Counseling Clients with BDSM Orientation - Building Theory and Skills

1. Kinky Clients – Part 1 – Building Theory and Skills to Counsel Clients with A BDSM Orientation ALCA 2014 Conference – Huntsville, AL. Wednesday, November 19, 2014 -- 2:30 - 3:45 pm Patrick K. Faircloth, Ph.D., L.P.C. (AL/MI), N.C.C. Assistant Professor, Troy University, fair20074@gmail.com

2. Who is a part of the BDSM Lifestyle/Orientation? The 1990 Kinsey Institute New Report on Sex reports:“Researchers estimate that 5-10 percent of the U.S. population engages in sadomasochism for sexual pleasure on at least an occasional basis, with most incidents being either mild or stage activities involving no real pain or violence. Most often it is the receiver (the masochist), not the giver (the sadist), who sets and controls the exact type and extent of the couple's activities. It might also interest you to know that in many such heterosexual relationships, the so-called traditional sex roles are reversed -- with men playing the submissive or masochistic role. Sadomasochistic activities can also occur between homosexual couples.” (Reinisch & Beasley, 1990, pp 162-163).

3. Who is a part of the BDSM Lifestyle/Orientation? The National Coalition for Sexual Freedom Surveys “The 2008 survey saw a total of 3,058 responses collected. Of those, 2,412 respondents resided in the United States (83.4%). Of the remaining 480 respondents, a total of over 42 other countries were represented. Where appropriate, the data is compared to the 1998 Violence & Discrimination Survey Against Sexual Minorities which collected over 1,000 responses to similar questions over the course of a year. The 1998 survey did not cover business or event-related experiences of harassment, nor did it ask about Internet experiences. The 2008 survey also included more questions about sexual activity and identity.” (Wright, 2008a) Table 1. Gender 2008 1998 Woman 51% 46% Man 45% 51% Transgender 5% 1% Intersexed 1% 2%

4. Who is a part of the BDSM Lifestyle/Orientation? The National Coalition for Sexual Freedom Surveys (continued) Table 2. Sexual Orientation  2008 1998 Heterosexual 41% 40% Bisexual 35% 36% Gay/lesbian 22% 22% Other 7% 4% (Wright, 2008a)

5. History of the DSM 1952 – DSM I 1968 – DSM II 1980 – DSM III 1987 – DSM III-R Revised 1994 – DSM IV 2000 – DSM IV-TR May, 2013 – DSM 5 (Implementation in September of 2014)

6. Morality or Mental Disorders in the DSM – Homosexuality, Gender Identity Disorder, BDSM It was not that long ago that the DSM contained 302.0 Sexual orientation disturbance (Homosexuality) in DSM-II, 1973 Dr. Evelyn Hooker’s research in the 1950’s discredited the idea that homosexuality was a mental illness. Through Dr. Hooker’s efforts homosexuality were depathologized. (Milar, 2011) The last remnant of pathologizinghomosexuality "ego-dystonic homosexuality" was removed from the DSM-III-R in 1987 – CURED! In many ways the BDSM community of the early 21st century resembles the gay community of the 1970s, and individuals who struggle with BDSM desires experience a similar internalized shame about their sexuality (Nichols, 2000).

7. Gender Dysphoria Gender Dysphoria – This chapter or group represents new information from a biological and social perspectives, addressing issues from children, adolescents and adults. The term replaces gender identity disorder in that the focus is not on identity but on the dysphoria as the clinical problem. Gender Dysphoria, Other Specified Gender Dysphoria, Unspecified Gender Dysphoria compose this group A posttransitionspecifer is added to apply to a person who has undergone at least on medical procedure such as cross-sex hormone treatment – CURED! (American Psychiatric Association, 2013)

8. Paraphilic Disorders Voyeuristic Disorder, Exhibitionistic Disorder, Frotteuristic Disorder, Sexual Masochism Disorder, Sexual Sadism Disorder, Pedophilic Disorder, Fetishistic Disorder, Transvestic Disorder, Other Specified Paraphilic Disorder, Unspecified Paraphilic Disorder are all found in this group (American Psychiatric Association, 2013)

