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Holism is perceived to be one of the major tenets of occupational therapy. This article discusses the relevance of sexuality to holistic health care and contributes to the continuing discussion regarding the legitimacy of sexuality as an area of concern for occupational therapists. Sexuality is an important part of the human experience and is linked closely with spirituality. However, it is often neglected by occupational therapists. The article explores the occupational nature of sexuality and demonstrates its connection with the core concept of occupation. Moreover, considering the importance of spirituality in holistic care, the article also presents an overview of the relationship between sexuality and spirituality and illustrates sexuality as a dynamic identity component. It is proposed that occupational therapists should recognise sexuality and its importance in the individual's life and incorporate it into therapy.
350 British Journal of Occupational Therapy August 2006 69(8)
The profession of occupational therapy has, for the last
20 years, been working towards the construction of an
occupation-based scientific paradigm to inform clinical
practice, research and education (Whiteford et al 2000,
Molineux 2004). An emphasis on occupation as the core
concept of occupational therapy and a commitment to
holism are among the main features of this emerging
paradigm (Molineux 2004). People are considered as
occupational beings with an inherently spiritual nature
rather than as mere disease entities and their views and
feelings need to be respected and addressed (Egan and
DeLaat 1997, Urbanowski 2003, Kielhofner 2004).
The conceptualisations of holism and its place in
occupational therapy vary (Finlay 2001). This polyphony
regarding the meaning and the importance of holism
might account for its inadequate application in clinical
practice. Abberley (1995) offered an analysis of holism
as a guilt aversion construct, which serves to remove the
culpability for a potential failure from therapists and
attributes it to the complex nature of the situation.
What ought to be a professional responsibility, holism,
becomes thus an excuse for unsuccessful interventions.
Finlay (2001) and McColl (1994) have both pointed
to a gap between the holism mandate and actual practice
in occupational therapy. Molineux (2004) argued that
occupational therapists might not appreciate or fully
understand the concept of occupation and that this
might be one of the reasons for the dissonance observed
between theory and practice.
Despite research indicating its importance (White et al
1992, Northcott and Chard 2000), sexuality is often
ignored in occupational therapy. Uncertainty as to both its
connection with occupation and its importance in the life
of the individual might be one of the reasons for this.
Moreover, the perceived misfit between sexuality and
spirituality (for a detailed discussion, see MacKnee 1997
and Helminiak 1998), which is a basic concept in holistic
care, might impede the inclusion of sexuality on the
agenda of the profession.
The purpose of this paper is to illuminate the
occupational and spiritual nature of sexuality and to
present it as a legitimate area of concern for occupational
therapists. First, an exploration of the concept of sexuality
and its connection with occupation, spirituality and
meaning is presented and, then, the link between sexuality
and occupational therapy is explored. This paper aims to
stimulate discussion on the topic and does not claim to
provide an exhaustive account of sexuality and its
relevance to occupational therapy theory and practice.
Sexuality develops throughout one’s life and is an integral
part of everyday thoughts, feelings and behaviour
(Couldrick 1998a). It shapes gender identity, contributes
to self-esteem and social role formation and relates to a
whole spectrum of attitudes, behaviours and activities
(Weeks 2003). In turn, it is shaped and influenced by the
cultural context (Caplan 1987). Green (1974, cited in
Shively and De Cecco 1977, p41) defined it as the ‘individual’s
basic conviction of being male or female’, while Miller
(1984, p173), an occupational therapist who worked as a
sexual health clinician, defined it as ‘the gestalt of all
Holism is perceived to be one of the major tenets of occupational therapy. This
article discusses the relevance of sexuality to holistic health care and contributes
to the continuing discussion regarding the legitimacy of sexuality as an area of
concern for occupational therapists. Sexuality is an important part of the human
experience and is linked closely with spirituality. However, it is often neglected
by occupational therapists.
The article explores the occupational nature of sexuality and demonstrates
its connection with the core concept of occupation. Moreover, considering the
importance of spirituality in holistic care, the article also presents an overview
of the relationship between sexuality and spirituality and illustrates sexuality
as a dynamic identity component. It is proposed that occupational therapists
should recognise sexuality and its importance in the individual’s life and
incorporate it into therapy.
Sexuality and Occupational Therapy:
Exploring the Link
Dikaios Sakellariou and Salvador Simó Algado
British Journal of Occupational Therapy August 2006 69(8)
dimensions of sex functioning; related to private experiences
and public expressions which indicate to oneself and others
that one is a man or a woman’.
Power is a central concept in Foucault’s (1978/1990)
analysis of sexuality. According to Weeks (2003), power
can operate through several axes, with those of gender,
class and race being the most influential. The axis of
health should be added to these. Several studies have
demonstrated that disabled people are often perceived as
asexual (Tepper 1999, Guldin 2000, Milligan and Neufeldt
2001). Moreover, while the sexuality of disabled
heterosexual men has received some attention from
researchers, Shakespeare et al (1996) have observed a
telling silence regarding the sexuality of women and
homosexual men (recently there has been some research
on female sexuality and disability; see, for example,
Lysberg and Severinsson 2003, Singh and Sharma 2005, and
Li and Yau 2006). For the purposes of this article, sexuality
is conceptualised as a dynamic identity component that
gives meaning to and is expressed through engagement in
sexual activities (for example, petting, sexual intercourse
or masturbation), sexual relationships and culturally
prescribed roles (for example, spouse).
