Delmonico, David L

Adolescents who use the Internet regularly (the “e-teen”) present a new set of challenges for marriage and family therapists. This article introduces marriage and family therapists to (a) the basic technological concepts and unique psychological characteristics of the Internet important in understanding and addressing adolescent online sexual behavior, (b) the appropriate developmental expectations for teens online, including risk-taking behaviors and critical decision-making skills, and (c) suggested strategies for assessment, prevention, and intervention when dealing with problematic online sexual behavior in adolescents. Marriage and family therapists cannot ignore the role the Internet plays in adolescent sexual development and its implication for the family. This article will serve as a primer for the marriage and family therapist when presented with adolescents who engage in online sexual behaviors.

Use of the Internet among teens in the United States continues to rise, with an observed 24% increase of teen use between 2001 and 2005 (Lenhart, Hiltlin, & Madden, 2005). In 2007, an estimated 93% of children aged 12-17 accessed the Internet on a regular basis in the United States (Macgill, 2007). Wolak, Mitchell, and Finkelhor (2007) found 34% of teens indicated that they were exposed to unwanted online sexual material, a figure that rose 9% over the past 5 years. The Internet influences the way adolescents think, feel, and behave both online and in the real world (Kaiser Family Foundation, 2001). Teens who use the Internet regularly, referred to as the “e-teen” in this article, present new challenges for marriage and family therapists. Issues such as Internet safety, overexposure to information, compulsive Internet use, access to pornography, and parental concerns for the e-teen are just a few of the new presenting issues in family therapy. Teenagers in this day and age have been referred to by some as the “@ Generation.” The evolution and development of technology in our culture has been dramatic, and adolescents have embraced these new methods of information and communication exchange. Livingstone, Bobber, and Helsper (2005) reported that 98% of children aged 9-19 in the United Kingdom have accessed the Internet, and similar studies have shown that 75% of the teens in the United States regularly access the Internet (Madden, 2003).

Two distinct problem areas emerge when discussing the sexual behavior of e-teens online. The first is the risk of online victimization by others. The second is the e-teen’s behavior that may place them at risk for developing unhealthy sexual behavior patterns. Such an example would be teens who develop compulsive use of online pornography. Although this article addresses both of these issues to some extent, much has already been written about the prevention of online victimization for teens (Federal Bureau of Investigation, 2005; Mitchell, Finkelhor, 6 Wolak, 2003; Stahl & Fritz, 2002; Wolak, Finkelhor, & Mitchell, 2004). Therefore, this article focuses on those online sexual problems resulting from the adolescent’s own behavior, and not the online victimization by others. The purpose of this article is to provide information regarding Internet technology, psychology, child development, and issues related to prevention, assessment, and intervention for the e-teen.


Internet and Technology Basics

One essential factor in working with e-teens and their families around online sexual behavior is for the marriage and family therapist to have a basic understanding of technology and the Internet. This understanding will allow therapists to formulate relevant questions and accurately interpret comments and responses made by e-teens related to their online sexual activities. This is not to say that all therapists must be technology experts, but they must have a working knowledge of technology before clinically useful conversations can take place.

The following paragraphs introduce fundamental technology-related concepts. Although there are a variety of other issues, this section presents those most useful for the marriage and family therapist when working with e-teens and their families.

Multiple Internet venues. Although the World Wide Web is most commonly thought of as the place to view pornography or engage in sexual conversations, marriage and family therapists should keep in mind that there are many areas of the Internet where sexual activity can occur outside of the World Wide Web. These areas may include Internet Relay Chat (IRC), newsgroups, file servers, multiplayer games, etc. Marriage and family therapists should familiarize themselves with these areas since e-teen clients are just as likely to engage in sexual behaviors here as on the World Wide Web. These areas are not difficult to access for today’s tech-savvy teens and often allow access to more sexually illicit information than the World Wide Web.

Although there are various areas of the Internet, the World Wide Web is often the first place teens are at risk for experimenting with online sexual behavior, or becoming victims of sexual harassment or offense. Areas such as social networking sites (e.g., MySpace, Facebook, Bebo), video-/photo-sharing technologies (e.g., MySpace, Google Video, Photobucket), and online gaming (e.g., Gunz, Runescape, World of Warcraft) all have practical, nonsexual uses, but each presents its own risk for inappropriate or sexualized activities. These activities may include the posting of nude or sexually provocative photos, videos, and/or sexualized communications via chat rooms, email, or other postings (Berson & Berson, 2005; Gillispie & Gackenbach, 2007). Venues on the World Wide Web are preparing younger children much earlier for participating in social networking and chat room venues. Sites such as ClubPenguin or Webkinz cater to the 12-and-under group by creating webspaces that allow them to interact with others, play games, and customize their own area of the web (not unlike the adult/teen social networking sites). As a result, younger children are accessing the more “teen-oriented” areas of the Internet and risking exposure to sexualized conversation and images at younger ages.

