A Thematic Analysis - Working with Paedophillic Clients by We Are Survivors

A Thematic Analysis Exploring the Experiences of Therapeutic Professionals Working with Paedophilic Clients A dissertation submitted to The University of Manchester for the degree of Master of Arts in Counselling in the Faculty of Humanities 2016 Stuart Avery Student ID: 92619640 School of Environment, Education and Development

Table of Contents

TABLE OF CONTENTS ABSTRACT DECLARATION INTELLECTUAL PROPERTY STATEMENT ACKNOWLEDGEMENTS

2 5 6 7 8

INTRODUCTION

INTRODUCTION TO THE RESEARCH STUDY INTRODUCING MYSELF AS A RESEARCHER AND COUNSELLOR THE RESEARCH QUESTIONS MOTIVATION BEHIND THE RESEARCH THE PROBLEM WITH THE WORD “PAEDOPHILE” CHECKS AND BALANCES DISSERTATION STRUCTURE

9 9 10 11 11 12 13

LITERATURE REVIEW

INTRODUCTION SEARCH METHODS AND TOOLS OVERVIEW OF KEY AREAS AND GENERAL FINDINGS SOCIAL DISCOURSE AND STIGMATISATION MORAL PANIC AND THE MEDIA THE “PAEDOPHILE” LABEL THE CHALLENGES OF DEFINING, NAMING AND UNDERSTANDING PAEDOPHILIA TREATMENT AND PUNITIVE LEGISLATION CONTACT VERSUS ONLINE OFFENDING – A VERY HETEROGENEOUS GROUP COMPULSIVE INTERNET USAGE, PORNOGRAPHY AND PAEDOPHILIA THERAPEUTIC PROFESSIONALS’ EXPERIENCES OF WORKING WITH PAEDOPHILES COUNSELLORS’ PERCEPTIONS AND ATTITUDES TOWARDS PAEDOPHILES

14 14 15 15 17 17 18 19 20 21 22 23

METHODOLOGY

OVERVIEW ONTOLOGICAL AND EPISTEMOLOGICAL CONSIDERATIONS QUALITATIVE RESEARCH METHODS METHODOLOGY – THEMATIC ANALYSIS RECRUITMENT OF PARTICIPANTS AND SAMPLING INTERVIEWS DATA ANALYSIS ETHICAL CONSIDERATIONS

25 25 26 27 29 30 31 33

FINDINGS

THEME TABLE

A -‐ PERCEPTIONS 37 1 INACCURATE PERCEPTIONS ARE HARMFUL AND DANGEROUS 37 1.1 THE “PAEDOPHILE” LABEL IS INSUFFICIENT, INACCURATE AND UNHELPFUL 37 1.2 THE MEDIA DISTORTS PERCEPTIONS 38 1.3 UNHELPFUL AND UNINFORMED SOCIAL VIEWS 38 B – EXPERIENCES 39 2 EXTREMELY COMPLEX AND DIVERSE PRESENTATIONS AND DEFINITIONS 39 2.1 A WIDE SPECTRUM, NOT A CULTURALLY OR SOCIALLY HOMOGENOUS GROUP 39 2.2 COMPLEX AND MULTIPLE REASONS FOR OFFENDING 40 2.3 COMPLEXITY OF DIFFERENT PRESENTATIONS AND DIAGNOSES 41 3 A LACK OF RESOURCES TO ADDRESS THE PROBLEM 41 3.1 A LACK OF PREVENTATIVE MEASURES AND SUPPORT 42 3.2 A LACK OF FUNDING 42 3.3 A LACK OF KNOWLEDGE AND PROFESSIONAL AGREEMENT 43 4 HIGH LEVELS OF STIGMATISATION 44 4.1 STIGMATISATION TOWARDS THE CLIENT GROUP IS UNHELPFUL 44 4.11 A BARRIER TO THERAPEUTIC WORK AND REHABILITATION 44 4.12 STIGMA COMPOUNDS SOCIAL ISOLATION AND POTENTIALLY INCREASES THE RISK OF RE-‐ OFFENDING 45 4.2 STIGMATISATION TOWARDS THERAPEUTIC PROFESSIONALS 45 5 CURRENT APPROACHES TO MANAGING THE PROBLEM ARE INEFFECTIVE 46 6 I EXPERIENCE THIS WORK AS MEANINGFUL AND PERSONALLY REWARDING 47 6.1 WHAT I DO REALLY WORKS AT AN INDIVIDUAL LEVEL 47 6.2 REACHING OUT TO THE MOST MARGINALISED AND ABANDONED MEMBERS OF SOCIETY 47 6.3 CHALLENGING AND FASCINATING WORK 48 C – THINGS NEED TO CHANGE 48 7 APPROACHES TO THIS PROBLEM NEED TO CHANGE 48 7.1 PREVENTATIVE MEASURES AND SUPPORT ARE NEEDED 49 7.2 A MORE BALANCED, WELL-‐INFORMED DISCUSSION IS NEEDED 49 DISCUSSION

INTRODUCTION SUMMARY OF KEY FINDINGS AND CONTEXTUALISATION WITHIN THE LITERATURE PROJECTION AND SPLITTING -‐ NOBODY WANTS TO ENGAGE WITH THIS CHALLENGING FOUCAULDIAN DISCOURSE ANALYSIS -‐ COULD IT BE ANYONE? UNHEARD VOICES – A PARALLEL PROCESS? RECOMMENDATIONS FOR RESEARCH AND COUNSELLING PRACTICE PARAMETERS OF THE STUDY

51 51 53 55 57 58 59

CONCLUSION

STUDY OUTCOMES REFLEXIVE CONSIDERATIONS AND PERSONAL INSIGHTS REFLECTIONS ON THE PROCESS OF CONDUCTING THIS STUDY FINAL THOUGHTS

62 62 64 65

REFERENCES

APPENDICES

APPENDIX A – LITERATURE SEARCH RESULTS APPENDIX B – PARTICIPANT INFORMATION SHEET APPENDIX C – PARTICIPANT CONSENT FORM APPENDIX D – SEMI-‐STRUCTURED INTERVIEW SCHEDULE APPENDIX E – CREATION OF CODES USING NVIVO 10 APPENDIX F – PROGRESSIVE NODE MAPS APPENDIX G – CREATION OF FINAL THEMES AND SUB-‐THEMES APPENDIX H -‐ RESEARCH JOURNAL EXTRACTS

73 74 77 78 81 87 90 93

WORD COUNT: 16,479

Abstract In the last two decades, public and media preoccupation with paedophilia has gained an increasingly high profile, and yet the research that exists on this emotive subject suggests a limited public understanding, and uncertainty and disagreement amongst professionals over its definition, treatment and management. This study aimed to examine the lived experiences of a range of therapeutic professionals working with offending and non-‐offending paedophiles, in particular within the context of the powerful social discourse surrounding paedophilia. Seven therapeutic professionals were invited to take part in semi-‐structured interviews, and the results were analysed using thematic analysis. The study found that the therapeutic professionals interviewed considered current perceptions to be inaccurate and unhelpful in tackling the issue of paedophilia effectively. The participants’ experiences differed greatly from the public and media perceptions they discussed. They suggested that their clients were an extremely heterogeneous group, and high levels of stigmatisation, a lack of resources and preventative measures, and ineffective current approaches were obstructive to their work. The therapeutic professionals considered their work to be highly effective and rewarding for both parties, but experienced operating largely below the radar of mainstream public awareness. A number of recommendations are made including the need for a widespread shift in attitudes towards paedophilia, more balanced and well-‐ informed discussion around the subject, a change in current approaches to the problem, and a need for much greater research and funding.

Declaration This dissertation is my original work and no portion of it has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning.

Intellectual Property Statement Notes on copyright and the ownership of intellectual property rights: i.

The author of this dissertation (including any appendices and/or schedules to this dissertation) owns certain copyright or related rights in it (the “Copyright”) and he has given The University of Manchester certain rights to use such Copyright, including for administrative purposes.

ii. Copies of this dissertation, either in full or in extracts and whether in hard or electronic copy, may be made only in accordance with the Copyright, Designs and Patents Act 1988 (as amended) and regulations issued under it or, where appropriate, in accordance with licensing agreements which the University has entered into. This page must form part of any such copies made. iii. The ownership of certain Copyright, patents, designs, trademarks and other intellectual property (the “Intellectual Property”) and any reproductions of copyright works in the dissertation, for example graphs and tables (“Reproductions”), which may be described in this dissertation, may not be owned by the author and may be owned by third parties. Such Intellectual Property and Reproductions cannot and must not be made available for use without the prior written permission of the owner(s) of the relevant Intellectual Property and/or Reproductions. iv. Further information on the conditions under which disclosure, publication and commercialisation of this dissertation, the Copyright and any Intellectual Property and/or Reproductions described in it may take place is available in the University IP Policy, in any relevant Dissertation restriction declarations deposited in the University Library, and The University Library’s regulations.

Acknowledgements I would like to thank the interview participants who gave their time to talk with me and share their personal experiences. Heartfelt thanks also to my supervisor, Dr Liz Ballinger, for her on-‐going support and guidance through the process of writing this dissertation, and for our many interesting and thought-‐provoking discussions. Finally, I would like to thank my wonderful family, friends and partner, for the encouragement, love and support you have given me throughout this process.

Introduction

Introduction to The Research Study I arrived at this research topic through a desire to illuminate a taboo subject that I feel would benefit enormously from discussion. Societal preoccupation around paedophilia seems considerable, yet well-‐informed discussions about it often appear to be eclipsed by hysteria and moral panic (Critcher 2006; Harrison & Manning 2016), considered by some to be a defence against confronting the difficult subject of childhood sexuality (Angelides 2008; Jewkes 2010). I personally feel uneasy about a social commentary on this issue that to me often appears based on a narrow, overly simplified perspective. Thus a desire to explore this landscape in depth drives my study. Some of the statistics and research around paedophilia reveal an alarming gap between media and social portrayals of paedophiles and how most offences actually occur, that suggests there might exist a dangerous collective social denial around this subject (Ashenden 2002; Edwards 2001; Angelides 2008). Stigmatisation may make it harder for potential offenders concerned about their thoughts or behaviour to seek help (Edwards 2001) – and social views around this controversial and emotive subject mean available help is very limited (McCartan 2008). Some evidence suggests this social environment encourages those at risk of committing child sex offences to disengage from society, and leads ultimately to increased offending against children (Collins & Nee 2010).

Introducing Myself as a Researcher and Counsellor As a researcher and counsellor, exploring these issues feels urgent and important, both in the pursuit of greater knowledge in an under-‐researched and misunderstood area (Harrison & Manning 2016; Imhoff 2015; McCartan 2008) and to create a safer society for everybody. I believe that intervening earlier with therapeutic support could

ultimately make a real difference, and some evidence appears to support this idea (STOPSO 2016), which has increased my motivation to explore this subject. But my interests in this area go beyond a desire to reduce sexual offending against children. As I develop my own integrative counselling style, a strong value that continues to emerge is a desire to be hopeful and compassionate towards all people, no matter what they have done, and to work with anyone who is willing to make changes. Already, I have found myself able to build good rapport with clients who have done things that I might be judgemental about in a different context. This, for me, is the gift of the counselling relationship – it enables me to set aside judgement, separate the behaviour from the person, and find common ground and positive regard for any client who wishes to work on himself, discover who he is, or be a better person. In the future, I would consider working with this client group, not just to reduce the risk of offending, but because they are also human beings who need compassion, understanding and help.

The Research Questions My principal research question is: “What are therapeutic professionals’ experiences of working with paedophiles?” The study aims firstly to explore perceptions around this difficult subject, and then compare them to the experiences of seven therapeutic professionals working with paedophiles. However, I also wanted to explore their experiences in the context of the emotive social discourse around this subject, so I wrote a secondary question: “What are therapeutic professionals’ experiences of the current social discourse around paedophilia?” I set out to explore in detail the lived experiences of those working regularly with a diverse range of paedophilic clients, and gain insight into how they experience this group, how they work therapeutically with them, what the challenges and rewards are, and how the social discourse impacts on them and their work. I wanted to hear their perspectives on current approaches and attitudes towards this problem, and give them a platform to voice recommendations for change. I used a qualitative research approach to gain a rich depth of data, and thematic analysis to synthesise it into key themes.

Motivation Behind the Research My personal interest in this area stems from a desire to gain informed knowledge on a subject that seems often to be discussed only in reactionary and hysterical ways that perpetuate stereotyped perceptions towards paedophiles (Edwards 2001; Jewkes 2010). Clearly and understandably, child sexual abuse is, and should be, an emotive and concerning subject. But are we directing this emotional energy in the right direction? Do current views keep children safe or stand in the way of tackling this problem? Do we really understand the problem, or are we panicking about it, and acting based on fear and lack of knowledge? Throughout the process of conducting this study, I have experienced unease and discomfort about being seen as a paedophile sympathizer, or someone who makes light of the terrible damage caused to children by paedophilic offences. But my sense is that this often-‐overwhelming feeling of discomfort is what makes it so difficult to talk about. So my study aims to do just that – to tolerate those feelings of unease, encourage discussion, and allow the voices of those with first-‐hand experience to be heard.

