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Think Kink - Therapy with BDSM Clients

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on 5 November 2014

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Transcript of Think Kink - Therapy with BDSM Clients

Think Kink: Therapy with BDSM Clients
Views on BDSM
Clinical Practice Concerns
Be a kink-aware therapist
Own values/beliefs informed by cultural, political, or religious background
Learn about BDSM/kink culture
Help clients implement consent and safety
Confidentiality & Reporting
Harm to self and/or others
Be informed and inform clients of laws/liabilities
Typical therapy goals just as relevant
Anger management, stress coping, boundary setting to reduce risks
Develop personal insight and awareness, motivations behind BDSM
Recognizing abuse ***
What is BDSM?
Acronym of “B&D” (Bondage & Discipline), “D&S” (Dominance & Submission), and “S&M” (Sadomasochism)
Set of erotic preferences involving "powerplay"; include/exclude any aspects of the 3 concepts
Top/bottom, dom(me)/sub, switches
Brief History of BDSM
from the Mental Health Perspective
SSC - Safe, sane, and consensual (1983)
Most widely used philosophy of BDSM play
"To distinguish from criminally abusive or neurotically self-destructive behavior popularly associated with S&M"
Alienation and isolation from stigma
Internalized negative stereotypes
Shame, self-hatred, guilt
Inability to derive sexual pleasure from non-BDSM activities
Barriers between self and vanilla lovers
"Coming out" to partners/others or discovery
Managing reactions from others when "out"
Sexualized, invasive, judging
Overcoming bad experiences, limits pushed too far in scenes
Potential for BDSM to be destructive
BDSM Statistics
BDSM practiced in all social strata, both heterosexual and homosexual men and women in varied frequencies and intensities (Breslow et al., 1985)

2-3% of Americans
play with BDSM
(Castleman, 2013)

1.3 million

users
on Fetlife.com, alt sex practices are mainly males
(Buehler, 2104)

Random sample survey from Australia found
1.8% of men
and
1.2% of women
were involved in B&D or S&M in last year. Significantly more likely in
bisexual and gay men

(Richters, de Visser, Rissel, Frulich & Smith, 2008)

14% of men
and
11% women
had personal experience with sadomasochism. Further studies find
much higher incidence of BDSM fantasy

(Kleinplatz & Moser, 2007)

Global Sex Survey by Durex:
36%
of adults in US use masks, blindfolds, and bondage tools during sex (2005)

Study on American students found higher percentage for
homosexual males
and
lesbian or bisexual females
(Elliot & Brantley, 1997)
Vivian Eng
EDUC 636, Fall 2014

Bondage & Discipline
Restraint, rules/punishments
Blindfold, tying up, spanking
Arm-binders, spreader bars, cuffs, elaborate rope arrangements
Dominance & Submission
Most purely emotional
Fantasy: boss/secretary, teacher/student
Power exchange ranges from benign/formal to intense (elements of emotional abuse or humiliation)
Sadism & Masochism
Most physical
Sadism: Derive sexual pleasure from inflicting pain, suffering, or humiliation on others
Masochism: Derive sexual pleasure from one's own pain or humiliation
Most parodied/misrepresented in media
Rough sex acts: pulling hair, smacking, sharp biting
Paddling, whipping, hot wax, blood sports,
Edgeplay: erotic asphyxiation, fire play, knife play
(Veaux, 2013)
1905 - Freud coined "sadomasochism", neurotic

Original
DSM
classified sexual sadism as a deviation

DSM-II
did same for masochism

DSM-IV
listed S&M as psychiatric disorder

DSM-V
has depathologized kinky sex (cross-dressing, fetishes, and BDSM). Unusual sexual interests called "paraphilias". Itself is not sufficient to diagnose for paraphilic disorder or justify/require clinical intervention (American Psychiatric Association, 2013)

Diagnostic criteria manuals in certain European countries have removed their references to BDSM
Many laypersons and some MH professionals consider BDSM perverted or dehumanizing.

