The 2026 Kink Clinical Guidelines Are Here!

Feel free to skip to the next section if you only want to read the guidelines. I blabber on a lot, I don't blame y'all.

What are the Kink Clinical Guidelines?

The 2026 revision of the Kink Clinical Guidelines is now available through the Diverse Sexualities Research and Education Institute, compiled by Charles Moser, PhD, MD, and Peggy J. Kleinplatz, PhD. This is one of those resources that makes me want to gently slide a link across the table to quite a few professionals and say, with great warmth and only a very small amount of side-eye, “Perhaps today is a good day for continuing education.”

The guidelines are written for clinicians, and their central message is clinically simple: kink-involved clients deserve care that is informed, non-pathologizing, and aware of context. That sounds obvious until you have listened to enough kinky people describe what happens when they bring BDSM, power exchange, fetish, fantasy, or kink identity into therapy. Many clients learn very quickly that they need to test the room before they tell the truth. Whether that be softening wording, over-explaining consent, leaving out parts that they worry may become the focus of the whole session, regardless of how relevant it may be, it usually boils down to folks making their kink identity or practice sound easier to understand, because they are trying to avoid being reduced to it.

The guidelines name this problem and speak on the reason why it is present. Clinicians, like everyone else, grow up in cultures that can be sex-negative, kink-negative, and deeply invested in narrow ideas of acceptable desire. Quite unfortunately, those beliefs do not vanish when someone receives a degree (especially when the programs themselves often either fail to mention the diversity of sexuality, if they mention it at all). Bias can affect diagnosis, treatment goals, engagement, and the client’s ability to feel safe enough to speak honestly.

One of the strongest points in the guidelines is that many kink-involved clients seek professional help for concerns that are unrelated to kink. A person might be in therapy for anxiety, grief, depression, relationship conflict, trauma, burnout, family stress, identity questions, or to hone their communication skills. Kink may be part of their life without being the central clinical issue. It may be relevant context, a source of joy, stress, or shame, or a way to find connection or community. It may also be entirely beside the point, but relevant in their random anecdote from a munch in 2010.

Good clinical care requires the ability to tell the difference.

A kink-aware clinician looks at the full picture. They stay aware that the existence of kink does not automatically indicate trauma, pathology, poor judgment, instability, or a desire to change one’s sexuality. This is extremely important because often, many clients have already spent years wondering what their desires “say” about them. Therapy should not become one more room where they have to place their sexuality on trial before the actual work can begin.

The guidelines also offer a useful reminder about consent. Consent in kink is described as an ongoing and dynamic process. This is important clinical language because it allows for a respectful assessment of relationships, which may include conversations around whether all participants can freely stop or withdraw. This allows therapists to take safety seriously while still recognizing that negotiated intensity and harm are not the same.

Stigma is another major piece of the guidelines. They address that distress around kink may come from discrimination, shame, secrecy, fear of being outed, privacy concerns, relationship conflict, or internalized kinkphobia. Stigma can shape how people speak, how they relate to their own desire, and whether they seek care at all.

There is also a section on clinician qualifications and expertise, which may be one of the most practically useful parts of the document. The guidelines call for supervision, consultation, training, current research, cultural humility, and awareness of local and international kink community practices. They describe cultural expertise as a mix of competence, humility, and literacy, which is, in my opinion, a great standard. I appreciate the emphasis on the fact that a therapist does not need to know every term, role, protocol, toy, symbol, scene structure, or community debate before working ethically with a kinky client. They do, however, need enough humility and knowledge to avoid making the client responsible for educating them out of judgment.

Kink-aware care means the client can bring in the parts of their life that matter without the session immediately becoming about defending kink. It means the therapist can hold both ordinary and kink-related concerns within the same clinical frame. It means talking about relationship conflict without assuming power exchange is the problem. It means talking about trauma without deciding every fantasy is a symptom. It means talking about risk without panic, pleasure without embarrassment, and shame without making the client feel shamed.

The 2026 Kink Clinical Guidelines give clinicians a clearer standard for this work and give clients language for what they are allowed to (and should!) expect. Respectful care is not a special favor for people whose sexuality is easy to explain.

So for any providers who may find themselves on my page: if you haven’t caught up on them, please have a read. It’s a wonderful resource.

And for kink-involved clients, let this remind you that you deserve care that can understand the full context of your life without turning your desire into a problem before anyone has even listened to you.

The Guidelines

Read up on the guidelines below or here on DSREI's website. Dominant Discourse is registered to post and distribute these guidelines. The copyright for the guidelines below is owned by the Diverse Sexualities Research and Education Institute (DSREI, https://dsrei.org), a 501(c)(3) nonprofit corporation. These Guidelines were compiled by Charles Moser, PhD, MD, and Peggy J. Kleinplatz, PhD, and are administered by DSREI.

The Kink Clinical Guidelines Revision - 2026©

Compiled by Charles Moser, PhD, MD and Peggy J. Kleinplatz, PhD

Introduction: “Kink” refers to a diversity of sexual, gender, and relationship interests, behaviors, orientations, desires, and identities often stigmatized by the cisgender, heterosexual, and monogamous (CHM) dominant culture. In these Guidelines, intended for all clinicians, we will capitalize Kink to emphasize its socio-political and community importance.

