Kink, BDSM, and Sex-Positive Counseling

Affirmative counselors recognize how vital it is to validate a client’s sexual orientation, yet some mental health practitioners are reticent to talk about sex-positive identities and alternative sexual lifestyles like kink and BDSM. This can be very stifling for clients whose sexual journey is a foundational part of their lived experience.

Of course, there is a broad range of how people integrate kink and BDSM into their lives. For some, it’s all about curiosity and experimentation, viewing kink and BDSM as a behavioral act used to spice things up. For others, it’s a sexual fetish they had to accept and destigmatize in their pursuit of self-understanding and self-esteem. And for others still, kink and BDSM are an integral part of their identity, going beyond the bedroom to include their community, social engagement, creative expression, and political advocacy.

Unfortunately, sex-positive identities and alternative sexual lifestyles have been pathologized by the mental health field for over a century. As such, mental health counselors can unwittingly carry their sex-negative attitudes into session, perpetuating outdated myths, pathologizing clients, and creating an atmosphere of shame. 

For more on this, review Kolmes, Stock, and Moser’s (2006) Investigating Bias in Psychotherapy with BDSM Clients;  Barker, Iantaffi, and Gupta’s  (2007) Kinky Clients, Kinky Counseling? The Challenges and Potentials of BDSM ; and Khan’s (2015) Sadomasochism in Sickness and in Health: Competing Claims from Science, Social Science, and Culture.  

Unpacking one’s bias around sexuality and sexual identity is no small undertaking, as it requires mental health practitioners to challenge their comfort zones so as not to yuck their client’s yum. So let’s explore why it’s important to empower sex positivity, the history of the sex-positive movement, and how to continue one’s education.

Empowering Sex Positivity

Masochism and sadomasochism, domination and submission, and even top and bottom sexual dynamics, are no more subversive than the act of sex itself. The taboo association stems from a long history of social, religious, and legal persecution. Understanding this, it’s no wonder that sex-positive people created kink and BDSM clubs, countercultures, and even nonprofits like the National Coalition for Sexual Freedom (NCSF) to connect with each other and further protect themselves.

Today there’s still a lot of stigma around kink and BDSM, yet is it really so abnormal? One of the largest surveys focusing on sexual behavior was documented by Bedbible, a private organization that reviews sex toys. Of their 12,700 international respondents, 42 percent had tried BDSM at least once in their life. Intriguingly, sifting through their demographic data reveals that 86 percent of Americans had tried BDSM at least once in their life, with 34 percent of Americans engaging in BDSM on a regular basis. 

To compare, Brown, Barker, and Rahman’s (2020) meta-analysis of 60 empirical research articles on the subject found that anywhere between 40 and 70 percent of males and females fantasized about BDSM, with 20 percent of the population incorporating BDSM into their sex life.

Now, because of the media’s portrayal of alternative sexual lifestyles, many believe BDSM to be wild, hardcore, and reckless. These concepts are subjective, yet the commonplace practice of BDSM is far less extreme than most imagine. People typically begin their exploration with light forms of impact play, like flogging and spanking; restraint play, like ropes and handcuffs; power play, like dominance and submission; and role play, like taking on a persona. 

Yet those who go beyond this introductory tier can discover numerous subcultures, each with their own spectrum of intensity. In reality, a person’s physical and psychological well-being has far less to do with the act one engages in and far more to do with the consent culture, experience, empathy, and safety-awareness of the people involved. This is as true for knife play, cutting, and hook suspensions, as it is for an innocent scene involving blindfolds and chocolate-covered strawberries.

Ethically, mental health counselors do not endorse self-harm, yet there may be a bias in this thinking worth reflecting on. First, one must take context into account to re-conceptualize the definition of “harm.” Cutters, whose self-punishing behavior stems from depression, will view scars and bruises as a reminder of their self-deprecation. This is not equitable to sexual masochists, whose scars and bruises are a reminder of their life-affirming passion. 

On top of this, counselors may also need to re-examine their assumptions of risk. Consider how the aforementioned knife play, if handled correctly, is an exercise in controlled danger with structured safety protocols and clear communication. Now consider how the seemingly harmless strawberry scene could go awry if the participants ignore consent, overstep boundaries, or are so inexperienced with chocolate fondue they accidentally scald each other. 

