Sibling Sexual Abuse:
A Parent's Guide to Finding Help for Your Son

Tiffany: With this episode, we are wrapping up our podcast series. We previously talked about reporting to authorities, and this now is going to be talking about finding help and what's out there. What do you do in regards to therapy and how do you know if your son needs treatment? So let's talk about that.

Finding a CSAT Therapist for Your Son

Initially, parents ask, what do I do? Do I find him a therapist? If so, is there a specialty? What kind of therapist? And yes, the answer is there is. Now, it's not a perfect certification for adolescents, but it's going to be probably the best option. What you should look for is a CSAT or certified sexual addiction therapist. That's what you're going to want to find for your son initially for outpatient therapy. And this person is trained to deal with this specific issue, with problematic sexual behaviors.

Shawn: Well, it's really training for therapists helping adults with sexual addiction. There isn't currently, that I know of, a CSAT-type training that focuses on adolescents, because adolescents are very different than adults.

But it's good. It really does help therapists understand more what is going on psychologically. You understand the line between addiction and dependency and the different methods used. And the therapist has to be really, really good at being able to say, I'm going to tailor this more for an adolescent than an adult.

Tiffany: There are some CSAT therapists who won't take adolescents. They only work with adults. And now to give you some perspective, as a CSAT therapist you have to go through, I believe it's two years of intensive training and certification while being supervised. So it's a really intensive certification.

It is important to find a trained therapist who knows what they're talking about, who's not scared to have these tough conversations, and not afraid to ask the really hard questions. The therapists at Oxbow Academy are more than qualified and trained to do all that.

Shawn: The only other issue that I would bring up, is that someone can look really good online. Let's say you're looking for a therapist, you're looking at their profile online, you're reading their credentials. That's an important start. But really what you're looking for, and that you can't get until you actually meet with them, is knowing will their personalities match up with your family.

And there's a balance between being too hard and too soft. So a professional therapist that's really, really good doesn't blur those lines. The professional therapist knows that I'm not here to be your buddy, and I'm not here to be your friend. I need to have a relationship of trust, but I am here to help you. And I'm here to guide you.

Tiffany: And, as a therapist, I care about you. I'm willing to gain your trust and build a relationship.

Shawn: So over the years of working with therapists, we've had both. We've had therapists who pushed too hard and harder than the relationship with their client would really allow. Now, if your relationship with the client is really solid and there's a lot of trust, as a therapist, you can push really hard.

Tiffany: You have to create a place of safety, validation, and hope and it takes a lot of work. It takes a lot of groundwork before you can really hold your client's feet to the fire.

Shawn: When you have that space, clients will let you push them in an appropriate way. They'll let you. Those therapists empower clients to take accountability

The worst, the most detrimental therapist, in my opinion, is one who wants to be your friend, wants to be your buddy, wants to take the softer road, wants to make you comfortable, and feels uncomfortable by conflict. Because the truth is, real therapy is conflict.

Shawn: There's conflict between how things are, how things need to be.

Tiffany: It's challenging. You're holding up a mirror to someone and saying, Let's look at all your self, including your flaws and your strengths. And that should be uncomfortable. Any self-reflection is uncomfortable.

Shawn: So the balance of finding a professional that:

• has the qualifications,
• has the experience,
• but also has a personality that matches up with your son

Those are the three elements you should look for.

Tiffany: So that's the first important step. Get him into therapy, outpatient therapy. If they have acted out sexually already and crossed that line, I mean, once a week or a couple of times a week at least, it's important to find an intensive outpatient therapy for your son because he's once a week is just not going to cut it. Get him on the journey to working through his disclosure and all that.

The next step is going to be finding a trauma-informed therapist for the victim, making sure that they are getting the help that they need, that they have a safe place to go, and someone who is an advocate for them and validates their feelings and emotions and helps them work through this very difficult, traumatic experience. That's going to be huge.So not only for your son but also for the victim.

I know I've said this a lot, and obviously, I'm a big advocate for this and bias as a therapist but go find your own therapist a support group as well, which can be hard with this kind of situation. I think that the hardest part for parents, is they feel so alone because there aren't readily available support groups for this topic. It's hard.

Preparing for Clarification & Reunification

Shawn: I'd like to add what you said about the victim having a trauma-trained therapist. Because there's an aspect of treatment that's going to come down the line and that is the clarification piece. After that is the reunification. And here's what's key to that. The reunification process, and all of the healing process, has to be driven by the therapist and the victim, not by the aggressor.

Tiffany: So let's talk layman's terms. Say someone has no idea what those terms are. We know them. But to explain

• clarification is the process where your son would write a letter clarifying what happened to the victim and taking accountability in accountable language to let them know that it wasn't their fault.
• reunification is the process of bringing your son back into the environment with that victim after everyone has gone through the healing process, and at the appropriate time for the victim.

Now, as you said, it cannot be on your terms or your son's terms. Or even your son's therapist's terms. It has to be on the victim's terms. They have to be ready. They have to give the consent and greenlight and be like, Yes, I'm ready to hear this. And if they're not...and I've had some cases where they're never ready. And I have to help that young man understand that you've done your part and they may never be ready to hear from you ever again in this lifetime. And you got to be okay with that.

Shawn: Yeah. The key to all that is working with professionals who understand the process and know how it goes. If a professional doesn't know what they're doing and the trauma therapist pushes it, it's almost like re-victimization. So they both have to be in a place of health, both the aggressor and the victim. They have to be in a position of health and empowerment. But mostly empowerment on the victim's side because they have to feel like, I know this wasn't my fault and I'm control I'm in control because.

Tiffany: Because they had no control up until this point.

Shawn: So it really can get messy if the professionals that you select to work with your kids don't understand those elements.

Tiffany: Yeah, that's going to be really important. You can't just go put the victim with any therapists. They need to understand the trauma involved and their role as a victim in all of this and help them be empowered.

How to Know if Your Son Needs More In-depth Therapy

Tiffany: Okay, so let's ask a big question. How do you know if your son knows treatment? You've done all these steps you've gotten to this point now?

