Children and Adolescents with Problematic Sexual Behaviors:

Children and Adolescents with Problematic Sexual Behaviors:
Lessons from Research on Resilience
Jane F. Gilgun
University of Minnesota, Twin Cities
6100 words
Key words: resilience, developmental psychopathology, child sexual abuse, antisocial behaviors, emotional and behavioral self-regulation, pro-social behaviors, selfdestructive behaviors
Running head: Gilgun chapter
To appear in Current perspectives on working with sexually aggressive youth and youth with
sexual behavior problems, Robert Longo & Dave Prescott (Eds.). Holyoke, MA: NEARI
Jane F. Gilgun, Ph.D., LICSW, is professor, School of Social Work, University of
Minnesota, Twin Cities, 1404 Gortner Avenue, St. Paul, MN 55108 USA. Phone:
612/624-3643; e-mail: [email protected] She does research on how persons cope with
adversities, the meanings of violence to perpetrators, and the development of violent
behaviors. She has published widely in these areas, as well as on qualitative
research methods and the development of clinical assessment tools.
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Children and Adolescents with Problematic Sexual Behaviors:
Lessons from Research on Resilience
Children and adolescents with problematic sexual behaviors typically have
experienced adversities, but this by itself does not account for their inappropriate
behaviors. If there were a direct route between adversities and outcomes, then all
persons with risks for sexually problematic behaviors would have them. This is not the
case. Such a simple observation leads to a search for factors that moderate the effects of
adversities on behaviors. Developmental psychopathology provides many important
ideas about outcomes, risks, vulnerability, and protective factors that moderate the
effects of risks.
This subfield of developmental psychology studies high-risk groups, usually
longitudinally, for the purpose of identifying factors that lead to good and poor
outcomes under adverse conditions (Luthar, 2003). Persons who don’t have the negative
outcomes associated with risks they have experienced are termed resilient. Thus,
children and adolescents who have risks for developing sexually inappropriate
behaviors do not do so because they have actively engaged with resources in their
various environments that help them to cope with, adapt to, and overcome these risks.
The purpose of this chapter is to show how research and theory on resilience
contribute to assessment and treatment planning for children and adolescents with
problematic sexual behaviors. This body of knowledge has a great deal to offer
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practitioners who are on the lookout for good ideas that they can use in their therapy
and psychoeducation programs. Increasing numbers of programs are incorporating
these ideas to the advantage of clients.
Children and young people themselves have ideas about their own resilience,
and our task as practitioners is to find the “hidden” resilience in behaviors that are
harmful and sometimes illegal (Gilgun & Abrams, in press; Ungar, 2004). I will end this
chapter with an overview of their points of view.
I do this because effective
interventions start where clients are; that is, they seek to connect with clients’ points of
view and build assessments and treatment plans from there.
Research on Resilience
Research on resilience has much to offer treatment professionals. Foremost is an
optimistic message that persons can recover from adversities, a view that is backed by
substantial research evidence (Curtis & Cicchetti, 2003; Egeland, Carlons, & Sroufe,
1993; Gilgun, 1996a; 1999c; Gilgun, Klein, & Pranis, 2000; Masten & Wright, 1998;
Richters & Martinez, 1993; Rutter, 2000; Shields & Cicchetti, 1998; Werner & Smith,
1992; Widom, 1991). The effects of adversities, such as childhood abuse and neglect,
parental abandonment and death, and forced migration can be life-long and have
serious effects on quality of life. Yet, study after study has shown that most persons
manage to cope with and adapt to adversities and carry on with their lives in
productive, pro-social, and law-abiding ways.
This research has documented the
existence of protective processes, which by definition, are factors that moderate the
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effects of adversities and are associated with capacities for personal well-being and
Adaptation, Vulnerability, and Dysregulation.
When individuals experience adversities, they adapt, and these adaptations fit
the types of adversities they’ve experienced. For example, being on the alert for the
sound of footsteps and the angry utterances of a drunk parent with abusive tendencies
will lead children to hide or escape the family home until the drunk person passes out.
