Therapy for Pedophilia "I Hate My Desires - They Make Me Sick"

Ralf P. is plagued by sexual fantasies of the kind he would rather not have -- he's pedophile and struggling to resist his own impulses. Berlin's Charité hospital now offers a new program combining counseling and hormone therapy for men in his situation.

When the girl dressed in skimpy summer clothes sits down across from him and smiles, Ralf P. goes into a panic. His heartbeat speeds up and he begins to breathe heavily and unsteadily. He breaks into a sweat.

He tries to look the other way, but he can't. He stares at the girl for minutes at a time. Then he gets up abruptly and steps off the public bus at the next stop. Never mind that he's still a long way from his destination. P. spends an hour wandering aimlessly through the city. He's a man on the run from himself.

Ralf P. finds himself in this kind of situation all the time -- in restaurants, on the escalator at the shopping mall, on elevators, at the supermarket. "Why me?" is the question he asks himself every time it happens. "Damn it, why me of all people?"

The girls that plunge him into this restless and confused state, making him forget everything that goes on around him, are young -- much too young. They're 10 or 11 years old -- 12 years at best.

Ralf P. is a pedophile.

"I hate my desires," he says brusquely. "They make me sick." Then, after a brief pause, he adds: "But I've never abused a child."

Ralf is a stocky man in his mid-50s, with dark blonde hair that is turning gray at the sides. He seems a friendly enough and looks perfectly normal, as he sits in a room in Berlin's Charité hospital. No unusual features distinguish him from other people.

A questionnaire lies on the table in front of him. Ralf P. is making an effort to answer all the tedious or embarrassing questions honestly. "How old are the sexual partners you fantasize about?" reads one question. "How do you think of your own sexuality? Do you think of yourself as normal or as a pervert?" the questionnaire continues. Another question asks: "What do you think about when you masturbate?"

Ralf P. is participating in a therapy program called "Prevention of Unrecorded Sexual Child Abuse." It's conducted by the Institute for Sexology and Sexual Medicine at the Charité Hospital. Behind the project's awkward name lies a simple intention -- that of preventing pedophile men from ever putting their sexual fantasies about small boys and girls into practice.

"Do you love children more than you would like?"

A campaign of posters and TV ads ("Do you love children more than you would like?") has been started to encourage pedophile men to get in touch with the scientists at the program: "We can help -- free of charge and confidentially."

The offer is directed at a minority, but the minority is a large one: About one percent of all men aged between 17 and 80 are considered pedophiles, according to the calculations of sexologists and the estimates of international medical panels. That's 290,000 men in Germany alone -- almost as many as suffer from Parkinson's disease.

The program at Charité is designed to prevent lives from being ruined. Child abuse provokes more disgust than almost any other crime. The perpetrator's reputation is quickly destroyed and few crimes have similarly severe consequences for the victims. Child abuse victims often think they've put their traumatic childhood experiences behind them, only to find that those experiences still cause them to distrust or fear their sexual partners years later. They may suffer from impotence or frigidity. Often child abuse victims are unable to enter into sexual relations when they grow up.

The statistics are shocking. German police files register about 14,000 cases of child abuse every year; the total number of cases is much higher. Reliable surveys indicate that 8.6 percent of all girls and 2.8 percent of all boys are sexually abused.

The only cases that make it into the headlines are those that involve dramatic murders -- about eight a year -- or spooky kidnapping cases like that of the Viennese girl Natascha Kampusch  or the 14-year-old German child abuse victim Stephanie Rudolph. But such cases are exceptions. Most cases are never reported.

Complete candor

Much is being asked of the men participating in the Charité's therapy program. Because when they show up in old part of the hospital in Berlin's city center -- a brownstone building where Robert Koch discovered the tuberculosis virus 124 years ago -- there's one commitment they can't shirk: They have to be completely candid.

People who have kept their sexual preference secret for years, hiding it from their parents, siblings and colleagues -- sometimes even from their wives -- now have to acknowledge that preference in front of others, as part of their group therapy. "Yes," they have to say. "I am a pedophile."

"It's a nightmare for all of them," says Christoph Joseph Ahlers, the psychologist who is coordinating the project in addition to running two of the therapy groups. The sexologist is a tall, reserved and yet friendly man. He knows from countless conversations that pedophile men want nothing more than to hide their urge from the world and from themselves. But he also knows that if those men don't acknowledge who they are, no progress can be made: "If I accept something as a part of me, I can control it in a reliable way," Ahlers says.

And control is what it's all about. There is one question at the heart of the therapy program: What should I do when my urges overpower me?

Many of the answers to that question are simple -- at least in theory. One answer is not to drink alcohol, not to use drugs and to avoid everything that weakens your inhibitions. Another answer is not to get close to children and to categorically refuse requests for helping them with their homework or giving them a ride. A third answer is to avoid pornography.

It's not easy putting the theory into practice. Ahlers regularly makes his patients practice techniques for resisting their urge -- and also the temptation to blame difficult situations on the children. The therapist often hears telling remarks such as: "The girl wasn't wearing anything except a really short T-shirt. And she was giving me seductive looks the whole time." Or: "It's not my fault if this boy sits down right next to me in the cinema."

Role-playing games are one technique Ahlers uses in order to get the men to put themselves in the situation of the children. Ahlers wants the men to see themselves from the point of view of their potential victims. He wants to make them understand that children are sexual beings but would never, under any circumstances, desire sexual contact with adults.