A loud silence
Here I (first author) want to recount an incident that
happened less than 10 years ago while I was an
undergraduate student in Greece. My first placement was
in a large facility that comprised a special school and
prevocational and vocational training centres for young
people with learning disabilities. Sexuality was not viewed
as a valid identity component of these young people and
they were closely monitored for ‘inappropriate’ behaviour
(for example, kissing or hugging, anything beyond
holding hands). The therapists did not acknowledge the
importance of sexuality in the occupational life of the
clients and, upon asking, I was told that ‘these people
should not be encouraged to engage in sexual activity’.
Therefore, safe sex and contraception were not dealt with
in this setting. It was believed that discouraging clients
from engaging in sexual activities would effectively
suppress their sexuality, which was a taboo issue. The
therapists and educators working in this setting chose to
ignore sexuality because of a fear of legitimising it. This
silence regarding sexuality was likely to have had major
implications for the lives of these young people.
It is to be hoped that nowadays this example might
ring unfamiliar to many occupational therapists
(although not all, and this greatly depends on the cultural
context and the setting in which clinical practice takes
place). Therapy, however, takes place within a certain
sociocultural context (Wilcock 1998, Milligan and
Neufeldt 2001) and, therefore, occupational therapists
often carry socially shared beliefs and behaviours as well
as prejudices into their practice. This means that, along
with the wider society, occupational therapists may not
view their clients as sexual beings and, therefore, the topic
of sexuality can be either neglected or not fully addressed
in therapy (Li and Yau 2006). Research, however, has
shown that sexuality is an important area of concern for
disabled people (White et al 1992, Kreuter et al 1994, Li
and Yau 2006).
Through a review of the literature dealing with
sexuality and its relevance to occupational therapy, it
became apparent that the majority of the occupational
therapists believed sexuality to be a legitimate and
important area of concern for the profession and
considered service users as sexual beings (Miller 1984,
Couldrick 1998b, 1999). Most of the occupational
therapists, however, did not deal with sexuality in their
clinical practice, with lack of education being the main
reason given, perhaps highlighting the inadequacy of
educational curricula (Couldrick 1998b). Many of them
shared concerns regarding the sensitivity of the issue
and agreed that occupational therapists should deal with
it in a delicate way (Summerville and McKenna 1998,
Couldrick 1999).
The occupational therapists who reported engagement
with sexuality issues were dealing mainly with issues
pertaining to physical performance (for example,
positioning or energy conservation) (Yallop and Fitzgerald
1997). It is interesting that occupational therapists
reported significant disparity between the attention given
and the attention that they wished to give to issues of
sexuality during intervention (Engquist et al 1997).
The occupational nature of sexuality
Sexuality is one of the main concerns of disabled people,
as many studies have revealed (Alexander et al 1993,
Kreuter et al 1994, Phelps et al 2001). Several authors
have suggested that therapists should learn about
sexuality and what it means to their clients and must
acknowledge sexuality as a valid area of concern (Novak
and Mitchell 1988, Summerville and McKenna 1998,
Couldrick 1999). The American Occupational Therapy
Association (2002) has classified sexual activity as falling
under the domain of activities of daily living and thus
belonging to an area of concern for occupational
therapists. Although this might signify that the profession
has started to acknowledge the importance of sexuality,
reducing it to sexual activity might indicate that sexuality
only becomes an issue in occupational therapy when
sexual functioning is perceived as problematic.
It is now generally acknowledged that occupation lies
at the core of occupational therapy and is both the means
and the ends of intervention (Trombly 1995, Pierce 2003).
Occupations appear to possess several qualities that
distinguish them from non-occupational activities: they
have identifiable start and end points; they are repeatable,
intentional and consciously executed; they tend to be
meaningful within the context of a person’s life; and they
are culturally identified (Yerxa et al 1990, Larson et al
2003, Pierce 2003).
Sexuality is expressed through many activities that can
be classified as occupations according to the above
characteristics. Dating or having sex, for example, both
352 British Journal of Occupational Therapy August 2006 69(8)
have a start and an end point; they are repeatable,
intentional and consciously performed; they can have
meaning in a person’s life; and, finally, they are named and
labelled within a specific cultural group. Occupation does
not refer to a narrowly delineated area of human
experience. According to Wilcock (1998), occupation
refers to all doing that has extrinsic or intrinsic meaning
and thus sexuality has an inherently occupational
dimension, which can be expressed through a variety of
meaningful occupations such as dating, grooming or
having sex. A role of occupational therapists as enabling
occupation can be very broad and refers to all aspects of
people’s occupational lives.
