Kink Affirming Therapy

Richard Freiherr von Krafft-Ebing, a German psychiatrist, published Psychopathia Sexualis in 1886, one of the first clinical books to define, identify, and diagnose atypical sexual habits. The book is credited with coining concepts like ‘masochism’ and ‘sadism’, as well as being one of the first to clinically characterise male homosexuality. Von Krafft-Ebing identified three types of sexual disturbances: pathologically increased sexual impulses, sexual instinct absence, and sexual instinct perversions. He developed these categories based on 238 case studies, portraying sexual deviance as a type of mental illness that 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.

Christian Joyal, a Quebec psychologist and researcher, published a groundbreaking study in 2016 based on a randomised sample survey of Quebec’s general population. Nearly half of the participants in the survey said they were interested in at least one or more sexual practises that von Krafft-Ebing would consider deviant and disordered. Around a third of the participants had engaged in these activities at least once, and numerous so-called deviant hobbies, such as voyeurism, fetishism, and masochism, were reported at levels that were statistically exceptional. Joyal’s remarkable research turns von Krafft-Ebing’s theories on their head and shatters many clinical assumptions about sexuality.

Unfortunately, therapists have had a difficult time finding excellent training and knowledge about kinky sexual activities. Many therapists don’t know what they’re doing. Interest in sexual kink is seen as an indication of pathology and trauma in many popular psychiatric methods, ranging from sex addiction to attachment therapies. Luckily, things changed. Starting in 2010, a group of clinicians who work closely with these sexually stigmatized groups have been developing a set of guidelines for therapists who want to work from a place of knowledge and health, as opposed to ignorance and shaming. At an annual clinical conference, now known as The Multiplicity of the Erotic, in 2012, the first steps towards defining these clinical guidelines were outlined. A research and clinical group was formed with the purpose of summarising and documenting studies and best practises, while a second group was formed to gather information from stakeholders in the process – people with kinky sexual preferences who had sought professional services.

These guidelines should be reviewed by every mental health physician. Whether they realise it or not, every clinician is most likely working with kinky clients. Using the concept of intersectionality as a foundation for kink therapy is absolutely essential. When it comes to kink, we cannot simply look at sexual and erotic desires on their own; we must approach it from a framework that encompasses the many identities of our clients and their varied experiences in the world. The ethical obligation of therapists is to advocate for their clients. For many, that will come from their work within the therapy room, but for some of us, that means shifting the systems that contribute to their distress. It is our duty to utilize the tools that we have to jump in the ring and join the fight.

-Tanvi Bothra

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