Dialectical behavioral therapy (DBT) with young people who sexually offend and have cognitive disabilities

Johan Nordahl, lic. psychologist, Off.Clinic

Off.Clinic

• Outpatient and residential treatment for adolescents who have commited some kind of sexual offense, placement dependent on risk assessment (e.g. Erasor)

• Children with sexual behavioral problem

• And/or adolescents and children with sexual trauma

• Family and network education

• Group and individual therapy

• Ages 10-18 at Visslan HVB (residential care center)

• More and more of the clients have some kind av cognitive disability (autism, learnings disorder or other neuropsychiatric diagnoses)

• Education/supervision of other professionals

• DBT, TF-CBT, PE and much more…

Why DBT?The behavioral problems displayed by these students are similar to the problem areas that DBT aims to change through treatment and skill training:

•The students usually have decreased control of emotions – making them more impulsive and display more risk behaviors.

•The student usually have difficulties taking care of relationships with peers, and are thereby less likely to meet a partner. (social isolation is a reoccuring risk factor for commiting new sexual abuse)

•It is not unusual for students to lack strategies of how to restrain themselves in the moment of abusive behavior.

•Many of the students have difficulties reading their own and others signals – body language, facial expressions and so on.

•And, dependent of their cognitive functioning many of the students have difficulties to generalize their aquired knowledge.

The four modules of DBT

Mindfulness – the capacity to pay attention and stay focused, without judging, recognizing signals. Distress tolerance – skill used to regain behavioral and emotional control, opposite action, acceptance.

Emotion regulation – how to identify/labeling feelings, identify vulnerabilities of emotion mind, to use mindfulness and distress tolerance skills.

Interpersonal effectiveness - to meet the goal, without damaging the relationship, while keeping self respect.

And, the treatment programme helps to create a common language between different treatment facilitators, the student’s family and the student himself/herself.

DBT – using the skillsThe aim of mindfulness in classical DBT is to be able to use emotions as well as reasoning as part of the solutions to different problems. With the increased ability to use this skill it is more likely to reach wisemind.

To be able to communicate more easily about this skill we introduce the following:

Emotion ReasoningWisemind

The Lizard

The Wizard The Robot

What else?

• Find ways to commit yourself and the client to the treatment

References

o Brainwise – Patricia Gorman Barry – www.brainwise-plc.orgo Start now - University of Connecticut Health Center – Susan Sampl, Robert

L. Trestman and Jane Harrison.o DBT – Skillstraining for adolescents by Miller, Rathus, Landsman, Linehan

2003o The Skills System Instructor’s Guide – Julie F. Brown, jbrown@jri.orgo ERASOR – James R. Worling & Traycy Curwen 2001. jworling@ican.neto Treating Trauma and Traumatic Grief in Children: A Clinician’s Guide,

Judith Cohen, MD, Anthony Mannarino, PhD – Allegheny General Hospital o TF-CBT, Esther Deblinger, PhD – CARES Institute, Order online at

www.guilford.como Brief TF-CBT overview training available for free at http://tfcbt.musc.eduo Cognitive Behavioral Group Therapy for Children with Sexual Behaviour

Problems -Treatment manual by Barbara L. Bonner, C. Eugene Walker and Lucy Berliner University of Oklahoma, USA

Contact information

www.offclinic.sejohan.nordahl@offclinic.se

marie@offclinic.se (head of department – outpatient care units)

erik@offclinic.se (head of department – Visslan HVB)anette@offclinic.se (method manager)