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Vol. 22 •Issue 17 • Page 47

The missing activity of daily living

The goal of occupational therapy is to maximize the client's functioning. This very often includes assisting the client in intimate acts such as bathing, dressing and toileting. Despite this, there is one fundamental aspect of human life that practice of occupational therapy is neglecting: sexuality.

In a climate with an emphasis on evidence-based practice, a brief look at the research reflects that sexuality is largely ignored during the rehabilitation process (Dombrowski, Petrick & Strauss, 2000; Friedman, 1997; Haboubi & Lincoln, 2003; McAlonan, 1996). Rehabilitation professionals strongly agree that this is an area that needs to be addressed, but admit they themselves do not address it (Haboubi & Lincoln, 2003). Several reasons for this oversight have been identified.

First, many professionals do not feel comfortable addressing sexuality with clients, often because they feel they are not qualified to address the issue (Dombrowski, Petrick & Strauss, 2000; Haboubi & Lincoln, 2003; McAlonan, 1996). Second, the roles of team members are often blurred, resulting in role confusion. For example, the occupational therapist thinks sexuality falls under social work, social work thinks the physician will address it, etc. (Friedman, 1997; McAlonan, 1996). Finally, there is the traditionally held myth that those with disabilities do not need this information (Hayes, 1998).

The American Occupational Therapy Association (AOTA), in the Occupational Therapy Practice Framework (2002), lists "sexual activity" as an activity of daily living (ADL), and defines it as "engagement in activities that result in sexual satisfaction" (p.620).

Annon (as cited in Friedman, 1997) developed what is known as the PLISSIT Model for addressing sexuality issues: P is permission, LI is limited information, SS is specific suggestions, and IT is intensive therapy. Permission means simply letting the client know it's okay to address the topic and that further information is available when and if he or she wants it. Limited information means giving clients only the information for which they ask; they may not be comfortable or ready for any additional information.

Specific suggestions means addressing a specific issue in more depth; i.e., does the client have a specific goal? Problem-solving may be appropriate, but use discretion. An example of intensive therapy may be addressing psychological issues. Intensive therapy requires that the occupational therapist refer the client on to another professional, such as a counselor or sex therapist.

Friedman (1997) writes that occupational therapists can address the first three issues in this model. It is essential, however, that the therapist be aware of his or her own comfort level. If an issue extends beyond the therapist's comfort level, the client needs to be referred to another professional that can assist. If a therapist is not comfortable addressing a topic, clients will sense this. Clients are already in vulnerable positions, and it is important that the therapist's issues not interfere with their recovery (Friedman, 1997; Hayes, 1993; McAlonan, 1996).

Clients may want to discuss issues pertaining to sexuality but may not feel comfortable approaching the topic. Thus, in order to meet the needs of clients, it is therapists who need to take the initiative. While possibly offending a client may be a concern, according to Friedman (1997), this can be avoided by bringing sexuality up within the context of multiple problems. Another way is to simply mention sexuality as a possible area of concern. If the client does not express interest, drop the issue, letting him or her know you are available if anything changes (Friedman, 1997).

Unfortunately, the amount of time OTs can see clients has decreased, so initially sexual functioning may not be a high priority. Concurrently, clients in the acute phase, such as with a spinal cord injury, may only be interested in day-to-day functioning. Interest in issues regarding sexuality may not arise until later. Outpatient therapy is an excellent setting to address these issues (McAlonan, 1996).

As a client moves towards recovery, sexual expression is a fundamental aspect of being human, and thus should be embraced by occupational therapy in order to assist clients in achieving the highest level of function in all areas of occupation. n

References available at www.advance or upon request.

Sarah H. Lindner, OTS, is in the final stages of completing her entry-level master's degree in occupational therapy. She also has a bachelor's degree in sociology, and was published as an undergraduate in the field of cultural anthropology.


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