Week 9: Taboo Occupations, Sexual Identity & Sexuality

sexual activity

• engaging in broad possibilities for sexual expression and experiences with self or others

• intimacy, state of mind, how we feel about ourselves

• ex) hugging, kissing, foreplay, masturbation, oral sex, intercourse

basic issues of sexuality for youth

• secondary sexual characteristics - puberty

• reproductive health

• social expectations: when is dating appropriate and whom is an appropriate partner?

• gender identity

• self esteem and safety

issues specific to sex and disability for youth

• desirability

• function

• assistance

• comfort with the topic

• safety and physical comfort

therapist comfort

• talking about sex

• working on ct issues of sexuality

• getting support as needed

• referring out as appropriate

issues affecting LGBTQ youth

• 2-3x more attempted suicide

• increased risk for STDs (gay men, trans people)

• higher rates of smoking, drinking, other drug use

• less likely to get preventative care

• higher rates of behavioral health issues

• increased risk of victimization

strategies for working with LGBT clients

• respectful communication

• pronoun and preferred name use

• avoid asking unnecessary questions

• educate yourself about diversity

• non-judgemental attitude

• practice increasing comfort

• be an accountability advocate

treatment approaches

• health promotion

• remediation

• modification

health promotion with youth

• safe sex practices

• birth control awareness

• consent

• self-esteem and self-determination

remediation

restoration of skills such as ROM, strength, endurance, effective communication, and social engagement as part of meeting sexual needs

modification

changing the environment or routine to allow for sexual activity and satisfaction

ex) positioning, adaptive techniques and tools

Ex-PLISSIT model

• guide to working with clients on issues of sexual

• not linear, but cyclical in nature

• all intervention levels should begin with permission-giving

Permission (PLISSIT)

• allowing client to feel and express thoughts about sexuality

• providing affirmation to clients that their concerns with sexuality are in fact appropriate and can be addressed by a health care professional

• providing permission during therapy session is a safe way to let clients know that OT is an appropriate setting in which to bring up their concerns

Limited Information (Ex-PLISSIT)

• info related to the impact of illness on sexuality and sexual function

• clarify any misinformation the client may have

• only provide factual info that can be easily understood

Specific Suggestions (Ex-PLISSIT

• problem-solving approach to address a particular issue

  • need to be tailored to address specific needs and will require further assessment into the nature of the particular problem

intimacy assessment

• compilation of questions that address client concerns with sexuality that is initiated by either the client or OT

• used to guide intervention during specific suggestions stage

Intensive Therapy (Ex-PLISSIT)

• most advanced stage of PLISSIT model

• used when extensive counseling is needed for serious issues or when abnormal coping patterns are present

  • provided by a health professional with advanced training, NOT OT

Reflection and Review

• after all stages of intervention

• increases opportunity for effectiveness

  • enables practitioners to ID their own attitudes

issues of sexuality with a client who has ASD

• exploration of personal sexual behavior is normal but generally not accepted in public settings

• sexual interest in others may not occur

• awareness of inappropriate advances from others and how to respond to those advances

Issues of sexuality with a client who has ID

• have typical sexual interests and exploration

• at greater risk for sexual predators and sexual abuse

• sexual advances by others may be seen as affection; hard for them to assess someone’s interest/motivation

• important to identify how/when to say “no”/”yes”

• identify private sexual behaviors and location for them to occur in

Issues of sexuality with a client who has a TBI

• sex drive may change

• erectile problems (40-60% of men have temporary /permanent impotence)

• inability to orgasm

• reduced frequency of sex

• personality may change

• decreased decision making and impulse control

• inappropriate expression of sexuality (public places, with inappropriate people)