Gabriele Hoff
Life-Style Education
San Francisco, California USA
Richard A. Sprott
Community-Academic Consortium for Research on Alternative Sexualities
Berkeley, California USA
Assessing pathological from non-pathological expressions of alternative sexuality requires close connections between research, clinical practice, and professional training. Stigmatization of various forms of sexuality can cause significant difficulties in gaining information from and making observations about people with alternative sexualities. The present investigation employed a content analysis approach to stories and reflections expressed by 32 heterosexual couples who practice consensual erotic BDSM (bondage/discipline, dominance/submission, sadism/masochism), and their experiences in therapy. Five main categories emerged: Termination Of Therapy, Prejudice, Neutral Interactions, Knowledgeable Interactions, and Non-Disclosure Of BDSM Sexuality. This analysis highlights, from the point of view of the client, the importance of treating a disclosure of BDSM sexuality as only one of several possibly important factors about the client during the therapeutic interaction. Also important to effective therapeutic interaction is to avoid automatically communicating about BDSM sexuality from a cultural model of “BDSM is sickness/pathology” or “BDSM is immoral/wrong” but to discern whether the client’s activities fit the alt-sex community standard of “safe, sane, and consensual.”
In the field of mental health, one current cutting edge is the identification of appropriate and inappropriate therapeutic techniques with people with alternative sexualities. When topics of alternative sexuality arise in the context of therapy, misapplications of diagnostic criteria and a lack of familiarity about alternative sexualities can combine to foster disruptions or dysfunction in the therapeutic interaction (Nichols, 2006). As the field of mental health gains more information about the full range of human sexuality, the increase in knowledge can lead to more accurate diagnoses, effective interventions, and address public misconceptions about human behavior and mental health.
Clinical practice around issues of alternative sexuality and mental health is hindered by the difficulties in translating research and scholarship into clinical practice. In particular, assessing pathological from non-pathological expressions of alternative sexuality requires a close relation between research, clinical practice, and professional training. While there are many factors that lead to a noticeable hindrance of scholarship in how to translate sexuality research into practice and clinical practice into research, one factor that we explore in this study is the experience of stigma within therapeutic contexts.
Stigmatization of various forms of sexuality can cause significant difficulties in gaining information from and making observations about people with alternative sexualities. By stigma, we mean that a person is recognized or labeled as having an “undesired differentness from what we had anticipated” (Goffman, 1963; p.5) – and that this difference is seen as discrediting the person, making others suspect that the person is incapable, immoral or diseased. In several cases, the cues for stigma cannot be readily seen by the public, but must be inferred through the “labeling” of a person (Goffman, 1963; Major & O’Brien, 2005). Stigmatized identities based on characteristics unseen by the public can lead people to “pass” as not having that characteristic, or lead people to avoid interactions and conversations about the stigmatized characteristic with those who don’t share that characteristic. The labeling of certain kinds of sexuality as a mental disorder or illness (whether justified by scientific evidence, or not) can instigate the experience of stigma. Stigma can be realized through the activation of stereotypes, prejudice and discrimination – and people with stigmatized sexualities can experience difficulties in accessing mental health services. Some of these difficulties may be caused by negative assumptions held by health care providers about the client’s sexuality and others emerge from negative assumptions internalized by the client.
This paper will focus on the experience of people whose sexuality includes BDSM practice. BDSM stands for bondage/discipline, dominance/submission, and sadism/masochism. BDSM is a term that is used and recognized widely by the members of several alternative sexuality subcultures (Kleinplatz & Moser, 2006). Very few studies of BDSM currently exist, but those few extant studies indicate that it is an aspect that is present in approximately 23% of the population in terms of fantasy, at least on occasion (estimates range from 12-33% for women, 20-50% for men; Kinsey et al. 1953; Arndt et al, 1985) and expressed in behavior by 10% of the population (Masters et al. 1994).