Internet-based video cameras (e.g., webcams) have increased in popularity among teens. The cameras are relatively inexpensive and online venues such as Yahoo Chat, AOL Instant Messenger, and MSN Messenger have incorporated webcam capabilities into their software. Although the cameras can be a great form of entertainment and add another dimension to Internet communication, they also allow potential perpetrators another venue for exploiting children online. The cameras are also commonly used by teens to experiment with seductive, voyeuristic, and exhibitionistic sexual behaviors that were not as readily available prior to the availability of the webcams.

In addition, it is important to not just “know” these areas, but actually to experience them. Marriage and family therapists who work with adolescents should establish accounts for the most popular venues used by teens (e.g., Instant Messenger, MySpace, Facebook, peer-to-peer, newsgroups). Actually experiencing these various online areas can serve several clinical purposes: (a) it helps clinicians not only understand online behavior and technology, but also experience the psychological factors associated with the Internet; (b) knowing the world firsthand helps clinicians formulate better questions to determine the extent of an adolescent’s Internet use, and (c) the experience of participating will help the clinician join with adolescents in a more informed and genuine way.

Online terminology. In addition to understanding the various online venues where teens may develop problematic sexual behaviors, it is also important to have a basic grasp of the language used to describe the Internet and the slang terms used in online settings. Several resources can help educate therapists (and parents) about online terminology, slang, and acronyms commonly used. Netlingo is an online dictionary of technology and Internet-related terms ( Another such resource is Noslang, which introduces adults to a variety of online slang terms and includes a list of 25 terms all parents should know (http:// Examples of terms include the following:

Cybering-engaging in sexual activity with someone online.

Lurking-nonparticipation in a chat room; chat observer.

IRL-In real life (as in, let’s meet in real life).

POS-Parent over shoulder.

MOTSS-Member of the same sex.


Portable devices. The belief that desktop and laptop computers are the primary ways to access the Internet is mistaken. Technologies such as cell phones, the Blackberry, gaming systems, and personal data devices (e.g., Palm Pilots) all provide avenues to access the Internet. These venues provide avenues for accessing sexual content 24 hr, 7 days a week. Sexualized advertisements on cell phones, pornography for iPods (podnography), even sexualized conversation while playing standard gaming systems connected to the Internet (e.g., Xbox Live, Playstation Portable) provide the e-teen with a variety of venues for engaging in online sexual activities. When discussing technology with a family, it is important to inquire about all forms of Internet access, not just computer access.

Remote and portable storage. The hard drive on a computer is often the primary permanent storage medium. However, the invention of removable storage media (e.g., jump drives, USB drives, portable hard drives) allows users to store information from the Internet (or other sources) onto small devices that can easily be hidden from others. In addition to possible pornography downloads, teens may also use jump drives to hide their sexual surfing history from parents, or even in some cases, to bypass blocking or filtering software installed on a machine, allowing access to inappropriate areas of the Internet. If teens are using jump drives, it is important to know how they are used and what information is being stored on them.

File sharing. In the 1990s, Napster made peer-to-peer file networks popular, but new filesharing networks are even more popular. LimeWire, Kazaa, Gnutella, and BitTorrent are all software programs that allow for the sharing and exchange of any type of file or program (including pornography, sexual videos, and sexual games). If file-sharing software is used on a computer, it is important to inquire about the types of files being sent and received. Although file-sharing programs are often associated with copyrighted music infringements, it has been reported that over 40% of all files exchanged on file-sharing networks are pornographic, and 97% of all files exchanged (Brown, 2003). It has also been discovered that many of the nude images of teens on file-sharing networks may actually have been posted by the teens themselves. E-teens may use these venues as an additional way to experiment with their sexuality.

Filtering software. There are a variety of software programs that can assist in preventing sexualized content and sexual conversations/activities on an e-teen’s computer. Younger children may benefit from these programs to prevent them from accidentally viewing sexual information; however, these programs, since they can be easily circumvented, are far less effective for older eteens. In addition, most of these programs primarily filter sexual content from the World Wide Web and are far less effective in other areas (e.g., peer-to-peer, newsgroups, Internet Relay Chat). Although marriage and family therapists may recommend these programs to families attempting to prevent problems or manage an e-teen’s Internet behavior, the programs should not give a false sense of security regarding an e-teen’s Internet use. Therapists and parents should remain vigilant and engage in regular conversations about appropriate and inappropriate use of the Internet and possible sexual content that may be pursued or discovered.