Arguments that BDSMers are pathological, angry, violent, victims of child abuse/rape/ trauma, and/or sex addicts.
BDSMers consider it a loving, nurturing, intimate form of human contact and play. Sex that necessitates clear communication and emotional connection.

Consider that not too long ago, oral sex and homosexuality were considered "perverse."
Discussion Questions
Where do you stand?
Any biases/prejudices?
Transference or countertransference?

BDSM Safety
RACK - Risk awareness consensual kink (1999)
SCC doesn't cover the possible risks involved in play
All partners well-informed of risk, in light of these they offer preliminary consent in alternative sex activities
PRICK - Personal responsibility informed consensual kink (2000s)
CCC - Committed Compassionate Consent
None of others apply to emotional well-being of involved parties
Compassion would help players be more attuned to mental state of mind
(beasexeducator.com/2013/04/30/scc-rack-prick/, 2013)
BDSM resources on safe play:
Couples/players create "scenes"/script to ensure boundaries
"Safeword" tips - green-yellow-red
Choosing partners, new partners
Best types of equipment/gear/toys - floggers, candle wax, handcuffs
Physical warning signs during play - restraint
Breath control - no safe way, learn CPR and how to deal with coronary arrest, never alone
(Veaux, 2013)
Psychological Effects & Therapeutic Concerns
(CARAS, BDSM and Therapy Project, 2013)
Discussion
Question
Kink-aware therapists should be able to differentiate between non-pathological expression of BDSM and problematic sexuality or abuse.

What are some questions to keep in mind or ask clients who practice BDSM?
Legal/Ethical Concerns
Sociocultural Concerns
The law treats BDSM as violence. Even if there is consent, the causing of harm itself is criminal.

To what extent will the law excuse this criminal conduct based on fact that the injured person consented?

Consent is defense for only minor harm/injury.

To date there is not a single court decision in US that accepted consent as defense

Our job: Reiterate the importance of
safety, consent, and personal responsibility
with our BDSM clients.
People vs Jovanovic in 1996. Male convicted of sexual assault, kidnapping, and rape. Overturned based on email messages. Female declined to testify at retrial and case was dropped.

Spanner case in 1987. Group of gay men jailed for engaging in SM practices. "Consent is not a valid legal defense" for bodily harm.

R. vs Wilson in 1996. A woman was branded by husband at her request. Judged "not guilty, strictly consensual activity between husband and wife in privacy of matrimonial home"
National Coalition for Sexual Freedom
Stigma and negative stereotypes
Societal values, media, culture, religion, generational cohort

BDSM is intrinsically linked to LGBT/queer movements
to promote
acceptance of alternative sexualities and activities
Our clients may be part of the LGBT community, and face additional barriers and challenges. Social stigma and discriminatory laws and policies may be compounded for them
Address and validate their struggles with...
The heterosexual privilege in our society
Bias towards marriage and monogamy
Society's difficulty accepting that pain/injury can be associated with sexual pleasure
Discussion Question
A heterosexual engaged couple have opposing views of BDSM. The male has recently "come out" to his fiancee and is gradually introducing her to the world of BDSM.
Female: I can't help but feel there's something wrong with this kind of passion. Violence is never a good sign. Lovemaking should be pure and warm. Why is he interested in this stuff? Is it ok? Is it healthy?
Male: I've been excited by and interested in BDSM since adolescence. The pain, in the right places and right amounts, is arousing. For me it's something fun and safe and there's no reason to look for anything wrong with it.
What are your initial thoughts and reactions?
How would you begin working with this couple?
What information would be important to know?
Issues of transference or countertransference?

