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An Introduction to BDSM for Psychotherapists

Cite This Article

Kolmes, K. (2015, October). An introduction to BDSM for psychotherapists. [Web article]. Retrieved from: http://www.societyforpsychotherapy.org/an-introduction-to-bdsm-for-psychotherapists

What is BDSM?

BDSM is an acronym that refers to Bondage & Discipline, Dominance & Submission, or Sadism & Masochism between consenting adults. It may be considered a practice, a lifestyle, an orientation, and a subculture. However, many people may engage in BDSM practices while not identifying with this label. Other terms you may hear to indicate an interest or affiliation with BDSM include kink, fetish, leather, and S&M.

Although popular culture may convey BDSM as something that is about inflicting or receiving pain, there are many people who engage in BDSM who simply eroticize bondage, sensation play (pain, hot/cold, touch, tickling, etc.), or power dynamics. Some prefer just one of these activities and do not pursue play that includes the full range of these behaviors.

People who engage in BDSM may take part in “scenes” when they “play” together. Those who practice BDSM may identify as dominants, tops, masters, mistresses, or sadists. Those who are in more passive roles may identify as submissives, subs, bottoms, masochists, boys and girls, or slaves. Some people switch roles during play and are called switches.

Negotiating Boundaries

People engage in very careful negotiations before play in which boundaries, limits, and sensitivities are explained and agreed upon. For example, a submissive may expressly state that he or she does not like being called certain names during a scene. Or, he or she may object to pain play but enjoy performing acts of service. It is the responsibility of both parties to clearly communicate preferences and limits before play.

Another part of negotiation includes what each party (especially the bottom or submissive) may need as aftercare when they are coming down from the scene. Many people also require some aftercare and a check in the day after play.

Skilled “players,” understand these aspects of play and they also have usually obtained education in learning how to practice these acts without causing serious harm. For example, they know where on a person’s body it is dangerous to engage in “impact play” (e.g., spanking or flogging). Or they know how to put someone into bondage safely without risking loss of circulation, inability to breathe, or damage to limbs or organs.

SSC = Safe, Sane, and Consensual

These are the principles guiding BDSM play. Safe means measures are taken to prevent risks. Sane means that people do not engage in BDSM when drunk, tired, or under the influence of substances or strong emotions, but are sure to be in a sound state of mind. Consensual means that the full consent of all parties is obtained before entering into play. Other people use the term RACK which stands for Risk Aware Consensual Kink.

What are Safe Words?

These are agreed upon words that any partner can use to slow down or end a BDSM scene immediately. For example, “yellow,” might be used to indicate that the bottom or submissive needs things to slow down, whereas “red” would indicate, we need to stop now. But tops and dominants might also decide to slow down or stop scenes if they become concerned about safety. If someone is gagged, other cues may be used such as one hand squeeze or two, or having the bottom drop a handkerchief she is holding to communicate non-verbally to her top.

Who Engages in BDSM?

  • The Kinsey Institute estimated that 5-10% of people in America engaged in BDSM for sexual pleasure (Reinisch & Beasley, 1990).
  • Janus & Janus (1993) found that up to 14% of American males and 11% of American females have engaged in some form of BDSM behavior.
  • A 2005 survey of 317,000 people indicated that 10% of people in the U.S. have engaged in BDSM and 5% of people worldwide have engaged in it (Durex, 2005).
  • Over 60% of 1,516 people have fantasized about BDSM (Joyal, Cossette, & Labierre, 2014).
  • People of all genders, abilities, ethnicities, and sexual orientations engage in BDSM.

Why Learn More About Kinky Clients?

  • Because there may be kinky people in your practice who just haven’t revealed themselves to you. You don’t want to commit a microaggression against such a client.
  • Because a friend, family member, or partner of a kinky person may be a patient of yours and they may wish to discuss this with you.
  • Because you will need to be a safe and knowledgeable clinician by the time a client discloses these things to you.
  • Because you should know when it is appropriate to refer a client to a kink-aware clinician or when you need to consult with one.

In a study on 175 kink-identified people who had been in treatment, 65% disclosed their BDSM identity to their psychotherapist and 45% did not ever tell their psychotherapist they were kinky (Kolmes, Stock, & Moser, 2006).

Why Do They Do It?

Most participants who engage in BDSM report that it is trust enhancing. It is experienced as pleasurable and joyful. They report enhanced intimacy and greater sexual satisfaction.

It is important to remember that not everyone experiences sensation or pain in the same way, and when aroused, many people experience pain differently than they would when not aroused. Others enjoy playing with the power dynamics.

Many people consider kink just one of the activities they enjoy and they also enjoy and engage in “vanilla” (non BDSM) sex and intimacy.

Are BDSM People Pathological?

Despite being historically stigmatized and pathologized, there is empirical evidence negating such theories of mental illness for BDSM participants.

One study of 132 American BDSM practitioners showed that the sample was comparable to published norms on tests of clinical pathology and severe personality pathology (Connolly, 2006) and there were no elevations on measures of depression, anxiety, OCD, psychological sadism or masochism, or PTSD. This study did, however, indicate slightly higher levels of narcissism in the BDSM group.

In a nationally representative sample from Australia, BDSM play was not related to any sexual difficulties or higher psychological distress, and, in fact, men had significantly lower psychological distress than the non-BDSM control group (Richters et al, 2008).

In a Dutch study of 902 participants, BDSM participants were found to be less neurotic, more extraverted, more open to new experiences, more conscientious, but less agreeable. They also had similar or better attachment scores than the control group, were less sensitive to rejection, and reported higher subjective well-being. (Wismeijer & van Assen, 2013).

