By Benjamin Marr, M.A., M.B.C.


I dedicate this article to my mother, who always encouraged me to use my assets, although they had their limitations due to my disabilities. She motivated me to use my remaining skills to develop my intellect to an even higher level, never to perceive myself as handicapped (“cap-in-hand”), but as differently abled. This is something I will always thank her for, now that she is dead.

I further direct this article to a teacher at school who, rather than inspiring me to achieve and to make much of myself, made it clear that, in her opinion, the blind and visually impaired, as well as disabled people had particular roles and positions in society and they must remain there. To aspire to anything else would be an abomination, in “her eyes”. Nevertheless, as often is the case, her negative attitude went against the grain for me, as, when she said: “You are only fit for telephony, dear” and I strived to achieve higher aims academically and socially. “When you have a disability, knowing that you are not defined by it is the sweetest feeling.” – “In My Dreams I Dance “, Autobiography by Anne Wafula Strike (p. 79). The demoralising effect of her words only inspired me to feed on degrees and various other qualifications, until I was overflowing.


Why did I become a therapist?

Well I don’t know, my parents were both healers, they were doctors. Maybe in some ways I want to be like them and as Oscar Wilde said: “Keep love in your heart. A life without it is like a sunless garden when the flowers are dead”. My upbringing had taught me that attachment principles were essential for my own self-growth and for the self-growth of others.

However, I was never good at mathematics, so I could not have gone to medical school; also I had an artistic side which was very strong – I was constantly


painting, writing, sculpting, dancing and trying to make people laugh. My solution was to become an art therapist and I worked with a number of therapists in Dublin.

When it came to my official training in London, I was faced with all the other creative therapies and realised that there was a little dancer inside me and I changed my pathway completely and became a dance movement psychotherapist. I had previously done a course in lesbian and gay counselling at Birkbeck College, University of London. It was this training that was to bring forth the duality of creativity and the analytical self within me. To look deeply into my need to become a therapist, I had to ask myself truly where my creative role lay. My family was one where things were often not alright. I believe that my internal self had become a mediator, listener and therapist from a very early age.

Having worked for over fifteen years in the field of relational psychotherapy with an emphasis on issues surrounding eroticism in the context of disabilities and sadomasochism, every day it seems to me to be clearer what professional demands arise from these themes.

The idea of having such a relational psychotherapy practice from my home emerged from my perception of such a need in my Central London location, as at the time, there seemed to be a lack of friendly and secure home-based practices covering such issues. I, therefore, assumed that it would be important to create such a socially beneficial concern in order to encourage individuals struggling with such relational encumbrances to safely explore and overcome whatever aspects may have been holding them back from having healthy and vibrant personal relationships with others. My rationale was based on the concept of establishing an environment of recognisable personal well-being.

The emphasis of my practice is based on the notion that individuals that seek such relational psychotherapy may be motivated by the need to overcome the interpersonal limitations of such internal struggles. In some instances, their erotic sadomasochistic temptations had seemingly been the cause of these limitations. As a result, my practice has gained professionally rewarding experience amongst current and previous clients and has catered to the perceived conflicts of the clients with the aim of positively changing their outlooks and constructing the basis for an extensive and in-depth personal development. This way, my clients may create within themselves a true sense of positive self-worth, together with a better understanding of their healthy emotional limits and potential.

I have always wished that my clients take away with them an enhanced ability to strengthen their social skills, with the ability to properly support their existing and future life-partners, families and friends in their mutual relationships through freely shared self-development. My greatest wish is for these clients to enjoyably follow their life-paths and careers. I facilitate their attitude to actively and positively interact with their friends, care-givers and society, hence contributing to cohesive self-worth in their minds and positive attitude in their lives. So long as they can move forward in dealing with the demands that such interpersonal links create, they will better get to know themselves, the needs of their immediate circle of family, friends and partners.


This article is written about disability, sexuality, sadomasochism and disability in all its various forms and perceptions within psychotherapy. On our pathway throughout this piece it will become apparent that sadomasochism, disability and the erotic are more often revealed in psychotherapy than is commonly realised. The transference and counter transference within psychotherapy can provide certain challenges for the disabled client and/ or the disabled therapist. Equally, this can just as easily apply to the able bodied client with the able bodied therapist.

