STES
Safe Taboo Exposure Standard
protocol for Taboo OCD ERP
PURPOSE
STES defines a structured clinical standard for constructing and delivering sexual and violent taboo intrusive thought OCD exposures without unsafe improvisation, unnecessary disclosure, or ethical concerns.
CORE STANDARD
STES is an ERP (Exposure and Response Prevention) standard for sexual and violent Taboo OCD treatment. It preserves the intensity required to treat sexual and violent OCD types, while setting guidelines for exposure sourcing, procedures, response prevention fidelity, strict minor confidentiality, suicide risk, and measurable provider review.
Providers may know ERP conceptually but lack a reviewable structure for high-shame, high-liability taboo exposure work.
Clients may be harmed when providers avoid the content entirely, reassure, disclose unnecessarily, or improvise unsafe exposure tasks.
STES is intended to make taboo exposure work structured, simulation based, measurable, and clinically containable.
SCOPE
Ethical Scope:
STES is grounded in the professional obligation to treat clients whose symptoms are stigmatized, misunderstood, and difficult for providers or systems to tolerate.
STES applies that ethical obligation to sexual and violent Taboo OCD by giving practitioners a clinical standard for treatment rather than leaving them to avoid the content, refer without a treatment pathway, reassure the client, disclose unnecessarily, or improvise exposure treatment without a framework.
Clinical Scope:
STES applies when the treatment target is the OCD cycle that follows the intrusive content. This includes rumination, checking, reassurance seeking, confession, avoidance, mental review, body scanning, self testing, shame, certainty seeking, among others.
STES is intended for use across mental health professions where providers treat OCD, including outpatient therapy, community mental health, hospital programs, private practice, group practice, agency treatment, and institutional care.
Standardization Scope:
STES exists because sexual and violent OCD treatment requires a formalized exposure treatment standard. Without a standard, providers may rely on instinct, counter-transference based assessment of syntonicity, personal comfort, personal discomfort, or improvised exposure tasks.
STES defines a shared structure for exposure modules, exposure sequencing, treatment of minors with the disorder, strict confidentiality, suicide risk protocol, and measurable provider review of outcomes. The purpose is to make clinically appropriate treatment easier to provide with confidence, stability, consistency, and ethical support.
PUBLIC BENEFIT AND CLINICAL NECESSITY
Sexual and violent OCD creates a public treatment gap because many clients are willing to seek help only if they can be certain the provider fully understands the disorder and the full implication of coinciding ego-dystonicity and ruminative uncertainty, will not disclose, and will not show non-simulative based visible discomfort (real discomfort). If a clinician has an unplanned authentic reaction, good practice requires the clinician to recognize it through self-monitoring, regulate it, and realign with the client and the OCD formulation rather than allowing the reaction to become treatment direction, risk labeling, reassurance, disclosure, or avoidance.
When the provider does not have a clear exposure treatment structure, the client often learns that the content is too disturbing to discuss, too shameful to treat, and could ruin their life for seeking treatment. That reaction can cause increased risk of suicide and decreased help seeking behavior.
STES addresses the treatment gap by giving clinicians a shared clinical structure for presentations that are commonly avoided because of subject matter discomfort. The benefit is not only improved treatment quality. The benefit is that more providers may be willing to treat these cases at all.
STES allows for providers to be able to provide sexual/pedophilic, and violent (sometimes combined) OCD exposure without the heavy emotional toll on providers, resulting in less burnout and increased ability to deliver treatment to more patients in need.
A major clinical risk in sexual and violent OCD is provider countertransference based assessment of syntonicity. Providers may hear taboo content, especially when the intrusive thoughts are about a child that the patient has regular private access to, and feel alarmed. This alarm sometimes results in the provider unconsciously treating their own countertransferred fear as diagnostic information, mandated reporting indication, treatment change necessity, or other harmful provider response. STES identifies this as a clinical failure.
The public benefit is strongest for teens and adolescents. A minor with sexual or violent OCD may stop disclosing symptoms entirely if the provider breaks confidentiality or communicates the intrusive content to a parent, other provider, or caregiver who then begins to treat the child as dangerous. STES supports strict minor-client confidentiality.
It is important to note that STES does not consider children under 12 eligible for Taboo OCD ERP and would assess if a child under 12 presenting with Taboo OCD-like symptoms has experienced significant sexual, psychological, physical, or other abuse - rather than turning them away.
