the group’s spokesperson, who uses a pseudonym to protect his identity. “Even though we acknowledge the existence of research in the past that might say that some sort of contact between teenagers and older people might not be so harmful.”

This ambiguity made Adam and some others uncomfortable, and it’s why he didn’t stick around for long after signing up. A splinter group was formed, named Virtuous Pedophiles. Now the largest pedophile support group in the U.S., its 318 active members are clear in their belief that sex with children is wrong. The founders, Ethan Edwards and Nick Devin (also pseudonyms), both family men with children, enact this policy with tight moderation. If someone is seen to be voicing the opinion that minor sex is acceptable, he gets a warning. Repeat offenders are ousted from the group. The membership list is also restricted to those aged 18 and over, lest they be accused of wrongdoing.

While Adam contributes to discussions there from time to time, his focus remains on the young men who come to his own group for help. James, for one, speaks with a clear reverence for Adam. Though his status as a sex offender means he must attend court-mandated therapy, it is Adam and the others that he credits with helping keep him on the right path. It’s also not lost on him that, for everyone else, it is the only lifeline they have. “If they want help, if they want to be better, to try and fix their behavior and be a better person, he’s never given up on them,” he said. “He didn’t give up on me, he didn’t give up on Mike, he never gave up on any of us.


WHEN I TOLD Professor Letourneau that I was in contact with a group of young, non-offending pedophiles, she seemed taken aback. In her 25 years in the field she’s had plenty of experience with juveniles who have abused children, but she had never met a pedophile who hasn’t. It seemed strange to me considering her line of work, but she explained that, because such pedophiles rarely come forward, researchers have no way of accessing this particular segment of the population. “I don’t know anyone else who has made it a goal to talk to young people who have an attraction to younger people,” she said.

I asked her if she’d like to be put in touch with the group, and she jumped at the chance. After speaking with four of them over the phone, which she described as “kind of a life-altering experience,” she flew out and met Adam face-to-face, and has been speaking with him regularly ever since. She said they have taught her things about pedophilia that she didn’t know before, and it’s giving her a clearer understanding of how these attractions develop. She’s now using this information to modify her proposed treatment plan and has brought Adam on as an official advisor.


“I’m not a teenage boy attracted to children, and so I don’t know what that experience is like,” she said. “They all describe years of just agonizing self-hatred, agonizing fear of being detected as having sexual interest in children, viewing themselves as monsters, being afraid to look for help… If they could have just turned to someone to talk about this, a professional who’s going to treat this subjectively and see them as a person of worth, who’s going to know that they’re not bad kids, that they’re good kids but they have this aspect of them that they really need help controlling. That’s what they’re looking for and that’s what I hope we can provide.”

Adam’s input has helped expedite the pilot program she’s putting together, aimed at pedophiles aged 17 and under. If successful, it will provide the foundation for a comprehensive preventive model, which she hopes to eventually expand to include pedophiles of all ages, that will be rolled out online and to therapists across the country. Though it’s in the early planning stages, Letourneau imagines it will involve disabusing them of the notion that sex with children is ever appropriate, improving self-esteem in light of a situation that might not change, and strengthening social interaction with their peers. In many ways, it’s an extension of what Adam has been doing with his group for the past three years.

The last time I saw Adam in person we found ourselves sitting, once again, in his car. We had been talking for a few hours and were about to finish up when I asked him what it feels like to be not only a pedophile, but something of a pioneer. He paused for a moment before answering. “It’s one part of what defines me. You know, a small part of the puzzle,” he said. “Part of me is a pedophile but that’s not all I am. I’m also, I think, a very decent person in a lot of other ways. I’m definitely a very caring person… I have hobbies, I have interests, I have studies, and things like that all put together define who I am.”



This story was written by Luke Malone. It was edited by Mark Lotto, fact-checked by Hilary Elkins, and copy-edited by Lawrence Levi. Illustrations by Simon Prades. A version of this story first appeared on This American Life.

Read more: Editor Mark Lotto discusses the graphic nature of this story, and art director Erich Nagler talks about how to illustrate the most horrifying piece in the world.

