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Out On The Couch

Kink-Aware Therapy: Consent and Negotiation

Posted: 12-16-20 | Rachel Gombos

Collage including images of floggers, handcuffs, a couple on a couch in conversation, and two men holding hands. This represents how consent and negotiation are important for therapists to help kink clients with.

By Rachel Gombos MSW, LISW

Please note that this article contains content related to sexual trauma.

In this article, the first in a three-part series about kink-aware therapy, I will lay the groundwork for practitioners to gain an understanding of BDSM and key concepts such as consent and negotiation. Many may believe that BDSM represents bondage, dominance, and sadomasochism practiced during sex–yet these encompass only a small portion of the practices present in the BDSM and kink communities. After emerging in the late 80s and early 90s, the term BDSM itself has gone through a transformation as of the early 2000s (Taormino, 2012) to become more inclusive. 

With the passage of time and availability of content on the Internet, the use of BDSM as an umbrella term has expanded to reflect the history of kink vocabulary and the wide variety of practices it encompasses. These include bondage and discipline, domination and submission, and sadism and masochism. While the differences among them may not be immediately clear, these terms are neither mutually inclusive nor exclusive, and kink activity is not limited to sexual experiences. 

BDSM has traditionally been pathologized through psychiatric diagnostic manuals such as the DSM (Reiersøl & Skeid, 2006), the effects of which are evidenced by report data. For instance, Kolmes, Stock and Moser (2006) report a concern among consensual BDSM participants that they will receive biased care from mental health professionals. This information was gleaned from a survey administered to both BDSM-involved individuals who have received psychological services and to mental health professionals themselves. 

There are a number of reasons why a client might not disclose their participation in kink and BDSM to a provider. Regardless of the context, remaining affirming and empowering combats the classical psychoanalytic and medical traditions of pathologizing BDSM and kink. Because of this, along with evidence suggesting that kinky clients may fear that providers will focus on their “unconventional” sexual desires instead of their concerns, it’s essential that providers become familiar with some basics of kink-affirming therapy. 

Moser and Kleinplatz (2004) propose that when therapists accept their clients’ sexuality, clients are empowered to focus on their own concerns rather than defend themselves. The client’s BDSM practices are not “curable,” and any connected distress and dysfunction needs to be understood in the context of discrimination and stigma. 

Creating safety in therapy allows clinicians to dispel harmful myths surrounding kink and trauma, and where necessary, to facilitate healing through the basic tenets of kink: consent, empowerment, autonomy, advocacy, and fun. There are two common but contradictory myths, neither more damaging than the other, that prevent many clients from talking about kink with their therapists. Learning about these myths is a way to challenge provider bias, and constitutes a great step toward developing kink awareness. The first is that trauma inherently causes kink, and the other is that you cannot engage in kink if you have a trauma history. 

In consideration to the first myth, I refer to a lesson from my undergraduate psychology course regarding a twin sibling study. The study stated that a set of identical twins were separated at birth and both were obsessively clean. When asked why they thought they had this trait, one sibling reported that they had learned it from their adoptive parents. The other stated that their adoptive parents were so dirty that they vowed to never be this way. Perpetuating the connection of experience to meaning not only reinforces shame, but creates a space in which therapists may potentially pathologize a person’s existence. It can be a function of human nature to look back over our lives to find meaning and significance, yet the narratives we choose are not always rooted in a truth of cause and effect. Truthfully, we do not know why individuals develop the fetishes or kinks that they do. 

The second myth regarding trauma histories proposes that engaging in kink will cause further harm and will be addressed at length in my next article.

Navigating Kink: The Basics for Kink-Affirmative Therapists

It is important that clients who are first realizing their interest in kink educate themselves before taking action. This is the only safe way to engage in kink. Similarly, therapists require education regarding kink dynamics in order to provide kink-aware therapy and provide a safer space for clients. Consensual kink upholds partner/personal consent, limit setting, and full disclosure of the risks that exist in a kink dynamic, as well as other important considerations that help keep each participant safe. 

Let’s explore the extensive communication surrounding consent, limits, safewords, aftercare, and risk awareness that create a foundation for a healthy sexual dynamic. 

Here is a terrific guideline to consent that is as easy as FRIESS* from Planned Parenthood (2020). I’ve added an extra S for an important factor you may encourage your clients to take into consideration.

Freely give





*Sober (C. Cathers, personal communication, November 22, 2020)

Consent is freely given when it does not entail any degree of coercion, threat, or intimidation and it is reversible. This means that consent can be retracted at any time; consenting parties have the right to change their minds. Consent can only be considered informed and specific when every participant is aware of and agrees upon what is going to happen, what would be okay if it happened, what cannot and will not happen, and where, when, and how events are to take place. Think of kink-informed consent like a contract that outlines the expectations and understandings clearly for everyone. 

