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Psychotherapeutic Issues with “Kinky” Clients

Taylor & Francis
Journal of Homosexuality
Authors:
  • Institute for Personal Growth

Abstract

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."
... As misinformed individuals deem BDSM a dangerous activity, BDSM practitioners might be seen as a threat. This misinformation is elaborated on later in this paper, but negative perceptions spread via mainstream culture, outdated views in medical and mental health care, and biased wording in scientific papers contribute to this narrative where BDSM practitioners have abnormal urges and are likely to be abusers (Hansen-Brown & Jefferson, 2022;Hughes & Hammack, 2019;Nichols, 2006;Sprott & Randall, 2017). This then connects to the Integrated Threat Theory (ITT), as the theory proposes that when people anticipate threats from an external group, it might foster prejudice (Makashvili et al., 2018). ...
... The need to conceal your own identity (especially a stigmatized one) leads to negative outcomes in various forms, like a lower sense of self-regard and the feeling of isolation (Camacho et al., 2020). To illustrate further with an example: if an individual withholds information regarding an important part of their life (in this case, practicing BDSM), they might not be aware that their long-term individual work can be compromised negatively as their therapeutic journey may be ineffective (Nichols, 2006). Since concealment of identity is necessary for most BDSM practitioners to feel safe and secure, non-disclosure tends to happen whenever they are in a vulnerable position, like during an interview or when they are seeking help from others (Sprott et al., 2021). ...
... Since concealment of identity is necessary for most BDSM practitioners to feel safe and secure, non-disclosure tends to happen whenever they are in a vulnerable position, like during an interview or when they are seeking help from others (Sprott et al., 2021). Current laws and systems do not protect the rights of BDSM practitioners; their relationships with friends and families can be destroyed due to inappropriate disclosure (Nichols, 2006;Stiles & Clark, 2011;Wright, 2008). For example, medical providers can report an individual for engaging in domestic abuse when they see bruises and marks on their partner even though it was a result of a consensual BDSM scene (Waldura et al., 2016). ...
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This study aims to examine the effect of the level of awareness about BDSM on the attitudes towards BDSM practitioners in a conservative country such as Malaysia. A total of 124 Malaysian participants were recruited. Over 5 weeks, the experimental group underwent educational interventions, whereas the control group received neutral, unrelated information. The Attitudes about Sadomasochism Scale was used to record responses from both groups before and after the experiment. Results indicated that the experimental group showed a greater reduction in stigmatizing attitudes towards BDSM practitioners after the intervention period, demonstrating that the level of awareness of BDSM significantly affects participants' stigmatizing attitudes towards BDSM practitioners. In conclusion, educational interventions might be essential to reduce stigmatizing attitudes.
... -32 - El BDSM se define como un conjunto de prácticas sexuales no convencionales que tienen como elemento en común el intercambio erótico de poder y los juegos de rol (Fedoroff, 2008;Nichols, 2006). Existe una gran cantidad de fantasías, reglas y prácticas que se pueden realizar, agrupándose las más frecuentes generalmente en 6 grandes categorías: bondage, disciplina, dominación, sumisión, sadismo y masoquismo (Fedoroff, 2008;Nichols, 2006;Botta et al., 2019). ...
... -32 - El BDSM se define como un conjunto de prácticas sexuales no convencionales que tienen como elemento en común el intercambio erótico de poder y los juegos de rol (Fedoroff, 2008;Nichols, 2006). Existe una gran cantidad de fantasías, reglas y prácticas que se pueden realizar, agrupándose las más frecuentes generalmente en 6 grandes categorías: bondage, disciplina, dominación, sumisión, sadismo y masoquismo (Fedoroff, 2008;Nichols, 2006;Botta et al., 2019). ...
... Un concepto relacionado con el BDSM que actualmente tiene una amplia difusión es el kink. Este se define como prácticas, conceptos o fantasías sexuales no convencionales o normativas, abarcando además de las prácticas BDSM, fetiches y parafilias (Nichols, 2006). Su interpretación personal es dinámica, igual que en el BDSM, varía desde una forma de exploración sexual hasta aspectos más identitarios o estilos de vida (Nichols, 2006;Richters et al., 2008;Waldura et al., 2016). ...
