Every Saturday The CSPH highlights news or recent research in the field of human sexuality. This week we’re looking at a recent study from Psychology & Sexuality, which assesses how US psychotherapists feel about BDSM and working with clients who engage in such activities.
Therapists hold quite a lot of power: they help individuals who are ailing or experiencing problems, guide them towards behaviors that they view as healthy, and, often, are also the decision-makers surrounding what is well-adjusted and what is pathological and how individuals should feel or behave. For this reason, researchers out of Midwestern State University set out to understand the attitudes held by American psychotherapists with regards to BDSM, the sexual or erotic exchange of power and/or pain. As their study explains, an estimated 10 to 14 percent of people in the United States have engaged in BDSM activities, meaning that the majority of therapists likely have worked with a BDSM-involved client. At the same time, there are a number of negative stereotypes and beliefs surrounding practitioners of BDSM, including that they are pathological or acting out in response to past trauma, which dictate who can be seen as mentally well. Thus, a study was proposed to examine how a selection of licensed psychotherapists felt about BDSM, what sort of experience and comfort they had working with BDSM-involved clients, and how much education or training they had received on BDSM and sexual minorities in general. All information was collected anonymously via an internet survey, and ultimately included a sample of 766 individuals: 57% female and 43% male, majority European-American (94%), between the ages of 23 and 76 (average age of 50), and who saw between 0 and 60 patients per week (with an average of 21).
Of this sample, over three-quarters reported working with at least one client who engaged in BDSM, with an average of 6.7 per therapist. This was not uniform, however: 50% of the population having seen 10+ BDSM-involved clients and about a quarter who had seen none, while twelve respondents had seen over 100 clients engaged in BDSM. Over two-thirds of the respondents did not agree with the pathologization of BDSM, stating that it could be a part of a healthy relationship or that it did not need to be eliminated in therapy. This response, too, was skewed, with therapists who had seen more BDSM-involved clients reporting more accepting attitudes. A little less than half of the therapists considered themselves to be competent, and about three-fourths had received training at some point on sexual minorities. Most (64%) had reported no training throughout their graduate education, and over half of all participants claimed to have sought out training on their own after graduating. Demographically, individuals who were more inclined to report accepting attitudes towards BDSM included those who were of younger ages and those who held liberal political views.
Overall, this study found the therapists’ beliefs to counter to the mainstream, pathologizing tropes about BDSM: that it should be cured, that it is the result of sexual abuse, that it is harmful to relationships, etc. Indeed, the responses from this study are consistent with established psychological recommendations that BDSM should not be considered as a central therapeutic issue if it is only peripherally related to the client’s presenting concerns.
However, it does indicate a number of areas of concern in the mental health field with regards to alternative sexualities in BDSM. Primarily, the lack of education is worrying. While most psychotherapists had received some sort of education—in this survey, classified as anything more than absolutely no training—on sexual minorities, there is a difference between learning about sexual minorities in general or in the abstract and dealing with BDSM. In many ways, there are similarities between the struggles of those whose sexual orientations differ from the mainstream: stigma, coming out to family, addressing internalized notions about one’s sense of self sexually; yet there are many considerations that are specific to the BDSM experience, such as disclosing sexual interests to partners, negotiating boundaries, and learning how to set limits in a relationship. These factors may not be intuitive to many professionals not involved in BDSM themselves, and so would require their own skill sets and levels of understanding that cannot be attained without specific education.
What is most alarming about this lack of training is that while 76% of therapists have seen clients involved in BDSM, only 48% rated themselves as competent to address BDSM-related issues. This means that therapists are seeing these clients, fully aware of their lack of preparedness, unable to necessarily understand the complexities of their concerns, and potentially with no clear referral options because there are so few sex therapists or sexual minority specialists, especially in rural or central areas of the country.
It is unclear what the ultimate impact of a study like this can have, given its low response rate (only 9%) and the high opportunities for selection bias because of the nature of the topic (where more open-minded or interested therapists might be more likely to enroll). It is difficult to see how much the numbers ultimately and accurately reflect the level of comfort among psychotherapists. What this study can do, however, is show, via demographics, which therapists might be the most likely to be accepting and competent: in general, those who are younger and identify as liberal, and those who have sought out education on the subject. As well, it shows where there are holes in the mental health field that need to be addressed, namely in the lack of education in graduate training around sexual minorities and the high rate of providers seeing clients about BDSM who do not feel competent to discuss the topic. In order to create a safer mental health culture in this country, one that recognizes the dignity of choice, consent, and alternative sexual expressions, we must first ensure that the mental health field is adequately trained to serve clients who engage in BDSM practices.
For free access to this study, click here. If you yourself are seeking out a therapist or medical practitioner who is BDSM-knowledgeable and friendly, please visit the National Coalition for Sexual Freedom’s Kink Aware Professionals directory.
