Saturday, May 11, 2013

More Flavors

One of the keys to successful therapy is managing our feelings towards our clients.    These are called by the psychoanalytic term ‘counter-transference,’ even by non-Freudian therapists.  There are two sources of counter-transference.  Some feelings are brought to mind because the client is treating you in a particular way that may well be related to the problems you are working on together.  At its most powerful, a client brings a disposition to treat many people that way, and pointing it out in therapy can create insight and facilitate change.  I call this ‘induced counter-transference.’

In order to be sensitive to client’s dynamics, effective therapists are aware of their own dispositional tendencies so they can be empathic without their own unresolved issues getting in the way.  When the therapist’s feelings and prejudices do interfere, that is ‘neurotic counter-transference,’ and it is a formidable barrier to hearing the client’s point of view in his or her own terms.  

Not all neurotic counter-transference is provoked by full blown psychopathology.  People choose their professional and recreation roles in life for systematic reasons, and for the great majority of therapists who are not themselves kinky, there is good chance that they see the world differently than their sexually variant clients.  This is an important idea to keep in mind when looking at a few important dimensions of kinky activities that are implicit in kinks, even though they do not contribute initials to ‘BDSM.’

"Can you hang on just another minute?  I'm trying to get a peak centered in the background!"

Risk:  This is an unstated dimension in BDSM activity, but given that kinky behavior is socially stigmatized activity, every participant comes to some provisional adjustments about risks associated with possible discovery.  For some, the fact that variant activities are novel or even dangerous is part of the erotic frisson; overcoming or managing risk can be erotic and/or counter-phobic.  For others it is a potential turn off that needs to be managed.  Of critical importance is the fact that subjective risk experienced by kinky clients and actual risk (in so far as you can know it) may be very different.  Everyone into BDSM makes decisions about the risks and benefits of being out, but sometimes the risks that are being played with are highly symbolic reenactments childhood issues.  Sometimes variant behaviors involve here-and-now safety risks with self-damaging potential consequences. Psychologically or physically dangerous activities are openly acknowledged by the BDSM communities, and are referred to as ‘edge play.’

In my experiences, the average therapist is a good deal more risk averse than the typical kinkster.  And taking sexual risks does not imply that kinky people are taking other life risks, like playing penny stocks, drag racing on the street or cage fighting.  It is always wise to research the risks of client behaviors more thoroughly if they make you uncomfortable.  Maybe its just you, or maybe the client is in therapy because of her own mixed feelings about the risks.

Sometimes its good to be bad!

Transgression:  This unstated dimension is important to assess because it is seldom explicitly examined.  Many BDSM participants are turned on by the fact that what they are doing is regarded as bad or naughty, breaks the rules, or defies convention.  BDSM is sometimes a bid for acceptance of ideas, feelings or fantasies that one feels would likely be rejected if others knew.  Finding a partner who understands this feels like achieving special acceptance.  A common danger is that this conflict becomes externalized, and clients cannot get satisfactory acceptance from others for things about which they are judgmental in themselves.  Playing with pain, fear, horror, and loss of freedom can feel like defiance of the boundaries that constrain others, and sometimes the shock value is part of the thrill.

BDSM’ers tend to be more transgressive as a group than most therapists, at least about sex.  It is not necessary to be willing to do the things that transgressive clients do to talk about and understand them, but it is important to recognize that, even when their behavior seems hostile or unloving to you, very few sexually variant clients come to therapy unaware that other people think they are bad.  They are in your office because of the limited therapeutic value of social disapproval.  

Looks worse than it probably is!
Probably worse than it looks!

Fantasy:  Fantasy is very important in sexuality for variant and vanilla folk alike.  Sex therapists talk about this in terms of taking a sexual history, and determining how much of a client’s sexual outlet is partner activity or autoerotic.  Because a relatively small portion of people are out about their variations, it can be hard to find partners, and pornography and autoerotic outlets are all that are available to some clients.  When they show signs of shame or feelings of inferiority, or compulsive sexual behavior in the treatment, it is important to ask if they are primarily showing these symptoms because of the desires themselves, or the pain at lack of a partner, lack of a community, or self-blame for not having solved the problem, or conflict about their unconventionality and problems of social acceptance.

