Treating pedophilia in the Norwegian setting: an overview
- Eirik Svela
- Jun 1
- 8 min read
Updated: Jun 9
Pedophilia is a psychiatric disorder characterized by a stable pattern of sexual attraction towards children. Despite the subjective distress often experienced by these individuals, and the potential for sexual abuse associated with the condition, people with pedophilia are often unable to access appropriate psychiatric treatment. The objective of this communication is to describe the approach taken in Norway over the last ten years, which addresses some of these challenges. My hope is to be able to shed some light on this stigmatized group, and to stimulate the reader to consider the problem of how to design and deliver effective treatment for individuals with pedophilia.
Eirik Svela
Clinical psychologist at the psychiatric outpatient clinic at Lovisenberg Hospital, Oslo. He has previously worked with patients with pedophilia at a specialized clinic at the Oslo University Hospital. He is pursuing advanced training in psychoanalytic psychotherapy, and one of his primary interests is how to adapt and make this approach more accessible to patients with severe mental illness, including psychosis and severe mood disorders.
What is pedophilia?
Pedophilia is a diagnostic entity in the ICD-11 and DSM-5 diagnostic systems, where it is classified among other paraphilic disorders (WHO, 2022). According to the ICD-11 definition, it refers to ‘a sustained, focused, and intense pattern of sexual arousal—as manifested by persistent sexual thoughts, fantasies, urges, or behaviours—involving pre-pubertal children’. In order to receive a diagnosis of pedophilia, this pattern of arousal must have led the individual to act on the urges, and/or it must have caused the individual ‘marked distress’. Because the diagnosis is defined in terms of subjective states that are difficult to operationalize and measure objectively, the individual subjective experience of having a pedophilic disorder is likely to vary a great deal among individuals, yielding a heterogeneous patient population.
The etiology of pedophilia is currently insufficiently understood. However, like most psychiatric conditions, the etiology is likely to be complex, multifactorial, and varied; nature (neurophysiological differences/variations, prenatal and obstetric factors, genetic influences) as well as nurture (childhood trauma and abuse, attachment disturbances) factors are frequently thought to contribute to the etiology of the condition.
Perhaps due to the stigma associated with the condition, individuals with pedophilia rarely seek out mental health treatment, which makes it difficult to derive sound epidemiological data. However, the prevalence is estimated to be 3-5% in males (Seto, 2004). Most reported cases of pedophilia occur in males, and most research has been conducted in male populations. The reasons for this fact remain poorly understood.
Pedophilia can be associated with significant subjective distress. While this distress is multifaceted and likely to vary among individuals, it is likely to be comprised of feelings of shame, being excluded/feeling left out, and fear of consequences for illegal actions. Although many individuals with pedophilia will never act on their sexual urges in a way that harms children, it is an unfortunate fact that some do. Harm to children may happen directly, e.g., through contact or online sexual offences, or indirectly, e.g., through viewing child sexual abuse material (CSAM).
It should be noted that not all people with pedophilia acknowledge subjective distress due to their condition. Indeed, some deny that sexual activity between children and adults harms children, and attribute any discomfort associated with the condition to strictures imposed by society which they consider illegitimate.
It should also be noted that not all acts of sexual abuse against children are committed by persons with pedophilia, as there may be other sources of motivation for such acts, e.g. personality pathology, intellectual disability, or psychosis. When acts of sexual abuse are committed by individuals with these disorders, it is not considered indicative of pedophilia.
Changing approaches to treatment
In Norway, as in many other countries, past treatment efforts have been focused on objectives that are currently not considered relevant or conducive to positive outcomes. This includes psychotherapeutic approaches that emphasize helping the individual to achieve an individual psychological understanding of what factors might have led them to develop a pedophilic pattern of arousal. Interestingly, and perhaps counterintuitively, acknowledging a pedophilic disorder, and accepting responsibility for having sexually abused children, are not factors that have been consistently shown to be relevant to positive outcomes.
In a different vein, some approaches taken in the past have tended to emphasize behavioural interventions. These have included reliance on promoting behavioural avoidance, e.g., by encouraging the individual to avoid locations and contexts where the individual is likely to meet children; and trying to achieve change through conditioning aversive reactions to pedophilic arousal and/or conditioning appetitive reactions to normative sexual arousal. Like their psychotherapeutic counterparts, these interventions have generally not been found to be effective.
The current consensus in the field is that the pattern of arousal seen in pedophilia likely does not change over the lifespan of an individual, and there is little evidence that it can change as a result of psychotherapy, medication, or other targeted treatment efforts. Indeed, some prominent researchers suggest that pedophilia should be considered equivalent to normative sexual orientations, like homosexuality or heterosexuality, in terms of its development and stability (Seto, 2012). As a consequence, the focus of treatment has shifted from targeting the pattern of sexual arousal to targeting factors that have been empirically shown to be associated with being at risk of offending.
The Good Lives Model
One example of such an approach is the Good Lives Model (GLM) (Ward et al., 2012), which has been adopted in the Norwegian mental health and criminal justice systems.
The Good Lives Model proceeds on the tenets of the broader Risk-Need-Responsivity framework (Bonta and Andrews, 2017), which holds that the intensity of treatment must be matched to the individual level of risk, target specific and individual risk factors for offending, and employ interventions that are empirically supported and capable of addressing individual obstacles to engagement in treatment.
Intervening appropriately to the individual risk level is important in terms of allocating resources effectively, and also ensures that treatment intensity is determined by the individual risk profile of the patient rather than preconceived but erroneous notions, e.g., “all individuals with pedophilia commit sexual offences”, or “all sexual offenders re-offend”. Over- or under-treating an individual can lead to alliance issues that may undermine the treatment.
