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Abstract

Participants in alternative or ‘kinky’ sexual behaviours are a sizable enough minority that psychotherapists are likely to see them in their practices. However, those who engage in bondage and discipline (BD), dominance and submission (DS) and sadism and masochism (SM) (BDSM) are concerned that mental health-care providers will view BDSM as evidence of psychopathology. This research employed an Internet-based survey of 766 therapists in the United States to assess therapists' attitudes towards the BDSM community. Seventy-six per cent of the sample reported having treated at least one client who engaged in BDSM, although only 48% perceived themselves to be competent in this area. Attitudes towards BDSM were related to socio-demographic variables and self-perceived competence.

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... This paper explores how counselor education and clinical interventions can be enhanced through increased knowledge and understanding of kink culture and practice. misunderstanding as well as continued stigmatization and clinical judgment errors of sexual subcultures such as the kink community (Diambra, Pollard, Gamble, & Banks, 2016;First, 2014; P. Kleinplatz & Moser, 2004;Kelsey, Stiles, Spiller, & Diekhoff, 2013;Laska, 2013;Miller & Byers, 2010;Nichols, 2006;Walters & Spengler, 2016). ...
... This is particularly evident in non-normative sexual behavior such as kink. Several studies have reported that kink clients experience bias and pathologizing-even having their sexual practices reported to legal authorities despite the fact that no criminal sexual activity had been disclosed (Harris & Hays, 2008;Kelsey et al., 2013;Yost, 2010). Kelsey et al., (2013) surveyed 766 psychotherapists in the United States to assess attitude toward and self-reported competence for working with BDSM clients. ...
... Several studies have reported that kink clients experience bias and pathologizing-even having their sexual practices reported to legal authorities despite the fact that no criminal sexual activity had been disclosed (Harris & Hays, 2008;Kelsey et al., 2013;Yost, 2010). Kelsey et al., (2013) surveyed 766 psychotherapists in the United States to assess attitude toward and self-reported competence for working with BDSM clients. While 76% of the participants stated they worked with clients who engaged in kink sexuality, only 48% rated themselves as competent to do so. ...
... Kink-involved communities have largely been viewed as non-normative and negative societal implications have been attributed to them (Blount, Booth, Webb, & Liles, 2017;Kelsey et al., 2013). Th e kink sexualities involve: ...
... In a recent book by Lehmiller (2018), BDSM is one of the most common types of sexual fantasies. One study found at least 11% of women and 14% of men have engaged in some sort of consensual, non-normative sexual activity (Kelsey, Stiles, Spiller, & Diekhoff , 2013). Kelsey et al. (2013) surveyed 766 psychotherapists revealed 76% reported having treated at least one client who engaged in BDSM with an average number of 6.7 clients reporting BDSM involvement. ...
... One study found at least 11% of women and 14% of men have engaged in some sort of consensual, non-normative sexual activity (Kelsey, Stiles, Spiller, & Diekhoff , 2013). Kelsey et al. (2013) surveyed 766 psychotherapists revealed 76% reported having treated at least one client who engaged in BDSM with an average number of 6.7 clients reporting BDSM involvement. Sixty-four percent of those surveyed reported no training in working with BDSM individuals in graduate school. ...
Article
There is a growing movement to incorporate sex positivity into clinical and counseling psychology. Although sex positivity has a framework that promotes diversity and inclusion, intersectionality in sex positive research, training, and practice is practically non-existent. The aim of the present paper is to analyze issues related to sex and sexuality from an intersectional sex positive framework. Discussion surrounding intersectional issues among subgroups, sexualities, and relationship structures will be provided. In order to fully adopt an intersectional sex positive approach, recommendations for research, training, and practice will be described.
... Counselors frequently report feeling uncomfortable engaging in sexuality-related topics in session and many actively avoid doing so (Dupkoski, 2014). Research shows that many counselors are biased against SGM clients in some way (Kelsey et al., 2013) and many counselors outright report incompetence in this area (Harris & Hays, 2008;Kelsey et al., 2013). This general lack of ability is important to overcome because it has been frequently documented that inadequately prepared counselors are detrimental to their SGM clients (Grove, 2009), who already have higher than average rates of mental health disorders and higher rates of seeking counseling (Herek, 2009;Meyer, 1995). ...
... Counselors frequently report feeling uncomfortable engaging in sexuality-related topics in session and many actively avoid doing so (Dupkoski, 2014). Research shows that many counselors are biased against SGM clients in some way (Kelsey et al., 2013) and many counselors outright report incompetence in this area (Harris & Hays, 2008;Kelsey et al., 2013). This general lack of ability is important to overcome because it has been frequently documented that inadequately prepared counselors are detrimental to their SGM clients (Grove, 2009), who already have higher than average rates of mental health disorders and higher rates of seeking counseling (Herek, 2009;Meyer, 1995). ...
Article
The purpose of this study was to examine the lived experiences of fifteen counselors-in-training (CITs) who had completed a sexuality counseling course. The study design was a thematic analysis of qualitative codes developed through a constant comparative method applied to transcribed interviews. Four themes were found: (a) competency issues, (b) sensitivity concerns, (c) awareness of a need for continued exposure throughout all their education and training, and (d) disappointment in the level and availability of education and training outside of this one course in their program. Data-driven suggestions for how to better to prepare CITs through sexuality counseling courses are offered.
... This study also examines what kind of individuals in a specific socio-cultural context (e.g. conservative or liberal, adhering to social norms or not) are more favorable toward less typical sexual practices and/or preferences such as BDSM (Kelsey et al., 2013;Rye et al., 2011). ...
... In all, research data show that BDSM practitioners may experience stigmatization due to their endorsement of this sexual activity. For example some express fear of being fired from their jobs due to their BDSM preferences (Kelsey et al., 2013). Feminist power struggles and hegemonic discourses stemming from patriarchal structures may also affect social attitudes toward BDSM practices (Carlstrom, 2017). ...
Article
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Opposition and stigmatization toward BDSM (bondage and discipline, dominance and submission, and sadomasochism) preferences or lifestyles only recently have begun to be documented. BDSM is stigmatized since vanilla sexuality (standard or conventional sexual practice) is considered the norm assuming BDSM practitioners as socially unacceptable, and BDSM as an unethical and unacceptable form of sex. This study examined women’s attitudes toward BDSM practices in the Greek socio-cultural context. An exploratory cross-sectional study was conducted between October 12 and December 12, 2021, via an online survey. This study’s convenience sample consisted of female undergraduate students (N = 240) who were recruited from two universities in the northern part of Greece. A between-subjects, correlational design was employed. Bivariate correlation was generated to explore the associations between variables of interest. Next, a multiple regression model was employed to predict ASMS (Attitudes toward Sadomasochism Scale) from the other study measures, based on the significance of the associations. This study’s findings show that the more conservative participants (whether in political or religious terms) oppose BDSM practices. The current study adds to the limited literature that examines the attitudes of people toward BDSM intending to clarify the social-psychological and socio-cultural factors that shape prejudicial attitudes towards BDSM and enhance the efforts of advocacy groups to promote social justice.
... Research has shown that unless specifically requested, mental health professionals avoid addressing, diagnosing, and treating sexuality issues in session, which includes sexuality growth and training opportunities due to personal discomfort (Hanzlik & Gaubatz, 2012;Miller & Byers, 2009;Ng, 2007). As a result of this discomfort, clinicians frequently evade dialogue about sexuality issues (Burnes, Singh, & Witherspoon, 2017;Dupkoski, 2012;Harris & Hays, 2008), particularly when the concerns extend beyond their content-based knowledge, further inhibiting client disclosure and dialogue around sexuality-related issues (Hanzlik & Gaubatz, 2012;Kelsey, Stiles, Spiller, & Diekhoff, 2013). Similarly, when counselors believe that they received inadequate training to work with the LGBTQIA+ community, they are more likely to reference personal life experiences to make up for their educational shortcomings (Owen-Pugh & Baines, 2013). ...
... Sexuality is an innate part of human development that impacts mental and physical health and is integral to one's wellbeing. Research evinces that, often, clinicians either avoid the discussion of sexuality issues (Burnes et al., 2017;Dupkoski, 2012;Harris & Hays, 2008) or are often unwilling to explore or ask about sexuality concerns (Hanzlik & Gaubatz, 2012;Kelsey et al., 2013). With a lack of confidence and willingness to discuss sexuality issues on the part of clinicians and clients, this leaves massive deficits in a client's mental health and wellness needs that should be addressed. ...
Article
Full-text available
Although sexuality counseling is an essential component in counselor education training, research demonstrates that counselors lack competence and willingness to explore sexuality issues with clients. Counselors must be ready to address sexuality issues to provide comprehensive and culturally competent care. Sexuality counseling education needs further exploration to inform future training and educational standards. This qualitative study uses thematic analysis to examine 524 reflective journals of counselors-in-training (CIT) engaged in a sexuality counseling course to inform future education, training, and clinical practice standards in this area. This study revealed themes reflecting common ways CIT matured personally and professionally through sexuality counseling education and identified critical factors and barriers that enhanced and hindered learning outcomes.
