What Happens in Therapy for Sex Addiction or Compulsive Sexual Behaviour?
Booking therapy for sex addiction or compulsive sexual behaviour can feel difficult, particularly if you have been managing the problem alone or a partner has recently discovered it. You may be wondering what you will need to explain, whether you will be judged, and what therapy can actually change.
You do not need to arrive with a diagnosis. The starting point is a conversation about what is happening and what you would like help with.
The first appointment: making sense of the pattern
I begin by asking what has brought you to therapy now. That might be repeated pornography use, sexual encounters you feel unable to control, secrecy, relationship difficulties, or concern about the consequences of your behaviour. We can begin with the part you can describe; you do not need a perfectly organised account.
Useful questions to bring include:
What do I want to understand or change?
What have I already tried, and what happened?
What am I most worried about telling a therapist?
What needs attention immediately?
Assessment may continue over more than one appointment. We consider your sexual and relationship history, current circumstances, physical and mental health, substance use, and the effect on other people. The purpose is to develop an individual understanding rather than assume everyone has the same problem.
Do I have to call it sex addiction?
No. “Sex addiction” is a familiar search term, while Compulsive Sexual Behaviour Disorder (CSBD) has specific diagnostic requirements. High sexual desire alone is not a disorder, and distress arising entirely from moral disapproval is not enough to establish CSBD. You can read more about sex addiction, CSBD and high sexual desire.
Agreeing goals that mean something in your life
“I want this to stop” may be the first goal. We then explore what that means in practical terms: which behaviours need to change, what boundaries matter, and what a safer, more honest sexual life would look like. Goals might concern sleep, spending, work, relationships or the ability to make a different choice when an urge appears.
Therapy does not require one universal rule about consensual sex, masturbation or pornography. Your goals need to take account of your wellbeing, consent, responsibilities and the effects of your behaviour.
What happens between appointments?
We may agree manageable tasks such as noticing what happens before a difficult episode, changing a routine involving a device, or practising how to respond to a particular situation. A short written account can help: what happened, what you felt, what you did, and what followed. It is material for discussion, rather than a test to pass.
If you return to a behaviour you intended to change, bring that into therapy. We can examine where the plan was insufficient and what needs adjusting, while taking any harm seriously.
Understanding the behaviour as well as changing it
Practical change and psychological exploration can sit alongside each other. Depending on your needs, we may explore shame, loneliness, emotional regulation, attachment or relationship patterns. Trauma is considered where relevant; it is not assumed to explain every presentation.
Research supports psychotherapy as an important part of CSBD treatment, but the evidence remains developing. No responsible therapist can promise a fixed number of sessions or guarantee an outcome. We review progress together and consider other professional input where appropriate.
Confidentiality and affected partners
We discuss confidentiality and its limits at the outset, including relevant safeguarding or legal obligations. You can ask how information is recorded and when it might need to be shared.
A partner may need support in their own right. Individual therapy does not replace their choices about boundaries or the future of the relationship, and attending therapy does not itself rebuild trust. Where relationship work is appropriate, we discuss its purpose and how it relates to individual treatment.
Starting specialist therapy in London or online
Read about my specialist sex addiction and compulsive sexual behaviour therapy, or request a consultation. You can start by briefly explaining the concern and what you hope to get from an initial conversation.
About Simon Wilson
I am a UKCP-registered psychotherapist, COSRT-accredited psychosexual and relationship psychotherapist, and clinical sexologist. I have specialised in sex addiction and compulsive sexual behaviour for 15 years, and hold a Level 5 Diploma in Sex Addiction and Compulsive Sexuality Counselling from ISAT.
My master’s dissertation focused on sex addiction and compulsive sexual behaviour. I previously managed the Addiction Treatment Programme at Priory Hospital North London, specialising in substance and behavioural addictions.
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