SEXUAL ABUSE PERPETRATOR

CLIENT PRESENTATION

  1. Arrest and Conviction for a Sexual Offense (1)1
    1. The client has been charged with and convicted of a sexual offense and ordered into treatment.
    2. The client is currently on probation for a sexually related offense.
    3. The client reported a history of repeated sexually related offenses.
    4. The client has not been charged with or investigated for any sexual offense since he/she began treatment.
  2. Sexual Abuse of Younger Victim (2)
    1. The client has been arrested and convicted for sexually abusing a younger sibling.
    2. The client has been charged with sexually abusing a younger child in his/her community.
    3. The client is suspected of sexually abusing his/her younger siblings and other younger children in the community.
    4. There have been no further accusations or charges of abuse brought against the client since he/she started treatment.
  3. Language with Sexual Content (3)
    1. The client presented as being unusually open with talk that was very sexually explicit.
    2. It is reported by teachers and other adults that the client's talk frequently contains sexual innuendos and references.
    3. The client confirmed that he/she likes to talk about sexual things.
    4. The client's sexual references have diminished significantly.
  4. Sexualized Relationships (4)
    1. The client's relationships have a definite and consistent sexual context to them.
    2. The client seemed to quickly sexualize most if not all relationships.
    3. The client acknowledged having sexual feelings toward most people with whom he/she relates.
    4. The client has started to consciously work at forming genuine, respectful relationships.
  5. Sexually Preoccupied (5)
    1. The client seemed to be sexually preoccupied a majority of his/her free time.
    2. The client reported having frequent thoughts, dreams, and fantasies about sexual things.
    3. The client indicated that whenever his/her mind wanders it always goes to sexualthings.
    4. The client has engaged in the use of pornographic magazines, videos, and Internetsites.
    5. The client has recently reported a decrease in his/her sexual preoccupation and now will think of other things.
  6. Sexual Self-Interest (5)
    1. The client reported a history of numerous sexual encounters with partners with whom he/she had little or no emotional attachment.
    2. The described sexual behaviors are focused on self-gratification only and with no interest in the needs or concerns of the other partner.
    3. The client indicated he/she sees sexual satisfaction as his/her right.
    4. The client has begun working at changing his/her thinking regarding the issue of sexual self-interest.
  7. Family History of Incest (6)
    1. The client and parents reported a multigenerational pattern of sexual abuse within the family.
    2. The parents indicated that several family members have been convicted of sexually related offenses that include incest.
    3. The parents denied any history of incest, despite legal documents that indicate otherwise.
    4. The client revealed several family secrets that involved incestuous relationships between family members.
  8. Childhood Sex Abuse (7)
    1. The client is very guarded and closed about his/her childhood sex abuse.
    2. The client provided specific examples from his/her childhood of instances in which he/she was sexually abused.
    3. The client has begun to verbalize some insight and understanding into how previous instances of childhood pain are connected to his/her acts of sexual abuse perpetration and a sense of detachment from others.
  9. Use of Pornographic Materials (8)
    1. The client admitted having in his/her possession a significant amount of sexually explicit videos and magazines.
    2. The client acknowledged being caught by parents visiting adult Internet sites and calling 900 numbers.
    3. The client admitted spending a large portion of his/her free time with a variety of pornographic materials.
    4. The client reported he/she has disposed of all his/her pornographic materials but experienced some difficulty in doing so.

INTERVENTIONS IMPLEMENTED

  1. Build Trust (1)2
    1. Initial trust level was established with the client through the use of unconditional positive regard.
    2. Warm acceptance and active-listening techniques were utilized to establish the basis for a trusting relationship in which thoughts and feelings could be openly shared.
    3. The client has been engaged in a trust-based relationship and has started to share openly his/her thoughts and feelings.
    4. Despite the use of active listening, warm acceptance, and unconditional positive regard, the client remains guarded, mistrustful, and willing to disclose only on a superficial level.
  2. Initiate Self-Disclosure (2)
    1. A celebrity interview format was utilized to start the client talking about nonthreatening topics.
    2. The exercise “Celebrity-Style Interview” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) was used to initiate self-disclosure.
    3. The client's self-disclosures were affirmed, encouraged, and reinforced.
    4. Despite the use of nonthreatening approaches, the client remained guarded and willing to disclose only superficial information.
