Collected Papers

on GSDT 2012-2013

Copyright

© the authors for their respective chapters

This eBook is offered free and not available for resale.

A version of the GSDT chapter and the chapter on Sexual Orientation appears in the Sage
Handbook for Counselling and Psychotherapy and has been adapted and subsequently
translated into a variety of languages.

A version of A Kink in the Process was originally published in Therapy Today and has been
subsequently translated into a variety of languages.

If you wish to view the foreign language translations of these papers, please visit
http://www.pinktherapy.com/en-gb/knowledge/translations.aspx

i
Pink Therapy

Pink Therapy is the UK's largest
independent therapy and training
organisation to specialise in working with a
broad range of gender and sexual
diversities (GSD).  Founded by Dominic
Davies in 1999, we are regarded by all UK
therapy organisations as the lead agency
in this area.  We run the only university
accredited specialist Diploma in Gender
and Sexual Diversity Therapy in Europe,
which has attracted therapists from the
UK, Netherlands, Singapore and Australia.
 In September 2013 we will commence a
new one year Diploma in Relationship
Therapy with GSD.
Our online Directory of Pink Therapists and
now include therapists from around the
world and our website hosts a valuable
Knowledge section of self help resources
and recommended reading, videos and
podcasts.  www.pinktherapy.com We are
active on social media. Follow us on
Facebook (Pink Therapy), Twitter
(@PinkTherapyUK), Tumblr
(PinkTherapyUK.tumblr.com) and LinkedIN
(Pink Therapy International).

We also run a five day intensive

International Summer School where
therapists from around the world come to
study with us.  Pink Therapy offers
training, clinical consultation, supervision
and consultancy to therapists overseas in
person or via Skype.  

Dominic Davies - Founder and Director

ii
Contributors
Olivier Cormier-Otaño
MBACP (Accred.), is an
integrative and relational
counsellor and a psy-
chosexual therapist in pri-
vate practice. After many
years as a volunteer coun-
sellor for various LGBT
charities in London, he is mostly working
with gender and sexual diversity clients.
He also specialises in counselling in
French and Spanish. He is an Advanced
Accredited Sexual Diversity Therapist with
Pink Therapy. He has been presenting his
research on asexuality to conferences and
universities.
Dominic Davies
FBACP is a Fellow of
British Association for
Counselling and Psycho-
therapy (BACP) and a
BACP Senior Regis-
tered Practitioner who
has been working with
gender and sexual diversities for over 30
years. He is Director of Pink Therapy, the
UK’s largest independent therapy organisa-
tion specializing in working with gender
and sexual diversity clients. He is co-editor
(with Charles Neal) of the Pink Therapy tril-
ogy of textbooks (Open University Press)
and has written and taught extensively on
the subject of sexual diversity therapy in
the UK and internationally. He is an Ad-
vanced Accredited Sexual Diversity Thera-
pist with Pink Therapy.
Su Connan is a person-
centred counsellor with
a part-time private prac-
tice in South East Lon-
don and works for a
learning disabilities char-
ity in North London. She
is a graduate of the Pink
Therapy specialist training in Gender and
Sexual Diversity Therapy and a course tu-
tor on the Certificate in Alternative Sexuali-
ties where she teaches an introductory
module on Understanding BDSM/Kink 