The STES-Protocol workbooks also reduce avoidable liability for providers and facilities by replacing improvised exposure treatment with a reviewable clinical process. A provider following STES-Protocol can obtain standardized sexual and violent exposure modules, safety protocols, and treatment outcome tracking. This gives the provider a clearer clinical standing record than informal exposure planning.
STES Define Exposure Standards
STES establishes clinical boundaries that support direct exposure treatment for sexual and violent OCD for both children and adults, while maintaining clarity, confidentiality, treatment intensity, and reviewable clinical structure.
These standards are intended to guide provider judgment, reduce improvisation, and preserve the treatment frame without turning provider discomfort into client risk or provider comfort into client risk.
1. Exposure material is fully pre-selected with clinical intention before it is used.
Exposure stimuli should be pre-selected based upon client reported intrusive thoughts in a defined treatment purpose within the STES sequence. The provider should know what material is being presented, why it is being used, and which OCD intrusive thought is being targeted.
If a client prefers to give a generalized overview of thoughts due to discomfort, the provider should still engage in pre-selected stimuli for exposure treatment with as much information as possible and should not decline to provide exposure therapy due to provider determinations of lack of specificity.
Clinicians should consider using AI-generated, fictional, non-identifiable images for POCD simulation rather than sourcing legal photos of real children online.
STES considers it more ethical to use a fictional child image that does not depict an actual child than to rely on photos of real kindergartens, gymnastics classes, child pole dancing competitions, children at swimming pool photos, social media posts, child modeling, etc.
It is not that the old way of finding legal POCD exposure simulation material was ethically wrong, it is simply that new tools exist where clinicians do not need to use those any longer.
2. Exposure sourcing should reduce unintended clinical risk.
STES favors prepared, reviewable, clinically appropriate materials instead of spontaneous sourcing, especially during session. Open search processes, algorithmic feeds, related content explorations, or broad search terms like “naked ‘toddler’” and “murder scene” should not be used because they may be sourced from actual child sexual abuse material or glorified gore. Open search exposures result in some of the highest risk - incidental introduction of abuse material outside the intended exposure.
There are real world, highly esteemed, inpatient facilities and providers engaging in ERP for Taboo OCD with routine treatment plans involving having patients engage in Groinal Response manual activation with a doll in front of providers and staff, perform internet searches for legal photos of naked toddlers, and more. Certainly searches for nude toddlers are intended to be legal in nature and follow the same exposure mechanism of something such as the Nirvana album cover, however, the above risks including secondary exposure to algorithmic introduction of ‘similar’ material produces extreme risk and serious ethical implications of client harm.
This is not meant to target any provider or become a witch hunt. STES recognizes that many providers doing intensive Taboo OCD work are delivering high-quality care in one of the most difficult areas of mental health treatment. It also recognizes that when clinicians do this work every day, often with patients who need increasingly direct exposures, the work can become desensitizing, exhausting, and unusually isolating.
Most of the clinicians doing this level of work are already solo practitioners, senior providers, supervisors, or program leaders, which means there may not be a supervisor to provide feedback on the exposure plan. STES is meant to create a shared standard for those situations: not to punish clinicians for difficult clinical judgment calls, but to give providers and programs a clearer baseline.
3. Countertransference based syntonicity assessment is never clinically appropriate.
Providers should never assess syntonicity or risk of intent/desire of an OCD client’s intrusive thoughts. In sexual and violent OCD, uncertainty about desire, body response (including Genital Response), identity, morality, or meaning is part of the disorder itself.
4. Provider discomfort is not clinical evidence.
A provider may feel discomfort when hearing sexual or violent intrusive thought content. That reaction should be managed clinically and should not become disclosure, reassurance, avoidance, interrogation, assessment, or risk labeling.
5. STES preserves strict minor confidentiality.
For teens and adolescents, taboo intrusive thought content is not disclosed to parents or guardians. Disclosure is limited to suicide safety planning if the client is suicidal, without any mention of the cause of the suicidality.
A disclosure of even the type of OCD, without client’s explicit full expressed consent and preparation, can have extreme repercussions in the family, at home, and in the community. The harm that could be done by a clinician feeling the parent will understand the ego-dystonicity of the intrusive thoughts could have lasting damages for the rest of the child-client’s life.
6. STES utilizes ERP.
STES does not use thought replacement, reassurance, distraction, calming behavior, values review, or self or other behavioral changes to avoid discomfort from intrusive thoughts when those responses function as avoidance or neutralization.
