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What is a Certified Sex Addiction Therapist (CSAT)? Frequently Asked Questions

What is involved in becoming a CSAT therapist or counselor?

First, an important point to remember is that only those therapists who are already licensed or otherwise credentialed in their particular counseling field (e.g. psychologists, clinical social workers, marriage counselors, pastoral counselors) are eligible to enroll in the CSAT training.

Certified sex addiction therapists take approximately four weeks of intensive training with faculty of the International Institute for Trauma and Addiction Professionals (IITAP) which describes its membership as follows:

We are comprised of licensed mental health professionals, IITAP Certified Sex Addiction Therapists (CSAT), trauma/EMDR clinicians, AASECT sex therapists and BBS Supervisors.

The CSAT training designed by Dr. Patrick Carnes and others involves gaining expertise in assessing the level and type of sexual dependence, the clients sexual and trauma history and an assessment of family of origin issues and other addictions and addiction interactions that may be present. Next, there is training in using a highly manualized, 30 task approach to treatment designed to be followed in individual and group sessions as well as being consistent with any 12-step self help program for addiction. Following the training, the trainee is required to get 30 hours of supervision (by CSAT supervisors) of actual clinical work with sex addiction clients prior to certification.

There are also continuing education requirements for renewal of the CSAT certification every two years. However, each therapist is also under the jurisdiction of their state board and/or professional licensing body for professional requirements or disciplinary issues.

Can CSATs address things that other therapists might miss?

Yes.

Other therapists and doctors may not assess for sex addiction. If a client does not complain about their sexual problem the practitioner may miss the signs and may not ask the right questions. For example a client may complain of erectile dysfunction and be treated in a variety of ways when in fact ED is a frequent result of compulsive porn use. This kind of ED goes away after a period of abstinence form porn and does not necessarily require any other treatment.

In addition there are differences in approach to clients with known sex addiction issues. CSAT therapists may be much better able to break through the addicts denial and deception. They will know when the timing is right for group therapy support and when and how to assist in the making of full disclosure to spouses and partners. Sex addiction therapists will be versed in evaluating and addressing multiple addiction situations or addiction interactions (e.g. sex and drugs, sex and eating disorders, etc.) See also my blog What Happens in Sex Addiction Counseling?

One of the most important things that a non CSAT therapist may miss is the fact that sex addiction is not a byproduct of relationship problems. Many people seek couple therapy and continue in couple therapy when the problem of sex addiction must be addressed before couple therapy. Also, seeing sex addiction as a relationship issue can implicate the spouse or partner in a way that is inappropriate.

Can CSATs rule out alternative diagnoses?

Yes.

CSATs are therapists first and sex addiction specialists second. In addiction to assessing for sex addiction, they can and do perform an overall clinical interview and may do other testing and gather other information as well.

All licensed counselors and therapists are trained to be sensitive to the presence of issues that may lie outside their area of competence and consult about it and refer out to other doctors or specialists when necessary. We all are constantly attempting to update our knowledge of new findings that may suggest causes of sexual compulsivity such as brain damage, other disease processes or medication side effects.

Are sex addiction therapists biased against sex?

Absolutely not.

See another post of mine devoted to this topic called Is Sex Addiction Therapy Anti-Sex? The idea that sex addiction therapists are rigid or moralistic is false. That is not part of the training or approach.

Can CSATs cure intimacy disability?

Yes but they address the sex addiction first.

Sex addiction treatment has both short and long term goals. In the initial phase of sex addiction recovery the addict is becoming abstinent from his or her sexually compulsive activity in order to allow the body and brain to kick the addiction and become stabilized. Next, treatment helps the addict work through the early relational trauma or other factors related to the addiction so as to prevent relapse and build the foundation for a stronger sense of self. This prepares the addict to enter into healthy intimacy. The later phases of treatment/recovery i. e. from the 2^nd or 3^rd year on involve a shifting of gears to focus on relationships, intimacy and fulfillment in all other aspects of life. See also my blog Will Sex Addiction Treatment Cure Intimacy Issues?”

Can CSATs treat the spouses and partners of sex addicts?

Yes.

In fact most sex addiction clinics and programs work with addicts and partners both separately and, as appropriate, together. There are also specific intensive outpatient and inpatient programs which treat spouses and partners of sex addicts and specific clinicians who specialize in the treatment of partners and spouses.

Can I trust that a CSAT trained person will be a good sex addiction counselor?

Most likely yes.

