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 with that.”
A great place to start is with a problems list. I don’t need to tell them it’s page one of a workbook. I just grab a whiteboard and ask, “What are the problems in your life right now?” We list everything. Communication with their partner. Money stress. Sleep. Issues at work. Whatever comes up. Then we look for themes. Here’s what I believe: all roads lead to Rome. If the sex addiction is really the core issue, we can talk about any topic, and within fifteen minutes the client will start talking about their sexual behaviors. I don’t have to force it. I let the topic prove itself.
If they say they just want to cut back, not stop, I don’t fight them on it. We build a plan to reduce their unwanted behaviors. What often happens the next week? They share they still looked six times. I empathize, validate, and then we adjust the plan. Next week, five times. We keep validating, adjusting, and reflecting.
This is the real power of harm reduction: it gives the client the opportunity to change while still using, and to see for themselves what happens. Often, after enough weeks of trying and failing to control it on their own terms, they arrive at a profound conclusion themselves: they can’t healthily use this. And when a client discovers that on their own, it means ten times more than if I had told them on day one! The Big Book gets at this same idea, that if someone questions whether they’ve crossed into dangerous territory, the honest test is to try to leave it alone and see what happens. That’s harm reduction. Let their actions become the evidence, not your words.
I also think about James Clear’s research from Atomic Habits: the average person can be pushed three to five percent before they give up. For someone in pre contemplation, three to five percent is not very far. But five percent a week for six months is real growth! A little push here, a small push there, and you learn to feel when the client feels up against the wall. That’s when you pause and back off.
Harm reduction isn’t giving up on full recovery. It’s respecting that the client has to get there honestly, on evidence they generated themselves, not evidence I handed them. I truly believe in Carnes’ 30 Task Model rooted in abstinence. Sometimes clients are incapable of engaging the model at the start of therapy. That’s okay. Give the client the space to come to their own conclusions. For in the end, the only thing you can control is yourself.