Compulsive Sexual Behavior

Help for Pornography Use, Sexual Urges, or Behaviors That Feel Difficult to Control

Perhaps you have promised yourself, or someone you love, that the behavior would change. You have deleted apps, installed filters, confessed, recommitted, or tried to suppress the urges through sheer determination. Then the pattern returns.

The secrecy, shame, relationship consequences, and repeated loss of control can make it feel as though pornography or sexual behavior has taken over your life.

You may call it sex addiction, porn addiction, compulsive sexual behavior, or Out-of-Control Sexual Behavior (OCSB). You may not know what to call it at all.

When Sexual Behavior No Longer Feels Like a Choice

I specialize in assessing and treating sexual behavior that feels difficult to regulate. My approach combines sex therapy, the OCSB treatment model, Acceptance and Commitment Therapy, mindfulness, harm-reduction principles, attachment work, and practical behavioral strategies.

Sessions are available in person in Boulder, Colorado, and by telehealth throughout Colorado and New York.

When Sexual Behavior No Longer Feels Like a ChoiceOut-of-Control Sexual Behavior is a non-diagnostic term describing consensual sexual thoughts, urges, or behaviors that feel difficult to regulate and create meaningful distress, consequences, or conflict with one’s sexual-health goals.

The concern is not determined by how frequently someone has sex, masturbates, thinks about sex, or uses pornography. A strong sexual desire is not inherently a disorder. What matters is the relationship you have with the behavior and its effect on your life.

Assessment Checklist

You may benefit from an OCSB assessment when:

  • You have repeatedly tried to change a sexual behavior without sustaining the change.

  • Pornography, sexting, sexual encounters, masturbation, or other sexual activity consumes more time and attention than you intend.

  • The behavior continues despite consequences to your relationship, work, health, finances, or emotional well-being.

  • Secrecy or repeated violations of relationship agreements have damaged trust.

  • Sexual behavior has become a primary way of managing anxiety, loneliness, anger, shame, boredom, rejection, or stress.

  • An urge feels less like information you can consider and more like a command you must obey.

  • Relief is brief and is followed by shame, regret, fear, or another promise to stop.

OCSB refers specifically to consensual sexual behavior. Concerns involving force, coercion, exploitation, or a person unable to consent require a different form of specialized assessment and intervention.

The Behavior Is the Starting Point—Not the Entire Explanation Two people can engage in similar sexual behavior for entirely different reasons. Effective treatment therefore begins with careful assessment rather than an automatic diagnosis.

Assessment may explore:

  • Your sexual and erotic development

  • The pattern of urges, thoughts, behaviors, and consequences

  • Previous attempts to stop, reduce, or change the behavior

  • Relationship agreements, secrecy, trust, and partner impact

  • Attachment patterns and the ways you seek closeness, distance, reassurance, or relief

  • Anxiety, depression, ADHD, substance use, trauma, mood changes, medications, and relevant medical factors

  • Religious, cultural, and personal values

  • The difference between genuine behavioral dysregulation and distress arising primarily from moral conflict or shame

A thorough assessment helps us understand what is actually maintaining the pattern. It also protects against pathologizing a healthy variation in desire or dismissing behavior that is causing genuine harm.

Is This Different From the Sex-Addiction Model?

There is no single universally accepted explanation for sexual behavior that feels out of control. Different clinicians and recovery communities use different frameworks.

Is This Different From the Sex-Addiction Model?

  • Addiction-Oriented Approaches:

    Addiction-oriented approaches have helped many people. They can offer structure, accountability, peer support, language for recognizing consequences, and a community in which people feel less alone. Some clients find the language of addiction and the principles of 12-step recovery personally meaningful.

  • The OCSB Model Difference:

    The OCSB model differs primarily in that it does not begin by assuming that every problematic sexual pattern represents a chronic addiction. It recognizes that similar behaviors can develop through different pathways and therefore require individualized assessment and treatment.

  • Goals of Treatment:

    OCSB treatment also does not automatically define sexual health as abstinence from pornography, masturbation, fantasy, or other consensual sexual behavior. For some clients, a period of abstinence or firm behavioral boundaries may be essential. For others, the appropriate goal may be moderation, honesty, changed context, clarified relationship agreements, or a different relationship with desire.

The purpose is not to defend the behavior or minimize its consequences. It is to understand it accurately enough to create meaningful and sustainable change.

What May Be Driving the Pattern?

The OCSB model examines three areas that can compete with your intentions and contribute to the feeling of being out of control.

Self-Regulation:

Sexual behavior may become a rapid way to change an internal state—to escape anxiety, numb shame, relieve tension, create stimulation, or briefly quiet loneliness.

Treatment develops the capacity to experience difficult emotions and strong urges without moving automatically into behavior.

Attachment and Relationships:

Sexual behavior may also regulate closeness and distance. It can become a way to seek reassurance, avoid vulnerability, manage fears of rejection, or create connection without the risks of emotional intimacy.

Treatment helps you recognize these patterns, strengthen attachment regulation, and develop clearer relationship agreements and healthier ways of connecting.

