Sexual Aggression

Sexual aggression refers to uninvited sexual behaviors or attitudes toward another person. Acts of sexual aggression can be verbal or physical.

Verbal sexual aggression refers to sexually explicit talk. This includes:

• Spoken (oral) sexual statements.
• Sexual messages sent via email or social media.
• Sexual messages sent via cell phones, which can be referred to as “sexting.”

Physical sexual aggression, or sexual assault, can include molestation and rape.

A sexual aggressor is someone who initiates physical or verbal sexual aggression towards another person.

• Some sexual aggressors may be acting out what they have learned. This is commonly called being sexually reactive.
• Some children who act out sexually may have been exposed to sexual abuse, pornography, and/or adult sexual behavior.

When working with people who are sexually aggressive, do not shame them for their sexual behaviors. Shame is an ineffective way to approach behavioral and emotional change and can backfire. In addition, psychological damage often occurs when a sexually reactive child is shamed for sexually acting out. Instead, remember and remind your clients that with the appropriate treatment, aggressors and victims can recover and heal.

Guide your treatment and interactions with children by what is normal sexual behavior for their age, including self-exploration and masturbation at all ages. Review Chapter D-23: Sexual Health and Wellness for information.

Talking to children about sex will help to prevent inappropriate sexual behaviors or experiences. Encourage parents to create an open dialog with their children about sexuality.

Acts of sexual aggression are more likely to be reported if they are violent in nature.

Sexual aggressors are more likely to offend against a family member or someone they know. Sexual aggressors may use threats, force, or violence with their victims to instill fear and prevent discovery of their behaviors.

Acts of sexual aggression often occur when the aggressor or victim is impaired by the use of substances. Sexual aggressors may also use substances to subdue their victims.

Sexual aggressors and victims may be either male or female.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history related to overall development, social functioning, sexually transmitted diseases, and abuse or neglect.

Treatment Plan, including a history of presenting problem and recommended course of treatment.

Sexual behaviors

• As an adult, has a sexually explicit (detailed) conversation with a minor
• As a minor, has a sexually explicit (detailed) conversation with a younger child
• Touches another person’s genitals
• Forces another person to expose their own genitals
• Teases or taunts others with sexual talk
• Induces fear or threatens the use of force with others
• Makes sexually explicit proposals and threats, possibly including written notes
• Repeatedly or chronically "peeps" (looks at someone who is naked or changing clothes without their permission), exposes himself, or has excessive or inappropriate pornographic interests
• Compulsively masturbates or stops a task to masturbate
• Pretends intercourse with dolls, peers, or animals
• Has problematic, frequently repeated sexual behaviors (beyond spontaneous, exploratory sexual play)

Family-related factors

• Experiences regular or increased stress
• Sees others use manipulation to get what they want, especially as a minor
• Has family members who use substances or drugs
• Has family members who tend to act out sexually
• As a minor, has poor supervision by caregivers in the home
• As a minor, fears caregiver or fears rejection by caregiver

Personality

• Lacks warmth and empathy for others
• Has little internal sense of right from wrong
• Blames others and denies responsibility for actions

Personal history

• Has experienced abuse or neglect
  • If abuse or neglect is currently happening, see Chapter D-3: Abuse and Neglect.
  • If abuse or neglect was in the past, see Chapter D-4: Past Abuse and Neglect.
• Has thoughts of suicide
  • See Chapter D-6: Suicidal Thoughts and Plans.
• Has witnessed domestic violence
  • See Chapter B-5: Mandatory Reporting and Duty to Warn.
• Feelings of worthlessness
• As a minor, has witnessed sexual acts between others, either forced or consensual

Sexual behaviors

• Has anyone ever talked to you about the concept of appropriate and inappropriate touch? What does this concept mean to you?
• Have you ever sent sexual messages or images by cell phone or online?
• Has anyone every made you touch them on their genitals or private parts when didn’t want you to?
• Have you ever forced someone to touch you or have sexual intercourse who did not want to?
• Have you ever touched anyone in a way that made them feel uncomfortable, confused, or scared? If so, have you told anyone?
• Have you ever hurt someone or threatened to hurt someone if they didn’t do what you said? If so, how?
• Are you currently in a sexual relationship with one or more people? Are the sexual interactions all consensual?
• [For minors] Have you ever touched someone else’s private parts? If so, what were the circumstances?
  • If the child sexually offended another person, see Chapter B-5: Mandatory Reporting and Duty to Warn.

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, for victims of sexual abuse, you may consider:

• Individual counseling to help people who have experienced abuse:
  • Understand it’s not their fault.
  • Learn to identify safe adults.
  • Learn coping skills.
  • Develop their ability to express themselves in a healthy, appropriate way.
• Educational counseling focusing on:
  • Appropriate and inappropriate touch.
  • Healthy boundaries.
  • Healthy sexuality.
• Family therapy and support related to:
  • Normal versus inappropriate sexual behaviors.
  • Appropriate and inappropriate touch and what to do if someone touches him in an inappropriate way (e.g., say no, walk away, and tell a safe adult).
  • Sexual aggression or acting out.
  • Parental supervision.
  • The causes of sexual acting out behavior and possible solutions.
• Outpatient counseling focused on:
  • Improving self esteem.
  • Identifying healthy relationships.

For individuals who have behaved sexually aggressively or have demonstrated concerns with how they are expressing their sexuality, the Risk-Need-Responsivity (RNR) model is an evidence-based approach to treatment. The RNR focuses on assessing and targeting the risk level for offending and client preferences to tailor the treatment for best outcomes. Motivational Interviewing (MI) is an additional evidenced-based practice for creating change. MI addresses ambivalence by showing empathy toward the client, promoting self-efficacy, considering the benefits and drawbacks of negative behaviors, and encouraging hope and confidence. The Good Lives Model (GLM) is and additional treatment and emphasizes the client’s strengths and skills as the basis for relapse prevention and personal growth.

Interventions, you may consider:

• Address inappropriate thoughts and beliefs.
• Learn healthy relationships and boundaries.
• Practice positive social behavior.
• Develop social and emotional coping skills.
• Enhance self-esteem.
• Develop strategies for high-risk situations.
• Learn healthy ways of expressing sexuality.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.