on being a sex addiction therapist...

This article expands on a recent interview with the Masters in Counseling podcast about what sex addiction therapy is and why I am honored to call this my profession.

by Staci Sprout, LICSW, CSAT*

August 21, 2018

1. Of all of the specializations from which to choose, why did you decide to pursue a certification and specialization in the sex addiction field?

I was familiar with the concept of sex and love addiction from personal attendance in 12-step meetings, but when clients started coming to my therapy practice complaining of compulsive sexual behavior, I realized that there was a big difference between my personal 12-step sexual recovery and clinical best practices to assess and treat sexual addiction. Right around that time, I was offered a job at a sex addiction/sex offender treatment clinic near Seattle, and part of the benefit package included certification training as a sex addiction therapist. At first I felt scared to enter that specialty, due to the intensity, but as I considered it, I experienced a strong inspirational urging to say yes, so I took the leap. I come from a family of generations of sexual abuse and various compulsions, so I wanted to take the opportunity to become part of the solution.

2. What is a "CSAT"? There are other sex addiction certification/training programs (e.g., the American Association for Sex Addiction Therapy, SASH's training); why did you choose IITAP (and what is IITAP?)

CSAT stands for “Certified Sex Addiction Therapist” and it is an earned title after one’s name. This training is one of several specialties offered by the International Institute of Trauma and Addictions Professionals, or IITAP (info here: https://www.iitap.com/certification/). The qualifications are rigorous and only available to licensed providers. My employer at that time believed the CSAT training was the most advanced preparation to treat trauma and addictions available anywhere, and encouraged anyone treating sex addiction to take it. The Society for Advancement of Sexual Health (SASH) and other trainings developed after I’d attained my CSAT; back then the only other options besides CSAT were Christian-based, and I wanted a more spiritually-inclusive training. I’ve gotten some criticism for saying that the CSAT is the “gold standard” of preparation if you want to specialize in treating sexual compulsion, but I stand by my opinion. There are many skilled therapists who are not certified, and I don’t mean to exclude other valuable training programs. But in my experience, CSAT training is the most in-depth; it is backed by extensive research on best practices; the work is supported by incredible literature and clinical support materials; and perhaps most importantly, entering the CSAT treatment community provides the opportunity to join a global network of visionary leaders in the evaluation, treatment and education about trauma and sex addiction. And no, I am not paid by IITAP to say this. My career has advanced in so many ways because of the knowledge and experience I received from IITAP, I would encourage this path to anyone! The training I received on trauma treatment alone far surpassed anything available to me in graduate school, let alone the non-existent education about clinical responses to sexual compulsion.

3. What is the importance of creating a niche in one's practice? Are there limitations in focusing on a sex addiction niche?

Moving from a general practice therapy clinic to a specialty practice clinic gave me the experience of what it was like to treat sex and love addiction almost exclusively, and I found that though intense, I loved the work! So when I felt it was time to open a private practice, I wanted to continue to focus on this area. At first I felt concerned that this might be too limited, but I had a mentor I respected tell me that specialty practices fill up with people who know exactly what they want. That has absolutely been my experience; my practice has been full for the past five years and I make referrals out regularly. Our collegial network of sex addiction therapists consult and co-refer regularly because it is very reassuring to know that we can co-treat in couples and families with other providers who know what we are doing and have similar education, language, and approaches. Like any specialty, treating sex addiction has its own lingo based on the needs of the population (e.g., “discovery,” “reconciliation process,” “partner disclosure prep,” “formal disclosure,” “clarification,”) and unique technology (e.g., use of fidelity polygraphs) that requires training and experience to use successfully. Not all CSAT’s or sex addiction specialists use all these tools, but familiarity with them saves everyone time and energy.