Thursday, February 20, 2014

Supposed Adult Pays Man To Sit In Room And Listen To Him Talk About His Feelings

This is from The Onion, so don't take it seriously. However, this little piece of satire points out a stigma that still is common in our culture - that seeing a therapist is weak, especially for men.

Supposed Adult Pays Man To Sit In Room And Listen To Him Talk About His Feelings

News in Brief ISSUE 50•07 • Feb 19, 2014


BRIDGEPORT, CT—Reportedly going twice a week to his special safe place where he’s told he doesn’t have to be afraid, local accountant and supposedly grown adult Carl Rowley confirmed Wednesday that he pays a man to sit right next to him in a room and listen to him talk all about his feelings. “It’s really helpful to talk through my issues out loud with someone who has an objective viewpoint,” said the feeble approximation of a mature self-respecting grownup, describing the hour-long sessions in which he nestles himself on a big comfy couch with a soft pillow and tells the nice man how he’s sad and lonely and wants everything to feel good again. “I think I’m making a lot of progress, especially around issues with my family. I definitely think it’s something every [oh-so-fragile little infant masquerading as an actual grown man] should try.” At press time, sources reported that Rowley felt much better after the kindly listening man, a so-called doctor, told him that it was okay to cry.

Saturday, September 28, 2013

Aaron Anderson - Five Signs a Man Needs to See a Counselor

From the Good Men Project, Aaron Anderson offers five signs that we might need to seek out therapy. I agree for the most part - and none of the reasons given here are indicative of serious psychological symptoms (like suicidality, audio hallucinations, panic attacks, or dissociation).

When I began therapy, it was because I was unhappy with my life, my relationships, and my future. Therapy helped me know who I am, understand how I had come to that point in my life, and how to change the things I was not happy with in my life.

Counseling can save your life, but it can also help you find the life you have always wanted to live.

Five Signs a Man Needs to See a Counselor

September 22, 2013
by Aaron Anderson

Men aren’t supposed to go to counseling, they’re supposed to be tougher than that, right?


For a lot of men, the thought of going to a counselor for therapy is silly. It’s just not part of the man code to go and see a counselor. Seeing a counselor means talking about feelings and your childhood and there’s always the potential of the counselor telling you that your problems are occurring because you’re still in love with your mother. It’s no wonder then, why a lot of men don’t seek out counseling. And then there’s always the question of ‘do I need therapy anyway’? Everyone goes through rough spots. But how do you know when you need therapy? Let’s take a look.

Five signs a man needs to see a counselor.

1) The ‘rough patch’ stays rough for a while. Everybody goes through rough patches now and again. Whether it’s a rough time at work, a rough time in your marriage or a rough patch in life. But if these rough patches stay rough for a while you probably ought to see a counselor. You could wait it out, but what’s the point? Seeing a counselor sooner than later ensures that you get back on track sooner and start enjoying life sooner, too.

2) Your wife/mother/significant other suggests counseling. As a counselor who specializes in marriage counseling, I dread phone calls from men. I dread them because they usually go something like this: Me: Hello? Him: Hi, I need to set up an appointment for my wife and I to come to counseling. She’s been threatening to divorce me for three years and she finally left this morning. Do you have any appointments later today? Me: I have an appointment for later this week if that will help. Him: Okay. Great. Let me call my wife and see if she’ll come.

They normally don’t call back. The ones who do call back are just being courteous to tell me that their wife has gone to the courthouse for the divorce papers and won’t be needing my services after all. Men, do yourselves a favor and go to counseling the FIRST time your wife/mother/significant other suggests it.

3) You want more out of life. In his book Real Boys by William Pollack, PhD, Dr. Pollack talks about the ‘boy code’ that we hear as young men. As young men we often hear to sit down, shut up, and don’t complain. We’re also told to suck it up, don’t cry and move on. So as grown men we often feel like we can’t want more out of life because we just have to suck it up and accept our life as it is. But counseling is a great way to get exactly what you want out of life and get the tools you need to get there. You may have to talk about your feelings but you shed those unwanted burdens that are keeping you down. And you get exactly what you want out of your life in the mean time, too.

