Some of the biggest assumptions in the therapy world can be misplaced. One is that there will be more effective therapy, if practitioners personally identify with the presenting issues, or mirror the profile of the person they are seeing. Self-disclosure, whether on the basis of lifestyle choices, sexual orientation or past lived experiences, is often encouraged and actively promoted in support of the belief that there will be greater receptivity, connection, empathy and rapport with those seeking therapy. Specifically related to kink it can be misplaced to believe that a therapist who personally identifies as leading an alternative sexual lifestyle themselves will be more open-minded about any expression of sexuality in the therapy room. As we know, judgementalism and unconscious biases can be present in so-called diverse backgrounds, perhaps even when least expected.
Misconceptions in how to relate to alternative sexual lifestyles can be commonplace and may result from ignorance, shame and stigma, even in counselling and psychotherapy circles. For instance, kink and polyamory can be referred to in an interchangeable way. In practice, there are polyamorous individuals who can express their sexuality in a vanilla manner. Equally, kinky individuals can remain monogamous in their relationships just like kinky individuals may engage with multiple partners.
Seeking to have more effective therapy from actively pursuing so-called ‘sex positive’ practitioners can be a way of seeking to overcome the shame and stigma and the perceived roadblocks to accessing unbiased treatment. Self disclosure by therapists can be well intentioned but this can potentially backfire. Self disclosures by one’s therapist can hinder and restrict therapeutic growth if you perceive them as not being neutral, perhaps even colluding with your presentation. Specific self disclosures can, therefore, create blockages in the transference.
Some self-disclosure can be undertaken with good intent, since the therapist might be seeking to build rapport with such personal interventions. However, what you the client need when seeking help is a private, confidential, neutral and non-judgmental space where you can discuss your life choices in a free manner and where you perceive the therapist not having any vested interests. It can be unhelpful to need to be mindful of the personal views of your therapist, whether they have any negative, or even positive for that matter, biases. People in the kink or polyamory community, especially, do not want to feel patronised by their therapist if that self disclosure is perceived as routine rapport building that risks sounding platitudinous.
However, people engaged in a kink or polyamory lifestyle do fear being stigmatised and may have encountered negative experiences in counselling and psychotherapy environments due to ignorance, lack of awareness or prejudice. In an attempt to address this, a team of experienced therapists gathered in America to explore what constitutes clinical best practices when working with those who are interested and/or involved in kink, BDSM, and/or fetish eroticism. The intention was to help bring greater awareness of the particular presentations in this field and how to work more effectively with people who seek help. The clinical best practices group produced a set of guidelines in an attempt to address this need and their guidelines can be downloaded here.
The clinical best practices group conceptualizes kink as sexual identities,
erotic behaviors, sexual interests and fantasies, relationship identities, relationship orientations, and relationship structures between consenting adults not accepted by the dominant culture. Activities, and social and sexual choices, include BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism),
leather, and fetish as being integral parts of the umbrella term of kink. The guidelines make clear that most counselling and psychotherapy training institutions fail to adequately cover this material in their training programmes. This has been my experience too. I recall the ‘sexual development’ experiential weekends from my own training and I can’t remember any of this material being covered. “Sex” was actually what was missing from the discussions. The over-riding memory from those times was a silly experiment the facilitators undertook with an exercise where coins were placed on the floor and group participants went to retrieve them. I am still confused about that was supposed to have achieved.
Useful as the guidelines are, I am, however, left with the rather obvious observation that any good therapist, already adhering to existing ethical frameworks, should be observing these good practices in their way of working already. For example, guideline 2 states “Clinicians will be aware of their professional competence and scope of practice when working with clients who are exploring kink or who are kink-identified, and will consult, obtain supervision, and/or refer as appropriate to best serve their clients”. Or, guideline 4 when it states “Clinicians understand that kink is not necessarily a response to trauma, including abuse”.
There can also be a whole cottage industry around some aspects of providing continuing professional development (CPD) courses for therapists around gender, sexual and relationship diversity (GSRD). Adverts in the therapist journals ask if practitioners are GSRD competent, implying you could be incompetent without their training provision. That said, the guidelines, and CPD training courses, can have their purpose, for those who need it most, either because of their own limitations, inadequate training, or unimaginative previous CPD units, or as a way of addressing their own biases and prejudices.
For more on this area see my article on kink and polyamory and when the lifestyle becomes a problem
Noel Bell is a UKCP accredited psychotherapist based in London and can be contacted on 07852407140
