Trauma and Problematic Sexual Behavior Among Adolescents: Creating an Integrated Intervention

Background and Purpose: Adolescents account for one third of all sexual offenses; these youth with problematic sexual behavior (PSB) often have significant histories with trauma - a potential driver of PSB. Yet no intervention systematically addresses both. Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is the intervention with the strongest empirical support for addressing the effects of trauma among children and adolescents. Yet this model has not been applied to adolescents with PSB. This project’s aim was to identify how TF-CBT can be enhanced to meet the dual needs of adolescents with PSB.

Methods: This exploratory study utilized a qualitative method of inquiry based in grounded theory. The sample consisted of 24 clinicians who specialize in the treatment of PSB among adolescents and one former client and caregiver, both within the community and in juvenile justice facilities. The clinicians came from three different agencies who participated in focus groups lasting approximately 1.5 hours; the client/caregiver dyad were in a separate session. Using a semi-structured interview guide, the participants were asked about how they integrate trauma and PSB in their therapy, the challenges, how they incorporated TF-CBT principles, and other recommendations for developing a more structured approach to this treatment. The qualitative data were analyzed using the constant comparative method for content analysis and Olson and colleagues’ 10-step multiple rater process to achieve an ICR of 85% or higher. After the final round of coding, the research team members sorted the 24 remaining codes into the final six major themes.

Results: The clinicians endorsed needing assistance with the integration of trauma and PSB specifically around the six themes: family, non traumatic psychoeducation, intervention structure, systems impact, therapeutic relationship, and trauma. Family is defined as the family’s participation in treatment and understanding the family as a system. Non-traumatic psychoeducation refers to the need to address topics related to youth development, safety, interpersonal relationships, and sexuality. Intervention structure referred to their need for flexibility and structure for the sequencing of the intervention in terms of trauma or PSB, as many struggled with how to organize the treatment. System factors included, mandated reporting, adjudication, and engagement with parole officers that impacted the youth, family, and treatment process. Trauma refers to when and how a clinician addresses trauma during treatment, the connection between their own trauma histories, problematic sexual behaviors, and having their experiences validated.

Conclusion and Implications: Clinicians who work with youth with trauma histories and PSB need an empirically-supported intervention that addresses both. This project will serve as the critical foundation for interventions aimed at reducing PSB and the effects of trauma among adolescents leading to reduced time interfacing with the criminal justice and mental health systems, and improved quality of life. This project will also lay the foundation for future research to test and refine this enhanced model of TF-CBT to increase its effectiveness for this important population.