Guiding the Discussion of PSB with Families


By Stephen C. Schultz



As a clinician, just about everyone has dealt with clients who share very personal, intimate and poignant information with us. There is a trust and therapeutic alliance that we hope to establish over time. I would bet that most of us have also worked with clients who share only partial information. They aren’t quite ready to “spill all of the beans”.

I want to reach out in a helpful manner concerning conversations you may have with families pertaining to Problematic Sexual Behavior (PSB) and teenagers. I’ve been thinking a lot about a recent conference I attended in San Antonio, Texas. I had conversations with no fewer than seven clinicians and allied health professionals about families and students that are struggling with PSB, yet the families are hesitant to address the issues head on.



It is obvious that when a family is resistant to working on these very sensitive issues that it puts you, as the clinician, in a very awkward position concerning the family, other treatment providers and especially the student.

You may already know about Oxbow Academy and the separate evaluation house that has certainly filled a huge clinical need. So, this email is really about how to have a caring and compassionate conversation with the family. How can we help them understand that it’s better to know the extent of the PSB than “Hope” it’s taken care of in another setting.

If my son had a lump under the skin on his arm, I would take him to the doctor. If the symptomatology was such that there was some risk of cancer, I would go to a specialist. I would want to go to the very best specialist that provides the most extensive evaluation and testing possible. I would want to know exactly what he is dealing with and what we are facing as a family over the long term. There will certainly be uncomfortable tests performed as well as an extensive conversation about health, exposure to harmful substances and family history. At the end of this evaluation process, I would know one way or the other what we, as a family, were burdened with. We would know the truth and there would be an appropriate treatment plan moving forward. There may be no cancer and the lump may be benign. What a relief that would be. However, there may still be a treatment regimen that is needed.



In either situation, there are heightened emotions of anxiety, maybe some depression and most likely a lot of worry. There is an ongoing reflection of history and thoughts about how we got to this place in time.

I know this medical model comparison isn't new or unique. In fact, you have probably thought this through more than I have. This all sounds very logical until we realize that for PSB, it’s complicated by shame. People are empathetic and supportive if your son were to have cancer. If your son is struggling with PSB, you most likely are hesitant to share this info with others for fear that people will avoid you. The shame and stigma surrounding this issue is similar to what “Addiction” issues were 35 - 40 years ago.

This discussion has already been too long. I hope it’s been helpful in framing some thoughts around the issue of PSB. Below is a link to an article I wrote about the similarities between sexual concerns and addiction issues. This also may be helpful when speaking to parents.

Please know that Oxbow Academy does not diagnose teenagers as “Sex Addicts”. In fact, Oxbow works very hard at helping the students avoid labeling themselves with any number of societal labels that tend to get attached to PSB. However, the thought patterns and behaviors demonstrated in PSB often reflect patterns seen in many process and substance use addictions.      

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