Adolescents with Problematic Sexual Behavior – just the phrase conjures up stereotypes of these youth as “mini sex offenders.” For many years, treatment approaches for these youth were founded on a set of principles drawn from theories about adult pedophilia. Treatment protocols for youth were merely adult sex offender treatment models adapted “downward” for children and teens. These inaccurate assumptions often led to treatment practices that were mismatched and sometimes harmful, for this youthful population (Chaffin, 2008).
Fortunately, current research and best practices support treatment of this population as youth first, with their problematic sexual behavior (PSB) viewed as a possible function of their age and developmental stage. Unlike adult predators, adolescent PSB may be rooted in poor decision-making and impulse control, lack of knowledge of sex laws, and misdirected sexual curiosity. The prefrontal cortex (responsible for consequential thinking, impulse regulation, etc.) does not fully mature until a person’s mid-20s, making adolescents highly vulnerable to short-sighted, impulsive sexual decision-making. In this context, it is easy to understand why caregiver involvement in treatment for adolescents with PSB is so important. With caregivers in joint treatment groups, the dynamic shifts from fixing the teen to growing together as a team. By learning the same impulse-control and decision-making skills as their teens, caregivers can better model these skills at home in real time. They can reinforce new skills learned and address family dynamics that contribute to a teen’s behavior. Caregivers can also learn how to monitor and supervise their youth more appropriately. Active caregiver participation effectively bridges the gap between the clinical setting and the home environment, giving the adolescent a better chance of generalizing the skills they learn in treatment to the real world in which they live.
My journey treating youth with problematic sexual behavior began last year, when I attended a learning collaborative at the University of Oklahoma’s National Center on the Sexual Behavior of Youth (NCSBY). A colleague and I were trained in the evidence-based treatment protocol of PSB-CBT-A: Problematic Sexual Behavior — Cognitive Behavior Therapy Program for Adolescents. PSB-CBT-A was developed by Dr. Barbara Bonner in 1986 to treat youth who had been adjudicated for illegal sexual acts or had been otherwise identified as engaging in problematic sexual behavior. In the 40 years since its inception, the PSB-CBT-A program has built a robust evidence base for its effectiveness at reducing recidivism rates for adjudicated youth. Data indicates that over 97% of successful program completers were free of any sex offense arrests or reports at long-term (average of 10 years) follow-up. In other words, only 3% had a future offense or report. In contrast, approximately 15% of non-completing participants had a future sex offense arrest or report (University of Oklahoma Health Sciences Center, 2026). Importantly, the strongest single predictor of successful program completion was parent or caregiver involvement.
PSB-CBT-A uses a modular, weekly group format (with one pass through the program lasting approximately five to six months), with participants attending separate caregiver and teen groups for the first hour each week, then coming together for a combined half-hour group. Modules include psychoeducation (sex laws, anatomy, principles of healthy sexual relationships), CBT-focused exercises (understanding thoughts and feelings that precede PSB and other problematic behaviors), and family-strengthening skills (supervision, rules in the home, caregiver/teen communication). The core tenets of PSB-CBT-A include its being developmentally focused — teens are impulsive, not deviant; they have the capacity to learn and make healthier choices; strengths-based – no shaming, focus on behavior and better decision-making; trauma-informed – recognizing that many of the youth and caregivers have experienced trauma themselves; and family systems oriented – caregivers provide encouragement and enhance communication with and supervision of youth.
In the time I have been running PSB-CBT-A groups, I have seen caregivers go from reluctant, skeptical participants to enthusiastic, passionate contributors. Many caregivers come to group feeling defeated and hopeless, believing that there is “something wrong” with their child and that their parenting is wholly to blame. They may feel stigmatized, isolated from their usual social support networks, and may believe some of the myths and misconceptions about youth with PSB. The PSB-CBT-A group becomes a normalizing environment where caregivers meet others who are “in the same boat,” and caregiver shame and guilt about their predicament are reduced.
With shame and guilt reduced, the power of their participation in treatment with their teen becomes apparent. Caregivers begin to understand they are the therapist’s frontline extension in the home, translating cognitive-behavioral strategies into techniques their teen can use to regulate themselves when they feel distressed or on the verge of engaging in negative behavior. The caregiver practices communication skills learned in treatment at home, contributing to more effective conflict resolution and less arguing. The caregiver feels more comfortable setting rules for their teen because they discussed behavioral expectations in group and their teen provided input on what rewards and consequences they believe are fair and motivating.
Perhaps most importantly, the teen’s view of the caregiver changes as a result of the caregiver’s involvement in treatment. The teen realizes the caregiver sees their pain, not just their bad behavior. The teen feels valued for who they are, not just judged for their worst behavior. Seeing a caregiver sit in a room and do hard emotional work proves to the teen that the adult is willing to change too. The vulnerability the caregiver shows in group makes them seem more human and relatable, which actually increases the teen’s respect for them. And with this shared family journey, where judgment is replaced with partnership, the teen will feel he has the active, daily support he needs to sustain long-term change. The teen, and indeed the entire family, will be better for it!
Suzanne Katz, LCSW, MBA, is Assistant Director of the Trager Lemp Center for Trauma and Resilience at Westchester Jewish Community Services. She can be reached at 914-949-7699, ext. 2471, or [email protected].
References
Chaffin, Mark (2008). Our Minds Are Made Up – Don’t Confuse Us With the Facts: Commentary on Policies Concerning Children with Sexual Behavior Problems and Juvenile Sex Offenders. Child Maltreatment: 13(2): 110-121.
University of Oklahoma Health Sciences Center. (2026). Information on the Problematic Sexual Behavior – Cognitive Behavior Therapy – Adolescents (PSB-CBT-A). University of Oklahoma Board of Regents.
