- We are physiologically no different from you, and you could probably learn to enjoy the same things we do if you wanted to, and it’s fine if you don’t.
- Nonjudgmental questions are not a problem.
- Prescribe all medications, particularly for pain, as you would with anyone else. We do not enjoy pain from illness or injury any more than you do.
- For further information, we recommend you read “Health Care Without Shame” by Dr. Charles Moser, listed in the Resource Guide.
- If you are still perplexed by something you do not understand, and your patient can’t explain it to you to your satisfaction, you can always seek consultation. In our Resource Guide you will find the information to access Kink-Aware Professionals, a list of doctors and therapists who are knowledgeable about kink, in every state and some foreign countries.
- It is not a crime to not know how something works. If you have no experience of S/M or kink, then you have little or no idea of how it works. As long as you understand that, and seek more information when you are confused, you will do just fine at treating your kinky patients with care and respect.
- Remember that you do not know how many people you see who have kinky sex lives. You can only identify those few who have visible marks on their bodies at the time you examine them, or who talk to you about their alternative sexual practices. Most of your patients try very hard to conceal their kinkiness from you. We worry about this: we’ve heard from too many kinkyfolk who are reluctant to seek medical care when they need it for fear of discovery and judgment.
- If you want to do a small-scale statistical study of your own practice, compare the incidence and severity of injuries caused by S/M that you treat to the injuries suffered by those who ski. Then compare your feelings about them.
Psychological professionals. You may have clients, in your private practice or in community service work, who are practitioners of S/M or other kink. Kinky people seek therapy for the same reasons that anyone else would: anxiety, depression, conflict in a relationship, recovery from chemical dependency, healing from childhood abuse, etc. Your kinky client’s needs may have little or nothing to do with his sexual practices, or they might, or perhaps your client wants to feel safe talking to you about all aspects of his life.
Since Krafft-Ebing, many psychological theorists have assumed that kink is universally caused by underlying psychopathology. All forms of sexual variation have been defined as sick, and it is only recently that we have begun to accept gay, lesbian and bisexual people as sane.
The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, usually known as the DSM-IV, has changed the criteria for diagnosing paraphilias, including fetishism, transvestism and sadomasochism, to indicate that sexual behaviors involving consenting adults are only to be considered pathological if: “The behavior, sexual urges, or fantasies cause clinically significant distress or impairment in social, occupational or other forms of functioning.” “...A Paraphilia must be distinguished from the nonpathological use of sexual fantasies, behaviors or objects as a stimulus for sexual excitement in individuals without a Paraphilia.”3
The alternative sexual behaviors we describe in this book are now comparable to oral sex thirty years ago, when it was included in many legal definitions as “sodomy” (which is still true in some states), and believed to be degrading and disrespectful. Today, sexual variation is actively coming out of the closet. The changes in the DSM-IV definitions were made after extensive lobbying from the various kink communities.
Tolerance is not the same thing as understanding. Safe, sane and consensual kink is not, and should not be, self- or other-destructive. Sexual abuse does happen, and is pathological, whether the participants are wearing leather and chains or cotton and sweats. The abuse part lies in the mistreatment of one person by another, and, sadly, happens in all forms of relationships from the far out to the conventionally married. Thoughtful practitioners of kink are not responsible for all the bad sex in the world.
Dossie once had a young woman come to her who had questions about S/M practices she had been introduced to. She told Dossie that her top had put her in a bathtub with a six-volt car battery. Dossie says, “I bit my tongue. Being an experienced player myself, I strongly felt that this was not okay. But I didn’t want to shake my finger at her and make her feel bad. So I asked her if she felt that this was safe. She responded that she didn’t, and that’s why she was seeking therapy, because she knew that she was doing things that weren’t healthy for her. I think if I had lectured her instead of asking for her opinion, she would not have felt safe enough with me to work on her issues.”
What is hard for outsiders to understand is that kinky people have figured out ways to enact fantasies, stimulations and psychodramas safely within the boundaries of scene space. So while what they do might look dangerous - indeed, they might go to some lengths to make their play appear dangerous - they work hard all the while to keep things safe both physically and emotionally... sort of like sexual stuntpersons.
Theories and reductionism. Kinkyfolk do enact archetypes, myths, and all kinds of stores. Psychoanalytical theorists often try to analyze these stories to tease out an underlying psychodynamic. This is fine when you are endeavoring to understand the individual, but it can be a real problem if you are predisposed to find pathology, or resistant to the possibility of health.
Even when you have a good idea about the dynamic of one person’s story, you can’t generalize. All people who are eroticized to shoes, for instance, are not the same. They couldn’t be; there are too many of them. Beware generalizing and reductionism. Freud, for instance, tried to reduce our entire sexual heritage to the single story of Oedipus, with a brief bow offstage to Electra.
