Prevalence
BDSM is practiced in all social strata and is common in both heterosexual and homosexual men and women in varied occurrences and intensities. The spectrum ranges from couples with no connections to the subculture outside of their bedrooms or homes, without any awareness of the concept of BDSM, playing "tie-me-up-games", to public scenes on St. Andrew's crosses at large events such as the Folsom Street Fair in San Francisco. Estimation on the overall percentage of BDSM related sexual behaviour vary but it is no longer assumed to be uncommon.
A non-representative survey on the sexual behaviour of American students published in 1997 and based on questionnaires had a response rate of about 8–9%. Its results showed 15% of openly homosexual males, 21% of openly lesbian and female bisexual students, 11% of heterosexual males and 9% of female heterosexual students committed to BDSM related fantasies. In all groups the level of practical BDSM experiences were around 6%. Within the group of openly lesbian and bisexual females the quote was significantly higher, at 21%. Independent of their sexual orientation, about 12% of all questioned students, 16% of lesbians and female bisexuals and 8% of heterosexual males articulated an interest in spanking. Experience with this sexual behaviour was indicated by 30% of male heterosexuals, 33% of female bisexuals and lesbians, and 24% of the male gay and bisexual men and female heterosexual women. Even though this study was not considered representative, other surveys indicate similar dimensions in a differing target groups.
A representative study done from 2001 to 2002 in Australia found that 1.8% of sexually active people (2.2% men, 1.3% women but no significant sex difference) had engaged in BDSM activity in the previous year. Of the entire sample, 1.8% men and 1.3% women had been involved in BDSM. BDSM activity was significantly more likely in bisexual and gay men. But among men in general, there was no relationship effect of age, education, language spoken at home, or relationship status. Among women, in this study, activity was most common for those between 16 and 19 years of age and least likely for females over 50 years. Activity was also significantly more likely for bisexual women, lesbians, and women who had a regular partner they did not live with, but was not significantly related with speaking a language other than English or education.
Richters et al. (2008) study also found that people who engaged in BDSM were more likely to have experienced a wider range of different sexual practices (e.g. oral or anal sex, more than one partner, group sex, phone sex, viewed pornography, used a sex toy, fisting, rimming, etc.). They were, however, not any more likely to have been coerced, unhappy, anxious, or experiencing sexual difficulties. On the contrary, men who had engaged in BDSM scored lower on a psychological distress scale than men who did not.
Another representative study, published in 1999 by the German Institut für rationale Psychologie, found that about 2/3 of the interviewed women stated a desire to be at the mercy of their sexual partners from time to time. 69% admitted to fantasies dealing with sexual submissiveness, 42% stated interest in explicit BDSM techniques, 25% in bondage. A 1976 study in the general US population suggests three percent have had positive experiences with Bondage or master-slave role playing. Overall 12% of the interviewed females and 18% of the males were willing to try it. A 1990 Kinsey Institute report stated that 5% to 10% of Americans occasionally engage in sexual activities related to BDSM. 11% of men and 17% of women reported trying bondage. Some elements of BDSM have been popularized through increased media coverage since the middle 1990s. Thus both black leather clothing, sexual jewellery such as chains and dominance role play appear increasingly outside of BDSM contexts.
According to yet another survey of 317,000 people in 41 countries, about 20% of the surveyed have at least used masks, blindfolds or other bondage utilities once, and 5% explicitly connected themselves with BDSM. In 2004, 19% mentioned spanking as one of their practices and 22% confirmed the use of blindfolds or handcuffs.
A 1985 study found 52 out of 182 female respondents (28%) were involved in sadomasochistic activities.
BDSM is practiced in all social strata and is common in both heterosexual and homosexual men and women in varied occurrences and intensities. The spectrum ranges from couples with no connections to the subculture outside of their bedrooms or homes, without any awareness of the concept of BDSM, playing "tie-me-up-games", to public scenes on St. Andrew's crosses at large events such as the Folsom Street Fair in San Francisco. Estimation on the overall percentage of BDSM related sexual behaviour vary but it is no longer assumed to be uncommon.
