While recent decades have seen changes in the way in which gays, lesbians, and to a lesser extent bisexuals and transgendered people are regarded by psychologists and psychotherapists, this comparative enlightenment has not extended to the so-called ‘paraphilias.’ Moser (2001) has decribed in detail the inconsistencies and circular reasoning used in classifying atypical behavior and object preferences as paraphiliac ‘disorders.’ In this paper, I am aligned with a small but growing group of professionals (Moser,2002,2001; Kleinplatz, 2002,2001;Weinberg and Levi-Kamel, 1983; Morin,1995) who consider certain of these ‘paraphiliac’ preferences to be statistically abnormal but pathologically ‘neutral;’ i.e., no more inherently healthy or unhealthy than mainstream sexual practices.

In this paper I am specifically referring to sexual behaviors variously described as S/M (sadism/masochism); D/S (dominance and submission; BDSM (bondage/discipline/dominance/submission/sadism/masochism) as well as to sexual attractions that are often labeled ‘fetishes,’ i.e., attractions to non-human objects or to specific parts of bodies. Collectively these practices and attractions are sometimes referred to as ‘kink.’ I follow the definitional guidelines promulgated by the ‘kink community’ itself (Wiseman, 1996): ‘Kinky’ activities may be highly unusual, but they are always ‘safe, sane, and consensual.’ Therefore, in this paper I am not referring to rape and other coercive sex, sex with minors, and sexual activities clearly meant to harm self or others.

I am a psychologist and sex therapist who has worked primarily with ‘queer’ clients for more than twenty years– in other words, with people who are gay, lesbian, bisexual, or transgendered, or who participate in ‘kinky’ or polyamorous sexual activities. My agency, the Institute for Personal Growth in New Jersey, U.S.A., employs two dozen therapists, and the material in this paper derives from our collective experience. Over the last two decades, much of our work has amounted to ‘damage control:’ repairing egos battered by the judgmental attitudes of traditional psychotherapists. The focus of this paper, therefore, is education. I will first address some of the most prevalent myths about BDSM, and then outline the most common clinical issues encountered in working with this population. Throughout, my goal is to give concrete, practical advice to clinicians who may find themselves working with clients engaged in BDSM activities. All cases used in this paper have been disguised to protect confidentiality.

Common Misconceptions about BDSM

Briefly, some of the most common misconceptions about BDSM are as follows:

1. BDSM is mostly about the ‘dominant’ partner getting his/her way with a passive, exploited ‘submissive.’ In reality, BDSM “scenes” (the name given for the often elaborate playing out of a sexual fantasy) are highly negotiated and scripted ahead of time, and all the basic ‘limits’ are set by the submissive partner. While the ‘dominant’ is in charge, he or she acts within guidelines set by the ‘bottom.’ In theory, a submissive can be exploited in the same way any trusting sexual partner is vulnerable; the myth ignores the fact that the motive for the submissive partner to consent is pleasure.
2. BDSM is about physical pain. First, kinky preferences are highly variable, and even when they do include ‘pain,’ it is not pain as we typically think of it. Think “pain” as in biting your lover in a moment of sexual abandon, not “pain” as in root canal; visualize being pinched or scratched when you are highly aroused, as opposed to being punched in the nose.
3. BDSM activities inevitably escalate to extremes and/or become addictive (“it’s so good don’t even try it once.”) Some people who have suppressed their preferences for years may initially be consumed with ‘making up for lost time;’ this is a phenomenon seen frequently when pleasurable desires have been repressed, e.g., married gay men who ‘come out’ in middle age. Eventually, BDSM activity tends to level off, though that level may be different for different people and can range from a desire to occasionally incorporate kinky practices into a predominately ‘vanilla’ script, to the wish to live a ‘24 by 7’ BDSM lifestyle
4. BDSM is self-destructive. There is no evidence that practitioners of ‘kink’ use it self-destructively any more frequently than ‘vanilla’ sex is used self-destructively. Anything pleasurable is subject to abuse and addiction; BDSM is no exception.
5. BDSM comes from childhood abuse- again, no evidence that the incidence of childhood abuse is different within and outside the s/m community (Moser,2002)
6. BDSM is an avoidance of intimacy. No evidence, and many clinicians who practice within this community will tell you about long-term BDSM relationships that are not only intimate, but have ‘hot’ sex years into the relationship, perhaps more frequently than their non-kinky counterparts.
7. BDSM is separate from ‘vanilla’ sex. For most practicioners, BDSM activities and “regular” sex – intercourse, oral sex, etc., called ‘vanilla’ sex within the kink community – are combined some or all of the time, and ‘vanilla’ sex can occur without BDSM.