Such situations can result in hypervigilance, which can be protective when it leads
individuals to avoid future frightening and dangerous situations. Children who behave
this way are displaying adaptive behaviors whose intent is to ensure at least some wellbeing and even survival. They are coping with and adapting to noxious events.
Yet, such children are vulnerable to anxiety in situations that are safe but that
trigger memories that a drunk, violent parent is about to arrive. Vulnerabilities
represent residual emotional and psychological hurt. These hurts can be thought of as
psychic wounds that may require life-long effort to manage. These wounds are like
“hot buttons” that environmental cues may set off, activating the reliving of past
trauma and other troubling responses.
Many individuals have resources such as
supportive families and a history of secure attachments that result in capacities for
engaging in process that help them cope with this hurt. Despite the availability of
resources, persons with psychic wounds are vulnerable to dysregulation, when they are
in situations that evoke earlier adversities.
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When dysregulated, children experience a sense of unmanageability of their
thoughts, emotions, and behaviors (Shields & Cicchetti, 1998).
Their autonomous
nervous systems, too, may be dysregulated. They are likely to have such emotional
statues as anxiety, depression, withdrawal, lethargy, hyperactivity, and bouts of crying,
bed wetting, sleep disturbances, and oppositional behaviors.
When dysregulated, individuals seek to re-regulate; that is, to regain selfefficacy, control, and mastery over themselves and their various environments (Gilgun,
in press). Re-regulation can occur in three general ways: pro-social, anti-social, and selfinjurious.
Pro-social efforts to re-regulate include seeking comfort and affirmation from
attachment figures, talking to someone about the hurt and confusion and finding
that this helps, channeling the negative affect into positive behaviors such as
physical exercise and artistic expression, and seeking ways to reinterpret meanings
of the hurt away from the self as worthless and helpless to a sense of self as good
and competent.
Anti-social efforts to re-regulate include effacement and destruction of property,
teasing and taunting others, bullying, physically aggression, acting in sexually
inappropriate ways which can provide temporary relief from the subjective distress
of dysregulation, stealing and other oppositional behaviors. School shootings are
extreme examples of young people using anti-social methods of re-regulation. From
individuals’ point of view, anti-social acts typically are attempts to restore a sense of
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honor, self-respect, and a form of impression management. Persons can be strongly
motivated to show others that they are not wimps and sissies but strong, forceful,
and worthy of respect and even awe.
Self-injurious efforts at re-regulation include cutting, anorexia, bulimia, use of drugs
and alcohol, suicide attempts, recklessness, and playing with guns and other
weapons. These behaviors, too, provide a sense of relief and a restoration of sense of
The consequences of these behaviors show another aspect of the human
dilemma of solutions that become part of the problem. The relief is temporary and
may lead to further dysregulation and a cycle of self-destructive behaviors.
Efforts at coping take place over time and often contain a mixture of these
general classes of behaviors. For example, the immediate response to a noxious event,
such as an incident of being sexually abused, can be psychic numbing, followed by selfdestructive negative thoughts, overeating, aggression toward others, and seeking
comfort from an attachment figure. Furthermore, some people may cope successfully
with some adversities, but find their capacities to be overwhelmed by others. Positive
coping and resilience, then, are not all -or-nothing processes but are situational and
dependent upon the meanings the noxious events have to individuals affected, the
other risks that are activated, and the availability of resources on which individuals
may call.
Protective Processes
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Research has shown that children and adolescents who have experienced
adversities tend to manage well in a variety of situations if they have engaged in
protective processes (Curtis & Cicchetti, 2003; Gilgun, 1996a; 1999c; Gilgun, Klein, &
Pranis, 2000; Masten & Wright, 1998; Rutter, 2000; Shields & Cicchetti, 1998; Werner &
Smith, 1992). These can include a long-term caring relationship with at least one other
person with whom they share personal and painful experiences.
These persons also
model pro-social behaviors that they encourage and reward in younger persons, who,
in turn want to emulate these positive persons. The younger persons thus internalize
favorable working models of themselves, others, and how the world works. These
working models are likely to guide them toward pro-social ways of dealing with other
stressors and adversities, or minimally, serve to counteract inner working models that
channel thoughts, emotions, and behaviors toward destructive actions.