4) You’re easily irritated. Men display mental health difficulties differently than women do. Women internalize their difficulties by feeling sad, quiet and guilty. Men are much more external in their displays of mental difficulty. This means they get irritated at others more, become more aggressive and even become physical at times. If this isn’t how you normally react to stress and you’re reacting this way more and more it’s time to see a counselor. If you do normally react this way to stress, you still need to see a counselor.

5) You just want to be left alone for extended periods of time. Everybody goes through spells where they just want to be left alone for a few hours, night a day or a weekend. But if you find yourself day after day just wanting to be left alone by your wife, kids and colleagues at work it’s time to see a counselor. Being left alone is a temporary solution. Sometimes being left alone temporarily is all you need to get your mind back in the game and get a fresh perspective on how to fix things. But if you find yourself wanting to be left alone day after day after day, that’s a big red flag that something more serious is going on.

Unfortunately, there’s still a stigma about seeing a counselor. And for some reason, many men wait until the last minute or just don’t go at all. But a real man does whatever a man has to do in order to be a man; including going to counseling.

About Aaron Anderson
Aaron Anderson is a Licensed Marriage and Family Therapist and owner of The Marriage and Family Clinic in Denver, CO. He also writes for several publications online and in print all on the topic of marriages, families and men. In his spare time (whatever that is) he is secretly preparing to be the next great chef. You can find him on Twitter @MarriageDr and on Facebook giving great info without the psychobabble.

Thursday, September 12, 2013

Gratitude

Over the past decade or so, I have mentioned my last therapist, Maude (the one therapist who really helped me heal), in various conversations with friends, always with a sense of awe or deep appreciation. She didn't offer answers or platitudes, but she had the wisdom of lived (and learned) experience, as well as a very skillful compassion that was not always gentle. Some days her compassion was so direct that it broke me wide open, left me gasping for air, feeling as raw as an exposed nerve.

With Maude I learned to cry again. I learned how to mourn. I learned that my childhood was not normal and not healthy. I learned how to accept myself, and in that process I learned how to forgive my parents for their failings, their shortcomings, and their ignorance. I learned that I was a kind of ugly duckling in my family and that separating from them as soon as I was able was not ungrateful, not disloyal, not selfish - it was necessary for my growth and survival.

I learned that all the drugs, alcohol, and promiscuity of my teen years - behaviors that had filled me with a sense of shame, that made me feel like a broken and terrible person - were nothing more than unskillful coping strategies, they were the ways I found not to chase a bottle of Vicodin with a fifth of whiskey and a handful of Valium. I learned to feel compassion rather than contempt for that scared and wounded kid that I had been.

I learned that depression can be a sane response to an insane world (this is a reframe of a quote from Ronald David Laing, who once said: "Insanity sometimes is the sane response to a mad society"). I also learned that my particular kind of depression was a form of living in the past, and that my anxiety was a way to live in fear of the future, a perspective that came originally from Lao Tzu:
If you are depressed you are living in the past.
If you are anxious you are living in the future.
If you are at peace you are living in the present.
I learned how to apply mindfulness and awareness to my interior states, an approach I was familiar with from the writings of Pema Chödrön. I learned that my Buddhist practice was not confined to time spent in meditation, that the best place to practice was my daily life.

After a couple of years, I began to notice that I was not so reactive to daily stresses and annoyances. I came to realize that the political blog I was writing at the time was making me miserable and cynical, aggravating my depression. I stopped following political news and switched to blogging at Integral Options Cafe, then to this blog.

I switched my blogging focus to growth, psychology, philosophy, and health. I became curious about what it means to be a man in this culture, during this time when gender roles and identities are shifting so rapidly. I began blogging here, at The Masculine Heart.

Soon I realized it was time to go back to school, to return to my original goal of becoming a psychotherapist. That had been my major during my first stint in college, but the program as too reductionist and I switched to an English degree and then a masters in humanities (literature and comparative religions).

When I was nearly 40, I was finally ready to become a therapist.

I am still learning, still trying to be a better person, and through working with my clients, I become my best self more and more every day. This is the gift they give me without ever knowing.