I would say the limitation for the niche center around the same thing: intensity. This is not low risk therapy! We deal with child sexual abuse risk, high conflict divorce and collaborating with forensic parenting evaluations, illegal behavior, unwanted pregnancies and STI risk, suicidal ideation and high risk, high profile reputation risks, coercive or offensive sexual behaviors, and the risks of ending careers and devastating families. This is often a highly traumatized population, so trauma treatment skills are essential. We need to know when to refer for sex offender evaluations (some sex addictions specialists do both addiction and offender work, but most do not), when to refer to sex therapists (some CSATs are dually trained and/or certified as sex therapists, others are not), and when to refer for inpatient and intensive outpatient treatment for sexual compulsivity and related issues. Knowledge of the myriad of specialty resources available to clients is vital, and good networking within the specialty field makes all the difference to mitigate the intensity, via supervision, consultation, and ongoing training and education.

4. Do you treat sex offenders?

It can be a tricky distinction when considering "offender" in such detail as we are compelled to do in sex addiction work. Here I use the term in the legal context, as in one who has committed or been accused of a criminal sexual act. In sex addiction, we certainly see clients who have offended others (cheated on spouses, sexually objectified, used other consenting adults for sex without care, etc.) but those are not actual sex offenses in the legal sense. I teach a class on Sexual Ethics where we talk about treating sex offenders from two perspectives (and the discussion widens from there):

 1. Scope of Practice -- Do we have the proper training to be qualified to offer treatment that the client needs? Treating outside Scope of Practice is an ethical problem and could lead to difficult consequences, not only for the client and others but for us as practitioners, personally and legally. If we are treating someone who admits to a sex offense, whether or not they are formally charged with a crime, do we have any special training, certification, and/or supervision to qualify us to do so?   I do a phone screen for all potential new clients, and if someone admits to engaging in public exhibitionism or voyeurism, offenses against a minor, or other sex crime activity besides prostitution (I ask about harming others and legal involvement in my screening), I almost always consult with or refer them to a Sex Offender Treatment Provider (SOTP). This is the state designated special classification/training for those licensed to treat sex offenders in Washington, my home state. If these issues came up only during the in-person assessment, I would finish the assessment and then refer to an SOTP for a second opinion, following their judgment as to whether or not I would stay the primary therapist or if the client needed an SOTP to be primary. Certainly I would consider a treatment intensive, inpatient treatment, group therapy and 12-Step support group referrals, but I’d defer the plan to the SOTP. So everyone who treats sex addiction should have at least two SOTP’s or the equivalent that they know and trust for referrals.

 2. Mandatory Reporting -- Do we have clarity on what our obligations are as Mandatory Reporters? That is influenced by where we live, but there is also a personal aspect to interpreting our duties here. And I believe our experience, training, supervisor/consultation groups, and particular practice discipline also influence when and how we report. If we don't report, we can get in trouble! In Texas, for example, anyone who fails to report the abuse of a minor can be fined and do jail time for a misdemeanor crime. However, if we wrongly report, we can get in trouble too, for violating client confidentiality. An interim step that often works is calling the state reporting line with an anonymous hypothetical situation and getting advice on how to proceed, and documenting! However, I have found that such advice can be variable and asking another person later can lead to different advice, so trusted attorneys are the best last word. It’s vital to have a sex offender-informed attorney available to consult if you treat sex addiction.

What makes ethics so fascinating for me are the complexities we face in the sex addiction field. If we treat beyond our Scope of Practice, we can be liable. And yet in a related ethical issue, Abandonment, we must not abandon clients who are entrusted in our care. Here it can be important to distinguish who is "in our care" and whom has merely inquired about services. Signed Practice Policy forms, Informed Consent, and Privacy Rules come into play here, as we know. Advising clients that the issues presented need a second opinion or need a different expert is always called for when appropriate, with two or more referrals, given kindly. As providers, we get to have limits!

5. Do you work with people interested in alternative sexual lifestyles?

In my practice I usually refer people who contact me primarily seeking support to explore kink, fetish behaviors, polyamory, or Bondage-Domination-Sadistic-Masochistic (BDSM) sexual practices to others who specialize in that area because it’s not the focus of my practice. Some people confuse those behaviors or explorations with sexual addiction, but sex addiction is about how someone uses any sexual behavior, not what kind of specific sexual behavior they engage in. Our local GLBTQ counseling agency is a great resource for support when exploring alternative sexual lifestyles (including asexual), and I have other colleagues to whom I can refer who focus on this specialty for people of all sexual orientations. 

