Sex and love addiction fellowships

1. Introduction

Version followed: each fellowship's own current web pages and pamphlets as opened in October 2026: Sexaholics Anonymous (SA) Practical Guidelines for Group Recovery (1995, revised 2004 and 2018, with the 2010 Statement of Principle and 2016 addendum); Sex Addicts Anonymous (SAA) ISO "Sobriety" page; Sexual Compulsives Anonymous (SCA) Statement of Purpose and Sexual Recovery Plan worksheet (2023 upload); Sex and Love Addicts Anonymous (SLAA, The Augustine Fellowship) Journal #164 "Setting Bottom Lines" (Dec 2016) plus a published "Tools of Recovery" list; Sexual Recovery Anonymous (SRA) New York pages. Clinical framing: ICD-11 6C72 Compulsive sexual behaviour disorder (CSBD).

What these are. These five are peer-run, non-professional mutual-aid fellowships adapted from the Alcoholics Anonymous Twelve Steps and Traditions. They are not therapies, and a clinician does not run them. SA states it "should remain forever non-professional" and does not endorse or lend its name to outside facilities [source: SA Practical Guidelines]. This guide is written for a psychotherapist who assesses whether a client fits one of them, refers and prepares the client, works alongside the client's fellowship involvement, and adapts its principles inside therapy. All clinician procedures below are marked [synthesis] unless a fellowship publishes them.

The fellowships (as verified).

SAA: founded 1977 by men seeking more anonymity than existing programmes offered; basic text Sex Addicts Anonymous; open to all sexual orientations; has in-person, telephone and online meetings, mixed and gender-specific, open and closed [source: SAA Sobriety page; Wikipedia SAA (secondary)]. Founding place not confirmed [uncertain].
SA: the most restrictive sobriety definition (see §2 table); groups that do not follow its Statement of Principle may not call themselves SA meetings [source: SA Practical Guidelines]. Founding date and founder are [uncertain].
SCA: founded either 1973 in Los Angeles or 1982 in New York (accounts differ), originally for gay and bisexual men, who remain the main membership; open to all orientations [source: Wikipedia SCA (secondary)] [uncertain on date].
SLAA: legally "The Augustine Fellowship, S.L.A.A., Fellowship-Wide Services"; addresses sex addiction, love/relationship addiction and "anorexia" (compulsive avoidance of sexual or emotional intimacy) [source: SLAA Journal #164]. Founding date and place not verified [uncertain].
SRA: founded 1990 as a "progressive offshoot" of SA; permits sex within a committed relationship rather than only within heterosexual marriage; concentrated around New York with meetings elsewhere in the US, Mexico and Europe; AA permission to adapt the Steps granted 1991 [source: Wikipedia SRA (secondary); SRA Program Tools].

Core idea of how change happens (as the fellowships publish it). Members admit powerlessness over specific sexual (and, in SLAA, romantic/relational) behaviours, abstain from them one day at a time under a written or stated definition of sobriety, and are sustained by meetings, a sponsor, daily contact with other members, literature, and working the Twelve Steps, which are presented as producing a spiritual awakening and the wish to help others [source: SA Practical Guidelines; SAA Sobriety page; SRA Program Tools; SLAA Journal #164]. SAA describes meetings as "forums for learning how to integrate the steps into our lives" [source: SAA Sobriety page].

Diagnostic context the clinician must hold. "Sex addiction" is a fellowship and popular term, not a diagnosis. DSM-5-TR contains no sex addiction or hypersexual disorder diagnosis [stated as general knowledge; uncertain on wording]. ICD-11 includes 6C72 Compulsive sexual behaviour disorder: a persistent pattern (example duration about six months) of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour; sex becomes central to life to the neglect of health, care and responsibilities; repeated unsuccessful efforts to reduce it; continuation despite adverse consequences or little satisfaction; causing "marked distress or significant impairment". Distress that is entirely related to moral judgements and disapproval of one's sexual impulses or behaviour is not sufficient; paraphilic disorders are excluded [source: ICD-11 6C72 entry via findacode transcription]. ICD-11 places it outside the addiction chapter, among impulse control disorders [uncertain: parent category not shown]. Moral disapproval of one's own pornography use robustly predicts self-perceived compulsivity, and the two track each other over time, which complicates diagnosis [source: Grubbs, Kraus, Perry, Lewczuk & Gola 2020].

