Wednesday, August 1, 2018

Sexual Behaviors in the United States and in Quebec: Looking at Sex Variation

Debbie Herbenick, PhD

In July of last year, Indiana University School of Public Health researcher Debby Herbenick and her study team published the first replication of Ed Laumann et al’s National Health and Social Life Survey (NHSLS) in nearly 25 years.   Commissioned to provide a scientific basis for sexual health interventions in response to the AIDS crisis, the NHSLS was limited to asking questions about hetrosexuality, homosexuality, and those behaviors most instrumental in HIV transmission.  Laumann et al, wisely focused on social networking theory in the hope that understanding who was sleeping with whom might guide policy.  But the NHSLS did not inquire broadly about sexual variation.  It barely made it through the Congressional appropriation process over the politics of using public money to pay researchers to ask citizens questions about their sexual behavior.  Kink was simply too outrè to include and retain hope of funding.



Despite the fact that Karl Marx first used survey methods to forecast London election results in the 1840s, and the US had been regularly using surveys for a variety of purposes since the 1940’s, the NHSLS was the first and only investigation of US sexual behavior using a statistically representative sample of the US population until Herbenick’s recent work.  Not that Laumann’s work accomplished much politically.  Following his publishing of The Social Organization of Sexuality (1994) and Sex in America (1995) based on the NHSLS dataset, fear provoked by the AIDS crisis led the Federal Government to squander over a billion dollars on ineffective abstinence-only education which relied upon none of this research team’s insights.  But that study did provide the first sound statistical basis for describing who and was having sex with whom, and what kinds they were having among the various common sexual practices that comprise the modal portion of the spectrum of sexual variability.  It is the single most frequently cited work in the sociology of sex since the work of Alfred Kinsey.

Herbenick has been conducting sexuality studies on representative US samples for eight years.  Most of these have looked at sexual variation issues related to heterosexual and LGBT orientation, modal sex behavior, and even and sex toy use.  Spurred by the dark whispers of various insurgents and her own towering scientific curiosity, Herbenick, D, Bowling, J, Fu, T, Dodge, B, Guerra-Reyes, L and Saunders, S, in PLOS One (2017) broadened the spectrum of behaviors investigated, directly replicating Laumann’s questions about conventional practices, but inquiring substantially more broadly.  Herbenick’s 2015 questionnaire published therein was not a comprehensive Noah’s Ark of every conceivable variant practice, but it did cover the rudiments of homosexual practices; multiple partner behaviors; kink, sex toy and erotica use; and inquired about internet use and mobile apps.  To repeat, this study provides the first inquiry ever about such an assortment of practices on a representative US sample.  And it provides plenty of brand new information and basis for suggestions about how those of us interested in further research on CNM, polyamory and kink might delve next for a deeper understanding of the relationship between kink, mental health concepts, and the management of social stigma.  This in turn, is valuable to therapists who might treat the problems and discontents of the sexually adventurous.

Here is a very abbreviated summary of the study results. These are lifetime percentages of the listed behaviors for men and women:



Behavior
M%
F%
Behavior                    
M%
F%
Vaginal intercourse:
85
83
Gave partner oral sex:                    
83
82
Received oral sex:                                       
85
85
Insertive anal sex:
46
-
Received anal sex:                                       
09
37
Worn sexy underwear/lingerie:    
26
75
Partnered sex in a public place:
45
43
Tied up partner, or been tied up:
26
22
Playfully whipped or been whipped:
16
14
Spanked or been spanked:
30
34
Used vibrator/dildo:
33
50
Used an anal sex toy: 
18
16
Sex enhancement pills/herbal supps:  
21
08
Read erotic stories:
57
57
Sex guide or sex self-help book:
32
34
Used a phone app related to sex:
12
06
Looked at a sexually explicit magazine:
79
54
Sexually explicit video/‘porn’:
82
60
Sex over Facetime/Skype:
14
11
Nude or semi-nude photo of self:
24
27
Received nude or semi-nude photo:
41
27
Flirted with someone in chat/SMS:
40
36
Gone to a strip club:
59
30
Taken a class/workshop about sex:
04
04
Had a threesome:
18
10
Had group sex:
12
06
Gone to a sex party or swingers party:      
06
05
Gone to a BDSM club or dungeon:
04
03

