A talk for Oregon Counseling Association on kink, transgender and other altsex populations.

1. Affirming Sexuality and Sexual
Health with Diverse Clients
Oregon Counseling Association
Kate McNulty LCSW

2. Affirming Sexuality
An affirming attitude requires counselor’s:
• Self-knowledge
• Professional judgment
• Ability to monitor and manage own reactions
• Willingness to research new perspectives,
practices and identities

3. World Association for Sexology’s Declaration of Sexual Rights
• The right to sexual freedom
• The right to sexual autonomy, sexual integrity, and safety of
the sexual body
• The right to sexual privacy
• The right to sexual equity
• The right to sexual pleasure
• The right to emotional sexual expression
• The right to sexually associate freely
• The right to make free and responsible reproductive choices
• The right to sexual information based upon scientific inquiry
• The right to comprehensive sexuality education
• The right to sexual health care

5. Sexual Health
What qualities and behaviors do mental
health professionals consider in determining
sexual health?
How do we support clients in identifying their
sexual needs and aspirations?
How do our personal beliefs and experiences
inform or interfere with this aspect of our
work?

6. SIECUS (Sexuality Information and Education Council of the US)
List of Life Behaviors of a Sexually Healthy Adult
A sexually healthy adult would:
• Appreciate one’s own body
• Seek further information about reproduction as needed
• Affirm that human development includes sexual
development that may or may not include reproduction or
genital sexual experience
• Interact with both genders in respectful and appropriate
ways
• Affirm one’s own sexual orientation and respect the sexual
orientation of others

7. • Express love and intimacy in appropriate ways
• Develop and maintain meaningful relationships
• Avoid exploitative or manipulative relationships
• Make informed choices about family options and
lifestyles
• Exhibit skills that enhance personal relationships
• Identify and live according to one’s values
• Take responsibility for one’s own behavior
• Practice effective decision-making

9. • Communicate effectively with family, peers, and
partners
• Enjoy and express one’s sexuality throughout life
• Express one’s sexuality in ways congruent with one’s
values
• Discriminate between life-enhancing sexual behaviors
and those that are harmful to self and/or others
• Express one’s sexuality while respecting the rights of
others
• Seek new information to enhance one’s sexuality
• Use contraception effectively to avoid unintended
pregnancy

10. • Prevent sexual abuse
• Seek early prenatal care
• Avoid contracting or transmitting a sexually
transmitted disease, including HIV
• Practice health-promoting behaviors, such as
regular check-ups, breast and testicular self-
exam, and early identification of potential
problems
• Demonstrate tolerance for people with
different sexual values and lifestyles

11. • Exercise democratic responsibility to influence
legislation dealing with sexual issues
• Assess the impact of family, cultural, religious,
media, and societal messages on one’s thoughts,
feelings, values, and behaviors related to
sexuality
• Promote the rights of all people to accurate
sexuality information
• Avoid behaviors that exhibit prejudice and bigotry
• Reject stereotypes about the sexuality of diverse
populations

13. World Health Organization
• 2002 Declaration on Sexual Health is another
resource for personal and societal models of
sexual wellness and sexual rights
• Includes extensive report on characteristics of
sexually healthy societies

14. Why does this matter?
• Portland is thought of as a haven and we need
to reflect that in our practices
• Blunders and insensitivities cause alienation in
people who often have no margin left
• Counseling is supposed to help, not
perpetuate societal problems

15. Sexual Orientation
• Sexual orientation describes an enduring pattern
of attraction—emotional, romantic, sexual, or
some combination of these—to the opposite sex,
the same sex, or both sexes, and the genders that
accompany them. These attractions are generally
subsumed under heterosexuality, homosexuality,
and bisexuality, while asexuality , the lack of
romantic or sexual attraction to others is
sometimes identified as the fourth category.
These categories are aspects of the more
nuanced nature of sexual identity.-Wikipedia

16. Kinsey Scale
0- Exclusively heterosexual with no homosexual
1- Predominantly heterosexual, only incidentally homosexual
2- Predominantly heterosexual, but more than incidentally homosexual
3- Equally heterosexual and homosexual
4- Predominantly homosexual, but more than incidentally heterosexual
5- Predominantly homosexual, only incidentally heterosexual
6- Exclusively homosexual

18. Gender Identity-as defined by Planned Parenthood
• Each of us has a biological sex — whether we are
female, male, or intersex. Our gender is our social
and legal status as men or women.
• Each of us has a gender and gender identity. Our
gender identity is our deepest feelings about our
gender. We express our gender identity in the
way that we act masculine, feminine, neither, or
both. Some of us are transgender — which
means that our biological sex and our gender
identity do not match up.

