Treatment Models for Children with Sexual Behaviour Problems
It is natural and healthy for children of the same age and size to explore voluntarily each other’s bodies as well as gender roles. These behaviours become unhealthy when the interest in sex is much more than the child’s other interests, when it is no more spontaneous and carefree but a way to get rid of one’s anxiety, and when it involves coercing or duping other children. Children who have been clinically assessed as having unhealthy sexual behaviours (being sexualized), who did not follow the rules set by their parents to reduce or end the behaviours, or who have molested other children, need to receive professional treatment. In this paper, three treatment models are presented in a concrete and non-theoretical fashion: an individual therapy, a family therapy, and a group therapy. None of these treatment models are by themselves sufficient for helping the sexualized children. Only a treatment plan that is a combination of all of these models would be optimal.
1. Individual Therapy
Individual therapy is generally more convenient for sexualized children who do not molest other children, or sexually abusive children who cannot be treated within a group setting. More importantly, since the children’s sexualized and/or molesting behaviours are usually indicators of serious psychological problems or earlier victimization, individual therapy allows for an in-depth or long-term work on these issues while the inappropriate behaviours decrease.
Main Objectives of Individual Therapy
Forming a Working Therapeutic Relationship with the Child
Coming to therapy is often experienced by children as frightening or some kind of punishment. The therapist shows interest in the child and presents the therapy session as a safe and even delightful experience that the child would like or consider worthwhile. The therapist meets the child in a room with a niche for play therapy. He/she conveys to the child that the problem behaviour will be brought up in many different ways. He/she identifies language that will be used in all the sessions for naming the child’s sexual behaviour. For instance, if the parent has talked about the child having been humping other children, the therapist asks the child how he or she calls this act.
Using Different Techniques to Gather Information From the Child
Although the therapist has got an account of the sexualized behaviours from the child’s parents, he/she asks the child to describe “what happened” in his or her own language .In the beginning of individual therapy, the therapist creates a safe, positive, and dependable environment where denial is permitted for a short period of time in order to avoid power struggle. Art work is used to diagnose children and get information about their self-image and psychological issues. The therapist may ask the children to draw a self-portrait, a picture of themselves doing something they like or they don’t like, or the picture of the worst and the best thing that ever happened to them. There is a discussion after each drawing.
The technique of externalizing the sexualized behaviours away from the children is also used. Children are presented with the concept of the sexualized behaviour becoming a monster that has got control over them. They then give the monster a name (e.g., touching monster) and try to control it by detecting when and how the monster appears and influences them, and what they can do to get help instead of fighting the monster by themselves. The therapist may also use therapeutic games such as Let’s Talk About Touching or Walk the Walk which provide children with a means to deal with complex issues while playing card or board games. Another technique would be to tell children what is already known about the sexualized behaviours and ask them to fill in details.
Developing Appropriate Vocabulary With the Child
The therapist asks the child to help him/her choose a vocabulary for addressing the child’s sexualized behaviours. This vocabulary needs to be clear, simple, and nonjudgmental, as it is used to correctly identify the behaviours and to help decrease and eventually eliminate them without injuring the child’s growing self- esteem. Harsh phrases such as “that disgusting play” are counter-productive.
Taking a baseline measure of the child’s sexual behaviours
The therapist writes down all of the child’s sexualized behaviours, from compulsive masturbation to exposing his/her genitals in public, to peeking in the school’s washrooms.
Determining the Precipitants of the Sexualized Behaviours
The therapist thereby finds out the precipitating factors of the behaviours as well as its risk factors, which help the creation of an individual treatment plan. But, the knowledge of the precipitating factors is also crucial to the children themselves. As Toni C. Johnson says, “It is very helpful for the children to know what precipitates their problematic sexual behaviour so that they can anticipate the feelings and gain control over their behaviours. If the precipitating situations are ones which the child cannot avoid, then the child must be aware of them and find ways to control himself/herself when these situations arise, or find ways to alert others to help on these occasions.” (1994).
