Wednesday, September 16, 2015

What if You Get Squicked?


Like everything on this blog, context matters.  So if you find yourself acutely uncomfortable with a client’s material, what you do depends on when, where, and how it comes up.  Some of these suggestions will not be helpful in all contexts.  Some even contradict each other.  Apologies to Mies van der Rohe, who didn’t first say ‘The devil and God are both in the details.’

Safety first, yours and theirs.  Insofar as you can, do not back away from the material, and do not ask for details that you are not ready to hear and/or the client seems unready to discuss.   You need the client to be able to observe their own responses, and for you to be listening to how it feels for them.  Consent is critical in BDSM as it is in therapy.  It is legitimate and often necessary to question the client about their consent when you reaction comes from ambiguity about whether they have agreed to whatever is disturbing you.

Ask yourself why you or the client are so offended.  If the behavior violates your core values, or you are unwilling to do the work in understanding it in the client’s terms, maybe you need to refer the client out to someone who can.  If the discomfort is primarily the client’s, then it may be resolved through therapeutic discussion.  While the typical condition of human existence may involve some ambivalence, acute and intolerable ambivalence is a proper subject of treatment.  Raw, unprocessed and out of control feelings do not advance the therapeutic process, and are signs that it may be premature to discuss disturbing material.

Give yourself permission to have your own feelings and do not rush to judge them a sign of inadequacy as a therapist.  In order to use your own feelings in therapy, you must first have them and recognize them.  Resolving countertransference is often a powerful resource in therapeutic change.  It is often uncomfortable.  Freud thought resolving transference was what therapy is all about, and countertransference was often how transference was first recognized.  Even if you think your response is excessive, recognizing your feelings is the first step that can eventually lead to acting on them in ways that serve your client.  If you have a strong therapeutic alliance with your client, any mistake you make is likely to be a point of learning for both of you, rather than ruin the treatment, if you deal with it honestly and directly.

Ask yourself if understanding and discussing the squicked material is essential to the treatment goals.  Often a client’s kink is not central to the goals of therapy.  If your client complains they are deeply troubled by their desire, obviously the details of their fantasies and actions are essential to understand.  If they went to an event one time and had a bad reaction, you could be doing yourself and the client a favor to let the client vent as they need to, and return as soon as you can to the primary contract for treatment.  And if you do not understand the relevance on any material, squicked or not, ask your client what connections they see.  If neither of you see the relevance, let it go.  One sure characteristic of treatment is that if you gloss over important issues, they will come up again, so if it is important, you are likely to get another good chance to discuss it.

Get more information.  This holds the promise of helping you clarify why you are uncomfortable, and possible increasing your understanding in ways that make your reaction more manageable.  The question is often where to get good information.  Be careful of using sources like porn and fantasy sites, where there is a strong stylistic tendency to exaggerate for effect.  On-line sources – yes, I realize Elephant in the Hot Tub is one of those – vary in their objectivity and reliability.  Different Loving 2ed by Brame, Brame and Jacobs is a reliable resource for starters.  Look also at reliable sources on edge play.  It is wise when doing this work to have colleagues whose opinions you trust.  Sometimes professional listservs and forums can be helpful.  Triangulate information from multiple sources, and don’t simply cherry pick the information that suits your preconceptions.  Do not take a poll on social media, or inadvertently out your client with specific information, even without names attached.  Often edgy practices are rare or singular events, and public discussion creates the impression that people are being outed and confidentiality violated.

If you have such contacts, ask others in the kink community about how similar material is treated there.  In this, you are not looking for advice, but trying to understand the context, contracting, consent, and community reactions to it.  Kink communities differ, have their own micro-cultures and house rules, and are not unfailingly accepting or nonjudgmental.  But understanding uncomfortable behavior in the likely context of the kink community can help you frame your own reaction, and perhaps, the client’s.

Know your strengths and limits.  That knowledge is crucial in deciding which of the strategies listed here are most applicable to any specific case.  In the Goode Olde Days, therapists had 5 years of psychoanalysis to deepen their self-understanding. That was good, but by no means a perfect assurance of self-knowledge. Nowadays you can practically get licensed by reading a few good books.  Self-knowledge is fragile, but is also the best defense.