The “Mysterious” Allure of BDSM: Towards a New Paradigm of Sexuality

Psychological theories, especially psychoanalytic ones, have an abundance of pathology-oriented explanations for the existence of “paraphiliac” interests and behaviors. These unproven theories tend to get in the way of effective clinical work with ‘kinky’ clients. It is helpful to remember that sex, by and large, is still a mystery even to those who study it professionally. In recent years attempts have been made to develop new paradigms of sexuality that can encompass the tremendous range of behavior found not only among humans but in all animal species (Bagemihl,1999; Kaschak & Tiefer, 2001; Kleinplatz, 2001,2002; Morin, 1995; Nichols, 2000). What these models share is a reluctance to assume pathology without evidence. Here are a few very straightforward, understandable, healthy reasons why BDSM sexual activities may be appealing to kink aficionados:

1. BDSM can be a lot of fun, and it can make sex very hot. Probably the most important factor.
2. Some people see BDSM sexuality as spiritual, not unlike Tantric sex
3. Others feel it enhances intimacy in a committed relationship, and/or accomplishes healing of earlier psychic wounds in the context of a trusting partnership.
4. Some kinky practices explore the ‘shadow side’ of sexuality. Just as risk makes activities like bungee jumping or roller-coaster riding fun for some people, the taboo or apparently risky nature of some BDSM can enhance pleasure.
5. Some BDSM practicioners feel that this form of sexuality is a non-chemical way of attaining pleasurable and enlightening altered states of consciousness.
6. The tremendous variety of activities encompassed within kink mitigate against the tendency for sex to become routine and monotonous, especially in monogamous relationships.

It is probably clear by now that the appeal of BDSM sex is quite variable. In fact, it is possible that the only thing that people who engage in these forms of sexuality have in common is that they are sexual adventurers (Moser, 2002) and that sex is a high priority in their lives; they have high libido as a rule and get many needs met by their sexuality. Notice that none of these reasons for interest are necessarily ‘pathological.’

II. CLINICAL ISSUES
    Countertransference

The first and most common issue therapists confront when working with “kinky” clients is dealing with their own judgments, feelings, and reactions to this sexual behavior. The countertransferential feelings most commonly encountered by clinicians with comparatively little experience with BDSM are some combination of the following: shock, fear, anxiety, disgust, and revulsion. When this countertransference is intellectualized, the therapist may experience a deeply felt conviction that the client’s behavior is self-destructive with little but vague abstractions to justify the firmness of the conviction. When counselors find themselves believing that their clients’ pathology is ‘self-evident’ despite no concrete evidence of harm, it is fairly certain that countertransference is present.

There are many reasons why this might occur. Often the therapist simply lacks information or experience. For example, the client may tell his or her therapist that he/she participates in ‘cutting’ scenes and the therapist may assume danger when in fact the vast majority of all such activities involve superficial, easily healed wounds that are little more than well-placed scratches. Many sexual activities look strange to the uninitiated: consider the child’s usual reaction of disgust or disbelief when sexual intercourse is first described to them. It often helps to find out some of the “technical” information behind a practice. The clinician might want to read sex manuals like the ones written by Brame (2000), Miller and Devon (1995) or Wiseman (1996), or watch instructional videos such as “Whipsmart” (Good Vibrations, 2002). These books and videos often convey not just the technique, but something of the personal experience of BDSM. Besides gaining information, therapists can use these materials to explore their own “kinky side,” even if it is a minor part of their sexuality. The more adventurous therapist might consider visiting an S/M club or organization; this gives both a taste of the lifestyle and an appreciation of the attitude of warmth and community support found in these institutions.