Email: su@suconnancounselling.co.uk
3
1
Gender and Sexual
Diversity Therapy
Gender and Sexual Diversities
This chapter will focus on working with
gender and sexual diversities (GSD). This
is a more inclusive term for the more
traditionally used LGBT (IQ) (lesbian, gay,
bisexual, transgender/sexual, intersex,
questioning). It encompasses a wider
range of gender and sexual diversity
identities including, but not restricted to,
people who either engage in Kink/BDSM
(bondage, dominance, discipline,
submission, sadism and masochism)
Olivier Cormier-Otaño
and Dominic Davies
practices or lifestyle - irrespective of
sexual orientation (Langdridge and Barker
2007) - as well as people who may identify
anywhere across the gender spectrum and
not simply intersex or transgender.
Gender and sexual diversities (GSD) are
also opening up the debate on different
possibilities in relationships such as
asexuality (Rothblum and Brehony 1993)
and celibacy or polyamory, swingers and
other forms of consensual non-monogamy
(Barker and Langdridge 2010).
4
Recent theories (Diamond 2008) around
sexual orientation elaborate on its natural
fluidity. Sexual preference is best thought
of as a continuum and may vary according
to the social context and over time: some
same sex attractions may occur at various
points in one’s life, whilst libido or desire
for sex may also vary in degree. Diamond’s
research indicates that women are more
fluid than men as they tend to be attracted
to an individual rather than a sexual object.
Gay men tend to be more rigid in their
choice of partner-type (Diamond 2008)
(see also Davies 2012). Individuals often
identify their gender or sexuality differently
from one stage of their life to another; for
instance gender variance may manifest
late in adult life (Lev 2004).
Clients present with different ways of
experiencing romantic and/or sexual
relationships. Often the issues are about
interpersonal rather than intrapsychic
factors. The asexual population (whether in
romantic relationships or not) is struggling
to be out and accepted: individuals not
engaging in sexual activities are frequently
pathologised and discriminated against.
When disclosing their asexuality they face
social opprobrium and pressure to partner
up and have sex (Cormier-Otaño
forthcoming). At the other end of the
spectrum are polyamorous relationships,
where individuals are concurrently having
more than one romantic and sexual
relationship. Polyamory - like asexuality -
embraces heterosexual, homosexual or
bisexual individuals.
The possible combinations of sexual
preferences, sexual orientation, gender
identity, gender preferences and
relationship choices are varied and each
becomes an individual narrative. Some of
these narratives come with varying degree
of difficulties, but of course most GSD’s
never present for therapy and lead happy
and fulfilled lives. Helping clients to identify
and name their own sexuality highlights
the complexity faced by gender-variant
clients, who challenge society’s definition
both of gender and of sexual orientation: is
a lesbian couple still in a same sex
relationship when one of them transitions
to become a man? (Lev 2004)
Gender and Sexual Diversity
Therapy
Gender and Sexual Diversity Therapy
(GSDT) is a recent and deliberate move
away from Gay Affirmative Therapy (GAT)
to encompass and support all forms,
aspects and issues around gender and
sexual diversities. It is a trans-theoretical
approach where all theoretical models
(Psychodynamic, Humanistic, Behavioural)
5
can operate within their central organising
principles and tenets (Davies and Neal
2000).
The name Gay Affirmative Therapy was
problematic in a number of ways. On a
political level it may appear to exclude
(amongst others) lesbians and bisexuals or
the gender-variant. It also ignores
subcultures and groups where opposite
sex attractions are present (kink, fetishism,
swingers, etc…). Finally the concept of
“gay affirmation” implies an agenda for
clients’ self-actualisation.
Hypervigilance - a key concept
GSDs have a long history of being
considered ‘mad, bad or dangerous to
know’. This results in hypervigilance
against pathologisation or
negative
judgements
and GSDs will scan their
environment for signs of hostility or safety:
am I going to be (mis)read? Am I going to
be accepted or understood? Is it safe to
reveal myself? (Carroll 2010). This very
sensitive state is a source of anxiety and
distress that will also be present in the
counselling room. GSD clients will often
unconsciously or directly question their
therapists around their understanding of
gender and sexual differences.
Consequently, some clients may benefit
from or request to work with a therapist
who is also from a gender or sexual
diversity; others may benefit from, or
prefer to work with, someone from outside
of their community. The client’s choice of
therapist is charged with meaning and well
worth exploring the assumptions that lie
behind the request for a minority therapist
or indeed a non-minority therapist.
However, the clients’ wishes need to be
respected and accommodated where
possible. This issue also raises the
question of whether GSD therapists are
comfortable and willing to reveal their
sexual orientation or gender history.
Good Practice:
Most counsellors and psychotherapists are
unlikely to be specifically trained to work
with GSD’s (Davies 2007). Virtually all
developmental models and many
counselling theories privilege
heterosexuality, both as a social norm and
as a sign of psychological health. Recent
6
UK research found that 17% of
counsellors would agree to help a client
suppress their same sex attractions
(Bartlett et al 2008). So-called
“conversion” or reparative therapies are
not only unethical because they collude
with social and internal oppression that
same sex desire equals pathology and
have been shown to be harmful to
individuals who undergo them. (Daniel
2009).
Good practice in GSDT requires a subtle
curiosity and interest in the client’s life, and
an ability to work sensitively with their
hypervigilance. It is not the client’s place to
educate the therapist with regard to the
social context of their experience.
However, the client’s own perspective on
that social context is, of course, entirely
relevant and appropriate. This requires
therapists to have a wide understanding of
the social context in which gender and
sexual diversities are living their lives, as
well as how multiple identities can interact
and sometimes conflict. There are a wealth
of books and information online that deal
with gender and sexual diversity clients.
Much of the current literature is American,
although the UK is now making a good
contribution to the field.
It is also paramount for any therapists to
develop their awareness of their own
prejudices, beliefs and assumptions about
what is ‘healthy’ and ‘normal’ in terms of
sex, gender role, relationships etc. As all
of us have been socialised within
mainstream culture, in which
heteronormative beliefs are an inherent
and perpetuated given, and therefore none
of us is entirely free of heterosexism and
homophobia - in the same way as it is hard
to be free of racist or sexist attitudes.
UK therapy trainings rarely offer adequate
training around gender and sexual
diversity issues. Often these issues are
included in a single lecture on diversity
and rarely exceed three hours of teaching.
A common training experience is that GSD
issues are included only upon the demand
of LGBT trainees and these students are
expected to facilitate their peers’ learning.
This can result in their own learning needs
7
(to work effectively within their own
communities) unattended to, and they are
forced to seek post qualification specialist
training elsewhere (Davies 2007).
A third area for learning and developing
good practice is to understand more about
gender and sexual diversity psychology,
and the impact of stigma on the
development of the self. Therapists
should not fall into the trap of denying the
very real differences that exist between
those of a diversity identity and those of
the heterosexual mainstream or majority.
Lesbian relationships are quite different
from gay male relationships, which differ
again from heterosexual couplings. There
are many differences between each of the
GSD identities as well as some sharing of
common features. It is the authors’ view
that training is essential to have a sufficient
understanding of the intrapsychic, as well
as socially constructed, elements of GSD
experience.
Personal experience and clinical practice
are helpful ways of gaining knowledge.
Volunteering as a counsellor in GSD
charities is a unique way to learn but these
organisations may require their counsellors
to identify as GSD. Meeting with other
therapists and sharing information, books,
supervision and support is another way to
maintain good practice. Just having a gay
friend is not enough, nor is it sufficient
simply to hold a GSD identity. Training is
essential for all wanting to work in this
area.
Supervision is undoubtedly a key factor to
good practice – as it is in all other aspects
of the therapist’s work. Although it can be
difficult to make enquiries of a long-term
supervisor, or to challenge their knowledge
and awareness, therapists working with
gender and sexual diversity clients are
best served if their supervisor has had
some specific training in this area as well.
A therapist reflecting on his/her own
prejudices around issues affecting gender
and sexual diversity clients needs a
supervisor who has worked on his/her own
prejudices as well. Otherwise, issues such
as erotic transference/countertransference
or angry feelings in the counselling room
will remain unexplored or ill advised (Pope,
Sonne and Holroyd 2000). An
uncomfortable example would be a kink-
aware therapist wanting to think about
their work with a client whose sexual
practices usually involve domination, faced
with a supervisor who understands BDSM
as the acting out of self-harming
tendencies, resulting from childhood
abuse or pathology.
8
Understanding social context and
particular issues:
GSD clients may well come to therapy with
issues not so different from those
presented by all clients, but the social
context will bring an extra dimension and
different layers to their narrative.
It is important to consider the power of the
heteronormative, patriarchal and
Eurocentric society in which we have
evolved. External oppression and negative
messages around sexual orientation,
gender and ethnicity lead to internalised
oppression. A young boy pressured to
behave in a way stereotypical of his own
gender (e.g. wearing blue or having short
hair) can lead to the internalised belief that
it is wrong for a man to dress in pink or
have long hair. Such beliefs, if not
challenged, may lead to this adult man
accepting the idea that a feminine side to
himself is wrong or socially unacceptable.
Similarly, messages that sex and its
expression should be limited to
heterosexual, procreative activities, remote
from consensual experimentation, can lead
to feelings of guilt and shame. This kind of
internalised oppression can result in self-
loathing, low self-esteem, isolation, fear of
rejection and other psychological
difficulties.
Gender and sexual diversities experience
higher levels of mental health distress,
depression, self -harm and substance
misuse than heterosexuals (King et al
