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Sexual Diversity
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs

CEUs/OPD/CPD for this presentation can be found at for clinicians in the US or for clinicians in Australia.

Trigger Warning and Cautions
~ The following presentation involves frank discussions of kink and sexuality.
~ While not graphic, some of the content might be triggering for some people.
~ This series is meant to provide an overview to help clinicians to understand kink, BDSM and Poly, but is by no means all inclusive. It is designed to increase awareness of common issues and help clinicians identify areas where they may need further training.
~ Explain why it is important to understand various sexual practices including kink, polyamory and asexuality
~ Define different types of sexual practices that clinicians may encounter
~ Explain the DSM V’s stance on kink and other practices
~ Describe the mental health impact of kink on participants
In this Series
~ Human Sexuality and Cultural Responsiveness
~ 12/13/2018 LIVE Human Sexuality: Exploring Kink (Overview)
~ 12/18/2018 LIVE Human Sexuality: BDSM
~ 12/20/2018 LIVE Human Sexuality: Dom/sub and Female Led Relationships
~ 12/26/2018 LIVE Human Sexuality: Polyamory and Open Relationships

Activity Part 1
~ Would you be concerned or not if a friend or a client revealed taking part in this activity?
~ An individual gets a rush out of being put in terrifying situations which makes him scream and cry out in fear. He engages other people to put him in a special device which will result in these effects. When his time in the device is up, his face is white and he has tears in his eyes, but he begs them to let him go through it again.
~ A woman asks strangers to cause her extreme pain to her genital area. She does this regularly, as she feels more attractive following the painful session. Sometimes, she’ll even do it to herself. If it’s done right, no permanent harm results.

Activity Part 1
~ Would you be concerned or not if a friend or a client revealed taking part in this activity?
~ A small group of people arrange to meet in a private space in order to watch others role-playing being raped, humiliated and tortured. They find this an enjoyable way of spending their evening.
~ Two people arrange to take part in a public scene. They spend a great deal of time preparing separately in advance. On the night they dress for the occasion in clothes made of satin. Watched by a gathered group of people they strike each other. The scene is considered successful if one of them briefly loses consciousness. The beatings are so severe they can result in permanent damage.

Activity Part 1
~ Would you be concerned or not if a friend or a client revealed taking part in this activity?
~ A woman spends several hours preparing her appearance. She chooses from items of clothing on which she has spent a lot of money, all of which painfully restrict parts of her body, forcing it into an unnatural shape and making it impossible for her to function normally. Over an extended period of time she knows this will damage her permanently. However, she experiences great pleasure despite the pain.
~ As part of a group ritual a man consents to an event which he knows will be grueling, although he doesn’t know exactly what will take place. During the event, among other things, he is put in an altered state of consciousness, stripped and left alone in public.

Activity part 2
~ All of the activities listed are actually commonplace practices in mainstream culture.
~ a rollercoaster
~ a bikini wax
~ watching a horror movie
~ a boxing match
~ wearing high heeled shoes or a corset
~ a stag/bachelor party or fraternity pledging
~ tons of books and resources

~ It’s a form of “playing,” Cavanah said. It’s everything that falls outside of the confines of having sex simply to orgasm, which means it can take many different forms.
~ The term kink describes sexual behaviors and identities encompassing bondage, discipline, domination and submission, and sadism and masochism (collectively known as BDSM) fantasy and toy play and sexual fetishism.
~ Activities range anywhere from your “traditional” lover of bondage and spankings, to the more acquired taste of the furry population.

~ 15-20% of people in some studies report engaging in BDSM
~ BDSM is set of sexual activities that include role-playing, dominance and submission, restraints and a variety of other sexual behaviors.
~ BDSM relationships vary from other sexual relationships because there is a dominant and submissive partner (Although some people are a switch)

Polyamory and Open Relationships

~ “An open relationship is one where one or both partners have a desire for sexual relationships outside of each other, and polyamory is about having intimate, loving relationships with multiple people,”
~ In polyamory, the whole point is to fall in love with multiple people, and there’s not necessarily any relationship hierarchy
~ Open relationships typically start with one partner or both partners wanting to be able to seek outside sexual relationships and satisfaction, while still having sex with and sharing an emotional connection with their partner
~ Swingers typically are singles or partners in a committed relationship engage in sexual activities with others as a recreational or social activity

~ Kink, BDSM and Poly are anti-feminist
~ All of these alternative sexual activities allow women to take charge of their own sexuality, declaring what they like, getting their emotional and physical needs met and making sex about more than just having babies.
~ Most people involved in kink or BDSM are trying to work through traumas
~ Just because someone has experienced trauma doesn’t mean they are trying to work through it this way
~ Sometimes it is helpful for people who have experienced trauma to work through “scenes” with someone whom they trust to reclaim their power.

~ Kink, not just BDSM, done in the wrong way or for the wrong reasons can be physically or psychologically damaging. (bondage, pegging, role play etc.)
~ There MUST be an atmosphere of implicit trust, excellent communication (both ways) and it must be safe, sane and consensual.
~ Even with all that, scenes can trigger unexpected or intense emotional reactions. Participants must have high levels of self and other awareness, a safety plan and an aftercare plan.
~ 15-20% of people in some studies report engaging in BDSM
~ Approximately 34% of people report engaging in some form of “kink” in their lifetime.
~ Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men. Herbenick D, Bowling J, Fu T-C(Jane), Dodge B, Guerra-Reyes L, SandersS (2017) PLoSONE 12(7): e0181198.

