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Tenbergen et al., ATSA Talk, 2020 updated 1

Replicating The Global Prevention Project
in New York State: Insights From a New
Collaborative Initiative
Gilian Tenbergen, PhD
Catherine Diana, LCSW
Candice Christiansen, LCMHC
#ATSAfromhome; October 23rd, 202 0
Core Assumption:
Primary Prevention of CSA through
MAP Wellness
Who is a (NO)MAP? NOMAP refers to Non-Offending Min or
Attracted Person
Minor Attracted I ndividual is a person
who experiences a sexual preference
toward (pre-)pubertal children. Umbrella
term to include
These individuals subscribe to anti-
contact/non-offending views toward
child sexual abuse (CSA) and Child
Sexually Exploitati ve Materials (CSEM).
Tenbergen et al. , (2015) .
Levenson et al., (2017, 2018, 2019).
Gerwinn et al. , (2018)
Gibbels et al. , (2019)
Cantor and McPh ail ( 2016)
The Global
Prevention Project:
A Crash Course
The Global Prevention Project (TGPP)
is a project designed to pr event
CSA/CSEM use by offering supportive
services to NOMAPs in the community
Model is based on core assumption
MAP Wellness
humanize and empathize with clients
Support group design with optional
recommendations for ind ividual
Assumption: non-offending. Does not
directly work with Darkfield individuals
Christiansen and Dettamanti
(2020): MAPs Wellness
TGPP Curriculum
What do groups look like?
Curriculum structure is based on
groups of 10-12 participants
Screening process for i nquiries
Offered space in group if eligi ble and
intake packet is complete
Curriculum contains 12 unique topics,
to be addressed consecutively
Groups are open: new members can
join as long as opening exists
Tenbergen et al., submitted
TGPP Curriculum -Core Concepts
1. “Attraction is not Action”
2. Groups are psychoeducational, not therapeutic
3. Focus is holistic; not only on (deviant) sexual preferences
4. 12 modules designed to address underlying issues in treatment of NOMAPs
5. There are 10 core goal s: What are they?
Tenbergen et al., submitted.
Christiansen and Dettamanti(2020):
MAPs Wellness Curriculum
Assumption #1
Affirm your clients’ self-worth
Extremely important for these clients to feel like they are more than their
attractions and that we, as their therapists and treatment teams , see them
as human
Remember that acceptance of the client as a person, does not condone
or endorse any illegal or abusive behaviors
“We believe that attraction is not action and know that you are m ore than
your unique experience of sexual, romantic, or emotional attraction”
Levenson et al., (2019).
B4U-ACT, Principles and Perspectives
of Practice.
Assumption #2
Use the clients’ preferred language and terminology
Although we as therapists, may be usi ng DSM-5 Diagnostic labels, it is
important to use neutral language with our clients throughout group and
individual sessions
It is important to avoid triggering labels and often misunderstood diagnoses,
because of this, we would like to explore what terms feel comfortable to you
This group refers to “minor-attracted persons” or MAPs, a term that some
individuals prefer. What term feels comfortable to you?
Levenson et al., (2019).
Assumption #3
Clarify your role as a therapist or facilitator and the purpose of the group
or therapeutic relationship
NOMAP clients seek treat ment for a variety of reasons
Every NOMAP or person with minor-attractions that seeks therapy has different
goals and expectations, can you share your main reasons for seeking therapy?
Will you prioritize those reasons or goals i n order of what is most im portant to
All group members come to group with dif ferent goals, despite all identifying as
minor-attracted. Let’s have each member share two areas they would like to
work on with the group’ s support
Levenson et al., (2019).
Assumption #4
Balance bei ng open and dire ct, with avoi ding assumptions
Adopt an “Ask, Don’t Tell” mental ity when working with NOMAPs
Tell me about how your minor-attraction affects your daily lif e?
What are your biggest concerns about your sexuality? How do you
handle the distress associated wit h your sexual attractions? What
do you want me or the group to understand about your
Levenson et al., (2019).