CSAT training is a sub-specialty. It adds an area of expertise and experience but it will not make a bad clinician into a good one. I used to believe that credentialing did more harm than good and that people were better off judging for themselves how helpful or harmful a given practitioner was. But I also know that people seeking therapy may not be together enough initially to be confident in their own ability to make such judgments. It helps to know that a clinician has had the right kind of training, but unfortunately there is still an element of judging for yourself and getting additional opinions.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource and at www.sexaddictionscounseling.com

895 therapists Nizhny Novgorod, 2599 reviews

Therapist: a brief description of the specialty

Doctors whose professional activity is aimed at providing medical care to patients who have reached physical maturity are called a therapist. In our country, it is generally accepted that the human body physically matures by about eighteen years, that is, by the time of adulthood. Therefore, the therapist's patients are representatives of different sexes who have stepped over this age limit. nine0005

Therapists differ from most other medical specialists in that their work is dominated by a preventive focus, and among the methods of treatment, only conservative ones are used, the basis of which is pharmacological therapy. Therapists are doctors of a wide profile - they have an idea about all the pathological processes that can develop in the body of an adult, therefore they can detect and differentiate most common diseases. In addition, it is these doctors who know all the criteria for health, so they can give an objective conclusion about the state of the patient's body. nine0005

What is the job of a therapist?

The main goal of the work of general practitioners is to help the patient maintain health at its original level or restore it in case of a disorder. To do this, they carry out active preventive, sanitary-educational, advisory and therapeutic activities.

Therapists consider the patient's body as a single system of interconnected organs. Based on the slightest changes in the patient's state of health or the results of an objective examination, these doctors can suspect the presence of a pathological process, conduct a more thorough examination and establish a preliminary or final clinical diagnosis. As a rule, therapists deal with the treatment of diseases that occur in a mild form on their own, and more severe forms are treated by specialists of narrow profiles: cardiologists, gastroenterologists, endocrinologists, rheumatologists and others. If the disease is chronic, the patient is observed by a general practitioner and a narrow specialist at the same time. At the same time, the therapist ensures that the existing disease does not adversely affect the health of other organs and systems. nine0005

Patients with severe forms of somatic disorders of unclear etiology, which significantly affect the general well-being and condition of the patient, are examined in the therapeutic departments of hospitals. It also treats patients with diseases accompanied by a high risk of complications and life-threatening conditions.

Patients with mild forms of somatic pathologies are treated on an outpatient basis, preventive work and medical examinations of the adult population are carried out. nine0005

In the event that the disease takes an acute (fulminant) course and causes a sharp deterioration in the patient's well-being, he is helped by emergency medical professionals. They carry out the necessary therapeutic measures and decide on the further tactics of treating the patient.

When should I see a therapist?

The reason for contacting a general practitioner of the polyclinic is:

1. any ailment, deterioration in general well-being;
2. occurrence of medical questions; nine0026
3. the need to obtain a conclusion on the general state of health of the patient.

Periodic visits to a therapeutic specialist is also one of the measures necessary to maintain the health of the body at its original level, or to strengthen it.

How to become a therapist?

In Nizhny Novgorod, employees of the Nizhny Novgorod Medical Academy provide an opportunity to become a therapist. For many years they have been training students who later become qualified specialists in various fields of medicine. nine0005

Well-known specialists of Nizhny Novgorod

Significant influence on the development of therapy in Nizhny Novgorod and the Nizhny Novgorod region was provided by such outstanding specialists as:

• AP Matusova;
• O. V. Maslennikov;
• G. A. Isaevich;
• A. I. Gefter;
• K. V. Zvereva.

They have managed to create a solid platform for scientific and practical research, as well as the training of qualified specialists in the field of internal medicine, hospital and polyclinic therapy. nine0005

Understanding Transgender Reality World of Psychology

Source: Used with permission.

In February, at the International Institute of Trauma and Addictions International Symposium (IITAP) annual International Symposium, I was honored to hear one of the international speakers, transgender and author of Second Son Ryan Sallance speak. His presentation moved and educated those of us who attended and I wanted to share my understanding with the general public. We conducted our interviews by email rather than by phone (we live in different states) because Ryan wanted to be able to carefully review his responses. I am grateful that he did this and I hope that his words will provide understanding and hope to those who need it - whether they are transgender people or loved ones of a transgender person. nine0005

***

People sometimes ask you, "How did you know for sure you were transgender?" If yes, how do you feel about asking this question and how do you usually answer?