The Problem with the Word “Paedophile” Throughout the process of planning, executing and writing this study, one of the greatest challenges has been what language to use. I am personally uncomfortable with using the word “paedophile” since I feel it is a very emotionally loaded term that carries with it much more than its Oxford English Dictionary (2016) definition of “an adult who is sexually attracted to children” or the Diagnostic & Statistical Manual of Mental Disorders (DSM5) diagnostic criteria for a paedophilic disorder of: “Over a period of at least six months, recurrent, intense, sexually arousing fantasies, sexual urges, or behaviours involving sexual activity with a prepubescent child or children (generally aged 13 years or younger)” (American Psychiatric Association 2013). Using the word “paedophile” in the original title of my study and in interviews, felt uncomfortable, awkward, clumsy and almost naïve, and was unsettling for some of my

interview participants. Despite this, using it was important, because I wanted to explore my participants’ relationships with the word, reactions to it, and examine the challenges of naming their client group. As the study progressed and my participants told me they rejected the word as stigmatising and inaccurate, I again found myself in a dilemma. I had used it necessarily to guide the discussions, and yet to use it in the final title of my dissertation felt somehow “cheap” -‐ as though it ignored the complexities discussed by my participants, and undermined the professional validity and worth of my study. I considered the term “child sex offender”, but this would be an inaccurate substitution, as not all people with sexual interest in children are offenders. In the end I substituted “paedophile” for “paedophilic clients” in the study’s title as this felt less stigmatising and dehumanizing, but kept it in the research questions, since it had been integral in exploring my participants’ experiences of the social discourse. The problem of what word to use throughout the writing of this study to describe people with sexual interest in children remained. In the absence of any less-‐stigmatising and loaded alternative, I concluded that using the word “paedophile” was unfortunate yet necessary. So ultimately, despite its difficulties, inaccuracy, and my personal distaste for the word, I have still used it throughout the study, albeit as an inadequate and problematic label. My struggles to define this group of people without inadvertently joining in with the damning social perceptions attached to the label felt highly relevant, as they illustrated the power of the social discourse permeating this subject, and the need to challenge it.

Checks and balances It is important to own and acknowledge my personal strong views on current social attitudes towards paedophiles, in order to maintain the trustworthiness of the study. Failing to acknowledge them, and their role in guiding the direction of my study, would be unethical and incongruent. I have attempted to remain vigilant throughout the process towards the possibility that such views, if unchecked, could encourage me to search for support for my own views in the data. A number of checks and balances were put in place to safeguard against this, and these are discussed in the Methodology section, under “Ethical Considerations”.

Dissertation structure The study is presented in a number of pertinent sections. An overview of current literature follows, in which the study is contextualised, current research and discussions around paedophilia are explored, and notable gaps highlighted. Methodological approaches are then explained, including recruitment methods and interview techniques. A section highlighting key findings from the interviews follows, where salient themes and sub themes are presented. A discussion follows, where the data is explored, compared to the literature, and some tentative theories are put forward; recommendations and limitations are also discussed. The study ends with a reflective conclusion and summary of the outcomes.

Literature review

Introduction The literature review serves a two-‐fold purpose in contextualising both the research questions and findings from my interviews. It highlights key discussion areas and apparent gaps in the research. It begins with an overview of search methods and areas explored, and then examines the wider context and broad issues around the problem of paedophilia, gradually focusing down to more specific areas around the experiences of therapeutic professionals, in particular counsellors.

Search Methods and Tools The PsycINFO (2016) website, Google Scholar and The University of Manchester’s library search engine were used to conduct an extensive review of current literature. Electronic searches were restricted to peer-‐reviewed journals to maintain trustworthiness and academic rigour. Since my study aimed to explore paedophilia within the context of current social attitudes and popular culture, searches were restricted to journals published since 2000. Books were also reviewed using similar tools, as well as relevant websites relating to support and treatment for paedophiles using Google. Searches were not restricted to UK literature; however, cultural disparities between different regions were considered. It was important to avoid assumptions that international literature was transferable to the UK, especially regarding the social discourse, but it did nevertheless help to contextualise the subject area. Following the interviews and data analysis, further searches were performed around significant areas discussed with my research participants to contextualise their views within current literature. Appendix A shows details of key search phrases with statistics of what was retrieved.

Overview of Key Areas and General Findings Subject areas reviewed included: definitions of the word “paedophile”; medical criteria for paedophilia; social attitudes towards paedophiles; media portrayals and reporting on child sexual abuse; perceptions of counsellors and other therapeutic professionals towards paedophiles and sexual offenders; legislation, rehabilitation and treatment approaches; differentiation of presentations and diagnoses of paedophilia; and the effects on therapists, and their motivations, for working with this client group. The literature review yielded a wealth of reflective journal articles, mainly from the UK and US, which focused on media and social perceptions and the challenges of treating paedophiles. Some studies examined various presentations of paedophilic offending behaviour, the motivations behind these offences, and drew distinctions between contact and online offending (Babchishin, Hanson & VanZuylen 2015) whilst others explored the efficacy of treatment (Grønnerød, Grønnerød & Grøndahl 2015). Other studies focused on the effects of stigmatisation and use of the word “paedophile” as a label (Imhoff 2015), and the experiences of working therapeutically with a broad range of sex offenders (Pais 2002; Sandhu, Rose, Rostill-‐Brookes & Thrift 2012). Professionals’ experiences were also explored in some peer-‐reviewed journals (Lea, Auburn & Kibblewhite 1999; Slater & Lambie 2011); however, studies examining attitudes and perceptions of therapeutic professionals working specifically with paedophilic clients were notably lacking. A discussion of the key areas now follows.

Social Discourse and Stigmatisation UK and US based peer-‐reviewed journal papers exploring social attitudes towards paedophiles comprised a significant proportion of the literature reviewed. Many of these challenged the accuracy of societal perceptions, and explored their latent and damaging consequences. The notion of the paedophile as a “one-‐dimensional monster” (Edwards 2001) was a recurrent theme. Edwards suggests that this inaccurate and

limited stereotype is perpetuated in constant media portrayals of paedophiles as unshaven, scruffy loners loitering in playgrounds, when in fact a substantial amount of clinical psychology research considers paedophiles to be an exceptionally heterogeneous group, with diverse and complex reasons for committing offences (Taylor & Quayle 2003; Collins & Nee 2010; Jewkes & Wykes 2012; Jewkes & Andrews 2005; Lea et al. 1999; Wolak, Finkelhor & Mitchell 2005). Jewkes (2010) addresses an apparent disconnect between the social discourse and evidence around paedophilia, in a peer-‐reviewed opinion piece based on her professional experience, where she theorises that the notion of “stranger danger” allows us to distance and dissociate ourselves from the individual, splitting off and positioning problematic sexual behaviour in the “other”, whilst circumventing unsettling evidence that the majority of child abuse takes place within families, in the home (Jewkes 2015, 2010; Jewkes & Wykes 2012; Collins & Nee 2010; Lea et al. 1999; Ashenden 2002). Yvonne Jewkes, a UK-‐based Professor of Criminology, seems to be a well-‐respected voice on this subject, who has written extensively about it. There have been notable historic endeavours in the UK to challenge inaccurate social attitudes towards paedophiles, such as Max Pemberton’s (2013) Telegraph article and Chris Morris’ (2001) Brass Eye “Paedophile Special”, which both triggered a phenomenal backlash of hysterical public complaint that aptly illustrated the difficulties inherent in attempting to challenge such stereotypes. Despite these challenges, UK-‐ based services such as STOPSO (2016), Circles UK (2016) and The Lucy Faithfull Foundation (2016), and campaigns like Stop It Now! (2016), are doing just that, and offering therapeutic support to this client group, which suggests alternative viewpoints are developing, albeit slowly. Furthermore, the beginnings of a more balanced and well-‐informed discussion appear to be developing very recently, as demonstrated by a recent Channel 4 (2016) documentary “The Paedophile Next Door”; information on The Loudoun Trust website (2016); and a recent article in The Guardian by Jon Henley (2013); all of which, amongst other more progressive views, dispel overly simplistic attitudes, and make a case for

more rational discussions and working with paedophiles rather than stigmatising and demonising them.

Moral Panic and the Media A number of peer-‐reviewed journals argued that popular culture and the media demonstrate hypocrisy by encouraging moral panic around paedophilia, whilst simultaneously sexualising young bodies and children for profit (Jewkes & Wykes 2012; Jewkes 2010; Bray 2008; Critcher 2006; Kitzinger 1999; Kleinhans 2004). In two peer-‐ reviewed opinion pieces, Angelides (2008) and Harrison (2016) describe this moral panic as a necessary social defence mechanism that maintains a collective social denial around the tricky subject of childhood sexuality, whilst others make reference to the damaging effects of promoting and perpetuating a cultural hysteria that they see as obstructive to developing effective solutions (Meyer 2010; Critcher 2010). Some saw inaccurate, media-‐constructed discourses as having informed and influenced current legal responses to the problem in an unhelpful way (Meyer 2010). Others supported these views, arguing that the current legal and moral climate focuses heavily, for instance, on downloading images from the internet, distracting resources, attention and funding away from the areas where they are needed most -‐ addressing physical incidents of child sexual abuse occurring at home (Kleinhans 2004; Jewkes 2010). Jewkes outlines the need for research into links between the possession of indecent images and physical contact offences, whilst Taylor & Quayle (2003) recommend a move towards evidence-‐based interventions and away from hysterical reactions to paedophilia.

The “Paedophile” label The potency of the label “paedophile” was demonstrated in an online German study by Imhoff (2015), in which a diverse group of 345 participants showed considerably harsher judgment towards people described as a “paedophile” than those described as having “sexual interest in (prepubescent) children”. Widespread stigmatisation, and a

lack of distinction between desire and acts of physical abuse, seems to foster punitive attitudes – Imhoff (2015, p42) writes: “the label itself is laden with negative connotation above and beyond its actual meaning”. Some suggest that moving away from stigmatisation (Seto 2008; Imhoff 2015) and towards seeing paedophiles as members of society with mental health issues (Henley 2013), could avoid extreme isolation that some research suggests enhances the risk of offending (Collins & Nee 2010; Edwards 2001; Lea et al. 1999). Imhoff (2015, p42) summarises his findings by citing paedophilia as “one of the most stigmatized but simultaneously severely under-‐ researched stigmas”.

The Challenges of Defining, Naming and Understanding Paedophilia Much of the literature explored contradictions and difficulties inherent in trying to define paedophilia medically, scientifically and socially. Research indicated discrepancies between the dictionary and medical definitions of the word “paedophile”, and society’s tendency to use the word as a stigmatising label. Some literature distinguished between non-‐offending paedophiles and child sex offenders – a distinction rarely reflected in social attitudes or the universal deployment of the word “paedophile” (Seto 2008; Imhoff 2015). Seto argues that sexual attraction towards children does not always lead to offending, yet in the majority of cases the word “paedophile” is used indiscriminately between both groups. Furthermore, he highlights frequent and inaccurate usage of the word in society and the media to define an adult who has engaged illegally in sexual activity with an underage but post-‐pubescent adolescent (Seto 2008). Some research suggested that a consistently effective definition of paedophilia also appeared to elude professionals and organisations working in this area. In a peer-‐ reviewed opinion piece drawing together a range of divergent conceptions from a large body of literature, Harrison & Manning (2016) explore the many professional contradictions around societal, legal and clinical definitions and understandings, reflecting on the difficulties this causes with professionally engaging this client group.

Feelgood & Hoyer (2008) describe the lack of a coherent definition despite current pre-‐ occupation with the subject. The literature review also highlighted considerable professional misunderstanding and contradiction around paedophilia, disagreement around the causes and best treatment approaches, and confusion within government over making and enforcing effective policies (McCartan 2008; Silverman & Wilson 2002). Some attributed this to a lack of research (Jewkes 2010); others suggested that although paedophilia had become a popular contemporary research topic, it was largely based on “strongly held beliefs and relatively few facts” (McCartan 2008, p3) and failed to provide a cohesive academic understanding of the problem (O’Donohue, Regev & Hagstrom 2000). The literature reviewed made a number of recommendations for resolving some of the current ambiguities around paedophilia, including an increase in research and funding, changes in media reporting, a better-‐informed public awareness, changes in policy and alternative treatment approaches (Harrison & Manning 2016; Meyer 2010; McCartan 2008; Feelgood & Hoyer 2008).

Treatment and Punitive Legislation There appears to be no research evidence that suggests paedophilia can be changed or cured, so much treatment is focused on cognitive and behavioural interventions that help clients to manage problematic urges, (and chemical treatment to reduce sex drive in serious offenders) (Seto 2014, 2009). Reliable research studies demonstrating the effectiveness of treatment on convicted child sex offenders appear to be notoriously difficult to obtain, as evidenced by Grønnerød et al’s (2015) Norwegian meta-‐analysis of 14 studies, which, despite referencing a large body of research, was unable to establish the effectiveness of any treatment, as almost all the studies failed to meet the scientifically acceptable standard required to provide credible data. Similarly, there appears to be no research evidence on the effectiveness of treatment on non-‐offending paedophiles (Seto 2009). Wood (2010, p160) amongst many others calls for “an urgent need for improved understanding of this condition and for the further development and dissemination of psychological therapy”.

The literature also revealed interesting data around current legislation and punitive approaches to sex offenders. Edwards (2001) argues that current legislation – especially community notification laws (which publicise information on the whereabouts of sex offenders) -‐ has unintended consequences that actually create barriers to a sex offender’s rehabilitation, and potentially increase rather than decrease their risk of re-‐offending by exacerbating isolation. Edwards (2001, p85) suggests that the Criminal Justice System’s legislative approaches “do not address or even consider the offender’s ability to successfully reintegrate into society or to obtain even the most basic human needs such as shelter, social contact and assistance, and employment”. Some suggest that the highly emotional landscape surrounding paedophilia obscures lawmakers’ abilities to recognise ineffective legislation that is based on a “limited and narrow discourse” (Edwards 2001, p84), for fear of being seen to be “soft” on child abuse (Presser & Gunnison 1999). Edwards suggests that legislation tends to focus on managing the one-‐dimensional stereotyped view of sex offenders shared by society, and posits that legislation based on more realistic views of the whole person and their complex experience would be more effective.