Assumption #5
Express your understanding and seek to normalize emotions
Society at large may struggle t o understand attract ion to minors and t herefore feel
that they could never relate to a minor-attracted person
most peopl e ca n re late to feel ings of lon elin ess, iso lati on, shame , j udgeme nt,
depression, f ear, anxiety, and hopelessness. Normalizing these emoti onal
experiences and practi cing empathy with your cl ients is vit al
Having a secret you believe is so d amaging and s haming that you can’t share i t with
anyone can be incr edibly isolati ng and lonely. I wonder if thi s is the onl y place that
you have ever been able to share that; thank you. We hear you. I want you t o know
that you are not alone in feeling this way
Levenson et al., (2019).
Assumption #6
Provide psychoeducation about pedophilia, minor attraction, and
sexuality in general
As therapi sts and helpi ng professio nals seeking to work with NOMAPS, it is our
ethical responsi bility to pro vide accurate informati on to our clients, specificall y
when it comes to pedop hilia , minor -attraction, and sexual development
Attracti on is not Action. Havi ng these at tractions d oes not make y ou a bad per son. I
believe that you are here because you want to avoid any harm to others and better
yourself. It is brave to seek help; I know it’s not easy
Tenbergen et al. , (2015) .
Levenson et al., (2017, 2018, 2019).
Gerwinn et al. , (2018)
Gibbels et al. , (2019)
Cantor and McPh ail ( 2016)
Assumption #7
Do not assume that every NOMAP is a hypersexual “ticking time bomb”
It is an assumption that MAPs have stronger or m ore uncontrollable
sexual urges than the general population
If a NOMAP clien t does present with symptom s of hypersexuality and/or
sexual addictive behaviors (often seen with the compulsive use of
pornographic materials), this needs to be addressed as a separate issue
from their minor-attraction
Tell me about how you handle stress? Can you share more about how you
handle your sexual attractions to minors?
Levenson et al., (2019).
Assumption #8
Being trauma-informed is not about excuse -making
A trauma-informed approach does not m ake excuses for any maladaptive
relationship patterns or ineffect ive coping, but instead assists in the
conceptualization of client issues, strengths, and overall treatment needs
In a group setting , the BIO-PSYCHO-SOCIAL framework is used often to
ensure a trauma-informed (psycho) approach to and understanding of the
clients participating in group
Levenson et al., (2019).
Assumption #9
Acknowledge the loss
Specificall y for exclusi vely minor-attracted persons, the l oss of one’s sexuality or
“sexual self” can be a large part of the treatment process
These indivi duals often c hoose to give up “the one pote ntial source of sexual
satisfaction that exi sts for them”
Acknowledging t heir loss and empathizing with them as they grieve in imperati ve in
their healing
Be careful not to dismiss their pain or seek to j ustify it away in favor of abuse
I hear that it feels lonely, frustrating, unfair, scary, to give up this part of yourself. You
may f eel l ike you w ill never have what ever yone else wants or alre ady ha s
Levenson et al., (2019).
Assumption #10
Cultivate hope
To come full circle in the presentations of these strategies to engage
MAPs, NOMAPs are more than their attractions
They are human beings that can have meaningful and fulfilling lives just
like everybody else
There is a reason that this curriculum, while preventive in nature, focuses
on MAPs Wellness, because we believe that through support, meaningful
relationships, and insight into w orth and self-esteem, that NOMAPs can
lead healthy, satisfying and fu lfilling lives
Levenson et al., (2019).
Replication Process
in NYS
1. To prevent CSA by emphasizing MAP
Welln ess
1. To evaluate the MAP Wellness Cur riculum
2. To provide da ta on NOMAP populati on
3. To offer a unique method of CSA prevention
in NYS
Duration: on-going for 2 years, wi th status chec k
in 2021
Replication Process Determine gr oup format: onl ine or
Role of nove l Coronavirus Pan demic
Accessibil ity Issues
Recruitment Pr ocess
Facilitator Descri ption and Training
Screening an d Intake Process
Due to a sudden global pandemic...