The previous sections provide the marriage and family therapist with a basic education about technology and Internet-related concepts necessary in understanding and communicating with the e-teen. While it may not be possible to remain current with the constantly changing technologies, it is important to stay as updated as possible. One source of information is the eteen client. Teens are the best source of keeping therapists updated about the Internet and its many uses-including online sexual activity.

Psychology of the Internet

Over the past 10 years, a new field of psychology has emerged: Internet Psychology. Although perhaps not an official designation, the study of the way people think, feel, and behave online is a growing area of research and clinical interest. Researchers such as Carnes, Delmonico, Griffin, and Moriarity (2001), Schneider and Weiss (2001), Young (2001), Cooper, Putnam, Planchon, and Boies (1999), and Suler (2006) have all examined ways individuals think, feel, and behave differently online than when offline. Research consistently demonstrates that there are characteristics of the Internet, different than other forms of media, that contribute to individuals behaving differently online than when they are offline.

There are several models for understanding why the Internet is attractive and powerful to users. Carnes et al. (2001) presented the Cyberhex, a six-sided figure representing various aspects of the Internet that when combined together create an almost “hex” or trancelike state. These facets are as follows: Interactive, Intoxicating, Isolating, Integral, Inexpensive, and Imposing. Cooper (1998) termed the attraction to the Internet “The Triple A Engine,” referring to the accessibility, anonymity, and affordability offered to its users. In addition to understanding the power and attraction, other Internet psychologists are exploring aspects of the Internet to explain why people behave differently online than offline.

Suler, who writes extensively about the psychology of cyberspace, described how and why people behave differently online than in real life, through the online disinhibition effect (2006). Suler (2004) wrote the following about the online disinhibition effect:

It is well known that people say and do things in cyberspace that they would not ordinarily say or do in the face-to-face world. They loosen up, feel more uninhibited, express themselves more openly. Researchers call this the “disinhibition effect.” It’s a double-edged sword. Sometimes people share very personal things about themselves. They reveal secret emotions, fears, wishes, or they show unusual acts of kindness and generosity. On the other hand, the disinhibition effect may not be so benign where individuals explore the dark underworld of the internet, places of pornography and violence, places where they would never visit in the real world. What causes this online disinhibition? What is it about cyberspace that loosens the psychological barriers? Several factors are at play. For some people, one or two of them produces the lion’s share of the disinhibition effect. In most cases, though, these factors interact with each other, supplement each other, resulting in a more complex, amplified effect, (p. 323)

Suler (2004) named the elements of the online disinhibition as (a) You don’t know me (anonymity), (b) You can’t see me (anonymity), (c) See you later (the ability to get out of trouble easily), (d) It’s all in my head (the line between fantasy and reality is not clear), (e) It’s just a game (there are no consequences to others from my online actions), and (f) We are equals (everyone is a peer).

When these factors combine together, they allow individuals (including adolescents) to do and say things online beyond what they may do in real Ufe. Teens who are experimenting with interpersonal and social skills may see the Internet as a laboratory where they can experiment with their identity and behaviors. The online disinhibition effect may be one reason why adolescents who seem well adjusted in real life may develop online sexual behavior problems. It may also help explain the rise of another significant adolescent problem – cyberbullying and cyberharassment (Stover, 2006).

Although the online disinhibition effect can be useful in understanding many forms of online behavior (sexual and nonsexual), Ben-Ze’ev (2004) wrote extensively about the psychology of relationship formation and ‘love’ on the Internet. Many of the concepts overlap with those previously discussed, but Ben-Ze’ev goes into much greater depth in understanding how the Internet enhances and interferes with adults’ ability to develop relationships online. Many of these same concepts (e.g., attachment, fantasy, and online emotional development issues) are certainly applicable to adolescents online.

Marriage and family therapists who understand the basic psychological underpinnings of Internet behavior will be better equipped to discuss and intervene with e-teens and their families. Such understanding will lead to more open and honest dialogue with the e-teen and assist parents in maintaining vigilance about their e-teen’s behavior and establish clear and appropriate boundaries for the use of the Internet in the home.

Child Development and the Internet

It is important to consider issues related to human growth and development when working with e-teens. The Internet presents a great deal of challenge even to adults who already have a certain level of physical, psychological, emotional, and relational maturity. E-teens present an even higher risk online because they often lack the physiological and emotional development necessary to use the Internet in healthy and safe ways consistently. Developing technologies allow researchers to gather physiological data about the adolescent brain. Although in its early stages, such technology is showing that the adolescent brain develops differently than previously thought, adding scientific evidence that a child/adolescent brain is not just a “mini-adult” brain.

