(Un)desirable approaches in therapy with Swedish individuals practicing BDSM: client’s perspectives and recommendations for affirmative clinical practices

Abstract

This transformative study aimed to explore how people who practice BDSM (bondage, discipline, dominance, submission, sadism, masochism) experience therapy; specifically, what sort of therapist responses and qualities they described as problematic and desirable in relation to addressing BDSM in therapy. Semi-structured interviews were conducted with 27 Swedish BDSM practitioners with experiences of psychotherapy. The interviews were analysed using inductive thematic analysis. Three themes were identified: 'A professional stance', relating to how therapists handled their professional roles when BDSM was addressed, 'Therapists' approaches towards BDSM', regarding therapists' opinions and attitudes towards BDSM, and 'Conversations about BDSM', regarding how therapists handled conversation about the topic. Participants reported negative experiences where therapists expressed prejudice, judgment or pathologizing attitudes, failed to contain their own emotions, questioned their clients about BDSM, used their clients to inform themselves about BDSM, avoided or focused excessively on the topic. Positive experiences were characterised by non-judgement, asking client-centred questions, and stimulating a collaborative exploration of matters relevant to the client. BDSM practitioners' experiences of therapy were related to those documented in the literature on other minoritized identities. This study contributes to the growing literature on kink-aware therapy, which makes psychotherapy more affirmative, accessible, and rewarding to BDSM practitioners.

The correlation between sadomasochists' experience and their sadomasochistic behaviors and fantasies: A qualitative analysis of interviews

“…Lack of information about sadomasochistic behaviors and fantasies drives therapists to use their clients to explain sadomasochism for them, which was found to be negative experiences reported by sadomasochists with experiences of psychotherapy (Lantto & Lundberg, 2021 ). The types of sadomasochistic play mentioned by the interviewees were classified into five categories, known as “spirit,” “punishment,” “sex,” “canine,” and “excretion” play.…”

“…With the development of online psychological counseling, counselors and therapists are increasingly serving sadomasochists. Unfortunately, sadomasochists have long been discriminated against by the general public and professionals, and the treatment effect for them has been unsatisfactory (Hansen‐Brown & Jefferson, 2022 ; Kolmes et al, 2006 ; Lantto & Lundberg, 2021 ; Sprott et al, 2017 ). Kelsey et al ( 2013 ) found that about 25% to 30% of sadomasochists are not willing to disclose their sexual interests when seeking professional help because they worry about being resented by the therapists.…”

Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students

“…Subsequent research might explore healthcare use among people who have been choked during sex, including whether those who have experienced LOC or AIC have been screened for TBI. Given the prevalence of choking and other forms of rough sex (e.g., Herbenick et al, 2021b;Keene, 2019;Vogels & O'Sullivan, 2019), and that some proportion of experiences will have been frightening or part of an assault, findings underscore a need for trauma-informed, kink-aware clinical care (Lantto & Lundberg, 2021;Speciale & Khambatta, 2022).…”

Associations between sexually submissive and dominant behaviors and sexual function in men and women

“…Paraphilia is "an intense and persistent sexual interest other than an interest in genital stimulation or preparatory fondling with phenotypically normal physically mature, consenting human partners" (1). Common subtypes of paraphilic behavior include "Bondage and Discipline, Dominance and Submission, Sadism and Masochism," which in short, are widely known as BDSM (2,3). Importantly, the large majority of individuals who are into BDSM would not fulfill the diagnostic criteria of paraphilic disorder which requires distress or harm to be present (1).…”