Contact Versus Online Offending – A Very Heterogeneous Group A much-‐debated area in the literature was the relationship between online-‐only and contact paedophilic offending (involving physical contact with a child). A Canadian 2014 meta-‐analysis of 30 studies (28 of which were UK-‐based), ranging between 98 and 2702 samples of online only, offline (contact), and mixed (a combination of both) child sex offenders (mainly from USA, UK and Canada), found significant and wide-‐ranging differences between the groups, and considered the common banding together of a highly heterogeneous group under the label “paedophile” to be problematic (Babchishin et al. 2015) – a notion echoed by many others (Harrison & Manning 2016; Wood 2013, 2011; Taylor & Quayle 2003; Seto 2008; Quayle, Holland, Linehan & Taylor 2000). The meta-‐analysis found that offline and mixed offenders were more likely to display anti-‐social behaviour characteristics, whilst online offenders demonstrated more psychological barriers to sexual offending and were regarded as a distinct and different

group -‐ a “new type” of offender (Babchishin et al. 2015). The mixed group was considered the highest risk, with the greatest level of paedophilic interest. Paedophilia was considered to be not a sufficient or necessary condition in contact offences against children, with only around 50% of offline contact offenders being classified as sexually interested in pre-‐pubesecent children (Seto 2008). The study found that online offenders displayed higher levels of paedophilia, but the fact that securing convictions involving images of underage but post-‐pubescent children was more difficult unless they were very obviously under 18 was highlighted as a limitation (Babchishin et al. 2015). These findings appear to support much literature that considers paedophiles to be a very diverse and heterogeneous group, with a multitude of different and complex reasons underlying their problematic behaviour (Harrison & Manning 2016; Meyer 2010; McCartan 2008; Taylor & Quayle 2003), as well as other research that suggests the categorising of paedophilia is often further complicated by comorbidity with other psychopathologies, such as antisocial personality disorder (Gilbert & Focquaert 2015; Marshall 1997).

Compulsive Internet Usage, Pornography and Paedophilia Whilst compulsive internet usage was a common factor amongst online offenders, it was considered by no means an inevitable condition, with the online-‐only offender group scoring in the middle range compared with a general scale of internet preoccupation (Babchishin et al. 2015; Lee, Li, Lamade, Schuler & Prentky 2012), and some online offenders reporting no internet addiction problems (Seto, Wood, Babchishin & Flynn 2012). In two papers drawing on clinical experience as a psychological therapist working with this client group, and supported by an extensive review of current literature, Wood (2013, 2011) examines the role of the internet in the emergence of a new type of offender who is not consistently paedophilic, with no prior history of paedophilic traits, but whose dormant unconscious processes are stimulated and eventually crystallised, through the gradual breakdown of egoic defences. Wood’s theories dismiss

dichotomous, polarised views of paedophiles as “other”, and alert us to the possibility that “normal” human beings have disturbing undercurrents in their subconscious psyche, and their egoic defences can unravel within the context of compulsive and repetitive engagement with online pornography (Wood 2013, 2011). Many others refer to the harmful effects of compulsive internet usage and pornography in the development of paedophilic interests, describing a gradual progression to increasingly extreme images, via reinforcement and normalisation of problematic behaviour in the absence of an external observer or any policing of the boundaries that exist in the real world (Johnson 2016; Quayle et al. 2000; Voros 2009). Most of this literature appeared to conclude that the internet has created a new category of sex offender – an idea supported in the findings of a US study analysing 51 offenders prosecuted for online internet offences (Briggs, Simon & Simonsen 2011). Babchishin et al. (2015) conclude their paper by underlining the need for further research based on clearer sample compositions that reflect the diversity of different offender groups.

Therapeutic Professionals’ Experiences of Working with Paedophiles The literature review was focused specifically on the experiences of therapeutic professionals – in particular counsellors, since the study related to a Counselling MA -‐ working with paedophiles. The search found a number of peer-‐reviewed journals that offered opinion and discussion, and some qualitative research studies from the UK. These resources suggested there were relatively few counsellors working with paedophiles, and highlighted a number of challenges, including stigmatisation from other professionals by association to this client group (Grady & Strom-‐Gottfried 2010; Pais 2002; Van Deusen & Way 2006). Pais argues in a peer-‐reviewed opinion piece that such stigmatisation can cause counsellors to feel isolated from their professional communities, and considers this potentially to be causal to the lack of counsellors working in this area. For those who do, some suggest that such isolation, along with exposure to traumatic and shocking material, can lead to emotional responses that are problematic in the therapeutic alliance, such as feeling vulnerable, suspicious, or unable

to provide compassion and empathy (Ennis & Horne 2003; Grady & Strom-‐Gottfried 2010; Thorpe, Righthand & Kubik 2001). The literature review retrieved two qualitative studies that examined the experiences of counsellors in the UK and US working with sex offenders – but not specifically paedophiles. These studies outlined the potential for negative emotional impact on counsellors’ personal relationships and burnout as considerable risks (Pais 2002; Sandhu et al. 2012). Holding firm boundaries and managing counter-‐transference were highlighted as particularly challenging in Grady & Strom-‐Gottfried’s (2010) literature-‐ based review exploring the challenges faced by counsellors working with sex offenders. Other sources discussed the importance of having a comprehensive understanding of common psychological traits displayed by offenders, in particular outlining a tendency to manipulate or skilfully exploit counsellors’ vulnerabilities (Pais 2002; Ellerby 1997; Andreason & Black 2006). Many sources considered regular supervision from professionals experienced with this client group to be absolutely essential (Sandhu et al. 2012; Pais 2002; Slater & Lambie 2011; Ennis & Horne 2003; Thorpe et al. 2001). However, as these sources were either opinion pieces, or qualitative research studies that related to a broad category of sex offenders, drawing generalised conclusions from this material about therapeutic professionals working specifically with paedophiles is not possible. Finally, an attempt was made to contextualise the study with information about the proportions of counsellors, psychologists, psychiatrists, psychotherapists or probation officers working with this group, and why. However, no data was found – this appears to indicate a gap in the research.

Counsellors’ Perceptions and Attitudes Towards Paedophiles Although finding research specifically relating to counsellors’ attitudes towards paedophiles was difficult, some relevant data was found in two qualitative studies, which interviewed 23 and 30 professionals respectively who worked with sex offenders in the UK (Lea et al. 1999) and New Zealand (Slater & Lambie 2011). These studies

outlined a range of both positive and negative attitudes towards sex offenders including empathy, understanding, anger, resentment and abhorrence. A common value held by many of the counsellors was that they rejected labels and stereotypes of paedophiles in favour of a more holistic perspective of the whole person (Lea et al. 1999; Slater & Lambie 2011). They also spoke optimistically about their clients’ ability to change, and demonstrated a desire to represent heavily stigmatised and marginalised members of society (Slater & Lambie 2011). One study specifically examined perceptions of paedophiles – the participants felt they were often “driven by the need for company and affection… having low self-‐esteem, being introverted and quiet”, exhibited learned behaviour as opposed to genetic characteristics, and struggled to establish “normal” relationships (Lea et al. 1999, p110). In conclusion, Lea et al.’s qualitative study most closely matched mine; however, it is important to note that it neither focuses specifically on either paedophiles or therapists, nor does it focus on their experiences through the lens of social discourse. There appears to be something of a gap in the research here, which this study aims to investigate.

Methodology

Overview This section sets out the study’s methodology. It begins with a discussion of the broad understandings of knowledge and reality that shaped my methodological approach. The research method and methodology is then explained. This is followed by an explanation of how participants were recruited and interviewed, and how data arising from interviews was analysed and arranged into themes. Finally, ethical considerations relating to the study are explored. The aims of my research can be summarised as follows:

-‐ To explore the lived experiences of therapeutic professionals working with paedophiles, and examine how these fit with the social discourse. -‐To examine how societal attitudes and media portrayals of paedophiles affect therapeutic work with this client group. -‐ To explore therapeutic professionals’ attitudes towards paedophilic clients and child sex offenders. -‐ To examine the challenges and rewards of this work, and its impact on therapeutic professionals.

Ontological and Epistemological Considerations In choosing my research method it was important to consider the nature of the enquiry and balance this with an understanding of reality and knowledge that was personally fitting with my own way of experiencing the world.

In ontological terms, the notion of reality as being independent of individuals’ belief systems and experiences (realism) (Ritchie & Lewis 2014) felt incompatible with both my values as a counsellor and the very nature of my research question. In contrast, my aim to explore my participants’ individual lived experiences within the context of social discourse seemed rooted in idealism, which considers reality as constructed in the mind and affected by social forces and shared ideologies (Ritchie & Lewis 2014). Epistemology is concerned with identifying the theory of philosophy one holds whilst engaged in the pursuit of knowledge and meaning (McLeod 2011; Ritchie & Lewis 2014; Braun & Clarke 2006). A positivist epistemological stance considers objective social research to be possible and might seek to gain understanding through measuring or testing human behaviour using quantitative methods such as randomised controlled trials (Blaikie 2007). This approach assumes to some extent that human behaviour has preconceived meaning attached to it and is guided by fixed rules independent of individuals’ values (Willis 2007; Ritchie & Lewis 2014). Considering my ontological stance of valuing multiple realities and individual experience, this approach seemed ill fitting as a philosophical framework within which to attempt to answer my research questions. An interpretivist epistemology, however, adopts a more phenomenological approach to gaining understanding. McLeod (2011, p21) defines phenomenology as “describing the essential quality of an experience”, a principle that seemed to embody the aims of my research much more effectively than a positivist approach. Interpretivism enabled my understanding of the data to be based to some extent on the meaning making and interpretation that both the participants and myself the researcher engaged in (Bryman 1988; Guest, MacQueen & Namey 2012). In this way, the perspectives of both parties are considered to be active ingredients in the acquisition and construction of knowledge and understanding.

Qualitative Research Methods My intention was not to test theories, prove hypotheses or draw generalisable conclusions from the data about therapeutic professionals’ experiences, rather to

explore a depth of experience and extract phenomenological data that might inform understanding. Therefore, a qualitative approach was far more fitting than a quantitative approach, whilst also embodying the epistemological and phenomenological philosophies discussed above. A qualitative research method values individual voices and depth of experience over generalisation and breadth of participants, which is more characteristic of quantitative research (McLeod 2011). Qualitative methods also acknowledge the influence of the researcher’s views and preconceptions on the data (Braun & Clarke 2006; McLeod 2011), placing the researcher as an active participant in generating themes and codes as opposed to being a passive vessel giving voice to the participants (Fine 2002; Braun & Clarke 2006). Thus data is co-‐created between researcher and participant through conversation, rather than lying dormant, awaiting discovery (Dallos & Vetere 2005; Braun & Clarke 2006). Since I have my own fairly strong views and interests in social and media constructions of paedophiles, it was essential for the trustworthiness of my research to adopt a method that enabled me to own these views, and see them as inextricably linked to the codes and themes I would ultimately find in the data. Qualitative research enabled me to do this, whilst seeking real depth in the individual voices of my participants. A key aspect of my research was to explore my participants’ experiences within the context of social and media perceptions. Thus, within an interpretivist epistemology, the concept of constructionism, which locates meaning and experience within social discourses (Patton 2002; Braun & Clarke 2006), was highly relevant to my study. Closely related to constructionism is contextualism, which Braun & Clarke (2006, p81) explain as acknowledging “the ways individuals make meaning of their experience, and, in turn, the ways the broader social context impinges on those meanings”. Thus contextualism appeared to align closely with the goals of my study, and fit within a qualitative approach.

Methodology – Thematic Analysis In choosing a methodology, I noted that Braun & Clarke cite thematic analysis as a diverse and flexible methodology which is comparatively straight-‐forward compared to

some others and therefore good for the novice researcher, whilst also being appropriate for a number of theoretical frameworks, including interpretivism, constructionism and contextualism (Braun & Clarke 2013, 2006; McLeod 2011). Thematic analysis could facilitate answering my research questions by enabling me to generate themes from my participants’ accounts whilst being flexible enough to examine both similarities and differences. This would mean losing the individual’s voice to some extent in the interests of highlighting the most important aspects of the overall data set (Braun & Clarke 2006). Braun & Clarke have challenged conventional views of thematic analysis as a tool to be used within other research methods (Boyatzis 1998; Ryan & Bernard 2000), championing it as “a method in its own right” (Braun & Clarke 2006, p79). Described by O’Neill (1998, p45) as “a somewhat more self-‐conscious version of the meaning-‐making in which we engage throughout our lives”, it seemed an appropriate methodology for a number of reasons. It could acknowledge the active role that I, the researcher, played in deciding on where the themes lay in the data (Elliott, Fischer & Rennie 1999), as opposed to suggesting themes lie waiting to be discovered or “emerge” (Braun & Clarke 2006; Ely, Vinz, Downing & Anzul 1997). Transparency in showing how data was analysed was key to ensuring my study’s trustworthiness and locating it within the context of other research (Braun & Clarke 2006). Thematic analysis also offered the flexibility to interpret only specific aspects of the data (Boyatzis 1998). This enabled me to narrow and focus analysis to a few key areas of interest, namely experiences, attitudes and social perceptions of paedophilia, within a much larger body of data – an example of my active role as researcher in shaping the findings. However, in keeping with Braun & Clarke’s (2006) ideology of contextualism, my study aimed to explore both semantic and latent themes, presenting a rich overview of the data of a previously very under-‐researched area (semantic), whilst also exploring the underlying influence of social discourse on my participants’ experiences (latent) (Boyatzis 1998). Themes were co-‐constructed through conversations with my participants, and semi-‐ structured interview techniques afforded flexibility that allowed rich and sometimes unpredictable content to emerge. It is important to acknowledge both my role in creating the themes, as well as my areas of interest that informed the direction of data

analysis. A principally inductive “bottom up” approach was used in the initial coding of the data, but I then switched to a more deductive approach in establishing and discussing themes. Thus my overall data analysis method was a hybrid inductive and deductive approach that allowed the data to inform the codes, whilst also allowing the themes and discussion to be shaped to some extent by a pre-‐existing agenda (Fereday & Muir-‐Cochrane 2006; Tobin & Begley 2004; Koch 1994).

