Mental health provider bias and clinical competence in addressing asexuality, consensual non-monogamy, and BDSM: a narrative review

Abstract

The aim of this narrative review is to integrate the published literature on mental health provider bias against less recognized groups who may be marginalized due to their sexual identities or sexual and relationship practices. These include asexual-identified individuals, individuals who practice consensual non-monogamy (CNM), and those who engage in sexual practices that include bondage and discipline, dominance and submission, and sadism and masochism. We situate these findings regarding provider bias within broader themes emerging from the literature on affirmative mental health care provision for members of these sexually stigmatized groups. We identified the relevant literature by searching PsycINFO, as well as Google Scholar, given the novel topic areas. We summarize and evaluate published articles and then present our analysis of the broader themes, strengths, and limitations that emerged among these three developing literatures. Finally, we discuss implications for future research and clinical practice to aid clinicians who wish to minimize bias against these relatively understudied groups. These recommendations are summarized as follows: avoiding normative assumptions, countering pathologization, and taking responsibility for training.

LAY SUMMARY

This paper describes current research on bias among mental health providers against asexual clients, as well as clients who practice consensual non-monogamy or kink. Clinicians are encouraged to avoid assumptions and seek out to training to address their own biases about clients with these identities and practices.

Keywords:

• Asexual
• consensual non-monogamy
• polyamory
• BDSM
• kink
• psychotherapy
• bias
• stigma
• clinical competence

Acknowledgements

We thank Drs. Sarah Hayes-Skelton and Alice Carter for their helpful feedback on an earlier iteration of the paper. We are grateful to Clara Roth and Brittany Buckley Shelton for their help with reviewing references and formatting the manuscript.

Disclosure statement

The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding statement

The first author is supported by the Office of Academic Affiliations, US Department of Veteran Affairs (VA).

Disclaimer

The view(s) expressed herein are those of the authors and do not reflect the official policy or position of the affiliations, the Department of Veterans Affairs, or the U.S. Government.