MST for Problem Sexual Behavior works with youth engaging in inappropriate sexual behaviour
The sexual behaviour of young people is often difficult to fathom, even more so when that behaviour harms someone else. Estimates suggest that nearly a quarter of reported cases of child sexual abuse are committed by an individual younger than 18. Victims are often younger than the perpetrator and known to them, either as a family member or family friend.
When disclosures of such abuse are made, the ramifications are enormous and long lasting, both for the victim, the perpetrator and for their wider family networks. Professionals also struggle to understand the level of risk and what needs to happen to mitigate that risk. As a result, young people who have engaged in harmful sexual behaviour can be stigmatized, with concomitant feelings of humiliation and isolation. Yet these young people are often troubled, and in order for them to lead healthy, successful, socially connected lives, they warrant being treated with compassion and understanding.
MST-Problem Sexual Behavior (MST-PSB) is an evidence-based treatment model for young people displaying harmful sexual behaviour and aims to address the multisystemic factors that drive such conduct, hence reducing risk. The model is specifically recommended within the National Institute for Health and Care Excellence (NICE) guidelines. The approach focuses on working alongside parents and caregivers to help them deliver the relevant interventions. Inherent in the model is the understanding that strengthening the relationship between parent/caregiver and child is crucial to success.
Harmful sexual behaviour towards sister
Toby was 13 when he was found guilty of three specimen charges of rape against his younger sister, Kate. The offences took place over two years. During this period, his parents separated, and Toby witnessed many episodes of domestic violence perpetrated by his father. At the time of sentencing, Toby was living with his grandparents and had not seen his sister since she had disclosed the abuse. He had regular contact with both his parents. Kate was receiving counselling independently. His family wanted to make sense of what had happened and work toward Toby and Kate having contact, should this be safe and seen to be in their best interests.
Initial work involved Toby, his mother and grandparents. His father was reluctant to participate. However, over time, the therapist was able to engage the father in the treatment process. Comprehensive, individualized safety planning formed the first stage of the work, followed by clarification of the harmful sexual behaviour with Toby, led by his mother.
Clarification includes looking at the multiple factors that led to the harmful conduct, detailed sequencing of the episodes and an understanding of how it affected the victim and the larger family. This is done in the context of the family, as this can help the healing process for everyone involved. This was an emotive process for all, but enabled Toby to take responsibility for what had occurred. It also identified areas relevant for further intervention (e.g., considering the impact of pornography on Toby). Toby’s remorse was evident, and he decided to write an apology letter to his sister.
Toby lapses at school
Although all seemed to be progressing well, the school discovered that Toby had breached his safety plan (which included no unmonitored use of the internet) and had contacted vulnerable girls at school, seeking a sexual relationship. At this point, school personnel felt unable to control Toby. A meeting with school professionals demonstrated there was high anxiety about whether the boy could be managed in the community, putting his school placement at risk. The MST therapist worked alongside the professionals to secure Toby another educational placement. A safety plan was then developed at the new school specific to that environment.
Further clarification around Toby’s breach of the safety plan indicated other areas for intervention included the need to address his attitude toward women and not understanding the concept of consent. His father played a pivotal role in addressing these areas with Toby. In addition, both parents talked openly to Toby about sexual relationships, dating and expectations of a partner, conversations that we hoped would continue into the future.
Reunites with sister—under strict supervision
Alongside this work, Toby’s dream was to spend Christmas day with his sister, Kate. Careful planning with Kate’s therapist led to a reunification meeting between Toby and Kate at a local garden centre, accompanied by both parents, and supervised by Kate’s therapist and the MST-PSB therapist. This was an emotional meeting for all. No physical contact was allowed, and although Kate ran to hug Toby when she first saw him, he followed through with the planning and just gave her a high-five.
At the end of therapy, Toby was able to have regular contact with his sister, supervised by parents, but without professional involvement. Two years later, there have been no further reports of sexually harmful behaviour. Toby’s mother said at the end of treatment, “All in all, it has been a very important part of getting our family back on track. It has given us all the tools we need for the future. It has been a valuable service we will forever be indebted to.”
Denise Whetzel is an MST-PSB Expert at MST Associates and Sarah Reeves is a MST Supervisor at The Four Authority Partnership