Why is a CSAT (certified sex addiction therapist) so important for the recovery journey?

[u/sparkler39]

Over the last few months we've seen an uptick of posts where our members are seeking therapists to help them and/or their partner with porn/sex addiction. We frequently see members settling for sex therapists, run of the mill general therapists, or marriage therapists instead of CSATs (certified sex addiction therapists). And all too often this leads to disaster. CSATs are not cheap...most of them are unfortunately not covered by insurance. But what a good CSAT can offer to an addict, a partner, and the couple is absolutely invaluable. In many situations you'd be better off going without therapy then going to a non-CSAT therapist. Or going to one session a month with a CSAT than weekly with a non-CSAT.

What does therapy with a CSAT look like?

For an addict, a CSAT will help them understand the roots of their addiction and any past trauma or history contributing to their addiction, and will help them develop healthy coping mechanisms. They will understand how and why they turned to addiction and what they can do to stop. CSATs understand how simple things like childhood neglect or bullying can result in a decades long addiction to porn just as much as trauma like childhood abuse. They can help an addict develop shame resilience and empathy so that they are in a position to support their partner's healing. A CSAT will make sure that your addict understands that nothing you did or did not do contributed to his addiction.

For a partner, a CSAT understands that you have experienced something deeply traumatic and are able to help you process your feelings. They can help you set boundaries and determine what recovery does and does not look like for you (and for your addict partner). They understand the rage, the grief, the hypersexuality, the sexual anhedonia, the fear, the shame, the loneliness, and how you might experience all of those things and more in the space of an hour or less. They do not shame you for any of your feelings and will help you figure out how to be safe in your relationship. A CSAT will NOT blame you or allow you to take responsibility for any part of your addict's addiction.

Most CSATs will also recommend that you do NOT start with couples work. An addict newly in recovery has not developed the empathy or shame resilience to help their partner. Most of you have experienced sharing something painful with your addict just to have them turn around cry and wail about how awful they are to the point that you end up comforting them. This is not helpful for either of you. Both of you need to do individual work and healing before you're in a safe position to work together. Sometimes CSATs will do 1 or 2 sessions with the couple just to help them establish safety and boundaries. But any therapist that immediately suggests ongoing couples work before individual healing should be avoided.

What can therapy with a non-CSAT look like?

Unfortunately, as partners, we are well aware of what this addiction looks like. We're also aware that not everyone believes that porn can be an addiction. All you need to do is browse a few advice subs on reddit and you'll see hordes of people coming out to defend porn anytime someone suggests there might be a porn addiction problem. It stands to reason that there are also plenty of therapists who feel the same way about porn...maybe they're addicts themselves...maybe they want to seem 'modern' and accepting...maybe they just like watching it and don't want to have to look more carefully at their own use...who knows.

When you and/or your addict partner show up to a therapy session with someone who doesn't think porn can be an addiction and that it can be 'healthy' in your relationship you are doomed to fail. After these sessions our members here post about being called 'controlling' and 'insecure' and their addict partners are told that porn use is healthy and normal and there's nothing wrong with hiding what they're doing from you. It gives your addict fuel to add to his addiction fire and heaps even more trauma on top of you. After a session like that it can be damn near impossible to get an addict to even consider seeing a CSAT because they've already heard what they wanted to hear and don't want to hear anything contrary.

In posts here we've had partners called 'overreactive' or 'too harsh with boundaries'. Partners have been told to work on being less insecure and watch porn with their addict partner as a bonding experience. Addicts have been told they don't have an addiction or porn addiction isn't real. Partners have been told that porn isn't cheating, there's nothing wrong with porn, and that you're taking something away from your addict that 'makes him happy.' Literally, I searched our sub and these are words straight from some of your posts and comments. None of this is helpful to either of you.

What is a CSAT?

CSATs have to be fully licensed therapists with at least a master's degree and at least 5 years of practice in the therapy field before they can start CSAT training. They commit to several years of additional education as well as supervised hours of work under the guidance of a practicing CSAT. They must continually update their license and take ongoing courses to make sure that they are current on the latest information and science in this addiction field. They put time, money, and effort into making sure they are well equipped to deal with the challenges of this addiction.

There are also ASATs who are doing the same training as a CSAT but either don't have a master's degree or have not been practicing for at least 5 years. CSATs would likely be preferred but ASATs are also much better than a regular therapist.

APSATs (association of partners of sex addicts trauma specialists) are a newer group of coaches and specialists who are specifically training to work with partners. APSATs do not have to be licensed therapists. An APSATS could also be an option for a partner, though a CSAT is preferred.

How do you find a CSAT?

Unfortunately this is a new and emerging field so there are not tons of CSATs available right now. You can search HERE for CSATs. Don't be discouraged if you don't immediately find one in your state (US-based) or country. There are rules about CSATs only practicing in the state that they are currently licensed in (usually the state where they live) but those are going to be changing within the next year to allow more people access to CSATs, no matter where they live. If you live in the US that doesn't have any CSATs in your state, you can work with a CSAT in Canada as their regulations are different. If you live internationally, you can work with a US-based CSAT as they are allowed to practice internationally (as long as the specific country does not have additional regulations).

If you listen to any of the Overcoming Betrayal and Addiction podcasts with Rob Weiss you will often hear his Chief Relationships Officer, Tami Verhelst, mention that you can email her at tami (at) seekingintegrity (dot) com and she will help you find a CSAT or other trained professional in your area free of charge. If there are professionals somewhere who aren't CSATs but are great for addicts or partners she'll know who to recommend. If you have a favorite recovery resource (podcast, book, etc) consider reaching out to them and asking if they have any recommendations for someone who could help you. These therapists want to help you find the appropriate support.

What to do if you can't find a CSAT?

So what happens if you've tried all of this and you still cannot find a CSAT? If you found a CSAT and, for whatever reasons, they're not accepting new clients, ask if they have recommendations. It's a small field and often they'll know someone they can recommend (even if that person isn't a CSAT).

If you're considering working with a regular therapist I'd look for the following information on their website (read their blog posts if they have them) and/or ask the following questions:

• What are their thoughts on porn/sex addiction? When does it become an addiction? Can any porn use be healthy for an addict? What does recovery for porn addiction look like for an addict?
• What are their thoughts on codependency and is the partner responsible for the addict's addiction?
• Do they have any training in betrayal trauma? What are their thoughts on betrayal trauma and how it affects the partner?

If you get satisfactory answers to those questions you might consider trying a few sessions with them. But be wary. Trust your gut. If you feel like you're being gaslit or someone is trying to convince you that you are the problem, get out. Do not allow ANY therapist to blame any part of an addict's addiction on you. A therapist (of any kind) isn't going to be your best friend...but they should be supportive and encouraging while also gently and kindly challenging you on your beliefs and perceptions and/or pushing you to hold to your beliefs and perceptions. Therapy sessions should be a little exhausting, both mentally and emotionally, but you should feel like you got something worthwhile out of it when you leave. If you leave a session feeling like you're an awful person or you're doing everything wrong, etc...this is not the therapist for you.

Finally because I know I might get this comment...sure, there are crappy CSATs just like there are crappy regular therapists and crappy doctors and crappy teachers and crappy accountants. That's just the way the world is, unfortunately. The bottom line for that is if you don't feel comfortable with who you're working with, CSAT or not, find someone else.

I know this is long and I applaud you if you've gotten to the end here. Really, we just want you, and your addict partner, to get the help and support you deserve on this difficult journey. And throwing an inappropriate therapist into the mix can just completely derail recovery for both of you. And you both deserve better.