AbstractPaul, a 47-year-old, was referred to me for follow-up care after inpatient treatment for his sexual addiction and depression. He was married and had a stepdaughter and stepson. This, his only marriage, was of eight years duration. The hospitalization occurred as a result of fears of acting on his sexual fantasies about his 16-year-old stepdaughter. Paul had a long history of compulsive sexual fantasizing and masturbation. Within the past two years, he had begun to fantasize about his stepdaughter. His fantasies did not include other teenage girls. He also had a history of compulsive overeating and had been chronically overweight. He was a recovering alcoholic of 20 years. Paul was isolated, he had few friends, and his marriage was strained. He was sexually dysfunctional, having never been orgasmic during intercourse. His sexual activity in the past two years was exclusively autoerotic. During inpatient treatment, Paul had a memory of being sexually abused as a child.