click on this link to download or print this information, the basics of treating Child Sexual Abuse, always good to remember the basics.

10 command treat CSA

Hello fellow therapists,

Ya know when a person says “I don’t know” to almost every question? Typically, the office rule is that “I don’t know” is not allowed  in therapy so clients have the opportunity to share their feelings and do “the work”.  But what are they supposed to say instead?  Sometimes people, especially kids, are afraid to talk about things or they want to talk about it later, but they don’t know how to express that.  Some kids are trained to always give an answer, even if it’s not true, and sometimes, they really have no idea what to say.  These cards are meant to help kids understand the choices they have when talking about difficult subjects.

So Print these cards to help people know they have a choice in what they do or do not say…… and sometimes, “I can’t remember” is the correct answer!

click here:  what to say cards

Diagrams of how family is structured.

i’ll add more info later

CLICK HERE:  family structure worksheet


Here is a resource that therapists can  use to help kids manage their urges so they do not make UNWISE choices.  I have specifically chosen NOT to use the words “unhealthy”, “poor”, “wrong” or “negative” to describe the option of making a choice that is regrettable.   I have chosen the word UNWISE because the thinking part of  the brain is not as involved in the choice as the emotional part  of the brain or other parts of the limbic system.  As adults we make UNWISE choices everyday and we can not expect kids to be better at this skill that we are.   But kids are learning how to manage their thought processes and these cards can remind them from outside their own brain, the things to think about when learning to control an urge.  These cards can be used with struggles with stealing, looking at pornography, non-suicidal self harm, masturbation or over eating; basically anything in which the person feels compelled to make an UNWISE choice.  The attachment shows an example of the ideas I have used with my clients.  You are free to use whatever cards you would like.


Use this photo to help you understand how they can be assembled.

You might want to recopy the items onto smaller cards and put them onto a metal ring so the youth can carry them around.

Even better, have caregivers use these cards so they can improve decision making and controlling urges.

When things are so frustrating, you barely know what to do, this card may help.  Please put something in each square of the card, then you will have pre-planned ways to help yourself; ways to give yourself some comfort when life really gets rough.

The six parts of the card are………….

  1.  Thing:  This can be anything that you can hold, a photo, a fuzzy blanket, a piece of jewelry from your grandmother. If you are a teen, this item is likely a phone, or a similar electronic device which takes on the purpose of a security blanket. This “thing” may also be a pet, but for some folks, a pet falls in the category of “person”.
  2. Place:  Think of someplace where you can go where you feel some peace or comfort, just by being in that place. It must be a place that you can get to within one hour of travel, so being in Nebraska, this is not the mountains or the ocean. If you are a  child, it needs to be a place you will always have permission to go to, like your room or the fort in your backyard.
  3. Person:  The ideal person is someone that makes you feel loved and special even if you do not talk about what is bothering you. If this person has died, then scents and odors are very powerful in re-creating the same feelings and memories you shared with this person.  Like I said in number one, this “person” could also be beloved pet
  4. Food/Drink: It is pretty easy to think of comfort food or drink.  Most people have a favorite when they are stressed, feeling ill or when it is  a special occasion.  Alcohol and large quantities of food may or may not be a good choice for you.  In fact, all of the items on this card are meant to be used in moderation.  The idea is to use many different kinds of things to help distract yourself when stressed or upset.
  5. Image/Memory:  This is something you can picture in your mind that will help you remember a positive event or feeling. It may be an actual memory of a vacation or visiting a calm place.  You can also invent something on your own, like a deserted tropical island with unlimited chocolate and a personal maid.
  6. Activity:  For this category there are two kinds of activities that can bring you comfort.  The first one is an energy releasing activity.  This would be something like cleaning, dancing, running or jumping on the trampoline.  Something that will help you get all of the stress out of your body, something that gets your heart rate up for at least 20 minutes.  The second one is a soothing activity.  Something that will help you relax and lower your heart rate.  This could be a bath, meditation, reading, listening to music or an old fashioned nap.  Please include both ideas in this box, ‘cuz sometimes you need one or both of these types of activities.

To print out your own comfort card, please use this pdf:       COMFORT THY SELF

So, if you survived Psychology 101 in high school or college, you probably know about Maslow’s Hierarchy of Needs.  The idea that each person has biological and psychological needs that must be met in order to achieve “actualization”.  The basic rule is that the lower needs have to be met BEFORE it is even possible to meet the higher needs of the pyramid/triangle.  I have applied this idea to the emotional needs of children.  This has helped me describe the emotional needs of children to the families that I work with.

