I Don't Treat Sex Addiction. Here's What I Do Instead.
If you found this page looking for a CSAT-certified sex addiction therapist, I'm probably not your person.
That's not a hedge. It's a clinical position I've arrived at after significant time with the research, and I want to be honest about it before you spend time reading further or reach out for a consultation.
Here's what I do treat: compulsive sexual behavior that is causing real harm in your life and your relationships. The shame, the secrecy, the gap between who you want to be and what you keep doing. The relationship damage. The underlying anxiety, dysregulation, and attachment disruption that are almost always driving the behavior. All of that is very much in my clinical wheelhouse.
What I don't do is treat it as a disease.
That's the distinction that matters. And if you're someone who has been in sex addiction treatment and felt like the framework didn't quite fit, or like the shame got heavier rather than lighter, or like you kept relapsing despite genuine effort and commitment, that distinction might be the most useful thing you read today.
What Sex Addiction Treatment Usually Looks Like
The dominant model in this space was developed by Patrick Carnes in the 1980s. It's built on an analogy to substance addiction. The behavior is framed as a disease. The treatment involves a program structure, a sponsor, meetings, sobriety from specific behaviors, and an ongoing recovery identity organized around the addiction.
This model has produced a significant industry. CSAT certification, inpatient programs, intensive outpatient, partner betrayal trauma protocols built on the assumption that the using partner has a disease. It's the language most people encounter when they first search for help with compulsive sexual behavior.
It's also built on a research base that doesn't hold up.
It has not been formally recognized as a diagnosable disorder in the DSM. The American Psychological Association and the American Association of Sexuality Educators, Counselors and Therapists have both raised significant concerns about the evidence base. The neurological analogy to substance addiction doesn't hold up under scrutiny. Sexual behavior, unlike alcohol or opioids, doesn't produce physical dependence. The withdrawal is psychological. Which means what looks like addiction from the outside is better explained by something else.
That something else matters enormously for treatment. Because if you're treating the wrong thing, you're going to keep getting the results that bring people back to treatment repeatedly, which is what the sex addiction model produces at a notable rate.
The Framework I Work From
Stanton Peele has been making the case since the 1970s that addiction is better understood as a biopsychosocial and cultural phenomenon than a disease. That the behavior develops in a context, serves a function, and is maintained by psychological and social conditions rather than a pathology that exists independently of the person's history and environment.
David Ley has applied this framework specifically to sexual compulsivity, and his work is where my clinical approach is anchored. The core argument is this: compulsive sexual behavior is real and it causes real harm. It is not, however, a sexual disorder or a brain disease. It is a behavior pattern that is driven by underlying psychological conditions and maintained by shame, secrecy, and the absence of genuine treatment for what's actually going on.
For some clients, especially those with ADHD or other forms of neurodivergence, the behavior is closely tied to regulation, novelty-seeking, and emotional intensity rather than addiction. The architecture looks similar from the outside. What's driving it is different. And what drives it determines what addresses it.
This reframe matters because it changes what treatment targets.
The disease model targets the behavior. Stop the behavior. Maintain sobriety. Manage the addiction indefinitely.
The Ley framework targets what's driving the behavior. The anxiety that has no other outlet. The attachment disruption that makes genuine intimacy feel too risky. The trauma that stored itself in the body and finds expression through sexuality. The shame that increases the urge rather than reducing it, because shame is a dysregulating state and the behavior was recruited to manage dysregulation in the first place.
When you address what's driving the behavior, the behavior changes. Not because you've achieved sobriety from a disease. Because the conditions that made the behavior necessary have been addressed.
Why Shame Makes the Disease Model Worse
This is the part that concerns me most clinically about the Carnes model.
The treatment leads with shame. You're an addict. Your sexuality is disordered. You've hurt people. You need to make amends, work a program, and accept a recovery identity organized around this.
Some of that is appropriate. Accountability matters. The impact on partners is real and needs direct attention.
But shame is not a treatment. Shame is a nervous system state. It's dysregulating. And it increases the internal activation that the compulsive behavior was recruited to manage in the first place.
More shame produces more dysregulation. More dysregulation produces more urge. More behavior produces more shame. The cycle doesn't break because the model that's supposed to address it is running fuel into it.