At times feelings of disgust or aversion may convey information about repressed or disowned parts of the therapist’s own sexuality. In order to work successfully with kinky clients, the therapist should be able to handle unexpected sexual feelings arising in conjunction with his or her work—including feelings the therapist thinks are “wrong” or “dangerous” or “politically incorrect.” In this situation, it is best to cultivate an attitude of slightly detached ‘observation’ of the entire process, including the revulsion, the desire or arousal, and the defensive reaction to the arousal. This process might go something like this:

• a)”I notice I feel disgusted when my client tells me about sexual scenarios in which her partner has humiliated her. What triggers this disgust in me – is it the humiliation, the specific method of humiliation, etc.?”
• b) “Why is my reaction so strong and aversive? Might I secretly want to humiliate or be humiliated?”
• c) “If so, why does that scare me? Why do I think it’s ‘bad’ or ‘wrong’ for me to feel this way? Does it clash with other values? Does it trigger memories of past trauma or other experiences involving humiliation?” In the BDSM community, the term “squicked” refers to having a strong negative emotional reaction to an activity while knowing that you don’t actually ‘judge’ the activity as ‘wrong’ or ‘bad.’ This is a helpful and neutral way to think of such countertransferential feelings.

This process not only can result in the counselor learning invaluable information about their own sexuality; it may also mirror the client’s internal experience or self-hatred or shame. When the therapist has analyzed his or her own negative reaction, he or she may also have an enhanced ability to be helpful to the client.

Non-Disclosure of BDSM

Though we have no way of knowing how common this is, it is very clear that many people within the BDSM community go to counseling and never reveal their sexual preferences to their therapist. Sometimes this does not interfere too much with therapy, especially if the therapy is relatively short-term and problems are unrelated. When the client or clients’ problems include sexual or relationship issues, however, therapy can be terribly compromised. Long-term individual work can be damaged as well, because the client is withholding information about a significant portion of his or her life. Clients themselves sometimes do not understand the therapy process well enough to predict that such secrecy may sabotage treatment, and so it may seem simpler to hide than to risk negative judgment. It’s hard to blame people in the kink community for doing this, however misguided it may be; given the training most therapists receive about sexuality, many would judge a client negatively if the information were revealed.

How can the therapist avoid this and encourage self-disclosure? If you or your agency are not known for sexual openness, you can communicate in indirect ways, with the literature in your office, your artwork, the books on your bookshelf. It is not necessary that you have sexually explicit material on view to achieve this. A visitor to the IPG offices sees a rainbow flag in one of the windows, literature on sexual minorities in the waiting room, and books like “S/M 101” on my bookshelf.

In addition, the questions asked on client questionnaires and in the initial interview with clients establish a tone of acceptance. For example, clients who come for sex therapy at IPG are asked to fill out a written survey that includes questions about bondage, fetishes, role playing, d/s, spanking, and so on, right next to the questions about oral, anal, vaginal, and manual stimulation. Other clients are asked less elaborate questions that nevertheless include items about sexual orientation and sexual interests. Over the course of therapy, a counselor might deliberately bring up BDSM in indirect ways. For example, when talking to presumed ‘vanilla’ clients about sex, I regularly mention the excellent communication skills of people who practice BDSM - just in case the client needs permission to reveal a ‘secret.’

Ignoring the Kink

It is important to understand that in all probability most of the clients you will see involved in kink will be coming to you for reasons unrelated to their sex lives. For these clients, you can demonstrate your understanding of BDSM, and your empathy, by NOT prodding them to talk uneccessarily about their sexuality. In the first years of IPG, in the early 80’s, we worked entirely with gay and lesbian clients. Our clients often said they came to us in order to avoid talking about their gayness. Frequently they reported experiences with uninformed straight therapists who had focused on gay sexuality when the clients wanted to talk about depression, relationship issues, family problems- in other word, the typical range of problems most people bring to therapy. Even if your desire to focus on your client’s kinkiness does not come from negative attitudes – even if it is because you are curious to learn – it is inappropriate to steer clients towards talking about issues that they do not consider important problems in their lives.

Problems of “Newbies”