Shawn: Do you mean treatment? As in residential? Inpatient?

Tiffany: Yeah, like outpatient therapy. Just not cutting it. Maybe you've got the local legal authorities involved and they want to possibly press charges. So how do we know?

Shawn: Well, let's talk about, how would you know if it wasn't working? I would argue every single student that is at Oxbow has started with outpatient. And the biggest indicator to know that it's not working is that the behavior hasn't changed, it's escalated. Which means the level of secrecy has now elevated.

Tiffany: They're willing to take more risk, more risks. And there's no empathy. They're like, "I'm sad I got caught, but I don't know if I care about how it affected other people."

Shawn: Parents would know. The parents I work with will tell you, "We tried it for two years and it was intense. It was twice a week. And we were involved and we were there. And again, my son could cognitively tell you word for word what his therapists were saying. But, there was no emotional buy-in, because when we go home, nothing has changed.

Tiffany: Or there's a disconnect. They're saying the right words or working through emotions. But, their behavior is not matching up, they're not connecting emotionally. There's just something that is off.

Shawn: A lot of times they will take the position of, "Hey, I'm the victim here. I'm the victim in all this." And in reality, they're not. But that's the position they're taking.

Tiffany: That's a thinking error.

Shawn: There are a lot of thinking errors they continue to engage in.

So as a parent, you'll know that it's working from an outpatient level or an outpatient treatment level, based on a couple of factors:

• your son's behaviors are starting to return more to a normative state than they were before.
• Your son's willingness to take accountability, not just for that, but for just about everything,
• and your son's level of vulnerability in relationships.

In my opinion, those three elements are key. Treatment is going to work, and you're going to know it works, as long as you feel that reestablishment of that relationship. The parent-child relationship and your son is now vulnerable and receptive to your parenting.

When it doesn't work, he's not vulnerable to you and is seeing you as possibly the aggressor or you're the person abusing him now because you're asking him to go to therapy.
Tiffany: It's him against you.

Shawn: It's always a conflict.

So when should you start looking at your situation, it's not working and that level of conflict is going up. Your feelings within your home is not a feeling of rest. There's not a feeling of safety. You're kind of walking on eggshells and you just don't know when the other shoe is going to fall. When you feel that it's imminently going to fall it's time to move because your body is telling you that you're in a trauma response right now. When you're feeling that overriding feeling of dread, if you will, that something else is going to happen. If you feel powerless against it, then that's a pretty good sign that outpatient therapy is not working.

Tiffany: And if you suspect there's more. And the truth is that coming out and the stories never match up. If your son is saying one thing and the therapist is saying, well, he told me this and the victim is saying this and none of the stories match up. Then after some time with this therapist, it is probably time to look for treatment because you're not getting the full truth.

Shawn: And, you know, sometimes the solution is a change of therapist. But more than not, that's not the issue at all. What's driving it is you're talking the therapist is talking about things that are known and they're not talking about the things that are unknown. And this and the child is keeping that very, very close to the chest and not willing to reveal it.

Therefore, you have this conflict-type result where he's working hard to keep things away from his therapist, his therapist working hard to try to get to him. And now they're in an adversarial relationship because he's not ready or he just doesn't want to reveal all that has happened.

Tiffany: But the other aspect, too, is that you get him working in therapy. But there's so much going on behaviorally. Again, I think parents think like, it's just you only send him to a place like Oxbow because they're having a sexual issue. But oftentimes the sexual issue comes up every now and then and then kind of goes underneath the surface.

It's kind of like the iceberg effect. You just see the tip of it and there's a lot more going underneath. And oftentimes you'll get other big behaviors going on and those are, again, I'll call white rabbits or herrings that we're chasing after. They're important. Yet it's a way to deflect and kind of smoke mirrors that what's really beneath the surface.

So if you're so focused on their behavior, them not going to school or school refusal or, you know, isolating, not wanting to have big fights over electronics and tablets, etc. Again, it's not focus on the big issue that is at bay, but it's a way to distract you from not having to talk about the hard things.

Shawn: And you'll see little things like your son becomes very territorial over his devices or his backpack. Like, he will lose it over you even looking at his backpack because his backpack is concealing secrets he doesn't want you to see.

So again, you have to understand the full impact of treatment is about change. In order to effect a change, you have to have vulnerability, emotional vulnerability to where you're willing to take advice and you're willing to see yourself as you are and you're willing to be accountable. If there's this huge fight about I'm not willing to be vulnerable, then then outpatients not working.

So the vast majority of all the students at Oxbow were in outpatient therapy and it didn't work. Now there's a percentage. Remember, those adolescents who require, need, or could benefit from residential treatment are very small in numbers. A very small percentage of the overall population of their age group. For the vast majority of these teens, outpatient therapy is going to work. Outpatient will work, and it may be lengthy, but it does. You do feel the vulnerability return in the relationship. You do see things like willingness for accountability, and you also see your child is returning back to the child he was once was.

Tiffany: Can we say, though, in all reality, that if your son has crossed the line and sexually acted out with another person who's younger than them, family member, whoever, there is a high probability that you should look into treatment not first, initially, obviously take these steps, but if they've already crossed that boundary, my thought is as the therapist is, "What else is going on?" Which leads to the evaluation.

Shawn: Yeah. You're evaluating risk. It's really about what level of risk was your son willing to engage in to get sexually gratified, If it was a massive risk that he was willing to take, that means generally speaking, he probably needs to go somewhere that offers a different level of help.

Tiffany: I'm not saying that's for everybody. I'm not saying have that be your first call, but from my own therapeutic and clinical experience, that's typically what I see.

Shawn: So then you get to the point where, as a parent, you know that the outpatient clinical work is not working. The methods and the relationship aren't working and you end up finding out that your son can speak about the clinical issues better than his therapist can. He's cognitively got the language but you're not seeing crossover and a change in his behavior

Tiffany: We call that being therapeutically savvy.