BDSM activities are often dramatic, and it is easy to fantasize that something seen in pornography would feel better (or worse) than it does in live play.  This can be true for the client, and for you.  Unless you have very wide-ranging sexual interests or are very tolerant, and/or kinky yourself, you are bound to encounter activities that make you uncomfortable at some point.  So it is important to explore the relationship between fantasy and actual experiences when problems of sexual variation are brought into the consulting room.  Frankly, this is often true in sex therapy for vanilla clients, too.

A pair of good examples would be the examples of Florentine flogging and ballet boots.  In sensation play, being hit relatively slowly by relatively large floggers looks horrifying, but is not very intense.  Thin stinging thongs hurt much more. It is simple physics really, more pounds/square inch.  So just looking at a Florentine demo, where the poor masochist is being hit with two floggers at once, is likely to provoke misplaced empathy.  The ballet boots may look sexy, but they would be nearly impossible to walk in, and it takes a very special sensibility to find walking in them sensual, even if classically trained.  They are far more likely to be a turn on for the viewer than the wearer.

"Decalcomania 1966" Rene Magritte

Identity:  Kinky folk sometimes do stuff because they are curious, it is fun, and it is the flavor of the moment, or simply because they can.  Others are expressing what feels like the innermost core of their being.  Yet others times, they do things they are otherwise indifferent to out of the wish to please their partner(s).  Often the connection between identity and behavior is relatively unexamined, and clients vary tremendously in how articulate they are about that relationship.  Because many sexually variant activities are socially stigmatized, clients often keep them secret, and this makes the activities feel very important in their self-concept.  Cognitive dissonance alone would suggest that clients would hold especially tightly to beliefs for which they feel they have made great sacrifices.

There is an excellent cognitive behavioral training film in which Aaron Beck, one of its founders, talks to a depressed woman about her fantasy that her husband doesn’t love her because she is morosely depressed.  He challenges her idea that he might love her less simply because she is depressed.  I always wondered how Dr Beck responded next session when she came in with the report that the husband had just left her for a vivacious cocktail waitress and she is depressed about becoming impoverished in the upcoming divorce?   But kidding aside, it will do no client any good to suggest he should not be turned on by ballet boots because it is unrealistic to expect his partner to walk in them!  Kinky clients may not know where they got their kinks, but often desire is attached to identity in complex and subterranean ways.  It is important to be respectful of that.


Ambivalence:  A consequence of higher cortical function in humans is ambivalence.  Even many vertebrates can be observed to vacillate between competing emotions such as hunger and fear.  So it is presumably evolutionarily adaptive to be able to hold competing ideas in the mind at the same time. This is how we decide whether we can afford to remodel the kitchen, take a new job, or switch laundry detergents.  As will be discussed here when the topic of diagnostic criteria gets explored, one of the criteria for deciding when a sexual variation might be pathological is excessive ambivalence.  Modern diagnostic manuals like the DSMs demand that we assess it.

It is just about impossible for sexually variant people to avoid ambivalence in a larger social context where they can readily imagine everyone around them would be afraid, shaming, angry, hurt and judgmental about their kinks.  Making a determination with your client about whether they are being hurt primarily by their kinks, or mostly by the concerns about the reactions of others, can be a slow and ambiguous process.  It is necessary to wade through it without rushing to judgment to get the best results for your clients.

An adjustable spanner

Looking back on all the flavors in these two posts, whether you have noticed it or not, I have tossed a spanner (the British term for a wrench) into the works of one of modern psychiatry’s central ideas:  that we can reliably diagnose psychopathology by agreeing about observable behaviors. A corollary is that similar sets of behaviors have similar meanings.  There are times and places where this seems to be true.  This is not one of them.  Behavior needs context, hence the sub-title of this blog.

It is fitting that I close this post with a spanner, because that is the subject of my next post, Operation Spanner, and its relevance to the critical concept of consent.
© Russell J Stambaugh, PhD, Ann Arbor, Michigan, May 2013. All rights reserved.

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