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Research on youth sexuality


1. Abel, G. & Harlow, N., The Stop Child Molestation Book, Xlibris, 2001.

2. Burton, D. & Smith-Darden, J., North American Survey of Sexual Abuser Treatment and Models 2000, Brandon, VT: Safer Society Foundation, 2001.

3. Freeman-Longo, R., Bird,S., Stevenson, W., & Fiske, J., 1994 Nationwide Survey of Treatment Programs and Models, Brandon, VT: Safer Society Foundation, 1995.

4. Lotringer, S., Overexposed: Treating sexual perversions in America, New York: Pantheon Books, 1988.

5. Rivera, E.,”Teen Sues Clinic Using Penis Device,” Newsday, Nov. 12, 1993, City edition, News section, p. 6.

6. Righthand, S. & Welch, C., "Juveniles Who Have Sexually Offended," U.S. Office of Juvenile Justice and Delinquency Prevention, March 2001.

7. Shaw, J., Practice Parameters for the Assessment and Treatment of Children and Adolescents Who Are Sexually Abusive of Others, Journal of the American Academy of Child and Adolescent Psychiatry, 38(12 Suppl):32S-54S, 1999.

8. Yankowski, L., Testimony to the Arizona Senate's Committee on Children's Psychological Treatment Programs, September 16, 1992.

9. Young, A., “Sex Therapy 'Nightmare' Or Cure?”, Arizona Republic, July 26, 1992, Final edition, p. A1.

Ethical Treatment for All Youth
Email: etay@ethicaltreatment.org

About the author


"One is capable of the greatest evil only when one believes one is acting for higher purposes."
--Mathematician James M. Henle

Arousal reconditioning attempts to change sexual feelings based on the theory of behavior conditioning. Ivan Pavlov developed this theory in the early 1900s based on his studies of dog salivation. Further animal research led to development of methods to encourage certain behaviors by pairing them with pleasant consequences, and to discourage others by pairing them with unpleasant or painful consequences. These methods were then applied to human patients with the goal of creating these pairings at a deep emotional level, so that desirable behavior would occur reflexively, and undesirable behavior would no longer be attractive.

Therapists and police who use arousal reconditioning assume that they can change sexual feelings in this way. They originally developed these methods in the early to mid-1900s to convert homosexuals to heterosexuals. They attempt to eliminate certain sexual feelings by pairing them with boredom, pain, or unpleasantness. In effect, they assume that sexuality can be changed through punishment. 81% of juvenile sex offender programs and 62% of programs for younger children use some form of arousal reconditioning.2

Effectiveness of treatment with males is often measured by connecting a plethysmograph to their genitals while exposing them to sexually suggestive or pornographic photographs of children, teenagers, or adults, or audio-taped descriptions of sex acts involving them.7  Click here to see a TV news report about the use of arousal conditioning on children ages 12 and over in New York in 1993.

Verbal satiation

Verbal satiation requires the dictation on an audiotape of the most stimulating paraphiliac imagery [sexually deviant fantasy] for at least 30 minutes after masturbation 3 times a week. It is assumed that the paraphiliac fantasy becomes boring and subsequently extinguished.7
--American Academy of Child and Adolescent Psychiatry

Author Sylvere Lotringer interviewed a staff member at a juvenile sex offender clinic who described it as follows (in this case, photographs were used to assist the fantasies):

It won't be hard-core pornography. The child will just be standing there. There will be frontal nudity. Or she will be lying down...The boys wear the strain gauge [plethysmograph] while they look at the picture and they repeat the phrase over and over. We want to know if they get an erection while they look at the picture. Normally they don't, because the act of speaking prevents them from it.

They always repeat the same sentence?

