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michaelsalas45 Mar 13, 2017

What is Gay-Affirming Sexual Addiction Therapy?

There are many sex addiction therapy certification programs. The most popular and well-recognized credential is the CSAT credential. This certification is offered by the International Institute of Trauma Addiction Professionals (IITAP), which was founded by Dr. Patrick Carnes, who is the leading proponent in the topic of sexual addiction. This certification process trains therapists and counselors on tools that can be utilized to help clients who are struggling with compulsive sexual behavior. These tools work to assist clients in gaining a better understanding of their behavior, identifying triggers for their behavior, finding ways of avoiding trouble in the future.

Sex addiction therapy is not a treatment modality of its own. IITAP offers training to those who are seeking out the CSAT credential on materials and assessments that they have created to help with sexual compulsivity. These materials have to be used in conjunction with other therapeutic modalities. Widely accepted and respected psychotherapy and counseling approaches are used in the treatment of sexual addiction. Some of these include Cognitive-Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and Psychodynamic Therapies. The goal of such therapy is to help clients manage their out-of-control sexual behavior.

Because of the harm that reparative approaches can cause, those who value the Lesbian, Gay, Bisexual, and Transgender (LGBT) community have strongly advocated against reparative therapists. This cause for social justice can become very heartfelt and passionate for many sex therapists. Historically, the sex therapy community has been one of these advocating groups. However, this same passion has lead to unfair correlations of reparative therapy and the CSAT credential. Many sex therapy professionals take aim at CSATs, which leads to an attack-defend cycle that never seems to end.

In the midst of such passion, the topic of sex addiction often transforms into a heated professional issue, with little true discussion and compromise between sex therapists and CSATs. The groups who debate against sex addiction can become so extreme that they risk forgetting about clients who are in need of legitimate help. Clients deserve a clear path to manage problems in their lives, without making sense of contradictory professional arguments. This is especially true of a group of people who can be as vulnerable as gay men can be.

Gay-affirming therapy can be based in most therapeutic modalities as well. Affirming therapy is meeting gay clients where they are at in their journeys of self-acceptance, while providing them a safe container to travel this journey. It also includes validating their emotional and personal stories and experiences. Gay men contend with regular and serious levels of shame. Those who are affirming of gay men recognize and accept their own biases surrounding sexual orientation. Many therapists will describe themselves as being “gay-friendly,” which means that they will accept a gay client. However, this doesn’t mean that they have personal awareness of their own biases, nor do they focus on client comfort. When therapists are unaware of their biases, they are at a greater risk of shaming them, sometimes without even knowing that they have done so.

There are many gay men who come in for therapy for problems with compulsive sexual behavior. There are many gay men who come into therapy due to a struggle with self-acceptance. There are also straight men that come into therapy because they are having sex with other men, fear that they could be gay, or questions their sexual orientation. Therapists must be clear on the goals of the client. Goal clarity offers an opportunity to identify shame around sexual orientation, as well as to determine how the client is labeling himself.

Affirming therapy is a process that can require a lot of patience. Gay men can struggle to identify themselves as gay. The majority of role models of sex and relationships are based in heterosexual norms. When most straight men are experimenting with relationships and dating throughout adolescents, it is less likely that young, gay men had the same opportunities. Thus, this self-identification process may happen later in adulthood.

When treating sexual addiction in gay men, therapists need to take a gentle, balanced approach to the therapeutic process. They need to be aware of their own heterosexist perspectives and values about sexuality. However, they also need to be cautious not to tell these men how to live their lives or tell them who they are. If clients do not accept the label of “gay,” affirming therapists do not insist that these clients take this on. True gay-affirming therapy allows for self-determination of clients. This means that therapists should focus on holding space for these clients, while they define healthy sexuality for themselves.

Therapists should never offer SOCE. As long as gay men are subjected to discrimination, homophobia, and shame, there is always potential for clients to come into therapy in hopes of changing their sexual orientation. Therapists are not standing in the way of self-determination when they refuse to offer reparative therapy. Clients who are struggling with sexual orientation are responding to levels of shame and fear. They likely lack an open internal dialogue about their sexual orientation that is void of shame. To promote self-worth and growth, a gay-affirming therapist facilitates an interpersonal dialogue that helps these men make sense of this. This can take an extended amount of patience and time. These men are risking giving up relationships with their churches, status as being part of a dominant group, and relationships with family and friends. Therapists should expect this to be a non-linear journey. Clients may go from complete acceptance, to denial, and back and forth.

Gay men are much more likely to come into treatment for sex addiction for problems with compulsive cheating than any other sexual behavior. Therapists should work with these clients to help them reach their own therapeutic goals. This would be to help them gain an understanding of their compulsive behavior, so that they can live in congruence with their relationship value system. This can help them to connect with their partners, and have the kinds of relationships that they want to have.
Michael J. Salas is a counselor in Dallas, Texas who specializes in relationships and sexuality. Read more about his specialties and counseling perspectives at

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