Layla, a 30ish queer sub who enjoys domination by her partners—her name has been changed for her privacy—has been in therapy for about five years. She first sought therapy when she divorced a long-term spouse and began exploring a relationship with a dom. Layla's first therapist assured her that her treatment plan was "kink-friendly"—a designation Layla felt was crucial to her emotional well-being and progress. How that was expressed in practice, though, didn't feel understanding or inclusive of Layla's sexuality at all.
“My partner has been very key to my recovery in that he has been there both emotionally and, when I have needed him to be, in a dominant way," she said. "But I soon realized that if I discussed my kinks or my dom/sub relationship [with my therapist], she was extremely uncomfortable with it—she told me [my dom] was controlling.”
"Once it became clear my kinks in general were an issue, I stopped telling her anything more,” Layla said. “I wasn’t ashamed of being submissive and didn’t want to change. I’m glad that I wasn’t primarily seeing my therapist about sexuality, because the emotional result may have been much more damaging."
The widening cultural acceptance and exploration of different sexual identities, and consequently more clients and their partners needing to address questions in the context of counseling and therapy, has caused an uptick in kink- and non-monogamy-informed therapy. With this expanding market comes mental health clinicians who market their services as sex-positive—some who are qualified, and some who have little experience with kink in terms of their practice, but understand that there’s demand for kink-friendly therapy. Many of the latter variety of therapists are ill-equipped to treat these clients and rarely have the background to address inquiries surrounding kink because of their own clinical understandings of and training around deviance and mental illness, according to Psychology Today. Instead, they benefit from a growing client base —without the perspective necessary to treat them effectively.
Kink sexualities are vast and nuanced, meaning that if a client is seeking care for sexuality or if it comes up as a secondary concern, there are varying levels of kink awareness and treatment. Because kink, particularly, is often based on power dynamics, it’s easy for a clinician to pathologize these behaviors, when, in reality, they are often positive and healthy modes of sexual expression. Even if a client is actively concerned with the impact kink has on the rest of their mental health, consensual kink behavior does not equate to a mental disorder.
If a client is asking a question like, “Why am I curious to explore polyamory?” that a therapist doesn’t have the tools to properly assess, we begin to doubt ourselves, shame ourselves, feel misunderstood, and potentially be misdiagnosed, Andrea Glik, poly and kink affirming therapist, explained. When therapists misunderstand the dynamics of a kinky or polyamorous relationship, said Glik, “It makes us doubt ourselves, and it shames us, especially when this advice is coming from a perceived expert.” She said that, instead, therapists treating kinky clients need clearer tools for understanding that kink is not necessarily a response to trauma or abuse, and for being educated about how consent is managed in kink interactions and power-exchange relationships.
How Therapists Falsely Advertise Kink-Friendly and Polyamory-Friendly Treatment
It’s not enough for clinicians to just want to talk about sex openly and affirmingly. When therapists are truly informed about kink and non-monogamy, they have histories of expertise around the intricacies that come with those dynamics. The Kink Clinical Practice Guidelines Project outlines three levels of kink-affirmative therapy: “kink-friendly,” meaning having minimal kink awareness and openness to not pathologize kink behaviors, “kink-aware,” which includes clinicians that have worked with kink-identified clients and have a specific grasp of concepts and practices within kink culture, and “kink-knowledgable,” being able to affirm kink and know the difference between whether a client’s treatment needs to solely focus on kink behavior, or if it is a peripheral part of treatment. A therapist who is “kink-knowledgable” understands that consensual kinky practices do not ordinarily need to be treated as an impairment in work or life. Clinicians should not assess a client with the assumption that any concern is directly linked to kink or polyamory.
The sex therapy industry has mushroomed because of the cultural shift towards speaking more openly about sex in our society, which comes more than a century after famous sex researchers William Masters and Virginia Johnson began their research on sexuality that ultimately laid the groundwork for sex therapy techniques used in the 1960s to the current day. Now, their work is criticized by researchers over the exclusion of homosexual clients and their methods of observing sexual behaviors in a laboratory (as opposed to in response to cultural and personal constructs). The discipline was rooted in a traditional view: white, cisgender, heterosexual encounters.
“Sex therapy is still a young industry," explained Jamila Dawson, a therapist who specializes in treating LGBTQ people, poly people, and people who are involved in kink. The field is still evolving some 60 years after Masters and Johnson led early 20th century forms of sex therapy, which repressed and denigrated kinky sexual behaviors.
