Mature students studying in libraryWhat is involved in becoming a certified sex addiction therapist or counselor?

First, an important point to remember is that only those therapists who are already licensed or otherwise credentialed in their particular counseling field (e.g. psychologists, clinical social workers, marriage counselors, pastoral counselors) are eligible to enroll in the CSAT training.

Certified sex addiction therapists take approximately four weeks of intensive training with faculty of the International Institute for Trauma and Addiction Professionals (IITAP) which describes its membership as follows:

“We are comprised of licensed mental health professionals, IITAP Certified Sex Addiction Therapists (CSAT), trauma/EMDR clinicians, AASECT sex therapists and BBS Supervisors.”

The CSAT training designed by Dr. Patrick Carnes and others involves gaining expertise in assessing the level and type of sexual dependence, the clients sexual and trauma history and an assessment of family of origin issues and other addictions and addiction interactions that may be present.  Next, there is training in using a highly manualized, 30 task approach to treatment designed to be followed in individual and group sessions as well as being consistent with any 12-step self help program for addiction.  Following the training, the trainee is required to get 30 hours of supervision (by CSAT supervisors) of actual clinical work with sex addiction clients prior to certification.

There are also continuing education requirements for renewal of the CSAT certification every two years.  However, each therapist is also under the jurisdiction of their state board and/or professional licensing body for professional requirements or disciplinary issues.

Can CSATs address things that other therapists might miss?


Other therapists and doctors may not assess for sex addiction.  If a client does not complain about their sexual problem the practitioner may miss the signs and may not ask the right questions.  For example a client may complain of erectile dysfunction and be treated in a variety of ways when in fact ED is a frequent result of compulsive porn use.  This kind of ED goes away after a period of abstinence form porn and does not necessarily require any other treatment.

In addition there are differences in approach to clients with known sex addiction issues.  CSAT therapists may be much better able to break through the addict’s denial and deception.  They will know when the timing is right for group therapy support and when and how to assist in the making of full disclosure to spouses and partners.  Sex addiction therapists will be versed in evaluating and addressing multiple addiction situations or addiction interactions (e.g. sex and drugs, sex and eating disorders, etc.) See also my blog “What Happens in Sex Addiction Counseling?”

One of the most important things that a non CSAT therapist may miss is the fact that sex addiction is not a byproduct of relationship problems.  Many people seek couple therapy and continue in couple therapy when the problem of sex addiction must be addressed before couple therapy.  Also, seeing sex addiction as a relationship issue can implicate the spouse or partner in a way that is inappropriate.

Can CSATs rule out alternative diagnoses?


CSATs are therapists first and sex addiction specialists second.  In addiction to assessing for sex addiction, they can and do perform an overall clinical interview and may do other testing and gather other information as well.

All licensed counselors and therapists are trained to be sensitive to the presence of issues that may lie outside their area of competence and consult about it and refer out to other doctors or specialists when necessary.  We all are constantly attempting to update our knowledge of new findings that may suggest causes of sexual compulsivity such as brain damage, other disease processes or medication side effects.

Are sex addiction therapists biased against sex? 

Absolutely not.

See another post of mine devoted to this topic called “Is Sex Addiction Therapy Anti-Sex?”   The idea that sex addiction therapists are rigid or moralistic is false.  That is not part of the training or approach.

Can CSATs cure intimacy disability?

Yes but they address the sex addiction first.

Sex addiction treatment has both short and long term goals.  In the initial phase of sex addiction recovery the addict is becoming abstinent from his or her sexually compulsive activity in order to allow the body and brain to “kick” the addiction and become stabilized.  Next, treatment helps the addict work through the early relational trauma or other factors related to the addiction so as to prevent relapse and build the foundation for a stronger sense of self.  This prepares the addict to enter into healthy intimacy.  The later phases of treatment/recovery i.e. from the 2nd or 3rd year on involve a shifting of gears to focus on relationships, intimacy and fulfillment in all other aspects of life.  See also my blog “Will Sex Addiction Treatment Cure Intimacy Issues?”

Can CSATs treat the spouses and partners of sex addicts? 


In fact most sex addiction clinics and programs work with addicts and partners both separately and, as appropriate, together.  There are also specific intensive outpatient and inpatient programs which treat spouses and partners of sex addicts and specific clinicians who specialize in the treatment of partners and spouses.

Can I trust that a CSAT trained person will be a good sex addiction counselor?

Most likely yes.