In addition to these gender differences, the Herbenick team tabulated data about age cohorts, and how many people had done the behaviors in the last month and last year.  They also inquired about the subjective appeal of the above behaviors, which was in all cases broader than actual participation.  Of course, behavior and meaning are highly variably associated.  The research team addresses this explicitly in accounting for the large number of lower frequency sexual behaviors that are conducted by less than two percent of respondents in the last month but have much higher aggregate lifetime percentages.  These data focus on behavior, and appeal, but not on other attitudes or identifications so it is fair to say that these data tell us a lot about who has had sex scenes with multiple partners simultaneously but does not tell us about polyamory or consensual nonmonogamy.  Although some of the signature behaviors of BDSM are asked about directly, it is not possible to estimate the overall prevalence of the main BDSM behaviors without items addressing cross dressing or fetishism.  We eagerly await the team’s later report about trans, gay, lesbian and heterosexual behavioral differences in these behaviors.

Christian Joyal, PhD

Still, much can be said about this rich data trove that comes from the brave first effort to collect systematic data on a much broader spectrum of sexual practices.  The first observation is that, like Christian Joyal’s team’s research on Quebecoises, the conventional romantic behaviors remain widely the most popular.   The largest proportion of respondents in both data sets find them appealing and in both data sets, appeal is broader than participation.   In both data sets, a very wide bandwidth of sexual variability is common, and an even broader bandwidth is uncommon, but statistically frequent enough to be practiced by more than 5% of the population.  Whatever one’s moral judgments might be, none of these behaviors were statistically aberrant.   In this sense, they constitute a partial validation of Joyal’s conclusions about the Diagnostic and Statistical Manual’s paraphilia diagnoses, even though Herbenick did not attempt a direct replication:  appeal and frequency of most behaviors do not justify calling any of these activities paraphilias except taking classes and workshops and attending BDSM clubs or dungeons if the definition of ‘paraphilia’ requires they be statistically anomalous.

For comparison, here's a look at Joyal and Carpentier’s lifetime frequencies on their sample of questions based on the eight paraphilias of the DSMs.

Voyeurism
Men: 60%
Women: 35%
Exhibitionism
Men: 06%
Women: 03%
Fetishism
Men: 40%
Women: 48%
Frotteurism
Men: 34%
Women: 31%
Sadism
Men: 09%
Women: 05%
Masochism
Men: 19%
Women: 28%
Transvestism
Men: 07%
Women: 06%
Sex with a child
Men: 01%
Women: 00%

Joyal and Carpentier’s questions do not line up well with Herbenick’s.  For example, the psychiatric definition of voyeurism as being aroused by viewing someone non-consensually is very different from viewing porn or receiving a sexy pic from a willing partner.  Herbenick did not report questions that assessed frotteurism or cross dressing at all.  Additionally, cross dressing means very different things in Gay female impersonation, heterosexually identified cross dressing, fetishistic cross dressing and humiliation play, ‘shemale’ porn, and transgender sexualities where it is not technically cross dressing at all because clothing is fully appropriate to one’s (non-traditional) gender.  Sadism and masochism also track poorly to ’whipped or been whipped’ and ‘spanked or been spanked’ questions where power role is not specified.  Joyal’s and Carpentier’s conclusion that 48% of Quebecois respondents endorse at least one ‘paraphilic’ behavior begs for a comparison statistic from Herbenick’s sample about how many Americans had done at least one of any BDSM or multiple sex partner activity lifetime, last year, or last month, although this would still exclude the nonconsensual paraphilias Joyal included in his overall figure. 

It takes some reading between the lines, but in many way, these figures look similar.