Dossie recently attended a lecture by a current psychoanalyst offering his theory that all people (he actually spoke only of men - well, one man) who like beating and bondage had martyr mothers. Of course, almost all of us of a certain age did have martyr mothers - they constituted the only approved variety in the pre-feminist era of Donna Reed and June Cleaver. Thus one-case reasoning reduces to a one-story theory.
We believe that if studies were made of a representative cross-section of kinky people, lots of psychological health would be discovered, and many, many stories. There are as many stories as there are people, and more still if you count that many of us explore more than one story.
When you are trying to understand someone, you would do better to listen for her story rather than to try to fit what you are hearing into some other prefabricated story. Let us not allow therapy to become a Procrustean bed in which we tear people apart, discarding something here, stretching there, to make sure they fit our theories. Kinky people have only one thing in common, their love of kinkiness. Otherwise we are a totally diverse group of people, just like everybody else. Beware of generalizations: they so easily become oppressive.
Are kinkyfolk all abuse survivors? Some of us are, some are not. Your authors are one of each. Does it matter? The real question is, are we thriving? - and if we are not, is it our sexual practices that hinder us? Or are we struggling with the same obstacles of nature and nurture, programming and belief systems, that everybody else comes to therapy to work on?
Some people believe that those of us who enact fantasies of abuse, kidnap, infantilism, helplessness or infinite power are perpetuating a negative psychodynamic, helplessly repeating the abuse of our childhood, unable to escape. This may be true for some people, both kinky and vanilla. But for many of us kinky folk, reliving a story that embodies a profound conflict allows us to work it through, to heal and empower ourselves. An old tape can be changed and cleansed with eroticizing. When we enact a roleplay, we engage in a form of psychodrama, and we get to choose the ending. We get an opportunity to enter into a painful memory and come out of it in a new and positive way, with sexual pleasure, with support, with love.
While erotic play may be therapeutic, it is emphatically not a substitute
for therapy. When deep emotional issues open up in kinky play, we strongly recommend taking those issues to a kink-positive therapist and using that opening as an opportunity for increased self-understanding and, ultimately, healing. Sometimes we are doing in S/M and kink is a journey through our own Jungian shadow, experiencing, in a safe and contained environment, some of the forbidden parts of ourselves. And why should sexual play not be a place to bring our shadow selves into consciousness in a positive and life-affirming relationship? As an old friend of ours used to say, “I know my fantasies have dirty roots.” And how else shall we grow roses?
What should the therapist do? There is no reason why a therapist who knows little about alternative sexualities cannot do good work with a kinky person. Although some individuals’ issues require an in-depth understanding of their sexual lifestyle, it is really only occasionally necessary or advisable to refer a client to a therapist with special training in kink. If your client, for instance, is exploring his psyche through a master/slave or a daddy/boy relationship, you might need some experience with what normally goes on in such relationships to understand what your client is telling you. Most often, however, the challenge will be similar to working with a client whose ethnic background or life history is different from your own. Most of what your kinky client needs you will be able to understand, and occasionally you will misunderstand. That is not the end of the world, as long as you are willing to acknowledge any confusion. We have both had excellent therapists who were not themselves players. The open-mindedness that any good therapist should have can carry you through.
Be willing to educate yourself, and to learn from your client. Take care of yourself. If you feel your own buttons getting pushed, work that through, get some support, get a consultation from another professional on the Kink-Aware Professionals list. Read some of the books written by people who have been playing with kink for many years. Avoid judgments and pathologizing. Treat your client with respect. Listen. Listen. Listen.
A final thought: Experienced erotic roleplayers develop a lot of skills at journeying in the shadowy parts of their psyches. As you might predict, this is so much like therapy that many of us take to therapy like ducks to water. We could become some of your most rewarding clients.
10
What If It’s Your Partner?
If you are uncomfortable with variant forms of sexual expression, and your partner tells you that she has been exploring or wants to explore an alternative sexuality, you may find yourself in a difficult and painful position.
Your problem is not that your partner has gone crazy: kink is a sane and ethical life choice. Your problem is that you and your partner have a difference. Once we all understand that kink is neither mysterious, destructive, immoral or crazy, then we can see that this might simply be a difference - a very important difference.
Suppose one of you wants a child and the other doesn’t. Suppose your lover decides to devote himself to a demanding spiritual practice. Suppose your wife gets a fabulous professional advancement - in a different state. Imagine any difference where one partner’s choices have a profound effect on the other. That’s the kind of problem you have, a serious difference with a large potential impact on your relationship. Why should it being about sex make it more difficult than these other differences?
There is hope. Other families, and other couples, have dealt with such issues successfully, and the struggle to maintain their intimacy in the face of profound difference has often brought them even closer together than they were before, reinforced in mutual love and respect. The caring that you and your partner share can fuel the strength you need to struggle toward mutual understanding, even when it’s painfully hard, and to accept change in your relationship with mutual tolerance.
