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J Can Acad Child Adolesc Psychiatry. 2010 August; 19(3): 233.
PMCID: PMC2938761

Children with Sexual Behavior Problems: Family-Based, Attachment-Focused Therapy

Reviewed by G.T. Swart, MD

Children with Sexual Behavior Problems: Family-Based, Attachment-Focused Therapy.
William N. Friedrich .  WW Norton & Company:  New York, NY,  2007.  336 pages.  $38 (US). 

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This posthumously published work is an excellent book for the clinician starting to work with children under the age of 12 years who have sexual behaviour problems. The first part of the book is an overview of theory and therapeutic strategies and the second half is a manual for assessment and treatment when working with these youth and includes many of the instruments that William Friedrich developed.

The first chapter reviews the literature, reminding us that sexual behaviour is on a continuum from normative to pathological, that concerning sexual behaviour can be exhibited for many reasons, and that children with concerning sexual behaviours tend to come from troubled families and to experience more adversity than their peers. The next two chapters explain the role of the family in the development or sexual behaviour problems, and treatment for them based on attachment theory and the family’s approach to sexuality. The last three chapters in this section describe Friedrich’s approach to assessment and treatment. They are well written and have numerous case examples. The author directly addresses two major issues that are front and centre when working with children who have sexual behaviour problems: their families are generally very troubled and hence more difficult to work with, and they generally have a greater than average complexity. Therefore, assessment must continue throughout treatment and treatment must start with the first assessment appointment. The use of parent-child interaction therapy is promoted as an effective way to enlist the necessary parental involvement in treatment especially when the parent is ambivalent about the child. The final chapter in this section deals with individual therapy for youth with sexual behaviour problems. This permits the therapist to keep a focus on the referral problems while providing maximal support and engaging the parents whenever possible.

The second part of the book provides a manual outlining the aim of each session, detailing who should attend, specific questions to ask, and specific activities to use during each session. The sequence appears very reasonable. The final chapter contains all of the assessment and treatment forms that are mentioned in the book.

This book is easy to read, well organized, and thoughtfully laid out. I recommend it to any psychiatrist, psychologist, or social worker involved in assessment and treatment of youth under 12 years old with sexual behaviour problems.


Articles from Journal of the Canadian Academy of Child and Adolescent Psychiatry are provided here courtesy of Canadian Academy of Child and Adolescent Psychiatry