In my own research, I have found that emotional expressiveness is the single
most important protective factor that differentiates persons with problematic sexual
behaviors from persons who do not have these behaviors (Gilgun, 1990, 1991, 1992,
1996a, 1996b, 1999; 2000). Other protective processes associated with good outcomes
under adverse conditions include
A confidant(e), who can be a peer or an adult, either inside or outside of the family,
and with whom the at-risk person reciprocates a sense of closeness, seeks support
and counsel during times of stress and fear, and freely shares painful personal
issues; typically persons who show resilience have relationships of more than two
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years with both peers and adults, who can be parents, siblings, peers, coaches,
teachers, parents of friends; supplemental confidantes can be journals or diaries
young people keep, or other forms of verbal expression such as writing poetry or
stories; playing musical instruments, drawing, and sculpture are not verbal avenues
of emotion expression. Some young people have no one to confide in for many
years, but, in my research, they know that they are stressed and hurting. They also
do not hurt other people, and they seek situations where they feel safe such as
libraries or the corner pool hall. When they finally find someone whom they think is
safe, they do confide sensitive, personal information.
A strong desire to be pro-social, persons with this quality consciously and actively
seek to do no harm to others. Thoughts of hurting others may evoke their own
psychic pain, and they do not want to inflict this pain on others. Theories of human
agency recognize that persons have choices, but their choices are limited by their
personal experiences that take place at particular times, places, and settings and are
further influenced by their gender, social class, age, income, and a range of other
status variables.
A favorable sense of self that challenges inner representations of the self as bad and
these are positive inner working models that arise from secure
attachments, long-term caring relationships, confidant relationships and from a
personal sense of competence in a range of areas, such as emotion regulation and
forming relationships;
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Doing something positive really well, such as reading, athletics, drawing, riding a
bike, etc., and getting positive attention for these accomplishments; research on selfefficacy and competence have emphasized how important this quality is for
surviving adversities and developing resilience (Masten & Coatsworth, 1998);
The ability to engage in self-soothing behaviors; for example listening to music,
engaging in affirming self-talk, physical activity, and imagining a fulfilling future;
An affirming, gender, ethnic and cultural identity; these various identities shape
who we are; in cultures that convey an “us and them” mentality,” children and
adolescents who are typed as “other” are at risk for adverse outcomes; they may
internalize negative stereotypes and for a variety of reasons act out these inner
representations of self, others, and how the world works;
Hope for a positive future, capacities to imagine a positive future and seeking
and using resources that build that positive future; some young persons who
have experienced multiple adversities may have unrealistic expectations about
what they can achieve. An example is wanting to be a movie star or a multimillionaire athlete. Hope, resources to achieve dreams, and efforts that engage
these resources are significant components of this protective factor.
Key elements of protective processes include whether young people want to behave in
pro-social ways and whether they engage with the personal, familial, and social
resources that are available to them (Gilgun, in press).
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Researchers and practitioners have observed these protective processes in
natural environments, where young people have developed them in response to the
resources available to them. Practitioners can seek to foster these processes in treatment
and psychoeducation programs. Typically, a combination of factors lead to pro-social
outcomes, but it is unlikely that pro-sociality comes about without capacities for
emotional intelligence (Goleman, 1995), both in terms of knowing and expressing one’s
own emotions in appropriates ways and also connecting to and having empathy for the
emotions and situations of others.
Most children and adolescents with sexual behavior issues have experienced
substantial adversities, and these must be identified and dealt with if treatment is to be
effective. The younger the person when their problematic sexual behaviors first appear,
the more likely they have experienced adversities, such as being victims of child sexual
abuse that adults leave unattended or mismanage. Immediate, constructive responses
to children who have been sexually abused greatly reduce the risk of long-term harm
and of the child perpetrating child sexual abuse themselves.