Whatever way we cross-link these couplings, we have different types of transference and counter-transference. Such transference often has roots in society’s negative and regressive perceptions of the capabilities of disabled people and the able bodied. These perceptions go back to before Roman times where disabled people were often killed at birth.
In the Middle Ages, disabled people were described as idiots and cast out onto the street and spent their short lives begging. In the eighteenth and nineteenth centuries things were not appreciably better. Disabled people were housed in crowded asylums and ladies and gentlemen amused themselves by visiting these institutions, jovially pointing and laughing at the physically and mentally ill.

Even today, our fear of those who are different to us is very tangible. In psychotherapy, we are scared that our own security in our selfhood may be threatened by the other in the room that has a different status. This can just as easily apply to any sense of insecurity about oneself, whether we are disabled, or able bodied.

It is important as psychotherapists, that we look very closely at and are very honest with our clients in order to be sure where the issue with regard to disability is. Is it on the psychotherapist’s chair (a counter-transference issue), or on the couch (an issue that the client is struggling with)? Of course, in attachment therapy the issue of disability lives permanently, neither on the chair, nor the couch, but rather bounces back and forth between client and therapist in the transference and counter-transference.

Disability from a sexual perspective should be a positive thing. It should be perceived as a good thing in a disabled person’s life, by their family, friends and carers. Disabled people having sex in any form should definitely not disgust us.

As Kath Gillespie-Sells finds out in one of her reference studies, she asks disabled people to respond to their feelings on sexuality and one of them says: “Experiment, try new positions, new games, make it fun. I find not letting my disability hinder me or cause lack of confidence was hard at first, but once the partner didn’t seem bothered I relaxed and forgot about it and had a lot of fun, laughs and good sex.”

Part (1)
Experiences of working with a female client from a far-eastern background


Hereinafter called BL, my mission with this client was to temper, if not work through, her acutely sadistic relational tendencies and severe aversion to any form of change by way of engendering a verifiable degree of self-worth. She was defined, in accordance with the DSM-IV, as a sexual sadist: “Sadistic Fantasies, or acts, may involve activities that indicate the dominance of the person over the victim”, Ideas in Psychoanalysis – Sadomasochism, Icon Books, 2002. Her relational sadism seemed to have a concrete detrimental effect on both her physical and emotional health. My one-to-one sessions with her had the aim of creating subjective instruments in her own mind that she herself could use to strengthen her own self-esteem in order to break the negative cycles she had found herself creating in her relationships with her fallback sadistic attitudes.


Over the space of two years, we carefully worked through her unconscious negative attitude to any form whatsoever of change and her self-defensive use of seriously passive-aggressive postures to all those around her. This virtual abuse and disrespect of acquaintances, family members and occasional intimate partners manifested itself in various ways, but sexually, even she recognized their troubling aspects and it was clear that this resulted from the abandonment by her father. In this instance, I opted for an emphasis in not only developing her own self-worth, but engendering the concept of allowing those around her to enjoy her positive personality in a safe and welcoming environment.

Methodically, she grew accustomed to the notion of giving her close relationships the sufficient space to develop in mutually beneficial ways. From her far-eastern background, BL lived in North London at home and harboured a not-so-positive relationship with her father and less so with her mother. The cultural environment that she lived in was based around a non-Christian faith and the ensuing religious life that this involved.

She projected the persona of being a little girl, bringing into therapy all the inherent little-girl fantasies. It was whilst she was in therapy that the problems with her father came to light and were partially addressed. BL had at the time a boyfriend whom she described as sexually virile and with no control of standard boundaries. He was then going through a divorce and had been involved in court cases.

When the relationship had started, BL had felt insecure about the whole thing. They spent all their time in her house, even though the boyfriend had his own place. Her perceptions became clear towards the end of the psychotherapy sessions with me. It gradually became obvious to her that she was not really a little girl and that she was acting the role to ensure that no change would happen and that she would not have to acknowledge the responsibility of being a woman and that all that that entailed. She manipulated her boyfriend for him to remain living with her by using class C drugs and sadomasochistic intimacy. On numerous occasions during our sessions together she would defend against any of my interventions that discussed any form of change. In my opinion, she was not sadomasochistic, as one would recognise in the term from photographs and images (men and women dressed in leather and rubber, using whips and chains). However, unconsciously, due to her abandonment in her childhood, she felt that her only way of conducting relationships was by constantly pleasing, or searching for attention to be pleased herself. In her mind, this was the most effective tool of control in her over-arching objective to maintain the status-quo in their relationship.

