Harmful Sexual behaviour - Dealing with resistance in a play therapy context

Initially published on 3 June 2024 on LinkedIn.

This article is written in the context of children between the ages of 6 and 10 who display harmful sexual behvaiour (HSB). I am not an expert, but I am learning. This is a space to explore my growth and discoveries. Please feel free to comment and share your expertise!

"Resistance is the child's ally; it is the way she takes care of herself. I expect resistance and I respect resistance." Violet Oaklander in Hidden Treasure: a map to the child's inner self. 2006.

In the context of HSB, children are resistant because they are fearful, or feeling guilty and ashamed, or all of these and more. If the behaviour is truly harmful ie: beyond the norm of sexual play which is developmentally appropriate, a child knows inherently this is not OK.

Furthermore, caregivers and other adults who don't know how to respond to the HSB may emotionally or physically distance themselves from the child, causing feelings of rejection. This can impact their ability to trust and brings about resistance to interventions.

So often, children simply do not want to talk about "it" - the behaviour that happened. They may already have had a lecture/punishment and several uncomfortable conversations with caregivers and/or teachers. They do not want to go through all of that discomfort- again. They fear judgment or already feel judged and so they will resist anything remotely related to the topic.

Open the conversation to discharge high emotions around HSB

One strategy that I have found helps from the outset is having a meeting with the parents and child present to simply, gently and clearly talk about the reason they are coming for play therapy. Using terminology related to the HSB events such as "You're coming to see me because of what happened between you and other children about touching one another's penises in the classroom. I have been told that this has happened lots of times and I know it maybe feels hard to stop, now that you know it feels good."

The fact that what we are there about is out in the open, makes it clear that there are no secrets, that the adults are working together to help the child, and that they are not in trouble. The acknowledgment that this behavior feels good and can be self-perpetuating is helpful for the child to know that you know. They are not pathological or deviant, they are repeating behaviour that makes them feel good. But the clinician gives the clear message that it is neither healthy nor appropriate for them to continue the behavior, and I am there to help them do kid's stuff that is way more important and really great for them at their age.

The fact that the clinician is comfortable using language around the body establishes a norm for future work with the child - we can talk about the anatomy, especially genitals, without shame. There is the added sense of safety for the child that their caregivers know this is the topic being dealt with and that the clinician is helping the caregivers help the child too.

Furthermore, the clinician models for the parents a firm, yet caring and gentle way to speak with the child directly about the behaviour. Parents may really struggle with all of their own emotions and resistance in the beginning and so their reactions could range widely between shock and horror, denial, and rage.

My words, the way I deliver them, and how I interact can help to set a tone that takes the "charge" out of the reaction to the behaviour. I want to offer regulation, instead. A safe space for both caregivers and children to process what has happened and all of their feelings about it.

Clear is kind

Brene Brown gave us this lovely statement of truth; clear really is kind. Most children are not going to open up the topic of the HSB directly with the clinician. But if I as the clinician am constantly putting the topic on the table throughout the therapy sessions, I am making a clear statement: This is important to talk about, and I am here to talk about it when you are ready.

I will make statements such as "I know this is difficult to talk about. I'm not embarrassed. I won't be shocked. I am here to help."

I am giving the message that I am not running away from the topic, I am strong enough to deal with anything they want to talk about. I will still want to be their friend, no matter what they tell me.

Giving agency

Allowing the child to be resistant gives them agency. They get to choose when and in what ways they would like to deal with the HSB. The clinician doesn't collude with them; resistance doesn't mean we never deal with it. But it does mean I go at the child's pace whilst still being clear, kind, firm and open.

Disclosure

It has to be acknowledged that one reason a child may display resistance is that they have a disclosure to make that not even their caregivers/parents/teachers know about yet. This may be related to abuse or exposure that set off the HSB. This is something I keep in the back of my mind during sessions and informs the questions I ask myself and the adults in the child's life. Sometimes the adults don't know all the answers to these questions and so it is a process of exploration and assessment.

When did the behaviour start? Where could they have been exposed to sexualisation of this sort? Is there a possibility that they have been abused? Have they been with other children who are sexualised?

Conclusion

Is this perhaps the key to dealing with resistance on such an emotionally charged topic; consistent acceptance helps gently peal away resistance at a pace the child can handle.

What are your thoughts?