2. Framework

The fellowships have no clinical phases or session counts. Their published structure is: arrive at meetings, choose a sobriety definition (or accept SA's), get a sponsor (often a temporary one first), work the Steps in order and repeat Steps 4 and 5 as needed, do daily practices, then do service and sponsor others [source: SA Practical Guidelines; SRA Program Tools; SLAA Tools]. The phased clinical framework below is [synthesis], built to fit around that structure.

How each fellowship defines sobriety (as each publishes)

Fellowship	Who defines sobriety	Published definition (paraphrased)	Tool
SA	Fellowship (fixed)	Married: no sex with self or anyone but one's spouse, where spouse means a partner in a man–woman marriage. Unmarried: no sex of any kind. All: plus "progressive victory over lust".	Statement of Principle; Steps
SAA	Member, with sponsor	No universal definition; abstinence from member-chosen behaviours; most members do not aim to stop being sexual.	Three Circles (inner, middle, outer)
SCA	Member	Members define sexual sobriety for themselves; aim is to express sexuality without excessive time/energy, legal risk, or harm to mental, physical or spiritual health; explicitly not suppression.	Written Sexual Recovery Plan, shared with sponsor or witness
SLAA	Member, with sponsor	Abstaining one day at a time from personal bottom-line behaviours; bottom lines may be sexual, romantic or anorexic; recovery is more than abstinence.	Bottom lines, boundaries/middle lines, top lines; recovery plan
SRA	Fellowship framework, member applies	"Sobriety is the release from all compulsive and destructive sexual behaviors." Members report this has also meant no masturbation and no sex outside a committed partnership.	Steps, HALT/SAFE, meetings

[source: SA Practical Guidelines; SAA Sobriety page; SCA Statement of Purpose and Plan worksheet; SLAA Journal #164 and Tools list; SRA about page]

Clinical phases [synthesis]

Phase A — Assessment and formulation (1–3 sessions, individual). Goals: establish what the behaviour is, whether ICD-11 CSBD criteria are met, whether distress is mainly moral incongruence, comorbidity and risk, and the client's values, orientation, relationship structure and faith. Move on when you and the client share a formulation and the client has said what they want to change.

Phase B — Fit and matching (1 session, can overlap A). Goals: decide whether a fellowship is indicated at all, which one, and whether alongside therapy. Move on when the client has chosen a fellowship (or declined) with informed understanding of its sobriety definition and spiritual language.

Phase C — Preparation and first meetings (1–2 sessions + 2–6 weeks of attendance). Goals: practical planning, expectations, safety, first debrief. Move on when the client has attended several meetings, can name what helped and what jarred, and has a provisional sobriety definition or plan.

Phase D — Parallel work (ongoing, weekly to fortnightly therapy). Goals: therapy addresses formulation-driven targets (emotion regulation, trauma, shame, relationship, sexual health) while the fellowship provides peer structure. Each session briefly reviews sobriety plan, meetings, sponsor contact and slips. Move on when sobriety is stable for a period the client and you agree, functioning has improved, and shame is reducing rather than rising.

Phase E — Consolidation and review (monthly, then as needed). Goals: revise the plan as sexual health and values clarify (SLAA members revise bottom lines every 30 days to six months; SCA expects the plan to evolve [source: SLAA Journal #164; SCA Plan worksheet]); decide how much fellowship involvement continues; relapse-prevention plan. Exit therapy when the client can manage lapses using their own and peer supports.

Re-entry criteria to Phase A at any point [synthesis]: rising shame or suicidality, a sobriety definition becoming more and more restrictive, evidence the fellowship is reinforcing moral incongruence rather than reducing distress, new legal or safety issues, or a slip pattern that persists despite engagement.

3. Guiding principles

Fellowship principles (as published), with what each means for the clinician:

Non-professional and self-supporting [source: SA Practical Guidelines; SCA Statement of Purpose]. You do not direct the group, attend as an expert, or use the fellowship's name for your service; refer and collaborate only through the client.
Only requirement is a desire to stop (SCA: compulsive sex; SRA: compulsive sexual behaviour; SA: to stop lusting and become sober by SA's definition) [source: SCA Statement of Purpose; SRA about page; SA Practical Guidelines]. The client self-selects; you never mandate membership as a condition of therapy [synthesis].
Sobriety is defined either by the member (SAA, SCA, SLAA) or by the fellowship (SA; SRA's framework) [source: §2 table]. Match the definition to the client's values before referral, not after.
Problem is the addictive behaviour, not sex itself (SAA, SCA) [source: SAA Sobriety page; SCA Statement of Purpose]. Keep sexual health and pleasure in the treatment goals; watch for drift into suppression.
One day at a time; abstinence first, then broader recovery [source: SRA Program Tools; SLAA Tools]. Frame goals in short, achievable blocks.
Sponsor-guided honesty about what belongs in the plan (denial can leave key behaviours off) [source: SAA Sobriety page; SLAA Journal #164]. Encourage the client to let a sponsor see the whole plan; you hold the clinical view in parallel.
Focus on the solution, not on retelling acting-out [source: SA Practical Guidelines]. In sessions, limit graphic recounting to what formulation and risk need.
Spiritual but not religious; Higher Power of one's own understanding (SRA, SLAA) — SA keeps "God and the program" central [source: SRA Program Tools; SLAA Tools; SA Practical Guidelines]. Explore the client's relationship to spiritual language before referral.
Anonymity and confidentiality [source: SLAA Tools; SAA founding rationale, Wikipedia SAA]. Never ask a client to identify other members; treat material about others' disclosures in group as confidential third-party information.
Balance: over-focusing on recovery is itself a compulsion [source: SLAA Tools]. Monitor time spent in meetings against the rest of life.
Professional help is compatible (SLAA lists therapy with clinicians who understand sexual addiction as a tool) [source: SLAA Tools]. Present therapy and fellowship as complementary.

Clinician principles [synthesis]:

Diagnose before you label. Use ICD-11 CSBD language and the client's own words; do not adopt "addict" identity for the client unless they choose it.
Separate moral incongruence from dyscontrol. Ask what the client does, how often, with what loss of control and consequences, and separately how they judge it.
Affirm sexual and gender diversity. Same-sex attraction, kink between consenting adults, or non-monogamy are not in themselves symptoms; refuse to treat orientation or identity as an inner-circle behaviour.
Client autonomy over sobriety definition. The client, not you, chooses abstinence targets; you check them against safety and values.
Shame is a treatment target, not a tool.
Risk first. Legal risk, sexual health, partner safety, suicide risk and any child-protection concern override fellowship timetables.

4. Intervention inventory

Part A describes the fellowships' own tools as they publish them, so you can explain them, help the client use them and work with them in session. You do not run these; members and sponsors do. Part B gives the clinician's procedures, which are [synthesis] unless a source is named.

Part A — Fellowship tools (as published)

A1. SAA Three Circles

Purpose: gives each member a personal, concrete definition of sobriety [source: SAA Sobriety page].
Steps (as published): draw three concentric circles. Inner circle: behaviours the member wants to abstain from and counts as acting out (addictive, harmful or unacceptable for them). Middle circle: behaviours that may lead to acting out, or that the member is unsure about. Outer circle: healthy behaviours that enhance life and recovery. The member fills these with a sponsor or others in recovery; the sponsor guides inner-circle choices [source: SAA Sobriety page]. Examples in a secondary source: inner, paying for sex; middle, contacting a former acting-out partner; outer, sex with a monogamous partner, enough sleep [source: Wikipedia SAA (secondary)].
Clinician use [synthesis]: ask the client to bring their circles; check that inner-circle items are specific behaviours (not thoughts, fantasies, orientation or identity), that the outer circle contains real sexual and relational wellbeing items, not only avoidance, and that middle-circle items are the client's actual high-risk chain.
Example language (illustrative): "Talk me through your inner circle. For each one, what makes it harmful for you, rather than just something you feel bad about?"
Watch for: inner circles that keep growing; outer circles empty of sexual items; the client listing same-sex contact or consensual practices they have been taught are wrong. Working when the client can say why each item is there and keeps most days inside outer-circle life [synthesis].