BDSM vs. Abuse 

Sometimes abuse does occur in a BDSM relationship. It is when this is happening that a clinician well-versed in the community norms can help a client identify this. Abuse in BDSM relationships can be particularly difficult for a client to deal with. Because the BDSM community is already stigmatized, many people feel afraid of telling others about abuse, especially if it happens with an experienced player who has a good reputation. This may lead to greater isolation. NCLR offers a good document defining the difference between BDSM and abuse.

Why do BDSM or Kinky People Seek Treatment?

In one study, 74.9% of 175 BDSM clients noted that the issues that brought them into therapy had nothing to do with BDSM (Kolmes, Stock, & Moser, (2006).

However, when several kink-aware practitioners were asked by this author to note themes that had come up in therapy with kinky people when the treatment issues were directly related to kink, the following items were listed (personal communication, 2013):

  • Coming out (to self, partner, or someone else) or fear of others discovering BDSM identity or interests;
  • Compulsive issues around sexuality or BDSM;
  • Discomfort with BDSM identity or wanting to extinguish BDSM interests;
  • Fear of not being able to find partner(s) with compatible desires/interests;
  • Identifying or recovering from an abusive dynamic in a BDSM relationship;
  • Guilt and shame about accidentally hurting a partner or crossing a partner’s boundaries;
  • Lack of clarity around sexual interests or type(s) of sensation or power dynamics that would be most satisfying;
  • Mismatch in sexual preferences within a relationship;
  • Difficulty sharing BDSM community space with a former partner after a breakup.

Are There Guidelines for Working with BDSM Clients?

APA has not published formal guidelines; however, those familiar with kinky clients in psychotherapy have suggested some. These guidelines (Kolmes & Witherspoon, 2012) were adapted from Kleinplatz & Moser (2004), and they also include polyamorous people (those who practice consensual nonmonogamy).

  • Be aware that distress over kink or poly identity may be a normal part of internalized cultural bias against the sexual orientation rather than evidence of a disorder. The clinician can take the role of validating the distress and helping a client to locate and get support from community resources.
  • Take note of whether and how kink or poly identities affect work, social, and family relationships.
  • Be careful to not assume that a client’s presenting issue is caused by or is related to their kink or poly lifestyle.
  • Be mindful about making assumptions about clients’ treatment goals – particularly that these goals include changing their sexual desires.
  • Do not try to “cure” clients of BDSM or poly desires. This may be   as ineffective as reparative therapy for LGBT clients.
  • Do not assume abuse when someone is in a BDSM relationship.
  • Do not assume a client is cheating or is tolerating cheating if they bring up other partners.
  • Do not assume that BDSM interests mean that a client is not also interested in conventional sexual behaviors.
  • Be aware of your own countertransference issues and how they may enter the therapy. Consult with colleagues who are knowledgeable about altsex behavior.
  • Educate yourself, seek consultation, or refer out when you are practicing outside of your boundaries of competence.

Who are Kink-Aware Professionals and Where Can I Find One?

If you are looking for a Kink-Aware professional in your community to refer to or consult with, the best national resource is at the National Coalition of Sexual Freedom. Their Kink-Aware Professionals database also includes other professionals such as attorneys and accountants.

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References

BDSM Impact Play Safe Zones - Deviance & Desire. (2014, December 10). Retrieved from http://bdsminthemind.boydenon.com/2014/12/bdsm-impact-play-safe-zones/

BDSM vs Abuse. (n.d.) Retrieved from https://ncsfreedom.org/key-programs/consent-counts/consent-counts/item/467-sm-vs-abuse.html

Connolly, P. (2006). Psychological functioning of bondage/domination/sadomasochism (BDSM) practitioners. Journal of Psychology and Human Sexuality, 18(1), 79-120.

Durex. (2005). Durex 2005 Global Sex Survey. Retrieved from http://www.durex.com/en-jp/sexualwellbeingsurvey/documents/gss2005result.pdf

Janus, S. S. & Janus, C.L., (1993). Janus report on sexual behavior. New York: John Wiley and Sons, Inc.

Joyal, C.C., Cossette, A., & Lapierre, V. (2014). What exactly is an unusual sexual fantasy? The Journal of Sexual Medicine. doi:10.1111/jsm.12734

KAP Directory. (n.d.). Retrieved from https://ncsfreedom.org/resources/kink-aware-professionals-directory/kap-directory-homepage.html

Kleinplatz, P. and Moser, C. (2004). Toward clinical guidelines for working with BDSM clients. Contemporary Sexuality, 38(6), 3-4.

Kolmes, K., Stock, W., & Moser, C. (2006). Investigating bias in psychotherapy with BDSM clients. Journal of Homosexuality, 50(2-3) pp. 301-324.

Kolmes K., & Witherspoon, R. G. (2012).  Sexual orientation microaggressions in everyday life: Expanding our conversations about sexual diversity: Part I. Independent Practitioner, Summer 2012.

Kolmes K., & Witherspoon, R. G. (2012).  Sexual orientation microaggressions in everyday life: Expanding our conversations about sexual diversity: Part II. Independent Practitioner, Summer 2012.

Reinisch, J. M., & Beasley, R. (1990). The Kinsey Institute new report on sex: What you must know to be sexually literature. New York: St. Martin’s Press.

Richters, J., de Visser, R.O., Rissel, C.E., Grulich, A.E., & Smith, A.M. (2008). Demographic and psychosocial features of participants in Bondage and Discipline, Sadomasochism or Dominance and Submission. (BDSM): Data from a national survey. Journal of Sexual Medicine, 5(7), 1660-1668. Doi:10.1111/j.1743-6109.2008.00795x.

Wismeijer, A. J., & van Assen, M. L. (2013). Psychological characteristics of BDSM practitioners, The Journal of Sexual Medicine, 1-10. doi:10.1111/jsm.12192

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