9. Paraphilic Disorders (Changes) In the DSM-5 new course specifiers are “in a controlled environment” and “in remission” Paraphilias in the DSM-5 are not seen as “ipso facto” mental disorders, and they were not in the DSM-IV-TR either If a person meets criteria A then they have a Paraphilia, however if they do not meet criteria B they do not have a Paraphilic Disorder because it does not cause significant clinical impairment (KINKY PEOPLE – CURED! (American Psychiatric Association, 2013)

10. Definition of a Mental Disorder All diagnoses established using the DSM-5 must meet the following definition, which expands on the commonly & previously cited portion of the text in bold. “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviors (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.” (American Psychiatric Association, 2013)

11. A Non-Pathological Definition A fetish is defined as an object, body part, or behavior that triggers sexual responsiveness in an individual. The focus of the fetish is not innately sexual and can include feet or shoes, leather, latex, the act of smoking, or a variety of other stimuli Sexual sadism is defined as the enjoyment of administering pain or humiliation to another individual, and sexual masochism is the enjoyment of receiving pain or humiliation (Wiseman, 1996). Every action or activity must be Safe, Sane, and Consensual or it is not BDSM. Unlike the DSM criterion of sexual sadism, which requires the involvement of a non-consenting individual which is a criminal action.

12. Competencies While there are no ACA recognized competencies for working with a client who identifies as a member of the BDSM Lifestyle/Orientation it is my opinion that we would do well to consider the Association for Multicultural Counseling and Development Multicultural Counseling Competencies http://www.counseling.org/docs/competencies/multcultural_competencies.pdf?sfvrsn=3 Culturally skilled counselors possess specific knowledge and information about the particular group with which they are working. They are aware of the life experiences, cultural heritage, and historical background of their culturally different clients. This particular competency is strongly linked to the "minority identity development models" available in the literature (Arredondo et al., 1996). the ALGBTIC Competencies for Counseling LGBQQIA Individuals http://www.counseling.org/docs/ethics/algbtic-2012-07.pdf?sfvrsn=2 and the ALGB TIC COMPETENCIES FOR COUNSELING TRANSGENDER CLIENTS http://www.counseling.org/Resources/Competencies/ALGBTIC_Competencies.pdf

13. A Call For BDSM Competencies As Kolmes,Stock,& Moser stated in 2006. “Until training and education about BDSM lifestyles and practices are offered routinely, clients are left without reliable means to assess the expertise of “kink aware” professionals. It is apparent that there is a critical need to develop guidelines for psychotherapy with BDSM clients. This study is intended to begin the process,”… similar to that which was followed in the development of the guidelines for working with the lesbian, gay, and bisexual (GLB) communities (APA, 2000). Since 2006 several researchers and therapists have called for the APA to establish competencies and for good reason.

14. Is BDSM An Orientation? • For some practitioners, BDSM is merely an occasional form of sexual expression, while others see it as a sexual identity or orientation much like we conceptualize sexual orientation, and still others see it as a lifestyle. (Kolmes,Stock,& Moser, 2006). • This controversy still exists in the academic literature and within the community, however there does seem to be a shift to orientation.

15. Will the real Mr. Grey please stand?Fifty Shades of Grey or Mr. Grey and the movie The (James, 2011/2015) Secretary (Shainberg & Shainberg2002) http://www.youtube.com/watch?v=YmSO07r_zTc

16. Symbols – Terms & Definitions BDSM Symbol, Retrieved from http://www.cafepress.com/+bdsm-symbol The triskelion is a symbol with many meanings. According to Merriam-Webster (2013), “a figure composed of three usually curved or bent branches radiating from a center.” It has been adopted by members of the BDSM communities as a symbol that has different meanings to many people.