A2. SCA Sexual Recovery Plan

Purpose: a written, self-defined sobriety plan; SCA aims not to suppress sexuality but to express it without excessive time and energy, legal risk, or harm to health [source: SCA Statement of Purpose].
Steps (as published): a dated worksheet with three parts: people, places and acts the member asks to be freed from; circumstances in which compulsions most often occur; people, places and joyful activities to add in recovery. Signed by the plan holder and a sponsor or witness. Write only what you are willing to follow, not what you think you should; any written plan shared with another person and followed as well as possible counts; it evolves [source: SCA Plan worksheet]. A secondary source describes it as three columns: abstinence, high-risk, recovery, and links it to Overeaters Anonymous food plans and Carnes's work [source: Wikipedia SCA (secondary)].
Clinician use [synthesis]: the "willing, not should" rule is a useful therapeutic stance: use it to check plans are realistic. Map the "when compulsions occur" column onto a formulation of triggers (emotion, time, place, substance use, loneliness).
Example language (illustrative): "SCA asks you to write what you're actually willing to do. Which lines here are 'should' lines?"
Watch for: plans written in one rush under shame; no third column. Working when the plan is revised as insight grows.

A3. SLAA bottom lines, boundaries and top lines

Purpose: defines sobriety as abstaining from personal bottom-line behaviours daily [source: SLAA Journal #164].
Steps (as published): bottom lines are the behaviours the member is powerless over that make life unmanageable; a common starting point is whatever brought them in. Keep the list short and specific (one member: three or four items). Set them with a sober, experienced sponsor because denial leaves items off; some sponsors start with clearly illegal or relationship-damaging behaviours and add more later. Revisit regularly (members report every 30 days to six months). Bottom lines need not be sexual (e.g., late-night intense conversations that trigger obsession). Top lines are positive replacement behaviours; some members use a three-circle exercise to sort top, middle and bottom lines; "accessory" behaviours such as flirting may be noticed rather than banned, depending on the person and sponsor [source: SLAA Journal #164]. A published tools list adds boundaries (middle-circle limits) and a written recovery plan reviewed often [source: SLAA Tools list] [uncertain: that page's status as an official FWS publication not confirmed].
Love addiction and anorexia lines: love-addiction bottom lines are harder to identify and need ongoing peer feedback; examples include not falling headlong for someone early and a dating plan limiting sexual contact and escalation for a set period. Some members later add anorexia bottom lines (against compulsive withdrawal from intimacy) [source: SLAA Journal #164].
Example language (illustrative): "If your bottom lines are only about stopping things, what's on your top line, the life you're moving toward?"
Watch for: stopping all bottom lines at once can bring severe withdrawal; members advise pacing changes with a sponsor [source: SLAA Journal #164]. Clients with avoidant patterns may use bottom lines to justify isolation; check for anorexia patterns [synthesis].

A4. SA sobriety and the lust focus

Purpose: a fixed, fellowship-wide sobriety definition (see §2 table) plus "progressive victory over lust" [source: SA Practical Guidelines].
As published: married members are advised to consider total sexual abstinence for a time until the lust–sex link is broken, and open-ended abstinence is said to strengthen non-sexual intimacy; members should not spend years processing each lust episode but focus on Steps; when triggered, stop and call the sponsor at once [source: SA Practical Guidelines].
Clinician use [synthesis]: discuss the implications openly before referral: the definition excludes masturbation, sex outside marriage, and same-sex relationships, since spouse means a man–woman marriage. A spousal abstinence period affects the partner, who should have a voice.
Example language (illustrative): "SA's definition would mean no sex outside a marriage between a man and a woman. How does that sit with who you are and what you want?"
Watch for: LGBTQ+ clients referred without this being explained; moral incongruence deepening; partner distress over imposed abstinence.

A5. SRA sobriety and HALT / SAFE checks

Purpose: SRA's sobriety (§2 table) with practical warning-sign checks [source: SRA about page; SRA Program Tools].
As published: awareness, acceptance, action (listen at meetings to become aware of feelings, admit experiences to self and others and accept oneself, then act differently); HALT flags hunger, anger, loneliness, tiredness; S.A.F.E. flags secrecy, abusiveness, disconnection from feelings and emptiness; slogans; daily literature; writing; service; telephoning [source: SRA Program Tools]. SLAA publishes a similar S.A.F.E. test (secret, abusive, used to manage feelings, empty of commitment) [source: SLAA Tools list].
Clinician use [synthesis]: HALT and SAFE are easy to fold into a daily check-in or a slip review.
Example language (illustrative): "Before the slip on Thursday, which HALT letters were lit up?"
Watch for: SAFE used as a moral verdict on all private sexuality; keep it tied to harm and compulsion.