2008).
In urban environments the majority of
socialising between individuals of gender
or sexual diversity groups takes place in
clubs and bars. Many new designer drugs
have been introduced on the gay club
scene first, thus becoming a very common
ingredient to a night out - prior to
becoming mainstream on the general club
scene.
This use of drugs and alcohol among
gender and sexual diversity groups can be
understood in part as
a response to
pressure and
oppression. There is
an urge to escape
from external
pressures, to lower inhibitions, and to
experience a sense of community with
one’s peers. The misuse of drugs and
alcohol can also lead to unsafe sexual
practices or risky situations.
Isolation, hiding and shame are common
amongst GSD clients and can lead to a
lack of access to accurate information.
9
This means that the counsellor may need
to employ psycho-educational methods
and bibliotherapy, homework etc to help
with relationship skills, sex education and
other issues. In cases where the therapist’s
sexual orientation matches the client’s and
is disclosed, the therapist can sometimes
be seen as a role model whether they want
that or not. This of course is one of the
dynamics to be discussed in supervision.
Identity and belonging:
Individuals carrying such strongly
internalised self-oppressive thoughts may
well question their own identity and sense
of belonging. Only by exploring their own
narratives or in finding kindred spirits does
the client experience an integration of
these different parts. The GSD-aware
therapist can help to empower clients to
find the words to describe and make
sense of their own sexuality and sexual
expression. Having gained a sense of their
own sexual identity, clients will often move
to a position where the need to belong to a
community then becomes more important.
However, difficulties can arise when the
pressure to embrace cultural norms within
the GSD communities is very strong and
oppressive (fashion, lifestyle, peer
pressure) and lead to the development of a
false self where the client again feels only
conditionally accepted.
Many GSD individuals want to marry (civil
partnership) and adopt
children, thus
recreating a lifestyle
more attuned to the
heterosexual
mainstream. For some people this is
looking towards the dominant majority for
a seal of approval; for others they might
see their ‘minority’ identity as an
insignificant feature in their lives.
GSD clients belong to many communities
(spiritual, cultural, professional, political,
families, gender etc.) and may experience
the impact of conflicting beliefs or
ideologies. Most religions or faiths do not
tolerate same sex relationships. Similarly
within the various GSD communities, not
all individualities, ethnicities, sexual
practices or gender identities are
embraced. Ableism, ageism and racism
are just some of the very real
discriminations operating from within a
broadly GSD culture.
Moving times and olden days:
Historically, in order to negotiate a place in
society, gender and sexual diversity
individuals had to ‘pass’ as heterosexual
or to come out: either to pretend to be
what they were not (reinforcing external
and internal oppression) or to disclose to
10
self and others their own sexual
preferences or gender identity and put
themselves at great risk. This is a process
of self-acceptance and exposure that
heterosexual individuals do not have to
undergo.
Coming out is a process and not a single
event. It is complex and recurrent, there is
a well-founded fear of being rejected,
victimised or abused (trans and
homophobic hate crime is on the rise) and
the constant decision of whether to come
out or not in each new social or
professional situation (work, friends, family,
neighbours, authorities, institutions, GP’s
etc) is very stressful and anxiety provoking
for some individuals particularly where the
level of internalised and externalised
oppression is too high. (Carroll 2010).
Universal ‘coming out’ is also a western
concept that may have little relevance for
people from other social and ethnic
groups. Coming out can result in
exclusion from the family and community -
especially for members of black and
minority ethnic communities where other
ways of negotiating the integration of
minority sexual identities are more relevant
(das Nair and Thomas 2012, Beckett
2010). das Nair describes a process of
stepping in and out of the closet,
sometimes having to manage their gay
identity more covertly and alongside
cultural expectations to marry and have
children. Beckett, eloquently describes, in
her work with a young Muslim man the
process of ‘inviting in’ rather than coming
out, where significant people are
selectively invited into knowing more
about the client’s life and sexuality.
Fortunately, the coming out experience (or
‘emerging’ as it has come to be known for
trans people, Lev 2004) and acceptance of
GSD by significant others and society has
(for a larger number of people) changed for
the better in recent years. New generations
may be more comfortable with a “queer”
identity rather than a gay or lesbian one
and may be completely at ease with their
identity as “other”. The notion of making a
declaration of a fixed sexual or gender
identity is breaking down amongst many
young people for whom nailing their
sexuality to a post is irrelevant. This so-
called ‘Rainbow Generation’ may
experience their identities more fluidly.
On the other hand, the older GSD
population might still be struggling with
internalised oppression and repression
from past experience (electro-convulsive
therapy, criminalisation of same sex
practices, public naming and shaming etc)
11
Active listening and empathy are key skills
to allow the client to develop their narrative
in order to realise the impact of the social
context on their identity. The difficulties
experienced by people with GSD identities
will often have common causes, but as
ever it is the reflective, aware, respectful
and non-judgemental clinical approach to
each client’s unique situation that is at the
core of a good practice and will ultimately
support their well-being and mental health
(Davies 1996).
The skilled and ethical GSD practitioner
needs to be flexible enough to work with
all clients regardless of the client’s stage of
accepting their sexuality. Therapeutic
work around sexual or gender identity may
well help the client work through unease
about difference, but does not take on an
agenda to alter this integral part of a
person’s lived experience.
Finally GSD therapists should be ready to
work with clients presenting with requests
for ‘cure’ or reduction of their same sex
attractions, or who have been damaged or
abused by ‘reparative’ therapies.
Sexual practices
Pleasure, procreation and play are the
three aims for sex and imagination can be
fertile when it comes to sexual practices. It
is the therapist’s
responsibility to have an
open mind and an
understanding of diverse
sexual practices should
they choose to work with
gender and sexual
diversity clients.
Language and communication between
client and therapist should be on a similar
level or register; the therapist’s vocabulary
should mirror the client’s and unfamiliar
words be congruently explored by the
therapist. The impact of using medical or
anatomical terms by the therapist in
response to informal, colloquial, or slang
terms used by the client may well send
messages of discomfort or disapproval
from the therapist.
It is also helpful for the therapist to have
reasonably current knowledge of sexual
health, HIV awareness, treatments and
safer sex.
Conclusion
Gender and Sexual Diversity Therapy is
cognisant of the social context in which
gender and sexual diversities live as well
as the particular concerns of each
individual. It works with the hypervigilance
and consequences of living within a
12
society which is biased towards
heteronormativity and binary conception of
gender. It helps clients understand their
experiences and the impact of external
oppressions, how they are internalised and
a range of issues specific to these
populations and communities. It stresses
the need for clients to self-define and for
developing personally relevant values and
moral codes.
GSDT good practice requires a thorough
working through of the therapist’s
prejudices around sex and gender and a
minimum knowledge of how these
diversities live, not only in a western,
heteronormative and patriarchal society
but also in different settings around the
world.
Therapists will continuously be challenged,
provoked and educated by clients whose
presenting issues confront two of the
world’s biggest and most sacred taboos:
sexuality and gender.
References:
Barker, M. and Langdridge, D. (eds) (2010)
Understanding Non-Monogamies. Hove: Routledge.
Bartlett, A., Smith, G. and King, M. (2009) The
response of mental health professionals to clients
seeking help to change or redirect sexual
orientation. BMC Psychiatry 9 (11) available online:
http://www.biomedcentral.com/1471-244X/9/11
Beckett, S. (2010) Azima ila Hayati: An Invitation
into My Life: Narrative Conversations about Sexual
Identity. In Lyndsey Moon (ed) Counselling
Ideologies: Queer Challenges to Heteronormativity.
Farnham: Ashgate.
Carroll, L. (2010) Counselling Sexual and Gender
Minorities. Columbus: Merrill.
Daniel, J. (2009) The Gay Cure? Therapy Today.
October: 10-14
das Nair, R. & Thomas, S. (2012). Race and
Ethnicity. In R. das Nair & C. Butler (eds.)
Intersectionality, Sexuality, & Psychological
Therapies: exploring lesbian, gay, and bisexual
diversity. London: Wiley Blackwell/BPS-Blackwell
imprint. Pp59-88.
Davies, D (1996) Towards a Model of Gay
Affirmative Therapy in D. Davies and C Neal (eds)
Pink Therapy: a Guide for Counsellors and
Therapists Working with Lesbian, Gay and Bisexual
Clients. Buckingham: Open University Press.
Davies, D. and Neal, C. (eds) (1996) Pink Therapy: a
Guide for Counsellors and Therapists Working with
Lesbian, Gay and Bisexual Clients. Buckingham:
Open University Press
Davies, D. and Neal, C. (eds) (2000) Therapeutic
Perspectives on Working with Lesbian, Gay and
Bisexual Clients. Buckingham: Open University
Press
Davies, D. (2007) Not in front of the Students.
Therapy Today. February 2007
Davies, D (2012) Sexual Orientation in C. Feltham &
I. Horton (eds) The Sage Handbook of Counselling
and Psychotherapy 3rd edition. London: Sage
Publications
Diamond, L. (2008) Sexual Fluidity: Understanding
Women’s Love and Desire. Massachusetts: Harvard
University Press.
13
Langdridge, D. and Barker, M. (eds) (2007) Safe, Sue, D. W. (2010) Microaggressions in
Sane and Consensual. Basingstoke: Palgrave.
Everyday Life: Race, Gender and Sexual
King, M., Semlyen, J., Tai, S.S., Killaspy, H., Osborn,
Orientation. New Jersey: Wiley.
D., Popely, D. and Nazareth, I. (2008) A systematic
review of mental disorder, suicide, and deliberate
self-harm in lesbian, gay and bisexual people. BMC
Psychiatry 8 (70) http://www.biomedcentral.com/
1471-244X/8/70
Lev, A. I. (2004) Transgender Emergence:
Therapeutic Guidelines for working with Gender-
Variant People and Their Families. New York:
Haworth.
Pope, K.S., Sonne, J. L. and Holroyd, J (2000)
Sexual Feelings In Psychotherapy. Washington:
American Psychological Association.
Rothblum, E.D. and Brehony K. A. (1993) Boston
Marriages: Romantic but Asexual Relationships
among Contemporary Lesbians. Amherst: University
of Massachusetts Press