Recruitment of Participants and Sampling This study was originally focused on the experiences of counsellors working with paedophiles. After an exhaustive search for participants at the STOPSO (Stop Sexual Offending) organisation (2016), The Lucy Faithfull Foundation (2016), and through contacting professionals working in secure mental hospitals, prisons and psychiatric wards, it became apparent that few counsellors work with paedophiles. In custodial or secure environments housing offending paedophiles, it appeared that forensics psychologists or psychiatrists generally worked with this client group, but rarely counsellors. In fact STOPSO (2016) was the only organisation I could find where counsellors were working with paedophiles. This was interesting data for my study, and is discussed later in the Discussion section. Due to the lack of counsellors working with paedophiles, I altered my research questions to focus on “therapeutic professionals”. This enabled me to recruit sufficient participants for a thematic analysis, but also gave me richer data by enabling me to interview a range of professionals in different roles. Purposive convenience sampling was chosen as my sampling method on account of the specific nature of my research and the limited number of potential participants. I aimed to recruit participants from a range of different backgrounds to ensure my study encompassed the views of those working with very serious offenders through to non-‐offending paedophiles, in order to keep my study within the context of the diversity and complexity of paedophilia as discussed in the literature review. However, most of my participants worked primarily with offenders and working with non-‐offending paedophiles was under-‐represented in the study. The reasons for this arose from the interviews and formed an important part of the data set, which is addressed in the Discussion section.

During recruitment, inclusion criteria were adjusted from “counsellors currently working with paedophiles” to “therapeutic professionals with experience of working with paedophiles” as I wanted to include professionals who may no longer work with this client group. Participants were required to have considerable professional experience of working with paedophiles either over several years, or as a significant percentage of their client group for a defined period of their professional career, and to be working within an established ethical framework such as the BPS or BACP ethical framework. This was checked after initial email exchanges with a screening phone call. At this point, some participants engaged me in quite lengthy conversations to establish my own views before agreeing to the interview. This felt highly relevant within the context of a social discourse that often demonises paedophiles as “monsters” – they were checking that my research did not seek to reinforce this portrayal before agreeing to take part. Despite an urge to hold back my personal views for fear of influencing the data, I quickly realised how unrealistic this was and how, as researcher, my involvement had already begun to shape the outcome of the study. These conversations also felt ethically important in reassuring potential participants that the interview would be a safe space for them to express their views. My final thematic analysis interviewed seven participants – identifying as a range of different therapeutic professionals: counsellor, psychological therapist, consultant psychotherapist, clinical psychologist, medical director, probation officer, and manager of services aimed at reducing child sex offending. All participants worked in England. They were aged between 35 and 66 (mean age 50), three were male and four were female. Six participants identified themselves as White British and one as British Indian.

Interviews All participants were sent an information and consent form (Appendices B & C) at least four weeks before interviews. Semi-‐structured face-‐to-‐face interviews ranging between 54 and 89 minutes were conducted at participants’ places of work or The University of Manchester. All interviews were recorded using a hard disc recorder and later transcribed in full.

The semi-‐structured interview method used a conversational and informal style to encourage disclosure, help participants feel at ease and open up, and facilitate exploration of unexpected themes (Dallos & Vetere 2005) outside of the open-‐ended interview schedule used (Appendix D). Drawing on listening skills acquired in counsellor training, broad open questions were used flexibly, sometimes omitting or adding additional prompts as required, and reflecting back content to deepen rapport and show attentiveness (Bryman 2012). Closed questions were avoided in an attempt to open up a dialogue between participant and researcher within which themes could be co-‐constructed. This method provided the flexibility required to explore the individual lived experience of my participants, whilst considering the influence of wider social factors (Kvale & Brinkmann 2009) -‐ as Tanggaard (2009, p1513) describes it, semi-‐structured interviews aim to “explore, through words and discourses, peoples’ socially and historically embedded modes of understanding”. A trial interview was conducted with a course colleague before interviews with my participants began, enabling me to test and modify my interview schedule and practice my interviewing technique. Due to the emotive content of the study, it felt ethically important to adopt a sensitive interviewing style, and allow time at the end of interviews to debrief and converse with my participants. This gave them space to process any anxieties and ask questions arising from our conversations.

Data Analysis My data analysis method attempted to balance a hybrid inductive and deductive approach. As this was a very under-‐researched subject, I wanted to allow the data to inform the themes. Therefore initial coding followed an inductive approach. However, I had a specific interest in social constructionism and thus I attempted to balance capturing the broad semantic themes in the data with a focus on social discourse and how societal attitudes and perceptions affected my participants’ experiences. As data analysis progressed and focused on these areas, it became more deductive.

The validity of the analysis was checked through discussions with my supervisor and peers, to ensure that I was not shaping the data to fit my own preconceptions (Dallos & Vetere 2005). Data was analysed using the six stages of thematic analysis described by Braun & Clarke (2006) as familiarisation, initial coding, searching for themes, reviewing, defining, and writing up of the themes identified. These stages were not always followed in a linear way -‐ some phases overlapped, and the process of data analysis was fluid and flexible, sometimes returning to and reviewing earlier stages. Familiarisation and immersion in the data was achieved through listening to the recordings multiple times and transcribing the interviews. I was then able to identify initial codes using Nvivo software (see Appendix E), through a process of re-‐reading the transcripts, cross-‐referencing them with information collected in the literature review and performing checks and balances through conversations with colleagues and my supervisor. Initially, I had aimed to approach the coding stage methodically, coding all seven interviews before starting to cluster codes into parent themes. I quickly realised this was unrealistic as I would end up with hundreds of individual codes and would become lost in data with no order to it. Thus I began tentatively grouping codes into clusters early in the process. This was a somewhat more fluid and messy process than I had anticipated, but it worked well, helping me to establish order and direction, and begin structuring a large amount of data into categories that were constantly refined and updated, and which eventually informed the final themes. These were then checked against the initial recordings and transcripts for accuracy (Braun & Clarke 2006). During this process, I continually checked for new codes and themes until I reached a saturation point where nothing new was found in the data. Some sub-‐themes were established early in the process, but these were refined and updated many times, and again later when writing up the Findings. Appendices E-‐G show examples of the on-‐ going process of establishing themes in an attempt to demonstrate transparency, and hence trustworthiness.

Ethical considerations The study received ethical clearance from The University of Manchester and was conducted within the framework of its research ethical guidelines (University of Manchester 2015). As a qualified counsellor, I adhered to the ethical principles of trustworthiness, beneficence, non-‐maleficence, autonomy, self-‐respect and justice outlined in the BACP's (2010) ethical framework throughout the research process. In developing relationships with my interview participants, I also considered Tim Bond’s (2004) ethical guidelines relating to conducting counsellor research. Participants were provided with an information sheet outlining the nature of the research, and informed consent was obtained using a signed consent form (Appendices B & C). Participants were informed of their right to withdraw at any time up until submission without giving a reason. Due to the potentially distressing nature of the subject, participants were advised they could terminate the interview or pause at any time, and reassured that any boundaries they had regarding the subject matter discussed would be respected. Anonymity and confidentiality were assured by changing personal information that could make participants recognisable during the transcription process. Audio recordings and transcripts were kept on a password-‐ encrypted laptop, and destroyed once the final study had been submitted. Participants were offered the opportunity to review the transcripts to check their accuracy, and were given the opportunity to remove anything they did not feel comfortable with. Ensuring the trustworthiness of my study was an important part of my ethical considerations. I came to this research topic with some fairly strong views, and maintaining an awareness of these, and my own cultural and social filters throughout the research process was important in understanding my own influence on data collection and analysis, and checking I was not slipping into imposing my own opinions on the data (Bond 2004; Elliott, Fischer & Rennie 1999). As a counsellor interviewing therapeutic professionals, I considered myself to have something of an insider researcher position, although I personally had no experience of working with this client group. A reflexive journal was used to bracket personal views and process thoughts and opinions that came up during the research process – Appendix H shows some extracts

from this journal. My interview schedule and data analyses were checked in discussions with my supervisor and through peer reviews with other colleagues on my course to make sure they were not loaded or being used to validate personal opinions.

Findings Data analysis revealed a narrative that seemed to cover three distinct areas. The themes are arranged in a progressive order, which tell the participants’ stories; as themes are intrinsically linked, some of them overlap. Firstly, participants talked about problematic perceptions and misunderstanding in relation to social and media views of paedophilia. This informed my first theme. They then discussed their experiences and how different these were from those perceptions. Five key themes were identified in this area. Finally, all participants expressed the need for a change to current approaches, which informed the final theme. The table below outlines my seven themes, with relevant sub themes, and shows the number of participants who talked about each theme. A discussion of the findings in each theme follows.

Theme Table

AREA THEMES / SUB-‐THEMES A – PERCEPT-‐ IONS B -‐ EXPERIENCES C -‐THINGS NEED TO CHANGE

1. Inaccurate perceptions are harmful and dangerous 1.1 The “paedophile” label is insufficient, inaccurate and unhelpful 1.2 The media distorts perceptions 1.3 Unhelpful and uninformed social views 2. Extremely complex and diverse presentations and definitions 2.1 A wide spectrum, not a culturally or socially homogenous group 2.2 Complex and multiple reasons for offending 2.3 Complexity of different presentations and diagnoses 3. A lack of resources to address the problem 3.1 A lack of preventative measures and support 3.2 A lack of funding 3.3 A lack of knowledge and professional agreement 4. High levels of stigmatisation 4.1 Stigmatisation towards the client group is unhelpful 4.11 A barrier to therapeutic work and rehabilitation 4.12 Stigma compounds social isolation and potentially increases the risk of re-‐offending 4.2 Stigmatisation towards therapeutic professionals 5. Current approaches to managing the problem are ineffective 6. I experience this work as meaningful and personally rewarding 6.1 What I do really works at an individual level 6.2 Reaching out to the most marginalised and abandoned members of society 6.3 Challenging and fascinating work 7. Approaches to this problem need to change 7.1 Preventative measures and support are needed 7.2 A more balanced, well-‐informed discussion is needed

PARTIC-‐ IPANTS 7 7 5 7 7 5 5 6 7 7 5 3 7 6 6 6 6 7 7 7 5 4 7 6 5

A -‐ Perceptions

Inaccurate perceptions are harmful and dangerous

All participants discussed the harmful consequences of inaccurate perceptions and misunderstanding relating to paedophilia and child sex offenders. Discussions focused around three key areas, which formed three sub themes: problems caused by the “paedophile” label, the media’s role in promoting distorted perceptions, and poorly informed, inaccurate social views. 1.1

The “paedophile” label is insufficient, inaccurate and unhelpful (7)

All participants considered the word “paedophile” an insufficient, inaccurate label that was unrepresentative of their clients, describing it as: “A complete misnomer, really problematic (Diane), meaningless (Peter), dangerous, a self-‐fulfilling prophecy (James), a term of abuse (Frances)”. The majority of, and in some cases all their clients, did not fit the DSM5 criteria of a paedophile. They described an extremely heterogeneous and complex client group, with individual and varied reasons underlying their paedophilic behaviour, and thus rejected the term “paedophile” as limiting and unhelpful. You're not having a conversation with a blank canvas that has just got the word “paedophile” written on it. (Peter) Most participants avoided using the word both in their work and socially, and one expressed anger and almost declined the interview because it was used in the study’s original title. Instead, they discussed the importance of working with the whole person holistically and separating them from the label, which they saw as a barrier to therapeutic work and rehabilitation. Calling people paedophiles is really problematic. So it's easy to do, but it's a bit like in medical work, you know… talking about “the abdomen in bed 8”, as if that's all a

person is… These are people with paedophilic traits and paedophilic sexual interests, but the most important thing is that they're people. (Diane) The participants considered the term derogatory and pejorative, and felt it had become used as a judgment that categorised a very broad range of people indiscriminately under one label, creating stigma, preventing sensible discussion, fuelling social fear and misunderstanding, and hindering preventative work with people concerned about their behaviour, but too scared to seek help for fear of being branded a “paedophile”. Some felt the label was impossible to ever recover from and reintegrate back into society. 1.2

The media distorts perceptions (5)

Five participants discussed the large impact the media has on social views of paedophilia, and its role in scaremongering and presenting a distorted, sensationalised view. Media reporting was seen as highly inaccurate, unbalanced and fuelling public fear and hatred. They felt that sex offenders were highly stigmatised and demonised in the press, and described dichotomous, “black and white” views where people were either normal, or “othered” as monstrous paedophiles. They will always be pervert, demon, monster, sinister, scary, manipulative, grooming…. all these words that people are scared of. (James) Participants felt that the term “paedophile” was constantly used incorrectly, with rarely any distinction made between offences against pre-‐pubescent children and teenagers. Some expressed anger at the devastating effects of “trial by media”, where allegations were presented as facts, regardless of the trial’s outcome.

1.3

Unhelpful and uninformed social views (7)

All participants considered social views of paedophilia to be highly inaccurate compared to their experiences, still predominantly preoccupied with the concept of “stranger danger”, and showing little awareness of research evidence that suggests

most childhood sexual abuse is perpetrated by a family member in the child’s home, and that perpetrators are an extremely diverse group: This kind of stereotype of the paedophile, you know -‐ the older man in the mac and all that kind of shit -‐ well the person who might hurt him might be a kid not much older than him. (Frances) Some participants described “splitting” as society’s defence against acknowledging the “reality” of the problem, and felt that problematic sexual behaviour was perceived as abhorrent and unusual, when in fact it is much more common than most people think. Some expressed the view that any of us could in fact be a sexual offender given a certain set of circumstances. Many expressed a wish to educate and dispel stigma. Some also discussed inaccurate public perceptions that all paedophiles are considered to be sexual offenders, and vice versa.

