Working with Kink: Shifting the Clinical Perspective

The importance of proper kink education and a shift in clinical perspective.

Posted Feb 22, 2021

When we look at the educational requirements to become a therapist, human sexuality is fundamentally lacking. While most programs, at least in California, require some sexuality training in order to be eligible for licensure, most of these courses are spent learning about sexual disorders, sexual trauma, psychopharmacology, and additional issues pertaining to sexual functioning.

While all of these topics are vital to obtaining a well-rounded sex education, the time spent reviewing matters related to Gender, Sex and Relationship Diverse (GSRD) clients is minimal. It is often argued that the human sexuality component of a Master’s program is not nearly as thorough as necessary to establish any sort of competence in working with that population. Under the umbrella of GSRD clientele are kinksters who often attend therapy with a counselor who is ill-equipped to work with the issues they present. 

Михаил Решетников/ Adobe Stock
Source: Михаил Решетников/ Adobe Stock

In addition to the flawed educational system, multiple layers act as barriers between a lack of kink knowledge and the foundational kink awareness necessary to enable therapists to work with that population effectively. On a macro-level, harmful societal ideas about kinksters are often perpetuated through misrepresentation of kink in the media.

We also have a professional bias that comes from the therapeutic community itself and, of course, personal bias that comes from our own values and understanding of sex. The framework that therapists often approach clients with is frequently an expansion of their own worldview, and it is possible to unconsciously sway clients towards a life that is in line with that of the therapist.

Further, therapists often approach clients from a place of fear. With our intention rightfully on protecting our clients from harm, whether from others or themselves, we keep our antennas up and remain vigilant. We meticulously dissect language, attune to their gestures and movement and keep our eyes and ears open to any indication of danger.

Many of us clinicians see ourselves as protectors, and in many ways we are, but what happens when what we see looks like harm and what we hear sounds like harm but isn't actually harm? How do we manage to look at something where years of training have told us it means danger but trust that it is not? These questions are the foundation of the struggle that so many therapists have when working with the kink community, and the answer is not as complicated as one may think. To put it simply, if you are misinformed or lacking proper education around kink, you might see abuse even when abuse is not present. 

One of the fundamental stereotypes that surround the kink community is that kink is inherently abusive. It is an argument that floods forums, comes up in supervision sessions, gets debated in classrooms, and continues to run rampant within and outside of the therapeutic community. We can assume that most therapists have the purest of intentions when it comes to protecting their clients; however, sometimes protecting clients means confronting the very thing we, as clinicians, do not understand.

We must marinate in our discomfort and accept that what we see is not always what it looks like, and most importantly, we must be willing to listen to our clients. One of the questions that I am frequently and, to be honest, frantically asked time and time again is, how can you tell the difference between healthy kink expression and abuse? This is an excellent question and one that can be answered through proper kink education. 

We have to take a look at both the concepts of kink and abuse to understand where the difference lies because the expression may actually look similar. For example, being degraded is a very common form of emotional abuse. If a client explained that their partner was calling them derogatory names in an attempt to humiliate them, our inner sirens would be blaring. Rightfully so. That said, a client could hear the exact same phrase from a kink partner and it could be completely and utterly blissful for them. So, where does the difference lie?

One central theme exists across all types of abuse, whether sexual, physical, financial, emotional and more. That is that one party is behaving in a way that violates the boundaries and consent of the other. On the contrary, the one central theme that exists across all types of kink is that all parties involved consent to every action or behavior that is occurring. Consent is the primary differentiating factor. Kink cannot exist without consent. The moment that kink play pulls out of a consensual space, it is no longer a kink space. From the most mild to the most extreme expressions of kink, consent must always exist. 

Anton/Adobe Stock
Source: Anton/Adobe Stock

Once we understand that consent is a must for kink, we can begin to address the more nuanced red flags that may come up in a therapeutic space. Simply put, lack of consent equates to abuse, but what about additional factors that may be harmful to a client? Well, this is where our basic therapy training comes into play and where we must remind ourselves that while our clients are kinky, they still experience the same relationship struggles as our non-kinky clients. We must be expansive about our curiosity and not focus entirely on the kink itself, but continue to remember that the kink is there.

First and foremost, we must listen to our clients. We must trust that they are experts in their own lives and respect that their kink relationships may present themselves in ways we do not quite comprehend. We can also use our clinical skills to understand more about their kink interactions and relationship dynamics as a whole. For example, there are several questions we can ask ourselves and our clients when discussing their kink exploration.

First, are we seeing other negative interactions occurring in their relationship outside of the erotic space? Is gaslighting present? Is the consent that is existing happening from a place of coercion or manipulation? Are they consenting while intoxicated or in the middle of a scene where they may not be in the proper headspace to make informed decisions? Are health concerns being taken seriously? Are respect, love, care, and compassion present in the relationship? Does our client have the ability to end the relationship if they so choose? These questions are relevant in all relationships, whether or not kink is involved. When we get overwhelmed or overly focused on the kink aspects of someone's relationship, we may fail to see what is actually happening. 

A client can come into therapy with bruises on their body, a collar around their neck, and be living in an incredibly happy, fulfilling, and loving relationship. If we do not expand our knowledge about what kink may sometimes look like, we can inadvertently shame our clients for something that is perfectly healthy in their lives. Research has indicated that therapists have refused to see clients unless they admitted that their healthy kink relationships were abusive. (Wright 2006). It has also suggested that several therapists believe that kink should be entirely eliminated by therapy (Kelsey et. all 2013). This information is not only problematic but is harmful to our kink clients.

When it comes to kink, we must alter our perception of abuse and adjust it accordingly. We must continue to remain vigilant but also be aware that when kink is involved, we need to take off our vanilla lens and put on a different one. If not, we may shift away from being the ones who are protecting our clients to being the ones who are actually harming them.


Wright, S. (2006). Discrimination of sm-identifying individuals. Journal of Homosexuality, 50, 217-231

Kelsey, K., Stiles, B. L., Spiller, L., & Diekhoff, G. M. (2013). Assessment of therapists’ attitudes towards BDSM. Psychology & Sexuality, 4(3), 255–267. DOI:10.1080/19419899.2012.655255