CBT for children with problematic sexual behaviour

Domain II · Behavioural & cognitive · Silovsky, Swisher, Widdifield · 1999 · Oklahoma

What it is

PSB-CBT is a structured, manualised outpatient programme that combines group, psychoeducational, cognitive-behavioural and behavioural-parenting methods. It is not a single technique. Problematic sexual behaviour (PSB) means behaviour that a child initiates, that involves sexual body parts, and…

Format

• Format by version
• PSB-CBT-P (3–6 years): closed group, 12–14 weekly 90-minute sessions, 5–7 children per group, with a parallel caregiver group and a joint parent–child component. The model can be delivered to a single family when a group is not suitable.

Who practises it, and how they are trained or regulated

• PSB-CBT-S (7–12 years): 18 weekly 60–90 minute sessions with concurrent child and caregiver groups and monthly multi-family sessions. CEBC describes an open-ended group from which children graduate in about 4–5 months. Children's groups are split by age (6–9 and 10–12) with 5–8 children each. The 2006 randomised trial used a 12-session version. The Sacred Circle resource gives 18–22 sessions.
• Staffing: co-therapists for each child group and one therapist for the caregiver group. Programme staff also include a supervisor or director and staff who carry out intake assessments. Lead clinicians should be licensed and experienced with behaviour problems, maltreatment and caregivers.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Plans that are too long to remember. Working when: the child can explain the plan unaided.
• Consistently wrong items, which show you what to reteach. Working when: scores approach ceiling.
• Graduating on time served rather than on criteria. Working when: gains hold at any follow-up contact.
• Rules applied only to the child with PSB, which signals blame. Working when: siblings can also state the rules.
• Generating only one option, or options that break the safety plan. Working when: the child produces safe alternatives quickly.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.