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Research on youth sexuality

See excerpts from actual treatment materials:

Steps to Healthy Touching
a workbook for ages 5-12

Roadmaps to Recovery
a workbook for ages 6-12

a workbook for ages 11-21

Jefferson County, TX
treatment program

assorted materials
(Warning: these materials are sexually explicit and seethe with hatred.)

Sources for this comparison:

Abel, G. & Harlow, N., The Stop Child Molestation Book, Xlibris, 2001.

American Academy of Child & Adolescent Psychiatry, “Facts for Families:  Conduct Disorders,” 1997.

Braithwaite, K. & Duff, J., “Conduct Disorder in Children and Adolescents,” Doncaster, VIC, Australia:  Behavioural Neurotherapy Clinic, 2001.

Kahn, T.J., Pathways:  A Guided Workbook for Youth Beginning Treatment, Brandon, VT:  Safer Society Press, 1999.

Kahn, T.J., Roadmaps to Recovery:  A Guided Workbook for Young People in Treatment, Brandon, VT:  Safer Society Press, 1999.

MacFarlane, K. & Cunningham, C., Steps to Healthy Touching, Indianapolis: Kidsrights, 2003.

Searight, H.R., Rottnek, F., & Abby, S.L., “Conduct Disorder:  Diagnosis and Treatment in Primary Care, American Family Physician, April 15, 2001.

Shaw, J., “Practice Parameters for the Assessment and Treatment of Children and Adolescents Who Are Sexually Abusive of Others,” Journal of the American Academy of Child and Adolescent Psychiatry, 38(12 Suppl):32S-54S, 1999.

Steiner, H. & Dunne, J.E., “Summary of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Conduct Disorders, Journal of the American Academy of Child and Adolescent Psychiatry, 36(10suppl), 1997.

Zimring, F.E., An American Travesty:  Legal Responses to Adolescent Sexual Offending, Chicago:  University of Chicago Press, 2004.

Ethical Treatment for All Youth
Email: etay@ethicaltreatment.org

About the author


The table below compares treatment for children and adolescents who have sexual behavior problems with those who have a pattern of committing violent (non-sexual) crimes and are diagnosed with conduct disorder. Notice that the harsh and adversarial methods (including attempts to control thoughts and feelings) used on youth with sexual behavior problems are not even used with children who commit violent crimes.

Child/adolescent with
conduct disorder
Child/adolescent with
sexual behavior problem
Target behaviors –
any of
violating curfew
running away
breaking and entering
destruction of property
bullying, threatening
use of dangerous weapon
cruelty to people or animals
preoccupation with sex/pornography
obscene phone calls
consensual sex play with sibling or
     younger child
consensual sex with younger
     romantic partner
indecent exposure
suggesting sexual activity to
     younger child
sexual harassment
sexual coercion

Threshold for treatment
Pattern must be present over 6 month period.
There must be clinically significant impairment in social, academic or occupational functioning.
Often after only one incident.
No requirement of impairment.
Characteristics of client These are not assumed for all patients; individual differences are recognized:
Inability to appreciate others' welfare
Little guilt or remorse
Views others as malicious
These are assumed for all "offenders" even if not actually present:
Denies behavior or its harmfulness
Minimizes harm
Rationalizes behavior
Treatment priority Least restrictive intervention that fulfills patient needs Protection of community
Therapist-client relationship Therapeutic/supportive Adversarial
(excerpt on assessment)
Therapeutic language:
no need to confront to overcome denial etc.
- client is called "patient" or "child" rather than "offender"
- no data gathered from victims
- no physiological measurement of client's feelings or thoughts