If you are not known within the “kink” community, it is possible that the most common kind of BDSM client who will request your services is the “newbie:” the person who is just ‘coming out’ to themselves and/or others about their kinky desires. Ironically, this is precisely the client for whom you must be most knowledgeable and positive about BDSM. People with “kinky” desires have grown up with the same judgmental, uninformed societal attitudes as has everyone else. Therefore, they are likely to have a good deal of internalized shame, fear, and self-hatred about their sexual preferences even if they have finally succeeded in admitting their identity to themselves or telling someone else. For this person, providing acceptance and modeling positivity is crucial and has intense power as an intervention. “Newbies” look to therapists for a “seal of approval”: you, as a mental health professional, can validate that they are “ok.” Thus with these clients you cannot assume a passive, “non-judgmental” stance; you must give feedback. A “newbie” is likely to assume that “no comment” equals negative judgment. Thus the therapist must emphatically reassure them they are not “sick,” must explain that others have the same experiences, and should refer them to books, internet URL’s, and organizations where they can begin to develop a support network. Provided one genuinely believes this, the counselor can be enormously beneficial with relatively simple comments and suggestions. Some time may need to be spent helping clients understand how their own self-hatred has been inculcated by societal prejudice, and in assisting them in forming a more positive self-image. The person may have social problems related to their isolation; for example, some people avoid intimacy as a way of containing their desires, and therefore he or she may have poor intimacy skills even after they ‘come out.’ Other clients may have built all their social relationships on a lie, so to speak, and experience stress related to ‘fronting,’ fear of being ‘found out,’ and/or feelings of being a ‘fake’ or ‘imposter.’ And indeed, the fear of being found out is not entirely paranoia. Since at present few laws protect the rights of the BDSM community, people can and do lose jobs, friends, family, and children because of inappropriate disclosure or inadvertent ‘outing’(Wright, S.,2002). Advice about “coming out” to others must include information on realistic dangers. Treatment of the “newbie” almost always involves validating them, psychoeducation, bibliotherapy, and guiding them to support groups. It is very gratifying and often not difficult work.

It is almost impossible to work with BDSM “newbies” without receiving requests from clients to eradicate their kinky desires. This can create conflict for the therapist, as clients who want to be “cured” report horrible psychic pain around their sexuality, and it is normal to want to help them attain their goal. In fact, such personal discomfort, coupled with BDSM desires, qualifies the client for a diagnosis of paraphilia, just as, in the 1970’s, discomfort with homosexuals qualified an individual for the diagnosis of “ego-dystonic homosexuality” even after homosexuality per se had been removed from the nomenclature.

The category of “ego-dystonic homosexuality” was eventually removed as a diagnosis through the efforts of gay activists, who argued that the average gay person went through at least a stage, if not a lifetime, of introjecting societal values as self-hatred and rejection of the ‘offending’ feelings and behavior. Activists called that phenomenon ‘internalized homophobia,’ and insisted that appropriate treatment was to help the person eradicate the internalized homophobia, not the homosexuality. In many ways the BDSM community of the early 21st century resembles the gay community of the 1970’s, and individuals who struggle with BDSM desires experience a similar internalized shame about their sexuality (Nichols,2000). At IPG, when these clients ask to be “cured” of their kinky feelings, our first assumption usually is that the problem is not the BDSM, but rather the client’s self-hatred and the desire to repress or obliterate their sexuality. In addition, we are mindful that the history of attempts to eradicate particular sexual desires has been pretty dismal. We tell clients that although they can choose to not act upon their sexual feelings, they will probably never get rid of them, and that not accepting these desires may very well inhibit the rest of their sexuality, as well. In most cases, when we - professionals who are “experts” on sexuality- validate the client’s BDSM desires, the level of their self-hatred is immediately reduced and they quickly abandon their goal of repressing or eradicating their feelings. However, if a client continues to want help eradicating their desires, we refer him or her to local professional organizations who can connect them to counselors who will agree to work towards this goal. In addition to the fact that we think such “cure” oriented treatment has a poor prognosis, we also feel offering treatment like this would conflict with and compromise our stance of validation of BDSM.

The Partner and Family

Many “kinky” individuals have been aware of BDSM sexual fantasies from an early age, although a large number will make enormous effort to suppress behavior and repress desire because of the acute social disapproval of this form of sexuality. Therefore, many “kinky” people have chosen to hide their feelings, behavior and/or identities until mid-thirties and beyond. During their years of secrecy, they may have infrequent clandestine encounters, Internet contacts, or only allow themselves the outlet of masturbating to BDSM fantasies. By the time this person feels he or she can no longer contain his or her desires, he or she may have long ago married and perhaps had children with a (presumably) ‘vanilla’ spouse. In addition to the issues experienced by most ‘newbies,’ the person with an unsuspecting partner has a whole host of other problems. In fact, some requests for help may come from the spouse who has just discovered the BDSM partner’s sexuality. In other cases, you learn this from the BDSM partner in individual therapy, or both members of the couple may ask for couples counseling. The BDSM may have already been revealed before the person or couple comes for help, or it may be your job to facilitate disclosure.

