What is a CSAT? The Certified Sex Addiction Therapist credential, explained

CSAT stands for Certified Sex Addiction Therapist. It is a post-licensure specialty credential issued by the International Institute for Trauma and Addiction Professionals (IITAP), and it is the most widely recognized training in the treatment of compulsive sexual behavior. A CSAT is already a licensed mental health professional, a counselor, social worker, marriage and family therapist or psychologist, who has completed a specific additional curriculum in this clinical area and a supervised practicum in it.

If you are looking for treatment, the credential answers a question you should be asking: has this clinician been trained in the thing I have, or are they applying a model built for something else?

What the training covers

The CSAT curriculum, developed by Dr. Patrick Carnes, is built around a specific clinical model of compulsive sexual behavior: how the pattern develops, how it escalates, how it organizes itself around concealment, and how it is interrupted. Training runs across four modules, with a supervised practicum between them, and covers assessment instruments specific to the field (the SAST-R and related tools), the role of trauma and attachment in the pattern, the structure of therapeutic disclosure to a partner, relapse and its sequence, and the partner's own injury. The ICD-11 framework that the field now uses for diagnosis sits alongside it.

A candidate who has completed the modules but not yet the practicum hours is a CSAT candidate, and the IITAP directory lists them as such.

Why it matters when you are choosing a therapist

Most therapists are good at what they were trained in, and most were not trained in this. A generalist who sees a man with compulsive sexual behavior often treats it as a symptom of anxiety or of a marital problem, and waits for it to resolve when those do. It does not, because the pattern has its own mechanics. Common results of untrained treatment: a year of weekly sessions with the behavior continuing between them; a disclosure to the partner that happens in pieces, which does more damage than the behavior did; and a partner who is told her response is codependency.

A CSAT is trained to ask about the full extent of the behavior at the start, to work out a definition of sobriety that is specific to the man, to structure a disclosure rather than let one happen, and to make sure the partner has her own clinician rather than a seat in his treatment.

The credential is not a guarantee of a good therapist. It is a guarantee that the therapist has been trained in the right model, which is a different and more useful thing.

Related credentials

The partner side of this field has its own training. A CCPS, Certified Clinical Partner Specialist, through the Association of Partners of Sex Addicts Trauma Specialists (APSATS), is trained in the partner-trauma model rather than the addiction model, and is the right credential to look for if you are the partner. Iron Ridge's partner program is led by a CCPS candidate under supervision.

IITAP also certifies a CSAT-S (supervisor) and a CPTT (Certified Partner Trauma Therapist). A CCSAS is a certified clinical sexual addiction specialist through a different body.

How to find a CSAT

IITAP's public directory lists every certified therapist and candidate, searchable by city and by radius. In Austin and the surrounding metro there are roughly two dozen. Most work in weekly private practice; a CSAT in an intensive outpatient program is rarer, and the difference matters for a pattern that needs more than an hour a week.

Iron Ridge's Clinical Director, Ian Birdwell, LPC, CSAT, leads the clinical model, and every client's individual work in the program is with a CSAT. Referring therapists, including other CSATs whose clients need a higher level of care, can reach us here.

Questions worth asking any therapist before you start

Whether or not the credential is on the wall: Have you treated this specifically, and how many men? How do you handle disclosure to a partner? What happens to my partner, does she get her own clinician? How do you define sobriety? What is your plan if weekly sessions turn out not to be enough? A therapist trained in this will have ready answers. A therapist who is not will usually say so honestly, and that honesty is worth something too.

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.