B – Experiences

Extremely complex and diverse presentations and definitions (7)

The first theme identified within therapeutic professionals’ lived experiences was that the client group, and the presentations of paedophilic issues, were extremely varied, diverse and complex, with multiple contributing factors. This was further complicated by different definitions of these issues. The participants’ experiences were far from the limited and simplistic perceptions they had discussed in Theme 1. I identified three sub-‐ themes within this theme. 2.1

A wide spectrum, not a culturally or socially homogenous group (5)

Five participants described their clients as being extremely diverse demographically, ranging in age from young children to elderly people, and from very disparate social, cultural, religious and ethnic backgrounds. Their clients’ family backgrounds, education

and employment histories ranged from very stable to very unstable. They rejected the notion of this group as a homogenous entity. They are just so different and their challenges will be different and the way you approach them will be different because of their own life stories. (Peter) My client group's been from 10 upwards to adults in their 80s who've committed anything from quite minor sexual offences to serious sexual offences, and been either cautioned, doing a community disposal or anything up to a life sentence. (Amanda) Participants held no particular view of paedophiles or sex offenders, seeking instead to develop a comprehensive understanding of the individual, and tailor therapeutic interventions to fit each person. They also discussed a very wide spectrum relating to their clients’ levels of insight, from no remorse or awareness to extreme distress and suicidal ideation. 2.2

Complex and multiple reasons for offending (5)

Five participants described a very complex and diverse range of reasons for offending. These included sexual interests, obsessive or dysfunctional sexual thoughts, poor attitudes to women and relationships, pornography addiction, social isolation, low self-‐ esteem, poor social skills, and lack of knowledge or confusion over the age classification of indecent images. All participants agreed that a complicated combination of factors usually influenced offending behaviour rather than one clearly defined trigger. There’s loads of factors that can cluster together and make it more likely that someone's going be risky and more likely to reoffend. (Amanda) I see them as such individually complex individuals, maybe presenting with end results that are very similar but via so many different ways and means, mediated by so many different external variables and environmental challenges. (Peter)

Participants felt that certain risk factors such as alcohol or substance misuse, and the breakdown of adult relationships or support networks, could lower a person’s threshold for offending, but acknowledged there was no one defined pathognomonic risk factor that could predict this outcome. Some saw offending behaviour as a consequence of experiencing a troubled, traumatic life. 2.3

Complexity of different presentations and diagnoses (6)

Six participants described a very complex range of different presentations and diagnoses, highlighting the need to distinguish between them and apply different interventions. For example, participants distinguished between offending and non-‐ offending paedophiles; attraction to only pre-‐pubescent children; only post-‐pubescent children; differentiation within these categories depending on the child’s age; attraction to children but also adults; and those who are not consistently paedophilic but experience periodic breakdowns into paedophilic behaviour due to adult relationship breakdowns or other stress factors. Some distinguished between internet-‐only and contact offenders, and rejected conventional notions that the former leads to the latter. Other presentations discussed included obsessional collecting and sorting of vast quantities of images, development of OCD obsessional fears of being or becoming a paedophile, and autistic, Asperger-‐type or learning difficulties-‐related presentations. One of the things that poses a challenge clinically is what might be called differential diagnosis… the term 'paedosexuality' would be much more appropriate, an umbrella term to talk about a range of different presentations of people with these kind of problems. (Diane)

A lack of resources to address the problem (7)

All participants discussed a considerable lack of resources, and often expressed frustration that instigating significant, widespread change was unlikely until this changed. They described a lack of preventative measures, support, funding, research, knowledge, services and resources. I identified three sub-‐themes in this area.

3.1

A lack of preventative measures and support (7)

All participants described a huge lack of preventative measures and support, expressing frustration that there are many people concerned about their thoughts or behaviour, desperate to access help, but with nowhere to go. Some believed this lack of services and early intervention inevitably led to more victims being created, citing examples of offenders who had said if there had been somewhere to access support they may have been able to stop. Why aren't we working with somebody who hasn't even created a victim yet? That makes sense to me. (James) We had waiting lists with men and women on them who were telling us -‐ telling forensic services -‐ that they felt they were dangerous… they weren't seen as needing a service, and there wasn't a service at that time… There was nothing available for a person who feels he or she is a risk before they've committed an offence. (Frances) Participants described the few existing preventative services as extremely effective, but expressed frustration at the difficulties in accessing them and their inability to meet the high demand. I think it's gross. I think we've really got to fight. In the Government's eyes you've got to offend and be sentenced for longer than a year before anyone gets hold of you at all, and there is nothing other than voluntary groups. (Anne) 3.2

A lack of funding (5)

Five participants discussed the lack of funding and investment into services and research, and described how difficult it was to secure government backing for projects. Investment in this area was seen as desperately needed, but a “hard sell”, and something that would never be a public vote-‐catcher. Some participants’ organisations had designed and pitched innovative new services that never became a reality because nobody would invest in them.

The idea of Governments funding huge sums of money into an area that most people would actually perhaps, dare I say it, psychologically prefer to be in a black box and to be forgotten about, would be a brave decision, but one that ought to be taken. (Peter) It's a really hard sell… It needs somebody to take it on and lead it, and find funding and make it happen. (Diane) 3.3

A lack of knowledge and professional agreement (3)

Three participants talked about a lack of knowledge and professional agreement around medical and biological understandings of paedophilia, as well as disagreements and tensions between different agencies, such as the Criminal Justice System’s punitive stance coming into conflict with the therapeutically-‐oriented medical professions. Furthermore, participants expressed a range of quite different and in some cases contradictory views and beliefs, which seemed to mirror the lack of professional agreement they had discussed: Anybody can change if they want to. (Frances)… That orientation [paedophilia] is incurable, it's incurable. There is no cure. (Michael)… It’s not about love of children. (Diane)… They did love the child… they honestly thought they did. (Michael)… Unconditional positive regard… It's very difficult with sex offenders but it is possible. (Frances)… Unconditional positive regard… I think it's impossible, and possibly counterproductive. (Peter) Differing views on what factors cause paedophilia were also apparent, for example: genetic sexual orientation, environmental conditioning not genetics, an addiction, a mental health problem, learned behaviour and social issues.

High levels of stigmatisation (7)

All participants highlighted extremely high levels of stigmatisation relating to their work, directed towards their client group, but also towards themselves to some degree by association.

4.1 Stigmatisation towards the client group is unhelpful (6) 4.11 A barrier to therapeutic work and rehabilitation (6) Six participants saw the stigmatisation experienced by their clients as a considerable obstacle to therapeutic work and rehabilitation. They saw high levels of stigma as obstructive to setting up preventative and supportive services, and some gave examples of high levels of prejudice directed at clients by professionals working within services: One of them [a probation officer] actually said at one point, “If I had a choice I would just shoot them, but we can't shoot them so we put them through this programme”. (Michael) The participants felt high levels of stigmatisation compounded their clients’ hopelessness of ever being able to reintegrate into society. They said their clients were often facing terrible and desperate situations, where they felt isolated, rejected, despised by society, and felt everyone was against them – one spoke of society wanting to “keep them in the gutter”. Child sex offenders were seen as the ultimate taboo, and the effects of this were potentially life-‐long. Stigma also made it very hard for clients’ family or friends to support them through rehabilitation for fear of being thought to condone their behaviour.

It compounds their feeling of hopelessness that they will ever climb out of this situation, because of the feeling that they're always going to be labelled, always going to be categorised with the most severe sex offenders, assumed to be predatory, calculating, psychopathic. (Diane).

4.12 Stigma compounds social isolation and potentially increases the risk of re-‐ offending (6) Six participants felt that social isolation from the stigma of being branded a “paedophile” compounded risk, as people ostracized from their communities had nothing to loose by re-‐offending. Some quoted evidence of extremely low or zero re-‐ offending rates on projects focused on re-‐integrating sex offenders into the community. Others discussed the risks of socially isolating ex-‐offenders as an unintended consequence of measures imposed by the Criminal Justice System, that potentially increased rather than reduced the risk of re-‐offending.

I do think there's a direct correlation. I think if everybody's telling you you're going to do it anyway, and shuts the door in your face at every opportunity, and you've got no friends, no one to turn to… you are going to reoffend, definitely. (James)

4.2 Stigmatisation towards therapeutic professionals (6) Six participants expressed experiencing some degree of stigmatisation by association to the client group; however one had not experienced any stigmatisation. Participants had experienced stigma from other professionals -‐ some had experienced derogatory comments and being treated with suspicion and mistrust, citing concerns that others thought they condoned the behaviour of sex offenders. Others had experienced anxieties around being assumed to have a prurient interest or hidden agenda for working with this group. Another described being stigmatised by the press, quoting an article referring to their organisation as “paedo pals”. Some participants also expressed reluctance to talk to friends and family about their work for fear of judgement. Others had never told their close friends and families they worked with sex offenders; some of those who had said their work concerned their partners. I would be very wary of telling people what I did… I would have to know them very well before I told them. (Anne)

Current approaches to managing the problem are ineffective (7)

The first three themes in the “Experiences” category seemed to suggest that current approaches are ineffective. This was expressed by all participants, and formed the next theme. Participants felt that measures and restrictions imposed on sex offenders by the Criminal Justice System were unhelpful, increased isolation, stigmatisation and made rehabilitation difficult, potentially increasing the risk of re-‐offending. Uneven sentencing practices and a lack of clear thinking from the CJS were also seen as unhelpful, in some cases labelling and stigmatising a person for life for a relatively low level online offence, for example. Many participants considered the lack of preventative measures discussed in Theme 3 an example of the ineffectiveness of current approaches, and saw the “reporting culture” as an obstacle to people seeking help. Overall, some of the severe on-‐going environmental and social consequences of being a registered sex offender were seen as damaging and counter-‐productive to rehabilitation. When people say… “He only got five years for that, that's a disgrace” -‐ he didn't only get five years. It's a life sentence… He won't ever be able to earn money again. He won't be able to buy a house, he won't have contact with his family, he's lost his friends. That's not five years, that's forever. And people don't want to know that… they just say: “Five years, that's a disgrace. He should be locked up and throw the key away.” In some ways you'd be doing him a favour if you did that. (Michael) A lot of them will say to me, “What's the point in me having friends? What's the point in me trying to get a relationship? You're going tell the person anyway… And I'm just going to be on my own”. (James)

I experience this work as meaningful and personally rewarding (7)

Despite frustrations about ineffective current approaches and social perceptions, participants expressed passion for their work, and felt they were really making a significant difference to their clients. They experienced the work as meaningful, personally rewarding and closely aligned with their values. I identified three sub themes within this theme. 6.1

What I do really works at an individual level (7)

All participants experienced their work as highly effective, championing a variety of different models including psychoanalytical, psycho-‐educative and person-‐centred approaches. Participants felt their work enabled the clients to gain important insights into the roots of their problematic feelings and behaviours, increased their self-‐esteem and confidence, and reduced feelings of isolation and self-‐loathing. All these factors were seen as important in rehabilitation and preventing offending. The overall message was that these interventions worked, but they were operating within a society that rejected the notion of working with child sex offenders. If anybody really means they're going do child protection they need to start working with this group who are offenders. It's really simple. (Frances) We're doing something really good and we’re preventing further victims. And it does work, you know. (James) 6.2

Reaching out to the most marginalised and abandoned members of society (5)

This was a key motivation for five participants. They expressed values around nobody being beyond hope, and not wishing to turn their back on any human being, whatever they had done. Their message was a hopeful one that showed compassion and humanity, and their belief systems and values seemed to have led them to this work.

I'll not be part of a society that feeds people to the wolves… to discard a whole population, just say: “Put them on an island or shoot them” is… I think is indefensible. It's scandalous. (Michael) Working with people that nobody else would was important to them, and they described the rewards manifest in restoring self-‐worth and dignity to those who felt utterly outcast, as well as working with clients who were experiencing great distress. 6.3

Challenging and fascinating work (4)

Four participants described their work as “challenging” and “fascinating”, and reflected on the intellectual and psychological challenges of exploring the more extreme facets of human behaviour, that many others would find abhorrent. They experienced reward and fulfilment from striving to genuinely comprehend their clients’ worlds, and the experiences that had shaped their difficulties, despite being confronted with difficult material.

C – Things need to change

Approaches to this problem need to change (7)

The participants had told me about inaccurate perceptions and understandings around paedophilia, and compared this to their first-‐hand experiences, highlighting some of the challenges they faced, but also reflecting on the effectiveness of their personal interventions with clients. They seemed to be telling me: “We know what we do works, but the current systems in place don’t work”. This led to the final part of their narrative, and my final theme, in which all participants expressed a need for current approaches to change. I identified two sub themes here.

7.1

Preventative measures and support are needed (6)

This theme linked closely with theme 3.1, where participants had talked about the current dearth of resources. They described the effectiveness of their organisations’ preventative and supportive measures, but said nowhere near enough of these resources were available nationally to make a significant impact. It [preventative work] is something that needs far more development… so it's not just a reactive thing, it's about people understanding why stuff happens and then being able to understand what they can do to prevent it... it would just be good for more services to be available because what we generally hear from the men is 'I wish I'd been able to access help earlier'. (Amanda) Some participants referred to very successful preventative projects in other countries, and said the UK urgently needs an equivalent. Participants explained the need for much earlier intervention, and believed this would considerably reduce offending rates. They also discussed the need for confidential services where people could begin to address their concerns without fear of being immediately reported and labelled a “paedophile”. 7.2

A more balanced, well-‐informed discussion is needed (5)

Five participants espoused the need for more balanced, well-‐informed discussions. They considered paedophilia the ultimate taboo, which was either not discussed at all, or talked about in hysterical and unhelpful ways. They felt that more balanced discussions would help address the problem, reduce some of the stigma around it, and make it easier for paedophilic people to seek help and support. More adult conversation around this would be healthier for all concerned… we don't talk about it except in terms of hatred. (Michael) In order to protect people, everybody ... we have to start talking about this stuff. (Frances)

Three participants also expressed some hope that very recently there had been some signs of a more helpful societal attitude in professional circles and even the press: I'm struck in the last year how many people have approached me, come to speak to me, writing articles, doing different projects, studies, media studies students, taking on this issue, so I think there's the beginnings of societal concern. (Diane)

Discussion

Introduction This study aimed to answer the questions: “What are therapeutic professionals’ experiences of working with paedophiles?” and “What are therapeutic professionals’ experiences of the current social discourse around paedophilia?” I will firstly summarise and contextualise the findings within the literature reviewed, and then explore key salient themes with a discussion. As each theme has already been summarised in the Findings section, the Discussion section explores what I consider to be the important overall messages of interest relating to the research questions and arising from an attempt to synthesise the themes, literature and my own experiences into a meaningful discussion.

