The purpose of this chapter is to provide clinicians with an overview of general practices that are common within Bondage, Discipline/Dominance, Sadism/Submission, Masochism (BDSM) in order to develop a foundational competency when serving clients from or interested in becoming a part of the BDSM community. This chapter is intended to help deconstruct misconceptions about and/or biases toward people who practice BDSM and provides information from a strengths-based perspective. Basic definitions and key features of practices that are common or standardized within the BDSM community are outlined. A brief overview of the empirical and theorized impacts that BDSM activities have on the people who practice them, specifically regarding those who engage in dominant/submissive dynamics and knife play, is provided. Additionally, this chapter identifies aspects of BDSM activities which have the potential to be abused in an effort to assist clinicians in identifying possible foul play. The importance of keeping personal values out of therapeutic work is highlighted and thought-provoking questions are provided to assist the clinician in developing greater competence for working with individuals who practice BDSM.