What Happens in Sex Addiction Counseling?

Counseling vs. Treatment

Most of the sex addiction programs and certified sex addiction therapists (CSATs) that treat people for sex addiction make a distinction between “counseling” vs. “treatment.”  The initial approach to helping people with sex addiction  is more often thought of as “treatment.”  The difference is that when we think of counseling or therapy we tend to think of a process whereby people change because they get insights into the cause of their problems and this awareness makes them behave differently.  In treating sex addiction it is the other way around.  It is easiest to think of “treatment” for sex addiction as changing behavior first and thought processes second. 

Treatment for sex addiction can be thought of as a behavior modification program.  It does not require any in depth self analysis to embark on a program of recovery from sex addiction.  It only requires that the addict begins to believe that he or she has a problem and accepts, at least tentatively, that there is a need to get some kind of help in order to fix it.  Treatment is an “action program” requiring that the client agree to follow the directions of the treating professional, make a commitment to see the program through and complete a set of tasks designed to promote abstention from sexually addictive behavior. 

Components of the Treatment Program

Whether it is in a residential rehabilitation program, a clinic or an individual sex addiction counselor’s office, the beginning of a program for treating sex addiction involves some version of the following:

  • Acceptance
  • Action
  • Accountability

Acceptance: Understanding that the compulsive sexual behaviors in question whether they are internet pornography use, serial extra-marital affairs, prostitutes, anonymous sex, or even illegal sexual behaviors represent a hypersexual disorder, an addiction, and that it is out of the addict’s control.  Acceptance means learning enough about sex addiction to realize that it is not going to go away by itself and that no amount of will power can make it stop.  It also involves the dawning realization that the addict has been causing harm to himself and to others.

Action: A commitment to abstaining form the addictive sexual behavior and to regular participation in a program which puts a number of tools in place to help maintain sexual sobriety.  Usually the program or counselor suggests an initial period of abstinence from all sexual activity for three to six months or more. This abstinence applies to sex with anyone including a spouse and even includes masturbation.  During this period the sex addict will usually experience symptoms of withdrawal which can include cravings, strange physical symptoms, sleep disturbances, bizarre fantasies and sexual dreams.  This is because the addictive sexual behavior numbs out feelings in much the same way that drugs and alcohol can.  When that escape is no longer present, the sex addict’s body and brain will be going through a period of re-adjustment.

Accountability:  Treatment promotes sexual sobriety by teaching the recovering sex addict various tools to support the addict’s commitment to abstain from sexual “acting out” addictive behavior.  These include:

  • Education and reading about sex addiction in order to gain a better understanding of the function it serves in addicts’ lives and the process of recovery.  This includes raising the addict’s consciousness of the fact that their life has been one built on secrecy and shame and that recovery demands “rigorous honesty” from now o.
  • “Reporting in” to an individual therapist and a support group or therapy group in order to increase the recovering addict’s motivation to succeed.  The addict learns to notice signs of dishonesty, isolation, or neglect of self care which could be problematic and opens up about these struggles and the plan to improve in these areas.
  •  Attending 12-step meetings such as Sex Addicts Anonymous which allows for more support and encourages the addict to reach out to other people for support and understanding.  In behavioral programs the person is expected to reach out to someone before they act out or when they feel themselves at risk.
  • And a series of structured tasks which fill out the addict’s understanding of how they got that way, such as constructing a timeline of one’s addictive acting out behavior, inventories relating to other addictions, family history of addictions, and childhood history of abuse and/or neglect.

During the initial recovery process, the therapist or counselor serves as a combination coach, cheerleader and watchdog.  Establishing sexual sobriety is the beginning step in a much longer process of recovery.  At some time during the initial period of abstaining from sexual acting the addict will be encouraged to “disclose” to a spouse or significant other the nature of the addiction and begin the process of starting to relate on a different and more honest footing.  This disclosure is difficult for everyone and should only be done with the assistance of a sex addiction therapist or counselor.

Long Term Recovery Takes Three to Five Years

Getting honest with one’s self and others, staying honest, and staying sexually sober are the initial phases of treatment.  This is usually the first year or so of recovery.  Later phases involve personal emotional growth and resolving early childhood issues, repair of a primary relationship or starting a new one in a healthy way, dealing with issues involving family or origin, and working on issues involving children extended family, and work, so as to create a balanced, fulfilling lifestyle.


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