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?
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.