Some of the brain research indicates that the adolescent brain does not attend well to risk or make good choices when risk is present. Also, the brain’s developing neurochemistry causes it to crave risk more than a fully developed adult brain (Spear, 2003). Think of the excessive and irrational risk behaviors of adolescents in general; these same types of risk behaviors exist online for the e-teen. Many adolescents attempt to find risky places to go on the Internet, which predisposes them for dangerous online situations, possibly as a way to satiate this risk-seeking tendency.

Issues such as “risk attenuation,” a concept often discussed in other areas related to adolescent prevention (e.g., tobacco use, alcohol/drugs), refers to the adolescent’s inability to use critical thinking and decision-making skills to discern more risky from less risky behavior. Risk attenuation is thought not to develop fully until later adolescence or young adulthood. This lack of risk attenuation can easily create problems for the e-teen in environments where one must decide which interactions are safe and which are potentially dangerous-including the Internet. Similarly, decisions about how much personal information to give others online, or whether to meet an online friend in real life, are also subject to the e-teen’s deficiency in deciphering risk.

Complicating the issue is the intermittent ability of teens to make appropriate decisions about their onUne behavior. This inconsistency can lead teens to believe they have mastered a skill, when in fact they are only practicing the skill and are far from mastery. The teen’s brain is still learning how to make these decisions and therefore will be inconsistent in perceiving and interpreting various situations. Another challenging concept for teens is that of “generalization.” Typically, when adults learn something new, they can generalize the information to a variety of settings and situations. This process of generalization does not occur easily for teens and can lead to online difficulties. For example, they may understand not to provide personal information on a social networking site (e.g., MySpace), but when in a chat room, they do not generalize the same rule. In addition, adults often assume rules established in the real world for the e-teen will be generalized and translated to online behavior. Safety guidelines such as “don’t talk to strangers” do not seem to register with underage online users-in fact many areas of the Internet encourage the façade that everyone online is a “friend” and so there is no such thing as an online stranger. For example, people in instant messenger areas are typically referred to as “Buddies,” and those on social networking sites (e.g., MySpace) are referred to as “Friends.” The language, in and of itself, suggests that everyone online is approachable and friendly. Combine this lack of generalization with a not yet fully developed prefrontal cortex, and dangerous or unhealthy behaviors are not far behind. The role of the prefrontal cortex is to assist with the brain’s executive functions, including planning ahead, considering consequences, and managing emotional impulses (Walsh, 2004).

Finally, many teens approach the world in a fairly trusting way. They are often naive and lack the capacity to see others as intentionally harmful or malicious. While this is an admirable quality, it also creates a dangerous dynamic in the online environment. In general, one of the most effective ways adolescents learn is by watching the modeling behavior of adults around them. However, the Internet is a fairly isolating event and rarely provides opportunities for the e-teen to witness an adult make decisions about which windows to ignore, how to manage pop-ups, and what to do if someone acts inappropriately online. The main way teens learn is essentially unavailable when it comes to online behavior.

When we understand that many issues influence the way kids think about themselves, their world, and the Internet, it is no wonder that “Just Say No” and “Scared Straight” strategies rarely work in promoting healthier and safer online behavior for e-teens. Although such strategies may work in the short term, these approaches do not have the long-lasting impact necessary to keep the e-teen safe into adulthood.

Perhaps one of the most problematic issues is the lack of dialogue between adults and teens when it comes to Internet use. This is especially true when trying to set rules and limits about online behavior. These issues become more complicated when sexual behavior enters the equation. Most adults are uncomfortable discussing sexual issues with their teens, and many are intimidated by computers, technology, and the Internet; therefore, the issue remains widely unaddressed. Livingstone et al. (2005) found teens report their primary sources of information for how to use the Internet are parents (44%) and teachers (66%), yet these two groups are often under-informed when advising teens about safe and healthy use of the Internet. One role of the marriage and family therapist is to provide information directly or help parents and guardians become adequate resources for the e-teen’s online behavior-including online sexual behavior.


Sexual activity is available in all areas of the Internet. It may be pornographic pictures, videos, sound clips, text-based stories, or sexuality conversations. Even with the use of blocking/ filtering software, teens will be exposed to sex on the Internet. In fact, 70% of all teens (ages 10-17) say they have seen some form of pornography on the Internet. Due to the prevalence and ease of access to online sexual activity, screening the e-teen for online sexual problems is relevant and important even in cases where the marriage and family therapist may not suspect problems.

Below is a list of common indicators that may be present when online behavior problems are occurring. These may be based on self-report or on collateral report from someone close to the e-teen (e.g., parents, siblings, peers).

