Johan Nordahl, lic. psychologist , Off.Clinic

1. Dialecticalbehavioraltherapy (DBT) withyoungpeoplewhosexuallyoffend and havecognitivedisabilities Johan Nordahl, lic. psychologist, Off.Clinic

2. Off.Clinic • Outpatient and residentialtreatment for adolescentswhohavecommitedsome kind of sexual offense, placementdependent on risk assessment (e.g. Erasor) • Children with sexual behavioral problem • And/or adolescents and childrenwith sexual trauma • Family and networkeducation • Group and individual therapy • Ages 10-18 at Visslan HVB (residential care center) • More and more of the clients have some kind av cognitive disability (autism, learnings disorder or other neuropsychiatric diagnoses) • Education/supervision of other professionals • DBT, TF-CBT, PE and much more…

3. Why DBT? The behavioral problems displayed by these students are similar to the problem areas that DBT aims to change through treatment and skill training: • The students usually have decreased control of emotions – making them more impulsive and display more risk behaviors. • The student usually have difficulties taking care of relationships with peers, and are thereby less likely to meet a partner. (social isolation is a reoccuring risk factor for commiting new sexual abuse) • It is not unusual for students to lack strategies of how to restrain themselves in the moment of abusive behavior. • Many of the students have difficulties reading their own and others signals – body language, facial expressions and so on. • And, dependent of their cognitive functioning many of the students have difficulties to generalize their aquired knowledge.

4. The four modules of DBT Mindfulness – the capacity to pay attention and stay focused, without judging, recognizing signals. Distress tolerance – skill used to regain behavioral and emotional control, opposite action, acceptance. Emotion regulation – how to identify/labeling feelings, identify vulnerabilities of emotion mind, to use mindfulness and distress tolerance skills. Interpersonal effectiveness - to meet the goal, without damaging the relationship, while keeping self respect. And, the treatment programme helps to create a common language between different treatment facilitators, the student’s family and the student himself/herself.

5. DBT – using the skills The aim of mindfulness in classical DBT is to be able to use emotions as well as reasoning as part of the solutions to different problems. With the increased ability to use this skill it is more likely to reach wisemind. Wisemind Reasoning Emotion To be able to communicate more easily about this skill we introduce the following: The Robot The Wizard The Lizard

6. Whatelse? • Find ways to commit yourself and the client to the treatment

7. References • Brainwise – Patricia Gorman Barry – www.brainwise-plc.org • Start now - University of Connecticut Health Center – Susan Sampl, Robert L. Trestman and Jane Harrison. • DBT – Skillstraining for adolescents by Miller, Rathus, Landsman, Linehan 2003 • The Skills System Instructor’s Guide – Julie F. Brown, jbrown@jri.org • ERASOR – James R. Worling & Traycy Curwen 2001. jworling@ican.net • Treating Trauma and Traumatic Grief in Children: A Clinician’s Guide, Judith Cohen, MD, Anthony Mannarino, PhD – Allegheny General Hospital • TF-CBT, Esther Deblinger, PhD – CARES Institute, Order online at www.guilford.com • Brief TF-CBT overview training available for free at http://tfcbt.musc.edu • Cognitive Behavioral Group Therapy for Children with Sexual Behaviour Problems -Treatment manual by Barbara L. Bonner, C. Eugene Walker and Lucy Berliner University of Oklahoma, USA

8. Contact information www.offclinic.se johan.nordahl@offclinic.se marie@offclinic.se (head of department – outpatient care units) erik@offclinic.se (head of department – Visslan HVB) anette@offclinic.se (method manager)