... Measures for gender minorities have also been created by contrasting the gender identity scales to existing sexual orientation scales (Nagoshi et al., 2008). Most of the literature regarding competencies with BDSM practitioners has utilized study specific surveys (e.g., Kelsey et al., 2013;Stockwell et al., 2017). Kleinpatz and Moser (2004) proposed a set of guidelines for therapists who work with BDSM-active patients. ...
... Providers should take steps to make all clients feel welcome in their practice. For those patients who are a part of the BDSM community, it is important that a provider not make them feel as though they are engaging in an unhealthy behavior (Kelsey et al., 2013;Kolmes et al., 2006). ...
Article
Full-text available
Disparities in the health services delivered to sexual and gender minority (SGM) individuals are widespread across health service disciplines. Many health service providers do not have the knowledge, comfort, or skills necessary to provide health services to SGM individuals. The objective of the current systematic review was to review the correlates of competency (defined as knowledge, attitude, and skill) that health service providers possess for working with SGM individuals. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PsycInfo/PsycArticles, PubMed/Medline, and Google Scholar databases were searched to find studies that addressed health service providers’ competency working with SGM individuals. There were 31 studies included in the review. Approximately half of the studies utilized the full definition of competency (knowledge, attitude, and skill). The most common competency assessed was knowledge, and the least common was skill. The majority of the studies addressed health service providers in the social sciences. Health service education needs to emphasize competency working with SGM individuals. Of particular importance is developing skill sets, as many providers reported that they did not have the skills necessary to provide culturally competent health services to SGM individuals.
... Guideline 21: Clinicians support the development of professional education and training on kink-related issues. Kelsey et al. (2013) conducted a survey of therapists' attitudes and experiences with kinkinvolved clients (n=766). They found that 76% had treated at least one kink-involved client, but KINK CLINICAL GUIDELINES DEC. ...
... Clinicians as professionals have an ethical responsibility to develop their field and increase the effectiveness of their work with clients, and this includes addressing kink interests and kink involvement as part of professional education and continuing education and training as clinicians. There is abundant evidence from the clinical professionals and from the kink communities that kink-involved people are asking for clinicians to be better trained (Dunkley & Brotto, 2018;Hoff & Sprott, 2009;Kelsey et al, 2013;Kolmes, Stock & Moser, 2006). ...
Technical Report
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Created by a team of clinicians and researchers (19 members), the practice guidelines presents the current best knowledge and practices for working with clients and patients who have strong interests in kink sexuality, who are kink-identified, or who are involved in fetish, BDSM, leather or kink communities.
... These mixed social attitudes toward BDSM can lead to lack of disclosure in clinical contexts, with many BDSM practitioners being worried about disclosure during therapy (Kelsey, Stiles, Spiller, & Diekhoff, 2013;. A study of licensed mental health professionals 965 found that 76% reported having at least one client that engaged in BDSM ( Kelsey et al., 2013). ...
... These mixed social attitudes toward BDSM can lead to lack of disclosure in clinical contexts, with many BDSM practitioners being worried about disclosure during therapy (Kelsey, Stiles, Spiller, & Diekhoff, 2013;. A study of licensed mental health professionals 965 found that 76% reported having at least one client that engaged in BDSM ( Kelsey et al., 2013). Sixty-seven percent agreed that it could be part of a healthy relationship, and 70% disagreed that it should be treated through therapy. ...
Article
Full-text available
BDSM (bondage, discipline, dominance, submission, and sadomasochism) encompasses a diverse set of sexual interests. Research interests in BDSM have been historically underpinned by examining potential mental health issues, unhealthy fixations on specific sexual behaviors, and/or the presence of childhood trauma, as is predicted by psychopathological and psycho-10 analytic models. The objective of this scoping review was to provide an overview of the current landscape of BDSM research, including incidence rates, evidence for psychopathological, psychoanalytical, biological, and social etiological factors, demographics of BDSM practitioners , and the psychological correlates of those with BDSM interests. After the literature search and screening process, 60 articles were included. BDSM related fantasies were found to 15 be common (40-70%) in both males and females, while about 20% reported engaging in BDSM. Results show little support for psychopathologic or psychoanalytic models. In the selected samples studied, BDSM practitioners appear to be white, well educated, young, and do not show higher rates of mental health or relationship problems. Research supports BDSM being used as a broadening of sexual interests and behaviors instead of a fixation on a specific interest. Future 20 empirical research should focus on non-pathological models of BDSM, discrimination of BDSM practitioners, interpersonal relationships, and biological factors.
... Practitioners should continue their education and training associated with expanding knowledge and competency of marginalised communities, including an understanding of their behaviours and unique needs. In one study of psychotherapists, researchers found that a majority of respondents did not have any formal training addressing BDSM topics or other sexual diversity issues, even though 76% had seen a client reporting some type of BDSM involvement (Kelsey, Stiles, Spiller, & Diekhoff, 2013). Furthermore, in the same sample of psychotherapists, researchers found that only 48% rated themselves as competent in the area of sexual diversity and BDSM topics (Kelsey et al., 2013). ...
... In one study of psychotherapists, researchers found that a majority of respondents did not have any formal training addressing BDSM topics or other sexual diversity issues, even though 76% had seen a client reporting some type of BDSM involvement (Kelsey, Stiles, Spiller, & Diekhoff, 2013). Furthermore, in the same sample of psychotherapists, researchers found that only 48% rated themselves as competent in the area of sexual diversity and BDSM topics (Kelsey et al., 2013). Therefore, it is critical that practitioners seek out good clinical supervision, along with individual therapy if necessary and additional educational and training opportunities to help combat individual experiences of shame and create an open environment to address issues of sexuality as they arise. ...
Article
Full-text available
The BDSM community comprises a diverse group of individuals who engage in bondage and discipline, dominance and submission, and sadomasochism, among other practices associated with role play, fetishes and leather. To date, there remains a limited amount of literature and research surrounding the personal and professional lives of those who practice BDSM, along with subsequent implications for health and mental health practitioners. A mixed method online survey was conducted to examine the lives and experiences of individuals who practice BDSM. A total of 63 participants, predominately white, North American, heterosexually identified and college educated responded to the survey. Main qualitative themes included the following: (1) role of various intersecting identities; (2) openness and disclosure of BDSM identity; and (3) shame, empowerment and resilience. Results will be presented from a systemic and strengths-based perspective to help create a clearer understanding of this uniquely diverse community while also providing implications for practitioners in the field.
... These fallacies include: those who enjoy kink come from a history of childhood trauma or abuse (there is no reported evidence that people who enjoy kink are any different than those who do not in terms of histories of trauma or abuse); kink is similar to addiction, in that participants will always want to try something more extreme (there is also no such evidence of this phenomenon, though there is research suggesting that individuals may reach a plateau unique to themselves) (Barker, 2005;Barker et al., 2007;Nichols, 2006); poly-identified people are promiscuous (research indicates that some poly-identified people consider themselves to be promiscuous, while others reject the term promiscuity as culturally relative and pathologizing of sexuality, and still others have fewer lifelong partners than many monogamous-identified people); poly-identified people run a higher risk of contracting sexually transmitted infections (STIs) than monogamous-identified people (research shows that while poly-identified people may have more lifetime sexual partners than monogamousidentified people, the former report greater condom use and more frequent STI testing than the latter, with no difference in STI diagnoses across relationship type) (Klesse, 2006;Lehmiller, 2015;Wosick-Correa, 2010). It is not uncommon for non-kink-and/or polyidentified therapists to be reported by clients as inadequate, or feel inadequate themselves in treating kink-and/or poly-identified individuals (Bettinger, 2003;Brandon, 2011;Graham, 2014;Kelsey, Stiles, Spiller, & Diekhoff, 2013). In a 2013 study assessing therapists' attitudes towards BDSM, 76% of the sample had worked with at least one BDSMoriented client, though only 48% felt they were culturally competent enough to do so (Kelsey et al., 2013). ...
... It is not uncommon for non-kink-and/or polyidentified therapists to be reported by clients as inadequate, or feel inadequate themselves in treating kink-and/or poly-identified individuals (Bettinger, 2003;Brandon, 2011;Graham, 2014;Kelsey, Stiles, Spiller, & Diekhoff, 2013). In a 2013 study assessing therapists' attitudes towards BDSM, 76% of the sample had worked with at least one BDSMoriented client, though only 48% felt they were culturally competent enough to do so (Kelsey et al., 2013). Research indicates a gap in both kink and poly content in most mental health training programs (Bettinger, 2003;Graham, 2014;Pillai-Friedman et al., 2015), highlighting the importance of therapists' self-awareness around cultural competency, and the need for therapists to self-educate, seek consultation or supervision, and promptly refer their clients to a culturally competent colleague as needed (Kleinplatz & Moser, 2004;Pitch, 2014). ...
Article
Full-text available
There is little academic literature published on the intersection of kink- and polyamorous-identified individuals, though there are relatively frequent mentions of people who identify as both kink- and poly-oriented in the literature that focuses on one or the other of the two communities. The prevalence of intersecting kink and poly identifications tends to be acknowledged, accepted, and depathologized in both communities, and polyamory is sometimes considered a norm in certain kink subcultures. In order to help and give voice to this understudied population, a review of the literature was conducted on the characteristic commonalities in these communities, as well in kink- and poly-oriented relationships. Common themes in the intersection of these relationship types are identified; historical background is given for the respective communities; theories of identity formation are explored; clinical issues are reviewed; and recommendations for clinical interventions are made.
