If sexual behavior or pornography use is hurting your relationship, choosing the right therapist can feel like an enormously consequential decision.
Maybe you are the person who is worried about your own behavior. You have made promises to stop, tried to change on your own, or watched someone you love get hurt by choices you do not fully understand yourself. You may be thinking, “I don’t want to keep doing this.” anymore. I need someone who actually knows how to help me.
Or maybe you are the hurt partner. You may be frightened, angry, confused, or unsure what to believe. Perhaps you have discovered behavior you never expected, or you have been through repeated cycles of discovery, promises, and disappointment. You may be wondering: What if this never stops? What if we choose the wrong therapist? How do I know my partner is getting the best care available? When the stakes feel this high, it is natural to look for something that tells you clearly who the expert is.
What Really Matters When Choosing a Sex Therapist
When searching for help for sex or porn addiction, people often encounter the term CSAT, or Certified Sex Addiction Therapist.
You may see the credential on therapist directories and websites or hear that someone struggling with sex addiction, pornography addiction, compulsive sexual behavior, or infidelity “needs a CSAT.” Sometimes the message is even stronger, suggesting that only a CSAT is qualified to treat these concerns.
The team at Pacific Behavioral Healthcare does not agree with that conclusion. Our founders began their professional journey with CSAT training themselves, but subsequently pursued extensive additional education in human sexuality and other advanced models for understanding problematic sexual behavior.
We respect the important contributions Dr. Patrick Carnes made to the evolution of this field. At the same time, we believe people struggling with sexual behavior concerns deserve care informed by the broader field of human sexuality and multiple ways of understanding problematic sexual behavior, rather than automatically applying one model to every person.
What Is a CSAT?
CSAT stands for Certified Sex Addiction Therapist. The credential is offered by the International Institute for Trauma and Addiction Professionals, commonly known as IITAP.
It is important to understand what that means.
IITAP operates as IITAP, LLC, a private, for-profit business. Patrick Carnes founded IITAP, and IITAP describes its origins as a training program founded by Carnes that focused on treating compulsive and addictive sexual behaviors through what became known as the CSAT program (Better Business Bureau, n.d.; International Institute for Trauma and Addiction Professionals, n.d.).
IITAP’s own description of Carnes also identifies him as its founder and describes his assessment tools and 30-task treatment methodology for addressing compulsive and addictive sexual behavior (International Institute for Trauma and Addiction Professionals, n.d.). Carnes’ treatment model is heavily influenced by the 12-step addiction recovery philosophy.
In other words, CSAT is not a governmental license to practice psychotherapy, nor does it represent certification across the full range of clinical models used to understand problematic sexual behavior. It is a specialized credential offered by IITAP that grew out of Patrick Carnes’s sex addiction methodology.
That distinction matters when you are trying to decide what a credential tells you about a therapist you are considering working with.
Respecting Contributions While Recognizing Advances
Beginning in the 1980s, Patrick Carnes’s promotion of the sex addiction model helped bring greater attention to people who experienced their sexual behaviors as repetitive, destructive, difficult to control, and harmful to themselves or people they loved.
We respect that contribution.
For people who felt profoundly out of control sexually, and for partners living with secrecy, betrayal, and the consequences of those behaviors, having clinicians take these struggles seriously was important.
But recognizing the contribution of a model is different from concluding that it provides the best explanation for every person who struggles with problematic sexual behavior.
The field has continued to evolve.
Other advanced conceptual models now provide different ways of understanding sexual behavior problems. These include the Out-of-Control Sexual Behavior Model, developed by Doug Braun-Harvey and Michael Vigorito; the Impulsive-Compulsive Sexual Behavior Model, associated with Dr. Eli Coleman; and the Dual Control and Sexual Tipping Point Model, associated with Dr. Peer Briken. At Pacific Behavioral Healthcare, we are also developing an Integrative Problematic Sexual Behavior Model that draws on multiple frameworks rather than assuming a single model can adequately explain every person’s difficulties.
This is an important reason we do not believe the question, “Is my therapist a CSAT?” should become the sole test of whether someone is qualified to help you.
The CSAT credential represents training in the Carnes-based sex addiction model. It does not demonstrate expertise in every other clinical model of problematic sexual behavior.
