OPENING THE ‘CAN OF WORMS’: AN INVESTIGATION INTO OCCUPATIONAL THERAPY PRACTICE IN RELATION TO SUPPORTING CLIENTS’ SEXUAL CONCERNS

Introduction: Sex is an important aspect of health, wellbeing and identity (Couldrick, 2007), yet it is an often overlooked, ignored and omitted aspect of healthcare due to feelings of stigma, taboo and discomfort (Couldrick, 1998; Yallop and Fitzgerald, 1997; Jones et al, 2005). Occupational therapy uses occupation to enable and support people engaging with activities that matter to them (COT, 2015). Within occupational therapy, there has been debate as to whether sex is an occupation and within the remit of occupational therapists. In practice, occupational therapists rarely address sexual health concerns due to attitudinal and structural barriers (Couldrick, 1998). This research sought to explore the work of occupational therapists who address the sexual concerns of their client in order to find out more about experiences, thoughts and feelings, in order to support future practice.

Methods: This research used a mixed-methods approach to explore the practice and experiences of occupational therapists who do address sexual health concerns in predominantly physical and neurological settings. This study was undertaken using a purposive sample in three phases; a scoping survey which sought to identify eligible participants who include sexual concerns in their work (105 respondents), a questionnaire focusing on the practice and background of those who broached sexual concerns (14 participants), followed by semi-structured qualitative interviews focusing on their thoughts, feelings and experiences of broaching sexual concerns (12 participants). This research gained ethical approval from the University of Huddersfield’s School of Human and Health Sciences.

Results: The participants recognised sexual health as a meaningful occupation, an activity of daily living and an important aspect of client lives, viewing sex as an occupation and therefore part of their remit. They adapted and applied their core professional skills and knowledge such as reasoning, activity analysis, building rapport, creativity and problem-solving skills. The participants reported using a range of interventions including advice, adaptive equipment/aids, motivational interviewing, and client education. Drawing on their occupational focus, several participants indicated they felt well-placed to view sexual concerns holistically, considering the impact on the client’s role/identity and body image as well as practical, functional considerations around impairment. The participants also indicated they faced barriers similar to those found in the literature such as issues around lack of resources, education and training, negative attitudes to sex and organisational constraints (Haboubi and Lincoln, 2003; Dyer and Das Nair, 2013; McGrath and Lynch, 2014). At times, the participants indicated they made assumptions about their clients based on reasoning. The participants recognised sex to be a sensitive, taboo subject, which can be described as occupationally ‘tainted’ or ‘dirty work’, and used strategies based on their professional values to counter this. Limitations to this study include the lack of representation from those working in trauma and orthopaedics and other areas of occupational therapy practice, and the low number of quantitative data responses, which mean that this study is not generalisable and the quantitative data is not statistically significant.

Conclusion: This research indicates that occupational therapists could recognise sexual concerns as meaningful and important occupational concerns, and an important aspect of health, wellbeing and identity, and that there is a role for occupational therapists in supporting client sexual concerns as part of holistic and client-centred practice in accordance with the values of the profession. Occupational therapy skills and knowledge were transferable and could be applied to sexual concerns, whilst education, training, previous exposure to sensitive subjects and a strong sense of professional values were important facilitators for raising confidence and competence. By addressing sexuality occupational therapists can normalise the legitimate concerns of their clients and ensure that support for sexual needs is provided or available for all, in accordance with the profession’s core holistic and client-centred values.