Group Format Discussions among collaborators in
early 2020 suggested preference for
online format
Proceed with online format: who will
group facilitator be?
LMHC? Social Worker? PhD? Graduate
Student in Trai ning?
Decision: PhD graduat e student in
Social Work (L MSW)
Facilitator background?
Knowledge of SOTP? Nai ve to fiel d?
Decision: trained as SOTP, retraining
in preventative wellness curriculum
Facilitator Training
Facilitator is person with clinical
background who “runs” the group
Responsible for guiding discussions,
introducing new information, and
ensuring all issues ar e adequately and
appropriately addressed
This individual should have some formal
clinical training and be licensed or
Clinical traini ng should be decided based
on location
Training took place on 4 Fridays, 6
hours/day focused on all curriculum
modules (12)
Recruitment Process
Fliers distributed via:
MAP Su pport Club
Associated Websites
Contact made by email
Screening call s scheduled
Intake paperwork completed
Data collected from March 2019-August 2020 via
Sample recruited from Oswego, NY and Twitter
Out of 272 responses, 235 supported idea of
community-based prevention efforts (5 no, 32 did
not respond)
159 respondents agreed that MAPs can
experience sexual attraction to children without
acting on it (29 no, 62 maybe, 22 did not specify)
224 respondents agreed that child sexual abuse
is preventable by offerin g supportive services to
those at “risk of offending” (25 no, 23 did not
Further analysis ongoing!
First Data from NYS
Replication Process
As of Sept ember 8th, 2020, we have:
6 confirmed group members
8 group contacts (i n 4 week recruitment
Locations of members:
NYS (3)
CA (1)
Ohio (1 )
Canada (1)
Age range of members:
19 -50 years
Further data collection and analysis ongoing!
ATSA 2021?!
First Data from NYS
Replication Process
-Group Data
Issues Encountered Structure as support group, not
treatment group
Decide on background for clinical
Accessibility: phone vs internet
Intake paperwork : maintain
Email communication: keep separate
and limited access
Mandatory reporting: we don’t ask
about previous offenses
Conclusions and Future Plans
1. It IS possible to offe r primary prevention against CS A/CSEM use in
the US!
2. Focus on MAP Wellness, not pathology of sexual preference
3. Address assumptions in group
4. Community supports this idea of prevention
5. Even more relevant in COVID-19 world
Future data on program effectiveness and experiences forthcoming
Looking at #ATSA2021!
B4U-ACT. (2008). Principles and Perspectives of Pract ice. Obtained from: -and-perspectives-of-practice/
Cantor J.M., McPhail I .V. (2016). Non-offending pedophiles. Current Sexual Health Reports, 8, 121-128.
Christiansen, C. and Dett amanti-Martinez, M. (2020). Giving voi ce to the voiceless: A minor attra cted
person wellness curriculum. An adaptive l ogic model. Copyrighted 2013-2020.
Gerwinn H., Weiss S., Tenberge n G., et al. (2018). Clinic al characteristics associated wi th paedophilia and child sex
offending -Differentiating s exual preference from offence st atus. European Psychiatry: The Journal of the
Association of European Psychiatrists, 51, 74-85.
Gibbels C., Kneer J., Hartmann U., Krueger T.H.C. (2019). State of the art treatment options for actual and potential
sexual offenders and new prevention strategies. Journal of Psychiatric Practice, 25, 242-57.
Levenson J.S. and Grady M.D. (2018). Preventing sexual abuse: Perspectives of minor-attracted persons about
seeking help. Sexual Abuse : A Journal of Research and Treatment.
Levenson J.S., Willis G.M., Vic encio C.P. (2017). Obstacles to help-seeking for sexual offenders: Implications f or
prevention of sexual abuse. Journal of Child Sexual Abuse, 26, 99-120.
Levenson, J.S., Grady, M. D., & Morin, J. W. (2019). Beyond the “Ick Fac tor”: Counseling non-offending
persons with pedophilia. Clinical Soc ial Work Journal, 48, 380-388.