The same sentence, for twenty minutes. The sentence might be, 'I'm feeling this girl's body.' It's something short. I tell them in advance that it's going to be boring for twenty minutes...there's certainly satiation to that particular sentence.4

A 1994 survey (the most recent national survey which reported specific types of arousal reconditioning) found that 18% of juvenile offender programs used verbal satiation.3

Masturbatory satiation

The offender is first encouraged to masturbate to ejaculation in response to socially appropriate sexual fantasies with the concomitant feelings of affection and tenderness. After this experience the offender is required to masturbate to deviant sexual fantasies. If the offender becomes aroused, he or she is told to switch to an appropriate fantasy or in some instances exposed to an aversive stimulus such as ammonia.7
--American Academy of Child and Adolescent Psychiatry

A 17 year old boy interviewed by Lotringer, convicted of having sex with a 15 year old, said, “They give you an hour-long cassette and you’re supposed to masturbate out loud for an hour, in your own home, in private. The doctor talks it over with you first.”7

Newsday journalist Elaine Rivera reported the following description of masturbatory satiation used on a 15 year old boy:

At the clinic, the youth was told he would undergo 'sexual behavior testing,' and when he resisted, he was told that he would go to jail if he did not participate, the lawsuit states. According to the lawsuit, 'his pants were lowered around his ankles and (he) was forced to place a round, mercury-filled plastic device around his penis, and further forced to wear earphones and listen to pornographic tapes including descriptions of sex between adults and children, and between children and children, violent rape, forced sex and other abnormal sexual acts.' Afterward the youth was encouraged to masturbate, [attorney] Paladino states.5

The U.S. Office of Juvenile Justice notes some concerns about the method:

Masturbatory conditioning, however, has presented practical as well as ethical concerns, because the approach requires asking the juvenile to masturbate, and may include masturbating to deviant stimuli...very little is known about the effectiveness of these approaches for reducing deviant arousal or about the types of juveniles for whom they may be most effective.6

The 1994 survey found that 17% of juvenile offender programs used this method.3

Covert sensitization

Covert sensitization attempts to pair the child or teenager's sexual feelings with emotionally painful consequences. It requires him to describe (sometimes into a tape recorder) his sexual fantasies. Then he is required to describe intensely negative consequences of his feelings or behavior, such as public shame, humiliation, or imprisonment. The 1994 survey found that 36% of juvenile offender programs used this method.3

  • The offender learns to extinguish pleasurable responses to sexually stimulating deviant imagery through the imagining of some negative reaction or aversive stimulus. Scenes are constructed for each offender according to his or her preferred sexual-erotic fantasies...[In] assisted covert sensitization, aversive stimuli such as noxious odors are used to facilitate an aversive reaction.7
    --American Academy of Child and Adolescent Psychiatry

  • Most programs that address deviant arousal do so through covert sensitization...Weinrott raised the concern that this technique, as typically used, may not be vivid enough to be effective for adolescents who might not have the language abilities to design effective fantasies to counter deviant thoughts or who may simply find the task too boring. He also stated that behavioral conditioning with noxious stimuli, such as ammonia and, possibly, low-intensity electric shock, may be effective.6
    --U.S. Office of Juvenile Justice

Aversion therapy

Sexually stimulating deviant imagery is presented which is followed by the presentation of a noxious odor.7
--American Academy of Child and Adolescent Psychiatry

Aversion therapy was first used 70 years ago to cure homosexuality. (Covert sensitization was developed soon afterward for the same purpose.) It involves exposing the youth to sexually arousing photographs or tape recordings, while administering an unpleasant or painful sensation: noxious odors (ammonia is most commonly used) or electric shock. The use of noxious odors is known as "olfactory conditioning", and the use of electric shock is known as "faradic conditioning".

The expectation is that the youth will come to associate his sexual feelings with pain or fear, and that this will reduce them. The procedure is repeated regularly over several weeks or months. In 1994, 11% of juvenile treatment programs used olfactory conditioning, and 3% used faradic conditioning.3

Although the method is recommended only for adolescents, there are reports of its use with younger children.