Reading Suggestions:
Finnegan, D.G. and McNally, E. B. (2002)
Counseling Lesbian, Gay, Bisexual, and
Transgender Substance Abusers: Dual
Identities. New York: Haworth

Moon, L. (2008) Feeling Queer or Queer

Feelings: Radical Approaches to
Counselling Sex, Sexualities and Genders.
Hove: Routledge

Pattatucci Aragón. A. (2006) Challenging

Lesbian Norms: Intersex, Transgender,
Intersectional and Queer Perspectives.
New York: Haworth

14
2
Dominic Davies
Sexual Orientation

Sexual orientation describes a pattern of orientation as being heterosexual, lesbian/

emotional, romantic, or sexual attraction to gay or bisexual but there is increasing
men, women, both men and women, evidence that some people are attracted
neither gender, or another gender. More neither to men nor women and would
traditionally we might think of sexual identify as asexual and there is an

15
emerging awareness of people who are
attracted to people who might identify as
Third sex (e.g. Hijras were recently legally
recognised in India, Bangladesh and
Pakistan) and in the West, this orientation
may be expressed as trans-oriented, being
attracted to people who are transsexual.
This chapter will mainly focus on
homosexuality and bisexuality although it
is anticipated by the next revision of this
volume we will be seeing more published
work on both asexuality and trans-oriented
people.
History of homo and bisexuality
Representations of homosexuality and
bisexuality have been found by
anthropologists and historians around the
world and from the earliest times. In some
cultures homosexuality is seen as a natural
and normal variation of human sexuality, in
other cultures same-sex relationships are
encouraged or given high status, and in
some others still homosexuality is reviled
and persecuted. What is clear, though, for
anyone who has spent time exploring the
issue, is that same sex desire is a naturally
occurring phenomenon. Some people see
their homosexuality and bisexuality as an
essential part of their nature. Such people
may say, ‘I was born this way.’ They may
be able to give examples of childhood
same-sex attractions and desires to
support their experience. Others may say
they have chosen their sexuality or maybe
even that they have tried sexual
relationships with the ‘opposite’ sex or just
one gender, and prefer for a variety of
reasons to have relationships with the
same sex. Generally speaking gay men
tend to use essentialist ideas (that they
were born gay) to explain their
homosexuality and lesbians and bisexuals
may be more likely to use arguments of
‘choice’.
Some people vary in their choice of sexual
partners over time or in different situations,
some are confused or questioning, others
experiment while others have no sexual
relations and some experience no sexual
feelings. There exists a vast array of
expressions of sexual desire and
behaviour as well, increasingly, of ‘sexual
identity.’
Sociologically, views of homosexuality are
divided into two camps. There are those
who see sexual identity as a social or
cultural construct particular to a place and
time. In this view, homosexuality in, say,
Thailand, Ancient Greece, or Pakistan has
little in common with the modern gay man
living in London or New York. Others argue
that, because there is evidence of people
16
who have always been gay, in every
culture and through time, there is
something essential or natural about
homosexual identity. These arguments
continue and evidence accrues in support
of both views. Is sexuality determined by
nature (essentialism) or nurture (social
constructionism)? Individuals seeking to
understand why they are lesbian, gay or
bisexual will find plenty of evidence to
support theories of homosexuality and
bisexuality as essentialist or socially
constructed. Most lesbian, gay and
bisexual people, however, have little
interest in why they are the way they are –
it is just a given.
Grahn (1990), highlights the fact that in
many cultures lesbians and gay men are
holding up a mirror to the way their society
views sex, gender and sexuality. They are
showing different ways of being a man or
woman and of relating. In some societies
this is supported by the culture, in others a
separate sub-culture exists to support
lesbian, gay or bisexual people.
People with diverse sexual orientations
have been among the European witches
and their rites – over a 400-year period,
seven million witches were burned on piles
of faggots (not simply bundles of wood,
but piles of human bodies – there is
evidence that many of these people would
have been strangled gay men (Grahn,
1990). They have been among the
shamans and medicine men and women of
the Native Americans (where many tribes,
including the Sioux, Cherokee and Navajo,
sanctioned same-sex love and held it in
high regard). Lesbian, gay and bisexual
people have been despised, tortured and
murdered by, among others, Nazis in
Germany, and in modern-day Iran, China
and elsewhere.
Although individual LGB&T men and
women participate in both heterosexual
and lesbian, gay and bisexual communities
and cultures, there is an invisible thread
linking all sexual minorities. This thread is
the way lesbian, gay and bisexual people
have manifested and worked within
societies throughout the world to facilitate
a crossover in the way the genders
operate with each other. When a lesbian
cuts her hair short and wears ‘male’
clothing she is not trying to look like a
man. She is showing another way of being
a woman, in which she, as a woman,
defines how she looks, rather than
allowing men to define how she should
look. A gay man wearing a ‘camp’,
perhaps effeminate outfit of a loose-fitting
shirt in pastel shades is not trying to look
like a woman but to show a different way
17
to be a man. There is a strength that
comes from being able to reinvent oneself,
and in creating different ways to be who
and what one is.
It was only as recently as 1992 that the
World Health Organization (WHO) removed
homosexuality from their International
Classification of Diseases (ICD9). This was
two decades after the American
Psychiatric Association declassified
homosexuality from the Diagnostic and
Statistical Manual III. There are still a great
many practitioners, particularly those
working in the mental health sector, who
erroneously believe that to be lesbian, gay
or bisexual is an illness or perversion
(Bartlett, Smith and King, 2009).
Therapists trained in gender and sexual
diversity issues believe that it is
homophobia which is the cause of mental
distress and difficulties (King et al. 2008).
Homophobia means a fear, dread or hatred
of homosexuals or homosexuality
(Weinberg, 1972; see also Davies, 1996a
for more on homophobia and
heterosexism). ‘Biphobia’ describes
equivalent attitudes towards bisexuality
from either heterosexual or homosexual
people.
For over 100 years most ‘helping’
professionals have seen homosexuality as
an illness. Some of the worst atrocities
have been committed by people
supposedly dedicated to helping and
supporting people, in the name of trying to
cure people of this ‘disease’. Lesbians and
gay men have been subjected to electric
shock treatment, aversion therapy and
crude attempts at psychosurgery. Others
were subjected to long-term, intensive
psychotherapy where they wrestled with
their natural desire to love someone of the
same
gender,
and
society’s
(and
often
their
therapist’s) view that this was sick or
perverted. The declassification of
homosexuality as a mental illness has
helped end these particular persecutions.
Of equal concern, however, is the way
certain ‘Counselling’ groups identifying as
‘Christian’ have sought to ‘cure’ lesbian,
18
gay and bisexual people. Preying on
confused and vulnerable people in this
way, those who have religious or moral
objections to homosexuality continue to
bring the notion of ‘helping others’ into
disrepute and cause untold damage to
their ‘clients’.
Homophobia as pathology
The last three decades, however, have
slowly seen a growth in what have come to
be known as sexuality affirmative (or gay
affirmative) models of therapy. This work,
undertaken in the main by lesbian, gay and
bisexual therapists in the USA and Europe,
has sought to show non-pathological ways
of viewing homosexuality and bisexuality.
Maylon describes gay affirmative therapy
thus:
“Gay affirmative psychotherapy is not an
independent system of psychotherapy.
Rather it represents a special range of
psychological knowledge, which
challenges the traditional view, that
homosexual desire and fixed homosexual
orientations are pathological. Gay
affirmative therapy uses traditional
psychotherapeutic methods but proceeds
from a non-traditional perspective. This
approach regards homophobia, as
opposed to homosexuality, as a major
pathological variable in the development of
certain symptomatic conditions among
gay men”. (1982: 69)
The concept ‘gay affirmative’ is not
without dissenters among lesbian and gay
therapists themselves. Du Plock (1997)
and Ratigan (1998), among others, have
rightly questioned who or what is being
affirmed in gay affirmative therapy. The
term can imply that the therapist is giving
permission and is encouraging the client to
be gay. This can make it difficult for the
client to explore his or her own negative,
internalized, self-oppressive structures,
feeling that these won’t be accepted or
approved of by their gay-affirming
therapist. ‘Gay affirmative’ has been said
to exclude other sexual minorities and
gender-variant people. A more neutral
term, growing in use, is Gender and Sexual
Diversity Therapy. The addition of Gender
in the title reflects increasing links being
made between gender identity and sexual
identity and contemporary attention to
different relationship models and lifestyles.
(Cormier-Otaño and Davies 2012).
Such non-pathologizing approaches are
now slowly being integrated into the
syllabus of European therapy training
programmes. In lamentably few courses,
however, are they located within the core
curriculum of the training institutes. More
19
often they are raised at the request of
individual students (usually lesbians and
gay men), and sometimes only addressed
through self-directed study (Davies,
1996b, Davies, 2007). This marginalization
of sexual diversity therapy issues only
serves to perpetuate and reinforce
pathological models.
Cayleff (1986), in discussing the ethical
issues involved in counselling the culturally
different (in which she includes lesbians,
gay men and bisexuals), questions how
therapists graduating from training
programmes that do not require courses in
working with cultural minorities may
ethically work with these populations.
Since formal education is a socialization