Shawn: And it's all cognitive work. If that's happening, rest assured it's not going to stick.

Tiffany: So then what? What's the next step?

How to Find a Treatment Program for Your Son

Shawn: Well, first of all, it's hard to get to that point yet. Generally what happens is another event happens. So this is what my experience is, parents know that outpatient therapy hasn't been all that effective, but they're still holding on to hope. And then something happens, like a re-victimization or an attempt or a grooming behavior.

Tiffany: They find something really deviant on their phone.

Shawn: Or they get kicked out of school because of something that happened at school. Whatever it is, it's just one more drop in the...you know, I would put it like this. The other shoe has just fallen. Now it's like, I know for sure it's not working. And so my son's level of sexual risk is high enough that it needs a higher level of intervention.

Tiffany: Of I don't take care of it, if the legal system isn't involved, they will be soon.

Shawn: Correct. So then it's really very difficult to search for the right program. And the process is just as intense as searching for the right therapist. You're looking for a program that's good.

Tiffany: Even more so.

Shawn: You're looking for specialization. One of the things that bothers me in the world of residential treatment is a program that says they can treat everything.

Tiffany: Jack of all trades.

Shawn: The list of things they treat are a page and a half long. And my thing is, if you say you can treat everything, you end up treating nothing. So you want a program that specializes, especially with regard to sexual behavior problems. You want to have a program that says, this is all we do. Now, having said that there's always more to the kid that is more complicated than the problematic sexual behaviors.

Tiffany: It's never just the sexual issues. In fact, sometimes those aren't always the first issues.

Shawn: But it's the one that has to get extinguished. It's the one that the parents are the most anxious about. You can deal with OCD and you can deal with neurodiversity and these other complicated issues. But it's the sexual piece that represents the most threat to you, your family, and to your son. It has the most risk. So specialization.

I'm going to add that it's really hard to get a real grasp on a program solely through the Internet and its website. Programs all look really good on their websites. And even though it is a challenge, before you place, you really need to have multiple conversations with multiple professionals. You need to do a deep dive and then you need to visit the place and meet the people.

I know the parents who have come and toured with Oxbow Academy and met with me, I could see it on their faces, they're exhausted. They're exhausted because they're so scared that they're about to turn their son over to strangers. Because they're at a tap-out point where they're either going to lose their son or someone else is going intervene.

Tiffany: They don't know what else to do.

Shawn: Right. So to finish, my thought is you've got a tour. And when you tour, there are a couple of things you need to look for. Most, if not all, residential treatment programs are going to show horses. Hey, I love horses, they're awesome. And usually, it's a beautiful picture. The first thing you do is if they are putting horses as part of their methods or part of their approach, you're going to want to see a tack room.

You're going to want to see all the things that lead you to believe that they actually have a horse program.

Tiffany: That they use the horse.

Shawn: And it's not the neighbor's horse that the kids can go over and pet once in a while. So you got to do the deep dive and say, "I want to see your tack room, and do the boys ride the horses?" And then pretty soon, within a few minutes, you're going to recognize, okay, they don't have a horse program, but they just posted or they just position themselves like they did. So right there is a red flag, number one.

Then you want to go into what are the qualifications of the clinical team. What is the clinical approach, and what does the environment look like that my son's going to be living in? What do the students look like? When you tour the program, I would strongly recommend asking if you can talk to the students.

When parents come to tour Oxbow, they sign a release. It's a HIPAA thing where they sign that it's all confidential. But then I want them to sit and talk with the students., but sometimes they're like, "No, I don't want to." Because here's the problem, if your son has sexual issues, you need to fight this idea that everybody else's son is a predator, but yours is not.

Okay. First of all, we don't use that language. Second of all, you have to drop this idea that kids with problematic sexual behavior problems are monsters.

Tiffany: So easier to objectify someone until you get up close. It's like what Brene Brown says, if you really want to stop objectifying someone you've got to get up close to see the person for who they are and realize that they are complex human beings who have made choices for so many complex reasons.

Shawn: So, the other thing that you're looking at is a specialization within the specialization. So let's say, you have a son, he's 14. He has some problematic sexual behaviors that have brought him to sex-specific treatment. But your son is complex and he also has level 1 autism / ASD or he has a processing issue. Or maybe he has some obsessive-compulsive behaviors and he has problems controlling his thoughts.

Tiffany: Or it might even be suicidal ideation.

Shawn: Or he's got some depression issues that are clinical and he's on a boatload of medication.

Tiffany: And can I add, all of the parents I've talked to say, "But he's a good kid."

Shawn: And he totally is.

Tiffany: In fact. All our kids are good kids.

Shawn: But treatment is complex and so the program needs to be complex in order to effectively deal with it.

So, again, avoid programs that say they treat everything and look for programs that have specialization and then specialization within the specialization. So let's say you go to a program and you meet the boys and they're all neurotypical kids, but your kid is a neurodiverse kid. Okay, then it is going to be, "How is my son going to feel comfortable and safe here when he's living with boys who for his entire life have been the ones that have been bullying him in school?"

Tiffany: As a therapist, I would treat a student who's ASD differently from a student who's neurotypical. Treatment is going to look very different.

Shawn:  The approach is going to look different, but the outcomes are the same. One of things we're looking for is the program should be research-minded, which means this program, whatever program that you're looking at, better be collecting data and better be able to show you the data and they better be analyzing the data they collect.

Tiffany: Yeah, because there's accountability in that research.

Shawn: There's accountability, but there's also a process of quantitative measurement, of progress. I love therapists, but the worst predictor of future behavior is a therapist's gut belief in their client. It's true. It's well-researched.

Tiffany: We just want you all to do well. We're in your corner. But you're right, we're all biased and too close to our clients to be objective.

Shawn: Research, data, and data analysis should be a part of the program that measures your son's progress so that when you're in a treatment team and your son is being evaluated, it's not just his therapist giving a verbal report on how he or she thinks your son is doing. You have to have data that's backing that up.

