Spring 2017 Workshop: Developing Best Practices

Developing Best Practices for Working with Minor-Attracted People

Mental health professionals at the cutting edge are coming to understand the importance of a holistic, wellness-focused approach when working with minor-attracted people (MAPs). However, professionally accepted guidelines for best practices have not yet been developed.  B4U-ACT’s spring 2017 workshop provided an opportunity to work together to flesh out the wellness-focused therapy envisioned at the 2016 workshop.  B4U-ACT held its ninth full-day workshop on Friday, April 28, 2017, in Baltimore, MD with 37 attendees, including minor-attracted persons (MAPs), MAP family members, mental health professionals, graduate students, and professors.  As always with our workshops, the workshop was planned and led by co-equally by MAPs and mental health professionals.

Russell Dick, LCSW-C, co-founder and chairperson of B4U-ACT, began the day telling how he came to know Michael Melsheimer, an MAP, and how Mike’s advocacy with Maryland’s Mental Hygiene Administration for publicly advertised, non-stigmatizing mental health services resulted in their co-founding B4U-ACT.  He provided a brief history of the evolution of B4U-ACT.  Psychodramatist Steve Kopp led an activity for participants to get to know each other a little better and to feel more comfortable discussing MAPs and their therapeutic needs.

Participating MAPs shared their personal experiences in realizing at a young age that they were MAPs, the effects of our culture’s stereotyping labels and demonizing of MAPs, their fears of being outed and subsequent isolation and inhibited social relationships, and their challenges in locating mental health providers who would focus on their mental health needs and not just focus on prevention of child abuse.

Richard Kramer, B4U-ACT’s volunteer Science & Education Director, and Maggie Ingram, a B4U-ACT volunteer and a graduate student in the Johns Hopkins Bloomberg School of Public Health, presented research findings regarding minor-attracted persons, including data regarding prevalence, age of onset, its persistence over time, their feelings of affection for children and adolescents, that many/most MAPs do not act sexually with children and adolescents, and they do not have aggressive, abnormal, or pathological characteristics.  They reviewed the conflicting research on the causes of minor-attraction and presented research that suggests it most helpful to consider it as a sexual orientation with a variety of attraction patterns.  The research also shows the diversity of characteristics of adult persons who sexually interact with children, and their distinction from individuals attracted to children and adolescents.

Following the MAP stories and research presentation, workshop participants discussed in small groups their reactions to what they had heard, placing themselves in the situation of being a minor-attracted person or a therapist working with a minor-attracted person.  A representative from each table then reported to the whole group the highlights of their table’s discussion.

Richard and Maggie introduced the document, “Psychotherapy for the MAP,” which B4U-ACT drafted following the Spring 2016 Workshop that had focused on the Wellness model of mental health treatment.  The draft document was compiled by a group of MAPs and mental health professionals, incorporating the suggestions from last year’s workshop, recent research, and the experiences of both MAPs and mental health professionals.  Due to the lack of a holistic, wellness-focused best practices guidelines when working with minor-attracted people, this document was B4U-ACT’s initial effort to develop such guidelines for the treatment of MAPs.  Sections of the document were highlighted during subsequent parts of the workshop to further refine it.

Several MAPs told of their experiences in seeking and participating in therapy, what was helpful and unhelpful.  They also reported on how they find fulfillment and wellness within their lives.  Maggie and Richard then presented more research findings regarding MAPs and their clinical needs.  Research clearly indicates that MAPs experience high levels of distress, anxiety, depression, hopelessness, loneliness, and self-hate due to stigma. One study reported that 25% are at risk of suicide and another study reported 33% have chronic suicidal ideation.  A study by B4U-ACT involving 200 MAPs found that 45% had seriously considered suicide and of those, 42% had seriously considered suicide when they themselves were still minors.

Maggie reported on the Moore Center’s “Help Wanted Project” in which persons between 18 and 30 years old who were sexually attracted to young, prepubescent children (generally those 12 and under) during their adolescence (ages 12 to 17), participated in an anonymous interview and online survey. The purpose of the study was to learn about how an attraction to young children impacts youths’ experiences and relationships during adolescence. She provided a series of anonymous quotes from the participants that demonstrated their severe depression, hopelessness, suicidal thinking, self-hatred, and loneliness and isolation as they realized their sexual and emotional orientation toward younger children, heard the stereotypes used by the culture to describe “pedophiles” and “child molesters,” and their fear of their thoughts and feelings being discovered.  The quotes also revealed their experiences with mental health professionals who treated them as if they active child abusers or destined to become so very soon, and who failed to address the mental health needs of the MAP. One person’s therapist said he was possessed by demons. Others reported having found a therapist who listened, treated them with respect, and focused upon how to improve their well-being. One person reported that his therapist had enabled him to be happy with himself, including everything that is a part of who he is. Adolescent participants reported a fear that a therapist would tell their parents of their being attracted to minors.

Richard reported that in that B4U-ACT survey of 200 MAPs, 58% wanted to see a therapist but didn’t due to fear; the most common fear (78%) was a negative reaction from the therapist. Only 18% felt they would be treated with respect by a therapist, only 12% felt a therapist would respond non-judgmentally, only 21% thought they would be treated ethically, and only 5% felt a therapist would understand their sexuality.

