Sexual Sadism and Masochism: An Overview of S/M in Psychotherapy

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 cultura...

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...r use with incarcerated individuals and it is not yet known if they would be appropriate for use in other settings. More work should be done to develop interventions that can be used with SMers who abide by the safe, sane, and consensual mantra characteristic of the SM scene. Furthermore, studies should be developed that represent the voices of female SMers as well as gender, sexual, and ethnic minority SM participants. A more well-rounded understanding of diverse communities within SM culture may lead to the development of more effective treatment methodologies. Lastly, psychologists should take note of the growing interest in the healing or “therapeutic” narratives presented in SM websites, literature, and popular media (Barker, Gupta, & Iantaffi, 2007) as these findings have been linked to psychological growth and increases in sexual self-efficacy (Bader, 1993).