A non-representative survey on the sexual behaviour of American students published in 1997 and based on questionnaires had a response rate of about 8–9%. Its results showed 15% of openly homosexual males, 21% of openly lesbian and female bisexual students, 11% of heterosexual males and 9% of female heterosexual students committed to BDSM related fantasies. In all groups the level of practical BDSM experiences were around 6%. Within the group of openly lesbian and bisexual females the quote was significantly higher, at 21%. Independent of their sexual orientation, about 12% of all questioned students, 16% of lesbians and female bisexuals and 8% of heterosexual males articulated an interest in spanking. Experience with this sexual behaviour was indicated by 30% of male heterosexuals, 33% of female bisexuals and lesbians, and 24% of the male gay and bisexual men and female heterosexual women. Even though this study was not considered representative, other surveys indicate similar dimensions in a differing target groups.
A representative study done from 2001 to 2002 in Australia found that 1.8% of sexually active people (2.2% men, 1.3% women but no significant sex difference) had engaged in BDSM activity in the previous year. Of the entire sample, 1.8% men and 1.3% women had been involved in BDSM. BDSM activity was significantly more likely in bisexual and gay men. But among men in general, there was no relationship effect of age, education, language spoken at home, or relationship status. Among women, in this study, activity was most common for those between 16 and 19 years of age and least likely for females over 50 years. Activity was also significantly more likely for bisexual women, lesbians, and women who had a regular partner they did not live with, but was not significantly related with speaking a language other than English or education.
Richters et al. (2008) study also found that people who engaged in BDSM were more likely to have experienced a wider range of different sexual practices (e.g. oral or anal sex, more than one partner, group sex, phone sex, viewed pornography, used a sex toy, fisting, rimming, etc.). They were, however, not any more likely to have been coerced, unhappy, anxious, or experiencing sexual difficulties. On the contrary, men who had engaged in BDSM scored lower on a psychological distress scale than men who did not.
Another representative study, published in 1999 by the German Institut für rationale Psychologie, found that about 2/3 of the interviewed women stated a desire to be at the mercy of their sexual partners from time to time. 69% admitted to fantasies dealing with sexual submissiveness, 42% stated interest in explicit BDSM techniques, 25% in bondage. A 1976 study in the general US population suggests three percent have had positive experiences with Bondage or master-slave role playing. Overall 12% of the interviewed females and 18% of the males were willing to try it. A 1990 Kinsey Institute report stated that 5% to 10% of Americans occasionally engage in sexual activities related to BDSM. 11% of men and 17% of women reported trying bondage. Some elements of BDSM have been popularized through increased media coverage since the middle 1990s. Thus both black leather clothing, sexual jewellery such as chains and dominance role play appear increasingly outside of BDSM contexts.
According to yet another survey of 317,000 people in 41 countries, about 20% of the surveyed have at least used masks, blindfolds or other bondage utilities once, and 5% explicitly connected themselves with BDSM. In 2004, 19% mentioned spanking as one of their practices and 22% confirmed the use of blindfolds or handcuffs.
A 1985 study found 52 out of 182 female respondents (28%) were involved in sadomasochistic activities.
Psychological categorization
In the past, many activities and fantasies related to BDSM were generally attributed to sadism or masochism and were regarded by psychiatrists as an illness. For example, the International Classification of Diseases (ICD-10) categorized 'sadomasochism' as a "Disorder of sexual preference" (F65.5) and described it as follows: "A preference for sexual activity which involves the infliction of pain or humiliation, or bondage. If the subject prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities."
With the 1994 publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) new criteria of diagnosis were added. The DSM-IV asserts that "The fantasies, sexual urges, or behaviors" must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" in order for sexual sadism or masochism to be considered a disorder. In an AASECT article providing guidelines for therapists working with BDSM clients, sexologists Charles Allen Moser and Peggy Kleinplatz highlight that distress can occur in BDSM patients due to stigma and discrimination surrounding BDSM, and that in these circumstances the role of the therapist is to "validate the distress rather than to 'cure' the BDSM desires". The DSM-IVs' latest edition (DSM-IV-TR) further requires that the activity must be the sole means of sexual gratification for a period of six (6) months, and either cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning" or involve a violation of "consent" to be diagnosed as a paraphilia.
That said, overlap of sexual preference disorders and the practice of BDSM practices can occur.