The need factor implies that interventions need to be specific to the particular risk/criminogenic factors present in a given individual. Treatment models that unduly emphasize generalized pathways to offending are unable to flexibly address problems that may be idiosyncratic to an individual, but significant to what makes them vulnerable to acting on their sexual urges.
Responsivity means that treatment needs to be based on modes of intervention that have been demonstrated to work in this population and working with individual factors that may be obstructing optimal treatment engagement and progress, e.g., personality dysfunction, low intellectual ability, or substance abuse.
The Good Lives Model focuses on identifying areas of the individual’s functioning that are associated with the risk of offending sexually, and that may contribute to an increased quality of life for the individual with pedophilia. For instance, a religious person who has lost contact with their congregation may be less vulnerable to acting on their sexual urges if they can be motivated to reconnect with their community. Crucially, such changes are not merely intended to reduce risk, but are also thought to improve the overall quality of life of the individual, on the reasoning that the possibility of a better life is inherently more motivating than the promise of a less harmful one (Ward et al., 2007).
As discussed above, this approach can have consequences which may seem counterintuitive. For instance, it could translate into choosing not to confront an individual convicted of a sexual offense with their offense, and rather focusing on efforts to foster prosocial activities, reconnecting with friends and family, or taking up creative pursuits that bring a feeling of mastery.
In fact, a patient does not even need to admit to having sexual urges towards children, so long as they are willing and motivated to work towards general goals that are likely to promote psychological well-being. While this may at first seem paradoxical, it makes the model well-suited to help patients in this group who are unprepared or unwilling, possibly due to overwhelming shame, to explicitly acknowledge their problems, which is not uncommon in this population. This includes patients in court-mandated treatment, who may claim to be innocent and may seem to have little intrinsic motivation, who can be motivated to work towards goals which improve their quality of life and render them less at risk of reoffending.
Implementing the model
Over the last ten years, the Good Lives Model has been concurrently deployed in prisons and in outpatient clinics in the mental health system in Norway. Consistent with the RNR model, three levels of care have been established, appropriate to varying levels of risk and need.
The lowest level of care, known as “Det finnes hjelp” (“Help is available”), targets individuals who have not committed contact sexual offences, and who are not currently under investigation or awaiting trial for such offences. Although these individuals have not had any involvement with the law, it is not uncommon for them to be using CSAM. The objective of this program is to reach individuals who may be at some risk of offending before they proceed to do so. Many individuals in this group are unlikely to have approached mental health treatment for their attraction to minors, or at all, and so there are broad advertising campaigns to raise awareness that the program exists, and it is made easily available through a hotline and an online chat service. The program follows a short-term cognitive-behavioral treatment manual which addresses problem areas that are common in this population, such as maladaptive beliefs about sexual abuse of children and difficulties in self-regulation.
The intermediate level of care, known as “Ny kurs” (“New directions”) targets individuals who have committed sexual offences who have either recently been released from prison, or who are approaching this point. In keeping with the RNR framework, treatment is tailored to the individual risk profile and specific needs of the individual.
The highest level of care, known as BASIS, targets individuals who are considered at high risk of reoffending. These individuals will often have served lengthy prison sentences. To be in the program, they need to be approaching the possibility for parole or approaching release. However, treatment may continue after the patient is released from prison.
Due to the paucity of information available on this patient population, the treatment centers collect a substantial amount of data about the participants, who are encouraged to consent to being part of research. The hope is that this data will enable researchers to learn more about individuals with pedophilia, and to what extent the treatment approach is effective.
Conclusion
Individuals with pedophilia often experience great subjective distress, and can sometimes be at risk of offending against children. Thus, effective treatment for this population is in the best interest of the individual as well as society as a whole. The Good Lives Model aims to help the individual to regulate pedophilic sexual arousal more effectively, but also motivates the individual to lead a pro-social and offence-free lifestyle that they personally find rewarding and meaningful. This model has a clear and plausible theoretical rationale, and is based on the well-established Risk-Need-Reward framework of offender rehabilitation. While preliminary findings seem to warrant cautious optimism (Willis and Ward, 2024), further research is needed to determine the extent to which this treatment approach succeeds in preventing sexual abuse against children and improving the quality of life of individuals with pedophilia. □
References
Pedophilic disorder. (2019). In World Health Organization, International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/browse/2026-01/mms/en#517058174
Seto, M. C. (2004). Pedophilia and sexual offenses against children. Annual Review of Sex Research, 15, 321–361.
Seto, M. C. (2012). Is pedophilia a sexual orientation? Archives of Sexual Behavior, 41(1), 231–236. https://doi.org/10.1007/s10508-011-9882-6
Ward, T., Yates, P. M., & Willis, G. M. (2012). The Good Lives Model and the Risk Need Responsivity Model: A Critical Response to Andrews, Bonta, and Wormith (2011). Criminal Justice and Behavior, 39(1), 94–110. https://doi.org/10.1177/0093854811426085
Bonta, J., Andrews, D. A., & Andrews, D. A. (2017). The psychology of criminal conduct (Sixth Edition). Routledge, Taylor & Francis Group.
Ward, T., Mann, R. E., & Gannon, T. A. (2007). The good lives model of offender rehabilitation: Clinical implications. Aggression and Violent Behavior, 12(1), 87–107. https://doi.org/10.1016/j.avb.2006.03.004
Willis, G. M., & Ward, T. (2024). Evidence for the Good Lives Model in Supporting Rehabilitation and Desistance from Offending. In L. A. Craig, L. Dixon, & T. A. Gannon (Eds.), The Wiley Handbook of What Works in Correctional Rehabilitation (1st ed., pp. 299–309). Wiley. https://doi.org/10.1002/9781119893073.ch22
