Have you ever talked through your life in therapy, but left your sex life out of it? Plenty of people have. In a US survey of nearly 1,400 kink-involved people, about half had not told their mental health clinician about their kink. Therapists can be unsure about the subject too. In a survey of 766 US therapists, three in four had worked with a client involved in BDSM, yet fewer than half felt competent to.

This matters for LGBTQ clients in particular. A national Australian survey found BDSM was more common among gay, lesbian and bisexual people. It also found that the people involved were no more likely to be unhappy or anxious. Kink is not something a therapist needs to fix.

So, who starts the conversation, and what should they ask? We went through our data and found four useful questions. If you are the client, you can raise them yourself too.

Where our figures come from

We run BeMoreKinky, an intimacy education app where partners explore questions about sex and kink. The figures below are anonymous and aggregate. Our research page has more findings. While we are researchers and collaborate with therapists, we do not claim to be therapists ourselves. 

1. Who wants what?

Take lingerie. In mixed-language couples, it matters which partner answers. On about half of the activities we show to everyone, the masculine and feminine partners answer very differently. Clothing is the clearest example.

In mixed-language couples, one partner mostly wants to look, while the other mostly expects to be looked at. In the same-language couples, most people wanted both. 

Researchers call this familiar pattern the heterosexual script: a set of matching parts for men and women, common enough that it can be measured. Our figures show that it shapes answers where it applies. People answer differently where it does not.

In a session: start with, “What do you want to do?” Then ask, “What do you want done to you or for you?” Do not merge the answers. Nobody should have to pick a side first. If you are the client, you can say both.

2. Who leads, and does that change?

At sign-up, people tell us whether they lean dominant, lean submissive, or switch between the two.

Mixed-language users line up much as the script predicts. Same-language users spread out. Among people who chose masculine words, leaning submissive was four times as common in the same-language group. Somebody’s preferred words do not tell you what they want to do in bed.

There is a caveat to that 25%. In mixed-language couples, the person who leads is usually the masculine partner.

This spread does not mean people avoid roles. Inside same-sex couples who chose feminine words, one partner tended to lead and the other to follow, as clearly as in mixed-language couples. 

Same-sex spouses share housework more equally, but that tells us about the dishes. In bed, top, bottom and versatile are widely used labels, and plenty of people identify as switches.

In a session: a therapist should assume neither an equal split nor a fixed one. Ask who tends to lead, who tends to follow, and whether that changes with the day or the activity. A clinical review warns that a clinician’s own picture of what sex should look like can get in the way of affirming care.

3. How many partners are we talking about?

We also ask whether people are solo, with one partner, or with multiple partners. Same-language users chose “multiple partners” about twice as often: 12 to 13%, against 4 to 6% of mixed-language users. The gap was there for masculine and feminine words alike.

In two national samples of single US adults, gay, lesbian and bisexual people more often reported consensual non-monogamy. A meta-analysis of 35 studies found people in these relationships were as satisfied as monogamous people. Unhelpful therapist practices predicted clients leaving therapy early.

In a session: intake forms and first questions should leave room for more than one partner. A therapist should not assume that non-monogamy is the reason you came. It may be part of your life without being a problem in your life. If you are choosing a therapist, ask at the start whether they have worked with non-monogamous clients.

4. When you want different things, what does that mean to you both?

Here we found nothing, and that is the finding. Partners in same-language couples agreed with each other as often as partners in mixed-language couples. In both groups, about one couple in three had one partner doing most of the answering. These groups are small, so a modest difference could be hiding in the figures.

A comparison of same-sex and mixed-sex relationships found far more similarities than differences. How people view a difference can matter as much as its size. In a study of women in same-sex relationships, those who saw their difference in desire as a problem were less satisfied than those who did not.

In a session: resist the urge to solve the difference straight away. Let each partner say what it means to them. Can they discuss it? Is one person doing most of the exploring? That belongs in the conversation too.

Between sessions

Many therapists suggest structured exercises, such as yes / no / maybe lists or sensate focus. I like them as a place to begin when saying what you want aloud feels daunting. They are common practice, not proven tools. We found no published study of yes / no / maybe lists, and a critical review of sensate focus calls the evidence limited.

Whatever you use, keep checking in. People in longer relationships report fewer consent signals. Time together is not telepathy. A couple of twenty years needs the habit as much as a new one.

BeMoreKinky is a digital version of the list exercise. It is not therapy. Clinicians can use it at no cost through our Free for Clinicians program, and clinical guidelines for working with kink-involved clients are available.

If you are looking for support yourself, the LGBTQ and All directory lists affirming therapists, including some who describe themselves as kink-aware or polyamory-affirming. You should be able to discuss your real relationships and desires in therapy instead of editing them into something more acceptable.

Takeaway

In our data, the couples who chose the same words for each other differ from the rest in what each person wants, which roles they choose, and how many partners they have. They agree with each other just as often. None of this tells a therapist what you want. It tells them to ask, and tells you it is fine to answer. Who wants what? Who leads? How many of you are there? What does a difference mean to you? Ask early, and ask again.