... With very few exceptions (e.g. Kelsey, Stiles, Spiller, & Diekhoff, 2013;Stockwell, Walker, & Eshleman, 2010;Yost, 2010), little is known about attitudes towards BDSM by non-practitioners. Kelsey et al. surveyed PhD-level psychotherapists through the internet and found that attitudes were generally favourable towards BDSM. ...
... Similar to our results, Yost (2010) found that scores on sexual conservatism were correlated with her sadomasochism scale such that those who were sexually conservative were more negative towards sadomasochism. Although not sexuality-related, Kelsey et al. (2013) also found that therapists who were more sociopolitically conservative were more negative towards BDSM. In the current study, across different measures and at different time points, erotophobia-erotophilia predicted comfort with and feelings about BDSM. ...
Article
Full-text available
This study is an empirical investigation into some of the determinants of attitudes towards BDSM. The methodology was mixed: a between-subjects’ factor was included along with correlational variables. Additionally, there was a longitudinal element to this methodology. Ninety-four university women read a passage which contained information about BDSM with a manipulation such that identical content was presented either positively or negatively. Erotophobia-erotophilia, a sexual dimension of personality (i.e. avoidance-approach to sexuality), was assessed with different instruments at two times. Results indicated (1) attitudes were generally neutral or slightly positive towards BDSM; (2) reading a negative or positive passage had little impact on BDSM attitudes and (3) erotophobia-erotophilia was a correlate of attitudes towards BDSM both several weeks before (i.e. predictively) and at the time of attitude assessment. Implications of these findings are that attitudes towards topics such as BDSM are probably not easily amenable to change as a function of a mild intervention - such as reading a positive or negative depiction of the topic. Underpinnings of attitudes towards sexual topics such as BDSM are probably more likely determined by pre-existing sexual liberalism/conservatism in personality. Thus, attitudes towards sexual topics such as BDSM are not likely to be easily changed.
... They argue that BDSM is only occasionally a central issue during their therapeutic work and that relationships are the chief concern of BDSM clients who often admit to feelings of shame and guilt (Lawrence and Love-Crowell 2008). Kelsey et al. (2013) found that a minority of therapists believe that there is a link between child abuse or maltreatment and the practice of BDSM. Although two thirds of respondents avoided characterising BDSM practitioners as deviant, 'they did not consistently endorse a clear acceptance of BDSM as a benign variation in sexual behaviour. ...
... As indicated by Kolmes, Stock and Moser (2006), BDSM individuals seek mental health treatment for both BDSM-related and unrelated issues but complain about either the voyeuristic interests of some inappropriate therapists or about the opposite tendency, the therapists' requirement for them to give up BDSM. Both tendencies are channelled more by personal interests and values than the professional search for the client's wellness (Kelsey et al. 2013). As for homosexual, lesbian, transgender or transsexual people (Faccio, Bordin, and Cipolletta 2013), a non-prejudiced attitude seems fundamental not only to health treatment but to every relationship with BDSM practitioners. ...
Article
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This study aims to explore personal meanings related to the constructs 'sexuality' and 'sexual pleasure' in people who choose to write in forums and blogs about their own experience with Bondage and Discipline, dominance and submission, and Sadism and Masochism (BDSM). We carried out semi-structured online interviews with 343 people, of whom 50 (24 women and 26 men) claimed to practise or to have practised BDSM, in order to investigate participants' definitions of their sexual experiences and the construction of sexuality and sexual pleasure from their personal point of view and from the perspective of the opposite sex. Data were analysed according to Grounded Theory methodology. Questions concerning the 'normality' or the 'deviance' of participants' sexual practices were reflected in the answers of the majority of BDSM practitioners. Sexuality was construed as a 'game' with specific rules, and 'pleasure' was associated with extremely intense experiences. The relationship between the partners was considered fundamental, as it gave meaning to the sexual practice. Both dominant and dominated roles were found to be tightly linked to the possession and management of power between partners, which either confirms or reverses the social construction of traditional male and female roles.
... Their fears are not baseless; in some states, medical professionals are required to report any suspicious bruising a patient has even if they are informed that the bruises were from consensual activities (Houry et al., 2002). The lack of knowledge about BDSM community members extends to mental healthcare professionals as well; a recent study found that 14% of therapists surveyed thought that sexual masochism could not be practiced in healthy ways and 29% believed that sexual sadism is unhealthy (Kelsey et al., 2013). BDSM community members often have previous experiences of biased mental healthcare, including therapists assuming that BDSM is unhealthy, abusive, or indicative of past abuse, and therapists requiring clients to give up BDSM activities in order to continue therapy (Kolmes et al., 2006). ...
Article
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Despite a recent increase in academic attention, little is known about how the general population perceives BDSM practitioners. Though the gay/lesbian community has undergone de-medicalization and de-stigmatization over time, the same process for BDSM practitioners is in its infancy. Past research suggests that BDSM practitioners do expect to be stigmatized by others, especially in the healthcare system; however, little is known about how the general population currently perceives and stigmatizes the BDSM community. In the current study, we found that the general population (N = 257) does stigmatize BDSM practitioners more than the gay/lesbian population, and both are stigmatized more than a low-stigma comparison group (people in romantic relationships), F(2, 253) = 21.70, p < .001, η2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\eta }^{2}$$\end{document} = 0.15. These findings help to inform mental healthcare providers and the general population about BDSM practitioners, with the goal of inspiring additional research and activism aimed at combating misinformation and reducing stigma toward this population.
... Unfortunately, the knowledge of how to work well with individuals with a kink identity appears to be quite rare among clinicians. Approximately 80% of psychologists support clients with presenting problems involving sexuality (Reissing & Di Giulio, 2010); however, many mental health professionals report feeling ill-equipped to intervene on sexuality-related issues (Miller & Byers, 2008) and even less on kink identities specifically (Kelsey et al., 2013). Most graduate-level programs do not require clinicians to obtain training in human sexuality or sexual diversity. ...
Article
Individuals in the kink community often report difficulty with finding affirming mental health care. Similarly, providers often report having limited knowledge of how best to support sexual diversity. This study highlights difficulties faced by kink individuals seeking clinical care and how providers can be more affirming. The current study utilized Delphi methodology to elucidate what clients with kink identities need from clinicians and the therapeutic environment. The study consisted of perspectives from 12 leaders in the kink community from across the United States. The culmination of their input is outlined and organized into five themes: Client Needs, Awareness and Understanding, Kink Client’s Perceptions of Therapists, Therapist Education & Training, and Client’s Perceptions of Therapy. These themes guide recommendations for practice that may be utilized in clinical training and guide clinical self-reflection.
... Insofar as stigma is a function of ignorance, content analyses of social work textbooks (Prior et al., 2019), mental health counseling journals (Zeglin et al., 2019), and The Counseling Psychologist and the Journal of Counseling Psychology (Crowell et al., 2017) demonstrate that diverse sexual practices beyond stable models of sexual orientation are poorly misunderstood by generalist counselors, therapists, and psychologists. Indeed, although 70% of clinicians stated they would not target kink behavior for reduction without client consent, 48% stated that they lacked competence with this population (Kelsey et al., 2013). Kink-identified clients endure in-session prejudice (Hoff & Sprott, 2009;Kolmes et al., 2006;Waldura et al., 2016), possibly a function of poor clinical delineation between kink practices and deleterious behaviors (e.g. ...
Article
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Bondage/discipline, dominance/submission, and sadism/masochism (BDSM; “kink”) are frequently pathologized as derivatives of abuse. Although the link is unsubstantiated, some kink-identified people who happen to be survivors of trauma may engage in kink, or trauma play, to heal from, cope with, and transform childhood abuse or adolescent maltreatment. The present study sought a thematic model (Braun & Clarke, Qualitative Research in Psychology, 3(2), 77–101, 2006) of trauma recovery through kink using a critical realist, inductive approach to inquiry. Participants were eligible if they had experienced early abuse, were adults, and practiced kink. Six superordinate themes were generated from semi-structured interviews with 20 participants from five countries: cultural context of healing (e.g. using BDSM norms and previous therapy to reframe kink and trauma), restructuring the self-concept (e.g. strengthening internal characteristics which had been harmed or distorted), liberation through relationship (e.g. learning to be valued by intimate others), reclaiming power (e.g. setting and maintaining personal boundaries), repurposing behaviors (e.g. engaging in aspects of prolonged exposure), and redefining pain (e.g. transcending painful memories through masochism). Notably, participants only reported retraumatizing experiences prior to learning about the structural safeguards of BDSM. Research and clinical implications are discussed by drawing on general models of trauma recovery.
... They have not focused on sexuality enough in their training for clinicians to feel comfortable discussing all aspects of sexuality with their clients, including sexual pleasure Bachenberg 2015, Tolman andDiamond 2014). Research has repeatedly demonstrated clinicians do not get adequate training in sexuality and are not comfortable discussing sexuality when they do discuss sexuality (Burnes et al. 2017, Hanzlik and Gaubatz 2012, Kelsey et al. 2011, Miller and Byers 2008, Miller and Byers 2009, Miller and Byers 2012, Mollen et al. 2018. Therapists and psychologists are required to understand basic sexual development and are not supposed to discriminate against sexual minorities. ...
