Sex Addiction Therapy: What to Look for, What to Avoid

 by Staci Sprout, LICSW, CSAT

The word is out, sexual addiction exists. In the reality of everyday life, more and more people—and not just celebrities—are coming forward to admit that they have a problem with compulsive sexual behavior. A growing number of therapists and addictions specialists maintain that sexual addiction is not only common; it’s easily definable and most importantly, treatable. The field of sex addiction therapy is growing exponentially, and it’s often consumer-driven. Because of this, it is widely misunderstood and mostly unregulated. If you’re concerned you might have a problem with sexual addiction, it is up to you to figure out how to get the best help possible.

I've been in private practice since 2011, and trained and worked for five years before that at a clinic that specializes in the assessment and treatment of sexual addiction, called Bellevue Community Services (BCS). The BCS clinical team has offered assessment and treatment for individuals, couples and families for over 25 years, and in both practices, I've see the miracle of healing and recovery happening every day. I have also heard many horror stories over the years from clients who have had previous therapy that wasn’t helpful for them at all, or was actually harmful. This article was inspired by those stories, to offer information to help anyone beginning recovery know what to look for in a therapist. If you’re looking for a sex addiction specialist, here are some important questions to ask:

Is Live or Prompt Reception Available?

When you call for help, does a live person answer during normal business hours? It can be difficult to leave personal information over a voicemail, particularly about sexual compulsivity, when distressed. Can you send a confidential email? If you call and no one answers, how long does it take for someone to call you back? Are they responsive to your questions? I recommend telling a therapist directly that you are seeking help with (possible) sexual addiction. Some therapists do not treat this and will refer you immediately, saving you the time and expense of a session with someone you won’t be seeing further. Most people do not want to wait long to see someone when they are in need of help, so a quick appointment is best if available. However, sometimes a wait might mean that the person or clinic is skilled and sought after. A quality program with a great reputation is worth waiting for. Since this is such a significant decision, it’s best to interview more than one provider and take time to think about it before committing to any course of treatment. Trust, knowledge, and respect are key considerations.

What Type of Accreditation Should I Look for In a Therapist?

Of all the questions you must answer, this is one of the most important. Does the individual who you’ll be meeting have a license? Do they have any special training in the assessment and treatment of sexual addiction? Does the clinic they work for have a particular focus in this area?

As therapists are seeking to expand their practices, many are beginning to advertise "sexual addiction therapy" as part of what they provide. However, such claims are not regulated by any health department or licensing body, and should not be taken at face value. I won’t list specific examples, but I’ve heard enough stories over the years to know that the course of people’s lives can be unalterably changed for the worse by participating in therapy with therapists who do not know how to assess the risks or treat the dangers inherent in sexual addiction. The difference can be immensely significant if you’re in crisis, because you will likely be seeking help making decisions that can influence your survival, your marriage or relationship, your family, or your professional life. It can be confusing for the consumer; you see a great website with lots of confidence-inspiring claims (e.g., "experts", "advanced training,") and yet…it is important to ask exactly what has created that expertise and what kind of training is being referred to. In my experience, the gold standard of training available for therapists who want to treat sexual addiction is called the Certified Sex Addiction Therapist, or CSAT.

Certified Sex Addiction Therapist (CSAT)
The most rigorous training available is called the Certified Sex Addiction Therapist (CSAT). This is most in depth (and expensive) training available, and was developed by Patrick Carnes, PhD., who is widely regarded as the founder of the sexual addiction concept and therapeutic model. Earning a CSAT requires the therapist to have 5 years of direct experience, attend four one-week training modules in person (120 hours plus additional homework), pass a series of competency tests, and have lengthy supervision by CSAT supervisors. Approved CSAT supervisors have to take special training as well, and in order to maintain active status as a CSAT or CSAT supervisor, a therapist has to attend an international conference every two years to learn about the latest treatment methods, and pay annual dues. Carnes and his CSAT staff train therapists from all over the world every year and are constantly conducting research, treating clients, and growing and evolving their knowledge base. For more information about this certification, or finding a therapist in your area who has it, go to http://iitap.com/.

