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Sexual Sadism And Masochism: An Overview Of S/M In Psychotherapy

2913 words - 12 pages

Psychotherapists have grappled with the concept of sexual sadism and masochism for decades. In his early writings, Freud (1924) described sadomasochistic (SM) practice as a means of attaining pleasure through the administration or attainment of pain. He acknowledged that SM behavior contradicted his theories on human instincts and the pleasure principle, and ultimately attributed the behavior to the interaction of flawed aggressive instincts, unconscious Oedipal guilt, and the enigmatic death drive. His initial perspectives on SM behavior eventually informed our field’s current perspectives of SM as a form of psychopathology. To date, some researchers study SM sexual practices through a psychopathological framework that characterizes SM identity as a type of abnormal sexuality. Meanwhile other psychotherapists view the practice as linked to complicated object relations, narcissism, affect regulation, and various neurotic responses (The Clinical Problem of Masochism, 2012).
Recently, researchers have pushed for a non-pathological understanding of SM behaviors. Lawrence and Love-Crowell (2008) assert that researchers and clinicians should adopt a non-judgmental and informed stance when undertaking work with SM populations. Others purpose that researchers should formulate broad, neutral, or positive definitions of SM practice (Powls & Davies, 2012). Unfortunately this initiative is hindered by society’s continued view of SM as deviant or abnormal. Additionally, SM culture and practice is not often discussed within psychology training programs. This paper will highlight empirical works that describe the history of the sadism and masochism diagnoses while acknowledging the limitations of studies in this area. Works that detail culturally sensitive assessment and treatment interventions will also be discussed.

History & Literature Review

SM has experienced an increase in visibility for the past three decades in the realms of fashion, music, and popular literature. It is estimated that 5-10% of people engage in SM type practice yet SM participants remain understudied within the field of psychology. According to Langdridge & Barker (2007) the psychological and medical professions have understood SM behavior as pathological without taking into consideration consensual and potentially non-pathological perspectives on the practice. This view has held true despite the lack of evidence suggesting that SM practitioners are less healthy than the general population (Moser & Levitt, 1987).
According to Kleinplatz and Moser (2007) SM practitioners have been stigmatized as a result of greater society’s conceptualization of SM behavior as strange or abnormal. Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) describes both sexual sadism and sexual masochism as abnormal behaviors that are worthy of psychotherapeutic intervention. However, the authors explain that the lack of objective criteria...

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