Article
Psychological associations require their trainees and professionals to work with diverse issues and diverse clientele, including sexual issues and sexual and gender minorities. While these organizations have been clear on their stance on non-discrimination toward sexual and gender minorities, research has demonstrated that most psychologists are not well trained on sexuality in general, even though educators and trainees believe sexuality is an important topic. Sexuality is a core aspect of human development across the lifespan. Although sexuality may be expressed differently across cultures, sexuality is a part of overall health and wellness for everyone. Sexuality is a broad concept that can include all types of sexual behaviors, sexual and gender orientation, sexual relationships, sexual pleasure, intimacy, attachment, and reproduction. It may be helpful for psychology to adopt a human rights perspective in their sexuality training. This perspective frames sexual rights as human rights and utilizes a sexual health and wellness framework. Utilizing this perspective, psychologists can focus on sexual citizenship from a global, rights-based, positive, and sexual wellness. Keywords: Human Rights, Pedagogy, Psychology, Sexual Rights, Sexual Wellness.
... Lack of knowledge and understanding of BDSM appears to be a widespread problem among psychotherapists. In one large study, 76% of the participating therapists reported that they had treated at least one client who practiced BDSM, but only 48% felt that they were competent concerning BDSM (Kelsey et al., 2013). In another study, therapists reported feeling more uncomfortable with treating BDSM practitioners than gay and lesbian clients (Ford & Hendrick, 2003). ...
Article
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This transformative study aimed to explore how people who practice BDSM (bondage, discipline, dominance, submission, sadism, masochism) experience therapy; specifically, what sort of therapist responses and qualities they described as problematic and desirable in relation to addressing BDSM in therapy. Semi-structured interviews were conducted with 27 Swedish BDSM practitioners with experiences of psychotherapy. The interviews were analyzed using inductive thematic analysis. Three themes were identified: “A professional stance”, relating to how therapists handled their professional roles when BDSM was addressed, “Therapists’ approaches toward BDSM”, regarding therapists’ opinions and attitudes toward BDSM, and “Conversations about BDSM”, regarding how therapists handled conversation about the topic. Participants reported negative experiences where therapists expressed prejudice, judgement or pathologizing attitudes, failed to contain their own emotions, questioned their clients about BDSM, used their clients to inform themselves about BDSM, avoided or focused excessively on the topic. Positive experiences were characterized by non-judgment, asking client-centered questions, and stimulating a collaborative exploration of matters relevant to the client. BDSM practitioners’ experiences of therapy were related to those documented in the literature on other minoritized identities. This study contributes to the growing literature on kink-aware therapy, which makes psychotherapy more affirmative, accessible, and rewarding to BDSM practitioners.
... Research suggests that therapists are impacted by taboos around, and a lack of comfort with, open and candid discussion of sex within the wider culture (Timm, 2009) and, furthermore, that the neglect of sex within training and clinical supervision are some of the biggest barriers to therapists discussing sexual matters with clients (Timm, 2009). It is perhaps unsurprising then that research exploring therapists' perceptions of socially non-normative sexual and relationship practices, such as non-monogamy, has found that many therapists pathologise such practices (Grunt-Mejer & Łyś, 2019) and also that training variables predict attitudes to non-normative sexual practices such as BDSM, with therapists with no training on such sexual practices having less accepting attitudes (Kelsey et al., 2013). ...
Article
Anxieties about sex and sexual problems are widespread and are often brought to counselling and psychotherapy. Research has found that even practitioners without specialist training often work with sexual difficulties because of the prevalence of such problems. Some of the most common concerns brought to therapy centre on desire discrepancies between male and female partners and a lack of sexual desire. In this paper, we ask the question what understandings of “heterosex” might await women and men bringing concerns about desire discrepancies and a lack of desire to the therapy room? We report the findings of a qualitative study exploring the discourses underpinning therapists' and psychology undergraduates' constructions of women and men repeatedly refusing sex in the context of an ongoing heterosexual relationship. Data were collected from 71 participants (33 therapists and 38 students) using the innovative story completion method, in which participants are presented with the opening sentences of a story centred on a hypothetical scenario and asked to complete it. The resulting stories were analysed with thematic analysis. Participants drew on heteronormative discourses of masculinity, femininity and heterosex to make sense of sexual refusal and its consequences. However, the stories written by male and, especially, female therapists included less problematisation of the absence of sex and more possibilities for overcoming sexual and relational problems. The data potentially raise questions about whether professional training allows therapists to access discourses that subvert dominant understandings of heterosex, as we argue it ideally should.
... Experiences of countertransference that may arise in non-kink aware professional counselors include feelings of shock, fear, disgust, anxiety, or revulsion (Nichols, 2006). In one study, although 76% of mental health professionals reported treating at least one client within the kink community, only 48% felt they were competent in this area (Kelsey, Stiles, Spiller, & Diekhoff, 2013). Given that 10% of adults in the general population have engaged in some form of kink or BDSM activity (Moser & Kleinplatz, 2006), it is of paramount importance for professional counselors to become kink aware in order to provide efficacious counseling services. ...
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BDSM is an overlapping acronym that includes bondage and discipline (BD), dominance and submission (DS), and sadism and masochism (SM). Over the past few years, kink culture and BDSM practices have become more prevalent in the mainstream culture. Kink is an umbrella term used to describe BDSM practices and paraphilias (Popp & Kaldera, 2014), kinky sex, role play, sex games, fantasies, fetishes, and other erotic expressions (Taormino, 2012). Although kink and BDSM represent exclusive terms, many individuals use them interchangeably (Taormino, 2012). The authors of this practice brief use the term kink culture to refer to the community as a whole while specifying when topics are specific to individuals who practice BDSM.
... Some studies investigated attitudes towards people engaging in BDSM (Bondage and Discipline, Dominance and Submission, Sadism and Masochism, Turley & Butt, 2015), revealing slightly favorable attitudes among female psychology students (Rye et al., 2015) and psychotherapists (Kelsey et al., 2013). As the term BDSM is reserved for instances where sadistic or masochistic fantasies are acted out with a consenting partner ("player"), this may have contributed to positive reactions. ...
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Except for pedophilia, little is known about public attitudes towards paraphilias and psychological conditions that are considered risk factors for sexual offending. In the present study we sought to compare the stigma attached to pedophilia with attitudes towards sexual sadism and antisocial tendencies (Study 1, N = 720) and with attitudes towards necrophilia and zoophilia (Study 2, N = 210) in convenience samples of community individuals. When investigating social distance attitudes both studies explicitly referred to people with paraphilic sexual interests or antisocial tendencies who had not committed any crimes. In both studies, people with pedophilia emerged as highly stigmatized even though most participants showed awareness that pedophilic interests cannot be chosen or changed at will. The present studies solidify the evidence that pedophilia occupies a place in the public consciousness as less deserving of acceptance than most other sexual offending risk-relevant conditions, including ones that compare in terms of rarity.
... Further, there is a paucity of research guidance available to MHPs on providing efficacious services (e.g., couples therapy) within the context of polyamorous relationships. MHPs have previously indicated little experience treating people who participate in kink or BDSM sexual behaviors; however, our findings indicate that this is a topic where additional research and discourse is desired to inform clinical practice (Kelsey, Stiles, Spiller, & Diekhoff, 2013). ...
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Sexual and gender minority (SGM) people experience significant disparities in mental health and substances use disorders. This study reached out to mental health professionals (MHPs) who treat SGM people to determine mental health priorities for research that would better inform their clinical practice. MHPs were surveyed and asked to rate items based on a likert-type scale. Open-ended questions were also queried and analyzed qualitatively. Five items had the highest mean scores: “stressors related to SGM status,” “lifestyle factors that support emotional resilience and wellbeing,” “depression,” “intimate relationships,” and “suicide.” Intersecting identities and sexual relationships emerged as qualitative themes.
... There remains a serious need across the helping professions for education and training on BDSM sexuality [32,33]. For example, recent studies have found that textbooks and journals in both counseling and social work are glaringly sex negative and tend to ignore, sometimes purposively, topics pertaining to kink and BDSM [34][35][36]. ...
Article
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Purpose of Review This review summarizes recent empirical and theoretical scholarship pertaining to two primary ways that BDSM is conceptualized, specifically as a unique sexual orientation or as a form of leisure experience. This review helps clinicians understand how BDSM is currently positioned by scholars and by some within the BDSM community. Recent Findings Recent studies have found strong support for both the sexual orientation and leisure perspectives, distinctly. The sexual orientation approach currently focuses on a somewhat narrow segment of highly invested BDSM participants, while the leisure approach accounts for a broad range of diverse participation and experience. Summary BDSM can be understood as both an orientation and as leisure for many but not all participants. Both perspectives share the same underlying multidisciplinary substrate. Although the emphases of the orientation and leisure approaches are different to some degree, the sexual orientation perspective (OP) and the serious leisure perspective (SLP) seem to account equally well for sexual identity centered on BDSM. Understanding both perspectives provides a more complete understanding of the variation and complexity of BDSM.
... A study in Belgium [14] corroborates the Dutch research and underscores the growing interest in BDSM, which is leading to its "destigmatization" and "depathologization." Research in Anglo-Saxon countries has arrived at a similar analysis [21]. The English researcher Meg Barker expresses a point of view that recalls Tania Glyde's in her 2007 article "Situating Sadomasochism" [22]. ...
