Kink and Therapy

It’s not uncommon for kinksters to seek out therapy. Like the rest of the population, some kinksters have mental health issues. Some have are survivors of childhood abuse, others encountered abuse from partners who presented it as bdsm. Some gay men have a deep sense of shame over their sexual desires, and straight men often feel ashamed of their submissive urges. Those raised in conservative Christian environments have typically been taught a model that stigmatizes female authority and sexual autonomy, as well as male submission, causing them to be confused when their desires don’t match up with the rules they were taught. Some may be distressed about a specific kink that they have but have trouble managing, such as findom. Like vanilla couples, kinky couples can have communication problems. 

Unfortunately, mental health professionals have tended to view kinky desires as a problem to be treated rather than as a manifestation of healthy sexuality. Submissive men and women are often told their submissive, masochistic or slave desires are problems to be overcome, and dominant desires, particularly sadistic ones, are often pathologized as antisocial. The notion of ‘sexual addiction’ has tended to view any form of sexual desire other than heteronormative vanilla sexuality as an illness that one must recover from, despite the fact that sexual desire doesn’t fit the model of addictive behavior (since the biochemical elements of substance addiction are not present to alter brain chemistry). These problems are often compounded if the counselor they are dealing with is affiliated with a conservative religious organization.

What this means is that kinky people face an additional obstacle when they seek mental health counseling. Not only do they have to deal with whatever issue they are seeking treatment for, they may also have to deal with a therapist’s anti-kink prejudices. At a time when someone is already feeling sad, scared, depressed, or desperate, they may find themselves receiving messages that their core sexual desires are either the root of their unhappiness or a contributing factor.

There are several important things to think about if you are a kinky person seeking counseling. (And I should say at this point that I am not a mental health professional. So don’t take any of this as formal medical advice. ) 

  1. Therapists, like all medical professionals, are legally bound by HIPAA, which ensures patient privacy. Your therapist will not discuss what you disclose to them without your consent, so they will not be gossiping about whatever kinks you discuss. You should not be afraid that word of your kinky desires will circulate, and should your therapist violate your confidentiality, you have legal recourse.
  2. The 5th and current edition of the Diagnostic and Statistical Manual of Mental Disorders (called the DSM-V), which is the guide to current state-of-the-art thinking about psychological issues, no longer lists things such as sadism, masochism, fetishes, and similar kinky things as automatic signs of mental illness. Instead, to be diagnosed as having a sexual disorder around such things, the patient must “feel personal distress about their interest.” This means for patients who are entirely comfortable with their desire to be submissive, for example, a therapist is less likely to identify the kink as a part of the problem. However, for a patient who may feel a sense of shame around their kink, a therapist might still diagnose the patient as having Sexual Masochism Disorder, for example. So if you go into therapy wanting help to accept your kinks, you might still find a therapist telling you that your kink needs to be cured. (Homosexuality, incidentally, was removed from the DSM with DSM-IV.)
  3. This means you as a patient need to advocate for yourself. You need to be clear with a therapist what you’re hoping to achieve through therapy and what role kink might be playing in whatever you’re seeking help with. Your kink is only a problem if you think it’s a problem. Do not let a therapist pathologize your desire, and point out to them that the DSM-V backs you up on this.
  4. Advocating for yourself starts with your first contact with your therapist. If your kinks are at all relevant to the issue you are seeking treatment for, ask a prospective therapist what their view on kink is and listen closely to their answer. Do they feel that kink can be a healthy form of adult sexual activity, or do they think that kink is a sign of mental illness that they can help you fix? If it’s the latter, find a different therapist.
  5. If you’re seeking a therapist, check out the Kink Aware Professionals database. This is a national listing of therapists and other professionals (such as attorneys, doctors, and so on) who are kink-friendly and will help you address your medical concerns in a way that is intended to be supportive of your sexuality. (KAP also is generally supportive of polyamorous relationships.)
  6. There is also an effort to establish a set of Kink Clinical Practice Guidelines, which outlines a best-practices approach to treating kinky patients. If you are already working with a therapist who is supportive of your sexuality but who doesn’t have familiarity with the particular needs of kink people, show them these guidelines.
  7. Overall, there is growing awareness among mental health professionals of the need to destigmatize kink, but, as with all matters related to sex, conservatism tends to run counter to that and many, perhaps a majority, of therapists and counselors are unaware of and in some cases resistant to these trends.
  8. If you are a kinky person struggling with your mental health, you deserve the support of an understanding therapist or counselor, and you deserve to enjoy your sexual desires (so long as you can indulge them consensually and in a non-destructive way). But you’re going to have to be cautious about how you seek help (especially if you are in a more conservative region of the country), and you will probably have to advocate for yourself. The National Coalition for Sexual Freedom advocates for a wide range of issues, and has various resources that may help you.

I hope you’re able to get the help you need and deserve! 

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