Stigma from Therapists Toward BDSM and Kink-Practicing Clients

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Stigma from Therapists Toward Kink and BDSM Practicing Clients

Surprisingly, some therapists would outright state negative judgments or try to automatically pathologize a client for their interest in BDSM or kink activities. Due to fear of stigmatization, many people who practice BDSM do not disclose their sexual practices to their therapists; in turn, if there is a longer-term therapeutic relationship, the client feels uneasy about revealing this aspect of their lives out of fear, affecting the therapeutic alliance. (D’Adamo, 2022; Dunkley & Brotto, 2018; Nevard, 2021; Vencill & Pantalone, 2021) Additionally, some therapists incorrectly assume that a client practicing BDSM meant that they had experienced childhood trauma, was indicative of them performing self-sabotaging or self-harming behaviors, or abandoned the client due to disapproving of their sexual practices. (Rogak et al., 2018)

It is therapists' responsibility to know their biases and increase their education to best serve clients. As a client, please know that you can end a therapeutic relationship at any time if you feel uncomfortable or stigmatized by your therapist. It may be beneficial and therapeutic to have a conversation about your feelings with the therapist, but you don’t have to. It’s important that you feel supported and heard and that the focus of the sessions is based on your goals for therapy.

BDSM and Kink Basics and Benefits

BDSM practices, if done correctly, can be beneficial for mental health and well-being. One study, which interviewed BDSM practitioners who had experienced early childhood abuse, found that practicing BDSM could increase the likelihood of achieving post-traumatic growth. (Cascalheira et al., 2023) I want to become a kink-affirming and sex-positive sex therapist. Kolmes (2020) shares a basic acronym and principles of BDSM and kink practices: SSC, which stands for Safe Sane Consensual; RACK, which stands for Risk Aware Consensual Kink; and the concept of using safe words. Doing BDSM and kink practices emphasizes consent, negotiation of what is appropriate for all parties, awareness of risks and dangers, and use of safe words to create as safe an environment as possible. (Kolmes, 2020) An example of safe words include: “yellow” for approaching my limit and “red” for immediately stopping all practices at that time. (Kolmes, 2020)

General Basics:

  • Consent is critical

  • Discuss limits and boundaries before you’re turned on

  • Safe words – communicate what words mean “more,” “continue,” “slow down,” or “stop completely.”

  • Knowing your limits is important.

  • Open communication and trust are critical.

  • Don’t practice under the influence.

  • Learn from others and practice as safely as possible.

  • Aftercare – taking care of each other physically and psychologically after play.

(Kolmes, 2020)

A Couple of Kink and BDSM Myths

Myth: People who practice kink and BDSM are abusive and promote “rape culture.”

Truth: One study found that people who practice BDSM, a practice which, if done correctly, emphasizes explicit consent and boundaries, expressed less rape-supportive beliefs than the general population of people who do not practice BDSM. (Klement et al., 2017) The BDSM practitioners in the study reported fewer sexist beliefs and fewer victim-blaming attitudes. (Klement et al., 2017) People who practice BDSM report higher sexual satisfaction. (Strizzi et al., 2022)

Myth: People who practice kink and BDSM must be unhappy in their relationship.

Truth: Sometimes, therapists assume that practicing BDSM indicates relationship satisfaction is lower than in people who practice non-BDSM sexual practices, but this is not true; one study found that the relationship satisfaction between BDSM-practicing and non-BDSM-practicing people was the same. (Rogak & Connor, 2018)  The second takeaway from my research is that BDSM and kink-practicing clients can have the same relationship satisfaction as people who do not practice and can experience a higher level of sexual satisfaction, which may be counter to what some people may believe.

Education and Advice for Therapists to Better Serve BDSM and Kink-Practicing Clients

It is vital to have a strong Sex Therapy base of education and, from there, enroll or learn more about kink-affirming therapy for additional specialization. To provide a high level of care for BDSM and kink-practicing clients, Sprott et al. (2017) recommend that therapists investigate their stigmatizing views and biases and make use of consulting with other therapists who may have more experience and knowledge of how to best work with people who have alternative sexual practices.

Something to keep in mind as a clinician: A study by Brown et al. (2017) in which they found that BDSM practitioners experience higher rates of suicidal ideation than people who do not practice BDSM. The BDSM practitioners in their study reported that 12% had experienced suicidal ideation as compared to 0.5% of the general population, and cisgender male BDSM practitioners were at higher risk of experiencing suicidal ideation and attempts when compared to cisgender female BDSM practitioners. (Brown et al., 2017) Keeping this information in mind, clinicians must screen for suicidal ideation but keep in mind not to stigmatize the client or for their BDSM practices and not to tie their sexual behavior to their suicidal ideation because although there may be a correlation between their practices and higher risk, it is likely not the cause of their suicidal ideation or previous attempts.