17. Symbols – Terms & Definitions On May 28, 1989, at the International Mister Leather contest in Chicago, Tony DeBlase presented his design for a Leather Pride Flag. In 1989 DeBlase stated, "The flag is composed of nine horizontal stripes of equal width. From the top and from the bottom, the stripes alternate black and royal blue. The central stripe is white. In the upper left quadrant of the flag is a large red heart. I will leave it to the viewer to interpret the colors and symbols.“(History of the Leather Pride Flag, n.d.) http://www.members.greenmountainleather.com/PrideFlag

18. Symbols – Terms & Definitions (Continued) A proposed flag meant to represent the Master/slave lifestyle was unveiled at the Master/slave Conference 2005 in Washington, D.C., on July 29. This symbol is offered as a representation of the Dominant / submissive or Master / slave Lifestyle. This simplistic design was created by combining established ideogrammic symbols. The vertical stripe is a universal symbol meaning power or dominance. The set of three horizontal stripes is a universal symbol meaning passive or submissive. The flag is a basic black with a white border. The Dom/sub symbols are in red and in the center. The intent was to create a symbol that represents the foundation of the Master/slave dynamic which is Dominance and submissiveness. (The Master/slave Flag, n.d.) http://www.masterslaveconference.org/history-Ms-flag.html

19. Terms & Definitions Safe, Sane and Consensual (SSC) - Safe is being knowledgeable about the techniques and safety concerns involved in what you are doing, and acting in accordance with that knowledge. Safety includes the responsibility of protecting yourself and your partner from STD (sexually transmitted disease) infection including the HIV virus. The organized SM community is active in promoting safety seminars and teaching the practitioners how to engage in these behaviors safely. The fact that SM practitioners are not clogging the emergency rooms every weekend, is an indication that these programs are working. If SM injuries were occurring, it seems obvious that the press would be highlighting this for the entertainment of its readers/viewers. (Wright, n.d.) Sane is knowing the difference between fantasy and reality. Fictional accounts of SM are often distorted for fantasy sake, and are not representative of real situations and relationships. Sane also distinguishes between mental illness and health. SM, like any other behavior, can be a sign of psychiatric problems. However the vast majority of its practitioners find that SM enriches and promotes functionality in the other areas of their life. (Wright, n.d.)

20. Terms & Definitions (continued) Safe, Sane and Consensual (SSC) – Consensual is respecting the limits imposed by each participant at all times. Consent is the prime ingredient of SM. One difference between rape and heterosexual intercourse is consent. One difference between violence and SM is consent. The same behaviors that might be crimes without consent are life- enhancing with consent. (Wright, n.d.) The type and parameters of control are agreed upon by the people involved, and the ongoing consent of all participants is required. Some practitioners use a safeword, which is a designated word that signals the scene must slow down or stop. (Wright, n.d.) Risk Aware Consensual Kink (RACK) – This is a departure from SSC and this definition is the topic of debate. However, many view RACK as a more specific philosophy when engaging in Edge Play.

21. Terms & Definitions (continued) Many of the definitions used in BDSM communities vary from region to region. There is no recognized authorities dictionary for BDSM terms. One of the commonly spoken mottos of the communities is: As long as it is SSC there is no wrong way to do BDSM. So here I will address some commonly held terms in the community. However, I encourage you to read some of the well know texts on the reading list, and conduct your own Google searches if you wish to know more. D-types & s-types, Daddy Dominant /babygirl/boi, Dominant /submissive, Gorean/Master-Kajira/ Fiction of John Norman, Leather Bear/cub, Leather Daddy/Leather boy or boi, Leather Family & Poly-leather family, Leather Master – Title, Leatherman/Leatherwoman, Master /slave, Mistress/slave, Mommy/boi/babygirl, Owner, Pet Owner & pet, Sadist/Masochist, Switch, Top/bottom

22. Terms & Definitions (continued) 24/7 TPE, Collar, Collaring (consideration-informal-formal - naming), Contract, Dungeon, Edgeplay/Edgeplayer, Fetish list, Furry, House, Limit List (Hard & Soft), LTR, Master's Creed, Munch, Negotiation, Old Guard, Play & Play Parties, Protocols - High, Medium, Low, Ritual(s), Safeword, Scene, submissive's creed, Subspace/Flying/Endorphin release, Sub-Drop, Domspace, Dom-Drop, Vanilla.