* Sacrificing previously enjoyed offline activities and substituting online activities, which may or may not include online sexual activities.

* Attempting to maintain a level of secrecy about the frequency or types of online activities in which they engage. This secrecy may also extend to not wanting peers to know the extent of online behavior.

* Increased signs or symptoms of depression and/or anxiety, especially noticeable immediately after Internet use or during extended periods of time when Internet access is unavailable.

* Increased frequency or intensity of offline behavioral difficulties, often with some association to Internet use or absence of use.

* Spending time and effort hiding online activity, either by deleting browsing history, etc., or by physically or electronically hiding content received on the Internet (e.g., pornography, sexual stories).

* Taking increased risks with online behaviors (e.g., using computers for pornography at school, meeting people from the Internet in the real world without precautions).

* Experiencing life consequences or jeopardizing important life areas as a result of Internet use (e.g., absent/tardy to school due to Internet use, losing relationships due to online use).

No single one of these signs is more important than another, nor is a single symptom an indicator of a serious problem; rather, marriage and family therapists should gather information from a variety of perspectives and look for constellations of signs and symptoms as indicators of possible problems. However, the lack of signs of symptoms should also not be over-interpreted to mean there are no online problems. E-teens can be adept at hiding their behavior, consequences, and symptomology.

The line between use, misuse, abuse, and compulsion is often difficult to discern. Although frequency (how much time a teen spends online) is useful information, it must be considered in the context of all the other data collected. Adults who experience significant problems as a result of their online sexual behavior typically report spending 1 1 or more hours per week specifically seeking sex online (Cooper, Delmonico, & Burg, 2000). Although it is unclear how this translates to the e-teen, questions related to frequency and duration of online behavior are comparable to “How many drinks does it take to make an alcoholic?” There is no definitive answer, but clinical judgment in combination with a variety of data points should be used to make a determination if an e-teen has crossed the use line into more problematic behaviors relative to his or her online sexual behavior.

In addition to general signs and symptoms and issues of frequency and duration, it is important to conduct an Internet-specific screen regarding specific online sexual behaviors. Based on the more widely known and used Internet Sex Screening Test (Delmonico & Miller, 2003), a brief screening instrument known as the Internet Sex Screening Test – Adolescent (ISST-A) was developed for the therapist who may want to screen an e-teen for problematic onUne sexual behavior (see Figure 1). The ISST-A has not been psychometrically validated and should be used in conjunction with other data gathered by the clinician. The ISST-A can also serve as the foundation for a semi-structured interview when discussing Internet issues with an e-teen and allow clinicians to use their clinical skills to delve deeper into any issues that may be indicated on the instrument.

The assessment strategies for adults who experience problematic online sexual behavior problems are early in their developmental stages. Assessment of the e-teen lags even further behind. However, even without solid assessment techniques, it is critical that questions about an e-teen’s online sexual behavior be posed and probed during an assessment interview. While it is certain we will continue to see more assessment tools available to assist the clinician in the next few years, at present clinicians must use their skills and clinical awareness to synthesize data gathered into a meaningful profile of online behavior before effective treatment strategies can be implemented.


Two levels of treatment strategies are necessary when working with any individual with an online sexual behavior problem. The first level is used to immediately address and/or minimize the problematic online sexual behavior; the second level is aimed at understanding the underlying issues that fuel the online sexual problems.

Strategies used in the first level of treatment include monitoring and management of the Internet and computer. These strategies are used in an attempt to immediately stop or minimize the problematic online sexual behavior. These strategies can be effective, but are often short-lived unless the second level of treatment is implemented. Management strategies are most often implemented on or near the e-teen’s or family computer; therefore, they typically require cooperation from the e-teen and the entire family. Although the marriage and family therapist may not directly perform the management strategies, he or she can offer them as suggestions either directly to the identified patient and/or the responsible adults in the family. In fact, the management strategies suggested here are not only useful for families with existing concerns, but can be preventive in nature for all families who have or will have e-teens using computers in the home.

Management is divided into two main areas: (a) physical and (b) electronic. Both are discussed below.

Physical Management

There are several techniques that may appear simplistic on the surface, but many marriage and family therapists falsely assume families already use these methods and therefore fail to suggest them as part of an overall prevention and intervention strategy for the e-teen. These basic interventions may include the following:

* Ensuring the computer is only used in high-traffic areas within the home (e.g., family rooms, living rooms, kitchens) and not isolated in an e-teen’s room, the basement, or the attic.

* Limiting the days/times of use (e.g., not to be used after 11:00 pm; not available on Sundays). (Software that can help manage this will be discussed later.)