Why One Size Does Not Fit All with Sex Therapy
Human sexuality is extraordinarily complex.
Sexual behavior can intersect with emotional regulation, relationships and attachment, learning history, impulsivity, compulsivity, trauma, anxiety, depression, sexual desire and arousal, beliefs about sexuality, shame, cultural or religious values, relationship conflict, access and opportunity, and many other factors.
Two people can engage in behavior that looks remarkably similar from the outside while the psychological processes underlying that behavior are quite different.
That matters because how a clinician conceptualizes a problem influences what the clinician believes should be done about it.
A therapist working primarily from an addiction framework may ask certain questions and emphasize particular addiction interventions. A clinician trained in other models may identify additional or alternative processes that deserve attention.
Comprehensive Assessments Help Understand the Individual
The purpose of a comprehensive assessment should therefore be to understand the individual person, rather than to determine how closely that person fits a predetermined model.
Research on treatments for compulsive sexual behavior disorder and problematic pornography use is continuing to develop. A systematic review by Antons et al. (2022) found some evidence supporting treatment approaches, particularly cognitive-behavioral interventions, but also concluded that the quality of the available evidence was limited by methodological weaknesses.
More recently, López-Pinar et al. (2025) found in a comprehensive meta-analysis that psychotherapy was associated with improvements in problematic pornography use and related outcomes. At the same time, the authors noted important limitations in the existing literature and the need for stronger research.
These studies do not establish that any single credential or treatment model is superior to all others. Rather, they reinforce the importance of approaching this developing area of clinical practice with appropriate scientific humility (Antons et al., 2022; López-Pinar et al., 2025).
The available science does not justify treating one privately issued credential as a guarantee that a clinician possesses the single correct way to understand or treat these complicated problems.
Why a Comprehensive Understanding of Human Sexuality Matters
There is another question that can get lost when people focus heavily on sex addiction credentials:
How Much Does This Therapist Actually Know About Human Sexuality?
Treating problematic sexual behavior requires more than knowing strategies intended to stop a behavior.
A clinician also needs to understand:
- Healthy sexual development and functioning
- Sexual desire and arousal
- Sexual interests
- Sexual relationships
- Sexual values
- Individual differences
- Sexual shame
- Sexual health
- The enormous diversity and complexity of human sexual experience
This is not a minor distinction.
For comparison, the American Association of Sexuality Educators, Counselors and Therapists requires applicants for AASECT Certified Sex Therapist credential to complete at least 90 hours of education in core human sexuality knowledge areas and at least 60 hours of sex therapy skills training.
Demonstrating that general knowledge of human sexuality and the clinical practice of sex therapy are considered distinct areas of competency (AASECT, n.d.).
That breadth matters.
A comprehensive understanding of sexuality helps a clinician distinguish among different sources of distress and dysfunction.
Without that broader perspective, there is a risk of interpreting sexuality primarily through a pathology framework. That can unintentionally cause harm.
For example, a clinician needs to be capable of exploring whether a person’s sexual behavior is genuinely experienced as out of control. Whether it conflicts with freely chosen personal values or relationship agreements, whether other psychological or relational processes are involved. Does shame, moral conflict, misinformation, or differing expectations about sexuality contribute to the distress?
This does not mean minimizing harmful behavior.
If someone has repeatedly lied to a partner, violated relationship agreements, engaged in infidelity, or continued behavior despite serious consequences and sincere attempts to stop, those concerns deserve to be taken seriously.
A hurt partner’s experience should not be dismissed in the name of being “sex positive.”
At the same time, taking harm seriously does not require automatically interpreting every sexual concern through one addiction framework.
Good treatment needs enough sophistication to hold both realities.
Are You Struggling with Problematic Sexual Behavior and Want to Stop?
If you are reading this because you are scared by your own problematic sexual behavior, you may already carry a tremendous amount of shame.
Perhaps you have told yourself, This is the last time, only to find yourself doing it again. Maybe you have hidden things from your partner and hate what the secrecy has done to your relationship. Perhaps you are terrified that you are going to lose someone you love.
You may desperately want someone to tell you what is wrong with you and how to make it stop.
An individual does not have to settle the terminology before you can begin getting help.
You do not have to decide whether “sex addiction,” “porn addiction,” “compulsive sexual behavior,” “out-of-control sexual behavior,” or another term perfectly describes your experience before walking into a therapist’s office.