process that transmits the values of the
dominant culture, the majority of
counselling and therapy training
programmes, through both course work
and practice, continue to explore individual
development, sex, gender, coupling, family
and relationship issues solely within a
heterosexual context (Iasenza, 1989).
Effects of homophobia and heterosexism
on lesbian, gay and bisexual people
The stress of living with a stigmatized
identity, where one is seen as ‘mad, bad
and dangerous to know,’ has been
demonstrated to contribute to poor mental
health (King et al 2008, King et al 2003,
Rivers, 2004). Lesbian, gay and bisexual
people may at some level feel shame
about their sexuality, and this internalized
homophobia can result in low self-esteem,
self- medication through drug and alcohol
misuse, overwork through trying to prove
oneself valuable, and avoidance of
drawing attention to oneself. Lesbian, gay
and bisexual people are also prone to
discrimination and violence. In a survey,
Queer Bashing, Stonewall (1996) found
that 34 per cent of gay and bisexual men
and 24 per cent of women had
experienced physical violence because of
their sexuality. In another study, the same
organization (Stonewall, 1993) found that
37 per cent experienced workplace
discrimination and almost half the
respondents (48 per cent) had been
harassed because of their sexuality. Even
though the UK now has anti-discrimination
legislation protecting against workplace
harassment, there is still a climate of fear
for many lesbian, gay and bisexual people
that it may happen and of course one does
not need to have experienced
discrimination to fear it. This leaves almost
all lesbians, gay and bisexual people
vulnerable to anxiety and disorganization.
20
There are not only negative effects to living
with a stigmatized identity. Lesbians, gay
men and bisexuals who are open about,
and comfortable with, their sexuality often
experience a strong sense of identity as
‘different but equal’ to heterosexuals.
These differences sometimes result in a
freedom to reinvent themselves anew with
values and attitudes that support their
individual and collective identities.
Lesbian, gay and bisexual people may, for
example, have critiqued much about a
heterosexual lifestyle and identity and
decided this is inappropriate. Their culture,
like those of other oppressed groups
(Jews, African-Caribbean people, etc.)
celebrates this diversity and different
perspective in art, music, literature and
other expressions.
Summary and key points
Don’t assume the client’s sexual
orientation is the cause of his or her
difficulties. Lesbian, gay and bisexual
people may present for counselling or
therapy with a range of life issues
(relationship breakdown, bereavement,
anxiety, depression, work stress, etc.).
Most of these bear little direct relevance to
their sexuality, although they are often
coloured by the experience of being from a
sexual minority in an oppressive and
discriminatory society.
Don’t make assumptions about a person’s
sexuality. Many married, apparently
heterosexual men have sexual
relationships with members of their own
sex. Significant numbers of gay men have
sex with women. The corollary is also true
for women. Encourage clients to define
themselves.
Don’t make assumptions about the client’s
lifestyle. Clients may have different notions
of what it means to be in a relationship
(‘monogamy’
may not be
the norm),
or to be a
family
(many
lesbian,
gay and
bisexual people will
consider their friends as their
family). Lesbian, gay and bisexual clients
may want to be parents or may already be
involved in childcare. They may be
uncomfortable in available gay or lesbian
subcultures, too.
Be aware of the client’s hypervigilance and
that you may be tested for signs of
homophobia and heterosexism. Work with
this and do all you can to learn more about
lesbian, gay and bisexual cultures and
21
lifestyles. Be honest about your experience
and work to create an open and non-
defensive relationship.
Reflect on your own attitudes to, and
experience of, your sexuality and to
homosexuality in particular. To be able to
work effectively with sexual diversity
clients you need to be comfortable with
who you are as a sexual being and to have
examined your beliefs, feelings and
prejudices about same sex love and
attraction. Everyone has them. The
therapist who says they are not prejudiced
is a therapist to be avoided, as they are
probably extremely low on self-awareness.
Therapists might like to consider what
impact on the therapeutic relationship
there might be for a sexual diversity client
working with them, if they have not
examined their attitudes before working
with such clients.
Working towards good practice
There are perhaps three main ways in
which we can prepare ourselves for
working with people whose sexual
orientation differs from our own.
Training workshops, which include didactic
and exploratory presentations about
gender and sexual diversity psychology,
including the various models of coming
out (see Davies, 1996c), dealing with
internalized homophobia and multiple
identities, and the social and political
context of living with a gender or sexual
diversity identity. Most importantly,
perhaps, experiential exercises aimed at
addressing our attitudes, experience and
knowledge of bisexuality & homosexuality,
as well as increasing understanding of our
own sexuality. A leading training provider
in this field is Pink Therapy
(www.pinktherapy.com) who regularly run
workshops and courses for therapists
wishing to improve their knowledge and
skill in this area.
Personal therapy and self-awareness work
to explore some of our sexual histories in
some depth, with therapists who have
themselves done the required work, which
itself raises a complication: where does
one find such people? Alongside this,
specific supervision/ consultation is
advisable from therapists experienced in
this field.
Spending time with lesbian, gay and
bisexual people at work and in recreation.
Personal contacts through genuine
friendships have been demonstrated to be
powerful ways of changing opinions and
behaviours. Become involved socially and
politically with the lesbian, gay and
22
bisexual communities. Manthei says,
‘there is no short cut to being involved in
and accepted by local communities so
that you are known to be supportive and
trustworthy’ (1997: 31).
References:
Bartlett, A., Smith, G. and King, M. (2009)
The response of mental health
professionals to clients seeking help to
change or redirect sexual orientation. BMC
Psychiatry 9 (11) available online: http://
www.biomedcentral.com/1471-244X/9/11
BACP (2002) Ethical Framework for Good
Practice in Counselling and
Psychotherapy. Rugby: British Association
for Counselling and Psychotherapy.
Cayleff, S. (1986) Ethical issues in
counselling gender, race and culturally
distinct groups. Journal of Counseling
Development, 64 (5): 345–347.
Davies, D. (1996a) Homophobia and
heterosexism. In D. Davies and C. Neal
(eds), Pink Therapy: A Guide for
Counsellors and Therapists Working with
Lesbian, Gay and Bisexual Clients.
Buckingham: Open University Press.
Davies, D. (1996b) Towards a model of gay
affirmative therapy. In D. Davies and C.
Neal (eds), Pink Therapy: A Guide for
Counsellors and Therapists Working with
Lesbian, Gay and Bisexual Clients.
Buckingham: Open University Press.
Davies, D. (1996c) Working with people
coming out. In D. Davies and C. Neal (eds),
Pink Therapy: A Guide for Counsellors and
Therapists Working with Lesbian, Gay and
Bisexual Clients. Buckingham: Open
University Press.
Davies, D. (2007) Not in front of the
students. Therapy Today February pp.
18-21.
du Plock, S. (1997) Sexual
misconceptions: a critique of gay
affirmative therapy and some thoughts on
an existential-phenomenological theory of
sexual orientation. Journal of the Society
for Existential Analysis, 8 (2): 56–71.
Grahn, J. (1990) Another Mother Tongue:
Gay Words, Gay Worlds. Boston, MA:
Beacon Press.
Iasenza, S. (1989) Some challenges of
integrating sexual orientations into
counselor training and research. Journal of
Counseling and Development, 68: 73–76.
King M, McKeown E, Warner J, Ramsay A,
Johnson K, Cort C, Wright L, Blizard R,
Davidson O (2003) Mental health and
23
quality of life of gay men and lesbians in
England and Wales: a controlled, cross-
sectional study. British Journal of
Psychiatry 183:552-558.
King, M. Semlyen, J. See Tai, S. Killaspy,
H, Osborn, D. Popelyuk, D. Nazareth, I.
(2008) A systematic review of mental
disorder, suicide, and deliberate self harm
in lesbian, gay and bisexual people. BMC
Psychiatry 8 (70) available online: http://
www.biomedcentral.com/1471-244X/8/70
Manthei, R. (1997) Counselling: The Skills
of Finding Solutions to Problems. London:
Routledge.
Maylon, A. (1982) Psychotherapeutic
implications of internalized homophobia in
gay men. In J. Gonsiorek (ed.),
Homosexuality and Psychotherapy. New
York: Haworth Press.
Ratigan, B. (1998) Psychoanalysis and
male homosexuality: queer bedfellows? In
C. Shelley (ed.), Contemporary
Perspectives on Psychotherapy and
Homosexualities. London: Free
Association Books.
Rivers, I. (2004) Recollections of bullying at
school and their long term implications for
lesbians, gay men and bisexuals. Crisis 24
(5).
Stonewall (1993) Less Equal than Others:
A Survey of Lesbians and Gay Men at
Work. London: Stonewall.
Stonewall (1996) Queer Bashing: A
National Survey of Hate Crimes against
Lesbians and Gay Men. London:
Stonewall.
Weinberg, G. (1972) Society and the
Healthy Homosexual. New York: St
Martin’s Press.
Recommended reading:
Carroll, L. (2010) Counselling Sexual and
Gender Minorities. Ohio USA: Merrill/
Pearson.
Clarke, V. Ellis, S.J, Peel, E, Riggs, D.W.
Lesbian, Gay, Bisexual, Trans and Queer
Psychology. Cambridge: Cambridge
University Press.
Davies, D. and Neal, C. (eds) (1996) Pink
Therapy: A Guide for Counsellors and
Therapists Working with Lesbian, Gay and
Bisexual Clients. Buckingham: Open
University Press.
24
3
Sexual Orientation Change
Efforts (Reparative Therapy) &
requests for help to change
Sexual Orientation Change Efforts - also
known as Reparative Therapy (RT) or
Conversion Therapy - is a multi-million
pound industry practiced largely by
conservative Christian groups (although
Dominic Davies
there is one Jewish organisation (JONAH).
It’s big in America where there is a
stronger religious culture, but Britain and
other parts of the world are increasingly
seeing ‘missionary’ work where some of
25
the leading RT proponents are travelling often found employment within the ex-gay
the world and to preach organisations.
their
perverted In June, Alan Chambers, President of

