Addressing Sex in Occupational Therapy: A Coconstructed Autoethnography

"You're Someone Different Now": An Autoethnography on Identity and Occupational Identity Disruption After Traumatic Brain Injury

IMPORTANCE

Identity disruption and occupational identity disruption are common after traumatic brain injury (TBI), but the relationship between these two phenomena is underexplored. Occupational therapy practitioners should be knowledgeable about identity challenges after TBI and ways to reconstruct a sense of self.

OBJECTIVE

To sensitize readers to the experience of identity disruption and occupational identity disruption and describe how those two experiences are interrelated and transactional in nature.

DESIGN

We completed an autoethnography, because this method privileges the insider perspective of participants as members of the research team. We interviewed Andi's family and friends, with textual and nontextual data being reviewed during team meetings that occurred 3 times per month over 3 yr. Data were analyzed by hand-coding transcripts to organize findings until we identified themes and salient text for constructing a narrative.  Setting: Community.

PARTICIPANTS

TBI survivor.

RESULTS

Identity disruption after TBI occurs because of physiological difficulties, psychological changes, and cognitive deficits. Additionally, survivors face interruptions in occupational participation that affect their identity as doers. Andi experienced identity disruption that was exacerbated by being unable to engage in written expression. When he was able to resume writing and regain his occupational identity, Andi was able to reconstruct his sense of self.

CONCLUSIONS AND RELEVANCE

Identity is created by occupational engagement. Occupational therapy practitioners can better serve their clients by exploring identity disruption and occupational identity disruption after TBI. Plain-Language Summary: This article describes the lived experience of identity disruption and occupational identity disruption with an emphasis on the transformative nature of occupation. Occupational therapists should work collaboratively with clients to identify key occupations that support their sense of identity.

Occupational therapists views on addressing the sexuality of adult clients in rehabilitation settings: A qualitative focus group study

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.

Experience of Recently Graduated Occupational Therapists in Addressing Sexuality with Their Clients

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.

Bringing sexuality out of the closet: What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?

INTRODUCTION

Sex has been recognised as an activity of daily living, and sexuality as an important part of our identity, with implications for our self-esteem and quality of life. Although this brings sex and sexuality within the scope of occupational therapy practice, empirical and anecdotal information suggests that neither are routinely included in therapy. The aim of this study was to investigate the experiences of therapists who are comfortable addressing sex and sexuality in practice, with a view to influencing future research and practice. The research question posed was as follows: "What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?"

METHODS

Interpretative Phenomenological Analysis (IPA) was used to explore the research question. Semi-structured interviews were conducted with 11 Australian occupational therapists who were purposively recruited. Interviews were audio-recorded, transcribed verbatim, and analysed following the guidelines for IPA data analysis.

RESULTS

Four master themes and five sub-themes emerged from the analysis and are discussed under the following headings: sexuality matters; know your boundaries; just do it; and seek support and mentoring. The themes provide insight into how occupational therapists successfully integrate sexuality into everyday practice.

CONCLUSION

According to the participants in this study, addressing sex and sexuality during therapy is part of providing holistic client-centred care. With clear personal and professional boundaries, occupational therapists can address sexuality within routine practice utilising core occupational therapy skills, such as communication, collaborative problem solving, pacing, positioning, and adaptive equipment. Furthermore, participants demonstrated that this can be done within a range of settings. It starts with a commitment and the motivation to find a way.