Even now, when I am working with clients, I hear Maude's voice in my head, asking the hard questions, reminding me to connect my brain with my heart in every moment. For that gift, I will be forever grateful.

Wednesday, September 11, 2013

Medal of Honor Recipient, in New Act of Valor, Thanks His Therapist

It's an act of bravery for a soldier to thank his therapist when accepting a Congressional Medal of Honor, but in an era where more men die of their own hand than die in battle, it is a necessary and laudable act. He is strong enough to admit that war and seeing friends die has had an incredible impact on his mental health, that he is emotionally scarred by what he has witnessed.

Wonderful to see the wall of silence being taken down by a man recognized as a hero.

This nice story comes from Pacific Standard.

Medal of Honor Recipient, in New Act of Valor, Thanks His Shrink

As wave of military suicides continues

Staff Sgt. Ty Carter speaking at a ceremony awarding him the Congressional Medal of Honor. (PHOTO: YOUTUBE) 

August 27, 2013 • By Marc Herman

The video below, from Stars and Stripes, shows Staff Sgt. Ty Carter’s speech at a ceremony awarding him the Congressional Medal of Honor yesterday. Carter, one of only five living recipients of the medal who fought in post 9/11 conflicts, was cited for his actions during a battle in Afghanistan in which he attempted to rescue a fellow soldier, Spc Stephan Mace. Carter pulled Mace to safety and treated him amid a 12-hour-long battle. Mace, wounded grievously, eventually died.*

Carter’s speech is notably different from the popular image of a war hero receiving a medal. In lieu of crisp salutes and talk of duty, Carter spends much of his time speaking about loss, and frankly discussing his own mental health after the ordeal. To be clear, Staff Sgt. Carter appears to be a person of extraordinary mettle. In his presentation, however, he does not mind projecting another image, of a young man who has seen too many terrible things. Speaking in what can only be called a tone of vulnerability, he tells the White House audience, including President Obama:
Only those closest to me can see the scars that come from seeing good men take their last breath. During the battle, I lost some of the hearing in my left ear. But I will always hear the voice of Specialist Stephan Mace. I will hear his plea for help for the rest of my life.
He goes on to talk about how he recovered from the experience.
However, thanks to the professionalism of my platoon Sgt, Sgt Hill, and my behavioral health provider, Capt. Cobb, and my friends and family, I will heal.
“Behavioral health” is a synonym for mental health. A “behavioral health provider” is a therapist. In a ceremony traditionally designed to showcase bravery in battle, Carter is taking the extraordinary step of focusing on how he, the classic American war hero, came home from Afghanistan with his head in a bad place. He goes on to speak of anguished families of the soldiers lost in the same violent battle for which he received the medal. President Obama also remarks on the mental health issue.

Certainly what the video below displays is a cultural shift, from the 1940s image of the hard-bitten GI, to the modern, human hero like Carter. It’s also tempting to read the focus of this week’s ceremony as a tacit pushback against an emerging skepticism about war’s role in a wave of military suicides over the past half-decade-plus. Coincidentally, two weeks ago a study published in the Journal of the American Medical Association claimed that military deployments were not to blame for the widely-reported rise in suicides among service members since 2005.

The study, which has sparked intense debate, found ”suicide risk was independently associated with male sex and mental disorders but not with military-specific variables.” It cited a rise in alcohol and drug abuse among the soldiers studied as likely causes for the increase in suicides, but did not consider those influences “military-specific.”


*UPDATE 08/28/2013: This post originally stated that Staff Sgt. Ty Carter was one of only five living recipients of the Congressional Medal of Honor. In fact, he is one of five who have received the MOH in the post 9/11 conflicts in Afghanistan and Iraq.

Saturday, October 27, 2012

End of Men: The "Feminization" of Psychotherapy


This article comes from Dr. Stephen Diamond's Evil Deeds blog over at Psychology Today. I don't know if I would say that psychotherapy has been feminized, but the percentage of male therapists and counselors (who are not psychiatrists) is probably less than 20% nationwide, and maybe lower if you look at the under-40 cohort [Stephanie Coontz, in her New York Times article said that 81 percent of social workers are now female, up from 64 percent in 1980].