A6. Meetings

Purpose: core of all fellowships: sharing, self-acceptance, connection [source: SRA Program Tools].
Formats as published: SA groups use book-study (short readings of SA and AA literature related to members' lives), Step or topic meetings, time-limited sharing, sobriety-length introductions and chips, and separate newcomer or information meetings to screen inquirers who do not want SA sobriety [source: SA Practical Guidelines]. SAA has in-person, telephone and online meetings, mixed or gender-specific, open (anyone interested) or closed (only those wanting to stop) [source: Wikipedia SAA (secondary)]. SCA lists in-person, Zoom, telephone and message-board meetings and a 24/7 WhatsApp group [source: SCA Statement of Purpose page]. SLAA suggests daily meetings early on ("90 meetings in 90 days"), that any two or more people can start a meeting, and conferences and retreats [source: SLAA Tools list]. SRA encourages newcomers to attend as many meetings as possible [source: SRA Program Tools].
Clinician use [synthesis]: help the client choose a first meeting that is open or newcomer-oriented, and gender-specific if they would be distracted or unsafe in a mixed group; suggest trying three different meetings before judging the fellowship.
Example language (illustrative): "Meetings vary a lot. Let's pick one newcomer meeting and one online one, then compare."
Watch for: meetings where detailed acting-out stories trigger the client; meetings with heavy religious content for a secular client.

A7. Sponsorship and recovery partners

Purpose: an experienced sober member guides the newer member through the Steps [source: SRA Program Tools; SA Practical Guidelines].
As published: SA offers temporary sponsors before newcomers leave their first meeting and asks newcomers to commit to Steps, meetings and a sponsor; sponsors give specific direction and model the principles [source: SA Practical Guidelines]. SRA advises considering sexual attraction when choosing a sponsor; either party can end it [source: SRA Program Tools]. SLAA suggests getting a sponsor early and changing if needed, plus recovery partners who check in with specific questions; do not pick your life partner for this role [source: SLAA Tools list; SLAA Journal #164].
Clinician use [synthesis]: talk about sponsor choice as a relationship decision: attraction, power, and whether the sponsor's sobriety definition matches the client's. Agree what, if anything, the client will share between sponsor and therapist.
Example language (illustrative): "A sponsor is a peer, not a therapist. What do you want from one, and what would be a red flag?"
Watch for: sponsors giving clinical, medication or relationship-ending directives; sexualised or exploitative sponsor relationships.

A8. Twelve-Step work

Purpose: the Steps are presented as the actual work of recovery, leading to spiritual change [source: SAA Sobriety page].
As published (SA, paraphrased): a written First Step inventory given to the sponsor and then shared with the group, kept concise and time-limited; Steps 2–3 centred on surrender, which may come gradually through willingness to take direction or as a definite prayerful experience with an understanding person; Steps 4–5 started soon after Step 3 and repeated as needed; Steps 6–11 lead to spiritual awakening and service; members who resist Step 4 or Step 9 are said to be at higher risk of dropping out [source: SA Practical Guidelines].
Clinician use [synthesis]: plan with the client how they will handle disclosures in Step 5 and amends in Step 9, especially where these involve legal exposure, partners, or people they harmed; amends to a partner may need couple-therapy support.
Example language (illustrative): "Before you do Step 9 with your ex, let's think about what it could stir up for them and for you."
Watch for: First Step inventories becoming graphic shame rituals; amends that endanger the client or burden victims.

A9. Daily practices: phone calls, literature, writing, slogans, service

As published: frequent, even daily, contact with other members, especially early; if one does not answer, call another (SA); daily prayer, a call to the sponsor, basic texts, meetings and helping others (SA); telephone, journaling, literature, affirmations, deep breathing, humour, physical activity, socialising, carrying recovery reminders, "Think it through" (pause and ask if acting out gets what you want) and willingness (SLAA); writing to reconnect with the healthy self and track progress (SRA) [source: SA Practical Guidelines; SLAA Tools list; SRA Program Tools].
Clinician use [synthesis]: turn these into a written daily routine with a small number of non-negotiables; use "Think it through" as a pause-and-consequence rehearsal in session.
Watch for: practices becoming compulsive in turn (SLAA warns that over-focus on recovery is itself a compulsion) [source: SLAA Tools list].

A10. People, places and things; withdrawal

As published: avoid triggers or make them safer, e.g., blocking software and keeping doors open; accept withdrawal discomfort as a path to wholeness (SLAA); SCA publishes "Moving Through Withdrawal" and "14 Ways to Avoid a Slip" [source: SLAA Tools list; SCA Statement of Purpose page] (SCA texts not drawn on [uncertain]).
Clinician use [synthesis]: set up environmental controls collaboratively; prepare the client for withdrawal-period low mood, irritability and urges, and screen mood weekly during it.
Watch for: depression or suicidality emerging as the behaviour stops.

