Therapy with Kink: An End to Shame

August 29, 2020

New recommendations describe best practices for clinical work with kinky people.

In 1886, German psychiatrist Richard Freiherr von Krafft-Ebing published Psychopathia Sexualis, one of the first clinical works which described, labeled, and diagnosed unusual sexual behaviors. The book was one of the first to clinically describe male homosexuality and is the origin of terms such as masochism and sadism.

Von Krafft-Ebing presented three categories of sexual disturbance, including pathologically exaggerated sexual instincts, absence of sexual instinct, and perversions of sexual instinct. He based these categories on 238 case studies, presenting sexual deviance as a form of mental pathology, which could be treated and cured. This view has shaped clinical approaches to any sexual behaviors which may be considered outside the norm, whatever we think the norm is.

In 2016, Quebec psychologist and researcher Christian Joyal published remarkable research, based on a randomized sample survey of Quebec’s general population. The study found that nearly half of the sample reported interest in at least one or more sexual behaviors which von Krafft-Ebing would have described as deviant and pathological.

Around one-third of the sample had pursued these behaviors at least once, and many so-called deviant interests, such as voyeurism, fetishism, masochism were reported by participants at levels above what could be considered statistically unusual. In many of these sexual interests, there were no differences between men and women, and interest in sexual masochism was significantly linked with higher levels of life satisfaction. Joyal’s remarkable research turns von Krafft-Ebing’s theories on their head and shatters many clinical assumptions about sexuality.

How can it be that nearly half of the general population have sexual interests once considered deviant? And how can it be that clinicians and therapists view these sexual interests as unusual, uncommon, and usually unhealthy, when anonymous research finds that these sexual interests may in fact represent the norm? Research by Keely Kolmes suggests that it is clinician bias, our assumptions of deviance, disturbance, and pathology, which lead to people keeping their sexual interests secret from their therapists.

Kolmes’ research, as well as further research by many other clinicians, has revealed that people experience sad, dismaying, and harmful responses from therapists when they share their sexual interests with therapists who are poorly trained on sexual diversity. Patients report being “fired” from therapy for being kinky, having Adult Protective Services called for engaging in consensual sexual behaviors, losing custody of their children, and generally being shamed and told that they are sick by therapists who believe, as von Krafft-Ebing did, that these sexual interests represent mental disturbance.

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