Treatment

TYPES OF INTERVENTIONS

Medication (Summit Medical Group, 2014)  

• Antiandrogens : reduce male sex hormone levels 

• SSRI's: medications such as fluoxetine (Prozac) increase serotonin levels which is thought to decrease sex drive and reduce compulsive behaviors and obsessive thoughts. 

Psychotherapy 

Behavior Therapy Techniques: (Summit Medical Group, 2014) 

• Biofeedback Therapy: while connected to a machine that measures for arousal, one is exposed to sexually exciting material and is desensitized to such material. 

• Covert Sensitization: following relaxation techniques, pictures that excite the offender are provided to which they are then required to imagine something negative i.e. cutting your genitals.

• Assisted Aversive Conditioning: negative stimuli are provided in the midst of offender acting out inappropriate sexual urges i.e. therapist spraying ammonia in the air during attempt of offense. The goal is to correlate negative action with negative consequence to diminish inappropriate urges. 

• A Case of Frotteurism & Its Successful Treatment By Behavior Therapy (Kurvilla & Joseph, 1983): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012344/pdf/IJPsy-25-159.pdf

Cognitive Behavior Therapy Techniques: (Moster et al, 2008)
most common form of treatment for Frotteruism which produced modest treatment effects. Moster et al. (2008) notes that "... a meta analysis of 43 sexual offender treatment outcome studies...found that, on average, sex offenders who had completed treatment had a 12.3% sex offense recidivism rate compared with the 16.8% recidivism rate seen for offenders who did not complete treatment" (Moster et al., 2008, p. 110).

• Theory: Change of thinking --> change of behavior
• Archetypal CBT Includes:
• Aversion Therapy
• Patient is exposed to sexually arousing material while also being subjected to some form of discomfort.

• Interventions to Enhance Interpersonal Skills
• Aim is to advance offenders' communication skills with others and initiate and maintain consenting relationships. 

• Intervention for Empathy Deficits
• Goal is to increase offenders' empathy for his victims; to understand another person's perspective.

• Interventions for Deviant Sexual Arousal
• Part of the aversion therapy process. Goal is to subdue inappropriate sexual urges.

• Interventions for Relapse Prevention & Self-Management
• Identify triggers and develop/practice coping mechanisms for when tempted to act on inappropriate sexual urges.

• Interventions for Cognitive Distortions
• Includes cognitive restructuring, describing account of offense to be aware of thoughts/beliefs, and typically group therapy with other offenders for feedback sessions.

• Interventions for Emotion Management
• Helps build coping skills when faced with negative affect.

• See: Moster el al.'s (2008) Cognitive Behavioral Therapy Interventions with Sex Offenders for full detail: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.874.2739&rep=rep1&type=pdf

A Real Life Sex Offender Treatment Plan:

* Note: Clark et al. (2016) found a high lifetime prevalence rate of Frotteurism. Overall, treatment does not have high efficacy. 

References
Kuruvilla & Joseph. (1983). A Case of Frotteurism & Its Successful Treatment by Behavior Therapy. Indian Journal of Psychiatry, 25(2), 159-161.

Schaffer, M., Jeglic, E. L., Moster, A., & Wnuk, D. (2010). Cognitive-Behavioral Therapy in the Treatment and Management of

Sex Offenders. Journal of Cognitive Psychotherapy, 24(2), 92-103. Doi 10.1891/0889-8391.24.2.92

Stines, S. (2015, August 31). Treating Pedophilia. Retrieved from https://pro.psychcentral.com/treatingpedophilia/

Summit Medical Group Web Site. (2014). Retrieved from https://www.summitmedicalgroup.comlibraryadult_healthbha_frotteurism/