We suggest you start dealing with this amazing news by taking very good care of yourself. Deal with the shock first. You may find all kinds of difficult feelings welling up in you: betrayal, fear, shame, horror, insecurity, rage - this is a revelation that hits very close to home.
Start by giving yourself time to process the feelings you are having. Most people find that how they feel at the first shock is quite different from how they will feel in three days or so, so allow yourself enough time to let this news sink in. Your partner may be impatient for your approval or acceptance, with good reason, but your partner may have to wait until you get more familiar with your own response. We strongly advocate that you do not rush to judgment. Both of you may be tempted - it’s not easy to let something this important rest in limbo while you sort out how you feel about it - but please don’t leap to a hasty solution just so you can get this acutely uncomfortable issue off the table.
When your partner lets you know of his interest or experience with kink, a second issue looms very large on the horizon. Unlike a friend or other family member, you, as the life-partner, spouse, lover of your kinky person, cannot fully separate yourself from her kink. The issue of your own participation suddenly becomes very important, because if your partner is doing a kind of sex in which you do not choose to join, your sex life together is likely to get wobbly no matter what else you do.
We are keenly aware that there may be heartbreak on the table. Whether you just fell in love last week or you have a twenty-year marriage with a house and three kids, we know you have made a profound emotional investment in your relationship, and the prospect of separating over a sexual difference is an overwhelming loss. You have our sympathy, and our assurance that we will share with you everything we know that can make your relationship work.
Remind yourself of what you value in this relationship already; it will help you summon the courage to hang in there long enough to make a thoughtful and informed decision. Remind yourself that your partner chose to love you, and to enter into a committed relationship with you, so your partner sees you as a very special person even if you’re not comfortable swinging a whip.
Your partner has not changed. What has changed is simply his vision of his, and your, ideal sexual future. That may be a big difference, but whatever it is you love about your partner is still true, and it is still true that your partner chose to love you.
Remember what you have read so far about how the realities of sexual variance may be very different from the stereotypes and myths you have heard. You need to get up to speed with accurate information, and learn some of the language your partner is using, so that you are both speaking about the same things in more or less the same language and you have a way to understand each other. Reading this book is a great start - you’re a real adventurer!
Once you get past the myths and stereotypes, you may discover that the reality of what your partner actually wants to do is quite different from your mental picture of perversion. The reality of kink is usually a lot less scary than your worst nightmare. It might even seem safe and, possibly, even approachable.
How will this knowledge change your relationship? Maybe less has changed than you think. If your partner, for instance, has been engaging the services of professionals to provide sexual experience he was afraid to ask you about, then perhaps he is confiding in you because he has more trust in you. Even if he has been “deceiving” you for some time, during this same time you have built the good things that you value in your relationship. Many people feel that a revelation like this makes their whole relationship a sham, but this is not true. What is true is that your partner has made sacrifices in order to stay with you, presumably because he wants you in his life.
Being full of care. That’s what “careful” means - caring about each other, letting your care for one another guide you through this difficult time. Empathy is your strongest asset. You may be feeling just terrible right now - unsafe, threatened, insecure, angry - and your partner probably knows this. Your partner is probably also fearful - of your rejection, your disapproval, your disgust. So do your best to be accepting of each other and respect each others’ feelings.
This is not about somebody being right and somebody else being wron
g, no matter how tempting it may be to blame. You are both dealing with this difficult stuff because you both want this relationship to succeed: you are both on the same side.
Your options. As we mentioned earlier, being the partner of a kinky person means that you have one less option than everyone else she knows: you don’t get to forget about the whole thing. This is your partner, your spouse, your mate, and pretending you never heard what she told you about her sexuality will not work.
So what are your options? You have quite a few.
Asking your partner to give up kink. What if alternative sexual behaviors are totally not okay with you? Can you ask your partner to just stop? In our experience, very few people succeed in denying their desires once they have discovered a safe way to make those dreams come true. For us, it would be like asking us to cut off our arm, to leave behind what we find to be a very valuable part of ourselves. We would feel incomplete and amputated if we were asked never to have our favorite kinds of sex. To ask someone to bury her sexual self is akin to demanding that she give up her integrity and become somebody else.
Furthermore, if you insist that she stop exploring her sexuality in a kinky direction, you run the risk of driving her underground. Then you get to deal with a secret life.
You may find yourself wondering whether his offer to rub your feet after a long day, or her slightly abrupt request that you take out the garbage, represents some sort of hidden sexual agenda. Will you ever be comfortable? Will you ever feel safe? Will you wonder about every hang-up phone call, every unexplained absence? Will you read her journal? Will she leave?
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