This form and expression of sexuality may intersect with the diagnosis of Paraphilias as a mental disorder. According to the DSM-IV-TR:
A Paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviors, or objects as a stimulus for sexual excitement in individuals without a Paraphilia. Fantasies, behaviors, or objects are paraphilic only when they lead to a clinically significant distress or impairment...(boldface in original) (APA 2000, p. 568)
Thus, both explicitly in the text of the DSM and inherent in the logical structure of current diagnostic criteria is a condition in which BDSM interests are present but are not clinically diagnosable as mental illness. Individual clinicians may make the mistake of assuming that all BDSM interests imply mental illness, but such an assumption is not inherent in the current DSM diagnostic guidelines. Diagnostic issues and controversies around appropriate application of these criteria can impact the therapeutic interaction, inviting the experience of stigma.
Moser & Levitt (1995), in a 1987 survey of 225 people who self-identified as practicing BDSM sexuality, found that 5% of their sample endorsed the statement “S/M may best be defined as a mental illness” and that 16.1% “sought help from a therapist regarding my S/M desires.” This indicates a relatively low level of internalized stigma but also may indicate a low level of disclosure to a therapist (disclosure rates were not directly measured in the survey). Kolmes, Stock and Moser (2006) surveyed 175 participants who self-identified as practicing BDSM sexuality and who had therapy experience. Of these respondents, more than one-quarter did not disclose their BDSM sexuality to their therapists because they either felt their sexuality was unrelated to the reasons for entering therapy or they were afraid of the response of the therapist. Of those who disclosed, the respondents reported 118 incidents of biased or inadequate care in reaction to the disclosure, and 113 incidents of sensitive or culturally aware care by the therapist upon disclosure.
Nichols (2006) presents an overview of clinical issues that might come up in therapy with BDSM clients or patients, and discusses the impact of stigma in this particular setting from the point of view of the practitioner. In particular, she examines issues of countertransference where the therapist intellectualizes their fear, disgust or anxiety after disclosure of BDSM practice, and the phenomenon of non-disclosure of BDSM as a response to internalized stigma on the part of the client. Having a disclosure narrow the focus of therapeutic interaction against the will or desire of the client, or having BDSM ignored completely, are also discussed as possible impacts of stigma on therapy.
The current study is distinctive from previous research in this area by providing a qualitative analysis of the experiences of BDSM clients in therapy, which can complement the few previous quantitative surveys and the explorations of this topic from the point of view of the practitioner. A careful study of the experiences of people with alternative sexualities when they interact with therapists and counselors would help identify roadblocks and areas of difficulty. A study of this nature can also highlight the positive experiences that people with alternative sexualities have had in counseling, which can act as guidance for future encounters with therapists, as well as provide information for the training of therapists. In this study, we examine the questions “What are the experiences of clients who express BDSM sexuality when they are in therapy? Does stigma make a felt impact on their therapeutic relationships, whether they disclose or not?”
The present investigation employed a content analysis approach to stories and reflections expressed by heterosexual couples who practice consensual erotic BDSM. Heterosexual couples were chosen to minimize the impact of an intersection with other sexual stigmas on the examined experiences of therapy. While couples were recruited as part of the protocol of the original study (Hoff, 2003), the unit of analysis for this study was the individual.
The type of sampling strategy for the study was criterion sampling (Miles & Huberman, 1994). All cases that met the following criteria were included: heterosexual couples who indicated a strong preference for BDSM sexuality in their relationships; committed couples who had been together for at least one year. Participants were recruited through the first author’s personal contact with four BDSM social community organizations: Society of Janus in San Francisco, California USA; Bundesvereinigung Sadomasochismus e.V.(BVSM), SMart Rhein-Ruhr e.V., and SM-Hamburg in Germany. The Society of Janus is an educational and social organization with approximately 500 members, and has been in existence for over 30 years. BVSM is a German national organization (no specific location) that promotes workshops and congresses for education about BDSM. BVSM is well-organized, featuring an elaborate website that provides viewers with news relevant to politics including BDSM issues (recent and archival). SMart Rhein-Ruhr e.V. is another political German BDSM umbrella organization located in the central western region of Germany (“Ruhrgebiet,” near Bonn and Essen). They call themselves a “communication platform.” SM-Hamburg is a smaller organization which functions as a social and educational organization along the same lines as the Society of Janus.