Part B — Clinician procedures

All of Part B is [synthesis] except where an ICD-11 or research source is named. None of it is fellowship practice.

B1. Assessment against ICD-11 CSBD and differential diagnosis

Purpose: decide whether there is a disorder, something else, or mainly value conflict, before any "addict" framing.
Steps: (1) Describe behaviours specifically: what, how often, duration, settings, time consumed, money, online/offline. (2) Check each ICD-11 feature in your own words: loss of control over urges; sex central to life with neglect of health, care, interests or duties; repeated failed attempts to cut down; continuation despite consequences or little satisfaction; pattern over an extended period (about six months as a guide); marked distress or impairment [source: ICD-11 6C72]. (3) Rule out or co-assess: paraphilic disorder (excluded from CSBD), manic or hypomanic episodes, substance use (including chemsex), ADHD impulsivity, OCD with sexual intrusive thoughts (ego-dystonic obsessions, not urges acted on), trauma-related re-enactment, neurological or medication causes. (4) Risk: legal exposure, consent, sexual health and STI testing, partner safety, finances, suicide risk (standard structured risk assessment; increased in the period after discovery or disclosure), and any indication of sexual interest in children, which requires your local safeguarding and specialist pathways, not a self-help referral.
Example language (illustrative): "I'd like to understand what actually happens, step by step, on a typical bad day, without you needing to give more detail than you're comfortable with."
Watch for: clients self-diagnosing from fellowship questionnaires (SCA's Twenty Questions, SLAA's 40 questions are fellowship self-tests, not validated diagnostic tools [uncertain]).

B2. Separating moral incongruence from dyscontrol

Purpose: ICD-11 excludes distress entirely due to moral judgement [source: ICD-11 6C72]; moral disapproval predicts self-perceived compulsivity [source: Grubbs et al. 2020].
Steps: (1) Rate frequency and loss of control separately from guilt. (2) Ask where their rules about sex came from (faith, family, culture, partner). (3) Ask a counterfactual: if their faith or partner had no objection, would they still want to change, and why? (4) Look for objective markers of impairment (missed work, money, health, legal, relationship damage beyond the value conflict). (5) Formulate: dyscontrol, moral incongruence, or both.
Example language (illustrative): "Some people struggle because they can't stop; others because what they do clashes with what they believe. Often it's a mix. Let's look at both."
Watch for: low-frequency behaviour with intense distress, which suggests incongruence; in this case a strictly abstinent fellowship may worsen distress, and values-focused or self-acceptance work may fit better.
Working when: client and clinician can describe the problem in both terms and goals reflect that.

B3. Matching the client to a fellowship

Purpose: fit the sobriety definition to the client's values, relationships and orientation.
Steps: (1) Explain that all five are free, peer-run, Twelve-Step and use spiritual language. (2) Lay out the five definitions using the §2 table. (3) Match: client wants to define their own sobriety and remain sexually active → SAA, SCA or SLAA; romance, obsession with people, serial relationships or intimacy avoidance prominent → SLAA; gay or bisexual man wanting a sex-positive, self-defined framework → SCA (also consider SAA); client in a committed unmarried or same-sex partnership wanting a fixed fellowship standard → SRA (permits sex in a committed relationship) rather than SA; client who is heterosexually married or celibate by conviction and wants a fixed, lust-focused standard → SA. (4) Check local and online availability. (5) Agree a trial period (e.g., six meetings) and a review session.
Example language (illustrative): "These groups differ mainly in who gets to define sobriety. Which of these definitions could you live with?"
Watch for: the client choosing the strictest definition from shame rather than values.