Treatment professionals also must develop strategies to deal with the messages
that young people receive from within their cultures about appropriate behaviors, life
goals, and how to achieve them. For children and adolescents with sexual issues, these
culture-based messages are usually gendered; in that certain behaviors are encouraged
in females and others in males, with both rewards and sanctions meted out according to
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how well individuals live up to these gendered, culture-based expectations (Brody,
Children and adolescents absorb information about expectations for themselves
as females and males, and they understand that non-conformity may subject them to
ridicule and social isolation. They learn how to behave as gendered persons not only
from how other persons treat them and how their behaviors influence the responses of
others, but also from observations of the gendered behaviors of others, including
representations in mass media. They notice and internalize which behaviors are valued
and which are not.
Gender is a core identity and frequently operates outside of
Unfortunately, gender stereotypes about males discourage expression of some
emotions, such as fear, hurt, compassion, and shame. Admitting weaknesses, backing
down from a fight, and crying invite ridicule and social isolation.
expressiveness, therefore, is difficult for many boys and young men to attain because of
social pressures. Thus, they are at risk to distance themselves from resources that might
help them to cope with, adapt to, and overcome adversities and other risks for
problematic outcomes. They may see the acting out of gender stereotypes as a more
acceptable way of restoring a sense of personal power and integration when they are
dysregulated than expressions of distress and vulnerability. Over time, they may rely
on physical and even sexual aggression to restore an integrated sense of self and self
respect, however temporary these outcomes may be.
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Girls receive a more positive reception of their expressions of hurt and
powerlessness and therefore are at lower risk to resort to aggressive sexual behaviors to
deal with the effects of the adversities they have experienced.
Female stereotypes
encourage help-seeking behaviors and direct efforts to relieve their psychic pain as
compared to male stereotypes. Thus, girls appear to be less likely to develop sexually
inappropriate behaviors that harm others, first, because they are positioned to deal
directly with hurt and vulnerability, and, second, because gender stereotypes
discourage sexual and physical aggression. How individuals absorb these stereotype
varies a great deal; thus, each young person in treatment must be carefully and
individually assessed to see if and how gender stereotypes play a role in sexually
problematic behaviors.
Though there are major variations in the risks and resources that male children
and adolescents bring with them as they enter treatment, they are likely to be faced not
only with learning how to cope more effectively with adversities, but they also have to
re-learn what it means to be male in this culture. By engaging in treatment, male
children and adolescents are faced with the incredible difficult task of changing deepseated ideas that go to the core of their identities as males and as worthy human beings.
Girls, on the other hand, are less likely to be referred to treatment for sexual
acting out. When they are, they often have several mental health diagnoses and may be
far more disordered and confused than most boys who are in treatment for sexually
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inappropriate behaviors.
Their mental health issues may be more prominent in
treatment than how they have internalized and acted out gender stereotypes.
In treatment, practitioners could develop protocols that guide the identification
of environmental cues that activate stereotyped, gendered-based styles of coping. Once
children and adolescents and people with whom they are in frequent interaction
identify hot buttons that result in harmful actions, children and adolescents may be
closer to managing their sexuality in appropriate ways.
Identifying these hot buttons, however, is only part of the processes that young
people have to undergo. They have to reexamine and re-interpret the adversities they
have experienced, which can be a long-term and painful process, and they may have to
develop new ideas about what it means to be male and female. Family members and
other persons with them they interact are essential to the profound changes that
treatment requires. Sadly, many children and young people in treatment for sexually
inappropriate behaviors do not have families who will engage in treatment and
processes of change.
Seeing Resilience in Sexually Inappropriate Behaviors
Another challenge for treatment professionals is to see resilience—or positive
qualities—in sexually inappropriate behaviors. If we are to build on client strengths,
then we have to identify and engage these strengths. If strengths are embedded in
behaviors that are destructive, then we can develop strategies for extricating them and
putting them to more positive uses. For example, a great deal of thought and planning
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often goes into acting out sexually. Though the outcomes for others and the self are
harmful, thought and planning are positive capacities.
When children and young
people trick and manipulate others, this shows creativity, ingenuity, and common
sense, which, of course, does not excuse the harm done. Most persons want to have a
sense of personal power and control, which often is part of the motivation for sexually
acting out.
How can treatment professionals channel these capacities away from destructive
behaviors to constructive behaviors?
