CBT Approaches Valuable for Developmentally Disabled

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SAN DIEGO -- Cognitive-behavioral treatment can help developmentally disabled persons with sexual behavior problems learn self-regulation skills, but don't expect one approach to work in all cases.

"Treatment has to be very concrete and directive, using plain language," Gerry D. Blasingame said at a conference sponsored by Rady Children's Hospital, San Diego. "The average learning cognitive level for an adult male with an intellectual disability is somewhere between fourth and sixth grade. So when you talk to these gentlemen, you need to think about plain language that you would use to communicate with somebody in the fifth grade."

That means being comfortable using "street words" for body parts and sexual behavior to make sure that clients understand and have the same mental association. "For example, I was working with a guy with an IQ of 57," recalled Mr. Blasingame, a licensed marriage and family therapist who practices in Redding, Calif. "I asked him if he ever masturbated. He said, 'No. I never do that.' I then asked him, 'Do you ever jack off?' He said, 'Oh yeah.'"

Clinicians who work with this population should also be prepared to tackle bizarre, sometimes disgusting behavior, such as clients who smear or eat their own feces for sexual gratification. Mr. Blasingame seeks informed consent before proceeding in the treatment of such clients. "We need to think about communicating with family members, with the regional center system, and perhaps with probation officers, to make sure that somebody who knows this individual can assist in making this process legitimate," he said.

Adapting cognitive-behavior approaches to this patient population means knowing the client's zone of proximal development. "I can take a client through one set of skills on subject A, but I can't assume that they will be able to apply the concepts to subject B, C, and D," explained Mr. Blasingame, author of "Developmentally Disabled Persons With Sexual Behavior Problems," 2nd ed. (Oklahoma City: Wood 'N' Barnes, 2005). "If you don't know what the client's zone of proximal development is, you might be overtreating them or missing the mark."

In his practice, individual therapy covers placement survival, family relationships, personal sexuality, integration of offender treatment, personal victimization, and follow-up on issues that arise during group or family sessions. Mr. Blasingame emphasizes relapse prevention and establishes an "avoid it" contract with the client. This defines the behavior that is to be stopped and avoided, and identifies internal and external risk factors.

For self-monitoring, he uses a weekly check-in questionnaire to hold clients accountable for reporting bad or nasty thoughts. …