Indeed, much of the discourse in the kink and BDSM community centers on consent; how to negotiate a scene, set boundaries, and establish safety protocols; how to increase endorphins via anticipation, imagination, and sensory experience; and the importance of physical and emotional safety and aftercare.

This is not to say the world of kink and BDSM is problem-free—yet social isolation, repression of one’s feelings, and a lack of education may increase the likelihood of physical accidents, psychological distress, and abuse. Given the social taboo, it’s not uncommon for clients to struggle with internalized shame or negative social repercussions. Some may continuously censor themselves or feel they must live a double life. 

These risks can be mitigated by creating safe communities where people can openly process their sexual experiences, teach best practices, and protect one another from bad actors and sexual predators.

In session, a safe, judgment-free atmosphere can help clients explore how their sexual roles, power exchange, and sensory process of pain and pleasure may intersect with their need for love and intimacy, their self-esteem and self-acceptance, and their use of boundaries and communication. 

Affirming a client’s sensory joy can also deepen their relationship with their body, particularly their sympathetic and parasympathetic nervous systems. What gives one chills, or causes one’s heart to race, differs from person to person, and many practice kink and BDSM to mindfully engage their self-awareness.

In her article “Learning from Extraordinary Lovers; Lessons from the Edge” (2006), Peggy Kleinplatz noted how the principles and practice of BDSM can heighten self-knowledge, subsequently increasing intimacy and communication in sexual and romantic relationships. Sagarin, Cutler, Cutler, Lawler-Sagarin, and Matuszewich (2009) put this to test in an empirical study of hormonal changes and couple bonding in consensual sadomasochistic activity. They found that BDSM lowered physiological stress levels while increasing closeness in the relationship. 

That said, mental health practitioners often wonder about the association between trauma history and a client’s affinity towards kink and BDSM. Exploring this, several researchers have found that BDSM isn’t actually a reenactment of a traumatic event, but an act of healing past traumas by creating safe and controlled scenarios to engage trust, vulnerability, pleasure, and pain. 

For more on this, review Lindermann (2011) BDSM as Therapy?; Thomas (2019) BDSM as Trauma Play: An Autoethnographic Investigation; Hammers (2019) Reworking Trauma through BDSM; Brink, Coppens, Huys and Morrens (2020) The Psychology of Kink: a Survey Study into the Relationships of Trauma and Attachment Style with BDSM Interests; and Cascalheira, Iljebor, Salkowitz, Hitter, and Boyce (2021) Curative Kink: Survivors of Early Abuse Transform Trauma Through BDSM

A Sex-Positive History

The historical rise of literotica like John Cleland’s work Fanny Hill (1748), the Marquis De Sade’s magnum opus 120 Days of Sodom (1798), and Leopold von Sacher Masoch’s notorious Venus in Furs (1870) caught the interest of psychologists like Richard Von Krafft-Ebing. His Psychopathia Sexualis (1886) was the first critical examination of “sexual deviance,” which he divided into four neuroses. These include:

  • Paradoxia (sexuality exhibited at the wrong time of life)
  • Anesthesia (the lack of sex drive)
  • Hyperesthesia, (excessive sex drive)
  • Paraesthesia (contrary sexual desire expressed towards the wrong goal, including homosexuality, pedophilia, masochism, sadism, and all forms of fetishism)

Chiming in, Sigmund Freud believed the civilized world required sexual repression as an anchor—a perspective relying heavily on the social contract theories of Locke, Hobbes, and Rousseau. In other words, he believed sexual freedom was chaos, a playground for neurosis and hysteria.  

Problematically, early psychoanalysts based their perspectives on unique and unusual case studies instead of the population at large. Just as Von Krafft-Ebing had based his ideas on historical hedonists like the Marquis De Sade, Freud had based his theories in the most extreme characters to sprawl on his couch. 

It’s also important to provide historical context for these ideas, as there was a sexual revolution during the fin de siècle that swept from Paris to Austria. The political and religious backlash to this open sexuality looked to psychoanalysts like Freud to institutionalize and cure these “perverts.” This stigmatization continued into the twentieth century, yet war and socioeconomic turmoil tend to correlate with both sex work as a means of survival and Free Love movements trying to scrape some bohemian joy from the rubble. In retrospect, Sexual Awakenings popped up every decade or so in major hubs like Paris, New York, Weimar Berlin, London, and San Francisco.