~ The American Psychiatric Association has depathologized kinky sex – including cross-dressing, fetishes, and BDSM
~ In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
~ Paraphilias are considered to be “unusual sexual interests”
~ Those who have sex with children or people who haven’t consented, or who deliberately cause nonconsensual harm to themselves or others, may be diagnosed with a Paraphilic Disorder

~ Using data from hundreds of thousands of Google search engine users over the period of 2006-2015, results show that searches for words related to polyamory and open relationships significantly increased over time and were significantly higher than popular Web queries over the same time period, indicating this pattern of increased interest in polyamory and open relationships is unique.
~ Has the American Public's Interest in Information Related to Relationships Beyond “The Couple” Increased Over Time? J Sex Res. 2017 Jul-Aug;54(6):677-684..

Training Deficits
~ 766 therapists in the United States to assess therapists’ attitudes towards the BDSM community.
~ 76% of the sample reported having treated at least one client who engaged in BDSM
~ Only 48% perceived themselves to be competent in this area.
~ Attitudes towards BDSM were related to socio-demographic variables and self-perceived competence.
~ Assessment of therapists’ attitudes towards BDSM Katherine Kelsey, Beverly L. Stiles, Laura Spiller & George M. Diekhoff Psychology and Sexuality Vol. 4 2013 Pages 255-267

Deficits in Training
~ Clinical training emphasizes monogamous relationships as being normal (termed “mononormativity”) and often does not explore any other relationship structures
~ Polyamory is legal, does not necessarily involve marriage, and can be structured in many different ways.
~ Public (and clinicians) often equate extramarital intimacy or sex with infidelity, yet these constructs are not the same.
~ Clinicians who are unaware of the many possibilities by which people may design and construct their preferred intimate relationships, may unintentionally cause serious harm to clients

Impact of Deficits
~ Fewer than half of practitioners were out to their current provider, with anticipated stigma being the most common reason for avoiding disclosure.
~ Patients are often concerned that clinicians will confuse their behaviors with intimate partner violence and they emphasized the consensual nature of their kink interactions.
~ Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients. J Sex Med. 2016 Dec;13(12):1918-1929. doi: 10.1016/j.jsxm.2016.09.019. Epub 2016 Oct 27.

Impact of Culturally Insensitive Practices
~ Stigma-related internalized feelings (i.e., shame and guilt) were positively associated with suicide ideation.
~ Thirty-seven percent participants indicated a nonzero level of suicide ideation.
~ Shame, Guilt, and Suicide Ideation among Bondage and Discipline, Dominance and Submission, and Sadomasochism Practitioners: Examining the Role of the Interpersonal Theory of Suicide. Suicide Life Threat Behav. 2017 Apr;47(2):129-141.
Addressing Deficits
~ Clinicians need to become more aware of their own biases concerning both sexual identities and relationship structures by reflecting on messages that they consistently receive about monogamy, and identifying assumptions about these messages (Barker, 2011).
~ When working with clients, avoid making assumptions about their relationships, and discuss relationships actively, rather than passively (Barker, 2011; Brandon,2011).
~ It can be empowering for clients to realize that relationships may be designed in different ways to better meet participants’ needs
Contemporary Polyamory: A Call for Awareness and Sensitivity in Social WorkD. J. Williams and Emily E. Prior

Other Tips
~ No one-size fits all for people in sexual relationships
~ There is no consensus about the “best way” to practice Kink/BDSM/CNM, even among the community itself
~ Do not assume clients problems are directly related to their sexuality – at the same time, do not assume they aren’t.

Dos and Don’t
~ Do
~ Remember that culture often designates monogamy as the “ideal” relationship structure
~ Monitor “microaggressions,” both verbal and non-verbal during a session
~ Be open to and accepting of all relationship structures and believing in their validity
~ Pay attention to the messages in your décor (Pictures of you and your spouse, religious décor, lobby reading material, bibliotherapy…) to the exclusion of other messages
Dos and Don’t
~ Don’t
~ Don’t liken polyamory/CNM relationships to infidelity (“cheating with permission”)
~ Don’t assume people in CNM have “commitment” or “attachment” issues
~ Don’t assume people who practice BDSM have trauma or abuse issues to work through
~ Don’t believe CNM or BDSM is “anti-feminist”
~ Don’t assume this is a “phase” or that someone’s participating in it because it is “trendy”
~ Don’t make assumptions about type of relationship(s)
Common Issues
~ Coming out/Disclosure
~ Increase in risk factors for health/economic disparity due to not coming out to providers or discrimination
~ Stigma – disapproval of friends, family, society
~ Legal ramifications
~ Child-rearing issues
~ Need for major self-awareness
~ Sexual health concerns (pregnancy and/or sexually transmitted infections)
~ Talking about issues/problems within nontraditional relationships giving detractors “ammunition”
~ Finding competent health and mental healthcare providers
~ A TON of misrepresentation (esp. in mainstream porn, 50 shades and some self-proclaimed Doms)
~ Christian Grey kind where he claims to “rectify the problem” of Anastasia’s virginity and often disregards her capacity and consent.

~ A majority of the population dabbles in some form of kink
~ Practitioners who embrace kink, especially BDSM and polyamory are often reluctant to disclose these issues to their medical or mental health providers
~ Issues of shame and guilt often arise when people first discover their alternate sexual preferences and can be compounded by a culturally insensitive therapist.
~ As with working with any diverse group, the catch all terms Kink, BDSM or Poly can mean many things and each person has their own level of comfort or “acculturation.”
~ In the following episodes you will explore each of these topics in greater depth, learning about the different forms or dynamics which might occur, the prevalence and clinical issues which might come up in counseling.