CSAT training is a sub-specialty.  It adds an area of expertise and experience but it will not make a bad clinician into a good one.  I used to believe that credentialing did more harm than good and that people were better off judging for themselves how helpful or harmful a given practitioner was.  But I also know that people seeking therapy may not be together enough initially to be confident in their own ability to make such judgments.  It helps to know that a clinician has had the right kind of training, but unfortunately there is still an element of judging for yourself and getting additional opinions.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

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  1. Sadly, the timing of the treatment phases of sex addiction by a csat leave the partner untreated or out of the treatment loop all together, except for Anon meetings. The addict gets group, individual, 12 step and occasional couples.meetings. The spouse gets to watch He Who Abandoned Her for addiction leave her again, this time for connecting socially with other men in group or in 12-step. One selfish addiction is replaced by another; in either addiction, the palieve csats are causing more relationship damage in their insistence on by applying their formulaic timeline that favors the addict over the partner. The addict gets most of the recovery resources even though he is probably in a lot less pain than his partner/victim who is told to “stay on her side of the street.”

    The Relationship in Recovery book will remain unfinished because it really requires that the old relationship be ended. The addict, who is now more psychologically whole than his long-deceived partner, is to evaluate the quality of any potential romantic partner. Yes, I have deep issues that make me want to maintain emotional distance and that I have been working on since before the trauma of Discovery Day. With the presumably improved addict at almost one year later, there is now a mental health disequilibrium: I am no longer of high enough mental healh quality, by the criteria in the book, for my spouse to even consider dating me. For his own progress, he needs to jettison me and find someone better for him.

    What I get from this is that he was the con artist and I was the mark. He took everything he could get from me and should now move on. UNFAIR and disheatening, especially because the Living With ebook was one of the emotionnal life rafts that helped me to not leave him when the pain was fresh. The csat/12-step program enables the addict’s continued self centeredness and permission to ignore his victim while he spends time away from his family “doing service” and taking care of (gratifying) himself — all because he is allegedly a victim. Well, so am I. What is the over arching point, is it that empathy cannot be learned or doesn’t need to be?

  2. Sexual addictions are becoming increasingly common nowadays. They can involve Internet porn or other forms of sexual behavior with or without a partner. We should be always careful while choosing a sex addiction therapist or a treatment program. Here are some questions to ask when looking for a good sex addiction treatment program:
    1. What percentage of the therapy program will be focused on compulsiveness and sexual addiction?
    2. What is the staff’s experience?
    3. What are the groups that address these issues?
    4. About the duration of the program.
    A good therapist ( ) can always solve the sexual addiction problem in a wise and proper way.

  3. Thank you for this page. I am the spouse of a sex addict. I am 61 and never suspected anything. It was an incredible relationship since age 18: I cannot explain the betrayal I feel from his annual visit to a hooker right up until 2 months before our 1980 wedding. There was a “spillage” event and I strongly feel he did not do anything to prevent me from 8 STDs. We had been monogamous for 6 years, I thought. I often inquired if he wished to continue as an unwed couple: he was enthusiastic about staying together, as was I. He is very handsome, girls flirted with him. I had my many minions on campus; they good-naturedly reported that he never showed interest in any other women. But he failed me big time in this controlled relationship where he paid a hooker for her services. He was reckless with my health, using lambskin condoms after marriage. We always wanted condoms as a back-up contraceptive. The box clearly read “For contraceptive use only. Does NOT prevent STDs” Bright red lettering, that I read from across the room. I feel he was selfish, thinking of his own pleasure (as he said, as an excuse). My generalist therapist has stated it is time to move on from this “relatively benign event that occurred years ago.” I had a tough 3 month PTSD reaction to all I learned in January. Yesterday I had a flashback to the box of condoms., and was back to weeping. I said nasty things to my husband causing him to feel defensive and angry. This is all new info to me; I never would have married or stayed marriage to a man who actually felt he never actually “cheated on me.I loved you; just had sex with her.” Who is the patient here? My husband has been “sober” for 4 months now; since the huge admission. He says has been faithful since marriage; but very extreme # of masturbation/ pornography episodes disgusts me .That SA behavior has caused ED b/c he is always at the level of satiety. This has always had a profound effect on our sex life. Sex is hardly worth the effort as the ED is such a source of apprehension for him. Higher dose of Celexa immediately killed his urges and he goes to therapist and SA group. I don’t know if I should be holding him accountable for things that occured 4 decades ago. His defensive posture makes me regret bringing up behaviors for which he should be taking responsibility. I wish I could let go of my resentment and terrible sense of wounding and betrayal. He was reckless with the serology test required two days before the wedding. He should have checked that out several wks prior. Why should I have been in the position of possibly having to cancel our wedding if his blood test was positive. No regard for me in these situations. His sexual needs were the priority. He was not thinking of me at all; admitted to me that he He is wonderful but “in a fog” when it is relevant to his SA. Why date me for 6 yrs and get engaged while all the while carrying on a secret affair with his hooker. Their relationship was clearly just “quid pro no”. Annually he needed to refresh his memories so he could fantasize to feed his compulsive masturbation actions. He tells me stuff like that as if I am not his sex partner, who wondered about his ED since age 19.When I asked why he did not drop me, as he obviously was unable to live with monogamy, he responded that he should have just joined the Marines to break him of his habit. In other words, he would have to leave me so he could get away from her and his compulsive porn/masturbation. He def feels shame for his behavior but gets furious with me for not being able to “let go.” of the SA behavior. I have had a few good weeks but was triggered yesterday, so I wept again.I had a flashback to feeling so proud that he felt safe using condoms that indicated he had been monogamous all along. I think I need a certified SA therapist for spouses. I am barely treading water when I need to process any new info. The green book stated that SAs should take responsibility for events where their addiction caused distress for family members.I want him to “own” that he neglected to prevent the STDs. He feels he has already apologized for the annual visits prostitute. Despite all this, he has always been a wonderful husband and father. He and I are into this notion of a “second marriage.” I am not delusional; he is a good man who has nursed me thru my many illnesses. Thank you.

