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Out On The Couch

Kink-Aware Therapist: Challenging Your Awareness

Posted: 7-7-21 | Rachel Gombos

A group of people talking revealed by a zipper on a latex or leather black mask to depict the importance of each kink-aware therapist to be able to talk about sexuality and kink with clients
Please note that this article contains content related to sexual trauma.

Together, we have journeyed through the previous articles in this series towards becoming a kink-aware therapist, Depathologizing Kink in Therapy and Kink-Aware Therapy: Consent and Negotiation to discuss kink practices and understand the consent and negotiation tactics that govern them. Buehler (2017) believes we have the power to change the rules about talking about sex in therapy. Additionally, clinicians have the ability to adopt new beliefs about sexuality (Beuhler, 2017). In this article, we will explore the Harris and Hays (2008) stages of acquiring new knowledge about sexuality as a framework for becoming a more kink aware therapist. 

Development as a kink-aware therapist

Learning about the fundamentals of kink-affirmative therapy in the last two articles may have challenged your view of what sexual health is. It may have expanded your view of how sexuality intersects with mental health treatment.  As a clinician you may have found yourself uncomfortable at the idea of talking about sex or kink with your clients. The idea of kink and trauma being able to intermingle and be healthy may be even harder. You are not alone. What are the consequences when we, the clinicians, don’t have or make opportunities to understand our own sexuality?

Buehler (2017) asks if we are able to call ourselves competent clinicians if we do not assess or treat the entirety of the human experience, including those that are baffling or taboo. Clients who experience shaming or judgment from their therapist may be more likely to terminate early. Harris and Hays (2008) outline a four-stage model aimed at assisting clinicians to find new knowledge regarding sexuality: self-examination, awareness of the problem from the client’s point of view,  increased freedom and comfort in discussing sexual topics, awareness of a new level of comfort with clients’ sexual issues. This model gives therapists and other mental health professionals a framework to navigate their own change state. Giving tangible points of expansion and progress allows us to find direction in a time when we may feel most vulnerable as clinicians. 

Stage 1: Self-examination of your sexological worldview

Sexological worldview is defined as “the result of the socialization process that is comprised of values, beliefs, opinions, attitudes and concepts specific to sexuality, including any and all sexual behavior and identities.” Understanding your own sexological worldview is the first step to understanding your clients as a kink-aware therapist. This starts with navigating your own worldview, connecting with your inner world so that you can have a more intimate understanding with the things at play in a sexological worldview.

Some questions to ask yourself:

  • How did have the following people/institutions influenced your views on sexuality while you were growing up? 
    • Friends?
    • Family?
    • Media?
    • Religion?
    • Spirituality?
    • Gender Norms?
    • Other systems?
  • How do they influence your views on sexuality today?
    • What about current friends?
    • Past or current partners? (if applicable)
  • How has your views on sexuality shifted as you have grown?
  • How did your views on sexuality influence your development as an a/sexual being?
  • What part(s) of you have conflicting views on sexuality? 
  • How do you manage any conflicting views?  

Our clients’ sexological worldview(s) will likely vary greatly from our own. Buehler (2017) finds this to be true, she states, “because values, beliefs and so fourth come from many sources, including one’s family, school, religion, peers and media as well as through sexual relationships and experiences” (p. 11).  The goal is in being able to set those differences and biases aside to meet a client where their worldview is, but first you must know where you and biases reside. The above questions can also be helpful to ask clients to help them explore their sexological worldview. 

My Experience of self-examination 

In writing about sexological worldview, I cannot help but reflect on my journey to kink positivity, both as a practicing kinkster and as a kink-aware professional. I ask myself, how has my sexological worldview changed and where did I start? For example, as a teenager I remember some of the adults in my life talking about how other moms, “let their daughters dress like sluts” in a shaming way. My belief was that teenage boys loved it when girls wore short skirts. Although I didn’t realize then, but it was confusing; I wanted someone to look at me with desire, but that also made me defective. Thus began the fight between “acceptable me” and “sexual me” and without me realizing it; my sexological worldview was being formed right in front of my eyes.

Stage 2: Awareness of the problem from the client’s point of view

Stage two asks for clinicians to look at each client’s particular presentation of sexual problems when considering dysfunction specifically. It is also important to note that presentation of pleasure will differ from one client to the next as well.  The ways in which an individual will present sexual dysfunctions differs greatly from the presentation of grief symptoms for example (Buehler, 2017). The client’s point of view also includes the language that is used from description of sexual acts to anatomical language.

As a kink-aware therapist, we must understand the client’s language and point of view. For example, while some people within the kink community may call themselves tops, others will say dom/domme, the language that each person uses is unique to their sexual expression and at times influenced by their gender or sexuality. With this step, one might find themselves exploring a client’s sexual schema and influences from the micro (how their parents talked to them about sex), to the macro (societal influences and expectations). Hovell et al. (2009) describe the importance of the macro in understanding the variability and impact of environment on the psychological. This means that the social systems that influenced a client’s sexological worldview are relevant to their experiences and expression.

The above questions can also be helpful to ask clients to help them explore their sexological worldview. When we understand our clients schema, we can begin to engage with them from a place of acceptance and understanding rather than assumptions. In addition to the questions above, reflecting back your clients experiences and expressions can be an invaluable tool when understanding your clients point of view. Ask for clarification using their own words to build rapport and safety.