  3. Gather Sexual Offense History (3)
    1. A history was gathered of the sexual abuse incidents perpetrated by the client.
    2. Information was obtained regarding the age and gender of victims, victim grooming practices used, degree of coercion, threat, or violence used and feelings generated during and after the abuse.
    3. Information about the current thoughts and feelings about the abuse, how the abuse came to be known, previous treatment, legal status, and charges pending was developed.
    4. The client was assisted in disclosing information about his/her history of sexual abuse through the use of the “Getting Started” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
  4. Conduct Psychological Testing (4)
    1. Psychological testing was arranged for the client to confirm or rule out severe emotional issues or psychopathology.
    2. The psychological testing results indicated that the client has severe emotional issues that underlie his/her perpetration of sexual abuse.
    3. No significant or severe emotional issues were discovered by the psychological testing.
    4. The results of the psychological testing were presented and interpreted to the client, and his/her questions were answered.
    5. The recommendations of the testing for ongoing treatment were emphasized with the client.
    6. The client was asked to make a commitment to follow through in completing all the recommendations of the psychological testing.
    7. The client was disinterested in the psychological evaluation recommendations and would not make a commitment to follow through on them.
  5. Arrange Substance Abuse Evaluation (5)
    1. The client's use of alcohol and other mood-altering substances was assessed.
    2. The client was assessed to have a pattern of mild substance use.
    3. The client was assessed to have a pattern of moderate substance use.
    4. The client was assessed to have a pattern of severe substance use.
    5. The client was referred for a substance use treatment.
    6. The client was found to not have any substance use concerns.
  6. Assess Level of Insight (6)
    1. The client's level of insight toward the presenting problems was assessed.
    2. The client was assessed in regard to the syntonic versus dystonic nature of his/her insight about the presenting problems.
    3. The client was noted to demonstrate good insight into the problematic nature of the behavior and symptoms.
    4. The client was noted to be in agreement with others' concerns and is motivated to work on change.
    5. The client was noted to be ambivalent regarding the problems described and is reluctant to address the issues as a concern.
    6. The client was noted to be resistant regarding acknowledgment of the problem areas, is not concerned about them, and has no motivation to make changes.
  7. Assess for Correlated Disorders (7)
    1. The client was assessed for evidence of research-based correlated disorders.
    2. The client was assessed in regard to his/her level of vulnerability to suicide.
    3. The client was identified as having a comorbid disorder, and treatment was adjusted to account for these concerns.
    4. The client has been assessed for any correlated disorders, but none were found.
  8. Assess for Culturally Based Confounding Issues (8)
    1. The client was assessed for age-related issues that could help to better understand his/her clinical presentation.
    2. The client was assessed for gender-related issues that could help to better understand his/her clinical presentation.
    3. The client was assessed for cultural syndromes, cultural idioms of distress, or culturally based perceived causes that could help to better understand his/her clinical presentation.
    4. Alternative factors have been identified as contributing to the client's currently defined “problem behavior,” and these were taken into account in regard to his/her treatment.
    5. Culturally based factors that could help to account for the client's currently defined “problem behavior” were investigated, but no significant factors were identified.
  9. Assess Severity of Impairment (9)
    1. The severity of the client's impairment was assessed to determine the appropriate level of care.
    2. The client was assessed in regard to his/her impairment in social, relational, vocational, and occupational endeavors.
    3. It was reflected to the client that his/her impairment appears to create mild to moderate effects on the client's functioning.
    4. It was reflected to the client that his/her impairment appears to create severe to very severe effects on the client's functioning.
    5. The client was continuously assessed for the severity of impairment, as well as the efficacy and appropriateness of treatment.
  10. Assess for Pathogenic Care (10)
    1. The home, school, and community of the client were assessed for pathogenic care and concerns.
    2. The client's various environments were assessed for the persistent disregard of the child's needs, repeated changes in caregivers, limited opportunities for stable attachment, harsh discipline, or other grossly inept care.
    3. Pathogenic care was identified and the treatment plan included strategies for managing or correcting these concerns and protecting the child.
