A professor I had in graduate school, Dr. Ron Welch, would say that the first five sessions of seeing a client are all assessment. He was adamant about it. He would say: “I am still consulting. They are not even my client yet.” I remember thinking, “What are you talking about?” But the older I get, the more I see the truth in his perspective. A common clinical instinct is to start treating the client quickly, and that’s understandable. The client is in front of you, they are struggling, asking for support, and you know enough to start doing something. But in complex cases (and most cases involving compulsive sexual behavior are complex), moving to treatment before the picture is clear is a liability. The assessment is the work. Here is a concrete example of why this matters. A candidate in supervision recently brought a case that illustrates this well. A young adult client comes in reporting both a pattern of substance use and sexual acting out behavior that runs against his own stated values. Over the years, the substances have shifted, and the sexual behavior has taken different forms during different periods. The two seem to trade off: when […]
When a Client Isn’t Ready to Quit
Every CSAT eventually gets the client who is not ready to quit. They didn’t come to therapy because they wanted to. Their partner found something, gave an ultimatum, and here they sit. They don’t believe they have a problem. They don’t want to stop. They may want to understand why they do what they do. In reality, they want to appease their partner. My instinct used to be to push. Tell them the truth, tell them where their actions are headed, tell them what the research says. But if a client is in the pre contemplation stage, pushing does not create change. It creates apathy, or it scares them off. Either way, you lose them. So instead, I lean on harm reduction. I want to be clear about this: harm reduction is not a lesser option or a compromise we settle for when a client won’t commit to full sobriety. It is a legitimate, evidence based treatment for addiction in its own right. The CSAT training is predominantly an abstinence based program, but that doesn’t mean abstinence is the only starting point. If a client says, “I don’t want to give this up yet,” my answer is, “Great, let’s work […]
The Model Isn’t the Focus: Your Client Is
The Model isn’t the Focus: Your Client Is I had a supervision session recently with a candidate who is doing good work. He is thoughtful, he cares about his clients, and he is trying hard to do CSAT work the “right” way. But partway through our conversation, I heard something I hear often from newer clinicians in this field. He was stuck on the workbook. Stuck on the assessment. Stuck on which exercise came next in the sequence. And in the process, he had lost sight of the actual human being sitting across from him. A Tool is Only as Good as the Hand That Wields It This is an easy trap to fall into, especially when you are early in your career and a structured model gives you something solid to hold onto. The CSAT task model and workbook exist for good reason. They are excellent tools! But a tool is only as good as the hand that wields it, and the moment you become married to the tool instead of the client, you are no longer doing therapy. You are administering a curriculum. I told him to picture a seven iron. It is a great club. But if […]
The Swimsuit She Keeps Adjusting
I was at the beach this past weekend with some old friends. One afternoon I was sitting on the beach, watching the water, in a conversation, and people watching simultaneously, like most of us do on vacation. Then I saw something I can’t shake. Where it Starts A cluster of girls, maybe twelve or thirteen caught out of the corner of my eye. Their swimsuits styled like adult lingerie, string bikinis leaving little to the imagination. Then they did something that caught my full attention: those same girls readjusting constantly, tugging on a strap, pulling at a bottom, crossing an arm over a chest that just started developing. You know what that adjusting is. We don’t need a citation to recognize they felt exposed in the bikini, uncomfortable at a level that was obvious, trying to convince themselves they look great and love it. But let’s name the framework anyway, because this is our territory. This is self-objectification. Fredrickson and Roberts named it almost thirty years ago: the chronic habit of watching your own body from the outside instead of just living in it (Fredrickson & Roberts, 1997). Their theory puts puberty as the starting point. The moment girls become […]
What Kink Gets Right Most Couples Get Wrong
What Kink Gets Right that Most Couples Get Wrong Here is a finding that consistently surprises clinicians when they first encounter it: the people who tend to have the best sex lives are people who practice kink and fetishes. The immediate reaction is usually something like, “What are we saying, kink is better?” No, that misses the actual finding. The research is not saying that kink itself produces good sex. It is saying something more useful and more transferable than that. In order to do kink safely (bondage, rope, asphyxiation, knife play, whatever you are talking about), a key component is required to make this a healthy experience. It’s not level of experience or if one pushes their limits, it’s simpler and more powerful. The level of clear communication and stated expectations required to engage kink well is through the roof. What do you desire? What actions do you want to perform? What is in bounds? What is out of bounds? What does a pause signal mean? What does stopping mean? What are each person’s limits today, knowing those limits might be different next time? The conversation has to happen before the sexual encounter. All of it stated explicitly, clearly, […]