Among the men who do go into counseling, at least from what I have seen here in Tucson, it seems a pretty large percentage of them are gay or bisexual. This should not even be an issue, but for traditionally masculine men it can be a serious issue, not to mention for those who are fundamentalist in their religious beliefs.

Anyway, Dr. Diamond (in response to an article by Sherrie Bourg Carter, Psy.D., Is It Really the "End of Men?") looks at the decline of male psychotherapists.

Are we witnessing the extinction of male psychotherapists?

I personally witnessed this insidious shift to a predominantly female demographic during my twenty years of teaching psychotherapy to graduate students. The reasons for men fleeing the field of psychotherapy are many. First, and foremost, is financial. In recent decades it has become  increasingly difficult to earn a decent living as a psychotherapist of any discipline, be it psychiatry, clinical psychology, clinical social work, marriage and family therapy, or counseling. For men, who traditionally have a family to support or must support themselves, the mental health profession, especially private practice, no longer provides a viable source of steady income. Many male psychotherapists dropped out of the profession, finding work in other better paying venues. While this economic crunch equally affected female practitioners too, those women who were not the sole breadwinner for the family or were financially supported by their partners and therefore didn't need to earn as much money were better positioned to enter or remain in the field. But it is not just about money.

Since so many men in our society place such a high value on status and power, and since status and power are closely associated with money, some men choose to pursue status and power in more monetarily rewarding professions than psychotherapy. Psychotherapy was once a fairly lucrative vocation. But not so much now. Moreover, the mental health professions--especially clinical psychology--have significantly lost status and prestige overall. Whereas, at one time, clinical psychologists were seen as distinguished clinical specialists and uniquely qualified providers of treatment, today we are generically lumped together by insurance companies and consumers as merely one of a multitude of non-physician mental health providers who, unlike psychiatrists, cannot prescribe psychotropic medication to patients. (In a few states, clinical psychologists can, with additional post-doctoral training, prescribe such medications, but this is the exception rather than the rule. See my prior post.) Psychiatrists, in contrast to clinical psychologists, are still mostly males, but this too is slowly shifting. One reason that not as many male psychiatrists have fled their profession is that most, perhaps up to ninety percent, exercised their option as physicians to focus on psychopharmacology exclusively, a far more lucrative specialty than psychotherapy could ever be. Hence, their status and power--and income--was preserved. But most clinical psychologists and other non-medical clinicians don't have that dubious and, in some cases, cynical option.

But this alarming phenomenon goes deeper than any one of these single factors, far deeper than former American Psychological Association president Dr. Dorothy Cantor's simplistic assessment cited in Carey's piece: "Usually women get blamed when a profession loses status, but in this case the trend started first, and men just evacuated. . . . Women moved up into the field and took their place." While this is true, it must also be admitted that during that same period there was a pervasive devaluation of the archetypal "masculine" by women, both within and without the mental health profession. Much of this devaluation was a compensatory reaction against the prior denigration of the "feminine" in psychology and psychiatry, starting with Sigmund Freud. (Freud's famous male pupils, Rank and Jung, both tried to counteract this patriarchal prejudice in psychoanalysis by rehabilitating the "feminine" in their own approaches, as did pioneering psychoanalyst Karen Horney.) One manifestation of this devaluation and rejection of the masculine by women can be seen in the relatively recent trend toward females seeking treatment only from female therapists, a gender preference that presumably negatively affected the caseloads--and already plummeting incomes--of male practitioners, since women statistically comprise a greater portion of psychotherapy consumers. (See Chapter Two, "Sex Wars," in my book Anger, Madness, and the Daimonic. and also this excellent article, "Gender Issues in Psychotherapy.")