Click on this link to see the diagram in a PDF file that you can print.

emotional needs pyramid


The idea of restorative justice and restitution has long been a part of probation protocols or requirements for youth who have illegal sexual behavior.  Almost all programs ask a youth to write clarification/apology letters to caregivers or the child they abused.  When working with young people who have sexually harmed, this process can be even more therapeutic.  Especially in the case of sibling sexual abuse; the children involved in the sexual abuse will likely be living together again.


Although clients and families may benefit from reading these articles, the ideas in these articles are intended ONLY for therapists, preferably therapists well-trained to treat children and teens with Problematic Sexual Behavior.

I have written six articles to assist therapists with the process of clarification, which I have renamed Therapeutic Reparation. These are the steps I take when helping youth with PSB achieve healing for the child they abused, their families and themselves.  I have included details in the links below about each part of the process, which can be applied in most cases. If you are a mental health provider and would like more information, please contact me for consultation, or check other articles on this website.

Good Luck

Part 1 understanding reparation

Part 2 helping a youth take accountability

Part 3 accountability family session

Part 4 caregiver letter of support

Part 5 Apology Letters

Part 6 the reparation project



When very young children are processing their sexual abuse in treatment, it may be very difficult for them to figure out their thoughts and feelings about the person who hurt them. One technique is to have them complete a worksheet that can be sent or given to the person who is responsible for the sexual abuse. This worksheet may or may not actually be sent to the person, but the child is likely to feel better if they can give that person a message in writing.

Click on the links below to view a worksheet that maybe helpful to a preschool child.

questions from preschool girl

questions from preschool boy





Each family and situation is unique and The Privacy Rules can be tailored to suit your individual needs.  Please consider the development, emotional maturity and past behavior of the child.   I recommend that the child or family make their own poster by choosing which cards to use and what the title should be.  Then they can use their own creativity to decorate it and post it in the home.  If you would rather just download the list, then that is fine too.   Please read the post on this site called “The 9 Rules about Private Parts that may Prevent Sexual Abuse” for more information on how to explain the privacy rules to children. 

Hover your mouse over the titles and click on them to be linked to a PDF that you can print out and use.

The basic Privacy Rules for anyone who will grow up someday, own a mobile device or know how to use google images.  privacy rules cards

The Privacy Rules for pre-teens or anyone who has at least one underarm hair, or thinks the pictures on the other cards are way too dumb for them.  The youth can make their own title and decorate the numbers and keep the list safely hidden where no peer can find it….which is fine, as long as they follow the rules.   privacy rules no clipart

Credit for knowing about privacy rules goes to the lovely folks at Oklahoma University and NCSBY.


All children seek the verbal or non-verbal feedback from the adults in their life to understand themselves.  A caregiver can provide encouragement, hope and a vision of a positive future for youth with Problematic Sexual Behavior.  I believe that putting these thoughts in writing makes it more sincere to the child and enables the youth the opportunity to re-read the information whenever needed.  Please use your own language and make the letter as authentic as possible.  Thanks in advance for your time and effort.

Here are five ideas about what to include in a letter:

1. Praise your child for the changes they have made with concrete examples; things you have noticed.  Such as:

  • Attending therapy
  • Admitting to the problem
  • Accepting their consequences
  • Doing better at school or completing chores
  • Putting forth effort, reading this letter for example

2. Briefly tell your child how you have accepted that they have made a mistake with their sexual behavior AND you believe they are capable to fix their wrong doing or learn from this event. (see handout of “What Caregivers Can Say” if you are stuck.


3. Encourage and support your child with physical and emotional needs.  Please give one or two concrete examples of how you will be supportive.  Perhaps:

  • Attend family sessions and pay for appropriate therapy without complaining
  • Have empathy for them, try to understand their thoughts and feelings, even if they haven’t completed treatment yet or you don’t “get it”.
  • Show respect by listening to them, or leaving them alone, etc. etc.
  • Change things in the home environment to encourage sexual respect and reduce objectification

4. You will guide your child to make good choices and do well in the future, such as:

  • Stay committed to treatment or whatever else is needed in the future
  • Helping your child to work out more issues in therapy
  • Maintain the safety plan or supervision so they will have an opportunity to succeed, even though they don’t like it
  • Provide more opportunities to do well in school or extra curricular activities
  • Maintain hope for positive outcomes in the future “because you have so much potential”

5. Model taking responsibility  if you have made a mistake or have a regret for your own behavior.  Make sure you do not burden your child with your own problems or minimize their accountability for their own behavior.  Show them that there is hope of being a better person in the future. Possible examples are: 

  • Under-reacting after disclosure of the problematic behavior such as not providing supervision or getting treatment right away
  • Not providing appropriate sex education when it was needed in the past
  • Not providing your child with treatment if it was needed in the past
  • Making things worse by over reacting; thinking this was the end of the world (catastrophizing) or predicting failure
  • Anything that has made this process, including court or treatment, longer or more complicated.




