By Stephen C. Schultz
It was a warm summer day when the call came to my phone.
On the other end was the mother of an adopted son. Just days earlier, she had uncovered some deeply concerning and risky problematic sexual behavior. Her voice carried a mix of shock, fear, frustration, disbelief, and embarrassment. She found herself using words and discussing topics she probably never imagined she would speak aloud as a parent.
Unfortunately, this is not an unusual call.
In fact, these are the conversations I have almost every day. They come from families all across the country. Parents who have been thrust into a reality they never anticipated. Families whose lives have suddenly become filled with questions, uncertainty, and concern for both their child and the people around them.
The details may vary, but the emotions are remarkably consistent.
"What happened?"
"How did we miss this?"
"Is my son dangerous?"
"Can he get better?"
"What do we do now?"
One of the first things I notice during these conversations is that parents are almost entirely focused on the risk their son may be taking. That is understandable. The behaviors can be alarming, confusing, and difficult to comprehend.
What often gets overlooked is that the entire family may be at risk as well.
When parents first discover problematic sexual behavior, they are usually focused on finding a therapist, arranging assessments, and determining the appropriate level of care. Those are important priorities. However, they sometimes fail to recognize how quickly the consequences of these behaviors can extend beyond the adolescent himself.
Over the years, I have spoken with families who have experienced situations they never imagined possible. I have worked with parents who suddenly found strangers showing up at their homes. I have spoken with families whose electronics were seized as part of law enforcement investigations. I have talked with parents who discovered their financial information had been compromised or that their family had become entangled with individuals online who posed significant risks to everyone in the household.
Not every family will encounter situations this serious. However, it is enough families that it is worth mentioning.
These examples highlight an important reality: problematic sexual behavior is rarely an issue that impacts only one person. The effects often ripple throughout the entire family system.
This is one reason specialized assessment and treatment can be so important. Effective intervention is not simply about reducing risk for the adolescent. It is also about helping families understand safety, supervision, technology use, boundaries, accountability, and the practical steps necessary to protect everyone involved.
When I speak with parents, I often encourage them to ask two questions simultaneously.
"What does my son need right now?"
and
"What does my family need right now?"
The answers are not always the same, but both questions deserve attention.
For most families, the immediate response is simple: get help.
That often means scheduling appointments with therapists, calling treatment programs, consulting professionals, and contacting their insurance company. It is a reasonable place to start. Parents want to do something. They want to move forward. They want answers.
What they often discover, however, is that the treatment system and the insurance system are not necessarily designed around the unique needs of youth with problematic sexual behavior.
Instead, they are designed around concepts such as medical necessity, authorization requirements, network participation, and the least restrictive level of care.
These concepts matter. They serve an important purpose. Insurance companies have a responsibility to ensure that treatment recommendations are clinically justified and that less intensive options have been considered when appropriate.
The challenge is that none of those processes automatically answer the most important question.
Is this the right treatment for my son?
Before any family can confidently answer that question, they must first understand the full scope of what they are trying to treat.
One of the challenges in working with problematic sexual behavior is that families are often making treatment decisions based on incomplete information. Initial disclosures frequently evolve over time. Additional behaviors, patterns, risk factors, and victim concerns may not emerge until a young person is engaged in a structured assessment process.
This is why a comprehensive psychosexual evaluation is often one of the most important steps a family can take early in the process. A quality psychosexual evaluation goes far beyond identifying what happened. It helps clarify risk factors, treatment needs, family dynamics, patterns of behavior, protective factors, and recommendations for supervision and intervention.
Equally important is ensuring that treatment providers are working from complete and accurate information. Programs and clinicians can only develop effective treatment plans when they understand the full picture. For many adolescents, this includes participating in a clinically supported and therapeutically guided disclosure process designed to increase honesty, accountability, and treatment effectiveness.
