Cutting and Kink Resources

MorpheusNYC and I worked on a research project about 2 years ago concerning the intersections, similarities and differences between self injury, body modification, and kink practices.  Though that project has gone pretty much permanently on the back burner (if any other academics would like to look at our findings and pick up where we left off that would be delightful) I thought that some of you might find this resource sheet that we designed for the councilors and therapists in attendance at our lecture for AASECT (American Association for Sexuality Educators, Councilors and Therapists) helpful.  If your councilors and therapists need a place to start, consider sending them to this page to get questions, ideas and resources as they begin their own journey exploring this terrain.  Feel free to also share your own resources below!


Lee Harrington

Cutting and Kink:
Transformations of Self-Mutilation into Erotic Play & Body Modification

by Lee Harrington and MorpheusNYC © 2009 and

While we believe that letting the client dictate the general course of where the therapy will go is for the best, some clients and clinicians find it useful to have open ended questions that they can discuss to make the therapeutic relationship more effective.

General concepts:

  • – Try to focus on the antecedents, emotions during the activity and energetic outcome, rather than the activity itself (whether the activity is Self-Injury, BDSM/Kink, or Body Modification).
  • – Keep an open mind and willingness to learn more, but do the homework of learning about BDSM/Body Modification on your own time (one or two questions is one thing, spending their entire hour asking “what’s that” is another). They are paying for your services.
  • – Don’t be afraid to tell your client that you are new to discussing these topics, and offer to table that part of the conversation until the next appointment so you can do research if they so choose.
  • – Be compassionate.
  • – Know what your limits are as a clinician. It’s ok to say “I don’t feel qualified to work with you in this area. It is my professional responsibility to refer you to someone else, or give you resources to find someone who is more qualified/knowledgeable in this area.”
  • – Keeping your composure is key when encountering BDSM/Kink, Body Modification, or Self-injury marks or concepts that are new to you. Few things can be more traumatizing to a client than being told (verbally or visually) that they are too weird for help.
  • – Jokes are always open to interpretation. Understand that sometimes, a misunderstanding with a joke (especially around anything that is part of someone’s identity) may damage your client in profound ways.
  • – If you are comfortable with discussing details of Self-Injury, BDSM/Kink or Body Modification, you can let your client know that you are available to discuss these issues if they so desire.
  • – What you ask is not nearly as important as how you ask it. Keep in mind your body language, intonation, eye contact and facial expressions when asking potentially sensitive questions.

Open-Ended Questions:

In addition to these questions provided, in our survey there are a wide number of possible therapy questions and conversation starters that may be of use to you and your clients. Some of our survey takers have commented that they have had some revelations around their Self-Injury behavior in taking the survey and/or in discussing their results with their therapist or counselor. In the following questions, “this” can be: SI, BDSM, Body Modification, Dominant/submissive relationship, Master/slave relationship and other related topics:

  • – Why are you here today?
  • – How is this serving you in your life?
  • – What do you get out of this?
  • – What does this mean to you?
  • – What is/was the intent with this?
  • – How does this affect your life?
  • – How does this affect the various relationships in your life?
  • – How does this bring happiness in your life?
  • – How does this negatively affect your life?
  • – In what ways do you find this fulfilling or rewarding your life?
  • – What are your hopes around this?
  • – Where would you like to be with this in 3 years? In the future?
  • – What does the Cost-benefit analysis of this look like for you?
  • – Do you think this behavior is healthy in your life?
  • – Do you think this behavior is sustainable in your life?
  • – What does a healthy relationship look like to you? (note to therapist: help them compare their answer to their current situation if they do not match)
  • – What books on the subject have you read? What did you think of them?
  • – Which classes on the subject have you attended? What did you think of them?
  • – Why is it important to have this sort of relationship?
  • – Do you feel this is a want or need? Why is this a need/want?
  • – Have you noticed any trends on what triggers your self-injury?
  • – Are you aware of any BDSM/Kink or Body Modification activities that might trigger your self-injury? (note to therapist: examples can include fear play, abandonment roleplay, age play, lack of aftercare, lack of processing, lack of formal starts/stops to scenes, lack of intention, specific physical activities)
  • – Do you ever feel that your BDSM/Kink or Body Modification activities are unhealthy, and if so, what causes you to feel that way?
  • – Do you ever do BDSM/Kink or Body Modification to get your self-injury needs met? If so, how do you feel about that?
  • – When you have cathartic or intense experiences, do you have a way to process the emotions, thoughts or concepts that were brought to the surface? Would you find it useful to process them here? Would they like to process with you after intense scenes/experiences? (note to therapist: only offer if you are truly able to discuss these experiences with them- sometimes they may need to share exactly what happened to be able to share why something came up for them).Would you like to write or draw your ideas in a journal for us to process together? (things brought up in scenes)
  • – What areas of the body do you tend to injure? Why those body parts?
  • – Do you feel you get to negotiate the structure of your relationship? Do you feel you are fairly and truly listened to? Are your concerns respected?

Ascertain knowledge level of your client regarding these communities and see how aware he/she is regarding: experience level, involvement in local real-time (or on-line) community (e.g., are they taking reasonable precautions, does he/she have outreach/support networks within these communities for emotional and educational and safety support. If client is not aware of these resources (books, organizations, classes, on-line communities, munches) then consider letting the client know that it may be in their best interest to seek them out for emotional and safety reasons.

Things to watch out for/warning signs:
None of these “warning signs” are a guarantee that your client is engaged in unhealthy BDSM/Kink or Body Modification, but instead are discussion point for further examination.

  • – Does your client act passively or passive-aggressively to have things “done to them”?
  • – Does your client simply use others in BDSM/BM so that he/she can get their SI needs met? Is this done without intention or connection?
  • – Does your client’s partner actively encourage their self injury (not related to BDSM/Kink or Body Modification) activities?
  • – Do their rates or severity of self injury escalate after play, after interacting with a specific partner, after going to events, or every time a partner leaves? Are there other trends or cyclical patterns?
  • – If they did self-injure after a scene, consider asking why/what came up for them, instead of assuming it was because of the scene itself.
  • – Does their partner provide aftercare (touch, affection, down-time, or any tool used to ground/establish normalcy or connection after play or an experience) or process (to discuss, contemplate, evaluate or address emotions, concepts or issues that arose) with them about the scene or experience they had?
  • – Have they been isolated from support networks (BDSM/Kink, Body Modification, Familial, Friendship)?
  • – Does your client do these activities because they feel they are being pressured from others?
  • – Does your client feel these activities or relationship(s) are negatively affecting his/her life?
  • – Does your client have access to a Safeword in his/her scenes? Is that safeword respected? If playing without safewords as a form of consensual play, does the client feel his/her limits/boundaries/person are respected?

General comments:

  • – For clients with DID (Dissociative Identity Disorder), role play may be an issue as alters can come out to play and their BDSM/BM partner may not know.
  • – It may not be best to encourage clients to give up SI even if they happen to be unhealthy, their BDSM/Kink or Body Mod practices, until they have developed replacement coping mechanisms or had a chance to truly examine and process through the underlying reasons for the need for such mechanisms.
  • – Self-harm contracts work better if (a) client brings them up as an idea (b) client gets to help design them (c) therapist/counselor is not acting as an “almighty parental figure” that is going to punish them if they do wrong.
  • – Injury to the Eyes, Face, Breasts and Genitals: Literature and standard treatment may argue that any change from self-injury to self-mutilation may require immediate intervention, psychiatric evaluation or hospitalization. In some texts, this is automatically defined as including all self injurious behaviors aimed at the eyes, face, breasts or genitals. Be aware that in some parts of the BDSM/Kink community, as well as in many practices of Body Modification, seemingly damaging practices can be common, including when done in as an auto-erotic practice. These may include but are not limited: genital play, piercing, breast bondage, clips/ clamps, facial scarification, tattooing, tongue splitting, sub-dermal implants, temporary piercing, suturing, whipping and super-gluing. Thus, it is of the utmost importance to find out whether these behaviors were engaged in for the purposes of sexual arousal, pleasure, body modification or aesthetics before assuming that the client is likely to escalate to major self-mutilation or suicidal behaviors.