These non-profit educational/social groups posted the request for study participation in their newsletters and websites. Data collection occurred in two phases. The first phase was in 2002, the second phase in 2005-2006. Four USA couples participated in the first phase that involved an in-depth recorded face-to-face interview with the couple. These interviews were transcribed in their entirety. Twenty-eight couples volunteered to participate in 2005 and 2006, which involved an Internet survey procedure. Surveys in the USA and in Germany contained open-ended questions that focused upon the length and nature of relationship commitment, involvement in BDSM outside of and within the relationship, personal meanings attributed to BDSM practices within the relationship, socialization experiences with friends and family, and psychotherapy experiences.
The participants’ ages ranged from 22 to 60 years old; they were of different ethnic backgrounds: Caucasian, African, Latino and Asian. They had been in committed heterosexual relationships from between one to eighteen years; about half of the couples were married. Of the sixty-four individuals in the sample, only four individuals (all men) had no experience with therapy.
The first author provided English translations of the surveys collected in Germany before analysis began, and analysis was conducted by both authors in a recursive and reflexive fashion, in three phases. Phase 1: review of the database material together to discern themes and categories; Phase 2: separate coding of the databases to examine the feasibility of the phase 1 categories; and Phase 3: a comparison of similarities and differences in coding and an exhaustive and systematic review of the database together.
Using content analysis, five main categories emerged out of those parts of the interviews and surveys that directly addressed experiences with therapists. The first category was labeled “Termination” – these involved reports of actions taken by therapists or clients, upon disclosure of the BDSM sexuality, which terminated the therapy relationship. The second category was labeled “Prejudice” – these involved reports about therapists’ expressing negative comments upon disclosure and during subsequent therapy visits and the perception of the study participants as having experienced prejudice. Termination of therapy did not occur in this category. The third category was identified as “Neutral” – these involved responses by therapists upon disclosure which were not explicitly negative in valence but either sought more information or treated the disclosure in the same way as other disclosures while therapy continued. The fourth category was labeled “Knowledgeable/Supportive” – these reports involved accepting and informed responses on the part of therapists which supported the ongoing therapy relationship from the point of view of the study participants. Judgments of negative and positive interaction are not the authors’ judgments, but the judgments of the participants of the study embedded in their retellings of their therapy experiences. The fifth category was “Non-Disclosure” and the participants discussed the impact of not disclosing to the therapist about their BDSM sexuality on their therapy experience.
The authors found no apparent cultural differences in the responses, whether it was regarding the length of their relationships, their SM experiences or their positive or negative experiences with therapists. It appeared that the two samples are similar enough that no major differences appeared in the responses for this study.
In addition to describing therapeutic experiences, subjects were asked what advice they would give therapists who are working with clients with BDSM sexuality. This question was chosen to see if the participants addressed issues of stigma in a discussion that was more projective and hypothetical, rather than reflections on past experiences. Using content analysis, recurring themes were identified from the responses.
One person experienced termination of therapy by the therapist upon the disclosure of BDSM sexuality:
Sandra had been in therapy for nearly seven years, during which she was in a troubled relationship. The therapist had “encouraged me to break up with the person and develop an independence around my personality, which was a strong personality even then. So, she - it was a woman- kept encouraging me to develop my own interest and to be strong and to do what I needed to do.” Then Sandra became involved with Bill [and began to explore BDSM with Bill, with Sandra taking the role of the dominant and Bill the submissive].
Sandra : So, I met [Bill ] and right after I met him I disclosed [our relationship] to her, and she’s like “well, you know, you’ll be feeding into that activity, if that’s what you want to do, you will be feeding off each other’s needs, and I don’t know if that’s healthy.” I was not surprised…but I didn’t think of it that way. …I pursued therapy in order to see how I could get out of the [previous] relationship or that I could fix myself in terms of my destructiveness. I didn’t think that my sexuality had to do with my destructive behavior; it [the destructive behavior] rather had to do with my relationships with men and not being able to communicate effectively. So, I disclosed my feelings about Bill, to see if it would move towards marriage, and she’s like, are you sure you want to get married, you did not want to get married before, you have these issues in your mind. And I am saying, my issues are getting solved by meeting this type of person, and right before we got married she said she was unable to handle my type of situation, that she had no experience with the BDSM lifestyle, she called it SM life style, and that she couldn’t recommend anybody who could work with me. I was so in love, and we were on the path towards marriage and in the groove of establishing a life together, I really didn’t focus on the fact that she was abandoning me to the wind, leaving me out on a lurch and unsupported emotionally. [Sandra and Bill interview]
We examined the data for other stories of termination of therapy, related to the disclosure of BDSM sexuality. One participant discussed that, after disclosure of BDSM sexuality in her relationship with her partner (she was the dominant in the relationship), therapy became awkward and she felt the need to terminate it eight months after the disclosure. Another participant, a woman who took on the role of the submissive in her relationship with her partner, felt the need to terminate therapy after six months because her therapist “… would not stop trying to convince me that what I was doing [was] wrong.” These were the only stories of the BDSM sexuality disclosure resulting in the ending of the therapy relationship, directly attributed to the BDSM sexuality disclosure. It is important to note that while some men experienced prejudice or neutral reactions, no men in our sample experienced the termination of therapy as reported by these three women. The interaction between gender, BDSM role/sexuality, and therapy experience should be addressed in future research, both quantitatively and qualitatively.