A skilled sexual behavioral clinician should help you investigate what is happening rather than begin by assuming the answer.
Treatment can hold you accountable for choices that have caused harm while also helping you understand the psychological, relational, behavioral, and sexual factors that are maintaining the pattern.
The goal is not simply to give you a label.
The goal is to help you stop causing harm, regain meaningful control over your behavior, understand yourself more fully, and make sustainable changes.
If You Are the Hurt Partner and You Are Afraid It Will Never Stop
As the partner being hurt by the behavior, you may be approaching this from a very different place. You may:
- Be exhausted from wondering what is true
- Have heard all the promises before
- Desperately want your partner to get specialized help because you are frightened that anything less than the “best” treatment means the behavior will continue
If someone has told you, “Your partner has to see a CSAT, or they won’t get better,” that message can create even more fear around an already frightening situation.
A credential cannot make that promise.
If your partner’s sexual behavior is resulting in harm, they do need competent care. Experience with problematic sexual behavior matters. Understanding the relational consequences of secrecy and betrayal matters. Careful assessment matters. The clinician’s ability to recognize the limits of their own framework matters.
No single credential guarantees recovery
Psychotherapy research more broadly has repeatedly found that factors shared across different forms of psychotherapy, including the therapeutic relationship, collaboration, empathy, and agreement on treatment goals, contribute substantially to successful treatment (Wampold, 2015).
That does not mean specialized knowledge is unimportant. It means that a credential alone is not enough.
You also deserve attention to your own experience. Your fear, anger, uncertainty, grief, and need for reliable information should not be treated merely as extensions of your partner’s treatment.
Finding excellent care means asking broader questions than whether one particular acronym appears after a therapist’s name.
What Should You Look for in a Sex Therapist?
Instead of asking only, “Are they a CSAT?”, consider asking:
How much experience does this therapist have treating problematic sexual behavior?
Specialized clinical experience matters. Ask how frequently the therapist works with these concerns and what kinds of problems they treat.
What models do they use to understand problematic sexual behavior?
A knowledgeable therapist should be able to explain their conceptual approach and why they believe it fits your circumstances. They should also be able to articulate several possible conceptual explanations for why someone’s sexual behavior could become problematic.
What training do they have in human sexuality?
This may be one of the most overlooked questions. Treating sexual concerns without a broad understanding of human sexuality can create significant clinical blind spots.
How will they determine what is driving the behavior?
Assessment should come before assumptions. The therapist should be interested in the function, context, history, severity, consequences, and meaning of the behavior for the particular person.
How do they understand the hurt partner’s experience?
When secrecy, betrayal, or broken relationship agreements are involved, the partner’s pain matters. Ask how the clinician approaches that harm and how partners receive appropriate support.
Do they individualize treatment?
Ask whether treatment recommendations emerge from the assessment or whether essentially the same program is prescribed to most clients with sexual behavior concerns.
Can they explain why they are recommending a particular intervention?
You should be able to ask questions. A good therapeutic process should help you understand the reasoning behind treatment recommendations.
Do you feel that this therapist understands you and takes your concerns seriously?
Credentials and training matter, but they are not substitutes for a productive therapeutic relationship. Decades of psychotherapy research have shown that common therapeutic factors, including the quality of the therapeutic alliance, are important contributors to treatment outcomes (Wampold, 2015).
Our Perspective on CSAT at Pacific Behavioral Healthcare
Our perspective comes partly from our own professional evolution.
Pacific Behavioral Healthcare’s founders completed CSAT training early in their careers. They subsequently expanded their education in human sexuality and became Certified Sex Therapists while also studying additional advanced models for understanding problematic sexual behavior (Pacific Behavioral Healthcare, n.d.).
That broader education changed how we think about these concerns.
We continue to respect Patrick Carnes’s contributions to the evolution of treatment for people struggling with sexual behavior. His work helped draw attention to suffering and loss of control that deserved serious clinical attention.
IITAP itself acknowledges Carnes as its founder and says that the organization began as his training program focused on compulsive and addictive sexual behaviors, known as the CSAT program (International Institute for Trauma and Addiction Professionals, n.d.).
We also believe the field is larger than the model he created.
