Therapy & Kink

26 Jan

There are different ways of doing therapy – psychotherapy, that is.  Different ways of approaching it.

There’s the medical model.  Based on this model, you go to therapy because there’s something wrong with you.  You have an illness, a chemical imbalance, or you’re broken.   You need to be “fixed.”

Insurance companies typically work from a medical model.  They want to know what your treatment plan is, what your goals are, and whether or not you’re making progress.

That makes sense.  In a way.

The medical model is based on the idea that the therapist knows what you need, or at least has some knowledge or information that you’re lacking.  That the therapist can guide, direct, or teach you how to get “better.”  

The medical model believes you need to receive this guidance, knowledge, or information and make use of it to get “better.”  Getting better is objective and measurable in terms of symptom reduction.

Sometimes, therapy works like that.  Let’s say you come to see me because you’re depressed, lethargic, and sleeping all day.  You rate your depression at an 8, on a scale of 0-10.  

So we can work up a pleasurable activities schedule for you and, if you follow it, you will be sleeping less, be less lethargic, and your depression rating will probably go down.  It might drop to a 6.  Or a 4.  Easy as pie.

It’s prescriptive therapy.  You say, “here’s the problem,” i say “here’s how to fix it.”  If i’m a good therapist, i couch that in collaborative terms, i work with you, i don’t dictate.  

But the idea is the same.  i’m the expert, you’re not.  You’re the one who needs help.

Sometimes, it’s not the person that’s broken, it’s their life.  Sometimes, it’s circumstances ~ a death in the family, job loss, and so on.  But with a medical model, the principle is the same.  Problem = symptoms = need for help.  

It seems to me that when you introduce kink to a medical model approach, with a therapist who is not well aware of the BDSM culture, the temptation to see the kink as the underlying problem would be almost overwhelming.  Even if it’s just to tweak it a little ~ to make the submissive a little more assertive, the Dominant a little less controlling ~ it could seem so obvious.  And some of the time, it might even be helpful.

But the medical model isn’t the only way to do therapy.

My view of therapy ~ and i’ve been blessed to have therapists myself who helped teach me this ~ is that the client is the only one who knows what needs to happen in his or her life.  That whatever is going on with them makes perfect sense given their circumstances.  

They’re not broken or in need of fixing, even though they may feel like they are.   How they are is generally how they’ve learned to be in order to survive and to get their needs met.  Since they’re in therapy, what they’re doing is probably not completely working for them anymore.  They may want to look at some ways to do things differently, or some new ways to think about things , if they want to feel differently, but i don’t necessarily have “the answers.”

 i listen.  i  try to understand what their experience is, how they see themselves, the world, their past and their future.  We look at their life together and see what they think can change.

i do have some knowledge and expertise, and i share that with them, but i don’t have their answers.

It seems to me when you involve kink in the therapeutic mix that the therapist needs to be able to take an observer’s stance.  To help the client clarify their thoughts and feelings, explore, consider, ponder, even experiment.

i still bring my values to the therapeutic table.  And sometimes they make me not a great fit for someone.  When that happens, i’m fairly transparent about it.  Then the client can decide if he or she wants to continue with me.

But i think therapy’s a journey ~ it’s the client’s journey, and i’m there as a support.  

Therapists talk about “resistance” sometimes. That’s what we call it when the client doesn’t do what we think they need to do.  This bothers some therapists.  Shoot, sometimes it bothers me.  

But i believe in honoring the “resistance. ”  i won’t do a tug of war with you over your life choices.   You know yourself and your life better than i do.  i will want to understand more about it, and will be relying on you to really work to figure out what will be helpful.  

i will work to let go of whatever i think the answer is and let the ball rest in your court.

i can be a guide, a witness, or a mirror.  i can challenge, cheerlead, shine a light, or point out the path i know.  But it’s always the client’s journey.

And i’m not there to fix anyone.

12 Responses to “Therapy & Kink”

  1. Striving for Peace January 26, 2012 at 7:27 am #

    I liked this peek into your philosophy and approach. And yes — one of my fears of therapy is — how could I be honest without mentioning the kink aspects of my life

    but — how can they accept that part of me as a normal aspect — like having brown eyes — as opposed to something that is inherently broken.

    to be able to look at it and see — like any relationship — it MIGHT be broken — but isn’t necessarily the root of all evil.

