When a client is kinky: A response to an article in ‘therapy today’

Pink fluffy handcuffs

Recently, Therapy Today published an article: The researcher: would you believe it?, which is about the discovery by one man of a paper that discusses people who are ‘kinky’ (who like BDSM) and how they might have better mental health than people who are not kinky.

The article suggests that even if these results are true, you shouldn’t believe everything you read on the internet. Of course it’s wise to take everything with caution – some of the ‘best’ psychology studies have since been proven to be forged, but my issue is less with that and more with this: the therapy today article conflates BDSM and abuse. It discusses how the author has read ’50 shades’ as a fetish book and then goes on to say that Ana could be defined as a victim of domestic violence. This is absolutely correct. But there is nothing consensual about domestic violence, and kink (BDSM) is about giving informed consent. Very few people whether in to BDSM or not  who are reading the book would say that Ana was giving consent (let alone ‘informed’) a lot of the time.

Any ‘kink 101’ would soon show the difference between the two issues (as for 50 shades, the author has been explicit about the fact that she did very little research into her topic also). Just as one could be not kinky and abusive, one could be in to BDSM and be abusive. the BDSM is not the issue, ABUSE is the issue in the book.

The biggest problem with this article is that of course kinky people will be our clients. Some studies have shown that people who practice kink make up 15-20% of the population. They live and work and breathe, just like the vanilla people. they will have better or worse mental health. And as a trainee who has to have counselling as part of that training, and who has to deal with being different on many levels (including sexuality and disability) I want to know that the person I am choosing for a therapist knows what they’re talking about. This article seems to poke fun at kinky people (kinky people, having normal mental health? That can’t be!) and silences a minority further.

Since the publication of 50 shades, and the plethora of books on the topic that has followed, kinky sex has become more and more common (as anecdata – just yesterday I met someone who told me that 50 shades of grey had changed her life – that she had no idea she liked those things until she read the book, and finding them has made her happier), and certainly more accepted. This means that more and more of our clients will be a) reading this and b) exploring it.

It seems to me that we do our potential clients a massive disservice by discussing the topic in this manner (rather than genuinely trying to increase our understanding), and by viewing our clients in this way (people who like to dish out pain are abusive, and people who like to receive pain are clearly victims of domestic violence). If any of our clients wanted to talk to us about how they feel about discovering this side of themselves, or are people in these types of relationship who don’t want to have to filter their language (much as gay men used to have ‘wives’ with female names), they will certainly not be inclined to do so if they have any inclination that we hold these kinds of feelings towards them, and we are clearly not then doing the best that we can for our clients, whatever our modality may be. We are forcing our clients in to a closet and we are silencing them. Let’s not do that?

Original references:

1. BDSM users are better mentally adjusted. News. Therapy Today 2013; June: 5.
2. http://io9.com/kinky-people-have-better-mental-health-than-the-rest-of-510510381
3. http://www.livescience.com/34832-bdsm-healthy-psychology.html
4. http://psychcentral.com/news/2013/08/13/study-finds-its-more-like-fifty-shades-of-abuse/58393.html 
5. http://www.ted.com/talks/ben_goldacre_battling_bad_science.html 
6. http://weknowmemes.com/2012/07/dont-believe-everything-you-read-on-the-internet/

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Making the most of therapy/the therapeutic use of self

two people talking animatedly (from cyh.com)

If you’re anything like me, as a trainee you met the thought of therapy with a bit of excitement (yay – I get to work on some stuff) a bit of apprehension (oh – I get to work on stuff) and a bit of annoyance (damn it. I have to spend lots of money on working on stuff).

But equally, if you’re anything like me, although you might mostly like the idea of therapy, you often find it difficult to process.

I was recently reading Val Wosket’s ‘The therapeutic use of self’ and in a chapter (pp 76-77) about interpersonal process recall (IPR) conducted with a client, she writes a list of questions (reprinted here with her permission)

  • The most significant thing about the session for me was…
  • Something that I found helpful was…
  • Something that I found unhelpful was…
  • Something I wanted from the session and didn’t get was…
  • My counsellor could have helped me get this by…
  • Something I would have liked to say but didn’t was…
  • My counsellor could have helped me to say this by…
  • I would describe my relationship with my counsellor in this session as…
  • An image I have in relation to the session is…
  • A theme of the session was…
  • Something that occurs to me about the session or my counselling is…

These seem to me to be really useful questions to look at therapy with. She suggested for her client that this was done within 48 hours of a session (each session for her had parallel ‘my client’ questions, also to be completed within 48 hours). I think I might take it up. And whilst I don’t necessarily think that I will adopt it for every session with every client, I think it might prove a useful point to ‘jump off’ from if I am otherwise out of ideas!

