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How to be Trauma Informed Care when Addressing Sexuality

Trigger warning: discussion of traumatic experiences.

Trauma-informed care (TIC) practices are becoming more well-known and more widely-implemented in clinical practice. But what does this look like? And how can we as OTs provide TIC while addressing sexuality? In collaboration with OTD Student Hannah Zaininger, I recently did a deep dive into Trauma Informed Care approaches when addressing sexuality and intimacy.

 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. They have developed a framework to help health providers understand the existence of trauma, as well as support and provide treatment to all individuals whether or not it is known they’ve experienced trauma. This model of care uses six guiding principles, which should be incorporated into health care practices. These...

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What About Sex After Baby?

This week's blog is guest co-written with Kala Plasterer.  Kala will share a bit about herself below, but I’m delighted to bring in a mother, OT, and someone passionate about sex after baby to write about this topic.  Kala and I have been working together for a while as she is a virtual assistant to The Institute.  It was a no brainer to have her write about sex after baby!   

When it comes to addressing sex and intimacy, the impact of breastfeeding and pelvic floor muscles (PFM) may not be the first thing that comes to your mind... but, they will hopefully be something you consider after reading this!

A little bit about me.. I'm Kala. An occupational therapist, first-time mom, and virtual assistant for Kathryn! My personal journey with breastfeeding and motherhood fueled a fire within me and has motivated me to pursue a niche path as an OT and become a certified lactation consultant (CLC). As I’m sure is the case with many of us, we are...
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How to Overcome Unconscious Sexual Bias

If you have a brain, you have a bias. Confronting our own biases is uncomfortable, but it is our ethical responsibility as occupational therapy professionals.  Considering how paramount reconciling our biases are to enhancing the therapeutic relationship and treatment efficacy, and reducing patient harm and health disparities...

Many of us weren't taught this in school.  

Welp, add it to the list of uncomfortable yet essential topics that were and are omitted from OT curriculum !  And it's a double whammy omission-effect when we combine this with sexuality. 

So what does this mean for OT professionals? 

We need to do the work to acknowledge our bias and make sure to include sexuality when doing so.  This is exactly my motivation behind my favorite CEU offering, "Guided Self-Reflection of Sexuality Values, Beliefs, Attitudes, and Biases" (see below section for more info).  We're all sexual beings with our own experiences and beliefs around...

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Top Tips for Teaching Sexual Communication

If you've been following along then you know this is the last post of my three part series: The Selfies, Sexplay and Sexual Communication

This week we're talking about Sexual Communication. Whether it's with a casual partner, one with relationship potential, or long time partner helping our clients learn how to establish sexual communication in their relationship is an important part of addressing sexuality and intimacy. 

If they are not already communicating about sex with their partner we may need to help them learn how to be the initiator, which can be uncomfortable for them. 

Establishing sexual communication is the foundation of good sexual experiences and most people will find it refreshing to share their preferences and boundaries.

 

So how do you teach sexual communication??

 Tip #1 - Teach your client to discuss their boundaries/ limits:

While reasons for setting sexual limits widely vary, it is not uncommon for individuals to set...

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Up Next...Sexplay

As promised, I'm continuing my three part series of important topics to cover when addressing sexuality and intimacy, which brings us to Sexplay.  As a part of Sexplay, I'm going to talk about dirty talk, pleasure, and sensate focus.  All of these can be helpful for our clients (and let's be real - US!) to understand as potential activity demands.  Below are some strategies and exercises you can share with your clients! 

DIRTY TALK

Communication is a key component during any sexual encounter and this can include using dirty talk to build arousal.

Tips to share with your client for creating their style of dirty talk: 

  • Think about how you like to describe your body. What makes you feel turned on or sexy? Try to describe your partners body this way too. 
  • What words excite you or make you feel aroused? 
  • What sexual activities do you like to do? Describe this activity to your partner. Use your dirty talk inside and outside the bedroom. 
  • Find...
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A Three Part Series: The Selfies, Sexplay and Sexual Communication

When it comes to helping clients with sexuality and intimacy there are several topics I find important and helpful to address: the selfies, sexplay and sexual communication. Being able to acknowledge and validate their wants and needs to their partner can be uncomfortable for our clients, especially if it's a foreign practice. 

