Kink-aware therapy where your desires and relationships are not the problem
Kink-aware and polyamory-affirming therapy in New York for people who practise BDSM, consensual non-monogamy or polyamory, or who are exploring them. Bring your whole self, without having to explain or defend how you love.
Too many people in kink and non-monogamous communities have sat across from a clinician who treated their relationships as a symptom. My practice works differently. Whether you are navigating jealousy across a polycule, negotiating boundaries with a play partner, coming out to family or carrying anxiety that has nothing to do with your sex life at all, you are met with curiosity, respect and clinical depth.
“Consensual desire is not a diagnosis. The work of therapy is to help you live your desires and relationships with more freedom, honesty and care.”
We begin from respect for your autonomy, not from suspicion of how you choose to connect.
What makes therapy truly kink and poly affirming
Kink-aware therapy is not a special technique. It is ordinary, rigorous therapeutic care delivered by someone who understands your world and does not pathologise it.
People who practise BDSM, consensual non-monogamy (CNM) or polyamory seek therapy for the same reasons everyone does: anxiety, depression, trauma, relationship strain, work pressure, grief. The difference is that they often have to spend precious session time educating a therapist, or quietly editing out large parts of their lives to avoid judgement. That editing is exhausting, and it limits what therapy can do.
In our work you do not need to explain the difference between a dom and a top, what a metamour is, or why aftercare matters. You also do not need to frame your relationships as the cause of your difficulties. Sometimes they are central to what you want to explore; sometimes they are simply part of the background of a full life. Either way, they are treated with the same respect as any other relationship structure.
My clinical background includes years as an LGBTQIA+ primary care provider and HIV specialist, as well as work with sex worker communities and survivors of intimate partner violence. That experience means I can hold conversations about sexuality, consent, sexual health and harm without flinching, and can help you tell the difference between consensual intensity and dynamics that no longer feel safe.
Consent, safety and the line between play and harm
Kink communities often have more explicit consent practices than mainstream culture, yet boundaries can still be crossed and trust can still be broken. If something happened in a scene or relationship that left you shaken, we can explore it carefully without assuming that kink itself was the problem. Equally, if you are a survivor of abuse who finds meaning or healing in kink, that is honoured here rather than questioned.
Polyamory, CNM and the complexity of many connections
Multiple relationships bring rich possibilities and real logistical and emotional complexity: time management, jealousy and compersion, hierarchy questions, opening an existing relationship, or the grief of a polycule changing shape. I work with individuals on these questions, helping you clarify your needs, communicate them and tolerate the feelings that arise along the way.
Common reasons people seek kink-aware therapy
Some people come to explore something specific to their kink or relationship structure; others simply want a therapist with whom they can be fully honest. Both are welcome. Here are some of the experiences people bring to our sessions, though you may have entirely different reasons for reaching out.
- Shame or confusion about desires
- Jealousy within open relationships
- Opening a monogamous relationship
- Negotiating boundaries and limits
- Fear of being outed
- Family or workplace stigma
- Difficult scenes or broken trust
- Sub drop or emotional crashes
- Polycule changes and breakups
- Anxiety or depression, unrelated
An integrative approach to desire and connection
I combine psychotherapy, somatic healing, mindfulness and cognitive tools, and as a psychiatric nurse practitioner I can also offer medication support. Everything is tailored to you, and nothing is applied by default.
Open, non-judgemental talk
We speak plainly about sex, power, desire and relationships. Psychoanalytic and relational perspectives help us understand what your desires mean to you and how your history shapes the way you connect, without reducing either to pathology.
Somatic awareness
Kink is deeply embodied, and so are anxiety and trauma. Somatic exploration helps you read your body's signals more clearly, which can support consent, notice when something does not feel right, and ease the crashes that sometimes follow intense experiences.
Values and boundaries
We clarify what you want, what you will not accept, and how to express that to partners and metamours. This is practical work that draws on DBT-informed and CBT-informed skills for communication and emotional regulation.
Navigating stigma
Hiding parts of your life from family, colleagues or health providers takes a toll. We look at the cost of secrecy, the risks of disclosure, and how to make choices about visibility that protect both your safety and your sense of self.