Not Attracted to Your Partner? A Sex Therapy Explanation
Not Attracted to Your Partner? A Sex Therapy Explanation Few things land harder in a couples session. It sounds like a verdict. Physical. Permanent. Out of anyone’s control. The partner on the receiving end usually goes quiet in a way that’s different from other conflicts, because this one feels like there’s nothing to argue with. Here’s the thing. In most cases, the statement isn’t accurate That’s not me saying the person is lying. It’s me saying they’re misidentifying what’s actually happening. Attraction in a long-term relationship isn’t a fixed property of the person being perceived. It’s a relational experience shaped heavily by felt safety. The parasympathetic system, which governs sexual arousal, requires a baseline of safety and connection to come online. When that’s gone, desire for that specific person fades — not because something is broken, but because the nervous system is doing exactly what it’s designed to do. So when a partner says “I’m not attracted to you anymore,” the clinical translation is almost always: “I don’t feel safe enough with this person right now to be physically vulnerable with them.” They are often saying “I don’t feel safe” That distinction matters. A physical verdict feels permanent, and the […]
Understanding Love: A Therapeutic Look at Sternberg’s Triangular Theory
Understanding Love: A Therapeutic Look at Sternberg’s Triangular Theory As a counselor, love is a topic that finds its way into many sessions—whether it’s the absence of it, the complexity of it, or the pain of watching it change. One of the most helpful models I’ve come across, both for understanding my own relationships and helping clients reflect on theirs, is Robert Sternberg’s Triangular Theory of Love. This theory breaks love down into three fundamental components: intimacy, passion, and commitment. Each can exist independently, in pairs, or all together. The shape of a person’s “love triangle” helps us make sense of the type of love they’re experiencing—or craving. The Three Pillars of Love Intimacy is the emotional bond between people—the sense of closeness, connection, and trust that allows someone to feel seen and safe. It’s the long talk after a hard day, the way someone remembers your coffee order, or the comfort of sitting in silence with a friend who gets you. Often in session, clients confuse intimacy with sexual closeness, but this part of the triangle is about emotional vulnerability and friendship. It’s what makes someone feel known. Passion is the spark—physical attraction, infatuation, sexual energy. It’s what fuels […]
Narcissism, Machiavellianism, and Psychopathy: Understanding the Dark Triad in Clinical Practice
Narcissism, Machiavellianism, and Psychopathy: Understanding the Dark Triad in Clinical Practice In therapy sessions, especially in the context of sexual addiction and betrayal trauma, we often encounter deeply ingrained relational dysfunctions that go far beyond surface-level behavior. These patterns—manipulation, emotional detachment, and domination—are not random. They often stem from personality traits collectively known as The Dark Triad: Narcissism, Machiavellianism, and Psychopathy. While they share common features like lack of empathy and a tendency to exploit others, they are distinct constructs with unique clinical presentations. 1. Narcissism: The Craving for Admiration Definition: Narcissism is marked by a grandiose sense of self-importance, a deep need for admiration, and a fragile self-esteem masked by arrogance. Examples: Clinical Insight: Narcissistic parts often develop as a protective layer over deep shame. These clients benefit from therapeutic approaches that build emotional resilience and self-compassion without feeding into their performance-based self-worth. 2. Machiavellianism: The Master Manipulator Definition: This trait is defined by a manipulative, calculating approach to relationships. Individuals high in Machiavellianism use charm and deceit to achieve personal goals, often without regard for others. Examples: Clinical Insight: These behaviors often stem from early environments where manipulation was a survival skill. Therapists can use parts work (e.g., IFS) to gently explore the client’s […]
The Impetus and Solution to Divorce in Modern Culture
The Impetus and Solution to Divorce in Modern Culture For most of human history, marriage was not a matter of personal fulfillment — it was a practical alliance. Across approximately 6,000 years, unions were formed based on political strategy, financial gain, family legacy, and social survival. Love, as we now understand it, rarely factored into the decision. Only within the past 150 years has the notion of marrying for love gained cultural traction. The emergence of romantic ideals — popularized by literature such as Jane Austen’s Pride and Prejudice — signaled a shift in societal expectations. For the first time, emotional connection and personal desire became not only valid but central to the concept of a successful marriage. Marriage as a Central Source of Fulfillment This cultural shift also restructured where individuals look for emotional fulfillment. Historically, people met their needs for connection, intimacy, support, novelty, and deep friendship through a network of family and community. A spouse was one part of that system — not the entirety of it. In contrast, the modern marriage model places a heavy burden on one relationship to fulfill nearly all aspects of personal well-being. This change is significant, and, as the data shows, […]