That said, the participation of the most popular single dimension of BDSM: spanking, runs at least 7 times the frequency of ever having attended a BDSM club or dungeon.  If we recognize that not all ‘spankos’ regard themselves as kinksters and recognize the non-overlap of those who prefer whipping, role play, bondage, and the absent major categories of crossdressing and gender play, and fetishism, it is probable that participation in BDSM communities covers about 10 percent or less of people who have ever tried kinky behaviors at least once so far in their lifetimes in Herbenick’s sample.  This makes those kinksters who do participate in ‘out’ community activities seem like an elite vanguard who are at risk of being systematically different from the bulk who do not socially participate.   This also suggests that considerable risks attend our efforts to extrapolate what we know about kink from studies of kink samples of convenience drawn from socially ‘out’ kinksters.   I note also that in S.Wright, D. Cox and R. Stambaugh’s 2014 Consent Violations Survey, 70% of our sample of convenience stated that they were not out to family, co-workers, or people with whom they lived.   I am using ‘out’ here in quotes to mean out enough to participate on-line or socially in kink, a definition shared by neither Joyal’s team nor Herbenick’s.

These results do not inquire directly about the important phenomenon of on-line sexual communities. But they do provide some basis for reassuring us against panic stemming from spreading technology use.   If negative health or psychological effects attend technology use, surely the low rates of use of phone apps, for example, preclude epidemics related to their use.  Men and women have strikingly similar rates of picture sharing on-line.  This does not prove that they are sent and received consensually, or such behavior is satisfying, but the appeal rates of these behaviors suggest that many find the fantasy appealing in prospect despite media-documented risks and problems.


©Russell J Stambaugh, PhD, Ann Arbor, August 2018

Wednesday, March 7, 2018

Boundaries, Identity, and Transgression



Something there is that doesn’t love a wall,
That sends the frozen-ground-swell under it,
And spills the upper boulders in the sun,
And makes gaps even two can walk abreast.
The work of hunters is another thing:
I have come after them and made repair
Where they have left not one stone on a stone,
But they would have the rabbit out of hiding
To please the yelping dogs.  The gaps I mean,
No one has seen the made or heard them made,
But at spring mending-time we find them there.
I let my neighbor know beyond the hill;
And on a day we meet and walk the line,
And set the wall between us once again.
We keep the wall between us as we go.
To each the boulders that have fallen to each.
And some are loaves and others so nearly balls.
We have to use a spell to make them balance:
‘Stay where you are until our backs are turned!’
We wear our fingers rough with handling them.
Oh, just another kind of outdoor game,
One on a side.  It comes to little more:
There where it is we do not need a wall:
He is all pine, I am apple orchard.
My apple trees will never get across
And eat the cones under his pines, I tell him.
He only says, ‘Good fences make good neighbors.’
Spring is the mischief in me and I wonder
If I could put a notion in his head.
‘Why do they make good neighbors?  Isn’t it
Where there are cows?  Here there are no cows.
Before I built a wall, I’d ask to know
What I was walling in or walling out,
And to whom I was like to give offense. 
Something there is that doesn’t love a wall,
That wants it down.’  I could say ‘Elves’ to him,
But it’s not elves exactly and I’d rather
He said it for himself.  I see him there,
Bringing a stone grasped firmly by the top
In each hand like an old-stone savage armed.
He moves in darkness as it seems to me,
Not of woods only and the shade of trees.
He will not go behind his father’s saying
And he likes having thought of it so well
He says again, ‘Good fences make good neighbors.’

Mending Wall, 1917  Robert Frost


Brene Brown

“Daring to set boundaries is about having the courage to love ourselves, even when we risk disappointing others.”

Brene Brown



On the eve of American entry into World War I, American poet Robert Frost penned "Mending Wall," this playful, transgressive, and highly nuanced meditation on boundaries.  In it, he questions everything about boundaries.  Their necessity and utility, the need for cooperation in their maintenance, their relationship to tradition and identity, the fact that maintaining the boundary provides occasion for community, and he recognizes that boundaries are both responses and prey to aggression that menaces us from the dark place in others of which we are often fearful.  Despite his neighbor’s otherness, Frost’s narrator cannot resist poking him about the wall, and when he does, he finds psychological differences and defenses that have little to do with good husbandry.  In this he recapitulates our ambivalence about diversity:  that the recognition of difference often requires tolerance.

