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Clinical Case Study...Problematic Sexual Behavior (PSB)

By Stephen C. Schultz


Case Study:

Jason, age 15, was referred to us because he was repeatedly sexually acting out in two previous placements. Each placement had a policy against these behaviors. Supervision was adequate for students without sexual issues. However, Jason required more extensive monitoring.

Although he was acting out with same age peers, the sexual activity was not consensual and other students were complaining to their therapists, counselors and parents that Jason was actively and persistently seeking sexual activity with them.


Jason was repeatedly warned and given sanctions but nothing stopped his behaviors. Treatment became marginalized for both Jason and his peers. Other students ostracized him from activities and would not discuss their issues in group therapy settings because he was present. Parents complained to therapists that they did not want this young man anywhere near their student, let alone in a therapy group. Jason was eventually removed from both placements.

By the time he came to Oxbow Academy, Jason was extremely embarrassed, ashamed, and appeared to be genuinely ignorant of how to control himself. His parents were devastated and embarrassed. They were not ready to take Jason home because of his anger management issues and substance abuse, not to mention the sexual acting out with other students.

As we worked with Jason we discovered that prior to his first placement he had been in trouble for inappropriately touching a female cousin and his younger brother. The behavior had been reported to child protective services. No criminal charges were forthcoming because his parents were in the process of sending Jason to a wilderness program.

His evaluation for that program contained only a casual mention of sexual behaviors. Apparently, no one thought it was a serious issue - until the sexual acting out in these programs was out of control. At Oxbow, Jason reported much more extensive sexual acting out than either of the previous programs were aware of.

The lesson from our experience with Jason is two-fold. First, our experience indicates if sexual issues are disclosed prior to program placement they are almost always minimized. It is important to ask some very delicate questions and you should not hesitate to probe further.

Secondly, students like Jason are often admitted to therapeutic settings; outpatient, day treatment, wilderness therapy and residential programs with behaviors that mask their sexual issues, i.e.: depression, substance abuse, etc. Treatment for depression, anxiety, ADHD or other common adolescent "diagnosis" will not automatically result in the cessation of sexual behaviors.

It is important to seek specialized care when sexual issues manifest themselves.
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Location: United States

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