I think I understand your upset, Eddy, but I don't think we know nearly enough about this couple to diagnose either one. When we're in the realm of fantasy and power games, we have to take some time to decode the verbal and non-verbal behavior, and to disentangle fact from emotional narrative.
In fact, sometimes patients themselves are ambivalent or unclear about what they want, what they feel, or what has recently happened. While we want to understand everything as best we can, we don't want to judge things prematurely. Doing so establishes a lens that colors everything we see after that, diminishing our effectiveness and sometimes alienating patients.
Finally, when dealing with erotic power play and fantasy games--whether wholesome, scary, or even those that go wrong--we need to be aware of our own feelings about these activities and the minds that enjoy exploring them. Sometimes we focus on aspects of these games that are quite different from what patients actually experience. That can be just as harmful an error as under-diagnosing a real problem.
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