In Europe, an organization called ReviseF65 has worked towards this purpose in the International Classification of Diseases (ICD-10).[97] In 1995, Denmark became the first European Union country to have completely removed sadomasochism from its national classification of diseases. This was followed by Sweden in 2009, Norway in 2010 and Finland 2011. Recent surveys on the spread of BDSM fantasies and practices show strong variations in the range of their results. Nevertheless it can be stated that the vast majority of the researchers assume 5 to 25 percent of the population showing sexual behavior related to joyfully experienced pain or dominance and submission. The population with related fantasies is considered even higher.
There have been few studies on the psychological aspects of BDSM using modern scientific standards. One pivotal survey on the subject was published by US-American psychotherapist Charles Moser in 1988 in the Journal of Social Work and Human Sexuality. His conclusion was that while there is a general lack of data on the psychological problems of BDSM practitioners, some fundamental results are obvious. He emphasizes that there is no evidence for the theory that BDSM has common symptoms or any common psychopathology; Clinical literature, though does not give a consistent picture of BDSM practitioners. Moser emphasizes that there is no evidence at all supporting the theory of BDSM practitioners having any special psychiatric problems or even problems based solely on their preferences.
Problems do sometimes occur in the area of self classification by the person concerned. During the phase of the "coming-out", self questioning related to one's own "normality" is quite common. According to Moser, the discovery of BDSM preferences can result in fear of the current non-BDSM relationship's destruction. This, combined with the fear of discrimination in everyday life, leads in some cases to a double life which can be highly burdensome. At the same time, the denial of BDSM preferences can induce stress and dissatisfaction with one's own "vanilla"-lifestyle, feeding the apprehension of finding no partner. Moser states that BDSM practitioners having problems finding BDSM partners would probably have problems in finding a non-BDSM partner as well. The wish to remove BDSM preferences is another possible reason for psychological problems since it is not possible in most cases. Finally, the scientist states that BDSM practitioners seldom commit violent crimes. From his point of view, crimes of BDSM practitioners usually have no connection with the BDSM components existing in their life. Moser's study comes to the conclusion that there is no scientific evidence, which could give reason to refuse members of this group work- or safety certificates, adoption possibilities, custody or other social rights or privileges. The Swiss psychoanalyst Fritz Morgenthaler shares a similar perspective in his book, Homosexuality, Heterosexuality, Perversion (1988). He states that possible problems result not necessarily from the non-normative behavior, but in most cases primarily from the real or feared reactions of the social environment towards the own preferences. In 1940 psychoanalyst Theodor Reik reached implicitly the same conclusion in his standard work Aus Leiden Freuden. Masochismus und Gesellschaft.
Moser's results are further supported by Richters et al.'s (2008) study on the demographic and psychosocial features of participants in BDSM done in Australia. Richters et al. (2008) found that BDSM practitioners were no more likely to have experienced sexual assault than the control group, and were not more likely to feel unhappy or anxious. The BDSM males reported higher levels of psychological well-being than the controls. It was concluded that "BDSM is simply a sexual interest or subculture attractive to a minority, not a pathological symptom of past abuse or difficulty with 'normal' sex."
In contrast to frameworks seeking to explain sadomasochism through psychological, psychoanalytic, medical or forensic approaches, which seek to categorize behaviour and desires and find a root "cause," Romana Byrne suggests that such practices can be seen as examples of "aesthetic sexuality," in which a founding physiological or psychological impulse is irrelevant. Rather, sadism and masochism may be practiced through choice and deliberation, driven by certain aesthetic goals tied to style, pleasure, and identity. These practices, in certain circumstances and contexts, can be compared with the creation of art.
In the past, many activities and fantasies related to BDSM were generally attributed to sadism or masochism and were regarded by psychiatrists as an illness. For example, the International Classification of Diseases (ICD-10) categorized 'sadomasochism' as a "Disorder of sexual preference" (F65.5) and described it as follows: "A preference for sexual activity which involves the infliction of pain or humiliation, or bondage. If the subject prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism. Often an individual obtains sexual excitement from both sadistic and masochistic activities."
