Although each individual may struggle with his or her own form of dysregulation, the fact that it is

dysregulation underlying the problem allows us to treat members of a heterogeneous group within the
same general frame. Some examples of potential case conceptualizations utilizing this approach are
provided below:

1. Rapist with hostile feelings toward women, psychopathic and sadistic traits
1. Emotional—anger, entitlement, resentment, defiance
2. Cognitive—judgment, blame, expectations of women, beliefs of sexual entitlement,
egocentricity
3. Interpersonal—hostility, manipulation, deceitfulness, dominance
2. Rapist with feelings of inadequacy and resentment
1. Emotional—anxiety, resentment, hurt, loneliness
2. Cognitive—self-criticism, self-judgment, all-or-nothing thinking, blame
3. Interpersonal—isolation, sarcasm, intrusiveness, poor boundaries
3. Paedophile with depression and anxiety, poor relationships with adults
1. Emotional—depression, anxiety, loneliness, helplessness
2. Cognitive—beliefs about sexual interactions, problem-solving deficits, rationalization
3. Interpersonal—isolation, poor social skills, manipulation
4. Noncontact offender (exhibitionist) with psychosis and poor social skills
1. Emotional—paranoia, inhibited emotions, anger
2. Cognitive—delusional beliefs, blame, cognitive disorganization, judgment
3. Interpersonal—accusations, arguing, isolation, poor social skills
5. Opportunistic offender against adults and children, males and females, with personality
pathology
a. Emotional—entitlement, boredom, excitement, labile emotional experiences
b. Cognitive—justification, sexual expectations and entitlement, perceptions of opportunity
c. Interpersonal—hostility, manipulation, grooming behaviours, deceitfulness

Basic Treatment Concepts

Sexuality, in Brief (Sessions 1–8)

Sexual education

Why is it important for people to have sex education?

How many clients have had past sex education?
What are your views on sex education (positive and negative)?
What should people gain from having sex education?

Gender and cultural gender roles

Do you know the difference between biological sex and gender (including
gender identity, roles, and expectations; sexual orientation)?
What are some stereotypes of men and women (positive and negative)?
How do these stereotypes affect interactions and relationships?

Sex and relationships

o Public versus private behaviours
What relationship/sexual behaviours do you think are okay in public? Only in private
(e.g., hugging, kissing, touching, masturbation, intercourse)?
Why do you think are there public prohibitions against certain behaviours?
o Different types of relationships
What are some different types of relationships (e.g., stranger, acquaintance,
authority figure, enemy, friend, intimate partner, family member)?
How do these relationships differ? (Draw out differences in how formed,
level of trust, how one acts, expectations.)
o Healthy and unhealthy relationships
What makes a relationship healthy? Unhealthy?
How do you know if you’re involved in an unhealthy relationship
(emotional reactions, expectations, physical feelings, etc.)?
What are some of the negative consequences of being involved in an
unhealthy relationship?
What can a person do if he or she is in an unhealthy relationship?

o Boundaries
What are boundaries?
Can you describe one or more of your own personal boundaries in
relationships (e.g., personal space, rules about privacy, how soon to reveal personal
information)?
Sexual Offending and victimization (Sessions 9–14)

Sexual offending
What is a sexual offense? Discuss your jurisdiction’s statutory definitions of
sexual offenses.
Discuss “violent” versus “nonviolent” offenses.

Consent
What is consent? (Begin by defining in general terms, e.g., in medical
decisions, financial contracts.)
What makes someone able to consent? What makes someone unable to
consent? What does someone have to know in order to consent to sexual activity?
What are examples of people who are unable to consent to sexual activity? Why?
Why is consent important?

Sexual victimization of children and adults

What happens to someone after he or she has been sexually victimized? Discuss with
clients the physical, psychological, interpersonal, and functional
effects of sexual offenses on victims and important others in the victim’s life.
How does it impact people hearing a story about sexual violence on the news?
How does it shape society’s views of sexual offenders?
When people fear victimization, what do they think of offenders?

