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Counselors who treat clients for compulsive sexual behavior often encounter challenging ethical decisions that are not fully addressed by professional codes of conduct. This article describes six core concepts that can provide a meaningful and efficient framework for a counselor to independently evaluate ethically challenging situations. These core concepts provide informed consent, operate in a competent and theoretically sound manner, insure confidentiality, and maintain clarity of cultural and personal values. Special attention is devoted to confidentiality dilemmas including duty to warn/protect, HIV, minors, and family secrets, as well as counselor boundary issues such as self-disclosure, touch, sexual attraction, and a personal history of compulsive sexual behavior.