Sexually kinky clients present ethical issues

By Ryan G. Witherspoon, Ph.D.
February 4, 2020



sexual kink and ethicsKink can be broadly defined by the compound acronym BDSM, which stands for bondage and discipline, domination and submission, sadism and masochism. It refers to a broad spectrum of erotic behaviors and relationships that incorporate ritualized, consensual and erotic power play.

Long hidden underground, in recent decades kink has become increasingly normalized as research and clinical evidence has mounted countering its historical pathologization.

Nationally representative statistics suggest that 10 percent to 15 percent of adults in North America engage in kinky behaviors. Clinicians working with kinky clients should be mindful of certain ethical issues that may arise, such as those involving cultural competence, countertransference, risk assessment and boundaries.

Kink-oriented people can be conceptualized as a stigmatized and invisible sexual minority group. As with other such groups, it is imperative that clinicians seek to build their level of cultural competency in working with this population. This requires clinicians to reflect on their own level of kink-related knowledge and expertise, as well as assessing the extent to which kink may or may not play an important role in therapy for a given client or time.

Research shows that most kinky people seek therapy for reasons unrelated to kink, in which case in-depth knowledge of kink may be unnecessary. However, some clients may seek therapy specifically to help with kink-related issues. In these cases, clinicians are advised to engage in their own research and/or seek additional training regarding kink, in order to ensure that the client receives culturally competent and appropriate care.

Should clinicians feel unequipped to provide this care, consultation with a kink-knowledgeable expert may help the clinician determine whether referring the client out would be more appropriate. It must also be noted that some clients may be reticent to disclose their kink interests or involvement due to fears of stigmatization or pathologization – or they may disclose early or abruptly as a way of testing the clinician.

Considering the transgressive and sometimes provocative nature of kink, clinicians may develop strong and potentially negative countertransference feelings. This may stem from the clinician’s own sexuality-related experiences, beliefs or biases.

Careful monitoring of this countertransference is encouraged, as well as being mindful to avoid pathologizing kink itself. Sometimes, these potentially negative feelings a clinician holds may be enacted unwittingly via microaggressions, which could negatively impact therapy outcomes.

Clinicians are advised to carefully consider their tone, timing of questions and assumptions, as well as to follow the client’s lead regarding when and to what extent to focus on kink in treatment.

Another facet of cultural competence relates to assessing the level of potential risk a client may be engaged in. The kink community has widely accepted standards for how kink-related risks are assessed, negotiated and consented to. Clinicians working with this population should have, or acquire, enough kink-related knowledge to help a kinky client differentiate for themselves between kinky behaviors that play healthy or harmful roles in the client’s life.

In addition, kinky relationships may also involve abusive dynamics, similar to any close relationship, which may make differentiating these factors more difficult for those with limited competency with this population.

Finally, clinicians who themselves are kinky may face boundary and dual-role issues with kinky clients. Even in a large city, the kink community may be small and close-knit, which could place clinicians within the realm of “small town” ethical dilemmas.

Dual role issues and disclosure dilemmas may arise working with kinky clients and participating in the same larger community. Consultation and developing a strong kink-affirming referral base are advised.

Thanks in part to the popular 50 Shades of Grey series of books and films, and despite the inaccurate and dismal portrayal of kink in those works, interest in kink is expanding in popularity.
Clinicians are increasingly likely to encounter kinky clients or similar issues in their practices, despite the fact that the vast majority of clinicians have not received any education or training regarding kink.

In addition, kink-affirming and competent care is a growing niche specialty for clinicians. For these and other reasons, clinicians are encouraged to educate themselves about kinky behaviors, communities and culture as part of the broader spectrum of consensual sexuality.

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Ryan G. Witherspoon, Ph.D.. is a psychotherapist, researcher and author who lives in Los Angeles. He is currently co-authoring a book on clinical work with kink-oriented clients. His email address is: ryanwitherspoon@gmail.com.

 

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