Discussion on Sexuality in OT Practice – 21st February 2012

Huge thanks go to our two guest contributors for their summaries of the #OTalk on Sexuality.

#OTalk: Discussing sexuality in OT practice (completed by @michelliwelli)

21 February 2012

One of the first questions that were asked was whether sex is an occupation. There was agreement that it was an occupation despite Kielhofner’s previous assertions that it is an activity and is based on biological instincts rather than an occupation. It was pointed out that sex is listed as an ADL in the 2^nd ed of the OT practice framework and some also regarded it as a human right. Users suggested that if that was the case then cooking would also simply be classed as an activity. There is more to sex than simply the act of intercourse. Contributors talked about sex as encompassing physical non-sexual touch, social behaviours and self care also. Sex is influenced by culture and can have an effect on identity formation and maintenance, roles and self esteem.

Sex can have varying personal meanings and importance to different service users and should therefore be addressed as we need to provide holistic care. The concept of flow was also mentioned and determining its presence during sex may be a way to ascertain the meaning or importance of the occupation.

How comfortable OT’s are at discussing sexual issues was also raised. Some reasons for this discomfort was discussed and is listed below

• private nature of sex
• professional boundary issues
• lack of  experience and/or training in this area in practice/education
• embarrassment/ taboo subject to discuss
• cultural/personal values may not concur with service users’ issues
• “collision of private and public spheres”

A useful suggestion was for us to assess and reflect on why we experience discomfort if we do. One way to make sure issues are not ignored is to pass on information to more experienced, knowledgeable peers or to discuss the issue in MDT meetings, OT meetings  or OT forums (need to be mindful of confidentiality of course). This means OT’s who don’t want to deal with the issues alone because of discomfort/lack of knowledge, won’t give incorrect advice to service users.  In cases where we carry out interventions, we need to be aware of the implications this might have on sexual expression.

The issue of patients feeling uncomfortable with discussing sex was also mentioned and the PLISSIT model of sex therapy was referred to. A link is provided for further info but the relevant part of this model to this discussion is where we ask and the service is given permission to talk about any sexual issues, also giving them the opportunity to decline discussion. We may also not need to be experts; the service users may only need signposting. There are currently no OT specific guidelines on approaching this subject but the NHS published recommendations (Working together for high quality sexual health) as well as a response to these (link below).  Importance of building rapport prior to discussing sex was also seen as important as they are more likely to feel comfortable discussing this topic.

On issue of occupational justice, it is important not to view those with illnesses, physical disabilities or the elderly as asexual. Some OT’s mentioned their involvement in educating service users on risky sexual behaviour, HIV transmission, and impact of drug use on sex-life and relationships and self esteem as well as running dating agencies for service users with LD and LGBT support groups. Although those involved in discussion seemed positive about sex being part of OT practice, some unprofessional and negative attitudes has also been witnessed in practice. It was also clear that a definite need for better education and training is needed in this area.

Thank you very much to everyone’s contribution to the chat, it was very interesting and enlightening.

Further Reading and Resources

 

Websites:

http://www.telegraph.co.uk/news/uknews/law-and-order/8301100/Court-bans-man-with-low-IQ-from-having-sex.html

http://www.telegraph.co.uk/news/uknews/1540753/Hospice-helped-dying-man-lose-his-virginity.html

http://www.stroke.org.uk/information/our_publications/factsheets/sex_after_stroke.html

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_103090

http://sexual-communication.wikispaces.com/PLISSIT+Model+of+Sex+Therapy

http://www.stonewall.org.uk/at_home/health/2658.asp

Articles:

Couldrick, L. (1998) ‘Sexual issues: an area of concerns for occupational therapists?’. British Journal of Occupational Therapy 61(11), 493-496

Couldrick, L. (1998b) ‘Sexual issues within occupational therapy, part 1: attitudes and practice’. British Journal of Occupational Therapy 61(12), 538-46

Couldrick, L. (1999) ‘Sexual issues within occupational therapy, part 2: implications for education and practice’. British Journal of Occupational Therapy 62(1), 26-30

Couldrick, L. (2005) ‘Sexual Expression and Occupational Therapy’. British Journal of Occupational Therapy 68(7), 315-318

Devine, R., and Nolan, C (2007) ‘Sexual Identity & Human Occupation: A Qualitative Exploration’.

Journal of Occupational Science 14(3), 154-161

Pollard, N. and Sakellariou D. (2007) ’Sex and Occupational Therapy: contradictions or contraindications’. British Journal of Occupational Therapy 70 (8) 362-365

Sakellariou, D., and Simo Algado, S. (2006) ‘Sexuality and Disability: a Case of Occupational Injustice’. British Journal of Occupational Therapy 69 (2), 69-76

 

Sladyk, K. (1990)Teaching safe sex practices to psychiatric patients. American Journal of Occupational Therapy 44(3), 284-6

Taylor, B. (2011) ‘The impact of assistive equipment on intimacy and sexual expression’. British Journal of Occupational Therapy 74 (9), 435-442

Summary of #OTalk on sexuality on OT practice, 21/02/2012 (completed by ‏ @Lisa_D_OT )

During this #OTalk, it was discussed whether sexuality is currently addressed or considered in occupational therapy practice. Contributors had largely negative experiences of the inclusion of sexuality in OT practice:

However, participants agreed that sexuality should be included by OTs as part of their role, largely due to the importance and meaning of this occupation to clients, but also because there are many everyday occupations which are linked to sexuality:

The reasons for the lack of inclusion of sexuality in OT practice were discussed, these included OTs not being comfortable in discussing this topic with clients, and a variation in the inclusion of sexuality as an aspect of OT education:

There was some discussion as to whether sex was considered an occupation, and therefore whether it should be considered part of the OT’s role to address this:

A lack of OT research and literature on the subject was identified, although models from nursing literature were described as being helpful in giving clients permission to broach this subject with their OT:

Several useful references were provided:

And here’s an archive of all the tweets:

And here in PDF form: OT and Sexuality