Sexual and Erotic Conflict:

Sometimes what is sexually compelling conflicts with what you believe you should want. Desire, fantasy, identity, religious teachings, relationship expectations, and fear of rejection can collide.
Treatment creates room to examine these conflicts honestly. The goal is neither to condemn your erotic life nor excuse behavior that violates your commitments. It is to develop an integrated sexual identity that supports responsibility, authenticity, and sexual health.

The Six Principles of Sexual Health

The Six Principles provide a compass for evaluating sexual choices. They are not a rigid moral code, nor do they dictate what your sexuality should look like. They help you define a sexual life that is safe, responsible, pleasurable, and aligned with your values.

01

Consent

Sexual activity is freely chosen, mutually understood, and responsive to each person’s ability to give, withhold, or withdraw consent.

02

Nonexploitation

Sexual activity does not depend upon coercion, manipulation, deception, or the misuse of power or vulnerability.

03

Protection From STIs and Unintended Pregnancy

Sexual health includes informed, practical attention to physical safety and the well-being of everyone involved.

04

Honesty

Sexual health requires honesty with yourself and truthful communication with partners, including keeping or openly renegotiating relationship agreements.

05

Shared Values

Partners clarify what sexual behavior means to each person and identify the values, expectations, and agreements shaping their relationship.

06

Mutual Pleasure

Pleasure is treated as a positive and important dimension of sexual health. Sexual experiences should consider the physical, emotional, and erotic well-being of everyone involved.

Together, these principles move treatment beyond one question—“Did I stop the behavior?”—toward a more substantial one: “Am I building a sexual life I can live with honestly and sustain with integrity?”

The Pathway Toward Sexual Health

01

Complete a Comprehensive Assessment

We begin by understanding the behavior, its context, its consequences, and the emotional, relational, sexual, and biological factors that may be contributing to it. Assessment is not an interrogation or a demand for confession. It is a structured process for creating an accurate formulation and a focused treatment plan.

02

Develop a Personal Sexual Health Plan

Your Sexual Health Plan translates values and intentions into specific behavioral commitments. It can include three categories:

  • Boundaries: Behaviors you are prepared to stop or change.
  • Ambivalence: Behaviors you are not yet ready to change but agree to observe and discuss honestly.
  • Health: Behaviors, relationships, skills, and sources of pleasure you want to cultivate.

The plan is not imposed by the therapist. We develop it collaboratively, using the Six Principles, your values, your relationship commitments, and the consequences you want to change.

03

Strengthen the Pause Between Urge and Action

Urge surfing is one tool for moving from automatic reaction to deliberate choice.

Instead of immediately obeying an urge, or exhausting yourself trying to force it away, you learn to observe it with curiosity. You notice the associated thoughts, emotions, and physical sensations as the urge rises, crests, and eventually changes.

This pause allows you to ask:

  • What am I feeling?
  • What is this urge trying to solve?
  • What might I actually need?
  • What action would align with my Sexual Health Plan?

Urge surfing builds the capacity to experience desire without surrendering your ability to choose.

04

Address the Pattern Beneath the Behavior

Treatment may include developing emotional-regulation skills, increasing tolerance for discomfort, examining attachment patterns, reducing rigid or self-attacking thinking, clarifying erotic conflicts, strengthening boundaries, and expanding sources of connection and pleasure.

We also identify environmental structures that support change. Insight matters, but insight without practice rarely interrupts an established pattern.

05

Build Accountability

Reducing shame does not remove responsibility or minimize harm. It creates the conditions for honesty, learning, empathy, and sustained behavioral change.

When sexual behavior has injured a partner or violated a relationship agreement, that impact gets addressed with this work. Exploring why the behavior occurred is not used to excuse it. Treatment addresses honesty, empathy, responsibility, repair, and the development of relationship agreements.

Assessment and the OCSB Men’s Group

We start with a comprehensive assessment, development of your Sexual Health Plan, and focused work on the factors maintaining the behavior.
After completing the assessment process, some men may be eligible for the ongoing OCSB Men’s Group. The group offers structured accountability, honest feedback, connection, and repeated practice applying sexual-health principles in relationships.
Group participation complements rather than replaces individual therapy. Members are required to remain engaged in individual therapy while participating.

Frequently Asked Questions

  • Yes. I work with people who describe their concerns as sex addiction, porn addiction, compulsive pornography use, compulsive sexual behavior, or OCSB. You do not have to adopt my preferred terminology, or abandon language that has been meaningful to you, to work with me.

  • There is no predetermined answer. Some clients need clear abstinence-based boundaries, particularly when a behavior has become firmly associated with loss of control or serious consequences. Others work toward moderation, changed context, greater honesty, or more deliberate use. Your treatment goals will be based on assessment, sexual health, relationship agreements, and your values.

  • No. Frequency alone does not establish that a behavior is compulsive, addictive, or unhealthy. Assessment considers control, function, consequences, distress, values, and the broader context.

  • Your values will be respected rather than argued away. We will examine how your behavior aligns with those values while also distinguishing between behavioral dysregulation and shame arising primarily from moral conflict. The objective is greater clarity—not persuading you toward or away from a particular belief system.

  • No. A non-shaming approach is not a consequence-free approach. Partner impact, secrecy, broken agreements, and necessary repair remain central to treatment. Understanding the behavior more accurately allows for greater responsibility; it does not erase it.