In the B4U-ACT survey, participants were asked what they thought the goals for their therapy should be:

• 73% – Figure out how to live in society with this attraction
• 68% – Deal with society’s negative response to my attraction
• 52% – Understand the cause of the attraction
• 51% – Deal with sexual frustration
• 48% – Improve self-concept
• 32% – Learn to control the sexual feelings

Workshop participants then discussed the implications of this research for developing models for therapy with MAPs, therapist knowledge and skill requirements, and needed attitudes and beliefs of therapists. The core principles to guide treatment were identified as trust, autonomy, and client-centered treatment.  By improving the mental health, social supports, and well-being of MAPs, without focusing upon prevention, MAPs would be less isolated, less suicidal, and, subsequently, less at risk of harming children.

During lunch, the workshop participants had the opportunity to interact informally to get to know each other better as individuals, apart from their labels as MAPs, mental health professionals, advocates, or family/friends of MAPs. After lunch, Richard provided an overview and update of B4U-ACT’s recent activities and accomplishments in four areas: practice, collaboration with researchers, MAP support, and interaction with media.  He also announced that B4U-ACT has requested and been approved to begin doing business under the “trade name” B4U-React.  It is hoped that this name will more clearly should better reflect our mission and work, and our goal that all people should think before speaking or reacting to MAPs or their situation.

Richard provided further research indicating the majority of MAPs found that their prior therapists held misconceptions consistent with common stereotypes and prejudices.  In 2/3 of these cases, the misconceptions interfered with therapy.  Nearly all research on MAPs is based on forensic studies, thus providing a very skewed sample.  However, some initial research on MAPs’ experiences recommends that therapists show empathy, explore possibilities for positive “coming-out” experiences, provide resources to MAPs’ loved ones, and explore possibilities for MAPs to experience sexual fulfillment.

In light of the dearth of best practices models with a wellness focus on MAPs, Richard suggested an empirically-tested model with another stigmatized group, the LGBT community, and the affirmative mental health models for their treatment.  He noted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, which is empirically validated, alleviates stress-sensitive mental health disorders (e.g., depression), is based on learning and cognitive theory, and can be adapted based on minority stress theory.

Richard’s presentation was followed by a discussion of these approaches and how they could be implemented with MAPs.  Mental health professionals considered the knowledge and skills they already have in working with clients, additional skills they might lack, and what supports they might need to expand their practices to include MAPs.

Richard and Russell used a PowerPoint presentation to stimulate discussion of some of the ethical and legal issues surrounding mental health treatment with MAPs.  There was again the issue of social control vs. client’s therapeutic goals, with most of the existing models of treatment focusing on prevention, with the assumption that MAPs will offend.  As one person in the B4U-ACT survey stated about the DSM, “It refers to ‘pedophiles’ as if they were some kind of dangerous animal, or a threat by default.”

There was a brief review of the Code of Ethics for psychologists and social workers which included statements such as: “Psychologists strive to benefit those with whom they work and take care to do no harm…”; “Psychologists establish relationships of trust with those with whom they work…”; “Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination… Psychologists are aware of and respect cultural, individual and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language and socioeconomic status and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors…”

The NASW Code of Ethics states: “Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people…Social workers strive to ensure access to needed information, services, and resources; equality of opportunity; and meaningful participation in decision making for all people…”; “Social workers respect the inherent dignity and worth of the person. Social workers treat each person in a caring and respectful fashion, mindful of individual differences…They seek to resolve conflicts between clients’ interests and the broader society’s interests in a socially responsible manner…”; “Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible before the disclosure is made…”; “Social workers should monitor and evaluate policies, the implementation of programs, and practice interventions. Social workers should promote and facilitate evaluation and research to contribute to the development of knowledge. Social workers should critically examine and keep current with emerging knowledge…”

Regarding the legal issues in working with MAPs, providers need to know clearly what is and is not required to be reported; and, before beginning therapy, a provider needs to explain to all clients what must be reported.

During the workshop wrap-up, participants who were interested were invited to sign up to participate in two committees and a Dialog on Therapy discussion group in the months ahead.  One committee was to revise the draft document “Psychotherapy for the MAP,” incorporating research and discussion content from the workshop.  The second committee was to design a system in which mental health providers who agree to practice by B4U-ACT’s guidelines for “Psychotherapy for the MAP” and “Principles and Perspectives of Practice” could sign up to receive referrals from MAPs who contact B4U-ACT in search of competent, respectful, wellness-focused, affirmative mental health practitioners.

The workshop ended with participants completing evaluations of the workshop and mental health professionals receiving Continuing Education certificates.  Seventy-eight percent of participants assessed the workshop as a whole as “excellent,” while the remaining rated it as “good.”

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ADDENDUM:  The two committees mentioned above completed their work, resulting in B4U-ACT making available on its website the pamphlet Psychotherapy for the Minor-Attracted Person, which provides guidelines for therapy endorsed by B4U-ACT. It was also advertised in a major professional journal for mental health therapists. The procedures for mental health professionals to sign on to receive referrals and for MAPs to request to be referred to therapists who have agreed to our Guidelines and our Principles and Perspectives was completed and is available on our website here.

The Dialogue on Therapy Discussion Group is meeting monthly in a conference call.