    4. No pathogenic care was identified and this was reflected to the client and caregivers.
  11. Gather Sexual History (11)
    1. A thorough sexual history was collected from the client and the parents.
    2. The client and family were confronted on the vagueness of the information given regarding their sexual histories.
    3. The client and family were supported for providing complete and honest information regarding the client's sexual history.
  12. Develop a No-Sexual-Contact Agreement (12)
    1. The client and family were assisted in developing a no-sexual-contact agreement between the client and any others.
    2. The parents agreed to implement and enforce the no-sexual-contact agreement.
    3. The client was asked to and did sign the no-sexual-contact agreement.
  13. Monitor No-Sexual-Contact Agreement (13)
    1. The no-sexual-contact agreement was monitored for the parents' and the client's follow-through.
    2. The parents were confronted on their inconsistency of follow-through on enforcing the no-sexual-contact agreement.
    3. The parents were given positive feedback on enforcing and monitoring the no-sexual-contact agreement.
    4. The client was given positive verbal feedback on his/her compliance in abiding by the no-sexual-contact agreement.
    5. The client was confronted on his/her pushing the limits of the no-sexual-contactagreement.
    6. Since the client failed to keep the no-sexual-contact agreement, a more restrictive, supervised treatment setting was sought for him/her.
    7. The client was referred to a 24-hour residential treatment program specifically designed for adolescent sexual offenders.
  14. Explore Incidents of Sexual Misconduct (14)
    1. The client was asked to describe in detail each incident of sexual misconduct he/she committed.
    2. The client was assigned the exercise “Negative Effects of the Abuse” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client's history of incidents of sexual misconduct was processed and examined for incompleteness and lack of honesty.
    4. Positive feedback was provided as the client expressed ownership for his/her sexual misconduct.
    5. Denial and rationalizations were offered by the client for his/her sexual misconduct, and he/she was confronted about this pattern.
  15. Introduce Key Treatment Concepts (15)
    1. The client was asked to complete an exercise on sexual boundaries to begin his/her education and treatment of his/her offense cycle.
    2. The client was assigned a sexual boundary exercise from the Safer Society Press Series (Freeman-Longo and Bays).
    3. The client was asked to complete and process the “Getting Started” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) to familiarize him/her with treatment-specific terminology.
    4. The client was assisted in gaining a working knowledge of key treatment concepts.
    5. The client was encouraged to ask questions about any aspects of or concepts related to his/her treatment.
    6. The client has not completed the assignments to begin the process of education and treatment of his/her offense cycle and was redirected to do so.
  16. Increase Awareness and Respect of Boundaries (16)
    1. The client was assisted in building his/her awareness of and respect for personalboundaries.
    2. The client's barriers to being aware of personal boundaries were identified and addressed.
    3. The client was encouraged to ask questions when he/she was in doubt about personal boundaries.
    4. Key points of the necessity of maintaining appropriate boundaries were clarified and reinforced with the client.
    5. Role-plays were used with the client to practice maintaining appropriate boundaries in social situations.
    6. The client was given feedback regarding his/her actions in the role-plays, and appropriate behaviors were modeled for him/her.
    7. The client was given positive feedback for honoring and respecting appropriate personal boundaries.
  17. Confront Sexual References in Speech/Behavior (17)
    1. Sexual references in the client's speech and behavior were pointed out to him/her.
    2. The client was assisted in increasing his/her awareness of sexual references in his/her speech and behaviors.
    3. The client's feelings and thoughts that underlie the sexual references were explored and processed.
    4. The client was resistive to sexual references being pointed out in his/her speech and behavior.
  18. Assign Gathering of Feedback about Sexualized Speech (18)
    1. The client was asked to gather feedback from others regarding sexual references they note in the client's speech and behavior.
    2. Feedback that was gathered by the client from others was processed and language options were explored.
    3. The client was encouraged to identify and implement alternative behavior and language patterns.
  19. Explore for Sexual Abuse (19)
    1. The client's childhood history was gently explored for sexual, physical, or emotional abuse.
    2. The client was asked specifically how others respected or violated his/her physical boundaries as a child.
    3. The client was assigned the exercise “My Story” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    4. The client was presented with data on the percent of perpetrators who are themselves abused, and the data was processed for his/her response.
    5. The possibility of the client being a victim of sexual, physical, or emotional abuse was explored with his/her parents.