7. Suicide risk is addressed as a separate clinical layer.
Acute suicide risk pauses or modifies exposure treatment according to clinical judgment. A history of suicidal ideation does not exclude STES, but it requires pacing, monitoring, support planning, and treatment judgment. This may present as reduction in the intensity of exposures to ensure client safety or standard interview to assess for increase in suicidality.
A. Each exposure includes a full description to the client of what to expect if the client has never done exposure treatment. If the client consents to proceed, prior to starting, the client is asked about suicidal thoughts, the provider prepares for exposure intensity adjustments based on clinical judgment of suicide risk.
B. After suicidality is assessed, a scale-based client-directed consensual selection of the desired anxiety level to be reached is completed. After the clinician has the client-selected anxiety level to be reached the client is provided increasing intensity exposures with a scale based anxiety rating between each exposure. Once the client reaches their pre-selected anxiety level, they are guided to allow and embrace the discomfort and to not force change in their thoughts or behavior.
8. Each exposure has a measurable treatment endpoint.
Clinicians should prepare at least 15 minutes prior to session end to stop exposure,
allowing the client time to process without be rushed out of the door immediately
following their highest level exposure.
Treatment response is evaluated by:
-
Reported reduction of symptoms between sessions.
-
Same/similar exposure modules completed with reduction in anxiety ratings.
-
Reduction in need for therapy / eliminated need for therapy.
STES Treatment Map
Description of what to expect (only if this is the first treatment)
Suicidality screening
↓
Client selected anxiety ceiling
↓
Exposure
↓
Anxiety rating
↓
Continue exposure sequence
↓
Anxiety rating
↓
Anxiety ceiling reached or completion of module
↓
Stop exposure sequence no later than 15 minutes before session end
STES Treatment Chain
- Suicide risk screening
Suicide risk screening occurs before exposure treatment begins, with added emphasis for first time clients, clients with prior suicidal ideation, clients with shame based collapse, and clients entering sexual or violent OCD exposure treatment for the first time.
- First session orientation
The provider explains what the client should expect before beginning the exposure sequence, including increased anxiety, shame activation, uncertainty, simulated accusation or simulated provider disgust, simulation of client being an offender, intrusive thought spikes, and strong possibility of nervous system aftershock following the exposures.
- Client selected anxiety ceiling
Before any exposure sequence begins, the client selects the maximum anxiety level they are willing to reach during the module.
1 2 3 4 5 6 7 8 9 10
This number guides pacing and intensity for the module.
- Exposures begin
The provider presents the exposure direction, stimulus or task, and response area in the STES sequence.
- Anxiety rating
After each exposure, the client rates anxiety from 1 to 10.
1 2 3 4 5 6 7 8 9 10
- Continue or hold
If the client remains below the selected anxiety ceiling and adequate session time remains, the provider continues to the next exposure followed by another anxiety rating.
- Anxiety ceiling reached
If the selected anxiety ceiling is reached, the provider holds the exposure sequence and shifts into remaining with the feeling rather than escalating intensity.
- Module completion
If all levels are completed before the anxiety ceiling is reached, the module closes with treatment response review and next step planning.
- Session safety buffer
Exposure escalation ends no later than 15 minutes before the scheduled session close. The final 15 minutes are reserved for safety review, stabilization, post exposure monitoring, suicide risk reassessment when indicated, and transition out of session.
- Treatment response review
The provider reviews whether the client completed the exposure sequence with reduced amount of OCD rumination or impulse.
STES Code of Ethics
Ethic #1: Non-Discrimination
Providers should not treat clients as dangerous, immoral, predatory, deceptive, or untreatable because of the content of OCD symptoms. Providers should not allow stigma, disgust, liability fear, demographic assumptions, or personal discomfort with taboo content to replace clinical treatment.
(e.g. Clients may be misread when their obsessional content is stripped of OCD context. A new mother with Harm OCD involving her children, a male teacher with POCD involving female students, or an older teenage sibling with incest-themed Sexual OCD may all be viewed as riskier because of socially projected fear. STES rejects that distortion and emphasizes that all people be seen, viewed, and treated with equality.)
Ethic #2: Exposure Boundaries
Taboo OCD exposure work may involve highly sensitive sexual or violent material. Providers should handle exposure sourcing and exposure treatment in a manner that protects clients, providers, and uninvolved third parties. Casual searching, spontaneous sourcing, or sourcing live exposures from unknowing adults or children should not be part of treatment.