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Por tod*s y para todes es una publicación del Equipo de Género y Subjetividades Trans de ONG CERES, la cual compila trabajos de investigación producidos en contextos de formación académica de pre y posgrado que hacen uso de estrategias de lenguaje inclusivo de género. Su objetivo es favorecer la aceptación y naturalización de los vectores de transformación sociolingüísticos género afirmativos relativos a las personas trans* y no binarias, bajo la convicción de que resulta imperioso «abrir el campo de enunciabilidad de variantes sexogenéricas en constante construcción» para la construcción de una sociedad más justa e igualitaria, con perspectiva de género y centrada en la defensa de los derechos humanos. Por tod*s y para todes está compuesto por tres versiones abreviadas de tesis, dos ensayos de seminario, un ensayo de cátedra y una fundamentación de un proyecto de investigación doctoral, los cuales atravesaron instancias de evaluación estándar en el marco de las pragmáticas de formación de las ciencias sociales, los estudios de género, la medicina, la estética y el psicoanálisis. Dicho conjunto va antecedido por una introducción que releva la particularidad de la demanda de justicia sociolingüística transafirmativa a partir de la experiencia del activismo, la docencia universitaria y el trabajo editorial. El diseño, edición y diagramación estuvo a cargo de Débora Fernández Cárcamo, mientras que de la corrección editorial la misma autora y de Marcela Weintraub.
... Studies similarly document that those who do report their BDSM practice or fantasies can face stigma from clinicians who have not developed a "kink-aware" cultural competency (Shahbaz & Chirinos, 2016;Simula, 2019b). As a result, disruptions in the therapeutic alliance, disruptions in the therapy process, and unnecessary diagnosis of pathology among clients are all possible scenarios that may keep BDSM practitioners from utilizing therapy (Nichols, 2006). Notably, there is also a preponderance of evidence suggesting that pathology diagnoses are not warranted based on BDSM activity alone (Sprott et al., 2017). ...
... Although some research has suggested a correspondence between experiences of stigma and pathways of identity formation between BDSM practitioners and other sexual minority groups such as the LGB and consensually non-monogamous (CNM) populations, other literature has identified unique experiences of stigma and pathways to identity formation within the BDSM community (Chaline, 2010;Mosher et al., 2006). As a result, clinicians must consider distinct clinical issues with BDSM practitioners, such as stigma, concealment, non-disclosure, diagnosis, clinician discretion in addressing BDSM as relevant to treatment, countertransference toward BDSM practice, understanding BDSM relationship dynamics in the context of common psychotherapeutic interventions, separating BDSM practice from domestic abuse and self-destructive psychopathology, and approval-seeking behavior from clients who are new to BDSM practice (Dunkley & Brotto, 2018;Meyer & Chen, 2019;Nichols, 2006). ...
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BDSM practitioners represent a large sexual minority group often overlooked, misunderstood, and unnecessarily pathologized by mental health clinicians. Although developing cultural competence for diverse and marginalized populations is widely understood to be a core component of delivering efficacious therapeutic services that can counteract these stigmatizing mental healthcare experiences, no measures currently exist that assess clinicians’ self-reported competence to work with BDSM practitioners. Previous measurement work has been done to establish self-report competency scales for clinicians working with other sexual and gender minority groups, but no such scales exist for working with BDSM practitioners. In the current study, we adapted a version of the Sexual Orientation Counselor Competency Scale (SOCCS) to measure clinicians’ self-reported competence to work with BDSM practitioners and did a preliminary exploratory factor analysis of the new scale (n = 124). After an initial 24-item administration, principal axis factoring of our final 17-item solution revealed two latent factors (attitudes and skills/knowledge) consistent with the 2013 SOCCS and the theoretical constructs of cultural competency. The BDSM Counselor Competency Scale (BDSM-CCS) can help clinicians, practices, agencies, and training programs track self-reported cultural competence with the BDSM population. Future research directions for scale development and clinical and training applications are discussed.