My Experience of gaining awareness as a kink-aware therapist

I can recall being acutely aware of this lesson of schema for the first time as a professional. A colleague of mine shared with me that they were a kinky person and talked about how their experience in kink was influencing other areas of their life. They spoke about their shame and how that was impacting them. For me kink and sex are a knot that is tied together like the impossible knot of headphones (an artifact of the past now) in your pocket. There is no disconnection, That is my schema. This friend never mixes the two and her desire for powerplay and bondage does not end or begin with sexual contact. 

My support of her revolves directly around understanding things from her view, rather than my own. If I used my view, I would talk to her about the sexual liberation of kink and relish in ways that through kink you can dominate (pun intended) the patriarchal system by owning your sexual pleasure. None of these things would have brought her closer to processing the shame she was feeling. Kink is not a tool she uses to tap into her sexual being. In fact, I am perpetuating the narrative that her kink is flawed when I use my lens of kink to define hers. 

Stage 3: Increased freedom and comfort in discussing sexual topics

The third stage in our quest to find comfort in discussing sexuality and sexual behavior with clients is aimed at just that, comfort and freedom in communication (Buehler, 2017). Sometimes people laugh when talking about sex or may find sharing these details of their life embarrassing. As a clinician you may find it hard to use language associated with sex outside of your day-to-day discourse (Roberts, 2020). I think the ability to role-play with other clinicians is a crucial part of growth and in this stage, essential. Start with your close colleagues and see how it expands, empower yourself to pioneer this conversation with those you are most comfortable with. This increased ability to discuss sexual topics is essential for kink-aware therapists.

My Experience of discussing sexual topics

I have been and continue to be incredibly lucky in this regard. I work along some amazing clinicians that are supporting me through this journey of sex therapy education and they are always there for me to practice discussing with clients. However, what I learned about the way I talk to close people in my life about sex was more impactful. In order to shed the confusion that at times still lingered from my childhood understanding of sexuality I needed to embrace sexual and kink expression. It was not always easy to embrace my own sexual and kink identity in the face of a world that tries to put it in a box high on a shelf that I only get down and dust off when it fits the world’s expectations. So I talked. I talked with my partner, my best friend, my mom, and my colleagues. 

Stage 4: Awareness of a new level of comfort with clients’ sexual issues

When entering stage four, you may find a new or renewed comfort in talking to your clients about sex. Harris and Hays (2008) state that the more you talk about sex the more you find that it plays a critical role in mental health. Awareness is a culmination of the other stages working together like well oiled gears. Noticing how your sexual worldview influences you and being open to attuning to your clients sexual worldview is part of operating as an affirmative therapist. Kink practices may not be a part of your sexual worldview, but in stage four you are non-judgmental, comfortable and affirming of where your client is. This is the goal for the kink-aware therapist. Through attunement to your clients needs and experiences, we create safety. Through giving our clients space to be their unapologetic selves, we create space for us as clinicians to claim our own truth. 

My Experience of gaining a new level of comfort as a kink-aware therapist

Becoming an advocate for my clients sexual pleasure has given me permission to explore my own with less shame. I have found my own experiences being mirrored in those of my clients. When I give them space to ask questions, share desires and process frustrations, I unintentionally pave the way to increased connection to my own sexual self.  

Now What?

Becoming comfortable with one’s own sexuality and a client’s is a process, you may be noticing that you are at stage 1. That is ok! Give yourself the grace that we ask our clients to afford themselves every day. We are always learning. Be present with your client as they share their experiences and understand their inner worlds. Sex can be as scary as it can be wonderful. Each experience is individual, including the experience of the clinician. Consultation is an invaluable tool in the mental health profession. 

No matter where a client is in their healing process, there is a starting point and there are many good resources available to help on the way. Safety, education, and affirmation of experience and desire are non-negotiable limits in therapy and kink exploration. A person’s kink is a feature of their existence, not a flaw. 

Resources for the Kink-Aware Therapist

Affirmative Couch courses



The Leather Couch


Buehler, S. (2017). What every mental health professional needs to know about sex. New York, NY: Springer Publishing Company.

Harris, S. M., & Hays, K. W. (2008). Family therapist comfort with and willingness to discuss client sexuality. Journal of Marital and Family Therapy, 34, 239-250.

Hovell, M., Wahlgren, D., & Adams, M. (2009). The logical and empirical basis for the behavioral ecological model. In R. J. DiClemente, R. A. Crosby, & M. C. Kegler (Eds.), Emerging theories in health promotion practice and research (pp. 415–449). Jossey-Bass/Wiley.

Roberts, M (2020). Beond Shame: Creating a Healthy Sex Life on Your Own Terms. Minneapolis, MN: Fortress Press.

Learn More about Kink Affirmative Therapy

Red background with flogger and leather handcuffs. Fundamentals of Kink presented by Elyssa Helfer, MA, LMFT 2 CE Course Text: “The Healing Power of Open Relationships presented by Kathy Slaughter, LCSW 4 CE Course” under an image of a mobile of different colored hearts to represent how early childhood attachment can influence adult relationships and how open relationships can be healing of attachment wounds.Two hands tied up by rope with the words "The psychological impact of suppressing kink identity" presented by Elyssa Rice, MA, LMFT 2 CE Course underneath



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