by Valerie Igl, MFT

This question is the topic of the April 1998 issue of In The Family which bills itself as "the magazine for lesbians, gays, bisexuals and their relations." The publication's focus seems to be on matters of interest to sexual minority clients and their therapists, with a different theme in each edition.

The April issue is a thoughtful discussion of the subject that tries to be balanced, although it took them six months to find a therapist who was willing to write an article critical of S/M. According to the editor, people seemed to be afraid of being seen as "politically incorrect" or "sex-negative."

An interview with Guy Baldwin reminds us that "the attitudes that most therapists have about S/M are culturally determined rather than formally educated." His commentary was quite informative, especially his distinction between abuse and S/M. I appreciated the way that he keeps an open eye to possible pathology.

Suzanne Iasenza's article makes good points about the power dynamics between people in "everyday life." She also gives us a historical context in which to place feminist thought about S/M over the last two decades.

Angela Bloomsbury's piece includes a personal account of her journey of discovery about S/M, which unfortunately she didn't feel she could publish under her own name. She also offers a considerable bibliography.

All three of these therapists emphasize that S/M activities are not inherently pathological, but need to be evaluated in the context of a relationship.

Carol Brockman takes a different view, one which her own examples don't seem to support. She believes that S/M "is problematic on profound levels for my clients," and yet she maintains that she works "in a respectful, open way that doesn't preclude my having judgments." Let's just think about what she's saying for a minute. If we substitute for example the characteristic of lesbianism for S/M, how many of us would agree that therapists who believe being a lesbian is "problematic on profound levels" can treat their lesbian clients in a "respectful, open way"?

Brockman states that her goal is "not to influence" clients, but to help them "understand themselves"; yet in her case studies, she only seems to count treatment as a success if they drop their interest in S/M. She even admitted that she told a client "most of my clients ... concluded that S/M had significant drawbacks."

Her presentation of two particular cases raised questions for me about her clinical priorities. With one couple, she describes what seems like polysubstance abuse, if not addiction. They quit therapy, yet she says that she "would have been happy to continue working with them, with no requirement that they change."

It's common knowledge in the S/M community that the ability to have safe, sane, and consensual S/M is seriously compromised by drug use. I thought it was common knowledge in the clinical community that therapy with substance abusing clients is only effective if sobriety is a goal. It doesn't sound like S/M was this couple's most "problematic" issue. Brockman didn't address their drinking and drugging adequately.

With another couple, she depicts a battering relationship. Not only does she treat them in couples counseling, which is not normally the treatment of choice with violent relationships because of the danger of escalation, but she doesn't inform them about the legal limits of confidentiality at the onset of therapy. She reports: "I did describe their relationship to them, eventually, as abusive. ... When their abusive behavior continued, and I informed them of my reporting obligation ... they both quit therapy." (Italics mine.) Why did she wait to label their behavior and tell them about the laws? Did she expect their response would be different somehow?

Brockman seems to miss the point that while S/M can be misused in a dysfunctional relationship, it is unfair, and potentially negligent, to make S/M the problem. There are several situations in which S/M can be misused: for example, when partners are angry with each other, and are using S/M to express that emotion; when a participant is not able or willing to respect the other's limits; or when people try to live out S/M roles 24 hours a day (this is rare). As clinicians, we need to be able to make distinctions between pathology and personal preference.

I'm concerned when a therapist minimizes countertransference about S/M. This can harm a client in many ways, including 1) causing the client to terminate prematurely and not get help, or 2) confusing the client through mixed messages. A better way to serve clients would be to get education or consultation, or refer out to therapists who feel more comfortable with the issues.

I strongly agree with Suzanne Iasenza in her statement: "I think every therapist has a bottom line, and there are clients we can't work with. If we can't hold the space non-judgmentally and become overwhelmed by the content, then maybe we aren't the right therapist for those clients. We need to know what our limits are, and to be able to say so."

I've been thinking about these issues for some time, and I'm open to informal peer consultations, and of course, referrals. I offer knowledgeable, non-judgmental counseling for the S/M community.

Request an appointment with Valerie Igl.