Her partner consistently struggled with his desire for autonomy and his need to support BL. He was also supporting a family with two daughters, where the wife had refused him access to his children. Even though he was spending practically all his available time with BL, she would persist in keeping him in-doors, on the pretext that she wanted him to be part of her family.

She encouraged him to take more Class C drugs than he would normally have done so; to ensure that he would feel sexually satisfied in their role-playing games, as well as that he would be unable to take up the challenge of job applications, or interview, and finally, that he would constantly be in a state of apathy and not disagree with any of her passive-aggressive suggestions. BL was inherently frightened that her boyfriend was going to leave her, as he was white and so was his wife; her jealousy was intense, as the boyfriend and wife were in constant communication. Any contact with him from another woman (and there were many) inspired insecurity in her and this brings us back again to her abandonment issues in childhood.

The major problems arose when events did not turn out as BL had wanted and instead of stopping to reflect on how she could better handle developments in her relationship with her partner, she only opted for wanting to assume an ever greater controlling role in the relationship. This, eventually, proved to be completely counter-productive and even with this relational challenge, the client preferred to move on even more determinedly to take much more effective (in her eyes) control in future relations. Our initial sessions were very much centred around the notion of getting her to recognise, at the pace she felt most comfortable with, the inevitable risk in failing in her relationships. She ran the risk in therapy of not challenging her goals because of her control issues.

One productive route was the use of her very straightforward female seduction techniques, without lapsing into any facet of sadomasochism. In effect, she had to remember that romantic eroticism is positive. Her use of sadomasochistic role playing was possibly founded on her misconception that control could only be useful if applied intensely and this viewpoint was carried over into her intimate relations. Once she began to consider, however hesitantly at first, how these tactics could be perceived by her partner, slowly, the realisation grew that she could better attain her goals by other more positive, but no less erotic, means.


From the outset, my assessment with BL was to facilitate her overcoming her inherent trepidation, down an alternate path where playful sadomasochism has a positive role to play in her intimate relationships and that an uplifting “glass half-full” attitude was exceedingly more likely to succeed in her wish to keep such relationships as constant as possible. So simultaneously, my attempts were directed at introducing the concept that relational change, if thought out, can not only be useful to develop and strength friendships and relationships, but can be a sound basis for a healthy outlook on life and a major support in increasing and maintaining self-esteem.

Equally, if BL could get her head around the notion that to have a safe, stable and welcoming home life, there was no real need to have intensive control of your partner, including the practical abusiveness of such acute sadomasochism, she could eventually find it in herself to comfortably balance a contemporary loving relationship with her socio-religious background. This would have the benefit of not unnecessarily separating her from the circle of family and friends that she enjoyed in childhood. It was after this point in her youth that her home life was damaged by her father’s departure during the period of her life when adolescent sensibilities were so acute.

Though never explicitly sited, I gathered the possible impression that BL’s mother to a degree attempted to ingrain in her the idea that it was a woman’s role to be submissive in any loving relationship. There were some indications that it was against this backdrop that her daughter reacted so much in revolt of, as in her mind, such a secondary position in no way contributed to a stable home life and she seemed to have convinced herself that it actually contributed to the major risk of tumultuous and uncontrolled change. What seemed to have calmed to a degree her severe anxiousness in this respect was the idea that if she attempted to handle her relations on a basis of mutual consent, the foundations for a stable home life would be greatly strengthened. This could be achieved, by way of each partner agreeing to autonomously taking on specific roles, including the employment of erotic and romantic intimacy, all with the aim of having long-lasting loving relationships.

I believe that BL took away from therapy the idea that if erotic sadomasochism is practiced in a healthy, safe and mutually consensual manner, it has a truly pleasurable and positive role to play in any intimate relationship. Practically speaking, my client convinced herself that she was no longer trapped in a form of enslavement wherein her only weapon against so much unwanted and feared change was to assume an acutely intensive form of control of both personal relationships and all types of sexual encounters.

Difference and Disability

An adequately structured, attachment based psychotherapeutic intervention with a psychologically damaged individual, resulting from practically any form of disability can have considerable rewards for both the patient and the psychotherapist. At its essence, such a process will assist the client to properly understand themselves and to engender a true sense of tangible self-worth. Often, this can best be achieved by psychotherapy that dwells on positive self-acceptance, but also an awareness that everything in the garden does not have to be always hunky-dory. This can include the joint exploration of what is most positive in the client’s life, be it particular character attributes, or specific skill sets. On occasions, this exploration can be particularly rewarding to the clients, when facets of theirs that they had ignored, or not even recognised in themselves are examined openly with the psychotherapist.