* Using the computer only when responsible adults or siblings are nearby (e.g., not when home alone, not with friends, not when parents are not home).

* Specifying locations where the Internet can/cannot be used (e.g., not in the e-teen’s bedroom, not at a friend’s house; especially useful if a house has a wireless laptop).

* Ensuring monitor and open windows are visible to others when using the computer (e.g., facing monitor towards traffic areas, not minimizing windows as a parent passes by).

* Placing screen savers/backgrounds of important people on or near the computer (e.g., family, friends, pets). (This is useful to counteract the “trance” state that draws users into a fantasy world.)

These are just a few suggestions-many more could be developed and tailored to the specific needs of e-teens and their families. It is wise to involve e-teens in the development of these ideas since they are familiar with their online rituals that may lead to problematic behavior and be more invested in the implementation of these new strategies if they have been involved in their development.

Taken one step further, these strategies can be formalized into an “Acceptable Use Plan” (AUP) for general computer use in the home. AUPs can be useful for all family members regardless of age, family status, or problematic Internet usage. Parents can model appropriate boundaries and behaviors by including themselves in an AUP (e.g., no computer use between 7:00 PM and 9:00 PM since that is homework help time). In addition to the strategies previously mentioned, below are common topics that could be considered when customizing a family’s AUP. The AUP can be negotiated as part of a therapy session with a family or may be assigned as therapeutic homework.

* Specify that the family’s Acceptable Use Plan applies when accessing the Internet in the family home AND from other places (e.g., friend’s house, school).

* Outline the number of minutes/hours each member of the household is permitted to use the Internet each day/week. Include time limits for ALL family members, including the adults.

* Specify times during the day that each member of the household is permitted to access the Internet (e.g., not during homework time without permission, not after bedtime). Include time of day limits for ALL family members, including the adults.

* Explain what to do if inappropriate or objectionable material is displayed on the computer accidentally (e.g., tell an adult so they may discuss it and ensure it does not happen again).

* Provide specifics on who should and should not be on “buddy” or “friends” lists. Using words like “face friends” (only those whose face you see in real life) can be used to help set limits (e.g., only those people who you see at least once a week can be on your buddy list). Be prepared to make exceptions on a case-by-case basis.

* Passwords should be kept secret from ALL peers-even boy/girl friends. No one should know passwords to access any area of the Internet except adults in the household who may keep a master list in case it is needed.

* Personal information should be protected while onUne and not transmitted unless it is certain that it is safe to do so (e.g., do not post personal information on your MySpace or send to a person you do not know).

* Specify that the AUP applies not only to computers, but to any device that accesses the Internet (e.g., cell phones, gaming systems, Palm Pilots).

* Explain if blocking and/or monitoring software will be used, and be sure everyone understands that the AUP prohibits working around any software installed to help protect the family. If monitoring software is used, explain how and why the computer will be monitored. It also may help to explain what you are not trying to monitor (e.g., not trying to find out if they use bad words, only monitoring things you think compromise health and safety).

* Prohibit the creation of new accounts for online services without permission of a responsible adult (e.g., no new email addresses, no new MySpace accounts). E-teens have been known to create multiple accounts, most of which are unknown to their parents, but used widely with their friends.

* Explain the possible consequences and outcomes if the AUP is violated (e.g., more limited computer time, loss of computer privilege, increased monitoring or blocking).

The AUP is a changing document based on usage needs, ages and maturity of children, ability to follow the AUP, etc. It typically takes several weeks for a family to customize the details of the AUP for the family. Limitations may be increased or decreased as the children get older and can handle increasing responsibilities. The AUP will be a useless document if it is not monitored and enforced. There are many ways to monitor and enforce the AUP, including increased awareness and accountability for all family members, as well as delivering consequences for breaking the AUP. There are also “Electronic Management” strategies which can also assist in enforcing the AUP.

Electronic Management

Filtering/blocking. Electronic filtering and/or blocking of Internet content can occur in a variety of ways. Typically, software is installed on a computer that previews information prior to displaying it. This can be useful in preventing access to certain areas of the Internet or filtering out inappropriate content (e.g., pornography, inappropriate language). Many of the filtering/blocking packages also have the capability of placing time limits for individual computers and/or users. This may be useful if part of the Acceptable Use Plan involves time and/or time of day limitations.

Filtering methods can be effective, but have their disadvantages: (a) software can be easily circumvented, especially by older children and teens, (b) software packages typically focus on specific areas of the Internet while ignoring other areas (e.g., newsgroups, Instant Messenger), and (c) blocking packages often provide a false sense of security to the marriage and family therapist and parents, resulting in decreased conversations about appropriate Internet use. There are many online resources for information on choosing an Internet filter. One useful resource is, which reviews various filters and provides user feedback from those who are actively using the filter.

