Problematic Sexual Behavior – Cognitive-Behavioral Therapy™ (PSB-CBT™)

Addressing Problematic Sexual Behavior in Youth

Problematic Sexual Behavior – Cognitive-Behavioral Therapy™ (PSB-CBT™) is an evidence-based treatment model for children and adolescents ages 3-18 who have engaged in problematic sexual behavior (PSB). Typically, children participate in a treatment group based on their age (preschool, school-age, or adolescent) while parents participate in a concurrent caregiver group. The model may also be adapted for individual (family) therapy.

PSB-CBT™ effectively addresses a wide range of problematic and illegal behaviors, including failure to recognize socially acceptable physical boundaries, excessive masturbation, preoccupation with pornography and other sexualized content, generation and/or dissemination of sexualized images of self or others, and coercive and/or aggressive sexual acts.

PSB-CBT™ has been successfully delivered in a variety of community, residential, and confined settings, including outpatient clinics, schools, homes, group homes, inpatient psychiatric facilities, and juvenile justice facilities. PSB-CBT™ can be offered through a variety of service delivery models, including outpatient, enhanced outpatient, intensive in-home, day treatment, and residential psychiatric services.

Maximum benefits are seen when the youth’s primary caregiver is actively involved in treatment. The number of treatment sessions and length of PSB-CBT™ treatment are dependent on the age of the child or adolescent.

Problematic Sexual Behavior Cognitive Behavioral Therapy (PSB-CBT) is an evidence-based treatment model for children and youth ages three up to 18 who have engaged in problematic sexual behavior (PSB). Typically, children participate in a treatment group based on their age (preschool, school-age and adolescents) while parents participate in a concurrent caregiver group. Treatment consists of 12 to 23 sessions, depending on the age of the child. The model may be adapted for individual (family) therapy. PSB-CBT effectively addresses a wide range of problematic and illegal behaviors, including failure to recognize socially acceptable physical boundaries, excessive masturbation, preoccupation with pornography and other sexualized content, generation and/or dissemination of sexualized images of self or others, and coercive and/or aggressive sexual acts

PSB-CBT may be delivered in a variety of community, residential, and confined settings, including; outpatient clinics, schools, homes, group homes, inpatient psychiatric and juvenile justice facilities. Additionally, PSB-CBT can be offered through a variety of service delivery models, including outpatient, enhanced outpatient, intensive in-home, day treatment, and residential psychiatric services.The average length of treatment is eight to 25 weekly, 60- to 90-minute sessions. Maximum benefits are seen when the youth’s primary caregiver is actively involved in treatment. TF-CBT has been successfully delivered in diverse settings, such as clinics, in-home, residential treatment facilities, schools and juvenile detention facilities.

Treatment Goals

Develop age-appropriate psychosexual knowledge and boundaries
Eliminate or reduce problematic sexual behaviors
Improve coping skills and self-control strategies
Enhance social competence skills

Enhance social competence skills
Improve caregiver monitoring, supervision, and behavior management skills
Reduce out-of-home placement risk

Criteria for PSB-CBT™ Training Eligibility

PSB-CBT™ is a good fit for clinicians who have cognitive-behavioral and family systems orientations and are comfortable with directive approaches in clinical treatment. Interested clinicians should have experience with group treatment models and presentation and facilitation skills for group training and education sessions.

An ideal clinician should be comfortable managing youth behavior in a group setting and discussing sexual development and sexual content. Strong family and client engagement skills, good organizational and communication skills, and the ability to actively collaborate with partnering agencies and community stakeholders are important as well.

Tuition

The North Carolina Child Treatment Program can subsidize the cost of this training through grant funds provided by the North Carolina Division of Child and Family Wellbeing. Tuition is $750 per clinician, which covers the Learning Sessions and consultation for training cases. The North Carolina Child Treatment Program partners with the University of Oklahoma Health Sciences Center Problematic Sexual Behavior – Cognitive Behavioral Therapy™ Training and Technical Assistance Program to provide this training.

Return on Investment

The majority of children and youth who participate in PSB-CBT™ cease to engage in problematic sexual behaviors. The recidivism rate among school age children is 2% 10 years following completion of treatment.

Children and youth who participate in PSB-CBT™ also show significant improvement in non-sexual behavior problems, emotional difficulties, and trauma symptoms.

Most children and youth benefit from outpatient PSB-CBT™, avoiding the cost and disruption associated with out-of-home placement. The approximate annual costs (2018 dollars) for placement in a North Carolina psychiatric residential treatment facility or a juvenile justice facility are greater than $50,000 and $100,000, respectively.

Other Implementation Costs include:

Staff time for training:
- Problematic Sexual Behavior – Cognitive-Behavioral Therapy™, School-Age (PSB-CBT™-S): Eight (8) days of in-person training in Durham, NC, and one (1) virtual training day
- Problematic Sexual Behavior – Cognitive-Behavioral Therapy™, Adolescent (PSB-CBT™-A): Five (5) days of in-person training in Durham, NC, and two (2) virtual half-day trainings
- Problematic Sexual Behavior – Cognitive-Behavioral Therapy™, Preschool (PSB-CBT™-P): Two (2) days of in-person training in Durham, NC

Staff travel costs for in-person training dates in Durham, NC (dates vary by program)
Staff time to meet other training requirements (e.g., client screening and assessment; weekly PSB-CBT™ sessions, planning time, and session documentation; bi-weekly consultation calls, and monthly implementation team meetings)
Physical space or digital platform and materials for weekly PSB-CBT™ sessions.
Visual equipment/resources to record and submit sessions for fidelity monitoring

Is PSB-CBT™ Right for Your Agency?

PSB-CBT™ is a good fit for agencies that are strong collaborators with juvenile justice, child welfare, treatment services systems, schools, child advocacy centers and other community partners. Clinical services teams should be trained in evidence-based treatment. Agencies should have active parent and caregiver involvement and policies and practices for working with this population that are strengths-based, trauma-informed and non-punitive.

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