These sessions can be a positive contribution to assisting the clients to confront any pain they may feel around their particular disability, in an emotionally balanced manner. It can also be particularly helpful to the individual if this process can provoke a more stoical recollection of any painful episodes, particularly during childhood and adolescence. Hence, the disabled client may be able to take away from psychotherapy the ability to handle issues around their disability that may have caused them anxiety, apprehension or discomfort in a balanced and even a matter-of-fact way.

Sometimes, on these occasions, I find music helpful, not necessarily to be played in therapy, but the lyrics of songs can often be suggested as interventions. An example of this is a song by Gabrielle, “Play to Win”, where the chorus is: “Let it go, Let it go, Let it go.”In this way, the therapist may be able to tap into the natural rhythms that their patient has in order to be able to move forward and address change more creatively.

This has the scope to effectively deal with emotional stagnation, isolation and irritability. Physical and psychological disabilities have the very regrettable potential to being the underlying causes of a myriad of predictable ailments, such as stress, anxiety, depression, sadness and low self-esteem. In addition, they can also be at the root of such more basic day-to-day issues, such as a lack of concentration, procrastination in outlook, problematic relationships, eating disorders, addictions, compulsive behaviour, obsessions, phobias and even bullying.

When we reflect on difference and disability from the point of view of the client, or the therapist, we must bear in mind that when both client and therapist are disabled, there occurs an unconscious affinity or frustration in the transference. This may result from notions of credibility on behalf of the client, even though the therapist is also disabled. The same can also apply amongst other minority groups.

For example, one would assume that a black therapist working with a black client would create a safe place; however, many factors can come into play with regard to ethnicity that may cause friction, rather than receptiveness. Furthermore, this can also be a feature when a gay therapist is working with a gay client, as the LGBT community has many different groupings and backgrounds, as well as aspirations.

This implies that reflection on the part of the disabled therapist should carefully review the choices that a disabled client may make. This type of clinical self-study by the therapist, although subject to the usual rigorous therapeutic procedures, should assist in the interaction with the client and enable the latter to develop a more objective outlook on psychotherapy, in the event that she/ he also is disabled.

As a disabled therapist, it is essential to be fully cognitive and proud of your own abilities, whilst practicing; to believe that you are a good therapist and that you are able to facilitate positive change within the therapeutic space, it is fundamental that this self-assuredness exists and is there for your client to believe in you, trust in you and take on board change. To be different, or to be disabled, is one of these states that are sent to try us and it should not be seen as an all-consuming, all-enveloping downer. I personally reflect, whilst writing, on the message of Channel 4’s Paralympics advert this year ( ); the essence of the publicity is the phrase “Yes I can, Yes I can….”. That is the way I have attempted to live my own life and that is the way I work as a disabled therapist with my clients.

Part (2)
Experiences from relational psychotherapeutic sessions with a male client


Hereinafter called NM, this was an individual that was openly a transvestite, based on what became obvious during the psychotherapy from a traumatised childhood. From an abnormally young age, he morphed the normal tendencies of small children to dress up in both genders’ clothes into an acute obsession with his mother’s undergarments that was left completely unfettered by the parents due to their unconscious embarrassment. From this foundation, his tendency was to increasingly involve himself with female sexual partners whose proclivities were always accompanied with differing degrees of sexual bondage. In addition, he had also developed an intense addition to marijuana.

His relationship with his partners from a sadomasochistic point of view progressed to a level that, on one occasion, she tied him up in a position where he momentarily stopped breathing and an ambulance had to be called. According to the DSM-IV: “One particularly dangerous form of Sexual Masochism, called hypoxyphilia, involves sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical ….”. This was a wake-up call for both of them and the nature of their bondage play, as well as their use of marijuana.