Woodrow Wilson imagined he could keep a divided United States out of World War I.  Once in, he violated many of our most cherished boundaries that protect freedom of dissent.

Back in 1914, secure within the natural boundaries of two great oceans, the United States had a strongly pacifist President, and little reason to fear that the dark forces gathering in Europe would engulf us.  Greater was our natural fear of our own fellow citizens, whose historical ethnicities and identifications would be deeply divided when the war broke out in Europe.  About a third of Americans were of German origin, and sympathy for Germany was widespread.  Another third, and many of our country’s cultural traditions, came from Great Britain,  one of Germany's opponents  And yet we would all have to pull together when the Atlantic proved not to be a boundary, but a battleground.  German insistence on using unrestricted submarine warfare sank American ships and killed American sailors, thus dragging the US into the war.  Uncomfortable with one another or not, Americans would fight together despite their differing ethnic identifications and identities over this 'boundary issue.'

In psychotherapy, boundaries are often viewed as a valued necessity.  In my shorter quote, Brene Brown sees them as a concomitant of constructive self-esteem.  She is emphasizing that we cannot uphold our values if we cannot say ‘no’ to pressures from others to compromise them.  Like Frost’s classic poem, which was apt to his times, Brown’s quote is apt to ours, when public servants decline to compromise across party lines for fear of betraying their principles.  Parlous times make for rough boundaries.  Some are even proposing a wall…


The Great Wall of China.  Our current President was hardly the first to consider a wall.  This one was indeed, 'great', 'big' and 'beautiful', although far from entirely effective.

Boundaries are an important kind of psychological resource, and those who experience serious boundary problems are vulnerable to many social ills.  But boundary problems are endemic to the human condition, careful thought and reflection are needed when clients appear to handle them in a dysfunctional manner.  Community context, subcultural values, client goals, and partner agreements must be thoroughly understood to interpret the meanings associated with boundaries properly.  Often, boundary problems are overdetermined, influenced by many factors, and are not susceptible to simplistic solutions.
Boundaries are often described as an individual psychological skill or attribute.  People do vary considerably in their skills at using them. However, this essay proceeds from a rather difference conceptualization; boundaries are socially constructed, and require collective participation to maintain or break.  Often, they are not a simple contract between two parties, nor is the responsibility for their maintenance clear or constant.  Anyone who examines successive maps of Europe over the last millennia sees that boundaries are far from static, as they ebb, flow, endure and evaporate over time.  Nor are they simple contracts between neighbors, as Frost observes.  For a look at how much the map of Europe has changed over the last 1017 years, click on this link to YouTube (takes about 2 minutes.) Changing European Boundaries 1000AD to the Present

In the previous essay on this blog, Darkness I closed with the suggestion that consent was an important ethic, but only the starting point for an ethical framework for BDSM.  Boundaries are an excellent example of how consent cannot cover all the bases.  Boundaries are often not a simple matter of agreement between two roughly equal parties.  Not only are parties not always nearly equal, but boundaries are defined, imposed and maintained by stakeholders who may not be present nor have any input in consent agreements.

One of the things I have often heard from therapists about kinksters is that they have “poor boundaries.”  This is a very interesting comment, and it does not do to immediately refute it.  This is particularly true because we all know clients, kinky or not, who do in some manner have poor boundaries.  They are late for appointments, or they fail to pay their bills.  They don’t do their therapeutic homework, or interrupt us or their partners in session.  They show off at inappropriate times, or hog the spotlight.  Sometimes they insist on being the identified problem.  Other times, they refuse our suggestion that they have any problem at all.  Some, in a meeting of G-7 participants, barge in front of the assembled heads of state.  Oops, sorry, that is not a kinky client, that’s the President of the United States!  “Good fences may make good neighbors”, but there is a lot of boundary violation going around these days.   In the electronic realm, we often do not even know where the boundaries are.