With the 1994 publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) new criteria of diagnosis were added. The DSM-IV asserts that "The fantasies, sexual urges, or behaviors" must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning" in order for sexual sadism or masochism to be considered a disorder. In an AASECT article providing guidelines for therapists working with BDSM clients, sexologists Charles Allen Moser and Peggy Kleinplatz highlight that distress can occur in BDSM patients due to stigma and discrimination surrounding BDSM, and that in these circumstances the role of the therapist is to "validate the distress rather than to 'cure' the BDSM desires". The DSM-IVs' latest edition (DSM-IV-TR) further requires that the activity must be the sole means of sexual gratification for a period of six (6) months, and either cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning" or involve a violation of "consent" to be diagnosed as a paraphilia.
That said, overlap of sexual preference disorders and the practice of BDSM practices can occur.
In Europe, an organization called ReviseF65 has worked towards this purpose in the International Classification of Diseases (ICD-10).[97] In 1995, Denmark became the first European Union country to have completely removed sadomasochism from its national classification of diseases. This was followed by Sweden in 2009, Norway in 2010 and Finland 2011. Recent surveys on the spread of BDSM fantasies and practices show strong variations in the range of their results. Nevertheless it can be stated that the vast majority of the researchers assume 5 to 25 percent of the population showing sexual behavior related to joyfully experienced pain or dominance and submission. The population with related fantasies is considered even higher.
There have been few studies on the psychological aspects of BDSM using modern scientific standards. One pivotal survey on the subject was published by US-American psychotherapist Charles Moser in 1988 in the Journal of Social Work and Human Sexuality. His conclusion was that while there is a general lack of data on the psychological problems of BDSM practitioners, some fundamental results are obvious. He emphasizes that there is no evidence for the theory that BDSM has common symptoms or any common psychopathology; Clinical literature, though does not give a consistent picture of BDSM practitioners. Moser emphasizes that there is no evidence at all supporting the theory of BDSM practitioners having any special psychiatric problems or even problems based solely on their preferences.
Problems do sometimes occur in the area of self classification by the person concerned. During the phase of the "coming-out", self questioning related to one's own "normality" is quite common. According to Moser, the discovery of BDSM preferences can result in fear of the current non-BDSM relationship's destruction. This, combined with the fear of discrimination in everyday life, leads in some cases to a double life which can be highly burdensome. At the same time, the denial of BDSM preferences can induce stress and dissatisfaction with one's own "vanilla"-lifestyle, feeding the apprehension of finding no partner. Moser states that BDSM practitioners having problems finding BDSM partners would probably have problems in finding a non-BDSM partner as well. The wish to remove BDSM preferences is another possible reason for psychological problems since it is not possible in most cases. Finally, the scientist states that BDSM practitioners seldom commit violent crimes. From his point of view, crimes of BDSM practitioners usually have no connection with the BDSM components existing in their life. Moser's study comes to the conclusion that there is no scientific evidence, which could give reason to refuse members of this group work- or safety certificates, adoption possibilities, custody or other social rights or privileges. The Swiss psychoanalyst Fritz Morgenthaler shares a similar perspective in his book, Homosexuality, Heterosexuality, Perversion (1988). He states that possible problems result not necessarily from the non-normative behavior, but in most cases primarily from the real or feared reactions of the social environment towards the own preferences. In 1940 psychoanalyst Theodor Reik reached implicitly the same conclusion in his standard work Aus Leiden Freuden. Masochismus und Gesellschaft.
Moser's results are further supported by Richters et al.'s (2008) study on the demographic and psychosocial features of participants in BDSM done in Australia. Richters et al. (2008) found that BDSM practitioners were no more likely to have experienced sexual assault than the control group, and were not more likely to feel unhappy or anxious. The BDSM males reported higher levels of psychological well-being than the controls. It was concluded that "BDSM is simply a sexual interest or subculture attractive to a minority, not a pathological symptom of past abuse or difficulty with 'normal' sex."
In contrast to frameworks seeking to explain sadomasochism through psychological, psychoanalytic, medical or forensic approaches, which seek to categorize behaviour and desires and find a root "cause," Romana Byrne suggests that such practices can be seen as examples of "aesthetic sexuality," in which a founding physiological or psychological impulse is irrelevant. Rather, sadism and masochism may be practiced through choice and deliberation, driven by certain aesthetic goals tied to style, pleasure, and identity. These practices, in certain circumstances and contexts, can be compared with the creation of art.