The term “sex positive” was first coined by Freud’s pupil, Wilhelm Reich, who noted how sex is a healthy aspect of one’s identity and development. In The Function of the Orgasm (1927) Reich stated, “There is only one thing wrong with neurotic patients: the lack of full and repeated sexual satisfaction.” 

However, the term sex positive didn’t pick up traction until the Free Love movement of the 1960s. By the 1970s, an organized sexual revolution was forthcoming, leading to the rise of Sex Radicals, sexually empowered Feminists, and Queer Advocates tired of being marginalized and criminalized.

Sex Radicals are empowered, sexually experimental individuals of every gender and orientation who strive to normalize the full scope of sexuality. Gayle Rubin expands on this in her chapter “Thinking Sex: Notes for a Radical Theory of the Politics of Sexuality,” which can be found in the larger anthology of In Pleasure and Danger: Exploring Female Sexuality. Rubin observed that society is subject to a sexual caste system, wherein certain sexual identities are valued higher than others. Rubin’s “Charmed Circle” theory portrays this caste system as a halo of social acceptability, demonstrating how heterosexuality is held above homosexuality, the married above the nonmarried, the monogamous above the promiscuous, the procreative above the non-procreative, and of course, the Vanilla lifestyle above the BDSM lifestyle. 

Critics have noted how the Charmed Circle omits dimensions of race and ethnicity, as BIPOC contend with a unique array of social issues within the Kink and BDSM community, ranging from discrimination to fetishization. In 1992, Elisabeth Schüssler Fiorenza coined the term “Kyriarchy” in her book But She Said: Feminist Practices of Biblical Interpretation. Like Rubin’s Charmed Circle, Kyriarchy maps the differentials of power and privilege resulting from sexism, racism, ethnocentrism, ableism, ageism, homophobia, transphobia, classicism, antisemitism, Islamophobia, anti-Catholicism, xenophobia, colonialism, and so forth. Yet, the Kyriarchy model does not include discrimination against kinky and sadomasochistic people.

Carol Queen, renowned sexologist and founder of the San Francisco Center for Sex and Culture, adds that the demolition of the sexual caste system is, in and of itself, a Feminist goal. In her book Exhibition for the Shy: Show Off, Dress Up, and Talk Hot (1995), Queen observes how women are frequently discouraged from exploring, empowering, or acting upon their sexual desires, or anything that deviates from “good girl” propriety. 

In The Necessary Revolution: Sex-Positive Feminism in the Post-Barnard Era (2008) Queen and Comella define the sex-positive position as a “cultural philosophy that understands sexuality as a potentially positive force in one’s life…Sex-positivity allows for and in fact celebrates sexual diversity, differing desires and relationships structures, and individual choices based on consent.”

While many holistic psychologists in the 70s, 80s and 90s were already trying to humanize people’s experience of sex and sexuality, the authors and advocates that came from the Sex Radical, Feminist, and Queer communities were instrumental in what would become “Sex Positive Psychology.” As a holistic perspective, Sex Positive Psychology promotes honest sexual communication free of oppression, shame, and guilt, while also helping clients contend with stigma and oppression as it pertains to their sexuality.

Continuing Education

Practicing in the scope of one’s competency is an ethical imperative, and there are many certification programs and even graduate-level degrees for those who want to become a sex therapist. Yet one doesn’t necessarily have to be a sex therapist in order to help clients cultivate a sex-positive identity or explore an alternative sexual lifestyle. Beyond self-education and community involvement, there are several certification programs for mental health practitioners who want to help their clients navigate and process the complex world of kink and BDSM.

Each certification program is distinct, yet typically covers a range of subjects, including but not limited to the history and sociological framework of kink communities; the empirical research around kink and BDSM; the intersection of BDSM, trauma, and mental health; the nuances of kink and BDSM in BIPOC communities; and how to explore interpersonal relationship dynamics from a sex-positive perspective.  

While not an endorsement, some available certification programs include:

Alex Stitt, LMHC

Alex Stitt, LMHC

Writer & Contributing Expert

Alex Stitt is a nonbinary author, queer theorist, and licensed mental health counselor living in Hawaii. As a proud Queer Counselor, they work to educate professionals in the mental health field interested in working with LGBTQ+ populations. Their textbook, ACT for Gender Identity: The Comprehensive Guide, demonstrates how to apply Acceptance and Commitment Therapy to gender self-actualization.