Several other participants related experiences and stories that, upon disclosure of the BDSM sexuality, resulted in negative comments and evaluations on the part of the therapists. The reported negative comments fell into four categories, three of which reflected three distinct discourses or cultural models (Holland & Quinn, 1987) : “sickness/addiction/pathology” model, a “broken/fix” model, and “wrong/harmful/immoral” model. It is unclear in the current database whether these models are intended to be depictions of the therapists’ own cultural models, or whether these are the cultural models used by the participants to interpret their experience of the therapists’ reactions. Further research in this area is needed. The fourth category reflected a perceived negative reaction on the part of the therapist but the participants gave a non-specific description (and therefore could not be assigned to a distinct cultural model). All of the participants experienced these comments and negative evaluations as prejudicial, and damaging to the therapy relationship. The following quotes from the database illustrate these negative experiences:
Ellen: I had a vanilla shrink who could do nothing but pathologize SM. She didn't even want to consider that it might be anything but that. Although I believe that SM can be a healthy expression of sexuality, there are certainly instances in which portions of it can be a manifestation of some dysfunction. A good therapist will be able to make this differentiation. [Tom and Ellen survey]
Simone: And I know a lot of people in the scene have this same experience [with therapists]. A number of women all sat around one day and said, have you heard this one [her therapist’s theory explaining why Simone was involved in SM], and everybody had. …Or counselor or your parents or brothers or people pathologize it in a different way, because you’re depressed or it’s because you are power hungry or because you never had Tootsie Rolls when you were a child. People make up all kinds of reasons why we do this, and by way of sort of expressing this like there is something wrong with it, and you should not do it, and you should have to be fixed. [Simone and Tim interview]
Survey: Have you ever had contact with psychotherapists? If, yes, what attitudes have you encountered from psychologists about SM?Phoenix: Yes. Several years with different psychologists, MFTs. By and large they think it's aberrant and somehow harmful emotionally and psychologically. [Katherine and Phoenix survey]
Sandra: And that’s what I felt, that I was telling her something and that it was a faux pas, that it was wrong. [Sandra and Bill interview]
Several participants described negative and prejudicial interactions with therapists upon disclosure, but describe a more generalized negative experience, not reflective of any particular type of discourse or cognitive model:
Merlin: Yes, 3 psychologists. It was difficult for me to speak about SM, and I got negative reactions. I always regretted to have brought it up. Did not help therapy progress. [Merlin survey]
Vivian: …during the second one I did disclose, but it was not a good experience: too many uncomfortable questions. [Vivian survey]
Several participants described experiences with therapists that were neutral in valence, upon disclosure of BDSM sexuality.