Summary of Key Findings and Contextualisation within the Literature The interview participants’ views supported much of the research that dispelled the idea of “stranger danger” as inaccurate (Edwards 2001) and instead considered paedophiles and child sex offenders to be a diverse and varied group with a multitude of complex factors contributing to their issues (Jewkes & Wykes 2012; Babchishin et al. 2015). The functions of projection and splitting as a defence against both the issues of childhood sexuality and the problem of paedophilia (Harrison 2016; Jewkes 2010; Angelides 2008) also fitted with my participants’ experiences, and, like much of the research suggested, they saw the media as very influential in perpetuating stereotypes that fuelled public misunderstanding and dissociation (Critcher 2010; Meyer 2010). The participants affirmed literature that suggested current approaches to the problem are ineffective, in particular focusing on the harmful latent effects of measures imposed by The Criminal Justice System as counter-‐productive (Edwards 2001). However, whilst much of the literature focused on inadequate measures born out of distorted and over-‐ simplified understandings of child sex offenders (Meyer 2010; Edwards 2001), the

participants focused much more on a severe lack of preventative resources and support, which were seen to be exacerbating the problem of child sex offending. Confusion and contradictions around definitions and understandings of paedophilia in the literature (Harrison & Manning 2016; Seto 2008; McCartan 2008) were reflected in a variety of contradictory beliefs and views held by my participants. However, they all agreed that the label “paedophile” was a damaging, stigmatising and loaded term that echoed the findings of Imhoff’s (2015) study, and described the importance of working holistically with the whole person, not the behaviour, which reflected the sentiments of Slater & Lambie’s (2011) paper on working with sex offenders. They also discussed the negative impact of compulsive pornography usage as a key factor amongst many of their clients, that appeared to fit with Wood’s (2013, 2011) papers that explore the role of the internet in encouraging people with no previous history of paedophilic traits to start engaging in the consumption of illegal material – what Wood and Briggs et al. (2011) refer to as a “new type of offender”. Many of the participants’ experiences of working with this client group supported findings from the literature review – for example most had experienced stigmatisation by association (Grady & Strom-‐Gottfried 2010), said that expert supervision was essential (Sandhu et al. 2012), described the importance of managing counter-‐ transference and boundaries (Grady & Strom-‐Gottfried 2010), and felt positively about their clients’ abilities to change (Slater & Lambie 2011). Their desires to work with heavily stigmatised members of society also reflected Slater & Lambie (2011). However, the message of my participants’ work being meaningful and rewarding came across much stronger in the interviews than the research as the key factor that kept them doing the work, despite the many challenges they faced working against the current social discourse. This appears to show a gap in the research that fails to explore the motivations and values behind therapeutic workers in this area. A discussion of important areas arising from the themes identified now follows.

Projection and Splitting -‐ Nobody Wants to Engage With This A strong message that I believe came out of the interviews, literature review and my own experience of interacting with the problem of paedophilia was that nobody wants to engage with this issue in a meaningful way. Both the literature and some of my interview participants talked about this avoidance in terms of projection and splitting. It might be helpful to understand these ideas within a psychodynamic framework – indeed one participant considered this an essential component of their therapeutic work. In psychodynamic terms, “projection” describes the externalisation of unacceptable or painful feelings and aspects of one’s own personality by attributing them to others (Brown & Pedder 1991). Closely related is the concept of “splitting” -‐ the separation of good and bad aspects of oneself or other people into completely dichotomous entities (Brown & Pedder 1991). Both splitting and projection form one of Freud’s (1936) classic psychodynamic defence mechanisms that act to prevent experiencing unbearable psychological pain or anxiety by keeping unacceptable aspects of ourselves in the subconscious. When considering my themes, projection and splitting could be seen to run through most of them. Inaccurate perceptions and stereotypes could be seen as a manifestation of such a defence mechanism, with stigmatisation, experienced by the clients and professionals, keeping it going. The literature and some participants suggested that current approaches are ineffective because they are rooted in a collective social desire to fix the problem of monstrous, evil child molesters lurking in the shadows of playgrounds rather than address the true complexity of paedophilia (Meyer 2010). My participants described an urgent need for a change in attitudes, and experienced their work as extremely meaningful and effective when they avoided projection and splitting, and instead engaged holistically with the whole person (Lea et al. 1999; Slater & Lambie 2011). Some saw paedophiles as “victims” of a harrowing mental illness, and talked about the importance of recognising and working with the “victim within the perpetrator” with child sex offenders – both concepts that are considerably at odds with the level of splitting evident in current social paradigms.

The participants discussed the damaging consequences of labels and stereotypes (Meyer 2010; Seto 2008; Feelgood & Hoyer 2008; Collins & Nee 2010), which they felt distorted their client group, and acted as a barrier to both discussion and the development of preventative work (Edwards 2001; Meyer 2010; Critcher 2010). Through the psychodynamic concepts of projection and splitting, we might see “paedophiles” as the ultimate receptacle for the projection of all the bad, unacceptable parts of our society, and of us as individuals living within that society. This potentially sends anyone with problematic sexual desires a message that all they are and ever can be is a wicked monster, who has no place in decent society. As one of my participants suggested, it could be argued that such messages risk creating a self-‐fulfilling prophecy by isolating and stigmatising the person, and greatly reducing the chance of them seeking help. The participants felt there is hardly any help available (McCartan 2008) for someone resourceful enough to seek support despite these obstacles, and that this lack of preventative services was a result of common attitudes that nobody wants to help or support paedophiles and sex offenders. This could be seen in psychodynamic terms as another function of society’s collective projection and splitting. Echoing Taylor & Quayle (2003), the participants expressed the need for society to start engaging with the “reality” of this issue if any significant change is to happen. As Frances explained: “If anybody really means they're going do child protection they need to start working with this group who are offenders. It's really simple”. However, they agreed that challenging such high levels of splitting amounted to a huge challenge that would need a brave person to take it on, and some suggested the construction of our political system makes this harder. Diane and Michael referred to it as “a really hard sell to the public” and “definitely not a vote catcher”. They felt that suggesting more supportive and less punitive approaches would be likely received by the public as “soft on child abusers” (Meyer 2010; Edwards 2001), and would amount to career suicide for politicians. An exploration of the influence of political systems on legislation and policy would be a useful research area relevant to this topic. Some participants challenged projection and splitting of paedophiles as monsters and psychopaths in their views that any “normal” human being could end up where their clients had, given a certain range of pre-‐determined and environmental factors. This

view was very under-‐represented in the literature, but seemed to fit to some extent with Woods’ (2013, 2011) and Briggs et al.’s (2011) “new typology” of sex offender. I personally experienced a lot of anxiety from interacting with this idea, since a natural question that followed was “Could that ever be me?” – a truly terrifying idea that, for me, demonstrated just the sort of psychological pain the mechanisms of projection and splitting defend us against. This forms my next discussion point, which explores these concepts within the context of Foucauldian Discourse Analysis.

Challenging Foucauldian Discourse Analysis -‐ Could It Be Anyone? “It could be anyone” was an unsettling message that arose from discussions with my participants. Some suggested that problematic sexual behaviour is much more common than we think, and described many of their clients as “normal” people who had never thought they could become a sexual offender. They saw their clients as human beings, ordinary people similar to the rest of us, but with a problem – whether it was seen as a mental health, behavioural or addiction problem depended on the participants’ beliefs and professional backgrounds. I was struck by how this perspective jarred with current social paradigms described in the literature (Harrison 2016; Jewkes 2010; Edwards 2001). The concepts of contextualism and social constructionism (Patton 2002; Braun & Clarke 2006) were highly relevant to this study, as it aimed to explore the participants’ experiences in the context of the social discourse. These theories align closely with Foucauldian discourse analysis, which examines the relationship between power and knowledge, and how they are used to mediate social control and shape discourses (Arribas-‐Ayllon & Walkerdine 2008). Michel Foucault is considered a key voice in the development of social constructionist theory (Bury 1986). Power relationships between people, and evident in behaviour and language, are seen as both reflective of and exerting an influence on the social discourse. Much of the literature exploring constructions of social discourse around paedophilia referenced Foucault – some examples being: societal and governmental responses to the perceived threat posed by child sex offenders (Ashenden 2002); the challenges facing therapists working with sex offenders in prisons (Collins & Nee 2010); and the role of language in popular media in

the creation of social discourse (Meyer 2010). A high level of stigmatisation towards both paedophiles – this word itself being seen as a stigmatising label (Jewkes & Wykes 2012; Meyer 2010) -‐ and professionals working with this group (Grady & Strom-‐Gottfried 2010; Pais 2002; Van Deusen & Way 2006) was a key discussion area in the interviews. Michael considered paedophiles and sex offenders to be “at the bottom of the pile” within the social hierarchy, and also felt they were regarded as “the lowest of the low” amongst offenders. Within the context of Foucauldian discourse analysis, collective social power, amongst both the public and offender populations, might be seen to perpetuate stigmatisation of this group – to “keep them in the gutter” as Michael put it – casting them out from the social discourse where they remain powerless and unheard. Whilst James described paedophilia as “the ultimate taboo” – an attitude that reflected all my participants’ concerns over the negative effects of stigmatisation of their clients -‐ it struck me that this taboo also has a positive function in acting as a social deterrent against engaging in sexual activity with children. Removing the taboo entirely might have dangerous consequences in the other direction. In this case the power dynamics of Foucauldian discourse could be seen to protect the majority at the expense of stigmatising the minority. However, given the research evidence that suggests some 80% of child sexual abuse is perpetrated at home by a family member (Jewkes & Wykes 2012; Jewkes 2010; Lea et al. 1999; Ashenden 2002), it could be argued that the taboo around “paedophiles” has over-‐reached its positive function and taken on a more problematic nature – in focusing our attention on “stranger danger”, is the same taboo now protecting a majority that in fact statistically contains 80% of child sex offenders, allowing them to operate below the radar of the social discourse? The therapeutic professionals I interviewed appeared to show a conscious intent to step outside of socially constructed paradigms where social power places paedophiles at the “bottom of the pile”, and considered doing so to be an essential part of working effectively with their clients as well as a personal value. But they expressed frustration at working against a tide of misunderstanding, prejudice and stigmatisation (Taylor & Quayle 2003; Collins & Nee 2010; Jewkes & Wykes 2012). Despite their insights, none of

the participants had a tangible solution to challenging the ingrained discourse around paedophilia that was reflected in a similar gap in the literature, and would be a useful area for further research. Their recommendations of further research, funding, alternative legislation and treatment reflected some of the literature’s recommendations (McCartan 2010) but the social discourse appeared to be a major barrier to implementing these recommendations. An interesting observation I made from analysing the interview data, which I felt was also evident in my participants’ enthusiasm to be interviewed, seemed to be that their experiences in some way reflected their client group -‐ their voices were unheard, and their experiences existed outside of the social discourse. This forms my final discussion point.

Unheard Voices – A Parallel Process? Parallel process is a feature of counselling whereby the experiences and feelings of the client are mimicked to some extent by the counsellor, or the relationship between counsellor and supervisor reflects the relationship between counsellor and client (Mothersole 1999). This relates to the psychodynamic concepts of transference and counter-‐transference – the unconscious projection of feelings between counsellor and client that the counsellor brings into awareness as part of the work (Freud 1977). The experiences of my participants’ clients as stigmatised and isolated individuals appeared to demonstrate to some extent a parallel process with their own experiences of remaining largely unheard behind the noise of an often-‐hysterical social discourse around paedophilia (Critcher 2006; Harrison & Manning 2016). I saw the participants as pioneers with an important message that could potentially reduce the problem of child sex offending and at the same time promote a more compassionate and humanistic understanding of paedophilia. But this message did not seem to be getting through, and they seemed to feel that, with a few exceptions, society did not want to hear it. A parallel process seemed to exist between both the participants’ and their clients’ views and experiences being unacceptable to society.

Whilst the literature review identified some discussions of stigmatisation towards professionals working with sex offenders (Grady & Strom-‐Gottfried 2010; Pais 2002; Van Deusen & Way 2006), there was very little about parallel processes between therapeutic professionals and paedophilic clients other than Wood’s (2010) paper exploring the benefits of using a psychoanalytic model with this client group. A much greater level of research into outcomes of different therapeutic interventions would help to validate my participants’ views, and hopefully allow their voices to be heard louder.