Just as we refer to MSM (Men who have Sex with Men) to include men who are sexually active with men but who do not define themselves as Gay, "Kink" includes people who do not define their sexuality as Kink, but who engage in, fantasize about, struggle with personally accepting, or are concerned with the lack of social acceptance of Kink interests. Some of these individuals are active in Kink communities, while others are not.

We respect everyone’s right to define themselves as they choose, but in interactions among people involved in Kink and clinicians, we suggest that you refrain from using words that have been used historically to denigrate or pathologize people. We recommend that you ask all individuals about how they prefer to be referred to and how they define their sexualities. We recommend that you use their preferred terms.

People often experience subtle or overt discrimination, rejection, and social sanctions when they are Kink-identified. Unfortunately, attempts to hide or suppress Kink desires can result in stress, unsatisfying relationships, self-loathing, unmet healthcare needs, and can have an adverse impact on individuals’ lives. Despite these problems, many people continue to pursue Kink.

Clinicians (and patients) are not immune from the effects of growing up in a sex-negative, Kink-negative, or Kink-stigmatizing culture and may harbor unrecognized biases. These biases can lead to inappropriate or missed diagnoses, misguided treatment goals, or a lack of engagement in the treatment process. Many Kink-involved patients seek professional assistance for issues unrelated to their Kink. Clinicians should not assume (because of their own biases or discomfort) that Kink should be the focus of therapy. The Kink Guidelines Revision - 2026, is one step towards providing nonjudgmental care for all.

© 2026 by Diverse Sexualities Research and Education Institute (DSREI). All rights reserved. If you would like to post or distribute these Guidelines, which is encouraged, please complete the agreement form following these guidelines.

The Kink Clinical Guidelines Revision - 2026©

1)  Clinicians understand that Kink interests, behavior, or identity…

• Do not indicate that individuals have a problem or want to change their sexuality.
• Do not typically reflect a response to trauma or abuse.
• Can be recognized at any age, usually evolve over one’s lifespan, are influenced by experiences, the beliefs of others, and by other intersecting identities (e.g., race, religion). The same obviously holds true for other forms of sexuality.

Clinicians recognize that exploration of Kink may result from curiosity, pleasure, identity exploration, or a desire to please one or more partners. In interacting with Kink patients, many clinicians lack the nonjudgmental attitudes and knowledge about the range of consensual Kink practices that are needed to provide care to Kink-identified and Kink-exploring patients.

2) Avoiding Clinical Bias

• Kink-identified patients often have had negative experiences with clinicians in the past, which might affect their initial interactions with a new clinician. The clinician should not judge the patient’s affect on the basis of such interactions alone.
• The presence of Kink interests does not imply any underlying psychopathology, history of trauma, or an inability to control one’s behavior. Please note that individuals with psychopathology may also have Kink interests.
• Clinicians do not assume that any clinical problems are caused by Kink.
• Reparative or conversion therapy, that is, “treatment” intended to eliminate Kink, is unethical, ineffective, and never appropriate.
• Diagnoses of psychopathology should not be based solely on Kink interests. Diagnostic criteria should not differ based on the specifics of patients’ sexual interests (e.g., CHM, Kink, LGBTQ+).

Clinicians recognize that they need sex-positive, Kink-positive, and non-discriminatory perspectives to effect nonjudgmental and supportive care. A “sex-positive” perspective entails treating sex as a normal and healthy part of life, respecting others’ sexual desires, and having nonjudgmental attitudes about consensual sexual practices, regardless of whether you would choose them for yourself. Similarly, “Kink-positivity” reflects the same nonjudgmental and positive perspective but is specifically focused on Kink sexualities. To that end, clinicians support evidence-based continuing education.

Treatment to promote acceptance of one’s Kink interests is more effective than trying to change those interests. Treatment may alter the way in which Kink is expressed or experienced, but not the presence of Kink per se in the patient’s life.  Exploring how Kink interests might be expressed differently might be appropriate. It is important to remember that not all interests need to be actualized; some joyfully remain as erotic fantasy.

The interaction of one’s Kink and psychological problems can be conceptualized as: 1) Kink and problems are independent of each other. 2) A specific Kink is the cause of the patient’s problems. 3) Kinks are not the cause of the problems, but affect how problems are manifested. 4) The problems are not the cause of the patient’s Kink but may affect how the Kink is expressed. 5) Or a mix of all of the above.

The diagnostic criteria and rationale put forth for Paraphilias and Paraphilia Disorders in the ICD-10, ICD-11, and DSM-5-TR are flawed and should not be relied upon.

3) Consent

“Explicit Prior Permission” (EPP) has become a framework to determine the adequacy of consent in legal situations (whether criminal or civil). The American Law Institute has created a draft framework for the revised Model Penal Code intended to help understand consent. This framework can be useful to clinicians to assess the adequacy of consent. It requires that participants:

• Understand the risks of participating. Participants agree on the nature and intensity of the specific acts involved. (Clinicians can help patients to determine their risk profile.)
• Agree as to what level or type of “resistance” can be ignored.
• Can stop and withdraw from the activities, or a particular aspect of an activity, at any time (e.g., via safewords or safe signals).
• Are adults and have the capacity to consent freely.
• Will avoid serious injury, including protracted loss of function of a limb or organ, permanent serious disfigurement, or risk of death.