In these relational psychotherapeutic sessions, I opted to openly examine with NM his general childhood and early sexual experiences and how these developed into a preference on his part for sadomasochistic alternatives to other forms of sexual encounters. To a certain degree we covered the evidently inter-linked themes around how the cross-influences of his gender self-interpretation manifested itself in his heightened sexual stimulation from sadomasochistic sexual episodes. As an expression of his standard erotic desires, our sessions allowed for the refinement of his self-analysis on the complex environmental and parenting processes he was exposed to from an early age and how these may have influenced his sexual preferences. In particular, our sessions together enabled him to freely recognise that he could become more open to healthier sexual spheres, wherein erotic situations could easily be contrived where less, or even no abuse during love-making would become standard. The initial step taken was to introduce the concept that it was normal to seek the thrill of sexual pleasure and that straightforward elements of risk were perfectly acceptable. From this healthy articulation NM developed a more balanced perception of what was erotic and what was just play; the aim throughout was for him to derive true pleasure from a tangible state of well-being – the important thing was for him was to really feel the vitality of his life from less abusive, but no less pleasurable experiences with his partner. Once he accepted that it was good to feel the thrill of the natural risks that we all encounter in everyday sexual experiences, it was then a question of him interpreting such thrill-seeking with less abusive intimacy and preferably, instances where no such physical and/ or psychological abuse was practiced by his sexual partners. With time, NM grew to accept the notion that there was no compelling need to negatively confront his tendencies, but rather to positively develop them into less self-harming preferences where much of the satisfaction created was precisely from being exposed to less physical and emotional risk. By way of healthier episodes, he could still experience fulfilling sexual fantasies and still be the object of desire to those sexual partners he was most attracted to. One constant imperative utilised in our psychotherapy was the engendering in NM of his own sense of self-belief that he had the ability to set straightforward limits to his sexual partners’ role-playing and that this position was perfectly normal. Furthermore, what also seemed to be a breakthrough in his therapy was the development of his self-analysis, which helped him with his overall confidence, his family relationships, his friends and his sporadic work. NM increased his capacity, when it came to simple tasks in his day-to-day life, such as managing his sleep pattern, feeding his ducks and cooking. He also coped more easily with the on-going issues outside the realm of his sadomasochism, such as his agoraphobia. Also, the then recent death of his mother which caused him much emotional turmoil, required from him a development of a relationship with his father and his sister. It was my feeling that these emotional challenges were the foundation of NM’s therapy. Therefore, you could argue that his issues around attachment, loss and separation described the very phases of his therapy. It could be said that it was for these reasons that the therapy was a true success.


Once there was no perceived risk of “dislocations” in NM sexual perceptions as a result of his psychotherapy, together we methodically increased his positive outlook and attraction for vividly dynamic sexual experiences that were based on healthier practices. One useful tool was the creation of sufficient self-confidence for him to develop, of his own volition, inventive and new fantasies; all of this could be sprinkled with generous doses of both straightforward risk and the positive thrill of even the mere expectation of the pleasure to come. Thus, it was somewhat easier for NM to grasp the positivity in not using demarcations between himself and his sexual partner, so as to promote a greater sense of stress-free love-making. So long as his encounters were not subject to any greater exposure to abuse, then the healthy broad-minded sexual imaginativeness that he was naturally capable of had the potential to hold him in good stead for his emotional and sexual development in the future.

Sadomasochism and Sex

At its heart, sexual activity is merely the physical and sensual stimulation created, with the explicit introduction of an intimate act, which clearly distinguishes itself from pornography. Hence, this type of sexual desire describes not only, generally speaking, the state of sexual excitement, but also extends itself into the standard interpretations in various forms of art, such as literature and painting. To a relative degree, it is by way of this artistic appeal that straightforward sexual intimacy distinguishes itself from pornography, insofar as the latter state tends to concentrate on the purely sexual, whereas the former is somewhat more capable of being focused on the aesthetic.

On the other hand, sadomasochism refers to the relationship between opposite tendencies that come together for the purposes of deriving sexual pleasure from the application, on the one part, and the acceptance, on the other, of physical abuse and pain. Thus, in a sadomasochistic relationship, one party will mostly be sadistic, whereas the other will mostly be masochistic. Together with the tangibly physical aspects of such a relationship, I am of the opinion that a psychotherapist worth his salt has to, in every instance, examine and treat the resulting psychological reasoning for the seeking of such pleasures.

In the majority of cases of individuals with somewhat damaged backgrounds, the difficulty arises is maintaining such a healthy balance whilst involving themselves in these types of sexual proclivities. This point of view is backed up to a degree by the study carried out in 2013 by Dr. Andreas Wismeijer of Tilburg University, entitled “Psychological Characteristics of BDSM Practitioners” and published in the Journal of Sexual Medicine, wherein he attests that those that enjoy the sensation of whip lashes on the skin, as well as the titillation of chains against the body, are quite capable of having psychologically healthy sex lives.