    6. The client and the parents were supported as they acknowledged that the client has been a victim of sexual, physical, or emotional abuse.
    7. The client and parents denied any history of sexual abuse, and this was accepted.
  20. Identify Connection Between Sexual Abuse and Offense (20)
    1. The client was asked to list the consequences of being a victim of sexual abuse.
    2. The list of consequences resulting from being a victim of sexual abuse was processed with the client.
    3. The client was assisted in making the connection between his/her own victimization and the development of his/her current attitudes and patterns of sexual abuse perpetration.
    4. The client was unable to identify any concrete consequences of being a victim of sexual abuse and stated that the abuse had no impact on his/her current behavior; he/she was provided with tentative examples in this area.
  21. Play Games to Initiate Disclosure (21)
    1. Various therapeutic tools were used to assist the client in becoming capable of identifying, labeling, and expressing his/her feelings.
    2. The UnGame (UnGame Company) and The Talking, Feeling, and Doing Game (Creative Therapeutics) were played with the client to give him/her opportunities to share things about himself/herself and to increase self-awareness.
    3. The client was assisted in identifying his/her likes and dislikes to help expand self-awareness.
    4. Positive affirmation and reinforcement were given to the client's self-disclosures while playing The UnGame.
    5. The client was assigned the exercise “Your Feelings and Beyond” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    6. The client was reinforced for his/her use of new skills to label and express his/her emotions.
    7. Despite the use of therapeutic tools, the client was unwilling to identify, label, or express his/her feelings, and he/she was provided with tentative interpretations in this area.
  22. Reinforce Feeling Recognition (22)
    1. The client was reminded of the positive benefits of identifying, labeling, and expressing his/her own feelings and of being sensitive to the feelings of others.
    2. The client was given feedback on each occasion where he/she failed to show an awareness of the feelings of others.
    3. Positive reinforcement was given to the client on each occasion where he/she showed recognition of the feelings of others without outside direction.
    4. The client displays the ability to identify and express his/her feelings much more readily.
  23. Support Client in Describing Sexual, Emotional, or Physical Victimization (23)
    1. Barriers and defenses that prevented the client's openness regarding being sexually, physically, or emotionally abused were addressed and removed.
    2. The client's fears about disclosing the details of his/her own abuse were processed and resolved.
    3. The client was encouraged and supported in telling the story of his/her own sexual, emotional, or physical victimization.
    4. Even with support and encouragement, the client was unable to tell any of the details related to his/her own abuse.
  24. Support Client Telling Parents of Victimization (24)
    1. The client's fears about revealing his/her victimization to his/her parents were identified, processed, and resolved.
    2. The worst-case-scenario approach was used in preparing the client to tell parents about his/her victimization.
    3. The client was assisted and supported in telling the story of his/her own abuse to the parents.
    4. The client's experience of telling the story of abuse to the parents was processed.
    5. Even with preparation, assistance, and support, the client refused to tell parents the story of his/her abuse experience and again started denying any such experience.
  25. Refer to Perpetrator Group Treatment (25)
    1. The need for group treatment for sexual perpetrators was explained to the client.
    2. The client was referred to a group treatment program specifically developed for sexoffenders.
    3. The client's acceptance of group treatment was affirmed and reinforced.
    4. The client was very resistive to the referral to a group therapy treatment program for sex offenders.
  26. 26 Identify Exploitive Beliefs (26)
    1. The client was assisted in identifying and processing his/her thoughts and beliefs that gave him/her justification for being sexually abusive.
    2. The client was assisted in identifying socially acceptable thoughts that are respectful and not exploitive of others.
    3. New respectful, nonexploitive thoughts were affirmed and reinforced with the client as he/she used them in daily interactions.
    4. The client's justification for holding to old beliefs and resistance to new respectful, nonexploitive ones were confronted and addressed.
  27. Refer for Medication Evaluation (27)
    1. The client was referred for a physician evaluation for psychotropic medications.
    2. The client followed the recommendations and completed the physician evaluation for possible medications.
    3. Psychotropic medications have been ordered for the client, and he/she has agreed to take them consistently.
  28. Monitor Medication (28)
    1. The client's psychotropic medication was monitored for effectiveness and for the client's compliance in taking as prescribed.
    2. The client and parents were directed and encouraged to report any side effects of the psychotropic medication to the prescribing physician.