I have been trained in supporting people to explore their gender identity and move from incongruent to self-congruent gender definitions, sometimes transitioning genders, and find this delightful, rewarding work. But this is separate from the sexual addiction/compulsion treatment I offer.

Interest in all kinds of sexual expressions certainly comes up in my practice with clients seeking help for sexual addiction. It’s natural that as a client resolves whatever compulsive sexual patterns cause them and others deep shame, pain and unmanageability, they want to reclaim the aspects of their erotic template that bring them the most excitement and pleasure. Clients developing their own ideas and experience of what sex means is a key milestone in their work, and it’s an honor to support this profoundly vulnerable part of their journey. I support sexual sovereignty, or the right of an individual to choose what they do sexually, as long as it doesn't cause genuine harm to themselves or others.

However, the question I don’t hear asked enough about fetish, kink, polyamory and Bondage-Domination-Sadistic-Masochistic sexual behavior in recovering sex addicts is what are the clinical best practices for evaluating subconscious trauma reenactment in these patterns? In my experience, implicit trauma (whether or not it is sexual in nature) is often reenacted via sexuality as part of a person attempting to accept and integrate the trauma story that is not yet consciously known to them, and gain mastery over it. Think of the well-known neuroscience quote: “neurons that fire together, wire together.” For example, sexual abuse trauma can cause sexual associations between pain and pleasure that did not exist prior to the trauma. Or, a parental betrayal of infidelity or oppression can cause associations between commitment and pain, leading to an unexamined conclusion that all monogamy = betrayal and emotional trauma. Ironically, polyamory can be intimacy avoidance for some people. Others are happy and fulfilled in an ethical polyamory lifestyle, and still others are simply exploring all options.

My role as a therapist to be curious about any fixed sexual behavior or rigid beliefs--including those held by the dominant paradigm--is one of the best gifts I can give to my clients. When therapists overlook this kind of non-shaming curiosity, I believe it can be a disservice to sexual healing. The well-known statistics about sexual abuse in our culture are staggering: 1 in 3 girls, 1 in 5 boys (underreported), and familial sexual and relational betrayal trauma is undeniably common, yet most people never get resolution for this. In my opinion, it’s not an illogical assumption that some of this trauma gets acted out through sexual power dynamics of control and compliance, rigidity, and lifestyles that replicate the original pain, particularly if there is deception involved. Or via harmful sexual fantasies, pornography use, and masturbation. If someone is reenacting a trauma without mindfulness, they cannot integrate it and heal it. So, if a client who has struggled with sexual compulsivity is drawn to kink, fetish behaviors, polyamory, or Bondage-Domination-Sadistic-Masochistic (BDSM) sexual practices - particularly if these interests are rigid and fueled by fantasy, I consider respectful curiosity and evaluation for abuse reenactment as clinical best practice as a trauma-informed therapist.

These days I am seeing more people who had no internal interest in these kinds of sex until they became compulsive about viewing pornography. First porn viewing today is reported to occur on average at age 11 – 13, a highly formative time in kids’ development. Counselor Magazine featured a great article titled Adolescents and Pornography by Alex Lerza, LMFT, CSAT that detailed the many problems this can create for kids. I believe (and research has demonstrated) that sexual templates (sexual roadmaps to pleasure) can be altered by pornography in a way that strangles authentic sexual development, causing damage to a person’s authentic sexual unfolding. In these cases, the porn itself is toxic, usually unwittingly self-inflicted due to the high pleasure it simultaneously stimulates. My role is to support people who have had these experiences to acknowledge and reclaim their true sexuality from the inside out--as they define it--so they no longer have to let it be hijacked from the outside in.  

In another example, many women I work with have deeply ingrained fantasies of sexualized violence and may have acted out these rape fantasies in real life, to their great detriment. Often these fantasies were created as a solution to coping with actual childhood violence - an ingenious way for a little girl to find mastery when she was otherwise utterly powerless. It is a form of dissociative coping. In these situations, first we focus on stopping the harmful re-enactments of violence in her sexual life, then later we move into resolving unwanted fantasy (intrusive traumatic ideation).