    • I feel my husband has also been a good man and father and yes he has been there for me but he is a functional SA. He has been able to have his family image stay intact because he was such a great pretender.
      I don’t think you are delusional at all. Most of us partners have had to assess the good with the bad…no SA is a complete disaster, my husband certainly has done well in his professional life and created a very comfortable lifestyle for the rest of us. I think what partners wish they could have is a “crystal ball” that would tell them what the future holds. I know I wish I could. I am financially independent (now) but prior to that I truly felt “stuck” and for me and my little ones I felt I needed to stay put. Not knowing the depth that my husband had sunk was helpful until I got the dreaded STI…and until discovery soon after. Here’s what I know now that I didn’t know then. I found out that I have been slowly killing my health by lack of sleep and not understanding that I was suffering with PTSD. I didn’t think it was playing out that way until my therapist pointed it out. So, I separated and my migraines left, I got good sleep and I started to conect the dots. My husband is addicted to a lifestyle that will eventually dissolve his soul and I am truly sorry for him. As his partner I can either watch his slow death or keep my head above water. I have had to accept this reality even though my body refuses to believe this is the same man I married. My dear husband is the one who has turned down the volume on his conscience and cannot see that he holds a distorted view of reality. It only serves the purpose of creating false hope for me….which has kept me in this relationship far too long. I saw him through so many relapses and had his female friends call me (which is a stress I cannot describe since it is one thing to believe that what your partner is doing is somehow “fake” when people come out and call your cell by accident you know its the real thing).
      I believe what me and the rest of the partners out there are describing is something I will call battle fatigue. We have been beaten down, used, deceived on every level, and called out for being too angry or resentful. And empathy? Let me look at the word I just typed…I wouldn’t recognize empathy if it every showed up on my doorstep. I have spent so much time in the waiting room of my life only to realize that I if I stay put any longer I will merge with the wall and become meaningless. I am done with my life with him…Why am I paying for sins I didn’t commit? Why am I waiting on my partner to find the next intensive to go to (when all the previous ones never took)? And why do I feel like shit all the time? Is this what I signed up for? No. I did not. But now that I am more aware than my 24 year old self, I have the courage and integrity to meet the demands of my reality. I will be on my way the minute I graduate (second career…) and find what feels good to me. Find what will enable me to have peace in my soul and joy in my day to day. As a partner of a SA I have no regrets, I tried to build a marriage with a broken man so what did I expect? I may have failed in the test of my endurance but I know that I gave it my best shot. Now for all of you who are in that state of animated suspension I have one thing to say, your milage may vary and the outlook may be crazy but quit smoking the ”hopium” and start taking a realistic view of your life. Get a plan going about how you could make this work with or without the addicted partner. Then, make your decision; unfortunately no one but you can do this. Do not let your inner rom com spirit make this decision…let the adult woman decide. You only have one life and if I did believe in reincarnation then maybe I would stay…but since I don’t my inner spirit tells me I need to release him. There is grieving to be done, but as with all losses in life there is more to be gained from giving it all a funeral once and for all. I know I will always love him but to live in his world has implications that I cannot negoitiate. I will not take another bullet and I lay bleeding while he hovers over me expecting me to put out another fire. I cannot. Goodbye Mr.Porn Addicted Spouse…it has been real and fun but not really fun at all…

      • Thank you. I don’t feel so alone now.

    • Hi Eileen, my heart breaks for you.
      An observation I have made going through this journey myself for 3 years now is that not often do these sex addiction therapist talk about leaving. More often than not they tell us to stay 12 months before making a decision. A life saving and safe decision to put our own safety ahead of these sociopaths that have broken every vow in the book and then (in your case) brought home an STD that you may have to live with for the rest of your life, get treatment for or it has damaged your body.
      You cannot and should not just get over it, this is the selfishness of sex addicts and tells me he’s not in real recovery. You deserve better, you always did.
      You do not have to stay with a cheater, a liar, someone who has had zero regard for your feelings, your safety, your marriage. You have a choice, please don’t allow people to say you have to stay and support his recovery (if he ever gets into honest recovery) it’s your time now to put yourself first and find safety to heal and process all that has happened. You are not required to forget or forgive at this point, forgiveness takes time. He’s working on his own agenda because he doesn’t want to look at the pain the consequences of his actions.

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