23. Terms & Definitions (continued) Various forms of play/work: Age play, Begging, Biting, Bondage (heavy/light), Branding, Breath, Caning, Cling film, Crops, Cross Dressing, Cupping/suction, Electrical, Face slapping, Feathers, Fire, Food selection/directed eating, Gags, Genital torture, Hair pulling, Hand cuffs, Humiliation, Hypnosis & Erotic Hypnosis, Ice, Intricate (Japanese) rope bondage, Knife, Lace, Leather clothes, Medical scenes, Mouth gag, Needle, Nerve excitation, Over-the-knee spanking, Pinching, Pony play, Prolonged orgasms, Role Play for example (Boss / Secretary) Ropes, Spreader bars, Standing in corner, Straightjackets, Suspension, Tens Unit (electricity), Wax.

24. A sampling of quotes from the section In Their Own Words, of the 2008 Survey of Discrimination and Violence Against Sexual Minorities conducted by Susan Wright with the National Coalition for Sexual Freedom. There were 63 comments made regarding Mental Health Practitioners. Just a few comments are offered for your consideration. Question "Please use this space to describe any significant experiences of discrimination by professionals that you have had." “I was made to feel like I am not normal and a social deviant. I felt uncomfortable and felt I could not freely be myself or talk openly about issues concerning myself to my psychologist. I spent more than half of one of my sessions trying to defend myself and my position in the BDSM community.” “Mental health practitioner for the Veterans administration's comment was that she did not want to get involved in my games. She looked at my BDSM lifestyle as counterproductive to my mental health and thought it was caused from a dysfunctional relationship with my father.” (Wright, 2008b).

25. Question "Please use this space to describe any significant experiences of discrimination by professionals that you have had.“ (Continued) “After finding out about my interest in BDSM, my psychiatrist stated that I 'cannot be ruled out as a danger to myself or others due to her interest in BDSM.” “My therapist (MSW) was totally flummoxed and astounded by both my bisexuality and the fact that I consider myself a switch. Once I told her about these things, she focused on them almost entirely, neglecting the issues at hand (I didn't have a problem with my bisexuality or my BDSM interactions at the time, they weren't causing any problems in my life/job/family...but my husband's severe alcoholism *did*). She decided she wanted to write a book on her patients' bisexual and BDSM lifestyles, and it got to a point where I couldn't believe I (and my insurance company) were actually paying her to do research for a book. I really needed the help with separating from my husband, learning to detach, learning to put my needs first, and not prurient interest from someone who was supposed to care.” “I have had substantial difficulty finding counselors that are willing to work with me because of my kink. Additionally, as a teenager, I had a therapist who spent substantial time trying to convince me that kink was bad and I should stop. She also told me I was not queer.” (Wright, 2008b).

26. Question "Please use this space to describe any significant experiences of discrimination by professionals that you have had.“ (Continued) “I have seen two Mental Health Therapists who insisted that my sexuality was the source of all my problems. I became more depressed under their care. My current therapist is more accepting, and I am happy and much more functional now. My former minister (who was an OUT practicing Lesbian) was horrified by both my Polyamory, and my Leather activities. Somehow the sexual revolution must have ended once Lesbians were allowed. I am amazed at the hypocrisy. In counseling sessions I was told I must not practice my lifestyle with others in my church, including partners I'd been with for years. My current minister is much more understanding, and respects the agreements between my husband, my partners and I.” “I've had therapists and shrinks insist on analyzing my avowed masochism as pathology and/or self-hatred and when I told them that I was fine w/it, didn't want to be judged, and had other issues I had come to them for they ignored my comments and insisted in viewing every issue in my life through the lens of BDSM 'pathology'. Needless to say, I have since changed mental health professionals.” “Neither my psychiatrist nor my therapist has a clue about BDSM. They don't seem to judge me over it, and the therapist seems genuinely interested in learning, but sometimes it just takes too much effort to teach her.” (Wright, 2008b).

