Skip to main content

Teen Problematic Sexual Behavior (PSB) - A Data Informed Treatment Approach



By Stephen C. Schultz

I recently returned from a visit to California, where the clinical director of Oxbow Academy and I met with a family whose son had recently graduated from Oxbow. This meeting was intended to "check in" with the family, see how things were progressing, and assist in realigning any unmet expectations. One thing that stands out is the remarkable maturity and insight students gain during their time at Oxbow, often surpassing their peers. As we continue working with these families—who are truly pioneers in their persistence and dedication to their sons—we have observed some consistent trends.

Key Trends

  • Previous Treatment: Sixty percent of students have had prior treatment experiences, such as outpatient care, day treatment, partial hospitalization, or placement in a residential treatment center (RTC).
  • Adoption: Similarly, about 60% of students at Oxbow are adopted.

The Challenges of Addressing Sexual Issues

Due to the shame associated with sexual issues, what therapists and families initially uncover is often just the "tip of the iceberg." Many boys are skilled at playing what we call “information poker,” revealing a "card" of minimal information while keeping the rest of their “cards” close to their chest. This dynamic makes adolescents particularly difficult to work within outpatient settings. General residential care often struggles to address these challenges as well.

By the time families contact us, behaviors have often escalated into a crisis, and financial resources for treatment may be running low. This prompted us to ask a critical question:

"How can we set up a system that encourages and supports early intervention?"

A Structured Approach: The First 90 Days

I’m pleased to share that the initial phase of treatment provides an integrated and consolidated evaluation process. This initial phase lasts up to 90 days and includes the following components:

  1. Integration into Core Areas:
    Students are fully engaged in academics, residential living, and therapy during this period.

  2. Comprehensive Data Collection:
    Data is compiled across academics, residential living, and therapeutic progress using the Residential, Emotional, Social, Behavioral Assessment (RESBA).

  3. Full Sexual Disclosure:
    Each student works closely with their therapist to provide a full sexual disclosure.

  4. Bio-Feedback Exam (Polygraph):
    Students participate in a bio-feedback exam to validate their honesty during disclosure.

  5. Psychosexual Evaluation:
    Summaries of the student’s efforts in academics, residential living, and therapy are combined with the bio-feedback results. This comprehensive data is then sent to a psychologist for a detailed Psychosexual Evaluation.

Upon completion of this initial phase, parents and referring professionals receive an Integrated Functional Assessment, Psychological Testing, and Sexual Risk Assessment. This allows families and professionals to make informed decisions about the next level of care required. Some students return home and enter IOP, PHP or other wrap around services with a specific focus and goal determined from the testing. Others continue on at Oxbow based on additional information and diagnosed treatment needs.

Benefits of This Approach

  • Limited Initial Commitment: Parents commit only to the first 90 days of treatment.
  • Informed Treatment Planning: Data collected during this phase directly informs the student’s treatment plan.
  • Flexibility for Referring Professionals: Students can return home to a refined treatment process if clinically appropriate.
  • Sophisticated Clinical Support: Allied professionals gain a robust and clinically sophisticated option to discuss with families when needed.
  • Full Engagement: Students are actively involved in academics, residential activities, and therapy throughout the evaluation process.
  • Encouraging Transparency: The clinical use of the polygraph encourages students to “lay all their cards on the table,” ensuring the development of a complete and accurate treatment plan.


NEW HOPE. NEW HELP. NO SECRETS

Labels:

Comments

Post a Comment

Popular posts from this blog

The Young Boy and the Rattlesnake

By Stephen C. Schultz (Editors note: This is a story used in a Wilderness Treatment Program. Many come to this program having struggled with depression, anxiety and substance use.)   Many years ago there was a young Native American who lived in the very land you are residing in. He decided to seek wisdom by journeying to the top of Indian Peak. As he approached the base of the mountain he came across a rattlesnake that slithered beside him. The snake coiled as if to strike and the young boy moved back quickly in fear of being struck by the snake’s deadly venom. At that instant the snake spoke to the boy saying, “Don’t be afraid of me, I mean you no harm. I come to you to ask a favor. I see that you are about to traverse to the top of Indian Peak and was hoping that you may be willing to place me in your satchel so that I don’t have to make the long journey alone.” The young boy surprised by the snake’s request quickly responded by turning down the offer, stating, ...
4 comments
Read more

Measuring What Matters: Oxbow’s Edge in Predicting Progress

By Stephen C. Schultz Therapists are highly trained to guide, support, and assess progress. Yet, research continues to show that even experienced clinicians have mixed results at predicting which clients will improve, drop out, or struggle in therapy. This isn’t a critique of therapists—it’s a reality supported by data. And for those who place trust in residential treatment programs—families, school districts, educational consultants, and Managed Care Organizations (MCOs)—this insight is critical. At Oxbow Academy , we take this seriously. That’s why we use validated, research-backed tools to supplement clinical intuition and track meaningful progress in real time. Research Shows: Intuition Isn’t Enough In a foundational study by Hannan et al. (2005), therapists failed to recognize which of their clients were likely to experience treatment failure—even when objective outcome data pointed to risks. Similarly, Hatfield et al. (2010) demonstrated that therapists tend to overestima...
1 comment
Read more

When Emotional Pain Looks Like Manipulation: Oxbow Academy

By Stephen C. Schultz The teenage years are often full of complexity—especially for young people who struggle with impulse control, social understanding, or emotional regulation in relation to Problematic Sexual Behavior (PSB). For some, this difficulty is compounded by co-occurring conditions like Autism Spectrum Disorder (ASD), ADHD, or Nonverbal Learning Disorder (NLD) . These teens may unintentionally find themselves caught in compulsive, confusing, or embarrassing situations—sometimes involving inappropriate behavior with siblings, neighbors and friends or accessing dark corners of the internet. As these patterns continue, parents are often left feeling overwhelmed, frightened, and unsure of what to do next. Some worry that law enforcement or government agencies might get involved. Others have already experienced the fear of having electronics confiscated or home environments scrutinized. In the midst of this chaos, many parents recognize that their child’s behavior isn’t just a...
Post a Comment
Read more