However, as I write this, we see lots of analogies on the international stage that make boundary violations inevitable, if not exactly acceptable, and the root causes for these are not always clear.  Fighting in Syria deliberately destroys the boundaries of people’s neighborhoods, and they find themselves struggling to smuggle themselves into Europe, thereby violating international borders.  Donald Trump determines to build a 30-foot wall on the American/Mexican border at a point when net migration from Mexico is zero.  And his conceptual boundaries decline to differentiate an American citizen of Mexican descent from an undocumented migrant.  These discussions of boundaries are impregnated with issues of power.


Syrian Refugees coming ashore on the Greek Island of Lesbos in 2016.

Boundaries are an important part of social life, and transgressive values can be highly problematical with these.  Often, therapeutic boundary discussions are saturated with power dynamics that conflict with constructive therapeutic goals.   We as therapists often assume our role is to set boundaries in therapy and if we have difficulties getting a client to accept our lead on how these boundaries are to be observed, we make negative judgments about the client.  That may be appropriate sometimes.  In kink, as in other walks of life, transgressive behavior can denote insensitivity, hostility, and a readiness to harm others.  But like those unwanted migrants, these behaviors originated someplace else before they wash up on the shores of our consulting rooms.  Often clients are using the best boundaries they are able, and their handling of limits is a reflection of their past experiences that seem far more compelling to them than our rules do.   In our own ways, all of us are like those Syrian refugees, living as best we can within the boundaries around us until we can’t, and then taking the risks that we will be sanctioned for violating somebody else’s rules.   It turns out, feeling like you can set your own boundaries is often correlated with having high social privilege.

Of course, this discussion of boundaries follows hard on the post about darkness because of the problems ‘boundary violations’ pose for the attempts of the kink communities to use consent and contracting as boundary processes.  Consent violations degrade safety, and undermine the integrity of kink’s PR claim that “Safe, Sane and Consensual” provides genuine security for participants to make sound decisions about which erotic risks they wish to assume.  Contrary to Frost’s implication that walls aren’t needed if there are no longer any cows to stray, boundaries provide a measure of security, whether we need it every moment, or only occasionally, and even when there are no longer any cows.

As a cautionary, I point to data from the 2014 Consent Violations Study, in which one sixth of those people who had had at least one consent incident to report, described five or more.  Given the prevalence of kink education efforts and the pervasive kink culture of consent, it is fair to conclude that there are people who repeatedly risk re-traumatization through BDSM experiences that are not conforming to safety norms in the kink community.  Although we found that consensual non-consent and 24/7 submission experiences are riskier than some other BDSM experiences, these multiple consent victimizations were not associated with especially high-risk types of play.  Rather, those complaining of these violations seemed to take little benefit from the norms and structures that kink has set up to make communities safer.
 
Therapeutic Boundaries and Ethical Considerations:

The culture of psychotherapy may share some fundamental values with the kink community, but the two cultures diverge at many points.  One of these key differences is in how boundaries are understood.  This essay on therapeutic boundaries for altsex clients is the beginning of a discussion about the various goods that are in conflict, but it is intended to legitimate the feelings often reported by kinky clients and the therapists who treat them that crucial goods are in conflict which are understood in fundamentally different ways by the two communities.  In such circumstances, it is typical to feel ambivalent and torn between competing values.  This is often a consequence of social role conflict, and competing values, not necessarily deep-rooted psychopathology. 

Some of these differences emerge from the histories of the helping professions and of kink, which will be briefly reviewed here.

In previous essays, I have reviewed the lives and some of the contributions to kink of crucial figures like the Marquis de Sade and Leopold von Sacher-Masoch.  These authors wrote and behaved in ways that were very critical and defiant of the conventional social boundaries of their times.  The Divine Marquis never saw a socio-sexual boundary he did not wish to break.  He eroticized murder and disparaged the use of the guillotine for bureaucratically decreed dispassionate executions.  Von Sacher-Masoch gave us the sadomasochistic contract, but despite his erotic fantasies of submission, he leveraged his social position to coerce his wife into behaviors to which she declined to consent.  Although these two writers did not dictate the modern boundaries of BDSM, they did much to establish its ethos.  And it is an ethos of violating contemporary sensibilities about how sexuality is conducted between partners in which conventional boundaries are ignored.