Computer monitoring. Monitoring software can be installed on a computer to track Internet use and provide reports of hours used, places visited, and patterns of use. One challenge to using monitoring software is that a “reviewer” needs to examine the reports and determine if inappropriate activity has occurred. Reviewing the monitoring data can be time consuming and difficult for the technologically challenged adult. A company that provides a variety of monitoring tools is Spector Software ( They sell products that monitor a variety of Internet activities including web browsing, email, instant messages, and chatting.

Most e-teens refuse to report online problems to adults since they fear the complete loss of their Internet privileges. Depending on the situation, it may be useful for the marriage and family therapist to suggest a brief “time-out” from the computer, but the ultimate goal is to educate the e-teen about appropriate ways to use the Internet, and how to manage his or her online behavior.

Implementation Roadblocks

The practical consideration of implementing the aforementioned strategies is dependent on a parent’s willingness and ability to use such strategies. The reluctance on a parent’s part could be due to a number of factors, including lack of understanding or intimidation by technology, or minimization of the problem. Given the prevalence of problematic online sexual behavior, it may also be true that the parent struggles with his or her own online sexual behavior and addressing such issues with the adolescent could bring his or her own issues to the surface. Also, setting clear rules with an adolescent often leads to additional turmoil in a relationship that is many times already strained. The list of reasons why a parent may not “buy in” to treatment strategies is long, but in order to be effective, parents must subscribe to the idea that they are responsible for their children’s behavior and experiences, both offline and online.

One strategy to address a parent’s reluctance is the use of a “prediction” or “anticipation” technique. The roadblocks to making computer/Internet management strategies effective could be problem-solved prior to them becoming an issue. Asking parents to anticipate potential roadblocks (not in the presence of the adolescent) could allow them to identify and resolve their feelings about the strategies before actually having to set and enforce them. In addition, including the adolescent in this discussion could be highly beneficial. For example, asking the adolescent, “What roadblocks do you anticipate your parents facing while trying to use these strategies?” or “How might you try to sabotage these strategies?” could provide good information and discussion as to the benefit and effectiveness of such management strategies.

Underlying Issues

Most teens use the Internet with few online sexual problems, but for those who truly become out of control with their online sexual behavior, there are often underlying issues fueling the problem. As previously stated, addressing these underlying issues represents the second level of treatment. The genesis of these problems is often varied and indeterminate, but regardless of the cause, underlying issues are often grouped in the following way: (a) attachment issues, (b) early traumatization, (c) intimacy and relationship development, (d) grief and loss issues, and (e) difficulties with physical, emotional, psychological, and sexual development. These underlying issues can manifest as (a) underdeveloped social skills, (b) low self-esteem/ self-worth, (c) isolation and withdrawal, (d) depression and/or anxiety, (e) relational conflict or difficulties, (f) inappropriate sexual behaviors, (g) poor coping skills, and (h) attention deficit issues. While the initial management techniques previously discussed may be useful, the underlying issues must be uncovered and addressed or the problematic behavior will likely recur, either on the Internet or elsewhere.

The marriage and family therapist’s competition when working with the e-teen is the fastpaced, entertaining online world. While entertainment should not be a treatment goal, it is important to develop fun, creative, and engaging methods of discussing technology and Internet issues with e-teens. One way to accomplish this goal is to incorporate a variety of media into therapy sessions. Delmonico and Griffin (2008) introduced common forms of media useful in addressing the underlying issues related to problematic online sexual behavior. The list is not exhaustive, and marriage and family therapists should be creative in using various forms of media to reach adolescents and their families. Listed below are some of the common forms of media found to be useful.

Motion picture clips. Motion pictures (including television clips) can be a powerful medium to discuss difficult concepts. Motion picture clips help individuals step back and discuss themselves through the characters in the clips. Once a concept is understood at the intellectual level in the clip, clinicians can assist adolescents in translating the concept to their own situation.

Books and other text-based materials. The use of books, poems, and other written text helps engage adolescents and promotes understanding of concepts relevant to underlying issues. Adolescents who use Instant Messenger, chat rooms, and other text-based areas of the Internet may be particularly fond of this form of creative intervention.

The telling of stories, legends, and/or fairy tales. Fairy tales are often aimed at teaching information in a metaphorical manner. Metaphors are a powerful way to translate important concepts to an adolescent. Individuals can often relate to characters in the story at a level that makes it safe to discuss the characters’ assets and deficits. Appropriately chosen stories allow the therapist to guide the client into relating the story to his or her own life in a safe, nondefensive manner.