Consent is an ongoing, dynamic process and should not be reduced to simple “yes-or-no” negotiations. Consent discussions include clear and honest statements of limits, desires, goals, aftercare, debriefing, risks, probable and possible outcomes.

Consent, how it is managed and negotiated, is often an issue in Kink relationships and a concern for the clinician treating Kink patients. By definition, Kink is consensual. If it is not consensual, it constitutes violence. EPP is a place to start, but it is complex, and much has been written and debated about it. Kink communities do attempt to educate their members about consent; the process and adequacy of consent are ongoing considerations.

4) Stigma

• Clinicians recognize how stigma, discrimination, and violence directed at people involved in Kink can have an adverse impact upon their health and well-being.
• Clinicians understand that distress about bias against Kink can result in a patient’s understandable reluctance to engage with the clinician.
• Distress about Kink might reflect internalized stigma (or internalized Kinkphobia) rather than serving as evidence of disorder or diminution of the patient’s capacity to function.

The effects of stigma are significant and usually arise as patients struggle with defining themselves and/or accepting themselves, managing interpersonal conflicts, being outed by others, or privacy and confidentiality concerns. People often have conflicts with other co-existing identities (e.g., submissive feminist women, Black individuals who identify as slaves). Kinkphobia, an irrational fear of Kink, may be internalized, but it is also a phenomenon among people who attribute negative intentions to members of the Kink communities.

Some individuals have attempted to deprive others of their civil rights by citing their Kink activities. Intimate partner violence/domestic violence (IPV/DV) can be confused with Kink and can also co-exist with Kink activities or relationships. IPV/DV assessments should be Kink-informed. Inappropriate or inadequate assessments of patients can threaten the individuals’ employment, immigration, child custody, and financial status. Such assessments could result in potential imprisonment for consensual adult activities.

5) Personal Growth and Support

Clinicians recognize that Kink experiences can lead to healing, personal growth, and empowerment.

• Kink may be therapeutic in some situations, but Kink is not therapy.
• Suppression of Kink interests or expression can have negative effects on the patient’s health.
• Helping patients to find a group of like-minded individuals (i.e., Kink support groups), may be helpful in alleviating stigma and enhancing personal growth.

Kink support groups can be formal or informal groups of individuals who have common interests (e.g., bondage) or who share other identities (e.g., Kink-identified people of color). Please note that underage individuals may have interests in Kink, but Kink communities can only provide support to adults. There are some sex-positive, youth education platforms (i.e., Scarleteen), which can be supportive.

Clinician Qualifications and Expertise

All clinicians should routinely seek supervision, consultation, and further training, as well as keeping up with the latest academic evidence-based literature on Kink. Licensing boards, continuing education programs, training programs, and academic courses should help clinicians stay current with the latest science and clinical skills concerning Kink. Clinicians should also have an awareness of local and international Kink community practices. It is incumbent upon the professional to recognize that this area of practice is constantly changing.

It is a rare individual who has not absorbed the dominant culture’s sex-negative beliefs, including or especially about Kink. To combat these biases, clinicians should evaluate their own beliefs critically. We refer to this process as developing Cultural Expertise, which can be understood as a combination of cultural competence (i.e., clinical knowledge and skills required to interact effectively with patients involved in or who are contemplating exploring Kink); cultural humility (i.e., ongoing personal introspection into one’s own biases and limitations); and cultural literacy (i.e., knowledge of Kink). Cultural Expertise requires a commitment to lifelong learning.

Training courses may give certificates of attendance, but do not confer certification.

Levels of Kink Clinicians’ Expertise

Kink Aware: The clinician is open to seeing patients who are Kink-identified, engage in Kink activities, or have questions or concerns regarding Kink. The clinician is sex- and Kink-positive and is cautious about preconceived notions (whether positive or negative), about what having a Kink identity, interests, and/or participating in Kink means for/about the patient. The clinician approaches the patient with an attitude of cultural humility. Clinicians operate from the desire to expand their Cultural Expertise.

Kink Informed: The clinician meets the definition of Kink Aware and demonstrates significant clinical experience or knowledge of several types of Kink interests and/or behaviors. Clinicians are committed to expanding their Cultural Expertise to improve interactions with patients.

Kink Expert: The clinician meets the definition of Kink Informed as well as demonstrating extensive clinical experience and knowledge of the treatment of patients with a variety of Kink interests and/or behaviors. Clinicians are actively expanding their Cultural Expertise related to Kink.

Supervising Kink Expert: The clinician meets the definition of a Kink Expert and has additional training and experience in supervising and training of Kink Aware Clinicians.

Kink Specialist: Recognition of specialized educational achievements. (This title is a designation ordinarily reserved for nonclinicians, e.g., educators, lawyers.)