I have been repeatedly asked, "How do you really know?" It is always difficult for me to answer this question, because knowledge did not happen overnight. My consciousness slowly began to build internally from when I was a child into adulthood. Looking back, I realize that there were times when my feelings of being a man were very strong, but then another life obstacle would move to the fore, forcing my feeling of being a man into the background. nine0005

• Journal entry about blushing
• Suicide: not all in the mind
• Why being normal isn't always great
• Stunning silence
• Why "Erotized Fury" is an absurd concept 9004 The day I knew 9003 9005 that I was transgender was 25 years old, after I stumbled into an LGBT bookstore. On the shelves was a photography book called Body Alchemy by Lauren Cameron. The pages featured photos and stories about transsexuals (men who were born female but transitioned to male). When I looked through the pages and saw the faces of these people, I finally saw myself. At that moment, the piece that was sitting in my stomach dissolved. I didn't know how to do it, but I knew that I needed to go. nine0005

  After hearing my story about when I know if people still don't understand, I ask them, "How did you know you were a man or a woman?" They usually hesitate and then respond, "I'm just like that."

  If you're starting your transition over and over again, you first went to a therapist and said, "I think I'm transgender," what is the most important thing the therapist could say to you? Conversely, what is the worst thing a therapist could say to you?

  • Can you identify 10 characteristics of a child adult? nine0026
  • I would do anything for love (but I won't)
  • How to organize my financial life
  • What do you think you should think, what should you do?
  • Why should we forgive?

  Saying out loud "I think I'm transgender" is one of the hardest things to do, especially if it's the first time. My therapist was the second person I chose. Prior to our session, I organized the photos into a chart that I planned to use as a reference. I stumbled to find my words and my hands were trembling, but as I described my feelings, I placed the photo on her desk to provide further evidence. I could tell she was expecting a big reveal, so I nervously whispered, "I think I'm a boy." nine0005

  She looked at me, took a deep breath, and simply said, "Okay, I don't know anything about this topic, but I want to learn." Her comment had a huge impact on me, because I was afraid to go out to her for fear that she would reject me or say that it was not real, and that my feelings were only related to my past history with an eating disorder. So that she doesn't hesitate and hear her say "I want to study" send me a message that she will be there for me and she will help me on my journey. nine0005

  Other helpful responses from the therapist may include:

  How does it feel for you to say this out loud to me?
  Tell me more about what you mean by "I think"?
  What are your thoughts?
  What were your thoughts and feelings in the past?

  Staying open and sitting with a client who is learning about gender identity is key. Also, it's crucial not to assume or put the customer in a box.

  Things you can't tell the customer include:

  I'm surprised to hear you say that.
  You are not acting like a boy/girl.
  I have worked with transgender clients in the past and I don't think you are transgender.
  Are you sure?

  Just how would you like your friends and family to react ideally to the news? And what would you like to hear the least?

  What I would most like to hear is "I love you" and then "I will support you no matter what." These are the most powerful and successful words that a transgender person can hear when they first come out. There are so many unknowns in the transient process that it often becomes very overwhelming. Knowing that you are loved and supported, even if you and the person you go out to feel scared, worried and/or troubled, is doing what needs to become more manageable. nine0005

  Unfortunately, this answer is not the one that is always given when a person chooses an exit, primarily due to the other person's confusion, fears, ignorance about the topic, and feelings of shame, embarrassment, and/or denial. Phrases you don't want to hear include:

  You are not transgender. You're just embarrassed.
  You are doing it.
  I don't want to hear about it.
  This is one more stage.
  I will always love you, but as a daughter / daughter.

  In your book, your brother tells you at some point that he always thought you were transgender. nine0068 Would you like him to mention this earlier, or are you glad he let you discover things in your time?

  After my brother told me that he already thought I was transgender, I jokingly told him, "I wish you would tell me because I didn't know." But really no one can tell you who you are; you need to open it yourself.

  Looking back at my life, I sincerely believe that my realization of my transgender identity came to me at the age of 25 because I could not deal with it before. Six years into therapy to this time, I was able to grow and overcome some of my other struggles, and I also managed to find solace in shaping my identity outside of my family, but I wasn't ready to admit that I was transgender. nine0005

  My heart breaks every time I think of teenagers who internally affirmed their transgender identity but did not receive external recognition or support from their family, friends or school. I'm not sure I would have been strong enough as a teenager to keep this knowledge of myself while trying to survive in my small town of Nebraska.

  For providers and families who are gender creative or transgender, I simply ask that you remain open and allow the child the space he or she needs to further explore his or her personality. The stories we see in the news about suicide, bullying and harassment should be enough to make us understand that this is not a phase and these children are suffering. In addition, studies show that adopting a family creates happy and healthy children. If a clinical provider is working with someone who is transgender, then it is the therapist's professional responsibility to seek training, join resource networks, find qualified referrals, and acknowledge his or her limitations. nine0005

  Your support network in the book is almost all FTM. Do you also interact with the MTF community? Or are the support networks quite separate?