“Although the order of obtaining data may vary, the evaluator should interview both the patient and the parents, separately and together, to obtain history. It also may be desirable to interview other family members and professionals familiar with the patient. Releases for contact with medical, school, social service, and juvenile justice personnel should be obtained as indicated…DSM-IV target symptoms may not be apparent or acknowledged during the patient interview, but may be detected by interviewing parents and other informants.”
(Steiner & Dunne)
Adversarial language:
"Important sources of information include medical and psychological reports, offense reports, victim statements, protective services reports, and probation reports. The collateral information should be obtained before the individual interview; otherwise one is left relatively unprepared before the offender's normal proclivity to minimize and deny…Because in many cases laws have been transgressed, the offender is often less than forthcoming...The interviewer confronts minimization, denial, and the apparent omissions of important information… Some authors have recommended the use of phallometric testing, the measuring of penile erection in response to various stimuli, as a way to determine sexual preferences.”

Features of Treatment

Child/adolescent with conduct disorder Child/adolescent with sexual behavior problem
Prosecution Not part of treatment Considered part of treatment
Juvenile justice to support supervision and limit-setting yes yes
Traditional individual psychotherapy May be helpful: Usually a combination of behavioral and explorative. Discouraged for fear that patient will manipulate therapist.
School Build parent-school alliance, ensure appropriate academic placement. Not mentioned
Community Encourage involvement in structured, supervised peer & community activities.
Replace deviant peer group with socially appropriate one.
Not mentioned
Family therapy Improve parent-child communication.
Teach parents use of consistent, non-harsh discipline with clear rules, rewards, consequences.
Encourage parents to monitor whereabouts of children, and supervise exposure to violent entertainment.
Encourage parent-child play.
Improve parent-child communication.
To build an accountability system.
To teach parents about sexually abusive behavior, risk and protective factors, and characteristics of sexual abusers.
To teach parents styles of interaction and management of their children's sexual behavior.
Psychoeducational interventions Social skills training
Anger management
Assertiveness training
Sex education including deviancy
Control of sexual impulses
Victim awareness/empathy
Cognitive restructuring
Anger management
Assertiveness training
Social skills training
Stress reduction
Autobiographical awareness
Disclosure & Self-castigation Not used Recount every illegal sexual act in detail (including planning, method, and aftermath).
Pressure to disclose more crimes.
Describe all hurtful and selfish non-sexual behavior.
Describe family history of selfish, hurtful, or illegal behavior.
Use of polygraph (lie detector).
Victim clarification Not used Describe all victims, their reactions and feelings, and all possible effects on them.
Relive own actions from victim's perspective.
Education about effects on indirect victims (family & friends of victim & self).
Describe in detail every incident of  own victimization.
Listen to stories of victimization.
Education about effects on victim.
Changing thoughts and feelings Not attempted Admit and identify criminal thinking patterns (denial, minimization, rationalizing, etc.).
Disclose all thoughts/feelings before, during, and after crime.
Replace dangerous feelings and thoughts with right ones.
Change sexual fantasies through behavioral reconditioning (Covert sensitization, aversion therapy, masturbatory satiation, or other sexual arousal reconditioning).
Monitoring of thoughts and feelings Not done Both sexual and non-sexual, including fantasies and masturbation habits:
By therapist through required daily journals.
Reported to therapy group weekly.
By polygraph (lie detector) and/or plethysmograph attached to genitals
“No-cure”/Addiction Model Not used Admit no cure.
Take on identity as offender.
Identify cycle of dangerous feelings & behavior.
Identify tempting, dangerous situations.
Analyze tendency to overcome inhibitions and victim resistance.
Identify maintenance behaviors.
Develop relapse prevention plan.
After treatment No action prescribed Restrict future movement & jobs.
Continued monitoring of thoughts, feelings, and behavior.
Registration and tracking.

See sample materials used in treatment
Read conversations with treatment providers

Understanding the Issue

When experts are wrong
Casualties of war
   Lack of knowledge
   Confused definitions
   Invalid instruments
   Humiliation as therapy
   Arousal reconditioning
   Dangerous drugs
   Sriking comparisons
   Sample materials
   Convos with providers
Ethical violations
Deja vu