In his study, Dr. Wismeijer came to the conclusion that enthusiastic, but healthy, practitioners of sadomasochism, which can include slavery roles as well as disciplinary, sadistic and masochistic sexual acts, would actually score more highly in the personality tests he carried out on his sample participants, as compared to those that went for milder, or even non-existent, sexual fetishes. He found that, as a rule, these individuals had the potential to be more extroverted, open-minded to new sexual experiences and particularly less neurotic.

One relative drawback to this type of study, however, is that it was carried out “blindly”; namely, the participants responded online and were not made explicitly aware of the underlying reason for the study, as the questionnaire platform was amply sprinkled with very generic questions on general character traits. The fact that participants did not have the opportunity to consider what some could have perceived as their own worrying behaviour, could arguably be a reason for taking such a positive outcome with a very heavy dose of salt.

Generally speaking, sexual intimacy seems to work best for both parties when there is mutual respect in the acts carried out and that any particular aspect that may generate discomfort in one party is freely talked through by both. Thus, those that have drifted into acutely abusive forms of sadomasochism may be best served by a methodical psychotherapeutic process of psychotherapy so that they can better grow in themselves with healthy sexual desires and avoid the psychologically harmful effect of deeming themselves to practitioners of socially unacceptable behaviour.

Pornography can also have links to thwarted and damaged behaviours and learning in childhood. It may result in similar difficulties in the sexual arenas within relationships. Otherwise, it may also be a happy release for both men and women.

Some clients develop a compulsive need to use pornography which can result in an inability to perform adequately in sexual encounters. Society’s pressure to push us to be princesses and studs can often lead to failure and general collapse, especially in the early years. The most common solution for all forms of dependencies, whether they concern drugs, sex, alcohol, or pornography, has been abstinence.

However, it is important that, whilst making a change in any of these areas, that the client is contained throughout the process of recovery. Between addictions, sadomasochism and disability stems the idea of Winnicott’s precepts of the “the good enough parent”: “The ‘not good enough’ mother leads to ‘false self disorders’ in the child”. Despite this, this philosophy has not been generally imparted amongst all our clients and in many cases, children and young adults react against the overt expectations of their parents.
All this said, if carried out in a relatively healthy and playful manner, practitioners of lighter versions of sadomasochism have the potential to be perfectly balanced in psychological terms.

Part (3)
Experiences from relational psychotherapeutic sessions with a male client


Hereinafter called QT, this individual is an example of the many ways that you can hurt yourself when your self-esteem is damaged by your own perceptions. On the surface this client seemed like a normal individual fruitfully employed. However, there was a big question of where all his money was going?
This client suffered from body dismorphia. He oscillated somewhat between states of moderate self-loathing and extreme body dismorphia. In order to convince himself that his feelings of body dismorphia were not off-putting to women, he would see at least one prostitute per day and on many occasions two; the client believed that each prostitute had a true feeling for him to some varying degree.

His negative feelings towards his body were quite extreme, so I had to attempt to pass across the room the idea that “his body was his temple” and on occasion, fell on deaf ears. QT was, what I would describe, as an extreme masochist; he would even feed off any fee reduction that any prostitute would eventually give him. He seemed never to get enough rejection from his encounters and one of his ultimate rejections was one that he created in psychotherapy when I raised my fee and he said he could not afford it: “Tell me what you fear and I will tell you what has happened to you.” Donald Woods Winnicott, Radio 4 lectures.

QT was heterosexual in tendency, but he only seemed to derive real fulfilment from his sexuality through the extensive use of prostitutes; outside these engagements, he freely admitted that he had no social life. Equally, he used sadomasochistic practices in the sexual encounters with prostitutes precisely aimed at achieving some sense of self-destruction.


Naturally, the greater willingness that the prostitutes would have to be truly sadistic, the greater the fulfilment QT would derive from being proportionately masochistic. However, based on both the commercial basis of these encounters and his constant pushing for ever greater sadistic treatments, in no reasonable sense could it be considered that these were any type of emotional relationships. Although only thirty years of age, these ever more intense tendencies for abandonment and rejection in relationships started to develop from the early age of eighteen when his first girl-friend seemed to be into playing the role of a passive-aggressive partner. From thereon in, QT’s ability to form relationships diminished.

