The Importance of Kink-Aware Sex-Positive Therapy

“Shame dies when stories are told in safe places.”

—Ann Voskamp

I recently published a course about working with kinky clients, and when I received the notification that it went live, I was instantly paralyzed with deep shame and anxiety—and that surprised me. This is what I do for a living. What was going on here?

Although I have a lot of professional experience in kink, BDSM (bondage/discipline, dominance/submission, and sadism/masochism), and sex-positive therapy, I continue to be surprised at the kind of feelings that are evoked in me when publicly speaking about these topics. I sometimes still experience what research professor Brené Brown calls “shame attacks.”

In an attempt to recover from this shame attack, I reached out to a therapist friend. She asked me to think about why I continue to teach and train on the issue of kink-aware sex-positive therapy if it increases my anxiety. She suggested that I think about how my clients feel when they have to navigate therapy around this issue on their own.  

Creating Space for Sex-Positive Therapy

Therapists must understand what kink-aware sex-positive therapy is in order to make their clients feel safe and heard. Kink and BDSM are both relatively broad terms that can be used to describe anyone who engages in sexual activities or identifies outside what is considered mainstream—which actually applies to more people than you might think.  

Nearly 47 percent of women and 60 percent of men have fantasized about sexually dominating someone. Although domination is only one expression of a kinky relationship, almost 47 percent of adults have expressed interest in at least one non-traditional type of sexual activity. 

Due to a lack of clinically relevant knowledge about the BDSM and kinky communities, many clients are at risk when they decide to disclose a kinky identity to their provider. When a therapist is uneducated about this population or the dynamics of a kinky relationship, it’s easy to make mistakes that can make a client feel ignored—or even shamed.

As a therapist, your ultimate goal is to connect with your clients, and do everything to make them feel heard. When clients open up about their sexual identities, they tend to be at their most vulnerable. And if that information isn’t well-received by their therapist, it can do a lot of damage. 

Combating Shame by Improving Connection

My friend’s questions about why I do this work really put things into perspective for me. I spent a lot of time thinking about why I continue to educate on this topic, and it comes down to two main reasons—increasing connections for my clients and decreasing their shame. These two things are closely intertwined, especially when it comes to addressing concerns about sexuality in therapy. 

The issue of connection in therapy became even more clear to me when one of my supervisees was struggling with retaining her clients beyond a couple of sessions. She’s well-trained, effective, and well-liked, so I was baffled by this problem. But then, I realized her mistake. 

She wasn’t focused on building rapport with her clients, or forming real connections with them. As a new therapist, she was overly focused on proving her technical skills. She was jumping right into interventions with clients without giving them to the chance to feel heard, seen, or connected to. Once she started to focus on forming genuine connections with her clients, they kept returning and started to see improvements. 

Why Sex-Positive Therapy Matters

This experience with my supervisee cemented my belief that connection is the singular factor that can make or break a person’s experience in therapy—especially when it comes to sex therapy. A therapist can execute textbook therapy for a client, but that doesn’t mean much if the client feels like the therapist doesn’t get them. Most of the therapists I know are trying to connect with their clients. But as a field, we’re missing the mark when it comes to sex-positive therapy due to lack of training and education.

The Risks Clients Take in Being Open

One of my first kinky clients told her previous therapist that she was in a kinky relationship, but the client didn’t feel it had any impact on the reason she was in therapy. The therapist didn’t respond to this in the session, but after, they called the police, filed a report with adult protective services, and misdiagnosed my client with a paraphilia. Although the police didn’t act on the report, the damage was done—because of that experience, my client stayed out of therapy for more than 10 years. 

There may be circumstances where a client is in danger, and in those cases therapists should take measures to make sure their clients don’t get hurt. However, a lack of education about the dynamics and specifics of kink and BDSM may result in a situation like this one, where my client wasn’t in danger, but her therapist didn’t have the knowledge they needed to recognize that fact.  

Defeating the Stigma

Another client recently took six months to open up about their kink to me, despite the fact that I advertise widely that I’m a kink-friendly therapist. Given how long it took for this client to disclose, I was braced for something shocking or concerning. 

It turned out that their kink was incredibly mild and not anything illegal or dangerous. It would not even cause a movie to get an R rating. But their previous therapist had suggested that they were dangerous, sick, and should leave their partner to protect them. The judgement and ignorance my client faced at their previous therapist did lasting damage, and explains why they had so much anxiety talking to me about their kink. 

Both of these clients were struggling with untreated anxiety—and on top of that, they also struggled with shame and guilt about their kink. And I’ve heard too many stories like this from my other clients as well. They’ve had experiences telling therapists about their sexual identities and felt shut down, disregarded, or have been diagnosed inappropriately. 

There’s already a large stigma around kink and BDSM, both in society in general and in the mental health community. Therapists should be offering a safe space to their clients with sex-positive therapy, not adding to that shame. Education and training is necessary to equip therapists to offer the best care to everyone, including the full scope of sexual identity. 

Advocating for the Right to Pleasure

I’ve done a lot of work to process my own feelings about speaking so publicly about these communities. It’s sometimes tempting to focus on the anger and frustration I feel at people’s lack of compassion and education. But that adds to the division, and also masks my own shame and anxiety. I’ve made an effort to face that shame head-on, because I know that’s something I have to do in order to effectively advocate for this community. 

I’ve come to understand that my calling is exactly that—to advocate for understanding and acceptance of everyone’s fundamental right to pleasure without being pathologized. It would be so much easier to be a sex therapist that focuses on helping couples reconnect sexually or helps someone gain confidence in their sex life, but that’s not my calling. 

I know that no one becomes a therapist with the intention of causing harm. That said, a lack of understanding of diversity can still cause inadvertent harm. I’m hopeful that by providing education about what kink-aware sex-positive therapy is and offering other therapists the tools to provide more culturally competent care, the stigma that still exists in the mental health community about kink and BDSM will start to go away. 

In advocating for pleasure, shame has to be addressed. There are still moments where a client describes a kinky behavior to me and I experience a strong negative reaction.  However, I’ve learned to control my internal response and meet my clients with acceptance. 

I often have to remind my clients—and sometimes myself—that acceptance isn’t about agreeing with something. It’s about accepting it as it is. That can be an incredible gift in its own right, and it helps increase connection with clients while decreasing their shame.