This case study is a description of a psychoanalytically oriented therapy with a patient, Drew, who entered therapy self-identifying as a “sex addict” and struggling with aspects of the 12-step paradigm espoused in the Sex Addicts Anonymous group he had been attending for 5 years. I explored what effects and meanings this label—sex addict—had for Drew and how it related to his compulsive behaviors and intrusive thoughts. Throughout, I explored the challenges and frustrations posed by a relational therapeutic stance, whereby I empathized with Drew in a “non-blame paradigm” (Cohn, 2014, p. 79), which sometimes became destabilized by Drew’s inclination to self-pathologize his sexual activities.