form of Exodus International renounced their

‘love’ (love position on being able to ‘cure’

the sinner, homosexuality. Exodus is the largest ‘Ex-

not the sin) Gay’ organisation in the world. Chambers

and train told their annual conference that he is

Christian “wary of claims that the approach could

‘counsellors’. ‘cure’ a person of same-sex attraction,”

essentially heterosexual re-orientation is
However, the edifice of Reparative Therapy an unsustainable myth.
is crumbling. In April this year Dr Robert
Spitzer, a psychiatrist who had been At the end of August, California state

instrumental in getting the American senators voted (by 22-12) that they would

Psychiatric Association to remove ban RT being offered to children as they

homosexuality from the DSM, offered an are unable to offer the informed consent

apology and retraction of his controversial necessary. Parental opposition to the

and deeply flawed 2001 study which, proposal was along the lines that it

when published in the Archives of Sexual infringed their individual civil rights to treat

Behavior, saw the rest of the volume (and beat) their children as they so wished.

dedicated to various critiques of his

What concerns me most, as someone who
methodology and findings. Spitzer, who is
has spent over thirty years working in this
now very unwell with Parkinson’s Disease
field is not the actions of a relatively small
said "In retrospect, I have to admit I think
number of well funded cranks trading on
the critiques are largely correct" What
the fears and concerns of religiously
Spitzer found from conducting 200
conflicted conservative Judeo-Christians,
telephone interviews with the best success
but the fact that when British therapists
cases of people put forward by the ex-gay
were asked (Bartlett et al, 2009) had they
movement was that even after many years
engaged in attempts to help reduce same
of therapy and prayer that most still had
sex attractions from ‘confused’ or
same sex desires, including those who

26
conflicted lesbians and gay men, 1:6 had
agreed to such contracts and 4% had
attempted to ‘cure’ homosexuality. This
has been well reported in by Daniels
(2009).
I feel all this attention we’re giving to RT is
a diversion from my colleagues admitting
their lack of knowledge or, discomfort, with
people whose sexuality is different to their
own. I feel they are deflecting their own
responsibilities for culturally sensitive and
informed care onto so called ‘religious
zealots’ so they can feel comfortable in
their own smug ignorance.
Bartlett et al’s therapists were not acting
from a personal conviction that
homosexuality was a sin or morally wrong,
but a mixture of ignorance and ideas about
freedom of choice, and client autonomy.
Such therapists have been severely let
down by their training organisations who
pay scant attention to human sexuality, let
alone to equipping them to know how to
respond ethically when a client presents
deeply upset or confused about their
sexual desires and feelings.
Because harm surely does result from
attempts to redirect sexual orientation,
whether that is through RT or performed
by well meaning counsellors who don’t
have a bloody clue because they’ve not
actually read the literature or had any
formal training. By agreeing to help the
client reduce their Same Sex Attractions
you are complicit in affirming the client’s
view that homosexuality is wrong, that gay
people can’t
be happy
and healthy
and when
you both
fail to get
the kind
of results
your client wants, the
resulting depression, low self esteem
and sense of hopelessness the client feels
about their ability to function in a society
which is oriented towards heterosexuality
could well lead to suicide or self harm.
What would I like our professional
associations to do about this? I would like
to see them taking a proactive stance in
ensuring all accredited courses adequately
prepare their students to a level of
competence that they know how to work
with explicit requests to change sexual
orientation and why such attempts are
likely to fail.
I’d also like my colleagues who are already
qualified to inform themselves about how
27
to work with requests to change, either via
training such as our own BACP endorsed
CPD Essentials in Gender and Sexual
Diversity Therapy or reading the
comprehensive new guidelines from the
British Psychological Society (BPS, 2012).
Daniel, J. (2009) The Gay Cure, Therapy Today, v20
(8) Accessed 13 Sept 2012 http://
www.therapytoday.net/article/show/1168/
Davies, D. (2007) Not in front of the students.
Therapy Today. v18 (1) pp18-21 Accessed 13 Sept
2012 http://www.pinktherapy.com//Portals/0/
CourseResources/Not_In_Front.pdf

LGB people represent a lucrative ‘cash
cow’ for many therapists as we have
higher rates of mental health distress than
the general population (King et al, 2003)
and present more frequently for therapy
and mental health support but it’s my
experience that very few training courses
King, M., McKeown, E., Warner, J., Ramsay, A.,
Johnson, K., Cort, C., Wright, L., Blizard, R. &
Davidson, O. (2003b). Mental health and social well-
being of gay men, lesbians and bisexuals in
England and Wales: A summary of findings.
London, Mind. Accessed 13 Sept 2012 http://
www.mindout.org.uk/documents/
SummaryfindingsofLGBreport.pdf

actively programme into the core
curriculum, content on working with LGBT
people and when it does happen, it’s
usually the lesbian or gay students who
are asked to teach something (Davies,
2007).
Spitzer, R.L.(2003).Can some gay men and lesbians
change their sexual orientation? 200 participants
reporting a change from homosexual to
heterosexual orientation. Archives of Sexual
Behavior v32 (5). 403-417. Accessed 13 Sept 2012
http://www.stolaf.edu/people/huff/classes/
Psych130S2012/LabDocuments/Spitzer.pdf

References:
Bartlett, A., Smith, G. and King, M. (2009) The
response of mental health professionals to clients
seeking help to change or redirect sexual
orientation. BMC Psychiatry 9 (11) Accessed 13
Sept 2012 http://www.biomedcentral.com/
1471-244X/9/11

British Psychological Society (2012) Guidelines and

Literature Review for Psychologists Working
Therapeutically with Sexual and Gender Minority
Clients. Accessed 13 September 2012. http://
www.bps.org.uk/sites/default/files/images/
rep_92.pdf

28
4
Su Connan
A kink in the process

Sadomasochistic sex is arguably one of the least understood and most

demonised forms of consensual sexuality. How able are we to offer ethical
therapy to kinky clients when there is so little awareness of the kink experience?

29
There are a lot of kinky people out there.
An American study reported ‘14 per cent
of men and 11 per cent of women have
had… personal experience with
sadomasochism’,1 and further studies
reveal a much higher incidence of BDSM
(bondage and discipline, dominance and
submission, sadism and masochism)
fantasy. Many of us are confident in our
kinky sexuality and celebrate our exciting
sex lives, but some of us feel shame, guilt
or confusion around our desires. Yet we
struggle to find a counsellor or therapist
with whom we can feel confident and
comfortable. As kink-identified therapists
are rare, what we need is someone who
will not judge us or be ‘freaked out’ if we
disclose our kinky identities or practices.
 practitioners.
Sexual sadism and masochism have been
conceptualised as deviant, labelled as
pathological and are currently listed in the
DSM-IV (Diagnostic and Statistical Manual
of Mental Disorders) and ICD-10
(International Statistical Classification of
Diseases) as paraphilias. ‘Like
homosexuality some 20 years ago,
sadomasochistic sex is considered
alongside rape and child sexual abuse as
individual sexual pathology in need of
explanation, treatment and cure.’2 Yet,
encouragingly, recent research has turned
to the BDSM community in an attempt to
understand the meanings it holds for those
who incorporate BDSM practices into their
sex lives or experience BDSM as integral
to their sexuality.  



As counsellors and therapists we need to
be reflective of our own personal values
and beliefs around sexuality and how they
are informed by our cultural, political or
religious heritage. We need to be aware of
how our therapeutic models approach the
issue of sexuality and be prepared to
question those who pathologise BDSM
sexual expression. The key to working
ethically with this diverse community is
through understanding the world of kink
and the meanings held by BDSM


Increasing BDSM awareness

BDSM is a term which covers a wide range
of behaviours, generally involving the use
and exchange of power in an eroticised
relationship. Informed Consent
(www.informedconsent.co.uk), the leading
website about BDSM in the UK, defines
BDSM as ‘a catch-all phrase’. I use ‘BDSM
participant’ or ‘SMer’ to describe those
who identify with BDSM as a lifestyle or as
an activity, and ‘kink’ and ‘kinky’ to
describe both BDSM practices and
practitioners. 

30


Many of the words used to describe kinky
activity refer to its often highly theatrical
nature: it may take place as part of a
‘scene’ or in a dungeon; participants or
players who identify as dominant are
referred to as ‘dom/me’, ‘master/mistress’
or ‘top’; submissive players use ‘sub’,
‘bottom’ or ‘slave’. Those who enjoy both
roles use the term ‘switch’. The use of a
safe word ensures the physical and
emotional safety of both sub and dom/me.
Kink practitioners often refer to non-kinky
sex as ‘vanilla’.
 counsellor who will be knowledgeable and


This article is an extract of a paper I wrote
for my Pink Therapy Certificate in Sexual
Minority Training and following my own
experience of diversity awareness during
my counsellor training. In response to my
peer group’s lack of knowledge of sexual
diversity, and the homogenous,
heterosexual nature of the group, I
disclosed my kink identity. I wondered how
these counsellors in training would
respond to me, should I (or someone like
me) walk into their consulting room in
years to come. Happily my disclosure was
not met with overt expressions of hostility
or rejection. The prevailing response from
those prepared to engage with this new
challenge was a good-natured attitude of
curiosity, though I felt my peers perceived
my sexuality as exotic. The experience left
me wondering how able we are to offer
ethical therapy to sexual minority groups
when training is delivered from such a
heteronormative approach and there is so
little awareness of the kink experience in
particular.