27. Discussion & Questions

28. References Arredondo, P., Toporek, M. S., Brown, S., Jones, J., Locke, D. C., Sanchez, J. and Stadler, H. (1996) Operationalization of the Multicultural Counseling Competencies. AMCD: Alexandria, VA. Retrieved November 18, 2013, from http://www.counseling.org/docs/competencies/multcultural_competencies.pdf?sfvrsn=3 Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling. (2009). Competencies for counseling with transgender clients. Alexandria, VA: Author. Retrieved November 18, 2013, from http://www.counseling.org/Resources/Competencies/ALGBTIC_Competencies.pdf Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling. (2012). Competencies for Counseling with Lesbian, Gay, Bisexual, Queer, Questioning, Intersex and Ally Individuals. Retrieved November 18, 2013, from http://www.counseling.org/docs/ethics/algbtic-2012-07.pdf?sfvrsn=2 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. BDSM image. Retrieved November 18, 2013, from http://www.cafepress.com/+bdsm-symbol

29. References Connolly, P.H. (2006). Psychological functioning of bondage/ domination/sado-masochism (BDSM) practitioners. Journal of Psychology & Human Sexuality, 18(1), 79-120. History of the Leather Pride Flag (n.d.) Retrieved November 18, 2013, from http://www.members.greenmountainleather.com/PrideFlag James, E. L. (2012). Fifty shades of Grey. New York: Vintage Books. Kolmes, K, Stock, W. & Moser, C. (2006). Investigating bias in psychotherapy with BDSM clients. In Kleinplatz & Moser (Eds.) Sadomasochism: Powerful pleasures. Binghamton, NY: Harrington Park Press, Inc. Hoff, G., & Sprott, R. A. (2009). Therapy experiences of clients with BDSM sexualities: listening to a stigmatized sexuality. Electronic Journal of Human Sexuality, 12. Milar, K.S., (2011, February). The Myth Buster: Evelyn Hooker’s groundbreaking research exploded the notion that homosexuality was a mental illness, ultimately removing it from the DSM. Monitor on Psychology, 42(2), 24. Nichols, M. (2000). Therapy with sexual minorities. In S. Leiblum.&R. Rosen, (Eds.). Principles and practice of sex therapy (pp. 335-367). NewYork: Guilford.

30. References Richters, J., de Visser, R. O., Rissel, C.E., Grulich, A.E., & Smith, A.M. (2008). Demographic and psychosocial features of participants in Bondage and Discipline, Sadomasochism or Dominance and Submission (BDSM): Data from a national survey. Journal of Sexual Medicine, 5(7), 1660-1668. Reinisch. J.M., & Beasley, R., (1990). Kinsey Institute New Report on Sex, St. Martin's Press: pg. 162-163. Shainberg, S. (2002). Secretary - Movie Trailer. Retrieved November 18, 2013, from http://www.youtube.com/watch?v=YmSO07r_zTc Shainberg, S. (Producer), & Shainberg, S. (Director). (2002). The Secretary [Motion picture]. United States: 2002 Lions Gate Entertainment. triskelion. 2013. In Merriam-Webster.com. Retrieved November 18, 2013, from http://www.merriam-webster.com/dictionary/triskelion The Master/slave Flag was unveiled during the Master/slave Conference 2005 (n.d.) Retrieved November 18, 2013, from http://www.masterslaveconference.org/history-Ms-flag.html

31. References Wiseman, J. (1996). SM101: A realistic introduction. San Francisco: Greenery Press. Wright, S. (n.d.). SM is Safe, Sane, and Consensual. Retrieved November 18, 2013, from https://ncsfreedom.org/key-programs/education-outreach/what-is-sm.html Wright, S. (2008a). In Their Own Words. Retrieved November 18, 2013, from https://ncsfreedom.org/images/stories/pdfs/BDSM_Survey/in_their_own_words.pdf Wright, S. (2008b). In Their Own Words. Retrieved November 18, 2013, from https://ncsfreedom.org/images/stories/pdfs/BDSM_Survey/bdsm_survey_fast_facts.pdf