Taboo OCD ERP exists in an unusual ethical space. In any other mental health treatment, asking a client to simulate being a child rapist, abuser, or dangerous person would immediately be well outside the ethical boundaries of treatment. In Taboo OCD treatment, simulations of the feared event or identity are clinically appropriate and ethical.
STES does not try to make treatment polite or watered down. STES believes in keeping high-intensity exposure work away from drifting into practices that create avoidable harm, such as manual Groinal Response activation, nude child-image searches, or using real children as hidden exposure participants.
Ethic #3 Client Protection
Clients with Taboo OCD are uniquely vulnerable to provider exploitation because treatment places the clinician in possession of highly stigmatized and easily socially misinterpreted client information. This creates an unusually severe provider-client power imbalance built into the clinical context itself. The provider holds not only clinical authority, but also the client’s most misunderstood and socially dangerous private information. It creates structural blackmail: the provider does not need to threaten disclosure, because the client already knows that reporting requires revealing the very information that would ruin their life.
In that context, ordinary consent language is not enough. Providers have a heightened responsibility to recognize that clients are being guided through ethically inverted treatment, where an exposure could be violating beyond symptom exposure even when the provider is acting in good faith. A client may feel pressured to complete an exposure whether the discomfort is from ERP or an actual boundary violation, and still be unable to realistically report the incident without exposing the OCD thoughts.
(e.g., A teenager with POCD involving a sibling half their age could be asked by a provider to touch themselves with a doll while the provider watches and simulates disgust, as part of an exposure. If the teenager feels violated and wants to stop therapy or report the event, they may still feel unable to tell a parent. Explaining the provider’s conduct would eventually require explaining the Taboo OCD content that led to the request. The disclosure barrier becomes part of the harm itself.)
Providers should protect clients with Taboo OCD from any disclosure of stigmatized symptoms or thought content in records, communication, consultation, and family involvement. Clinical notes should remain entirely non-specific regarding the intrusive thought content, feared identity, feared target, sexual or violent theme, or OCD subtype.
For minors who have been clinically deemed appropriate for Taboo OCD treatment, disclosure to parents, guardians, caregivers, schools, outside providers, or other systems should not include the subtype or content of the intrusive thoughts.
If any disclosure is considered, it must be limited to a pre-planned, specific statement that the client has reviewed and freely agreed to before the disclosure occurs. The client’s agreement must not be obtained through pressure, implication, fear, or clinical authority. The client should not feel that disclosure is expected, necessary, required, or coerced. Providers should recognize that even vague disclosure can cause serious family, social, legal, and identity harm when Taboo OCD is misunderstood, even when the disclosure is pre-planned and fully clinically explained.
STES BASELINE
STES aims to provide a simple baseline that helps providers recognize when they may be moving outside the appropriate clinical scope or venturing too far, even when their intent is good or their in-the-moment clinical judgment feels justified.
This baseline is intentionally not overcomplicated. It does not aim to clinically assess, deny, or override clinical judgment in cases that may be highly individualized. Instead, it establishes the most basic standard:
1) Patients should never be asked to touch their genitals or anyone else's.
2) Patients should never be asked to look at photos of naked children or processes that could expose them to actual abuse material by algorithm or incidental exposure.
3) Child interaction should never be used as a source for sexual exposure material.
4) Minors under 12 should never be given Sexual, Violent, POCD, or other Taboo OCD exposure treatment.
STES hopes these aren't controversial and aims to set a baseline industry standard with these four simple rules.
STES understands that baseline #3 may be the hardest for providers to come into agreement with, however, hopes the providers who disagree will consider exploring alternative exposures that do not involve direct child interaction as sexual exposure treatment.
STES BELIEVES CLINICIANS SHOULD CONSIDER SOME FORM OF OVERSIGHT FOR PROGRAMS OR PROVIDERS
WHICH ENGAGE IN
SEXUAL EXPOSURE THERAPY WITH MINORS
This should maintain the absolute strictest level of client anonymity and be done by professionals with the
strongest clinical awareness of POCD and Sexual OCD.
Exposure Therapy sexual simulation / simulated abuse of others, with a minor, even when that treatment is limited to guided visualization, would typically be considered illegal under any other circumstance, outside of the context of OCD treatment.
At the very least, some form of these minimal standards in STES would be beneficial.