Cue, The Selfies.

I've developed some helpful handouts that I use in my practice and wanted to share the content of them here with you! This week I'll be sharing The Selfies, which are a great addition to your OT treatment session and can make for great discussions, worksheets or role play exercises. 

 

Self-Advocacy

The practice of communicating your personal desires, preferences, needs, boundaries, and rights to yourself and to partners. Taking responsibility for yourself as a sexual and intimate person by advocating for what you want and do not want through explicit communication.

  • How to practice...

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The Value of An Occupational Therapy Sexuality and Intimacy (OTSI) Program

It's been several years in the making so I'm so excited to share my very first peer-reviewed publication and the things I've learned! 

(You can check out the full article here) Sexuality and Intimacy Rehabilitation for the Military Population: Case Series

With help from my colleagues, I sought out to find the effect of sexuality and intimacy interventions on injured service members.

Like many client populations, service members can struggle with sexuality and intimacy secondary to physical, emotional, and/or mental injury/illness. Trauma such as amputation, spinal cord injury, and PTSD (to name a few) can lead to trouble with self-esteem, genitourinary dysfunction, pain, loss of desire, testosterone deficiency, body image challenges, and more.

During the time that I completed this case series I was working at a Military Treatment Facility (MTF). This particular facility has an Occupational Therapy Sexuality and Intimacy (OTSI) program,...

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Do We Need Privacy? NO! We're Talking About Sex, Not Having Sex!

I often get asked by OTs how I create a private space to bring up the topic of sex. But, let’s be honest. It’s just not realistic. We’d be waiting for a long time before the opportunity of a private moment presented itself, especially in an acute care setting. Between the client's family and friends, nurses, doctors, and hospital staff you can almost guarantee there’s always someone in the room.  Or think about a busy pediatric outpatient clinic with all of the families and children in the gym.  Think there's always going to be privacy to ask about sexual development and concerns and questions parents may have?  

It’s just not realistic to think we have to first create a private space to ask about sex. 

But, how can you ensure privacy for the discussion if that's what the client wants? I like to first ask about sex and intimacy during the initial evaluation. Around whoever is in the room. Spouse. Kids. Grandma. Grandpa. ...

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"OT Should be Apolitical"... F That!

I am reflecting on the political landscape these past few weeks and on AOTA's statement about the insurrection & white supremacy and especially the comments in response to that statement that said AOTA and OT should not be political and here are some thoughts I'd like to share.  

It's important to remember that what is happening politically in the US right now is not disconnected from our work as OTs, especially OTs working in sexuality and intimacy. It is our duty to uphold the values of occupational justice and stand up against white supremacy, systematic racism, antisemitism, islamophobia, xenophobia, transphobia, homophobia, ableism, and all other forms of oppression/harm towards others that impact people's self-determination to live as authentic and healthy sexual beings.

 Part of being a culturally humble practitioner involves reflecting on yourself and your own internal biases. It also means knowing the populations you serve and the specific harms by...

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Inclusive Infographic for Sexual Positioning Post-Joint Replacement

Many times we have lamented and noted that patient educational handouts rarely show variety in race, gender expression, bodies, and sexual orientation and that they tend to be white, cisgender and heteronormative.  This becomes even more problematic for sexuality handouts as these occupations involve our bodies, other bodies, and those we love and care most about, as well as, the need to navigate body image and stigma.

 

But the trailblazer, Jennifer Hutchinson (they/them), had an answer. 

Jennifer combined their occupational therapy skills and mission to promote social justice with the talent of a self-identified Queer artist to develop an inclusive handout and infographic for sexual positioning post-joint replacement. The soon-to-be Dr. Hutchinson is also a graduate of The Institute for Sex, Intimacy, & Occupational Therapy's Program Development Group Coaching Summer 2019 Cohort, so I am particularly tickled pink at the work they are already...

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