What I find in my clinical work is that reducing shame is often the most important early intervention. Not excusing the behavior. Not bypassing accountability. Replacing the shame-based identity of addict with an accurate understanding of what's actually happening, which is that a nervous system found a behavior that managed an otherwise intolerable internal state and kept using it.
That understanding is not permission. It's the foundation for actual change.
A Note for Partners
If you're a partner trying to understand what happened and whether repair is possible, this framework does not minimize what happened to you. The betrayal is real. The harm is real. The question is how we understand the behavior in a way that actually leads to repair rather than a disease narrative that can inadvertently remove accountability from the person who caused the harm.
You deserve a framework that takes your experience seriously. That's what this approach is designed to do.
Who I Work With and How
People who are engaging in sexual behavior they don't want to be engaging in and can't seem to stop through willpower alone.
People who have been in sex addiction treatment and found that the model didn't fit their experience, that the shame got heavier, that the recovery identity felt more like a life sentence than a path forward.
People who want to understand what's actually driving the behavior rather than just managing it indefinitely.
Partners who have been harmed and are trying to understand what happened and whether repair is possible.
The work starts with an honest assessment of what the behavior is doing, not just what it's costing. What internal states it's managing. What it's providing that nothing else is currently providing. What the nervous system learned and why it keeps going back to this particular solution.
From there we address those underlying conditions directly. The anxiety. The attachment patterns. The trauma. The shame that has been compounding rather than resolving. We build genuine regulation capacity so the behavior is no longer the most efficient available tool for managing an internal state that has become more tolerable.
A Note on the CSAT Framework
If you've done significant work in a CSAT framework and it has helped you, I'm not here to take that away from you. Some people find genuine community and support in the program model. If that's working, that's not nothing.
If you come to work with me having a CSAT framework and a recovery identity that feels authentic and useful, I will work within that. Client-centered work means meeting you where you are, and where you are includes the framework that has made sense of your experience.
What I won't do is apply a framework I don't clinically agree with to someone who hasn't already found it useful. For someone coming in fresh, without a prior investment in the disease model, I'm going to work from the framework that the evidence supports.
What This Actually Looks Like in Practice
A first session that starts with curiosity about what the behavior is doing rather than building a case for why it needs to stop.
A treatment approach that addresses what's underneath rather than overlaying a program on top of an unchanged system.
Accountability without shame. The behavior has caused harm. That harm needs to be acknowledged and addressed. That work doesn't require a disease identity to be real.
A genuine reduction in the urge over time, not through sustained willpower and sobriety maintenance, but through addressing the conditions that made the behavior feel necessary.
The Question Worth Sitting With
If the model you've been working from were the right one, would you still be looking?
Not as a criticism of the work you've done or the path you've taken. As an honest question about whether the framework fits and whether the results match what you were hoping for.
The behavior is real. The harm is real. The need for help is real.
The disease model is one framework for addressing those things. It's not the only one. And for a significant number of people it's not the right one.
If you're someone for whom it hasn't quite fit, that's worth paying attention to.
If you're dealing with compulsive sexual behavior and the standard framework hasn't given you an explanation that fits or results that last, let's talk about what's actually happening and what a different approach might look like.
We'll cover:
What the behavior has actually looked like and what it's been doing for you
Whether the framework you've been working from is the right fit for your specific situation
What addressing the underlying drivers rather than just the behavior looks like
Whether we're a good fit to work together
No judgment. No shame. Just an honest conversation from someone who works with this differently than most.
If you've been trying to figure this out alone or cycling through treatment that hasn't produced lasting change, one conversation will tell you more than another round of the same approach.
The hardest part is reaching out. After that, we figure it out together.
About the Author
Christan Mercurio, AMFT
Registered Associate Marriage and Family Therapist
20 Years in Tech | 20 Years in Recovery
Registration No. AMFT 156566
Supervised by: Harry Motro, Psy.D., MFT, P.C., CA License: MFC 53452 and Jennifer Lynn Weise, LMFT #90891
Contact:
📧 cm@christanmercurio.com
📞 (669) 240-0319
Serving San Jose, Campbell, Los Gatos, Willow Glen, Almaden Valley, Saratoga, Silicon Valley, and Santa Clara County
