Do Medical Professionals See Kinky Patients?
In mental health professional ethics, it is considered unethical, and a poor standard of practice, to treat patients without understanding their culture, and there are a number of ethical standards in place to address the importance of a multicultural study. Multicultural competence also includes the fundamental understanding of the various subcultures or minor communities found within each large culture. If a mental health provider is not competent in these areas, it puts a patient at potential risk. These ethical standards are discussed further in Chapter two. As mental health professionals, we have the ability to assess a client and apply a label, which will follow the client for the rest of their lives. If we are not properly trained, these labels could have significant negative consequences for our patients. We hold the power to do great harm to our clients if we remain ignorant. Ortmann and Sprott (2013) clearly illustrate this point when they said:
Whether due to fear, misunderstanding, or a lack of education, our culture has tremendous room to improve when it comes to discussing sex in a candid, open fashion, devoid of shame and judgments. The same, unfortunately, holds true for those of us in the mental health profession. (p. 6)
A subculture is defined as a cultural group that holds values, customs, and interests that vary from the primary culture. If we are inferring that the Kink Community is a subculture within western culture, it is important for mental health professionals to either have specialized training, supervision, or a list of appropriate providers to which to refer out when seeing sexual and relationship minority clients. It is also important to note that being Kinky and personally practicing a BDSM lifestyle does not qualify as specialized training in the same way that being diagnosed with cancer in the past does not qualify one as an oncologist.
There are currently no specific regulations that provide an exact outline for what qualifies a medical professional to be considered Kink Aware or Kink Knowledgeable, but there are some movements towards that and there are a few specialized training programs that are currently under development and review (NCSF, personal communication, November 2016). The National Coalition for Sexual Freedom is a non-profit organization “whose mission is to create a political, legal and social environment in the US that advances equal rights for consenting adults who engage in alternative sexual and relationship expressions” (NCSF, 2016). Thus, their goal is to normalize and advocate for the rights of sexual and relationship minorities. This manual uses their Kink Aware Professional definition as a guide to direct the curriculum. National Coalition for Sexual Freedom defines a Kink Aware Professionals as:
“A professional who is Kink aware recognizes BDSM play as a normal part of the sexual spectrum and is able to distinguish healthy BDSM play from non-consensual abuse. Ideally such a professional has educated themselves about BDSM via books, articles, lectures, websites and or discussion groups. They are aware of what constitutes safe and unsafe play acknowledging, of course, that is different folks have different standards for that. They are aware of the types of roles and role expectations that are commonly encountered in the BDSM scene. They understand the stress that some clients may experience in keeping their BDSM lifestyle secret. They have also worked with a number of clients from BDSM community and is explicitly welcoming of such clients in their advertising materials. Finally, they are aware that for many Kinky patients, BDSM might not have anything to do with the reason that the client is coming in for medical treatment or therapy. Often, BDSM is just another facet of the client’s life like their veganism and knitting.”Kolmes & Weitzman, 2010
Despite the work toward eliminating or limiting the effects of personal bias, there have been a significant number of studies, noted below, that show that many medical professionals continue to be a product of their personal values and this alone can create a detriment to the Kinky patient. In a study performed by Kolmes, Stock, and Moser (2006), it was reported that 118 incidents of 175 participants where a therapist either showed personal bias or provided inappropriate and inadequate care to BDSM patients. This has little difference than other typical medical errors such as prescribing inappropriate medication or surgery on the wrong limb. Medical providers, especially mental health professionals, have extraordinary power with their clients and can significantly harm them if they allow their own bias and lack of training to interfere with their ability to properly support the wellbeing of their patients.