Masturbation almost always includes fantasy and for true sex addicts such fantasy can amplify into a downward spiral of obsession, objectification and eventually full-fledged compulsion. This is especially true when pornography is included as part of a masturbation ritual. From this perspective masturbation may need to be considered off-limits for many sex addicts. Treatment Stages One expert in treating patients with compulsive sexual behaviors conducted a study that included nearly 1,000 people. He examined the steps these patients took in recovery and treatment and was able to outline the general stages and how long they lasted. Each person is unique, but he found that, in general, patients moved through these stages before being in recovery. Group Treatment Experience When I provided inpatient treatment for Dr. Carnes, we had stuffed animals for hugging in our hospital day room. Between the cute stuffed animals was an ugly, humpbacked dragon with only one eye. Once, as I walked past, I saw some patients kicking this creature around and calling it names. As a relationship expert, I had two immediate questions: Who gave him the idea that he needed to surrender to anything? Why did he think was doing it wrong? I soon learned that the very person he and his betraying partner turned to for guidance, their couples therapist, had implicated him as the problem partner! There is so much to discuss about needs, but what I want to focus on in this article is how I help individuals and couples break needs down in order to understand where this larger topic of needs might be getting stuck for them. We can look at the navigation of needs in several stages. As I break it down, think about which part may be most difficult for you. As with the paralytic, the conditions we deal with actually consist of two problems. With a pornography/sexual addiction, the outer problem is our acting out behaviors. And for the spouse, it is the loss of trust and damage to a marriage relationship. We want all of these circumstances we find ourselves in to go away.