Other Certifications
There are other certification programs or trainings available in sex addiction therapy. Some are on-line courses, where therapists purchase DVD’s that contain education on a variety of topics related to sexual addiction treatment and pass a competency evaluation. Others are weekend workshops or week long intensives. I can’t comment on the merit of such programs, other than the impression that a therapist who invests more time and energy in training may have more to offer as a result.

Quality certification programs require candidates to have malpractice insurance, licenses, letters of reference, and supervision by another certified member. They conduct background checks on applicants to rule out malpractice, criminal history, or other disciplinary action on their records. The CSAT requires membership in another professional organization, called the Society for the Advancement of Sexual Health, or SASH. For information about SASH, go to http://www.sash.net/.

Training as a Sex Therapist, Not a Sexual Addictions Therapist
There is a major difference between someone who is trained as a "Sex Therapist" versus someone trained to assess and treat sexual addiction. This can be confusing, because a common definition of a Sex Therapist is one who is trained to help clients work through their sexual problems. The current definition of Sex Therapy on Wikipedia lists sexual addiction as part of what Sex Therapists treat. However, self titled sex therapists may or may not have had specific training in the diagnosis, treatment, and ethics of sex addiction. Although there are some certifications for sex therapists, sex therapy overall is an unregulated specialty and even the certification programs have minimal focus on sexual addiction assessment and treatment. Recommendations designed for non-sex addicts (like using pornography to explore arousal patterns or spice up a marriage) can have disastrous effects on people with sexual compulsivity, or their partners. For specific information about certification for Sex Therapists, go to http://www.aasect.org/. Conversely, a therapist with training and certification in sex addiction therapy may have only minimal training in sex therapy. Some CSAT’s refer to sex therapists for assessment and treatment of specific sexual problems outside the arena of sexual addiction, and some therapists are both CSAT’s and sex therapists. With sexual addiction, the first priority is to get support to stop destructive sexual behaviors. Many intimacy-related sexual problems resolve with solid sobriety and intimacy skills training and practice. For those that don't, some excellent resources can be found from Drs. Bill and Ginger Bercaw, http://cacenterforhealing.com/resources/products/. As their website states, "The Bercaws are the only married, doctoral level Clinical Psychologists who hold both the CSAT and CST certifications."

No Training
There is minimal classroom training about sexual addiction and recovery available in most universities, colleges, and other therapy educational programs, though this is changing in some areas. If a therapist reports receiving all their knowledge about sexual addiction assessment and treatment in school, you may want to double check the curriculum! You can also check with your state health licensing board (if in the U.S.) or other regulatory agency to ensure the therapist you are considering does not have any complaints filed against his or her license.

Therapist’s Own Addiction Recovery, and/or Sexual Addiction Recovery
Many therapists who offer services for sexual addiction are recovering addicts and/or sex addicts themselves, and this can be a fine motivation for getting into the field. Some of the best and most successful therapists are those who have lived their recovery and gone on to get training as to how to offer therapy to others. However, personal recovery is different than therapeutic recovery; if you want only 12-step sponsorship you can attend a 12-step meeting and get a sponsor at no charge. If you ask a prospective therapist if they are a recovering sex addict themselves and they say yes, the next question to ask is "How long have you been sober?" Getting help to get better from someone who hasn’t gotten better/sober in their own personal life would be a mistake. If the therapist declines to answer this question, this may be concern. The next question is: "What kind of formal clinical training have you had in the assessment and treatment of sexual addiction?"

What Kind of Experience and Reputation Do They Have?

There are some excellent providers of sexual recovery therapy that do not have a CSAT qualification, but whose experience and reputation are top of the line. In general, more experience is better, and a great reputation is the best referral of all! Attending 12-step sexual recovery meetings (try http://saa-recovery.org/, or http://www.slaafws.org/ for starters) and asking around is a great way to hear about who’s who in the local treatment community. Also, calling a referral center like http://www.sexhelp.com/ can narrow down the search. Or you could call one of the major inpatient hospital/treatment centers for sexual recovery therapy and ask who they would recommend. A few well-known centers are: Gentle Path (http://www.pinegrovetreatment.com/gentle-path.html); Sierra Tucson (http://www.sierratucson.com/); The Meadows (http://www.themeadows.org/); Del Amo (http://www.delamohospital.com/SexualAddiction.html); and Santé Healing Center (http://www.santecenter.com/). There are many other great inpatient programs out there, and any qualified sexual addiction therapist can assess whether or not inpatient treatment is necessary. The inpatient treatment centers also conduct their own assessments for those considering residential care.