Finding a kink-aware counsellor requires
dedication. Knowledge of the gay or kink
scene is helpful. For an individual who may
be conflicted and anxious about their
sexual desires or practice, looking for a
non-judgmental is no mean feat. Clients
unable to identify a suitable kink-friendly
therapist may feel a need to ‘test out’ their
counsellor in an attempt to assess their
attitudes towards BDSM practices. This
can be a risky and expensive business,
especially for an individual experiencing
conflict around their sexual desires or
practice, and may lead to the prospective
client covertly or (perhaps less likely)
overtly interviewing the therapist. 



My own experience bears this out. In an
attempt to reduce my costs in emotional
expenditure, time, and money, I drew up a
set of what were effectively interview
questions which I posed when
approaching each potential therapist over
the telephone. This resulted in some rather
31
disconcerted counsellors who, to their or assess risk. There is an ongoing debate
credit, handled the experience with within the BDSM community regarding the
generally unflappable good humour. 
 issue of risk, with some arguing for ‘risk

 aware consensual kink’ in response to
Safe, sane and consensual 
 ‘safe, sane and consensual’ in recognition
Moser and Kleinplatz3 offer a warning to of the risks inherent in any activity, and as
those attempting to understand the a rejection of what can be constructed as
motivations of BDSMers: the individual an ongoing need to ‘prove’ one’s sanity.4 

meanings, hopes and desires of each 

participant will be unique, and apparently Power and transcendence,
similar behaviours may have entirely bondage and humiliation

different meanings as each player seeks
By adopting dominant and submissive
diverse experiences. I would add that even
roles, a deliberate and temporary ritual
the same individual in similar scenes may,
exchange and play with ‘power’ is
at different times, desire and achieve a
enacted. Easton describes this as
varied range of emotions and sensations.

providing a


safe context
People often get caught up on the issue of
for the giving
pain and may not understand the full
and receiving
meaning of consent. Consent is
of intense
fundamental to SM – without consent, it is
physical and
abuse. A complex scene is often preceded
emotional
by a period of discussion and negotiation,
experiences –
including what is off limits – what is a turn-
the opportunity
on for one person will be a total turn-off for
to play out the rebellious child, experience
another. The kink slogan ‘safe, sane and
a range of emotions or release from daily
consensual’ counters assumptions that
responsibilities.5  A number of researchers
kink is dangerous and crazy. It emphasises
have identified a state of ‘transcendence’
that even when ‘playing hard’ there is a
achieved through the practice of BDSM.6
commitment to avoiding actual harm, and
Bridoux quotes from an SMer describing
that individuals do not play when angry or
their SM sexual encounter as an
otherwise unable to maintain boundaries
‘openness, which is often the key to a truly

32
profound and personal psycho-sado-sex
experience, opens the psyche in ways it is
not “normal” to operate in’.7
 understanding this aspect of BDSM.
The act of binding and being bound is a
major theme within BDSM and carries with
it many and complex meanings. It may
involve an act as delicately restricting as
binding another’s thumbs, to using rope to
‘hog tie’ and even suspend one’s partner.
Simply commanding another not to move
can have a powerful effect, relying as it
does on the willingness of the ‘sub’ to
obey, the consequences of disobedience
and opportunities for the thrill of
‘punishment’. 
 shown that the


‘What is devastatingly humiliating to one
person is not humiliating at all to the
next,’3 which leads Moser and Kleinplatz
to conclude that this is one of the most
difficult aspects of kink play to describe.
Being referred to as ‘slave’; being ‘forced’
to wear certain items of clothing; or being
utilised as a footstool in a play club may all
provide the cues and scenarios in which
satisfying humiliation can be experienced
by the ‘sub’, yet offer few explanations as
to why an individual would find satisfaction
in such experiences. However, Moser and
Kleinplatz note that as certain activities
lose their culturally proscribed status (eg
fellatio and cunnilingus), so they lose their
power to ‘confer a particular feeling state’3
which may provide some clues to


Pain, joy, humour and creativity 

It may seem difficult to understand and
find empathy for individuals engaged in
the giving and receiving of pain, yet risk
and pain are culturally sanctioned within
the world of sport and in the pursuit
of beauty. The pain experienced during SM
scenes is context specific; an SMer is
unlikely to welcome painful experiences
outside a BDSM
scene. Studies have
body releases
endorphins in
response to
pain which
produce a ‘natural
high’ and increase tolerance
for pain. This ‘rush’ may be helpful in
accounting for why some SM practices are
tolerable. Yet SMers’ accounts do not
always fit this picture,8 nor does it fully
answer the questions a therapist may have
when working with clients. Neither does
this theory help in understanding the
meaning of pain for the individual.9 A
research respondent said, ‘It’s like people
think that because I’m a masochist I must
33
enjoy going to the dentist... bizarre.’10
 of the matrimonial home, is not, in our


While it is apparent to academic
researchers that BDSM offers participants
an intense experience, what is often
missed in their analysis is an appreciation
of the delight in the sheer creativity
involved in role play and scenes. Coupled
with this is the inventiveness borne of
intimate knowledge of one’s play partner(s)
and what produces the desired feelings
and experiences. There can be a ready
acknowledgment of the absurd and at
times a scene may need to be ‘paused’
while clothing and dignity are readjusted or
giggles brought under control.
 legally consent to assault’.11
SM and the law 
 The academic perspective
While it is not illegal to be an SMer, there
are activities which may put the BDSM
practitioner in conflict with the law. It is
interesting to note that following the
infamous Spanner case (R v Brown), in
which a group of gay men were jailed for
engaging in consensual SM practices,
there was a review of a previous case, R v
Wilson. This case involved the branding of
a woman (at her request) by her husband.
Bridoux reports the House of Lords judged
them ‘not guilty and declared it a strictly
private matter: consensual activity
between husband and wife, in the privacy
judgment, a proper matter for criminal
investigation, let alone criminal
prosecution’.7 



This apparently contradictory ruling
illustrates the different positions accorded
to different groups, the confirmation of
heterosexual privilege, and the difficulties
society experiences when pain and injury
are associated with sexual pleasure.
Sissons notes that such cases have
‘raised two intertwined issues: whether
consensual S/M interactions constitute
assault, and whether an individual can




BDSM is arguably one of the least
understood and most demonised forms of
consensual sexuality – and these beliefs
carry over into the therapeutic
community12 One of the difficulties in
challenging the psychoanalytic theory that
BDSM is linked to psychopathology lies in
the data, as it is sexual offenders who
have been most commonly studied. In a
damning assessment of the English
analytic perspective, Denman states: ‘The
tone of discussion by the analysts is so
relentlessly hostile, contemptuous and
denigratory that all of the patient’s sexual
34
and other life is at once pre-judged as SM sex and that they mix these two forms
hopelessly pathological and of sexual expression freely.’14

contaminated.’8
 


 Clinical issues and implications
An alternative approach to considering SM
for training and practice 

is offered by Denman through her
We frequently encounter attitudes and
construction of ‘transgressive’ sex (that
behaviours in our clients that challenge us
which attracts social disapproval or legal
as individuals and therapists, and
sanction) and ‘coercive’ sex (that to which
managing our own responses and working
one party has not consented). Denman
with these challenges are part and parcel
states: ‘Linking perversions with other
of the work. Exploring where our
psychiatric disorders is important to
experience of our own sexuality intersects
psychoanalytic theorists because it helps
with BDSM takes that commitment to the
to establish that transgressive sex is
next step.

pathological.’8  Much attention is paid to


the causes of an interest in BDSM.
In adopting a non-pathologising approach,
Theories include Money’s vandalised
it is important to remain alert to
‘paraphillic love map’ through which he
possibilities of abuse. Kolmes, Stock and
proposes a segregation of affectionate
Moser’s research identified that ‘therapists
love and erotic lust,8 and a history of
also acknowledged the dangers of
childhood abuse, though these are not
assuming that all BDSM clients are
borne out by research. Barker, Iantaffi and
healthy, emphasising the need for
Gupta challenge the myth of childhood
therapists who can recognise the
abuse as a possible cause of interest in
complexity and presence of both abuse
BDSM and the perpetuation of these
and BDSM in some BDSM relationships.’15
myths within the therapeutic community.12 


 Useful questions for the therapist to hold
Indicating an integrated experience of in mind are:
what Money describes as ‘affectionate
love and erotic lust’, and thus countering • How aware is the client of their own
his position, Denman writes, ‘Thompson boundaries, limits and needs?
(1994)13 reports that the participants have
straight sex far more often than they have

35
• Is any of the behaviour experienced 

as self-destructive? Nichols suggests that these feelings may
• What do you know of what the client provide useful information for the

is doing to make sure their BDSM practice counsellor around aspects of their own

is safe? sexuality which may be ‘repressed or

disowned’, and offers a model for
• Is the behaviour nourishing or
processing such feelings. 

experienced as diminishing?


