Treatment options for compulsive sexual behavior

There are four levels of care for compulsive sexual behavior, and the question that matters is which one matches the stage the pattern has reached. Most of the harm done by choosing wrong comes from choosing too low: a year of weekly therapy for a pattern that needed daily contact. Some comes from choosing too high, and paying for containment that was not needed.

This section describes each level plainly, including the two Iron Ridge does not provide, and the treatment questions that sit alongside the level-of-care decision.

The four levels

Weekly outpatient therapy. One clinician, one hour, once a week. Enough for early patterns with a therapist trained in this area, and the right step-down after intensive work. Not enough for a pattern that has organized itself around concealment.

Intensive outpatient. Nine to twelve clinical hours a week for eight weeks, at home and at work throughout. The level most men with an established pattern need, and the one Iron Ridge is built around.

Partial hospitalization. Most of every day at a facility, sleeping at home. Rare for compulsive sexual behavior on its own; usually indicated where a co-occurring psychiatric condition needs daily monitoring. Iron Ridge does not provide it.

Residential. Living at a facility for thirty to ninety days. Indicated where there is active substance dependence, a safety concern, or repeated failure at lower levels. Iron Ridge does not provide it, refers to it where indicated, and takes men stepping down from it.

Alongside the level of care

Two further pages are in preparation: the role of medication, including SSRIs and naltrexone, which is adjunctive rather than primary in this condition; and the 12-step fellowships, SAA, SA, SLAA and SCA, which are peer support rather than treatment and which many men find useful alongside clinical care.

Where to start

A confidential consultation is a clinical conversation about which level fits. If the answer is not Iron Ridge, we say so.

If you are in immediate danger or thinking about harming yourself, call or text 988 — the Suicide and Crisis Lifeline, available 24 hours a day — or call 911.