The use of toys as tools in treatment. Although toys are often thought of in relation to play therapy with children, they can also be excellent tools in treating adolescents. Therapists can learn a great deal as clients relate their own stories to the toys. Toys can represent various aspects of one’s personality, which is often easier to discuss when separated out.

Music (audio and lyrics). Most adolescents enjoy listening to music, and the growth of the iPod and mp3 industry has only increased the likelihood of adolescents and music being closely tied together. Either finding songs that have a message or allowing teens to bring in their favorite songs will give you a great deal of information about them. In addition, having the lyrics to the songs or having teens develop lyrics to a song they write can be insightful and also can provide an avenue for working through underlying thoughts and feelings that may be troublesome for the teen.

Use of the Internet itself in recovery. Most adolescents will continue to use the Internet throughout their lives. The goal of treatment is to develop healthy attitudes and behaviors while using the Internet. The same characteristics that attract adolescents to the Internet may also engage them in the treatment process. Assigning homework involving use of the Internet, finding healthy resources, or revising MySpace accounts can all be useful in the practical application of concepts learned in treatment.


As more adolescents present in therapy regarding Internet issues, it is important that schools, religious communities, families, and the therapeutic community assume responsibility to educate e-teens about the Internet. Marriage and family therapists must accept their role as prevention specialists when it comes to educating e-teens and their families about safe and healthy Internet use.

The average age for first exposure to online pornography is 11 years old (Mitchell et al., 2003); therefore, prevention strategies should be implemented early so that young children will begin to learn healthy ways to use the Internet and appropriately communicate with others while online. Prevention strategies are often delayed until middle-school age, long after the e-teens’ beliefs and attitudes about online behavior have been formed. Starting as early as age five, concepts regarding proper Internet behavior can be linked to already existing lessons regarding character formation. This would include teaching young children not to say mean things about others online, not to call other people names on the Internet, to respect people’s privacy, and to never use another’s password or username without their permission, etc. Such concepts are important to healthy and appropriate Internet use and will be far more effective if introduced early and repeated often throughout the child’s development.

Additionally, many children learn through the modeling behavior of adults during “teachable moments.” As previously discussed, use of the Internet tends to be an isolating event and provides few opportunities for adults to model appropriate ways to interact with the Internet or respond to its inappropriate content. Prevention strategies, especially those at home and at school, would benefit from creating opportunities for children to witness adults engaged in critical decision-making and behavior skills while online. For example, it may be helpful to allow younger children to sit with adults while they use the computer and explain their thinking and decision-making skills when pop-ups appear or someone asks to be added to a “friend” list. The Acceptable Use Plans discussed earlier incorporated adults into the plan – such inclusion begins to model healthy boundaries and interactions on the Internet.

The early introduction of healthy Internet habits also provides more opportunity to dialogue with children about their Internet use. The open dialogue will present more opportunities for detecting the start of problematic issues, as well as allow teens to feel safer in approaching adults who are familiar with the Internet.


This article provided a brief overview of the issues relevant to marriage and family therapists who work with e-teens and their families. Space limitations prevent an in-depth look at all the technological and psychological issues relevant to this concern. However, this article was a primer that provided basic information about how teens use the Internet, the psychological attraction to the Internet, and ways to assess, manage, and treat problematic sexual use of the Internet by adolescents. Finally, the marriage and family therapist as “educator” must also assume the role of prevention specialist to instruct teens and their families about prevention strategies related to the development of online sexual behavior problems.

Marriage and family therapists must consider problematic online sexual behavior among adolescents as a relevant and important topic to address within the profession and to discuss with their clients. The Internet is a permanent aspect of the adolescent world and influences the way teens think, feel, and behave-both positively and negatively. Failure to address these issues in a therapeutic context will lead to more difficulties in late adolescence, in early adulthood, and into adulthood. The days of referring families concerned about Internet problems will be short-lived. Therapists who provide assessment and intervention for families with existing problematic Internet issues, as well as prevention strategies to deter the development of online problems, will be an expectation of the ever increasing demand for understanding and addressing Internet-related problems.


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David L. Delmonico

Duquesne University

Elizabeth J. Griffin

Internet Behavior Consulting

David L. Delmonico, PhD, NCC, Duquesne University, School of Education, Pittsburgh, Pennsylvania; Elizabeth J. Griffin, MA, LMFT, Internet Behavior Consulting, Eden Prairie, Minnesota.

Address correspondence to David L. Delmonico, Duquesne University, School of Education, Pittsburgh, Pennsylvania, 15236; E-mail:

Copyright Blackwell Publishing Ltd. Oct 2008

Provided by ProQuest Information and Learning Company. All rights Reserved

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