From this relationship, he became increasingly unable to conduct relationships in a positive manner. In his early twenties, he gradually began seeing prostitutes and then without totally being aware of the issue at hand, he was spending up to £500 per week on this proclivity. In addition, he admitted he had never discussed his sexual addiction and dependency on prostitutes with anybody else, which seemed to have bred the notion in him that such relationships were normal.

Of course, this idea stemmed from his internal panic that the external world, or the therapy, would threaten the only thing that made him feel safe. That was the relationship he was having a purchased partner. Despite all this, my attempts throughout were not aimed at being in any way to contradict these tendencies, but rather, guiding him, as far as he felt comfortable, to consider less self-abusive life choices. To this methodology, he normally put up little, if any, resistance, though there were occasions of more evident intensity on his part when I gauged that at these times, it was best to let him simply recall the latest example of his intimate encounter, rather than offer any intervention.
All that said, he freely admitted that in general society, he had an overwhelming sense of being subject to aggressive preconceptions if he were to ever discuss these preferences with any trusted family members, or friends. Therefore, in his day-to-day professional and social dealings he had a continuous fear of being open, but simultaneously and somewhat self-contradictorily, saw no need to forego encounters that gave him such measurable pleasure.


Despite the evident soundness in his belief in being timorous with others before sharing such preferences, once an effective degree of self-worth had been engendered in our sessions, he naturally, and without the need for any type of guidance, toned down the intensity of his dependent and commercial sexual encounters and at a rate that was sporadic, but noticeable over time. Once he took on the notion that there was no hard-and-fast rule book to what was naturally acceptable as mutually consensual sexual behaviour, he increasingly and evidently felt more comfortable in himself. It was also no less useful a methodology to encourage him to broaden what had been a somewhat limited scope until then of sexual partners; this includes such facets as age, ethnicity, nationality, race and even social background.

Irrespective of his body dismorphia, though particularly emotional when he first touched on the issue, he persisted throughout in repeating that his greatest desire was not to become tarnished by the pain of rejection in the future. All this said, at no time did QT ever reflect on the physical risk to himself of his sexual encounters.

On the occasions that I felt him to be more receptive, I would attempt to assist him to self-analyse and reflect on his sexual dependencies with the prostitutes that he met. Equally, the sense of positive self-worth that he developed meant that, when he felt comfortable, he could eventually open up to truly trustworthy social confidants, even if only in the form of straightforward banter; all this did help in increasing his self-confidence. The crucial factor with QT always seemed to be that the most fruitful aim would be to reduce, or eliminate his acute need for self-defensiveness.
He ended therapy being aware that he had further challenges to overcome with his remaining inability to control his frustrations, but realising that his process of therapy had achieved closure and that he had said all that was to be said, as well as being heard sufficiently.

Overall Conclusion

In conclusion, I have looked at disability and sadomasochism in this article, with reference to the unresolved desires in psychotherapy; we have also referred to ideas concerning pornography, sexual addictions and fetishism. I have concerned myself with the nature and complex fears the belie being a disabled therapist and/ or disabled client. This work has looked at three particular previous clients between 2006 and 2014; namely, BL, NM and QT.
In the case of BL, I observed that her unregulated controlling behaviour was a barrier to her change making experience in psychotherapy and deep growth within attachment psychotherapy was not truly possible: “Thus we take it for granted that, when a relationship to a special loved person is endangered, we are not only anxious but are usually angry as well. As responses to the risk of loss, anxiety and anger go hand in hand”, John Bowlby, A Secure Base: Parent-Child Attachment and Healthy Human Development. As to NM, it appeared that, even though he completed psychotherapy, whilst still involved in sadomasochistic behaviour and mild addictions. He perceived his psychotherapy as being a success, due to the fact that it had given him the confidence that he had always craved.
When it comes to QT, he did not achieve closure in the way he may have originally desired. His expectations and insecurities meant that when he completed psychotherapy, like in many instances, his issues of sexual addiction and mild body dismorphia had been challenged, but not completely resolved. When individuals go down the route of seeking sexual satisfaction from sadomasochistic behaviour, they may open themselves up to the risk of getting involved in addictive, sexual fetish-like, or harmful behaviour and, in worst cases, crime. Within the parent-child attachment, difference can be perceived and accepted in various ways. Sex, drugs and “rock & roll”, as well as sadomasochism, can be difficult to talk about with parents, and vice-versa.

