Chemsex

This chapter examines the complex intersections among chemsex, intimacy, and mental health among gay, bisexual, and other men who have sex with men (GBMSM), with a focus on therapeutic considerations for clinical practice. It integrates empirical literature and encourages clinical reflections to illuminate the nuanced experiences of individuals engaging in chemsex. The chapter situates chemsex within broader socio-cultural contexts, including minority stress, sexual subcultures, stigma, and the pursuit of intimacy, pleasure, and connection. It highlights both potential harms, such as sexual health risks, dependency, and trauma, and the resilience, agency, and meaning-making that can also emerge in these spaces. The chapter foregrounds the role of shame, loneliness, and community belonging and considers how these dynamics shape sexual behaviour and relational patterns. Therapeutic implications are explored, with an emphasis on trauma-informed, non-pathologising, and cultural humility approaches that validate sexual diversity while addressing health and well-being. Practical guidance is offered for building trust, engaging with harm reduction strategies, and supporting clients in navigating their sexual and relational lives. This chapter endeavours to contribute to a growing body of work seeking to bridge the gap between academic research and effective, affirming therapeutic practice with understanding chemsex.