Sooner or later, the married person in this position usually needs to reveal their true identity to the spouse/partner. If you are called upon to aid in this process, consider fairness to the spouse as well as the individual desires of your client. While the reaction of the spouse who has been deceived ranges from surprise to horror –occasionally with delight – there is almost always some anger about the deception. At IPG we feel we have some ethical responsibility to partners, however undefined that may be. While we would never consider violating confidentiality, we do try to steer the married BDSM client towards eventual disclosure. There are many reasons to do this, both practical and moral.

On the other hand, timing and readiness are crucial. As mentioned, the partner’s reaction may vary widely. It is important to remember that his or her first reaction is just that – a first reaction. Unless the partner is also unexpectedly kinky, the first reaction is unlikely to be a joyous one. So if your client is the “kinky” one, first prepare them and help them assess their readiness for an unpleasant interlude. When he or she is ready, you can help your client plan the disclosure for the most opportune time and setting, and you can role play to practice the actual situation.

Both you and your “kinky” client must be ready for a partner who must go through a grief process before he or she can think rationally about the marriage/relationship. When you can, empathize with and validate the reactions of the partner, and refer them if possible to support networks/internet groups. After the partner is able to consider options for the relationship, your job will be to help the couple accommodate if possible or separate in as loving way as possible if no accommodation can be made. In this situation, your success is contingent to a large degree upon factors you cannot control, namely, the partner’s feelings, attitudes, and sexuality. In many cases divorce will be the answer. In others, the partner may be willing to allow the kinky person to have some sexual outlets outside the relationship. In yet others, the vanilla partner will develop kinky desires him/herself. In fact, this is not at all an impossible goal. Keep in mind that BDSM practicioners usually enjoy vanilla sex as well, so there is already some compatability in their sex lives. In addition, recognize that enjoyment of “kink” can sometimes be learned in adulthood: not all kinky people fantasized about BDSM from childhood. Open, curious, flexible vanilla adults can develop quite strong kinky preferences over time; it helps if the vanilla partner has a strong libido to start with.

In the case of Gerry and Lisa, for example, a professional couple with two children, an established home in a respectable, high end community, and a strong and loving relationship, accommodation is being negotiated. Gerry came to IPG in his mid-thirties, having recently allowed his kinky urges to surface after suppressing them for the most part since childhood. His fetishes included being dominated by a woman and forced to wear diapers or female undergarments. However, he enjoys vanilla sex and many other forms of BDSM, and is somewhat ‘switchable,’ i.e., able to be either dominant or submissive in a sexual situation. Lisa, initially shocked that the man she thought she knew thoroughly could be hiding something of such import from her for so long, adjusted fairly quickly once assured that Gerry was most probably not a transsexual in early stages of transitioning, something she had been adamantly told by her last therapist. Lisa discovered she could get sexual enjoyment out of dominating Gerry and, in addition, she found she could get the housework done efficiently by ordering him to clean while diapered, and then end this “scene” with intercourse if she desired. This case is in part interesting because Gerry’s primary fetishes are not “turn-on’s for Lisa, but neither do they “squick” her. Rather, what is happening is that the partners are evolving sexual scripts that satisfy his fetishes in a BDSM context while including elements that strongly satisfy Lisa.

Nick and Diane, on the other hand, have a less happy outcome. Nick had gone through a period in his life where he decided he was a sex addict and had decided that kinky sex was inextricably linked to his addiction. During that period he not only repudiated BDSM, he apparently deliberately married a rather asexual and prudish woman. Years later Nick began to secretly explore BDSM once again. This time, he found he could manage his desires without feeling compulsive, and began to want to manifest his fantasies in kinky sexual behavior with this wife. Diane, however, had not changed since their marriage. She not only will not participate, she insists upon Nick’s abstinence from kink as a condition of marriage. The couple is seesawing back and forth between periods when Nick controls his urges to make his marriage work, and when he “acts out” sexually and the couple veers towards divorce. The latter seems ultimately inevitable. As this case suggests, many kinky people attempt abstinence in order to keep a marriage and family together. Sometimes this works, depending upon many factors, including strength and quality of the relationship, presence of children, commitment to putting family life above individual needs, and, in all probability, factors like the “kinky” person’s level of sex drive and self-control over sexuality.