B4. Fit for LGBTQ+ clients

Purpose: prevent referral into frameworks that pathologise orientation or identity.
Steps: (1) State explicitly that orientation and gender identity are not symptoms and cannot be inner-circle items. (2) Point out that SA defines spouse as a man–woman marriage, so same-sex sex is never "sober" in SA [source: SA Practical Guidelines]; SAA states it is safe for all orientations [source: Wikipedia SAA (secondary)]; SCA arose among gay and bisexual men and is LGBT-friendly [source: Wikipedia SCA (secondary)]; SCA and SAA let the member define sobriety. (3) Assess minority stress, internalised stigma, chemsex and venue-specific risks. (4) If the client was raised in a setting that framed their orientation as sin, screen for past conversion-practice exposure and keep any fellowship away from that framing. (5) Suggest LGBTQ+-specific meetings where they exist [uncertain: availability varies and was not verified].
Example language (illustrative): "Being gay isn't something we're treating. What we're looking at is the pattern that's hurting you."
Watch for: the client equating orientation with acting out; sponsors or members suggesting otherwise.

B5. Fit for religious clients and moral incongruence

Purpose: support faith-congruent recovery without colluding with shame.
Steps: (1) Ask what the faith teaches, how the client lives it, and what a faith leader they trust would say. (2) Do B2. (3) If dyscontrol is present and the client wants a strict, faith-congruent definition, SA's definition may fit; discuss SA's God-centred tone [source: SA Practical Guidelines]. (4) If distress is mostly incongruence, work first on values clarification and self-compassion, and present fellowships as optional. (5) Offer consultation with the client's chosen faith leader, with consent.
Example language (illustrative): "Your faith matters here. I want to help you live by your values without being crushed by guilt."
Watch for: escalating scrupulosity; partners or faith communities mandating attendance.

B6. Preparing the client for first meetings

Steps: (1) Explain format: readings, sharing, first names, newcomer welcome, possible offer of a temporary sponsor [source: SA Practical Guidelines]. (2) Explain that listening only is fine. (3) Plan travel, timing, an exit plan and a post-meeting call or text to a support. (4) Discuss anonymity and what the client might see or hear. (5) Book a debrief session.
Example language (illustrative): "You don't have to speak. Notice when you feel you belong and when you feel judged."
Watch for: avoidance after one bad meeting; triggering stories.

B7. Reviewing the sobriety plan in session

Steps: (1) Ask the client to bring circles, plan or bottom lines. (2) Check each item is a specific behaviour tied to harm. (3) Add sexual health and connection items to the healthy column. (4) Link high-risk items to the formulation (affect, situations). (5) Revise at agreed intervals, in line with the fellowship's own revision practice [source: SLAA Journal #164; SCA Plan worksheet].
Example language (illustrative): "What's one outer-circle thing about sex or closeness, not just about avoiding things?"
Working when: plan is stable, specific, and includes positive sexuality.

B8. Slip and relapse review

Steps: (1) Normalise and reduce shame. (2) Walk through the chain: vulnerability (HALT), trigger, middle-circle steps, decision points, the behaviour, aftermath. (3) Identify one change at each link. (4) Check safety: STI exposure, legal, partner, suicide risk. (5) Ask whether the client used fellowship tools (call, meeting) and what got in the way. (6) Revise the plan if a line was unrealistic. Note SA addresses lapses through the Steps rather than detailed analysis [source: SA Practical Guidelines]; explain to SA members that the clinical review is different from, not in conflict with, that approach.
Example language (illustrative): "Let's look at it like a film, frame by frame, to find where you could step off the track next time."

B9. Collaborating with the sponsor and the fellowship

Steps: (1) Collaborate only through the client, unless the client gives specific written consent for contact. (2) Clarify roles: the sponsor guides programme work; you handle diagnosis, risk, trauma, mental health and medication referral. (3) If guidance conflicts (e.g., sponsor advising to stop medication or to disclose to a partner abruptly), discuss with the client and support their decision making.
Watch for: the client triangulating sponsor and therapist.

B10. Partners and families

Steps: (1) Offer the partner their own support: COSA is a Twelve-Step fellowship for people affected by another's compulsive sexual behaviour [source: Wikipedia SAA (secondary)]; S-Anon and similar partner fellowships exist [uncertain]. (2) Consider couple work after the individual is stable. (3) Plan disclosures carefully, with attention to safety and STI testing.
Watch for: partner trauma symptoms; the partner being made the client's monitor.

B11. Periodic review of fellowship involvement

Steps: every 8–12 weeks review: attendance and benefit; shame (up or down); whether sobriety lines are widening; time spent; relationships with sponsor and members; functioning. Decide to continue, change fellowship, reduce, or stop.
Example language (illustrative): "Is the group making you feel more like yourself or less?"

5. Handling problems

The fellowships' published guidance on problems is limited to what is noted with a source; everything else here is [synthesis].