And I'll tell you why. Over the last three decades have been so many treatment teams and those treatment teams looked pretty similar. We were going to evaluate a student, so they began talking and the therapist gave a verbal report. But the report is either positive, negative, or slants positive or negative, depending on the last 3 to 5 days.

Tiffany: Well, that's all I can remember.

Shawn: That's right. So a therapist's view and reporting how a kid is actually doing a treatment is going to be skewed by what they can retain. As human beings, we have a 3 to 5-day stretch. And really the older I get, it's about a day and a half.

What's going to happen is there's not going to be an accurate evaluation of progress data. And I noticed this early on. And so in my career, I've just been pushing the data button, finding tools, developing tools, and looking at ways that we can link up outcomes with trends.

And I remember distinctly a treatment team where a therapist was giving a report on a student and that was negative and I was on my computer and I clicked over. I pulled his data up and actually compared how he was doing compared to the other students. He was doing great.

And that made the therapists go, "Well, okay, yeah, I guess I can see that he was doing really good. He just has had a rough couple of days." Why is he having a rough couple of days? He's working on his disclosure and he's bringing up really hard stuff. So he's actually very healthy, doing very well. because it's natural for him to be struggling through this.

Tiffany: He's a human being going through something extremely hard emotionally.

Shawn: If we don't have that data to keep us in line, we're going to get way off track.

Tiffany: I agree.

Shawn: So anyway, those are the elements that I would make sure that you're looking at as a parent. If it turns out that you need residential care.

Tiffany: Can I add one more? Ask to talk to families who have been at the program or who are alumni. We have many parents who are more than willing to give out their information or at least their number, and have you text them and say, "Hey, I'd love to have a call about your experience. Give me the good, the bad, the ugly, the great, whatever.
Want to hear the whole experience from someone who's been through it." And then that also provides a connection to have support as well for parents who are willing.

Working With An Educational Consultant

Shawn: There are also professionals who are whose job it is to research and know programs.

Tiffany: Yeah, tell me more about them.

Shawn: They're they're called educational consultants and their job is to know the program tour the program, know the people, know what they specialize in, and they act more of a guide for parents. So for example, if I'm a dad and my son has an issue and I get online and start typing in search terms to see if I can find the place, an educational consultant will tell you these are the places you should be looking at that are good. And I know this because I have toured their program, met with their team, or worked with them in the past.

Tiffany: They've done all the work They've created, the relationships, they visited the programs. They are awesome at what they do in their jobs.

Shawn: They may even present programs that were not even available to you.

Tiffany: Or that Google won't show for whatever reason.

Shawn: So do the work. And I guarantee you that if you do the work upfront, you're going to feel much better, especially because it's all relationship-based. And so knowing the people, meeting the people, you're going to get a feel for of this and if this is right for your son. The hope is you visit more than one, visit three or four or several. You do the work just like your son's life depends on it.

Tiffany: And then trust your gut as a parent.  It's one of the most powerful tools you have.

What to Expect During the Treatment Process: Evaluation

Tiffany: So you come to this decision that outpatient treatment isn't working and we need treatment. So let's look at what treatment looks like. What things do you need? For example, do you need an evaluation as part of the treatment process? And what should you expect? So specifically, since Shawn works at Oxbow, that's what we're talking about.

What does it look like for us at Oxbow? So let's start by talking about why we offer a 90-day evaluation. What even is that?

Shawn: I would like to start with 90 days. Is this really should be, say, an evaluation period? Yeah, 90 days is an average. Okay. So it's just an average time that it takes to get through the process. It doesn't mean it's going to take 90 days, but it could mean it's going to take more.

Tiffany: Yeah, we want to give parents a timeline because I think it's such a huge financial commitment and a scary commitment to take this next step. We want to give parents an idea that let us have at least three months to evaluate your son and do a deep dive to decide what he really needs. So what does that look like?

Shawn: Well, the first responsibility that Oxbow has is to determine if your son really needs us or not. At Oxbow, because we don't know that, the evaluation house is one of the houses at Oxbow that focuses on this evaluation period. We start with education, psychosocial, and social education. We spend a lot of time on consent and understanding appropriate social dynamics. Especially for neurodiverse kids, it's a really hard concept.

Tiffany: I mean, that's the huge part. Before we can dive into their disclosure and their history of what happened and to do that investigation right. What really is the truth and what what are we looking at? They have to be educated.

Shawn: You have to build a framework and a vocabulary where you can work from.

Tiffany: And build a relationship with them so that when we do ask the hard questions, we can feel comfortable talking about those issues.

What to Expect During the Treatment Process: Clinical Polygraph

Shawn: Right out of the gate, through the process, our students know that they're going to have to validate their truth, they're going to validate their story. So why that's important is because that makes it so that they're not going to be able to do to one of my therapists what they've been doing to their outpatient therapist. They're not going to be able to hold onto their secrets and just cognitively navigate the process without affecting real change.

They're going to know right up front that we're going to help your family get to your truth, but then we're going to validate it. So what that takes the adversarial part of this process away from the therapist and the parent and puts it on the polygraph. So the polygraph is now what these boys are worried about, it's not their therapist.

Tiffany: So that allows me, as a therapist to team up with the student and say, we're going to pass this, it's me and you kind of against this and your chance to prove that you're telling the truth to your parents. We're going to validate that truth. If you say you're telling the truth, let's validate it right and show it.

Shawn: And so it's way different. It's we're not trying to catch them in a lie. We're not trying to trick them. That's why the clinical polygraph is really just a biofeedback measure. It's important, but it's not nearly as important as the work getting to it.

So as your son is working with the therapist and slowly wading into the waters of his disclosure and getting ready to build a disclosure, he's going to be talking about his sexual history. And this is where parents are really, really important to the process. Because he's not doing this away from his parents. He's doing this with them. So the parents are involved in the processes of disclosing and validating the sexual history. The boy shares this information with his parents and his therapist.