20. What’s the *?
• “Trans” means trans-men and trans-women
“*” includes non-cis-gendered people:
• Transgender
• Transsexual
• Transvestite
• Genderqueer
• Genderfluid
• Non-binary
• A-gender

22. Sexual Diversity is Everywhere
• There is some overlap between the GLBTQ
and alternative communities, but only a
minority of GLBTQ people report considering
themselves kinky or in open relationship.
• Kinky sexual practices and flexible relationship
structures occur in all populations, age groups
and social strata.

23. Effective Helping
Attitudes of acceptance and honest curiosity
are extremely helpful strategies in establishing
relationships with diverse clients.
Choose neutral language; avoid assumptions
about the relationship structure or gender of
the client’s household members and
acquaintances.

24. Do I have to be like my client?
• The fact that a health professional belongs to
a sexual minority group themselves does not
mean that they will prefer, or will do effective
work with, all sexually diverse clients.
• Professionals who are different from their
clients can still create good rapport and offer
useful services.

25. Common Complaints of Clients
• If you want to work with this population, you
must take responsibility for educating
yourself.
• Clients don’t want to take their valuable
session time to explain terminology or
concepts to you.
• However, clients may enjoy an opportunity to
educate you on obscure points, or benefit
from deliberating about controversies with
you; this requires you being well-informed.

26. …more client feedback
• Clients do not want to have to justify their
behaviors to you.
• Clients do not want to try to convince you
about the legitimacy of what they consider
healthy or desirable activities.
• Clients do want you to express and offer
concern for their safety, health and well-
being.

28. Disaffiliation
• In work with marginalized people, I can’t put
the burden on the client to educate me
• Marginalization requires huge self-advocacy-
draining and exhausting
• Don’t have same experiences at DMV or
doctor’s office as everybody else
• Plenty of organizations and resources for you
to do the research and be well-informed

29. The Clinical Gaze
• Frequent life experience of alt clients is to be
met with silence or scrutiny
• Some face constant belittling, skepticism
• Make sure “affirming” isn’t just a buzzword

31. Kinky Possibilities
• BDSM
• Dominant-Submissive
• Fetish

32. Sex Industry Professionals
• Porn actors and actresses
• Dancers
• Cyber sex workers
• Prostitutes

34. Non-Monogamous Clients
• Swingers
• Open Relationships
• Polyamorous

36. How do I recognize diversity?
• The concept of sexual diversity can refer to a
broad range of sexual choices, including a
variety of non-monogamous or sexually
unconventional behaviors.
• People who belong to sexually diverse
communities may appear deliberately
eccentric or completely ordinary.

38. Alternative Sexuality Myths
• The people we’re talking about are not
inherently self-destructive, abusive, or
criminal.
• No credible scientific research has been
produced that suggests a higher rate of
neurosis, abuse histories or other pathologies
in alternative lifestyle members than that
found in the general population.

39. Rape Culture
• Don’t ever assume people have not been
abused
• We are all affected by life in a sexually
confused and hostile society
• Not helpful to view exclusively through the
lens of trauma

40. Interpersonal Skill Level
• The motto of many people in this lifestyle is
“safe, sane and consensual.”
• Because of the need for structure and defined
agreements in alt social groups, many
members actually have unusually
sophisticated interpersonal abilities and
negotiating skills.

41. Consent Controversies
• Ongoing discussion and refinement of topic in
kink community, particularly BDSM but also
poly
• How do we define, understand, express,
interpret the concept of consent?
• Nuanced experience, not B&W

43. Biology? Choices?
• Very minimal research involving alternative
communities has been conducted.
• At this point, people practicing alternative
lifestyles are presumed to be making a choice.
• We really don't know whether any of these
are chosen practices and preferences, or
inherent tendencies.

44. Recent Rapid Changes
• Until the advent of the Internet, most people in these
groups experienced isolation, shame and secrecy.
• The opportunity to create connections in chat rooms and
develop offline, in-person community has contributed to
some degree of unity and pride.
• However, alt people continue to face significant social
stigma and legal discrimination.
• The majority of lifestyle participants remain closeted.

45. Progress, To Be Continued
• Decreased shame does not equal greater
visibility or safety
• Don’t collude in or encourage measurement
against the cultural standard
• Our training provides an extremely limited
framework

47. Toward Inclusive Models
Capitalist Patriarchy=Pervasive absence of
sexual health
Dismantle status quo
Western “medical-ized” point of view
Collaborative models and development of ideas
with marginalized people

48. Non-Monogamy
• People who identify as Polyamorous or Open
may be single, partnered, or living in a
polyamorous family.
• Those who consider themselves “ethical sluts”
may look down at swingers, who they view as
emotionally shallow and lacking in relationship
skills.
• However anyone who agrees to non-
monogamous activity is likely to gain extensive
practice at communicating their needs.

