Fantasy management in sex offender treatment: Letting go of long-loved "buddies

Affecting sexual fantasies of sex offenders is a difficult therapeutic issue. What makes a fantasy "deviant? Do sex offenders fantasize more than the average citizen? And what role do sexual fantasies play as a risk factor in sexual abuse and recidivism? Sexual fantasies can be managed via therapeutic techniques Kris Vanhoeck and his colleagues at the I.T.E.R., Centrum voor Daderhulp, Brussels, say in the Journal "Sexual Offender Treatment. Yet, what it takes beforehand is a careful screening of clients and a thorough need assessment. Sex offenders have to be motivated to say good-bye to their long loved "buddies.

"Deciding to give up abuse is one step, preparing oneself to tackle longtime cherished fantasies is quite a different one, Kris Vanhoeck says. The forensic psychologist has treated many sexual offenders and is yet astonished how committed some clients are to their fantasies. "Years, sometimes decades, they have been the lifeline, the ally, the refuge, the soul mate, the source of comfort. The client could always rely on them. Its important to realize this before starting fantasy management.

Vanhoeck argues that a clients motivation is the key element when addressing the topic of sexual fantasies and affecting them successfully in therapy. The first step to fantasy management is to offer clients psycho-education on sexual fantasies in general and on the role they might play in the offense chain. Then, as a second step, it is crucial to carefully screen the clients for the need of fantasy management. Due to Vanhoeck, "clients who suffer from their fantasies or are aware that they constitute a problem, as well as clients whose fantasies may play a major role in the offense cycle and possibly in their relapse risk might benefit from fantasy management.

"Sexual deviation is often indicated as a potential risk factor for recidivism of sexual abuse and the Sexual violence risk 20 (SVR-20) infers sexual deviation in a paraphilia related way from fantasies, urges, physiological arousal and behavior. Still, the link between fantasizing and behavior is not direct. "We have to be very careful with generalizations when we talk about the role of fantasies in recidivism, Vanhoeck warns. "Through group therapy discussions about the role of fantasies we distinguish four features which may play a role in the abuse cycle:

Maintain the arousal pattern, and often even spark it
Sustain cognitive distortion about themselves, the world and about the victims
Try out scenarios and elaborate them
Keep the road open to recidivism

Therapists should note carefully what role sexual fantasies might play for the client and how emotionally bound he seems to be to his fantasies.

In addition, following an ethical framework might help therapists to address the topic with the right attitude.
"Sexual fantasies are free and belong to everyones intimate privacy. This is an ethical principle, Vanhoeck stresses. "The therapist must [] justify himself before he can insist that the content of fantasies should be discussed in therapy. [] The deviancy of a sexual fantasy is not its content, but the possible link to criminal behavior. That is the starting point from which to address fantasies.

The therapists highlight that deviant fantasies may be managed if the client thinks they are undesirable. Although the emergence of a fantasy cannot be controlled, the way in which a client deals with it can be affected via specific cognitive, behavioral and sexological management techniques. LKZ