Tiffany: And his parent's role, your role as a parent is to say, "Hey, remember that one time when this happened and you told me this, but I saw this, What was the truth? Or that one time I looked at your computer and all the history was deleted and you said you didn't do anything. What really happened?"

Shawn: Exactly. So it really is a time to explore everything together. Once that big net has been thrown out there and the student, therapist, and parents all feel like we've got an adequate history here...

Tiffany: And it's not just on a sexual history, it can be a broad history of whether there is any drug or alcohol use, school refusal or tardies, anything, any questions that they have.

Shawn: And a lot of times at this point, there may be some leanings towards their own victimization where they were victimized that nobody knew about

But again, the process is one you just don't jump into or say, okay, tell me everything that's ever happened to you sexually. Right. The therapists are trained and know how to ease into those waters.

Tiffany: The goal is to create a therapeutic relationship with them so that they can feel safe and heard and validated to be able to go down this scary road because we're going to ask them to do some really hard and courageous things. But we're not going to have them do it alone.

Shawn: So once that's completed, then we move towards, okay, let's, let's work together on the disclosure. And the disclosure just takes this big net and it just pulls the facts out. And so you have this great big net and now you have a really small net of facts and the facts that are most important. And the student is creating his disclosure with his therapist.

So it's not something that says, okay, I'm going to put this on you. It's like we're looking together at this big old history, asking "What do you think needs to be on the disclosure?"

Tiffany: Well, let's specify that it's also about accountability. Having an accountable language is important. So we help students distinguish between was it consensual, were they a victim, were you a victim and help them really kind of go through those muddy waters to figure out like, where's the accountability lie?

Shawn: That has to be established before the disclosure starts to form.

Tiffany: It is part of the process.

Shawn: So once that gets started and then the disclosure is formed and then it's gone over multiple times with the therapist. Now, let's talk more about this. Let's talk more about this. How do you feel about that? And then we're getting closer to that process of the student knowing he's going to have to validate this truth.

So this is an interesting dynamic because it happens more than does not. And that is we think we have a complete disclosure. The student is saying it's complete. Parents are ready, students are ready, therapists are ready. He goes to the polygrapher and drops more. It's not uncommon and it's okay. But he's finally there and he's finally saying, I want to pass this thing and I won't if I don't drop this.

And so fortunately for Oxbow Academy, the polygrapher we use is also he's also a therapist. So he'll spend upwards of 45, 50 minutes just going over the process.

Tiffany: Just prepping them for it.

Shawn: ...reading through the disclosure, and then those two come up with the questions. Yeah, this is vital because I think it's wrong and immoral to ask a client or a student a question on a polygraph that he doesn't know you're going to ask. Okay, It's wrong. So we take plenty of time to prepare our students for that clinical polygraph process..
For those reasons, we have a 93% first-time completion or passed polygraph rate. This means the first time they're going to do it's the first disclosure, 93% of the time they pass. But again, it's interesting how that dynamic works out. We don't necessarily care how the information comes out. We just want the information to come out.

Tiffany: And there's therapeutic value in them passing. It builds their confidence. That starts a healing process that, again, you're only as sick as your secrets. In order for them to start the healing process, they need to get all the secrets out.

Your Son Will Try to Manipulate the Process

Tiffany: And there will be a behavioral build-up before our students go and take this clinical polygraph? Oftentimes you'll see big behavior, something called an extinction burst right before the disclosure. Or a big manipulation, or white rabbits to chase, because they're scared. They don't want to talk about these things. And if they can get you as a parent to look over here or over there at this behavior, then they don't have to talk about what's really going on.

And oftentimes it's really easy to do because you just put your child in treatment with these people you don't really know. And you're worried if your son's safe. Is he going to be protected? Is he getting the help he needs? And so you get on a weekend phone call and on these phone calls, we allow kids it talk freely. They should have that opportunity and right to. And so you might hear some things like, is he getting enough food? Or maybe, "Are the other kids being nice?" And your son, let's admit it, knows what buttons to push. They're they're pretty good at it, too.

And so it's not uncommon for kids to go and try to push these buttons of their parents to react and to draw their focus over here so that they don't have to talk about the really hard secret they're holding on to and avoid passing the polygraph. If you can get your parent reactive, and this is common in a lot of treatment because they know that if they can tug on your emotional heartstrings as a parent and get you to feel shame, guilt, or question if they're safe, they don't have to say what really happened and hopefully they can get you to take them home.

Shawn: So the whole the whole process is really to get his truth out. So that now is something that we can heal, that we can help him resolve. You can't resolve secrets. That's the definition of a secret, it just stays in you. The problem with secrets that I have noticed with, especially if they're big secrets of a sexual nature, they never kind of stay where they're at. They grow and they start impinging other aspects of a teen's development and they become either bigger than they really were or smaller.

And it's an internal struggle that's like endless, right? Secrets are horrible because they're not resolvable. The way that I like to explain it to parents is like this, your son is in pain, but he knows the pain he's in. And he's been in it for a long time. And the pain you know is better than the pain you don't. And treatment is asking him to wade into pain he does not know.

Tiffany: And lean into it.

Shawn: And to lean into it. And he's like, I'm in enough pain as it is. I don't want more. I'm I'm fine with it, I've been living with it. I've lived with it my whole life.

Here's the problem. The pain that they're in is unresolvable in its current state. It will go with them the rest of their life. The pain treatment is asking them to wade into,
is, in the end, resolvable. And it could finally be out and be done with. But they don't know that. All they know is they're in pain and we're asking them to lean into more pain.

Tiffany: Shame is bred in secrecy. So the more that they keep and lean into the secrecy, the more shame that is going to surmount on their shoulders.

Shawn: They have to work to maintain it. And generally speaking, they self-medicate. At some point, they're going to self-medicate.

Tiffany: And part of it can be through a sexual outlet.

Shawn: Absolutely. So the bottom line is, okay, so once we have the truth, why do we need the truth? Because they're about to be evaluated. Okay. And in order to have an accurate evaluation, you have to have accurate information. The reason why Oxbow moved to put this evaluation at the end of the disclosure process...

