Bringing sexuality out of the closet: What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?

Abstract

Introduction: Sex has been recognised as an activity of daily living, and sexuality as an important part of our identity, with implications for our self-esteem and quality of life. Although this brings sex and sexuality within the scope of occupational therapy practice, empirical and anecdotal information suggests that neither are routinely included in therapy. The aim of this study was to investigate the experiences of therapists who are comfortable addressing sex and sexuality in practice, with a view to influencing future research and practice. The research question posed was as follows: "What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?" Methods: Interpretative Phenomenological Analysis (IPA) was used to explore the research question. Semi-structured interviews were conducted with 11 Australian occupational therapists who were purposively recruited. Interviews were audiorecorded, transcribed verbatim, and analysed following the guidelines for IPA data analysis. Results: Four master themes and five sub-themes emerged from the analysis and are discussed under the following headings: sexuality matters; know your boundaries; just do it; and seek support and mentoring. The themes provide insight into how occupational therapists successfully integrate sexuality into everyday practice. Conclusion:According to the participants in this study, addressing sex and sexuality during therapy is part of providing holistic client-centred care. With clear personal and professional boundaries, occupational therapists can address sexuality within routine practice utilising core occupational therapy skills, such as communication, collaborative problem solving, pacing, positioning, and adaptive equipment. Furthermore, participants demonstrated that this can be done within a range of settings. It starts with a commitment and the motivation to find a way.

Supporting occupational therapists to initiate conversations about sexuality with people with intellectual disability: Co‐design by deliberative dialogue

“…In line with O'Mullan et al (2021), we acknowledge that the responses of participants may change when researchers are present throughout data collection and researcher bias may alter interpretation during data analysis. To mitigate this, we offered participants multiple opportunities and means to check and correct findings (Lincoln & Guba, 1985); likewise, all authors were involved in reviewing the data to ensure the final content produced avoided discrepancies or overstatements (Patton, 2014).…”

“…O'Mullan et al (2021) argue specialist training is not needed for occupational therapists to address sexuality. This view was supported by our participants.…”

“…Participants reported that developing the confidence to initiate conversations, and the skills to carry them forward, requires cultivating an awareness of knowledge gaps, for example, understanding the evolving language people use to identify themselves and communicate their preferences (Javaherian et al, 2008). O'Mullan et al (2021) similarly identifies self‐education practices as a key to increased comfortability in having conversations that address sexuality. Developing knowledge and confidence to discuss sex and sexuality allows occupational therapists more opportunities to create the space to have the discussion, thus enabling clients to discuss their concerns at any time and in as much detail as they wish, to provide a person‐first, occupation‐focused approach to sexuality.…”

“…Occupational therapy discourse has long asserted that sexuality and sexual functioning are domains of human occupation (Sidman, 1977), demanding adequate attention in curricula to equip clinicians to address these topics with clients as part of their standard practice (Conine et al, 1979; Spaseska et al, 2022). Despite widespread recognition that sexuality is an important dimension of human experience to be addressed by occupational therapists (Farman & Friedman, 2016; Lynch & Fortune, 2019), clinicians routinely report low levels of comfort in supporting their clients in this space (O'Mullan et al, 2021; Spaseska et al, 2022; Yallop & Fitzgerald, 1997). Occupational therapists are even more unlikely to address sexuality with people with intellectual disability, given this level of discomfort (Coulter et al, 2023), along with limited disciplinary and population specific scholarship reporting on best practice (Schmidt et al, 2021).…”

“…Mackey (2007) has identified a narrowness in professional discourse and called for a more expansive, interdisciplinary critical approach to occupational therapy practice. In line with the strengths‐based approach adopted by O'Mullan et al (2021), insight was sought from occupational therapists who identified themselves as comfortable in addressing sexuality with their clients and/or who work primarily with people with intellectual disability. The present study is part of a broader project led by AO to co‐design resources to support LGBTQ people with intellectual disability (Rainbow Inclusion, 2023a).…”