When kink began to organize as a subculture, however, it developed boundaries of is own.  This initially involved respect for other participants’ secrecy about ‘the Life’, and shared efforts to prevent those who were not part of sadomasochistic communities from knowing about BDSM activities until they were regarded as safe to tell.  In some of the early gay leathersex motorcycle cubs, new members had to prove they were sincere by starting out in submissive roles, regardless of their preferred sexual scenes.  This ensured that new members were fully indoctrinated in the group’s etiquette, as well as discouraging anyone who was not serious or sincere.  Early contact organizations carefully protected sadomasochists’ identities through re-mail services, in which codes were employed to ensure that participants’ identity and addresses were protected until they were ready to reveal them to those who corresponded to establish relationships or sex play.


Boundaries about doctor/patient confidentiality implemented by the United States Federal Government

Doctors and psychotherapists are also aware that many matters discussed with their clients are stigmatized.  Clients are afraid that others will know if they have a disease, disability, or painful history.  In an attempt to ensure that such matters are fully shared in treatment, doctor-patient communications are confidential.  Laws like the Health Insurance Parity and Portability Act (HIPPA) ensure that many aspects of a patient record remain confidential.  It is a measure of the social acceptability of these arrangements that such rules are characterized as ‘privacy’ when we discuss medical information, but ‘secrecy’ when discussing customarily private sexual behavior!  But therapists and altsex clients are both familiar with the importance of confidential communications even if some reasons are more widely viewed as legitimate than others for maintaining these boundaries.

In another chapter I discussed the development of the Safe Sane and Consensual (Slogans) ethos and its viral spread among the early above ground kink communities in the 1980’s. This led to the eventual development of an ethos of explicit sexual contracting, and educational programs aimed at making play safer.  Other attempts to create boundaries include the institution of Dungeonmasters to monitor the safety of playspaces, and house rules of conduct in playspaces to prevent outsiders or novices from interfering in scenes.  While there are many kinksters who criticize, disagree, or even reject some of these ideas and procedures for enforcing boundaries, it is fair to say that experienced participants in kink social organizations have extensive exposure to community boundaries, and many who have never played face-to-face have read about them.


Figaro was a barber and a surgeon.  Its all in the wrist, you know!

Therapists, proceeding from their status as allied health professionals, learned about professional boundaries from the professional ideologies of physicians.  Physicians in turn, learned their professional boundaries from their long emergence from quasi professional status in the medieval period to alpha professionals today.  Back in Galen’s time, “First do no harm” was their equivalent of “Safe, Sane and Consensual”.  Intended as a professional ethic, it also functioned as a public relations statement. Back when doctors had little knowledge of the boundaries of what they ‘knew”, it was impossible to implement except by rote repetition of accepted practice.  Remember that melodious buffoon in The Marriage of Figaro?  He wasn’t just a barber, but a surgeon, and as such he was the object of much jest, but also considerable fear.  Although adept with a blade, surgeon/barbers lost many patients due to the risks of therapeutic bloodletting and from unintended sepsis due to unsanitary incisions stemming from the lack of knowledge about the germ theory of disease.  With the emergence of medicine as a systematic science in the 19th century, physicians and surgeons gained the social and commercial power to dictate what good professional boundaries meant.  Good patient management has gradually come to mean not only that physicians, not patients, get to determine the time and place of their meetings with clients, but that they no longer make house calls and instead maintain offices with lots of diagnostic equipment and the tools to maintain sterile conditions.  The power balance between physicians and clients has been decided by physicians, hospitals, technological advances and medial insurers, with little input from their clients.