    3. The client was confronted on his/her failure to take the medication as prescribed.
    4. The client's compliance and the overall effectiveness of the psychotropic medication were reported to the prescribing physician.
  29. Assign Anger Control Exercise (29)
    1. The client was assigned exercises to assist in learning to manage his/her anger better.
    2. The client was asked to complete the “Anger Control” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) to increase anger recognition and ways to effectively control it.
    3. The client was asked to complete an exercise from The Anger Control Workbook (McKay and Rogers) to increase anger recognition and ways to effectively control it.
    4. The client was asked to complete an exercise from The Anger Workbook for Teens: Activities to Help You Deal with Anger and Frustration (Lohmann and Taylor) toincrease anger recognition and ways to effectively control it.
    5. The client was asked to complete an exercise from The Anger Workout Book for Teens (Stewart) to increase anger recognition and ways to effectively control it.
    6. The client has learned new strategies to control his/her anger and has reported that these have been effective in helping him/her manage anger more effectively.
    7. The client has not completed the assigned exercises regarding anger control and was redirected to do so.
  30. Refer to Anger Management Group (30)
    1. The client was referred to an anger management group to build skills in effectively controlling angry feelings.
    2. The benefits and gains from attending an anger management group were explored and identified.
    3. The client followed through on referral to the anger management group and reported positive gains.
    4. The client has not followed through on the referral to the anger management group and was redirected to do so.
  31. Encourage Increased Peer Involvement (31)
    1. The client was helped to identify specific ways he/she could increase positive social involvement with peers.
    2. Barriers that have held the client back from involvement with peers were explored,processed, and removed.
    3. The client was asked to identify two ways to increase socialization that he/she would like to try and then to plan how he/she would go about implementing them.
    4. Role-plays of peer social situations were used to give the client the opportunity to build confidence and comfort with peer interactions.
    5. The experience of the social situation role-plays was processed to reinforce gains.
    6. The client reported that he/she is feeling more confident and comfortable with peer interactions and was encouraged to continue.
  32. Promote New Social Activity (32)
    1. A list of possible new social activities was developed with the client, and he/she was asked to choose one to implement each week.
    2. The client was assigned the exercise “Developing Conversational Skills” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client was assigned the exercise “Greeting Peers” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    4. The client was monitored for his/her compliance of trying one new social activity each week.
    5. The client was asked to engage a peer in conversation once daily.
    6. The client processed the experience of the new social activity/conversation and identified the specific gains he/she obtained from the experience.
    7. The client's failure to attempt a new social activity/conversation was explored and addressed.
  33. Assign Books on Dating (33)
    1. The client was assigned books to help build his/her awareness of what is appropriate or inappropriate behavior when interacting with the opposite sex.
    2. The client was asked to read Dating for Dummies (Browne) or The Complete Idiot's Guide to Dating (Kuriansky) to increase his/her awareness of appropriate and inappropriate behaviors with the opposite sex.
    3. All questions raised by the client's reading of dating books were answered and processed.
    4. Role-play was used to further build the client's relationship skills and awareness of appropriate behavior with the opposite sex.
    5. The client politely declined to read dating books that were recommended.
  34. Teach SAFE Formula for Relationships (34)
    1. The SAFE formula for relationships (avoid relationships that are Secret, Abusive, used to avoid Feelings, or Empty of caring and commitment) was taught to the client.
    2. All the client's questions about the SAFE formula were addressed and answered.
    3. The client was given various scenarios of relationships and asked how they did or did not fit the SAFE formula.
    4. The client was assisted in identifying how to implement the SAFE formula into his/her daily life.
    5. The client was monitored and redirected in his/her use of the SAFE formula.
    6. Positive feedback and reinforcement were given to the client for consistently putting the SAFE formula into daily practice.
  35. Explore Family Patterns of Sexual Abuse (35)
    1. A genogram was developed with the family that depicted the extended family's boundary-breaking patterns of interaction and identified members' inappropriate sexual behavior.
    2. Boundary-breaking patterns of interaction and sexual abuse behavior identified by the genogram were processed and addressed with the family.
    3. Ways to begin breaking unhealthy patterns of interaction and sexual behavior wereexplored with the family.
  36. Explore Family Sexual Patterns, Beliefs, Behaviors (36)
    1. Family sessions were conducted in which the family members' sexual patterns, beliefs, and behaviors were explored and identified.