References
(Castleman, 2012)
(Tomasulo, 2013)
BDSM and Therapy Project. (2013, January 1). Retrieved November 1, 2014, from https://carasresearch.org/professional/bdsm-and-therapy-project

Breslow et al. On the Prevalence and Roles of Females in the Sadomasochistic Subculture: Report of an Empirical Study. Archives of Sexual Behavior 14/1985, P. 303–17. In Thomas S.
Castleman, M. (2012, June 15). A Loving Introduction to BDSM. Retrieved October 30, 2014, from http://www.psychologytoday.com/blog/all-about-sex/201206/loving-introduction-bdsm

Buehler, S. (2014). Alternate Sexual Practices. In What every mental health professional needs to know about sex (pp. 241-249). New York: Springer Publishing Company.

Connan, S. (2010). A kink in the process. Therapy Today, 21(6). Retrieved October 30, 2014, from http://www.therapytoday.net/article/15/52/categories/

CONSENT and BDSM: The State of the Law. (2010, January 1). Retrieved October 29, 2014, from https://ncsfreedom.org/component/k2/item/580-consent-and-bdsm-the-state-of-the-law.html

Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.

Durex Global Sex Survey. (2005, January 1). Retrieved October 30, 2014, from http://www.durex.com/en-jp/sexualwellbeingsurvey/documents/gss2005result.pdf

Elliott, Leland / Brantley, Cynthia, Sex on Campus, 1997, Random House, New York

Kleinplatz P, Moser C. Is SM pathological? In Langdridge D, Barker M (eds) Safe, sane and consensual: contemporary perspectives on sadomasochism. Hampshire: Palgrave Macmillan; 2007.

Richters, J., De Visser, R., Rissel, C., Grulich, A., & Smith, A. (2008). Demographic And Psychosocial Features Of Participants In Bondage And Discipline, Sadomasochism Or Dominance And Submission (BDSM): Data From A National Survey. Journal of Sexual Medicine, 5(6), 1660-1668.

SSC - RACK - PRICK. (2013, April 30). Retrieved November 1, 2014, from http://beasexeducator.com/2013/04/30/ssc-rack-prick/

Tomasulo, D. (2013). Can BDSM Behavior Be Healthy?. Psych Central. Retrieved on November 2, 2014, from http://psychcentral.com/ask-the-therapist/2013/02/07/can-bdsm-behavior-be-healthy/

Veaux, F. (2013, August 1). Xeromag | BDSM? What's with this bondage/sadomasochism stuff anyway? Retrieved October 28, 2014.

Weinberg: S&M: Studies in Dominance and Submission, (Ed.), Prometheus Books, New York, 1995


Resources
Database of legal cases and court records/documents
Violence and Discrimination Survey Against Sexual Minorities
Resource Library with educational materials on alternative sex practices. Glossary of BDSM terms, how to protect your event, how to become a kink aware professional
Clarisse Thorn, an S&M feminist and author of several books on BDSM, sexuality, and subcultures
Clarissethorn.com/bdsm-resources/
Books, films/documentaries, online forums/websites
FetLife.com, free social network for BDSM and fetish community
Finding friends, making connections
Events listed in your local community
Learn, share, and explore kinks
Forums to ask questions, get/give advice
lgbt.ucla.edu/LeatherandKinkCommunity.htm
Education and information
Communities based in LA, clubs and societies
Checklist to negotiate and discuss likes/dislikes with partner
BDSM Explanations
Many theories guess at cause of BDSM/kink
Attachment - early trauma, can't attain/maintain appropriate healthy relationships. Substitute affection for power differentials with S&M
Behavioral - classical conditioning, exposure caused arousal, strengthened association with masturbation, fantasy, actual experiences
Sociocultural - Western culture highly sexualized and directed at males, some do not have appropriate outlet and alternative sex practices are a compromise solution
Personality characteristics - low self-esteem, empathy, insight, social skills, impulse control
Many who practice BDSM experience their behavior as ego syntonic and are content with their alternative sexual self-expressions. This presentation will focus on therapy with such individuals
(Buehler, 2014)
Full transcript