“The Republic learned that more than 100 children, more than one-third of them 10 to 12 years old, go through the program each year...Many are tested for deviant sexual responses by a penile plethysmograph, a ringlike device slipped around the penis to measure changes in circumference as a patient views nude photographs. The program includes use of aversion therapy, in which patients inhale ammonia to prevent inappropriate arousal...The hospital had told the girl to record a sexual fantasy. 'Then every time she listened to it, she had to use that ammonia,' the woman said. 'It wasn't really a fantasy, it was just really bizarre. On the tape she was talking about hurting this child (in a violent, sexual manner). My daughter is very passive; she's never been violent.' The woman is convinced that the fantasy came from the minds of therapists. 'They told her she had to make this tape. She had to rewrite and rewrite until they were sure she'd get sexually aroused to it.'"
--Journalist Alison Young

Other arousal reconditioning methods

A 2000 survey listed other possible methods of arousal conditioning on its questionnaire, but the final report did not indicate how many programs used them or what they entailed: orgasmic reconditioning, minimal arousal conditioning, masturbatory training, modified aversive behavioral rehearsal, sexual arousal card sort, fantasy work, vicarious sensitization, and behavioral modification.2

Effects of Arousal Reconditioning

Although some treatment experts have mentioned ethical concerns regarding arousal reconditioning, none have considered its emotional effects on children.

  • Dr. Judith Becker in her testimony before this committee and before the Board of Psychologist Examiners candidly acknowledged that there is no normative data regarding the plethysmograph with juveniles and that, in the absence of empirical studies regarding a treatment strategy for juveniles, "any and all work with children [would be] experimental." Before the Board of Psychologist Examiners she also acknowledged that there was no scientific basis for the use of aversion therapy with children. ALL of the witnesses who testified before this committee acknowledged that there are no follow-up studies indicating that this treatment is effective and not harmful. ...Dr. Otto Bendheim, a Phoenix psychiatrist, has stated in a previous affidavit that because of the unreliability of penile plethysmography and because it involves manipulation of the genitalia and the showing of pornographic materials, it could permanently damage a child's concept of sexuality.8
    --Attorney Lois Yankowski, testimony to the Arizona Senate's Committee on Children's Psychological Treatment Programs

Reports of the use of arousal reconditioning on gay men and on juvenile sex offenders have shown that its effects may include severe stigma, trauma, depression, nightmares, suicidal thoughts, self-hatred, destroyed self-esteem, and a damaged concept of sexuality. These are the very effects of sexual abuse itself. In other words, arousal reconditioning may very well be a form of sexual abuse.

Nevertheless, these methods continue to be used. One book, written by a leader in the field of childhood sexual deviance and endorsed by several others, urges all parents to question their sons in sixth grade about their sexual fantasies. If they involve younger children, or if they've been sexually touched by older children or adults, the book instructs parents to have their sons tested using the AASI, a lie detector, or plethysmograph. If they test positive, parents are to find a sex-specific therapist who uses “covert sensitization, aversion, or satiation.” This information is also at the author's website, along with a list of recommended therapists.

There is even software which automates the process of diagnosing children and prescribing arousal reconditioning methods. Psych Screen, Inc. markets its software to sex offender clinics around the country. A sample report diagnoses a hypothetical 12 year old with several types of deviance, and recommends treatment including Depo-provera, aversion therapy, covert sensitization, masturbatory satiation, and "thought stopping". The company advertises the software as providing “cost effective, comprehensive, easy to understand, highly useful clinical information at the touch of a button. Our software can generate 10 times its cost - it's not unusual for a clinic to gross an additional $35,000 or more per year through use of routine intake screening.”

Understanding the Issue

When experts are wrong
Casualties of war
   Lack of knowledge
   Confused definitions
   Invalid instruments
   Humiliation as therapy
   Arousal reconditioning
   Dangerous drugs
   Sriking comparisons
   Sample materials
   Convos with providers
Ethical violations
Deja vu