Medication when it helps
If anxiety, depression or ADHD are affecting your life, I can assess and prescribe, and we can discuss sexual side effects openly. Any medication decisions are gradual, collaborative and closely monitored, with your priorities at the centre.
Mindfulness and recovery
Mindfulness practices can help you stay present, tolerate difficult emotions like jealousy, and recover after demanding experiences. We find approaches that suit you rather than prescribing a single method.
Affirming care versus tolerant care
Many therapists say they are open-minded. Kink-aware and poly-affirming care goes further.
Tolerant but uninformed
- You spend sessions explaining terms
- Kink treated as the presenting problem
- Non-monogamy seen as avoidance
- Subtle pressure towards convention
- Sexual health discussed awkwardly
Kink-aware and affirming
- Shared language from the start
- Focus on what you came to explore
- Every relationship structure respected
- Your autonomy at the centre
- Frank, informed sexual health conversations
Beginning kink-aware therapy
A simple, private way to start, with your consent guiding every step.
-
1
Free consultation 15 minutes
A brief, confidential conversation where you can share as much or as little as you like and ask how I approach kink, BDSM and non-monogamy. It is a chance to see whether you feel comfortable before booking.
-
2
Getting to know you
In our first full session we explore your history, current relationships, health and what brings you now. You choose what to disclose and when. If medication is relevant, I begin a careful psychiatric assessment.
-
3
Setting direction together
We agree on what you would like to focus on and how we will work: talk therapy, somatic practice, skills for communication, medication support or a blend. The plan is yours and stays flexible.
-
4
Steady, ongoing work
Regular 60 or 90-minute sessions give room to go deep. Over time, many people find they feel less divided, more confident in their choices and more able to communicate what they need.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Therapy for Kink, BDSM, CNM & Polyamory FAQs
Are you a kink-aware therapist in New York?
Yes. I offer kink-aware and polyamory-affirming therapy and psychiatric care in New York. That means I understand BDSM, kink and consensual non-monogamy as legitimate forms of intimacy, and I will not treat them as symptoms. You can talk openly about your desires, practices and relationship structures without needing to educate me first or worry that they will be judged.
Will you try to change my relationship structure or desires?
No. My role is not to steer you towards monogamy, vanilla sex or any particular way of living. If you want to explore whether a structure is working for you, we can do that honestly, but the conclusions are yours. Respect for autonomy is a core value of my practice.
Do I have to talk about kink or polyamory in therapy?
Only if you want to. Many people simply want a therapist with whom they do not have to hide anything, while the actual focus is work stress, anxiety, grief or family history. Knowing that your whole life can be mentioned freely often makes therapy feel safer and more effective, even when sex and relationships are not the main topic.
Can you help with jealousy in a polyamorous relationship?
Yes. Jealousy is a normal human emotion, not proof that non-monogamy is wrong for you. We can explore what it is pointing to, whether that is unmet needs, insecurity, old attachment wounds or practical imbalances, and build skills to tolerate and communicate it. This work can also help you notice compersion and other feelings alongside jealousy.
Something happened during a scene and I feel unsettled. Can we talk about it?
Absolutely. Boundary violations, miscommunications and emotional crashes can happen even in experienced, caring communities. We can explore what happened at your pace, without assuming kink is to blame, and look at how your body and mind are responding. If what you experienced was assault or abuse, we can also talk about options for safety and support.
Is our work confidential if I am not out?
Yes. Confidentiality is fundamental to my practice, within the usual legal and ethical limits, which I explain clearly at the start. Many clients are not out to family or employers, and we can discuss any concerns about records or privacy so that you feel safe speaking openly.
Can you prescribe medication if it affects my sex life?
Yes, and we can talk about sexual side effects directly, which some prescribers avoid. If medication is helpful for anxiety, depression or ADHD, we weigh benefits against effects on libido, arousal or sensation, and adjust gradually and collaboratively if needed. Supplements may also be considered, always reviewed for safety and interactions.
Be fully yourself in therapy
Book a free 15-minute consultation and see what it feels like to talk with a clinician who understands your world. No explanations required.