Client won't go to a meeting (ambivalence, shame, fear of being recognised). Explore the fear specifically; offer online or telephone meetings first (available in SAA and SCA) [source: Wikipedia SAA (secondary); SCA Statement of Purpose page]; suggest listening-only attendance; accept that a fellowship is optional and therapy can proceed without it [synthesis].
Client attends but is stuck (no sponsor, no step work, repeated slips). SA's own guidance is to offer a temporary sponsor and redirect from venting to the Steps and taking direction [source: SA Practical Guidelines]. Clinically, check whether the sobriety definition is realistic (SCA's "willing, not should" rule [source: SCA Plan worksheet]), whether the plan targets the actual chain, and whether untreated depression, ADHD, trauma or substance use drive the pattern [synthesis].
Repeated slips and despair. Do a structured slip review (B8); screen for suicidality, especially after discovery, disclosure or legal events; reduce shame-based framing; consider whether the fellowship's definition is fuelling an all-or-nothing cycle; if so, discuss moving to a self-defined fellowship [synthesis].
Overwhelm from withdrawal. SLAA members warn that stopping all bottom lines at once brought severe withdrawal and advise pacing with a sponsor [source: SLAA Journal #164]. Clinically, stage the plan, monitor mood weekly, and add grounding and emotion-regulation skills [synthesis].
Escalating restriction and sexual anorexia. Signs: inner circle grows to include ordinary sexuality, masturbation guilt, avoidance of all intimacy, "lust" policing of thoughts. SCA explicitly does not aim to suppress sexuality [source: SCA Statement of Purpose] and SLAA treats compulsive avoidance (anorexia) as its own problem with its own bottom lines [source: SLAA Journal #164]. Respond with values review, sexual health education and possibly sex therapy referral; consider whether SA's or SRA's fixed standard suits the client [synthesis].
Moral incongruence being reinforced. If distress rises while behaviour is low-frequency, revisit B2; with consent, discuss with the client whether the fellowship is helping; offer values-based or acceptance-based work [synthesis] [source for rationale: ICD-11 6C72; Grubbs et al. 2020].
LGBTQ+ client told by members or literature that their orientation is the problem. Name this as harmful; help the client move to an affirming fellowship (SCA or SAA) or leave; assess for internalised stigma and past conversion-practice exposure [synthesis] [source for SA definition: SA Practical Guidelines].
Sponsor or member boundary violations (sexual approaches to newcomers, exploitation, money, sponsors giving medical or legal directives). SRA advises weighing sexual attraction when choosing a sponsor and that either party may end sponsorship [source: SRA Program Tools]. Help the client end the relationship, change meetings, and report criminal conduct; fellowships have no professional regulator [synthesis].
Non-adherence to the plan. Treat as information: rewrite to what the client is willing to do [source: SCA Plan worksheet]; reduce to the few highest-harm items, as some SLAA sponsors do [source: SLAA Journal #164]; check for secret ambivalence about change [synthesis].
Compulsive recovery (many meetings daily, recovery crowding out life). SLAA's balance tool names this [source: SLAA Tools list]; agree a sustainable schedule [synthesis].
Rupture with the therapist (client feels judged, or feels the therapist undermines the programme). Acknowledge directly; clarify that you respect their fellowship while holding clinical responsibilities; avoid debating Twelve-Step theology; repair by returning to the client's goals [synthesis].
Mandated or coerced attendance (courts, partners, employers, faith bodies). Fellowships require only a personal desire to stop [source: SCA Statement of Purpose; SRA about page]. Help the client find their own reason or negotiate alternatives; document carefully [synthesis].
Legal or safeguarding disclosures in session. Follow your jurisdiction's mandatory reporting and duty-to-warn rules; fellowship anonymity does not change clinicians' obligations [synthesis].
Partner insists on full disclosure or monitoring. Slow the process, involve couple work, support the partner separately (COSA or similar) and avoid making the partner a monitor [synthesis] [source for COSA: Wikipedia SAA (secondary)].
Gaps in the published sources. Not found: any fellowship guidance on psychiatric comorbidity, suicide risk, medication, trauma, or clinician collaboration; SA, SAA and SRA founding details beyond those stated above; SCA's "Moving Through Withdrawal" and "14 Ways to Avoid a Slip" texts; SLAA's 40 questions and Augustine Fellowship basic text [uncertain].

Sources

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