Relevance of sexuality to occupational
A series of articles (Jackson 1995, Kingsley and Molineux
2000, Williamson 2000, Harrison 2001) has discussed
the relevance of the sexuality of gay, lesbian or bisexual
people to occupational therapy. Both Jackson (1995) and
Williamson (2000) have demonstrated that sexuality
can influence participation in occupation and give
meaning to it, an issue discussed later in this article.
Similarly, Jessop (1993) observed the significance of
many occupations (including activities of daily living
and work) in expressing sexuality and highlighted the
role of occupational therapy.
This view is not accepted unanimously within the
profession. Couldrick (2005) presented two opposing
opinions, one for and one against the inclusion of
sexuality as an area of concern for occupational therapy.
The argument against the inclusion of sexuality in the
occupational therapy agenda has been expressed by
Kielhofner (1993, p138), who asserted that ‘sexual activities
are rooted in the biologic requirements of the individual
and the species’ and cannot be called occupations.
Sexuality, however, is much more than a biological
requirement. It has been described as a cultural script and
as a cultural phenomenon (Laumann and Gagnon 1995).
According to Foucault (1978/1990), it is an historical
construct that influences the way that people behave and
interact within society, while Weeks (2003) asserted that
there are many ways to express sexuality and that the
activities through which such expression occurs may
occupy a very wide gamut.
By this, there is no wish to deny the biological
component of sexuality; rather, there is an intention to
show that many authors have suggested that sexuality is
much more than an instinct or a basic drive. What may
have begun as a basic biological need for reproduction has
evolved into a complex social phenomenon, which is an
integral part of the identity of the individual.
Sexuality and gender
Men and women are expected to act according to the
expectations of a normative society (Caplan 1987).
A failure to conform might lead to marginalisation. Who
can do what, when and how depends upon gender, and
sexuality can be thought of as a gendered fiction (Peplau
2003, Weeks 2003).
Male sexuality and masculinity are often conceived as
performative and instrumental and are perceived as being
embodied in physical assertiveness and productive work
(Connell 1995). Linschoten (1969/1987) described man
as homo faber, highlighting the importance of occupation
in male identity formation, and Beagan and Saunders
(2005) explored the production of masculinity through
engagement in occupation.
Women, on the other hand, are expected to be caring
and nurturing figures and it is thought that they value the
emotional and dialectical aspects of sexuality over the
physical (Weeks 2003). Moreover, occupations like child
rearing or household maintenance are thought of as
female and, in the past, women have been denied access
to occupations on the grounds of a gendered division of
roles (Wicks and Whiteford 2005).
These cultural stereotypes demonstrate that sexuality
and gender are expressed through participation in
occupations. Weeks (2003) argued that sexuality is not
fixed but is constructed through what people do in their
daily lives.
Spirituality, meaning-making
and sexuality
Spirituality remains an elusive concept in occupational
therapy and there exists considerable disagreement
regarding its exact nature and role in therapy (Udell and
Chandler 2000, Hammell 2001, Wilding 2002). According
to Howard and Howard (1997) and Egan and DeLaat
(1997), spirituality may be expressed through
participation in occupation and permeates every aspect of
one’s life. In this paper, Urbanowski and Vargo’s (1994)
conceptualisation of the term is used and is perceived as
the experience of meaning in life.
Unruh et al (2002) demonstrated that spirituality was
a multifaceted concept and suggested that it should
concern occupational therapists to the extent that it has
an impact upon the occupational identity of the client.
Occupational identity is conceptualised as ‘a composite of
one’s occupations over time’ (Unruh 2004, p292) and can
provide a sense of coherence and meaning in the life of
the individual (Christiansen 1999).
An important concept closely related to spirituality and
occupational identity is resilience. Resilience helps people
to find meaning in traumatic experiences and to view
them as a chance to become better and advance towards
maturity. Urbanowski (2003, p102) defined spiritual
resilience as ‘the successful completion and entrenchment
of meaningful occupations that one engaged in prior to a
life changing event occurring, or to engage in new
occupations to create a post-event trajectory’. In order to
achieve that, people either try to reconnect with their
occupational identity as it was experienced before or seek
British Journal of Occupational Therapy August 2006 69(8)
therapy. Providing sexual counselling, for example, is
beyond the professional role of occupational therapists
and thus inappropriate and perhaps unethical.
Learning from the client
Based on the principles of holistic health care, as outlined
by McColl (1994), this section explores the ramifications
of holism for addressing sexuality in practice. The first
principle states that the individual is the expert on his or
her condition. He or she is the one who experiences
disruption in an occupational area and not only knows
how it feels but is also aware of what needs to be done to
restore balance (McColl 1994). This first principle is
closely related to the second, which states that
‘occupational function or dysfunction is an experienced
phenomenon, rather than an objectively observable one’
(McColl 1994, p75).
These principles imply that therapists should seek to
learn from the individual if and how his or her sexuality
has been changed by an occupational life disruption.
Therapists should seek information as to how sexuality is
interwoven into the occupational trajectory of the
individual and the role that sexuality plays within this. It
is important that occupational therapists approach the
topic in a considerate and non-threatening way.