Article
Objective BDSM is a overlapping acronym that refers to the practices of bondage and discipline, dominance and submission, sadism and masochism. The American Psychiatric Association “depathologized” kinky sex – including cross-dressing, fetishism, and BDSM –, despite retaining a clinical justification, in the fifth edition of its Diagnostic and Statistical Manuel of Mental Disorders (DSM-5). Henceforth, the paraphilias are considered “other sexual interests.” Method We analyze several psycho-sexological studies that treat sadomasochistic practices as psychic case studies. BDSM practices are no longer considered deviant behaviors, but, on the contrary, “common” behaviors that have been adopted by a large number of individuals. These individuals use contractualization in a specific context. Result Rather than considering BDSM practice to be a perversion by assimilating it to homosexuality, current research in gender and psychiatry and in the psychology of subsexualities has moved beyond the analysis of “deviance,” preferring a scientific study of the effects of BDSM practice, particularly of their positive effects on mood, stress, or depression. Discussion The BDSM and Therapy Project is concerned with articulating the possible risks of BDSM play and with clarifying situations where BDSM play is neither safe nor helpful. Members of the BDSM community have expressed the following points: the development of barriers between community members; the risks of alienation and isolation through stigmatization; having one's limits violated during a scene; the potential risk of dehumanization and destruction. Conclusion BDSM therapy, in a therapeutic setting as well as within the community, is based on consent. BDSM can be a form of psychotherapy for the subject. BDSM therapy would consist in the modification of the meaning of physical suffering by transforming it into voluntary pain, through consensual constraint. A functional BDSM therapeutic practice requires at least three conditions: (1) the SM relationship involves a willing dominant and a willing submissive; (2) this erotic duo exists in a codified setting; (3) the dominant is a “therapizer” in her/his display of empathy for the submissive; (4) a two-way flow of reciprocal benefits in terms of post-session well-being.
... 53 Also, from a clinical perspective, it was demonstrated that most psychotherapists do not tend to see BDSM as a benign variation in sexual behavior, and almost half of these therapists were unsure whether most of the BDSM practitioners were "psychologically healthy". 54 Worryingly, some therapists were unable to differentiate between BDSM and abuse and, as a result, required clients to give up BDSM as a condition of treatment. Unsurprisingly, then, Waldura et al 55 found that only 38% of their sample was able to disclose their kink orientation to their clinician. ...
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Background: BDSM (Bondage and discipline, Dominance and submission, and Sadism and Masochism) increasingly receives attention from the scientific community. Where earlier research efforts mainly focused on epidemiological characteristics, psychological and biological factors driving BDSM preferences have recently gained interest as well. Aim and Methods: The current systematic review brings together all the existing literature on BDSM from a biopsychosocial perspective. Results: Biological factors like gender identity, sex hormone levels and the neurological constitution of the brain’s pain and reward systems influence BDSM orientation. With regard to psychological factors, both personality traits (f.i. higher levels of openness or extraversion) and the presence of a personality disorder have been associated to a heightened BDSM interest, although only limited supporting evidence is available. Additionally, sensation seeking levels and impulsivity seem to contribute, as they presumably guide one’s drive to explore new and/or more intense kinks. As attachment styles impact couple dynamics they also influence willingness to explore limits in a BDSM context. Lastly, education levels impact relational and/or sexual dynamics. Strengths and Limitations: The limitations of the current review reflect those of the topical scientific literature. Although the number of studies focused on all aspects of BDSM is exponentially growing, most of these are only descriptive and very few focus on underlying driving processes. Conclusion: From this biopsychosocial perspective, we offer a dimensional approach while integrating the factors driving the onset and evolution of BDSM interests.
... Other studies reported similar results on both psychological and psychopathological variables assessed in BDSM and non-BDSM samples. 16,25,26 A recent study 27 showed that the profile of BDSMers was characterized by a set of balanced, autonomous, and beneficial personality characteristics and a higher level of subjective well-being, compared with control subjects. These results highlight that BDSM practitioners are not differing from control subjects on maladaptive psychological processes or psychopathologies. ...
Article
Background: Published studies show good psychological health of people involved in bondage-discipline, dominance-submission, and sadism-masochism (BDSM) activities; nevertheless, there are few studies on characteristics related to gender, role in the BDSM scene, sexual functioning, and satisfaction among BDSM practitioners. Aim: The aim of this study was to explore gender and role differences, prevalence of sexual complaints, related distress, and sexual satisfaction in BDSM participants compared with the general population. Methods: A group of 266 Italian consensual BDSM participants (141 men and 125 women) were recruited with a snowball sampling technique. An anonymous protocol, including self-reported ad hoc and validated questionnaires, was used. The control group was composed of 100 men and 100 women who were not significantly different from the BDSM group for the sociodemographic data and were randomly extracted from an Italian database on sexual functioning of the general population. Main outcome measures: Self-reported demographic factors, including favorite and most frequent BDSM practices, the Sexual Complaint Screener, and the Sexual Satisfaction Scale, were completed by the participants. Results: The mean age of the BDSM group was 41.42 ± 9.61 years old (range 18-74). Data showed a varied outlook of practices, fantasies, rules, and roles. With regard to concerns about BDSM activities (fantasies and behaviors), participants reported a very low self-declared degree of distress. The dominant and switch groups appear to be more satisfied and less concerned about sexuality than the general population and the submissive group. Role in the BDSM scene was the only significant predictor of sexual satisfaction, showing a medium effect size. Clinical implications: Results from this study could be helpful to inform sexual health care professionals and to reduce the stigma related to the BDSM population. Strengths & limitations: In general, this study may help to describe better some characteristics related to gender, role, sexual preferences, function, and satisfaction. The main limitation regards the sampling method, which does not allow us to consider the group as representative of BDSM participants in general. Conclusion: Data showed a varied outlook of practices, fantasies, rules, and roles in both BDSM men and women. BDSM participants (especially dominant and switch groups) appear to be more satisfied and less concerned about sexuality than the general population. This is an attempt to increase the attention of researchers and health care professionals to this important topic and to improve the care provided to people with specific preferences and behaviors. Botta D, Nimbi FM, Tripodi F, et al. Are Role and Gender Related to Sexual Function and Satisfaction in Men and Women Practicing BDSM? J Sex Med 2019;16:463-473.
... In an Internet-based survey of therapists' attitudes toward BDSM, 76% of therapists reported having treated at least one client involved in BDSM, while only 48% of therapists perceived themselves to be competent in this area (Kelsey, Stiles, Spiller, & Diekhoff, 2013). Prevalence estimates of BDSM practitioners are comparable to the number of adults involved in same-sex activity, suggesting that therapists can expect to encounter clients who practice BDSM as often as they encounter lesbian, gay, and bisexual clients (Lawrence & Love-Crowell, 2008). ...
Article
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BDSM is an overlapping acronym referring to the practices of Bondage and Discipline, Dominance and Submission, and Sadism and Masochism. This paper reviews the psychological literature on BDSM practitioners, and discusses issues concerning BDSM that are relevant to clinicians and sexual health care providers. The literature concerning the psychological health of BDSM practitioners and clinical issues in treating BDSM practitioners was exhaustively reviewed. BDSM practitioners differ minimally from the general population in terms of psychopathology. Six clinical considerations emerged: Ignoring vs. considering BDSM; Countertransference; Non-Disclosure; Cultural Competence; Closer Relationship Dynamics; BDSM, Abuse, & Pathology.
... The Explicit Attitudes Questionnaire was a VAS that asked participants to rate the same eight target terms from the IRAP task on a 100-mm line ranging from Sick to Healthy. The Social/Therapist Explicit Attitudes Questionnaire assessed participant attitudes regarding BDSM individuals in both social and clinical contexts through 29 Likert-type questions with a scale of 1 (strongly disagree) to 5 (strongly agree; adapted from Kolmes et al., 2006; see also Kelsey, Stiles, Spiller, & Diekhoff, 2013). The Confederate Questionnaire assessed the confederates' evaluations of how the participants treated them during each interview through five Likert-type questions with a scale of 1 (very negative) to 5 (very positive). ...
Article
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The present study examined participants’ implicit and explicit attitudes toward mainstream and BDSM (bondage and discipline/dominance and submission/sadism and masochism) sexual terms using the Implicit Relational Assessment Procedure (IRAP) and several questionnaires and investigated the relationship between scores on these measures and participant behavior toward a BDSM-labeled and a non-BDSM-labeled confederate during an interviewing task. Twenty-one participants, who were either graduate psychology students or practicing clinicians, completed the study. Results were consistent with previous research (Stockwell, Walker, & Eshleman, The Psychological Record, 60(2), 307–324, 2010) in that responses on both the IRAP and Visual Analogue Scales showed an acceptance of mainstream sexual terms and unfavorable responding to BDSM terms; in contrast, Likert-scale questionnaire responses generally reflected favorable attitudes toward people who practice BDSM. IRAP scores were positively correlated with differences in smiling across the two interview conditions; that is, participants with anti-BDSM responding on the IRAP smiled significantly less while interviewing the BDSM-labeled confederate than when they interviewed the non-BDSM confederate. No other differences in interviewing behavior were observed or correlated with IRAP responding, suggesting that implicit attitudes may not be a reliable predictor of participant behavior during interviews of individuals labeled as practicing BDSM.