    2. The family was assisted in identifying which sexual patterns, beliefs, and behaviors need to be changed and coached on how they might begin to go about doing it.
    3. The family was encouraged to implement their planned changes of identified inappropriate sexual patterns, beliefs, and behaviors.
    4. The family members were confronted on their resistance to moving beyond identification and changing the identified unhealthy sexual patterns, beliefs, and behaviors.
  37. Develop/Implement Structural Intervention (37)
    1. Family sessions were conducted in which structural interventions were developed, specific plans for implementation made, and a verbal commitment elicited for follow-through.
    2. Structural interventions were monitored for their effectiveness and adjusted as needed.
    3. The family was monitored and encouraged regarding their follow-through on the structural interventions that they developed.
    4. The family's lack of follow-through on structural interventions was confronted, addressed, and resolved.
  38. Refer to Parenting Education Group (38)
    1. The parents' strengths and weaknesses in parenting were explored.
    2. Concerns of the parents about parenting teens were explored and processed.
    3. The parents were referred to an education group on parenting teenagers.
    4. The parents accepted the referral to an education group on parenting techniques and have begun to attend the meetings.
    5. The parents have refused to accept a referral to a parenting education group.
  39. Assign Books on Parenting (39)
    1. The parents were assigned books to help expand their understanding of adolescence and to build their parenting skills.
    2. It was suggested that the parents read books such as Parenting with Love and Logic (Cline and Fay) to expand their understanding of teens and to build their parenting skills.
    3. Knowledge gained by the parents from reading books on parenting techniques wasprocessed, and key concepts were reinforced.
    4. The parents read small portions of the books that were suggested and processed what information they had gained.
    5. The parents have not followed through on the recommendation to read any of the material recommended on effective parenting techniques and were reminded to do so.
  40. Develop New Family Rituals (40)
    1. The members were educated on the meaning, use, and benefits of establishing rituals for the family.
    2. The family was assisted in identifying and developing family rituals of transition, healing, belonging, and identity that would increase family structure, connection, and meaning.
    3. Ways to implement the new family rituals were explored and agreed to.
    4. Continued work to establish the family rituals was encouraged and reinforced.
  41. Assign Feelings Awareness Exercises (41)
    1. The client was taught the importance of expanding his/her awareness of his/her feelings and those of others.
    2. The client was asked to complete the exercise “How I Have Hurt Others” from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) to expand his/her awareness of feelings.
    3. A variety of scenarios were given to the client to help him/her identify how he/she would feel and how he/she thought others might feel in a given situation.
    4. The client was gently confronted and helped to recognize situations where he/she was showing a lack of awareness of others' feelings.
    5. It was noted that the client has demonstrated an increased ability to recognize and express his/her own feelings as well as to recognize the feelings of others.
  42. Assign Fantasy Journal (42)
    1. The client was asked to keep a daily journal of his/her sexual fantasies.
    2. The client was assigned the exercise “Journal of Sexual Thoughts, Feelings, and Conflicts” in the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    3. The client's sexual fantasy journal was reviewed for patterns of appropriate and inappropriate fantasies in order to provide feedback, redirection, and reinforcement.
    4. The client was worked with to make his/her journal entries less vague and more specific.
    5. The client was confronted on his/her journal entries that lacked openness and honesty.
    6. A review of the client's sexual fantasy journal material shows evidence of a preoccupation with inappropriate sexual urges.
    7. A review of the client's sexual fantasy journal material shows evidence of only appropriate and expected sexual thoughts.
  43. Define Appropriate/Inappropriate Sexual Fantasies (43)
    1. The client was asked to a make a list of the major themes of each of his/her sexual fantasies.
    2. Education and guidance were given to the client concerning what constitutes an appropriate and inappropriate sexual fantasy.
    3. The client was assisted in creating appropriate sexual fantasies.
    4. Feelings of other parties that were a part of the client's sexual fantasies were reflected to the client to increase his/her sensitivity to others.
    5. The client was given feedback that rejected fantasies involving pain and exploitation as inappropriate.
  44. Investigate Apology (44)
    1. The client's attitudes regarding apologizing to his/her victim and forgiving himself/herself were explored and assessed.