As Summerville and McKenna (1998) have suggested,
there are many ways to introduce the subject and gain
permission to talk about the issue. For example, the
therapist could mention sexuality while outlining the role
of occupational therapy. It should never be assumed that a
person is too old, too disabled or too overwhelmed with
health concerns to be sexual. Alternatively, the therapist
could ask the client during assessment whether he or she
has any concerns regarding his or her sexuality. This
should be done not only in the initial interview when
other issues might be more urgent, but also in follow-up
assessments. To facilitate the communication and sharing
of information, therapists must convey a feeling of
trustworthiness and a non-judgemental attitude
(Couldrick 1999, Harrison 2001), and if a client does
not feel ready or willing to share his or her concerns
then this should be respected.
It is suggested that occupational therapists
acknowledge the issue of sexuality early in the
rehabilitation phase and seek to obtain information
regarding the client’s values, beliefs and concerns because
this can facilitate the design of meaningful therapeutic
interactions (see, for example, Jackson 1998). Sexuality
needs to be a concern for occupational therapists not only
as a pathological entity but also as an identity component.
Thus even when sexuality-related problems are not
present, occupational therapists should examine the role
that sexuality has in the occupational life of their clients
and try to include it in therapy. This could be done simply
by acknowledging sexuality and its importance in the life
of the client. When engagement in sexuality-related
occupations is compromised, therapists can apply
problem-solving techniques to the specific issues that
to create a new, personally meaningful occupational
identity. Sexuality plays an important part in this process.
Jackson (1995) and Williamson (2000) have demonstrated
that sexuality can provide meaning to occupations and
contribute to identity formation.
For Merleau-Ponty (1962/2002), sexuality has a
metaphysical significance and it cannot be understood if
people are treated in a reductionist way. It cannot be
separated from the individual since it is an essential
quality of human nature; it is ever-present and both
permeates existence and is permeated by it (Merleau-Ponty
1962/2002). Thibeault (2003) and MacKnee (1997)
asserted that sexuality can transcend the existential and is
one of the paths leading to maturity and resiliency.
According to MacKnee (1997), sexuality and spirituality
are related aspects of the individual which cannot be
separated one from the other and they are both
characterised by a desire to fill an inner existential
vacuum and to advance in self-knowledge. Eastern
traditions speak of a sexual ideal ‘of self-discovery and
selflessness’, with the ultimate purpose being to ‘attain
self-knowledge and cultivate genuine union, a real
expansion beyond the persona’ (Thibeault 2003, p89).
Tantric and Taoist traditions, for example, view sexuality
and spirituality as interconnected and integral
components of the individual (Francoeur 1992).
Sometimes, however, sexuality is perceived as
tantamount to suppressing ideals of beauty and physical
performance. It can be reduced to ‘an autistic satisfaction
of genital lust’ (Linschoten 1969/1987, p176), and
‘servility’ along with ‘satiation’ are sometimes seen as the
raisons d’être of sexuality (Lazos 1997, Thibeault 2003,
p89). Sexuality can thus be rendered a mere physical
process, disconnected from the occupational identity of
the individual. Although possibly valid for some people,
this operative conceptualisation of sexuality can be
oppressive and meaningless for many others.
Sexuality is more than a carnal affair. It is an
indispensable part of a happy, meaningful and balanced
life and an integral component of the individual (Chicano
1989, Couldrick 1998a, Northcott and Chard 2000).
Sexuality has the potential to instil meaning in a variety of
occupations that people perform (Jackson 1995, Weeks
2003) and may help people to reconnect with their
occupational trajectory. It can be conceptualised as one of
the ‘rituals of daily life’ (do Rozario 1994, p50), which
infuse meaning in people’s lives.
Implications for occupational
Occupational therapists are not experts in sexuality. They
are experts in occupation and they must be very clear
about this. Therefore, occupational therapists need to be
very careful that they address sexuality in therapy in a way
that falls within the professional boundaries of occupational
354 British Journal of Occupational Therapy August 2006 69(8)
concern each particular client, as long as these issues fall
within the remit of occupational therapy (for example,
positioning, social outings or personal hygiene).
The person and the environment
The third principle of holistic health care states that the
‘understanding of occupational dysfunction must be acquired
through a synthesis of the person in his or her environment
and not through an analysis of the subsystems comprising
the individual’ (McColl 1994, p75). This combines well
with Yerxa’s (1998) view of people as complex open
systems who interact with their environments.
This is also congruent with the conceptualisation of
disability as an integrated biopsychosocial phenomenon,
as proposed by disability theorists (Shakespeare and
Watson 2002) and upheld by the International
Classification of Functioning, Disability and Health
(ICF, World Health Organisation 2001). According to
the ICF, impaired body structures and functions (as,
for example, paralysis caused by spinal cord injury)
do not necessarily compromise participation in daily life.
Having quadriplegia or paraplegia does not necessarily
lead to sexuality-related problems. When sexuality-related
problems are present, the cause is not always the paralysis
but could be attributed to contextual factors, such as
negative societal attitudes (Shakespeare et al 1996,
Sakellariou 2006, Sakellariou and Sawada 2006, Sakellariou
and Simó Algado 2006).