... And that exploration helped me come to terms with the various issues arising from being sexually abused. This theme of overcoming past trauma has been recognized by therapists and researchers, but it has not yet been explored in depth (Cascalheira et al., 2023;Gewirtz-Meydan et al., 2024;Hammers, 2014;Nichols, 2006;Ortmann & Sprott, 2013;Shahbaz & Chirinos, 2017). The data reported here show possible connection to Personal Growth, Autonomy, and Positive Relationships with Others, as categories of psychological well-being involved in experiences of healing from past trauma. ...
Article
Past research has examined the incidence of psychological distress and mental disorders among people who practice alternative sexualities known as “kink” or BDSM, but there are very few studies of the positive impact of kink sexuality on psychological well-being. A total of 1,402 individuals participated in the 2016 National Kink Health Survey; 1,003 participants were included in the analysis presented here. Participants were included if they answered the survey question: (a) Do you feel that your involvement in kink has affected your mental health, either positively or negatively? Two other follow-up questions were asked: (b) If yes, has that effect been positive or negative or both?; (c) Please comment, if you would like, to expand on your experiences related to the last question. Results indicated that 66% of the 1,003 participants found that kink sexuality had a positive impact on their mental health, and qualitative analyses found that the impact focused on four areas of well-being: autonomy, positive relations with others, personal growth, and self-acceptance. Negative impacts were also noted, mostly in the area of difficult/negative relations with others that included stigma/prejudice, interest discrepancies within intimate relationships, and poor treatment or abuse from intimate partners. This research indicates that participation in kink sexuality can be a source of personal growth and healing, at least for some individuals.
... Ainda Silva (2016), baseada no trabalho de Lanteri-Laura, identifica que posteriormente a esse período de primazia da reprodução, a norma psiquiátrica da sexualidade "sadia"/"normal" se transformou e passou a normalizar a presença e a (Bezreh et al., 2012;Facchini & Machado, 2013;Santos, 2013;Wismeijer & van Assen, 2013;Mota & Oliveira, 2014;Silva & Paiva, 2014;Gregori, 2015;Quaresma, 2019), e também aqueles que indicam problemáticas na condução clínica a partir da manutenção do olhar hegemônico clássico, propondo outras possibilidades de condução (Kolmes et al., 2006;Nichols, 2006;Lawrence & Love-Crowell, 2008;Hoff & Sprott, 2009;Waldura et al., 2016;Ansara, 2019;Sánchez, 2020;Lantto & Lundberg, 2021 (Boss, 1976) e na análise do caso da Dra. Cobling (Boss, 1999 O primeiro caso, nomeado como "Um fetichista", conta o caso de K. S., cujas experiências erótico-sexuais se vinculavam a objetos de vestuários femininos de couro ou peles. ...
Article
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No livro Sentido e Conteúdo das Perversões Sexuais, publicado em 1947, Medard Boss realiza uma daseinsanálise de oito casos clínicos, destacando como as supostas “perversões” seriam estreitamentos do fenômeno do amor. Este artigo objetivou realizar um exercício de releitura contemporânea desta obra. Identificamos não só limitações do pensamento de Boss, ainda muito preso a convenções sociais da época, na seção “três homossexuais”, mas também potencialidades para uma fenomenologia das dissidências sexuais a partir dos casos dos pacientes fetichistas. O acolhimento dos sentidos descritos pelos sujeitos possibilitou rupturas com os modelos universalizantes e patologizantes até então disponíveis, bem como facilitou outras compreensões do modo de existência amoroso, apreendendo essas expressões de sexualidade enquanto possíveis “clareiras” que permitiram aos sujeitos o acesso ao fenômeno do amor, isto é, a abertura na relação com o mundo e a ruptura com modos existenciais engessados.
... În contextul non-masochist și în cazul grupului de control, pragurile durerii au fost similare, Luo & Zhang (2017) sugerând că un context de natură masochistă atenuează durerea resimțită de practicanți (Rossman S., 2022). Acest studiu confirmă rezultatele cercetărilor anterioare (Nichols M., 2006;Scott G.G., 1983;Defrin R. et al., 2015) care dovedesc că durerea în afara contextului SM este percepută ca o experiență negativă (Dunkley C., 2019, p. 2). Într-un studiu neuroimagistic similar, care a combinat durerea cu imagini ce prezentau în primă fază teme masochiste, apoi teme non-masochiste, Kamping S. et al. (2016) au observat că operculul devine mai activ la practicanții masochiști când acestora le sunt administrate impulsuri dureroase alături de imagini specifice (Rossman S., 2022). ...