    2. The client was asked to complete the “Perpetrator Apology to Victim” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis) to prepare him/her to apologize to the victim and to forgive himself/herself.
    3. The sincerity of the client's remorse was assessed to determine his/her ability to make a genuine apology for the abuse.
    4. The sincerity of the client's remorse for his/her sexual abuse was questionable.
    5. The client seemed sincere in his/her remorse and regret for his/her acts of sexual abuse.
    6. The client's barriers to making a genuine apology were addressed and processed to their resolution.
  45. Letter of Apology (45)
    1. The purpose and benefit of writing a letter of apology to the victims of his/her sexual abuse were explored and processed with the client.
    2. The client was asked to write a letter of apology to his/her victim that is genuine.
    3. The client's written letter of apology was presented and processed, and feedback was given on his/her letter of apology regarding its sincerity and genuineness.
    4. The client was given direct feedback on the lack of sincerity and genuineness in his/her letter of apology.
  46. Role-Play Verbal Apology (46)
    1. Role-play was used with the client to assess his/her readiness to verbally apologize to the victim and to evaluate what further work needs to be done.
    2. Role-playing revealed that the client is ready to make an apology to the victim, and that process was set in motion.
    3. Role-playing clearly identified the issues that the client still needs to work on in order for him/her to be at the point of making an apology.
    4. Role reversal was used with the client to further his/her sensitivity to the feelings andreactions of the victim.
  47. Support Apology to Victim and Family (47)
    1. A family session was conducted in which the client, in the presence of his/her family, apologized to the victim and victim's family.
    2. The apology session was processed with the client, and his/her feelings were identified and expressed.
    3. The client's follow-through on giving a sincere, genuine apology was affirmed andreinforced.
    4. The victim's feelings toward the abuse and the perpetrator were explored and processed during the apology session.
  48. Identify Relapse Triggers/Coping Strategies (48)
    1. Education was provided to the client regarding identifying, recognizing, and handling triggers that could cause a relapse into perpetrating sexual abuse.
    2. The client was assisted in specifically identifying his/her sexual abuse relapse triggers.
    3. The importance of maintaining awareness of sexual abuse relapse triggers and behavioral/cognitive coping strategies for sexual abuse relapse triggers was emphasized with the client.
    4. The client was asked to complete the “Thought-Stopping” exercise from the Adolescent Psychotherapy Homework Planner (Jongsma, Peterson, and McInnis).
    5. Specific behavioral and cognitive strategies were developed for each of the client's identified sexual abuse relapse triggers.
    6. Role-play and behavioral rehearsal were used for the client to practice implementing the behavioral and cognitive coping strategies developed for his/her relapse triggers.
    7. The client was reminded of the importance of maintaining an awareness of relapsetriggers and timely use of the cognitive and behavioral strategies.
  49. Develop and Process an Aftercare Plan (49)
    1. The client was educated on the components of an effective aftercare plan to prevent future sexual abuse perpetration.
    2. The client was asked to develop a written aftercare plan.
    3. The aftercare plan developed by the client was processed in a family session, and family input and feedback was incorporated into a revised aftercare plan.
    4. A copy of the finalized aftercare plan was given to each family member.
    5. The client was assisted in implementing his/her aftercare plan.
    6. The client was monitored and redirected for implementation and follow-through on his/her aftercare plan.
  50. Hold Checkups and Give Feedback (50)
    1. Regular checkup sessions were held in which the client's aftercare plan was reviewed for its effectiveness and his/her follow-through with its components.
    2. After review, the client was given feedback on the aftercare plan and necessary adjustments were suggested.
    3. The client's failure to follow through with the aftercare plan was identified, addressed, and resolved.
  51. Report Revealed Sexual Offenses/Process Outcomes (51)
    1. The client was informed of the therapist's legal requirement to report any sexual offenses that are revealed to him/her.
    2. Sexual offenses revealed by the client were reported to the appropriate authorities.
    3. The client reported the outcome of the investigation and the results were processed.
    4. Issues of responsibility for behavior and respecting personal boundaries were processed in regard to the incident of sexual abuse perpetration.
    5. The client was firmly confronted on his/her failure to take responsibility for the incidents of sexual abuse perpetration.