Research emphasizes that persons with pedophilic interests are among the most stigmatized group of individuals in society [23]. This is important when reaching out to this patient group, as the psychological stress associated with stigmatization (fear of discovery of pedophilic interests, perceived loneliness, emotion regulation problems, low self-esteem) causes reduced help-seeking and is assumed to be an indirect risk factor for the commission of sexual abuse [24, 25]. In line with this, the pilot project has shown that providing low-threshold and anonymized treatment is essential for reaching this highly stigmatized patient group. Especially the fact that no information is passed on to health insurance companies was considered essential by our patients. In order to guarantee this, financial funding is necessary. Despite many initial concerns about anonymous treatment and associated potential risks related to offending, all of our patients disclosed their personal information to the practitioners during assessment, which illustrates a high level of trust in the practitioners and in the handling of personal data.

Furthermore, a comprehensive concept, as advocated by the “Kein Täter Werden” network, is considered relevant in order to reach this group of patients but also to create public acceptance for a (funded) treatment offer. In this context, the differentiation between the sexual preference (the fate of the person affected) and the associated problematic or delinquent behavior (the responsibility of the person affected) is highly relevant.

Our data indicates high drop-out rates. Reasons for dropping out (40.1%) after first contact were criminal proceedings, other severe mental illnesses, or refusal of an appointment. In 25 cases, the circumstances remained unknown: In 24 of the 25 cases, contact was made by e-mail without further correspondence. One patient was referred by a specialist without further contact. Concerning the drop-out rate after the initial consultation, our data is comparable to similar treatment locations [26]. Our data suggests that the majority of the drop-outs can be attributed to formal exclusion criteria (ongoing criminal proceedings / other psychiatric disorders).

Most of the patients at our facility seek treatment voluntarily, which is why good treatment adherence is common. Aspects of severe self-harm were more frequent than aspects of acute danger to others. A report to the police due to potential danger to others has not been filed yet. In line with reportings from similar programs by other institutes [27], this highlights that criminal prevention in terms of hands-on-delinquency is the most important, but not the only goal in treatment for this group of patients. Most of our patients told us, that they never committed CSA (s. Table 1); rather, the consumption of CSAM, comorbidities, and clinically relevant psychological distress are their predominant treatment needs. This illustrates that a treatment program aimed exclusively at pedophilia is insufficient [28]. Psychiatric comorbidities and psychosocial stress factors as potential indirect risk factors for committing sexual abuse must also be taken into account and be evaluated during treatment. Potential outcome variables of treatment need to be assessed on various dimensions, such as the reduction of specific behavior (e.g., frequency of CSAM use), but also potential indirect risk factors, such as e.g., psychosocial functioning and treatment outcomes concerning other psychiatric comorbidities. This individualistic approach results in a high degree of heterogeneity in treatment but is in line with common forensic treatment concepts and crime prevention [17, 18, 29].

Finally, further research should also address critical points: There is no reliable empirical data on whether this approach actually has a crime prevention effect in terms of preventing CSA or CSAM [30]. Empirical studies have considerable methodological shortcomings (no control group, small sample size, self-report, etc.). Nevertheless, web-based treatments show empirical evidence for a reduction in CSA and use of CSAM [31].

Secondly, concerns about possible negative (risk-increasing) effects of forensic sex offender treatment should be addressed. Such effects have been shown to be particularly relevant for offenders with a low risk of reoffending [32]. From our point of view, the treatment received in our program cannot be compared with criminal justice measures. Our patients seek treatment voluntarily and are mostly intrinsically motivated. They have more opportunities to influence the course of treatment (frequency, length of treatment, content) and probably show a greater openness in reporting problematic behavior (especially use of CSAM, online contact with children) to their therapist due to not having to fear negative consequences (e.g., reporting to authorities). Nevertheless, such dynamics need to be evaluated during treatment by taking the mentioned aspects into account, as e.g., openness concerning problematic behavior, motivational factors, and the impact of psychiatric comorbidities on the risk of offending.