Consent, Culture, and Complexity: Ethical Practice with BDSM Couples

Written by [Haythem Lafhaj]

Working with BDSM-practicing couples challenges therapists to move beyond stigma and into nuanced, informed care. In one case study, a therapist noticed visible bruising on a submissive partner. Rather than assume harm, ethical practice required slowing down, assessing consent, and understanding the dynamics of the relationship.

The AAMFT Code of Ethics (2015) urges therapists to honor client autonomy and respect diverse relationship structures. This includes understanding the role of power, play, and safety in consensual BDSM dynamics. As Hanna & Brown (1995) emphasize, therapists must respond without pathologizing, particularly when working with non-mainstream expressions of intimacy.

Using the SLEEPP model, clinicians can examine sociocultural assumptions, legal mandates, ethical obligations, and the internal power dynamics of the relationship. The focus becomes ensuring both partners can consent freely and feel emotionally and physically safe—not projecting personal discomfort onto the couple’s practices.

As a PLMFT, competence also means knowing when to consult, seek supervision, and engage with community resources to better understand the population you’re serving. Affirming care doesn’t mean turning a blind eye to red flags—it means viewing clients through a lens of curiosity, not judgment.

References:
AAMFT. (2015). AAMFT Code of Ethics.
Hanna, S. M., & Brown, J. H. (1995). The Practice of Family Therapy: Key Elements Across Models.