I want to add that I am a strong ally of the LGBTQ community and would never attempt to change the sexual orientation, authentic preferences, nor the gender identity of a client - that is unethical and in Washington, thankfully, so-called "Reparative Therapy" is illegal. I work with LGBTQ clients who are in great pain due to being unable to stop compulsive sexual or relational behavior that is causing them and others great distress, to help them find self-defined, empowered intimacy and sexuality. Sometimes clients have same sex attractions and do not want to, or they feel shame about some kind of desired sexual behavior due to religious or cultural oppression, and the underlying issue is sexual self-acceptance and finding new ways to deal with oppression - both external and internalized, not sexual addiction. In these cases I support clients to advocate for themselves and what they want, as part of healthy sexual esteem.

These are complicated clinical issues that must be considered on a case-by-case basis. If unsure, I get clinical supervision and expert consultation to be of best service to my clients.

6. What advice would you share with a therapist interested in specializing in sex and love addiction?

I would advise someone seeking to specialize in sex addiction treatment to intern or employ at a specialty clinic, where they can receive support, training, consultation, and referrals while they are building their experience. I recommend getting the CSAT training, and starting out slowly in your practice if you can. To mitigate the intensity of work, don’t take all sexually compulsive clients, couples, or partners betrayed by sex addicts--mix it up for a while as you assess if this is truly what you want to do. And, always do a screening of new clients over the phone before inviting them in for a first session. I think this is a good practice for any therapist, but especially with this population. I assess if clients are in crisis, if they are dealing with forensic/legal issues (and thus may need a specialist in sex offense litigation), or if they are involved in illegal behavior. I also take an implicit or “gut check” for deception from the phone call, and if there is hesitation for any reason, I refer. It may seem surprising, but by and large I have found that people who seek help for sexual compulsion are intelligent, well-resourced, and genuinely interested in healing. But screening for fit is important for my serenity as a therapist.

7. What are the top joys of CSAT work that you have experienced as a clinician?

1. Seeing daughters read letters to their formerly sexually compulsive fathers about the ways they felt harmed by their fathers’ sexual acting out, and witnessing the fathers--who have worked very hard on their healing--take full responsibility for these harms and repair with their daughters, always brings me deep joy and admiration.

2. Facilitating therapy groups of women sex and love addicts, and witnessing these women risk trusting other women, and offer nurture and support to each other to find their voices, this is deeply meaningful to me, and healing to be a part of.

3. Watching partners of sex addicts grow their incredible grace and dignity as they walk through the process of healing from profound betrayal, whether they stay with their addicted partners or not, is such a privilege.

4. Participation with the reconciliation process of couples and families once shattered by the discovery of sexual infidelity, where lies become truth, betrayal is named and owned, profound pain is articulated, expressed, and released, direct and living amends and apologies are made, fidelity is attained and protected, grace and forgiveness emerge, and children in the family are nurtured to heal -- that is incredible to witness and facilitate!

5. Seeing those whose sexual template has including sexually offending another person (or people) realize the consequences of their actions and become capable of empathy, forever changing their capacity to repeat such offenses, is truly awesome. Anyone who says all sex addicts and/or sex offenders can’t be helped is uninformed about the amazing potential for healing in human beings!

Yes this work can be intense, but the rewards are incalculable. I feel like the luckiest therapist in the world for what I get to do – as long as I don’t overdo it.

8. What are the top misconceptions or biases regarding CSAT work that you have encountered at a sex addiction therapist?

Mainly people don’t understand what sex addiction is, and develop inaccurate assumptions or ideas about it. The same dynamic for denial of sex addiction exists that has existed for all addictions – probably more due to the shameful nature of sexual compulsivity. CSAT’s see the social, emotional, and relational devastation of sex addiction in our practices every day. It is one of society’s darkest secrets.