It is vital that therapists acknowledge this, because
otherwise they might not be able to provide effective
services. For example, an occupational therapist acting
under the assumption that the sexuality issues of a person
with a spinal cord injury revolve around difficulty with
positioning may fail to acknowledge that the client’s
problems could result from his or her altered social status
or that he or she may not be able to find a partner.
Therefore, occupational therapists should not make
assumptions, but should listen to their clients.
Focusing on positive outcomes
The fourth principle of holistic health care suggests that
illness should be viewed as a learning opportunity
(McColl 1994). Occupational therapists have been
described as ‘search engines for potential’ (Yerxa 1998,
p413) and they focus on the positive outcomes, and not
on the negative consequences, of a disruption in the
occupational life of an individual. Therapists should help
service users to develop a resilient and meaningful
occupational life (Urbanowski 2003).
Several studies have suggested that disability may
influence a person’s sexuality positively and can lead to a
more meaningful sexual life (Shakespeare et al 1996, Cole
2004, Sakellariou and Sawada 2006). Some of the
respondents in these studies indicated that after their
injury they felt free to experiment with their sexuality and
to reinvent it in a personally satisfying way. By focusing on
the potential for a positive change, occupational therapists
could help clients to perceive sexuality in its totality and
not merely as a physical function. This could lead to the
transition from a performative notion of sexuality, dependent
upon the physical body, to an integrated one, connected to
the whole self of the individual.
In recent years, there has been a renewed interest by
occupational therapists in holism and client-centred
and occupation-based practice. Eager to provide best
practice, professionals have tried to reestablish occupation
as the basic therapeutic means of occupational therapy.
Also, a discourse has been initiated and several papers
have sought to illuminate the concept of holism and its
importance to the profession (McColl 1994, Finlay 2001).
Peloquin (2002, p517) urged occupational therapists to
reach ‘for heart as well as hands’. Mattingly and Fleming
(1994), in their clinical reasoning study, found that
occupational therapists viewed clients in a holistic way
and valued both the ‘lived body’ and the ‘body as a
machine’ (pp37, 64). Holism, however, has been found
to mean different things to different people (Finlay 2001).
It is an ambiguous term and this may account in part for
the discrepancy between theory and practice, as suggested
by McColl (1994). Therefore, intentions for holistic
practice do not always lead to holistic practice.
If occupational therapists wish to provide holistic
treatment then they cannot exclude integral identity
components, such as sexuality, from therapy. As practitioners,
therapists need to empower clients to reconnect with their
chosen occupational life trajectory, as argued by Urbanowski
(2003). Failing to view sexuality as an integral part of the
individual may compromise therapy and lead to suboptimal
therapeutic encounters and outcomes. Occupational
therapists may thus find themselves in the unfortunate
position of reinforcing disabling cultural scripts and
societal metaphors. This would be a paradox for a
profession that claims to be holistic and client centred.
The authors would like to thank Mrs Sarah Kantartzis, MSc, DipCOT, for
the insightful comments she provided on an earlier draft of this paper.
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... Occupational therapists (OT) are not experts in sexuality [34]. Although the [28,33] recognized sexual activities as a known activity of daily living (ADL), an area of occupation which should be of concern for OT, OT has to be extremely cautious, i.e. within the professional guideline of OT board, they address sexuality in therapy [34]. ...
... Occupational therapists (OT) are not experts in sexuality [34]. Although the [28,33] recognized sexual activities as a known activity of daily living (ADL), an area of occupation which should be of concern for OT, OT has to be extremely cautious, i.e. within the professional guideline of OT board, they address sexuality in therapy [34]. OT endorses the belief of sexuality as a fundamental factor and central characteristic of human quality of life [28]. ...
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Sexual education is crucial for individuals with intellectual disabilities (ID), but there are limited studies which show the effectiveness of sex education to this population. We conducted a systematic review to synthesize, analyze and identify sex education intervention for people with ID. We used quality indicators to identify and evaluate eight studies which employed single-subject research methodology (Horner in Except. Child. 71:165–179, 2005). Ways for improving skills and enhancing knowledge were reported. Results of our analysis suggest three moderate and five low quality studies exist in sex education to ID people. Nevertheless, professionals can consider the interventions with moderate effect in the future. Future studies should undergo more Randomized controlled trials (RCT) studies to evaluate the effectiveness of a new intervention (Hariton & Locascio in Int. J. Obstetr. Gynaecol. 125:13–1716, 2018) and meet high-quality standards to improve evidence-based practice.
... [10] Although many clients perceive sexuality-related concerns as challenging, [11,12] OTs have not been properly addressed on their roles in sexual-related concerns. [13,14] Many factors prevents OTs from addressing sexual-related concerns, including embarrassment or discomfort, [15] lack of perceived knowledge and skill, [3,9,10,[15][16][17][18][19] lack of competence, [3,10,17,18] Medicine ambiguity about professional roles and boundaries, [20] viewing sexuality as irrelevant for people with disability, [17,21] and attitudes associated with particular cultures and beliefs. [10,17] Taylor and Davis [22] reported that clients waited for healthcare professionals to approach their sexual issues first. ...
