Clinical modalities

Iron Ridge uses established mental health interventions, selected against the individual clinical picture rather than applied uniformly to everyone. There is no single "CSBD protocol" with a robust evidence base behind it, and we will not pretend otherwise. What there is, is a well-evidenced set of treatments for the conditions that typically sit underneath compulsive sexual behavior — OCD, ADHD, anxiety disorders, depression, PTSD, and attachment trauma — and a clinical judgment about which of them this particular case needs.

This page explains what we use, what each one is actually for, and how honest the evidence is.

How modality selection works

Your clinician builds a formulation during stabilization — what the behavior is doing, what condition is underneath it, what the history is. Modality selection follows from that formulation.

A man whose behavior is neutralizing intrusive obsessional thought needs something different from a man whose behavior sits inside untreated complex trauma, who needs something different again from a man with undiagnosed ADHD and no trauma history at all. Treating those three identically is the most common failure in general programs that have added compulsive sexual behavior as a specialization.

In practice, across an eight-week arc, most clients work in two or three modalities plus group. Nobody gets all six.

What we use

Cognitive-behavioral therapy

The belief structure and the decision sequence. Strongest general evidence base of anything on this list, and the most commonly used element of the arc.

Acceptance and commitment therapy

The space between urge and action — the point where the behavior has historically been automatic. ACT has the most direct research support of any approach studied specifically in compulsive sexual behavior and problematic pornography use, though that literature is still small.

Internal family systems

IFS-informed work on the internal conflict of doing something you did not want to do. Frequently the first framework that makes sense to men who have concluded there is something fundamentally wrong with them.

Psychodynamic and attachment work

The relational patterns underneath — how closeness, need, and rejection have been handled, usually since long before the behavior started.

Group therapy

Where most of the clinical hours sit, and the element clients most often name as the one that mattered. Isolation is a load-bearing part of this presentation and group is what removes it.

Partner programming

A separate clinical track for partners, with its own clinician, run on the Multidimensional Partner Trauma Model (MPTM) rather than as an adjunct to the client's treatment.

What we do not do

We do not use aversive conditioning, "reparative" or orientation-change approaches of any kind, or anything organized around moral or religious correction. If a faith framework matters to you personally, that is yours and we will work respectfully alongside it, but it is not the clinical model and we will not substitute it for one.

We also do not prescribe. Where medication is clinically indicated, we coordinate with a prescriber and will help you find one.

Honesty about the evidence

Compulsive sexual behavior disorder was only formally recognized in ICD-11 as 6C72, and it is classified as an impulse control disorder. The treatment literature specific to it is thinner than the literature for depression, PTSD, or OCD by a wide margin.

What that means in practice is that a responsible program treats the well-characterized condition underneath with the interventions that have real support for it, and stays honest about the parts that are clinical judgment rather than trial data. Any program claiming a proprietary, proven CSBD protocol is describing marketing, not evidence.

See also: the 8-week clinical arc · what to expect · treatment programs