There is some fantastic research emerging on the overwhelming impact of the “supernormal stimuli” found in the compulsive pursuit of sex--particularly that found in much of online streaming video pornography. I watched an interesting documentary called “Addicted to Porn: Chasing the Cardboard Butterfly” (2017) that explores this issue.

Anyone with a good faith desire to learn more about sex addiction can easily do so. As I’ve said often, it’s the best time in human history to talk about it, because there are more resources available for understanding and treating it than ever before. An intelligent discussion of the evidence and criticisms of sex addiction can be found in a paper called “Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics” by Bonnie Phillips, Raju Hajelab & Donald L. Hilton Jr. In fact there are two journals from Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention that are dedicated to summarizing decades of scholarship and research for anyone interested, Volume 22, Number 2, 2015 and Volume 23, Number 1 from 2016. Another commentary can be found in the journal Addiction, here: Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction by Shane W. Kraus, Valerie Voon, Ariel Kor, and Marc N. Potenza. I would recommend anyone concerned about sex addiction clinical specialties to read these articles prior to attempting debate.

We need to keep getting stories out about sex addiction recovery from real people to help educate about the disease and the healing that is possible from it. We need to work through the problem of sex addiction as a society, not deny it. That is why I wrote my own recovery story: Naked in Public: A Memoir of Recovery From Sex Addiction and Other Temporary Insanities.

There’s a good article on the misconceptions and myths about sex addiction called “Sex Addiction is Not a Myth When Neuroscience Keeps the Score” in the Magazine of California Marriage and Family Therapists called The Therapist. It can be found here: http://viewer.zmags.com/publication/b8aafbfd - /b8aafbfd/15

9. In what ways have you grown as a woman and as a clinician doing this work?

This work has challenged me to go to the depths of my understanding of unconditional love and stretch farther, in order to hold my unconditional positive regard for who my clients are despite what they have done. It helps that everyone I see is sincerely trying to get “sexually sober” and heal deeply.

I’ve come to see how much I enjoy working with women, and the work has also expanded my understanding of men a great deal, and helped dissolve many stereotypes I had from growing up about who men are, and who they are not. When I first started working at the sex addiction/sex offender clinic, I was afraid. A male colleague offered to walk me to my car at night after work, in case one of my male clients followed me. But I have only been harassed within or outside of work once, via email, and that was a highly unusual case, easily dealt with.

I love the work; it is a tremendous privilege to witness people heal and grow. While I focus on goals and solutions with my clients, reaching them often requires deep psychodynamic exploration and trauma clearing. I’ve studied a myriad of ways to support trauma healing to help clients have a faster growth rate, and I’ve had to grow spiritually to better comprehend the mysteries of sexuality, objectification, vulnerability and sexual harm. I’m fascinated by these topics and the transformation that occurs when people reach for it!

10. How do you deal with issues of oppression, like homophobia, sexism, racism? Gender biases? Are these recognized in your field? Is this a specialty that would be welcome to therapists of color? To GLBTQ communities?

I feel we still have lots of room to grow in our field, sex addiction therapy, in truly being ethnically representative as practitioners and attracting clients from an ethnically diverse population. I know a few CSAT’s of color in my hometown right now, but not enough; I hope to see many more join our ranks and bring the broader world-view and sensitivities that we all need. We need to do more to reach out to people of color and tailor services and resources so they feel included and honored. I have seen mostly acceptance for the LBGTQ population in the CSAT community, though because sex addiction therapists are often concerned about the negative impact of pornography on their clients, we have been unfairly blamed as sex negative or anti-gay. There is now a sex therapy training certification with a Transgender Training for therapists track that was started by a CSAT, Dr. Carol Clark, that I’m delighted to see.

I am accepting and affirming, an ally to the LGBTQ community, and hope more therapists from all communities will get trained and raise the general awareness. I’m glad to see it is an ethical requirement as a CSAT to agree to never practice “conversion therapy” which is not actual therapy, but harmful indoctrination. At my recent CSAT conference, I enjoyed two workshops taught by a transgender man, Ryan Sallans, and found it very helpful. Rob Weiss’ Cruise Control: Understanding Sex Addiction in Gay Men is a classic in the field, and Lesbian Love Addiction by Lauren D. Costine is a classic for women.