Does the sex of your psychotherapist really matter? As Carey's timely article notes, there is nothing in the rather limited mainstream scientific literature on gender and treatment outcome suggesting unequivocally that either males or females make better, more effective psychotherapists. (Having said that, the Helsinki Psychotherapy Study [2004] suggests some significant relationship between professional efficacy and personal qualities such as introversion and extraversion, self-confidence, and active vs. passive approaches to treatment.) So individual differences in personality style, some of which are inevitably linked to gender, do impact treatment. A male psychotherapist may be more effective for some patients than others; just as a female may have more success with certain cases than others. Part of this difference does have to do with gender and often unconscious gender psychology. Some male psychotherapists, for example, are fearful or out of touch with their "masculine" aggression, while others are estranged from their "feminine" side and feelings. Some female therapists either overidentify with the "masculine,"or devalue and dissociate it in their own personalities. This can all come into play during treatment, and commonly does so unconsciously in the form of what we call "countertransference" and other blindspots and biases on the psychotherapist's part. (For more on defining the archetypal "masculine" and "feminine" from a Jungian perspective, see my prior post.)

For instance, when women stepped into the void left by men in the field of clinical psychology and other mental health professions, many adopted men's "masculine" perspective and rational orientation to treatment. Cognitive-Behavioral Therapy (CBT) is a good example of such a highly "masculinized" approach today, one which imputes primacy to rationality and thinking over affect, the unconscious, and the so-called "irrational" (i.e., "feminine" or emotional) aspects of experience. The choice of this one-sidedly logical, mechanistic orientation to treatment represents an overvaluation of the "masculine" and devaluation of the "feminine" in psychotherapy itself. Paradoxically, given the vast popularity of CBT with today's female and few remaining male psychotherapists as opposed to more analytical, humanistic or existential approaches, it is clear that, unfortunately, the "feminization" of the psychotherapy field in terms of gender does not necessarily translate into a more truly "feminine" (i.e., compassionate, caring, affective and relational) orientation to psychotherapy. And, when it does, it tends to be a lopsidedly "feminine," nurturing, soft, passive, supportive approach to treatment in which firm limits, boundaries, diagnosis, structure and confrontation are sorely lacking. Balance between "masculine" and "feminine," between a focus on both feeling and thinking, intellect and experience, rational and irrational, is essential in psychotherapy, whatever the clinician's gender.

One key issue Carey's article touches on has to do with both male aggression and sexuality. Can a female therapist relate adequately to that which is archetypally and instinctually masculine? To the innate, primitive, often intimidating aggression, anger or rage of men? To the unique nature and primal power of male sexuality? Much of that depends, in my estimation, on how conscious and related she is to what Jung called her animus or inner masculinity. And on her own personal experiences with men. For male psychotherapists treating female patients, the same may be said regarding the awareness of and attitude toward their anima or inner femininity. Much like their patients, psychotherapists can suffer unconsciously from either "fear of the feminine" or "fear of the masculine." And unless they have faced that fear in themselves, and its psychological significance, it can be difficult to help others to deal with it.

Still, some men simply don't feel comfortable talking with a female therapist about these intimate matters. Just as some women feel uneasy with male therapists. Now the reasons for this discomfort, for either gender, can be--and, in my experience, often are--neurotic forms of negative transference, resistance or deep-seated distrust and dread of the opposite sex. Or, sometimes, of the same sex. Or one's own sexuality. In many such cases, it may be advisable for the male patient to, despite his reticence, courageously consult a female therapist and work through his anxiety with her as part of the treatment process. Or vice-versa for the fearful female patient. Or for the person who insists on only seeing an opposite sex psychotherapist to work with someone of the same sex. To choose to challenge the conscious or unconscious avoidance. But the fact remains that men and women clinicians have very divergent perspectives, psychologies and life experiences, and each bring something different to the therapeutic table. Not better or worse, superior or inferior. Just different, but equally valuable. This is why it is wisely recommended, and in some analytic training programs required, that therapy trainees undergo two courses of treatment--one with each sex.