Some children get anxious and want to engage in sexualized behaviours, when they sees aggression on TV, when they foresee aggression in their environment, and when they recall specific individuals or relationships. Some children despise authority figures, some hate men, and some may feel anxious around women who are mothers. There are children who can make a connection between their difficult feelings (e.g., loneliness, sadness) and the need to act out sexually. For instance, one boy who saw his prostitute mother being beaten up by a man and then taken to the hospital began making an association between loneliness and sex that was very much like the classical conditioning: whenever he felt lonely he had the desire to hurt another child sexually, or whenever he had the desire to act out sexually the same type of sadness and loneliness he had experienced at the time of his mother’s beating would come over him.
Gathering Information About Risk Factors
Circumstances or situations that may contribute to the recurrence of the sexualized behaviour constitute risk factors, which include:
1. Sexualized behaviours across settings.
2. A history of impulsive and aggressive behaviour.
3. A history of victimization.
4. Obsessive-compulsive behaviour.
5. The use of threat or violence.
6. Propensity for multiple victims.
7. An unconcerned family in denial.
8. Being unrepentant and unwilling to stop the behaviours. A list of risk factors can be drawn for each child after getting the maximum information from parents, caregivers, teachers, the child and his or her siblings. For example, one nine-year-old who molested many children in the neighborhood was more prone to sexualized behaviour when he was unsupervised, when he played with smaller or younger boys, when his mother and her boyfriend were nude in front of the child, and when he walked home from the school instead of taking a bus.
Assessing a History of Victimization
The therapist assesses for the history of earlier abuse, neglect, family violence, and substance abuse. He or she also asks the child’s earlier experience with the sexualized behaviour: “How did you learn about this kind of touching/rubbing?” “Did you ever see anyone touch/rub this way?” “Did anyone touch/rub you this way?” The therapist may use the child’s self-portrait to remind him or her what words were used by the child to call different body parts, and then ask if anyone touched the child’s genitals, and if so, what were the circumstances.
Understanding the child’s Perceptions of Family Dynamics
Another reason for individual therapy is to find out if the child’s needs are being met in the family, as well as what the child’s perceptions of family conflicts and parental discipline are. However, the therapist can not rely on information from the child and must make a full family assessment.
Reducing /Stopping the Sexualized Behaviours
The child should be removed from any person or thing which may be causing the child’s feelings of acting out sexually. Based on the baseline data, the therapist decides which one of the child’s sexualized behaviours needs to be worked on. An abusive behaviour should be attended before other behaviours. As for the other sexualized behaviours, the therapist chooses the one that is easiest to stop so that the child gets some encouragement for the treatment of his/her behaviours. It is important to work on one behaviour at a time, and to check with the database to see if a behaviour has been decreasing. It is also important to allow the child participate in the therapeutic plan and feel control over his/her life, as this will contribute to more positive results and to a greater sense of self-esteem. The therapist teaches the child that sex does not equate love, that he/she is responsible for his/her behaviours, that he/she has choices to make regarding his/her behaviours. The child is provided with appropriate sex education, acceptable sexual behaviour, a system of consequences for misconduct, and strategies to anticipate and control the desire to sexually misbehave.
Assessing the Child’s Readiness and Preparing Him/Her for Group Therapy
In order to assess if the child is ready for group therapy, the therapist should see if he/she is able to:
1. Listen and understand.
2. Conform to pointers.
3. Associate with peers.
4. Comply with group rules and adapt himself/herself to limits.
5. Manage his/her own affect (not to become overly excited by peers, and not to lose control and cool which prevents him/her from learning and causes distraction in others).
6. Take part in group activities. The child needs to understand the specific topic of the group in advance. The therapist may portray the group in the following way: “You’ll be coming on Monday morning to meet with me, and four other children your age. You and the other children have a lot in common- you’re all boys (or girls), you’re all 9 years old, and you’ve all had problem with touching other children. We’re going to talk about the touching problem and find out ways to help you stop doing that.”
Processing Material Produced in Group
Individual therapy enables the therapist to investigate into relevant clinical material that rises within group therapy sessions.
Secondary Objectives of Individual Therapy
These objectives are about helping children improve their self-concept and self-esteem, learn social skills, reduce their feelings of helplessness and vulnerability, identify their needs and get their needs met, have realistic views of family and family roles, and become future-oriented.