... Bias is not the only obstacle to competent care; there is a lack of knowledge of CNM and BDSM among clinicians. For example, Kelsey et al. (2013) assessed 766 therapists' attitudes toward BDSM, and found that although 76% had treated at least one client who disclosed their BDSM interests or behaviors, only 48% felt that they had enough competence in this area. Additionally, there is limited research on mental treatment that involves individuals and families in which there is CNM engagement or desire. ...
Article
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A traditionally marginalized subset of couples engage in consensual nonmonogamy (CNM: open marriage, polyamory, swinging, etc.) or alternative sexualities, such as kink or bondage/discipline, dominance/submission, and sadism/masochism. Nonmonogamous and sexually diverse individuals often experience discrimination or stigma in various domains of professional services, including mental healthcare. These cases require knowledge, skills, and awareness to provide culturally sensitive care, which is often called "kink aware therapy" or "poly-friendly therapy" within alternative sexuality communities. This article explores one application of a kink-focused and CNM-focused therapeutic framework for working with a couple who is exploring nontraditional sexualities. This case incorporates evidence-based clinical practice and identifies the limitations and significant gaps in the empirical research literature.
... 226). Indeed, another study by Kelsey et al. (2013) shows that clinicians may receive even less training about clients who participate in non-normative sexual practices, such as BDSM, an acronym they define as "bondage and discipline (BD), dominance and submission (DS) and sadism and masochism (SM)" (p. 255). ...
Article
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The author uses a queer critical lens to analyze the marginalization of case study research in the evidence-based practice model of clinical social work. He argues that narrative case studies are necessary for the production of context-dependent knowledge about social work practice and asserts that the method offers particular utility in conducting queer inquiry. The method is explored in relation to its capacity to describe non-normative phenomena and the impact of normative cultural pressures on queer subjects. An abbreviated case study by the author is included to demonstrate these capacities.
... For example, recent years have witnessed social discourse concerning the themes of eroticized power found in the Fifty Shades trilogy of novels by E. L. James (James, 2012): In the summer of 2012, the books occupied the first, second, and third spots concurrently on the New York Times best-selling fiction list (New York Times, 2012), and in February 2015 the movie adaptation of the trilogy's first book broke several international box-office records (Rentrak Corporation, 2015). However, increased media representation does not imply increased acceptance, and several analyses of media (Weiss, 2006), legal (Kleinplatz & Moser, 2006;Wright, 2008), occupational (Bezreh, Weinberg, & Edgar, 2012;Kolmes, Stock, & Moser, 2006), and clinical (Kelsey, 2012;Moser & Kleinplatz, 2006a) contexts suggest BDSM is regularly stigmatized in the United States and other countries. ...
Article
Bondage-discipline/Dominance-submission/sadomasochism (BDSM) is an often misunderstood and misrepresented social phenomenon warranting further discourse and study. Community-based research that engages member perspective can assist in understanding socially marginalized experiences. The current study examined the role, meaning, and function of BDSM communities from the perspective of self-identified members. Seven nominal group technique workshops were conducted representing a variety of practitioner experiences and identities. Workshops involved 48 participants and resulted in the generation of 133 unique terms describing the role of BDSM communities in their lives. Terms were coded using a five-step procedure involving both academic and community members. A total of 15 categories were identified and included domains such as acceptance, sexual expression, friendship, safety, and sharing of educational knowledge. Results underscore the multifaceted nature of the role of such communities. While results consisted of mostly positive features, participants also identified certain negative aspects, such as conflict among members. Results from the study provide a succinct, member-derived, structured inventory of the role of BDSM communities that can serve to validate and synthesize existing research, improve dissemination of community voice around BDSM, and inform future research. We conclude with a discussion of the study's implications for sex education, clinical practice, and community dissemination.
... In 2013, Kelsey et al. conducted a large Internet-based survey of 766 therapists in the USA to assess their attitudes towards BDSM clients [56]. Encouragingly, their hypothesis that the majority of therapists would hold negative, pathologizing views of BDSM was not borne out; to the contrary, 67 % of those surveyed believed that "BDSM can be part of a healthy, long-term relationship." ...
Article
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This article reviews and compares competing depictions of sadomasochism (SM) sexuality, examining portrayals that range from sick to healthy, from normal to abnormal, and from dangerous to healing. The body of this article proceeds in four parts. The first section considers the treatment of SM in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). The second section addresses debates about the costs, benefits, and scientific validity of the inclusion and definition of SM in the DSM-5. It further highlights how quantitative and qualitative empirical studies of SM practitioners indicate that they fall within normal ranges in psychological and social functioning. The third section examines research on one negative consequence of the inclusion of SM in the DSM: It may interfere with the therapeutic relationship with clients who practice SM or have SM desires by reinforcing broader societal stigma and encouraging diagnostic misuse. The fourth section reviews an emerging body of research that reverses the “SM as pathology” discourse by showing the therapeutic and healing potential of bondage-discipline-dominance-submission-sadism-masochism (BDSM) practice and ethos. Based on this review, the conclusion argues that there is no valid reason to continue identifying SM as a potential mental disorder, and furthermore, there are detrimental effects of its association with pathology in the DSM-5.
Article
The aim of this narrative review is to integrate the published literature on mental health provider bias against less recognized groups who may be marginalized due to their sexual identities or sexual and relationship practices. These include asexual-identified individuals, individuals who practice consensual non-monogamy (CNM), and those who engage in sexual practices that include bondage and discipline, dominance and submission, and sadism and masochism. We situate these findings regarding provider bias within broader themes emerging from the literature on affirmative mental health care provision for members of these sexually stigmatized groups. We identified the relevant literature by searching PsycINFO, as well as Google Scholar, given the novel topic areas. We summarize and evaluate published articles and then present our analysis of the broader themes, strengths, and limitations that emerged among these three developing literatures. Finally, we discuss implications for future research and clinical practice to aid clinicians who wish to minimize bias against these relatively understudied groups. These recommendations are summarized as follows: avoiding normative assumptions, countering pathologization, and taking responsibility for training.
Article
This national web-population study from Norway (N = 4,148) assessed 1) the prevalence of BDSM and role-play interests and behaviors, 2) the socio-demographic characteristics of the BDSM-oriented participants, and 3) the associations between a) BDSM and b) role-play interests and behaviors, and sexual satisfaction, relationship satisfaction, and relationship closeness. Over one in three study participants endorsed at least one BDSM interest or behavior variable. There were no gender nor educational level differences between the BDSM-oriented participants and their traditional "vanilla" (non-BDSM-oriented) counterparts, though BDSM and interests were more common among younger and self-identified LGBQ+ participants. Sexual satisfaction was positively associated with role-play and BDSM behaviors while interest in role-play (but not having previously engaged in it) was negatively associated with this outcome. Lower relationship closeness was associated with an interest in role-play (but not having tried it). No BDSM-related variables were significantly associated with relationship closeness. The findings suggest that BDSM interests and behaviors are relatively common and are linked with sexual and relationship satisfaction.
Article
Limited research indicates that people from the kink community may not find talking therapies accessible. Findings are presented from a thematic analysis of five semi-structured interviews with adults who self-identify as kinky. Participants reported self-censorship as a risk-management strategy to avoid encountering (i) social stigma, (ii) medicalisation and (iii) conflation of true BDSM with abuse or self-harm. Interviewees required counsellors to be better informed, and for services to be more inclusive and proactive. They regarded the kink community as therapeutically minded, harbouring a population motivated and appropriately skilled to engage with counselling and psychotherapy. Findings recommend potential changes to counsellor training and service provision aiming to enable practitioners to work more effectively and ethically with sexually diverse clients.