... Sexual concerns are often a priority for people with disabilities; thus, the therapist is responsible for understanding and approaching them. [10,13,42] The importance of OTs' role in addressing clients sexuality in domestic rehabilitation settings should be proposed, and it is necessary to develop and implement a continuing education program on professional knowledge and skills for OTs who encounter clients' practical issues. ...
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Sexuality is a common concern among people with disabilities or chronic conditions, and failure to address sexuality can lead to poorer rehabilitation outcomes. To explore the factors affecting addressing the sexuality of adult clients in clinical practice as perceived by Korean Occupational Therapists (OTs) and the perspective on what needs to be established to address sexuality in occupational therapy practice. This descriptive qualitative study using focus group interviews was conducted with 15 OTs providing rehabilitation services for adult clients in the post-onset maintenance phase or for outpatients in Seoul, South Korea. Data collected through focus groups were analyzed using the constant comparative method. The main factors influencing addressing clients sexuality in clinical practice were identified: "absence of institutional system for addressing sexuality in rehabilitation setting" for environmental factors; "lack of professional competency" for therapist-related factors; and "repressed sexuality" for client-related factors. Moreover, recognizing that "sexual health is one of the goals of rehabilitation" and prioritizing it in rehabilitation settings are essential. OTs must be "experts with knowledge and skills" to access the client's sexuality, and "education and publicity" should be actively conducted to raise awareness of sexual health for clients. To deal with clients sexuality, institutional preparation should be prioritized under the recognition that sexual health is one of the goals of rehabilitation. In addition, it is necessary to prepare a relevant curriculum for OTs and create awareness so that clients can recognize improving sexual activity as a role of OTs.
... Within the academic disciplines of occupational therapy and occupational science, reflections on the relationship between sexuality and occupation have been quite limited [1][2][3]. In the field of sexuality and occupational therapy, various occupations or activities have been understood as relevant to individuals, such as dating, kissing, masturbating, or engaging in sexual intercourse [2,4]. Other activities related to daily life and connected to sexuality, such as personal hygiene or self-care, have also been recognized [5]. ...
... Theoretical approaches to sexuality as a relevant aspect within both disciplines could contribute to a fundamental dimension of individuals [4,18]. Simultaneously, it enables the development of perspectives and broadens the possibilities for research and interventions [1]. ...
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Sexuality and occupation are two constructs studied in different fields of knowledge. Particularly, in occupational therapy and occupational science, their relationship has been sparsely explored from a philosophical perspective. In the following reflection, we present some philosophical approaches to sexuality, occupation, and performativity to inquire about the impact of discourses about sexuality on the practice of occupations. For this analysis, we take an example developed by Foucault in one of his classes at the Collège de France. We believe that this helps us question the established discourses surrounding truth, especially concerning sexuality. Subsequently, we address the concept of occupation, taking into consideration Schliebener’s proposal from existentialist philosophy. Understanding occupation as a dimension of being, we explain how it can be comprehended through Butler’s theory of performativity and, consequently, express a sexual dimension. Finally, we establish an interconnection between the preceding concepts, taking sexual dissidents as an example. We propose that this reflection can broaden the possibilities of understanding occupations as points of resistance against normative discourses about sexuality. This may be relevant for contemplating practice and research in occupational science and occupational therapy, as it expands the understanding of sexuality beyond mere activities and centers it as a form of expression of being through occupation.
... Sexuality has been described as gender identity, orientation, eroticism, pleasure, intimacy, reproduction, sensuality and sexualisation [10,11]. An individual's ability to express their sexuality, such as being intimate with a partner, can often be impacted by injury, disease or disability, resulting in a negative outcome on their health, wellbeing, and occupational identity [10,12,13]. ...
... Research, since the inclusion, is biased towards experienced occupational therapists and students [15][16][17][18][19]. Of the studies completed, there is a consensus that occupational therapists believe addressing sexuality is an important part of their role, particularly relating to the physical aspects of sexuality [13,18,[20][21][22][23]. However, despite identifying this need, it does not translate to practice. ...
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Health care consumers have emphasised the importance of being able to express themselves in a sexual nature, regardless of their health conditions. Unfortunately, literature based on experienced occupational therapists and students, indicates sexuality is poorly addressed, despite being a meaningful occupation. There is limited literature based on Australian experiences or the experiences of recent graduates, therefore this study aimed to explore how comfortable and prepared 11 recent graduates who studied in Australia, were in addressing sexuality, as well as the enablers and challenges experienced. A qualitative research design was utilized, with results demonstrating that undergraduate curricula are not adequately preparing new graduates to feel equipped with the knowledge, skills, comfort and preparedness to address sexuality. Enablers such as education, professional development and supportive workplaces, can aid to facilitate positive change in this area of practice, which may improve client outcomes.