With regard to disability, it is similarly considered to be shaming; thankfully, less so today. It is still difficult, however, to discuss the full gamut of shameful thoughts and insecurities, even with close family and friends.
My practice arose from my contacts with colleagues already working in their profession, who inspired me to work in this field and to concentrate on the attachment principals. I also had contacts with numerous charities, such as the Chelsea Methodist Church and Survivors U.K.

Right from the outset, I felt I could not “walk on by” without actively recognising such scope for self-improvement.
Therefore, over the last eight years, since my last Attachment article, I have striven to construct amongst my clients true improvements in their personal and professional quality of life; hence I have now opted to present in the form of a clinical article a certain number of notable observations annotated in my clinical notes over this period. My hope will be that these pages will stimulate some discussion on the topics of eroticism in disability and sadomasochism that I have somewhat found to may be lacking in our professional field.

It is my belief that the field of relational psychotherapy can positively contribute to improving the general understanding of such behavioural limitations in order for the realisation of a tangible social benefit. I am convinced that upon this credence can we develop policies and practices to assist with problematic perceptions in clients. Such a relatively demanding objective seems to be reasonable when we consider the unique society that is Greater London, with all the opportunities and, needless to say, possible temptations that arise within it.

As we are dealing with, in some instances, considerably different communities, I have always believed that an emphasis should be made to create a true understanding of what brings together potentially disperse attitudes. In this way, I believe, we can mitigate potential difficulties that clients may have in dealing with their personal relationships. The final well-being of these clients being the aim of all of us dictates, to a degree, a willingness to consider methodologies that encompass the most natural of urges that practically all humans harbour, but that some have, through no particular fault of their own, turned into problematic tendencies.

Some of the themes I cover here, may be relatively straightforward, but most, I assume, will be anything but. However, I consider these to be of great relevance to the successful relational psychotherapeutic treatment of clients. My greatest wish in all this is that all clients derive the greatest benefit possible from their sessions in order to positively enrich their lives with whatever degree of forward-thinking, optimism and constructive self-esteem that they feel comfortable with – after all, the greatest asset all of us have is each other.

Writing this article, has been a profound experience for me. It has also brought forth in me reflections on my own selfhood and disability. It has helped me reflect on my practice, as well as my existing clients, my previous clients and the place of difference and sexuality in psychotherapy. I was brought up and trained to “keep going”, to listen and to learn, to never say things are not possible and always to try again.

I find the work of my colleagues and the material of my clients inspiring. Therefore, I hope that the reader finds this article as motivational, as it was to write.

Benjamin Marr

Acknowledgements and References
• Exile and Pride – Disability, Queerness and Liberation, by Eli Clare, Duke University Press, 1999
• The Examined Life – How We Lose and Find Ourselves, by Stephen Grosz, Vintage, 2014
• The Ultimate Guide to Sex and Disability – For All of Us Who Live with Disabilities, Chronic Pain and Illness, by Cory Silverburg, Miriam Kaufman and Fran Odette, Cleis Press, 2004
• On Being a Therapist, by Jeffrey Kottler, Jossey-Bass, 2010
• Further Learning from The Patient, by Patrick Casement, London Press, 1990
• Separation: Anxiety and Anger, Attachment, Loss – Sadness and Depression, by John Bowlby, Pimlico, 1998
• Ideas in Psychoanalysis – Sadomasochism, by Estela Welldon, Icon Books, 2002
• Queer Crips – Disabled Gay Men and Their Stories, by Bob Guter and John Killacky, Harrington Park Press, 2004
• Psychotherapy – An Erotic Relationship – Transference and Countertransference Passions, by David Mann, Routledge, 1997
• The Sexual Politics of Disability – Untold Stories, by Tom Shakespeare, Kath Gillespie-Sells and Dominic Davies, Cassell, 1996
• Understanding Disability – From Theory to Practice, by Michael Oliver, algrave 1996
• Treating The Adult Survivor of Childhood Sexual Abuse – A Psychoanalytic Perspective, by Jody Messler-Davies and Mary Frawley, BasicBooks, 1994
• Psychological Characteristics of BDSM Practitioners, by Dr. Andreas Wismeijer, University of Tilburg, 2013
• Playing and Reality, by D. W. Winnicott, Penguin Books, 1971
• Freud and Psychoanalysis, by Nick Rennison, Pocket Essentials, 2001