Paraphilias

[purplekath]

I work in an acute unit which deals with the forensic mental health cases for our city. Lately I seem to have had a lot of ppl with paraphilias of an illegal nature -- namely pedophiles, voyeurs, rapists etc. Often we get these patients because they become suicidal and are deeply remorseful for their thoughts/behaviour. Mostly they come from the prison system.

I long since got over the emotional aspect of nursing someone whose actions repel me. I feel that it is important to HELP these ppl... for themselves and to prevent them victimising others in the future. There is precious little information out there on treating/couselling these types of ppl.... even the DSM-IV has no real advice for clinicians.

So, thought I'd throw it open to my fellow psych nurses - how do you approach a paraphiliac wanting help? Apart from the basics (administering Depoprovera or Androcur and keeping them locked into the unit)...what can we do to help? What kind of therapies are useful for these kinds of patients?

[KellNY, RN]

I have very strong feelings regarding sexual predators, and out of respect for the OP and the original topic, I will keep them private. However, I am interested in hearing other's responses.

[purplekath]

Oh trust me...I have strong feelings too. I think most of us do. But guess that a big part of wanting to help these ppl are because ultimately it helps society, including potential victims of crime. I'd still be interested in hearing your point of view. Are you in psych nursing BTW? Do you ever nurse these patients?

[fidelio]

I work in an acute unit which deals with the forensic mental health cases for our city. Lately I seem to have had a lot of ppl with paraphilias of an illegal nature -- namely pedophiles, voyeurs, rapists etc. Often we get these patients because they become suicidal and are deeply remorseful for their thoughts/behaviour. Mostly they come from the prison system.

I long since got over the emotional aspect of nursing someone whose actions repel me. I feel that it is important to HELP these ppl... for themselves and to prevent them victimising others in the future. There is precious little information out there on treating/couselling these types of ppl.... even the DSM-IV has no real advice for clinicians.

So, thought I'd throw it open to my fellow psych nurses - how do you approach a paraphiliac wanting help? Apart from the basics (administering Depoprovera or Androcur and keeping them locked into the unit)...what can we do to help? What kind of therapies are useful for these kinds of patients?

There are some effective techniques for those who haven't been too proliferant in their offending. These mostly center around impulse control. If you get people early in their "careers" they still may have a good shot at rehabilitation.

As a psych NP student, I don't like to think that anyone is beyond hope, but obviously this is a very tricky area. Many sex offenders have antisocial personality traits. Such people are more likely to feign remorse than to actually feel it.

Severe torment on the part of an offender could be a positive sign as far as I am concerned. It can mean that the offender has an idea of the damage that he or she has done. Or they could just be upset they got caught. Again, it's tricky. It's natural to have a lot of strong feelings about these patients (particularly pedophiles). A provider has to come from a very grounded place in order to offer help to a sexual offender. I would state something on the order of the following:

"By your own admission, you have done horrible things. You have damaged lives including your own. If any repair to your own life is possible, you are the only one who can make that repair. Any success that you have in this area may only be partial. Talking with a professional may help. I am willing to listen to you objectively and support you in making positive choices."

The humanistic theorist Carl Rogers wrote a great deal about approaching patients with an "unconditional positive regard" in therapy. Such an approach can be therapeutic in and of itself particularly for this group. Sex offenders are often without a support group and their problems tend to follow them for life. This being the case, as a provider you should feel fairly comfortable listening to issues related to religious faith as these issues may be of considerable importance to the patient.

Good Luck