Tenbergen, G., Dettamanti-Martinez, M., and Ch ristiansen, C. Primary prevention of child sexual abuse in
the United States: New strategies with The Global Prevention Project. (under review).
Tenbergen G, Wittfoth M, Frieling H, et al. (201 5). The neurobiology and psychology o f pedophilia: Recent advances
and challenges. Frontiers in Human Neuroscience, 9.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Would you feel prepared if a client in your clinical practice shared that he was sexually attracted to children? Mental health professionals come in contact with these individuals primarily through the child welfare or criminal justice systems. But it is now increasingly evident that a population exists of non-offending minor-attracted persons (MAPs) who have never molested a child and have no intention of doing so. By becoming familiar with their unique treatment needs, clinicians can develop competence to provide effective, ethical, and compassionate services for this stigmatized and hard-to-reach population, with a dual focus on sexual abuse prevention and client well-being. This article will first describe what is known about pedophilia and minor-attraction. Next, the legal and ethical questions that therapists may ask in relation to this work will be explored. This paper will review obstacles to help-seeking identified by MAPs and discuss their treatment needs. Finally, recommendations will be offered for engaging MAPs in an emotionally safe and non-shaming therapeutic encounter. In this way, clinical social workers can contribute to advancing child sexual abuse prevention efforts.
Full-text available
Persons with potentially harmful sexual interests such as attraction to minors are unlikely to seek or receive treatment before a sexual offense has been committed. The current study explored barriers to help-seeking in a sample of 372 individuals in treatment for sexual offending. Results revealed that the shame and secrecy resulting from stigma associated with pedophilic interests often prevented our respondents from seeking professional counseling, and only about 20% tried to talk to anyone about their sexual interests prior to their arrest. Barriers to seeking and receiving psychological services included concerns about confidentiality, fears of social and legal consequences, personal shame or confusion about the problem, affordability, and challenges finding competent therapists who were adequately equipped to help them. Understanding and ultimately reducing obstacles to help-seeking can improve the quality of life for people with harmful sexual interests and potentially prevent sexual abuse of children or other vulnerable individuals.
Full-text available
Non-offending pedophiles are a unique population of individuals who experience sexual interest in children, but despite common misperceptions, have neither had sexual contact with a child nor have accessed illegal child sexual exploitation material. An emerging body of research has examined the prevalence of pedophilic interests, characteristics of non-offending pedophiles, correlates of pedophilic interests, and stigma associated with pedophilia. Treatment programs are beginning to produce findings regarding the effectiveness of treatment in supporting non-offending pedophiles to remain offence-free. The current review spans these areas of research and discusses potential treatment options for working with non-offending pedophiles based on that research base.
Full-text available
A pedophilic disorder is recognized for its impairment to the individual and for the harm it may cause to others. Pedophilia is often considered a side issue and research into the nature of pedophilia is delayed in comparison to research into other psychiatric disorders. However, with the increasing use of neuroimaging techniques, such as functional and structural magnetic resonance imaging (sMRI, fMRI), together with neuropsychological studies, we are increasing our knowledge of predisposing and accompanying factors contributing to pedophilia development. At the same time, we are faced with methodolog-ical challenges, such as group differences between studies, including age, intelligence, and comorbidities, together with a lack of careful assessment and control of child sexual abuse. Having this in mind, this review highlights the most important studies investigating pedophilia, with a strong emphasis on (neuro-) biological studies, combined with a brief explanation of research into normal human sexuality. We focus on some of the recent theories on the etiology of pedophilia such as the concept of a general neurodevelopmental disorder and/or alterations of structure and function in frontal, temporal, and limbic brain areas. With this approach, we aim to not only provide an update and overview but also a framework for future research and to address one of the most significant questions of how pedophilia may be explained by neurobiological and developmental alterations.