Essentially, the best psychotherapy is not merely about eliminating some specific symptom, but confronting one's demons, facing one's fears, discovering one's true self, finding and fulfilling one's destiny. In this sense, psychotherapy is a type of spiritual mentoring and initiation into powerful secret wisdom for dealing with life's most perplexing problems. (See my prior posts.)  In the Arthurian legend of the Holy Grail, Perceval is mentored into knighthood by a wise hermit named Gurnemonz, who served as the model for the wizened and diminutive Yoda in Star Wars. Perceval, whose name means "innocent fool," is a young man destined to find the Holy Grail. But before he can fulfill his personal destiny, he must intensively prepare psychologically, physically and spiritually, a difficult, arduous, painstaking process requiring many years.

Luke Skywalker's secret initiation into Jedi knighthood by both Obi-Wan Kenobe and Master Yoda closely parallels both the psychotherapy process itself and psychological and spiritual development in general. There are similar archetypal examples of initiation of women into the feminine mysteries solely by females. In different cultures around the globe for millennia young men have been initiated into adulthood and the essential secrets of masculinity by men, just as young women have been initiated by women. The time-honored wisdom of such structured, socially sanctioned, transformative rituals suggests that it is crucial to acknowledge and honor the profound differences--both biologically and psychologically-- between men and women, and that there are certain initiatory tasks best conducted by specially prepared members of the same sex. Such painful yet healing  initations or rites of passage are not limited to children approaching puberty or adolescents entering adulthood, but occur also during later stages of psychological development like marriage, child-birth, parenthood, mid-life crisis and old age. ( See, for instance, my prior post "Staring at Sixty.")

Such existential crises and painful rites of passage can differ significantly for males and females. Becoming a mature man is not exactly the same task as becoming a mature woman, and sometimes demands a very different set of skills and values. But, given the current "feminization" of psychotherapy, with the number of female therapists and therapists-in-training far outnumbering males, where will men, already reluctant to seek psychological treatment, go for such much-needed assistance? And, if women dominate the field of psychotherapy completely, what will become of the sacred clinical secrets of masculinity? Who will be the cultural containers and teachers of this sacred masculine wisdom passed down traditionally from one generation of male psychotherapists to the next?  Because of our complementary polar differences, women will always need male psychotherapists, and men female psychotherapists. There are certain wounds inflicted by women on men that only women can help heal, as there are those inflicted on women by men that require a "corrective emotional experience" with a male.

Despite of, or really, because of our profound psychobiological gender differences, we still have a great deal to learn from each other. Female psychotherapists, as women, can provide precious therapeutic perspectives to male patients, and vice-versa. But men will always need mentoring and initiation into manhood mainly by men, and women by women. Now that there is a critical shortage of men remaining in or entering the psychotherapy field, coupled with the scarcity of psychodynamic practitioners in general (see my prior post), consumers have increasingly fewer choices--not only regarding the particular type of mental health treatment they receive, but what gender will provide it. Thie feminization of psychotherapy may be good for women. But can this gender imbalance be good for the profession? I wonder. Women make wonderful psychotherapists. But so do men.

My hope is that, as with the recent signs of renascence of psychodynamic psychotherapy (see, for instance, my forthcoming review of 2012's Psychodynamic Psychotherapy Research for PsycCRITIQUES) now in motion, eventually the gender pendulum will slowly swing back toward middle ground, with men once more being drawn to becoming psychotherapists alongside women. The practice of psychotherapy itself is dying. (See my prior post.) If the profession is to survive, we definitely need men's masculine energy and perspective in clinical psychology to complement that of female practitioners. And vice-versa. But how can we make the psychotherapy profession today more attractive, especially to men? Is it all about money? Prestige? Status? Power? Have men lost touch with their nurturing, giving, caring, compassionate side?  Have we brutishly become more materialistic and selfish than women? Too technical, mechanistic or mercenary? Have men lost their faith in psychotherapy? Or have men in the field of psychotherapy simply surrendered to women in the proverbial war of the sexes? Resolutely accepted defeat and withdrawn from the field of battle?

Is this really the "end of men" in general? Is what we are seeing in the mental health professions merely a symptom or sign of a much more pervasive trend in American culture? (See PT blogger Mark Sherman's review of a recent book by Hanna Rosin titled The End of Men here. See also a response by another PT blogger, Melissa Kirk here.) Reader comments, as always, are welcome on this particularly exquisitely sensitive subject.