Article
Résumé Objectifs Le BDSM est un acronyme imbriqué faisant référence aux pratiques de bondage et de discipline, de domination et de soumission, de sadisme et de masochisme. L’American Psychiatric Association a « dépathologisé », après le DSM-IV, malgré sa justification clinique, le kinky sex — y compris le cross-dressing, les fétiches et le BDSM — dans le Manuel diagnostique et statistique des troubles mentaux, cinquième édition (DSM-5). Désormais, les paraphilies sont considérées comme des « intérêts sexuels inhabituels ». Méthodes Plusieurs études psycho-sexologiques, que nous analysons ici, utilisent les pratiques sadomasochistes, dites BDSM (Bondage, Discipline, Domination, Soumission, Sadomasochisme) comme des études de cas psychiques, non plus comme comportements déviants, mais bien au contraire en termes de conduites « communes », car adoptées par un grand nombre d’individus. Ces individus utilisent la contractualisation consentie dans un cadre précis, qui peut être un apport considérable dans l’accueil thérapeutique. Résultats Plutôt que de les considérer comme une perversion, les études actuelles sur la psychiatrie du BDSM et la psychologie des subsexualities ont renversé l’analyse déviante en une étude scientifique des effets des pratiques BDSM notamment sur leurs bénéfices sur l’humeur, sur le stress ou sur la dépression. Discussion Le projet BDSM et thérapie est soucieux d’articuler les risques possibles du jeu BDSM et de clarifier les situations limites où le jeu BDSM n’est pas sain ou utile. La thérapie BDSM a-t-elle pour objectif de régulariser les pratiques BDSM et de les calibrer ? Certains membres de la communauté BDSM ont exprimé les points suivants : Des barrières sociales peuvent se développer entre soi et les amateur(e)s ; Aliénation et isolement par la stigmatisation qui peut produire des stéréotypes négatifs intériorisés ; Risques liés à des limites poussées trop loin (mal identifiées en amont) dans une scène ; Potentiel de déshumanisation et de destruction du BDSM dans certaines situations unsafe du BDSM. Conclusion La thérapie BDSM, tant dans la clinique que dans la pratique communautaire, repose sur le consentement et le respect des limites de chacun(e) (safe et secure). Le SM peut être une psychothérapie pour le/la soumis(e) mais aussi pour le/la dominant(e). La thérapie BDSM consisterait, par la contrainte, à modifier le sens de la souffrance corporelle pour transformer celle-ci : le BDSM n’implique pas nécessairement de douleur (fluctuant par exemple dans les pratiques de bondage ou de domination psychologique ; par ailleurs la dimension sexuelle y est très variée, parfois non génitale, voire absente). Pour fonctionner, le processus thérapeutique BDSM exige au moins trois conditions : (1) la relation BDSM engage un(e) dominant(e) et un(e) dominé(e) (volontaires) ; (2) ce binôme érotique fonctionne dans un cadre strictement codifié ; (3) le/la dominant(e) est « thérapeutisant(e) » en ce qu’il fait preuve d’empathie envers le/la dominé(e) ; le/la dominé(e) respecte les limites du/de la dominant(e) ; (4) le flux est à double sens avec les « souminatrices » par exemple, qui sont des soumises résistantes et désobéissantes, explorant leurs propres limites au contact du/de la dominant(e).
Article
Human sexuality is a pervasive and universal part of being human and despite this, receives inadequate attention in counselor education curricula. Consequently, counselors may be ill-prepared to assist clients who present with sexuality issues. The authors provide support and recommendations for infusing sexuality content throughout counselor education programs.
Article
Sexual behaviors and styles that differ from that of the majority culture have been pathologized throughout history. One such category of sexual variation is BDSM (bondage-discipline/dominance-submission/sadism–masochism). Research onpsychotherapists suggests beliefs that BDSM practitioners cannot sustain healthy relationships. A growing body of literature, however, describes those who engage in BDSM activities as socially well-adjusted individuals who are no more likely to have psychological distress than the general population. This study used an online survey distributed via BDSM community websites and word-of-mouth to measure relationship satisfaction among BDSM practitioners who were in committed relationships. The Revised Dyadic Adjustment Scale (RDAS) was administered, as well as a number of demographic and BDSM participation questions about both the participants and their partners. Findings indicated participants did not score above the clinically distressed criterion cut-off on the RDAS. Additionally, data analysis compared gender and BDSM roles on RDAS scores. This yielded no statistically significant results. These results were considered in the context of the feminist critique of BDSM and family systems theory. The current study adds to previous research by examining relationship satisfaction, providing more evidence that those practicing BDSM are not significantly more pathological than the population in general.
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Introduction: The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) and sexual fetishism. Individuals who engage in kink could be at risk for health complications because of their sexual behaviors, and they could be vulnerable to stigma in the health care setting. However, although previous research has addressed experiences in mental health care, very little research has detailed the medical care experiences of kink-oriented patients. Aim: To broadly explore the health care experiences of kink-oriented patients using a community-engaged research approach. Methods: As part of the Kink Health Project, we gathered qualitative data from 115 kink-oriented San Francisco area residents using focus groups and interviews. Interview questions were generated in collaboration with a community advisory board. Data were analyzed using a thematic analysis approach. Main outcome measures: Themes relating to kink-oriented patients' experience with health and healthcare. Results: Major themes included (i) kink and physical health, (ii) sociocultural aspects of kink orientation, (iii) the role of stigma in shaping health care interactions, (iv) coming out to health care providers, and (v) working toward a vision of kink-aware medical care. The study found that kink-oriented patients have genuine health care needs relating to their kink behaviors and social context. Most patients would prefer to be out to their health care providers so they can receive individualized care. However, fewer than half were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure. Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions. Conclusion: Like other sexual minorities, kink-oriented patients have a desire to engage with their health care providers in meaningful discussions about their health risks, their identities, and their communities without fear of being judged. Additional research is needed to explore the experiences of kink-oriented patients in other areas of the country and internationally.
Article
To date, no study has examined rates of suicide ideation or theory-based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty-seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma-related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.
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The DSM-IV-TR (2000) sets its own standards for inclusion of diagnoses and for changes in its text. The Paraphilia section is analyzed from the perspective of how well the DSM meets those standards. The concept of Paraphilias as psychopathology was analyzed and assessed critically to determine if it meets the definition of a mental disorder presented in the DSM; it does not. The Paraphilia diagnostic category was critiqued for logic, consistency, clarity, and whether it constitutes a distinct mental disorder. The DSM presents “facts” to substantiate various points made in the text. The veracity of these “facts” was scrutinized. Little evidence was found in their support. Problems with the tradition of equating particular sexual interests with psychopathology were highlighted. It was concluded that the Paraphilia section is so severely flawed that its removal from the DSM is advocated.
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This is a qualitative investigation of 73 individuals in the Bondage and Discipline, Dominance and Submission, and Sado-Masochism subculture. There is tremendous stigma attached to this subculture, and while the academic community may be increasingly accepting, the general public is not as accepting or knowledgeable. Fear of negative consequences means that many engage in secrecy and concealment strategies as protective measures. Although there is much literature on the possible consequences and the reasons for concealment, there remain gaps. Our findings reveal how many conceal to cover up or to hide what outsiders may consider immoral or otherwise unacceptable behavior. Others conceal as a means to create a distinction for themselves as part of a secret subculture. Whatever their reasons, those in this subculture engage in a variety of strategies to manage their identity and to minimize their vulnerability.
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The intergroup contact hypothesis is tested with self-reports of 3,806 survey respondents in seven 1988 national probability samples of France, Great Britain, the Netherlands, and West Germany. With seven key variables controlled, the hypothesis is confirmed-especially for intergroup friendships and affective prejudice. Nonrecursive models indicate that the predicted friends-to-less-prejudice causal path is larger than the prejudice to-fewer-intergroup friends path. These effects generalize in two ways: to immigration polity preferences and a wide variety of out-groups. To explain this generalization, three mediating processes are proposed that can override the many cognitive barriers to generalization: empathy and identification with the out-group and reappraisal of the in-group (deprovincialization). A situation's "friendship potential" is hence indicated as an essential condition for optimal intergroup contact.
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I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Masochism for the Sexual and Gender Identity Disorders Work Group for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Masochism, the assessment of Sexual Masochism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Masochism using the DSM in non-forensic populations. I concluded that the diagnosis of Sexual Masochism should be retained, that minimal modifications of the wording of this diagnosis were warranted, and that there was a need for the development of dimensional and structured diagnostic instruments. It should be noted that this summary reflects my original literature review. Subsequently, interactions with other members of the workgroup and advisors have resulted in modification of these initial suggestions.
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I reviewed the empirical literature for 1900-2008 on the paraphilia of Sexual Sadism for the Sexual and Gender Identity Disorders Workgroup for the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The results of this review were tabulated into a general summary of the criticisms relevant to the DSM diagnosis of Sexual Sadism, the assessment of Sexual Sadism utilizing the DSM in samples drawn from forensic populations, and the assessment of Sexual Sadism using the DSM in non-forensic populations. I conclude that the diagnosis of Sexual Sadism should be retained, that minimal modifications of the wording of this diagnosis are warranted, and that there is a need for the development of dimensional and structured diagnostic instruments.
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There is a concern among consensual BDSM participants that they will receive biased care from mental health professionals. Results are presented of an anonymous Internet-based survey administered to both BDSM-identified individuals who have received psychological care and to mental health professionals. The survey included socio-demographic data and invited participants to write narrative accounts of biased or culturally sensitive care, from which common themes were identified. Mental health providers (N=17) responded in fewer numbers than those who identified as BDSM-identified participants (N=175). Descriptive characteristics of the sample will be discussed. Themes from the qualitative data may be useful in informing the future development of guidelines for practitioners to work more responsibly with clients who identify as members of this sexual minority group.
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People whose sexual repertoire includes BDSM, fetish, or other "kinky" practices have become increasingly visible, on the Internet, in the real world, and in psychotherapists' offices. Unfortunately, the prevailing psychiatric view of BDSM remains a negative one: These sexual practices are usually considered paraphilias, i.e., de facto evidence of pathology. A different, affirming view of BDSM is taken in this paper. After defining BDSM and reviewing common misconceptions, a variety of issues the practitioner will face are described. These include problems of countertransference, of working with people with newly emerging sexual identities, working with spouses and partners, and discriminating between abuse and sexual "play."