Get quality supervision from someone who knows about the scary practices that are vexing you.  That does not necessarily mean falling back on an old supervisor who is a fantastic clinician, helped in your training, but knows nothing about kink.  It is generally unwise to try to clinic such cases on listservs where just anyone can chime in, both for reasons of confidentiality, and for reasons that people unfamiliar with such material are at risk of being made uncomfortable too, and may simply and unintentionally reflect widespread social prejudices.  That may mean cultivating professional relationships ahead of time with people who have a wide familiarity with outliers among the populations you treat.

If you think your own reaction violates your core values, or reflects incomplete work on your part, by all means return to psychotherapy.  Being made uncomfortable by someone’s material is ultimately a problem you can walk away from.  Be made uncomfortable with your own material is not.

Discuss your discomfort with an experienced and open client. This is their work too, and to the extent that they can cooperate in understanding together what your discomfort means, the client is an important resource.  Ultimately, you are responsible for your feelings, but when they are a reflection of the client’s conflicts, showing the client you are comfortable with discussing your own discomfort can be good role modeling, and help them achieve important insight.  When you lack a trusting relationship and good working alliance, discussing your own discomfort can be disruptive and drive away a client.  It is wise to out-refer to someone better able to help.  If a client is gaming you in a way that feels manipulative, make sure that you take steps to ensure your own safety.  BDSM edge play, that is play that is known to be more dangerous and transgressive in the kink community, is mostly unsafe to discuss with severely personality disordered clients and clients with weak observing egos.

Therapy is a great way to fight social problems and social injustice in the world.  But it operates under ethical guidelines that put the client first.  Perhaps you can bring your own reaction into balance better by confronting some of the root problems that make you uncomfortable through teaching, advocacy, or direct social action and philanthropy better than through your psychotherapy with any one client.  This is a special subset of my final suggestion:

Make sure that you are adequately supported in the clinical work you are doing.  This may include your primary and secondary relationships, your institutional setting, your fees, office, training and other aspects of the context of doing treatment.  It may include proper organizational affiliations, and friends who do similar work.  And it includes collecting referrals and biblioresources that support the psychotherapy you are doing.  All of these factors make it easier to understand intense and/or unexpected client materials if they suddenly arise and help you use them to better serve your clients.

That is a starter list, but it is far from exhaustive.  Perhaps you can think of good coping strategies or additional resources I have left out.  By all means, include them in the comments section.

Resources:

Finkelhor, D., Araji, S., Baron, L., Browne, A. Peters, S. D. & Wyatt, G. E. A Sourcebook on Child Sexual Abuse. Thousand Oaks, CA, US: Sage Publications, Inc (1986). 276 p.

Richters, J., De Visser, R. O., Rissel, C. E., Grulich, A. E., & Smith, A. (2008). Demographic and psychosocial features of participants in bondage and discipline, "Sadomasochism" or Dominance and Submission (BDSM): Data from a National Survey. The journal of sexual medicine, 5(7), 1660–1668.

Andreas A.J. Wismeijer PhD, Marcel A.L.M. van Assen PhD: Psychological Characteristics of BDSM Practitioners. The Journal of Sexual Medicine, Volume 10, Issue 8, pages 1943–1952, August 2013.

Patricia A. Cross PhD and Kim Matheson PhD in the book “Sadomasochism: Powerful Pleasures” (2006), published simultaneously as the Journal of Homosexuality, Vol. 50, Nos. 2/3.)

“Psychotherapeutic Issues with “Kinky” Clients: Yours and Their’s” by Margie Nichols, PhD in Sadomasochism:  Powerful Pleasures ed. P Klienplatz and C. Moser (2006) published simultaneously as the Journal of Homosexuality, Vol. 50, Nos. 2/3.)

2015 Russell J Stambaugh, Ann Arbor, Michigan. All rights reserved.

1 comment:

  1. The best defense is a good offense. Reading widely helps you encounter uncomfortable ideas before they appear in treatment. It is far easier to encounter any discomfort and deal with it before you have to face it with a client. This means a certain amount of reading outside your comfort zone.

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