Sexual Offending, Mental illness, and Self‐regulation (Sessions 15–19)

Sexual offenses and mental illness

Clients describe relationship between symptoms of mental illness and sexual
offenses. These may include paraphilias, if relevant.
What are some symptoms of mental illness (like depressed mood, hearing
voices, impulsivity, racing thoughts, paranoia, or unusual sexual desires)?
How do these symptoms affect behaviour?
How do they affect sexual behaviour?

Self-regulation and the multi-modal self-regulation theory

Explain self-regulation and dysregulation.
Why do we self-regulate?
Describe the four domains of self-regulation—emotions, thoughts,
interpersonal interactions, behaviours—and examples of dysregulation from
each.
Encourage clients to identify domain(s)/area(s) they struggle with.
Discuss how these are related, and how maladaptive behaviours “help” with
self-regulation.
Explain reinforcement and self-regulatory strategies.
What is rewarding about sexual behaviours? Punishing? (Focus discussion more on
positive reinforcement.)

Behavioural chain analysis (Sessions 20–25)

Distinguishing thoughts, urges, and emotions
Make sure clients are able to differentiate between thoughts, emotions, urges,
and behaviour.
How can thoughts, urges, and emotions be related to behaviour?

Introduce behavioural chain analysis

Purpose: To change a behaviour, clients must know the underlying factors that
lead to it.
What is chain analysis?
It breaks down an event into its parts, examining in detail what preceded
maladaptive sexual behaviours.

Each client completes a behavioural chain analysis of one or more sexual offenses
o Steps in doing a chain analysis
Identify one target behaviour of one client.
Identify time frame for analysis.
Identify general situations and specific events that preceded the behaviour.
Identify thoughts, emotions, and urges associated with each event.
Track client dysregulation through the sequence; have client rate intensity of emotions
and urges.
o Ask the group to reflect on the chain analysis.
o What aspects of the analysis stand out?

Self‐Monitoring and Self‐Management (Session 26)

Introduce self-monitoring
Purpose: Self-monitoring helps clients increase their awareness of dysregulation in
their daily lives and alerts them to opportunities for skills use. It also makes them more
aware of vulnerabilities and situations in which they are more vulnerable to strong
urges.
Clients will now develop a self-monitoring log using sources of dysregulation from the
behavioural chain analysis. Clients select their own self-monitoring targets and share
them at the beginning of each group from this point forward.

Emotions and Emotional Regulation

Identifying and Understanding Emotions (Sessions 1–8)

Basic and complex emotional states

Eight basic emotions
Thoughts, other emotions, physiological sensations, and urges/behaviours related to
these basic states
Relationship between basic and more complex emotional states
Describing emotional states
Intensity and duration of emotions
Why and how we self-monitor emotional states

Origins of Our emotions (Sessions 9–12)

Why do we have emotions?

Biological and learned emotional responding
Adaptive nature of emotions
Pros and cons of emotional experience
What causes my emotions?
Clients list examples of four precursors/triggers for their emotions
Situational factors
Cognitive factors
Interpersonal factors
Emotional factors

Experiencing emotional distress (Sessions 13–17)

Emotional distress and emotional dysregulation

Facets of emotional distress and dysregulation—emotional and physical responses
Intensity—how strong is it?
Sensitivity—how much does it affect you?

Relationship between emotions and maladaptive behaviour

Reacting to extreme emotions
How are reactions maladaptive?
How are maladaptive behaviours or reactions to extreme emotions reinforced?
Emotional coping—adaptive and maladaptive

Emotional dysregulation and Problematic Sexual Behaviour (Sessions 18–22)

Specific emotional states related to sexual offending

Clients define and identify how these states are related to their own and others’ sexual
offending behaviours
o Entitlement | Anger | Resentment | Defiance | Boredom
| Excitement | Sadness | Loneliness | Disappointment | Anxiety or fear

Precursors to risky emotional states

Review of situational, cognitive, interpersonal, and emotional triggers for these specific states

TaBLe 7.5. alternative forms of coping: Basic Techniques (Sessions 23–25)

Basic strategies
Review strategies for preventing emotional dysregulation, soothing

intense emotions, and distracting from emotional distress

Using alternative strategies

Include discussion of alternative strategies in weekly self-

monitoring assignments