Without a thorough assessment and an accurate understanding of the behaviors involved, families can find themselves selecting treatment based on assumptions rather than clinical realities. The result is often frustration, delays in progress, and uncertainty about whether the chosen provider is addressing the most significant concerns.
Too often, families spend months moving through a series of providers who may be well intentioned but have limited experience addressing problematic sexual behavior. The focus may be on impulsivity, anxiety, depression, ADHD, trauma, oppositional behavior, or general mental health concerns. While those issues may absolutely be present, they are not always the primary driver of the sexual behavior that brought the family to treatment in the first place.
As a result, parents can find themselves investing significant time, emotional energy, and financial resources without gaining the clarity they desperately need.
I am not suggesting that every child requires residential treatment or a highly specialized program. Many do not.
What I am suggesting is that families deserve to ask informed questions before deciding whether a provider is equipped to address the specific concerns they are facing.
The following questions can help parents better understand whether a program has the experience, training, and structure necessary to effectively work with youth who have demonstrated problematic sexual behavior.
10 Questions to Ask Programs That Do Not Specialize in Problematic Sexual Behavior
1. How many adolescents with problematic sexual behavior have you treated in the past year?
Experience matters. A provider may be excellent at treating general mental health concerns while having very limited experience working with PSB.
2. What specific training do your therapists and clinical staff have in assessing and treating problematic sexual behavior?
Not all therapists receive specialized training in this area. Understanding a provider's expertise can help you evaluate whether they are prepared for the complexity of your son's situation.
3. Will my child be participating in treatment alongside other youth with similar behavioral concerns, or is the program designed for a broader range of mental health and behavioral issues? How does that affect treatment planning and outcomes?
This question helps families understand whether PSB is a central focus of treatment or simply one of many concerns being addressed.
4. What assessments do you use to evaluate sexual behavior concerns, risk factors, and treatment needs?
A comprehensive assessment often provides the foundation for effective treatment planning and risk management.
5. How do you address secrecy, deception, grooming behaviors, manipulation, or minimizing responsibility when they are present?
Many problematic sexual behaviors are sustained through secrecy and distorted thinking. Effective treatment must address these patterns directly.
6. What specific safety measures and supervision recommendations do you provide for youth with a history of problematic sexual behavior?
Families need practical guidance that protects everyone involved while supporting healthy development and accountability.
7. How do you measure treatment progress and determine whether the risk of future problematic behaviors is actually decreasing?
Improvement should involve more than compliance or participation. Families deserve to understand how meaningful progress is evaluated.
8. How are parents involved in treatment, and how do you help families rebuild trust while maintaining appropriate safety measures?
Successful treatment rarely involves only the adolescent. Family involvement is often one of the most important predictors of long term success.
9. Can you describe a recent case similar to my son's and what treatment interventions were most effective?
While confidentiality must always be protected, experienced providers should be able to discuss the types of cases they have treated and the approaches they commonly use.
10. What factors would lead you to recommend a specialized problematic sexual behavior program instead of your program?
This may be the most important question on the list.
The answer often reveals how clearly a provider understands both their strengths and their limitations.
The Goal Is Not to Find the "Perfect" Program
Families often call me looking for certainty.
I understand why.
When you discover problematic sexual behavior, certainty feels like the one thing that has disappeared.
Unfortunately, certainty is rarely available in the early stages of this journey.
What is available is information.
Good questions lead to better information. Better information leads to better decisions.
Whether your path leads to outpatient therapy, intensive outpatient treatment, a partial hospitalization program, residential care, or a specialized PSB program, the goal is not simply to find an available provider. The goal is to find a provider that understands the problem you are trying to solve, not only for your son, but for your family as a whole.
As I told the mother who called me that summer afternoon, I will tell any family facing this situation.
Take the time to ask questions.
Listen carefully to the answers.
Trust what you learn.
And remember that seeking help is not a sign that your family has failed. It is often the first step toward understanding what happened, creating safety, rebuilding trust, and helping a young person develop the skills necessary for a healthier future.
Comments