Resource List

Self Injury
Strong, Marilee
A Bright Red Scream: Self-Mutilation and the Language of Pain
ISBN 0-14-028053-7 : © 1998
This is probably the first book that both clients and therapists should read.

Walsh, Barent W.
Treating Self-Injury: A Practial Guide
ISBN 978-1-59385-216-0 : © 2006
This is probably the 2nd book that both clients and therapists should read and the first treatment book from a clinician point of view. BRS does a great job of introducing topics and a general overview. This book may be extremely helpful to patients after the introduction of Bright Red Scream by Armando R. Favazza.

Favazza, M.D, Armando R.
Bodies Under Seige: Self-mutilation and Body Modification in Culture and Psychiatry
ISBN 0-8018-599-4 : © 1987, 1996
This book is an excellent academic look into the topic, and the afterward by Fakir Musafar is a must-read for self-injurers drawn to BDSM/Kink or Body Modification.

Hyman, Jane Wegscheider
Women Living with Self-Injury
ISBN 1-56639-720-9 ; © 1999
This is a good book for clients and therapists yet is tertiary reading.

Levenkron, Steven
Cutting: Unerstanding andOvercoming Self-Mutilation
ISBN 0-393-02741-4 : © 1998, 2006
This book is not recommended for self-injurers due to language, but can be insightful as secondary reading for therapists.

Conterio, Karen
Bodily Harm: The Breakthrough Healing Program for Self Injurers
ISBN 0-7868-6464-8 : © 1998
This book is slanted against Body Modification and may be triggering for self-injurers who have Body Modification as part of their core identity.


Moser PhD MD, Charles and Madeson, Jj
Bound to Be Free: The SM Experience
ISBN-10: 0826410472 : © 1998
This psychology oriented book, in which numerous people in BDSM are interviewed and asked what they get out of it, is THE first book that clinicians and practitioners should read. This book is fascinating.

Miller, Phillip and Devon, Molly
Screw the Roses, Send me the Thorns: The Romance and Sexual Sorcery of Sadomasochism
ISBN 0964596008 : © 1988
This fun and informative book is a classic still worth the read for all forms of hands-on BDSM play.

Wiseman, Jay
SM 101: A Realistic Introduction
ISBN-10: 0963976389 : © 1998
A cerebral approach to the topic, this book is an excellent resource for therapist and client alike.

Brame, Gloria
Different Loving: The World of Sexual Dominance and Submission
ISBN-10: 0679769560 : © 1996
For clinicians and therapists seeking information on non-egalitarian relationship structures, this book offers a balanced and fair approach.

Kink Aware Professionals
Whether you are looking for someone to refer a client to, or if you are looking to advertise your own business and availability as a Kink Aware Professional, this is an invaluable resource from the National Coalition for Sexual Freedom.


Lee Harrington

Lee Harrington is an internationally known sexuality, relationships, and personal authenticity educator. Having taught in all 50 states and in 6 countries, he brings a combination of playful engagement and thoughtful academic dialogue to a broad audience. An award-winning author and editor on gender, sexual, and sacred experience, his books include “Traversing Gender: Understanding Transgender Journeys,” and "Sacred Kink: The Eightfold Paths of BDSM and Beyond," among many other titles. He has been blogging online since 1998, and been teaching worldwide since 2001. Welcome to his world, and your chance to expand your mind and heart alike.

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