All of this was very far along in practice in 1980 when I began training as a clinical psychologist.  I was taught that I was responsible for determining the time, place, length of appointments, and great training effort was expended on what I could say about clients and to whom.  I was instructed that therapeutic boundaries were all important in establishing the boundaries for successful treatment, and that it was my job to educate my clients to these rules.  This did not mean rigidity was recommended for its own sake, but my ethical boundaries as a therapist, while grounded in Galen’s dictum, were not just between my client(s) and me.  I was a representative of my entire profession, not just my personal values or therapeutic orientation.  I had responsibilities to my client and even myself, but also to my profession, the state, and to the larger society that needed to be considered in setting boundaries and in contracting with my clients.  This is equally true in 2018.  As an AASECT Certified Sex Therapist, I promise to adhere to The AASECT Code of Ethical Conduct.  This set of guidelines was adopted with three goals co-equally in mind:  protection of the public, protection of the profession, and protection of the individual practitioner.  Never mind that those lofty goods occasionally conflict, and their interpretation was dependent upon time, place and changing social context.
 
Boundary maintenance has a central role in the in how we as therapists think about professional ethics.  We set appointment times not only to regularize and regulate our own schedules, but to communicate our stability, predictability and reliability to clients.   We keep the focus on their thoughts feelings experiences and narratives as demonstration and fulfillment of our promise to put their welfare first.  We moderate our feelings about their stories because personal stories are highly emotional, and over-responding to their experience risks substituting our narrative for their own.   When Sigmund Freud discovered that severe behavioral symptoms might moderate from discussion alone, but that in such intimate discussion, patients often fell in love with their doctors, often in ways that went far beyond routine gratitude for the gifts of relief from illness, psychotherapists became sensitized to the importance of boundary maintenance in handling these transference feelings.  Professional neutrality wasn’t merely an expression of routine social discomforts about emotionalism, but disclosure might obscure the client’s symptomatic needs to view the therapist unrealistically, and failure to notice that in treatment might delay the process of cure.  So, all manner of personal information and contact outside of the therapeutic office became professional boundary issues too.

In June of 2017, AASECT put on an Ethics Workshop in Las Vegas addressing professional boundary issues in dealing with the alt sex communities.  Ruby Bouie Johnson, Angie Gunn, and I were moderated by Reece Malone and AASECT Ethics Advisory Committee Chair, Dan Rosen.  I went first and outlined some of the historical context I have presented above.  Noting that subjectivity was privileged in kink in a way that it was not in psychotherapy, I suggested that appropriate boundaries depended greatly on whether you accepted the Freudian ideas that transference was ubiquitous, and addressing it central to the process of therapeutic transformation. If you believed in transference, then you needed to keep firm boundaries so that therapy was not contaminated by what the client knows about the therapist’s life outside of the consulting room.  Ruby discussed process for negotiating boundaries in treatment in the context of intersectional cultural competence, and recognized that in her home state of Texas, some goods needed to be sacrificed to the necessity of maintaining a license to practice.  Angie emphasized the sex negativity of needing to hide our sexualities from our clients who were in the process of trying to decide to come out about theirs.  She maintained that authenticity required open expression of one’s gender and sexuality.  Still, you could hear a collective gasp when she revealed that she sometimes became nude with clients.  In the regulatory context of Portland, and with her clientele, Angie maintained that touch was a boundary violation, but nudity was a good role modeling.  Debate about this echoed for several weeks on the AASECT Listserv.


If this was intense enough to be worth doing, you may not want the therapeutic consequences of needing to discuss it's impact on the client who saw you.

Boundaries are not just about what goes on within the psychotherapeutic consulting room, however.  Among the most persistent inquiries in AASECT from those serving the kink communities are questions about how proper boundaries with that community are to be maintained.  In many places the alt sex communities are small, polyamorous, and it is not possible for kinky therapists to play near where they practice without risking the possibility of running into clients.  Many clients would not be offended and have no basis for objecting to seeing their therapist expressing personal sexualities.  But AASECT itself, and the other psychotherapeutic professions have serious and cogent objections.  Those of us who hold licensed professions and who have signed our agreements to uphold the codes of conduct from our professional organizations are contracted to uphold their standards of conduct.  Often these were made with the recognition that unethical therapists often used the intimacy of the consulting relationship to meet their own sexual needs with vulnerable clients who were seriously harmed by such behaviors.
 