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Introducere: Profilul psihologic al practicantului BDSM a fost conturat ca extensie a conceptului psihanalitic de sadomasochism, ce denotă un comportament autodistructiv, inhibarea globală a plăcerii și sentimentelor pozitive, căutarea activă a suferinței în toate dimensiunile vieții, incapacitatea de a forma altfel de relații în afara celor bazate pe control și exploatare. Conceptul psihanalitic expune doar marginal comportamente sexuale bazate pe schimbul de putere și administrarea/experimentarea durerii, iar când acestea apar în discuție, observațiile sunt bazate pe cazuri nonconsensuale și eminamente patologice. Ca urmare, actele BDSM au fost puternic stigmatizate. Obiectiv: De a proba aplicabilitatea teoriilor psihanalitice privind relațiile subculturii BDSM și a construi un profil relațional unic subgrupului. Metodologie: Studiu cantitativ derulat pe 234 participanți, compus dintr-o secțiune dedicată prelevării datelor demografice pentru determinarea profilului sexual (genul, orientarea, fanteziile, practicile și identificarea ca practicant), o scală pentru măsurarea retroactivă a calității relației cu părinții, respectiv o scală dedicată intimității cu partenerul. Rezultate: Studiul nu a indicat diferențe semnificative statistic între practicanți și non-practicanți în ceea ce privește calitatea relației cu mama din timpul copilăriei – niciuna dintre următoarele subscale nu a indicat că practicarea BDSM s-ar asocia unei relații retrospective problematice cu mama: dragostea percepută, comportamentul punitiv al mamei, minimizarea impactului pedepselor de către adult, controlul exercitat de mamă, ambițiile mamei, mama ca model, reversarea rolului mamă-copil. Au fost descoperite diferențe limitate în relația cu tatăl: practicanții au simțit că au primit mai puțină afecțiune din partea tatălui în copilărie, au perceput contactului fizic dorit de tată mai degrabă ca excesiv și au preluat comportamentul tatălui într-o mai mică măsură drept model de urmat, comparativ cu non-practicanții. Calitatea relației cu partenerul a fost superioară în cazul practicanților, aceștia înregistrând scoruri mai bune în raport cu grija acordată partenerului și grija primită din partea partenerului, validarea acordată și primită, precum și în ceea ce privește intimitatea în mod global, nefiind însă observate diferențe statistice între grupuri în legătură cu înțelegerea acordată și primită în relația cu partenerul. Concluzii: În ciuda unui istoric deficitar sub aspectul afecțiunii paterne resimțite, practicanții prezintă o imagine prezentă favorabilă, printr-o calitate superioară a relației cu partenerul. Studiul nu a găsit aspecte care să justifice stigmatizarea practicanților, iar faptul că teoriile psihanalitice nu au fost aplicabile decât într-o mică măsură arată cât de necesară este o analiză a profilului psihologic al practicantului BDSM, diferențiată de conceptul psihanalitic de sadomasochism. Cuvinte-cheie: BDSM; sadomasochism; intimitate; cuplu; erotic; calitatea relației; copilărie; părinte-copil.
