Therapist bias, attitudes, stigma, and disclosure-handling practices toward consensual adult BDSM/kink clients: a mixed methods systematic review

Consensual adult BDSM/kink is a clinically relevant but stigmatized domain of mental-health care, yet evidence on clinicians’ attitudes, bias, competence, diagnostic framing, and disclosure handling toward these clients has not been integrated. We conducted a mixed methods systematic review using JBI convergent integrated methodology, searching MEDLINE/PubMed, Embase, PsycINFO, Scopus, Web of Science, and CINAHL (664 records identified, 10 June 2026). Six primary clinician evidence reports met inclusion criteria, and convergent integration produced five findings. GRADE-CERQual confidence was moderate that clinician competence with BDSM/kink is measurable (and, by analogy to adjacent-population training evidence, plausibly trainable), and that sound formulation depends on distinguishing consensual kink from coercion, abuse, distress, and trauma; confidence was low for findings on clinician attitudes, pathologizing risk, and disclosure handling, which drew largely on self-selected samples. Methodological limitations were appraised at the criterion level (MMAT 2018); no pooled effect estimate or overall certainty score was derived. Targeted training and non-pathologizing, consent-aware formulation are justified now, while stronger claims await more representative samples and validated competence measures. The review was registered with PROSPERO (CRD420261420940).