Tiffany: Yeah, why not just send a kid to go get a psychosexual evaluation in two days once you know they've sexually acted out?

Shawn: It's the same reason we don't talk to our doctors about what we were like when we were 12 instead of what we're experiencing right now. Because when we were 12, we were way different. And the information in the evaluation is going to be completely off. So the evaluation is only as accurate as the information. So what was happening in the early days of treatment was that we were doing the evaluation because it was required for us to do it within seven days. Then we would get six months into the treatment process and the big fish started dropping out and the evaluation was completely invalid.

So now, we wait until we feel like we have the truth.

Avoid Conflicts of Interest

Shawn: This is another key aspect. We have to avoid conflict of interest as a program.

Tiffany: Yeah, tell me about that. Why wouldn't you have someone in-house do the evaluation?

Shawn: It's the same reason that if I'm a used car dealership and I have you as my salesperson and you go put your own car on my lot. Where are you motivated? What are you motivated to sell? Your own car! You have a better benefit. Therefore there's a conflict of interest between us.

So the program provider is making money. They're being paid to work with your son. They can't be the evaluator because the conflict of interests is there. At Oxbow Academy we don't evaluate, we just prepare that student to be evaluated. Parents pick their own independent evaluator.

Benefits of an Evaluation

Tiffany: Well, let me add I think it's great that you guys spend time collecting information because out of treatment and other places, they may not require a clinical polygraph and they may just send the boy to a psychologist who does a psychosexual, and have a risk assessment and evaluation. And really what that looks like is they're only there for two days and that person has two days to collect as much information as possible plus try to figure out the truth.

Versus, if they go somewhere like Oxbow with a 90-day evaluation or within that timeframe, you're able to send:

• a passed clinical polygraph
• a write-up of how the 90 days have been from a therapist's perspective,
• a write-up of how they've been in the community with their peers in the home setting,
• and then a write-up of how they're doing school-wise.

So this is going to be a much more comprehensive and accurate evaluation. And then if you were just to send them to go do an evaluation for two days.

Shawn: And the data that follows that trend. It's not just a perception of how they're doing, it is data-led or data-driven to say, here's the progress.

When it comes to finding an evaluator, the burden is on the parents again. Oxbow is not going to select the tester. These parents have to go back to work again, find a tester, a psychologist who is qualified, whose personality, and whose personal stance on this issue lines up with their own.

Because there's a whole variety of different psychologists with different approaches. Parents have to match them up. So we provide a list of those psychologists to the other parents have chosen in the past.

Tiffany: They don't have to go totally back to work. We will provide a list that Oxbow has used in the past and you can talk to other parents at Oxbow about what their experiences have been. But you don't even have to use anyone who's on our list. As long as they do the testing we require. That's what we need.

Shawn: A lot of times we'll get students that come in and testing has been done. Yeah, and fairly recent to that. And for the most part, like IQ tests, processing speed tests, I mean other things that a psychological test will have...

Tiffany: Neuropsychological testing.

Shawn: They're still good and they're still valid. What they're not valid on, in my opinion, is the sexual risk assessment. Because that's the part that must have the truth to be accurate. Often we'll say, we don't need a full-blown psychological assessment, we just need to do the psychosexual aspect of it. So we'll add to the body of work that's already been done. If it's within the two-year period.

Tiffany: Sexual Behavioral Risk Assessment, which for those listening, is an SBRA. That is the term we use.

Shawn: And then from that, okay, what we're looking for is a recommendation. So the psychologists will come back and will say your son is either

• a low level of risk and that means he doesn't represent more or less risk than any other teenager or youth of his age group that you would find anywhere. So he has a very low level of risk of continuing in the behaviors that brought him into treatment,
• a moderate level of risk, which means he has a moderate chance of continuing to engage in those behaviors that brought him into treatment
• or a high level of sexual risk, a high, high level in adolescence when they hit that there are other contributing factors. There's generally a personality disorder, if you will, or there's an arousal pattern that is very, very negative and involves arousal to things that are illegal like children. Or it involves scenarios where there's power and control, rape, like things like rape and things like that, where their arousal patterns are really tied to that. They become very, very difficult to treat.

Tiffany: Or their arousal pattern is tied to the hurting of another person.

Shawn: Yes. Where the pain of another person is part of their arousal. I will tell you, it's rare in adolescents to have one come back as a high. Now, the literature will tell you if they're at a high level of sexual risk, treatment doesn't work for them. And so it just allows us to have a real truthful conversation with parents.

Tiffany: As a therapist, I'm going to say that's the statistics, right? That doesn't mean they shouldn't get treatment and they shouldn't be helped.

Shawn: Right. Well, it just shows when you're at that high level, it generally just makes you more secretive and more manipulative in your methods. But again, for adults, it's basically saying you're not going to ever change that arousal. For adolescents, it just means it's going to be a little bit harder for you to change that arousal.

Tiffany: So it comes back and says it's recommended that they need a sex-specific treatment and that they're a moderate risk or something along those lines that's required. So the great thing about this before we move ahead, is that this allows parents to be able to say, does my son need long-term treatment? Because that's a big step to put your kid in treatment.

It's not only an emotional toll on the families, but it's a financial toll as well to take that kind of next step. And so it shows you specifically with a third party person evaluating that, yes, your son needs treatment.

As a therapist is great for me because it gives me an individualized treatment plan for this specific boy rather than having him go through a cookie-cutter treatment plan at a program. This allows me to know exactly what things he needs to be working on and what's going to help him the most.

When Teens Need Non-Sex-Specific Treatment

Tiffany: And so what other things can they expect? Once they've gone through the evaluation piece and they know that he needs treatment, what next?

Shawn: Well, it's important to know that about one-third of students that go through the process end up at a low level of risk. In which case it doesn't mean that they don't need treatment. It just means they don't need sex-specific treatment. Okay. So then we would go to work on finding, okay, the recommendation should tell you we recommend this, the treatment focus in these areas and then we help the parents. Hopefully, they have an educational consultant who would also help parents and give them a couple of programs to look at that. That's what they specialize in.