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This article describes a child custody case centered on the fitness of the mother, who was involved in an SM relationship with her live-in boyfriend. Although the investigation confirmed that no child abuse had occurred, that the child was unaware of the mother's sexual interests, that there were no incidents of inappropriate sexual activities in front of the minor, and that the child was doing well, the court severely limited the mother's visitation and custody arrangements and ended her alimony. Practitioners of alternative sexual lifestyles have not fared well in child custody hearings, and this case is no exception. The present case indicates how the family court system can be biased against sexual minorities in general and SM practitioners in particular. In addition, the present case demonstrates how the DSM diagnostic criteria can be misused in dealing with alternative lifestyle practitioners. Recommendations for further education of the court and for future research are made.
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The belief that sadomasochism (SM) is violence or abusive behavior has resulted in harassment, physical attacks, and discrimination against SM-identified individuals. Historically, they were often opposed by self-identified feminists. One reason the women who practiced SM were targeted was the official opposition to sadomasochistic practices promulgated by the National Organization for Women (NOW). Current statistics of incidents of discrimination, harassment and physical attacks against SM-identified individuals and SM groups are compiled by the National Coalition for Sexual Freedom (NCSF).
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People with sexual interests in bondage and discipline, "sadomasochism" or dominance and submission (BDSM) have been seen by many professionals as damaged or dangerous. To examine sexual behavior correlates of involvement in BDSM and test the hypothesis that BDSM is practiced by people with a history of sexual coercion, sexual difficulties, and/or psychological problems. In Australia in 2001-2002, a representative sample of 19,307 respondents aged 16-59 years was interviewed by telephone. Weighted data analysis used univariate logistic regression. Self-reported demographic and psychosocial factors; sexual behavior and identity; sexual difficulties. In total, 1.8% of sexually active people (2.2% of men, 1.3% of women) said they had been involved in BDSM in the previous year. This was more common among gay/lesbian and bisexual people. People who had engaged in BDSM were more likely to have experienced oral sex and/or anal sex, to have had more than one partner in the past year, to have had sex with someone other than their regular partner, and to have: taken part in phone sex, visited an Internet sex site, viewed an X-rated (pornographic) film or video, used a sex toy, had group sex, or taken part in manual stimulation of the anus, fisting or rimming. However, they were no more likely to have been coerced into sexual activity, and were not significantly more likely to be unhappy or anxious-indeed, men who had engaged in BDSM scored significantly lower on a scale of psychological distress than other men. Engagement in BDSM was not significantly related to any sexual difficulties. Our findings support the idea that BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with "normal" sex.
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Should the average psychologist receive specific training on lesbian, gay, and bisexual (LGB) concerns? On the basis of a random sample of practicing psychologists, LGB clients are present in-most caseloads. Respondents rated the most important therapeutic issues with LGB clients and identified training that would improve their work with LGB clients (including the topics of coming out, estrangement from family, support system development, and internalized homophobia). In addition, participants reported on the types of training that they are getting (most frequently reading articles, supervision, and continuing education). The implications for training programs and private practitioners are considered.
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Therapists may be confronted with clients whose sexual values and behaviors are different from their own. To understand more about therapists' sexual values and how these values may affect therapy, the current study assessed therapists' sexual values for both themselves and their clients in the areas of premarital, casual, and extramarital sex, open marriages, sexual orientation, and sex in adolescence and late adulthood. Therapists differed selectively in their sexual values depending on their gender, religious involvement, and political affiliation. Therapists appeared comfortable working with a variety of sexual issues in therapy, and it appears that training in sexual issues is helpful in clinical work.
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A demographic questionnaire and 7 psychometric tests were administered to 32 self-identified Bondage/Domination/SadoMasochism (BDSM) practitioners. Although psychoanalytic literature suggests that high levels of certain types of psychopathology should be prevalent among BDSM practitioners, this sample failed to produce widespread, high levels of psychopathology on psychometric measures of depression, anxiety, obsessive-compulsion, psychological sadism, psychological masochism, or PTSD. In fact, on measures of clinical psychopathology and severe personality pathology, this sample appeared to be comparable to both published test norms and to DSM-IV-TR estimates for the general population. There were, however, some exceptions to this general pattern, most notably the higher-than-average levels of narcissism and nonspecific dissociative symptoms found in the sample. This study also raises significant concern about the appropriateness of the diagnosis of sexual masochism and sadism in the Diagnostic and Statistical Manual of the American Psychiatric Association or, minimally, the diagnostic criteria of these disorders.
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This article reports results of a meta-analysis of survey response rates in published research in counseling and clinical psychology over a 20-year span and describes reported survey administration procedures in those fields. Results of 308 survey administrations showed a weighted average response rate of 49.6%. Among possible moderators, response rates differed only by population sampled, journal in which articles were published, sampling source and method, and use of follow-up. Researchers whose studies were included in this meta-analysis used follow-up but rarely used incentives, prenotification, or other response-facilitation methods to maximize response rates. Although the future of survey research in general may rely more heavily on Internet data collection, mail surveys dominate in this field.
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Polyamorous partners offer each other the freedom to pursue romantic bonds with other people, in addition to being romantically close within their own relationship. Given the prevalence of polyamory in the bisexual community, it is important that psychotherapists are aware of issues particular to people who are bisexual and polyamorous and who seek mental health services. The author will also present findings from her research on bisexuality and polyamory and will discuss implications for how therapists can be of support to polyamorous members of the bisexual community.
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Should the average psychologist receive specific training on lesbian, gay, and bisexual (LGB) concerns? On the basis of a random sample of practicing psychologists, LGB clients are present in most caseloads. Respondents rated the most important therapeutic issues with LGB clients and identified training that would improve their work with LGB clients (including the topics of coming out, estrangement from family, support system development, and internalized homophobia). In addition, participants reported on the types of training that they are getting (most frequently reading articles, supervision, and continuing education). The implications for training programs and private practitioners are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Recognizing research which suggests that many practicing psychologists enter the field without training or with inadequate training in the knowledge, skills, and awareness needed to treat lesbian, gay, and bisexual (LGB) clients, the authors in this Focus on Ethics provide suggestions for psychologists seeking competence with this population. In the lead article, Lyons fleshes out the contours of competent practice, presents the current state of psychologist competence, and calls for greater levels of competence. Next, Bieschke and Dendy respond by applying the Ethical Acculturation Model to describe the question of competence for those who may come from cultures not condoning of an LGB affirmative stance. Worthington provides hypotheses for the current rates of competence in the field and encourages the use of evidenced-based training and practice to increase competence. Finally, Georgemiller confirms the role of practicing psychologists who are heterosexual allies and identifies resources for gaining competence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Therapists may be confronted with clients whose sexual values and behaviors are different from their own. To understand more about therapists' sexual values and how these values may affect therapy, the current study assessed therapists' sexual values for both themselves and their clients in the areas of premarital, casual, and extramarital sex, open marriages, sexual orientation, and sex in adolescence and late adulthood. Therapists differed selectively in their sexual values depending on their gender, religious involvement, and political affiliation. Therapists appeared comfortable working with a variety of sexual issues in therapy, and it appears that training in sexual issues is helpful in clinical work. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Article
This article describes the development and validation of a new measure, the Attitudes about Sadomasochism Scale (ASMS). Exploratory factor analysis with 213 participants yielded four subscales (Socially Wrong, Violence, Lack of Tolerance, and Real Life). Confirmatory factor analysis with a different sample (n = 258) indicated that this four-factor model fit the data well. Validation analyses using all 471 participants showed that the ASMS positively correlated with other measures of social and sexual conservatism (right-wing authoritarianism, attitudes about lesbians and gay men, sexual conservatism, rape myth acceptance). However, a multiple regression analysis showed that the majority of the variance in the ASMS was not explained by the four measures of conservatism, indicating that the ASMS measures a unique attitudinal construct. Further validation analyses revealed that participants who had prior knowledge about sadomasochism (SM), participants who have engaged in SM, and participants who knew a friend involved in SM all endorsed more positive attitudes on the ASMS. Thus, this study presents a reliable and valid measure of stereotypical and prejudicial attitudes about individuals involved in these nontraditional sexual practices.
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The current study explored whether psychologists are receiving continuing education that may assist them in providing intervention to clients with sexual issues. One hundred and five clinical and counseling psychologists completed an Internet survey. Results suggest that observational opportunities are underutilized and that more training related to sexual problems, as opposed to healthy sexuality, appears to be occurring. Participants with more continuing education were more likely to directly ask about and treat clients' sexual concerns/problems. Nonetheless, in general, participants appeared reluctant to directly ask about and treat sexual issues. The implications of these results for designing continuing education programs are discussed.
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Recent literature about sadomasochism in Sociology and Social Psychology is reviewed. Studies include survey research and questionnaire studies, content analyses, ethnographic research, and critical essays. The current state of our knowledge of sadomasochism, including its defining characteristics, sadomasochistic identities, and sadomasochistic subcultures is briefly summarized.
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Consensual sadomasochism (Bondage and Discipline, Dominance and Submission, Sadism and Masochism; BDSM) is relatively common, but the experience of psychotherapists who work with clients who engage in BDSM has received little study. We conducted semistructured interviews with 14 therapists experienced in working with BDSM clients. Interviews were recorded, transcribed, and analyzed for thematic content. Therapists emphasized the importance of cultural competence, including a nonjudgmental attitude and knowledge of BDSM practices and cultural values. BDSM was rarely a central issue in therapy, relationship issues were clients' most common presenting concerns. Therapists who practiced BDSM themselves often encountered boundary issues with clients.
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