  The two transsexuals who feature prominently in my book are like brothers and sons, and each has had a huge impact on my life. However, everyone's entire support network is different. I found refuge with other transgender men, both online and in a few friendships, but I also had (and still have) trans women as good friends. Considering the community as a whole, where people find support depends on who they are and what they are looking for. Some people limit their interactions with certain groups, while others are very mixed. Not every transgender person is the same, and admits that this is helpful. nine0005

  Do you have a lot of minor issues (other than transgender people) such as eating disorder, possible struggle with alcohol, etc. Is this common among transgender people?

  If you look at national surveys conducted by organizations such as the National Center for Transgender Equal Equality and the National LGBTQ Task Force, you will see that mental and physical health issues affect people in the transgender community far more than the general population. Discrimination, stigma, rejection of friends, family, partners and spouses, racism, abuse by medical and mental health professionals, and lack of financial resources have a huge impact on people in the transgender community. Because of this, substance abuse, intimate partner violence, eating disorders, depression, anxiety, suicidal thoughts, and self-injurious behavior are common in the transgender community. For example, in a survey conducted by the National Center for Transgender Equal Equality in 2010, it was found that out of 6,450 respondents, 26 percent of respondents reported alcohol abuse to cope with the discrimination they experienced. nine0005

  When your book ends, your relationship with Lily is fairly new. Now, of course, you and Lily are married. (Congratulations!) Can you tell us a little about what this step meant for you as a transsexual?

  There are several unique issues and potential barriers when considering marriage as a transgender person. Since the state of marital equality is still in limbo throughout the country, the question arises: Will my marriage be legally recognized? Then you have to ask: Will my partner's family accept? Do they understand me as a person? Will they maintain our relationship and treat us like everyone else?

  Before proposing to my wife, I went to several members of her family to ask for their approval. (I know this can be considered very traditional, but there are some things I'm a bit old school about). All of them were open, friendly and glad to see us. I have been very fortunate in my relationships and with the people I now call family. nine0005

  For a longer answer to this question, I encourage readers to check out an interview I did with Dr. Robie Ludwig, published in the Huffington Post. In this interview, I discuss my perspective on marriage as a transgender person, including my fantasies of marriage from childhood to adulthood, my worries about coming out into my wife's family, and how I deal with what I perceive to be my own limitations. in life, especially reproduction and inability to produce sperm. nine0005

  In your book, you talk about how Larry King asked you on air, "When are you going to finish?" And how it was a very difficult question for you. Is this a simple question? Anyway, how would you answer this question today?

  Larry's question still evokes complex emotions and thoughts in me. At the time when I was thinking about physical rather than emotional fullness, I figured there would be a lower operation for me. It's been seven years since my bottom surgery and I can say that I still don't feel physically full. I believe the reasons for this have to do with the limitations I experience regarding reproduction and certain sexual behaviors. The concept of "completeness" is a topic that I am exploring in the second book that I am writing. I find that so much of what we focus on is the beginning of a person's transition, but what happens after they've made the transition? How do people feel about themselves, their lives and their bodies? nine0005

  If I could answer Larry King's question again, I would say, “Life is always in transition. When will either of us ever finish?

  Besides your own book, what resources (other books, websites, research, support groups, etc.) do you recommend for transgender people, their loved ones, and their therapists?

  Doing an internet search will bring up hundreds of different resources and books that may be helpful. In order not to get overwhelmed, first think about the specific area you are interested in learning. Are you interested in personal stories, medical and mental health care, media coverage, support for family and friends, politics and legality, movies or documentaries? nine0005

  If you want to start with professional organizations, some helpful resources include:

  World Transgender Professional Association
  National Center for Transgender Equality
  National LGBTQ Task Force

  Los Angeles Gender Center
  Lambda Legal
  Center of Excellence for Transgender Health

  TransLine – Project
  Transactive
  Trans Youth Family Allies
  Gender Spectrum
  PFLAG

  People may also want to read another interview I did with Dr. Robie Ludwig in the Huffington Post. I encourage readers to check out this particular interview because what I've been talking about here is entirely focused on people in the transgender community who are either looking for or have already transitioned - and this doesn't apply to every person who identifies as transgender.

  *

  Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Behavioral Health Elements. He has developed clinical programs for ranches outside of Nashville, Tennessee, the Monkey Treatment Centers in Malibu, and the Sexual Recovery Institute in Los Angeles. He is the author of Cruise – Control : Understanding Sex Addiction in Gays and Sex Addiction 101: The Essential Guide to Healing from Sex, Porn, and Love Addiction, and co-authored with Dr. Jennifer Schneider as Always On: Sex Addiction in an Era Digital Technologies and Closer Interaction, and: The Impact of Technology and the Internet on Parenting, Work and Relationships .

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