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Internet bardzo mocno wpłynął na życie erotyczne człowieka. Ludzie zaczęli zaspokajać swoje popędy i fascynacje seksualne przy użyciu nowych, cyfrowych technologii. Obecnie wzrasta liczba osób stosujących formy rozładowania napięcia seksualnego w sieci, przez co staje się to coraz powszechniejszym modelem aktywności seksualnej. Postęp cyfryzacji i powszechne korzystanie z Internetu oraz serwisów społecznościowych doprowadziło do pojawienia się nowych form przemocy seksualnej. Internetowa przemoc seksualna to rodzaj cyberprzemocy polegającej na stosowaniu szkodliwych i agresywnych nadużyć seksualnych popełnianych przy użyciu nowoczesnych technologii cyfrowych. Do form internetowej przemocy seksualnej zalicza się m.in.: pornografię zemsty i internetowe wymuszenie seksualne. Pornografia zemsty to udostępnianie treści o charakterze seksualnym bez zgody osoby poszkodowanej, często w ramach zemsty byłej sympatii lub w następstwie kradzieży zdjęć, hakerstwa bądź retuszowania nagrań i fotografii. Natomiast internetowe wymuszenie seksualne to groźba rozpowszechniania intymnych materiałów o charakterze seksualnym w celu uzyskania pewnych dóbr lub wymuszenie pewnych zachowań. Zjawiska te w ciągu ostatnich lat stały się poważnym problemem o daleko idących konsekwencjach. Niniejszy rozdział poświęcony jest problematyce internetowych form przemocy seksualnej, w szczególności pornografii zemsty (nonconsensual porn, revenge pornography) i internetowemu wymuszeniu seksualnemu (sextortion). Dokonano przeglądu dostępnych informacji na ten temat, co pozwoliło na zaproponowanie ram dla poszerzenia rozumienia internetowych form przemocy seksualnej. Niniejsze opracowanie przybliża aktualną terminologię, przedstawia dominujące dyskursy naukowe oraz określa charakterystykę ofiar i sprawców. W rozdziale przybliżono oraz omówiono konsekwencje tych zjawisk. Badania dowiodły, że doświadczenie internetowej przemocy seksualnej wpływa nie tylko negatywnie na zdrowie fizyczne i psychiczne jednostki, ale również oddziałuje na życie i zdrowie publiczne.
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W ostatnich latach, za sprawą przekazu medialnego, pojawia się coraz więcej doniesień w obszarze praktyk seksualnych związanych z BDSM: bondage & discipline (wiązanie i dyscyplina), domination & submission (dominacja i uległość), sadism & masochism (sadyzm i masochizm). Istnieje ogromna liczba sprzecznych informacji, najczęściej pochodzących z niewiarygodnych źródeł, które prowadzą do głębokiego zamieszania i kontrowersji wśród specjalistów zajmujących się zdrowiem psychicznym. Celem przedstawionych rozważań jest interdyscyplinarne ujęcie psychospołecznego funkcjonowania osób zaangażowanych w społeczności BDSM w kontekście ich doświadczeń oraz poruszenie kwestii terapii zorientowanej na osoby identyfikujące się jako kinkowe. W stosunku do (częściowo) tożsamego podrozdziału z ICD-10 nowy podrozdział ICD-11 nie zawiera takiej kategorii jak „sadomasochizm”. Przy czym z dwuczęściowej kategorii sadomasochizmu usunięto całkowicie masochizm,a zaburzenie opisywane jako „sadyzm seksualny” ma w swojej nazwie i definicjiwarunek stosowania przymusu wobec drugiej osoby. Cory, Cascalheira, Ijebori in. (2021) stwierdzili, że uczestnicy badania przekształcili swoją traumę poprzez kink, restrukturyzując obraz siebie, osiągając wyzwolenie poprzez związek, odzyskując władzę, zmieniając zachowanie i redefiniując ból. Zaś odkrycia Ten Birk, Coppens, Huys i in. (2020) nie potwierdzają hipotezy, że BDSM jest nieprzystosowanym mechanizmem radzenia sobie w odpowiedzi na dynamikę doświadczeń wczesnodziecięcych. Specjaliści zajmujący się zdrowiem psychicznym prawdopodobnie mają ograniczone informacje na temat osób, które angażują się w BDSM, mogą mieć stygmatyzujące przekonania i negatywnepostawy wobec nich, w efekcie czego niewłaściwie patologizują działania związane z BDSM. Niezwykle istotne zdaje się znalezienie terapeuty rozumiejącego i wspierającego, posiadającego informacje o różnorodności w zakresie ekspresji seksualnej. Sprzeczne perspektywy opisu i przedstawiania osób praktykujących BDSM pozostawiają psychoterapeutom i innym osobom w praktyce klinicznej więcej pytań niż odpowiedzi dotyczących definicji „normalnych” i zdrowych zachowań seksualnych w porównaniu z tymi, które mają charakter patologiczny.
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Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.
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