Do They Have 24 Hour Crisis Services?

Another question to ask a potential therapist is do they offer 24 hour on-call services staffed by sexual addiction therapy specialists, or do they rely on the local crisis line to take your afterhours calls? Most crisis clinics are volunteer-staffed and do not have any training on how to deal with crises related to sexual addiction, and therefore may not be able to offer focused interventions.

Do They Offer Group Therapy?

At Bellevue Community Services I learned that group therapy for sexual addiction is the very effective modality for reducing shame, practicing intimacy, building lasting friendships, and offering accountability. If a therapist does not conduct groups in their practice, ask if they know of any that they refer their clients to. If they don’t, keep looking.

Do They Offer Trauma Integration Specialties?

A significant majority of sex addicts have been emotionally, physically, and/or sexually neglected and abused in their childhood, so successful treatment includes safe methods to support healing from developmental or other trauma. Some methods popular with those in recovery from sex addiction include:

Lifespan Integration (http://www.lifespanintegration.com/ ), Emotional Freedom Technique, or EFT (http://www.eftuniverse.com/), EMDR (http://www.emdr.com/), techniques, somatic psychology (http://www.sensorimotorpsychotherapy.org/referral.html, http://www.traumahealing.com/somatic-experiencing/), and referrals to licensed bodyworkers.

Are They Part of a Team Practice, Consultation, and Supervision?

This is another component of sexual addiction assessment and treatment that is vital for treatment providers—do they have support to deal with the complexities that go along with sexual addiction? Although the following may sound extreme, they are issues that therapists who treat sexual addiction must be familiar with or, if not, be able to refer: threats of divorce, custody issues, accusations of inappropriate sexual behavior that may or may not be founded, job probation or termination, suicidal feelings or other self harm behaviors, domestic violence, use of illegal pornography, and much more. This is serious business, and if you are facing any of the above or other complex challenges, you will want to choose a therapist who has success helping others in similar situations. Making sure your therapist has a supervisor who has experience in treating sexual addiction offers an added layer of support and protection for you and your therapist!

What Are Their Fees?

Fees vary among therapists, clinics, and geographic regions, but often you can expect to pay more for specialized care. CSAT’s invest in their certification and ongoing training; they will hopefully pass the benefits on to their clients. Fees for expert assessment tests like the Sexual Dependency Inventory-R (SDI-R) often require paymet in addition to the cost of the therapist’s time. There are many excellent times to shop for a bargain in life, but this is not one of them. If you find someone skilled, invest in yourself by making it work to see them. Many therapists accept insurance and although sex addiction is not a reimbursable diagnosis by most insurance companies currently, qualified therapists also assess for other conditions that may be.

Some Additional Helpful Questions to Ask A Prospective Sex Addiction Therapist:

Do you have a clinical program designed specifically for the treatment of sexual addiction? If so, may I see your materials?

Do you have groups, or if not, do you refer clients to groups elsewhere? 

What do you think healing/recovery from sexual addiction looks like?

What is your perspective about 12-step programs and their impact on sexual addiction therapy?

Are you a licensed provider? [Licenses vary from state to state, but generally are evidence that a provider has more experience than a non-licensed provider, has passed a competency test, and is accountable to the licensing board]

Are you a recovering person yourself? If so, how long have you been sober?

How much do you charge per individual session? Group session?

Do you have any expectations about the commitment I would need to make? A contract?

Do you ever find that clients who come to you concerned about sex addiction are not, in fact, addicted to sex? Please explain.

Have you ever referred a client to inpatient treatment for sexual addiction? [Experienced sexual addiction therapists will have done this and learned when to refer for more intensive help]

Do you offer treatment for spouses/partners of sex addicts? Do you have groups for partners?

How do you support couples to heal after discovery of secret sexually compulsive behavior?

Do you have a religious focus/affiliation?

In summary, there is a lot more to consider when seeking help for possible sexual addiction than just which nearby therapist advertises it. Being an informed consumer is an essential first step in turning your life around. Do not be afraid to ask tough, direct questions! Despite the heavy shame that many struggling with compulsive sexual behaviors feel, everyone is worth excellent help. Give yourself the gift of finding it.

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