BDSM stands for Bondage & Discipline/ Dominance & Submission/ Sadism & Masochism. Although the activities can sometimes resemble sexual, physical, or emotional violence, and the costumes many participants favor can appear threatening, these theatrical forms of erotic expression are ordinarily distinguished by the informed, consensual, negotiated exchange of intense sensation and power dynamics.

People who enjoy BDSM assert that it can be extraordinarily intimate and even spiritually fulfilling. Despite the beliefs of early psychological theorists that these behaviors should be seen as developmental disorders, the small amount of reliable psychological research that exists in this area suggests otherwise: instead, it discloses a profile of people very much like their neighbors. BDSM participants have the same kinds of backgrounds; the same sorts of needs and desires; the same varieties of fears, hopes, and aspirations; the same expressions of anxiety, depression, peace, and joy; the same problems and pleasures with their parents, kids, and colleagues that other people have. And when they come to therapy they have the same right and need as anyone else to be heard concerning the issues that give them pain. To hear from a therapist who does not know about BDSM that all a person’s difficulties derive from his or her preferred form of sexuality does no good at all, especially when it is not so.

Therapists who have no real understanding of BDSM or its practices still occasionally rely on the judgments of those old line theorists who did no research themselves. They may also rely on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders (DSM). As happened with homosexuality long ago, people in the BDSM communities have often heard that therapists regard erotic power exchange as a mental disorder even though the behavior harms no one and participants themselves are pleased rather than distressed by it. Consequently, many players have come to mistrust therapists, and may be reluctant to turn to us about other matters in times of distress.

Partly because there is no viable evidence to support the DSM’s position or to suggest that fantasizing about or engaging in BDSM activities is inherently problematic, and partly because my personal experience suggests very strongly that it is not, in 1992 I joined with other licensed psychotherapists on “the DSM Project” to urge the American Psychiatric Association to reconsider its outdated and baseless position. I have been active ever since in the effort to educate therapists, physicians, students, and lay people to the reality of this form of sexual expression, in part by distinguishing it from the non-consensual, un-informed, un-negotiated, un-pleasurable suffering caused by genuine abuse. Many therapists who are familiar with BDSM are listed along with me at the Kink Aware Professionals website http://www.ncsfreedom.org/kap/