Treatment for Children Who are Sexually Aggressive

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Programs for children with sexual aggression issues involve individual therapy, group psychoeducation for the children, family therapy, and couples therapy for two-parent families, or individual therapy for single-parent families. Partners in two-parent families may also participate in individual therapy.

At the beginning of treatment, some parents and children are willing and able to engage fully in treatment. The children and remorseful and have capacities to reflect upon their behaviors, explain the circumstances of their behaviors, and seek direction from therapists about how to manage these behaviors.

Typically, however, both parents and children are angry, anxious, ashamed, disorganized, blaming, depressed, or so withdrawn they appear hollow. They may also show remorse and desire to take responsibility but they are inconsistent in this. Parents and particularly children may move back and forth between these states.

Therapists show empathy and understanding while they also are clear that the sexual behaviors are inappropriate. Therapists speak frankly about the children’s sexual behaviors

The children often experience great relief that adults are finally talking to them directly about sex and that the adults expect them to do the same. Their prior experiences have taught them that sexual topics are naughty, nasty, dangerous, and taboo.

The group experience for children who have sexually aggressive behaviors typically is time-limited, up to twelve weeks long, with five to six children and two therapists. As described earlier in the discussion of group treatment of child and adolescent survivors, each session has a theme that includes information on the topic and then practice in using what they learned.

Topics

The topics are sex specific, meaning that each of them is connected to sexual expression and these connections are made explicit in the groups. For example, on sessions dealing with feelings, children participate in sessions that help them to connect their sexual behaviors with their emotional states. In sessions on boundaries, children do exercises that help them to understand sexual boundaries, such as when, where, and with whom sexual behaviors are important.

Parents visit during the last ten or fifteen minutes of the group so that the children can show them what they learned during the session. Parents then can help children use what they learn at home.

In family work, therapists assess and work with the family processes that contribute to the children’s sexual issues. Professionals rely upon parental commitment to their children and their willingness to address issues that have negative effects on children.

Treatment is challenging under any conditions, but when the families are well-organized with relatively few stressors, therapists are optimistic. Treatment becomes more complicated and the outcome less likely to be optimal when families have multiple stressors.

Family Strengths

The identification of family strengths and resources is important in building working and their willingness and ability to be of help to the children. Thus, the identification of family strengths and affirmation of family members for their strengths may be pivotal in developing working alliances with families.

Guilt and shame associated with having a child who acts out sexually can be a barrier to parent's full participant in treatment programs for their children. Feeling affirmed for what they do well and avoidance of stigmatization and blaming are important to building working alliances.

Often long-term family relationships are factors in children’s sexual acting out. For example, in two parent families with marital conflict, the parents often are too preoccupied to be emotionally available to their children. In such instances, parents must deal with their own issues before they can be helpful to their children.

Case Examples

The following cases illustrate treatment issues in two different families. In one family, the child learned to control his sexually aggressive behaviors and the other child did not. The more risks children have and the fewer resources, the more difficult it will be for them to manage their sexually aggressive behaviors.

Chuck, for example, at age nine had so many risks and so few resources that treatment did not work and he had to live in a locked residential treatment facility. His mother Patricia first tried treatment in a community mental health center. When the therapists did the assessment, they were not optimistic that they could help Chuck. He had multiple mental health issues, some related to a history of trauma but many apparently related to neurological issues that included attention deficit hyperactivity disorder, oppositional defiant disorder, intermittent explosive disorder, and conduct disorder. Chuck was on three different medications for his behaviors and had had one psychiatric hospitalization.

Chuck had multiple instances of sexually acting out, including at school, in the neighborhood, and in the psychiatric hospital. He displayed other behavioral problems that included violent behaviors, fire-setting, wetting his bed nightly, difficulties controlling his bowels, and generally presenting as uncontrollable. He had never met his biological father. All he knew was that he is African-American. Patricia was white.

Patricia was a single mother who worked at low-paying jobs and had to take three buses to get him to treatment. She was concerned about her son and provided him with enriching experiences such as summer camp and Boys' and Girls' Club. She used respite foster care that seems to help her to tolerate Chuck’s difficult behaviors. Being poor, she and Chuck lived in a high crime neighborhood where Chuck had been sexually abused many times.

Patricia had a history of incest victimization by her brother, and her family never believed her. She had never had treatment for her incest and did not want it. She resisted the therapists' observation that her personal issues could affect Chuck. Patricia had few friends and often felt neighbors took advantage of her. She was estranged from her own family. She also had a series of boyfriends who beat her, often in the presence of Chuck.

Finally, Patricia did not follow through with the therapists' recommendation for individual therapy for Chuck and for therapy for herself..

Chuck learned a great deal in the group portion of the treatment, but he had so many behavioral issues that Patricia could not care for him in her home, and she had him placed in a residential treatment facility.

Optimism for John

In contrast to Chuck, therapists were optimistic that they could help John who came to their attention when he was six. John and his family had more resources than Chuck and his family. His parents were cooperative. Unlike Patricia, they had no histories of sexual abuse or other childhood traumas and no parental physical abuse. They had close relationships with their extended families. They both worked and had good paying jobs. They owned their own home in a pleasant residential neighborhood.

John was remorseful. Besides his sexually abusive behaviors, he had no other behavioral issues except anxiety, which the therapists attributed to family stressors and his history of being molested by the husband of his daycare provider. He also witnessed the sexual abuse of other children. The sexual abuse took place when he was about four years old. Soon afterward, John began acting out sexually with other children in the neighborhood. His parents could not persuade him to stop. John wanted to stop, but apparently could not.

John was sad and lonely. Neighborhood parents stopped their children from playing with John. John believed his father did not love him because he father was very quiet at home and rarely interacted with anyone in his family.

While John participated in group, individual, and family therapy, his parents did couples and individual therapy. John’s father admitted that he drank too much, was depressed, and was having an affair on the internet, though he had not met the woman. His mother realized that she also was depressed. Both of them agreed to go on anti-depressants for a trial period of six months while they did therapeutic work.

John’s father stopped drinking, broke off his affair, and spent more time with John and the rest of his family. John’s mother found that she felt much better. The two parents fell in love again and got married. Through family therapy, John realized that his father loved him.

After four months of group, individual, and family therapy and the improvement in his parents' relationship, John became a relaxed and happy boy. He had quickly grasped and applied concepts he learned in therapy. He had stopped trying to talk other children into sexual activities and grabbing other children’s sexual body parts. He developed friends at school, and parents in his neighborhood once again allowed their children to play with him.

This case had a "happily ever after" ending. John and his family successfully completed treatment. The therapists recommended that John return to treatment should issues arise as he reached various developmental stages

Children need professional help to manage their sexually abusive behaviors. The key building blocks for this help are parental cooperation.  Parents must be willing to do whatever it takes to help their children.  If they do not, the children may live a life of misery and of hurting other people.