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We are the brakes. The people we work with who struggle with Problematic Sexual Behaviors, including Sexual Addiction, usually first present with a desperate need for us to help them stop. Thankfully, when our training in well-established treatment protocols intersects with client willingness, we have a realistic opportunity to do just that. Once we have established some success in the braking department, a whole new world of opportunity begins to emerge. It’s the leading edge of a new frontier in a foreign land called “Healthy Sexuality.” Entry requires steady resolve and the patience of Job as we help our clients steer through the hazy illusion of false abundance (in which there was actually never enough) and into the warm embrace of true Sexual Abundance™, finding deep satisfaction in the renewable wealth of sexual expressions to which they can definitively say “yes.” In order to lead our clients bravely and wisely into this new territory, we as clinicians need to be very clear on two issues: a) our own concepts of healthy sexuality (because this will necessarily become part of the client’s treatment) and b) the conditions surrounding the clients as they continue to live in the same culture, (and many in the same relationships) in which their addiction once thrived. Their decision points are around every corner: Do I avoid standing near the attractive woman on the subway car? Do we go to the beach/pool and walk amongst the bikini-clad set? Do I consider taking masturbation out of my inner circle, and if so, how? Do we watch the R-rated movie together (the kind we used to take for granted, but now must cross-reference three different review sites for nudity content)? When we do watch that movie, do I close my eyes/leave the room/fast forward during the racy scenes? And which scenes “count” as racy? Would I be doing this for my own recovery or for my partner’s comfort? And what about our physical intimacy? When is the right time to be sexual again? Should we take a break from being sexual? Why could he be so sexually turned on with others but not with me? How can we even talk about sexual intimacy? The questions above barely scratch the surface, but what is clear is that the road to sexual health is going to be a bumpy and non-linear one, with many unpredictable obstacles along the way. Successful treatment is not simply a matter of contingency planning for scenarios like those above, but instead a complex, multi-layered conceptualization of treatment that encompasses everything from interpersonal neurobiology to 12 Step fellowships to good old fashioned psychodynamic and CBT approaches. And it most often involves caring not just for a single recovering person (though certainly, a number of our recovering clients are single), but for that person’s partner and for their recovering relationship. That relationship is where the potential for healthy sexuality truly emerges, and where the greatest potential for a complete recovery lies. In order for the coupleship to be healed, it will require nothing less than a consistently courageous commitment to intimacy. And what an amazing coincidence that intimacy just happens to be the Achilles heel of our recovering clients! Accepting the challenge to move into vulnerability (armed with the skill sets to do so smarter and safer) is exactly what their trauma histories taught them NOT to do but is also what yields the chance to have it all: The benefits of a trusting, respectful and equal Living Room, combined with a passionate, sensual and erotic Bedroom, all within the same relationship. So “braking” is not what our clients and couples ultimately aspire to. It’s something much more, even if they can’t quite imagine what that might look like in the early months (or years!). But once those brakes are firmly set, we can then begin steering our clients toward the same “finish line” that everyone is striving for, regardless of sexual acting out history: The integration of sexuality and intimacy. The need for us to be mindful of this endgame is constant, and as a field,...

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