CSAT is a credential offered by IITAP, LLC, a private, for-profit company founded by Patrick Carnes, and the CSAT program grew from the sex addiction treatment approach associated with his work (Better Business Bureau, n.d.; International Institute for Trauma and Addiction Professionals, n.d.).
It is one avenue of specialized training.
It should not be confused with comprehensive expertise across the many contemporary perspectives on problematic sexual behavior, nor should it be assumed to represent comprehensive training in human sexuality.
Pacific Behavioral Healthcare’s perspective is that clinicians treating sexual behavior problems benefit from extensive sex therapy training together with advanced training and supervision across multiple theoretical models, rather than relying on the sex addiction model alone (Pacific Behavioral Healthcare, n.d.).
What is the Right Question to Ask When Looking for Sex or Porn Addiction Therapy?
For us, the most useful question is therefore not:
“Does this therapist have the right acronym after their name?”
It is:
“Does this therapist have the breadth of knowledge, clinical experience, understanding of human sexuality, and judgment necessary to understand this particular person and provide thoughtful, individualized care?”
You Do Not Have to Get the Label Right Before You Ask for Help
If you are the person struggling with the behavior, you may be afraid you will keep hurting someone you love.
If you are the hurt partner, you may be afraid it will happen again.
Both of you may feel tremendous pressure to find the “right” treatment immediately.
Those fears deserve to be taken seriously. But fear should not force you into believing that there is only one legitimate treatment model or one credential that determines whether someone can help. When looking for a sex therapist, look for a clinician who:
- Understands the seriousness of problematic sexual behavior without losing sight of the complexity of human sexuality
- Can take relational harm seriously without approaching every person with a predetermined conclusion.
- Has enough breadth of training and clinical humility to consider multiple explanations, conduct a careful assessment, and develop treatment around the actual person sitting in front of them
The purpose of treatment is not allegiance to a particular model.
It is to understand what is happening, stop patterns that are causing harm, support the hurt partner, foster meaningful accountability and change, and help people build healthier lives, relationships, and sexuality.
That Is The Kind Of Care Worth Looking For
Pacific Behavioral Healthcare provides specialized treatment for problematic sexual behavior, concerns commonly described as sex or pornography addiction, betrayal trauma, and related relationship difficulties. Our approach emphasizes advanced training in human sexuality and multiple models for understanding problematic sexual behavior rather than reliance on any single framework.
Contact Pacific Behavioral Healthcare to Request an Appointment
In-person appointments are available in Seattle and Bellevue, Washington, with online therapy available throughout Washington State and telehealth services in participating PSYPACT states.
James Olsen, JD, PhD, LMHC, CST
Pacific Behavioral Healthcare
Dr. Olsen is the CEO of Pacific Behavioral Healthcare and an expert in sexual health. He specializes in treating problematic and compulsive sexual behaviors. Dr. James Olsen has helped countless individuals who presented with concerns of sexual addiction or other sexual behavior struggles. He has shown a unique ability to help these clients rebuild their lives and repair their relationships in ways they thought impossible.
References
American Association of Sexuality Educators, Counselors and Therapists. (n.d.). AASECT requirements for sex therapist certification. https://www.aasect.org/aasect-requirements-sex-therapist-certification
Antons, S., Engel, J., Briken, P., Krüger, T. H. C., Brand, M., & Stark, R. (2022). Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review. Journal of Behavioral Addictions, 11(3), 643–666. https://doi.org/10.1556/2006.2022.00061
Better Business Bureau. (n.d.). International Institute for Trauma and Addiction Professionals. https://www.bbb.org/us/az/carefree/profile/training-program/international-institute-for-trauma-and-addiction-professionals-1126-1000032654
International Institute for Trauma and Addiction Professionals. (n.d.). About IITAP. https://iitap.com/page/About_IITAP
International Institute for Trauma and Addiction Professionals. (n.d.). Dr. Patrick Carnes. https://iitap.com/general/custom.asp?page=dr_patrick_carnes
López-Pinar, C., Esparza-Reig, J., & Bőthe, B. (2025). Psychotherapy for problematic pornography use: A comprehensive meta-analysis. Journal of Behavioral Addictions, 14(2), 630–643. https://doi.org/10.1556/2006.2025.00018
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277. https://doi.org/10.1002/wps.20238