• What does the behaviour ‘do’ for the In considering the need for counsellors to
client? deal with their own responses to BDSM,
• What might it release the client from? Barker et al invite therapists to engage
with the ‘broader concept’ of ‘reflexivity’:
• Is client discomfort limited to or
‘Curiosity turned inwards, towards our own
associated with specific practices, scenes
beliefs, stories, feelings and thoughts…’
or words?
So the therapist may avoid becoming fixed
• What does the client enjoy or value on ‘one particular story or interpretation of
within their kinky relationship? meaning’.12 In this way, we do not need to
• When thinking about voicing be comfortable with every kink practice
concerns, consider which part of the but will be working in awareness of our
practice is the bit that does not feel ‘OK’.16 levels of comfort and discomfort.



When working with issues of BDSM
Kolmes et al carried out research into
practice, whether the therapist is a kink
BDSM clients’ experience of therapy.
practitioner or not, it is likely there will be
Drawing on this information, they made
elements of the client’s behaviour or
suggestions for creating a set of guidelines
favoured activities that may provoke a
for working with this client group. Some of
strong response in the therapist. Nichols
the themes which emerged, including
refers to the term ‘squicked’ as used
practices reported by the (few) therapists
within the BDSM community to describe a
who responded, were:15
‘strong negative emotional reaction to an
activity while knowing that you do not 

actually “judge” the activity as “wrong” or
“bad”.’17 


36
Beneficial
• The therapist being open to reading/
learning about BDSM
• Showing comfort in talking about BDSM
• Being able to ask questions about BDSM
• Helping the client to overcome associ-
ated shame and stigma
• Open-mindedness and acceptance
• Not expecting the client to provide all the
education for the therapist
• Understanding and promotion of ‘safe,
sane and consensual’ BDSM
• Being able to understand the distinction
between abuse and BDSM
• The counsellor who practises and identi-
fies with the BDSM lifestyle
• An ability to appreciate the complexity of
BDSM play
• Understanding that some clients may
need help to explore and establish if 
 BDSM lifestyle
they are using BDSM in a positive way.


Harmful
• The counsellor not understanding that
BDSM involves consent
• ‘Kink aware’ therapists who lack
appropriate boundaries
• Therapist assumptions that ‘bottoms’ are
self-destructive and acting from a history
of abuse
• Therapists who abandon clients who
engage in BDSM
• Counsellors who try to ‘fix’ the client on
the sole basis of their interest in BDSM
• Breaking confidentiality because the
therapist assumes others are at risk from
the BDSM activities
• Assuming past abuse has ‘caused’ the
interest in BDSM
• Expecting the client to teach the
counsellor
• Having a prurient interest in the client’s
• Therapists who shame or judge their
clients
• Therapists who adhere to theoretical
approaches that offer pathological
explanations for an interest in BDSM.
37
The argument for sexuality training
 scenes are taken from culturally accepted
The research by Kolmes et al revealed that
simply being willing to work with, or
practising and identifying with, the kink
community is not sufficient to ensure that
therapists working with kinky clients can
do so safely and ethically. It was
concerning to note 
 encourages ‘students and trainees to
that one research respondent described
her experience of working with a kink-
identified therapist as one in which the
therapist ‘seemed more interested in
sharing stories about fun S/M stuff we’d
both done than in acting as my therapist’.
15

Davies makes a case for addressing
sexuality issues in counsellor training in his
article forTherapy Today, ‘Not in front of
the students’. As he asserts, ‘The attitude
of, “I’ve got a friend who’s gay”, is not
actually a good enough prerequisite to
ensure one is going to be able to offer
competent therapy to sexual minority
clients. Neither, as it happens, is being a
member of a sexual minority.’18
 openness and receptiveness to the


A powerful tool in working with student
assumptions around BDSM has been
developed by Barker, in which group
participants are offered a series of ‘scenes’
and invited to consider what, if any,
concerns they may have. The majority of
activities (the stag night, pubic waxing, a
trip to the cinema), while a small number
are real SM scenes drawn from her
research. Barker notes, ‘But these are
almost never the ones that are picked out
as problematic.’ This approach
reflect critically on their existing constructs
before making other alternatives available
to them’.19



In conclusion

It is encouraging to find academics and
researchers increasingly turning their
attention away from pathologising and
towards BDSM communities. This offers a
fresh approach to exploring the
experiences and meanings of BDSM
practitioners which can inform therapeutic
work in the consulting room. Supported by
knowledge, with a willingness to examine
and reflect upon one’s own values and
therapeutic models, and holding an
experiences and meanings of the other,
more therapists may find they are able to
offer non-pathologising and ethical therapy
to members of the kink community. As a
client said to me recently, ‘It’s great, I can
bring all of me here.’
38
 17. Nichols M. Psychotherapeutic issues with ‘kinky’
References

clients: clinical problems, yours and theirs. In Kleinplatz
1. Kleinplatz P, Moser C. Is SM pathological? In
P, Moser C. Ibid.

Langdridge D, Barker M (eds) Safe, sane and
18. Davies D. Not in front of the students. Therapy
consensual: contemporary perspectives on
Today. Lutterworth: BACP. 2007; 18(1):18-21.

sadomasochism. Hampshire: Palgrave Macmillan; 2007.

19. Barker M. Turning the world upside down:
2. Langdridge D, Barker M. Situating sadomasochism.
developing a tool for training about SM. In Langdridge
Ibid. 

D, Barker M (eds). Ibid.

3. Moser C, Kleinplatz P. Themes of SM expression.
Ibid.

4. Medlin J. SSC vs. RACK. www.leathernroses.com/
generralbdsm/medlinssc.htm 
 This paper originally appeared in Therapy Today Vol
5. Easton D. Shadowplay: S/M journeys to our selves. 21 (6) July 2010 and can be found online: 

Ibid. 
 http://www.therapytoday.net/article/show/1984/
6. Beckmann A. The bodily practices of consensual SM,
spirituality and transcendence. Ibid.

7. Bridoux D. Kink therapy: SM and sexual minorities. In
Neal C, Davies D (eds) Issues in therapy with lesbian,
gay, bisexual and transgender clients. Berkshire: Open
University Press; 2008.

8. Denman C. Sexuality: a biopsychosocial approach.
Hampshire: Palgrave Macmillan; 2004.

9. Langdridge D. S/M and the eroticisation of pain. In
Langdridge D, Barker M. Ibid.

10. Taylor G, Ussher J. Making sense of S&M: a
discourse analytic account. Sexualities. London: Sage
Publications 2001; 4(3):293-314. 

11. Sissons K. The cultural formation of S/M. In
Langdridge D, Barker M. Ibid.

12. Barker M, Iantaffi A, Gupta C. Kinky clients, kinky
counselling?: The challenges and potentials of BDSM. In
Moon L (ed) Feeling queer or queer feelings?: Radical
approaches to counselling sex, sexualities and genders.
East Sussex: Routledge; 2008.

13. Thompson B. Sadomasochism. London: Cassell;
1994.

14. Denman C. Sexuality: a biopsychosocial approach.
Basingstoke: Palgrave Macmillan; 2004.

15. Kolmes K, Stock W, Moser C. Investigating bias in
psychotherapy with BDSM clients. In Kleinplatz P, Moser
C (eds) Sadomasochism: powerful pleasures.
Binghampton, NY: Haworth Press; 2006.

16. Barker M, Langdridge D. Understanding kink and
BDSM. London: Pink Therapy Workshop; 2008.


39
Further Resources

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library of resources (reports, articles,
podcasts, videos etc) on a wide range of
GSD issues.
£15
We’ve put together a USB key for sale and + £3 p&p
which you can order for £15 plus £3 p&p.

If you would like to purchase one, please

email admin@pinktherapy.com and we can
organise how to get one to you.

40