Issues of Bleed-through, Good and Bad

“Bleed-through’ is a BDSM term used to describe situations when the boundaries between roles in the bedroom and roles in the rest of the relationship blur, or when relationship issues and sexual issues merge. Bleed-through occurs in “vanilla” relationships, too, of course: e.g., the male who feels powerless in his marriage develops erectile problems, or, on a more positive note, the partner who feels nurtured, protected, and connected during a sexual encounter behaves more compassionately to his or her partner in the rest of the relationship. Bleed-through is sometimes more complex in BDSM relationships.

Pat and Claudia developed sexual problems in their roles as submissive and dominant when Claudia complained- and Pat agreed- that Pat was having more and more of a problem being submissive during sexual encounters. Upon exploration Pat realized she felt she was expected to be submissive to Claudia all the time, in and out of bed. Claudia denied wanting this, and it seemed apparent that both women valued egalitarianism in their day-to-day relationship. It took a few traditional couple counseling sessions to unravel the ways in which Claudia unconsciously generated cues that Pat interpreted as demands for subservient behavior, but once this happened Pat’s comfort with sexual submissiveness began to increase again. In addition, I began to suspect that couple’s sexual issues were being exacerbated by the fact that the transition between ‘real life’ and their sexual ‘scenes’ tended to be gradual and indistinct. Claudia and Pat were encouraged to develop a special ritual to designate when ‘real life’ was being left behind and ‘scene life’ was being entered; this was all the treatment they needed.

Amy and Joanne, on the other hand, had a more serious kind of bleed-through issue. In their sexual roles Amy was Daddy to Joanne’s little girl. Recently Joanne had been asking to extend these roles outside of sex to many significant areas of everyday life; for example, Joanne wanted Amy to dress her in the morning for work. Amy felt frightened by her partner’s behavior, and suffocated by the demands of the parental role. At the same time, her mild-mannered nature made it hard for her to say no to Joanne’s demands. Therapy served to help Amy be assertive with Joanne. Moreover, Joanne was advised to return to her individual therapist to resolve her strongly-felt urges to abdicate responsibility for herself and return to an infantile state. In this case, the bleed-through was emblematic of larger relationship and especially of Joanne’s psychological problems that were not particularly related to sex.

Diagnosing real abuse or self-destructive behavior

Domestic violence can occur in any type of relationship, including BDSM partnerships. Many BDSM organizations, mindful of the public perception of S/M, make special efforts to educate “scene” participants about domestic violence and promulgate guidelines to help assess whether or not their relationships are abusive. Occasionally domestic violence occurs during an actual sexual interaction, in the guise of S/M. When Sarah married Dan, she had had submissive sexual fantasies for most of her life but had never participated in kinky activities with anyone. Dan claimed to be an experienced dominant who would teach her about BDSM. Dan, however, was merely an abusive spouse with a slightly different ‘spin’ on abuse. Dan would immobilize Sarah in bondage and then, during sex, put a pillow over her face until she began to asphyxiate – an activity that terrified her. It is standard in BDSM ‘play’ to use a ‘safe word’ – a code word that the submissive partner can use to signify that he or she wants the sexual activity to stop. Dan convinced Sarah that to be a ‘good wife’ she had to give up her safe word, leaving her truly afraid for her life. . Sarah’s behavior and psychology became that of a battered wife, as by degrees she became more and more passive about her abuse. Fortunately, eventually Sarah managed to assert herself with Dan and ultimately divorce him. Sarah was helped by the fact that her IPG therapist, knowledgeable about BDSM, knew immediately that Dan’s behavior was domestic violence, not kinky sex.

Sometimes BDSM activities, like other behaviors, are turned to a psychologically self-destructive use. Suzy was a young woman with borderline personality disorder who was a sexual masochist. At times her BDSM activities, which mostly revolved around getting heavily flogged, were pleasurable and she felt connected to herself and to her partners. But at other times she, by her own acknowledgement, got herself flogged because she was full of self-hatred. While these floggings seemed to temporarily alleviate tension, both Suzy and I came to believe over time that they ultimately reinforced her self-loathing. Suzy eventually learned to distinguish when she wanted to be flogged for pleasure and when she was driven by the desire to punish herself. Once this happened, Suzy was able to stop the behavior that was motivated by self-hate without giving up her BDSM sexuality.

