Dear Patti,

My husband and I both agree that we have a good relationship, but recently we felt like we were drifting apart and started going to couples therapy. We specifically wanted to work on our intimacy and better communication with each other. I thought the sessions were going pretty good until the third time. I admitted that I had long buried sexual fantasies about being dominated and tied up. I felt very vulnerable admitting I was interested in domination and bondage, but I wanted to know how my husband felt about it. I was secretly hoping he might be into experimenting with some of my kinky desires, but I didn’t want to turn him off.

Instead of being supportive, it felt like the therapist insinuated that I was perverted for even having these ideas. She pushed for me to see her individually so we could look at my childhood history in order to figure out where this “urge to act out” stems from. I told her I didn’t like that she assumed I needed fixing, especially since I’m high functioning and not suffering from depression or anxiety.

Now, I no longer trust her to work with us as a couple and certainly not in individual therapy, which I wasn’t even seeking. I thought a therapist would create a safe place for me to open up with my husband, not make me feel defensive and judged. My husband was disappointed that we have to start all over again with a new therapist, but he actually seemed excited that I wanted to open up more to him.

I wish I could find a therapist that has similar kinky interests and might understand.

— Renee

Dear Renee,

Psychotherapy is a vulnerable, intimate journey traveled together by a patient (or two) and a therapist. In order to be effective and healing, there must be trust and support present. I understand that you had a negative experience, but I’m actually quite impressed with how you handled it. You spoke up immediately when you felt judged. When it became clear that the issue wasn’t going to be resolved, you left but you didn’t give up, and you’re still looking for another couples therapist.

A significant number of adult Americans engage in consensual sexual behaviors that involve bondage and discipline, domination and submission, and sadism and masochism (collectively abbreviated BDSM). It is important that a professional therapist who treats couples that are interested or involved in BDSM understand the difference between abuse, violence, and BDSM, differentiating between pathological and non-pathological behavior. A therapist needs to be able to recognize the difference between clinically significant psychological distress and socially induced stress related to the BDSM interests. As you know yourself, it was stressful to open up to your husband and you felt the need to hide feelings long ago when they initially surfaced.

Unfortunately, it’s not uncommon for people interested in BDSM to experience stress related to being honest, internalized shame, relationship conflicts with existing partners, and as you experienced, opening up in therapy. Therefore, having an accepting therapist that can model a positive, supportive attitude is extremely beneficial and has intense therapeutic power.

Therapists are often encouraged by their peers to explore their own countertransference in order to be aware of how the therapy they provide is influenced by their own emotions, values, and biases. This is especially true when working with minority populations, such as patients involved with BDSM. Without an understanding of one’s own emotions, a therapist’s feelings of anger, worry, or fear can manifest into a deeply felt conviction that the patient’s behaviors are self-destructive, even without concrete diagnostic evidence that the patient is being harmed. When that’s the case, there is a good possibility that countertransference is occurring.

I understand your desire to be with a therapist with similar interests, but it has been shown that having an interest in BDSM alone is not enough to qualify someone to work with BDSM patients. Professional clinicians should have coursework, supervision, and specialty training related to BDSM patients before ever attempting to specialize in these issues therapeutically.

Patients who believe they are negatively judged by their therapists based upon their BDSM interests are less likely to share information openly, which limits the therapeutic bond and weakens the success of therapeutic interventions. Therefore, it is important that BDSM patients receive competent treatment including respect and positive regard.

I hope this information helps you in finding the right therapist.


Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has an office in Pasadena. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her website, patticarmalt-vener.com