Hela: When I told her she didn’t flinch. She didn’t act really weird, she didn’t take a bunch of notes, because she never works that way anyway. She did ask me about communication, if I was adding too much into the relationship that was already kind of being tested with other issues. She felt that this was adding a whole other dimension that could break it because of the intensity of what needs to be done when you’re in [BDSM]. So she understood that there was a heavier dynamic added onto whatever I was already going through, what we were actually going through. She didn’t judge it, she just wanted to make sure I was safe, sane and doing the consensual thing. She didn’t seem to really know a lot about this kind of play, so I did explain a few things to her, but when I explained it to her, there wasn’t any weirdness in her voice, there was no strange inflections or anything like that. [Hela and Steven interview]
Lynn: We have both gone to counseling a few times since we’ve been married and I went to this one licensed clinical social worker and he and I were talking about the relationship that Brian and I had and I mentioned to him the SM and this man seemed fairly open about a lot of things but obviously he didn’t have a lot of experience with the SM and he made the comment I just mentioned. We were involved in SM and his response was ”well, that’s fine but do you have to do it every time?” And I had not said anything to him about the frequency or anything, and I just took it as, he was very naïve, he didn’t know anything about it. I didn’t really take it as he was being judgmental and I just basically said to him, well, that’s not really my problem here, if I can get back and focus on my problem and, we went on he accepted it. [Brian and Lynn interview]
Klaus: Had good therapy with female therapist who didn’t know a lot about BDSM but was open-minded and we worked well together. [Klaus survey]
Bernhard: Gisela [his partner] saw a therapist for self-actualization. The therapist (female) was open-minded but didn’t know about BDSM. [Gisela and Bernhard survey]
Steven: I do remember one counselor that I had, and this is while I was in college. I mentioned that I had done this [BDSM] with a partner…I just noticed the pen moving a lot more…she was just writing a lot more. I’m not sure what that was about, if she was…excited about what I was talking about…but whatever the case may be, she would bring the session back to other dynamics of the relationship…Either she didn’t want to concentrate on or it was more like, ‘OK but what about…’ I guess she would bring it back to putting the cap on the toothpaste…regular everyday relationship. [Hela and Steven interview]
In these reports of neutral experiences with therapists, all the participants discuss that the disclosure did not have any lasting impact on the therapeutic interactions, and that the client-therapist relationship continued as before the disclosure. Two themes capture the reaction of the therapists: either the BDSM sexuality is treated by the therapist as just one of several factors to consider in therapy, or the client was allowed to direct the focus of the therapeutic interaction after the disclosure. The ‘equal treatment of factors’ reaction by the therapists highlighted for the clients that this aspect of sexuality was neither more important nor less important than other factors in considering the presenting problems in therapy – and this allowed the clients to continue in therapy without disruption of the client-therapist interaction. Likewise, the second theme of clients experiencing an ability to direct the focus of the therapeutic interaction after disclosure is in contrast to the Termination and Prejudice themes, where the therapist insisted on a particular type of interaction after disclosure.
Another aspect of this category was the recognition by the clients that the therapists displayed some sort of ignorance about BDSM sexuality, resulting in some teaching/explaining interactions led by the client.
Some participants experienced what they considered to be informed, open-minded reactions upon disclosure of BDSM sexuality:
Jon: This time, I made up a list of questions and interviewed several therapists to find one favorable to my culture and lifestyle. The therapist I settled on turned out to be a remarkable and capable man. I would recommend him to anyone in the … BDSM community. [Jon survey]
Nicole: I went to see a (female) therapist, told her everything. She listened quietly, and then she told me that I am very healthy and that if I liked this opinion and was happy with it that it is all fine. This woman was the best that could have happened to me. [Nicole survey]
Tania: Yes, twice. The second (male) was good; we could look for causes without looking at me as pathological. (The first one was clueless). [Tania and Guido survey]
All of these stories reported positive experiences and evaluations of the therapy relationship and the participants reported progress in therapy. One theme that appears important is the proactive stance taken by the clients in choosing and interviewing prospective therapists specifically about their knowledge of BDSM sexuality, and then choosing a therapist who is knowledgeable or indicates the use of a cultural model that doesn’t reflect an automatic and systematic application of the “sickness/addiction/pathology” model, the “broken/fix” model, or “wrong/harmful/immoral” model.