IV. CONCLUSIONS

When “kinky” individuals and couples seek therapy, most of the time they are seeking help for the same reasons as other clients: depression or anxiety, family or relationship issues, and so on. However, there are some issues that are special to this population. Chief among them are problems related to ‘coming out,’ i.e., the recognition of “kinky” preferences after years of suppression of these desires. This problems include internalized shame and self-hatred, isolation from others with similar sexuality, and possible conflicts with existing marital or couple relationships.

Before a therapist can help kinky clients with these problems, he or she must first examine their own beliefs about BDSM. The counselor must discard most pathology-oriented paradigms of sexuality; adopt new models that allow for neutrality and, at times, celebratory attitudes towards diverse sexuality. He or she must also learn to analyze countertransferential feelings that are based not only upon ignorance but sometimes on fears about one’s own ‘darker’ sexual desires. In addition, therapists wishing to help ‘kinky’ clients must undertake to educate themselves, not only about BDSM, but about all sexual minorities, since there is considerable overlap between the BDSM community and gay/lesbian/bisexual populations as well as the polyamory movement.

Although considerable courage, effort, and honesty is required to attain a stance that will be helpful to clients in the BDSM community, the therapist is amply rewarded for his or her labor. First, this is a population that is truly under-served: the typical attitudes evinced by professionals towards BDSM are judgmentalism and condemnation. It is gratifying to know that one makes a difference, and supportive and validating therapy for ‘kinky’ clients genuinely helps, perhaps even saves, lives. But there are other benefits to the therapist as well. Working with sexual minorities keeps us constantly re-thinking, questioning, and re-formulating our own concepts of sexuality, and thus keeps our work in this area from becoming stagnant. And finally, working with people living “on the edge” helps bring us to our own edges, and this keeps us alive, growing and vibrant human beings.

References Bagemihl, B. 1999. Biological exuberance: animal homosexuality and natural diversity. N.Y.: St. Martin’s Press. Brame, G.G. 2000. Come hither: a commonsense guide to kinky sex. N.Y.: Fireside. Kaschak, E., & Tiefer, L., Eds. 2001. A new view of women’s sexual problems. N.Y.: Haworth Press. Kleinplatz, P. 2002. Psychotherapy with kinky clients. Workshop presented at the 34th conference of the American Association of Sex Educators, May 2- 5, Miami, Fla. Kleinplatz, P.J. 2001. A critique of the goals of sex therapy, or, the hazards of safer sex. In Kleinplatz, P.J. New directions in sex therapy: innovations and alternatives. Phila., Pa.: Brunner-Rutledge. Laumann, E.O., Gagnon, J.H., Michael, R.T., & Michaels, S. 1994. The social organization of sexuality: sexual practices in the United States. Chicago: University of Chicago Press. Miller, P. & Devon, M. 1995. Screw the roses, send me the thorns. Fairfield, Ct.: Mystic Rose Books. Morin, J. 1995. The erotic mind. N.Y.: Harper Collins. Moser, C. 2002. What do we really know about S/M: myths and realities. presented at the 34th conference of the American Association of Sex Educators, Counselors, and Therapists, May 2-5, Miami, Fla. Moser, C. 2001. Paraphilia: a critique of a confused concept. In Kleinplatz, P.J., Ed. New directions in sex therapy: innovations and alternatives. Phila., Pa.: Brunner-Rutledge. Nichols, M. 2000. Therapy with sexual minorities. In Leiblum, S. & Rosen, R., Eds. Principles and practice of sex therapy. N.Y.: Guilford. Weinberg, T., & Levi Kamel, G.W. 1983. S and M: studies in sadomasochism. Buffalo, N.Y.: Prometheus Press. Wiseman, J. 1996. SM101: a realistic introduction. San Francisco: Greenery Press. Wright, S. 2002. Sexual rights: the National Coalition for Sexual Freedom. Workshop presented at the 34th conference of the American Association of Sex Educators, Counselors, and Therapists, May 2-5, Miami, Fla.

Abstract

Psychotherapeutic Issues with ‘Kinky’ Clients: Clinical Problems, Yours and Theirs
Margaret Nichols, Ph.D./Director
Institute for Personal Growth/IPG Counseling
8 South Third Avenue, Highland Park, New Jersey 08904
www. Ipgcounseling.com

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. This paper takes a different, affirming view of BDSM. After defining BDSM and reviewing common misconceptions, the author describes a variety of issues the practicioner will face. These include problems of countertransference, of working with people with newly emerging sexual identity, working with spouses and partners, and discriminating between abuse and sexual ‘play.’