So let's say it's a low level of sexual risk, but there's some serious trauma, but it's not sexual in nature that it's it's more emotional trauma. Then and educational consultant can help them find a program that focuses on that, and that's what they specialize in.

Tiffany: Ultimately, we don't want to keep those kids. Correct, because that's not our specialty. We want them to get the help that they need.

Shawn: And those students are the exact reason why we have a separate standalone evaluation center. because we really don't know what they need and we don't want to guess what they need.

Tiffany: And because the nature of having a sexual issue has so much shame and secrecy, there's we don't want to mess with that and take as you said, take a guess. So it's in the best interests of the client.

When Teens Need Specialized Sex-Specific Treatment

Shawn: So what's the let's say on the other side it comes back that it's recommended that they complete a portion of sex-specific treatment. We want to get really specific and we're going to hold the psychologists accountable to say we want specifics. If he needs it, what does he need? So a portion of students will come back and say he's a moderate risk in these areas, focus your treatment here. And, he's not a moderate risk in these others, don't focus there. Then we specialize. We focus on those areas. Other students will come back and it is recommended that they complete all four phases or the complete sex-specific work.

Then you start looking at other specializations like, "My son is neurotypical, which means he processes information typically like most adolescents of his age." Then our approach with that with him is going to be different than if my son is neurodiverse. He processes information very differently than what is the standard, you know, the typical way to process information. So we still have to get to the same end. But the way we get there is different. We have specializations where we wouldn't put a neurodiverse student in a population of neurotypical boys. They need to be in their own population.

The other cut-off is age too. So if your son is 12. At Oxbow Academy, we do not want them in the milieu with a 14 or older kid. They need to be in their own milieu. And the approach is completely different than the approach that we would have we would have at our neurodiverse home or our neurotypical home of boys that are 14 and older. For those that are younger, it's a completely different thing altogether. So within the program you choose, there has to be complexity within the complexity.

Tiffany: Yeah. Specializations within specializations.

Shawn: Specific methods for specific populations.

Tiffany: Specialized treatment

Shawn: Specialization within that specialization and your therapists have to also be more specialized. So, you'll have therapists that lean more towards their specializations dealing with trauma as part of the sex-specific work, or their specialization is more about working with neurodiverse kids as it relates to the motives and the methods and the whys, and what-fors of their sexual behavior, because it is vastly different than a student who is neurotypical.

Tiffany: Which we could do a whole podcast on and we hope to because that is a whole other topic on its own to talk about.

Focus on Treatment Outcomes

Shawn: So that last little thing is a program should be absolutely focused on outcomes. As a parent, you should ask the program, "What are your outcomes?" If they can't produce the statistical outcomes of their program, they're not interested in outcomes. If they are not collecting and analyzing data and can't show progress, they're not interested in outcomes. And there's research out there.

Tiffany: But they say, "We're relationship-driven."

Shawn: Well, they say "We're relationship-based."

Tiffany: Everyone says they're a relationship-based program.

Shawn: They all do. You need to ask the right questions like, "How are you relationship-based? How do relationships contribute to the outcome?" As a parent in all this mess, all that's really important is the outcome, which means my son won't return to the behaviors that brought him here. That's it.

We'll take him the rest of the way to adulthood, we'll help him gain competency and will help him do all the things he needs to do to learn how to be successful in life. But, we need the sexual peace to be extinguished. Does that make sense?

And if the program is not dedicated to that end, then they're going to sing and give you a song and dance. And they're going to sound really good and they're going to they're going to play it up really good. But the truth is, they don't care about outcomes if they can't show it.

How Do I Know My Son Will Be Safe in Your Program?

Tiffany: Let me ask you the big question that I think almost every parent has asked me. How do I know my son's going to be safe at your program?

Shawn: It's a great question. Programs will have them within their design, things like cameras everywhere. They'll have trained staff and they'll have methods of supervision. Those are the steps that really increase the probability of success. Their dorms will be laid out in such a way that is very easy to supervise. Their bathrooms will be laid out with that one intent, that it's all about supervision and it's all about making sure that your son is safe while he's in programing.

Tiffany: Especially at a place like Oxbow.

Shawn: Especially if those programs are specialized in sex-specific work. Yeah, it's it's really thought out and everything. Everything has been thought of as maximizing supervision.

Tiffany: And I because I've worked at Oxbow, and I know that's how Oxbow's set up. It is constantly evolving based on if we, you know, feel like maybe there's a blind spot.

Shawn: And there are. If a program tells you "We never have events where kids act out," they're lying to you, because kids do act out. The question is how big of a window did they have? In a good program, a solid program, a student's window to act out is about 3 to 5 seconds. That's their window to act out.

Tiffany: That's little to nothing.

Shawn: Little to nothing. But it's still caught. The programs that are that aren't really all that concerned about supervision and their windows are in our hours. So when you evaluate what can my son do in 3 seconds versus what could he do in an hour, an unsupervised hour. So you've got to really walk through the facility because you can talk all you want, but when you walk through a facility, you're looking up, you're identifying where cameras are being placed.

Tiffany: Well, one thing you implemented when I was hired by you guys years ago was you started putting windows in all the offices.

Shawn: And it was a tragedy that brought that about. Not at my program. I love to learn by proxy. I think that's the best way to learn. We had a student get placed at Oxbow who was being sexually abused by a nurse when they brought them, brought them in and shut the door. And he was being abused sexually by the nurse. Terrible, terrible, terrible story.

And I remember the mom coming in. We were the second program. She was so scared. Yeah. She's like, she's in such a terrible spot because she can't take him home. Right? Because it's your family is going to be unsafe, but so he's got to stay in treatment. But he was there, the treatment program just failed her. So she came in and she looked at me and said, Why are there not windows cutting your doors? And I'm like, That's a great question. And within a week I had windows.