Esta coletânea reflete a riqueza dos diálogos interdisciplinares que se dão no cotidiano de um programa de pós-graduação feminista formado por pesquisadoras, pesquisadores e estudantes de formações acadêmicas variadas. Ao longo de nove capítulos, o livro oferece um panorama de diferentes temáticas e perspectivas teórico-metodológicas que revela o quanto o passado se encontra enredado ao presente. Além disso, permite vislumbrar devires, seja nas formas de agenciamento das mulheres sobre suas escolhas e vidas, seja nas diferentes estratégias elaboradas tanto nos centros urbanos como na zona rural, no Brasil, na América Latina, na Europa central ou mesmo no Egito.
Introduction: Occupational therapists routinely report low levels of confidence in addressing needs related to sexuality and intimacy. These issues are compounded when supporting clients with intellectual disability, due to prevailing assumptions about capacity and few practical support resources. At a disciplinary level, there is ongoing discourse around how to best conceptualise and support sexual and gender identities generally, within models of human occupation. Leveraging interdisciplinarity, where sexuality overlaps as a sphere of interest, can aid the development of practical support resources. Engagement with sociology (focussed on relationality) and disability studies (focussed on embodiment) offers a generative path forward. Methods: The deliberative dialogues framework was used to develop a co-designed resource by occupational therapists for occupational therapists. Six Australian occupational therapists with experience working with clients with intellectual disability and/or sexuality were purposively recruited to participate in co-design groups. Using the eight features of deliberative dialogue, data was collected and analysed by an interdisciplinary research team to collaboratively produce a practical support resource. Results: Participants agreed the greatest need was to develop a resource for clinicians, to support conversations with clients about sexuality. Five key themes emerged: (1) Theoretical explanations addressing why sexuality is important must be paired with practical advice; (2) make a conversational call to action from 'OTs' for 'OTs' by locating sexuality within the domain of occupational therapy; (3) make explicit that people with intellectual disability are sexual beings; (4) need for self-reflection; and (5) demonstrate how existing understandings of occupation apply to sexuality. Conclusion: A resource in the form of a brochure was developed, intended to be used as a conversation primer. The process used to develop the resource demonstrated the value of interdisciplinary collaboration and the utility of deliberative dialogue as a co-design method.
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Background: Sexuality is important in everyday lives; it contributes to a sense of self. Everyone has a right to access sexual experiences, form relationships, and obtain sexual health education. There is limited literature from the perspective of people with developmental disabilities about their sexuality and particularly how, or if, societal attitudes influence their sexuality and their opinions about sexual health education. The aim of this study was to explore the experiences of young adults with developmental disabilities about their sexuality, their perceptions about how their sexuality was viewed by the community, and about the sexual education that is required and how it should be delivered. Method: A qualitative interpretative phenomenological approach using a purposive sample was used to explore the perspectives of young adults, aged between 18 and 32 years old with developmental disabilities, to explore their perspectives on their sexuality, societal attitudes, and access to sexual health education. Seven semi-structured interviews were conducted and analysed using an interpretative phenomenological approach. Results: Five main themes were developed from the data: (1) sexuality is multidimensional and important, (2) the challenges and fear of expressing sexuality, (3) societal views need to change, (4) close support enables sexuality, and (5) sexual health education needs to be individualised. Conclusion: Participants suggested that sexuality was important to them, and they had the same expectations about sexuality and relationships as many young adults. However, their autonomy and self-determination to set sexuality goals were constrained by societal attitudes. Supportive family and friends enabled opportunities, but they believed the knowledge and attitudes about disability, and about disability and sexuality, of community members, service providers, funders, and educators needed to change to enable increased opportunity to express their sexuality. Participants reported a need for individualised sexual health education provided by professionals with expertise.
Considering that sexuality and gender are both relevant to the study of occupations and the practice of occupational therapy, this paper aims to investigate the importance of night-time leisure for the LGBTQ+ (lesbian, gay, bisexual, trans, queer, many other terms) group in identity shaping. An ethnographic study of five nightclubs, which were frequented by young LGBTQ+ pop scene in São Paulo, Brazil, was undertaken. Data were analyzed qualitatively through intersectionality and post-humanist Queer Theory. Findings show that night-time leisure can enact support for LGBTQ+ people; however, several forms of discrimination of this group remain, due to class, style, race, and generation markers. These operators of difference may reveal how occupations are shaped by identity, just like identity is shaped by occupation. Additionally, the findings support that ‘doing gender’ is related to technologies of gender. The article contributes to theoretical and methodological advances in studies on leisure and sexuality from an occupational perspective.