Not so simple

Studies have shown that children who receive too little love and care frequently become victims of child abuse -- partly because they feel they're not being perceived at all, and try desperately to remedy this. Ahlers knows from the stories his patients tell him that it's very easy to win the trust of such children: "Many of them are glad that someone is even just calling them by their first name."

Only those men are admitted to the Charité therapy program who have either successfully checked their urge until now or who have been prosecuted and have served their sentence.

The expectations these men bring to the therapy program are enormous. "At first I thought I was starting a new life," Ralf P. remembers. He dreamt of never being exposed to his sexual urges again, of escaping his vivid daydreams and fantasies, perhaps even becoming just like most men: someone who desires and loves an adult woman -- someone perfectly normal.

But that dream ended during the very first therapy session. When the therapist explained to Ralf that his sexual inclination itself cannot be treated, and that all he can be taught is how to handle that inclination, he wanted to get up and leave right away, withdrawing from the program then and there. He wanted to spare himself the weekly train trip to Berlin, which takes several hours -- not to mention the tortuous exchanges during the group sessions. Three words imprinted themselves on his mind: "No possible cure."

"Many of the participants are shocked when we tell them this," Ahlers point out. Most of his patients react bitterly when he provides them with the relevant background information on how human sexuality develops, telling them that a person's sexual inclination is fixed for good after puberty, without any possibility of future change, and that no one has the option of choosing their sexual desires -- by deciding, for example, whether they want to be heterosexual or homosexual. He tells them there's no choice.

"It's just fate," the psychologist explains, "one of nature's whims." Then he continues, as if he wanted to offer his listener consolation: "It's got nothing to do with good and evil, or with guilt." After all, he knows that almost all his patients are constantly plagued by intense feelings of guilt.

"You pervert!"

When Ralf P. first noticed that the bodies of pre-pubescent girls fascinate him -- he was 16 and working as an assistant at a holiday camp -- he tried desperately to banish his fantasies from his mind. They kept coming back, keeping him awake at night, and he became angry at himself.

"You pervert!" he said to himself. "You pervert, you disgusting pervert." He could already see himself standing in court -- spat on, threatened and despised by all: Ralf, the child molester.

Later he tried to distract himself by seeking contact with girls his own age. But some of them had already developed breasts, and he was repulsed by their curves. The same images kept dominating his fantasies: Images of pre-pubescent girls who want to cuddle him, girls he caresses and kisses -- but without violence and without penetration, as he insists on emphasizing.

Afraid his self-control might slip one day, Ralf P. became more and more reclusive. He avoided swimming pools, sports fields, cinemas -- every place where people gather in large numbers and where he might meet small children. Ralph has no friends that he could confess his problems to. He's completely alone with the images in his head, left to his own devices. The images return several times a day, like an obsession.

He abandoned his training as a teacher -- the risk of actually becoming a teacher and being exposed constantly to children would be much too great. He looks for jobs in places where he won't be tempted to give in to his urges. He works high up in the sky, as a crane operator, or cruises along the Rhine and Elbe rivers as a ship steersman. Often he speaks to no one for days.

After hesitating for a long time, he finally confessed to his doctor, who reacted helplessly. The doctor gave Ralf a prescription for a drug that lowers blood pressure, explaining that this will help to curb his sexual desire. Then he sent him to a psychiatrist. The psychiatrist fiddled nervously as he listens to Ralf's confession and then gives him a disgusted look. "I can't help you," he said. "All I can say is: The poor children."

Ralf P. tried to force himself to be normal. When he met a woman that he knew and was attracted to years earlier, when she was a 10-year-old girl, he made his first attempt at a relationship with an adult woman. He imagined she were still a girl in order to be able to be physically close to her. That didn't work out for very long.

Trying to be normal

Ralf P. tried repeatedly to confess to his partner. When he finally succeeded, she reacts understandingly -- at first. "Sex isn't everything," she tells him. But she never touches him again, just as he never touches her again. The relationship ends.

Ralf P. then has two suicide attempts. At age 18, he overdoses on sleeping pills. He's discovered purely by accident. At age 52, following the break-up with his partner, he wants to jump off a bridge. Policemen restrain him at the very last moment. He's placed in a psychiatric hospital.

Ralf's story isn't unique. "Almost all patients have fantasies of suicide," says Ahlers, the therapist at Charité hospital. The life-long necessity of repressing something that seems perfectly natural to most people -- your own sexuality -- and the fact of never being able to have a fulfilled sex life combine to produce depression and auto-aggression. Ahlers uses medical jargon and speaks of "clinically relevant psychological strain."

Sexual abstinence isn't made any easier by the fact that behind the sexual urge there lies a desperate urge for love, tenderness and recognition. Ralf P. has resigned himself to accepting what this means for him: "I know I will never be able to experience any of those things," he says.

The pressure on Ralf and others like him is intense. That's why the treatment they get as part of the Charité's therapy program isn't restricted to talk.

Every 14 days, Ralf P. receives injections of Androcur, an antiandrogenic hormone preparation that is also used to treat prostrate cancer. The drug curbs the production of male sex hormones. Ever since he started taking the injections, P. feels he is no longer being overwhelmed as vehemently by the images in his head. He feels in control of his own sexuality. It's the first time in his life. Ralf says he's now able to experience something like joy at being alive.

There is a caveat, however: He has sworn himself that if he gives in to his pedophile impulses even once, he will sentence himself to death.

The unusual pact is Ralf P.'s attempt to force himself to remain sexually abstinent. He's making his own survival dependent on his sexual behavior: "If I ever lay hands on a child," he says, "I'll kill myself. No one will save me then."

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