Cradle and all: outcome differences between kink-affirming and kink uninformed therapies for a complex client with paraphilia

Abstract

The Clinical practice guidelines for working with people with kink interests offers a powerful framework for therapists to use when conceptualizing their work clients presenting with paraphilic behaviors. Many of the practitioners who would benefit most from their guidance are unaware that this document is available as a free resource at www.kinkguidelines.com. The urgent need to promote this work is highlighted in the case study presented here: a young man presenting to two mental health providers with a constellation of behavioral, social, developmental, and intellectual challenges who self identifies as an Adult Baby/Diaper Lover (ABDL). One clinician, lacking in general kink competency and an awareness of the Kink Guidelines, diagnoses this client with dissociative identity disorder, resulting in a rapid decline in the clients behavioral and psychological functioning. The second, working within the framework of the Kink Guidelines, leveraged a kink-affirming and radically accepting approach to the client that stabilized his mental health, supporting him in setting behavioral goals to integrate his fetish play appropriately into his life and relationships, and helped build an interdisciplinary care team that could support his continued growth towards independence without shame or kink-stigma.

Lay Summary

Mental health providers risk misdiagnosing clients when they lack a full understanding of BDSM, kink, and fetishes. The case study presented here demonstrates how a clinician’s kink knowledge can be a powerful influence on the client’s therapy experience, their treatment outcomes, and overall quality of life.

Keywords:

• Kink-affirming
• paraphilia
• ABDL
• kink guidelines
• DID
• stigma
• bias

Acknowledgements

The author would like to acknowledge those researchers and clinicians who created the Kink Guidelines, and whose work has been instrumental in reducing stigma, confronting bias, and laying the foundation for kink-affirming practice.

Disclosure statement

The author has no financial interests to report.