A look at “Mental health provider bias and clinical competence in addressing asexuality, consensual non-monogamy, and BDSM: a narrative review” by Cara Herbitter, Michelle D. Vaughan and David W. Pantalone (2024)
When we talk about LGBTQIA+ affirming therapy, some letters tend to get more airtime than others. The “A” for asexual, and the many people whose relationships or sex lives don’t follow the usual script, are often left at the back of the parade. This American review gathers what’s known about how therapists treat three groups in particular: asexual people, people in consensually non-monogamous (CNM) relationships, and people who practise BDSM.
What they found
The authors searched for published research on therapist attitudes towards these groups and how clients experienced therapy. Across all three, the picture was strikingly similar.
- Asexual clients often fear their asexuality will be treated as a symptom, such as a hormone problem, trauma or low libido to be “fixed”. Many avoid disclosing it altogether.
- Clients in CNM relationships report therapists assuming their relationship structure must be the source of their problems, or nudging them towards monogamy.
- Clients who practise BDSM describe therapists equating kink with abuse or pathology. Some have even had their interests used against them in custody disputes.
Across all three groups, the authors found therapists who lacked basic knowledge, leaving clients to do the educating. On the positive side, clients valued therapists who were open, curious and willing to learn, and who responded calmly to disclosure.
The review ends with three clear recommendations for therapists:
- Avoid normative assumptions. Don’t assume a couple is monogamous or that everyone experiences sexual attraction. Inclusive intake forms help signal safety.
- Counter pathologisation. Don’t assume an identity or practice causes a problem just because it’s present. But don’t ignore genuine issues either; abuse or broken agreements can happen in any relationship.
- Take responsibility for training. Clients shouldn’t have to educate their therapist about the basics.
A grain of glitter ✨
This is a valuable and well-balanced review, and its recommendations are practical and sensible. But it’s a narrative review based on searches of just two sources, one of them Google Scholar, so it may not capture everything.
The studies it draws on mostly involve white, young, educated, American participants recruited from online communities. The authors are refreshingly upfront that this means the experiences of people of colour, and of those who practise CNM or BDSM without identifying with those communities, are largely invisible. Most studies also rely on self-reported attitudes, which may not reflect how therapists actually behave in the room. And the research was gathered before 2021, so newer guidance and studies aren’t included.
Why this matters
If you’re asexual, aromantic, polyamorous, kinky, or any combination, you deserve a therapist who doesn’t treat who you are or how you love as the problem. You’re entitled to ask about a therapist’s experience before you start, and to expect them to have done some homework rather than asking you to give them a crash course.
The rainbow has more than six colours. A good therapist knows the whole spectrum, glittery bits included.