In this episode, I interviewed Dr. Kate Eglseder, an OT with 20+ years experience with SCI rehabilitation. In this episode, she shares what she’s learned through her clinical practice and research with partners of people with SCI.
If you haven’t listened to the episode, find OT Uncorked on your favorite podcast player and take a listen. In this 30 minute conversation, Kate talks about the role of OT in giving clients and their partners permission to ask questions and explore what sexuality and intimacy looks like after injury. While Kate’s experience is with the SCI community, the ideas she gives apply to any client we serve in any population.
One major take-away is that addressing these issues is well within our scope of practice. If you have your OTPF sitting on your desk like I do, take a glance at the tables detailing occupations, client factors, performance skills, and contexts and environments through the lens of sexuality, sexual activity, relationships, and intimacy. I challenge you to see how many of these skills/categories relate! I bet you’ll notice, just as I did, the many ways we can support people’s participation in relationships and expression of sexuality.
Kate and I briefly mentioned the PLISSIT model, which is frequently mentioned in research and practice across many disciplines as a way of approaching sexuality. The original 1976 article is linked above, but I outline the model here, too.
The main idea is to initiate a channel of communication, giving clients Permission to talk about sexuality, intimacy, sexual activity, etc. As OT practitioners, whether comfortable or experienced with talking about the nitty gritty of people’s sexual participation or not, we can easily give permission. When I worked in an inpatient facility, I would introduce myself, then give a brief summary of what occupational therapy is and why, in broad terms, they were referred to us. Sometimes, it sounded something along the lines of:
“As an occupational therapist, I care about how you occupied your time before you came into the hospital, and how you’ll occupy your time after you leave. I want you to feel prepared to do what you need and want to do, even with the new challenges you’re experiencing. During therapy, we will address self-care, hobbies, home maintenance, employment, school, sexuality, sleep, and what ever else is important for you to return to…”
My current introduction is not perfect, and certainly doesn’t capture the full breadth of occupational therapy, but for now, it gives me the opportunity to tell them a little bit about why I’m coming into their room, and, I hope, conveys my true hope to help them engage in meaningful occupations. Additionally, I have seen faces perk up when I mention sexuality in my list of what we can address in therapy, and more importantly, I have heard people voice their previously secret concerns to me regarding their relationships and sexuality after injury. This first part of the PLISSIT model is so important and is truly something any OT working with an adult population (or parents of younger individuals for whom this may become a topic of concern in the future) can do without any further education.
The next part of the PLISSIT model, Limited Information requires only basic knowledge of how a diagnosis or health status may affect sexuality. This can include topics of self-image, self-esteem, social and community participation, reproductive function, communication, bladder and bowel care, dressing, child rearing, religion and spirituality, sleep and rest, problem-solving, or self-advocacy, to name only a few. When sharing Limited Information, the idea is to plant the seed. I have found this helpful when working with people who have no idea what questions to even begin to ask.
Offering Specific Suggestions does not require you to have a degree in sexology – it can simply involve applying what you already know about occupation, body systems, social participation, positioning, routines, etc. Our expertise applies to all occupations and performance – you know more than you think you know about sexuality and intimacy! Don’t know how to answer a client’s questions? That’s ok. You as an OT have access to a myriad of resources that you are well-trained to navigate and synthesize, and can bring your findings back to your patient. Beyond the information you provide, your clients will appreciate your honesty about what you know and what you are still learning.
Finally, Intensive Therapy rounds out the PLISSIT model, and refers to more intensive, expert approaches. As with Specific Suggestions, if you are not an expert in sexuality and intimacy, that’s ok! You have access to other professionals who may be more prepared to address the specific questions or concerns. Most OT practitioners I know are great at connecting people, so use those skills and help bridge gaps in clients’ experiences by working as a team.
Regardless of your current role as a practitioner, I hope this episode has helped you realize how prepared you are as an OT or OTA to be part of a team that supports client sexuality.
Check out the list of resources below, including an article that Kate and I published together!
2017 Ménage à Trois, California Red Blend
Resources mentioned in this episode:
Eglseder, K. (2017). The lived experiences and occupations of intimate partners of individuals with spinal cord injury related to sexuality – abstract. American Journal of Occupational Therapy, 71, 1.
Eglseder, K. (2016). Addressing sexuality in the clinic: Simple steps for practitioners. OT Practice, 21(17), 21-23.
Eglseder, K., & Demchick, B. (2017). Sexuality and spinal cord injury. The lived experiences of intimate partners. Occupational Therapy Journal of Research, 1-7.
Annon J. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioural treatment of sexual problems. Journal of Sex Education and Therapy, 2, 1-15.
Taylor, B., Davis, S. (2007). The extended PLISSIT model for addressing the sexual wellbeing of individuals with an acquired disability or chronic illness. Sex and Disability, 25, 135–139.
Eglseder, K., Webb, S., & Rennie, M. (2018). Sexual functioning in occupational therapy education: A survey of programs,” The Open Journal of Occupational Therapy, 6(3). https://doi.org/10.15453/2168-6408.1446
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