As for gender bias and sexism, I would say there are many powerful women involved in the IITAP community; more so than other kinds of organizations I’ve been a part of, which is lovely to see. IITAP is run by a woman, Dr. Stefanie Carnes, and the 2017 leadership award went to a woman, Dr. Alexandra Katehakis, whose work has shaped the field of sex and sex addiction therapy. I’ve felt encouraged to share my story of sexual recovery, though there are definitely more men’s stories and perspectives out there than women’s. Like with any specialty, clients need to assess the views in the specific therapists as they decide whom they wish to work with, but I believe any licensed professional who met the certification guidelines would be encouraged to participate in the CSAT training, regardless of sexual orientation, race, or gender. The International Institute for Trauma and Addiction Therapists offers two scholarships: one for service to no- or low income individuals, and one for ethnic minorities.

That being said, I would like to see more specific training at IITAP for how to help female love, sex and relationship addicts. I am working on my own program for training therapists in best practices with this unique population, with female-designed, female-informed interventions that have shown to be effective while working with women. I also love creating networking opportunities for this specialty. Anyone interested in this program or more support for therapists, coaches, and pastoral counselors working with women can check out my “Helping the Helpers” link at www.stacisprout.com.

11. What have been the most rewarding accomplishments of this work for you?

In addition to all the amazing individual, couple and family clients I’ve had the privilege to work with in my private practice, I am very proud to have started several successful therapy groups for women sex and love addicts, and more for partners of sex addicts! I have also written and published my own recovery story, “Naked in Public,” as I mentioned above, which has brought many rewards and new connections. At first I asked my current clients not to read it, just in case it changed their view of me as their therapist and interfered with their work. But then a client did read it and he said, “You’ve recommended many other books for me to read to heal from my porn addiction, but after reading your book I felt like you totally got it, and me. This is the book you should have recommended!” That was very high praise, and now I do recommend it in some cases, and we can discuss it as needed. I wrote that book to extend the service I could offer beyond the therapy room, because most people in need of help from sex and love addiction are not in therapy. Certainly most who struggle with compulsive pornography use never get into therapy. I want everyone to know there is hope for healing.

I created a YouTube channel called “Sex Addiction in the News” based on a Facebook Live show of the same name, to begin educating about sexual recovery stories beyond sex offenses or celebrities. Recently I’m interviewing ordinary people or industry experts who share hope for healing.

I’ve been honored to present at the International Institute of Trauma and Addictions Professionals (IITAP)’s annual symposium, about strategies we use to support partners of sex addicts and female sex and love addicts therapy groups. I created a tool called the Partner’s Disclosure Worksheet, which was later incorporated into the CSAT training curriculum for how to work with the couple’s reconciliation process after the shock of a sex addiction discovery. I’ve been able to present publicly and in the media on my book as an expert in sex addictions therapy due to my CSAT certification and experience, which has opened many doors. And I absolutely love the CSAT community, where people can contribute from all over the world about the growing awareness of what works in treating sex addiction!

12. What are you most excited about in the treatment of partners of sex addicts?

I’m very excited that we have many more resources for partners of sex addicts now than when I first started in this area of specialty in 2006. In the greater Seattle area there are multiple support groups available in various practices designated for partners, several outstanding books and now more personal stories being told openly that partners might identify with. The work of Barbara Steffens has really called out the betrayal trauma impact that sex addiction has on loved ones and was a pivotal addition to the treatment paradigm, and there are two growing sexual recovery fellowships for partners (COSA, S-Anon) where support is available for codependency recovery.

The partners I see heal the fastest are those who can look at both the trauma of their loved one’s sex addiction, and the areas from within that they want to grow as a result of discovery, for example healthy boundaries, communication skills and conflict management. Not every partner fits the codependency model, but they are almost all deeply wounded by sex addiction in some way. I witness partners transform whether or not the addict in their lives chooses recovery, which is heartening to see – they are empowered to use even horrible tragedy to become more authentically themselves and stronger as a result.