Tiffany: Get no, you had windows in every, every office.

Shawn: So every door has a window. Again, it's a progress. But what you're motivated by in the program is motivated by always increasing safety. Safety is first above all else, once you've established safety, then you can do all the other work you have to do.

How Long Does Treatment Take?

Tiffany: What about the length of time?

Shawn: Great question. Depends on how involved the student is. Again, it takes longer if your son is only engaged at a cognitive level, which means he can, he can talk better than his own therapist about the issue, but he's not willing to get vulnerable. He's not willing to be vulnerable to his parents. He's he's not willing to hit that emotional level once they're in.

When you have a student that comes in and he's already through the process of the evaluation, put himself in a position of vulnerability. It's very quick. It's within six months. So the average is, though, for neurotypical students at Oxbow is about 9 to 11 months. That's the average stay. That includes the three months of the evaluation.

For neurodiverse students, this won't be a shock to anybody, it takes longer. They're more willing to go to the place of vulnerability. It's just that they have a hard time with the cognitive piece, wrapping their head around processing things and the application.

Tiffany: But once they get it, man they get it.

Shawn: That's the good news. Once a neurodiverse student gets it, they are locked in a new way of living. And I've had neurodiverse students go home and hold their parents accountable for the smallest things. Because you're risking me, you know? So they're very, very concrete. That's how they are by nature.

Tiffany: They're rule followers, very black and white.

Shawn: The battle is getting them from being concrete in a deviant arousal pattern to being concrete in safety. That's a pretty good fight. But once they're there and they're concrete into safety, they're going to just do amazing things.

Additional Challenges in the Treatment Process

Tiffany: Are there any other challenges parents should be aware of? That's a loaded question. Any that you can think that would be helpful at this moment.

Shawn: The biggest challenge is thinking that there's not going to be a challenge, that it's not going to be challenging. The biggest challenge is being so uncomfortable with your son's discomfort that you won't let him go into discomfort. That is the biggest challenge.

Tiffany: And to realize that it gets worse before it gets better. Yeah, like real change is hard. It takes work and time and it's not a quick turnaround. If it took your son this many years to get to where he's at, it's not going to take a couple of months for him to quickly turn it around. And so oftentimes I tell parents, you know you're on the right path when things start to get bumpy.

So buckle up, put on your helmet, and get ready for a bumpy ride. Know that this is going to be painful and hard at some times and it gets worse before it gets better.

Shawn: And it has to, because we're scrubbing the wound and we need to get that boy in a position to heal. But there are a lot of hearts that need to heal in the process. It's just not their son that needs to heal, it's their whole family.

Tiffany: There are so many broken hearts along the way.

Shawn: The boy and it all, have value and all require effort in helping to to heal.

Will Insurance Pay for Residential Treatment?

Shawn: This is a big question for parents because the resources are thin and they're in a really tight spot now. Insurance is coming around. The programs that have an in-house billing system have a higher probability of being able to collect insurance than if it's an out-of-house network.

Having done both of them, I know what it's like. And having an in-house team, where there's accountability, is much better.

Tiffany: We get a lot better outcome that way.

Shawn: So when you're talking programs, something you should ask about is how do you bill insurance? What's the process? Is it in-house or out-of-house? And just be aware in-house systems have a better collection rate than out-of-house collection programs because of the accountability piece that's there.

Will My Son Get Behind in School?

Tiffany: Two more questions Will my son get behind in school?

Shawn: That's a great question. Our goal is absolutely not. We want him ahead in school. The truth is, until we deal with some of these emotional issues, he's not going to go anywhere in school. So that's paramount. And with us, most of our parents, are like, I don't even care about school.

Tiffany: They don't care at first.

Shawn: At first they're like, I'm just freaking out about the probability of my son not having a life. I need that dealt with.

Tiffany: Otherwise he may go to jail.

Shawn: But almost the very moment, the very moment that he begins to get healthy, school is now a primary focus. So for us, school is always a primary focus. Like we we have to give that that child every possible opportunity to catch up. And, if they're caught up, to stay caught up. Most of our kids are behind. And our school systems have to be to a point where students have the opportunity to catch up.

The school has to be accredited. It works better if there are accredited teachers. And it's not all just an online system.

Tiffany: Which Oxbow has.

Shawn: We have a blended learning. So we do get our curriculum from an online source, which is widely accepted. But we have we also have instructions by certified teachers and we have students working at their own level on where they're at, but we also have them working together in groups. So it's blended.

Tiffany: And there's accountability in school so they're not just sitting there doing nothing.

Shawn: Here's the interesting part, in the data that we collect as we're watching a student's progress, it's fascinating to me that when a student begins to trend healthy clinically, they trend healthy academically.

And I don't know if it's because academics is really nothing more than an exercise in the future. Like we went to school because what did our parents tell us? That's the door to your future. Like what's the point otherwise? If it didn't have some type of positive effect in the future I would have. So every kid knows that. Learning algebra does nothing for the present, but it has everything to do with the future and being able to think. So when our students are struggling the most in school it is because they literally don't see themselves having a future.

Tiffany: How could you?

Shawn: So sit down, Johnny, and let's learn about history, right? Why? I have no I have no future. I'm never going to use any of this. So when they heal and they begin to heal, this is what happens. They begin to see themselves in the future. And then school plays an important role. So we see a bump almost instantaneously in their academic performance. When they get clinically healthy, they improve their academic health.

Tiffany: You're battling so much of that shame, you're giving them things tools like at Oxbow, they do a mission statement of who they want to become. Our vision board. I mean, all that is so key to helping them heal. Because again, we're not healing the boy on this one aspect. We're trying to heal him as a whole and the family as a whole.

And so part of that has to do with having a future in education as well.

Conclusion

Well, thank you, guys, for listening to this podcast. Again, I want to reiterate that wish we didn't have to do this podcast, but we know there are people who need to hear it and that's why we chose to have this difficult conversation to provide hope and help parents realize that there is healing ahead.