There were several stories and comments about non-disclosure of BDSM sexuality:
Katherine: I saw a therapist (MFT) on and off for a few years; sex never was discussed. [Katherine and Phoenix survey]
Caah: In my own therapy (4 years) I never dared to speak about it, which is real sad. But I knew I would have been pathologized, [Caah survey]
Beatrix: Had 6 months of therapy but never mentioned the topic, because I believed that the therapist wouldn’t understand it, anyway. [Beatrix and Klaus survey]
Cheryl: I’ve seen a few therapists but never talked about sex or SM with any of them. I’d like for all therapists to recognize that SM activities can be (and are usually) very loving and safe. John and I both believe we are “hard-wired” perverts. Nature, not nurture, determined our turn-ons. Now that may not be true for everyone, but, as Freud said, “Sometimes a cigar is just a cigar” [Cheryl and John survey]
Jeannie: yes, 5 years ago, saw an MFT for 9 months, did not discuss sexuality. [Etaim and Jeannie survey]
Susie: I saw a psychologist a few times, for marital problems, some questions regarding my life, some anxiety. For a year pretty much once/week, then as needed. Did not disclose about D/s [Dominance/submission]. [Harold and Susie survey]
The responses in this category ranged from a participant’s “matter of fact” acceptance of non-disclosure and a simple reporting of non-disclosure, to heightened alarm and the expression of concerns that the impact of disclosure would be negative. A common theme in this category was the avoidance of all aspects of sexuality in the therapy relationship – neither the therapist nor the client initiated a discussion about sexuality.
The interviews and surveys included questions about “advice” to therapists – what concerns a therapist should have around BDSM sexuality, how a therapist should approach the topic or disclosure.
Tom: I think a therapist worth their salt would inquire about it, and honestly assess if it is an aspect of the client’s presenting problem. At most, treat it like one would any non-beneficial behavior. Snap judgments about causal relationships between presenting problems and SM should be treated with skepticism. [Tom and Ellen survey]
Beatrix: Psychologists should know about all the variations and ways to play of sexuality and relationships and help clients to penetrate to their inner core. They should be able to, even though they may not have any inclinations or ambitions themselves (in regard to the variations). They need to let the client develop and empower the client to live his/her own life. [Beatrix survey]
Caah: Psychologists must accept that [with] SM [there is] a possibility to live a healthy sexual life-style, given that it is safe, sane and consensual. Role-play with sub/dom status allows for ways to balance personality traits that may not find expression in the rest of life. In a good partnership, understanding and enabling the other gets intensified with D/s [Dominance/submission]. [Caah survey]
Katherine: Psychotherapists concerns regarding SM relationships should be similar to their concerns with partners in other relationships. They need to pay attention to the concerns that the client brings up and rely on their client’s self-evaluation of their happiness/satisfaction as a reasonable assessment [Katherine and Tiger survey]
Hela: Then the other thing to know is that within the realms of this safe, sane and consensual, communicative play there could be some insightful transformation, deep, deep issues that they can’t even get to with all that talk, talk, talk all the time [in talk therapy], because it empowers their patient to take their own healing in their own hands, and say yes and no and develop boundaries and connect with community instead of taking it into the back room somewhere and doing a secretive kind of weird thing. I think they could know that it could take you to a different level if it’s done in a safe way. [Hela and Steve interview]
Lynn : See how it fits in their entire life. If SM damages the person then they need help with it but if it’s a healthy part of their life then why bother with it…why mess with it? Accept it and learn from it. [Lynn and Brian interview]
Two recurrent themes appear in the data on “advice”: (1) therapists should treat BDSM sexuality as one of several factors to consider in therapy, and to treat these factors equally in importance; and (2) therapists should be able to discern when BDSM sexual practices are “safe, sane and consensual” and when they are not. “Safe, sane and consensual”, also called SSC in the BDSM subculture, is a cultural standard and value about BDSM activities, emphasizing that healthy BDSM activities do not result in long-term harm, that the lines between fantasy and reality are kept clear as they pertain to the physical activities of BDSM, and that the interactions are negotiated and agreed upon by the participants (NCSF, 1998; Wiseman,1996).
What are the experiences of clients who express BDSM sexuality when they are in therapy? Does stigma make a felt impact on their therapeutic relationships?
A content analysis of interviews and online surveys from 32 BDSM-identified heterosexual couples found a range of positive and negative experiences with therapists, and the experience of stigma within the therapeutic context was sporadic and had several different forms. Sometimes the stigma prevented these individuals from disclosing any involvement in BDSM sexuality; even after months of therapy, the topic of BDSM was never broached by the client and in some cases the topic of sexuality in general was not initiated by the therapist. Sometimes the stigma led to termination of therapy or to problematic interactions within the therapeutic context that negatively impacted the progress of therapy from the perspective of the client or patient.
