Intake assessment

Roughly ninety minutes with the clinician who will be working with you. This is where the clinical formulation gets built, and it is the most consequential hour of the program.

Why it matters more than it looks

Compulsive sexual behavior is the presenting concern. It is not the thing treatment is aimed at.

Underneath it, in nearly every case, is a mental health condition doing the driving — OCD, ADHD, an anxiety disorder, depression, PTSD, attachment trauma, or an adjustment picture, often more than one, and often undiagnosed for years. A meaningful proportion of the men who come to Iron Ridge have never had the ADHD identified or the trauma history taken properly.

Get the formulation wrong and the following eight weeks are aimed at the wrong target. That is the most common reason a man arrives having already been through a program that did not hold.

What happens

Structured assessment. The SAST-R, the PATHOS, and the CSBD-19, plus mental health screening instruments appropriate to what the history suggests. These are baseline measures — they are repeated at week four, week eight, and six months, and reviewed with you rather than filed.

Clinical history. Developmental, relational, sexual, psychiatric, and substance use. This is the detailed version, with a clinician, in a room — which is why it was not asked for on the phone.

The current picture. Frequency, escalation, contexts, access, what has already been tried, and what happened when it was.

Risk assessment. Direct and structured.

Formulation and plan. You are told what the formulation says. Not a summary handed over at discharge — an explanation, at the start, of what your clinician thinks is actually happening and what the treatment is therefore aimed at. You are allowed to disagree with it, and that conversation is useful.

What is expected of you

Accuracy, particularly about frequency and escalation. Almost everyone under-reports at intake, usually by a lot, and usually not deliberately — the account you have been telling yourself for years is well practiced.

You do not have to volunteer everything in the first ninety minutes. Things surface in week five that were not available in week one and that is normal. What is asked for is that you do not actively minimize when asked directly, because the interruption plan built in stabilization is only as good as what it was built from.

Confidentiality

Your record stays with Iron Ridge. We do not submit claims to insurers and we do not report to them about your care. We do not contact your employer or your family.

The standard clinical exceptions are stated here, up front rather than in fine print: risk of serious harm to yourself or another person, abuse or neglect of a child or vulnerable adult, and court order.

If you are using a superbill for out-of-network reimbursement, submitting it is your decision, and doing so puts a diagnosis code in front of your insurer. That trade-off is explained before you make it, not after.

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