To examine their biases and attitudes toward different sexual practices and experiences, it is recommended that all clinicians enroll and participate in a Sexual Attitude Reassessment (SAR) workshop. The SAR workshop helps clinicians gain exposure to a variety of different sex acts (such as group sex or food play), different populations having sex that they may not have been exposed to (such as differently abled people), and they get the opportunity to discuss their experiences and how their opinions have changed in a safe container. In addition to helping clinicians check in on their potential biases and viewpoints on sex, a SAR can help a clinician gain exposure to sexual acts outside of a client, first informing them of a sexual act that is outside of their realm of experience or knowledge. This, in turn, can help the clinician mitigate their automatic reactions toward a client’s disclosure so they do not inadvertently shame the client.

For kink and BDSM-affirming education, there are formal certifications that are longer and shorter courses so therapists can get exposure to what it is like to work with kink and BDSM practitioners; there are several different resources:

       

Additional Resources

 

References:

Berry, M. D., & Lezos, A. N. (2017). Inclusive sex therapy practices: a qualitative study of the techniques sex therapists use when working with diverse sexual populations. Sexual & Relationship Therapy, 32(1), 2–21. https://doi.org/10.1080/14681994.2016.1193133

Brown, S. L., Roush, J. F., Mitchell, S. M., & Cukrowicz, K. C. (2017). Suicide Risk Among BDSM Practitioners: The Role of Acquired Capability for Suicide. Journal of Clinical Psychology, 73(12), 1642–1654. https://doi.org/10.1002/jclp.22461

Cascalheira, C. J., Ijebor, E. E., Salkowitz, Y., Hitter, T. L., & Boyce, A. (2023). Curative kink: survivors of early abuse transform trauma through BDSM. Sexual & Relationship Therapy, 38(3), 353–383. https://doi.org/10.1080/14681994.2021.1937599

D’Adamo, K. (2022). Kink as healing professional. Ethics & Social Welfare, 16(2), 206–213. https://doi.org/10.1080/17496535.2022.2042038

Dunkley, C. R., & Brotto, L. A. (2018). Clinical considerations in treating BDSM practitioners: A review. Journal of Sex & Marital Therapy, 44(7), 701–712. https://doi.org/10.1080/0092623X.2018.1451792

Klement, K. R., Sagarin, B. J., & Lee, E. M. (2017). Participating in a culture of consent may be associated with lower rape-supportive beliefs. Journal of Sex Research, 54(1), 130–134. https://doi.org/10.1080/00224499.2016.1168353

Kolmes, K. (2020). An introduction to BDSM for psychotherapists. Society for the Advancement of Psychotherapy. https://societyforpsychotherapy.org/an-introduction-to-bdsm-for-psychotherapists/

Nevard, I. (2021). Counseling and the kink community: a thematic analysis. British Journal of Guidance & Counselling, 49(4), 617–628. https://doi.org/10.1080/03069885.2019.1703899

Sprott, R. A., Herbitter, C., Grant, P., Moser, C., & Peggy J. Kleinplatz, P. J. (2023). Clinical guidelines for working with clients involved in kink. Journal of Sex & Marital Therapy, 49(8), 978-995. https://doi.org/10.1080/0092623X.2023.2232801

Stockwell, F., Hopkins, L., & Walker, D. (2017). Implicit and explicit attitudes toward mainstream and BDSM sexual practices and their relation to interviewer behavior: An analogue study. Psychological Record, 67(4), 435–446.

https://doi.org/10.1007/s40732-017-0225-4

Rogak, H. M. E., & Connor, J. J. (2018). Practice of consensual BDSM and relationship satisfaction. Sexual & Relationship Therapy, 33(4), 454–469. https://doi.org/10.1080/14681994.2017.1419560

Strizzi, J. M., Øverup, C. S., Ciprić, A., Hald, G. M., & Træen, B. (2022). BDSM: Does it hurt or help sexual satisfaction, relationship satisfaction, and relationship closeness? Journal of Sex Research, 59(2), 248–257. https://doi.org/10.1080/00224499.2021.1950116

Vencill, J. A., & Pantalone, D. W. (2021). Representation of sexual and gender minority experiences in the kink/BDSM literature: Considering the clinical implications. Psychology of Sexual Orientation and Gender Diversity, 8(3), 384–385. https://doi.org/10.1037/sgd0000535

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