Sexual violence is a significant and devastating issue for men and women throughout the world. Its consequences are not only disastrous for victims of sexual violence but are also extremely costly (estimated cost of $41,000 per rape) for society. Successful treatment of sexual offenders is therefore an important goal for society as well as for victims and offenders themselves. Over the years, multiple treatment approaches for sex offenders have been developed. Treatment programs range from the risk-need-responsivity (RNR) model, which focuses on providing tailored treatment for high-risk and low-risk offenders, to psychodynamic models. This article presents an overview for clinicians of state-of-the-art offender treatment, describing the most common treatment approaches, in particular the RNR model, cognitive-behavioral programs (relapse prevention programs, sexual offender treatment programs), psychodynamic approaches (transference-focused psychotherapy, mentalization-based therapy), the Good Lives Model, as well as pharmacological options. In addition, it provides an evaluation of the various treatment programs. However, given the fact that most acts of sexual violence will never be reported to the police, the question arises if treating convicted perpetrators is enough. Do we need rather-in terms of preventive work-a program for potential sexual offenders and men with delinquent sexual fantasies? Given the prevalence of sexual violence and its impact on victims, society, and the medical community, it would be remiss not to try to reach potential/unconvicted perpetrators. This article offers novel ideas and a project the goal of which is to prevent sexual offenses against women by introducing the "I CAN CHANGE" program from Hannover Medical School.
The primary aim of this exploratory research was to gain information from minor-attracted persons (MAPs) about their (a) formal and informal experiences with help-seeking for minor attraction, (b) perceived barriers to seeking help for concerns about minor attraction, and (c) treatment priorities as identified by consumers of these services. A nonrandom, purposive sample of MAPs ( n = 293, 154 completed all questions) was recruited via an online survey. Results show that 75% of participants did seek formal help from a professional; however, just less than half of them found the experience to be helpful. Characteristics of helpful therapeutic encounters included nonjudgmental attitudes, knowledge about minor attraction, and viewing clients in a person-centered and holistic way. Barriers to help seeking included uncertainty about confidentiality, fear of negative reaction or judgment, difficulties finding a therapist knowledgeable about MAPs, and financial constraints. Understanding or reducing attraction to minors were common treatment goals, but participants also prioritized addressing general mental health and well-being related to depression, anxiety, loneliness, and low self-esteem. Implications for effective and ethical counseling and preventive interventions for MAPs are discussed.
Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO. The aim of this study was to distinguish between factors associated with sexual preference (paedophile versus non-paedophile) and offender status (with versus without CSO). Accordingly, a 2 (sexual preference) × 2 (offender status) factorial design was used for a comprehensive clinical assessment of paedophiles with and without a history of CSO (n = 83, n = 79 respectively), child sex offenders without paedophilia (n = 32) and healthy controls (n = 148). Results indicated that psychiatric comorbidities, sexual dysfunctions and adverse childhood experiences were more common among paedophiles and child sex offenders than controls. Offenders and non-offenders differed in age, intelligence, educational level and experience of childhood sexual abuse, whereas paedophiles and non-paedophiles mainly differed in sexual characteristics (e.g., additional paraphilias, onset and current level of sexual activity). Regression analyses were more powerful in segregating offender status than sexual preference (mean classification accuracy: 76% versus 68%). In differentiating between offence- and preference-related factors this study improves clinical understanding of both phenomena and may be used to develop scientifically grounded CSO prevention and treatment programmes. It also highlights that some deviations are not traceable to just one of these two factors, thus raising the issue of the mechanism underlying both phenomena.
Giving voice to the voiceless: A minor attracted person wellness curriculum. An adaptive logic model
  • C Christiansen
  • M Dettamanti-Martinez
Christiansen, C. and Dettamanti-Martinez, M. (2020). Giving voice to the voiceless: A minor attracted person wellness curriculum. An adaptive logic model. Copyrighted 2013-2020.
Primary prevention of child sexual abuse in the United States: New strategies with The Global Prevention Project
  • G Tenbergen
  • M Dettamanti-Martinez
  • C Christiansen
Tenbergen, G., Dettamanti-Martinez, M., and Christiansen, C. Primary prevention of child sexual abuse in the United States: New strategies with The Global Prevention Project. (under review).