Gender observances in research
Not much empirical research has been done on gender differences or prevalence rates of categorized roles within BDSM. Though, one Australian demographic study found higher rates of female participants than males, it can not be generalized.
Not much empirical research has been done on gender differences or prevalence rates of categorized roles within BDSM. Though, one Australian demographic study found higher rates of female participants than males, it can not be generalized.
- Gender differences in masochistic scripts
Baumeister (2010) found that masochistic males experienced greater: severity of pain, frequency of humiliation (status-loss, degrading, oral), partner infidelity, active participation by other persons, and cross dressing. Trends also suggested that male masochism included more bondage and oral sex than female (though the data was not significant). Female masochists, on the other hand, experienced greater: frequency in pain, pain as punishment for 'misdeeds' in the relationship context, display humiliation, genital intercourse, and presence of non-participating audiences. The exclusiveness of dominant males in a heterosexual relationship should be noted because, historically, men in power preferred multiple partners. Finally, Baumeister (2010) observes a contrast between the 'intense sensation' focus of male masochism to a more 'meaning and emotion' centred female masochistic script.
- Women in S/M culture
Orientation observances in research
Though BDSM in itself can be considered a sexual orientation or identity, and is considered one by some of its practitioners, the BDSM and kink scene is more often seen as a diverse pansexual community. Ideally, this is a non-judgmental community where gender, sexuality, orientation, preferences are accepted as is or worked at to become something a person can be happy with. In research, studies have focused on bisexuality and its parallels with BDSM, as well as gay-straight differences between practitioners.
Though BDSM in itself can be considered a sexual orientation or identity, and is considered one by some of its practitioners, the BDSM and kink scene is more often seen as a diverse pansexual community. Ideally, this is a non-judgmental community where gender, sexuality, orientation, preferences are accepted as is or worked at to become something a person can be happy with. In research, studies have focused on bisexuality and its parallels with BDSM, as well as gay-straight differences between practitioners.
- Differences and similarities between gay and straight men in S/M
Sexually speaking, the same 2006 study by Nordling et al. found that gay males were aware of their S/M preferences and took part in them at an earlier age, preferring leather, anal sex, rimming, dildos and special equipment or uniform scenes. In contrast, straight men preferred verbal humiliation, mask and blindfolds, gags, rubber/latex outfits, caning, vaginal sex, and cross-dressing among other activities. From the questionnaire, researchers were able to identify 4 separate sexual themes: hyper-masculinity, giving and receiving pain, physical restriction (i.e. bondage), and psychological humiliation. Gay men preferred activities that tended towards hyper-masculinity while straight men showed greater preference for humiliation. Though there were not enough female respondents to draw a similar conclusion with, the fact that there is a difference in gay and straight men suggests strongly that S/M (and BDSM in general) can not be considered a homogenous phenomenon. As Nordling et al. (2006) puts it, “People who identify as sadomasochists mean different things by these identifications.” (54)
- Bisexuality and BDSM
Brandy Lin Simula (2012), on the other hand, argues that BDSM actively resists gender conforming and identified three different types of BDSM bisexuality: gender-switching, gender-based styles (taking on a different gendered style depending on gender of partner when playing), and rejection of gender (resisting the idea that gender matters in their play partners). Simula (2012) explains that practitioners of BDSM routinely challenge our concepts of sexuality by pushing the limits on pre-existing ideas of sexual orientation and gender norms. For some, BDSM and kink provides a platform in creating identities that are fluid, ever-changing.
History of psychotherapy and current recommendations
Psychiatry has an insensitive history in the area of BDSM. There have been many involvements by institutions of political power to marginalize subgroups and sexual minorities. Mental health professionals have a long history of holding negative assumptions and stereotypes about the BDSM community. Beginning with the DSM-II, Sexual Sadism and Sexual Masochism have been listed as sexually deviant behaviours. Sadism and masochism were also found in the personality disorder section This negative assumption has not changed significantly evident in the continued inclusion of Sexual Sadism and Sexual Masochism as paraphilias in the DSM-IV-TR. These said biases and misinformation can result in pathologizing and unintentional harm to clients who identifies as sadists or masochists.