Important note: Readers may think that "manual Groinal Response activation" is not a standard treatment, however, unfortunately at least one highly esteemed inpatient facility which treats minors and adults with OCD would disagree.
Here is a direct quote from a treatment plan of the facility that I obtained from a former patient when she was discharged and referred to my practice: "Rub your baby doll against your genitals for 5 seconds in front of staff and say, “Toddlers make me horny.” "
Readers may feel that the rest of the BASELINE is unnecessary and common sense/law, however, the vast majority of providers source live children for exposures and many utilize open search processes or nude "toddler" photos.
The practitioner who is desensitized may look for the clinical value, assign best intent, minimize it as only 5 seconds (unless repeated). The writer hopes that STES can bring about a practitioner re-alignment where Taboo OCD providers begin to formulate ethical standards and standardized practice as well as a public health awareness.
STES
FOR THE PRACTICE OF
VIOLENT OR SEXUAL EXPOSURE THERAPY
WITH MINORS
protocol for Taboo OCD ERP
CHILDREN UNDER 12
Minors under 12 should never be given Sexual, Violent, POCD, or other Taboo OCD exposure treatment:
STES does not believe minors under 12 should not receive treatment due to "age appropriateness" as a barrier.
Instead, STES recognizes that exposure treatment for taboo intrusive thoughts requires the client to
a) tolerate simulated accusation
b) absorb a shocked nervous system from considered feared identity
c) experience intense uncertainty without using reassurance, avoidance, confession, or neutralization.
d) undergo unconscious instinctual rejection
Children under 12 generally do not yet have the developmental consolidation, personality structure, abstract unconscious instant knowledge of core self, or stable conscious internal identity anchor required to absorb the intense treatment or respond to ERP.
The safer clinical response to a child under 12 with symptoms presenting as a Taboo OCD, is warm non-judgmental listening, maintained confidentiality of their intrusive thoughts, and careful evaluation for possible sexual, psychological, physical, or other abuse.
For example, if a 9-year-old child repeatedly experiences sexualized intrusive thoughts involving touching her father's penis, and OCD is indicated because the child is confessing the thought, multiple times per day to that parent in a compulsive and reassurance-seeking manner, most providers would diagnose OCD after the impulsive confession of ego-dystonic taboo thoughts presented. STES would still treat Sexual ERP as *entirely* inappropriate, despite current clinical norms considering the child for Sexual OCD ERP.
The presence of compulsive confession, or any other provable OCD symptom indicator, does not make the child psychologically capable of tolerating ERP. When a child is under 12, the child’s sense of self, identity, subconscious processing, and unconscious instinctual rejection capacity are not sufficiently psychologically solidified to reliably respond to Taboo ERP.
Some providers may disagree because they view ERP as primarily training the mind not to perform compulsions around a feared subject, with exposures gradually creating a sense of normalcy. STES disagrees with that reduction. STES views subconscious processing and unconscious instinctive rejection as fundamental to ERP. ERP is not simply “becoming comfortable with intrusive thoughts about abuse.” If that were the whole mechanism, true remission would make little clinical sense.
Comfort with the presence of symptoms should be built through consistent, unchanging, nonjudgmental warmth from providers. If the child has disclosed these thoughts to their parents, that same warmth should come from parents as well. That support can help the child experience the symptoms as clinically manageable without exposing the child to sexualized material or trying to make the sexual abuse subject matter normalized. This is a less risky and more developmentally appropriate approach.
With a child under 12, there is the complete lack of the vital mutually understood dystonic undertone in the interpersonal dynamic occurring during Taboo ERP treatment.
STES does not exclude minors under 12 from Sexual ERP or POCD ERP because “sexual topics are off limits” for that age group; it prohibits it because, psychologically, their minds are not expected to respond to exposure treatment.
Separate from that, STES also recognizes the ethical risk that an unethical clinician could use “ERP” to say sexually exciting or sexually graphic things to a child, have them view photos of nude "toddlers", have them view photos or videos with implicit or stated sexual context, have them engage in sexually abusive discussion/simulation, or have them engage even sexual behavior and call it "treatment".
When age is combined with an industry standard finding that treatment for that age group is wholly ineffective, Sexual Exposure Therapy with children under 12 becomes indefensible as treatment.
MINORS AGED 12-17
For minors under 18, the provider has an increased responsibility to balance client-directed ERP with clinical restraint, including knowing when to pull back even when the work could otherwise continue.
