Dear Caregiver:
This letter will explain the process of developing a “Therapeutic Supervision Plan” for your family and your child who has concerning sexual behavior. You have probably just begun treatment and might still be in shock over the discovery that your child or teen has engaged in sexual behavior. Until all the dynamics surrounding the sexual behavior is figured out in therapy, it is essential that your child be strictly supervised for the first 3 months. If your child or teen is showing good judgment and following the rules, changes in the level of supervision will be considered. One thing that will likely never change is that the youth with Problematic Sexual Behavior (PSB) can never ever be alone with the child he/she has abused until that child is 18 or 19. This is the one rule that is consistent and constant for every client and family when there is sexual behavior between the children, even if they are the same age. I understand that this is likely a hardship on you, the caregivers and I will do all I can to support you.
Therapeutic Supervision Plans are different than the other plans from providers.
If you are involved in Juvenile Court, there are likely other rules your youth is expected to follow. Child Protective Services also asks families to commit to providing physical safety for the children in the home and they may have asked you to comply with a “Safety Plan”. Safety Plans may include having door alarms or requiring separate bedrooms. The “Therapeutic Supervision Plan” is different from a CPS Safety Plan because it is designed to meet different goals. I want to make sure that all the requirements and rules for your family do not conflict with each other. Sometimes, I can help other agencies or providers understand that a rule might not be therapeutic and needs to be adjusted. The Therapeutic Supervision Plan is a joint effort between me, the therapist, the youth and all caregivers.
Therapeutic Supervision is NOT for punishment, it’s for safety.
One of the most important things I want you to hear is that a “Therapeutic Supervision Plan” is NOT punishment, although it might FEEL restrictive to all involved. A very serious thing has happened, sexualized misbehavior, and something has to change in order to prevent this from happening again. The first thing that needs to change is the level of supervision. The number one thing that prevents problematic sexual behavior is adequate supervision by adults, primarily because the adult is there to help the youth learn new social skills, manage their feelings and give guidance with problems “in the moment” that they are happening. I know it might seem as if you are being punished for something your child has done, and it does not feel fair. I get it, and I am happy to meet with you alone to talk about this issue more. As caregivers, taking away privileges or giving consequences is the gold standard for handling ordinary misbehaviors. Severe punishments such as endless grounding, spanking or denial of all privileges will not help this kind of problem. This type of misbehavior (PSB) is based in emotional difficulties and needs to be solved with therapeutic interventions. Overly harsh statements, comments or punishments will actually make things worse for your child’s ability to have healthy sexual behavior in the future. If this has already happened, please let me know IN PRIVATE so we can make changes without any loss of “authority” in your family.
Rationales for supervision
Your child or teen is likely to groan and complain about being watched (supervised) and may throw out the “don’t you trust me?” argument. Please hold firm, you are the adult and therapeutic supervision is not about trust, it is about safety. For example, every child or teen wears a seatbelt while riding in a car. The seatbelt is there to protect them in case of a car accident, not because you “don’t have trust” and expect a car accident. Therapeutic supervision will keep your child or teen safe in case of an accidental inappropriate sexual situation. Supervision of your child is similar to other examples of having new rules to provide safety or prevent future problems such as: TSA procedures at airports, drug testing from employers, or having only one location in your home for the car keys, which you place there every! single! time!
Another rationale for direct supervision is to limit the chances of a false allegation or misunderstanding about the motivation or nature of a behavior. For example, if another child complains or over exaggerates an interaction, an adult is available to verify the situation and give more context to what really happened. Most importantly, depending on the circumstances and age of your child or teen, another legal charge or allegation of sexual assault may mean that outpatient treatment is no longer be an option. It is likely that a youth will be arrested and put into a detention center or sent to a residential treatment facility. Direct supervision will reduce the chance of a youth having the opportunity or temptation to engage in another unhealthy sexual act. On a more positive note, if everyone is adhering to the Therapeutic Supervision Plan, all family members can relax and be less worried about another incident of sexual abuse; which means there will be more time to enjoy each other and improve relationships. This is what I refer to as Emotional Safety, which just so happens to be a key factor in making progress in treatment.
Direct supervision means D-I-R-E-C-T supervision
The first thing on the list of expectations for you is that the supervision will be “Eye Line of Sight” or “Within Ear Shot”. Eye Line of Sight means that you are able to see your child or teen interact with others, by simply lifting your head. There is a direct line of sight between your eyes and their eyes; you will not have to move one step. Within Ear Shot means that you can hear what the children are talking about, even if you pretend not to notice. This will help you to know what is happening with the child or teen and then you can intervene to: teach social skills, help with sharing or conflict resolution, or stop sexualized talk or behavior. If you must leave the room, to answer the phone or use the restroom, please make arrangements so the youth with PSB is not left alone with another child. I will help you accomplish this with grace and skill so the interaction seems natural and is not noticeable to others. The goal is to provide safety without increasing the level of shame for the child with PSB.