Sober has been added as a reminder that if any participant is under the influence of mind-altering substances, consent cannot be freely given (C. Cathers, personal communication, November 22, 2020)

Within BDSM communities, practices are always understood to be Risk-Aware and Consensual. You may see activities commonly referred to as RACK:




For example, if a client wants to engage in impact play or any other kink activity such as spanking, caning, flogging, etc., that is great! First, it is important to learn some basic human anatomy so they know where it is safe to give and receive impact before they attempt impact play. Education first upholds awareness so that each participant knows how to create an interaction that is safe while still understanding the risks that are involved in any type of BDSM and kink activity. 

 There are wonderful educational books and Internet-based resources out there. Two of my personal favorites for fun education are SM 101: A Realistic Introduction by Jay Wiseman and videos by Evie Lupine, which you can find on YouTube. Please keep in mind these are not substitutes for completing accredited CE courses or learning from kink educators, but they are a great start. Remember that risk-aware kink practices are meant to keep everyone safe and enjoying themselves.

Negotiation, if done properly, is a collaboration towards a common goal: each partner’s pleasure. Negotiation always comes before a kinky interaction and includes factors like participants’ wants, needs, and soft and hard limits. Soft limits look like activities one is willing to try under the right circumstances, but that must be discussed and agreed upon before trying. Meantime, hard limits are the ones to which a participant says, “No, I am not interested in trying this at all under any circumstances.”

To unpack this a little further, negotiation is multifaceted and will include information such as the logistics of who will be involved, in what capacity, and in which roles. Everyone’s responsibilities must be considered further through the negotiation agreement. A thorough negotiation will also include safety information, including any injuries or illnesses, triggers, psychological limitations, and safewords. If you have further interest in learning about limits or encouraging a client to discover theirs, there are wonderful tools available; my personal favorite is the The Yes, No, Maybe Workbook by Princess Kali. 

Discussing and utilizing safewords is another essential aspect of kink safety. Use of a safeword communicates to all participants that a change or complete stoppage of play is needed. A few recommendations include making sure that the word is something easy to remember, but also something that you would not normally utter during kink or sexual activity. Deciding upon a nonverbal gesture is another important consideration, as some activities render a person unable to speak. Gestures can range from a hand signal to a double tap on one’s partner. Working with safewords can be a great exercise in helping clients learn boundary setting and communicating needs. 

When kinky play ends, aftercare allows all participants to feel safe, connected, and cared for. This can facilitate a sense of being grounded, an important factor considering the mental and physical “drop” that is described after the rush of endorphins experienced during play. No matter a participant’s role, drop can be experienced and may include aches and pains, feelings of guilt, and sadness or fatigue. This experience is normal and a routine of aftercare can help restore balance. Aftercare looks different for everyone in the same way that drop does, but often includes cuddling, reassurance, praise, a drink of water, or even a warm bath. It can be helpful to elucidate in the therapy room that asking partners what they need after play lays a foundation for stability and connectedness. 

While this article does not comprise a definitive list of all things kink, or even all of the basics, I hope it will serve as a starting point as to why kink is healthy and why we should be talking about it in therapy. In the second part of this series I will explore further how having a kink-aware practice reduces stigma, and how we can increase our comfort in working with kinky clients whose past experiences have included trauma. 

A Few General Resources for Kink-Affirmative Therapists:

American Sex Podcast with Sunny Megatron

Community-Academic Consortium for Research on Alternative Sexuality

Kink Academy

National Coalition for Sexual Freedom

SM 101: A Realistic Introduction by Jay Wiseman

The Yes, No, Maybe Workbook by Princess Kali

Evie Lupine’s YouTube videos

School of Squirt BDSM Ideas: An Illustrated Guide

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

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



Kolmes, K., Stock, W., & Moser, C. (2006). Investigating Bias in Psychotherapy with BDSM Clients. Journal of Homosexuality, 50(2/3), 301–324. http://www.tandfonline.com/doi/abs/10.1300/J082v50n02_15

Kleinplatz, P., & Moser, C. (2004). Toward Clinical Guidelines for Working with BDSM Clients. Contemporary Sexuality, 38(6), 1–4.

Reiersøl, O., & Skeid, S. (2006). The ICD diagnoses of fetishism and sadomasochism. In P.J. Kleinplatz & C. Moser (Eds.), Sadomasochism: Powerful pleasures (pp. 243262). Harrington Park Press.

Sexual Consent. (2020). Planned Parenthood. Retrieved November 23, 2020 from https://www.plannedparenthood.org/learn/relationships/sexual-consent 

Taormino, T (2012). The Ultimate Guide to Kink: BDSM, Role Play and other Erotic Edge. Cleis Press Inc.

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