The felt presence of stigma had the effect of narrowing the topics of therapeutic interaction (whether disclosure occurs or not) and creating a felt experience of insistent control by the therapist in interactions subsequent to a disclosure, to convince the client that there is something significantly wrong, immoral or broken about expressing this kind of sexuality – without any kind of cooperative exploration of any possible connection between the presenting issues and BDSM.
It is important to note that neutral and positive experiences after disclosure also occurred, and were marked by therapeutic interactions wherein the BDSM sexuality was neither ignored nor immediately a point of negative evaluation, but included in the therapeutic process like any other characteristic of the client. In these encounters, the client still felt they could affect the direction of the interaction and that the therapist did not immediately express a judgment or decision about the health or dysfunction of the client’s sexuality. Topics were not narrowed, and clients did not feel that the therapist was insisting on control of the therapeutic interaction.
The results support the few quantitative surveys that have been published (Moser & Levitt, 1995; Kolmes, Stock & Moser, 2006): non-disclosure occurred due to either fear of being stigmatized by the therapist, or due to the client not perceiving or endorsing a connection between their BDSM sexuality and their presenting problems. And those who do disclose their involvement in BDSM sexuality have both positive and negative experiences of the disclosure, with very little certainty of knowing what kind of response they will experience from the therapist.
The results also support the outline of clinical issues related to stigma as described by practitioners (Nichols, 2006). In particular, the experience of the clients in this study did mirror the concern that stigma will cause the practitioner to narrow the focus of therapeutic interaction to the BDSM sexuality against the will or desire of the client.
The participants in the study also articulated a specific recommendation for therapists after a disclosure of BDSM activity: discerning whether the BDSM activity met the BDSM community’s standard of “safe, sane and consensual” play. Becoming familiar with this community standard gives a tool to the therapist for assessing risk while avoiding stigmatization in the therapeutic interaction.
The stigma of BDSM sexuality may interfere with access to mental health services, in the form of either prejudice on the part of the therapist or nondisclosure and self-censuring on the part of the client. The stigma of BDSM sexuality may also create dysfunction in a client-therapist relationship when the therapist assumes that the sexual activity is, by itself, an indicator of mental illness without understanding how the client experiences their BDSM sexuality, and communicates this prejudicial attitude to the client without demonstrating openness to other possibilities. Positive interactions between clients and therapists around BDSM sexuality disclosure are also experienced by clients and therapists.
This analysis of the therapy experiences of 32 BDSM-identified heterosexual couples highlights the importance of treating a disclosure of BDSM sexuality as one of several, equally important factors about the client during the therapeutic interaction. Also important to effective therapeutic interaction is to avoid automatically communicating about BDSM sexuality from a cultural model of “BDSM is sickness/pathology” or “BDSM is immoral/wrong.” Most useful in the therapeutic milieu is an openness to the possibility that BDSM may or may not be related to the client’s difficulties, and a willingness to let the client take lead initially in choosing the focus of therapy after disclosure. Part of being open to this possibility includes the therapist’s informed understanding about the BDSM subculture’s standards and values around “safe, sane and consensual” BDSM activities, and discerning whether the client’s activities fit this community standard. This is an area where alternative sexuality cultures and the DSM have agreement – there are pathological and non-pathological expressions of BDSM sexuality. A discerning approach and knowledge base about BDSM sexuality on the part of the therapist will help avoid the impact of prejudicial stigma on the therapeutic relationship and help to establish a scientific basis for appropriate therapeutic interventions.
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National Coalition for Sexual Freedom (NCSF). (1998). SM vs. Abuse. [online]. Available: http://www.ncsfreedom.org/library/smvsabuse.htm
Wiseman, J. (1996). SM101: A realistic introduction. 2 nd edition. San Francisco, California: Greenery Press.
The authors are listed in alphabetical order. Dr. Richard Sprott is Executive Director of the Community-Academic Consortium for Research on Alternative Sexualities (CARAS). The views expressed are those of the authors and do not reflect any position or endorsement by CARAS. Address all correspondence to Gabriele Hoff, P. O. Box 3835, Berkeley, CA 94703-3835. Email Gabriele@LifeStyleEducation.net
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