Most couples I work with do stay together, because both people are willing to do the necessary steps, but sometimes the damage is too great and I support couples to part ways with care, particularly for their children.

13. What do you see in your work with female sex addicts--and has that changed over the last decade? What about younger women sex addicts, and teen girls?

When I started a decade ago, there were very few women who identified as sex and love addicts, and even fewer who came for treatment, and that has changed. Awareness is growing that sex addiction afflicts women as well as men, in various forms, and women need as much or more support to deal with the pain and stigma than men do. I wrote my book in part to offer women a roadmap out of sex addiction, at least one version of it, and help decrease the cruel shaming that women with compulsive sexual and romantic behaviors face. Happily, like for partners of sex addicts, there are more resources for women who struggle with sex addiction today!

Amy Smith of Worth Recovery created a podcast for women sex addicts to educate and support them in their recovery (http://worthrecovery.com/podcast/). It’s fabulous – Amy is vulnerably open about her own struggle with sex addiction, trauma healing and her unabashed hope that with hard work, anyone can heal. She tells her listeners exactly how, and empowers them on their own journeys. She creates events to educate women, info here:  http://worthrecovery.com/events/.

On the flipside, I feel deeply concerned for the plight of teen girls’ sexual development. We are just starting to offer options for teen girls who are struggling with sexual compulsions. I’ve listed resources specifically for women and teen girls at my website, www.stacisprout.com. I value the resources created by Dr. Gail Dines to help parents help their children with healthy sexual development. Her movement Culture Reframed is providing research-driven education to heal the harm caused by violent pornography and hypersexualized culture. My colleague Marnie Ferree recenty posted the first story I’ve seen on sexual compulsivity and teen girls. Porn use is growing fastest among women under 30, and some research shows it most likely escalates at age 18 to compulsion. We are just beginning to address this problem!

14. What do you hope to see changing in the field of sex addiction work?

My hope is within five to ten years we will see a widespread public acceptance of the reality of sex addiction, as we now do with alcoholism and drug addiction. Certainly we are seeing much more press about the damage porn can cause to on sexual attitudes, sexual templates, and lasting intimate relationships. Within ten years I hope treatment options will be far more available. I created my show Sex Addiction in the News to try to broaden the public discussion beyond sexual crimes and offenses into the beautiful realm of what healing and recovery can look like. Check it out!

15. Sex addiction and partner's trauma seems like complex and rigorous work. How do you practice self-care as a CSAT? 

This is a great question, very important! In my own recovery from addiction I have learned that I cannot neglect myself and expect to stay functional long term. I learned I was an “under be-er” which means I didn’t let myself fully enjoy being in the present moment and experiencing the joy and meaning there; I was always trying to escape and hide. That was my childhood trauma intruding on the present, where in my family growing up I often felt rushed, anxious, unwanted and in survival-mode. So later on, even when I looked successful on the outside, I was so busy, depressed and stressed out I couldn’t enjoy it.

Now I have a weekly and sometimes daily plan to keep me balanced and focused on my highest priorities, but it’s still a challenge. For me, balance includes inspirational development, joy, health and wellness, receiving life’s beauty, and being of service to my family, friends, and community. In that list, my work is important but it’s not #1. I do my best to deal well (mostly vegan gluten-free), exercise regularly, and balance out my sleep when it gets low - all efforts and never perfection. I don’t use alcohol or drugs, and I avoid refined sugars – sugar makes me feel crazy, and I don’t need that! I love to travel, walk my dogs around the lake, read whodunnits, watch action movies, and play flag football. I love doing almost anything with my husband Pat, who is my best friend.

To me there’s always the tension between stretching further into presence, in all its raw glory, and then contracting into escape for a while. I’m perfectly imperfect. Mindfulness, heart-full-ness is a life practice, and I feel passionate about being as awake and conscious as I can to enjoy the gift of my life!

*Anastasia was a Certified Sex Addiction Therapist (CSAT) and member of the International Institute of Trauma and Addiction Professionals (IITAP) from 2006 - 2023.