Serving BDSM Clients Part 1: Why All Relational Counselors Should Become Kink-Aware

Jan 17

This is part one of a two-part series exploring how relational counselors and therapists can become more kink-aware to better serve clients part of the BDSM communities.

In the largest survey of sexual fantasies of adults in the U.S. published to date, Justin Lehmiller in his book Tell Me What You Want found that out of 4,100 adults one of the most popular themes of sexual fantasies is that of bondage, discipline, dominance, submission, sadism, and/or masochism – otherwise known as “BDSM” or “kink.”These findings may be an indicator that BDSM fantasies are becoming more acceptable to the mainstream public and increasingly destigmatized through media like the 50 Shades novel series, the movie Secretary, and the Netflix show Bonding. However, these shows tell the public many false stereotypical narratives surrounding the kink community, without considering the more real aspects of BDSM and fantasies.

Other research on BDSM practitioners show that kinky people exist nationwide, come from all gender and sexual identities, and they are utilizing mental health treatment for both BDSM-related and unrelated issues. Researchers Dunkley and Brotto estimate that the prevalence of BDSM practitioners is comparable to the number of adults who are gay, lesbian, or bisexual, suggesting that counselors will encounter kinky clients just as frequently as they do these populations. Dunkley and Brotto also assert that many counselors like sex therapists and relational counselors are not adequately prepared to work with kinky clients. They also may be actively pathologizing kink. Even if a counselor or therapist is open to working with BDSM clients, the willingness to work with this population is not sufficient to ensure we are doing so in a safe and ethical way. Relational counselors must take our practice one step further and become kink-aware.

What is Being Kink-Aware and Why Must We Work Towards This?

A kink-aware counselor recognizes kink as a typical part of sexual expression. They are able to distinguish between abuse and healthy BDSM practices, as well as diagnose abuse within kink. They know what constitutes safe vs. unsafe kink. They have educated themselves about BDSM through books, articles, discussion groups, supervision, and other means. They are aware of kink-specific issues that might come up in therapy. The kink-aware professional has a good understanding of the kink community and its resources. They explicitly welcome clients who practice BDSM through their advertising materials and in their intake forms.

Not only must therapists be kink-aware themselves, but they must determine the difference between what type of therapy is needed. Sprott and colleagues define “kink-knowledgeable” therapy as practiced with BDSM in mind but kink is not the presenting issue.“Kink-focused” therapy is needed when the presenting issue is related to BDSM behaviors, identities, and dynamics.

So why do relational counselors need to become kink-aware? The academic literature says that failing to do so is unethical. Being kinky is a cultural identity and must be treated as part of the multicultural competence ethics for counselors as stated in multiple ethical guidelines. Counselors may also be putting themselves at risk for legal and professional sanctions by remaining ignorant of BDSM practices. Those who work outside of their areas of competence pose significant harm to their clients.

Failing to become kink-aware can also hinder the therapeutic process. Clients who have been traumatized by other counselors may refuse to seek out needed treatment. Clients can sense unexpressed kinkophobia, which can derail the maintenance of the therapeutic alliance. They may feel the need to test out their counselor in an attempt to assess the counselor’s attitudes toward kink. Many clients are fearful to disclose their BDSM practices to their counselor, which means that some BDSM practitioners are in therapy with counselors they don’t trust enough to manage information that is a big part of their life. This can damage long-term therapeutic work and work where sexuality and relationship issues are the presenting problem.

Misconceptions and Biases About BDSM

The first step to becoming kink aware is to learn to deal with countertransference and our own biases. Counselors need to confront our own mainstream value system, theoretical beliefs, and practice orientation; biases about various aspects of kink; and biases about our own sexuality. To provide the best care, we don’t have to be comfortable with every kink practice, we only need to be working through an awareness of our levels of comfort and discomfort.

Part of checking in on our own biases is mythbusting common misconceptions about the kink culture. Throughout history, the practice of BDSM has been treated as criminal behavior, mental illness, and sexual taboo, despite there being no researched correlations between BDSM and mental health challenges or tendencies toward criminal behavior. Research has found that many counselors don’t know consensual sexual sadism and sexual masochism aren’t in the most current edition of the Diagnostic and Statistical Manual as mental disorders. The DSM-V reserves those diagnoses for either criminal populations or individuals who are seeking therapy for extreme distress. But past inclusion of these BDSM practices in the manual has led to discrimination and stigmatization of consensual kink. A 2008 survey conducted by the National Coalition for Sexual Freedom of kink-and poly-identified people found that 11.3% of over 3,000 respondents reported being discriminated against or had experienced some form of harassment or violence, including in interactions with mental health professionals.

Counselor bias against BDSM practitioners has been frequently documented in academic literature as well as the corresponding poor outcomes for kinky clients. Researchers have found that counselors have participated in the following harmful acts against BDSM practitioners: shaming the client, refusing to provide therapy unless the client stopped their kink practices, abandoning the client without referrals, having a lack of appropriate boundaries with the client, and relying on the client as the sole source of information about BDSM. Some of these harmful practices come from a history of relational counseling being taught from a heteronormative approach that does not take into account alternative sexualities. Others come from misinformation that is perpetuated by popular media and religious organizations.

Research over the past few decades has worked to combat this misinformation. Nichols in her academic article Psychotherapeutic issues with “Kinky” clients combats some of the more common misconceptions:

Kinky desires do not stem from past histories of child, spousal, or family abuse
BDSM is not only about pain
There is no difference in psychological functioning or attachment styles between BDSM practitioners and non-practitioners
Kinky activities do not inevitably escalate to extremes, become addictive, or are any more self-destructive than other sexual practices
Kinky practices are not an amplification or aversion to intimacy any more so than other sexual activities
BDSM is not separate from vanilla (non-kinky) sex; vanilla sex can be combined with kink or can occur within the relationship without kink

I hope I’ve made the case as to the importance of mental health clinicians completing trainings and reading up on the kink and BDSM communities. Check out part two to learn more about what kink is and the do’s and don’ts of therapy with clients who are a part of these communities.