Problematic Sexual Behavior – Cognitive Behavioral Therapy (PSB-CBT)

What is PSB-CBT?

Problematic Sexual Behavior Cognitive Behavioral Therapy (PSB-CBT) is an evidence-based treatment model for children and youth ages 3-18 who have engaged in problematic sexual behavior (PSB). Typically, children participate in a treatment group based on their age (preschool, school-age, and adolescents), while parents participate in a concurrent caregiver group. Treatment consists of 12-23 sessions, depending on the age of the child. The model may be adapted for individual (family) therapy.

PSB-CBT effectively addresses a wide range of problematic and illegal behaviors, including:

  • Failure to recognize socially acceptable physical boundaries
  • Excessive masturbation
  • Preoccupation with pornography and other sexualized content
  • Generation and/or dissemination of sexualized images of self or others
  • Coercive and/or aggressive sexual acts

PSB-CBT is a good fit for agencies with:

  • Strong collaboration with juvenile justice, child welfare, treatment services systems, schools, child advocacy centers, and other community partners
  • Clinical services teams trained in evidence-based treatment.  
  • Active parent and caregiver involvement
  • Agency policies and practices for working with this population that are strengths-based, trauma-informed, and non-punitive

PSB-CBT is a good fit for clinicians who have:  

  • Cognitive-behavioral and family systems orientations  
  • Comfort with directive approaches in clinical treatment  
  • Experience with group treatment models  
  • Presentation and facilitation skills for group training and education sessions  
  • Comfort managing youth behavior in a group setting  
  • Comfort discussing sexual development and sexual content  
  • Strong family and client engagement skills 
  • Good organizational and communication skills  
  • Ability to actively collaborate with partnering agencies and community stakeholders  

Return on Investment

The majority of children and youth who participate in PSB-CBT cease to engage in problematic sexual behaviors; the recidivism rate among school age children is 2% ten years following completion of treatment.

Children and youth who participate in PSB-CBT also show significant improvement in non-sexual behavior problems, emotional difficulties, and trauma symptoms.

Most children and youth benefit from outpatient PSB-CBT, avoiding the cost and disruption associated with out-of-home placement. The approximate annual costs (2018 dollars) for placement in a North Carolina psychiatric residential treatment facility or a juvenile justice facility are greater than $50K and $100K, respectively.


Service Delivery

PSB-CBT may be delivered in a variety of community, residential, and confined settings, including; outpatient clinics, schools, homes, group homes, inpatient psychiatric and juvenile justice facilities.

Additionally, PSB-CBT can be offered through a variety of service delivery models, including outpatient, enhanced outpatient, intensive in-home, day treatment, and residential psychiatric services.



Treatment Goals

Eliminate or reduce problematic sexual behaviors

Improve coping skills and self-control strategies

Enhance social competence skills

Develop appropriate psychosexual knowledge and boundaries

Improve caregiver monitoring, supervision, and behavior management skills

Reduce out-of-home placement risk


NC CTP is able to subsidize the cost of this training through grant funds provided by the NC Division of Child and Family Wellbeing. Tuition is $500 per clinician, which covers the Learning Sessions and consultation for training cases. NC CTP partners with the University of Oklahoma Health Sciences Center Problematic Sexual Behavior – Cognitive Behavioral Therapy™ Training and Technical Assistance Program to provide this training.

Other Implementation Costs

  • Staff time for 2 half-days of virtual training.
  • Staff time and travel costs for 5 full days of in-person training in Durham, NC.
  • Staff time to meet other training requirements (e.g., client screening and assessment; weekly PSB-CBT sessions, planning time, and session documentation; biweekly consultation calls, and monthly implementation team meetings).
  • Space or digital platform and materials for weekly PSB-CBT sessions.
  • Visual equipment/resources to record and submit sessions for fidelity monitoring

Training Opportunities

In collaboration with the OUHSC PSB-CBT™ TTA Program, NC CTP will offer 1 training per year in PSB-CBT™. Training cohorts typically range in length from 12-18 months long and consist of face-to-face learning sessions and faculty and clinician consultation. Contact NC CTP for more information.