If someone seeks sex therapy, it benefits them to see a clinician with the same sexual experiences, Glik said. "As a queer therapist—and, also, a person who is in therapy with a queer therapist—the interrogation that I’ve done around my own sexuality, I want my therapist to have the same understanding of what that process is." This applies to other areas of sexuality, as well, according to Glik: "Obviously, the client’s and therapist’s processes are potentially different, but there’s a level of understanding and of self-reflection around the difficulties and nuances [that come with particular kinds of sexual expression]."
Every client and clinician approaches therapy with their own history and experiences pertaining to sexuality. “I don’t think it’s so much as therapists not having their own biases, but it’s being very aware of what their biases are, and that they’ve done work around their own sexuality specifically,” said Dawson. What’s important here is that those biases don’t interfere with the assessment of a client’s behaviors that are not related to or caused by their sexuality.
According to sex educator Jimanekia Eborn, “Folks are going into a session with a therapist already nervous, possibly [with] their guards up. Who knows what it took for that person to show up, and then they get there, and you know nothing about their identity? To trick someone into thinking that they are going into a safe space is so selfish."
If a therapist isn't aware of the nuances of a particular community and its sexual practices, they may misinform, and even possibly harm, clients they advertise to in those communities. This is what Zoe, a 20something non-monogamist whose name has been changed for their privacy, feels is what happened when they went to therapy with their partner to navigate their poly agreements. “One of the things that is important to me about polyamory, versus other types of ethical non-monogamy, is the focus on autonomy for all parties involved, but our therapist insisted that rules were necessary," Zoe said. "[The therapist] didn’t understand why her suggestion of what was essentially the veto system wasn’t ethical non-monogamy."
Part of what alarmed Zoe was that the therapist also said that a lot of her other clients followed a "one-penis policy" as a successful form of polyamory. (The "policy" prohibits women—Zoe uses they/them pronouns—from having multiple sexual partners, but the same rules don’t apply for the man in the partnership.) “She continued to talk over me about how some of her polyamorous clients only have sex with people outside of their primary partner(s), but aren’t allowed emotional relationships, and I’m like, That’s an open relationship, not polyamory… I felt entirely unheard,” Zoe said.
How to Find a Kink-Friendly or Polyamory-Friendly Therapist
There are increasingly emergent ways to seek out kink-aware therapists who truly account for and affirm healthy, consensual involvement in kink. Once Layla’s therapist made it clear that they would shame her queerness and BDSM practices, she decided to look elsewhere for mental healthcare. “I found my current therapist on the National Coalition of Sexual Freedom's kink-friendly professionals directory," she said, citing a resource that includes a listing of psychotherapists, medical, and legal professionals that are knowledgeable and sensitive to diverse sexualities. "[My current therapist] actually specializes in all kinds of kink/sexual identity/sexuality and relationships, as well as trauma. My experience with them has been mind-blowingly different, because I can actually tell them everything about how submitting to my dom is actually [part of] taking care of myself," she said.
"[My therapist] is able to help me leverage my D/S to continue my healing, and it’s really amazing," Layla continued. "So much of my comfort is in not having to be responsible for teaching someone the 'how' and 'why' of BDSM because they already understand it.”
Beginning in 2010, a group of clinicians who work with sexually stigmatized clients created a comprehensive set of guidelines for therapists that want to approach kink and other sexual identities without shame or ignorance. The Multiplicity of the Erotic, a conference created in 2012 by the Community-Academic Consortium for Research on Alternative Sexualities (CARAS) and Programs Advancing Sexual Diversity (PASD) reinforces these guidelines and promotes clinical training on alternative sexualities. The work of the clinicians that pioneered a broader scope of sex therapy is compiled as a set of kink-inclusive guidelines here.
Still, as Eborn said, “[Sex therapy] is expanding and looking more into kinks and understanding more identities. But there is so much gatekeeping in the community, and it is still really white. Those that are gatekeepers need to understand that there is enough work for all people, as well as realize where they are missing information and actually do the work.”
Therapists have a responsibility to provide accurate, community-informed care to their kink patients. To clients and experts, that means beginning with having clinicians evaluate their own biases and attitudes about kink, addressing how those can affect their interactions with clients, and making an effort to study and offer resources that pertain to kink- and poly-inclusive identities. Most important, clinicians must have the education and context to determine whether a person’s consensual kink behaviors, fantasies, or sexualities, by themselves, are directly related to their reasons for seeking therapy—or are simply their methods of sexual expression.
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