Deborah Jackson, LICSW is the Program Director of Justice Resource Institute- Integrated Clinical Services contributed this post. Deborah is intensively trained in DBT and has specialized expertise in the area of treating individuals with co-occurring ID and mental illness (MI). She has presented at several regional and national conferences on the topic of treating adults with ID/MI who have histories of engaging in sexually dangerous behaviors.

“I have found the Skills System model to be a useful treatment component when working with clients with ID that have exhibited sexually offending/sexually inappropriate behaviors. The Skills System provides a framework to address risk factors and also improve overall functioning and quality of life. These replacement skills are crucial for developing non-offending lifestyles. Through the structure of the Skills System clients learn how thoughts, feelings, urges and behaviors are interconnected. They learn how the intensity of emotions is usually paired by a corresponding increase in off-track behaviors.  The distinction between All-the-Time and Calm Only Skills helps clients understand how to be effective at every level of emotion, using Safety Plan to manage risk and choosing not to engage in interactive skills when experiencing emotional dysregulation.

A key benefit of the Skills System is that it pairs well with other theoretical models for addressing sexual offending/sexually inappropriate behaviors.  For example, it dovetails well with the Good Lives Model, a strengths-base rehabilitation model. The Skills System offers tangible skills to manage impulses and build/maintain positive relationships with self and others. Additionally, the Skills System is useful as part of relapse prevention-based treatment programs. The cognitive structuring helps clients to learn to become mindful of thoughts, urges, feelings and fantasies without attachment and determine if those things are helpful vs. not helpful with regards to their individual goals. Instead of getting mired in the dichotomy of things being good or bad, the emphasis is switched to clients identifying what is helpful and effective in relation to short- and long-term goals.  The strategies offer tangible steps for otherwise abstract concepts that often lead to relapses. These reflective steps prompt the client identify their own understanding of the world and pair that knowledge with outside facts/rules/laws/expectations.  Rather than prescribing a certain mindset or interactional style clients are able to identify things they can do to both preserve safety and build a life worth living.”