49. Arrangements & Variations
• open relationship, in which neither party is accountable to the other, and
activity with multiple partners is understood but minimally acknowledged
• primary commitment to one partner, with agreement that each person is
free to seek out intimate relationships with others, which may or may not
involve sexual contact or intercourse
• primary commitment with negotiated additional
intimate/emotional/sexual relationships or occasional contacts
• shared commitment of two or more couples to exclusive emotional and
sexual contact with each other, including fluid-bonding
• swingers tend to seek out relationships with third parties, or swapping
with other couples, that involve less ongoing emotional commitment, and
that focus exclusively on the sexual contact and novelty

50. Open or Flexible Boundaries
• Couples with a private “understanding” or
don’t-ask-don’t-tell arrangements seem to be
quite common, perhaps 15-28% of the general
population; may be a higher incidence in the
GLBT community.
• Not all couples with these arrangements
identify as Open, or want honest
communication about outside relationships.

52. Public Sexuality
• Some people are very private about their sexual
activities, and others attend sex parties or engage in
group sex.
• Most people in lifestyle communities have high
awareness about STDs, and exert peer pressure that
safer sex practices are followed, especially in group
scenes and gatherings.
• Group events and parties often include facilitators
who monitor the activity to make sure attendees stay
safe, and that rules and group agreements are
followed.

53. Kinky Concepts and Terminology
• “Kinky sex” doesn’t necessarily involve genital
contact or intercourse.
• Intimate contact, even when it involves pain,
is typically done with caring intent; the group
norm and value is that safety is well-
considered.

54. Kinky Social Scene & Norms
• People practicing kinky sex typically adhere to negotiated
agreements, for example identifying a “safe word” that
really means “stop,” prior to engaging in a scene together.
• Play parties provide an accepting space where guests can
use equipment and toys; these often serve to intensify
sensation and provide a high degree of stimulation, while
preventing injury.
• Experienced practitioners are often welcoming and
instructive with people coming from “vanilla” backgrounds.

55. “Queer” & “Kinky”
Often refers to BDSM activity such as:
• Wearing leather or latex garments
• Using handcuffs, collars and other complicated restraint devices, or
highly detailed knots made from belts or rope
• Dominant/ Submissive relationships: may involve physical pain or
erotic power play and psychological games like master-slave
contracts
• Some people restrict their Top/Bottom relationship to parties,
special events, or their bedroom; others live in D/S (dominant-
submissive ) relationships as a round-the-clock lifestyle

57. Other Kink Behaviors
• “Edge play” refers to stimulation involving blood, sharp objects, electrical
stimulation, or “breath play” (strangulation or choking to heighten
sensation)
• Rough sex, anal or vaginal fisting are other variations on conventional
genital contact
• Fetishes, such as obtaining one’s most powerful sexual gratification from
playing with feet, or wearing rubber clothing
• Some people also find it very erotic to wear a diaper or dress up as a baby;
others invest in elaborate outfits and accessories for “playing ponies” or
“puppy play”
• Engaging in exhibitionistic or voyeuristic activity holds some degree of
pleasure and interest for most people, but there are some who find this to
be their primary source of stimulation

59. Professional Pitfalls
• Professionals often presume that alternative lifestyle
members are unable to commit, have personality or
identity problems, or that they resort to alternative
arrangements because their relationship histories have
been unsatisfactory or damaged.
• Some professionals believe people having affairs are more
normal than those who communicate honestly about
having intimate contact outside the relationship.
• Out-of-the-ordinary sexual practices reflect the vastness of
the sexual-psychological landscape.

60. Positive Aspects of Alt
• While abuse and unhealthy relationships are possible
in any relationship structure, many participants in
lifestyle communities are engaged in innovative
experiments about developing new relationship
agreements and structures that encourage self-
awareness, allow for flexibility and provide a feeling
of belonging.
• Stigmatizing attitudes interfere with alternative
lifestyle clients’ willingness to seek help when they
need it, and overlook the sex-positive and affirming
nature of the community.

62. PLISSIT
• Permission
• Limited Information
• Specific Suggestions
• Intensive Therapy

63. Kinsey Institute Dual Control Model
• Sexual Excitation System SES: Scans
environment and internal imagination for
stimuli or turn-ons.
Sexual Inhibition System SIS: one aspect is
performance anxiety, one is fear of negative
consequences. Scans for turn-offs.
• Both aspects are needed for a healthy sex life.

65. Differentiation & Attachment
• Murray Bowen- family systems theorist
David Schnarch- contemporary couples tx
• John Bowlby- Mother and infant research
Susan Johnson couples tx EFT

66. Postmodern & Integrative Approaches
Bring together:
• Narrative
• Cognitive-Behavioral
• Solution-Focused
• Contemporary Psychoanalysis
• Existential-Humanistic

67. May I Be a Resource to You?
For further information, please feel welcome to
contact:
www.SexPositiveTherapist.com
(503) 295-6265
All images :credit to dreamstime