    Thank you for sharing this


    • aisha January 26, 2012 at 8:11 am #

      Dear Sfp,

      We all need therapy.

      Try the National Coailiton for Sexual Freedom’s kink aware professionals list. It’s not comprehensive – for example, i haven’t succeeded in getting my listing on there, some technical problem i think, so you could also ask around on fetlife.

      But yes, you need to be able to disclose that to someone who will have a good chance of “getting it.”


  2. heather1 January 26, 2012 at 7:42 am #

    Before I expressed my need for kink to R, I went to see a therapist. I had one session with her and thought it was a good fit. The next session I went sat in her waiting room, she escorted her patient out that she was seeing. Looked at me, went back to her office and shut the door. I figured she was just finishing up her paperwork with the last client because I was a few minutes early. Another therapist came out got someone else that was waiting asked me it I was there to see Dr. ### and I said yes I have an appointment with her. I sat there in the waiting room my whole appointment time. Needless to say I never went back.

    I found another therapist, she was okay but I had to stop seeing her as my insurance changed and they didn’t cover therapy any more.

    • aisha January 26, 2012 at 8:08 am #

      Good grief that really sucks {about that first therapist} i can imagine how crappy that felt! Makes me wonder if she had some kind of cognitive impairment that interfered with her ability to recognize faces. I worked with a therapist once who’d had a stroke years before and had a lot of trouble recognizing people. It was weird. I imagine the other therapist just figured your therapist was running late. But yikes, that really sucks.

      I’m sorry your insurance won’t cover therapy too! For what it’s worth, there are some therapists who offer sliding scale fees that are affordable… just saying.

      Thanks for sharing your experience here.


  3. vanillamom January 26, 2012 at 8:41 am #

    What a great view of what you do…and how hard it must be…i don’t think i could listen to people all day and *not* want to “fix* them…

    Yet after spending time with you…i can see that this is, really *is* who you are…Thoughtful and kind and caring….


    (its a new Master rule for Thursdays…sheesh–He just loves embarrassing me….)

    • aisha January 27, 2012 at 6:37 am #

      Thanks, ‘Nilla,

      Laughing… of course you’d want to “fix” them – it took me a while to figure out that wasn’t the way it works. Once you realize that, you can put your energy into honoring who they are.

      And i’m not even gonna tallk about this “zilla” thing… sheesh is right!


  4. K January 26, 2012 at 4:56 pm #

    Sounds like we got a similar approach ..can’t say i’m surprised -_- hug, K

    • aisha January 27, 2012 at 6:39 am #


      Yep, not surprised either!



  5. mouse January 27, 2012 at 6:31 pm #

    If you had been mouse’s therapist, it’s doubtful she would have abandoned therapy after becoming involved with Omega, because she still had so much to work out.

    Sometimes she feels she still does…

    On the other hand Daddy’s therapist understands the lifestyle and even uses ideas in his practice. It’s nice and great for O.


    • aisha January 29, 2012 at 7:04 am #

      Hi, Mouse,

      Yeah, I can imagine that it would be difficult to go from working on past trauma to kink with a non-kink-friendly therapist! I’m glad Omega’s therapist does understand!

      Kinda makes me wish you had a kink friendly therapist of your own…



  6. jade February 2, 2012 at 10:25 am #

    i always thought the concept that started with the assertion that the client is “sick” (or worse, “broken”) to be a model that was unable to honor the person as they are. Sometimes, it would be nice if we could look at the world as simply differences that are neither right nor wrong but just are.

    No one changes anything until they decide that the elephant in the room is a big, beautiful, stinky problem *for them.*

    i am happy for your clients that they have you. 🙂

    • aisha February 3, 2012 at 5:54 am #

      Hey, jade!

      Nice to see you!! 🙂

      Of course you’re right, a conceptual framework that starts with “broken” is not what i want to work with – nor how i want to be treated. i’m fortunate to have a staff that mostly seem to agree with that stance.

      Yep, if it’s not a problem for you, you’re not likely to put much energy into changing it. Learning not to work harder than one’s clients is a nice challenge for therapists.

      And thank you.

      i’ve missed you!



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