Adolescent sex offenders present a therapeutic problem in that they are both victim and perpetrator. As perpetrator they present a social problem and need containment while the underlying victimization needs treatment. A special unit has adopted an integrated model of systemic, cognitive-behavioural and psychodynamic frame works. To take into account both victim and perpetrator, psychoanalytic psychotherapy needs to be modified by (a) the incorporation of child protection measures and (b) a continuing focus on the offending behaviour. Given this structure the psychodynamic work helps to support a sex offender safely in the community and also produces dynamic material that illuminates the pathological processes from abuse to abusing. Themes that emerge in the treatment include sexualization of attachments, re-enactments of the abuse and a constant testing of the boundaries of the therapeutic relationship. Working actively with these issues can be seen to strengthen creative capacities in the young person as well as to help prevent recurrence of abusive behaviour. Clinic material is presented for illustration of these points.
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