There is not a single risk factor that is strong enough to cause a young person to have sexualized behaviors (PSB) with another child. Usually, there are at least 6 or 7 factors involved. To get a full assessment of a child’s overall functioning, I would recommend meeting with a Psychologist who specializes in this area. The most helpful way to use this list is to identify areas of concern to prevent inappropriate behaviors in the future. If you have questions, or want more information, please contact me at Woodhaven Counseling Associates in Omaha, NE or


per Wm. Freidrich Ph.D. Book: Children with Sexual Behavior Problems; Family Based Attachment-Focused Therapy
 Exposure to domestic violence or aggressiveness between parents or other adults in home
 Youth exposed to elicit sexual activity or images or information (pornography)
 Modeling of Coercion by adults: authoritarian parenting style, spanking, physical aggression, verbal threats
 Parental Stress and adversity: divorce, death, legal problems, job loss, drug/alcohol use, depression
 Overly permissive sexual attitudes in home
 Youth has poor social skills
 Youth has poor coping skills
 Nudity or lack of modesty in home
 Youth has seen a lot of violence in peers and /or community
 Poor supervision when youth is with other kids
 Youth has poor impulse control; acts w/out thinking
 Developmental delays compared to other children
 Lack of guidance, child is left on their own too much
 Physical abuse or physical harm to the youth
 Sexual abuse history; hands off or hands on offenses


 Emotional abuse of children in family: ignored, bullied, threatened, verbal abuse
 Overly permissive parenting in general
 Repressive or punitive sexual attitudes in family
 Not providing any explanation for age appropriate sexuality
 Chaotic home life; no schedule, rules change often
 Poor family boundaries; too tight or too loose
 Parents not responsible for family’s wellbeing
 Poor family communication
 General family dynamics are extreme
 Low income or poverty; lack of shelter or food
 Intense rivalry between siblings, sometimes unknowingly fostered by parents
 Adults confused about own sexuality or victims of childhood sexual abuse
 Children rely on each other to be soothed, rather than adults
 Parents have had extra marital affairs
 Children disliked or treated differently by parents for reasons not related to the child
 Caregivers unaware of current trends of sexuality on internet/social media


 Social alienation and isolation
 Bullied by peers, feels inferior in peer group
 Lack of same age peer friendships
 Aggressive or threatening to others
 Coercion from peers re: sexuality
 Uses sexuality to form friendships
 Uses sexuality to “look cool” with peers


 Alcohol or drug or pill abuse by the youth
 Uses sexuality to feel strong or powerful
 Uses sexuality to feel affection & love
 Uses sexuality to meet other emotional needs
 Unable to manage sexual arousal appropriately
 Inability to delay gratification
 Overwhelmed by depression or anxiety
 Extreme mood swings or emotional meltdowns
 Can’t think of non-sexual solutions to problems
 Breaking rules at home, school or community
 Has excuses for any wrong behavior
 Feels so special that he/she doesn’t have to follow the same rules as everyone else
 Inability to think for self or make own decisions
 Low self esteem, feels unworthy of a happy life
 Sexual interest in young children
 Is generally coercive in relationships with others
 Criminal history of other types of offenses
 Poor grades in school, lack of interest in school
 Preoccupied with sex and sexuality


 Unable to understand information during sex education from school or parents
 Emotionally immature
 Too young to understand sexuality
 Undeveloped conscience or morals
 Pre-mature puberty, biological and growth factors


 Presence of vulnerable people that could be harmed or tricked into keeping secrets
 Normal sexual outlets for age are limited or not allowed
 Has powerful or controlling role with possible victim (ex: babysitter, older sibling)
 Too much time with TV and video games


 No monitoring of internet use by caregivers (software filters don’t count)
 Crowded living conditions (no private bedrooms)
 Youth has chronic stressors in personal life
 Child observed adult sexual behavior without explanation or ability to understand
 Exposed to traumatic or scary events

Sheryl Overby’s Personally Recommended



I keep a running lost of resources that are I use personally and recommend often to other professionals or consumers/clients.  If you know of an especially great resource, please let me know via email.  We need all the help we can get and sharing resources is something we can all do. Click on the link below to get my latest list of resources concerning sexual respect, sexual health, sexuality, youth culture and sexual behavior problems….

Sheryl’s favorite resources (2021)