Recommendations for Research and Counselling Practice Some recommendations have already been made in the discussions above, however I would like to put forward a number of additional recommendations for both research and counselling practice that have arisen from conducting this study. Whilst there exists a considerable body of research on social attitudes and media representations of paedophilia, there appears to be a lack of reliable, scientifically sound studies that explore the complexity of different presentations or the efficacy of different treatments for these varied presentations (Grønnerød et al 2015). We seem to know that “one size does not fit all”, but thinking about paedophilic clients in more distinctly-‐defined groups, or even as individuals, appears as yet a somewhat underdeveloped area that could benefit from further research. Similarly, whilst much research questions the effectiveness of current approaches, little yet explores the more supportive, less punitive approaches championed by my participants. In short, research tells us a lot about the problems of current attitudes, representations and measures, but not very much about the validity of alternative solutions. The participants explained that preventative and supportive solutions do work; but it seemed their professional opinions lacked the support of much-‐needed research evidence that might add weight and validity to new approaches and encourage societal changes in attitude. Lack of funding was also highlighted as a key issue by participants and in the literature – more reliable research could help to open up

desperately needed funding sources that might address the current dearth of resources described by my participants. In terms of the counselling profession, it is important to consider that counsellors are not immune to societal attitudes and discourse. Training on working with sex offenders, and in fact with any stigmatised groups that might be considered the “social outcasts” or “baddies” of society was notably lacking on my Counselling MA; the focus was mainly working with “victims”, and scanning the indexes of counselling textbooks for information around this subject suggests that perhaps my course was not an anomaly. Counsellor training courses could be a good place to start trying to challenge the discourse and develop alternative attitudes and ways of working, such as developing therapeutic provision for offenders – not just so we are well equipped to work with and support this client group, but so we as human beings can be ambassadors for change in the way we discuss and debate this controversial subject. Finally, any platform that allows the experiences of therapeutic professionals working with paedophilic clients to be heard by society would be welcomed – whether that is more studies like this, articles in the press or television documentaries. As researcher, I feel an ethical responsibility to put this study’s results into the public domain, and thus it is my intention to publish the findings in Therapy Today.

Parameters of the Study This was a small-‐scale qualitative research study interviewing seven therapeutic professionals. I believe it has successfully achieved its aim to explore in depth their experiences of working with paedophilic clients within the current social discourse. However, it is important to note the study’s parameters and limitations. Due to the small sample size and qualitative approach, it is not possible to draw generalisable conclusions from the data that could be applied to all therapeutic professionals. Furthermore, my original intention was to recruit professionals working with a range of clients from serious offenders to non-‐offending paedophiles; however the majority of my participants worked mainly with offenders. This demonstrates a limitation of the

study, but also illustrates the difficulties inherent in reaching out to non-‐offending paedophiles due to the current climate of non-‐disclosure and lack of preventative measures discussed earlier. Further studies exploring the experiences of this specific group and considering differences between them and offending clients – and indeed the many different presentations of paedophilic problems within each group -‐ would help to fill the existing gap in research and further professional and societal understandings. The word “counsellors” was changed to “therapeutic professionals” in the study title at the recruitment stage to allow for an exploration of the experiences of a range of counsellors, psychotherapists, psychologists, psychiatrists and probation officers. This was initially due to difficulties recruiting exclusively counsellors for my interviews, as relatively few counsellors appeared to work with this client group; however I believe the decision to broaden the inclusion criteria enriched the data. There were notable differences in attitudes and experiences between different professional bodies – for example clinical forensic services compared with therapeutic services – and this would be an interesting area for further exploration, as would the reasons why interventions with child sex offenders currently appear to reside more on the medical end of the scale (forensic psychologists and psychiatrists), rather than within the more therapeutic domain. Furthermore, due to the low numbers of professionals working in this field, purposive convenience sampling was used to recruit participants. Thus this study does not attempt to explore experiences within any specific demographic, cultural or social boundaries, which would be another valuable area to examine with further research. It is also important to note that the hybrid inductive and deductive approach to data analysis meant that my final themes do not represent the entirety of the data set. In fact, many interesting codes were highlighted that did not make the final thematic map (see Appendices E-‐G). Thus, this study does not attempt to present the full picture from the data set in the way that a purely inductive approach might achieve. Finally, this study explores the experiences of paedophilic clients and their experiences of the social discourse through the professionals that work with them. Whilst this provides valuable insight, further research that directly interviews the clients themselves would be a valuable progression. This was not possible in this study due to

ethical clearance limitations.

Conclusion

Study Outcomes I believe this study has been successful in giving voice to the experiences of therapeutic professionals working with paedophilic clients, which have been previously largely unheard within the current social discourse. I think the study helps to challenge perceptions and attitudes, encourage a better-‐informed discussion, and present alternative approaches to tackling the problem effectively. Effecting change on a societal level is beyond the scope of this study; however I hope it can join the “beginnings of societal concern” that one participant believed were starting to emerge around paedophilia. A number of participants expressed benefits from taking part in the process. In some cases, they had gained new insights about themselves and their values, and some mentioned the process had been cathartic, and had inspired them to keep going with their work. I feel this is a positive outcome that enhances the study’s trustworthiness, and demonstrates good ethical practice through beneficence.

Reflexive Considerations and Personal Insights As a researcher, my understanding of this subject has grown considerably, not just from reviewing the literature and analysing interview data, but from observing my own responses and reflections from interacting with this subject in depth. The issues my participants discussed around the social discourse played out in my own experiences as researcher. I kept a reflexive research journal throughout the process that documented the permeability of the subject matter on my own experience. I hope this helps to demonstrate the trustworthiness of the study, and some key observations from it are summarised here.

I came to this topic with the motivation to explore an area I saw as quite distorted, and a desire to produce a meaningful and controversial study that I hoped could make a positive contribution to a taboo subject. Through discussions with my interview participants, I also became aware of a deep value I hold as a counsellor that mirrored some of the participants: I want to help and support all human beings, no matter who they are or what they might have done. I realised it is perhaps more socially acceptable to work with paedophiles to reduce child sexual abuse than to bring compassion and understanding to despised and stigmatised people considered “beyond the pale” by most of society. In the course of carrying out the study, I noticed a shift where I started to name this as a key motivation when telling people about my study, that I had previously hidden. The stigmatisation and projective identification discussed by my participants and in the literature (Grady & Strom-‐Gottfried 2010; Angelides 2008; Jewkes 2010) was playing out in my own experience as researcher. It also manifested itself in anxiety and careful consideration of what to say when friends and acquaintances asked what my research study was about. I became an active part of challenging the social discourse and expressing all my motives for conducting this research, including concern for child sex offenders who are still human beings. This felt like an important part of my emerging values as a counsellor who wants to be hopeful about all people, and not turn my back on anyone. In the course of conducting this study, I came face to face with the unsettling idea that anyone could be a paedophile. This invited a terrifying and disturbing question: “What about me?” In considering this question, I experienced intensely uncomfortable feelings of fear and anxiety as the social discourse protecting me from such challenging thoughts, and portraying paedophiles as “monstrous” or “evil” evaporated. Again, my experiences mirrored the challenges discussed by my participants on a very personal level and with great intensity at points. In really challenging the discourse, I understood first-‐hand the enormity of attempting to reframe ingrained social views around paedophilia. There may well be considerable projection and splitting occurring around this issue, but these defence mechanisms are serving an important protective purpose. I considered how careful I would be attempting to dismantle a client’s defence mechanism in the counselling room. I have emerged from conducting this study with great admiration for those who work in this area, and the courage they show in

subverting a social discourse that protects us from entering some very difficult and challenging territory.

Reflections on the Process of Conducting this Study Much like the process of thematic analysis outlined by Braun & Clarke (2006), my experience of conducting this study was fluid and non-‐linear. Since the start, I have altered the method, wrestled with the title, changed the research question several times, and added a secondary question. The data from the interviews and literature review constantly shaped the direction of the study, and the importance of the social discourse emerged through my participants’ accounts of working in the field, and my own experiences as the researcher. Throughout the study, whether or not to use the word “paedophile” was a continual dilemma that I wrestled with. At the interview stage, I became aware of feeling increasingly clumsy, awkward and uncomfortable using the word when many of my participants clearly rejected it. It felt highly inappropriate, and I became apologetic and almost embarrassed, worrying that I would seem ignorant. However, it was central in enabling me to explore my participants’ experiences of the social discourse, and after much consideration I concluded there really was no alternative. The word became a necessary but unfortunate part of my study, but was adjusted to “paedophilic clients” in the title, as I felt the word “paedophile” somehow undermined the study’s validity and did not pay respect to my participants’ views. The emotional responses it triggered and my on-‐going discomfort with being effectively “stuck with” the word felt like a parallel process playing out in my own experience as researcher that mirrored much of the interview data about problematic labels, stereotypes and stigmatisation. This even manifested itself in the process of gaining ethical clearance from the university, where two subjects were singled out on the application form as grounds for classification of the study as high risk -‐ one was terrorism, the other was paedophilia.

Final Thoughts My participants occupy a unique position in their professional and personal interaction with a taboo subject that many of us are protected from engaging with. Social discourse protects us all from processing difficult and unsettling thoughts and facing the true complexity of situations it is easier to simplify and distance ourselves from, and there are good reasons why many of us might avoid challenging the social discourse around paedophilia. My participants have had to do this in order to work with their clients. The over-‐arching message coming out of interviews was that failing to engage compassionately with the true complexities of paedophilia is a considerable obstacle to tackling the problem. Their therapeutic interventions go against the tide of social discourse, and involve trying to understand and support people with paedophilic traits, not banish them to a symbolic remote desert island as a lost cause. They experience their work as highly effective, but a lack of research, funding and political will to take on this highly emotive subject appears to eclipse their efforts. Whilst some of the themes identified in this study may seem bleak, others offer examples of humanity and hopefulness that I hope might contribute to making the world that every one of us lives in a safer and more compassionate place to be. Having completed this study, immersed myself in this subject matter for a year, read many papers and interviewed several professionals, I am still at a loss to find the ideal language with which to discuss paedophilia without stigma and inaccuracy. And that, in itself, is notable and significant data to arise from my study.

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Appendices

Appendix A – Literature Search Results

These tables show the key results from my literature searches on PsycINFO and The University of Manchester library. Note that literature that relates specifically to counselling paedophiles is rare compared with counselling sex offenders. Table 1 – PsycINFO search results

Search criteria

Results

Sex offenders Paedophiles OR Pedophiles Counselling OR counseling AND sex offenders Counselling OR counseling AND paedophiles OR pedophiles Counsellors OR counselors AND sex offenders Counsellors OR counselors AND paedophiles OR pedophiles Counsellors OR counselors AND paedophiles OR pedophiles AND perceptions OR attitudes Table 2 – Manchester University library search results

7,090 480 384 19 52 2 0

Search criteria

Results

Sex offenders Paedophiles OR Pedophiles Counselling OR counselling AND sex offenders Counselling OR counselling AND paedophiles OR pedophiles Counsellors OR counselors AND sex offenders Counsellors OR counselors AND paedophiles OR pedophiles Counsellors OR counselors AND paedophiles OR pedophiles AND perceptions OR attitudes

25, 602 1,730 160 13 23 4 0

Appendix B – Participant Information Sheet

Research study – What Are Therapeutic Professionals’ Experiences of and Attitudes Towards Working with Paedophiles? Participant Information Sheet rd

You are being invited to take part in a research study as part of a 3 year dissertation for an MA in Counselling at The University of Manchester. Before you decide, it is important for you to understand why the research is being done and what it will involve. Please take time to read the following information carefully and discuss it with others if you wish. Please ask if there is anything that is not clear or if you would like more information. Take time to decide whether or not you wish to take part. Thank you for taking the time to read this. Who will conduct the research? rd

Stuart Avery, a 3 year MA Counselling student at The University of Manchester, School of Environment, Education and Development. What is the purpose of the research? The aim of the research is to discover what attitudes and perceptions towards working with paedophiles are held by therapeutic professionals who work with this client group. In addition the interviews aim to shed light on the actual experiences of therapeutic professionals working with paedophiles and explore what aspects of the work are rewarding or challenging, and why. The research also aims to explore the effects of social views and attitudes, and media portrayals of paedophiles, on therapeutic work with this client group. Why have I been chosen? You have been chosen as you are a therapeutic professional (counsellor, psychotherapist, psychologist, psychiatrist) with experience of working with paedophiles. This might include a range of clients from those concerned about their sexual interests or fantasies through to offenders who have acted on paedophilic interests. The study will conduct one to one interviews with a maximum of 8 participants working with paedophiles. What would I be asked to do if I took part? You would be asked to take part in a “semi-structured interview”. This means that I will have some pre-planned areas and questions I would like to discuss with you, but the interview will be conducted in an informal style, which allows freedom for the subject matter to evolve through a conversation between us. I would expect the interview to last approximately 60 minutes, depending on what is covered, but in some cases this may be longer or shorter. As this is a potentially controversial subject, it is possible that the interview could create some feelings of discomfort. However, you would be entitled to decline to discuss any area that you were not comfortable to talk about, and I would respect your boundaries in terms of the subject matter covered.

What happens to the data collected? I would like to record the interview using a hard disc recorder. This will then be transcribed into a Word processor and analysed for themes. Once all the interviews are complete, I will analyse themes across all the data. How is confidentiality maintained? Recordings of the interviews will be destroyed once my research has been completed and submitted to The University of Manchester. Until this time they will be stored on the hard drive of a passwordprotected laptop. Transcriptions will be encrypted so that they cannot be opened without a password. Any personal details that may compromise your confidentiality will be changed or removed from the transcripts. What happens if I do not want to take part or if I change my mind? It is up to you to decide whether or not to take part. If you do decide to take part you will be given this information sheet to keep and be asked to sign a consent form. If you decide to take part you are still free to withdraw at any time up until the point of submission to The University of Manchester without giving a reason and without detriment to yourself. You can also request to terminate the interview at any time, for any reason. Will I be paid for participating in the research? I will not be offering payment for taking part in the research, but I will be happy to reimburse any expenses incurred as a result of your participation. What is the duration of the research? I expect the interview to take approximately an hour, but this may be slightly longer or shorter depending on the material covered. Where will the research be conducted? The interview will take place at The University of Manchester premises in Manchester, M13 9PL if this is convenient. If not, I will travel to your place of work to conduct the interview. If neither of these is possible, we can conduct the interview via Skype. Will the outcomes of the research be published? My aim is to get the findings from my research published in Counselling & Psychotherapy Research or Therapy Today. Who has reviewed the research project? The project has been reviewed by the University of Manchester Research Ethics Committee. What if something goes wrong? If something goes wrong during the interview, we can pause to allow you to assess the current situation and decide whether or not you wish to carry on or withdraw from the interview. You may withdraw and end the interview at any time. If you need to contact me for any reason after the interview, you can contact me at stuart.avery@postgrad.manchester.ac.uk. What if I want to complain? If there are any issues regarding this research you should contact the researcher in the first instance at stuart.avery@postgrad.manchester.ac.uk. However, if you would prefer not to discuss with

75 Â

members of the research team, please contact my research supervisor, Liz Ballinger at Liz.Ballinger@manchester.ac.uk. If you wish to make a formal complaint about the conduct of the research you can contact a Research Governance and Integrity Manager, Research Office, Christie Building, University of Manchester, Oxford Road, Manchester, M13 9PL, by emailing: research.complaints@manchester.ac.uk or by telephoning 0161 275 2674or 275 8093 How can I contact you? You can contact me (the researcher) at stuart.avery@postgrad.manchester.ac.uk. You can contact Liz Ballinger, my research supervisor, at Liz.Ballinger@manchester.ac.uk.