Minors aged 12 and over may receive Taboo ERP treatment in a limited capacity under the Safe Taboo Exposure Standard. STES does not lay down a fixed rule for this age group because it is highly individual. In anecdotal STES practice, best care is usually provided to ages 12-15 through exposure to uncertainty after disclosure of feared thought by the client, rather than simulation, accusation, or the more aggressive types of nervous-system shock treatment. If something like heavy obvious sarcasm is being used to anchor the dystonic contextual undertone, the provider risks harm if they find themselves needing repeated effort to maintain the minor’s continuity of unspoken mutual understanding of dystonicity. That would indicate the minor does not have the internal sense of self needed for that level of ERP, and treatment may need to be throttled, temporarily discontinued, or altered to a drastically reduced amount.
*This age group may also experience higher levels of confusion, and genital response self-exploration may have created stronger neural pathways toward consideration of a labeled abuse identity. Providers should not be afraid it is unethical to mold these client's identities in this unique space, by engaging in supportive core-identity scaffolding and neutral education, with the unconscious therapeutic message (identity building) that abuse-based or offender-based identity conclusions are *wholly* inaccurate despite confusion or incidents of self-exploration during intrusive thought cycles. Instead, the clinician should engage in the building of anchored non-abusive sexual identity. This would also indicate the minor does not have the internal sense of self needed for ERP and instead ERP would be used to contextualize non-abuse identity building. These minors should not be diagnosed as non-OCD sexually abusive persons by providers simply for exploration due to repeated intrusive thoughts, instead, the provider should understand the child's brain had not developed enough to have the unconscious instinctual rejection. This does differ from fully grown adults who engage in prolonged syntonic masturbation to children or other taboo subjects, obviously.
Usually around ages 16 and 17, STES can become slightly more aggressive. Accusation can usually take place around age 16 more safely, as the internal identity is developed enough for unconscious rejection to happen instinctually, and the nervous system is developed enough to endure waves of increased panic activation.
Around this age, if a provider acts inappropriately or the client becomes uncomfortable, the client is also more likely to vocalize that discomfort and take action to defend themselves.
That being said, being slightly under 18 does not automatically mean the client cannot handle more intensive ERP when clinically appropriate. Likewise, it does not mean that turning 18 makes a client magically capable of being treated with the most intensive ERP. Treatment must remain individualized. Clients who are over-exposed risk what many clinicians recognize, for lack of a better clinical term, as a nervous-system “blowout,” where ERP stops functioning as treatment and either becomes ineffective, compulsive, or destabilizing. This often occurs when exposure becomes unplanned, excessive, non-consensual in practice, or pushed beyond the client’s ability to remain therapeutically oriented.
CONCLUSION
Many providers may disagree, and certainly much of STES, especially the section on minors, is clinical opinion and anecdotal practice. However, opposing views are likely operating from the same level of clinical opinion. Debates around “not effective” versus “harm/benefit,” should at least occur. Understanding the difference between non-compulsive reactivity versus complete annihilation of intrusive thoughts in how remission should be defined is outside the scope of this standard.
A non-OCD professional or general reader may feel this issue is not serious enough, or not common enough, to require a standard. They are wrong. I have seen how perverted this area of treatment can become behind the polished surface, and there are many adults and children who seek OCD treatment for sexual and violent intrusive thoughts.
STES offers the 4 baselines as a starting point for minimal standardization, safety, and a long-overdue realignment:
1) NO HAVING PATIENTS RUB THEIR GENITALS OR OTHER'S GENITALS
2) NO PHOTOS OF NAKED CHILDREN EVEN IF THEY ARE "TODDLERS"
3) NO LIVE CHILDREN IN SEXUAL EXPOSURES
4) NO MINORS UNDER 12 RECEIVE SEXUAL OR VIOLENT EXPOSURES
STES hopes adjacent professionals will aid in establishing this standard as operating practice, at least until a better standard can be developed.
We all may have our own clinical opinions. STES is not theory alone. The author has substantial anecdotal experience showing approximately 80% full remission in approximately six weeks. That timeframe is typical for ERP. This was achieved with clients 12+ without violating these baselines. Other providers may disagree. They likely have not proven that violating any of the four STES baselines is needed for remission. STES holds that violating them is unnecessary and clinically indefensible.
This standard was developed by Daniel Carr, LICSW, based on field experience with hundreds of POCD, Sexual OCD, and Violent OCD cases, as well as his work providing free nationwide clinical supervision to help address the clinical issues outlined.