Pleasure-seeking and or self-soothing often
motivate sexually inappropriate behaviors, but, again, how can clients achieve this
while enhancing the well-being of others and of the self? There’s nothing unacceptable
about any of these goals, but using and abusing others sexually to attain them is
harmful. Perpetrators of these acts are subject to strong legal and social sanctions, and
victims experience harm.
Ideas from research on resilience guide practitioners to do even-handed
assessments that lead to the identification of strengths and risks that sometimes are
Practitioners would do well to show clients where their strengths are,
even if clients use their strengths to meet particular goals that are harmful. Their
deeper motivations could be the same goals that most if not all people have—personal
power and control, a sense of self-efficacy, pleasure, and well-being. So, if harmful
sexual behaviors have three dimensions – 1) motivations that most people have, 2),
strengths, and 3) outcomes that are harmful -- then two of three of these elements are
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positive and they are qualities that practitioners can build on, while simultaneously
starting where clients are.
Resilience from the Points of View of Young Persons
Research on resilience, as discussed earlier, can direct attention to the positive
elements of typical attitudes that young people bring with them into treatment. I will
suggest a few of them as a way of providing examples that I hope will generated further
thinking along these lines.
Don’t Treat me Like a Dummy.
Young clients want recognition for their capacities.
When they think
practitioners and others consider them stupid or inadequate, they are likely to respond
with hostility and withdrawal, hardly a basis for collaborative working relationships.
Research on resilience provides many ideas for identifying and engaging clients’ talents
and attributes while not minimizing the negative effects of some of their behaviors. For
example, taking responsibility for one’s own behavior is a major strength, that, skilled
practitioners can encourage in young clients if they behave toward clients in ways that
affirm their capacities for doing so.
I’m Protecting Myself When I Don’t Tell You Everything
Treatment professionals know well that many young clients withhold a great
deal of information not only about their sexual behaviors but about many other parts of
their lives that might be relevant to effective treatment. Their motivations may be selfprotection and a desire to maintain some control: they don’t want to feel the shame they
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believe is associated with their behaviors, and they want to feel as if they have control
over something.
Connecting with young people may require that practitioners
recognize these motivations and devise strategies that support youngsters in managing
shame and maintaining control. This is not a simple matter, but such an approach is a
logical application of research on resilience that guides practitioners to see the strengths
in client resistance to treatment.
I Am More Than My Sexually Inappropriate Behaviors
Many youngsters may fear that their sexually inappropriate behaviors define
them in their eyes of others, and they may define themselves as hopeless deviants and
social outcasts. Though reactions of others certainly reinforce these self-appraisals,
another dimension to consider is young people’s tendencies for all or nothing thinking
that sets them up for these self-appraisals. They may also contend, in hostile or passiveaggressive ways, that they are more than their inappropriate behaviors. As another
logical application of research on resilience, practitioners have the challenge of figuring
out how to let young people know that they do have positive attributes, that their
sexual behaviors do not define them, and that they can use their positive attributes to
manage their sexuality and cope with the shame and sense of being deviant.
I Want What Everyone Else Wants
Earlier in this chapter, I argued that the deep motivations that drive sexually
inappropriate behaviors are no different from motivations that drive any number of
behaviors. Young people get in trouble when the means they use to attain these ends
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are harmful. Thus, applications of resilience research suggest that practitioners can
consider these motivations as assets, but the strategies of inappropriate sexual
behaviors as unacceptable because of the consequences.
You’re Not Helping Me If You Don’t Know Your Own Blind Spots
Young people are quick to spot deficits in others, and they may be most adept
when they appraise those who have authority and power over them. We can dismiss
these negative appraisals as yet other forms of resistance and desire for control, or we
can look at ourselves from their points of view and admit to ourselves that we have
blind spots and then seek to address them. We can admit our own mistakes to young
people and call upon our own resources to deal with them. By such role modeling,
young persons learn to admit to and deal with their own deficits. Such self-disclosures,
of course, require clinical skill and must arise naturally in treatment.