This Project Has Been Approved by the University of Manchester’s Research Ethics Committee.

Appendix C – Participant Consent Form

Research study – What Are Therapeutic Professionals’ Experiences of and Attitudes Towards Working with Paedophiles? CONSENT FORM If you are happy to participate please complete and sign the consent form below. Please initial box 1.

I confirm that I have read the attached information sheet on the above project and have had the opportunity to consider the information and ask questions and had these answered satisfactorily.

I understand that my participation in the study is voluntary and that I am free to withdraw at any time up until the submission of the research study to The University of Manchester without giving a reason and without detriment to my treatment/service/self.

I understand that my data will remain confidential

I understand that the interviews will be audio-recorded.

I agree to the use of anonymous quotes.

I agree to take part in the above project Name of participant

Date

Signature

Name of researcher

Date

Signature

This Project Has Been Approved by the University of Manchester’s Research Ethics Committee.

Appendix D – Semi-‐structured interview schedule

Interview schedule: What are Therapeutic Professionals’ Experiences of and Attitudes Towards Working with Paedophiles – A Thematic Analysis

Subject areas: -‐ Initial demographic questions. -‐ Experiences of working with paedophiles (including effect on you). -‐ Definitions of paedophilia. -‐ Attitudes towards paedophiles – personal vs public? -‐ Social perceptions / media portrayal – effect on therapeutic work and the clients themselves? -‐ Conclusion. Interview schedule 1. Demographic and informational questions Place of work and location (not specific – i.e. type of organization / area in UK). Job title and brief description of job role. Length of time in this role, in what capacity do you work with paedophiles? Age, ( and gender). (Contact details). 2. Experiences of working with paedophiles I am interested in talking about your experiences of and attitudes towards working with paedophiles. Can you tell me how you came to work with this client group? Can you give me a sense of who you work with, and what sort of issues you’re working with? Your experience of working with paedophiles. (positive / negative aspects?). Rewards / challenges of the work… can you give me an example of a client you have worked with that was particularly challenging? Rewarding? (NB identifiable details will be omitted). What personal and professional skills are important in working with paedophiles? Can you relate this to examples of your work with clients?

Has working with paedophiles had an impact on your personal life or you as a person? If so what has changed? (Explore values, outlook on the world, empathy, UPR). Possible prompt / follow up questions: Can you tell me a bit about your values and their relationship with your professional work? How do you manage self-‐care as a professional working with paedophiles? 3. Definitions of paedophilia I’m interested in your understanding of what paedophilia is? DSM5 diagnostic criteria – does it fit your experiences / clients? Examples? What about public perceptions of paedophilia? How does this impact on your work? Possible prompts / follow-‐up questions: Is there anything else the label “paedophile” means to you beyond the medical definition discussed above? Are you aware of any similarities / commonalities across this client group? (their past history / attitudes / personal traits / perspectives about the world or themselves)? [The DSM5 diagnostic criteria for paedophilia is: “Over a period of at least six months, recurrent, intense, sexually arousing fantasies, sexual urges, or behaviours involving sexual activity with a prepubescent child or children (generally aged 13 years or younger)” (American Psychiatric Association 2013). ] 4. Attitudes towards paedophiles Your personal vs public attitudes, and the interplay between these two? What is the effect of this on you personally / professionally? Stigmatisation? (comes up a lot in the literature). Of the client group, and of professionals working with them by association. What is your experience here? Possible prompt / follow up questions: If you choose not to, can you say why? If you do can you tell me a bit about peoples’ reactions to you working with paedophiles? What do other counsellors who do not work in this area think about you working with paedophiles? To what extent do you share your area of work with people outside of the professional community? What are your thoughts and attitudes towards people who experience sexual feelings towards children but who haven’t offended? What about those who HAVE offended?

How do you manage feelings about your clients’ actions or behaviour in your therapeutic work with them? Have your attitudes towards paedophiles changed since you first began working with this client group? If so, how? Possible prompt / follow up questions: Can you tell me about how this material sits with your own values and morals? Does this affect the empathy and compassion you provide in the relationship? Are there certain clients you feel you would be unable to work with? If so can you tell me about your boundaries relating to this? How do you feel if clients you have worked with re-‐offend? How does this affect the therapeutic relationship? What is your experience of the rehabilitation of paedophiles? 5. Social discourse / media perceptions What do you think of current social views and / or media portrayals of paedophiles? Possible prompt / follow up questions: Do these differ from your attitudes and experiences of working with this client group? If so, how? How do these social views affect the therapeutic work you do with your clients? Possible prompt / follow up questions: How do your clients feel about the label “paedophile”? What is their response to social views of paedophiles? Do they feel stigmatised or demonised? What are your thoughts on current levels of support available for paedophiles or people worried about their sexual behaviour / thoughts? 7. Conclusion Is there anything else you would like to talk about? What was your experience of being interviewed today? Is it OK to get in touch with you in the future if I have additional questions

Appendix E – Creation of Codes using Nvivo 10 This appendix shows screenshots demonstrating the creation of codes in Nvivo 10. Hierarchies indicate child nodes within parent nodes that eventually became sub-‐ themes within parent themes. The number of participants relating to the codes is shown in the “Sources” column, with the total number of references to the code and the date created to the right of this. The final screenshot in this appendix shows the number of nodes and total number of references highlighted in the transcripts from each participant’s interview.

Appendix F – Progressive Node Maps This appendix shows progressive node maps from 29th May to 27th May. Codes from Nvivo were organised into maps and gradually refined into themes and sub-‐themes.

Appendix G – Creation of Final themes and sub-‐themes This appendix shows the creation of the final themes and sub-‐themes. This was done using a combination of Nvivo software and hand-‐drawn maps. The screenshot below shows the total number of participants who referred to each theme in the “Sources” column. The total number of references to the theme on the transcripts is shown in the “References” column. Whilst the number of participants was included in the table of themes in the Findings section, I chose not to include the number of references, as it felt like too much of a black and white, quantitative approach to presenting the data. Deciding which references fitted with a theme often required personal judgment and consideration of the wider context of the whole conversation – thus attempting to reduce my findings to a set of numbers felt problematic, since in many cases I felt an excerpt clearly fitted with a theme without necessarily overtly stating that theme in words.

Appendix H -‐ Research Journal Extracts I have included a few extracts from my Research Journal in the appendices, to demonstrate transparency and trustworthiness. These show my reflections and musings as I go through the process. The journal became a place to bracket and check personal opinions, mull over themes and sub-‐themes, grapple with the research questions and title, check I was in keeping with my methodological approach, reflect on my influence on the data, and note down thoughts that felt relevant to the study. Friday 19th February Just reflecting on the process of having 2 of my potential interview candidates really check out my position before agreeing to take part. If I deconstruct these conversations it feels very much like they were checking where I am locating myself within the social discourse to make sure I am not trying to prove that all paedophiles should be “strung up” – i.e. they were grilling me about the research, why I am doing it and asking me what I expect to find in the data. My initial feelings when asked was I wanted to hold back and not state my position due to not wanting to influence the research or to load it before we have even had the interview. But it is a great example of how I AM influencing it by just being there, and also by being male, a counsellor, the age I am etc. Is there something with this about stigmatisation by proxy? – i.e. these professionals bring a nervousness about my possible judgements about what they do (i.e. worried to be seen as a “paedophile sympathizer” etc)…. I have a lot of participants now working in the secure / offending end, but what about giving voice to those people who are concerned about their thoughts and haven’t done anything to anyone, but have nowhere to turn for support? How do you get at those people?... It seems very difficult in the current social discourse as society still sees these people as no different from offenders. This is the crux of my interest I think…. How to open up a conversation about this? It is ironic (but fitting I suppose) that most of the candidates I have access to are working with serious offenders. I think it will be really beneficial to try and find a couple of candidates working with non-‐offenders to get a balance of perspectives from both sides. Wed 23rd March Just on my way back from London where I’ve done my first 2 interviews. They seem to have gone well and I have a couple of reflections. I was struck by the difference between the “forensic” nature of XXXX’s work setting and the more therapeutic nature of XXXX’s. The key difference straight away was that XXXX said everyone she sees at XXXX are accessing therapy of their own free will and want to change. They are coming with an insight that their behaviour is problematic and needs to change. I asked her if she felt she could work

with people on the end of the scale who have no remorse and don’t think there is anything wrong with what they are doing. She had a good answer – “I couldn’t work with them because I am a psychotherapist, and there would be nothing to work with… there has to be at least a chink in the armour. If not, then there are other services – i.e. forensic services, but psychotherapy won’t work”. It seemed that everyone she works with is presenting with at least some level of distress. In contrast, XXXX talked about his role as a forensic psychiatrist being a balance of risk management and looking after the safety of society and the welfare of the client (but in the case of high risk clients this becomes secondary to the public interest). XXXX also talked about the huge range of clients from systematic offenders to those who have a latent paedophilic interest that is triggered when their adult relationships are not going well or they are very isolated / stressed… and also the type of person who falls into this through compulsive internet pornography use. Even splitting paedophiles into forensic vs therapeutic categories, it struck me today how complex and varied a client group they are, with many reasons for ending up in this place that is hopelessly inadequately represented in the word “paedophile” and the public understanding of the subject. Indeed as the interview progressed I found myself feeling more and more clumsy using the word to ask questions / prompts as it just feels clumsy, inappropriate and completely lacking in actually defining what we are talking about (but at the same time labels are necessary in order to be able to hold an interview). One strong theme that emerged from today (and also yesterday with XXXX) is the huge lack of preventative measures in place to try to help people at an earlier stage… and also the lack of support services available (XXXX spoke about the Dunkelfeld Project in Germany – when info about this was published they got flooded with requests from people in the UK worried about their behaviour that they can’t treat due to lack of resources). Thurs 7th April Just finished my interview with XXXX which was fascinating. Something very interesting happened before it even started, which I wish I had caught on tape (but I think I got at least some of it afterwards). When I asked XXXX about the info sheet and if there was anything she wanted to clarify, she asked me about the name of my study and how I arrived at this / and who helped me agree on it. She said that the word paedophile she had a real problem with, to the point that it nearly made her decline the interview, and the only reason she did it was because XXXX talked to her about me. She sounded pretty angry. I told her I had decided to use this word because part of the interview was about looking at the social discourse around this subject and the use of the word. She said something like “Well you won’t get any of the social discourse from me”, and said that basically this word belongs “in The Sun newspaper”. She said she would use the word “child sex offender” and talked about how the label paedophile is damaging, stigmatizing and unhelpful, stops people seeking help etc. This is a really interesting development. As I’ve gone through the interviews I have felt increasingly awkward and clumsy actually using this word as I can tell all of my interview participants REALLY don’t like it. I’ve found myself apologising for using it in the interviews but saying I need some way of delineating what I am referring to but the word

itself is hopelessly inaccurate in referring to the reality of what we are actually talking about. With this in mind, it feels like my research is asking a different question, or the question needs re-‐phrasing? But it’s a dilemma? How to explore the experiences of people within the context of the social discourse without using this word when it seems to encapsulate the emotional connotations and inaccuracies of that social discourse implicitly?! I feel like I’m back to asking 2 questions! 1 – What are your experiences / attitudes towards working with child sex offenders, and 2 – How does this differ from the social discourse, and how does your experience of the client group fit with the label “paedophile”? Fri 22nd April Just re-‐reading Braun & Clarke as now I have started looking at the data I feel a bit like I don’t know what I’m doing! And I’m glad I have cos it has given me some direction. They champion the importance of doing your own transcripts, and say you really do need to read them through and check their accuracy, and familiarise yourself with the WHOLE data set before jumping into coding. So I think I have been a bit premature with starting to code the first couple of transcripts. My plan now is to finish the XXXX interview but do no more coding, just read and listen and check for accuracy. Then I will just listen to the others that aren’t yet transcribed and start to make some initial notes in the diary about interesting themes and areas. I also need to keep in mind my methodological stance re how I am searching for themes. If inductive I need to try and code the entire data set accurately without prejudice to give a good representation of what is there. This doesn’t sound like me…. I think I am heading more towards deductive where I am bringing certain interests and views… however as it is an under-‐researched area I need to balance the two and aim for a hybrid approach. The other consideration I am wrestling with is the question. Since becoming more uncomfortable with the P word, and having done the interviews, I’m wondering whether my question is still right / accurate. I kept thinking back to this while coding but feel a bit like the data is answering slightly different question…. It’s more social, constructionist than purely people’s experiences. I’m also wondering whether I need the word attitude, as this is covered in experiences… i.e. people are going to reveal their attitudes in the course of the interviews. Perhaps a more accurate question would be: What are the experiences of therapeutic professionals working with child sex offenders? -‐ A thematic analysis…. OR What are the experiences of therapeutic professionals working with paedophilic clients? -‐ A thematic analysis. It’s a really difficult one… child sex offenders isn’t really accurate as not all paedophilic people are offenders. Similarly, not all child sex offenders are necessarily paedophilic. Finding the right, or “accurate” language is a real challenge. This needs more thought…. hopefully the right language will emerge as I spend more time with the data.