Importance: Sexuality is an important part of the human experience. However, little is known about the experience of sexuality from the perspective of adults with intellectual and developmental disabilities (IDD). Objective: To review evidence about the lived experience of sexuality among adults with IDD to inform future research and practice. Data Sources: We located articles using search terms summarized into three categories: intellectual disability, sexual activity, and feelings/opinions. Articles were indexed in the following electronic databases: CINAHL, Scopus, PubMed, and PsycINFO. Study Selection and Data Collection: Arksey and O’Malley’s methodology was used to review scientific literature published between 2008 and 2018. The studies were in English, were located in peer-reviewed journals, and described the experience of sexuality from the perspective of people with IDD or observations of expressed sexuality. Findings: Seventeen articles met inclusion criteria. Four main themes emerged: intimate relationships, oppressed sexual activity, knowledge, and identity. Findings indicate that sexuality is a part of the lives of many adults with IDD, regardless of their engagement in sexual activity. Conclusions and Relevance: Barriers to expression of sexuality exist for people with IDD. Some of these barriers are internal, although many are external. The results provide support for addressing sexuality among adults with IDD. What This Article Adds: This review provides evidence to support occupational therapy practitioners in including sexuality as a part of their holistic view of clients and as an area for advocacy.
The day-to-day practice of occupational therapy reflects an implicit concern for the spiritual dimension of life. This is demonstrated in what is done, why it is done, and how it is done. Occupational therapy enables clients to participate in occupation which allows connection with others and meaning-making. This is done because of a shared belief in the inherent value of all beings. Occupational therapy is carried out under a holistic, empowering framework using narrative reasoning. Attention is paid to the quality of the client-therapist relationship. Consideration is given to the personal limitations of the therapist and the opportunity for growth.
(from the chapter) distinguish between socially driven and biologically driven theories of sexual conduct by distinguishing between drive (or instinct) models and a strong socio-cultural theory of sexual action which is based on the theory of sexual scripts / [discuss] the historical significance of the individual sexual actor in traditional research on sexuality, even that which has been social in its orientation, pointing out that even social scripting theory has often not taken systematic account of the role of social structure in shaping sexual conduct / [indicate] the ways in which the interconnections between individuals directly and indirectly influence various types of sexual conduct [create] a framework for moving from the analysis of the behavior of isolated individuals and events (the usual form of sociological analysis) to more complex data structures and analytic schemes / discuss non-sexual as well as sexual examples of the kinds of data that might be gathered and problems that these kinds of data will produce for traditional forms of statistical analysis instinct, drive, script: alternative ways of understanding sexuality / the individual sexual actor / scripts: collective, interpersonal, and intrapsychic / social networks and sexuality / extended social networks and sexual conduct / stakeholders and audiences [in reproduction, in extramarital sex, in sexual practices, in solitary sex, in sexual gossip and fantasy, in sexual pleasure] / the need for stakeholders and audiences / the importance of pairs / the structure of sexual action
This article discusses spirituality as an integral component of the occupational performance model. Spirituality is defined as the experience of meaning in everyday life activities. Some of the difficulties commonly encountered in operationalizing the concept of spirituality are discussed. Strategies built on minimizing or eliminating some of the difficulties are reviewed. The recommendations for practising therapists encompass suggestions for assessment, goal setting, and practice. © 1994, Canadian Association of Occupational Therapists (CAOT). All rights reserved.
A transsexual's performance in the chosen gender role can be seen in the context of functional performance of life skills, and should thus potentially be improved with appropriate occupational therapy. A detailed case study is used to illustrate the application of occupational therapy assessment and treatment with one such person, a young male-to-female transsexual in the very early stages of the lengthy pre-surgery assessment phase.
Holism is an idea that occupational therapists use frequently to describe and characterize their practice. And yet, there seems to be some controversy about what it means and what it implies? This paper explores the historical and contemporary meaning of holism, and attempts to project implications for occupational therapy of adopting a strict definition of the holistic practitioner. Implications are explored according to four principles of holistic health care: that the individual is an integrated being, with the capacity to maintain equilibrium; that the goal of health care is the experience of health, not merely the absence of observable signs of illness; that evaluation of health should be a synthesis of understanding of the individual in his or her environment, not an analysis of the individual; and finally, that illness is a normal experience and an opportunity to achieve a higher level of self-awareness and integration with the environment. Each of these principles is explored relative to perceived current practices in the areas of service, research and education in occupational therapy. The paper concludes with a summary of the changes that would be required of the discipline of occupational therapy, if it were to adhere strictly to this definition.
The model of occupational functioning leads the author to conceptualize occupation both as treatment end goal and as means to remediate impairments. In both dimensions, meaningfulness and purposefulness are key therapeutic qualities. Purposefulness is hypothesized to organize behavior and meaningfulness to motivate performance. These aspects of occupation need explication through research. Some questions that need to be answered include the following: How does purposefulness of occupation-as-end organize a person’s life? Does purposefulness of occupation-as-means organize particular behavioral responses? What effect does meaningfulness of occupation-as-end have on achievement of role performance? Does meaningfulness of occupation-as-means motivate perseverance and effort during therapy?
The day-to-day practice of occupational therapy reflects an implicit concern for the spiritual dimension of life. This is demonstrated in what is done, why it is done, and how it is done. Occupational therapy enables clients to participate in occupation which allows connection with others and meaning-making. This is done because of a shared belief in the inherent value of all beings. Occupational therapy is carried out under a holistic, empowering framework using narrative reasoning. Attention is paid to the quality of the client-therapist relationship. Consideration is given to the personal limitations of the therapist and the opportunity for growth.