According to Kolmes et al. (2006), major themes of biased and inadequate care to BDSM clients are:
Psychiatry has an insensitive history in the area of BDSM. There have been many involvements by institutions of political power to marginalize subgroups and sexual minorities. Mental health professionals have a long history of holding negative assumptions and stereotypes about the BDSM community. Beginning with the DSM-II, Sexual Sadism and Sexual Masochism have been listed as sexually deviant behaviours. Sadism and masochism were also found in the personality disorder section This negative assumption has not changed significantly evident in the continued inclusion of Sexual Sadism and Sexual Masochism as paraphilias in the DSM-IV-TR. These said biases and misinformation can result in pathologizing and unintentional harm to clients who identifies as sadists or masochists.
According to Kolmes et al. (2006), major themes of biased and inadequate care to BDSM clients are:
- Considering BDSM to be unhealthy.
- Requiring a client to give up BDSM activities in order to continue in treatment.
- Confusing BDSM with abuse.
- Having to educate the therapist about BDSM.
- Assuming that BDSM interests are indicative of past family/spousal abuse.
- Therapists misrepresenting their expertise by stating that they are BDSM-positive when they are not actually knowledgeable about BDSM practices.
Clinical issues
Nichols (2006) compiled some common clinical issues: countertransference, non-disclosure, coming-out, partner/families, and bleed-through.
Countertransference is a common problem in clinical settings. Despite having no evidence, therapists may find themselves believing that their client’s pathology is "self-evident". Therapists may feel intense disgust and aversive reactions. Feelings of countertransference can interfere with therapy. Another common problem is when clients conceal their sexual preferences from their therapists. This can compromise any therapy. To avoid non-disclosure, therapists are encouraged to communicate their openness in indirect ways with literatures and artworks in the waiting room. Therapists can also deliberately bring up BDSM topics during the course of therapy. With less informed therapists, sometimes they over-focus on clients’ sexuality which detracts from original issues such as family relationships, depression, etc. A special subgroup that needs counselling is the "newbie". Individuals just coming out might have internalized shame, fear, and self-hatred about their sexual preferences. Therapists need to provide acceptance, care, and model positive attitude; providing reassurance, Psychoeducation, and bibliotherapy for these clients is crucial. The average age when BDSM individuals realize their sexual preference is around 26 years. Many people hide their sexuality until they can no longer contain their desires. However, they may have married or had children by this point. Therefore, therapists need to facilitate couples counselling and disclosure. It is important for therapists to consider fairness to partner and family of clients. In situations when boundaries between roles in the bedroom and roles in the rest of the relationship blurs, a "bleed-through" problem has occurred. Therapists need to help clients resolve distress and deal with any underlying problems that led to the initial bleed-through.
Nichols (2006) compiled some common clinical issues: countertransference, non-disclosure, coming-out, partner/families, and bleed-through.
Countertransference is a common problem in clinical settings. Despite having no evidence, therapists may find themselves believing that their client’s pathology is "self-evident". Therapists may feel intense disgust and aversive reactions. Feelings of countertransference can interfere with therapy. Another common problem is when clients conceal their sexual preferences from their therapists. This can compromise any therapy. To avoid non-disclosure, therapists are encouraged to communicate their openness in indirect ways with literatures and artworks in the waiting room. Therapists can also deliberately bring up BDSM topics during the course of therapy. With less informed therapists, sometimes they over-focus on clients’ sexuality which detracts from original issues such as family relationships, depression, etc. A special subgroup that needs counselling is the "newbie". Individuals just coming out might have internalized shame, fear, and self-hatred about their sexual preferences. Therapists need to provide acceptance, care, and model positive attitude; providing reassurance, Psychoeducation, and bibliotherapy for these clients is crucial. The average age when BDSM individuals realize their sexual preference is around 26 years. Many people hide their sexuality until they can no longer contain their desires. However, they may have married or had children by this point. Therefore, therapists need to facilitate couples counselling and disclosure. It is important for therapists to consider fairness to partner and family of clients. In situations when boundaries between roles in the bedroom and roles in the rest of the relationship blurs, a "bleed-through" problem has occurred. Therapists need to help clients resolve distress and deal with any underlying problems that led to the initial bleed-through.