The sexually unhealthy cultures that we tolerate as adults are chief among our
blind spots. Young people who grow up in sexually healthy families and communities
have one less risk for sexually inappropriate behaviors to contend with. Young people
with sexual issues have absorbed conflicting and harmful messages about sexuality that
they internalize and act out. Thus, in treatment programs we have a responsibility to
provide young people not only with information about sexual physiology but also with
the meanings of desire, how love and sexuality are connected, and how we can use our
sexuality to enhance our well-being and the well-being of others. We have a long way
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to go in figuring out how to promote the sexual well-being of young people, including
those who are in treatment for sexually inappropriate behaviors.
We have many other blind spots as well, such as our tolerance of gender role
stereotypes that undermine boys’ capacities for emotional expressiveness and that
foster instead the channeling of hurt, stress, and trauma into gendered, stereotypical
behaviors that is harmful. Research on resilience leads to the principle that we as adults
are positioned to model appropriate behaviors, including how to deal with our own
blind spots and take responsibility for their consequences.
It’s Not Fair
Adolescents and often younger children have a keen awareness of injustices in
their personal lives and in society as a whole. Though they may use the phrase “It’s not
fair,” as a way of deflecting their responsibility for their own behaviors, they have a
point about fairness. Research on resilience can be applied to suggest that we agree
with young people when they think that the adversities they have experienced are
unfair. They have experienced injustices. They have no responsibility for the abuse and
neglect perpetrated on them, nor is it fair when they blame themselves for parental
abandonments, deaths, and other adversities they may have experienced.
Treatment, of course, has to go beyond fostering an understanding of the
injustices children and young people have personally experienced. Once they have
some understanding that life has not been fair to them, it’s up to them to make choices
that will not perpetrate injustices on others. They also might be able to see that their
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perpetrating behaviors put them at risk for additional negative consequences.
Understanding the many dimensions of unfairness that they have experienced and
perpetuated, then, is an important dimension of treatment and draws upon positive
capacities for grappling with painful life events and willingness to emulate the prosocial behaviors that are in their various environments but that they have not emulated,
at least not when their behaviors are harmful to others.
There are many other ideas and attitudes that children and young people bring
with them to treatment. My point here is that research on resilience directs clinical
attention to elements of attitudes that we can use to engage young people in their
development of capacities for managing their behaviors and transforming their lives, no
small task. We are better positioned to be helpful when we start where clients are, and
these attitudes often go to the core beliefs that young people have. Finally, we will be
effective with young people if we uphold in our own lives the principles that we want
them to emulate in their own.
Research on resilience has a great deal to offer treatment programs for children
and adolescents with problematic sexual behaviors. Typically, these young people have
experienced adversities that contribute to their problematic behaviors.
simply having been subjected to adversities does not account for problematic behaviors.
If this were so, all persons with risks for sexually inappropriate behaviors would have
them, and this is not the case. When outcomes are pro-social, we can assume the
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presence of factors that moderated the effects of adversities. Resilience research terms
them protective factors or protective processes and has identified many of them, as
discussed earlier. When outcomes are harmful to self and others, we can assume that
protective processes were insufficient to the risks, were unavailable, or individuals
chose not to activate them.
Unfortunately for males, gender-based stereotypes often work against the
qualities research has identified as associated with resilience -- namely confiding in
others and finding comfort and affirmation in doing so, emotional expressiveness that
includes awareness and empathy for own emotions and those of others, and the
rejection of gendered stereotypes that give permission for physical and sexual
It is possible that some sexually problematic behaviors are unconnected to
adversities that persons have experienced and may instead be primarily the outcome of
socialization. Thus, some aspects of research on resilience may not apply to treatment
of young persons with problematic sexual behaviors.
However, when we examine “hidden” resilience in behaviors and attitudes of
young people, we can apply the idea that being even-handed means to identify both
positives and negatives wherever possible, even in behaviors that are illegal and
harmful. Children and adolescents can show considerable skill and intelligence in
problematic behaviors. Taking this idea a step further, we can also take a good look at
our own deficits and manage them as well as we can. In doing so, we provide young
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people with models of conduct that might help them manage their sexuality in ways
that promote their well-being and the well-being of others.
The applications of research on resilience to treatment programs for children and
adolescents with sexually inappropriate behaviors are vast. This paper suggests some
of these applications, and I hope that other professionals discover many others.
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