While this may go a long way towards clarifying the boundaries of professional behavior, it does not really resolve Angie Gunn’s challenge about the benefits of clients who are coming out about their sexuality.  For myself I have resolved this as follows:

1)   About 70% of 2014 Consent Violations Survey participants, all of whom discovered the survey either through on-line kinky groups or their local BDSM social organizations, said they were not out to family, co-workers, or other people with wom they interacted routinely.  As important as the decision to be out can be, under the prevailing conditions of social stigma, it is by no means a sure sign of sexual authenticity for all clients to be out.  I regard therapy as a place to explore such questions where, as passionately as the client, or even the therapist may feel about the issue, the opportunity is preserved for neutral discourse about it.
 
2) 150 years of professional sexology have failed to reveal enduring scientific principles about how people choose their preferred forms of sexual behavior.  In this vacuum of good theory, the dictum ‘first do no harm’ is better served by neutrality, and by trying to privilege the client’s discourse over the therapist’s about such matters.  In many cases, I refer clients to external sources for their psychoeducation.  Making clear that these are the opinions of the writers, not my own, the client is invited to discuss anything the readings may bring up.

3) While at SSSS 2017, I saw data suggesting that early childhood sexual experiences involving older, but non-adult participants, might account be correlated with paraphilic interests relative to normative ones.  This is the best data ever that some specific historical factors might predispose a client to kinks.  But even the biggest effect sizes accounted for only a substantial minority of the variance between measures: about 30%.  So even with such data, I would be assuming a lot if I tried to apply this to clients who didn’t volunteer such stories spontaneously in treatment. (Poster:  Associations between Paraphilic Interests and Early Sexual Experiences: The Role of Partners and Perceptions – Lauryn Vander Molen, BA; Scott Ronis, PhD; Raymond McKie, MSc; Terry Humphreys, PhD; Robb Travers, P.)

4) While therapeutic transference has never been adequately demonstrated by properly scientific means, it has been widely clinically understood for 130 years.  For half of that period, it was seen as the crucial factor in all treatment.  If a client’s feelings toward the therapist are crucial in many cases, I owe my clients’ freedom from the burden of knowing about my sexual interests and behaviors, even if this constitutes a kind of paltering that implies support for cis-gendered heteronormativity I may not really support.  I can only oppose conventional or alternative practices in therapy if I believe that these represent a clear and present threat to the client’s welfare or self-determination.  A client running into me at a kink event or a conventional one risks the possibility of provoking them to realistically re-context our work.  That has draconian implications for my ‘freedom’ to express myself sexually in place clients might encounter it, even if I had their full foreknowledge and permission.  If I am to be an authentic professional, I must put client welfare first, but I might still be an authentic kinkster if my kink did not require the general public to know about it.

5)    The fly in this ointment of personal disclosure is power. I enjoy professional power and privilege and a freedom to negotiate the boundaries of my treatment with clients who, from their personal discomfort, suffering, and even psychopathology, must turn to me for help.  In return for those powers, I must not demand of clients that they assent to being exposed to my personal sexual choices.  The professional consulting relationship deprives them of the full freedom to say whatever they think about my sexuality, no matter how hard I try to level the inherent power imbalances.  When advocates demand that I ‘check my privilege’, this is how I interpret the checking in question is to be accomplished.

6)    Because I cannot immediately effect the resolution of social power imbalances in American society, I have a professional and ethical obligation to advocate against arbitrary stigma.  This may be a long and arduous process, but it creates the possibility that a day may come when being out or not will not be a risky hallmark of personal authenticity.  When that happens, the boundaries we need will change, and therapists and clients might enjoy greater freedom of sexual expression.  I do not believe that day is yet here, but this essay is a tiny piece of the work towards bringing it about.

© Russell J Stambaugh, March, 2018, Ann Arbor MI, All rights reserved