Deviant sexual thoughts: mental control and the treatment of sexual offenders

Journal of Sex Research, Spring, 1997 by Lucy Johnston, Tony Ward, Stephen M. Hudson

The clinical literature has long illustrated the paradoxical findings that deliberate attempts to suppress particular thoughts actually increase their occurrence. These unwanted, often intrusive, thoughts that are a major feature of obsessive disorders, depression, sleep disorders, and a range of other disturbances are of particular clinical concern. The exploration of psychological factors associated with cognitive control is, then, clinically relevant. In the current article we consider the role of mental control, especially thought suppression, in explaining the occurrence of unwanted thoughts, specifically in relation to deviant sexual thoughts. Many features of sexual offending, such as the effects of stress or strong affective states on offending and the rapid escalation in severity and frequency of sexual offending, reported by both therapists and researchers, can be explained by the mental control literature. In addition, the role of suppression in therapy for sexual offenders and its implications for relapse are considered. We argue that the use of suppression techniques by therapists is not sufficient to prevent the occurrence of sexually deviant thoughts and the recurrence of sexual offenses. Therapists also must teach offenders to manage stress effectively and to develop appropriate beliefs about what is controllable. Making suppression techniques automatic and avoiding high-risk situations for offending are also important skills for the offender to learn in therapy.

The cognitive and emotional demands of modern life mean that it has become increasingly important to learn how to manage effectively our mental processes and behavior. In fact, the pursuit of happiness, knowledge, and a successful career depend to a large extent on the achievement of mental control (Wegner & Erber, 1993). Controlling one's thoughts and their expression is a vital component of everyday life. You may discuss some thoughts with your partner, but it would be unwise to discuss them with your boss; sexist thoughts about women may be shared with rugby club mates but not with work colleagues. We hesitate to share some thoughts with anyone, and we may try to banish them from our minds. Mental control has recently become the focus of a flurry of theoretical and empirical research and is moving beyond its folk psychological status (Wegner, 1994). A number of different psychological phenomena associated either directly or indirectly with mental control processes, for example, are attention, self-regulation, and defence mechanisms (Wegner & Erber, 1993).

As far back as Freud (1915/1957) it was proposed that people attempt to exclude negative material from awareness to preserve a sense of well-being. Indeed, Erdelyi and Goldberg (1978) found that 99% of nonclinical participants reported having tried on occasion to suppress disturbing thoughts to avoid the emotions associated with those thoughts. Freud proposed that this suppression of unwanted thoughts could occur both through unconscious processes and deliberate effort. More recently, Salkovskis and Campbell (1994) emphasized the need to consider differences between instructed suppression (thoughts supplied by the experimenter) and self-motivated suppression (thoughts supplied by the participant). Focus in the clinical literature has been on self-motivated suppression, especially failure to suppress successfully unwanted intrusive thoughts and its links to clinical disorders such as obsessive-compulsive disorder (Clark, Ball, & Pape, 1991; Salkovskis, 1989) and depression (Rachman & Hodgson, 1980; Wenzlaff, Wegner, & Roper, 1988).

The emphasis in this article is on thought suppression and its implications for relapse, and therapy in sexual offenders. In addition to the impact of self-imposed thought suppression by sexual offenders, the usefulness of instructed suppression in therapy, particularly cognitive behavioral therapy, is considered. Clinicians using recent cognitive-behavioral treatment approaches in sexual offending, such as relapse prevention, attempt to enhance offenders' self-management skills to maintain the initial behavior change induced by therapists (Laws, 1989). Effective mental control is a vital prerequisite to the development of such skills; self-management requires mental control.

The conceptual underpinning of current self-management, mental control, or thought-suppression techniques in therapy for sexual offenders is unclear and suffers from a lack of theoretical depth (Ward, Hudson, & Siegert, 1995). Simply instructing people to suppress unwanted thoughts is not sufficient to avoid those thoughts and behaviors (see Wegner, 1994, for a review). We argue that therapists need a more thorough understanding of the complexities of thought suppression before it can become an effective treatment tool. We suggest that an integration of the mental control literature with current views of sexual offender treatment can provide that theoretical depth and, hence, guide effective treatment programs. An understanding of the mechanisms underlying suppression may help therapists avoid certain pitfalls in the treatment of sex offenders. It also clarifies why certain internal strategies are effective and why some critical psychological processes in relapse, for example, the abstinence violation effect, occur following the return of unwanted thoughts or feelings.