This level of supervision might seem extreme, but unfortunately, not maintaining this level will put your child or others at risk. Other children I have known have tried to touch each other sexually while riding the back seat of a car or under the table a restaurant, so I have learned that we cannot be TOO careful. This highest level of supervision will not last longer than what is absolutely necessary. However, if this level of supervision is really too much for you, I understand. But that might mean your child or teen will have to live somewhere else, where there are no other children.
Therapeutic Supervision is always evolving based on needs.
While we do all we can to make the level of supervision appropriate for your child or teen’s problem solving skills and maturity level, there is almost always the need to “tweak” the plan as treatment continues. There are often situations that require the type of supervision to be increased or decreased, which will be discussed during a family therapy session. Any school aged child is expected to be generally compliant with the plan (especially if they are involved in creating it) and caregivers are expected to implement the plan 99.5% of the time. Although this is the goal, let’s face it, “life happens” and occasionally the supervision plan is not or cannot be followed by you, the caregiver. Please don’t be fearful or embarrassed to tell me about a glitch in the supervision or if the plan is not practical, it does not mean your child will be removed. Plus, if we can identify possible solutions during a family session, it would be a good opportunity to role model how to admit mistakes and use negotiation skills to prevent issues in the future. My goal is to modify the plan based on what you and your child and your family needs, which is probably changing day to day. Lastly, your child is not likely to comply with all the rules of our plan 100% of the time either, so please respond to any non-compliance in a calm manner. We can talk about what kind of consequence, if any, should be given to your child if they break a rule. Most likely, something needs to be changed, and it takes some trial and error to figure it all out, so don’t panic if your child is not able to comply with the plan, there may be something else going on.
Find the right person to supervise in a therapeutic way.
Sometimes it is necessary to have other adults supervise your child or teen with problematic sexual behavior. We recommend that this be an adult who has basic knowledge of your child’s problem and agrees to comply with the level of supervision needed with compassion. Many behaviors that lead to problems seem innocent on the surface and would not raise a red flag to the average person. Older siblings or young adults may not be suited for this type of supervision and should be discussed on a case by case basis. Younger siblings should never be put in the role of supervising a youth with PSB; this alters the family dynamic and creates an unhealthy balance among siblings that could facilitate other types of problems. It may or may not be helpful to inform school personnel of your child’s problematic sexual behavior. If the school requests a “school safety plan”, please discuss this with me as this document will likely remain in your child’s permanent school record and sometimes I can help the school manage this is a different way.
Therapeutic Supervision is intended to improve other relevant areas of concern.
We hope and expect families to do more than just intensely supervise their child or teen. Your child probably has at least 6 to 10 factors that have contributed to their problem with sexuality. These issues also need to be addressed and many families implement a host of “New Rules” for their family. For example, you may find it helpful to enforce rules such as modesty and monitoring of technology for every child in the family, not just the youth with PSB. There are also “growth skills”, which allow your child to “grow” into a healthy adult; for example, developing healthy pro-social friendships, participating in school events or improving family relationships. In these cases, it maybe necessary to change the therapy schedule or find alternatives to consequences in order for the growth skills to continue. Not all of the “New Rules” will be listed on the Therapeutic Supervision Plan, so be sure you talk with me about which rules are the most critical for your child’s situation.
Other documents on my website, www.sheryloverby.com that will help in knowing which therapeutic issues to focus on are:
- New Rules after Problematic Sexual Behavior(PSB)
- Sexual Respect for Young Children under 10
- Vulnerability Factors for Youth with PSB
- Sexual Boundaries in the Foster or Adoptive home
- Supervising Social Interactions
- 11 Rules about Private Parts that May Prevent Sexual Abuse
One step at a time.
For the first draft of your Therapeutic Supervision Plan, we will focus on sexual respect and direct, line of sight supervision, that’s it. We will include common problem areas relevant to all kids with PSB plus individualized concerns based on the information presented at your intake appointment. In 3 months, we will update the plan, review areas of concern, areas of strength and level of supervision needed. There is so much information to remember at the beginning of treatment, don’t be afraid to ask for a written copy of anything I recommend. To be honest, I write up most of my therapeutic interventions anyway so I don’t forget either. You are welcome to go to my website and download anything that may be helpful to you. I’ll keep a copy of the Therapeutic Supervision Plan in my file in case you need another copy. Remember, for now, focus on sexual respect and line of sight supervision while we are learning the privacy rules and I’m here to help you with every step.
Best Regards,
Sheryl Overby, MS NCC LIMHP
Child and Family Therapist