The hooks and barbs of life

Harpagophytum procumbens

Looks pretty vicious, doesn’t it? But the whole plant looks much less scary:

 

Harpagophytum plant

I was talking to a classmate today about not being held, and how that not being held was uncomfortable, even painful. And I became aware that there are two things here. There is the very real pain that I am feeling now, and the OTHER very real pain that is coming from the hook of the barbed plant.

 

You see, I think that many (if not all of us) have these things. It would be close I think to Rogers’ ‘conditions of worth’ where we internalise values imposed on us by others.

 

We also experience hurts. Sometimes, by playing in a place where we accidentally come across such a barb as above, where we don’t really notice what’s happened until it’s stuck. Sometimes we can get that barb out. Sometimes we can get most of it out, and we don’t realise until later. Sometimes people tell us it’s safe to play there, thinking that we won’t notice, or that we won’t tell. Sometimes we are too busy trying to avoid the GIANT BARB OF DOOM that we just don’t notice a dozen smaller barbs that have stuck in.

 

And then throughout our lives, we continue to Not Notice. Sometimes this not noticing is genuine, and sometimes we spend an awful lot of time and energy Not Noticing the barbs. Either way, I suspect that we spend a lot of time protecting the site of the barb, which may be red and angry, or it may have healed over almost completely. We protect it. We feel a niggling pain but because we are Not Noticing the barb, we pass it off as something else.

 

Then one day, perhaps we fall over and bash it, or perhaps someone says ‘what’s that?’ and we must look at it, we are confronted with the thought that ‘oww; this hurts!’ and we have a choice. We can go on protecting and Not Noticing, or we can take a look at the problem.

Perhaps we are lucky and have a therapist, and perhaps we are that therapist who has a client who has found a barb. Perhaps we have seen that barb and asked them what this curious thing is. As a person-centred therapist it would feel too directive to me, to DEMAND that a client look at the barb, but it would also feel like collusion to notice that something was there and pretend it wasn’t.

And then as we attend to the very real present hurt that has occurred in the bumping of the hurt, we must also attend to the removal of the hurt, which is often very dug in, not to mention sore, possibly slightly infected.

 

It seems to me that as clients, and as (trainee) therapists with such clients, that we (and they)  are much better meeting them where they are, and holding in them in all of Rogers’ conditions.

 

This post brought to you by a) meanderings and b) a reading of this paper

That first client

 

doormat that reads 'welcome'

welcome

I was lucky enough to get two calls very soon after we went ‘live’, and my first two assessments were happening on the same night.

I didn’t feel so bad during the day – my fulltime work is busy enough to keep me occupied, but come 5pm when I finished I had so many thoughts go through my head – would i be good enough for my client? would my client say ‘how many clients have you had?’ and go running out of the door when I said they were the first?

I had booked a pre-first appointment supervision with Fred, and we talked through many of these things, and whilst I was confident that I had answers for many of the questions I suspected would come up, I wasn’t entirely sure that on ACTUALLY being asked them, I would manage to give the answers I’d thought about! Lucky, come the time, none of those ‘bogey’ questions came up.

My first assessment was at 7.30, so of course I was at the placement ridiculously early – just to ‘make sure’, and I wandered around the room thinking about the shortcomings of the room (which is not set up as a therapy room, but is actually adequate for the need) when suddenly: ’tissues! I don’t have tissues!’ occurred to me. Then several other things occurred – what if the clock stopped? I don’t wear a watch. What if, what if? Mostly daft thoughts where my brain is just on overdrive. I wrote a list of the things I would need to bring each week and then it was time for that First Client.

Who was lovely. Just the kind of client you would want for a first client. He didn’t mind that I was a trainee, and my face, which tends to go pink at times of high stress, didn’t seem to bother him either. We had a good assessment session and at the end of it, I was confident that I had gathered enough information based on the things I’d considered in supervision and with a mental ‘thanks’ to Fred, I waved that first client away, ready to see them for the first time ‘properly’ the week after.

I made myself some verbal notes and then it was a couple of minutes’ break and on to the second assessment

The second assessment? It was a breeze. Lovely, interesting, but I was so much more confident that I had covered the things I needed that I could just sit and rely on my assessment process.

What did surprise me, however, was how much both of the assessments turned in to ‘therapy’ moments, with both potential clients sharing quite a lot of information with me. It’s something I try not to do when I am assessed as a client, so I wasn’t expecting it. It worked well however, and both clients wanted to come for more sessions, and I was happy to see them both. I guess that makes me a proper (trainee) therapist now – as opposed to just one in potential 🙂