When I mention to friends and fellow therapists that many of my clients practice BDSM, typical responses range from “Wow, you must hear some stories!” to “I just couldn’t relate to people who get off on pain and abuse.”
The truth is, most people don’t really understand BDSM – an acronym derived from Bondage and Discipline, Domination and Submission, and Sadism and Masochism. They assume it’s ‘weird’, ‘not normal’, and more about abuse than love.
Historically BDSM has been pathologised and stigmatised. The medical profession has done little to change perceptions. The latest edition of DSM-5 at least went someway to downgrade several BDSM practices (sexual sadism, sexual masochism and fetishistic disorder) from mental disorders to paraphilia. Although this isn’t that great, as a paraphilia is often described as something abnormal, dangerous and extreme; and DSM-5 lumps BDSM in with paedophilia and voyeurism!
In my experience, the truth couldn’t be more different. The world of BDSM is one of the most respectful communities I’ve ever encountered. Whilst most BDSM practices include sexual behaviours that involve some sort of power exchange between two or more partners and/or the use of pain to derive sexual pleasure, this power exchange is dependent on mutual consent, and consent can be withdrawn at any time, for example through the use of a safe word. In my opinion, BDSM’s underlying ethos of ‘safety, sanity and consent’ should underpin all relationships.
BDSM is much more common than you might think. The US journal, The Journal for Sexual Research, published an article¹ last month that explored the prevalence, etiological, psychological, and interpersonal factors associated with BDSM, which is well worth a read. It includes statistics on the prevalence of BDSM, distinguishing between fantasy and practice. Overall, findings from the research suggest that ‘BDSM related fantasies and behaviours are relatively common, though behaviour prevalence rates are typically lower than fantasies’ (Brown, 2020).
So why do so many therapists shy away from working with clients who practise BDSM? Why fear BDSM more than any other practice a client may participate in?
Hopefully, as therapists we uphold the concept of unconditional positive regard, developed by the humanistic psychologist Carl Rogers. Put simply, it’s the basic acceptance and support of a person regardless of what they say or do, especially in the context of psychotherapy.
When we’re approached by a client who’s into rock climbing but we have a fear of heights, do we turn them away? Or we get an enquiry from someone who’s into martial arts, but we can’t bear the thought of violence, do we say, “Sorry, I can’t work with you because you practice MMA”? We don’t. You don’t have to ‘get it’ to work with it.
Working with clients who practice or want to explore BDSM is no different from working with other clients. More often than not, BDSM is simply something they enjoy, it turns them on, it’s fun. It brings different dimensions into sensuality and sexuality. It promotes intimacy and trust. Exploring kink allows people to challenge their limits in a safe and controlled way. But this may not always be the case. As therapists, we do need to be able to distinguish when domination and submission, or sadomasochistic sex is a mutually free sexual expression, and when it might be an abuse of power.
My advice? Rather than shying away from working with BDSM, take time to understand more about it and the people who practice it. Meg-John Barker writes some great stuff about BDSM on their website Rewriting the Rules.
Di Hassall LDPRT alumni
¹ Brown, A. B. (2020, July). A Systematic Scoping Review of the Prevalence, Etiological, Psychological, and Interpersonal Factors Associated with BDSM. The Journal of Sex Research.
The views and opinions expressed in these blog posts are held by the author(s) and are for general interest in the field. These blog entries do not attempt give advice to the reader, they are for educational and information purposes only.